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Lubner RJ, Rubel K, Chandra RK, Turner JH, Chowdhury NI. Particulate matter exposure is associated with increased inflammatory cytokines and eosinophils in chronic rhinosinusitis. Allergy 2024; 79:1219-1229. [PMID: 38180309 PMCID: PMC11062815 DOI: 10.1111/all.16006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is thought to result from complex interactions between the host immune system, microbiota, and environmental exposures. Currently, there is limited data regarding the impact of ambient particulate matter ≤2.5 μm in diameter (PM2.5) in the pathogenesis of CRS, despite evidence linking PM2.5 to other respiratory diseases. We hypothesized that PM2.5 may result in differential cytokine patterns that could inform our mechanistic understanding of the effect of environmental factors on CRS. METHODS We conducted an analysis of data prospectively collected from 308 CRS patients undergoing endoscopic sinus surgery. Cytokines were quantified in intraoperative mucus specimens using a multiplex flow cytometric bead assay. Clinical and demographic data including zip codes were extracted and used to obtain tract-level income and rurality measures. A spatiotemporal machine learning model was used to estimate daily PM2.5 levels for the year prior to each patient's surgery date. Spearman correlations and regression analysis were performed to characterize the relationship between mucus cytokines and PM2.5. RESULTS: Several inflammatory cytokines including IL-2, IL-5/IL-13, IL-12, and 21 were significantly correlated with estimated average 6, 9, and 12-month preoperative PM2.5 levels. These relationships were maintained for most cytokines after adjusting for age, income, body mass index, rurality, polyps, asthma, and allergic rhinitis (AR) (p < .05). There were also higher odds of asthma (OR = 1.5, p = .01) and AR (OR = 1.48, p = .03) with increasing 12-month PM2.5 exposure. Higher tissue eosinophil counts were associated with increasing PM2.5 levels across multiple timeframes (p < .05). CONCLUSIONS Chronic PM2.5 exposure may be an independent risk factor for development of a mixed, type-2 dominant CRS inflammatory response.
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Affiliation(s)
- Rory J Lubner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kolin Rubel
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rakesh K Chandra
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Justin H Turner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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2
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Beswick DM, Liu CM, Overdevest JB, Zemke A, Khatiwada A, Gudis DA, Miller JE, Kimple A, Tervo JP, DiMango E, Goralski JL, Keating C, Senior B, Stapleton AL, Eshaghian PH, Mace JC, Markarian K, Alt JA, Bodner TE, Chowdhury NI, Getz AE, Hwang PH, Khanwalker A, Lee JT, Li DA, Norris M, Nayak JV, Owens C, Patel ZM, Poch K, Schlosser RJ, Smith KA, Smith TL, Soler ZM, Suh JD, Turner GA, Wang MB, Saavedra MT, Taylor Cousar JL. Predictors of Sinonasal Improvement After Highly Effective Modulator Therapy in Adults with Cystic Fibrosis. Laryngoscope 2024. [PMID: 38634358 DOI: 10.1002/lary.31438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/04/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES The 22-question SinoNasal Outcome Test (SNOT-22) assesses chronic rhinosinusitis (CRS) severity. We aimed to identify predictors of SNOT-22 score improvement following highly effective modulator therapy (HEMT) initiation and to corroborate the SNOT-22 minimal clinically important difference (MCID) in adults with cystic fibrosis (CF). METHODS Prospective observational data was pooled from four studies across 10 US centers investigating people with CF (PwCF) and CRS. Three studies evaluated HEMT's impact on CRS. For participants enrolled prior to HEMT initiation, SNOT-22 scores were obtained at baseline and after 3-6 months of HEMT. Multivariate regression identified predictors of improvement. Cronbach's alpha and four distribution-based methods were used to assess internal consistency and calculate the MCID of the SNOT-22. RESULTS A total of 184 PwCF participated with mean baseline SNOT-22 scores ranging from 18.1 to 56.7. Cronbach's alpha was ≥0.90 across sites. Participants at sites with pre- and post-HEMT data reported improvement in SNOT-22 scores after initiating HEMT (all p < 0.05). Worse baseline SNOT-22 score (odds ratio (OR): 1.05, p < 0.001, 95% CI: 1.02-1.08), F508del homozygosity (OR: 4.30, p = 0.040, 95% CI: 1.14-18.99), and absence of prior modulator therapy (OR: 4.99, p = 0.017, 95% CI: 1.39-20.11) were associated with greater SNOT-22 improvement. The mean MCID calculated via distribution-based methods was 8.5. CONCLUSION Worse baseline sinonasal symptoms, F508del homozygosity, and absence of prior modulator therapy predicted greater improvement after HEMT initiation. The mean MCID for SNOT-22 in PwCF is 8.5 points, similar to non-CF individuals with CRS, and provides a threshold specifically for PwCF. The SNOT-22 has strong internal consistency in PwCF. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.
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Affiliation(s)
- Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
| | - Christine M Liu
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
| | - Jonathan B Overdevest
- Department of Otolaryngology-Head and Neck Surgery, Columbia University, New York, New York, U.S.A
| | - Anna Zemke
- Division of Pulmonary Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Aastha Khatiwada
- Department of Biostatistics, National Jewish Health, Denver, Colorado, U.S.A
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University, New York, New York, U.S.A
| | - Jessa E Miller
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
| | - Adam Kimple
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, U.S.A
| | - Jeremy P Tervo
- Department of Otolaryngology-Head and Neck Surgery, Columbia University, New York, New York, U.S.A
| | - Emily DiMango
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University, New York, New York, U.S.A
| | - Jennifer L Goralski
- Department of Pulmonary Medicine, University of North Carolina, Chapel Hill, North Carolina, U.S.A
| | - Claire Keating
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University, New York, New York, U.S.A
| | - Brent Senior
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, U.S.A
| | - Amanda L Stapleton
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Patricia H Eshaghian
- Department of Pulmonary Medicine, University of California, Los Angeles, California, U.S.A
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Karolin Markarian
- CTSI, David Geffen School of Medicine, University of California, Los Angeles, California, U.S.A
| | - Jeremiah A Alt
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Todd E Bodner
- Department of Psychology, Portland State University, Portland, Oregon, U.S.A
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt Health, Nashville, Tennessee, U.S.A
| | - Anne E Getz
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, U.S.A
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, U.S.A
| | - Ashoke Khanwalker
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, U.S.A
| | - Jivianne T Lee
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
| | - Douglas A Li
- Department of Pulmonary Medicine, University of California, Los Angeles, California, U.S.A
| | - Meghan Norris
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, U.S.A
| | - Jayakar V Nayak
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, U.S.A
| | - Cameran Owens
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, U.S.A
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, U.S.A
| | - Katie Poch
- Department of Medicine, National Jewish Health, Denver, Colorado, U.S.A
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Greenville, South Carolina, U.S.A
| | - Kristine A Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Jeffrey D Suh
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
| | - Grant A Turner
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Marilene B Wang
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
| | - Milene T Saavedra
- Department of Medicine, National Jewish Health, Denver, Colorado, U.S.A
| | - Jennifer L Taylor Cousar
- Department of Medicine, National Jewish Health, Denver, Colorado, U.S.A
- Department of Pediatrics, National Jewish Health, Denver, Colorado, U.S.A
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Longino ES, Desisto NG, Ortiz AS, Chowdhury NI, Patel PN, Stephan SJ, Yang SF. Effect of Underlying Mental Health Disorders on the Correlation Between Patient- and Surgeon-Graded Synkinesis Scores. Facial Plast Surg Aesthet Med 2024. [PMID: 38569157 DOI: 10.1089/fpsam.2023.0291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Background: Little is known about how depression and appearance anxiety affect patient reporting of synkinesis severity. Learning/Study Objective: Measure prevalence of depression and appearance anxiety in facial synkinesis and correlations between subjective and surgeon-graded synkinesis severity. Design Type: Prospective cohort. Methods: Patients with synkinesis volunteered and completed: Synkinesis Assessment Questionnaire (SAQ), facial clinimetric evaluation (FaCE) scale, Center for Epidemiological Studies Depression Scale (CES-D), and Fear of Negative Appearance Evaluation Scale (FNAES). Standardized videos were scored by facial plastic surgeons using Sunnybrook Scale and eFaCE. Multivariate linear regression was used to compare patient- and surgeon-graded metrics. Results: One hundred patients participated, 91 were female. Mean age was 56.4 (12.3). Eight percent identified as Black and 87% White. The most common nerve injury etiology was idiopathic (47%). Mean synkinesis duration was 7.6 years (6.2). Twenty percent and 15% reported history of an anxiety or depressive disorder, respectively. Patient (SAQ, FaCE) and clinician (Sunnybrook, eFaCE) scores were correlated (Pearson's r 0.223-0.294, p < 0.05). Upon adjusting for CES-D/FNAES, correlations between most patient and clinician metrics became stronger. As CES-D and FNAES worsened, patient-clinician correlations weakened. Conclusions: Depression and appearance anxiety may affect patient reporting of synkinesis severity. Worse mental health scores may decorrelate patient and clinician synkinesis assessments.
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Affiliation(s)
- Elizabeth S Longino
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nichole G Desisto
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alexandra S Ortiz
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Priyesh N Patel
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott J Stephan
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shiayin F Yang
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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4
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Beswick DM, Han EJ, Mace JC, Markarian K, Alt JA, Bodner TE, Chowdhury NI, Eshaghian PH, Getz AE, Hwang PH, Khanwalkar A, Kimple AJ, Lee JT, Li DA, Norris M, Nayak JV, Owens C, Patel Z, Poch K, Schlosser RJ, Smith KA, Smith TL, Soler ZM, Suh JD, Turner G, Wang MB, Taylor-Cousar JL, Saavedra M. Factors that predict pursuing sinus surgery in the era of highly effective modulator therapy. Int Forum Allergy Rhinol 2024; 14:807-818. [PMID: 37725072 DOI: 10.1002/alr.23270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/19/2023] [Accepted: 09/08/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Comorbid chronic rhinosinusitis (CRS) remains unresolved for many people with cystic fibrosis (PwCF). While highly effective modulator therapy improves quality-of-life and symptom severity, the impact of this intervention and other factors associated with pursuing endoscopic sinus surgery (ESS) remains understudied. METHODS Adult PwCF + CRS were enrolled into a prospective, observational, multi-institutional study. Participants completed validated outcome measures to evaluate respiratory symptom severity, depression, headache, and sleep quality, as well as nasal endoscopy, sinus computed tomography (CT), and olfactory testing. Bivariate comparisons and regression modeling evaluated treatment cofactors, disease characteristics, and outcome measures associated with pursuing ESS. RESULTS Sixty PwCF were analyzed, including 24 (40%) who elected ESS. Pursuing ESS was associated with worse SinoNasal Outcome Test (SNOT-22) total, rhinologic, psychological, and sleep dysfunction domain scores; worse Patient Health Questionnaire-9-Revised depression scores; worse Pittsburgh Sleep Quality Index total scores; worse weight, role, emotion, and eating domain scores on the Cystic Fibrosis Questionnaire-Revised; more severe disease on nasal endoscopy; and lack of modulator therapy (all p < 0.050). Multivariable regression identified that worse SNOT-22 total score was associated with electing ESS (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.02-1.16, p = 0.015) and elexacaftor/tezacaftor/ivacaftor (ETI) treatment (OR 0.04, 95% CI 0.004-0.34, p = 0.004) was associated with pursing medical therapy. CONCLUSIONS Worse sinonasal symptom burden, lack of ETI treatment, sleep quality, depression, and nasal endoscopy scores were associated with electing ESS, while lung disease severity and sinus CT scores were not. ETI use was associated with lower odds of pursuing ESS independent of sinonasal symptom burden.
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Affiliation(s)
- Daniel M Beswick
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Ethan J Han
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, USA
| | - Karolin Markarian
- CTSI, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Jeremiah A Alt
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Todd E Bodner
- Department of Psychology, Portland State University, Portland, Oregon, USA
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt Health, Nashville, Tennessee, USA
| | - Patricia H Eshaghian
- Department of Pulmonary Medicine, University of California, Los Angeles, California, USA
| | - Anne E Getz
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Colorado, Denver, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford Medicine, Stanford, California, USA
| | - Ashoke Khanwalkar
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Colorado, Denver, USA
| | - Adam J Kimple
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jivianne T Lee
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Douglas A Li
- Department of Pulmonary Medicine, University of California, Los Angeles, California, USA
| | - Meghan Norris
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jayakar V Nayak
- Department of Otolaryngology-Head and Neck Surgery, Stanford Medicine, Stanford, California, USA
| | - Cameran Owens
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Colorado, Denver, USA
| | - Zara Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford Medicine, Stanford, California, USA
| | - Katie Poch
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kristine A Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, USA
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jeffrey D Suh
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Grant Turner
- Department of Pulmonary Medicine, University of California, Los Angeles, California, USA
| | - Marilene B Wang
- Department of Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Jennifer L Taylor-Cousar
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
- Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
| | - Milene Saavedra
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
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5
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Kuan EC, Wang EW, Adappa ND, Beswick DM, London NR, Su SY, Wang MB, Abuzeid WM, Alexiev B, Alt JA, Antognoni P, Alonso-Basanta M, Batra PS, Bhayani M, Bell D, Bernal-Sprekelsen M, Betz CS, Blay JY, Bleier BS, Bonilla-Velez J, Callejas C, Carrau RL, Casiano RR, Castelnuovo P, Chandra RK, Chatzinakis V, Chen SB, Chiu AG, Choby G, Chowdhury NI, Citardi MJ, Cohen MA, Dagan R, Dalfino G, Dallan I, Dassi CS, de Almeida J, Dei Tos AP, DelGaudio JM, Ebert CS, El-Sayed IH, Eloy JA, Evans JJ, Fang CH, Farrell NF, Ferrari M, Fischbein N, Folbe A, Fokkens WJ, Fox MG, Lund VJ, Gallia GL, Gardner PA, Geltzeiler M, Georgalas C, Getz AE, Govindaraj S, Gray ST, Grayson JW, Gross BA, Grube JG, Guo R, Ha PK, Halderman AA, Hanna EY, Harvey RJ, Hernandez SC, Holtzman AL, Hopkins C, Huang Z, Huang Z, Humphreys IM, Hwang PH, Iloreta AM, Ishii M, Ivan ME, Jafari A, Kennedy DW, Khan M, Kimple AJ, Kingdom TT, Knisely A, Kuo YJ, Lal D, Lamarre ED, Lan MY, Le H, Lechner M, Lee NY, Lee JK, Lee VH, Levine CG, Lin JC, Lin DT, Lobo BC, Locke T, Luong AU, Magliocca KR, Markovic SN, Matnjani G, McKean EL, Meço C, Mendenhall WM, Michel L, Na'ara S, Nicolai P, Nuss DW, Nyquist GG, Oakley GM, Omura K, Orlandi RR, Otori N, Papagiannopoulos P, Patel ZM, Pfister DG, Phan J, Psaltis AJ, Rabinowitz MR, Ramanathan M, Rimmer R, Rosen MR, Sanusi O, Sargi ZB, Schafhausen P, Schlosser RJ, Sedaghat AR, Senior BA, Shrivastava R, Sindwani R, Smith TL, Smith KA, Snyderman CH, Solares CA, Sreenath SB, Stamm A, Stölzel K, Sumer B, Surda P, Tajudeen BA, Thompson LDR, Thorp BD, Tong CCL, Tsang RK, Turner JH, Turri-Zanoni M, Udager AM, van Zele T, VanKoevering K, Welch KC, Wise SK, Witterick IJ, Won TB, Wong SN, Woodworth BA, Wormald PJ, Yao WC, Yeh CF, Zhou B, Palmer JN. International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors. Int Forum Allergy Rhinol 2024; 14:149-608. [PMID: 37658764 DOI: 10.1002/alr.23262] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Sinonasal neoplasms, whether benign and malignant, pose a significant challenge to clinicians and represent a model area for multidisciplinary collaboration in order to optimize patient care. The International Consensus Statement on Allergy and Rhinology: Sinonasal Tumors (ICSNT) aims to summarize the best available evidence and presents 48 thematic and histopathology-based topics spanning the field. METHODS In accordance with prior International Consensus Statement on Allergy and Rhinology documents, ICSNT assigned each topic as an Evidence-Based Review with Recommendations, Evidence-Based Review, and Literature Review based on the level of evidence. An international group of multidisciplinary author teams were assembled for the topic reviews using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses format, and completed sections underwent a thorough and iterative consensus-building process. The final document underwent rigorous synthesis and review prior to publication. RESULTS The ICSNT document consists of four major sections: general principles, benign neoplasms and lesions, malignant neoplasms, and quality of life and surveillance. It covers 48 conceptual and/or histopathology-based topics relevant to sinonasal neoplasms and masses. Topics with a high level of evidence provided specific recommendations, while other areas summarized the current state of evidence. A final section highlights research opportunities and future directions, contributing to advancing knowledge and community intervention. CONCLUSION As an embodiment of the multidisciplinary and collaborative model of care in sinonasal neoplasms and masses, ICSNT was designed as a comprehensive, international, and multidisciplinary collaborative endeavor. Its primary objective is to summarize the existing evidence in the field of sinonasal neoplasms and masses.
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Affiliation(s)
- Edward C Kuan
- Departments of Otolaryngology-Head and Neck Surgery and Neurological Surgery, University of California, Irvine, Orange, California, USA
| | - Eric W Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Nyall R London
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Sinonasal and Skull Base Tumor Program, Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Shirley Y Su
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marilene B Wang
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Waleed M Abuzeid
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Borislav Alexiev
- Department of Pathology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Jeremiah A Alt
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Paolo Antognoni
- Division of Radiation Oncology, University of Insubria, ASST Sette Laghi Hospital, Varese, Italy
| | - Michelle Alonso-Basanta
- Department of Radiation Oncology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Pete S Batra
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Mihir Bhayani
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Diana Bell
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Manuel Bernal-Sprekelsen
- Otorhinolaryngology Department, Surgery and Medical-Surgical Specialties Department, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Christian S Betz
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, UNICANCER, Université Claude Bernard Lyon I, Lyon, France
| | - Benjamin S Bleier
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Juliana Bonilla-Velez
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Claudio Callejas
- Department of Otolaryngology, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Roy R Casiano
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi Hospital, Varese, Italy
| | - Rakesh K Chandra
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Simon B Chen
- Department of Pathology, Stanford University, Stanford, California, USA
| | - Alexander G Chiu
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Garret Choby
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Martin J Citardi
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Marc A Cohen
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Roi Dagan
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Gianluca Dalfino
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi Hospital, Varese, Italy
| | - Iacopo Dallan
- Department of Otolaryngology-Head and Neck Surgery, Pisa University Hospital, Pisa, Italy
| | | | - John de Almeida
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Angelo P Dei Tos
- Section of Pathology, Department of Medicine, University of Padua, Padua, Italy
| | - John M DelGaudio
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Charles S Ebert
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ivan H El-Sayed
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - James J Evans
- Department of Neurological Surgery and Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christina H Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, New York, USA
| | - Nyssa F Farrell
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Marco Ferrari
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Nancy Fischbein
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Adam Folbe
- Department of Otolaryngology-Head and Neck Surgery, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Wytske J Fokkens
- Department of Otorhinolaryngology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Meha G Fox
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | | | - Gary L Gallia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mathew Geltzeiler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Christos Georgalas
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Nicosia Medical School, Nicosia, Cyprus
| | - Anne E Getz
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Satish Govindaraj
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Jessica W Grayson
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bradley A Gross
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jordon G Grube
- Department of Otolaryngology-Head and Neck Surgery, Albany Medical Center, Albany, New York, USA
| | - Ruifeng Guo
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Patrick K Ha
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Ashleigh A Halderman
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Richard J Harvey
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of South Wales, Sydney, New South Wales, Australia
| | - Stephen C Hernandez
- Department of Otolaryngology-Head and Neck Surgery, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Adam L Holtzman
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Claire Hopkins
- Department of Otolaryngology-Head and Neck Surgery, Guys and St Thomas' Hospital, London, UK
| | - Zhigang Huang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Zhenxiao Huang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Ian M Humphreys
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Alfred M Iloreta
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Masaru Ishii
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Aria Jafari
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - David W Kennedy
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mohemmed Khan
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Adam J Kimple
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Todd T Kingdom
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Anna Knisely
- Department of Otolaryngology, Head and Neck Surgery, Swedish Medical Center, Seattle, Washington, USA
| | - Ying-Ju Kuo
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Devyani Lal
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric D Lamarre
- Head and Neck Institute, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ming-Ying Lan
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hien Le
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Matt Lechner
- UCL Division of Surgery and Interventional Science and UCL Cancer Institute, University College London, London, UK
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jivianne K Lee
- Department of Head and Neck Surgery, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Victor H Lee
- Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Corinna G Levine
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jin-Ching Lin
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan
| | - Derrick T Lin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Brian C Lobo
- Department of Otolaryngology-Head and Neck Surgery, University of Florida, Gainesville, Florida, USA
| | - Tran Locke
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Amber U Luong
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Kelly R Magliocca
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Svetomir N Markovic
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Gesa Matnjani
- Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Erin L McKean
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Cem Meço
- Department of Otorhinolaryngology, Head and Neck Surgery, Ankara University Medical School, Ankara, Turkey
- Department of Otorhinolaryngology Head and Neck Surgery, Salzburg Paracelsus Medical University, Salzburg, Austria
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Loren Michel
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Shorook Na'ara
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Daniel W Nuss
- Department of Otolaryngology-Head and Neck Surgery, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Gurston G Nyquist
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gretchen M Oakley
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Kazuhiro Omura
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Richard R Orlandi
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Nobuyoshi Otori
- Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Peter Papagiannopoulos
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - David G Pfister
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alkis J Psaltis
- Department of Otolaryngology-Head and Neck Surgery, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Mindy R Rabinowitz
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Murugappan Ramanathan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ryan Rimmer
- Department of Otolaryngology-Head and Neck Surgery, Yale University, New Haven, Connecticut, USA
| | - Marc R Rosen
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Olabisi Sanusi
- Department of Neurosurgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Zoukaa B Sargi
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Philippe Schafhausen
- Department of Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Brent A Senior
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Raj Shrivastava
- Department of Neurosurgery and Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Raj Sindwani
- Head and Neck Institute, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Kristine A Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Carl H Snyderman
- Departments of Otolaryngology-Head and Neck Surgery and Neurological Surgery, University of California, Irvine, Orange, California, USA
| | - C Arturo Solares
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Satyan B Sreenath
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Aldo Stamm
- São Paulo ENT Center (COF), Edmundo Vasconcelos Complex, São Paulo, Brazil
| | - Katharina Stölzel
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Baran Sumer
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Pavol Surda
- Department of Otolaryngology-Head and Neck Surgery, Guys and St Thomas' Hospital, London, UK
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Brian D Thorp
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Charles C L Tong
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Raymond K Tsang
- Department of Otolaryngology-Head and Neck Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Justin H Turner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi Hospital, Varese, Italy
| | - Aaron M Udager
- Department of Pathology, Michigan Center for Translational Pathology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Thibaut van Zele
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Kyle VanKoevering
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Kevin C Welch
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ian J Witterick
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Tae-Bin Won
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Stephanie N Wong
- Division of Otorhinolaryngology, Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Bradford A Woodworth
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peter-John Wormald
- Department of Otolaryngology-Head and Neck Surgery, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - William C Yao
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Chien-Fu Yeh
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Bing Zhou
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology-Head and Neck Surgery, Ministry of Education, Beijing, China
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Rubel KE, Lopez A, Lubner RJ, Lee DL, Yancey K, Chandra RK, Chowdhury NI, Turner JH. Frailty is an independent predictor of postoperative rescue medication use after endoscopic sinus surgery. Int Forum Allergy Rhinol 2024. [PMID: 38268092 DOI: 10.1002/alr.23324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/01/2023] [Accepted: 12/28/2023] [Indexed: 01/26/2024]
Abstract
INTRODUCTION The modified five-item frailty index (mFI-5) is a validated risk stratification tool with the ability to predict adverse outcomes following surgery. In this study, we sought to use mFI-5 to assess the potential relationship between unhealthy aging and postoperative endoscopic sinus surgery (ESS) outcomes. METHODS Patients who underwent sinus surgery at Vanderbilt between 2014 and 2018 were identified and assessed using the mFI-5, which is calculated based on the presence of five comorbidities: diabetes mellitus, hypertension requiring medication, chronic obstructive pulmonary disease, congestive heart failure, and non-independent functional status. Multivariate regression analyses were performed to quantify the association of mFI-5 score on need for rescue oral antibiotics, oral steroids, and antibiotic irrigations within 1 year following ESS, adjusting for relevant potential confounders. RESULTS Four hundred and three patients met inclusion criteria. Within 6 months of surgery, 312 (77%) required rescue antibiotics, 243 (60%) required oral corticosteroids (OCS), and 31 (8%) initiated antibiotic irrigations. Increasing mFI-5 scores were significantly associated with higher postoperative use of rescue antibiotics (p < 0.0001), OCS (p = 0.032), and antibiotic irrigation (p < 0.0001). Frailty scores remained as an independent predictor of these outcomes after adjustment for age, polyp status, preoperative sinonasal outcomes test (SNOT-22) score, and revision surgery status. CONCLUSIONS Modified frailty scores may be a useful clinical tool to predict the need for postoperative rescue medication use after ESS.
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Affiliation(s)
- Kolin E Rubel
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Andrea Lopez
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rory J Lubner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Diane L Lee
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kristen Yancey
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Rakesh K Chandra
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Justin H Turner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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7
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Miller JE, Taylor-Cousar JL, Overdevest JB, Khatiwada A, Mace JC, Alt JA, Bodner TE, Chowdhury NI, DiMango EA, Eshaghian PH, Getz AE, Gudis DA, Han EJ, Hwang PH, Keating CL, Khanwalkar A, Kimple AJ, Lee JT, Li D, Markarian K, Norris M, Nayak JV, Owens C, Patel ZM, Poch K, Schlosser RJ, Smith KA, Smith TL, Soler ZM, Suh JD, Tervo JP, Turner GA, Wang MB, Saavedra MT, Beswick DM. Determining the minimal clinically important difference for the questionnaire of olfactory disorders in people with cystic fibrosis and factors associated with improvement after highly effective modulator therapy. Int Forum Allergy Rhinol 2023. [PMID: 38145393 DOI: 10.1002/alr.23312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/21/2023] [Accepted: 12/05/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Olfactory dysfunction (OD) is common among people with cystic fibrosis (PwCF). The Questionnaire of Olfactory Disorders (QOD) is a validated instrument that evaluates olfactory-specific quality-of-life. The QOD minimal clinically important difference (MCID) and factors associated with olfactory improvement after elexacaftor/tezacaftor/ivacaftor have not been determined for PwCF. METHODS Prospective observational data were pooled from three studies that enrolled adult PwCF with chronic rhinosinusitis (CRS). QOD scores and disease characteristics were assessed. To evaluate internal consistency and calculate the QOD MCID, Cronbach's alpha and four distribution-based methods were employed. For participants who enrolled prior to elexacaftor/tezacaftor/ivacaftor, QOD scores were obtained at baseline and after elexacaftor/tezacaftor/ivacaftor initiation. Multivariable regression was used to identify factors associated with QOD improvement. RESULTS Of 129 PwCF included, 65 had QOD scores before and 3-6 months after starting elexacaftor/tezacaftor/ivacaftor. Mean baseline QOD score was 6.5 ± 7.9. Mean Cronbach's alpha was ≥0.85. The MCID estimates were as follows: Cohen's effect size = 1.6, standard error of measurement = 2.5, ½ baseline standard deviation = 4.0, and minimal detectable change = 6.9. Mean MCID was 3.7. Of those with pre/post elexacaftor/tezacaftor/ivacaftor QOD scores, the mean change in QOD was -1.3 ± 5.4. After elexacaftor/tezacaftor/ivacaftor, QOD improvement surpassed the MCID in 22% of participants (14/65). Worse baseline QOD scores and nasal polyps were associated with improved QOD scores after elexacaftor/tezacaftor/ivacaftor (both p < 0.04). CONCLUSION The QOD MCID in PwCF was estimated to be 3.7. Elexacaftor/tezacaftor/ivacaftor led to qualitative but not clinically meaningful improvements in QOD score for most PwCF; PwCF with worse baseline QOD scores and nasal polyps improved in a clinically significant manner.
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Affiliation(s)
- Jessa E Miller
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Jennifer L Taylor-Cousar
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
- Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
| | - Jonathan B Overdevest
- Department of Otolaryngology-Head and Neck Surgery, Columbia University, New York, New York, USA
| | - Aastha Khatiwada
- Department of Biostatistics, National Jewish Health, Denver, Colorado, USA
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, USA
| | - Jeremiah A Alt
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Todd E Bodner
- Department of Psychology, Portland State University, Portland, Oregon, USA
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt Health, Nashville, Tennessee, USA
| | - Emily A DiMango
- Department of Medicine, Columbia University, New York, New York, USA
| | - Patricia H Eshaghian
- Department of Pulmonary Medicine, University of California, Los Angeles, California, USA
| | - Anne E Getz
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University, New York, New York, USA
| | - Ethan J Han
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford Medicine, Palo Alto, California, USA
| | - Claire L Keating
- Department of Medicine, Columbia University, New York, New York, USA
| | - Ashoke Khanwalkar
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Adam J Kimple
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jivianne T Lee
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Douglas Li
- Department of Pulmonary Medicine, University of California, Los Angeles, California, USA
| | - Karolin Markarian
- David Geffen School of Medicine, University of California, CTSI, Los Angeles, California, USA
| | - Meghan Norris
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jayakar V Nayak
- Department of Otolaryngology-Head and Neck Surgery, Stanford Medicine, Palo Alto, California, USA
| | - Cameran Owens
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford Medicine, Palo Alto, California, USA
| | - Katie Poch
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Rodney J Schlosser
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kristine A Smith
- Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, USA
| | - Zachary M Soler
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jeffrey D Suh
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Jeremy P Tervo
- Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, USA
| | - Grant A Turner
- Department of Pulmonary Medicine, University of California, Los Angeles, California, USA
| | - Marilene B Wang
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, USA
| | - Milene T Saavedra
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of California, Los Angeles, California, USA
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8
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Longino ES, Labby AB, Wu J, Chapurin N, Li P, Chandra RK, Turner JH, Chowdhury NI. Association of cytokine profile with prior treatment failure and revision surgery in chronic rhinosinusitis. Int Forum Allergy Rhinol 2023; 13:5-14. [PMID: 35670242 DOI: 10.1002/alr.23035] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/21/2022] [Accepted: 05/23/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Inflammatory patterns in chronic rhinosinusitis (CRS) may predict disease severity, need for multiple sinus surgeries, and treatment response. This study analyzes nasal mucus inflammatory cytokine patterns in patients with (CRSwNP) and without (CRSsNP) nasal polyposis and their association with revision sinus surgery. METHODS A total of 319 CRS patients who underwent sinus surgery were included. Cytokines were quantified in intraoperative mucus specimens using a multiplex flow cytometric bead assay. Cytokine expression patterns in patients with 0, 1, and ≥2 previous surgeries were analyzed using Kruskal-Wallis and principal component (PC) regression analyses. RESULTS There were 122 (38%) patients with CRSsNP and 197 (62%) with CRSwNP. On univariate analysis, interleukin (IL)-1β, IL-6, IL-8, and IL-21 were associated with increasing number of sinus surgeries in CRSsNP, as were IL-2, IL-4, IL-5, IL-6, IL-9, IL-17A, and tumor necrosis factor (TNF)-α in CRSwNP. PC analysis with continuous Poisson regression in CRSwNP demonstrated that high IL-5 and IL-13 and low IL-1β, IL-12, and IL-21 were associated with more prior surgeries. In CRSsNP low IL-13 and high IL-5 and regulated-on-activation, normal T-cell-expressed and secreted (RANTES) were associated with more prior surgeries. Age remained a significant covariate in the full regression model for CRSsNP, but was nonsignificant in CRSwNP. CONCLUSION In CRSwNP, elevated IL-5 and IL-13 levels were higher at time of surgery in patients with more prior surgeries. Type 2 cytokines in CRSsNP demonstrated mixed associations with revision surgery. For both phenotypes, IL-10, IL-12, and IL-21 were consistently lower as number of prior surgeries increased, suggesting that treatment-resistant disease may be modulated by impairment in these signaling pathways.
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Affiliation(s)
- Elizabeth S Longino
- Division of Rhinology/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery , Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Alex B Labby
- Division of Rhinology/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery , Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Jeffanie Wu
- Division of Rhinology/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery , Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Nikita Chapurin
- Division of Rhinology/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery , Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Ping Li
- Division of Rhinology/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery , Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Rakesh K Chandra
- Division of Rhinology/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery , Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Justin H Turner
- Division of Rhinology/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery , Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Naweed I Chowdhury
- Division of Rhinology/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery , Vanderbilt University School of Medicine, Nashville, TN, USA
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9
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Corey KB, Turner JH, Chowdhury NI, Chandra RK, Li P, Wu P, Cahill KN. Utility of nasal mucus inflammatory profile as a biomarker of nasal polyp regrowth in aspirin-exacerbated respiratory disease. J Allergy Clin Immunol Pract 2022; 10:1644-1645.e1. [PMID: 35398556 PMCID: PMC9469779 DOI: 10.1016/j.jaip.2022.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Kristen B Corey
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Justin H Turner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Rakesh K Chandra
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Ping Li
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Pingsheng Wu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tenn
| | - Katherine N Cahill
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn.
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10
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Chapurin N, Wu J, Labby AB, Chandra RK, Chowdhury NI, Turner JH. Current Insight into Treatment of Chronic Rhinosinusitis: Phenotypes, Endotypes and Implications for Targeted Therapeutics. J Allergy Clin Immunol 2022; 150:22-32. [PMID: 35469844 DOI: 10.1016/j.jaci.2022.04.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 10/18/2022]
Abstract
Chronic rhinosinusitis (CRS) is characterized by persistent locoregional mucosal inflammation of the paranasal sinuses and upper airway that has substantial associated health care costs1. Personalized approaches to care that incorporate use of molecular biomarkers, phenotypes and inflammatory endotypes is a major focus of research at this time, and the concurrent rise of targeted therapeutics and biologic therapies has the potential to rapidly advance care and improve outcomes. Recent findings suggest that improved understanding of CRS phenotypic and endotypic heterogeneity, and incorporation of these characteristics into clinical care pathways, may facilitate more effective selection of surgical and/or therapeutic interventions2. Ultimately, these personalized approaches have the potential to target specific inflammatory pathways, increase efficacy, reduce costs, and limit side effects. This review summarizes recent advances in the identification and characterization of CRS phenotypes, endotypes, and biomarkers and reviews potential implications for targeted therapeutics.
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Affiliation(s)
- Nikita Chapurin
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Jeffanie Wu
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Alex B Labby
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Rakesh K Chandra
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Justin H Turner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
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11
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Chapurin N, Dennis S, Chowdhury NI, Trone T, Chaballout B, Longino E, Turner JH, Chandra RK. Population differences between COVID-19 and other post-viral olfactory dysfunction: Results from a Large Case-Control Study. Int Forum Allergy Rhinol 2022; 12:1063-1066. [PMID: 34997952 PMCID: PMC9011799 DOI: 10.1002/alr.22955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/30/2021] [Accepted: 12/24/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Nikita Chapurin
- Vanderbilt University Medical Center, Division of Rhinology/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Nashville, TN, USA.,Vanderbilt University Medical Center Smell and Taste Center, Nashville, USA
| | - Spencer Dennis
- Vanderbilt University Medical Center, Division of Rhinology/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Nashville, TN, USA
| | - Naweed I Chowdhury
- Vanderbilt University Medical Center, Division of Rhinology/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Nashville, TN, USA.,Vanderbilt University Medical Center Smell and Taste Center, Nashville, USA
| | - Timothy Trone
- Vanderbilt University Medical Center, Division of Rhinology/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Nashville, TN, USA.,Vanderbilt University Medical Center Smell and Taste Center, Nashville, USA
| | - Basil Chaballout
- University of South Carolina School of Medicine Greenville, Greenville, SC, USA
| | - Elizabeth Longino
- Vanderbilt University Medical Center, Division of Rhinology/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Nashville, TN, USA
| | - Justin H Turner
- Vanderbilt University Medical Center, Division of Rhinology/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Nashville, TN, USA.,Vanderbilt University Medical Center Smell and Taste Center, Nashville, USA
| | - Rakesh K Chandra
- Vanderbilt University Medical Center, Division of Rhinology/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Nashville, TN, USA.,Vanderbilt University Medical Center Smell and Taste Center, Nashville, USA
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12
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Ayoub NF, Choby G, Turner JH, Abuzeid WM, Raviv JR, Thamboo A, Ma Y, Chandra RK, Chowdhury NI, Stokken JK, O’Brien EK, Shah S, Akbar N, Roozdar P, Nayak JV, Patel ZM, Hwang PH. Assessment of Opioid Use and Analgesic Requirements After Endoscopic Sinus Surgery: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2021; 147:811-819. [PMID: 34351376 PMCID: PMC8343514 DOI: 10.1001/jamaoto.2021.1839] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/21/2021] [Indexed: 02/01/2023]
Abstract
Importance The opioid epidemic has generated interest in optimizing opioid prescribing after common surgeries. Recent studies have shown a broad range of analgesic prescription patterns following endoscopic sinus surgery (ESS). Objective To compare the efficacy of different analgesic regimens after ESS. Design, Setting, and Participants This multi-institutional, nonblinded randomized clinical trial was conducted at 6 tertiary centers across the US and Canada and included participants who underwent ESS for acute or chronic rhinosinusitis. The study was conducted from March 2019 to March 2020, and the data were analyzed in November to December 2020. Interventions All participants received acetaminophen, 650 mg, as the first-line analgesic. From there, patients were randomized to either oxycodone rescue (oxycodone, 5 mg, as second-line therapy) or ibuprofen rescue (ibuprofen, 600 mg, as second-line therapy, with oxycodone, 5 mg, reserved for breakthrough pain). Main Outcomes and Measures Baseline characteristics and disease severity were collected at enrollment. Medication logs, pain scores, and epistaxis measures were collected until postoperative day 7. The primary outcome was the postoperative visual analog scale score for pain. Brief Pain Inventory Pain Severity and Pain Interference Scores were also collected. Results A total of 118 patients were randomized (62 [52.5%] oxycodone rescue, 56 [47.5%] ibuprofen rescue; mean [SD] age, 46.7 [16.3] years; 44 women [44.0%]; 83 White [83.0%], 7 Black [7.0%], and 7 Asian individuals [7.0%]). After exclusions for loss to follow-up and noncompliance, 51 remained in the oxycodone rescue group and 49 in the ibuprofen rescue group. The groups had similar demographic characteristics and disease severity. Thirty-two (63%) in the oxycodone rescue group had adequate pain management with acetaminophen only, while 19 (37%) consumed at least 1 oxycodone dose. In the ibuprofen rescue group, 18 (16%) required only acetaminophen, 28 (57%) used only acetaminophen and ibuprofen, and the remaining 13 (26%) consumed 1 or more oxycodone doses. The groups had similar average acetaminophen (9.69 vs 7.96 doses; difference, 1.73; 95% CI, -1.37 to 4.83) and oxycodone (1.89 vs 0.77 doses; difference, 1.13; 95% CI, -0.11 to 2.36) use. Both groups had similar postoperative visual analog scale scores. A subanalysis that compared opioids users with nonusers showed clinically significant lower pain scores in nonusers at multiple postoperative points. Conclusions and Relevance In this randomized clinical trial, most patients who underwent ESS could be treated postoperatively using a nonopioid regimen of either acetaminophen alone or acetaminophen and ibuprofen. Ibuprofen as a second-line therapy did not reduce overall narcotic consumption, but the overall narcotic use was low in both groups. Trial Registration ClinicalTrials.gov Identifier: NCT03783702.
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Affiliation(s)
- Noel F. Ayoub
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Garret Choby
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Justin H. Turner
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology, Vanderbilt Health, Nashville, Tennessee
| | - Waleed M. Abuzeid
- Division of Rhinology and Skull Base Surgery, Department of Otolaryngology–Head & Neck Surgery, University of Washington, Seattle
| | - Joseph R. Raviv
- Division of Otolaryngology–Head and Neck Surgery, NorthShore University Health System, Chicago, Illinois
| | - Andrew Thamboo
- Division of Otolaryngology, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yifei Ma
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Rakesh K. Chandra
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology, Vanderbilt Health, Nashville, Tennessee
| | - Naweed I. Chowdhury
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology, Vanderbilt Health, Nashville, Tennessee
| | - Janalee K. Stokken
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Erin K. O’Brien
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Sharan Shah
- Department of Otolaryngology–Head & Neck Surgery, Albert Einstein College of Medicine, Bronx, New York
| | - Nadeem Akbar
- Department of Otolaryngology–Head & Neck Surgery, Albert Einstein College of Medicine, Bronx, New York
| | - Pooya Roozdar
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Jayakar V. Nayak
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Zara M. Patel
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Peter H. Hwang
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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13
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Chapurin N, Totten DJ, Chaballout B, Brennan J, Dennis S, Lubner R, Chowdhury NI, Turner JH, Trone T, Chandra RK. Differential olfactory outcomes in COVID-19: A large healthcare system population study. Int Forum Allergy Rhinol 2021; 12:108-111. [PMID: 34289262 PMCID: PMC8426833 DOI: 10.1002/alr.22870] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Nikita Chapurin
- Department of Otolaryngology - Head and Neck Surgery, Division of Rhinology/Skull Base Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Douglas J Totten
- Department of Otolaryngology - Head and Neck Surgery, Division of Rhinology/Skull Base Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Basil Chaballout
- University of South Carolina School of Medicine, Greenville, South Carolina, USA
| | - Julia Brennan
- Department of Otolaryngology - Head and Neck Surgery, Division of Rhinology/Skull Base Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Spencer Dennis
- Department of Otolaryngology - Head and Neck Surgery, Division of Rhinology/Skull Base Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt University Medical Center Smell and Taste Center, Nashville, Tennessee, USA
| | - Rory Lubner
- Department of Otolaryngology - Head and Neck Surgery, Division of Rhinology/Skull Base Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Naweed I Chowdhury
- Department of Otolaryngology - Head and Neck Surgery, Division of Rhinology/Skull Base Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt University Medical Center Smell and Taste Center, Nashville, Tennessee, USA
| | - Justin H Turner
- Department of Otolaryngology - Head and Neck Surgery, Division of Rhinology/Skull Base Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt University Medical Center Smell and Taste Center, Nashville, Tennessee, USA
| | - Timothy Trone
- Department of Otolaryngology - Head and Neck Surgery, Division of Rhinology/Skull Base Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt University Medical Center Smell and Taste Center, Nashville, Tennessee, USA
| | - Rakesh K Chandra
- Department of Otolaryngology - Head and Neck Surgery, Division of Rhinology/Skull Base Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt University Medical Center Smell and Taste Center, Nashville, Tennessee, USA
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14
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Chapurin N, Li P, Chandra RK, Turner JH, Chowdhury NI. Elevated mucus interleukin-17A levels are associated with increased prior sinus surgery for chronic rhinosinusitis. Int Forum Allergy Rhinol 2021; 11:120-127. [PMID: 32702209 PMCID: PMC10722354 DOI: 10.1002/alr.22652] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/06/2020] [Accepted: 06/23/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Recent advances in molecular biology have enabled the identification of potential inflammatory endotypes of chronic rhinosinusitis (CRS), with prior work suggesting differential short-term surgical outcome trajectories based on cytokine signatures. However, there is a paucity of data assessing long-term treatment failure and need for revision surgery based on inflammatory biomarkers. METHODS Retrospective analysis of prospectively collected cross-sectional data from 231 patients electing surgical therapy for CRS. Intraoperative mucus specimens were quantitatively sampled for inflammatory cytokines using a multiplex flow cytometric bead assay. Univariate Spearman correlations between cytokine levels and prior number of surgeries were assessed. A stepwise adjusted multivariate Poisson regression analysis was used to model patient-reported prior sinus surgery counts as a function of cytokine levels. RESULTS Several cytokines (interleukin [IL]-1β, IL-4, IL-5, IL-6, IL-8, IL-10, IL-13, IL-17A, tumor necrosis factor α [TNF-α], interferon γ [IFN-γ], and eotaxin) demonstrated significant positive correlations with number of prior surgeries. However, only higher IL-17A levels were independently associated with a higher number of prior sinus surgeries (β = 0.345, p = 0.0003) after adjusting for the significant covariates of age (β = 0.018, p = 0.0036), Lund-Mackay score (β = -0.046, p = 0.02), history of aspirin-exacerbated respiratory disease (β = 1.01, p < 0.0001) and allergic fungal rhinosinusitis (β = 1.08, p < 0.0001). Higher levels of regulated on activation, normal T-cell expressed and secreted (RANTES) were conversely associated with a lower number of prior surgeries (β = -0.17, p = 0.048). CONCLUSION An IL-17A-predominant cytokine profile is linked to an increased number of prior sinus surgeries. Thus, type 3 inflammatory markers may indicate a particularly difficult-to-treat, recalcitrant CRS endotype.
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Affiliation(s)
- Nikita Chapurin
- Vanderbilt University Medical Center, Department of Otolaryngology-Head and Neck Surgery, Nashville, TN, USA
| | - Ping Li
- Vanderbilt University Medical Center, Department of Otolaryngology-Head and Neck Surgery, Nashville, TN, USA
| | - Rakesh K. Chandra
- Vanderbilt University Medical Center, Department of Otolaryngology-Head and Neck Surgery, Nashville, TN, USA
| | - Justin H. Turner
- Vanderbilt University Medical Center, Department of Otolaryngology-Head and Neck Surgery, Nashville, TN, USA
| | - Naweed I. Chowdhury
- Vanderbilt University Medical Center, Department of Otolaryngology-Head and Neck Surgery, Nashville, TN, USA
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15
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Scott WC, Cahill KN, Milne GL, Li P, Sheng Q, Huang LC, Dennis S, Snyder J, Bauer AM, Chandra RK, Chowdhury NI, Turner JH. Inflammatory heterogeneity in aspirin-exacerbated respiratory disease. J Allergy Clin Immunol 2020; 147:1318-1328.e5. [PMID: 33189729 DOI: 10.1016/j.jaci.2020.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/15/2020] [Accepted: 11/04/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Aspirin-exacerbated respiratory disease (AERD) is a mechanistically distinct subtype of chronic rhinosinusitis with nasal polyps (CRSwNP). Although frequently associated with type 2 inflammation, literature characterizing the milieu of inflammatory cytokines and lipid mediators in AERD has been conflicting. OBJECTIVE We sought to identify differences in the upper airway inflammatory signature between CRSwNP and AERD and determine whether endotypic subtypes of AERD may exist. METHODS Levels of 7 cytokines representative of type 1, type 2, and type 3 inflammation, and 21 lipid mediators were measured in nasal mucus from 109 patients with CRSwNP, 30 patients with AERD, and 64 non-CRS controls. Differences in inflammatory mediators were identified between groups, and patterns of inflammation among patients with AERD were determined by hierarchical cluster analysis. RESULTS AERD could be distinguished from CRSwNP by profound elevations in IL-5, IL-6, IL-13, and IFN-γ; however, significant heterogeneity existed between patients. Hierarchical cluster analysis identified 3 inflammatory subendotypes of AERD characterized by (1) low inflammatory burden, (2) high type 2 cytokines, and (3) comparatively low type 2 cytokines and high levels of type 1 and type 3 cytokines. Several lipid mediators were associated with asthma and sinonasal disease severity; however, lipid mediators showed less variability than cytokines. CONCLUSIONS AERD is associated with elevations in type 2 cytokines (IL-5 and IL-13) and the type 1 cytokine, IFN-γ. Among patients with AERD, the inflammatory signature is heterogeneous, supporting subendotypes of the disease. Variability in AERD immune signatures should be further clarified because this may predict clinical response to biologic medications that target type 2 inflammation.
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Affiliation(s)
- William C Scott
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Katherine N Cahill
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Ginger L Milne
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Ping Li
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Quanhu Sheng
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tenn
| | - Li Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tenn
| | - Spencer Dennis
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Jacob Snyder
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Ashley M Bauer
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Rakesh K Chandra
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Justin H Turner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tenn.
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16
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Chapurin N, Totten DJ, Louis PC, Lewis JS, Chowdhury NI, Turner J, Chandra RK. Sinonasal Small Cell Carcinoma-Case Series of a Rare Malignancy. Ear Nose Throat J 2020; 101:392-395. [PMID: 33090899 DOI: 10.1177/0145561320964640] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Sinonasal small cell neuroendocrine carcinoma (SNEC) is an extremely rare and aggressive neoplasm that can arise in the sinonasal region. These tumors are associated with high morbidity and mortality, are difficult to diagnose, and are hard to treat. We describe 2 cases of this poorly understood malignancy and review imaging, pathology, and treatment decisions. A 41-year-old male and a 64-year-old female presented to a tertiary center in 2019 after developing nasal obstruction and were found to have sinonasal masses on imaging. Both biopsies showed strong expression of pancytokeratin with dot-like reactivity and expression of neuroendocrine markers chromogranin and synaptophysin. The findings were diagnostic of SNEC. Staging positron emission tomography/computed tomography and brain MRI were performed, and patients were discussed at a multidisciplinary tumor board. Neither had distant metastatic disease at presentation. One patient had no intracranial or orbital disease and underwent a subtotal endoscopic resection with adjuvant chemoradiation. The other patient demonstrated middle cranial fossa, dural, and orbital involvement as well as cranial nerve V palsy. This patient was treated with induction chemotherapy, followed by concurrent chemoradiation. Both patients are presently alive at 4 months follow-up, but one with persistent local disease and the other distant metastasis. Sinonasal small cell neuroendocrine carcinoma is a rare and poorly understood malignancy with an aggressive clinical course. Continued careful review of pathology and study of molecular features are needed for improved understanding of SNEC, and particularly for head and neck SNEC, to establish a staging system and better formulate treatment protocols.
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Affiliation(s)
- Nikita Chapurin
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Peter C Louis
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James S Lewis
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Justin Turner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rakesh K Chandra
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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17
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Kimura KS, Freeman MH, Wessinger BC, Gupta V, Sheng Q, Huang LC, Von Wahlde K, Das SR, Chowdhury NI, Turner JH. Interim analysis of an open-label randomized controlled trial evaluating nasal irrigations in non-hospitalized patients with coronavirus disease 2019. Int Forum Allergy Rhinol 2020; 10:1325-1328. [PMID: 32914928 DOI: 10.1002/alr.22703] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 01/03/2023]
Affiliation(s)
- Kyle S Kimura
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Michael H Freeman
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | - Veerain Gupta
- Vanderbilt University School of Medicine, Nashville, TN
| | - Quanhu Sheng
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Li Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Kate Von Wahlde
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Suman R Das
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN.,Department of Medicine, Division of Microbiology and Infectious Disease, Vanderbilt University School of Medicine, Nashville, TN
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Justin H Turner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
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18
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Chapurin N, Totten DJ, Morse JC, Khurram MS, Louis PC, Sinard RJ, Chowdhury NI. Treatment of Sinonasal Teratocarcinosarcoma: A Systematic Review and Survival Analysis. Am J Rhinol Allergy 2020; 35:132-141. [PMID: 32954838 DOI: 10.1177/1945892420959585] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sinonasal teratocarcinosarcoma (SNTCS) is a rare malignancy of the anterior skull base with only 127 cases described in the English literature. Given the rarity of this tumor, new cases and analysis of published reports may assist in future management of SNTCS. OBJECTIVES 1) Describe findings from a systematic review of all available literature for malignant SNTCS including the clinical presentation, treatment modalities and outcomes. 2) Present two new cases of this rare anterior skull base tumor. 3) Compare treatment outcomes with respect to recurrence and mortality. METHODS A systematic review of all English literature available in 2 comprehensive databases was conducted by two independent reviewers using PRISMA guidelines. 85 publications were identified. Each case was reviewed for demographics, treatment and survival, and aggregate treatment outcomes were compared using Kaplan-Meier analysis. RESULTS A total of 64 articles meeting inclusion criteria were reported in the literature between 1977-2018. This represented a total of 127 patients, with a strong male predominance (83%) and mean age of 50 years (range 10-82). Mean follow-up was 21 months. Recurrence rate was 38%, with mean survival at 2 years of 55%. Almost all patients underwent surgery as a primary treatment modality (90%). The majority of cases were treated with multimodal therapy, with 55% receiving surgery and radiation and 20% receiving surgery with adjuvant chemoradiation. Kaplan-Meier analysis demonstrated a significant survival advantage for patients treated with combined therapy compared to surgery alone (p < 0.001) but did not show differences in recurrence (p = 0.085). CONCLUSION Two-year survival rates for SNTCS are 55%. Multimodality treatment outcomes appear to be superior to surgery alone based on the published data of this rare skull base tumor, although heterogeneity of treatment methods and reporting bias limits the generalizability of these findings.
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Affiliation(s)
- Nikita Chapurin
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Justin C Morse
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mohammad S Khurram
- Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Peter C Louis
- Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert J Sinard
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Naweed I Chowdhury
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee
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Succar EF, Li P, Ely KA, Chowdhury NI, Chandra RK, Turner JH. Neutrophils are underrecognized contributors to inflammatory burden and quality of life in chronic rhinosinusitis. Allergy 2020; 75:713-716. [PMID: 31583712 DOI: 10.1111/all.14071] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 09/10/2019] [Accepted: 09/16/2019] [Indexed: 01/14/2023]
Affiliation(s)
- Eric F. Succar
- Department of Otolaryngology‐Head and Neck Surgery Vanderbilt University School of Medicine Nashville TN
| | - Ping Li
- Department of Otolaryngology‐Head and Neck Surgery Vanderbilt University School of Medicine Nashville TN
| | - Kim A. Ely
- Department of Pathology, Microbiology, and Immunology Vanderbilt University School of Medicine Nashville TN
| | - Naweed I. Chowdhury
- Department of Otolaryngology‐Head and Neck Surgery Vanderbilt University School of Medicine Nashville TN
| | - Rakesh K. Chandra
- Department of Otolaryngology‐Head and Neck Surgery Vanderbilt University School of Medicine Nashville TN
| | - Justin H. Turner
- Department of Otolaryngology‐Head and Neck Surgery Vanderbilt University School of Medicine Nashville TN
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Chowdhury NI, Li P, Chandra RK, Turner JH. Baseline mucus cytokines predict 22-item Sino-Nasal Outcome Test results after endoscopic sinus surgery. Int Forum Allergy Rhinol 2019; 10:15-22. [PMID: 31645085 DOI: 10.1002/alr.22449] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/15/2019] [Accepted: 09/10/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Mucus cytokines have been linked to baseline metrics of quality of life and olfactory function in patients with chronic rhinosinusitis (CRS). However, their potential utility in predicting postoperative outcomes has not been assessed. Therefore, in this study we evaluated the role of mucus cytokines in predicting 22-item Sino-Nasal Outcomes Test (SNOT-22) scores after endoscopic sinus surgery (ESS) in a prospective cohort of CRS patients. METHODS One hundred forty-seven patients with CRS electing surgical therapy were enrolled in a longitudinal cohort study. Mucus was collected intraoperatively from the middle meatus and tested for interleukin (IL)-1β, IL-2, -4, -5, -6, -7,- 8, -9, -10, -12, -13, -17A, and -21; tumor necrosis factor (TNF)-α; interferon-γ; eotaxin; and RANTES (regulated-on-activation, normal T-cell expressed and secreted) expression using a multiplex flow-cytometric bead assay. Sixty-two patients were followed postoperatively (average, 10.2 months) with baseline and follow-up SNOT-22 surveys. Stepwise multivariate linear regression was used to model relationships between baseline cytokines, phenotype, and average postoperative SNOT-22 total and domain scores. A machine learning approach using a random forest algorithm was also used to investigate potential nonlinear relationships. RESULTS IL-5 was an independent predictor of postoperative total SNOT-22 improvement (β = -8.8, p < 0.0001), whereas IL-2 levels predicted postoperative worsening (β = 6.97, p = 0.0015). Similar relationships were also seen for postoperative SNOT-22 domain scores. The overall model was also noted to be significant fit for the data (adjusted R2 = 0.398, p < 0.0001). The random forest model similarly identified IL-5, TNF-α, IL-13, and IL-2 as major predictors of postoperative SNOT-22 scores. CONCLUSION Mucus cytokine profiles may help identify CRS patients who are likely to obtain postoperative improvement after ESS.
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Affiliation(s)
- Naweed I Chowdhury
- Division of Rhinology/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Ping Li
- Division of Rhinology/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Rakesh K Chandra
- Division of Rhinology/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Justin H Turner
- Division of Rhinology/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN
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Yancey KL, Li P, Huang LC, Sheng Q, Chandra RK, Chowdhury NI, Turner JH. Longitudinal stability of chronic rhinosinusitis endotypes. Clin Exp Allergy 2019; 49:1637-1640. [PMID: 31541576 DOI: 10.1111/cea.13502] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/02/2019] [Accepted: 09/03/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Kristen L Yancey
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ping Li
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Quanhu Sheng
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rakesh K Chandra
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Justin H Turner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Yancey KL, Lowery AS, Chandra RK, Chowdhury NI, Turner JH. Advanced age adversely affects chronic rhinosinusitis surgical outcomes. Int Forum Allergy Rhinol 2019; 9:1125-1134. [PMID: 31454179 PMCID: PMC6773466 DOI: 10.1002/alr.22404] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/09/2019] [Accepted: 07/18/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patient-specific and disease-specific factors shape the course of chronic rhinosinusitis (CRS) and its response to treatment, with optimal management involving interventions tailored to these factors. Recent evidence suggests CRS inflammatory signatures depend on age. The objective of this study was to determine whether age also influences quality-of-life (QOL) and postoperative outcomes. METHODS Retrospective analysis of prospectively collected QOL data from 403 adults with medically refractory CRS who underwent functional endoscopic sinus surgery (FESS) at a tertiary care medical center between 2014 and 2018 was undertaken. Total and subdomain scores from the 22-item Sino-Nasal Outcome Test (SNOT-22) and the Short Form 8 Health Survey (SF-8) measure of general health completed at preoperative and postoperative visits were reviewed. RESULTS Patients were divided into young (18 to 39 years, n = 100), middle-aged (40 to 59 years, n = 172), and elderly (≥60 years, n = 131) groups. Baseline total SNOT-22 scores differed between groups (p = 0.01), with middle-aged patients having the highest symptom burden and elderly patients having the lowest. Similar patterns were observed for SNOT-22 subdomains. Elderly patients reported smaller improvements and were less likely to achieve a minimally important clinical difference. CRS patients had worse SF-8 scores compared to the general population, and elderly patients were the least likely to match population norms following surgery. Age was an independent predictor of QOL outcomes after FESS. CONCLUSION Age may play a significant role in CRS pathophysiology, symptom burden, and surgical outcomes. Elderly patients report smaller improvements in disease-specific and general health QOL after surgery. CRS management in the elderly population should incorporate age-dependent differences in symptom burden and expectations into treatment algorithms.
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Affiliation(s)
- Kristen L Yancey
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Anne S Lowery
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Rakesh K Chandra
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Justin H Turner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
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Morse JC, Li P, Ely KA, Shilts MH, Wannemuehler TJ, Huang LC, Sheng Q, Chowdhury NI, Chandra RK, Das SR, Turner JH. Chronic rhinosinusitis in elderly patients is associated with an exaggerated neutrophilic proinflammatory response to pathogenic bacteria. J Allergy Clin Immunol 2019; 143:990-1002.e6. [PMID: 30468775 PMCID: PMC6408962 DOI: 10.1016/j.jaci.2018.10.056] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 10/15/2018] [Accepted: 10/29/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Potential effects of aging on chronic rhinosinusitis (CRS) pathophysiology have not been well defined but might have important ramifications given a rapidly aging US and world population. OBJECTIVE The goal of the current study was to determine whether advanced age is associated with specific inflammatory CRS endotypes or immune signatures. METHODS Levels of 17 mucus cytokines and inflammatory mediators were measured in 147 patients with CRS. Hierarchical cluster analysis was used to identify and characterize inflammatory CRS endotypes, as well as to determine whether age was associated with specific immune signatures. RESULTS A CRS endotype with a proinflammatory neutrophilic immune signature was enriched in older patients. In the overall cohort patients 60 years and older had increased mucus levels of IL-1β, IL-6, IL-8, and TNF-α when compared with their younger counterparts. Increases in levels of proinflammatory cytokines were associated with both tissue neutrophilia and symptomatic bacterial infection/colonization in aged patients. CONCLUSIONS Aged patients with CRS have a unique inflammatory signature that corresponds to a neutrophilic proinflammatory response. Neutrophil-driven inflammation in aged patients with CRS might be less likely to respond to corticosteroids and might be closely linked to chronic microbial infection or colonization.
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Affiliation(s)
- Justin C Morse
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Ping Li
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Kim A Ely
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tenn
| | - Meghan H Shilts
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Todd J Wannemuehler
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tenn
| | - Quanhu Sheng
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tenn
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Rakesh K Chandra
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Suman R Das
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Justin H Turner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tenn.
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Chowdhury NI, Chandra RK, Li P, Ely K, Turner JH. Investigating the correlation between mucus cytokine levels, inflammatory cell counts, and baseline quality-of-life measures in chronic rhinosinusitis. Int Forum Allergy Rhinol 2019; 9:538-544. [PMID: 30629853 DOI: 10.1002/alr.22287] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/17/2018] [Accepted: 12/20/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND It is hypothesized that uncontrolled inflammation is responsible for many of the manifestations and symptoms of chronic rhinosinusitis (CRS). Although earlier work has demonstrated an association between olfactory loss and mucus cytokines, the impact on other symptoms is unknown. In this study we investigated the relationship between cytokines, inflammatory cell counts, and patient-reported outcomes measures to better understand how the inflammatory microenvironment correlates with CRS symptomatology. METHODS The 22-item Sino-Nasal Outcome Test (SNOT-22) and 8-item Short Form Health Survey (SF-8) were administered to 76 patients undergoing endoscopic sinus surgery for CRS. Mucus was collected intraoperatively from the middle meatus and tested for 17 cytokines using a multiplex flow cytometric bead assay. Eosinophil/neutrophil counts were obtained from histopathologic slide review. Spearman correlations between cytokines, cell counts, and quality-of-life subdomain scores were assessed without multiple comparisons correction due to the small sample size. RESULTS Interleukin-4 (IL-4) correlated significantly with the Rhinologic domain (Rs = 0.25, p = 0.03), whereas eosinophil and neutrophil counts were inversely correlated with the Extranasal Rhinologic domain (Rs = -0.32, p = 0.01; and Rs = -0.27, p = 0.03). Subgroup analysis for nasal polyposis (CRSwNP) showed significant correlations between IL-6 and Total SF-8 (Rs = 0.35, p = 0.02), General Health (Rs = 0.34, p = 0.03), and Emotional (Rs = 0.47, p = 0.002) scores. In patients without polyps (CRSsNP), IL-21 correlated positively with Extranasal Rhinologic Symptoms domain (Rs = 0.41, p = 0.01). CONCLUSION This pilot study identifies possible pairwise correlations between mucus cytokine levels and baseline quality-of-life measures that need confirmation in larger, targeted studies. Due to the exploratory methodology, positive results may be spurious and should only be used as a starting point for future confirmatory work.
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Affiliation(s)
- Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Rakesh K Chandra
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Ping Li
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Kim Ely
- Department of Pathology, Microbiology, Immunology, Vanderbilt University School of Medicine, Nashville, TN
| | - Justin H Turner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN
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Chowdhury NI, Turner JH, Dorminy C, Wu J, Chandra RK. Preoperative quality-of-life measures predict acute postoperative pain in endoscopic sinus surgery. Laryngoscope 2019; 129:1274-1279. [PMID: 30613981 DOI: 10.1002/lary.27763] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Recent increases in opioid-related mortality have prompted a critical evaluation of postoperative pain management across all specialties. However, successfully limiting narcotic overprescription requires perioperative identification of patients who are at risk for high postoperative pain. Unfortunately, quality data to guide practice patterns are lacking. We therefore prospectively investigated several possible predictive factors of postoperative pain after endoscopic sinus surgery (ESS). METHODS Sixty-four consecutive patients undergoing ESS were enrolled. Baseline 22-item SinoNasal Outcomes Test (SNOT-22) and Short-Form 8 (SF-8) scores were obtained. Pain scores were collected postoperatively using a numeric rating scale. Spearman correlations and univariate linear regression models were used to investigate relationships between postoperative pain, patient factors, and SNOT-22/SF-8 domain scores. Multivariate linear regression was then performed to control for potential confounding variables. RESULTS Day-of-surgery pain scores were significantly correlated with the SF-8 role-physical domain (Rs = 0.32, P = 0.04). Whereas SF-8 pain scores were initially nonsignificant, at postoperative day 3 (POD3) the preoperative SF-8 pain score became correlated with self-reported pain (Rs = 0.39, P = 0.02). SNOT-22 total and subdomain scores were not associated with pain scores at any time point. Multivariate linear regression modelling identified baseline SF-8 role-physical and pain scores, smoking status, and undergoing a modified Lothrop procedure as significant independent predictors of POD3 pain (adjusted R2 = 0.359, P < 0.0001). CONCLUSION Baseline patient-reported global quality-of-life measures are associated with postoperative pain after ESS. Large multicenter studies are necessary to validate these findings and investigate additional factors associated with postoperative pain following ESS. LEVEL OF EVIDENCE 2c Laryngoscope, 129:1274-1279, 2019.
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Affiliation(s)
- Naweed I Chowdhury
- Vanderbilt University School of Medicine, Otolaryngology & Head and Neck Surgery, Nashville, Tennessee, U.S.A
| | - Justin H Turner
- Vanderbilt University School of Medicine, Otolaryngology & Head and Neck Surgery, Nashville, Tennessee, U.S.A
| | - Cindy Dorminy
- Vanderbilt University School of Medicine, Otolaryngology & Head and Neck Surgery, Nashville, Tennessee, U.S.A
| | - Jeffanie Wu
- Vanderbilt University School of Medicine, Otolaryngology & Head and Neck Surgery, Nashville, Tennessee, U.S.A
| | - Rakesh K Chandra
- Vanderbilt University School of Medicine, Otolaryngology & Head and Neck Surgery, Nashville, Tennessee, U.S.A
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Morse JC, Shilts MH, Ely KA, Li P, Sheng Q, Huang LC, Wannemuehler TJ, Chowdhury NI, Chandra RK, Das SR, Turner JH. Patterns of olfactory dysfunction in chronic rhinosinusitis identified by hierarchical cluster analysis and machine learning algorithms. Int Forum Allergy Rhinol 2018; 9:255-264. [PMID: 30485725 DOI: 10.1002/alr.22249] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/24/2018] [Accepted: 10/28/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Olfactory dysfunction is a common symptom of chronic rhinosinusitis (CRS). We previously identified several cytokines potentially linked to smell loss, potentially supporting an inflammatory etiology for CRS-associated olfactory dysfunction. In the current study we sought to validate patterns of olfactory dysfunction in CRS using hierarchical cluster analysis, machine learning algorithms, and multivariate regression. METHODS CRS patients undergoing functional endoscopic sinus surgery were administered the Smell Identification Test (SIT) preoperatively. Mucus was collected from the middle meatus using an absorbent polyurethane sponge and 17 inflammatory mediators were assessed using a multiplexed flow-cytometric bead assay. Hierarchical cluster analysis was performed to characterize inflammatory patterns and their association with SIT scores. The random forest approach was used to identify cytokines predictive of olfactory function. RESULTS One hundred ten patients were enrolled in the study. Hierarchical cluster analysis identified 5 distinct CRS clusters with statistically significant differences in SIT scores observed between individual clusters (p < 0.001). A majority of anosmic patients were found in a single cluster, which was additionally characterized by nasal polyposis (100%) and a high incidence of allergic fungal rhinosinusitis (50%) and aspirin-exacerbated respiratory disease (AERD) (33%). A random forest approach identified a strong association between olfaction and the cytokines interleukin (IL)-5 and IL-13. Multivariate modeling identified AERD, computed tomography (CT) score, and IL-2 as the variables most predictive of olfactory function. CONCLUSION Olfactory dysfunction is associated with specific CRS endotypes characterized by severe nasal polyposis, tissue eosinophilia, and AERD. Mucus IL-2 levels, CT score, and AERD were independently associated with smell loss.
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Affiliation(s)
- Justin C Morse
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Meghan H Shilts
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Kim A Ely
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Ping Li
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Quanhu Sheng
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Todd J Wannemuehler
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Rakesh K Chandra
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Suman R Das
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Justin H Turner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
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Chowdhury NI, Mace JC, Bodner TE, Alt JA, Deconde AS, Levy JM, Smith TL. Does Medical Therapy Improve SinoNasal Outcomes Test-22 Domain Scores? An Analysis of Clinically Important Differences. Laryngoscope 2018; 129:31-36. [PMID: 30208209 DOI: 10.1002/lary.27470] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Minimum clinically important differences (MCIDs) for the 22-item SinoNasal Outcomes Test (SNOT-22) in patients with chronic rhinosinusitis (CRS) electing endoscopic sinus surgery (ESS) are well described. However, similar estimations for the MCID have not been investigated for patients electing continued appropriate medical therapy (CAMT). We sought to determine MCID values for a medically treated CRS cohort and compare them to historical MCIDs associated with ESS. STUDY DESIGN Prospective observational cohort study. METHODS One hundred twenty patients with refractory CRS electing CAMT were prospectively enrolled from academic referral clinics into an observational cohort study. Baseline and posttreatment SNOT-22 survey responses were collected. Four distribution-based methods for calculating MCIDs (e.g., half-standard deviation, Cohen's d, standard error of measurement, and minimum detectable change) were used to identify a range of MCID values for SNOT-22 total and domain scores. RESULTS The average MCID value for SNOT-22 total scores was 8.0, whereas mean MCID values for rhinologic, extranasal rhinologic, ear/facial, psychological, and sleep symptom domain scores were 3.9, 2.5, 3.3, 3.4, and 2.9, respectively, comparable to previously reported values for patients electing ESS. Although change in SNOT-22 total scores following CAMT exceeded the MCID, none of the average SNOT-22 domain score improvements surpassed their respective MCID thresholds. CONCLUSIONS MCID values for SNOT-22 total and domain scores in patients electing CAMT are similar to previously published MCID values associated with ESS, indicating that MCID values are independent of treatment modality selection. Therefore, despite evidence of statistical significance, CAMT for CRS may not be associated with clinically discernable improvements in average SNOT-22 domain scores. LEVEL OF EVIDENCE 2c Laryngoscope, 129:31-36, 2019.
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Affiliation(s)
- Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, Oregon Health and Science University, Portland, Oregon
| | - Todd E Bodner
- Department of Psychology, Portland State University, Portland, Oregon
| | - Jeremiah A Alt
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Adam S Deconde
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, U.S.A
| | - Joshua M Levy
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, Oregon Health and Science University, Portland, Oregon
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Chowdhury NI, Smith TL, Chandra RK, Turner JH. Automated classification of osteomeatal complex inflammation on computed tomography using convolutional neural networks. Int Forum Allergy Rhinol 2018; 9:46-52. [PMID: 30098123 DOI: 10.1002/alr.22196] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/08/2018] [Accepted: 07/09/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Convolutional neural networks (CNNs) are advanced artificial intelligence algorithms well suited to image classification tasks with variable features. These have been used to great effect in various real-world applications including handwriting recognition, face detection, image search, and fraud prevention. We sought to retrain a robust CNN with coronal computed tomography (CT) images to classify osteomeatal complex (OMC) occlusion and assess the performance of this technology with rhinologic data. METHODS The Google Inception-V3 CNN trained with 1.28 million images was used as the base model. Preoperative coronal sections through the OMC were obtained from 239 patients enrolled in 2 prospective chronic rhinosinusitis (CRS) outcomes studies, labeled according to OMC status, and mirrored to obtain a set of 956 images. Using this data, the classification layer of Inception-V3 was retrained in Python using a transfer learning method to adapt the CNN to the task of interpreting sinonasal CT images. RESULTS The retrained neural network achieved 85% classification accuracy for OMC occlusion, with a 95% confidence interval for algorithm accuracy of 78% to 92%. Receiver operating characteristic (ROC) curve analysis on the test set confirmed good classification ability of the CNN with an area under the ROC curve (AUC) of 0.87, significantly different than both random guessing and a dominant classifier that predicts the most common class (p < 0.0001). CONCLUSION Current state-of-the-art CNNs may be able to learn clinically relevant information from 2-dimensional sinonasal CT images with minimal supervision. Future work will extend this approach to 3-dimensional images in order to further refine this technology for possible clinical applications.
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Affiliation(s)
- Naweed I Chowdhury
- Vanderbilt University School of Medicine, Otolaryngology-Head & Neck Surgery, Nashville, TN
| | - Timothy L Smith
- Oregon Health & Science University, Department of Otolaryngology-Head & Neck Surgery, Portland, OR
| | - Rakesh K Chandra
- Vanderbilt University School of Medicine, Otolaryngology-Head & Neck Surgery, Nashville, TN
| | - Justin H Turner
- Vanderbilt University School of Medicine, Otolaryngology-Head & Neck Surgery, Nashville, TN
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Muelleman T, Chowdhury NI, Killeen D, Sykes K, Kutz JW, Isaacson B, Staecker H, Lin J. Effect of Piecemeal vs En Bloc Approaches to the Lateral Temporal Bone on Survival Outcomes. Otolaryngol Head Neck Surg 2018; 158:716-720. [DOI: 10.1177/0194599818758994] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Lateral temporal bone resection (LTBR) has traditionally been performed en bloc in accordance with oncologic principles. Occasionally, this is not possible due to a low tegmen or lateralized vasculature. We sought to determine if outcomes of piecemeal and en bloc LTBR are comparable. Study Design Retrospective review. Setting Two academic medical centers. Subjects and Methods Multi-institutional retrospective cohort study. Current Procedural Terminology codes were used to identify patients with T1 to T3 squamous cell carcinoma of the external auditory canal (EAC) who underwent LTBR from 2005 to 2015. Kaplan-Meier curves were constructed to compare total survival between the 2 treatment approaches. Pairwise comparisons were performed using χ2 and Fisher exact tests (significance at P = .05), as appropriate. Results Twenty-five patients were identified. Ten patients underwent en bloc LTBR; 15 underwent piecemeal LTBR. Median follow-up time was 11 months (range, 1-60 months). There was not a significant difference in overall survival between en bloc (38.9 months; 95% confidence interval [CI], 22.7-55.2) compared to piecemeal (37.5 months; 95% CI, 21.1-53.9) procedures ( P = .519). Estimates of disease-free survival also did not reveal statistically significant differences: estimated mean disease-free survival was 48.1 months (95% CI, 33.7-62.6) in en bloc patients and 32.5 months (95% CI, 17.1-47.8) in piecemeal patients ( P = .246). Conclusion These data suggest that piecemeal resection can be considered for cases of squamous cell carcinoma involving the external auditory canal where anatomic constraints preclude a safe en bloc resection. Larger studies or studies with a longer follow-up time may provide improved insight into survival comparisons.
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Affiliation(s)
- Thomas Muelleman
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas, Kansas City, Kansas, USA
| | - Naweed I. Chowdhury
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, USA
| | - Daniel Killeen
- Department of Otolaryngology–Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Kevin Sykes
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas, Kansas City, Kansas, USA
| | - J. Walter Kutz
- Department of Otolaryngology–Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Brandon Isaacson
- Department of Otolaryngology–Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Hinrich Staecker
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas, Kansas City, Kansas, USA
| | - James Lin
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas, Kansas City, Kansas, USA
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Morrison DA, Wise SK, DelGaudio JM, Chowdhury NI, Levy JM. Intranasal tissue necrosis associated with opioid abuse: Case report and systematic review. Laryngoscope 2017; 128:1767-1771. [PMID: 29280484 DOI: 10.1002/lary.27069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Opioid abuse is a common disorder affecting over 2 million Americans. Intranasal tissue necrosis is a previously described sequela of nasal opioid inhalation, with a similar presentation to invasive fungal rhinosinusitis (IFRS). The goal of this case report and systematic review is to evaluate the evidence supporting this uncommon disease, with qualitative analysis of the presentation, management and treatment outcomes. DATA SOURCES MEDLINE, EMBASE, Google Scholar, Scopus, and Web of Science. REVIEW METHODS Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were utilized to identify English-language studies reporting intranasal mucosal injury associated with prescription opioid abuse. Primary outcomes included clinical presentation, treatment strategies, and outcomes. RESULTS Systematic review identified 61 patients for qualitative analysis. Common clinical features include facial pain without a history of chronic sinusitis or known immunodeficiency. Diagnostic nasal endoscopy revealed superficial debris with underlying tissue necrosis, consistent with a preliminary diagnosis of IFRS. Characteristic pathologic findings include mucosal ulceration with an overlying acellular substrate, often with polarizable material. Fungal colonization is often reported, with several accounts of angiocentric invasion in immunocompetent patients. Complete symptom resolution is expected following surgical debridement with cessation of intranasal opioid inhalation, with 89% of identified patients experiencing a complete resolution of disease. CONCLUSION Intranasal opioid abuse is a prevalent condition associated with chronic pain and tissue necrosis that is clinically concerning for invasive fungal disease. Whereas IFRS must be excluded, even in patients without known immunodeficiency, complete resolution of symptoms can be expected following surgical debridement with cessation of opioid abuse. Laryngoscope, 1767-1771, 2018.
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Affiliation(s)
| | - Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - John M DelGaudio
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Naweed I Chowdhury
- Department of Otolaryngology and Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Joshua M Levy
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia
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Beswick DM, Mace JC, Chowdhury NI, Alt JA, Hwang PH, DeConde AS, Smith TL. Comparison of surgical outcomes between patients with unilateral and bilateral chronic rhinosinusitis. Int Forum Allergy Rhinol 2017; 7:1162-1169. [PMID: 28941136 PMCID: PMC5716933 DOI: 10.1002/alr.22020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/25/2017] [Accepted: 09/05/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although the majority of patients with chronic rhinosinusitis without nasal polyposis (CRSsNP) suffer from bilateral disease, a subset suffer from unilateral disease. Currently, outcomes following endoscopic sinus surgery (ESS) for medically recalcitrant CRS are inferred from outcomes for patients with bilateral disease. This study compares outcomes of ESS between patients with unilateral and bilateral disease. METHODS Patients with CRSsNP who failed appropriate medical therapy and elected ESS were enrolled between 2011 and 2015. Patients were dichotomized according to radiographic evidence of unilateral disease (Lund-Mackay [LM] score = 0 for 1 side) or bilateral disease (LM ≥ 1 for both sides). The primary outcome of interest was the 22-item Sino-Nasal Outcome Test (SNOT-22), with secondary outcomes including the Brief Smell Identification Test (BSIT) and the Lund-Kennedy (LK) endoscopy staging system. RESULTS A total of 190 patients met inclusion criteria consisting of 19 with unilateral (10%) and 171 with bilateral CRSsNP (90%). Both groups were similar across all preoperative demographic factors, SNOT-22, and BSIT scores. Postoperatively, patients with bilateral disease reported greater improvement in mean SNOT-22 scores compared to unilateral disease, but this difference was not statistically or clinically significant (-24.3 ± 21.1 vs -21.5 ± 24.0, p = 0.582). Mean LK scores improved for patients with bilateral disease but not unilateral disease, without a difference between groups (-2.0 ± 3.5 vs -0.4 ± 2.4, p = 0.090). CONCLUSION Patients with unilateral CRSsNP experience improvement after ESS comparable to patients with bilateral disease on patient reported outcome measures.
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Affiliation(s)
- Daniel M. Beswick
- Oregon Health & Science University, Department of Otolaryngology-Head and Neck Surgery, Portland, OR
| | - Jess C. Mace
- Oregon Health & Science University, Department of Otolaryngology-Head and Neck Surgery, Portland, OR
| | - Naweed I. Chowdhury
- Vanderbilt University Medical Center, Department of Otolarynoglogy & Head and Neck Surgery, Nashville, TN
| | - Jeremiah A. Alt
- University of Utah, School of Medicine, Department of Surgery, Division of Otolaryngology – Head & Neck Surgery, Salt Lake City, UT
| | - Peter H. Hwang
- Stanford University, Department of Otolaryngology-Head & Neck Surgery, Stanford, CA
| | - Adam S. DeConde
- University of California – San Diego School of Medicine, Department of Surgery, Division of Otolaryngology, San Diego, CA
| | - Timothy L. Smith
- Oregon Health & Science University, Department of Otolaryngology-Head and Neck Surgery, Portland, OR
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Chowdhury NI, Mace JC, Bodner TE, Alt JA, Deconde AS, Levy JM, Smith TL. Investigating the minimal clinically important difference for SNOT-22 symptom domains in surgically managed chronic rhinosinusitis. Int Forum Allergy Rhinol 2017; 7:1149-1155. [PMID: 29053911 DOI: 10.1002/alr.22028] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/06/2017] [Accepted: 09/26/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Prior work has described 5 domains within the 22-item Sino-Nasal Outcomes Test (SNOT-22) that allow for stratification of symptoms into similar clusters and that can be used to direct therapy. Although the outcomes of various interventions on these symptom domains have been reported, minimal clinically important difference (MCID) values have not been investigated, which has limited clinical interpretation of these results. METHODS This study was designed as a secondary analysis of a prospective, multi-institutional, observational cohort. A total of 276 patients with medically refractory CRS who underwent surgical management were enrolled. Distribution-based methods (half-standard deviation, standard error of measurement, Cohen's d, and the minimum detectable change) were used to compute MCID values for both SNOT-22 total and domain scores. The Medical Outcomes Study Short Form 6D (SF-6D) health utility score was used to operationalize anchor-based associations using receiver-operating characteristic (ROC) curves. RESULTS The mean MCID of several distribution-based methods for total SNOT-22 scores was 9.0, in agreement with previously published metrics. Average MCID values for the rhinologic, extranasal rhinologic, ear/facial, psychological, and sleep domain scores were 3.8, 2.4, 3.2, 3.9, and 2.9, respectively. Anchor-based approaches with the SF-6D did not have strong predictive accuracy across total SNOT-22 scores or domains (ROC areas under-the-curve ≤ 0.71), indicating weak associations between improvement in SNOT-22 scores and health utility as measured by the SF-6D. CONCLUSION This estimation of MCID values for the SNOT-22 symptom domains allows for improved clinical interpretation of results from past, present, and future rhinologic outcomes research.
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Affiliation(s)
- Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Todd E Bodner
- Department of Psychology, Portland State University, Portland, OR
| | - Jeremiah A Alt
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Adam S Deconde
- Division of Otolaryngology, Department of Surgery, University of California, San Diego School of Medicine, San Diego, CA
| | - Joshua M Levy
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR
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Chandrasekharappa SC, Chinn SB, Donovan FX, Chowdhury NI, Kamat A, Adeyemo AA, Thomas JW, Vemulapalli M, Hussey CS, Reid HH, Mullikin JC, Wei Q, Sturgis EM. Assessing the spectrum of germline variation in Fanconi anemia genes among patients with head and neck carcinoma before age 50. Cancer 2017; 123:3943-3954. [PMID: 28678401 DOI: 10.1002/cncr.30802] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/27/2017] [Accepted: 04/24/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Patients with Fanconi anemia (FA) have an increased risk for head and neck squamous cell carcinoma (HNSCC). The authors sought to determine the prevalence of undiagnosed FA and FA carriers among patients with HNSCC as well as an age cutoff for FA genetic screening. METHODS Germline DNA samples from 417 patients with HNSCC aged <50 years were screened for sequence variants by targeted next-generation sequencing of the entire length of 16 FA genes. RESULTS The sequence revealed 194 FA gene variants in 185 patients (44%). The variant spectrum was comprised of 183 nonsynonymous point mutations, 9 indels, 1 large deletion, and 1 synonymous variant that was predicted to effect splicing. One hundred eight patients (26%) had at least 1 rare variant that was predicted to be damaging, and 57 (14%) had at least 1 rare variant that was predicted to be damaging and had been previously reported. Fifteen patients carried 2 rare variants or an X-linked variant in an FA gene. Overall, an age cutoff for FA screening was not identified among young patients with HNSCC, because there were no significant differences in mutation rates when patients were stratified by age, tumor site, ethnicity, smoking status, or human papillomavirus status. However, an increased burden, or mutation load, of FA gene variants was observed in carriers of the genes FA complementation group D2 (FANCD2), FANCE, and FANCL in the HNSCC patient cohort relative to the 1000 Genomes population. CONCLUSIONS FA germline functional variants offer a novel area of study in HNSCC tumorigenesis. FANCE and FANCL, which are components of the core complex, are known to be responsible for the recruitment and ubiquitination, respectively, of FANCD2, a critical step in the FA DNA repair pathway. In the current cohort, the increased mutation load of FANCD2, FANCE, and FANCL variants among younger patients with HNSCC indicates the importance of the FA pathway in HNSCC. Cancer 2017;123:3943-54. © 2017 American Cancer Society.
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Affiliation(s)
- Settara C Chandrasekharappa
- Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, The University of Michigan, Ann Arbor, Michigan
| | - Frank X Donovan
- Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Aparna Kamat
- Cancer Genetics and Comparative Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Adebowale A Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - James W Thomas
- Intramural Sequencing Center, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Meghana Vemulapalli
- Intramural Sequencing Center, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Caroline S Hussey
- The University of Texas Health Science Center School of Medicine, Houston, Texas
| | - Holly H Reid
- Department of Dermatology, The University of Texas Health Science Center School of Medicine, Houston, Texas
| | - James C Mullikin
- Intramural Sequencing Center, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Qingyi Wei
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Erich M Sturgis
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Chowdhury NI, Mace JC, Smith TL, Rudmik L. What drives productivity loss in chronic rhinosinusitis? A SNOT-22 subdomain analysis. Laryngoscope 2017; 128:23-30. [PMID: 28600803 DOI: 10.1002/lary.26723] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 04/25/2017] [Accepted: 05/05/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Previous studies have shown declines in productivity due to chronic rhinosinusitis (CRS) are correlated with disease-specific quality-of-life (QOL) measures. However, it is unclear which symptom domains contribute primarily to productivity loss. This investigation sought to assess the association between CRS-specific QOL subdomain impairment and productivity loss. STUDY DESIGN Prospective, multi-institutional, observational cohort study. METHODS There were 198 patients with refractory CRS enrolled between August 2012 and June 2015. Baseline QOL measures were obtained across five subdomains of the 22-item SinoNasal Outcome Test (SNOT-22). Lost productivity time was determined from patient-reported measures of annual absenteeism, presenteeism, and lost leisure time, and then monetized using annual daily wage rates from the 2012 US National Census and 2013 Department of Labor statistics. RESULTS Productivity losses correlated with impairments in both SNOT-22 psychological dysfunction (Spearman correlation coefficient [Rs] = 0.428, P < .001), and sleep dysfunction domain scores (Rs = 0.355, P < .001). Higher SNOT-22 total scores also significantly correlated with increased monetized productivity losses (Rs = 0.366, P < .001). The mean annual productivity cost was $11,820/patient, whereas patients with comorbid immunodeficiency ($23,285/patient), tobacco use ($23,195/patient), and steroid dependency ($18,910/patient) reported higher than average annual productivity costs. Multivariate linear regression found maximum annual productivity costs in adjusted psychological ($13,300/patient, P < .001) and sleep dysfunction ($9,275/patient, P < .001) domains. CONCLUSIONS Impairments in sleep and psychological SNOT-22 domains correlate with productivity losses. Patients with comorbid immunodeficiency, smoking, and steroid dependency had higher than average productivity losses. Targeted management of psychological and sleep dysfunction in combination with standard symptom control may improve patient-centered care and reduce the annual economic burden of CRS. LEVEL OF EVIDENCE 2c. Laryngoscope, 128:23-30, 2018.
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Affiliation(s)
- Naweed I Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology, Oregon Health and Science University, Portland, Oregon, U.S.A
| | - Luke Rudmik
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Calgary, Calgary, Alberta, Canada
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Brandl EJ, Lett TA, Chowdhury NI, Tiwari AK, Bakanidze G, Meltzer HY, Potkin SG, Lieberman JA, Kennedy JL, Müller DJ. The role of the ITIH3 rs2535629 variant in antipsychotic response. Schizophr Res 2016; 176:131-135. [PMID: 27396837 DOI: 10.1016/j.schres.2016.06.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/23/2016] [Accepted: 06/25/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There is mounting evidence that schizophrenia risk variants influence response to antipsychotic medication. Common single nucleotide polymorphisms (SNPs) in or near the inter-alpha-trypsin inhibitor heavy chain H3 (ITIH3) gene have been repeatedly associated with schizophrenia and related psychiatric disorders in genome-wide association studies. Here, we provide the first study to assess the relevance of the ITIH3 rs2535629 SNP in response to antipsychotic medication. METHODS The rs2535629 SNP was genotyped in N=256 patients receiving various antipsychotics for up to 26weeks. Treatment response was assessed using the Brief Psychiatric Rating Scale (BPRS) including its positive and negative subscales. Follow-up analyses were performed after stratifying for ethnicity and medication. RESULTS We found significant association of rs2535629 with improvement of negative symptoms in patients of European ancestry after six months of clozapine treatment (F1,87=8.8, pcorr=0.032). Patients homozygous for the minor A-allele showed the best improvement of negative BPRS scores. However, we observed no association between rs2535629 and changes in total BPRS score in the entire sample or the clozapine-treated subgroup. DISCUSSION Although there was no association of genotype with overall changes in BPRS scores, the greater improvement of negative symptoms in minor allele carriers indicates that rs2535629 may help to identify a subset of schizophrenia patients with better treatment response to clozapine. Therefore, our findings provide the first suggestive evidence that rs2535629 is relevant in antipsychotic response.
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Affiliation(s)
- E J Brandl
- Department of Psychiatry and Psychotherapy, Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - T A Lett
- Department of Psychiatry and Psychotherapy, Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - N I Chowdhury
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - A K Tiwari
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - G Bakanidze
- Department of Psychiatry and Psychotherapy, Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - H Y Meltzer
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - S G Potkin
- Department of Psychiatry and Human Behavior, School of Medicine, University of California Irvine, CA, USA
| | - J A Lieberman
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York State Psychiatric Institute, New York City, NY, USA
| | - J L Kennedy
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - D J Müller
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Brandl EJ, Tiwari AK, Zai CC, Nurmi EL, Chowdhury NI, Arenovich T, Sanches M, Goncalves VF, Shen JJ, Lieberman JA, Meltzer HY, Kennedy JL, Müller DJ. Genome-wide association study on antipsychotic-induced weight gain in the CATIE sample. Pharmacogenomics J 2015; 16:352-6. [DOI: 10.1038/tpj.2015.59] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 07/01/2015] [Indexed: 01/05/2023]
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Saha K, Shahida SM, Chowdhury NI, Mostafa G, Saha SK, Jahan S. Relationship between estimated foetal weight and renal volume in intra uterine growth retarded foetus in Bangladeshi women. Mymensingh Med J 2014; 23:752-757. [PMID: 25481596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Low birth weight (LBW) baby predisposes to long term renal disease, adult hypertension and related cardiovascular disease. This could be due to reduced nephron number in early life. From different studies, it is becoming increasingly clear that nephron number, indirectly reflected in renal volume may be related with normal or retarded foetal growth. This prospective study was undertaken in the department of Obstetric and Gynae in Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. One hundred pregnant women were included in this study and divided into two groups (IUGR and normally growing foetuses). Forty one foetuses weighted less than 2.5kg and fifty nine foetuses weighed 2.5kg or more. Kidney dimensions and estimated feotal weight were measured by USG by the same ultrasonologist. There were no significant difference between two groups regarding age, height, weight, and parity. The subjects with intrauterine growth retardation had smaller head circumference, abdominal circumferences, biparietal diameters, femur length, estimated foetal weight and lower amniotic fluid indices than did the subjects with non-intrauterine growth retardation (IUGR). All biometric data shows significant deference except head circumference (HC). Intrauterine growth retardation (IUGR) foetus had significantly lower kidney volume than normally growing foetuses.
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Affiliation(s)
- K Saha
- Dr Kakali Saha, Assistant Professor, Department of Obs & Gynae, Medical College for Women & Hospital, Uttara, Dhaka, Bangladesh
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Kao ACC, Rojnic Kuzman M, Tiwari AK, Zivkovic MV, Chowdhury NI, Medved V, Kekin I, Zai CC, Lieberman JA, Meltzer HY, Bozina T, Bozina N, Kennedy JL, Sertic J, Müller DJ. Methylenetetrahydrofolate reductase gene variants and antipsychotic-induced weight gain and metabolic disturbances. J Psychiatr Res 2014; 54:36-42. [PMID: 24725652 DOI: 10.1016/j.jpsychires.2014.03.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 02/11/2014] [Accepted: 03/13/2014] [Indexed: 10/25/2022]
Abstract
Weight gain and metabolic disturbances represent serious side-effects in antipsychotic (AP) treatment, particularly with clozapine and olanzapine. The methylenetetrahydrofolate reductase (MTHFR) gene is a key determinant in the folate metabolism and previous studies reported a significant effect on AP-induced weight gain and related metabolic abnormalities. Thus, we investigated MTHFR gene variants and changes in several important metabolic parameters in AP-treated patients. In this study, two functional MTHFR polymorphisms, rs1801133 (C677T) and rs1801131 (A1298C), were investigated for changes in weight and metabolic parameters. Genotypic associations were evaluated in a large population (n = 347 including 66 first episode psychosis, FEP patients) treated mostly with clozapine and olanzapine. We did not detect any genotypic association with weight changes (p > 0.05) in our total sample and in the sample refined for ancestry and medication. In our allelic analyses, we observed a trend for the 677-C allele to be associated with weight gain in the total sample (p = 0.03). This effect appeared to be driven by the FEP patients where those carrying the C-allele gained, on average, twice as much weight. Exploratory analyses revealed a significant association between the C677T and the A1298C polymorphism with HDL cholesterol serum levels in patients (p = 0.031). Overall we did not detect a major effect of two functional MTHFR gene variants and AP-induced weight gain. However, our findings suggest an effect of the C677T polymorphism in FEP patients and changes in weight and cholesterol levels. Further investigations in a larger sample are required.
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Affiliation(s)
- A C C Kao
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Biological Sciences, University of Toronto, Scarborough, ON, Canada
| | - M Rojnic Kuzman
- Department of Psychiatry, University Hospital Centre Zagreb, Zagreb School of Medicine, Croatia
| | - A K Tiwari
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - N I Chowdhury
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - V Medved
- Department of Psychiatry, University Hospital Centre Zagreb, Zagreb School of Medicine, Croatia
| | - I Kekin
- Department of Psychiatry, University Hospital Centre Zagreb, Zagreb School of Medicine, Croatia
| | - C C Zai
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - J A Lieberman
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, New York City, NY, USA
| | - H Y Meltzer
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - T Bozina
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb School of Medicine, Croatia
| | - N Bozina
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb School of Medicine, Croatia
| | - J L Kennedy
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - J Sertic
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb School of Medicine, Croatia
| | - D J Müller
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Lett TAP, Wallace TJM, Chowdhury NI, Tiwari AK, Kennedy JL, Müller DJ. Pharmacogenetics of antipsychotic-induced weight gain: review and clinical implications. Mol Psychiatry 2012; 17:242-66. [PMID: 21894153 DOI: 10.1038/mp.2011.109] [Citation(s) in RCA: 185] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Second-generation antipsychotics (SGAs), such as risperidone, clozapine and olanzapine, are the most common drug treatments for schizophrenia. SGAs presented an advantage over first-generation antipsychotics (FGAs), particularly regarding avoidance of extrapyramidal symptoms. However, most SGAs, and to a lesser degree FGAs, are linked to substantial weight gain. This substantial weight gain is a leading factor in patient non-compliance and poses significant risk of diabetes, lipid abnormalities (that is, metabolic syndrome) and cardiovascular events including sudden death. The purpose of this article is to review the advances made in the field of pharmacogenetics of antipsychotic-induced weight gain (AIWG). We included all published association studies in AIWG from December 2006 to date using the Medline and ISI web of knowledge databases. There has been considerable progress reaffirming previous findings and discovery of novel genetic factors. The HTR2C and leptin genes are among the most promising, and new evidence suggests that the DRD2, TNF, SNAP-25 and MC4R genes are also prominent risk factors. Further promising findings have been reported in novel susceptibility genes, such as CNR1, MDR1, ADRA1A and INSIG2. More research is required before genetically informed, personalized medicine can be applied to antipsychotic treatment; nevertheless, inroads have been made towards assessing genetic liability and plausible clinical application.
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Affiliation(s)
- T A P Lett
- Neurogenetics Section, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Chowdhury NI, Tiwari AK, Souza RP, Zai CC, Shaikh SA, Chen S, Liu F, Lieberman JA, Meltzer HY, Malhotra AK, Kennedy JL, Müller DJ. Genetic association study between antipsychotic-induced weight gain and the melanocortin-4 receptor gene. Pharmacogenomics J 2012; 13:272-9. [PMID: 22310352 DOI: 10.1038/tpj.2011.66] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Antipsychotic-induced weight gain (AIWG) may result in the metabolic syndrome in schizophrenia (SCZ) patients. Downstream variants of the melanocortin-4 receptor (MC4R) gene have been associated with obesity in various populations. Thus, we examined single-nucleotide polymorphisms (SNPs) in the MC4R region for association with AIWG in SCZ patients. Four SNPs (rs2229616, rs17782313, rs11872992 and rs8087522) were genotyped in 224 patients who underwent treatment for SCZ and were evaluated for AIWG for up to 14 weeks. We compared weight change (%) across genotypic groups using analysis of covariance for three SNPs (r²≤0.8). European-ancestry patients who were rs8087522 A-allele carriers (AG+AA) on clozapine gained significantly more weight than non-carriers (P=0.027, n=69). These observations were marginal after correction for multiple testing. We performed in vitro electrophoretic mobility-shift assay that suggested that the presence of the A-allele may create a transcription factor-binding site. Further investigation is warranted for both these exploratory findings.
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Affiliation(s)
- N I Chowdhury
- Neurogenetics Section, Department of Neuroscience, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Tsai YC, Delk NA, Chowdhury NI, Braam J. Arabidopsis potential calcium sensors regulate nitric oxide levels and the transition to flowering. Plant Signal Behav 2007; 2:446-54. [PMID: 19517005 PMCID: PMC2634334 DOI: 10.4161/psb.2.6.4695] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Accepted: 07/05/2007] [Indexed: 05/18/2023]
Abstract
In plants, flowering is a critical developmental transition orchestrated by four regulatory pathways. Distinct alleles encoding mutant forms of the Arabidopsis potential calcium sensor CML24 cause alterations in flowering time. CML24 can act as a switch in the response to day length perception; loss-of-function cml24 mutants are late flowering under long days, whereas apparent gain of CML24 function results in early flowering. CML24 function is required for proper CONSTANS (CO) expression; components upstream of CO in the photoperiod pathway are largely unaffected in the cml24 mutants. In conjunction with CML23, a related calmodulin-like protein, CML24 also inhibits FLOWERING LOCUS C (FLC) expression and therefore impacts the autonomous regulatory pathway of the transition to flowering. Nitric oxide (NO) levels are elevated in cml23/cml24 double mutants and are largely responsible for FLC transcript accumulation. Therefore, CML23 and CML24 are potential calcium sensors that have partially overlapping function that may act to transduce calcium signals to regulate NO accumulation. In turn, NO levels influence the transition to flowering through both the photoperiod and autonomous regulatory pathways.
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Affiliation(s)
- Yu-Chang Tsai
- Biochemistry and Cell Biology; Rice University; Houston, Texas USA
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Delk NA, Johnson KA, Chowdhury NI, Braam J. CML24, regulated in expression by diverse stimuli, encodes a potential Ca2+ sensor that functions in responses to abscisic acid, daylength, and ion stress. Plant Physiol 2005; 139:240-53. [PMID: 16113225 PMCID: PMC1203374 DOI: 10.1104/pp.105.062612] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2005] [Revised: 05/10/2005] [Accepted: 05/15/2005] [Indexed: 05/04/2023]
Abstract
Changes in intracellular calcium (Ca(2+)) levels serve to signal responses to diverse stimuli. Ca(2+) signals are likely perceived through proteins that bind Ca(2+), undergo conformation changes following Ca(2+) binding, and interact with target proteins. The 50-member calmodulin-like (CML) Arabidopsis (Arabidopsis thaliana) family encodes proteins containing the predicted Ca(2+)-binding EF-hand motif. The functions of virtually all these proteins are unknown. CML24, also known as TCH2, shares over 40% amino acid sequence identity with calmodulin, has four EF hands, and undergoes Ca(2+)-dependent changes in hydrophobic interaction chromatography and migration rate through denaturing gel electrophoresis, indicating that CML24 binds Ca(2+) and, as a consequence, undergoes conformational changes. CML24 expression occurs in all major organs, and transcript levels are increased from 2- to 15-fold in plants subjected to touch, darkness, heat, cold, hydrogen peroxide, abscisic acid (ABA), and indole-3-acetic acid. However, CML24 protein accumulation changes were not detectable. The putative CML24 regulatory region confers reporter expression at sites of predicted mechanical stress; in regions undergoing growth; in vascular tissues and various floral organs; and in stomata, trichomes, and hydathodes. CML24-underexpressing transgenics are resistant to ABA inhibition of germination and seedling growth, are defective in long-day induction of flowering, and have enhanced tolerance to CoCl(2), molybdic acid, ZnSO(4), and MgCl(2). MgCl(2) tolerance is not due to reduced uptake or to elevated Ca(2+) accumulation. Together, these data present evidence that CML24, a gene expressed in diverse organs and responsive to diverse stimuli, encodes a potential Ca(2+) sensor that may function to enable responses to ABA, daylength, and presence of various salts.
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Affiliation(s)
- Nikkí A Delk
- Department of Biochemistry and Cell Biology, Rice University, Houston, Texas 77005-1892, USA
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