ABSTRACT
(1) Background: Factors influencing the quality of life (QoL) of patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) are poorly understood. We set out to determine the predictive factors on patients' QoL using the Sino-Nasal Outcome Test-22 (SNOT-22); (2) Methods: An ambispective analysis of data from patients diagnosed with CRSwNP in our institution. All the patients underwent a nasal polyp biopsy and completed the SNOT-22 questionnaire. Demographic and molecular data as well as the SNOT-22 scores were collected. Patients were classified in six subgroups considering the presence of asthma, non-steroidal drugs (NSAID) intolerance and corticosteroid resistance; (3) Results: The mean SNOT-22 score was 39. Considering the clinical parameters, the SNOT-22 value was significantly associated with NSAID intolerance (p = 0.04) and the endoscopic polyp score (p = 0.04). A high SNOT-22 value was also correlated with high tissue eosinophilia (p = 0.01) and high IL-8 expression; (4) Conclusions: Eosinophilia, IL-8 expression and NSAID intolerance can be used as predictors of worse QoL in patients with CRSwNP.
ABSTRACT
BACKGROUND: A number of patients with chronic rhinosinusitis with nasal polyps (CRSwNP) are resistant to oral corticosteroids. Mucin 1 (MUC1) shows anti-inflammatory properties, and its cytoplasmic tail (CT) interacts with transcription factors, facilitating their nuclear translocation. Because glucocorticoid receptor (GR) nuclear translocation is key to the anti-inflammatory effect of corticosteroids, we hypothesized that MUC1 is involved in the effectiveness of corticosteroids. OBJECTIVE: To analyze the role of MUC1 in corticosteroid effectiveness in different cohorts of patients with CRSwNP and elucidate the possible mechanisms involved. METHODS: Seventy-three patients with CRSwNP took oral corticosteroids for 15 days. Corticosteroid resistance was evaluated by nasal endoscopy. The expression of MUC1 and MUC1 CT was evaluated by real-time PCR, Western blotting, and immunohistochemistry. Beas-2B knockdown with RNA interference for MUC1 (siRNA-MUC1) was used to analyze the role of MUC1 in the anti-inflammatory effects of dexamethasone. RESULTS: Nineteen patients had nasal polyps that were resistant to oral corticosteroids (NP-CR). MUC1 expression was downregulated in these patients. Primary epithelial cells from patients with NP-CR were insensitive to the anti-inflammatory effects of dexamethasone. In siRNA-MUC1 Beas-2B, dexamethasone showed weaker anti-inflammatory effects, a reduced inhibition of phospho-extracellular-signal-regulated kinases 1/2, a less severe mitogen-activated protein kinase phosphatase 1 increase, and a reduced GR nuclear translocation. Immunoprecipitation experiments revealed that MUC1-CT and GRα form protein complexes and translocate to the nucleus in response to dexamethasone. MUC1-CT-GRα complex was downregulated in NP-CR tissue. CONCLUSION: MUC1-CT participates in the corticosteroid response that mediates GRα nuclear translocation. The low expression of MUC1 in patients with CRSwNP may participate in corticosteroid resistance.
Subject(s)
Adrenal Cortex Hormones/therapeutic use , Drug Resistance/genetics , Gene Expression Regulation , Mucin-1/genetics , Rhinitis/drug therapy , Rhinitis/genetics , Sinusitis/drug therapy , Sinusitis/genetics , Anti-Inflammatory Agents/therapeutic use , Chronic Disease , Down-Regulation , Humans , Nasal Mucosa/drug effects , Nasal Mucosa/metabolism , Nasal Polyps/complications , Receptors, Glucocorticoid/genetics , Receptors, Glucocorticoid/metabolism , Rhinitis/complications , Rhinitis/metabolism , Signal Transduction , Sinusitis/complications , Sinusitis/metabolism , Toll-Like Receptors/geneticsABSTRACT
BACKGROUND: This study compared the chronic damage to laryngeal soft tissues produced by microdissection electrodes and a CO(2) laser after cordectomies. METHODS: We included patients who were operated on to treat T1 glottic carcinomas and needed a second laryngeal surgery. We examined specimens from 6 patients each operated on with a CO(2) laser or microdissection electrodes. The specimens were processed using Masson trichrome. We studied the grade and level of collagenization and analyzed relationships with age, interval between surgical procedures, and device. RESULTS: Control samples showed low collagenization. Second samples showed moderate collagenization, which was similar regardless of whether microdissection electrodes or a CO(2) laser was used. A relationship was observed between the level of collagenization and interval between surgeries, irrespective of the surgical procedure used. CONCLUSIONS: The chronic vocal fold tissue damage produced by a CO(2) laser and microdissection electrodes was similar. In our series, the vocal fold scar was completed between weeks 12 and 20.
Subject(s)
Carcinoma, Squamous Cell/surgery , Cicatrix/etiology , Electrosurgery/adverse effects , Glottis , Laryngeal Neoplasms/surgery , Lasers, Gas/adverse effects , Aged , Carcinoma, Squamous Cell/pathology , Chronic Disease , Cicatrix/pathology , Electrosurgery/instrumentation , Female , Follow-Up Studies , Humans , Laryngeal Neoplasms/pathology , Laser Therapy/adverse effects , Laser Therapy/instrumentation , Male , Microdissection/adverse effects , Microdissection/instrumentation , Middle Aged , Retrospective StudiesABSTRACT
OBJECTIVE: This study compared the acute tissue damage produced by a CO2 laser and microelectrodes in samples of vocal cords from patients undergoing laryngeal endoscopic surgery for stage T1 squamous cell carcinoma. STUDY DESIGN AND SETTING: Based on prior surgical experience with the CO2 laser and microelectrodes, the study protocol used hematoxylin-eosin staining of vocal cords treated with a CO2 laser (n=20) or microelectrode (n=20). RESULTS AND CONCLUSION: The acute tissue damage produced by the CO2 laser was similar to that induced by microelectrodes in cutting mode. The tissue damage resulting from the use of the microelectrode in coagulation mode was comparatively greater.
