bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gene Expression of MMP‐1, MMP‐2, MMP‐9, and TIMP‐1 in Nasal Polyps
Authors: Anselmo‐Lima Wilma T. , da Silva Joao S. , Malinsky Rafael , Küpper Daniel , Tamashiro Edwin , Valera Fabiana 
Published: September 2011

ObjectiveEdema in nasal polyps (NP) is related to extracellular matrix degeneration, which is regulated by MMPs (matrix metalloproteinases) and their inhibitor, TIMP. Several studies relate MMP and TIMP expression to airway inflammatory diseases. The purpose of this study was to evaluate which is MMP and TIMP expression in Brazilian NP.MethodThirty NPs were compared with 19 controls. MMP1, MMP2, MMP9, and TIMP1 mRNAs expression was evaluated by RQTPCR. Also, PCR results were correlated to extensiveness of disease. PCR data were analyzed through Student t test, and the correlation between PCR and clinical results was performed by Spearman test.ResultsNPs presented significantly higher expression of MMP‐1 (9.79 ± 12.62 for NP vs 1.38 ± 1.21 for middle turbinates, P vs 0.83 ± 0.61 for middle turbinates, P vs 90 ± 0.56 for middle turbinates, P <. 05). TIMP‐1 expression was detected neither in NP nor in middle turbinates. There was no correlation between clinical findings and gene expression.ConclusionBrazilian NP presented higher expression of all the 3 studied MMPs (MMP1, MMP2, and MMP9), but not of TIMP1. This pattern is very similar to that observed for NP in the literature. There is no correlation between gene expression and extensiveness of the disease.
Gene Transfer in Respiratory Epithelium Using Synthetic Vectors and Folic Acid Receptor
Authors: Mornet Emmanuel , Lacroix Candice , Potard Gael , Montier Tristan , Gauvin Yves , Marianowski Remi 
Published: September 2011

ObjectiveSynthetic vectors may be an interesting alternative way compared with viral vectors. They are potentially less toxic and immunogenic. However, synthetic vectors use an aspecific electrostatic recognition. Cellular targeting is one of the major conditions for development of efficient synthetic vectors for gene therapy.MethodA neutral colipid derived from archaebacteria with acid folic ligand was developed and associated with cationic lipid vector. Its efficiency was tested on human respiratory epithelium cell culture.ResultsSafe respiratory epithelium offer few targets for gene transfer. Indeed, using lectin for specific gene transfer is difficult because of numerous different oligosaccharides patterns. We studied the interest of folic acid receptor as a target for gene transfer. These receptors are sparsely represented on this epithelium but have a great affinity. We demonstrated a specific gene transfer using a competitive inhibition by free folic acid in media. For a healthy human respiratory cell line, this new vector is more efficient and less toxic than lipofectamin.ConclusionDespite a small presence on human respiratory epithelium, folic acid receptor is a pertinent target for nonviral gene transfer. This vector is to be tested on animals. Such a targeting will increase gene transfer because of low electrostatic disturbance. Neutral vector may decrease toxicity.
Identifying a Surgical Threshold for Recurrent Rhinosinusitis: A Productivity Based Health Economics Model
Authors: Leung Randy , Tan Bruce , Conley David , Chandra Rakesh K. , Kern Robert 
Published: September 2011

ObjectiveThe management of recurrent acute bacterial rhinosinusitis (RARS) remains a controversial subject. Distinguishing RARS from viral upper respiratory infection (URI) is difficult, and when to consider surgery is unclear. This study seeks to identify a threshold number of infections where the benefit of surgery balances the lost productivity from RARS.MethodAn economic model was constructed using literature‐reported medical and surgical response rates, as well as measures of quality of life and productivity. This data was utilized to estimate event frequency thresholds for which surgery would be beneficial.ResultsTime lost for the perioperative period balances out lost productivity from RARS exacerbations when patients suffer from 6 episodes/year (range, 2.9‐16.8) or 3 episodes/year (range, 1.5‐8.4) over 2 years, or 2 episodes per year (range, 1‐5.6) over 3 years. Because of possible confusion with URIs, we propose an approach similar to that adopted by the Rhinosinusitis Task Force. The average number of viral URIs suffered by adults annually is approximately 2 (1.4‐2.3). Thus, we suggest adding 2 to the above calculated thresholds, prior to considering surgery.ConclusionIn terms of lost productivity, surgery should be considered when patients suffer from 8, 5, or 4 RARS episodes per year for the past 1, 2, or 3 years, respectively. Discussion with the patient must include a rational consideration of the burden of disease and overall patient quality of life.
Impact of Nasal Drug Delivery System on Mucociliary Clearance
Authors: Schuschnig Uwe , Khadem‐Saba Gülnaz , Häussinger Karl , Canis Martin , Becker Sven , Keller Manfred , Möller Winfried 
Published: September 2011

ObjectiveAerosolized drugs are predominantly delivered by nasal sprays, but they target the anterior nose only, and the administered drug is rapidly cleared. Studies with pulsating aerosols showed improved sinonasal deposition. This study compared clearance kinetics and cumulative dose after nasal spray and pulsating aerosol delivery.MethodOpen label deposition study in 15 healthy volunteers using radiolabeled pulsating aerosols generated by a Vibrent nebulizer in comparison to nasal pump sprays. Nasal deposition and retention was assessed by gamma camera imaging at various time intervals over 24‐hours in the entire nose and in specified ROIs.ResultsNasal pump spray vs pulsating aerosol application resulted in a nasal deposition of 100% vs 70 ± 16%.ConclusionAs found in earlier studies, nasal clearance of pulsating aerosols is significantly retarded compared with nasal sprays, causing prolonged drug residence time in the nose. Our data suggest that this effect may be related to the small droplet size and pulsations rather than deposition in certain nasal regions.
Molecular Basis of Tobacco Induced Bacterial Biofilms
Authors: Antunes Marcelo B. , Zhu Jun , Goldstein Natalia , Liu Zhi , Palmer James , Cohen Noam A. 
Published: September 2011

ObjectiveTobacco smoke exposure has been correlated to recalcitrant chronic rhinosinustis. Prior work has demonstrated tobacco smoke mediated sinonasal biofilm formation. Thus our objectives were: 1) Construct a series of reporter constructs for pseudomonas biofilm forming genes. 2) Determine which biofilm forming genes are regulated by tobacco smoke.MethodPromoter regions of 6 genes involved in pseudomonas biofilm formation (LasI, LasR, RhlA, PilF, FlgK, and AlgC) were subcloned into the luciferase reporter plasmid pMini‐CTX‐Lux. Subcloning was confirmed with PCR with subsequent conjugation into Pseudomonas (PAO1). Each subclone was then challenged with serial tobacco smoke exposure and luciferase activity quantified.ResultsElevated levels of luminescence, indicating specific promoter activation was identified after daily tobacco‐smoke exposure in the LasI, PilF, FlgK, and AlgC genes. The promoter activation of these genes was significantly elevated (P <. 05) after 2 consecutive exposures with no additional activation following a third exposure (Kruskall‐Wallis non‐parametric test). The level of promoter activation of the LasB gene was not affected by tobacco smoke exposure, while the RhlA gene decreased progressively by daily exposure.ConclusionUtilizing the luciferase reporter construct mLuxI we demonstrate activation of several key biofilm forming genes by exposure to tobacco smoke. This confirms our prior finding that tobacco smoke induces biofilms in sinonasal microbes. Interestingly, not all biofilm pathways interrogated demonstrated activation, suggesting unique tobacco mediated biofilm forming pathways in pseudomonas.
Molecular Signatures as a New Classification Scheme for CRS
Authors: Al‐Mot Sawsan , Filali‐Mouhim Ali , Rousseau Simon , Tardif Valerie , Berthiaume Yves , Desrosiers Martin Y. , Mfuna‐Endam Leandra 
Published: September 2011

ObjectiveWe have identified 2 distinct gene expression patterns (CRS1 and CRS2) in cultured epithelial cells obtained from surgical biopsies in CRS patients with and without nasal polyps (NP), which may better classify this disorder. We wished to compare the cellular infiltrate in CRS when assessed by molecular and clinical phenotypes.MethodSurgical biopsies taken from 20 CRS patients and 10 controls were divided according to their molecular signature as determined from epithelial cell cultures. Immunohistochemistry (IHC) for neutrophil elastase (NE) and major basic protein (MBP) was used to identify neutrophils and eosinophils in the epithelial and submucosal areas.ResultsGroups were analyzed statistically using ANOVA and t test to identify significant differences between groups. When biopsies were assessed as function of the clinical phenotypes of CRSwNP compared with CRSsNP, while there were equal increases in the number of eosinophils and neutrophils cells in CRS patients compared with the control subjects, there was no difference between the win and sNP groups. However, when assessed according to molecular signature, while there was an increase in eosinophils in both groups, a significant increase in the number of neutrophils was only seen in the CRS2 group, suggesting a different pathogenic mechanism.ConclusionThis novel expression signature identifies a molecular phenotype of CRS that is characterized by a marked neutrophil infiltration. Assessments of disease mechanism and response to therapy according to molecular, as opposed to clinical, phenotype may identify mechanistic differences which “personalize” our management of individuals with this disease.
NovaGen Reduces Adhesions In Vitro and in 2 In Vivo Models
Authors: Das Subinoy , Medina Jennifer G. , Steinke John W. 
Published: September 2011

ObjectiveAdhesion formation is a negative outcome of sinus surgery and common cause for revision surgery. Chitosan has been approved by the Food and Drug Administration for use in hemorrhage control. We hypothesized that a chitosan‐based compound may be beneficial in sinus surgery for reduction in adhesion formation.MethodNovaGen, a sprayable‐gel formulation consisting of chitosan and starch derivatives was developed. To support a premarket submission to the FDA of a medical device, we examined efficacy of adhesion reduction by NovaGen in vitro, in an experimental rabbit peritoneal adhesion model and an experimental sheep sinus adhesion model.ResultsIn an experimental wound migration model of cultured human fibroblasts, NovaGen led to significant inhibition of fibroblast migration at 24.ConclusionNovaGen, a novel, chitosan‐based compound, reduced cultured human fibroblast migration, reduced adhesions by 75% in a rabbit model, reduced adhesions by 70% in a sheep sinus adhesion model, and demonstrated no discernible side effects. These data support NovaGen’s novel use in human sinus surgery for hemostasis and reduction in adhesion formation.
Ophthalmic Manifestations of PNS Disease: A Grading System
Authors: Al Dousary Surayie H. , Al Anazy Fatma H. 
Published: September 2011

ObjectiveThe most currently used grading system for the orbital inflammatory complications secondary to sinusitis (Chandler classifications) does not cover the most common ophthalmic manifestations of the paranasal sinus diseases, allergic fungal sinusitis and chronic paranasal sinus disease. We propose a clinical grading system that encompasses (inflammatory and non‐inflammatory).MethodThirty patients with ophthalmic manifestations due to paranasal sinus disease were graded according to the following: anatomic disturbance like proptosis (grade I); mild functional involvement in the form of epiphora, ophthalmoplegia, diplopia, ptoses (grade II); orbital infection (grade III); and visual impairment with or without orbital infection (grade IV).ResultsThe ages ranged from 8 to 65 years with a mean of 30 years. Fifteen patients had orbital proptosis (grade I); 10 bilateral and 5 unilateral. Eleven patients had mild functional disturbance (grade II); 5 had epiphora, 3 had diplopia, and 2 had ptosis. Eight patients had orbital infection (grade III), and 5 patients had a visual loss (grade IV); 2 with orbital infection and 3 with mucocele and allergic fungal sinusitis. The main cause of the ophthalmic manifestation is allergic fungal sinusitis followed by chronic rhinosinusitis. The urgency of the surgical intervention is proportional to the grade degree.ConclusionThis clinical grading system categorizes the ophthalmic manifestations due to paranasal sinus diseases; inflammatory and non‐inflammatory pathology. The higher the grade of ophthalmic involvement the more urgent the need of surgical intervention. Allergic fungal sinusitis is the most common cause followed by chronic rhinosinusitis, with a ratio of 2:1.
Preoperative Planning Using 3D Reconstructions and Virtual Endoscopy for Location of the Frontal Sinus
Authors: Nogueira Joao‐Flavio , Cruz Daniel N. 
Published: September 2011

ObjectiveDemonstrate the production of 3D reconstructions from CTs of patients and compare them to the surgery’s actual endoscopic images.MethodProspective study. The CTs files of 10 patients were reconstructed with a specific program. The reconstructions were performed before the surgeries, and a virtual endoscopy was made. The actual endoscopic images of the recess and frontal sinus region were compared to the virtual images.ResultsThe 3D reconstruction and virtual endoscopy were made in 10 patients submitted to the surgery. The virtual images had a large resemblance with the actual surgical images.ConclusionWith relatively simple tools and a personal computer, we demonstrated the possibility to generate 3D reconstructions and virtual endoscopies.
Biofilm Presence vs Postoperative Outcomes in Chronic Rhinosinusitis with Polyps
Authors: Bezerra Thiago F. P. , Gebrim Eloisa M. , De Rezende Pinna Fabio , del Melo Padua Francini G. , Saldiva Paulo , Voegels Richard L. 
Published: September 2011

ObjectiveEvaluate the role of biofilms on sinus surgery outcomes of patients with chronic rhinosinusitis with nasal polyps (CRSwP).MethodProspective study conducted in a tertiary care center among 2008‐10. Patients underwent sinus surgery for CRSwNP, and mucosal samples were harvested for scanning electron microscopic. Preoperative and postoperative (followed up to 12 months) data were recorded. Data were considered nonparametric. Mann‐Whitney test and Spearman rank correlation were used.ResultsThis was the first report to analyze the effect of biofilms only in patients with CRSwNP. Biofilms were present in 67.9 % (19/28) of the CRSwNP patients. Both groups had similar age median (Interquartile‐Range = 45.0[15.0] vs 46.5[27.0]). Patients with biofilms had better Lund‐Kennedy outcome (‐3[5] vs ‐1[2], U = 46.0, P =. 036). These patients had worst outcomes in SNOT‐20 (‐0.75[1.15] vs ‐1.30[1.32], U = 69.0, P =. 21) and similar outcomes in NOSE (‐55.0[50.0] vs ‐60.0[50.0], U = 81.0, P =. 67) and Lund‐Mackay (‐4[5] vs ‐4[4], U = 75.5, P =. 49). There was a correlation among QoL outcome scores in both groups, and between NOSE and Lund‐Mackay outcomes scores in the biofilms group. (Spearman’s rank).ConclusionThis study showed that biofilms were present in most patients with CRSwNP, and these patients have less improvement of QoL. Moreover, the best endoscopic improvement may reflect a worse clinical preoperative status. Although CRSwNP is not caused by biofilms, it could act as an aggravating factor to the clinical picture of these patients.
Revision Endoscopic Dacryocystorhinostomy
Authors: de Souza Chris , Nisar Jayesh 
Published: September 2011

ObjectiveEvaluate results following revision of failed endoscopic dacryocystorhinostomy (DCR).MethodA total of 422 patients underwent endoscopic DCR unsuccessfully. Of these, 177 underwent revision endoscopic DCR. A total of 167 patients underwent removal of the medial wall of the lacrimal sac. Ten had silastic stents inserted. Parameters of success were resolution of epiphora, no further attacks of dacryocystitis, and patency of neofistula.ResultsOf the 167 patients undergoing removal of the medial wall of the lacrimal sac, 121 patients were patent following surgery. The remaining 46 got blocked again within 10 days of surgery. A total of 31 underwent a third surgery and were patent. Fifteen were lost to follow‐up. Ten patients were found to have an atrophic lacrimal sac, required stenting, and were patent. None of the patients undergoing revision DCR had the medial wall of the lacrimal sac removed in the previous surgery. The procedures done on these patients previously were exposure of the lacrimal sac and drainage.ConclusionRevision of failed endoscopic DCR can still produce good results. A very large osteotomy and removal of the medial wall of the lacrimal sac are associated with good results.
Role of Itraconazole in Sinonasal Polyposis
Authors: Ravikumar Arunachalam , Kumar Prasanna 
Published: September 2011

Objective1) Diagnose fungal disease in sinonasal polyposis. 2) Compare the clinical outcome of patients with sinonasal polyposis treated with and without itraconazole.MethodTwo‐year, randomized case controlled study in university hospital. Thirty patients with sinonasal polyposis. Random allocation to study and control group. All underwent nasal endoscopy, CT PNS, Nasal swab for fungal smear and culture. Study group received itraconazole, per oral for 2 and 4 weeks pre‐ and postoperative period.ResultsA total of 60% of preoperative nasal swab were KOH positive for fungal hyphae. Both groups presented with headache and nasal obstruction. Wormald classification was used to grade polyps, edema, and discharge. Fungus was isolated in 46% of study and 34% of control group; the predominant fungus grown was Aspergillus flavus. Histopathology showed 66% inflammatory polyps and 44% allergic polyps. Statistical analysis and comparison of control and study group showed significantly lower clinical scores in study (itraconazole) group (P <. 002) at 6 months posttreatment. The Lund Mackay score for CT scan did not show significant difference.ConclusionFungal disease co‐exists in a majority of patients with sinonasal polyposis. It is not known if it is a causative factor. Itraconazole was found to improve the clinical outcome in patients treated for sinonasal polyposis. No untoward side effects of the drug was identified in our study.
Symptoms and Signs from the Nose and Sinuses in Asthmatics
Authors: Thorstensen Wenche Moe , Fossland Nils P. W. , Sue‐Chu Malcom , Bugten Vegard , Steinsvaag Sverre K. 
Published: September 2011

ObjectiveThe United Airways Disease hypothesis suggests a link between upper and lower airways in asthmatics. However, there is a need to know more about nose and sinus related quality of life, sinonasal symptoms, and objective nasal air flow in asthmatics compared with healthy individuals.MethodOne hundred asthmatics and 96 nonasthmatic controls underwent a prospective controlled survey from June 2009 to December 2010. Symptoms, quality of life, and nasal airflow were assessed on Visual Analogue Scales (VAS, 0‐100), Sino‐Nasal‐Outcome‐Test (SNOT‐20), and Peak Nasal Inspiratory Flow (PNIF), respectively.ResultsAsthmatics (male/female 41/59; mean age, 44.1 years; range, 19‐64 years) reported significantly more symptoms of nasal obstruction [mean VAS 38mm (SD 26) vs 9 mm (SD 12), P <. 001] than controls (male/female 43/53; mean age, 41 years; range, 20‐65 years). PNIF was significantly lower in asthmatics than controls [mean PNIF 85 l/min (SD 24) vs 102 l/min (SD 19), P <. 001].ConclusionThis study provides further evidence of the clinical importance of the upper airway in the diagnostic and therapeutic management of asthmatic patients.
Orbital Volume Differences: Indication for Surgery in Blow Out Fractures
Authors: Alinasab Babak , Stjärne Pär 
Published: September 2011

ObjectiveIn orbital floor fractures, the estimation of the herniated orbital content in the maxillary sinus has traditionally been the dividing line between surgical and nonsurgical management. We wanted to evaluate whether a relative change in volume would function as an indicator for surgical vs nonsurgical treatment of orbital floor fractures.MethodThis was a follow‐up study in patients with untreated unilateral isolated orbital floor fractures admitted to our department from March 2003 to April 2007. The volume of the orbital contentwas calculated digitally from the patients’ CT scans at the time of their injury. 18 norms were included as controls.ResultsFive of 23 patients showed 2 to 4 mm enophthalmus, and only 3 of them had intermittent diplopia. No statistical correlation was found between the herniated volume and enophthalmus. No statistical correlation supporting the supposition that 1 mL herniated orbital content would result in 1mm enophthalmus was found.ConclusionThe relative volume change between the fractured and nonfractured orbit in an individual does not appear to be a useful criterion for surgery. The importance of the herniated orbital tissue for the development of enophthalmus is unclear.
Toward the Treatment of Paranasal Sinus Biofilms Using a Novel Nuclease
Authors: Shakir Adam , Burgess Grant , Jakubovics Nick , Shields Robert , El‐Badawey Mohamed Reda 
Published: September 2011

Objective1) Characterize the microstructure of paranasal sinus biofilms. 2) Characterize the microbial composition of sinus biofilms. 3) Develop techniques to treat sinus infections by breaking up sinus biofilms using surfactants and a novel, marine derived nuclease.MethodSinus biofilms were collected intraoperatively. Microbial composition was investigated by culturing and 16S rDNA sequencing, and the biofilm structure was analyzed by electron microscopy. Duplicate samples were treated with or without the marine nuclease (NucB) at 370C. The effect of NucB was measured by mass reduction before and after treatment.Results16SrDNA analysis demonstrated populations of Staphylococcus aureus, S epidermis, and Kocuria rhizophila. Anaerobic bacteria were recovered in limited numbers, and few fungal strains were observed. Transmission electron microscopy of characteristic tenacious biofilms showed an unusual layered structure. Samples consisted of endogenous mucin‐rich layers with occasional pockets of bacterial cells, which were found throughout the biofilm. A commercially available surfactant was used to disperse the upper layers of mucin to allow penetration by the nuclease into the deeper bacterial biofilm. In vitro studies with the nuclease against model organisms also showed effective breakup of biofilms.ConclusionWe have shown that characteristic tenacious sinus “biofilm” has an unusual microscopic structure. Bacteria appeared to be localized in foci and may have been responsible for stimulating a host response. We are developing methods to remove sinus biofilms using a microbial nuclease that breaks down DNA holding the biofilm together.