Clinical characteristics in Japanese patients with chronic rhinosinusitis who underwent endoscopic sinus surgery.

OBJECTIVE: There is heterogeneity in the pathophysiology of chronic rhinosinusitis (CRS). Obtaining a detailed understanding of patient profiles in specific regions can provide valuable information not only for clinical practice but also future research plans. The aim of this study was to investigate the characteristics of patients who underwent endoscopic sinus surgery (ESS) for CRS. METHODS: This retrospective, single-center study examined the features of 453 patients with CRS who underwent ESS in the Tokyo area of Japan. The study evaluated various factors in patients with CRS including sex and age, the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC) score, the recurrence rate of CRS, comorbidities of asthma and/or allergic diseases, and IgE sensitization to 12 inhaled allergens. RESULTS: Age-related declines in the sensitization rate to inhaled allergens were observed, and the most notable age-related decrease in specific IgE antibodies was observed for house dust mites (HDM) (p = 8.3 × 10-7). Sensitization to HDM, cat dander, and various types of fungi, including Aspergillus, was frequently observed in the CRS with asthma group, with rates of 54%, 17%, and 17%, respectively. We found that 23% of the patients had recurrence. In the recurrence group, the positive rates of specific IgE antibodies for birch and cat dander were significantly higher than in the no recurrence group. Bronchial asthma was identified as an important factor for recurrence. Among male patients, the recurrence group was younger than the no-recurrence group (p = 0.0032). Severe eosinophilic CRS (ECRS) showed early recurrence after surgery, with over the half of the patients experiencing at least one recurrence within 2 years post-surgery. Among patients with ECRS, the recurrence rate for females was 1.92 times higher than for males. CONCLUSION: Our study revealed the influences of age and sex on various clinical phenotypes of CRS patients undergoing ESS. There was a high sensitization rate to cat dander in both the recurrence and asthma groups. Further research on diverse disease etiologies is necessary to improve therapeutic strategies for patients with CRS.

Cost-effectiveness of occupational therapy for older adults: a protocol for an updated systematic review.

INTRODUCTION: The ageing populations in developed countries are a global concern, with increasing numbers of older adults facing physical, cognitive and psychological challenges, resulting in reduced quality of life and higher healthcare costs. Healthcare expenditure worldwide has been on the rise, especially among older adults, emphasising the importance of enabling independent living while reducing healthcare costs. Occupational therapy holds promising outcomes in promoting functional independence and enhancing the quality of life for older adults, but research on its cost-effectiveness remains limited. This systematic review aims to evaluate the recent evidence on the cost-effectiveness of occupational therapy interventions for older adults from a pragmatic perspective. METHODS AND ANALYSIS: This systematic review will cover full economic evaluations, including cost-effectiveness, cost-utility and cost-benefit analyses, by reviewing randomised and cluster randomised controlled trials. The participants will be aged over 65 years without disease or disability restrictions. Primary outcomes will be assessed using functional status and quality-of-life assessments. Studies published before July 2023 will be searched in PubMed, Web of Science and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, with no language restrictions. ETHICS AND DISSEMINATION: Ethical approval is not required for this literature-based systematic review. The study's findings will update the evaluation of occupational therapy's cost-effectiveness in older adults and will be made public by publishing them in scholarly journals. PROSPERO REGISTRATION NUMBER: CRD42023453558.

Allergic fungal rhinosinusitis: What we can learn from allergic bronchopulmonary mycosis.

Allergic fungal rhinosinusitis (AFRS) and allergic bronchopulmonary mycosis (ABPM) are inflammatory disorders of the respiratory tract resulting from type 1 and 3 hypersensitivity reactions against fungi. The hallmark features of both diseases are eosinophil infiltration into the airway mucosa caused by localized type 2 inflammation and concomitant viscid secretions in the airways. Eosinophilic mucin-induced compression of adjacent anatomic structures leads to bone erosion and central bronchiectasis in the upper and lower respiratory tracts, respectively. Although these diseases share common features in their pathogenesis, they also exhibit notable differences. Epidemiologic findings are diverse, with AFRS typically presenting at a younger age, exhibiting less complicated bronchial asthma, and displaying lower total immunoglobulin E levels in laboratory findings compared with ABPM. Furthermore, despite their similar pathogenesis, the rarity of sinio-bronchial allergic mycosis in both AFRS and ABPM underscores the distinctions between these two diseases. This review aims to clarify the similarities and differences in the pathogenesis of AFRS and ABPM to determine what can be learned about AFRS from ABPM, where more is known.

A case of fungal otitis externa caused by coinfection of Candida auris and Aspergillus flavus.

Fungal otitis externa is a disease encountered occasionally and is caused mostly by Aspergillus or Candida spp. We report a woman with fungal otitis externa who also had typical findings in the external auditory canal. The results of a culture showed coinfection with Candida auris and Aspergillus flavus. Identification of both species was performed by sequencing analysis of the 26S rDNA (D1/D2) and ß-tubulin regions. Additionally, the newly developed CHROMagar™ Candida Plus medium was a useful tool for the easy and rapid identification of C. auris. To the best of our knowledge, this is the first report of fungal otitis externa caused by coinfection with C. auris and A. flavus. This case showed good susceptibility to many antifungal drugs and fortunately had a good clinical course with 1% bifonazole cream, which was applied to the fungal coinfection. Notably, C. auris is a multidrug-resistant yeast-like fungus. The increase in drug-resistant fungi and co-infections caused by these pathogens can make the diagnosis and treatment more complex and difficult. To solve these problems, performing rapid and accurate identification and susceptibility testing using chromogenic medium and molecular biological analysis would be useful.

Antioxidant Activity Enhancement Effect of Silver-Ionized Water: Silver Cation Prepared by Electrolysis.

In the present study, tap water, alkaline electrolyzed water (AlEW) and tourmaline water (TMW) were used as the electrolytes to generated the silver-ionized water (SIW), AlEW-SIW and TMW-SIW, respectively. The antioxidant properties of the samples containing ascorbic acid (AsA) were investigated by WST-kit method. The results showed that the SOD activity of AsA (2 mmol/L) dissolved in SIW (66.0%) was enhanced by about 8% compared to that of the tap water (57.9%). The SOD activity of the AlEW-SIW solution (77.3%), which was higher than that of the SIW solution, and lower than that of the AlEW solution (83.6%). The SOD activity of the TMW-SIW solution (83.0%) was similar to that of the TMW solution (82.5%). Furthermore, to classify the sample solutions, discriminant analyses were performed based on near infrared (NIR) spectral data, which was consistent with the results of the WST-kit method. The SOD activity of the AlEW-SIW and TMW-SIW solutions decreased slowly with storage time, and their SOD activities were higher than that of AlEW, TMW and the tap water solutions at storage time of 14 days. In summary, AlEW-SIW and TMW-SIW showed similar antioxidant activity enhancement as AlEW and TMW, and they also maintained the stability of the antioxidant activity of AsA during storage.

Effect of Functional Water on the Antioxidant Property of Concentrated Reconstituted Juice.

People often consume juice to easily ingest antioxidants, which can scavenge free radicals and reduce the risk of lifestyle-related diseases. In this study, the SOD assay kit-WST method was used to evaluate the antioxidant activity of two types of functional water, alkaline electrolyzed water (AlEW) and tourmaline water (TMW), reconstituted commercially available (Tropicana) and freshly squeezed concentrated juices and the effect of functional waters on physicochemical parameters and sensory evaluation of reconstituted juices was also analyzed. The reconstituted juice exhibited the highest antioxidant activity when the electrolysis current of AlEW was 8A or the tourmaline stone treatment temperature of TMW was 75 °C. Compared with the control group (69.4%), SOD activity of the reconstituted orange juice in the 8A-AlEW (77.2%) and 75 °C-TMW (84.5%) groups increased by 7.8 and 15.1%, respectively. Furthermore, the color and pH of the functional water reconstituted juice were not significantly different from the juice before concentration, and the taste was better. In summary, functional water could enhance the antioxidant activity of concentrated juice as a formula which could provide novel ideas for the development of functional beverages with antioxidant properties.

Magnetic Resonance Imaging and Histopathology in a Case of Pleomorphic Adenoma of a Minor Salivary Gland in the Nasal Cavity.

BACKGROUND Pleomorphic adenoma of the salivary gland is a common benign tumor of the parotid gland. However, pleomorphic adenoma arising in the minor salivary glands, including the nasopharynx, is uncommon. This report is of a case of nasal pleomorphic adenoma in which the preoperative imaging findings were consistent with the histological features of pleomorphic adenoma of the minor salivary gland, which differs from that of pleomorphic adenoma of the major salivary gland. CASE REPORT A 56-year-old Japanese man was referred to the department of otolaryngology following nasal endoscopy performed at a referral center that identified a right nasal mass. The findings of contrast-enhanced magnetic resonance imaging (MRI) were consistent with a pleomorphic adenoma arising in the nasal septum. Needle biopsy and histology confirmed the diagnosis of pleomorphic adenoma. The tumor was resected using endoscopic surgery, and the histology confirmed the diagnosis of pleomorphic adenoma covered by normal nasal mucosa. CONCLUSIONS This case showed that pleomorphic adenoma arising in the nasal minor salivary gland had typical MRI and histological findings and was a submucosal lesion. Preoperative MRI supported the approach to surgical resection to ensure complete excision.

Distinct gene expression profiles and regulation networks of nasal polyps in eosinophilic and non-eosinophilic chronic rhinosinusitis.

BACKGROUND: Chronic rhinosinusitis with nasal polyps (CRSwNP) is known to have 2 phenotypes in East Asia. Eosinophilic CRSwNP (ECRSwNP), defined as tissue eosinophilia and easily recurrent, is distinguished from other non-eosinophilic CRSwNP (NECRSwNP) types. However, the pathogenesis of each remains unclear. METHODS: Nasal polyp tissues from ECRS (ECRSwNP) and NECRS (NECRSwNP) patients were obtained, and their comprehensive gene expression profiles were investigated by microarray analysis. Bioinformatics approaches (eg, Ingenuity Pathway Analysis [IPA]) were used to interrogate the data sets. RESULTS: Hierarchical clustering and principal component analysis (PCA) collectively showed that ECRSwNP and NECRSwNP had distinct gene expression patterns. Of note, these genes could be divided into 8 distinctive clusters having different expression patterns and functions. Upstream Regulator Analysis revealed that not only T-helper 2 (Th2) and the eosinophilia-related molecules (interleukin 4 [IL4], IL5, and colony stimulating factor 2 [CSF2]) reported so far, but also cell cycle regulators (cyclin dependent kinase inhibitor 1A [CDKNA1] and cyclin D1 [CCND1]) and a tissue fibrosis-related molecule (transforming growth factor ß [TGFß]) were identified in ECRSwNP. On the other hand, mainly interferons (IFNs) and acute inflammatory cytokines (IL1 and IL6) were predicted as upstream regulators in NECRSwNP. CONCLUSION: These results are useful for understanding the molecular basis of the mechanisms of CRSwNP and point to new targets for developing specific biomarkers and personalized therapeutic strategies for CRSwNP.

Internal Jugular and Subclavian Vein Thrombosis in a Case of Ovarian Cancer.

Central venous catheter insertion and cancer represent some of the important predisposing factors for deep venous thrombosis (DVT). DVT usually develops in the lower extremities, and venous thrombosis of the upper extremities is uncommon. Early diagnosis and treatment of deep venous thrombosis are of importance, because it is a precursor of complications such as pulmonary embolism and postthrombotic syndrome. A 47-year-old woman visited our department with painful swelling on the left side of her neck. Initial examination revealed swelling of the region extending from the left neck to the shoulder without any redness of the overlying skin. Laboratory tests showed a white blood cell count of 5,800/mm3 and an elevated serum C-reactive protein of 4.51 mg/dL. Computed tomography (CT) of the neck revealed a vascular filling defect in the left internal jugular vein to left subclavian vein region, with the venous lumina completely occluded with dense soft tissue. On the basis of the findings, we made the diagnosis of thrombosis of the left internal jugular and left subclavian veins. The patient was begun on treatment with oral rivaroxaban, but the left shoulder pain worsened. She was then admitted to the hospital and treated by balloon thrombectomy and thrombolytic therapy, which led to improvement of the left subclavian venous occlusion. Histopathologic examination of the removed thrombus revealed adenocarcinoma cells, indicating hematogenous dissemination of malignant cells.

Cytotoxic alkylated hydroquinone, phenol, and cyclohexenone derivatives from Aspergillus violaceofuscus Gasperini.

New alkylated hydroquinones violaceoid A (1), violaceoid B (2), and violaceoid C (3), an alkylated phenol violaceoid D (4), and a cyclohexenoid violaceoid E (5) were isolated from a culture broth of Aspergillus violaceofuscus Gasperini isolated from moss. The structures were identified by interpretation of spectroscopic data (1D and 2D NMR, MS, and IR). Two known compounds, the cyclohexenoid 6 and eupenoxide (7), were also isolated. Compound 6 was isolated for the first time as a natural product and named violaceoid F. Isolated compounds were tested for cytotoxic activity against five human cancer cell lines and a mouse macrophage cell line. Violaceoid A was the most potent of the seven compounds against all cell lines. Violaceoid C and D exhibited cytotoxicity against the leukemia cell lines with LD50 values 5.9-8.3 µM, while violaceoid F was found to be cytotoxic against HCT116 and RAW264.7 with LD50 values of 6.4 and 6.5 µM, respectively. These results demonstrate that violaceoid derivatives are a new class of cytotoxic hydroquinones with a hydroxymethyl and a linear alkyl substituent.

Total synthesis of (+)-Sch 725680: inhibitor of mammalian A-, B-, and Y-family DNA polymerases.

The total synthesis of (+)-Sch 725680, a member of the hydrogenated azaphilone family, has been accomplished. The synthesis confirmed the absolute configuration and biological activities of the natural product. A key reaction to construct a hydrogenated azaphilone core skeleton is a Ti-mediated aldol reaction.