Evaluation of the Quality of Life of Patients Suffering from Chronic Rhinosinusitis in a Hospital Setting in Kinshasa

Background and objective: Chronic rhinosinusitis (CRS), a common disease worldwide, has a major impact on patients’ quality of life (QoL). In recent years, the measurement of health-related QoL has made it possible to assess the patient’s state of health, the severity of the CRS and the treatment. The aim of this study was to assess the QoL of patients with CRS in a hospital setting in Kinshasa. Methods: This was a cross-sectional analytical study conducted from June 2020 to May 2021 in the ENT service of the Kinshasa University Hospital and the Monkole Hospital Center. The study involved 113 patients aged at least 18 years, whose QOL was compared with that of a control group consisting of 100 non-patients. QOL was assessed using the Sino-Nasal Outcome Test (SNOT-22) Questionnaire. Results: The mean age of the patients was 41.0 years (18 - 74 years) and that of the controls was 39.1 years (19 - 77 years). More than half of the participants were university graduates. The median SNOT-22 score was 44 (14 - 78) in patients and 7 (1 - 40) in controls. Compared with subjects without CRS, patients with CRS had significantly higher scores in all four domains of the SNOT-22. Around 9 out of 10 patients had a severely impaired QoL compared with 2 out of 10 controls. Considering mildly impaired QoL, we found that in the otological and sleep domains, scores were not significantly different between patients and controls. In the case of severely impaired QoL, however, only the otological domain showed a non-significant difference in scores between the two groups. Conclusion: CRS is a real public health problem in our environment and significantly alters the QoL of patients suffering from it, with repercussions on their professional productivity;hence the need for better management.

鼻内镜Messerklinger中鼻甲成形术与鼻内镜中鼻甲部分切除术治疗CRSwNP的效果

目的探讨鼻内镜Messerklinger中鼻甲成形术与鼻内镜中鼻甲部分切除术治疗慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)的效果。方法选取2019年1月—2021年1月在我院拟行鼻内镜手术治疗的CRSwNP患者94例,随机分为鼻甲成形组和鼻甲部分切除组,每组47例。鼻甲成形组选择鼻内镜Messerklinger中鼻甲成形术治疗,鼻甲部分切除组选择鼻内镜中鼻甲部分切除术治疗,评估两组临床疗效,并对比两组术前、术后1周及术后3个月的鼻功能和粘膜组织炎症生化指标含量[人软骨糖蛋白-39(YKL-40)、白介素细胞-6(IL-6)、MUC5AC阳性表达面积百分率]变化,记录两组术后并发症和术后随访1年的复发率。结果与鼻甲部分切除组比较,鼻甲成形组的临床总有效率显著性提升(93.62%vs 76.60%,P<0.05);观察各项鼻功能指标和粘膜组织炎症生化指标发现,两组进行组间、时间点及组间·时间点的交互效应时,差异均有统计学意义(P<0.05),其中两组术后1周及3个月后的鼻粘膜纤毛输送速率相比术前有显著性提高,鼻气道阻力、内镜Lund-Kennedy、嗅觉功能评分和粘膜组织YKL-40、IL-6含量及MUC5AC阳性表达面积百分率相比术前显著降低(均P<0.05),上述指标两组间比较差异均有统计学意义(P<0.05);两组患者术后并发症总发生率差异无统计学意义(P>0.05);鼻甲成形组随访1年的复发率均显著低于鼻甲部分切除组(P<0.05)。结论CRSwNP患者选择鼻内镜Messerklinger中鼻甲成形术治疗,能提升临床疗效,促使患者的鼻功能、鼻粘膜炎症改善,效果比鼻内镜中鼻甲部分切除术更好,且并未增加术后并发症,患者术后复发率也更低。

龙牡安神方通过调节内侧前额叶皮质小胶质细胞极化改善CRS小鼠的焦虑行为

目的:探讨龙牡安神方对慢性束缚应激(CRS)小鼠内侧前额叶皮层(mPFC)小胶质细胞(MG)极化及焦虑行为的影响。方法:48只健康雄性昆明小鼠随机分为正常组、盐酸帕罗西汀组和龙牡安神方高、中、低剂量组。除正常组外,其余各组采用CRS构建焦虑模型,持续束缚35 d,从第15天开始,每日CRS 30 min后,正常组和模型给予蒸馏水灌胃,盐酸帕罗西汀组给予盐酸帕罗西汀(2.6 mg/kg)灌胃,中药组给予龙牡安神方高、中、低剂量(4.16、2.08、1.04 g/kg)灌胃,给药时间为21 d。通过明暗箱实验和高架十字迷宫评价小鼠焦虑行为的变化;ELISA检测小鼠mPFC组织匀浆中IL-1β、IL-6、TNF-α及IL-10水平;Western blot检测小鼠mPFC组织中诱导型一氧化氮合酶(iNOS)和精氨酸酶1(Arg-1)蛋白表达;RT-PCR检测小鼠mPFC组织中离子钙接头蛋白分子-1(Iba-1)、iNOS和Arg-1 mRNA的表达;免疫组化(IHC)检测小鼠mPFC组织中Iba-1蛋白的表达。结果:与正常组比较,模型组小鼠明箱停留时间、明暗箱穿梭次数、进入开臂次数百分比(OE%)及开臂停留时间百分比(OT%)均显著减少(P<0.01);模型组小鼠mPFC组织中Iba-1、iNOS蛋白及mRNA表达显著升高(P<0.01),IL-1β、IL-6和TNF-α水平显著升高(P<0.01),而Arg-1的蛋白及mRNA表达显著降低(P<0.01),IL-10水平显著降低(P<0.01)。与模型组比较,盐酸帕罗西汀组及龙牡安神方高、中剂量组小鼠明暗箱停留时间、明暗箱穿梭次数、OE%及OT%均显著增加(P<0.01);mPFC组织中Iba-1、iNOS蛋白及mRNA表达明显降低(P<0.05,P<0.01),IL-1β、IL-6和TNF-α水平显著降低(P<0.01),而Arg-1的蛋白及mRNA表达显著升高(P<0.01),IL-10水平显著升高(P<0.01)。结论:龙牡安神方能够抑制CRS小鼠mPFC组织中MG的激活,并可能通过调节M1/M2极化表型减轻神经炎症,增加抗炎细胞因子的水平,从而改善CRS诱导的焦虑行为。

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.

冰黄肤乐软膏对CRSwNp鼻内镜术后疗效、鼻黏膜功能及炎性因子的影响

目的探讨慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)患者鼻内镜术后采用冰黄肤乐软膏的效果。方法将2022年10月至2023年4月医院收治的CRSw NP患者80例随机分为2组,各40例,两组患者均行鼻内镜手术治疗,对照组术后实施常规护理,观察组术后实施常规护理+冰黄肤乐软膏,均干预3个月。比较两组临床疗效、鼻黏膜功能及炎症因子。结果较对照组,观察组治疗总有效率更高(P<0.05);治疗后,两组纤毛清除速度及纤毛清除率均比治疗前高,且观察组更高(P<0.05);治疗后,两组血清肿瘤坏死因子α(TNF-α)、白细胞介素(IL)-6及IL-8水平均降低,且观察组比对照组低(P<0.05)。结论CRSw NP患者鼻内镜术后采用冰黄肤乐软膏治疗效果满意,可调节炎症因子水平,改善患者的鼻黏膜功能。

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.

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.

粉尘螨滴剂结合鼻腔负压冲洗对CRS伴AR术后鼻纤毛功能及炎症因子的影响

目的分析粉尘螨滴剂联合鼻腔负压冲洗对慢性鼻-鼻窦炎(CRS)伴变应性鼻炎(AR)术后鼻纤毛功能及炎症因子的影响。方法将86例CRS伴AR术后患者随机分为两组,对照组予以鼻腔负压冲洗,试验组采用粉尘螨滴剂联合鼻腔负压冲洗治疗。评价两组治疗效果、鼻纤毛功能及炎症因子变化。结果试验组治疗后症状评分、鼻内镜评分及肿瘤坏死因子-α、白细胞介素-1β、γ干扰素水平均低于对照组(P<0.05),纤毛细胞/杯状细胞数量比值、鼻黏膜纤维传输速率均高于对照组(P<0.05)。试验组总有效率高于对照组,术后1年内复发率低于对照组(P<0.05)。结论对CRS伴AR术后予以粉尘螨滴剂联合鼻腔负压冲洗不仅可减轻症状、增强疗效,还可以减少复发。

Eosinophilic chronic rhinosinusitis in East Asians

Chronic rhinosinusitis(CRS) is a common disease worldwide, with a prevalence rate of 5%-15% in the general population. CRS is currently classified into two types: CRS with and without nasal polyps. CRS may also be divided into eosinophilic CRS(ECRS) and non-ECRS subtypes based on the presence of tissue eosinophilic infiltration or not. There are significant geographic and ethnic differences in the tissue eosinophilic infiltration, which is predominant in Western white patients and less common in East Asians, despite an increasing tendency for its prevalence in East Asia countries. ECRS differs significantly from non-ECRS in clinical characteristics, treatment outcomes and strategies, and underlying pathogenic mechanisms. ECRS commonly demonstrates more severe symptoms, polyp diseases with a higher incidence of bilateral polyps and sinonasal diseases on computed tomography, and the increase in blood eosinophils. ECRS is considered a special and recalcitrant subtype of CRS, commonly with poor treatment outcomes compared to non-ECRS. The differentiation of specific subtypes and clinical features of CRS will be important for developing novel treatment strategies and improving treatment outcomes for individual phenotypes of CRS. This review discusses clinical features, diagnosis, treatment and prognosis of ECRS in East Asians.

网络药理学和分子对接探究鼻灵散治疗CRS的作用机制

目的运用网络药理学和分子对接的方法探究鼻灵散治疗慢性鼻炎(CRS)的药理作用机制。方法借助TCMSP数据库筛选得到鼻灵散方中的活性成分及其对应靶点,通过Genecards、OMIM、DRUGBANK数据库筛选获取鼻炎治疗靶点。结果鼻灵散治疗鼻炎的核心活性成分包括槲皮素、山奈酚、木犀草素、豆甾醇等,相关核心靶点有PTGS2、NOS2、GABRA2等,分子对接验证亦显示大部分活性成分与核心靶点的结合活性较好。KEGG富集分析显示涉及的生物学通路主要是IL-17和TNF信号通路。结论鼻灵散以各种成分通过调控靶点PTGS2、NOS2、GABRA2,有可能是作用于IL-17和TNF信号通路,收缩鼻腔,减轻炎症反应,从而起到治疗鼻炎的作用。

术前布地奈德预处理在鼻内镜手术治疗CRSwNP患者中的应用效果

目的:探讨手术前给予布地奈德预处理在鼻内镜手术治疗慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)患者的中的应用效果及对鼻黏膜纤毛清除功能、血清总免疫球蛋白E(TIgE)、嗜酸粒细胞阳离子蛋白(ECP)的影响。方法:选取2018年1月-2020年1月鹰潭市人民医院拟接受鼻内镜手术治疗的CRSwNP患者60例作为临床研究对象,采用随机数字表法分为研究组和对照组,各30例。研究组术前1周给予布地奈德进行干预,对照组仅给予安慰剂。对比两组患者手术治疗的效果、手术前后各项临床症状评分、鼻黏膜纤毛清除功能及组织中Bach2蛋白的表达差异。结果:手术前,两组患者的SNOT-20评分、Lund-Kennedy评分对比,差异均无统计学意义(P>0.05);手术后3个月,两组患者的SNOT-20评分、Lund-Kennedy评分均低于治疗前,研究组均低于对照组,差异均有统计学意义(P<0.05)。手术前,两组患者的鼻黏液纤毛清除率、鼻黏液纤毛清除速度、糖精消除时间对比,差异均无统计学意义(P>0.05);手术后3个月,研究组的鼻黏液纤毛清除率大于对照组,差异有统计学意义(P<0.05)。手术前,两组患者的血清TIgE、ECP水平对比,差异均无统计学意义(P>0.05);手术后3个月,研究组的血清ECP水平低于对照组,差异有统计学意义(P<0.05)。研究组总体临床疗效优于对照组,差异有统计学意义(P<0.05)。结论:手术前给予布地奈德预处理有助于缓解鼻内镜术后CRSwNP患者临床症状,改善免疫功能,提高治疗效果。

滋水清肝饮对慢性束缚应激抑郁小鼠海马ERK、GSK3β、CREB、BDNF蛋白表达的影响

目的基于ERK/GSK-3β/CREB/BDNF信号通路探究滋水清肝饮对慢性束缚应激(CRS)抑郁小鼠的作用。方法除空白组外,其余小鼠建立CRS抑郁模型,造模成功后分为模型组、盐酸氟西汀组(10 mg/kg)和滋水清肝饮低、中、高剂量组(8.835、17.670、35.340 g/kg),给予相应剂量药物干预,同时继续进行CRS处理。给药7、14 d进行糖水偏好实验及行为学实验。给药14 d后,HE染色观察小鼠海马组织形态学改变,采用试剂盒检测血清超氧化物歧化酶(SOD)活性和丙二醛(MDA)水平,ELISA法检测血清5-羟色胺(5-HT)、肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)水平,RT-qPCR法检测海马组织BDNF、TNF-α、IL-1βmRNA表达,Western blot法检测海马组织ERK1/2、p-ERK1/2、GSK3β、p-GSK3β、CREB、BDNF蛋白表达。结果与模型组比较,给药14 d后,盐酸氟西汀组和滋水清肝饮中剂量组小鼠糖水偏好率升高(P<0.01),悬尾不动时间和强迫游泳不动时间缩短(P<0.01),海马组织神经细胞损伤有所改善,血清MDA、TNF-α、IL-1β水平降低(P<0.05,P<0.01),SOD活性和5-HT水平升高(P<0.05,P<0.01),海马组织TNF-α、IL-1βmRNA表达降低(P<0.01),BDNF mRNA和p-ERK1/2、p-GSK3β、CREB、BDNF蛋白表达升高(P<0.05,P<0.01)。结论滋水清肝饮可改善慢性束缚应激小鼠抑郁样行为,其机制可能与调节小鼠海马ERK/GSK3β/CREB/BDNF信号通路有关。

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.

Quality of Life after Functional Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis

Chronic Rhinosinusitis (CRS) is a group of disorders characterized by the inflammation of mucosa of the nasal passages and paranasal sinuses. It includes chronic rhinosinusitis with polyps, CRS without polyps and Allergic Fungal Sinusitis (AFS). This debilitating disease causes negative impact on quality of life (QOL) of patients. Functional endoscopic sinus surgery (FESS) is the mainstay of surgical treatment for patients and improves QOL of patients. This subjective assessment of QOL can be measured by disease specific questionnaires. SNOT-22 questionnaire is widely used and validated questionnaire for this purpose. Prospective study was done on 54 patients. Data were collected using SNOT-22 questionnaire and filled in pre-operative period then in post-operative follow-up visits on 1st, 3rd, 6th and 12th months. Paired sample t-test was used to compare pre-operative and post-operative SNOT scores and multivariate generalized linear model was used to estimate regression parameters for SNOT scores in CRS with polyp and AFS in comparison of CRS without polyps. Out of 54 patients, 59.3% were males, mean age was 35.98, 29.6% were in CRS without polyp group, 44.4% and 25.9% were in CRS with polyps and AFS group. Recurrence occurred in 7.4%, revision surgery required in 3.7% while 22.2% had history of asthma. Paired sample t-test showed statistical significant reduction in post-operative SNOT scores. Linear model results showed SNOT scores in CRS with polyp group was significantly reduced. Thus FESS provides significant improvement in QOL of patients in chronic rhinosinusitis.

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.

Systematic Review and Meta-analysis of Biyuanshu Oral Liquid in the Treatment of Chronic Rhinosinusitis

[Objectives]The objective was to study the clinical efficacy and safety of Biyuanshu oral liquid in the treatment of chronic rhinosinusitis(CRS).[Methods]Randomized controlled trial was adopted to conduct scientific and standardized assessment on the risk of bias in the included papers.With overall effect and incidence of adverse reactions as indices,meta-analysis was performed,and sensitivity and safety analysis was conducted on the included literature.[Results]A total of 15 papers were included,involving 1489 patients.The efficiency of Biyuanshu oral liquid combined with Western medicine was better than that of Western medicine alone.[Conclusions]Biyuanshu oral liquid is safe and effective in treating chronic rhinosinusitis,and is suitable for patients who are not convenient for surgery.However,as the 15 papers included are all low in quality and there is a certain degree of publication bias,the objectivity of the results is affected to some extent.

Dysregulation of E-cadherin in Chronic Rhinosinusitis with Nasal Polyps

E-cadherin is a key epithelial protein and adhesive molecule. This study detected the E-cadherin expression in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and controls, and analyzed its possible role in the pathogenesis of CRSwNP. The expression of E-cadherin was detected by using Western blotting and immunohistochemistry in controls and patients with CRSwNP. Computed tomography (CT) scan findings were scored. The results showed that the E-cadherin expression was up-regulated in patients with CRSwNP as compared with controls (P=0.039) and the positive staining was predominantly localized on the epithelial cell membrane. E-cadherin level was correlated negatively with Lund-Mackay scores in patients with CRSwNP (r=–0.604, P=0.005). It is suggested that E-cadherin may be involved in the pathogenesis of CRSwNP and correlated with disease severity.

The Influence of Jia Wei Cang Er San on the Postoperative Bacteriology of Chronic Rhinosinusitis: A Randomized, Placebo-Controlled, Double-Blind Study

Background: Antibiotics have been used routinely for postoperative care in patients with chronic rhinosinusitis (CRS). However, increased bacterial growth was found after antibiotic treatment. In traditional Chinese medicine, Jia Wei Cang Er San has been used to treat CRS. This study was to investigate the influence of Jia Wei Cang Er San on the postoperative bacteriology of CRS. Methods: Ninety-seven CRS patients who underwent functional endoscopic sinus surgery (FESS) were included. They were randomly divided into 3 groups. In the group of Chinese herbal medicine (CHM), patients were given a capsule of Jia Wei Cang Er San tid for 8 weeks and a placebo capsule for amoxicillin q8h for 4 weeks after FESS. In the amoxicillin group, patients were given a capsule of amoxicillin 250 mg q8h for 4 weeks and a placebo capsule for Jia Wei Cang Er San tid for 8 weeks. In the placebo group, patients were given both placebo capsules. Bacterial cultures were performed from bilateral middle meati before FESS, and 8 and 12 weeks after FESS. Results: In the CHM group, bacteria grew in 21 (46%) of 46 specimens pre-operatively, in 23 (50%) specimens 8 weeks and in 17 (37%) specimens 12 weeks after surgery. In the amoxicillin group, bacteria grew in 15 (28%) of 54 specimens pre-operatively, in 30 (56%) specimens 8 weeks and in 32 (59%) specimens 12 weeks after surgery. In the placebo group, bacteria were found in 13 (34%) of 38 specimens pre-operatively, in 16 (42%) specimens 8 weeks and in 12 (32%) specimens 12 weeks after surgery. The rates of bacterial growth did not change by Jia Wei Cang Er San 8 or 12 weeks after surgery, but increased significantly by amoxicillin 8 and 12 weeks after surgery. Conclusion: Our study showed that Jia Wei Cang Er San did not induce bacterial growth after FESS as amoxicillin.

CREB2和OMP与慢性鼻窦炎嗅觉障碍发生机制的相关性分析

目的通过检测慢性鼻窦炎(CRS)引起的嗅觉障碍患者嗅区黏膜上皮组织中环磷腺苷效应元件结合蛋白2(CREB2)与嗅觉标记蛋白(OMP)的表达情况,探讨其与CRS患者嗅觉障碍的相关性。方法纳入2021年9月—2022年3月徐州医科大学附属医院收治的25例CRS伴嗅觉障碍的患者作为观察组,另选15例鼻中隔偏曲嗅觉正常患者作为对照。术前采用嗅棒TDI评分检测2组患者的嗅觉功能,术中取嗅区黏膜作为组织标本,通过免疫组化染色和Western blot检测嗅区黏膜上皮组织中CREB2与OMP表达水平,并分析其与嗅觉障碍的相关性。结果观察组TDI分值显著低于对照组(P<0.05)。免疫组化和Western blot结果表明:观察组嗅区黏膜上皮组织中CREB2与OMP阳性细胞数和蛋白表达量与对照组相比显著下降(P<0.01)。嗅区黏膜上皮组织中CREB2、OMP表达水平与TDI分值呈正相关(r=0.974,P<0.01;r=0.959,P<0.01)。结论CREB2和OMP在CRS伴嗅觉障碍患者嗅区黏膜上皮组织中表达降低,表达水平与TDI分值呈正相关。CRS患者嗅区黏膜上皮组织中CREB2表达减少可能与嗅觉障碍的分子机制有关。