SciCombinator

Discover the most talked about and latest scientific content & concepts.

Journal: American journal of rhinology & allergy

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BACKGROUND: Transnasal cannulation of the natural ostium in patients with an intact uncinate process is complicated by the lack of direct visualizationof the ostium. Accuracy of transnasal dilation of the maxillary ostium was evaluated for a malleable-tipped balloon device that was bent to specific angles for avoiding the fontanelle during cannulation.METHODS: Transnasal cannulation and dilation of 42 cadaver maxillary sinus ostia was attempted by 6 surgeons including 3 with very limited clinicalexperience using the study device. All physicians received procedure training including the technique to shape the balloon device into the recommended 135 degree maxillary configuration. Tissue dissection was prohibited. Canine fossa trephination and transantral endoscopy were used to evaluate cannulation and dilation outcomes. Physician operators were blinded to transantral images and results were documented by two observers.RESULTS: Appropriate transnasal cannulation and dilation of natural maxillary sinus ostia occurred in 92.9% (39/42) of attempts. Two failures emanated from procedural deviations. In one deviation, the bend angle was changed to 90 degrees and the device tip did not cannulate the ostium. In the second, the device was passed through a preexisting hole in the uncinate and cannulated the natural ostium. A third failure occurred when the device was passed through the fontanelle creating a false lumen.CONCLUSION: Using recommended procedural techniques and a malleable-tipped balloon device, newly trained and experienced physicians alike can perform uncinate-preserving transnasal cannulation and dilation of the maxillary ostium with a high rate of success.

Concepts: Sinusitis, Physician, Failure, Angle, Maxillary sinus, Cadaver, Dissection, Uncinate process of ethmoid bone

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Secondary cerebrospinal leaks (CSF) are leaks that recur after an initial endoscopic repair of CSF leaks. Identification of characteristics that could predict secondary leaks may allow surgeons to plan repairs with the knowledge that these defects are more likely to fail.

Concepts: Scientific method, Futurology, Taxonomy, Cerebrospinal fluid, Spontaneous cerebrospinal fluid leak

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Allergic rhinitis (AR) and chronic rhinosinusitis with nasal polyps (CRSwNP) are inflammatory diseases of the upper airway, with a similar immunologic profile, characterized by aberrant and persistent type 2 inflammation. One cell population that has been identified as altered in both disease types is regulatory T cell (Treg). Tregs have the capacity to modulate T-effector function and suppress inflammatory cytokine production in a broad range of cell types. Given the ability of Tregs to control inflammation, the role of Tregs in respiratory diseases has attracted much attention. As discussed in this article, alterations in the Treg numbers and function, or both, have been identified in AR and CRSwNP, although much of the data is conflicting. Here, we explored what is known and, in many cases, unknown about the mechanisms by which Tregs differentiate and function, and how these functions can be controlled in the mucosal microenvironment. By gaining a greater understanding of these processes, it may be possible to harness the natural immunosuppressive activity of Tregs to ameliorate the chronic inflammation associated with AR and CRSwNP.

Concepts: Immune system, Inflammation, Asthma, Sinusitis, Allergy, T cells, Autoimmunity, Regulatory T cell

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CD8+ T cells and natural killer (NK) cells are cytotoxic cells that use granzyme B (GrB) and perforin. Defective cytotoxic function is known to play a role in dysregulated immune response as seen in chronic sinusitis, also referred to as chronic rhinosinusitis (CRS). However, to our knowledge, in the United States, neither GrB or perforin expression has been reported in patients with CRS.

Concepts: Immune system, United States, Sinusitis, Natural killer cell, Allergy, T cell, Cytotoxic T cell, Granzyme

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Activation of adenosine monophosphate-activated protein kinase (AMPK) by metformin, as a master regulator of metabolism, is involved in airway tissue remodeling. Here, we investigated the physical role of AMPK on cell migration, matrix contraction, and the production of matrix metalloproteinases (MMP) in nasal polyp-derived fibroblasts (NPDF).

Concepts: Protein, Signal transduction, Adenosine triphosphate, Enzyme, Extracellular matrix, Protein kinase, Matrix metalloproteinase, AMP-activated protein kinase

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We previously presented that women with chronic rhinosinusitis (CRS) who elected endoscopic sinus surgery (ESS) have a higher symptom burden than men. Causes of these gender-based differences warranted further study.

Concepts: Medicine, Medical terms, Sinusitis, Allergy, Biofilm, Functional Endoscopic Sinus Surgery

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Chronic rhinosinusitis (CRS) has a high prevalence and significant cost and quality of life implications. Many types of practitioners care for patients with rhinosinusitis; however, patients with chronic or complicated conditions are often referred for tertiary rhinology services. It is unclear how social determinants of health affect access and utilization of these services. A better understanding of social barriers to tertiary rhinology care is needed to reduce health care disparities and improve health outcomes. The aim of the present study was to measure whether income, insurance status, race, and education affect utilization of tertiary rhinology care.

Concepts: Present, Health care, Health care provider, Medicine, Public health, Health disparities, Illness, Gross domestic product

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A novel, bioabsorbable, fibrinogen-based implant has been developed as a mucosal dressing after endoscopic sinus surgery (ESS). This implant can be formulated with fluticasone propionate (FP) for local elution of corticosteroid to reduce postoperative inflammation and promote mucosal healing.

Concepts: Asthma, Surgery, Corticosteroid, Fluticasone propionate, Fluticasone, Fluticasone furoate

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Currently vitamin D3 (VD3) or cholecalciferol is considered an immunomodulator that may be implicated in nasal polyposis (NP) pathophysiology.

Concepts: Vitamin D, Sinusitis, Cystic fibrosis, Nasal polyp, Cholecalciferol

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Endoscopic sinus surgery (ESS) has had many complications, e.g., synechia formation. This meta-analysis investigated the effect of a novel chitosan-based dressing on prevention of synechia and wound healing after ESS.

Concepts: Wound healing