Triglyceride-glucose index in early pregnancy predicts the risk of gestational diabetes: a prospective cohort study.

OBJECTIVE: This study aimed to investigate the association between the triglyceride-glucose (TyG) index in early pregnancy and the development of gestational diabetes mellitus (GDM) in the second trimester. The primary objectives were to evaluate the predictive potential of the TyG index for GDM, determine the optimal threshold value of the TyG index for GDM assessment, and compare the predictive performance of the TyG index alone versus its combination with maternal age and pre-pregnancy body mass index on GDM. Moreover, the study explored the association between the TyG index in early pregnancy and the risk of other pregnancy-related complications (PRCs), such as placental abruption and gestational hypertension. PATIENTS AND METHODS: This prospective cohort study recruited 1,624 pregnant women who underwent early pregnancy antenatal counseling and comprehensive assessments with continuous monitoring until delivery. To calculate the TyG index, health indicators, including maternal triglycerides and fasting plasma glucose, were measured in early pregnancy (< 14 weeks of gestation). The predictive power of the TyG index for evaluating GDM in Chinese pregnant women was determined using multifactorial logistic regression to derive the odds ratios and 95% confidence interval (CI). Subgroup analyses were conducted, and the efficacy of the TyG index in predicting PRCs was assessed via receiver operating characteristic (ROC) curve analysis and restricted cubic spline, with the optimal cutoff value calculated. RESULTS: Logistic regression analyses revealed a 2.10-fold increase in the GDM risk for every 1-unit increase in the TyG index, after adjusting for covariates. The highest GDM risk was observed in the group with the highest TyG index compared with the lowest quintile group (odds ratios: 3.25; 95% CI: 2.23-4.75). Subgroup analyses indicated that exceeding the recommended range of gestational weight gain and an increased GDM risk were significantly associated (P = 0.001). Regarding predictive performance, the TyG index exhibited the highest area under the curve (AUC) value in the ROC curve for GDM (AUC: 0.641, 95% CI: 0.61-0.671). The optimal cutoff value was 8.890, with both sensitivity and specificity of 0.617.The combination of the TyG index, maternal age, and pre-pregnancy body mass index proved to be a superior predictor of GDM than the TyG index alone (AUC: 0.672 vs. 0.641, P < 0.01). After adjusting for multiple factors, the analyses indicated that the TyG index was associated with an increased risk of gestational hypertension. However, no significant association was noted between the TyG index and the risk of preeclampsia, placental abruption, intrauterine distress, or premature rupture of membranes. CONCLUSION: The TyG index can effectively identify the occurrence of GDM in the second trimester, aligning with previous research. Incorporating the TyG index into routine clinical assessments of maternal health holds significant practical implications. Early identification of high-risk groups enables healthcare providers to implement timely interventions, such as increased monitoring frequency for high-risk pregnant women and personalized nutritional counseling and health education. These measures can help prevent or alleviate potential maternal and infant complications, thereby enhancing the overall health outcomes for both mothers and babies.

[The predicting role of postoperative changes in self-reported symptoms in patients with recurrence eosinophilic chronic sinusitis with nasal polyps].

Objective:To investigate whether changes in postoperative symptoms and signs in patients can predict the recurrence of ECRS after nasal endoscopic sinus surgery. Methods:A total of 70 adult patients with ECRS were enrolled for ESS surgery from June 2020 to March 2022 in a single center. There were 50 males and 20 females, with an average age of （46.9±14.5） years. Follow-up after ESS was at least 52 weeks. Patients undergo peripheral blood tests, CT of the sinuses, olfactory T&T test, visual analogue scale of symptoms（VAS）, and endoscopic scoring. Results:VAS scores and endoscopic scores were analyzed at preoperative and 6th week, 12th week, 24th week and 52th week postoperative. After 12th week postoperatively, there was a clear correlation between symptom scores and endoscopic scores. Moreover, olfactory disorder and nasal discharge were the two most obvious symptoms. There were differences in the expression of multiple preoperative clinical inflammatory indicators between the symptom-controled group and the symptom-uncontrolled group（previous surgical history, concomitant asthma, nasal smear eosinophil, serum EOS%, total IgE, CT score, olfactory score, and symptom score, all with P<0.05）, while there was no difference in baseline endoscopic score（P>0.05）. At 12th week postoperative, the two groups of patients showed significant differences in both symptom scores and endoscopic scores. The symptoms and endoscopic score at the 12th week point of follow-up were used as predictive indicators for recurrence, with sensitivity and specificity of 62.5% and 83.3%, respectively. Conclusion:The changes in postoperative symptom score and endoscopic score in ECRSwNP patients indicated that the recurred ECRS. In the symptom-uncontrolled group, symptomatic and endoscopic scores showed consistent increased scores; In the symptom-controlled group, conflicting results between increased endoscopic scores and stable symptoms suggest that the presence of asymptomatic recurrence must be considered. The changes in symptoms and signs at the 12th week point of follow-up can serve as clinical indicators for preventing disease recurrence.

Analysis of Sinus Inflammation Associated With Maxillary Sinus Fungal Ball Based on CT Imaging.

Background: Paranasal sinus fungal balls usually occur unilaterally, and the maxillary sinus is most commonly involved. However, other sinuses could be concomitantly inflammed, and this phenomenon is rarely discussed. Aims/Objectives: To evaluate the severity of maxillary sinus fungal ball (MSFB) and the occurrence of sinus inflammation in paranasal sinuses according to the image findings and analyze the potential correlations. Material and Methods: A total of 1226 cases of MSFB were divided into 2 groups according to ostiomeatal complex obstruction on computed tomography. The potential correlations between sinus inflammation and MSFB in these groups were analyzed. Results: The patients were divided into 2 groups: those with obstructed ostiomeatal complex (OOMC) and those with clear ostiomeatal complex (COMC). The incidences of sinus inflammation in the ipsilateral sinuses of MSFB were higher in the OOMC group than in the COMC group, and there were no differences in the contralateral sinuses of MSFB. In the OOMC group, sinus inflammation was more common in all ipsilateral sinuses of MSFB than in the contralateral sinuses. In the COMC group, the incidences of sinus inflammation in the ipsilateral ethmoid and frontal sinuses of MSFB were higher than that in the contralateral sinuses. However, no significant difference was observed in the sinus inflammation incidence of bilateral sphenoid sinuses in the COMC group. The incidence of nasal polyps was higher in the ipsilateral nasal cavity in the OOMC group. Conclusions and Significance: MSFB stimulated sinus inflammation and nasal polyps in the adjacent sinuses through local factors.

The Nasal Bacteria Microbiome Comparison Among Fungal Ball Sinusitis, Chronic Sinusitis with Polyps.

To evaluate the composition of the microbial community of the middle nasal in paranasal sinus fungus ball (FB), chronic sinusitis with nasal polyps (CRSwNP) and healthy controls, providing new insights into the pathogenesis of FB and CRSwNP. Through 16 s rRNA gene high-throughput sequencing to determine the microbial characterization from patients with FB (n = 29) and CRSwNP (n = 10), and healthy controls (n = 4). The FB group had significantly lower αdiversity and significantly different ß diversity compared to the other groups. All three groups mainly consisted of four bacterial phyla (Firmicutes, Proteobacteria, Bacteroidetes, Actinobacteria). In the FB group, the highest relative abundance was found in Proteobacteria (47.04%). However, pairwise comparisons resulted in statistically significant differences only for Firmicutes (CRSwNP, p = 0.003, Control, p = 0.008). The CRSwNP group was statistically different from the control group in TM7(p = 0.010), Chloroflexi(p = 0.018) and Bacteroidete(p = 0.027). At the genus level, the FB group had the highest relative abundance of Haemophilus (11.53%), followed by Neisseria (7.39%), and Neisseria abundance (p < 0.001) was significantly different from the remaining two groups. Ruminococcacea abundance (p < 0.001) and Comamonadaceae abundance (p < 0.001) were increased in the CRSwNP group. The relative abundance of Lactobacillus (p < 0.001), Bacteroides S24_7 (p < 0.001), and Desulfovibrio (p < 0.001) was significantly decreased in the FB and CRSwNP groups compared to the control group. The imbalance of the microbial community is related to the pathogenesis of sinusitis.

Endotypes of chronic rhinosinusitis based on inflammatory and remodeling factors.

BACKGROUND: Previous studies on the endotyping of chronic rhinosinusitis (CRS) that were based on inflammatory factors have broadened our understanding of the disease. However, the endotype of CRS combined with inflammatory and remodeling features has not yet been clearly elucidated. OBJECTIVE: We sought to identify the endotypes of patients with CRS according to inflammatory and remodeling factors. METHODS: Forty-eight inflammatory and remodeling factors in the nasal mucosal tissues of 128 CRS patients and 24 control subjects from northern China were analyzed by Luminex, ELISA, and ImmunoCAP. Sixteen factors were used to perform the cluster analysis. The characteristics of each cluster were analyzed using correlation analysis and validated by immunofluorescence staining. RESULTS: Patients were classified into 5 clusters. Clusters 1 and 2 showed non-type 2 signatures with low biomarker concentrations, except for IL-19 and IL-27. Cluster 3 involved a low type 2 endotype with the highest expression of neutrophil factors, such as granulocyte colony-stimulating factor, IL-8, and myeloperoxidase, and remodeling factors, such as matrix metalloproteinases and fibronectin. Cluster 4 exhibited moderate type 2 inflammation. Cluster 5 exhibited high type 2 inflammation, which was associated with relatively higher levels of neutrophil and remodeling factors. The proportion of CRS with nasal polyps, asthma, allergies, anosmia, aspirin sensitivity, and the recurrence of CRS increased from clusters 1 to 5. CONCLUSION: Diverse inflammatory mechanisms result in distinct CRS endotypes and remodeling profiles. The explicit differentiation and accurate description of these endotypes will guide targeted treatment decisions.

Clinical effectiveness and potential predictability of omalizumab in patients with difficult-to-treat chronic rhinosinusitis with nasal polyps and asthma based on the noninvasive markers - A real-life prospective study.

Background: Clinical studies on the effectiveness of omalizumab in patients with difficult-to-treat chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma are scarce in China. Moreover, identifying potential biomarkers predicting its efficacy remains a great challenge. Methods: In this prospective trial, all enrolled patients underwent endoscopic examination, computed tomography, blood tests, etc, and they completed a 22-item sino-nasal outcome test (SNOT-22), visual analogue scale (VAS), and asthma control test (ACT) evaluation, at baseline and after 24-week omalizumab therapy. Results: Twenty-two patients were finally recruited. Their VAS scores were significantly better including nasal congestion, anterior rhinorrhea, postnasal drip, and loss of smell (P < 0.01). Seventeen patients reported a reduction in SNOT-22 scores of ≥8.9 and 19 patients achieved ACT scores >20. The median change in the Lund-MacKay score (LMS) was 6. Both the Lund-Kennedy score (LKS) and nasal polyp score showed significant improvement (P < 0.01). Only 3 parameters in the pulmonary function test showed evident amelioration (P < 0.05). The eosinophilic CRSwNP and the male subgroups showed better improvements in subjective and objective evaluation. A receiver operating characteristic curve indicated a cutoff value of 17.5 and 16.5 in LMS had the moderate predictive value (AUC = 0.706) for the decline in the SNOT-22 (more than 8.9 points) and reduction in anterior rhinorrhea VAS (more than 2 cm), respectively. A cutoff value of 18.5 in ACT could provide the moderate predictive value (AUC = 0.771) for the reduction of loss of smell VAS (more than 2 cm). Conclusions: The beneficial effectiveness of omalizumab in the patients with difficult-to-treat CRSwNP and asthma was confirmed. ECRSwNP and male patients were more likely to have positive responses. The multiple cutoff values for the LMS and ACT may serve as useful predictors for improvement acceptable to difficult-to-treat CRSwNP patients.

Time series study on the effects of daily average temperature on the mortality from respiratory diseases and circulatory diseases: a case study in Mianyang City.

BACKGROUND: Climate change caused by environmental pollution is the most important one of many environmental health hazards currently faced by human beings. In particular, the extreme temperature is an important risk factor for death from respiratory and circulatory diseases. This study aims to explore the meteorological-health effect and find out the vulnerable individuals of extreme temperature events in a less developed city in western China. METHOD: We collected the meteorological data and data of death caused by respiratory and circulatory diseases in Mianyang City from 2013 to 2019. The nonlinear distributed lag model and the generalized additive models were combined to study the influence of daily average temperature (DAT) on mortality from respiratory and circulatory diseases in different genders, ages. RESULTS: The exposure-response curves between DAT and mortality from respiratory and circulatory diseases presented a nonlinear characteristic of the "V" type. Cumulative Relative Risk of 30 days (CRR30) of deaths from respiratory diseases with 4.48 (2.98, 6.73) was higher than that from circulatory diseases with 2.77 (1.96, 3.92) at extremely low temperature, while there was no obvious difference at extremely high temperature. The health effects of low temperatures on the respiratory system of people of all ages and genders were persistent, while that of high temperatures were acute and short-term. The circulatory systems of people aged < 65 years were more susceptible to acute effects of cold temperatures, while the effects were delayed in females and people aged ≥65 years. CONCLUSION: Both low and high temperatures increased the risk of mortality from respiratory and circulatory diseases. Cold effects seemed to last longer than heat did.

Physical activity in asthma control and its immune modulatory effect in asthmatic preschoolers.

BACKGROUND: The impact of physical activity on immune response is a hot topic in exercise immunology, but studies involving asthmatic children are scarce. Our aims were to examine whether there were any differences in the level of physical activity and daily TV attendance, to assess its role on asthma control and immune responses to various immune stimulants. METHODS: Weekly physical activity and daily television attendance were obtained from questionnaires at inclusion of the PreDicta study. PBMC cultures were stimulated with phytohemagglutinin (PHA), R848, poly I:C, and zymosan. A panel of cytokines was measured and quantified in cell culture supernatants using luminometric multiplex immunofluorescence beads-based assay. RESULTS: Asthmatic preschoolers showed significantly more TV attendance than their healthy peers (58.6% vs. 41.5% 1-3 h daily and only 25.7% vs. 47.2% ≤1 h daily) and poor asthma control was associated with less frequent physical activity (PA) (75% no or occasional activity in uncontrolled vs. 20% in controlled asthma; 25% ≥3 times weekly vs. 62%). Asthmatics with increased PA exhibited elevated cytokine levels in response to polyclonal stimulants, suggesting a readiness of circulating immune cells for type 1, 2, and 17 cytokine release compared to subjects with low PA and high TV attendance. This may also represent a proinflammatory state in high PA asthmatic children. Low physical activity and high TV attendance were associated with a decrease in proinflammatory cytokines. Proinflammatory cytokines were correlating with each other in in vitro immune responses of asthmatic children, but not healthy controls, this correlation was more pronounced in children with sedentary behavior. CONCLUSION: Asthmatic children show more sedentary behavior than healthy subjects, while poor asthma control is associated with a substantial decrease in physical activity. Our results suggest that asthmatic children may profit from regular exercise, as elevated cytokine levels in stimulated conditions indicate an immune system prepared for responding strongly in case of different types of infections. However, it has to be considered that a hyperinflammatory state in high PA may not be beneficial in asthmatic children.

Advances and recent developments in asthma in 2020.

In this review, we discuss recent publications on asthma and review the studies that have reported on the different aspects of the prevalence, risk factors and prevention, mechanisms, diagnosis, and treatment of asthma. Many risk and protective factors and molecular mechanisms are involved in the development of asthma. Emerging concepts and challenges in implementing the exposome paradigm and its application in allergic diseases and asthma are reviewed, including genetic and epigenetic factors, microbial dysbiosis, and environmental exposure, particularly to indoor and outdoor substances. The most relevant experimental studies further advancing the understanding of molecular and immune mechanisms with potential new targets for the development of therapeutics are discussed. A reliable diagnosis of asthma, disease endotyping, and monitoring its severity are of great importance in the management of asthma. Correct evaluation and management of asthma comorbidity/multimorbidity, including interaction with asthma phenotypes and its value for the precision medicine approach and validation of predictive biomarkers, are further detailed. Novel approaches and strategies in asthma treatment linked to mechanisms and endotypes of asthma, particularly biologicals, are critically appraised. Finally, due to the recent pandemics and its impact on patient management, we discuss the challenges, relationships, and molecular mechanisms between asthma, allergies, SARS-CoV-2, and COVID-19.

Chinese Society of Allergy and Chinese Society of Otorhinolaryngology-Head and Neck Surgery Guideline for Chronic Rhinosinusitis.

The current document is based on a consensus reached by a panel of experts from the Chinese Society of Allergy and the Chinese Society of Otorhinolaryngology-Head and Neck Surgery, Rhinology Group. Chronic rhinosinusitis (CRS) affects approximately 8% of Chinese adults. The inflammatory and remodeling mechanisms of CRS in the Chinese population differ from those observed in the populations of European descent. Recently, precision medicine has been used to treat inflammation by targeting key biomarkers that are involved in the process. However, there are no CRS guidelines or a consensus available from China that can be shared with the international academia. The guidelines presented in this paper cover the epidemiology, economic burden, genetics and epigenetics, mechanisms, phenotypes and endotypes, diagnosis and differential diagnosis, management, and the current status of CRS in China. These guidelines-with a focus on China-will improve the abilities of clinical and medical staff during the treatment of CRS. Additionally, they will help international agencies in improving the verification of CRS endotypes, mapping of eosinophilic shifts, the identification of suitable biomarkers for endotyping, and predicting responses to therapies. In conclusion, these guidelines will help select therapies, such as pharmacotherapy, surgical approaches and innovative biotherapeutics, which are tailored to each of the individual CRS endotypes.

Use of Nasal Nitric Oxide in the Diagnosis of Allergic Rhinitis and Nonallergic Rhinitis in Patients with and without Sinus Inflammation.

BACKGROUND: Nasal nitric oxide (nNO) has been evaluated in patients with chronic rhinosinusitis with and without nasal polyps. However, nNO levels in patients with allergic rhinitis (AR) and nonallergic rhinitis (NAR) have shown conflicting results in previous studies. OBJECTIVE: To evaluate the value of nNO in diagnosing AR and NAR and the impact of absence or presence of sinus inflammation (SI). METHODS: A total of 173 consecutive patients scanned with high-resolution computed tomography (CT) and 46 normal controls (NCs) were included in our study. Patients were evaluated according to their medical history, nasal symptoms, endoscopic examinations, and skin prick test results. On the basis of CT scans (Lund-Mackay score >2), all patients were subgrouped as AR with SI (ARwSI) and AR without SI (ARsSI), or NAR with SI (NARwSI) and NAR without SI (NARsSI). nNO levels were measured with the NIOX, and eosinophils in nasal smears were evaluated simultaneously. Receiver-operating characteristic analysis was performed for differential diagnosis of AR, NAR, and subgroups. RESULTS: Ninety-four patients were diagnosed with AR and 79 patients with NAR. The levels of nNO were significantly higher in patients with AR and in NCs compared with patients with NAR (939 ± 335 in AR and 813 ± 272 in NCs vs 670 ± 188 in NAR; P < .001 for both), and significantly higher in patients with AR compared with NCs (P < .05). On the basis of sinus CT scans, 49% patients with AR (46 of 94) were defined as ARwSI and 51% patients with NAR (40 of 79) were defined as NARwSI. Patients with ARsSI showed the highest nNO levels (1180 ± 289) compared with other subgroups (P < .001), and patients with NARwSI showed the lowest nNO levels (522 ± 120) compared with other subgroups (P < .001). nNO could be used to discriminate AR, NAR, and subgroups with acceptable sensitivity and specificity. Moreover, patients with nasal smear eosinophilia had lower nNO levels than did patients with NAR (P < .05). CONCLUSIONS: nNO levels are different between patients with ARwSI/ARsSI and NARwSI/NARsSI, and may be used to discriminate these phenotypes.

A retrospective analysis of 1,717 paranasal sinus fungus ball cases from 2008 to 2017.

OBJECTIVES/HYPOTHESIS: To analyze the epidemiological characteristics, clinical features, and the outcomes of histopathology and microbiology for fungus ball (FB) in the last 10 years in our department. STUDY DESIGN: Database review. METHODS: In total, 1,717 cases of FB were reviewed from the case database of Beijing Tongren Hospital (between 2008 and 2017). Epidemiologic data, clinical manifestations, histopathology, and microbiology were analyzed. RESULTS: In the past 10 years, there has been a significant increase in patients with FB presenting at our department (P < .05). The mean age of patients with paranasal sinus FB was 54 years, and 67% of patients were female (1,156/1,717). The average age and female predominance were consistent with previous reports. In total, 1,626 cases (94.7%) were unilateral, and the most common location was the maxillary sinus (76.6%). Aspergillus spp. (72.8%) was the most abundant fungal species in our study. The direct smear positive rate was 68.6%, and the fungal culture rate was 22.6%. All cases were treated with functional endoscopic sinus surgery, with a very low rate of postoperative complications and reoperation (20/1,717). CONCLUSIONS: Histopathological and microbiological analyses are essential for the diagnosis of FB. Surgery is the most effective method of treatment. Direct smear after surgery is not necessary. Oral or topical antimycotic treatments are not recommended after surgery or during the perioperative period. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:75-79, 2020.

LncRNA MALAT1/MiR-145 Adjusts IL-1ß-Induced Chondrocytes Viability and Cartilage Matrix Degradation by Regulating ADAMTS5 in Human Osteoarthritis.

PURPOSE: Accumulating evidence suggests that microRNA-145 (miR-145) plays an important role in osteoarthritis (OA), which is a chronic progressive joint disease. Long noncoding RNA metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) promotes metastasis in cancers and functions as a sponge for miR-145. However, the role of MALAT1/miR-145 in OA pathogenesis has not yet been elucidated. MATERIALS AND METHODS: The expression of MALAT1 and miR-145 was examined by quantitative real-time PCR; the interaction between miR-145, MALAT1 and a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) 5 was verified by luciferase reporter assay. Correlations among MALAT1, miR-145, and ADAMTS5 were analyzed by Spearman rank analysis. Chondrocytes viability and cartilage extracellular matrix (ECM) degradation were investigated with cell viability assay and Western blotting analyzing expression of ADAMTS5, collagen type 2 alpha 1 (COL2A1), aggrecan (ACAN), and cartilage oligomeric matrix protein (COMP). RESULTS: MALAT1 was upregulated, and miR-145 was downregulated in OA samples and IL-1ß-induced chondrocytes. Mechanically, miR-145 could directly bind to MALAT1 and ADAMTS5. Moreover, miR-145 expression was negatively correlated with MALAT1 and ADAMTS5 expression in OA patients, whereas MALAT1 and ADAMTS5 expression was positively correlated. Functionally, overexpression of MALAT1 inhibited chondrocyte viability and promoted cartilage ECM degradation in IL-1ß-induced chondrocytes. In support thereof, MALAT1 silencing and miR-145 upregulation exerted the opposite effect in IL-1ß-induced chondrocytes. Moreover, the effect of MALAT1 was counteracted by miR-145 upregulation, and ADAMTS5 restoration could abate miR-145 effects. CONCLUSION: An MALAT1/miR-145 axis contributes to ECM degradation in IL-1ß-induced chondrocytes through targeting ADAMTS5, suggesting that MALAT1/miR-145/ADAMTS5 signaling may underlie human OA pathogenesis.

Iontophoretic delivery of transdermal patches containi.

The present clinical trial investigates the sustaining anesthetic effect of Ropivacaine when administered as epidural injection followed by transdermal patch with and without Reverse electrodialysis (RED) system in order to maintain anesthesia in children. It also focuses on rate of release of drug in-vitro when administered with RED system. The transdermal patch of Ropivacaine was prepared using evaporation technique enclosing 25 mg of Local anesthetic Ropivacaine. Thus prepared patches were evaluated for physical parameters like folding endurance, tensile strength, in vitro drug release etc. The thicknesses of the patches were in the range of 0.02 ±0.006 to 0.04 ± 0.007 mm with 95.79 ±1.85 to 97.45±0.07 % drug content. The average weight and tensile strength was found to be 0.15±0.2 to 0.17±0.18 gm and 0.42±0.006 to 0.58±0.002 kg/cm2. The folding endurance of the patches was in range of 155.21 ±0.2 to 167± 0.29 and content of moisture was 1.43±0.23 % to 2.97±0.23 %. The formulation shows In - vitro release in Phosphate buffer pH 7.4 as 55.56 % to 89.23 ± 0.24 % in 24 hr with reverse electrodialysis system attached and 43.76 % to 81.23 ± 0.14 % in 24 hr without reverse electrodialysis system. The children of different age groups, different body weight with no premedication of anesthetic of analgesic were selected as subjects with written informed consent and divided into two groups depending upon RED system to be attached or not. The patches with and without RED system were attached to forearm of subjects and trial is run. The results obtained showed that patch when attached with reverse electrodialysis system showed greater potential for thermal threshold, lowering of cool sensation and depth of pain. Keywords: Child Anesthesia, Iontophoresis, Reverse Electrodialysis ,Ropivacaine, Transdermal Patch.

The Relationships Between the Nasolacrimal Duct and the Anterior Wall of the Maxillary Sinus.

OBJECTIVES/HYPOTHESIS: To examine the anatomic relationships between the lower end opening into the inferior meatus of the bony nasolacrimal duct (NLD) and the anterior wall of the maxillary sinus. STUDY DESIGN: Anatomical investigation. METHODS: A total of 206 individuals were recruited for detailed anatomic investigation of the lower end of the bony NLD and their relation to the anterior wall of the maxillary sinus by high-resolution computed tomography (HRCT) imaging. The observed features were classified as either a fusion type or separation type, according to the HRCT images. Additionally, the angle between the anterior and medial wall of the maxillary sinus was classified as either an anterior mode or lateral mode. RESULTS: The NLD anatomical fusion type was found in 40.05% and the separation type in 59.95% of the HRCT imaging scans available. The anterior mode of angle between the anterior and medial wall of the maxillary sinus was present in 64.1% of the images, and the lateral mode in 35.9% of the images. In 165 cases of anatomical fusion, the anterior mode of angle was present in 15.8% and the lateral mode in 84.2% of cases. In 247 cases of anatomical separation, the anterior mode was present in 97.2% and the lateral mode in 2.8% of cases. CONCLUSIONS: The surgical anatomy of the lower end of the bony NLD and anterior wall of the maxillary sinus displays varied relationships. Preoperative use of HRCT and an awareness of the particular type of anatomical feature present are likely to aid in planning and performing successful endoscopic medial maxillectomy. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:1030-1034, 2019.

Recent advances in the diagnosis of allergic rhinitis.

INTRODUCTION: Allergic rhinitis (AR) is a disorder with high prevalence worldwide. Identification of clinically relevant allergens is the key step for the diagnosis, allergen avoidance and allergen specific immunotherapy for AR. Areas covered: With the new findings of mechanisms of AR and the development of technology, much progress has been achieved in the diagnosis of AR recently. We review the recent advances about local IgE, in vivo and in vitro tests, cytological diagnosis and nitric oxide (NO) in the diagnosis of AR. Expert commentary: AR is traditionally diagnosed with the combined evaluation of history and allergen sensitization by in vivo skin prick tests and in vitro allergen specific IgE in serum, to confirm the correlation between clinical history and potential allergens. Nasal provocation test and local IgE measurement can be used to diagnose local AR. Allergen microarray has the ability to detect more potential allergens. Basophil activation and mast cell activation tests can be used in allergen diagnosis and to modify the response to immunotherapy, while cytological diagnosis is useful in the differential diagnosis of AR and non-AR. Nasal NO has been confirmed to be an optimal biomarker to discriminate between AR and non-AR.

Function scores of different surgeries in the treatment of knee osteoarthritis: A PRISMA-compliant systematic review and network-meta analysis.

BACKGROUND: Osteoarthritis (OA) is the third most common diagnosis made by general practitioners in older patients. The aim of this study was to compare the function scores of different surgeries in the treatment of knee osteoarthritis (KOA). METHODS: Cohort studies about different surgical treatments for KOA were included with a comprehensive search in PubMed, Cochrane Library, and Embase. The standard mean difference (SMD) value was evaluated and the surface under the cumulative ranking (SUCRA) curve was drawn with a combination of direct and indirect evidence. A total of 265 eligible patients were enrolled and served as the nonoperative treatment group, osteotomy group, unicompartmental knee arthroplasty (UKA) group, total knee arthroplasty (TKA) group, and arthroscopic surgery group. Before surgery, 6 months after surgery, 1 year after surgery and 5 years after surgery, the hospital for special surgery (HSS) knee score, Lysholm score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and American knee society score (KSS) were recorded. RESULTS: A total of 9 cohort studies including 954 patients with KOA were finally enrolled into the study. The network-meta analysis revealed that osteotomy and UKA treatments showed a better efficacy on improving the function score. Our cohort study further confirmed that, a higher HSS knee score after 1 year and higher Lysholm score after 6 months and 1 year were observed in the osteotomy and UKA groups, while better HSS knee score and KSS after 6 months and 1 year were showed in the osteotomy and TKA groups. In the TKA group, Lysholm score and KSS were higher and WOMAC score was lower after 5 years than other groups. WOMAC score was lowest in the UKA group after 6 months, 1 year and 5 years of surgery. CONCLUSION: These results provide evidence that function scores of patients with KOA were improved by osteotomy, UKA, TKA, and arthroscopic surgery. And osteotomy and UKA showed better short-term efficacy, while TKA appeared better long-term efficacy.

Role of exhaled nasal nitric oxide in distinguishing between chronic rhinosinusitis with and without nasal polyps.

BACKGROUND: Chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP) nasal polyps is a global health concern. Several clinical biomarkers, such as inhaled carbon monoxide and exhaled nitric oxide (NO), have been studied to assess the presence and degree of inflammation in the airway mucosa. OBJECTIVE: To evaluate the clinical application of exhaled nasal NO (nNO) in distinguishing between CRSwNP and CRSsNP in consideration of the atopic status of patients. METHODS: Eighty-eight patients with CRS and 20 healthy volunteers were recruited for this study. The exhaled nNO level was measured by using a hand-held device. Nasal endoscopy (with Lund-Mackay scoring of CRS) and sinus computed tomographies (CT) were used to evaluate the nasal cavity and sinuses of the subjects. Atopic status was confirmed by using skin prick tests (SPTs). RESULTS: The mean ± standard deviation (SD) levels of nNO in patients with CRSsNP were significantly higher than those in patients with CRSwNP (591 ± 153 ppb versus 360 ± 181 ppb, p < 0.001), whereas patients with CRS exhibited lower levels of nNO compared with the control subjects (449 ± 204 ppb versus 881 ± 161 ppb, p < 0.001). Patients with atopy and with and without nasal polyps exhibited significantly higher levels of nNO compared with patients without atopy (atopic CRSsNP versus nonatopic CRSsNP, 734 ± 120 ppb versus 503 ± 92 ppb [p < 0.001]; atopic CRSwNP versus nonatopic CRSwNP, 518 ± 161 ppb versus 299 ± 150 ppb [p < 0.001]). The levels of nNO were negatively correlated with the Lund-Mackay scores in both atopic (r = -0.45; p = 0.016) and nonatopic (r = -0.600; p < 0.001) patients with CRS. Receiver operating characteristic curves differentiated patients as CRSwNP, CRSsNP, and healthy controls, and in atopic and nonatopic subgroups, with acceptable sensitivity and specificity (>70 to 90%). CONCLUSION: Exhaled nNO levels can be used to distinguish between patients with CRSwNP and patients with CRSsNP. However, the atopic status of the patient influenced the use of nNO as a diagnostic or monitoring biomarker in CRS.