CX3CR1 receptor as a potential therapeutic target in chronic rhinosinusitis and allergic rhinitis

Chronic rhinosinusitis and allergic rhinitis are chronic inflammatory diseases that affect the mucous membrane of the nose and paranasal sinuses. These diseases are characterized by recruitment of inflammatory cells to the upper airway. For this to take place a complex interaction between inflammatory cells and the cytokines/chemokines(ligand) liberated at the site of inflammation is involved in a process termed chemotaxis or directed cell migration against concentration gradient of the ligand. This entails signal transduction through the cell surface receptor resulting in cellular functional response and directed migration. In this editorial the novel role of CX3CR1 receptor in the immunopathology of chronic inflammation of the nose and paranasal sinuses will be explored with its potential role as therapeutic target in chronic nasal inflammation.

Effect of nursing intervention on rehabilitation of patients with chronic sinusitis and nasal polyps after nasal endoscopy

BACKGROUND Chronic sinusitis is a kind of chronic suppurative inflammation of the sinus mucosa.Nasal endoscopy is a good method to treat nasal polyps.However postoperative rehabilitation and care should not be neglected.AIM To investigate the Effect of nursing intervention on the rehabilitation of patients with chronic sinusitis and nasal polyps(CSNPS)after nasal endoscopy.METHODS A total of 129 patients with CSNPS hospitalized from February 2017 to February 2019 were studied.Using the digital parity method,we investigated nursing cooperation strategies for endoscopic surgery.The comparison group(64 cases):Surgical nursing was carried out with traditional nursing measures;experimental group(65 cases):Surgical nursing was carried out by traditional nursing countermeasures+comprehensive nursing measures.We compared postoperative recovery rates,nursing satisfaction rates,and nasal cavity ratings between the two groups.RESULTS Experimental group patients with CSNPS had a significantly higher recovery rate(98.46%)compared to the control group(79.69%).This difference was statistically significant(χ2=11.748,P<0.05).Additionally,the satisfaction rate with treatment was also significantly higher in the experimental group(98.46%)compared to the control group(79.69%),with a statistically significant difference(χ2=11.748,P<0.05).Before nursing,there was no significant difference in sinus nasal cavity scores between the experimental group(20.29±7.25 points)and the control group(20.30±7.27 points)(t=0.008,P>0.05).However,after nursing,the sinus nasal cavity score in the experimental group(8.85±3.22 points)was significantly lower than that in the control group(14.99±5.02 points)(t=8.282,P<0.05).CONCLUSION Comprehensive nursing intervention in patients with CSNPS can significantly improve the total recovery rate after endoscopic surgery.

Systematic Evaluation of Biyuan Tongqiao Granule in the Treatment of Chronic Sinusitis in Children Based on Meta-analysis

[Objectives]To make an evaluation of the efficacy and safety of Biyuan Tongqiao Granule in the treatment of chronic sinusitis in children,and provide evidence-based medical reference for clinical use.[Methods]Databases such as Chinese Biomedical Literature Service System(SinoMed),China Knowledge Infrastructure(CNKI),Wanfang Digital Journal Full-text Database(WF),VIP Database(VIP),EmBase,PubMed,Science Direct,and Cochrane Library were used to collect the clinical randomized controlled trials of Biyuan Tongqiao Granule in children with chronic sinusitis published since the creation of databases.The quality of the included literature was evaluated and the data were extracted.The data was analyzed using Review Manager 5.3 software for meta-analysis,and descriptive analysis was performed for studies that could not be combined.The GRADE method was applied to evaluate the quality of evidence.[Results]A total of 12 studies were included,including 1645 cases of patients.The analysis results show that compared with the control group,Biyuan Tongqiao Granule has an excellent curative effect on children with chronic sinusitis and has a lower incidence of adverse reactions.The GRADE evidence level indicated that the sinus CT scan lesion score was intermediate evidence,and the visual analog score,endoscopic mucosal morphology score,and total effective rate were low-level evidence.[Conclusions]Biyuan Tongqiao Granule has a significant effect in treating chronic sinusitis in children and does not increase the incidence of adverse reactions,but its efficacy and safety need support of more high-quality studies.

Relationship between chronic rhinosinusitis and lower airway diseases: An extensive review

Signifcant links between allergic rhinitis and asthma have been reported, and the united airway disease hypothesis is supported by numerous findings in epidemiologic, physiologic, pathologic, and immunologic studies. The impact of allergic rhinitis on asthma has been esta-blished. On the other hand, the relationship between chronic rhinosinusitis and lung diseases has been under investigation. Chronic rhinosinusitis is a common disease, and the high prevalence of chronic rhinosinusitis in some kinds of lung diseases has been reported. Recent studies suggest that the treatment of chronic rhinosinusitis has beneficial effects in the management of asthma. Here, we present an overview of the current research on the relationship between chronic rhinosinusitis and lower airway diseases including asthma, chronic obstructive pul-monary disease, cystic fibrosis, diffuse panbronchiolitis, primary ciliary dyskinesia, idiopathic bronchiectasis, and allergic bronchopulmonary aspergillosis.

Association of Comorbid Asthma and the Efficacy of Bioabsorbable Steroid-eluting Sinus Stents Implanted After Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis with Nasal Polyps

Objective To identify factors affecting the efficacy of steroid-eluting sinus stents implanted after endoscopic sinus surgery(ESS)in patients with chronic rhinosinusitis with nasal polyps(CRSwNP).Methods We performed a post-hoc analysis of a randomized self-controlled clinical trial on post-operative implantation of bioabsorbable steroid-eluting stents in patients with CRSwNP.Univariate logistic regression analysis was conducted to identify which of the following factors affect the response to post-operative stent implantation:sex,serum eosinophil levels,history of prior surgery,endoscopic scores,and comorbid conditions(asthma and allergic rhinitis).The primary outcome was the rate of post-operative intervention on day 30,and the secondary outcome was the rate of polypoid tissue formation(grades 2–3)on days 14,30,and 90.Results A total of 151 patients with CRSwNP were included in the post-hoc analysis.Asthma was identified as the only risk factor for a poor response to steroid-eluting sinus stents on post-operative day 30,with an odds ratio of 23.71(95%CI,2.81,200.16;P=0.004)for the need for post-operative intervention and 19(95%CI,2.20,164.16;P=0.003)for moderate-to-severe polypoid tissue formation.In addition,the asthmatic group showed higher rates of post-operative intervention and polypoid tissue formation than the non-asthmatic group on post-operative day 30.Blood eosinophil levels were not identified as a risk factor for poor outcomes after stent implantation.Conclusion Comorbid asthma,but not blood eosinophil level,impairs the efficacy of steroid-eluting sinus stents in the short term after ESS in patients with CRSwNP.

Socioeconomic Status Impacts the Prognosis of Chronic Rhinosinusitis Treated by Endoscopic Sinus Surgery:An Observational Cohort Study in Northeast China

Objective To explore the association between socioeconomic status(SES)and postoperative outcomes in patients with chronic sinusitis(CRS)after functional endoscopic sinus surgery(ESS).Methods We conducted an observational cohort study of 1,047 patients with CRS undergoing ESS.Discharged patients were followed up to 72 weeks for all-cause recurrence events.Baseline SES was established based on occupation,education level,and family income of the patients 1 year before the operation.Kaplan–Meier method was used to calculate the recovery rate after ESS,and Cox proportional hazards regression analysis was used to evaluate the relationship between SES and prognosis.Results Patients of middle SES had lower unadjusted all-cause recurrence than those of low or high SES;24-week overall recovery rate was 90.4%[95%confidence interval(CI):89.6%–91.2%]in patients of middle SES,13.5%(95%CI:12.8%–14.2%)in patients of low SES,and 31.7%(95%CI:30.7%–32.7%)in patients of high SES(both log-rank P<0.001).After adjustment for covariates,hazard ratios(HRs)were7.69(95%CI:6.17–9.71,Ptrend<0.001)for all-cause recurrence for low SES versus middle SES,and 6.19(95%CI:4.78–7.93,Ptrend<0.001)for middle SES versus high SES.Conclusion Low SES and high SES were more associated with the worse prognosis of CRS patients after ESS than middle SES.

Correlation between Radiological Staging of Chronic Rhinosinusitis and Revision of Endoscopic Sinus Surgery

Introduction: Chronic rhinosinusitis (CRS) is an inflammatory condition affecting the sinonasal mucosa with duration of more than 12 weeks. Multifactorial aetiology contributes to its refractoriness. Functional endoscopic sinus surgery (FESS) is the most common surgical technique preferred in CRS not responding to medical management, showing high success rates. However, some failure has been noted, requiring revision FESS. CT (Computed Tomography) is a diagnostic tool for CRS, and aids in improving surgical outcomes. Combined with the Lund-Mackay scoring system, CT can help stage the CRS, predicting the need for revision surgery. Methods: In our paper, we aimed to study the relationship between severity of CRS using radiological staging and revision of functional endoscopic sinus surgery, assessing outcome after at least 1 year of follow-up. There was a single centre retrospective study involving 150 patients selected by random sampling, to study the correlation between the severity of chronic rhinosinusitis and revision of functional endoscopic sinus surgery (FESS). The study was conducted in the ENT department of King Hamad University Hospital, Bahrain for a time period of 6 months. Records were scanned and scored using Lund-Mackay system. Lund Mackay score of 10 and above was considered severe. The relation between increased severity with Lund Mackay score on the CT scan and the need for revision sinus surgeries was then determined. Results and Conclusion: This study concludes that LMS score in CT scans can be used to predict the outcomes of primary FESS procedure and the need for revision surgery in the management of CRS.

Evaluation of the Effectiveness and Safety of One-Time Endodontics in the Treatment of Chronic Apical Periodontitis with Sinus Tract in Pediatric Deciduous Teeth

Objective:To observe the effectiveness and safety of one-time endodontics in the treatment of chronic apical periodontitis with sinus tract in pediatric deciduous teeth.Methods:109 cases of children with chronic apical periodontitis with sinus tract in the deciduous teeth treated in our hospital from January 2022 to December 2023 were selected and grouped by the randomized numerical table method,with 54 cases in the experimental group and 55 cases in the control group.The experimental group was treated with one-time endodontics and the control group was treated with conventional endodontics.Results:After the treatment,the total effective rate of treatment was higher in the experimental group than in the control group(P<0.05);the incidence of adverse events was lower in the experimental group than in the control group(P<0.05);the satisfaction of the children's family members was higher in the experimental group than in the control group(P<0.05);the pain duration was lower in the experimental group than in the control group(P<0.05).Conclusion:In the experimental group,children with chronic apical periodontitis with sinus tract of the deciduous teeth were given one-time endodontic treatment,and the results of its implementation were relatively good.

ACUPUNCTURE TREATMENT OF CHRONIC RHINITIS IN 75 CASES

For the past 2 years,the authors haveadopted acupuncture in the treatment of 75cases of chronic rhinitis with satisfactorytherapeutic results as summarized in the fol-lowing.Clinical DataThe series of 75 patients comprised 56males and 19 females;the age range was6-10 years in 3 cases,11-20 years in 17cases,21-30 years in 30 cases,31-40

Increased oxidative stress and altered antioxidants status in patients with chronic allergic rhinitis

Background: Allergic rhinitis is an inflammatory disorder of the upper airways. Although several oxidants and antioxidants are likely to be involved, alterations in only limited parameters have been studied. Objective: In this study an attempt has been made to study the oxidant-antioxidant imbalance by investigating changes in a wide range of oxidants and antioxidants in the blood. Methods: Blood samples were obtained from 39 chronic allergic rhinitis patients (males 24, females 15), aged 20-70 (mean age 36.33 ± 2.03) years and 53 individuals (36 males, 17 females);aged 24 to 64 (mean age 45.42 ± 1.36) years. Duration of allergic rhinitis was 1.77 ± 0.237 years. In the study group, nasal symptoms were scored and the results were recorded. The patients were classified as having perennial Allergic rhinitis (PAR) if they had had at least 2 rhinitis symptoms (sneezing, rhinorrhea, nasal obstruction, itching) for at least 6 months a year in the previous 2 years and if they had a positive skin prick test response to at least 1 clinically significant perennial allergen (e.g., house dust mites, molds, cockroach, cockroach excrement grass and tree pollen, cat and dog epithelia and molds, or animal dander). They had no other allergic diseases except persistent allergic rhinitis diagnosed by the physical and history examination. Erythrocyte lipid peroxidation, erythrocyte antioxidants viz., glutathione, glutathione reductase, superoxide dismutase, catalase and plasma antioxidants viz., ceruloplasmin, glutathione-S-transferase, vitamin C, total antioxidant activity were estimated in the above two groups. Results: Erythrocyte lipid peroxidation (0 hour, p < 0.01) and superoxide dismutase (p < 0.01) were significantly higher, whereas plasma vitamin C (p < 0.001), ceruloplasmin (p < 0.05) and total antioxidant activity (p < 0.001) were significantly lower in chronic allergic rhinitis patients when compared to controls. Plasma Glutathione S transferase and erythrocyte catalase, glutathione, and glutathione reductase remained unchanged from normal subjects. Conclusion: The changes in different parameters indicate an imbalance in the oxidant and antioxidant status in chronic allergic rhinitis patients. Further studies are required to investigate the potential for antioxidant supplements to be used as routine therapy in chronic allergic rhinitis patients. Capsule summery: The study shows that the body is trying to cope for the oxidative stress by altering the enzyme levels. But external supplement may also be required as the total antioxidant levels are very much depleted.

Efficacy of Hypertonic Saline and Normal Saline in the Treatment of Chronic Sinusitis

Introduction: Chronic sinusitis affects all age groups and is a cause for significant morbidity. Recent realization that noninfectious inflammatory causes can predispose to infectious sinusitis has evoked renewed interest in developing and documenting efficacious ancillary therapies that could supplement antibiotic use. Hypertonic saline solution has been shown to increase mucociliary clearance and ciliary beat frequency. Objectives: A double blinded randomized comparative study was undertaken to evaluate the effect of hypertonic saline (3.5%) nasal drops and normal saline (0.9%) nasal drops, to assess the tolerance of hypertonic saline nasal drops and to know if hypertonic nasal drops improve the “quality of life” in patients with chronic sinusitis. Methods: Fifty patients diagnosed as chronic sinusitis in the age group of 18-45 years were randomized into two groups;Group A was treated with normal saline and Group B with 3.5% hypertonic saline for a period of 4 weeks. Pre and Post treatment x-rays of the paranasal sinuses (Water’s view) were graded and radiological scores were given accordingly. The symptoms were evaluated before and after treatment using visual analogue score. Patients were queried about tolerance to the nasal solution and scores were given. Conclusion: Hypertonic saline nasal solution is more efficacious than normal saline solution in the treatment of patients with chronic sinusitis. Hypertonic saline nasal solution was well tolerated and it improved quality of life in these patients.

Chronic Sinusitis with Frontal Mucocele: A Case Report

Purpose: To describe a type IIIa frontal mucocele in a case of diffuse nasal polyposis. To discuss the clinical presentation, diagnostic and treatment modalities. Study Design: A case report including radiological, histopathological analysis and review of literature. Methods: A case report from a tertiary care centre. Histopathologic and radiological details are reviewed. Results: This case report presents a 59-year-old male who came to us with fronal headaches and nose blocks of 6 months’ duration. Clinical examination revealed bilateral nasal polyposis. Plain CT scan of paranasal sinuses revealed a circumscribed lesion with erosion of inner table of left frontal sinus amidst pan sinus haziness. We addressed the condition by combined FESS with eyebrow incision frontal craniotomy. Histopathological examination revealed a mucocele. Conclusion: In combined approach, eyebrow incision minimal frontal craniotomy remains the optimal option for visualisation of entire sinus, especially in laterally placed frontal mucoceles;while FESS helps in maintaining physiological drainage and proper follow-up.

Antibiotic Treatment for Chronic Rhinosinusitis after Endoscopic Surgery: How Long Should Macrolide Antibiotics Be Given?

Background: The purpose of this study was to determine an appropriate period for macrolide antibiotic therapy, and to investigate whether this period could be shorter, for patients with chronicrhino sinusitis (CRS) after functional endoscopic sinus surgery (FESS). Methods: A retrospective analysis of 41 patients undergoing FESS for CRS was performed. All patients underwent pre-operative computed tomography (CT). Patients with fungal sinusitis, allergic fungal sinusitis, and eosinophilic sinusitis were excluded. After FESS, normalized sinus mucosa was confirmed by CT and endoscopy in all patients. Postoperative antibiotic therapy consisted of first-line and second-line regimens. Garenoxacin (GRNX), or clarithromycin (CAM, 400 mg/day) was used as the first-line regimens and low-dose macrolide therapy (CAM, 200 mg/day) was used as the second-line regimen and was prescribed at outpatient visits based on our clinical criteria. Results: Second-line antibiotic therapy (low-dose CAM) was not necessary in 12 of 41 (29%) patients, while it was prescribed in 29 of 41 (71%). The mean duration of low-dose CAM therapy after FESS was 36 days (range 7 to 122 days;median, 25 days). Patients who received second-line therapy (n = 29) were divided into two groups based on the choice of first-line therapy, a GRNX group (n = 13) and a non-GRNX group (n = 16). Those in the non-GRNX had longer periods of postoperative CAM therapy than those in the GRNX group. Conclusion: GRNX was associated with a shorter duration of low-dose macrolide therapy after FESS, and 29% of patients did not need any low-dose macrolide therapy postoperatively. Therefore, macrolide antibiotics should not be routinely prescribed after FESS.

Correlation of the expression of Eotaxin-3 and Foxm1 with the expression of p38MAPK/NF-κB and inflammatory factors in mucosa tissue of chronic sinusitis

Objective:To study the correlation of the expression of Eotaxin-3 and Foxm1 with the expression of p38MAPK/NF-κB and inflammatory factors in mucosa tissue of chronic sinusitis.Methods:57 patients with chronic sinusitis and 38 patients with nasal septum deviation who received nasal endoscopic surgery in our hospital between March 2015 and August 2016 were selected and included in sinusitis group and control group respectively. Sinus mucosa tissues were collected to test the expression of Eotaxin-3, Foxm1, p38MAPK, NF-κB and inflammatory factors, and serum samples were collected to test the levels of inflammatory factors.Results:Eotaxin-3, Foxm1, p38MAPK and NF-κB protein expression in mucosa tissue of sinusitis group were significantly higher than those of control group, and the Eotaxin-3 and Foxm1 protein expression were positively correlated with p38MAPK and NF-κB protein expression;TGF-β1, IL-1β, IL-25, IL-33 and YKL-40 levels in nasal mucosa and serum of sinusitis group were significantly higher than those of control group, and TGF-β1, IL-1β, IL-25, IL-33 and YKL-40 levels in nasal mucosa and serum were positively correlated with p38MAPK and NF-κB protein expression.Conclusion:Eotaxin-3 and Foxm1 are expressed in mucosa tissue of chronic sinusitis, and can start the expression of inflammatory factors and induce the cascade amplification of inflammatory reaction through p38MAPK/ NF-κB signaling pathway.

T-bet, GATA-3 and Foxm1 expression in chronic sinusitis mucosa and their correlation with inflammatory molecule expression

Objective: To study the T-bet, GATA-3 and Foxm1 expression in chronic sinusitis mucosa and their correlation with inflammatory molecule expression. Methods: Patients with sinusitis and deflection of nasal septum who received nasal endoscopic surgery in Shengli hospital between June 2015 and February 2017 were selected and enrolled in CRS group and control group respectively. The nasal mucosa tissue was collected during operation to determine the mRNA expression of T-bet, GATA-3 and Foxm1 as well as the protein expression of inflammatory molecules. Results: T-bet, GATA-3 and Foxm1 mRNA expression as well as IL-1β, IFN-γ, TNF-α, IL-4, IL-5, IL-19, IL-20R1, IL-20R2, MMP2, MMP9, PI3K, Akt, GSK-3β and p38MAPK protein expression in nasal mucosa tissue of CRS group were significantly higher than those of control group;T-bet, GATA-3 and Foxm1 mRNA expression in nasal mucosa tissue of patients with CRS were positively correlated with IL-1β, IFN-γ, TNF-α, IL-4, IL-5, IL-19, IL-20R1, IL-20R2, MMP2, MMP9, PI3K, Akt, GSK-3β and p38MAPK protein expression. Conclusions: The high expression of T-bet, GATA-3 and Foxm1 in chronic sinusitis mucosa tissue can activate Th1 and Th2 immune response and cause mucosal inflammatory response.

Study on the Impact of Cognitive Nursing Model on Postoperative Quality of Life in Patients Undergoing Chronic Sinusitis Surgery

Objective:To explore effective nursing programs for surgical patients with chronic sinusitis(CS).Methods:62 CS surgery patients were randomly divided into a research group and a control group with 31 cases in each group.The patients in the research group received cognitive nursing care,while the patients in the control group received routine nursing care.The nursing effects of the two groups were compared.Results:The postoperative quality-of-life scores,health behavior scores,complication rates,and nursing satisfaction scores of the patients in the research group were all better than those of the control group(P<0.05).Conclusion:The cognitive nursing model significantly improves the condition of CS surgery patients,thus it should be popularized.

Non-allergic rhinitis in children: Epidemiological aspects, pathological features, diagnostic methodology and clinical management

Chronic rhinitis is a very common disease, as the prevalence in the general population resulted to be 40%. Allergic rhinitis has been considered to be the most frequent form of chronic rhinitis, as non-allergic rhinitis has been estimated to account for 25%. However, several evidences suggested that non-allergic rhinitis have been underrated, especially in children. In pediatrics, the diagnostic definition of non-allergic rhinitis has been often limited to the exclusion of an allergic sensitization. Actually, local allergic rhinitis has been often misdiagnosed as well as mixed rhinitis has not been recognized in most cases. Nasal cytology is a diagnostic procedure being suitable for routine clinical practice with children and could be a very useful tool to characterize and diagnose non-allergic rhinitis, providing important clues for epidemiological analysis and clinical management.

Management of 634 Consecutive Patients with Chronic Pilonidal Sinus: A Nine-Year Experience of a Single Institute

Objectives: Different surgical techniques, with variable morbidity and recurrence rates, have been advocated for the management of chronic pilonidal sinus (PNS). This study was conducted to report the outcome of surgical treatment of 634 cases of chronic PNS at a single institute between January 2001 and January 2010. Methods: Karydakis flap was performed in 244 patients (38.5%, Group 1). Excision and midline closure was performed in 371 patients (58.5%, Group 2), while the open method was used in 19 (3.0%). Data regarding patient and sinus characteristics, operative de-tails, postoperative course, complications and recurrence were recorded. Mean follow-up was 73.5 months. Results: 571 patients were male (90.1%) and 63 were female (9.9%). Their ages ranged between 16 - 44 years (mean 25.7 years). The mean body mass index was 31.2 (range 23.6 - 41.9), and 71.5% (453/634) were hirsute. Chronic PNS was the first presentation (primary) in 504 patients (79.5%) and recurrent in 130 (20.5%).Overall complication rate was 16.1% (102/ 634) and overall recurrence rate was 8.4% (53/634). Comparing both groups showed that they were similar regarding demographic characteristics, clinical presentation, hospital stay, healing time and time off work. Operative time was insignificantly longer with Karydakis technique (mean 43.2 versus 39.1 minutes, respectively). Complications were sig-nificantly more in patients with midline closure (21%, 78/371) as compared with Karydakis procedure (9%, 22/244) (P = 0.0001). Likewise, there was a significantly (P = 0.0001) higher rate of recurrence with midline closure (12.1%, 45/371) as opposed to Karydakis technique (2.5%, 6/244). Conclusions: 1) PNS affects mainly young male adults who are usually, obese and hirsute, 2) Karydakis technique for the management of chronic PNS, whether primary or recurrent, is a non-lengthy, efficient procedure that has less overall complications and a lower recurrence rate than conventional excision and midline closure.

Improved Angina Symptoms Following Coronary Sinus Flow Reducer Implantation in a Patient with Refractory Angina and Chronic Total Occlusion: A Case Report

Background: Due to the aging population and increased survival of the patients with coronary artery disease, there is an increasing number of patients with debilitating angina refractory to optimal medical treatment who are not candidates for revascularization. In case of low ischemic load, the treatment of stable refractory angina is aimed at symptom reduction. There are several new treatment methods targeting myocardial ischemia available, including coronary sinus flow reducer (CFR) implantation. Case Report: We report a case of a patient suffering from CCS class IV angina despite optimal medical therapy, with further revascualrization options exhausted, who was successfully treated with coronary sinus flow reducer (CFR). Besides technical skill to reach ostium of coronary sinus, the most important technical tip is precise positioning of the CFR. The reduction of angina symptoms started after epithelisation of CFR frame, usually 6 - 7 weeks after implantation. At 6-month follow-up, the patient reported a marked reduction of angina symptoms, with CCS grade improving by three classes (from IV to I). At 10-month follow-up, the sustainment of CCS grade I angina symptoms was reported by the patient. Conclusions: We conclude that CFR can be safely and successfully implanted in patients suffering from refractory angina. Considerable improvements in CCS grade may be experienced in certain cases.

The use of biologics in children with allergic rhinitis and chronic rhinosinusitis: Current updates

The therapeutic goals of the treatment of allergic rhinitis (AR) and chronic rhinosinusitis (CRS) are symptom relief, avoiding complications, and improving quality of life. In the treatment of AR and CRS, several limitations of currently prescribed medicines have been identified. Antihistamine administration (both oral and topical) together with intranasal corticosteroids bring relief to the majority of patients, but their dependency on the medications and a necessity to maintain strict compliance with regular medication regimes pose a challenge. Immunotherapeutic agents are an option in some patients, but polysensitized patients, the risk of anaphylaxis, and the need for daily administration for years are limiting it from becoming the main therapy modality. Immunotherapy in any form requires commitment by the patient, which renders adherence and compliance issues particularly relevant. The procedure involved are generally time-consuming and entail an associated risk of severe adverse reactions. The use of biologics could overcome the limitations of other therapeutic modalities. They could be used as a monotherapy or combined with pre-existing medications. The benefits of targeted therapy include less adverse effects and optimal efficacy. The aim of the present review was to investigate the collective literature to date pertaining to the role of biologics in managing children with AR and CRS.