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Hart L, Polášková A, Schalek P. Clinical decision support system RHINA in the diagnosis and treatment of acute or chronic rhinosinusitis. BMC Med Inform Decis Mak 2021; 21:239. [PMID: 34372852 PMCID: PMC8350307 DOI: 10.1186/s12911-021-01599-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background Rhinosinusitis is an inflammation of the sinonasal cavity which affects roughly one in seven people per year. Acute rhinosinusitis (ARS) is mostly, apart from allergic etiology, caused by a viral infection and, in some cases (30–50%), by a bacterial superinfection. Antibiotics, indicated only in rare cases according to EPOS guidelines, are nevertheless prescribed in more than 80% of ARS cases, which increases the resistant bacterial strains in the population. Methods We have designed a clinical decision support system (CDSS), RHINA, based on a web application created in HTML 5, using JavaScript, jQuery, CCS3 and PHP scripting language. The presented CDSS RHINA helps general physicians to decide whether or not to prescribe antibiotics in patients with rhinosinusitis. Results In a retrospective study of a total of 1465 patients with rhinosinusitis, the CDSS RHINA presented a 90.2% consistency with the diagnosis and treatment made by the ENT specialist. Conclusion Patients assessed with the assistance of our CDSS RHINA would decrease the over-prescription of antibiotics, which in turn would help to reduce the bacterial resistance to the most commonly prescribed antibiotics. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01599-3.
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Affiliation(s)
- L Hart
- Department of Otorhinolaryngology and Head and Neck Surgery, 3rd Faculty of Medicine and University Hospital Královské Vinohrady, Charles University in Prague, Prague, Czech Republic.
| | - A Polášková
- Charles University Computer Centre, 2nd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - P Schalek
- Department of Otorhinolaryngology and Head and Neck Surgery, 3rd Faculty of Medicine and University Hospital Královské Vinohrady, Charles University in Prague, Prague, Czech Republic
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Wu D, Yan B, Wang Y, Zhang L, Wang C. Predictive Significance of Charcot-Leyden Crystal Protein in Nasal Secretions in Recurrent Chronic Rhinosinusitis with Nasal Polyps. Int Arch Allergy Immunol 2020; 182:65-75. [PMID: 32927462 DOI: 10.1159/000510120] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/10/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The recurrence occurs frequently among patients with chronic rhinosinusitis with nasal polyps (CRSwNP), and predictors that could be conveniently detected during practice in outpatient service are needed. OBJECTIVE We aimed to illustrate that the concentration of Charcot-Leyden crystal (CLC) in nasal secretions can effectively and noninvasively predict polyp recurrence. METHODS 108 patients with CRSwNP were divided into recurrence (n = 68) and recurrence-free (n = 40) groups. Preoperative CLC concentrations in nasal secretions were collected and detected by ELISA. Polyp tissues were harvested during biopsy or endoscopic sinus surgery and were evaluated for inflammatory cells by histopathological staining. Demographic information and the clinical characteristics of each patient were reviewed for associations with recurrence. Binary logistic regression analysis was performed to determine predictive factors for polyp recurrence. Receiver operating characteristic (ROC) curves and the Youden index were performed to determine their predictive values. Survival analysis was performed to compare recurrence risk of patients with different CLC concentrations. RESULTS Sixty-eight (62.96%) patients developed recurrence during a 12- to 33-month postoperative follow-up. CLC concentrations in nasal secretions were positively correlated with eosinophil percent in polyp tissue and peripheral blood and were significantly higher in patients of the recurrence group than in the patients of the recurrence-free group (p < 0.001). Binary logistic regression and ROC curve demonstrated that CLC protein in nasal secretions is predictive of polyp recurrence. According to the Youden index, a CLC concentration of 34.24 ng/mL can predict postoperative polyp recurrence with 92.6% sensitivity and 87.5% specificity. Patients with CLC concentrations higher than the cutoff value yielded a higher risk of recurrence (p < 0.001, HR = 11.31, 95% CI: 6.41-19.98). CONCLUSIONS CLC protein in nasal secretions may serve as a promising noninvasive biomarker to predict CRSwNP recurrence.
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Affiliation(s)
- Di Wu
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Bing Yan
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Yang Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China, .,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China, .,Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China, .,Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China,
| | - Chengshuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.,Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China
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Liu C, Yan B, Qi S, Zhang Y, Zhang L, Wang C. Predictive Significance of Charcot–Leyden Crystals for Eosinophilic Chronic Rhinosinusitis With Nasal Polyps. Am J Rhinol Allergy 2019; 33:671-680. [PMID: 31269798 DOI: 10.1177/1945892419860646] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP) is a distinct phenotype of chronic rhinosinusitis with nasal polyps (CRSwNP), with many significantly different clinical features from non-eosinophilic chronic rhinosinusitis with nasal polyps (non-ECRSwNP). Thus, identification of subtypes is crucial for precise treatment. Immunohistology is a reliable way to present the subtypes; however, the results mainly depend on the observation of pathologist, and the method with automatic readout and the corresponding biomarkers is lacking. Objective The purpose of our research was to explore the predictive value of quantitative reverse transcription polymerase chain reaction (qRT-PCR) as an alternative method and messenger RNA (mRNA) expression of Charcot–Leyden crystals (CLC) as a corresponding target for ECRSwNP, which may benefit the automatized judgment. Method CLC mRNA levels in tissue samples from 48 CRSwNP patients and 10 controls were evaluated by quantitative real-time PCR. Hematoxylin and eosin staining was performed for histological assessment of CRSwNP and subtyping as ECRSwNP and non-ECRSwNP. Factors associated with ECRSwNP were determined with logistic regression analysis, the predictive value was presented by a receiver operating characteristic (ROC) curve, and optimal cutoff points of the predictors were identified as the Youden index. Results mRNA level of CLC in ECRSwNP was significantly elevated compared to either non-ECRSwNP group or control group, with no significant difference between non-ECRSwNP patients and controls. CLC mRNA levels were positively correlated with percentages of tissue eosinophil and peripheral blood eosinophil ( P < .001, r = .683; P = .003, r = .420, respectively). Logistic regression analysis revealed CLC mRNA level and blood eosinophil percentages were prediagnosis factors ( P = .007, P = .045, respectively) for ECRSwNP. ROC curves analysis indicated the area under the curve (AUC) of CLC mRNA level was 0.948 which was superior to the blood eosinophil percentage (AUC = 0.797; P = .044) as an optimal biomarker to predict ECRSwNP. Conclusions CLC mRNA levels based on the qRT-PCR may serve as a reliable and alternative method for the identification of ECRSwNP.
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Affiliation(s)
- Chang Liu
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, P.R. China
| | - Bing Yan
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, P.R. China
| | - Sihan Qi
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, P.R. China
| | - Yunyun Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, P.R. China
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China
| | - Luo Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, P.R. China
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China
| | - Chengshuo Wang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, P.R. China
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Analysis and Results of Endoscopic Sinus Surgery in Chronic Rhinosinusitis With Polyps. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.otoeng.2017.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Cabrera-Ramírez MS, Domínguez-Sosa MS, Borkoski-Barreiro SA, Falcón-González JC, Ramos-Macías Á. Analysis and results of endoscopic sinus surgery in chronic rhinosinusitis with polyps. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016; 68:80-85. [PMID: 27515764 DOI: 10.1016/j.otorri.2016.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 04/06/2016] [Accepted: 04/08/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND OBJECTIVES Endoscopic sinus surgery is currently the surgical procedure chosen in cases of sinonasal polyposis refractory to medical treatment. The aim of this study was to show our experience in managing such patients operated using endoscopic sinus surgery. METHOD A retrospective study of 246 patients with chronic rhinosinusitis and nasal polyps who were operated by endoscopic surgery. We studied the characteristics of the population, symptoms, grade of affectation, complications and recurrences. RESULTS The most frequent comorbidity was asthma (34.6%) and its relationship with Samter's triad (16.3%). Grades 2 and 3 polyposis prevailed according to Lildholdt staging by nasofibroscopy, coinciding with the radiological preoperative staging. The microdebrider did not shorten surgical time but it lowered complications. Reducing the average stay with the use of absorbable haemostatic agents and their effectiveness in controlling hemostasis were statistically significant. We found 23.2% complications, with only one (.4%) being a major complication; the rest were minor complications, with synechiae as the most frequent (16.3%). CONCLUSION Endoscopic sinus surgery is a minimally invasive and safe technique. Absorbable haemostatic agents are an effective alternative to get complete and stable hemostasis, reducing mean hospital stay. Synechiae continue being the most frequent complication. The fact that many patients recurred but without complications speaks in favour of a natural evolution of the disease and not of the influence of technique.
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Affiliation(s)
- M Soledad Cabrera-Ramírez
- Departamento de Otorrinolaringología y Patología Cervicofacial, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España.
| | - M Sandra Domínguez-Sosa
- Departamento de Otorrinolaringología y Patología Cervicofacial, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España
| | - Silvia Andrea Borkoski-Barreiro
- Departamento de Otorrinolaringología y Patología Cervicofacial, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, España
| | - Juan Carlos Falcón-González
- Departamento de Otorrinolaringología y Patología Cervicofacial, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, España
| | - Ángel Ramos-Macías
- Departamento de Otorrinolaringología y Patología Cervicofacial, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, España
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Grgić MV, Ćupić H, Kalogjera L, Baudoin T. Surgical treatment for nasal polyposis: predictors of outcome. Eur Arch Otorhinolaryngol 2015; 272:3735-43. [PMID: 25634061 DOI: 10.1007/s00405-015-3519-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/19/2015] [Indexed: 10/24/2022]
Abstract
Nasal polyps recur in approximately one-third of patients after surgical treatment. It would be beneficial to be able to predict the patients in whom we might expect recurrence and to predict the clinical outcome after surgery. The study included 30 patients operated for nasal polyps. Removed polyps were analyzed by immunohistochemical analysis for IL-5, IgE, vascular endothelial growth factor and eosinophilic infiltration. These parameters together with preoperative CT score were used as independent variables, and subjective score improvement after 2 years was used as a dependent variable in multiple linear regression analysis. Furthermore, the patients were divided into two groups: low and high polyp tissue immunoreactivity. The Chi-squared test was used to determine whether polyp immunoreactivity influences polyp recurrence and subjective score. Preoperative CT score had a slightly positive correlation with subjective score after 2 years. High eosinophil infiltration significantly predicted a higher risk for polyp recurrence. High IL-5 positivity was related to greater risk for polyp recurrence than low IL-5 reactivity but not significantly. IgE and VEGF reactivity in polyp specimens did not have any effect on polyp recurrence. High eosinophilic infiltration in polyps can predict worse outcome after surgical treatment of chronic rhinosinusitis with nasal polyposis. IgE and VEGF do not have prognostic significance to polyp recurrence after surgery. The preoperative extent of disease measured by CT score had a slightly positive correlation with worse outcome after surgery.
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Affiliation(s)
- Marko Velimir Grgić
- Department of ENT and Head and Neck Surgery, 'Sisters of Mercy' University Medical Center, Zagreb University School of Medicine, Vinogradska 29, Zagreb, Croatia.
| | - Hrvoje Ćupić
- Department of Pathology, University Hospital 'Sisters of Mercy' University Medical Center, Zagreb University School of Dentistry, Vinogradska 29, Zagreb, Croatia
| | - Livije Kalogjera
- Department of ENT and Head and Neck Surgery, 'Sisters of Mercy' University Medical Center, Zagreb University School of Medicine, Vinogradska 29, Zagreb, Croatia
| | - Tomislav Baudoin
- Department of ENT and Head and Neck Surgery, 'Sisters of Mercy' University Medical Center, Zagreb University School of Medicine, Vinogradska 29, Zagreb, Croatia
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Zhong C, Jiang Z, Zhang X. Effect of distribution of nasal polyps in ostiomeatal complex on long-term outcomes after endoscopic surgery. Eur Arch Otorhinolaryngol 2014; 272:3757-62. [PMID: 25502743 DOI: 10.1007/s00405-014-3432-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 12/05/2014] [Indexed: 10/24/2022]
Abstract
The objective of the study was to elucidate the characteristics of spatial distribution of nasal polyps in the ostiomeatal complex (OMC) and the corresponding correlation with long-term quality of life in patients who underwent endoscopic sinus surgery. 107 patients with unilateral or bilateral nasal polyps who had undergone functional endoscopic sinus surgery from September 2009 to June 2010 were enrolled in this study. Distribution of nasal polyps in the study subjects was documented. Long-term quality of life assessment was carried out at 1-year after surgery by SNOT-20 analysis. Observation of a total of 214 sides of rhinal cavities revealed that nasal polyps were distributed inside the OMC at 573 sites out of the total 635 sites (90.2 %), and predominantly distributed at the middle turbinate, the ethmoid sinus, the middle meatus, the uncinate process, the maxillary sinus, and the ethmoid bulla and significantly differed from the nasal polyps which were found outside the OMC (P < 0.01). Statistical analysis indicated that pre-operative Sinonasal Outcome Test 20 (SNOT-20) scores and 1-year post-operative scores were statistically significant (P < 0.05). The score changes of the left maxillary sinus, both sides ethmoid bulla were significant, respectively (P < 0.05). Nasal polyps predominantly distribute in the OMC. The differences among the sites of nasal polyps do not significantly impact the long-term score for quality of life except for the maxillary sinus and ethmoid bulla.
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Affiliation(s)
- Cheng Zhong
- Department of Otolaryngology, Southwest Hospital, The Third Military Medical University, Chongqing, 400038, China
| | - Zhendong Jiang
- Department of Otolaryngology, Southwest Hospital, The Third Military Medical University, Chongqing, 400038, China
| | - Xueyuan Zhang
- Department of Otolaryngology, Southwest Hospital, The Third Military Medical University, Chongqing, 400038, China.
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