BACKGROUND: Enhanced recovery after surgery (ERAS) protocols are a series of perioperative care to optimize preoperative preparation, prevent postoperative complications, minimize stress, and speed up recovery. This study aimed to assess the impact of ERAS protocols for functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). METHODS: One hundred and two patients with CRSwNP undergoing FESS were randomly divided into the ERAS group and the control group. The outcomes of the Self-Rating Anxiety Scale (SAS), Visual Analogue Scale (VAS), Medical Outcomes Study Sleep Scale (MOS-SS) and Kolcaba Comfort Scale Questionnaire (GCQ) were determined in both groups. The serum levels of C-reactive protein (CRP) were compared preoperatively and 24 hours postoperatively. RESULTS: The ERAS group had a significantly better SAS scores than did the control group (28 [24, 35] vs. 43 [42, 47], Z = 5.968, P < 0.001). The rhinalgia and headache scores at 2, 24 and 48 hours postoperatively were lower in the ERAS group than that in the control group (all P < 0.001). The outcomes of the MOS-SS (43 [42, 39] vs. 28 [22, 35], Z = 7.071, P < 0.001) and GCQ (76 [68, 87] vs. 64 [50, 75], Z = 4.806, P < 0.001) were significantly different between the two groups. No significant difference was found in the preoperative CRP levels between the two groups (1.3 [0.6, 2.8] vs. 0.5 [0.5, 1.2], Z = 3.049, P > 0.05); However, the CRP level in 24 hours postoperatively was significantly lower in the ERAS group than that in the control group (2.5 [1.4, 3.9] vs. 6.6 [3.8, 9.0], Z = 5.027, P < 0.001). The incidence rates of complications, such as nausea/emesis (χ = 0.343, P > 0.05), hemorrhage, aspiration and tumble, were not increased in the ERAS group compared with those in the control group. The ERAS group had a significantly shorter length of hospital stay (5 [4, 5] days vs. 8 [8,9] days, Z = 8.939, P < 0.001) and hospitalization expenses ($ 2670 [2375, 2740] vs. $3129 [3116, 3456], Z = 8.514, P < 0.001). CONCLUSIONS: ERAS protocols might optimize FESS for patients with CRSwNP by reducing psychological and physical stress, shortening the length of hospital stay and lowering hospitalization expenses without increasing postoperative complications. TRIAL REGISTRATION Chinese Clinical Trial Registry, No. ChiCTR1800015791; http://www.chictr.org.cn/showproj.aspx?proj=26872.
Adolescent ; Adult ; C-Reactive Protein ; metabolism ; Chronic Disease ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Nasal Polyps ; metabolism ; surgery ; Perioperative Care ; Postoperative Complications ; Postoperative Period ; Sinusitis ; metabolism ; surgery ; Surveys and Questionnaires ; Transanal Endoscopic Surgery ; methods ; Young Adult

In the present study, we investigated anti-inflammatory effect of Cardamine komarovii flower (CKF) on lipopolysaccharide (LPS)-induced acute lung injury (ALI). We determined the effect of CKF methanolic extracts on LPS-induced pro-inflammatory mediators NO and prostaglandin E2 (PGE2), production of pro-inflammatory cytokines (IL-1β, TNF-α, and IL-6), and related protein expression levels of MyD88/TRIF signaling pathways in peritoneal macrophages (PMs). Nuclear translocation of NF-κB-p65 was analyzed by immunofluorescence. For the in vivo experiments, an ALI model was established to detect the number of inflammatory cells and inflammatory factors (IL-1β, TNF-α, and IL-6) in bronchoalveolar lavage fluid (BALF) of mice. The pathological damage in lung tissues was evaluated through H&E staining. Our results showed that CKF can decrease the production of inflammatory mediators, such as NO and PGE2, by inhibiting their synthesis-related enzymes iNOS and COX-2 in LPS-induced PMs. In addition, CKF can downregulate the mRNA levels of IL-1β, TNF-α, and IL-6 to inhibit the production of inflammatory factors. Mechanism studies indicated that CKF possesses a fine anti-inflammatory effect by regulating MyD88/TRIF dependent signaling pathways. Immunocytochemistry staining showed that the CKF extract attenuates the LPS-induced translocation of NF-kB p65 subunit in the nucleus from the cytoplasm. In vivo experiments revealed that the number of inflammatory cells and IL-1β in BALF of mice decrease after CKF treatment. Histopathological observation of lung tissues showed that CKF can remarkably improve alveolar clearance and infiltration of interstitial and alveolar cells after LPS stimulation. In conclusion, our results suggest that CKF inhibits LPS-induced inflammatory response by inhibiting the MyD88/TRIF signaling pathways, thereby protecting mice from LPS-induced ALI.
Acute Lung Injury ; chemically induced ; drug therapy ; genetics ; metabolism ; Adaptor Proteins, Vesicular Transport ; genetics ; metabolism ; Animals ; Anti-Inflammatory Agents ; administration & dosage ; chemistry ; Cardamine ; chemistry ; Cyclooxygenase 2 ; genetics ; metabolism ; Female ; Flowers ; chemistry ; Humans ; Lipopolysaccharides ; adverse effects ; Male ; Mice ; Myeloid Differentiation Factor 88 ; genetics ; metabolism ; NF-kappa B ; genetics ; metabolism ; Nitric Oxide Synthase Type II ; genetics ; metabolism ; Plant Extracts ; administration & dosage ; chemistry ; Signal Transduction ; drug effects ; Tumor Necrosis Factor-alpha ; genetics ; metabolism

Objective To study the clinic significance of allergen serum immunoglobulin E (IgE) detection for the flying personnel with allergic rhinitis.Methods One hundred and twentyeight flying personnel with clinically suspected allergic rhinitis were drawn 2 ml venous blood.Serum tIgE (total IgE) and 14 allergen sIgE (specific IgE) including 7 aspiration allergens and 7 food allergens were detected with antibody kit.Strong positive reaction rates of the flying personnel with aspiration allergens and food allergens were compared as well as the correlation of serum tIgE and positive reaction rate of allergen sIgE was analyzed.Results Positive reaction rate of tIgE in 128 flying personnel with allergic rhinitis was 85.9 ％ (110/128) and positive reaction rate of sIgE was 91.4％ (117/128).The top 3 positive reaction rates of aspiration allergens were dust mite (66.4％),tree combination (32.8％) and house dust (23.4％).The top 3 positive reaction rates of food allergens were fruit combination (mango/pineapple/apple/peach/strawberry) (18.0％),seafood combination (shrimp/crab/scallop) (16.4％) and fish combination (ling/trout/weever) (13.3％).Positive response rate of the flying personnel with both aspiration and food allergens was 12.5 ％ (16/128).The aspiration allergens mainly reflected as strong positive reaction while the food allergens mainly expressed as weakly positive reaction.The strong positive reaction showed significance between aspiration and food allergens.(x2=16.881,P＜0.05).The strong positive reaction of allergen serum had the positive correlation to tIgE value (r=0.517,P＜0.01).Conclusions The allergen serum IgE detection have shown its objective,accurate and noninvasive advantages and are with less age,disease,medication,manipulation and other external limitations.The test results can be quantitatively or semi-quantitatively expressed and can determine tIgE level within the detection.So it has certain clinical significance on diagnosis,treatment,evaluation and prevention for the flying personnel with allergic rhinitis.

Objective To study the clinic significance of allergen serum immunoglobulin E (IgE) detection for the flying personnel with allergic rhinitis.Methods One hundred and twentyeight flying personnel with clinically suspected allergic rhinitis were drawn 2 ml venous blood.Serum tIgE (total IgE) and 14 allergen sIgE (specific IgE) including 7 aspiration allergens and 7 food allergens were detected with antibody kit.Strong positive reaction rates of the flying personnel with aspiration allergens and food allergens were compared as well as the correlation of serum tIgE and positive reaction rate of allergen sIgE was analyzed.Results Positive reaction rate of tIgE in 128 flying personnel with allergic rhinitis was 85.9 ％ (110/128) and positive reaction rate of sIgE was 91.4％ (117/128).The top 3 positive reaction rates of aspiration allergens were dust mite (66.4％),tree combination (32.8％) and house dust (23.4％).The top 3 positive reaction rates of food allergens were fruit combination (mango/pineapple/apple/peach/strawberry) (18.0％),seafood combination (shrimp/crab/scallop) (16.4％) and fish combination (ling/trout/weever) (13.3％).Positive response rate of the flying personnel with both aspiration and food allergens was 12.5 ％ (16/128).The aspiration allergens mainly reflected as strong positive reaction while the food allergens mainly expressed as weakly positive reaction.The strong positive reaction showed significance between aspiration and food allergens.(x2=16.881,P＜0.05).The strong positive reaction of allergen serum had the positive correlation to tIgE value (r=0.517,P＜0.01).Conclusions The allergen serum IgE detection have shown its objective,accurate and noninvasive advantages and are with less age,disease,medication,manipulation and other external limitations.The test results can be quantitatively or semi-quantitatively expressed and can determine tIgE level within the detection.So it has certain clinical significance on diagnosis,treatment,evaluation and prevention for the flying personnel with allergic rhinitis.