Objective To explore the relationship between the bacterial biofilm, allergy,inflammatory cytokines and refractory rhinosinusitis. Method According to the assessment of symptom by visual analogue scale and nasal endoscopy by Lund-Kennedy system, 19 patients with persistent chronic rhinosinusitis and 6 patients with curative chronic rhinosinusitis were recruited from 340 chronic rhinosinusitis patients underwent functional endoscopic sinus surgery for the first time and received standard medication postoperatively. These cases were divided into the study group and the control group respectively.Electron microscope scanning and enzyme linked immunosorbent assay were used to observe the bacterial biofilm formation on ethmoid sinus mucosal surface and detect the concentration of specific IgE and interleukin (IL) 4, IL-5, IL-6, and IL-8 in ethmoid sinus mucosal tissue. Then the differences between the group were all found biofilm formation in ethmoid sinus, besides the damage of epithelial cells and cilia. Six cases from the control group were found no biofilm, with the integrity of epithelial cells and cilia. Statistical Specific IgE: specific IgE was detected in nine cases from the study group and was not found in any case all detected under normal value both in the study group and the control group, except for only 2 cases from the study group with higher IL-8 concentration. Positive reaction to IL was detected as follows: IL-4 (7cases), IL-5 (14 cases), IL-6 (15 cases), and IL-8 (12 cases) in the study group; IL-4 (1 case), IL-5 (5 cases), IL-6 (5 cases), and IL-8 (5 cases) in control group. No difference in IL detection rate was found between the two groups (P > 0.05). Conclusion Bacterial biofilm and allergic inflammation are important factors resulting into refractory chronic rhinosinusitis.

t. Conclusion The study shows that nasal glucocorticoid improved the nasal obstruction, nasal resistance, nasal mucous membrane and quality of life in patients with PNAR.

OBJECTIVETo explore the health-related quality of life (QOL) status of patients with chronic rhinosinusitis and nasal polyps.

METHODSOne hundred and twenty patients with chronic rhinosinusitis and nasal polyps and two hundred individuals passing health examination were enrolled by random and their QOL scores were assessed by using QOL instruments including existing SF-36 questionnaire (Chinese version ) and SNOT-20 questionnaire translated into Chinese, of which clinimetric and psychometric properties were tested.

RESULTSThe feasibility, reliability, validity, and responsibility of Chinese version of SNOT-20 questionnaire all passed the test. By the assessment of SF-36 questionnaire, it revealed that scores of six domains such as physical functioning, role physical, bodily pain, mental health, vitality, and general health from patients with chronic rhinosinusitis and nasal polyps were lower than that of control group except social functioning and role emotional (P < 0.05). It showed by Chinese version of SNOT-20 questionnaire that patients exceeded healthy individuals in the scores of twenty items of three domains including physical problems, functional limitations, and emotional consequences, of which the most five important items affecting health status were respectively need to blow nose, thick nasal discharge, lack of a good night's sleep, dizziness, and post-nasal discharge (P < 0.05).

CONCLUSIONSQOL instruments such as Chinese version of SF-36 and SNOT-20 questionnaires can effectively differentiate the QOL status between patients with chronic rhinosinusitis and nasal polyps and healthy individuals. The negative impact of chronic rhinosinusitis and nasal polyps on patients' QOL includes physical functioning, role physical, bodily pain, mental health, vitality, general health, and emotional consequences. The problems of nasal discharge, sleep, and dizziness should be sufficiently emphasized in clinical treatment.

Adolescent ; Adult ; Aged ; Asian Continental Ancestry Group ; China ; epidemiology ; Chronic Disease ; Female ; Humans ; Male ; Middle Aged ; Nasal Polyps ; epidemiology ; ethnology ; Quality of Life ; Sinusitis ; epidemiology ; ethnology ; Surveys and Questionnaires

To investigate the inhibitory effect of Pluronic on P-glycoprotein (P-gp) drug efflux pump, Caco-2 cells and animal models were established to study the influence of Pluronic on celiprolol transport across Caco-2 cell monolayer and intestinal mucous membrane with verapamil set as a positive control. Drug concentration was measured by HPLC and the apparent permeability coefficient (P(app)), absorption rate constant (k(a)) and the effective permeability coefficient (P(eff)) were calculated. P(app) of basolateral to apical side and apical to basolateral side was (2.10 +/- 0.13) x 10(-6) and (0.333 +/- 0.018) x 10(-6) cm x s(-1), respectively. Transports of celiprolol across Caco-2 cell monolayer were influenced by both verapamil and Pluronic. The absorption constants (k(a)) of celiprolol at duodenum, jejunum, ileum, and colon were (0.09 +/- 0.03), (0.14 +/- 0.04), (0.11 +/- 0.03) and (0.05 +/- 0.02) h(-1), k(a) of celiprolol in verapamil group were (0.14 +/- 0.03), (0.24 +/- 0.02), (0.25 +/- 0.03) and (0.23 +/- 0.02) h(-1), and k(a) of celiprolol in Pluronic group were (0.13 +/- 0.02), (0.22 +/- 0.02), (0.22 +/- 0.03) and (0.20 +/- 0.03) h(-1), respectively. Pluronic showed significant effect on inhibiting P-gp of Caco-2 cell and intestinal mucosa in rats.
ATP-Binding Cassette, Sub-Family B, Member 1 ; metabolism ; Animals ; Biological Transport ; drug effects ; Caco-2 Cells ; Celiprolol ; pharmacokinetics ; Excipients ; Humans ; Intestinal Absorption ; drug effects ; Intestinal Mucosa ; metabolism ; Jejunum ; metabolism ; Male ; Permeability ; Poloxamer ; administration & dosage ; pharmacology ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo explore the characteristics of bacteria isolated from patients with chronic sinusitis (CR) and antibiotic-resistance.

METHODSThe purulent discharges taken from the maxillary sinus and posterior ethmoid sinus of 76 patients during endoscopic sinus surgery were cultured for both bacteria and fungi, then the antimicrobial susceptibility test and beta-lactamase-producing bacteria (beta-LPB) were detected. In the control group, the discharges from the nasal cavity from 10 healthy adults were also cultured for bacteria.

RESULTSTwenty species, including Staphylococcus epidermidis, Escherichia coli, Staphylococcus aureus, alpha-Hemolytic streptococcus and Streptococcus pneumoniae, were cultured from the testing group. The total positive rate of bacteria was 81.8%. The detectable rates of aerobe, anaerobe, gram-positive bacteria and gram-negative bacteria were 83.4%, 16.6%, 56.3% and 43.7%, respectively. The fungi was only detected in 1.4% patients. The antimicrobial susceptibility test demonstrated that Imipenem, Cefotaxime and Amoxicillin-clavulanate were good in vitro activity to aerobic pathogens and Metronidazole, Imipenem and Chloramphenicol was good to anaerobic pathogens. The beta-LPB was detected in 37.7% strains in which Staphylococcus epidermidis, Staphylococcus aureus, alpha-Hemolytic streptococcus and Branhamella catarrhalis were more frequent. Five species including Staphylococcus epidermidis and Escherichia coli etc were cultured from the control group. There was no significant difference of distribution of the same bacteria between the control group and the testing group (P > 0.05).

CONCLUSIONSThe pathogenic bacteria of CR mostly involve aerobes. The antibiotics-resistance of these pathogen is serious. The bacterial infection plays no leading role in CR, so the need of antibiotics should not be excessively emphasized. Before treatment by antibiotics, the antimicrobial susceptibility test should be performed. The broad-spectrum antibiotics containing beta-lactamase inhibitor such as Cefotaxime and Amoxicillin-clavulanate is recommended in condition that the test can not be finished.

Adolescent ; Adult ; Bacteria ; isolation & purification ; Bacterial Infections ; microbiology ; Chronic Disease ; Female ; Humans ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Sinusitis ; microbiology ; Young Adult

Objective The purpose of this study was to investigate the proper site for enlarging maxillary natural ostium during ESS,and to compare the draining mode of mucociliary trasportation system.Methods Three groups were designed to observe the differences of tracer agent transported from maxillary sinus to nasal cavity.Normal control group:30 cases;Trial group A:30 cases,the maxillary natural ostium were radically enlarged by all sides:Trial group B:30 cases,the maxillary natural ostiums were enlarged by reservation of whole inferior edge and cut away anterior and/or posterior edge.The patients in two trial groups were after nasal endoscopic sinus surgery for more than 12 monthes and the maxillary ostiums were well open.Results Tracer agent was drained from maxillary sinus to nasal cavity by inferior edge(s) of natural ostium in control group.The core area was posterior part of inferior edge.In trial group A,tracer agent was drained out by inferior edge in 4 cases (13.3%),tracer agent drained out by posterior and/or superior edge(s) and then dispersed to ethmoid sinus in 17 cases (56.7%),tracer agent stacked and/or circularlly flowed in the maxillary sinus,and could not be transported out in 9 cases (30.0%).In trial group B,tracer agent drained out by inferior edge to middle meatal in all subjects (30/30,100%),and there was no redirection of the mucociliary transportation.Conclusions The inferior edge of natural ostium is the main passage of mucociliary transportation system of maxillary sinus.If the inferior edge of maxillary natural ostium reserved,the post-operative drainage of maxillary sinus would be the same as normal ones. Radical removal of all edges of maxillary natural ostium could lead to redirection of mucociliary transportation,only few cases could drain out by inferior edge,most cases drained out by posterior and/or superior edge and then dispersed to ethmoid sinus.In some cases,tracer agent often stacked in the maxillary sinus and could not be drained out.When there was a need to enlarge the maxillary natural ostium in ESS, it should be done in the anterior and/or posterior edge of natural ostium,the inferior edge should not be damaged so as not to interfere the passage of mucociliary trasportaion system of the maxillary sinus.

Objective To observe the safety and efficacy ofintra-arterial thrombolysis guided by CT perfusion in patients with anterior circulation ischemic stroke presenting with symptoms longer than 6 h.Methods The clinical data of patients with anterior circulation ischemic stroke presenting with symptoms longer than 6 h (n=36) and shorter than or equal to 6 h (n=30),performed intra-arterial thrombolysis in our hospitals from July 2003 to December 2012,were retrospectively evaluated.Patients of the former group were evaluated the ischemic penumbra and core region of infarction and the mismatch between the two regions based on CT perfusion.The clinical features,clinical outcomes and complications were compared between the two groups.Results As compared with those in patients of symptoms shorter than or equal to 6 h,the early neurological improvement rate (13.3％ vs.22.2％) and long-term neurological improvement rate (86.7％ vs.77.7％),recanalization rate (80.0％ vs.88.9％) and 3-month mortality (6.7％ vs.16.7％) of patients of symptoms longer than were not significantly different (P=0.665,P=0.665,P=0.639 and P=0.607).Conclusions To patients with anterior circulation ischemic stroke presenting with symptoms longer than 6 h,the neurological function at 3-month significantly improves after intra-arterial thrombolysis guided by CT perfusion.Although the incidence of symptomatic intracranial hemorrhage increases,the mortality rate does not significantly increase.

Objective To examine the clinical effect of low-dose (250 mg/d), long-term ( 12 -28 weeks) macrolide Klacid on the persistent refractory inflammation of paranasal sinus mucosa following endoscopic sinus surgery (ESS). Methods Thirteen patients from a consecutive series of 141 patients undergoing ESS for chronic rhinosinusitis ( CRS ) during 2004 - 2006 for the first time were recruited for persistent refractory inflammation over 2 years postoperatively. All patients were given Klacid 250 mg/d orally for 12 - 28 weeks and simultaneously maintained the usual treatment including intranasal corticosteroid, mucolytics, and nasal douche. At the end of treatment and the sequential 3 and 6 months,13 patients were evaluated by symptoms of visual analogue scale and nasal endoscopy by Lund-Kennedy scoring system, respectively. Results Among the 13 patients, 1 patient stopped therapy for no obvious benefit 5 months after treatment, 12 patients finished the planned treatment till achieving.the stopping therapy standard. Ultimately both symptom (8. O0 [ 7.50, 8.50]and 1.00 [ 0.25, 1. 00], Z = - 3.201, P ＜0.01) and endoscopic evaluation (7.00[6.50, 8.00]and 1.00[0.00, 1.00], Z= -3. 194, P＜O. 01 ) showed total remarkable improvement after therapy in 13 patients. The comprehensive assessment showed very good outcomes in 6 cases, good in 6 cases, and no good outcomes in 1 case, respectively.During the sequential 3 months and 6 months, no recurrent sinusitis and side effect happened in any patients. Conclusions It is effective to treat chronic refractory sinusitis with a low-dose (250 mg/d), long-term ( 12 -28 weeks) Klacid on nasal mucosal persistent refractory inflammation after ESS. Klacid is well tolerated and safe to CRS patients during the use of 12 -28 weeks.

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.

Objectives To explore the time regularity of nasal mucous transitionary course of different sinuses after functional endoscopic sinus surgery.Methods Seventy-seven chronic rhinosinusitis patients following functional endoscopic sinus surgery were prospectively collected. The endoscopic appearances of different sinuses were respectively evaluated with Lund-Kennedy scoring system in 2 weeks,1,2,3,6,9 months,and 12 months postoperatively. Then the endoscopic scores and epithelization proportions of different sinuses in different stages were analyzed and compared.Results Of 77 patients,154 maxillary sinuses,154 ethmoidal sinuses,138 frontal sinuses,and 129 sphenoidal sinuses were scored endoscopically and analyzed statistically.In the 2 weeks after operation,the mucosa scores of sphenoidal sinus (3.5 ± 1.5 ),ethmoidal sinus(3.6 ± 1.4),maxillary sinus(3.7 ± 1.5 ),and frontal sinus (3.8 ±1.5 ) showed no significant differences by nonparameter tests ( x2 =1.674,P =0.643 ).In the 2,3,6,and 9 months postoperatively,the assessment of four kinds of sinuses showed separate transitionary tendency and the descending deflection points of scores and ascending peaks of epithelization proportions gradually emerged.In the 12 months postoperatively,by the above statistical methods,the mucosal scores (Z =-3.417,P =0.001 ) and epithelization proportions ( x2 =4.313,P =0.038 ) of sphenoidal sinus were superior to that of ethmoidal sinus,the mucosal scores ( Z =-2.218,P =0.027 ) and epithelization proportions (x2 =4.292,P =0.038 ) of ethmoidal sinus were superior to that of maxillary sinus,and the mucosal scores (Z =-2.244,P =0.025) and epithelization proportions (x2 =4.100,P =0.043) of maxillary sinus were superior to that of frontal sinus.Conclusions The transitionary course of different sinus mucosa after functional endoscopic sinus surgery shows significant time difference.The time sequencing to complete epithelization of sinuses is successively sphenoidal sinus,ethmoidal sinus,maxillary sinus,and frontal sinus.