bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epithelial Genes in Chronic Rhinosinusitis with and without Nasal Polyps
Authors: Richer Sara L. , Truong-Tran Ai Q. , Conley David B. , Carter Roderick , Vermylen David , Grammer Leslie C. , Peters Anju T. , Chandra Rakesh K. , Harris Kathleen E. , Kern Robert C. , Schleimer Robert P. 
Published: May 2008

Background Genetic studies on chronic inflammatory diseases have resulted in an emphasis on the epithelial interface with the environment and the genes that influence this interaction. This study examines the expression of key epithelial genes implicated in the pathogenesis of other inflammatory disorders for their role in chronic rhinosinusitis (CRS). Methods Epithelial cells were collected from the inferior turbinate, middle turbinate, and/or uncinate from 62 subjects undergoing sinonasal surgery. Patient groups included 21 CRS patients with nasal polyposis, 23 CRS patients without nasal polyposis, and 18 controls. Samples were analyzed for S100A7, S100A8, S100A9, SLC9A3R1, G-protein-coupled receptor for asthma, and serine protease inhibitor kazal type 5 (SPINK5) by quantitative real-time polymerase chain reaction. Immunohistochemistry (IHC) was performed to analyze expression of SPINK5 lympho epithelial kazal-type inhibitor (LEKTI) in sinonasal samples. Results Expression of S100A7 and S100A8 was significantly decreased in CRS with and without nasal polyps when compared with controls. S100A9 expression was significantly decreased in CRS without nasal polyps, and SPINK5 expression was significantly decreased in CRS with nasal polyps. SPINK5 (LEKTI) protein was detected in sinonasal tissue and was significantly decreased in polyp samples using IHC. Conclusion This study shows marked reductions in the level of expression of several genes involved in epithelial barrier maintenance and repair in the inflammatory state of CRS.
Diagnostic Evaluation of Inhalant Allergies: A Cost-effectiveness Analysis
Authors: Lewis Andrea F. , Franzese Christine , Stringer Scott P. 
Published: May 2008

Background The purpose of this study was to compare the cost-effectiveness of modified quantitative testing (MQT), intradermal dilutional testing (IDT), and in vitro allergy testing as diagnostic methods used in the management of patients with suspected IgE-mediated inhalant allergies. Methods A systematic review was conducted to determine key statistics for analysis, such as prevalence of disease, and sensitivity and specificity of each diagnostic modality. Costs were calculated based on charges from distribution companies to providers. A deterministic cost-effectiveness analysis then was conducted using a decision tree model to evaluate the various diagnostic strategies. After identifying results at baseline, we performed a sensitivity and threshold analysis to assess the strength of recommendations. Results At an allergic rhinitis prevalence of 20%, MQT dominated IDT and in vitro testing, with 85 people correctly diagnosed at a baseline total cost of $6630 for the 100 patients tested. Although in vitro testing had the highest effectiveness, it had an incremental cost-effectiveness ratio of $3185. The results were sensitive to changes in the prevalence, costs, and sensitivities and specificities of the different modalities. Conclusion The prevalence of allergic rhinitis is high and rising according to many studies, leading to a growing population of patients requiring allergy testing. Not only does today's medical community want effective health interventions, but also there is pressure to make health care cost efficient. This study looks at the cost-effectiveness of various diagnostic allergy tests. In our model, we found MQT to be the most cost-effective method of diagnosing allergic disease.
Comprehensive Management of Failed Frontal Sinus Obliteration
Authors: Kanowitz Seth J. , Batra Pete S. , Citardi Martin J. 
Published: May 2008

Background Treatment of patients with failed frontal sinus (FS) obliteration (FSO) remains an important challenge in the endoscopic era. Advances in endoscopic techniques have facilitated the application of minimally invasive approaches for clinical scenarios that previously required open procedures. Methods A retrospective chart review of patients presenting with failed FSO from January 1, 2001 to June 30, 2007 was performed. Results Seventeen patients (mean age, 52.8 years; 10 men and 7 women) presented at an average of 9.7 years from initial FSO. The most common primary presenting symptoms included headache (41.2%) and forehead swelling (23.5%). Seven patients had prior craniotomies and 10 patients had prior endoscopic sinus surgery. All patients underwent surgical exploration; revision procedures were required in 5 patients. Definitive procedures included endoscopic frontal sinusotomy (EFS; 10 patients), endoscopic frontal drill-out (3 patients), revision osteoplastic frontal sinusotomy with obliteration reversal (2 patients), and repeat FSO (2 patients). One patient required revision EFS twice. Initial intraoperative findings included mucocele (13 cases), bone wax (3 cases), fibrous tissue (2 cases), and polypoid mucosa (1 case). All patients had resolution or improvement of their primary presenting signs/symptoms. All FSO reversal patients achieved functional FS patency documented by endoscopy and/or CT scan with mean follow-up of 9.5 months (range, 1.5-30.8 months). Conclusion Operative exploration should be considered in all patients with persistent or recurrent symptoms and/or signs of failed FSO. In most instances, repeat FSO can be avoided, and a minimally invasive endoscopic strategy can be used successfully.
Reproducibility of Nasal Lavage in the Context of the Inhalation Challenge Investigation of Occupational Rhinitis
Authors: Castano Roberto , Thériault Gilles , Maghni Karim , Ghezzo Heberto , Malo Jean-Luc , Gautrin Denyse 
Published: May 2008

Background The nasal lavage (NAL) method is increasingly used to assess changes in upper airways inflammation in the investigation of occupational rhinitis (OR). A good reproducibility of the method is fundamental to accurately assess changes in markers of inflammation in nasal secretions before and after inhalation challenges. The main objective of this study was to assess the short-term reproducibility of cells and cellular markers of inflammation in NAL in the setting of specific inhalation challenge (SIC) investigating OR. An ancillary objective was to assess the reproducibility of NAL in the context of two different SIC methodologies. Methods Twenty-five subjects attended the laboratory for 2 separate days of NAL performed within the same week. On the first visit subjects underwent NAL before a SIC sham session and on the second visit before a SIC with the active agent. These prechallenge NAL measurements obtained on both days were used to analyze the reproducibility of the NAL method. Results The reproducibility for cell differential counts was satisfactory for neutrophils (intraclass correlation coefficient [ICC] = 0.68), for eosinophils (ICC = 0.95), for macrophages (ICC = 0.77), and for epithelial cells (ICC = 0.73). The reproducibility of total cell counting was poor (ICC = 0.12). The reproducibility of ECP concentrations was satisfactory (ICC = 0.67). Eosinophil counts were reproducible in the context of two different challenge methodologies. Conclusion The NAL method was shown to be sufficiently reproducible to be considered useful for the monitoring of upper airways inflammation during the investigation of OR by SIC.
Comparison of Maxillary Sinus Puncture with Endoscopic Middle Meatal Culture in Pediatric Rhinosinusitis
Authors: Hsin Chung-Han , Tsao Chien-Han , Su Mao-Chang , Chou Ming-Chih , Liu Chia-Ming 
Published: May 2008

Background Although maxillary sinus puncture is considered the gold standard for obtaining bacterial cultures, there is an increasing field of evidence indicating that results of endoscopic middle meatal culture correlate well with those of maxillary sinus punctures. However, the subjects of these studies were adults and there was no prior study comparing endoscopic middle meatal culture with maxillary sinus punctures in children with rhinosinusitis. The aims of this study were to compare the results obtained by endoscopic middle meatal culture and maxillary sinus punctures in children with rhinosinusitis. Methods A prospective study of children with community-acquired rhinosinusitis was conducted. Results obtained by endoscopic culture were compared with those of maxillary sinus puncture, and the correlation of these 2 techniques was investigated. Results There were 41 specimen sets sent for aerobic cultivation. Correlation obtained from the middle meatus with those from the maxillary sinus puncture was demonstrated in 32 of 41 specimens (78.0%). When looking at the diagnostic usefulness of endoscopic middle meatus sampling versus maxillary sinus puncture, endoscopic sampling provided a sensitivity of 75.0%, a specificity of 88.9%, a predictive value of a positive result of 96.0%, a predictive value of a negative result of 50.0%, and an accuracy of 78.0%. Conclusion We demonstrated that, when performed in pediatric patients, the correlation between endoscopic middle meatal culture and maxillary sinus puncture was not as favorable as in the case of adult patients.
Endoscopic Surgery for Malignant Tumors of the Sinonasal Tract and Adjacent Skull Base: A 10-year Experience
Authors: Nicolai Piero , Battaglia Paolo , Bignami Maurizio , Villaret Andrea Bolzoni , Delù Giovanni , Khrais Tarek , Lombardi Davide , Castelnuovo Paolo 
Published: May 2008

Background The increasing expertise in the field of transnasal endoscopic surgery recently has expanded its indications to include the management of sinonasal malignancies. We report our experience with the endoscopic management of nasoethmoidal malignancies possibly involving the adjacent skull base. Methods A retrospective analysis was performed of patients treated by an exclusive endoscopic approach (EEA) or a cranioendoscopic approach (CEA) from 1996 to 2006 managed by two surgical teams at the Departments of Otorhinolaryngology of the University of Brescia, and the University of Pavia/Insubria-Varese, Italy. Results One-hundred eighty-four patients were considered eligible for the present analysis. An EEA was performed in 134 patients and the remaining 50 patients underwent the CEA. The most frequent histotypes encountered were adenocarcinoma (37%), squamous cell carcinoma (13.6%), olfactory neuroblastoma (12%), mucosal melanoma (9.2%), and adenoid cystic carcinoma (7.1%). Overall, 86 (46.7%) patients received some form of adjuvant treatment. The patients were followed up for a mean of 34.1 months (range, 2-123 months). The 5-year disease-specific survival was 91.4 ± 3.9% and 58.8 ± 8.6% (p = 0.0004) for the EEA and CEA group, respectively. Conclusion To the best of our knowledge, this is the largest series reported to date of malignant tumors of the sinonasal tract and adjacent skull base treated with pure endoscopic or cranioendoscopic techniques. A 5-year disease-specific survival of 91.4% and 58.8% for the EEA and the CEA groups, respectively, seem to indicate that endoscopic surgery, when properly planned and in expert hands, may be a valid alternative to standard surgical approaches for the management of malignancies of the sinonasal tract.
A Scientific Review of Middle Meatal Packing/stents
Authors: Weitzel Erik Kent , Wormald Peter-John 
Published: May 2008

Background Nasal packing usually is placed after endoscopic sinus surgery (ESS) to control hemorrhage, but also may be used to prevent adhesions from forming and promote faster healing of damaged mucosa. Methods A literature review was performed to identify all forms of scientifically evaluated absorbable packing for ESS. Only English studies identifiable within the PubMed database were included. Studies were categorized by level of evidence and evaluated for methodological errors. Results Thirty-eight studies met the inclusion criteria. There was a diverse range of article evidence and quality. Conclusion The most effective hemostatic agent currently available is FloSeal; however, this product causes an increase in adhesion formation. For the purpose of preventing adhesions, resorbable packs appear to have no benefit over either nonresorbables or no packing. If the middle turbinate is unstable at the conclusion of surgery, suturing it to the septum may reduce adhesions. Although mitomycin C, hyaluronic acid, and retinoic acid all have shown potential in these roles, to date, none have shown to be useful in the post-ESS chronic sinusitis human patient.
Symptom-based Presentation of Chronic Rhinosinusitis and Symptom-specific Outcomes after Endoscopic Sinus Surgery
Authors: Soler Zachary M. , Mace Jess , Smith Timothy L. 
Published: May 2008

Background Very few studies have comprehensively examined specific symptom outcomes of endoscopic sinus surgery (ESS). The purpose of this study was to define the individual symptoms of a cohort of patients with medically refractory chronic rhinosinusitis (CRS) using visual analog scale (VAS) scores as well as report symptom-based outcomes after ESS. Methods Patients with medically refractory CRS presenting for surgical management were asked to evaluate baseline symptoms using 10-cm VAS measures. Participants were asked to rank their most debilitating symptoms in descending order. VAS scores were assessed postoperatively at 3, 6, 12, and 18 months. The Kruskal-Wallis test was used to assess improvement in mean symptom VAS scores at each of the postoperative time points. Results Nasal congestion elicited the highest preoperative VAS score with an average of 6.5, followed by fatigue (6.0), headache (5.8), decreased sense of smell (5.5), nasal drainage (5.5), and facial pain-pressure (5.5). Headache was the most commonly reported disabling condition. Follow-up data after ESS was available for 207 patients. Average VAS scores for 6 of 7 symptoms showed significant and sustainable postoperative improvement at 3, 6, 12, and 18 months after surgery (p < 0.001). Improvement in VAS score for headache was not statistically significant (p > 0.700). Conclusion This study indicates that patients with medically refractory CRS presenting for surgery complain of associated symptoms with great frequency. ESS results in both statistically and clinically significant improvements in six of seven symptoms. Headache, which was the most highly ranked disabling symptom, did not show significant improvement from baseline.
Preoperative Disease Severity at Sites of Subsequent Skull Base Defects after Endoscopic Sinus Surgery
Authors: DelGaudio John M. , Mathison Clyde C. , Hudgins Patricia A. 
Published: May 2008

Background Skull base (SB) injury is a known complication of endoscopic sinus surgery (ESS). Risk factors for SB injury include poor visualization, low-lying SB, and SB asymmetry. Anecdotal evidence indicates that many SB defects occur in areas with minimal mucosal disease adjacent to the SB. We evaluated preoperative computed tomography (CT) scans to determine the degree of mucosal disease present at the site of subsequent SB defects caused by ESS. Methods Retrospective review of patients with SB injury as a result of ESS. Preoperative and postoperative CT films were reviewed for extent of overall sinus disease and disease at the site of the subsequent SB defect and presence of risk factors for SB injury. Results Preoperative and postoperative CT scans were obtained for 22 patients with 23 defects, who underwent 21 primary and 1 revision ESS. Fifteen (65%) patients had no disease, 2 (9%) patients had minimal disease, and 6 (26%) patients had complete opacification at the site of subsequent SB injury. SB defects occurred in the ethmoid roof (15 patients, 65%), lateral lamella (5 patients, 22%), cribriform plate (2 patients, 9%), and sphenoid sinus (1 patient, 4%). Risk factors for SB injury were only identified in 6 patients. Conclusion SB injuries resulting from ESS occurred in SB regions with minimal or no mucosal disease in over two-thirds of cases. Explanations for this may include thinner bone and mucosa in areas without chronic disease that is easier to injure and less resistance to dissection in minimally diseased areas. Caution should always be exercised in ESS, but especially in minimally diseased areas.
Effect of Patient-related Delay in Diagnosis on the Extent of Disease and Prognosis in Nasopharyngeal Carcinoma
Authors: Sheng Liming , Shui Yongjie , Shen Li , Wei Qichun 
Published: May 2008

Background The reasons causing the patient-related delay in diagnosis (PRDD) and the effects of PRDD on the extent of disease and prognosis in the nasopharyngeal carcinoma (NPC) remain uncertain. The aim of this study was to investigate the status of PRDD and evaluate the relationship between PRDD and prognostic factors of NPC. Methods The data of 216 patients with NPC, from 2002 to 2006, were analyzed retrospectively with respect to patient age, gender, smoking status, education experience, living area, and symptoms. PRDD was recorded as the time from initial symptoms to the first visit to a medical doctor. The extent of disease was determined by TNM staging according to the International Union Against Cancer classification in 1997. Results PRDD of the analyzed cases ranged from half a month to 24 months, with a mean delay in diagnosis of 5.6 months. Senior residents and low education population tended to have longer PRDD (p < 0.05). There was a significant correlation between PRDD and the degree of invasion, clinical stage of NPC (p < 0.05). Conclusion Senior residents and low education population tend to have longer PRDD. Delay in diagnosis correlates with the degree of invasion and stage of NPC.
The Effects of Retinoic Acid on Ciliary Function of Regenerated Sinus Mucosa
Authors: Erickson Vanessa R. , Antunes Marcelo , Chen Bei , Cohen Noam A. , Hwang Peter H. 
Published: May 2008

Background Retinoic acid (RA) has been shown to enhance ciliary ultrastructure in regenerated sinus mucosa compared with controls. However, the functional status of the regenerated cilia has not been studied. Our objective was to evaluate the ciliary beat frequency (CBF) of regenerated sinus mucosa treated with topical RA in a rabbit model. Methods Twelve rabbits underwent bilateral surgical stripping of the maxillary sinuses, followed by treatment with RA gel in the right side and an inert gel control in the left side. The rabbits were then killed at either 2 or 4 weeks, and CBF analysis of the regenerated mucosa was performed. Three unoperated rabbits were used to establish normative CBF data. Results Functional cilia were recovered from 11/12 RA-treated sinuses and 12/12 gel control sinuses. At 2 weeks postoperatively, the RA-treated sinuses showed an average CBF of 19.78 Hz, which was statistically comparable with the normal unoperated controls (p < 0.26). The inert gel-treated mucosa showed a CBF of 29.24 Hz, which was significantly elevated compared with normals (p < 0.05). At 4 weeks, ciliary activity persisted, but both RA-treated sinuses and gel controls showed elevated CBF compared with normals (p < 0.03). Conclusion Topical RA placed in a demucosalized maxillary sinus yields functional cilia. RA appears to have a normalizing effect on CBF early in the mucosal wound healing process compared with control. This effect appears to be mitigated in later stages of wound healing. RA may be beneficial in enhancing morphological and functional aspects of regenerating cilia.
Recurrent Acute Rhinosinusitis: Presentation and Outcomes of Sinus Surgery
Authors: Poetker David M. , Litvack Jamie R. , Mace Jess C. , Smith Timothy L. 
Published: May 2008

Background Patients with recurrent acute rhinosinusitis (RARS) represent a challenging subset of patients with rhinosinusitis. Data regarding the outcomes of care for these patients is extremely limited. The purpose of this study was to evaluate objective and patient-based measures in patients diagnosed with RARS before and after surgical intervention. Methods A prospective, nested case-control study was performed. Cases of RARS (n = 22) were matched to patients with chronic rhinosinusitis (CRS) without polyposis (n = 22) by age, sex, and race/ethnicity. Preoperative computed tomography (CT) and pre- and postoperative endoscopic examinations, the Chronic Sinusitis Survey, and the Rhinosinusitis Disability Index were scored and compared between cases and controls. Results Patients with RARS were less likely to have asthma or previous sinus surgery. Patients with CRS underwent more extensive surgery. There were no significant differences in preoperative CT, endoscopy, or patient-based, quality-of-life (QOL) scores. Both groups showed statistically significant improvements in total postoperative QOL scores. Patients with CRS showed significant improvement on endoscopy scores. Patients with RARS used significantly fewer sinus medications after endoscopic sinus surgery. Conclusion Patients with RARS were more often primary surgical patients and underwent less extensive surgery than their CRS counterparts. Both groups reported improved QOL after surgery.
An in vitro Model of Pseudomonas aeruginosa Biofilms on Viable Airway Epithelial Cell Monolayers
Authors: Woodworth Bradford A. , Tamashiro Edwin , Bhargave Geeta , Cohen Noam A. , Palmer James N. 
Published: May 2008

Background Chronic rhinosinusitis (CRS) that is refractory to medical or surgical intervention may involve a particularly resistant form of infection known as a bacterial biofilm. Bacterial biofilms are three-dimensional aggregates of bacteria that often are recalcitrant to antibiotics secondary to physical barrier characteristics. To date, all studies investigating biofilms in CRS have been descriptive in either human or animal tissue. To better understand the interactions of bacterial biofilms with respiratory epithelium, we describe an in vitro model of biofilm sinusitis by establishing mature biofilms on airway epithelial air-liquid interface cultures. Methods Airway epithelial cell cultures were grown on collagen-coated semipermeable support membranes as an air-liquid interface on tissue culture inserts. Confluent air-liquid interface cultures were inoculated with the biofilm-forming PAO-1 strain of Pseudomonas aeruginosa and compared with cultures inoculated with two mutant strains (sad-31 and sad-36) unable to form biofilms. Inoculated tissue transwells were incubated for 20 hours, allowing for biofilm growth. The semipermeable membranes were then harvested and imaged with confocal laser scanning microscopy and scanning electron microscopy. Results Microscopic analysis revealed the formation of biofilm-forming towers in the PAO-1 inoculated wells. The bacterial biofilms were supported by a viable airway epithelial cell surface monolayer. Conclusion This study shows a reliable method for analysis of in vitro interactions of bacterial biofilms and airway epithelium. The experimental manipulation of this air-liquid interface model will help explore novel treatment approaches for bacterial biofilm-associated CRS.