Humans ; Maxillary Sinus ; anatomy & histology ; surgery

Allergic rhinitis (AR) clinically expressed by sneezing, rhinorrhea, nasal itching and congestion is an allergen-driven mucosal inflammatory disease which is modulated by immunoglobulin E. Epidemiological studies have indicated that prevalence of AR continues to increase, and it has been a worldwide health problem that places a significant healthcare burden on individuals and society. Given the evolving understanding of the process by which an allergen is recognized and the roles of mediators which account for AR progress, the pathogenesis of AR has become clearer. Current studies have demonstrated local allergic rhinitis (LAR) that patients with both sug- gestive symptoms of AR and a negative diagnostic test for atopy may have local allergic inflammation is a prevalent entity in patients evaluated with rhinitis, but further research remains needed. Management of AR includes aller- gen avoidance, pharmacological treatment and allergen-specific immunotherapy. Recently montelukast has exhibited previously undocumented anti-inflammatory properties, leukotriene receptor antagonists therefore may serve a more important role in the treatment of AR. Not only has immunotherapy proved its efficacy, but also been able to alter disease course and thereby mitigate progression to asthma. Thus immunotherapy can be initiated while receiving pharmacotherapy, especially in children with AR. As clinical guidelines, the ARIA (Allergic Rhinitis and its Impact on Asthma) provides basic principles of effective treatment of AR. Besides, choosing an appropriate treatment strategy should be based on the severity and chronicity of patient's symptom. The aim of this review was to provide an update mainly on the pathophysiology, epidemiology, and management of AR.
Acetates ; therapeutic use ; Allergens ; Anti-Inflammatory Agents ; therapeutic use ; Asthma ; prevention & control ; Child ; Humans ; Hypersensitivity, Immediate ; diagnosis ; physiopathology ; Immunoglobulin E ; immunology ; Immunotherapy ; Inflammation ; physiopathology ; Leukotriene Antagonists ; therapeutic use ; Prevalence ; Quinolines ; therapeutic use ; Rhinitis, Allergic ; diagnosis ; immunology ; physiopathology

Viruses (e.g. Human immunodeficiency virus, Human simplex virus and Prototype foamy virus) are obligate intracellular parasites and therefore depend on the cellular machinery for cellular trafficking. Bovine foamy virus (BFV) is a member of the Spumaretrovirinae subfamily of Retroviruses, however, details of its cellular trafficking remain unknown. In this study, we cloned the BFV gag gene into prokaryotic expression vector pET28a and purified the denaturalized Gag protein. The protein was used to immunize BALB/c mouse to produce antiserum, which could specifically recognize the BFV Gag protein in BFV-infected cells through western blot assay. Additionally, these results demonstrated that both the optimal and suboptimal cleavage of Gag protein occur in BFV-infected cells. Subsequently, the Gag antiserum was used to investigate subcellular localization of BFV. In immunofluorescence microscopy assays, colocalization microtubules (MTs) and assembling viral particles were clearly observed, which implied that BFV may transport along cellular MTs in host cells. Furthermore, MTs-depolymerizing assay indicated MTs were required for the efficient replication of BFV. In conclusion, our study suggests that BFV has evolved the mechanism to hijack the cellular cytoskeleton for its replication.

OBJECTIVETo investigate the correlation between nuclear factor-kappa B (NF-kappaB) activity and cytokine expression in nasal mucosa of chronic sinusitis.

METHODSIL-5, IL-6 and IL-8 levels in nasal mucosa were assayed by the method of ELISA in 52 cases of chronic sinusitis [concomitant with allergic rhinitis (AR group), without allergic rhinitis (NAR group)] and 12 normal subjects. Semi-quantitative RT-PCR and immunohistochemical staining were used to examine P50 and P65 subunits of NF-KB expressions and activation in nasal mucosa. The correlation between activities of NF-KB P50 and P65 subunits and cytokine expression was evaluated.

RESULTSIL-5, IL-6 and IL-8 levels in both AR and NAR groups were significantly increased (all P < 0.01 for AR group; P < 0.05, 0.05, 0.01, respectively, for NAR group, as compared with normal group), and the levels were much higher in AR group than that in NAR group (P < 0.01, 0.05, 0.01, respectively). The levels of P50 and P65 mRNA in both AR and NAR groups were enhanced (all P < 0.01 for AR group; all P < 0.01 for NAR group, as compared with normal group), and AR group had markedly greater P50 and P65 mRNA levels in comparison with NAR group (both P < 0.05). Immunohistochemical study revealed that nucleus-present rates of P50 and P65 in both AR and NAR groups were significantly higher than those of control group (all P < 0.01), and they were much greater in AR group as compared with NAR group (all P < 0.01). Pearson correlation analysis demonstrated that P50 and P65 nucleus-present rates were closely correlated with IL-6 and IL-8 levels, but not IL-5. The correlation coefficient was 0. 49 for P50 and IL-6, 0. 54 for P50 and IL-8, 0. 61 for P65 and IL-6, and 0.66 for P65 and IL-8 (all P < 0.01).

CONCLUSIONSActivation of P50 and P65 subunits of NF-kappaB might be one of the mechanisms for induction of IL-6 and IL-8 expression in chronic sinusitis. Concomitance of allergic rhinitis with chronic sinusitis further increased activities of NF-kappaB subunits, and further elevated IL-6 and IL-8 expression. IL-5 expression was independent of NF-kappaB pathway in chronic sinusitis.

Adult ; Chronic Disease ; Female ; Humans ; Interleukin-5 ; metabolism ; Interleukin-6 ; metabolism ; Interleukin-8 ; metabolism ; Male ; Middle Aged ; NF-kappa B p50 Subunit ; metabolism ; Nasal Mucosa ; metabolism ; RNA, Messenger ; genetics ; Rhinitis ; metabolism ; Sinusitis ; metabolism ; Transcription Factor RelA ; metabolism

An introduction of an intelligent testing instrument for medical electrical equipment security is given in this article. The realization of its testing functions is based on a single-chip processor, the high-voltage control circuit and the relay combination network technology. It can be used to test security parameters such as the continuous leakage current, patient auxiliary current, dielectric strength and protective earth impedance. It is suitable for the medical electricity security testing of Kind I, II and Type B, BF, CF (internal power supply) medical electrical equipments.
Electricity ; Equipment Design ; Equipment Failure Analysis ; instrumentation ; methods ; Equipment Safety ; instrumentation ; methods ; Software Design

BACKGROUND: Active compression-decompression cardiopulmonary resuscitation (ACD-CPR) has been popular in the treatment of patients with cardiac arrest (CA). However, the effect of ACD-CPR versus conventional standard CPR (S-CRP) is contriversial. This study was to analyze the efficacy and safety of ACD-CPR versus S-CRP in treating CA patients. METHODS: Randomized or quasi-randomized controlled trials published from January 1990 to March 2011 were searched with the phrase "active compression-decompression cardiopulmonary resuscitation and cardiac arrest" in PubMed, EmBASE, and China Biomedical Document Databases. The Cochrane Library was searched for papers of meta-analysis. Restoration of spontaneous circulation (ROSC) rate, survival rate to hospital admission, survival rate at 24 hours, and survival rate to hospital discharge were considered primary outcomes, and complications after CPR were viewed as secondary outcomes. Included studies were critically appraised and estimates of effects were calculated according to the model of fixed or random effects. Inconsistency across the studies was evaluated using the I2 statistic method. Sensitivity analysis was made to determine statistical heterogeneity. RESULTS: Thirteen studies met the criteria for this meta-analysis. The studies included 396 adult CA patients treated by ACD-CPR and 391 patients by S-CRP. Totally 234 CA patients were found out hospitals, while the other 333 CA patients were in hospitals. Two studies were evaluated with high-quality methodology and the rest 11 studies were of poor quality. ROSC rate, survival rate at 24 hours and survival rate to hospital discharge with favorable neurological function indicated that ACD-CPR is superior to S-CRP, with relative risk (RR) values of 1.39 (95% CI 0.99–1.97), 1.94 (95%CI 1.45–2.59) and 2.80 (95% CI 1.60–5.24). No significant differences were found in survival rate to hospital admission and survival rate to hospital discharge for ACD-CPR versus S-CRP with RR values of 1.06 (95% CI 0.76–1.60) and 1.00 (95% CI 0.73–1.38). CONCLUSION: Quality controlled studies confirmed the superiority of ACD-CPR to S-CRP in terms of ROSC rate and survival rate at 24 hours. Compared with S-CRP, ACD-CPR could not improve survival rate to hospital admission or survival rate to hospital discharge.

OBJECTIVETo explore the surgical approaches, methods and techniques of repair of cerebrospinal fluid (CSF) rhinorrhea via frontal sinus under transnasal endoscopy.

METHODSCerebrospinal fluid rhinorrhea, located at the posterior wall of the frontal sinus (n = 9) and posterior lateral wall of the frontal recess (n = 4) had been repaired surgically. A transnasal endoscopic approach was chosen in 12 patients and combined approach was used in 1 patient during the first procedure. Three patients needed the second surgery. Among them, one patient needed to repair CSF rhinorrhea, 1 patient needed to treat intracranial abscess of frontal lobe via combined approach and another one was treated because of the complication of frontal cyst.

RESULTSTwelve patients were successfully repaired in the first surgery. Only 1 patient needed second surgery. Two patients occurred complications. One was intracranial infection after surgery, external drainage and packing in the frontal sinus was used. Another was obstructive cyst in frontal sinus, transnasal endoscopic frontal sinusotomy was performed.

CONCLUSIONSCSF rhinorrhea which located at the posterior wall of the frontal sinus can be successfully repaired via transnasal endoscopic approach if the leak was visible under endoscopy. The size of the frontal ostium and leak vantage should be considered to prevent the drainage of the frontal sinus which would result in obstructive cyst in frontal sinus, frontal sinusitis and intracranial infection. Combined approach was suggested to the patients that leakage could not be seen in frontal sinus or frontal ostium was difficult to enlarge.

Adolescent ; Adult ; Cerebrospinal Fluid Rhinorrhea ; surgery ; Child ; Endoscopy ; methods ; Female ; Frontal Sinus ; surgery ; Humans ; Male ; Middle Aged ; Young Adult

OBJECTIVESTo study the concentration, distribution and expression of IL-5 in nasal polyp tissues and explore its significance in micro-environment differentiation of eosinophil accumulation.

METHODSThe concentration and expression of IL-5 in nasal polyp tissues of 40 patients were determined by ELISA and immunohistochemistry and inferior turbinate mucosa from patients with nasal polyps and healthy volunteers were used as control.

RESULTSIL-5 concentration in polyp tissues was significantly higher than that in turbinate mucosa (P < 0.05). There was no significant difference in the turbinate mucosae between patients with nasal polyps and healthy volunteers (P > 0.05). IL-5 concentrations in polyp tissues were markedly higher in patients with allergic rhinitis compared with those without (P < 0.05). IL-5 concentrations had no correlation with age and sex (P > 0.05). 80.1% of the eosinophils were positive for IL-5 and 90.9% of IL-5 positive cells were eosinophils. Only 3.7% of lymphocytes and neutrophils were positive for IL-5; IL-5 was not detectable in epithelial cells. IL-5 expression in eosinophils of polyp tissues was remarkably stronger than that of the turbinate mucosa (P < 0.05); there was no significant difference in the the turbinate mucosae between patients with nasal polyps and healthy volunteers (P > 0.05). IL-5 expression of eosinophils in polyp tissue was significantly stronger in patients with allergic rhinitis compared with those without (P < 0.05). There was no significant difference in IL-5 expression in lymphocytes and neutrophils between polyp tissues and turbinate nasal mucosa (both P > 0.05).

CONCLUSIONIL-5 is the key cytokine in eosinophilic pathologic mechanisms in nasal polyp tissues.

Adult ; Enzyme-Linked Immunosorbent Assay ; Eosinophils ; chemistry ; Female ; Humans ; Interleukin-5 ; analysis ; Lymphocytes ; chemistry ; Male ; Middle Aged ; Nasal Mucosa ; chemistry ; Nasal Polyps ; immunology ; Turbinates ; chemistry

Objective To introduce our experience of resection of petrous apex cholesteatoma through endoscopic,transnasal,trans-sphenoidal approach in 3 cases,and present a surgical technique of intracystic resection of lesion which yielded a relatively stable long-term outcome.Methods Resection of parasellar and petrous apex cholesteatoma via endoscopic transsphenoidal approach was performed in three patients between 2001 and 2006.Surgical technique was as follows: the ethmoid and sphenoid sinuses were opened under endoscope,the petrous apex was accessed by drilling skull base bone at the lateral wall of sphenoid sinus and anterior to the internal carotid artery,the cyst wall of cholesteatoma was incised and expanded,then intracystic removal of cholesteatoma was achieved by the suction,curette and rinsing.Results The petrous apex cholesteatoma in all 3 patients were removed clearly by endoscopic,transnasal,trans-sphenoidal surgery in one time.Before surgery,two patients with headache and orbital apex syndrome had a remarkable improvement just on the day after operation and completely recovered in 1-4 weeks.No postoperative complications happened in all three patients.All patients had no recurrence in symptoms and no imaging evidences of recurrence at a follow-up of 3-7 years. Conclusion The petrous apex cholesteatoma around the parasellar region could be treated by intracystic removal via endoscopic,transnasal,transsphenoidal approach,without the need to strip and remove the cyst wall,and the long-term efficacy was reliable.

Objective To explore the cause,urgent management,further treatment,outcome and prevention of internal carotid artery (ICA) injury during transnasal endoscopic surgery.Methods Five ICA injury happened during transnasal endoscopic surgery of sphenoidal sinus and (or) sellar region,involving 1 case of traumatic optic neuropathy,1 case of sphenoidal cyst,1 case of fungal sphenoid sinusitis,1 case of sellar adenoid cystic carcinoma and 1 case of pituitary tumor.These five cases were from three different hospitals in 1990 -2009,and the clinical data were collected and retrospectively reviewed.Results Injury of ICA was related with improper anatomic localization and operative procedures.The locations of injury were in cavenous segement in 3 cases,lacerum segment in 1 case,and clinic segment in 1 case,respectively.The types of injury included 3 cases of bleeding of laceration,1 case of carotid cavernous fistula and 1 case of pseudoaneurysme.Salvage sphenoid sinus packing with vaseline strip and subsequent intravascular stent graft implantation (2 cases) and endovascular embolization (2 cases) effectively controlled bleeding.Four cases were successfully treated without craniocerebral or ocular complications,only 1 case died of massive blood loss.Among 4 survival cases,1 patient abandoned further therapy,the other 3 patients were curcd of primary disease by reoperation or subsequent treatment.Conclusion Preoperatively,reading carefully the imaging data,intraoperatively,identifying anatomical positions accurately,performing proper operation,and stopping bleeding decidedly, postoperatively, seeking interdisciplinary cooperation to repair vascular damages,all these procedures can effectively reduce the surgical risk of ICA injury.