Chinese Expert Consensus on the Use of Biologics in Patients with Chronic Rhinosinusitis (2022, Zhuhai)

BACKGROUND

Chronic rhinosinusitis (CRS) is a common inflammatory disease in otolaryngology, mainly manifested as nasal congestion, nasal discharge, facial pain/pressure, and smell disorder. CRS with nasal polyps (CRSwNP), an important phenotype of CRS, has a high recurrence rate even after receiving corticosteroids and/or functional endoscopic sinus surgery. In recent years, clinicians have focused on the application of biological agents in CRSwNP. However, it has not reached a consensus on the timing and selection of biologics for the treatment of CRS so far.

SUMMARY

We reviewed the previous studies of biologics in CRS and summarized the indications, contraindications, efficacy assessment, prognosis, and adverse effects of biologics. Also, we evaluated the treatment response and adverse reactions of dupilumab, omalizumab, and mepolizumab in the management of CRS and made recommendations.

KEY MESSAGES

Dupilumab, omalizumab, and mepolizumab have been approved for the treatment of CRSwNP by the US Food and Drug Administration. Type 2 and eosinophilic inflammation, need for systemic steroids or contraindication to systemic steroids, significantly impaired quality of life, anosmia, and comorbid asthma are required for the use of biologics. Based on current evidence, dupilumab has the prominent advantage in improving quality of life and reducing the risk of comorbid asthma in CRSwNP among the approved monoclonal antibodies. Most patients tolerate biological agents well in general with few major or severe adverse effects. Biologics have provided more options for severe uncontrolled CRSwNP patients or patients who refuse to have surgery. In the future, more novel biologics will be assessed in high-quality clinical trials and applied clinically.

Moderate Dose Irradiation Induces DNA Damage and Impairments of Barrier and Host Defense in Nasal Epithelial Cells in vitro

Purpose

Radiotherapy (RT) is the mainstay treatment for head and neck cancers. However, chronic and recurrent upper respiratory tract infections and inflammation have been commonly reported in patients post-RT. The underlying mechanisms remain poorly understood.

Method and Materials

We used a well-established model of human nasal epithelial cells (hNECs) that forms a pseudostratified layer in the air-liquid interface (ALI) and exposed it to single or repeated moderate dose γ-irradiation (1Gy). We assessed the DNA damage and evaluated the biological properties of hNECs at different time points post-RT. Further, we explored the host immunity alterations in irradiated hNECs with polyinosinic-polycytidylic acid sodium salt (poly [I:C]) and lipopolysaccharides (LPS).

Results

IR induced DNA double strand breaks (DSBs) and triggered DNA damage response in hNECs. Repeated IR significantly reduced basal cell proliferation with low expression of p63/KRT5 and Ki67, induced cilia loss and inhibited mucus secretion. In addition, IR decreased ZO-1 expression and caused a significant decline in the transepithelial electrical resistance (TEER). Moreover, hyperreactive response against pathogen invasion and disrupted epithelial host defense can be observed in hNECs exposed to repeated IR.

Conclusion

Our study suggests that IR induced prolonged structural and functional impairments of hNECs may contribute to patients post-RT with increased risk of developing chronic and recurrent upper respiratory tract infection and inflammation.

Whole-transcriptome sequencing reveals heightened inflammation and defective host defence responses in chronic rhinosinusitis with nasal polyps

INTRODUCTION

The pathways underlying chronic rhinosinusitis with nasal polyps (CRSwNP) are unclear. We conducted genome-wide gene expression analysis to determine pathways and candidate gene sets associated with CRSwNP.

METHODS

We performed whole-transcriptome RNA sequencing on 42 polyp (CRSwNP-NP) and 33 paired nonpolyp inferior turbinate (CRSwNP-IT) tissues from patients with CRSwNP and 28 inferior turbinate samples from non-CRS controls (CS-IT). We analysed the differentially expressed genes (DEGs) and the gene sets that were enriched in functional pathways.

RESULTS

Principal component-informed analysis revealed cilium function and immune regulation as the two main Gene Ontology (GO) categories differentiating CRSwNP patients from controls. We detected 6182 and 1592 DEGs between CRSwNP-NP versus CS-IT and between CRSwNP-NP versus CRSwNP-IT tissues, respectively. Atopy status did not have a major impact on gene expression in various tissues. GO analysis on these DEGs implicated extracellular matrix (ECM) disassembly, O-glycan processing, angiogenesis and host viral response in CRSwNP pathogenesis. Ingenuity Pathway Analysis identified significant enrichment of type 1 interferon signalling and axonal guidance canonical pathways, angiogenesis, and collagen and fibrotic changes in CRSwNP (CRSwNP-NP and CRSwNP-IT) tissues compared with CS-IT. Finally, gene set enrichment analysis implicated sets of genes co-regulated in processes associated with inflammatory response and aberrant cell differentiation in polyp formation.

CONCLUSIONS

Gene signatures involved in defective host defences (including cilia dysfunction and immune dysregulation), inflammation and abnormal metabolism of ECM are implicated in CRSwNP. Functional validation of these gene expression patterns will open opportunities for CRSwNP therapeutic interventions such as biologics and immunomodulators.

Microarray Assay Reveals Ciliary Abnormalities of the Allergic Nasal Mucosa

Background

Gene expression patterns (particularly, cilia-associated genes) of nasal mucosa, the first-line defense system, in allergic rhinitis (AR) are not well understood.

Objective

We sought to screen for AR-associated genes in inferior turbinate (IT) from patients with AR, and to validate the expression of common cilia-related genes and ciliary shedding.

Methods

Prime View™ Human Gene Expression Array, which consisted of more than 530 000 probes covering more than 36 000 transcripts and variants, was employed to compare individual gene expression of ITs from control subjects (n = 11) and patients with AR (n = 19). Gene ontology (GO) analysis was performed with Cytoscape software. Eight of the common cilia-related genes were validated with quantitative polymerase chain reaction. We applied a semiquantitative scoring system for immunofluorescence assay to demonstrate ciliary shedding in 5 areas per paraffin section, with individual sections being scored between 0 (normal ciliary distribution) and 1 (ciliary shedding).

Results

Compared with control subjects, 160 (38 upregulated and 122 downregulated) genes were differentially expressed for at least 2 folds (all P < .05) in AR. Seven GO categories were significantly enriched, 4 of which were related to cilium assembly and motility. Quantitative polymerase chain reaction validated the predicted direction of change for common cilia-related gene expression. The ciliary distribution score was significantly higher (more prominent ciliary shedding) in AR than in controls ( P < .05).

Conclusion

The significant aberrant cilia-related gene expression, revealed by microarray assays, might be the critical driver of AR where ciliary shedding is prominent.

Mal-deficiency impairs the tolerogenicity of dendritic cell of patients with allergic rhinitis

The tolerogenic dendritic cell dysfunction is associated with the pathogenesis of immune diseases. Microbial stimulus is required in the maintenance of immune functions. This study aims to elucidate the role of Mal signal in the maintenance of DEC205⁺ DC (decDC) immune tolerogenic function. In this study, peripheral DCs were collected from allergic rhinitis (AR) patients and healthy control (HC) subjects to assess the functional status of decDCs. An AR murine model was developed to test the role of Mal signals in the maintenance of decDCs' functions. We observed that AR decDCs (decDCs obtained from AR patients) were incompetent in the induction of type 1 regulatory T cells (Tr1 cells). AR decDCs expressed less IL-10 than that in HC decDCs. IL-10 mRNA decayed spontaneously in AR decDCs. Tat-activating regulatory DNA-binding protein-43 (TDP43) protected IL-10 mRNA from decay. AR decDCs expressed lower levels of Mal than that in HC decDCs. Mal depletion resulted in IL-10 mRNA decay in HC decDCs. Reconstitution of Mal in AR decDCs restored the capacity of inducing Tr1 cells and attenuated experimental AR in mice. In conclusion, Mal plays a critical role in the maintenance of decDC's immune tolerogenic function. The absence or insufficient Mal signal impairs decDC's tolerogenic property. Reconstitution of Mal in AR decDCs can restore the immune tolerogenic capacity, which may have translational potential in the treatment of AR and other allergic diseases.

[Detection ofmethylated genes related to allergic rhinitis and establishment of methylation profile]

Objective:The aim of this study is to detect differentially methylated genes to allergic rhinitis (AR) based on methylation chip, and to analyze the relationship between DNA methylation and AR.Method:Illumina methylation chip were made by normal inferior turbinate mucous tissue obtained from patients(n=19) and healthy individuals(n=11). Detection of differential the sites of methylated genes, Gene Ontology enrichment, KEGG pathway enrichment database and literature search were used to analysis.Result:There were 94 aberrant methylation sites in patients with AR, including 51 hypermethylation sites (e.g. ST7,LCE2D,ATRIP genes) and 43 hypomethylation sites (e.g. PIK3CG, TLR6, IL-4 genes). The results of Gene Ontology enrichment and KEGG pathway enrichment indicates the DNA methylation has relative trend with AR, and DNA methylation of ST7, LCE2D, PIK3CG genes may be associated with AR, but the results of GO analysis and KEGG analysis were statistically significant. Moreover, literature search prompts that DNA methylation of TLR6 gene and IL-4 gene may be associated with AR.Conclusion:Varying degrees of methylated genes from inferior turbinate mucous tissue based on high-flux methylation chip hint gene methylation is an important cause of AR. The relationship between them needs further verification.

[Screening of differentially expressed genes of allergic rhinitis with asthma]

Objective:To detect the differentially expressed genes of allergic rhinitis(AR) with asthma and screen the pathogenic genes. Method: Eight nasal mucosa tissue samples from patients with nasal septum deviation (healthy control group), eight nasal mucosa tissue samples from patients with allergic rhinitis（AR） and eight nasal mucosa tissue samples from patients with AR and asthma were collected. Allergy & Asthma PCR Array was used to analyze allergy related genes expression level. Result: Compared to the control group, there are 84 related genes were found and 15 genes were up-regulated, 69 genes were down-regulated. Furthermore, there are 17 genes（ADAM33, BCL6, IFNGR2, IL12A, IL12B, IL13RA1, IL17A, IL31, IL4R, IL5, KIT, LTB4R, MS4A2, RORC, STAT5A, STAT6, TBX21） differentially expressed. Compared AR with asthma group to the AR group, there was 1 gene differentially expressed(RORC). Conclusion: ADAM33, BCL6, IFNGR2, IL12A, IL12B, IL13RA1, IL17A, IL31, IL4R, IL5, KIT, LTB4R, MS4A2, RORC, STAT5A, STAT6, TBX21 are the possible pathogenic genes of AR with asthma. RORC may be the specific marker gene in asthma induced by allergic rhinitis.

[Detection of differentially expressed gene of allergic rhinitis based on RT² profiler PCR array]

Objective:The aim of this study is to detect differentially expressed gene of allergic rhinitis (AR) based on RT² profiler PCR array. Method:The real-time PCR array containing 84 genes were used to compare inferior turbinate samples obtained from AR patients (n=8) and healthy individuals (n=8). Result:The results showed that 67 genes were down regulated and 17 genes were up regulated in AR inferior turbinate after analysis of 84 genes related to allergy and asthma. STAT6 and BCL6 were recognized as differentially expressed genes. Conclusion:The real-time PCR array can provide new insight into the pathophysiological processes involved in AR.

Endoscopic surgery for primary sinonasal malignancies: Treatment outcomes and prognostic factors

We retrospectively reviewed the cases of 85 patients with primary sinonasal malignancies who had undergone endoscopic surgery with curative intent achieved by "regional resection." Our goal was to assess the efficacy of endoscopic surgical treatment vis-à-vis traditional open surgery. Kaplan-Meier data analysis revealed that the 1-, 3-, and 5-year disease-specific survival rates were 82, 60, and 49%, respectively. Multivariate Cox model survival analysis revealed that male sex, certain pathologic types of cancer (i.e., undifferentiated carcinoma, olfactory neuroblastoma, and rhabdomyosarcoma), and T3/T4 category negatively impacted survival (adjusted hazard ratios: 3.601, 0.012, 0.287, 0.068, and 0.339, respectively; p < 0.05 for all). We also performed a separate analysis of 47 patients who had category T3 or T4 cancer to determine if the type of surgical approach is a prognostic factor. For this, we identified 20 new patients who had undergone open resection, and we compared them to 27 of our endoscopically treated patients who had similar clinical characteristics. We found that the type of surgical approach did not appear to be a prognostic factor (p > 0.10), although those patients who had undergone endoscopic resection had significantly shorter hospital stays (p < 0.001). We conclude that patients with primary sinonasal malignancies who are treated with endoscopic surgery have acceptable survival rates and therefore endoscopic surgery is justified in the hands of highly experienced surgeons in selected cases.

Endoscopic surgery for early-stage nasopharyngeal carcinoma: a justified initial option

OBJECTIVES

To assess the prognosis of initial endoscopic surgery in T1N0M0 and T2N0M0 staged NPC patients.

MATERIALS AND METHODS

Between 2002 and 2016, 10 previously untreated patients with T1N0M0 or T2N0M0 staged NPC volunteered to receive endoscopic surgery followed by four courses of TPF chemotherapy. EORTC QLQ-C30 and QLQ-H&N35 were used to evaluate the QOL after treatment.

RESULTS

With the median follow-up of 30 months (range, 9 months to 128 months), the 24-month survival rate was 100% (6/6), 90% (9/10) patients were still alive and well, 20% (2/10) patients reported tumor recurrence. One died of the disease at 128 months with nasopharyngeal recurrence. Another patient who refused preoperative PET-CT had a cervical recurrence at nine months, accepted nasopharynx and neck radiation two months later and was still alive and well at 50 months. In the post-treatment questionnaires, several NPC-specific (pain, swallowing, speech, social eating, opening mouth, dry mouth, sticky saliva) QOL domains were better preserved compared with radiotherapy alone or combined chemoradiotherapy in other surveys.

CONCLUSIONS

Initial endoscopic surgery combined with chemotherapy maybe justified in the hands of highly experienced surgeon in selected early-stage NPC cases and can improve their QOL. In addition, preoperative PET-CT should be included in case of possible minimal metastases.

[Endoscopic surgery and reconstruction for extensive osteoradionecrosis of skull base after radiotherapy for nasopharyngeal carcinoma]

Objective: To investigate the clinical efficacy of endoscopic surgery for extensive osteoradionecrosis (ORN) of skull base in patients with nasopharyngeal carcinoma (NPC) after radiotherapy. Methods: Seventeen patients diagnosed as ORN of skull base after radiotherapy for NPC and underwent endoscopic surgery were retrospectively studied with their clinic data. Results: Based on the CT and endoscopic examination, all patients had large skull base defects with bone defects averaged 7.02 cm² (range, 3.60 - 14.19 cm²). Excepting for curetting the sequestra, endoscopic surgery was also used to repair the wound or to protect the internal carotid artery with flap in 12 patients. No bone reconstructions were conducted in all patients with the bone defects of skull base. CT examinations were taken after endoscopic surgery when required. The postoperative follow-up ranged from 8 months to 6 years (average, 14 months). Aside from 1 patient with delayed cerebrospinal fluid (CSF), others had no related complications. Conclusions: The patients with extensive ORN can be treated with endoscopic surgery to curette the necrotic bone of skull base, and endoscopic reconstruction provides an alternative technique. It may not be necessary to reconstruct the bone defects at skull base, however, the exposed important structures of skull base, such as internal carotid artery, need to repair with soft tissue such as flap.

[Skull base metastasis from differentiated thyroid carcinoma: 3 cases report and review of literature]

Skull base metastasis from differentiated thyroid carcinoma (DTC), including papillary and follicular thyroid carcinoma, is a rare manifestation and easily misdiagnosed. In this study, we reported three cases whose initial clinical presentation was skull base metastasis complaints with the presence of silent primary sites. Based on the thyroid ultrasound and histopathology (identifying skull base and primary thyroid tumor), the final diagnoses of DTC metastasis to skull base were confirmed. Two patients underwent removal of metastasizing tumors in the skull base and primary thyroid cancer, and have respectively survived 58 months and 4 months since then. Another patient underwent tumor removal of the metastasizing skull base carcinoma leaving the primary lesion intact. However, the patient died of recurrent carcinoma after 18 months. We compared the diagnosis and treatment processes of three patients with DTC metastasis to skull base, and referenced the reported cases in the literature. In conclusion, DTC metastasis to skull base is a rare occurrence and hence easy to be misdiagnosed as primary skull base carcinoma. Clinical records, imaging tests, histopathology and immunohistochemistry are mandatory for differential diagnosis and final diagnosis. Surgical resection of both the primary and metastatic lesions is the recommended treatment. In cases where tumors are removed completely via surgery, no further treatment is necessary postoperatively when meticulously following up is in place. However, in cases where tumors are postoperative residual, radiation therapy after surgery is a feasible option.

Schisandrin B attenuates the inflammatory response, oxidative stress and apoptosis induced by traumatic spinal cord injury via inhibition of p53 signaling in adult rats

Schisandrin B is an active monomer of the Chinese magnolia vine (Schisandra chinensis) that can reduce transaminase activity in liver cells, inhibit lipid peroxidation, enhance antioxidant status, has protective effects in the liver and has antitumor effects. The present study investigated the potential protective effects of schisandrin B on the p53 signaling pathway in attenuating the inflammatory response, oxidative stress and apoptosis induced by traumatic spinal cord injury (TSCI) in adult rats. Behavioral examination, inclined plate test and spinal cord water content were used to evaluate the protective effect of schisandrin B in TSCI rats. The expression levels of superoxide dismutase (SOD), malondialdehyde (MDA), nuclear factor (NF)-κB subunit p65 and tumor necrosis factor (TNF)-α were examined using ELISA kits. Western blot analysis was performed to analyze the protein expression of caspase-3 and phosphorylated (p)-p53 in TSCI rats. In the present study, schisandrin B improved behavioral examination results and the maximum angle of inclined plate test, and inhibited spinal cord water content in rats with TSCI. Notably, schisandrin B reduced the activation of traumatic injury-associated pathways, including SOD, MDA, NF-κB p65 and TNF-α, in TSCI rats. In addition, schisandrin B suppressed the TSCI-induced expression of caspase-3 and p-p53 in TSCI rats. These results indicated that schisandrin B may attenuate the inflammatory response, oxidative stress and apoptosis in TSCI rats by inhibiting the p53 signaling pathway in adult rats.

[Clinical efficacy of endoscopic nasopharyngectomy for initially diagnosed advanced nasopharyngeal carcinoma]

Objective: To explore the clinical efficacy in patients who underwent endoscopic nasopharyngectomy for primary advanced nasopharyngeal carcinoma (NPC). Methods: Forty-five patients who underwent endoscopic nasopharyngectomy for primary advanced NPC encountered between Aug. 2007 and Sep. 2015 were retrospectively reviewed. Twenty-seven patients were male (60.0%), and 18 patients were female (40.0%), the ratio of male to female was 3∶2. The median age was 53 years old (ranged from 13 to 75 years old). The median onset time was 5 months (ranged from 1 to 72 months). TNM stage: 16 cases were at stage Ⅲ (35.6%), 29 at stage Ⅳ (64.4%); T3 16 cases (35.6%), T4 29 cases (64.4%); N0 38 cases (84.4%), N2 7 cases (15.6%). No patients were found to have distance metastasis. All patients underwent endoscopic resection of lesions. Postoperatively all the patients were treated with radiotherapy or chemoradiotherapy. Using SPSS 19.0 software, Kaplan-Meier and Log-rank test were done for the assessmen of survival rate; Cox proportional hazards model was used for the univariate analysis of prognostic factors. Results: The median follow-up was 36 months (ranged from 6 to 97 months), with 36 cases surviving (80.0%), 9 cases died (20.0%); 15 cases relapsed (33.3%). The overall 1 year survival rates (SR), 3 year SR, 5 year SR was 90.6%, 81.0%, 76.0%, respectively. The survival univariate analysis indicated the recurrence and metastasis were correlated with the survival (χ(2) value was 16.644, 6.451, respectively, all P<0.05). Conclusion: The patients who undergo endoscopic nasopharyngectomy for primary advanced NPC have better survival rate with lower recurrent rate and metastatic rate.

[Analysis and dynamic observation of inhaled and food allergens for people in Pearl River Delta]

Objective:To investigate the distribution of allergens in patients with suspected allergic diseases in Pearl River Delta, analysis the changes of allergens with seasons and years, and provide clinical references for management strategies with regional character.Method:Patients from 9 hospitals in Pearl River Delta, with suspected clinical symptoms and signs of allergic disease, were given serum specific IgE test from September 2012 to April 2016. The positive rate was compared with genders, ages, the dynamic changes of seasons, and years.Result:In 30 003 patients, the positive rate of dust mites, house dust, tree, mugwort, mold, animal dander were 39.3%, 26.1%, 16.9%, 26.1%, 9.0%, 6.0% respectively. In 22748 patients, the positive rate of egg, milk, fish, seafood, meats, fruits, nuts were 13.5%, 14.5%, 10.3%, 14.5%, 10.9%, 15.4%, 10.9%. The positive rate of female patients are higher than male patients in both inhaled and food allergens (P< 0.01). The positive rate of minor group was obviously higher than that of the adult group (P< 0.01). The highest positive rate of dust mite, mold, animal dander, egg, fish occurs in the spring, while trees, mugwort, house dust, milk, seafood, meats, fruits, nuts in summer (P< 0.01). There was an upward trend in the positive rate of dust mite, while the positive rate of house dust, mugwort, mold, egg, milk was on the decline, and positive rate of other allergens changed in volatility from 2013 to 2015 (P< 0.01).Conclusion:The dust mites, house dust, seafood and fruits were the main allergens in Pearl River Delta and should be the key for prevention and treatment of allergic diseases. More attention should be paid to the patients of allergic diseases of minors and major seasonal allergens in clinical prevention and treatment. The changes of allergens with the years and dietary habit in local area for the prevention and control of allergic diseases are also not allowed to be ignored.

[Analysis of the characteristics of salvage endoscopic surgery for residual or recurrent nasopharyngeal carcinoma with different rT grading after radiotherapy]

Objective:To understand the characteristics and the treatment methods of the Salvage endoscopic surgery for residual or recurrent nasopharyngeal carcinoma（rNPC）with different rT grading after irradiation failure, and to explore the effect of different endoscopic procedures on the prognosis of the diseases.Method:Ninety-six patients who underwent endoscopic salvage nasopharyngectomy for rNPC in our department between June 2009 and March 2015 were retrospectively reviewed.All the patients underwent the corresponding salvage endoscopic surgery under general anesthesia according to the different rT grading and the patients with cervical metastasis received the radical neck dissection at the same time.Result:The number of the patients whose lesions were completely removed was 44(Total removal rate 45.8%),and the number of subtotal removal was 52(subtotal removal rate 45.8%),respectively.Postoperative follow-up continued until April 2015，the median follow-up was 19 months(1-57 months),the number of overall survival patients was 62(64.6%),the number of death was 34（35.4%）. The overall 1 year survival rate(SR),2 year SR,3 year SR were 83%,68%,63%,respectively.The median survival time was 43 months.Conclusion:The patients who underwent salvage endoscopic surgery for rNPC could have a good survival rate,and the different rT grading made the different methods to resect the lesions by the endoscopy. The use of frozen pathological examination during the operation to determine the negative rate of the surgical margins is the key to ensure the operation curative effect.

Preoperative neutrophil-to-lymphocyte ratio is an independent prognostic marker in patients with laryngeal squamous cell carcinoma

Background

Neutrophil-lymphocyte ratio (NLR) has been shown to be associated with prognosis in various solid tumors. This study aimed to evaluate the prognostic role of NLR in patients with laryngeal squamous cell carcinoma (LSCC).

Methods

A total of 141 LSCC patients were retrospectively reviewed. Patients’ demographics were analyzed along with clinical and pathologic data. The optimal cutoff value of NLR was determined using receiver operating characteristic (ROC) curve analysis. The impact of the NLR and other potential prognostic factors on disease-free survival (DFS) and overall survival (OS) was assessed using the Kaplan-Meier method and multivariate Cox regression analysis.

Results

The optimal cutoff value of the NLR was 2.17. In the NLR ≤ 2.17 group, the 1-, 3-, and 5-year DFS rates were 88.2, 73.9 and 69.1 %, respectively, while in the NLR > 2.17 group, the DFS rates were 83.0, 54.6 and 49.2 %, respectively. Correspondingly, the 1-, 3-, and 5-year OS rates were 98.9, 85.1 and 77.4 % in the NLR ≤ 2.17 group and 97.9, 63.8 and 53.3 % in the NLR > 2.17 group, respectively. The multivariate Cox proportional hazard model analysis showed that NLR > 2.17 was a prognostic factor for both DFS [hazard ratio (HR) = 1.869; 95 % confidence interval (CI) 1.078–3.243; P = 0.026] and OS (HR =2.177; 95 % CI 1.208–3.924; P = 0.010).

Conclusion

Our results showed that elevated preoperative NLR was an independent predictor of poor prognosis for patients with LSCC after surgical resection.

Clinical survey and analysis of Chinese patients with family history of nasal polyposis

CONCLUSION

Nasal polyposis (NP) is frequently found to run in families. Earlier onset of the condition strongly suggested the genetic basis for the development of NP and implied that it might be a genetic disease involving multiple genes.

OBJECTIVE

The etiology and pathogenesis of NP remain largely unknown, although it is assumed to be associated with allergic reaction and infection. The reported familial cases suggested hereditary factors existing in NP. The purpose of this study was to determine whether a hereditary factor could be implicated in NP.

METHODS

A total of 418 NP patients admitted to our department were questioned concerning the existence of familial history (parents, siblings or children) and other accompanying diseases.

RESULTS

In all, 253 cases were successfully followed up. Among these, 44 cases (17.4%) were confirmed to have a familial history of NP, most (59.1%) of which had two immediate family members with a positive family history, with the distribution significantly greater among first-degree and second-degree relatives. Patients with familial NP reported an earlier onset (mean age = 27.7 years) than the sporadic group (mean age = 32.7 years, t = 2.133, p < 0.05). No statistical significance was found when both groups were associated with fungal and allergic diseases.

[Imaging diagnosis and forensic appraisal of orbital fracture]

Misdiagnosis and missed diagnosis are common in forensic appraisal of orbital fracture. Now imaging technology is very important for studying the forensic features of orbital fracture and evaluating the degree of injury. This article reviews the classification, pathogenesis and imaging diagnosis of orbital fracture. It may do some help to forensic appraisal of orbital fracture.