Therapeutic ultrasound as a treatment for chronic rhinosinusitis: A systematic review.

OBJECTIVE: To investigate the effects of therapeutic ultrasound in symptoms of patients with chronic rhinosinusitis. DATA SOURCE AND STUDY SELECTION: Searches were carried out in the MEDLINE (via OVID), SCOPUS, PubMed and Virtual Health Library databases. The study selection is as follows: Pre-experimental and experimental studies in English, Spanish and Portuguese that evaluated the effects of ultrasound on the signs and symptoms of patients with chronic rhinosinusitis were included. After study selection, data extraction, risk of bias and quality assessment, we performed a qualitative description of current data. RESULTS: Nine studies were selected, providing 309 participants (20 to 47 volunteers in each study), with an average age of 44.5 years. Three studies had assumed pretest-posttest design, four studies were single-blinded randomized controlled trial and the two studies were double-blinded randomized controlled trial. The modalities of ultrasound investigated were pulsed and continuous, and the studies evaluated the ultrasound effects immediately after one session or after a few sessions of treatment (6, 10 or 15 sessions). The use of ultrasound, in both continuous and pulsed modalities, demonstrated to reduce characteristic signs and symptoms of chronic rhinosinusitis. Despite these results, only two studies had a low risk of bias. A meta-analysis was not possible due to the huge heterogeneity of included studies. CONCLUSIONS: Despite ultrasound in continuous and pulsed modalities showing similar positive effects in the treatment of chronic rhinosinusitis, the studies are small, short duration, poor design and with a high risk of bias. Thereby, ultrasound cannot be appointed as a potential adjunct resource to current methods of treating chronic rhinosinusitis until large randomised controlled studies are performed.

Dietary supplementation with procyanidin-rich Pinus pinaster extract is associated with attenuated Ehrlich tumor development in mice.

Inflammation and oxidative stress are related to cancer initiation and progression. We hypothesized that dietary supplementation with a procyanidin-rich Pinus pinaster extract (Pyc) with known antioxidant and anti-inflammatory effects could induce systemic protection, thereby attenuating tumor development. To test our hypothesis, mice were subjected to long-term supplementation (20 days, every 24 h) with saline, 25 mg/kg resveratrol or 100 mg/kg Pyc. Pyc was administered at a maximum tolerated oral dose, previously determined using toxicity indicators. Ten days after Ehrlich ascites tumor induction, weight gain and abdominal circumference increase were calculated. Ascitic fluid from six mice/group was evaluated by determining total volume; tumor packed cell volume; cell viability; tumor cell death type; inflammatory infiltrate; and levels of tumor necrosis factor alpha (TNF-α), interleukin 1 beta (IL-1ß), carbonyl proteins, lipid peroxidation, cyclooxigenase-2 (COX-2) expression and Akt phosphorylation (p-Akt). Ten mice/group were monitored to evaluate survival. Pyc and resveratrol were associated with reduced weight gain (>30%), abdominal circumference and ascitic volume. Tumor packed cell volume was reduced in Pyc-supplemented mice (26%), which had the largest tumor cell count reduction (>35%), increased ascitic fluid apoptosis rates (20%) and the longest survival (>2-fold). Pyc and resveratrol treatment both reduced inflammatory infiltrate and levels of TNF-α, IL-1ß, carbonyl proteins, lipid peroxidation (~ 30%) and p-Akt (up to 4-fold). Only Pyc significantly inhibited COX-2. Pyc attenuated oxidative and inflammation mediators and impaired tumor development, supporting our hypothesis and suggesting Pyc as a candidate for future studies in multitargeted dietary-based cancer prevention approaches.