Evaluation of Fine Needle Aspiration Cytopathology in Salivary Gland Tumors under Milan System: Challenges, Misdiagnosis Rates, and Clinical Recommendations

(1) Background: Salivary gland tumors are rare in the head and neck. To determine the need and extent of surgical intervention, fine needle aspiration (FNA) is a widely accepted tool to approach salivary gland lesions. However, the FNA cytology varies between entities, while the lack of uniform terminology makes diagnosis more challenging. Since establishing the Milan system for reporting salivary gland cytopathology (MSRSGC) has become an increasingly accepted reporting standard, further examination and detailed recommendations were needed. (2) Methods: Between April 2013 and October 2021, 375 cases with FNA and salivary gland resection were retrospectively collected. All FNA specimens were reclassified according to the criteria of MSRSGC. After surgical excision, the FNA data were compared with the histological diagnosis to estimate the risk of malignancy (ROM), the risk of neoplasm (RON), and the diagnostic accuracy for each diagnostic category. (3) Results: Our cohort's distribution of ROM and RON was similar to the MSRSGC's recommendation. Carcinoma ex pleomorphic adenoma (CXPA) has the highest rate (66.7%) of misdiagnosed as a nonneoplastic lesion or benign salivary gland tumor. Pleomorphic adenoma (PA) and Warthin's tumor were the most common benign salivary gland tumors, while the cytology diagnosis of Warthin's tumor seems more challenging than PAs. (4) Conclusions: Despite the convenience and effectiveness of MSRSGC, we suggest close follow-up, re-biopsy, or surgical removal for salivary lesions even in Milan IVA-Benign for possibly missing FNA of malignancy, mixed lesions, or prevention of malignant transformation.

[Estimation of Early Postmortem Interval of Asphyxial Death Rats at Different Ambient Temperatures by GC-MS-Based Metabolomics]

Abstract

Objective To establish the orthogonal partial least square （OPLS） model for the estimation of early postmortem interval （PMI） of asphyxial death rats in four ambient temperatures based on gas chromatography-mass spectrometry （GC-MS） metabolomics. Methods The 96 rats were divided into four temperature groups （5 ℃, 15 ℃, 25 ℃ and 35 ℃）. Each temperature group was further divided into 3 h, 6 h, 12 h and 24 h after death, and 6 other rats were taken as the control group. The cardiac blood was collected at the set time points for the four temperature groups and 0 h after death for the control group for the metabolomics analysis by GC-MS. By OPLS analysis, the variable importance in projection （VIP）>1 and the result of Kruskal-Wallis test P<0.001 were used to screen out the differential metabolite related to PMIs in the cardiac blood of rats of different temperature groups. Then OPLS regression models of different temperature groups were established with these metabolites. At the same time, a prediction group for investigating the prediction ability of these models was set up. Results Through the analysis of OPLS, 18, 15, 24 and 30 differential metabolites （including organic acids, amino acids, sugars and lipids） were screened out from the rats in groups of 5 ℃, 15 ℃, 25 ℃ and 35 ℃, respectively. The prediction results of the four temperature group models showed that the prediction deviation of 5 ℃ model was larger than that of other groups. The prediction results of other temperature groups were satisfactory. Conclusion There are some differences in the changes of metabolites in cardiac blood of rats at different ambient temperatures. The influence of ambient temperature should be investigated in the study of PMI estimation by metabolomics, which may improve the accuracy of PMI estimation.

High Prevalence of Antibiotic Resistance in Isolates from the Middle Meatus of Children and Adults with Acute Rhinosinusitis

Background

The pathogens in acute rhinosinusitis are similar worldwide. An increase in antibiotic resistance has been shown in a large number of studies in recent years. The prevalence of resistance varies greatly in different countries. This study was performed to determine the endemic prevalence of antibiotic resistance in pathogens of acute rhinosinusitis in Taiwan.

Methods

Middle meatus discharge was taken for aerobic culture in 133 outpatients with the diagnosis of acute rhinosinusitis.

Results

One hundred two isolates of pathogens were found, including three major bacteria: Haemophilus influenzae (37.3%), Streptococcus pneumoniae (28.4%), and Moraxella catarrhalis (11.8%). Polymicrobial infections and positive cultures occurred more frequently in pediatric patients, as did recovery of M. catarrhalis infection. An extremely high percentage of resistance to first-line antibiotics was noted, viz., penicillin-nonsusceptible S. pneumoniae (PNSSP) (72.4%), ampicillin-resistant H. influenzae (60.5%), and M. catarrhalis (58.3%).

Conclusion

The high prevalence of drug resistance is a great threat to public health. Antibiotic use should be more prudent, especially in pediatric patients, who were found to be more susceptible to bacterial rhinosinusitis and multiple pathogenic infection.

The Expression of Human Antimicrobial Peptide LL-37 in the Human Nasal Mucosa

Background

LL-37, an antimicrobial peptide, has been discovered to be produced by a number of epithelial cells. It is identified as a key element in the innate host defense mechanism. Because little is known about the expression of LL-37 in human sinonasal tract, we conducted this study to investigate the expression of LL-37 in human nasal mucosa.

Methods

We investigated the expression of LL-37 gene by the reverse transcription polymerase chain reaction (RT-PCR) and localization of LL-37 peptide by immunohistochemistry in the inferior turbinate mucosa of 7 normal subjects and the nasal polyps of 12 patients with chronic paranasal sinusitis.

Results

The transcripts of the LL-37 gene were detected in all human nasal tissues analyzed by RT-PCR. There is a significant increase of LL-37 mRNA expression in nasal polyps as compared with the normal nasal mucosa. Using immunohistochemistry, LL-37 peptide was localized in surface epithelial cells and submucosal glands.

Conclusions

Our findings suggest that LL-37 is expressed by nasal mucosa and is upregulated during inflammation.

Investigating the association between diet and risk of head and neck cancer in Taiwan

Most studies reporting an inverse association between the consumption of vegetables and fruits and head and neck cancer (HNC) risk were conducted in Western populations and only a few included East Asians. The current case-control study investigated the association between diet and HNC risk using data of 838 HNC cases and 998 controls from a case-control study of HNC conducted in Taiwan. Each participant was asked about their consumption of fresh vegetables, pickled vegetables, fresh fruits, citrus fruits, meat, processed meat, fish, egg, and dairy products. Unconditional logistic regression was performed to estimate the odds ratio (OR) and 95% confidence interval (CI) of HNC risk associated with each food category, adjusted for sex, age, education, and use of alcohol, betel quid and cigarette. An inverse association was observed between HNC risk and daily intake of fresh vegetables (OR = 0.44, 95% CI: 0.20-0.95, p-trend = 0.002) or fruits (OR = 0.55, 95% CI: 0.43-0.72, p-trend = 0.00001). Individuals who did not consume fresh fruits and vegetables daily had more than double the risk of HNC compared to those with daily intake of vegetables and fruits (OR= 2.24, 95% CI: 1.54-3.25). The results of the current study supported an inverse association between the consumption of fresh vegetables and fruits and HNC risk. In addition to cessation of cigarette smoking and betel quid chewing and reduction of alcohol drinking, a public health campaign for preventing the occurrence of HNC should promote a healthy diet that contains plenty of fresh vegetables and fruits.

Investigating the Association between Alcohol and Risk of Head and Neck Cancer in Taiwan

Although alcohol is an established risk factor of head and neck cancer (HNC), insufficiencies exist in the literature in several aspects. We analyzed detailed alcohol consumption data (amount and type of alcoholic beverage) of 811 HNC patients and 940 controls to evaluate the association between alcohol and HNC by HNC sites and by genotypes of ADH1B and ALDH2. Alcohol was associated with an increased HNC risk in a dose-response relationship, with the highest risk observed for hypopharyngeal cancer, followed by oropharyngeal and laryngeal cancers. Liquor showed a stronger positive association with HNC than beer and wine. The highest HNC risk occurred in individuals with the slow ADH1B and slow/non-functional ALDH2 genotype combination. In our study population, 21.8% of HNCs, 55.7% of oropharyngeal cancers, and 89.1% of hypopharyngeal cancers could be attributed to alcohol. Alcohol accounted for 47.3% of HNCs among individuals with the slow ADH1B and slow/non-functional ALDH2 genotype combination. The HNC risk associated with alcohol became comparable to that of never/occasional drinkers after ten or more years of cessation from regular alcohol drinking. In conclusion, alcohol use is associated with an increased HNC risk, particularly for individuals with slow ethanol metabolism. HNC incidence may be reduced by alcohol cessation.

Regular recreational physical activity and risk of head and neck cancer

BACKGROUND

Although substantial evidence supports a 20-30% risk reduction of colon cancer, breast cancer, and endometrial cancer by physical activity (PA), the evidence for head and neck cancer (HNC) is limited. Three published studies on the association between PA and HNC have generated inconsistent results. The current study examined the association between recreational PA (RPA) and HNC risk with a more detailed assessment on the intensity, frequency, duration, and total years of RPA.

METHODS

Data on RPA were collected from 623 HNC cases and 731 controls by in-person interview using a standardized questionnaire. The association between RPA and HNC risk was assessed using unconditional logistic regression, adjusted for sex, age, educational level, use of alcohol, betel quid, and cigarette, and consumption of vegetables and fruits.

RESULTS

A significant inverse association between RPA and HNC risk was observed in a logistic regression model that adjusted for sex, age, and education (odds ratio (OR) = 0.65, 95% confidence interval (CI): 0.51-0.82). However, after further adjustment for the use of alcohol, betel quid, and cigarette, and consumption of vegetables and fruits, RPA was no longer associated with HNC risk (OR =0.97, 95% CI: 0.73-1.28). No significant inverse association between RPA and HNC risk was observed in the analysis stratified by HNC sites or by the use of alcohol, betel quid, or cigarette.

CONCLUSION

Results from our study did not support an inverse association between RPA and HNC risk. The major focus of HNC prevention should be on cessation of cigarette smoking and betel chewing, reduction of alcohol drinking, and promotion of healthy diet that contains plenty of fruits and vegetables.

Alcohol Drinking Obliterates the Inverse Association Between Serum Retinol and Risk of Head and Neck Cancer

This analysis evaluated the association between serum retinol levels and risk of head and neck cancer (HNC) and whether the association is modulated by the use of alcohol, betel quid, or cigarette. In addition, we also examined the association between HNC risk and 2 single nucleotide polymorphisms, TTR rs1667255 and RBP4 rs10882272, that have been associated with serum retinol levels. Unconditional logistic regression was performed to evaluate the association between serum retinol levels and HNC risk among 160 HNC cases and 198 controls. The associations between TTR rs1667255 and RBP4 rs10882272 and serum retinol levels or HNC risk were evaluated by linear regression and unconditional logistic regression, respectively, for 418 HNC cases and 497 controls. The results showed that HNC cases had a lower mean serum retinol level compared with controls (845.3 μg/L vs 914.8 μg/L, P = 0.03). An inverse association between serum retinol levels and HNC risk occurred among never/occasional alcohol drinkers but not among regular drinkers. TTR rs1667255 was associated with serum retinol levels; however, neither TTR rs1667255 nor RBP4 rs10882272 was associated with HNC risk. In summary, this study showed an inverse association between serum retinol levels and HNC risk, specifically among never/occasional alcohol drinkers. More studies are needed to establish the underlying biologic mechanisms for the inverse association between serum retinol levels and HNC risk and the modulation of this relationship by alcohol drinking.

Abstract 4145: Genetic polymorphisms of genes on the retinoic acid pathway and risk of head and neck cancer

Background: Although most cases of head and neck cancer (HNC) can be attributed to three established risk factors, including alcohol, betel quid, and cigarette, the underlying genetic variations among individuals may be important in modulating the risk of HNC. Previous studies showed that the metabolism or function of retinoic acid may be modified by the use of alcohol, betel quid, or cigarette, resulting in the dysregulation of cell growth, differentiation, and apoptosis. The current analysis examined the association between HNC risk and genetic polymorphisms of genes on the retinoic acid pathway.

Methods: 408 incident cases of HNC and 473 sex- and age- frequency matched controls were recruited from the department of otolaryngology and department of stomatology. Information on the use of alcohol, betel quid, and cigarette was collected by in-person interviews. In the discovery phase, 223 cases and 220 controls were genotyped for 368 single nucleotide polymorphisms (SNPs) of 37 retinoic acid genes. Unconditional logistic regression was performed to estimate the log-additive odds ratio (OR) and 95% confidence interval (CI) of HNC risk associated with each SNP. Those that had a P &lt; 0.05 were further genotyped for 185 cases and 253 controls in stage 2. Additional analyses were performed stratified by alcohol, betel quid, and cigarette to evaluate gene-environment interaction.

Results: In the stage 1, 25 SNPs were associated with the risk of HNC with a P &lt; 0.05. With additional genotyping performed for these 25 SNPs in stage 2, only one SNP of RARB showed a decreasing P value with additional samples (stage 1 OR = 1.43, 95% CI: 1.02-2.00, P = 0.04; stage 2 OR = 1.33, 95% CI: 0.94-1.89, P = 0.1; combined OR = 1.34, 95% CI: 1.06-1.69, P = 0.01). In addition, the association between this RARB SNP and HNC risk appeared to be modified by alcohol drinking status. A positive association between the minor allele of the RARB SNP and HNC was observed among never drinkers (OR = 1.96, 95% CI: 1.30-2.95) but not among ever drinkers (OR = 1.09, 95% CI: 0.81-1.47) (P for interaction = 0.01).

Conclusion: The risk of HNC was associated with a SNP of RARB and this association appeared to depend on alcohol drinking status. Further investigations are needed to determine the causal SNP and its functional significance.

Citation Format: Jeffrey S. Chang, Jenn-Ren Hsiao, Jang-Yang Chang, Tung-Yiu Wong, Sen-Tien Tsai, Chun-Yen Ou, Hung-I Lo, Sheen-Yie Fang, Cheng-Chih Huang, Wei-Ting Lee, Jiunn-Liang Wu, Ken-Chung Chen, Jehn-Shyun Huang, Yi-Hui Wang, Ya-Ling Weng, Han-Chien Yang. Genetic polymorphisms of genes on the retinoic acid pathway and risk of head and neck cancer. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4145. doi:10.1158/1538-7445.AM2014-4145

Tea consumption and risk of head and neck cancer

Background

The current study evaluated the association between tea consumption and head and neck cancer (HNC) in Taiwan, where tea is a major agricultural product and a popular beverage.

Methods

Interviews regarding tea consumption (frequency, duration, and types) were conducted with 396 HNC cases and 413 controls. Unconditional logistic regression was performed to estimate the odds ratio (OR) and 95% confidence interval (CI) of HNC risk associated with tea drinking, adjusted for sex, age, education, cigarette smoking, betel quid chewing, and alcohol drinking.

Results

A reduced HNC risk associated with tea drinking (OR for every cup per day = 0.96, 95% CI: 0.93–0.99; OR for ≧5 cups per day = 0.60, 95% CI: 0.39–0.94) was observed. The association was especially significant for pharyngeal cancer (OR for every cup per day = 0.93, 95% CI: 0.88–0.98; OR for ≧5 cups per day = 0.32, 95% CI: 0.16–0.66). A significant inverse association between HNC and tea consumption was observed particularly for green tea.

Conclusions

This study suggests that tea drinking may reduce the risk of HNC. The anticancer property of tea, if proven, may offer a natural chemopreventive measure to reduce the occurrence of HNC.

The interplay between alcohol consumption, oral hygiene, ALDH2 and ADH1B in the risk of head and neck cancer

Alcohol consumption is an established risk factor for head and neck cancer (HNC). The major carcinogen from alcohol is acetaldehyde, which may be produced by humans or by oral microorganisms through the metabolism of ethanol. To account for the different sources of acetaldehyde production, the current study examined the interplay between alcohol consumption, oral hygiene (as a proxy measure for the growth of oral microorganisms), and alcohol-metabolizing genes (ADH1B and ALDH2) in the risk of HNC. We found that both the fast (*2/*2) and the slow (*1/*1+ *1/*2) ADH1B genotypes increased the risk of HNC due to alcohol consumption, and this association differed according to the slow/non-functional ALDH2 genotypes (*1/*2+ *2/*2) or poor oral hygiene. In persons with the fast ADH1B genotype, the HNC risk associated with alcohol drinking was increased for those with the slow/non-functional ALDH2 genotypes. For those with the slow ADH1B genotypes, oral hygiene appeared to play an important role; the highest magnitude of an increased HNC risk in alcohol drinkers occurred among those with the worst oral hygiene. This is the first study to show that the association between alcohol drinking and HNC risk may be modified by the interplay between genetic polymorphisms of ADH1B and ALDH2 and oral hygiene. Although it is important to promote abstinence from or reduction of alcohol drinking to decrease the occurrence of HNC, improving oral hygiene practices may provide additional benefit.

A survey on the management of acute rhinosinusitis among Asian physicians

BACKGROUND

Based on the `European Position Paper on Rhinosinusitis and Nasal polyps (EP3OS 2007)`, this study aimed to investigate general practitioners (GPs) and other specialists` understanding when managing patients with acute rhinosinusitis (ARS) in Asia.

METHODOLOGY

Among a total of 2662 questionnaires completed, 2524 (94.8%) were valid for analysis. There were 1308 GPs (51.8%), 989 otolaryngologists (39.2%) and 227 paediatricians (9%) from Mainland China, Hong Kong, Indonesia, India, Malaysia, Pakistan, Philippines, Singapore, Thailand and Taiwan.

RESULTS

ARS is affecting an estimated 6 - 10% of patients seen in a daily out-patient practice. The EP3OS criteria are well supported by Asian physicians (94.1%). Most physicians (62.7%) agreed that radiological investigation is not needed to diagnose ARS. However, even for mild ARS (common cold), medical treatments were still recommended by 87% of GPs, 83.9% of otolaryngologists, and 70% of paediatricians. The top three first-line treatments prescribed were antihistamines (39.2%), nasal decongestants (33.6%), and antibiotics (29.5%). Antibiotics usage increased as the first line treatment of moderate (45.9%) and severe (60.3%) ARS.

CONCLUSION

ARS is commonly managed by GPs, otolaryngologists, and paediatricians in Asia. However, understanding of the management of ARS needs further improvement to minimize unnecessary use of radiological investigations, overuse of antibiotics, and under use of nasal corticosteroids.

An open-label, multicentre study of levocetirizine for the treatment of allergic rhinitis and urticaria in Taiwanese patients

Levocetirizine has been shown in observational studies in the west as an effective and satisfactory therapy for patients with allergic respiratory and skin disease. An open-label, multicentre observational study was conducted to investigate the patients' perception of levocetirizine in the treatment of allergic rhinitis (AR) and urticaria in Taiwanese patients. Three hundred and thirty-three patients (236 AR and 97 urticaria patients) attending out-patient clinics of medical centres across Taiwan were included in the study. Patients were treated with levocetirizine 5 mg once daily (AR patients for 2-4 weeks and urticaria patients for 2-6 weeks) and at the end of treatment, they evaluated for symptoms of disease, perception of change in symptoms, global efficacy and tolerability, global preference over previous antiallergic treatment, change in quality of sleep/daily activities, and safety and adverse events (AEs). Levocetirizine markedly improved the symptoms of AR and urticaria; with 70-75% of AR patients and 60-80% of urticaria patients reporting complete or marked improvements in individual symptoms. Asthma symptoms were completely or markedly improved in 44% of patients with AR and concomitant asthma. A majority of the patients was satisfied with levocetirizine therapy and 50-70% indicated preference for levocetirizine over previous therapy. Overall, 50-74% of all patients perceived improvements in quality of sleep/daily activities and 50-65% of the patients rated the onset of action for levocetirizine as very rapid or rapid. Somnolence was the most common AE, reported by 7.4% of AR and 7.0% of urticaria patients. The results of this study indicated that levocetirizine is an effective and satisfactory therapy for the management of allergic respiratory and skin disease in Taiwanese subjects.

Tissue-specific immunoglobulin E in maxillary sinus mucosa of allergic fungal sinusitis

OBJECTIVE

The objectives of this prospective study were to analyze the specific immunoglobulin E (sIgE) in maxillary sinus mucosa and to determine the importance of local tissue sIgE in the patients with allergic fungal sinusitis (AFS).

METHODS

We investigated tissue-specific IgE in the maxillary sinus mucosa. Thirty-four patients with rhinosinusitis and nasal polyposis were included in the study. The patients were divided into three groups--AFS, fungal sinusitis and chronic rhinosinusitis (CRS). The sIgE profile of the maxillary sinus mucosa was studied by the CAP method. Other parameters, such as allergic symptoms, presence of fungi hyphae and eosinophilic mucin in the sinus cavities as well as computed tomography (CT) scanning findings were also evaluated in all groups.

RESULTS

All patients in the AFS group had allergic symptoms, and the serum IgE test was positive to mites or house dust, but none had a positive serum IgE response to Aspergillus. However, 85.7% of this group had tissue sIgE to Aspergillus.

CONCLUSIONS

The local tissue sIgE profile is more specific than the systemic sIgE profile in determining the allergic status of AFS patients. Tissue sIgE for fungi may be considered as a part of AFS diagnostic criteria.

Allergic profiles in unilateral nasal polyps of bilateral chronic rhinosinusitis

BACKGROUND

Bilateral chronic rhinosinusitis (CRS), with unilateral nasal polyps (NPs), is a good model for study, being characterized by a similar inflammatory reaction and environment in both nasal cavities of a subject, although NPs exist in only one nasal cavity. It may be feasible to identify specific pathological factors responsible for the disparities by comparing the differences between the nasal cavities.

METHODS

In patients with bilateral CRS, polyp tissue and the middle turbinate tissue on the side of the polyp were examined and compared with contralateral nonpolyp middle turbinate tissue. Tissue and serum-specific immunoglobulin E (sIgE) levels were measured, and eosinophilic infiltration, interleukin (IL)-5 and IL-1-beta were assessed also in the polyp tissue.

RESULTS

The presence of allergic symptoms correlated well with a positive serum CAP test but poorly with a positive tissue CAP test. There were no obvious differences between tissue sIgE levels on the NP side compared with the nonpolyp side. Tissue eosinophilia was a general characteristic of NPs, whether there was allergy or not. IL-5 and IL-1-beta levels were elevated in NPs, regardless of allergy. There were no differences in the specimens on the nonpolyp side between allergy and nonallergy groups.

CONCLUSION

With this model, we have more precise, however, not new results. Localized allergic reaction is not a major factor for the development of a unilateral polyp. Inflammation associated with eosinophilic infiltration and the presence of proinflammatory cytokines, including IL-5 and IL-1-beta, are more important in the pathogenesis of NPs than the allergic reaction.

Expression of epidermal growth factor receptor in the inverted papilloma and squamous cell carcinoma of nasal cavity

The present study was undertaken to compare positive rate of immunostaining (PR) and positive intensity of immunostaining (PI) of epidermal growth factor receptor (EGFR) in inverted papilloma (IP), synchronous carcinoma with IP and metachronous carcinoma with IP of the nasal cavity. Ten subjects with nasal polyps, ten subjects with inverted papilloma (IP), five subjects with synchronous carcinoma with IP and ten subjects with metachronous carcinoma with IP were enrolled with a control group of ten subjects of inferior turbinate. Each specimen was divided into two portions: one for RNA isolation and the other for detection of EGFR protein. Positive rate of immunostaining, positive intensity of immunostaining for EGFR protein and EGFR mRNA were significantly up-regulated in the IP, synchronous carcinoma with IP and metachronous carcinoma with IP when comparing polyp and normal mucosa. A role for EGFR in the malignant transformation from IP to SCC of the nasal cavity is suggested.

Tissue-specific immunoglobulin E in human nasal polyps

Allergy is generally believed to be an underlying cause of nasal polyps. The objective of this study was to define allergic nasal polyps. We investigated specific immunoglobulin E (sIgE) in polyp tissue. Thirty pieces of polyp tissue were taken from patients with positive allergic symptoms, and 30 from patients without allergic symptoms. Nasal polyp tissue homogenate and serum from these patients were prepared for detecting sIgE by a CAP method. For patients with allergic symptoms and/or positive serum CAP test results, the rates of positive tissue CAP tests were low: 36.7% and 35.7%, respectively. However, nearly all of the tissue CAP-positive subjects had allergic symptoms and positive serum CAP tests. We conclude that the local tissue sIgE profile reflects more specifically the allergic status of patients with nasal polyps than does the systemic serum test or the presentation of allergic symptoms. Thus, polyp tissue CAP tests might be performed in patients with positive allergic symptoms and positive serum CAP tests to define an allergy-induced polyp precisely. Then, specific antiallergic treatment could be administered to prevent polyp recurrence.

Ethmoid sinus cancer: results of treatment with surgery and combined therapy

OBJECTIVE

Ethmoid sinus cancer is a rare paranasal sinus malignancy. Its characteristics include a low incidence rate, a great variety of histopathological types and multiple treatment modalities. Currently, there remains no definite consensus regarding its optimal management. The aim of this study was to examine the outcome of a population of Asian patients with advanced ethmoid sinus cancers that had been treated with surgery plus combined therapy.

MATERIAL AND METHODS

Between January 1989 and December 2002 inclusive, 19 newly diagnosed patients with ethmoid sinus cancers who had undergone surgical intervention were enrolled, T4 being the principal carcinoma stage (68.4%). All participating cases proved to be node-negative and no evidence of any distant metastasis was detected at the time of diagnosis. The major treatment modality was surgery plus postoperative radiotherapy. All but 2 of the 13 patients with T4 cancer underwent craniofacial resection with pericranial flap reconstruction.

RESULTS

The estimated overall and disease-free survival rates 3 years post-treatment were 49.4% and 26.3%, respectively. Local tumor recurrence was more common than regional recurrence and/or distant metastasis. A total of 5/15 T3-T4 patients (33%) developed a neck metastasis, 3 of whom also suffered a distant metastasis. There was no postoperative mortality for the cases treated with craniofacial resection.

CONCLUSIONS

Ethmoid sinus cancer typically demonstrates a propensity for late diagnosis and poor prognosis. This study confirms that craniofacial resection plus combined associated therapy is the optimal approach for the effective management of extensive ethmoid sinus tumors and is associated with an acceptable morbidity rate. More aggressive disease management featuring prophylactic concurrent chemoradiotherapy including neck or elective neck dissection plus chemotherapy should be considered for T3-T4 patients as opposed to T1-T2 patients.

The expression of human antimicrobial peptide LL-37 in the human nasal mucosa

BACKGROUND

LL-37, an antimicrobial peptide, has been discovered to be produced by a number of epithelial cells. It is identified as a key element in the innate host defense mechanism. Because little is known about the expression of LL-37 in human sinonasal tract, we conducted this study to investigate the expression of LL-37 in human nasal mucosa.

METHODS

We investigated the expression of LL-37 gene by the reverse transcription polymerase chain reaction (RT-PCR) and localization of LL-37 peptide by immunohistochemistry in the inferior turbinate mucosa of 7 normal subjects and the nasal polyps of 12 patients with chronic paranasal sinusitis.

RESULTS

The transcripts of the LL-37 gene were detected in all human nasal tissues analyzed by RT-PCR. There is a significant increase of LL-37 mRNA expression in nasal polyps as compared with the normal nasal mucosa. Using immunohistochemistry, LL-37 peptide was localized in surface epithelial cells and submucosal glands.

CONCLUSIONS

Our findings suggest that LL-37 is expressed by nasal mucosa and is upregulated during inflammation.

High prevalence of antibiotic resistance in isolates from the middle meatus of children and adults with acute rhinosinusitis

BACKGROUND

The pathogens in acute rhinosinusitis are similar worldwide. An increase in antibiotic resistance has been shown in a large number of studies in recent years. The prevalence of resistance varies greatly in different countries. This study was performed to determine the endemic prevalence of antibiotic resistance in pathogens of acute rhinosinusitis in Taiwan.

METHODS

Middle meatus discharge was taken for aerobic culture in 133 outpatients with the diagnosis of acute rhinosinusitis.

RESULTS

One hundred two isolates of pathogens were found, including three major bacteria: Haemophilus influenzae (37.3%), Streptococcus pneumoniae (28.4%), and Moraxella catarrhalis (11.8%). Polymicrobial infections and positive cultures occurred more frequently in pediatric patients, as did recovery of M. catarrhalis infection. An extremely high percentage of resistance to first-line antibiotics was noted, viz., penicillin-nonsusceptible S. pneumoniae (PNSSP) (72.4%), ampicillin-resistant H. influenzae (60.5%), and M. catarrhalis (58.3%).

CONCLUSION

The high prevalence of drug resistance is a great threat to public health. Antibiotic use should be more prudent, especially in pediatric patients, who were found to be more susceptible to bacterial rhinosinusitis and multiple pathogenic infection.

Mucosal changes in rhinitis medicamentosa

To evaluate the nasal mucosal changes in rhinitis medicamentosa (RM), especially those related to goblet cells and subepithelial glands, we studied specimens of the inferior turbinate mucosa from 8 patients with RM, 8 patients with chronic hypertrophic rhinitis (CHR), and 5 patients with normal nasal mucosa. All specimens were assessed by electron microscopy and immunohistochemical study. Under a scanning electron microscope, hyperplasia of goblet cells was most prominent in the RM group, and an increased number of gland openings was evident in the RM and CHR groups. In addition, the immunoreactivity of epidermal growth factor receptor staining was strongest in the hyperplastic epithelium of the RM group. According to our results, it is feasible that the mucosa of patients with RM is in a chronic inflammatory, hypersecretory state. Degenerative changes in the secretory elements may cause impairment of mucociliary transport and may be responsible for the nasal obstruction and posterior nasal drip in RM.

Expression of human beta-defensin 2 in human nasal mucosa

Human beta-defensin (HBD)-2, an antimicrobial peptide, has been discovered to be produced by a number of epithelial cells. It is identified as a key element in the innate host defense mechanism. Because little is known about the expression of HBD-2 in the human sinonasal tract, we conducted this study to investigate the expression of the HBD-2 mRNA gene by the reverse transcription polymerase chain reaction (RT-PCR) and localization of HBD-2 peptide by immunohistochemistry in human nasal inferior turbinates and nasal polyps. RT-PCR showed significantly higher expression of HBD-2 mRNA in nasal polyps than in inferior turbinates. Using immunohistochemistry, HBD-2 peptide was predominantly localized in surface epithelial cells. Thus, it is feasible that HBD-2 is expressed in nasal mucosa and is upregulated in a condition of chronic inflammation.

A 2.6 Mb interval on chromosome 6q25.2-q25.3 is commonly deleted in human nasal natural killer/T-cell lymphoma

Natural killer (NK)/T-cell lymphoma is a special subtype of rare malignant lymphoma that is more prevalent in Asia than in America and Europe. This newly characterized haemato-lymphoid malignancy is highly aggressive and frequently present in nasal and upper aerodigestive sites. Several studies have reported the commonly deleted region of chromosome 6q21-25 in this particular type of lymphoma. To refine the smallest region of overlapping (SRO) deletion for localization of potential tumour suppressor (TS) genes, we performed loss of heterozygosity (LOH) and homozygosity mapping of deletion (HOMOD) analyses on 37 nasal and nasal-type NK/T-cell lymphoma patients using a panel of 25 microsatellite markers, covering the 6q21-q25 region. In all patients studied, LOH was detected in eight (89%) paired-sample patients, while hemizygous deletion was detected in three (11%) single-sample patients. Combination of the LOH and HOMOD results defined a distinct 3 Mb SRO on chromosome 6q25. Quantitative multiplex polymerase chain reaction analysis of 10 sequence-tagged sites further refined the putative TS-gene-containing region to a 2.6 Mb interval between TIAM2 and SNX9. Eighteen known genes/Unigene clusters and 25 hypothetical genes are located within this 2.6 Mb region, but none are previously identified TS genes. These results provide a framework for future positional cloning of novel TS gene(s) at 6q25.2-q25.3.

Continuous cerebrospinal fluid drainage using a lumbar subarachnoid catheter for cerebrospinal fluid rhinorrhea after functional endoscopic sinus surgery

Anesthesiologists are frequently consulted for performing lumbar cerebrospinal fluid (CSF) drainage to facilitate surgery or manage complications. Functional endoscopic sinus surgery (FESS) is a common treatment for chronic sinus diseases. Cerebrospinal fluid (CSF) leakage is a serious complication following FESS and is typically treated with an endonasal free or rotational mucoperichondrial flap. Continuous drainage of CSF with a lumbar subarachnoid catheter has been used in patients who have undergone neurosurgery but it is seldom used in the treatment of post-FESS CSF rhinorrhea. We present a 71-year-old male patient who suffered from CSF rhinorrhea after FESS, and was treated successfully with continuous lumbar CSF drainage. We are of the opinion that continuous CSF drainage with a lumbar subarachnoid catheter is an effective and safe modality of treatment for post-FESS CSF leakage.

Overexpression of Fas-ligand in human nasal polyps

Apoptosis mediated through the Fas/Fas-L system is essential in regulating immune function, developing organs, and conferring immune privilege. To illustrate the role of the Fas/Fas-L system in the pathogenesis of human nasal polyps, we investigated the transcripts and protein level of the Fas-L gene in 8 human nasal polyp tissues and 7 nasal turbinate mucosa specimens using reverse transcription-polymerase chain reaction and Western blotting. Localization of Fas-L was performed with immunohistochemistry. The transcripts of the Fas-L gene were detected at similar levels in both polyps and nasal mucosa. There was a significant overexpression of Fas-L protein on nasal polyps compared to nasal mucosa. Fas-L-positive cells were localized on the epithelial layers of cystically dilated glands and the down-growing epithelium of nasal polyps. Fas-L may play an important role in the pathogenesis of human nasal polyps, including cystic degeneration of submucosal glands and conferring of immune privilege to nasal polyp formation.

Hypertonic saline nasal provocation stimulates nociceptive nerves, substance P release, and glandular mucous exocytosis in normal humans

Hypertonic saline (HTS) induces bronchoconstriction. Potential mechanisms were evaluated in a human nasal provocation model. Aliquots of normal saline (1 x NS, 100 microliters) and higher concentrations (3 x NS, 6 x NS, 12 x NS, 24 x NS) were sprayed into one nostril at 5-min intervals. Lavage fluids were collected from the ipsilateral and contralateral sides to determine the concentrations of specific mucus constituents. Nasal cavity air-space volume was assessed by acoustic rhinometry (AcRh). The distribution of substance-P-preferring neurokinin-1 (NK-1) receptor mRNA was assessed by in situ reverse transcriptase-polymerase chain reaction. Unilateral HTS induced unilateral dose-dependent increases in sensations of pain, blockage, and rhinorrhea, the weights of recovered lavage fluids, and concentrations of total protein, lactoferrin, mucoglycoprotein markers, and substance P. Contralateral, reflex-mediated effects were minor. There were no changes in IgG or AcRh measurements. NK-1 receptor mRNA was localized to submucosal glands. HTS caused pain with unilateral substance P release. The presumed nociceptive nerve efferent axon response led to glandular exocytosis, presumably through actions on submucosal gland NK-1 receptors. Vascular processes, including plasma exudation, filling of venous sinusoids, and mucosal edema were not induced in these normal subjects.

Analysis of the expression of Fas-L in nasopharyngeal carcinoma tissues

Nasopharyngeal carcinoma (NPC) is an epithelial cancer with a high incidence in Southeast Asia. How it escapes attack from the host immune system is not fully understood. Recently, pieces of evidence show that Fas-ligand (Fas-L)-mediated apoptosis may be involved in immune privilege of tumours. To determine whether a similar mechanism may exist in NPC, the expression of Fas-L was analysed. Biopsy specimens of the nasopharynx were taken from 27 NPC patients. Histologically, they were either non-keratinizing or undifferentiated carcinomas. Nasopharyngeal biopsies of 11 other patients that proved to have no tumour served as control. The transcripts of Fas-L were detected by reverse transcription-polymerase chain reaction. Localization of Fas-L protein was performed with immunohistostaining using an antibody recognizing human Fas-L. All nasopharyngeal tissues have a similar amount of transcripts of Fas-L. However, the Fas-L protein was detected exclusively on the cell surface of malignant epithelial cells of NPC. The present findings suggest that Fas-L protein may be involved in evading immune attack of NPC.

Application of endoscopic sinus surgery to primary atrophic rhinitis? A clinical trial

The aetiology of primary atrophic rhinitis (AR) is still unclear. Based on the sinus infection theories, endoscopic sinus surgery (ESS) was applied to treat AR. ESS was performed on 14 patients following Stammberger's techniques along with middle turbinectomy. Patients were evaluated using clinical symptoms, radiological sinus images, saccharine time tests, bacterial cultures and mucosal ultrastructures, before and 2 years after ESS. Three patients had good recoveries, 6 had partial recoveries and another 5 had persistent disease. Good recovery patients showed clear nasal cavities and mucociliary transport system normalisation. Patients possess in meagre infectious signs or crusting extending to their nasopharynx had poor outcomes. Patients with evidence of obvious infections (cloudy sinus images, mucopus presence in the sinuses and positive culture for Klebsiella ozaenae) had good recoveries following ESS. Candidate selection is critical for the success of ESS treatment in AR. Although further clinical trials are required to prove this strategy.

Distribution and quantity of neuroendocrine markers in allergic rhinitis

Neuroendocrine components exist in the human nasal mucosa. However, the pathophysiological and neuroimmunological roles of the regulatory peptides in allergic rhinitis (AR) require further investigation. To analyse the functional morphology and quantify the tissue concentration of regulatory peptides in the nasal mucosa of AR subjects, human inferior turbinate mucosa specimens from 25 patients with AR, 20 patients with non-allergic rhinitis and 10 patients without any nasal diseases were investigated. Using immunohistochemistry and radioimmunoassays, we detected the presence, distribution and concentrations of various neuropeptides [vasoactive intestinal peptide (VIP), neuropeptide Y (NPY), substance P (SP) and calcitonin gene-related peptide (CGRP)] and general neuroendocrine markers (neuron-specific enolase and chromogranin A). Quantitative analysis of the stained fibres and cells was performed using a graphic AutoCAD program. The presence and distribution of NPY, CGRP and SP nerve fibres and neuroendocrine cells were similar among the three subject groups. AR subjects had significantly higher tissue concentrations of VIP and SP. AR subjects had increased numbers of VIP fibres which predominantly innervated vessels. Thus, VIP and SP play important neuroimmunological roles in the pathogenesis of AR.

Assessment of p53 protein expression in normal mucosa and benign and malignant lesions of the nasal cavity

p53 gene mutation is documented in head and neck cancer. No reports exist relating this mutation to normal mucosa or benign and malignant lesions of the nasal cavity. We investigate p53 overexpression using immunohistochemical techniques improved by an antigen retrieval method. p53 protein was analyzed in the following cases: normal, benign [papilloma and inverted papilloma (IP)] and malignant [squamous-cell carcinoma (SCC) arising in IP, SCC alone, adenocarcinoma and small-cell carcinoma]. Both the intensity and rate of positive p53 immunostaining were evaluated using a quantitative Auto-CAD program. Overexpression of p53 protein was not identified in normal mucosa, benign or premalignant lesions; however, approximately 60% is correlated to nasal cancer. p53 overexpression correlates with heavy smoking. Both the IP and SCC portions of SCC synchronous with IP showed similar p53 immunoreactivity. SCC arising in IP shows a lower p53 immunoreactivity than SCC alone. Thus, smoking along with a p53 mutation may be a mutagenic agent in nasal cancers. Alteration of the p53 protein may play an important role in the early stages of the malignant transformation of IP. A low p53 immunoreactivity indicates the presence of wild-type p53 protein. This may show a better response to radiation therapy yielding a better prognosis for SCC arising in IP compared to SCC alone. However, further clinical trials are required to investigate this possibly worthwhile prognostic marker.

Immunohistochemistry of p53 in sinonasal inverted papilloma and associated squamous cell carcinoma

Gene mutation of p53 is documented in head and neck cancer. No reports exist relating human sinonasal inverted papilloma (IP) and its transformation to squamous cell carcinoma (SCC). Using immunohistochemical techniques improved by an antigen retrieval method, p53 protein was analyzed in the following subjects: 16 IP, 12 SCC arising in IP, and 15 SCC alone subjects. Both the intensity (PI) and rate (PR) of positive p53 immunostaining were evaluated using a quantitative AutoCAD program. We correlated p53 protein expression with clinical features. p53 immunoreactivity is significantly lower in IP than in SCC specimens. Both the IP and SCC portions of IP synchronous SCC subjects showed similar p53 protein expression. SCC arising in IP shows a lower p53 immunoreactivity than SCC alone. Alteration of p53 protein may have an important role in the early stages of IP malignant transformation and prove a potential biomarker for risk assessment. Low p53 immunoreactivity, indicating the presence of a wild-type p53, may correlate with the prognosis for SCC arising in IP. However, further clinical trials are required to investigate this possibly worthwhile prognostic marker.

Anticholinergic properties of brompheniramine, chlorpheniramine, and atropine in human nasal mucosa in vitro

Brompheniramine and chlorpheniramine have anticholinergic activities, but the relative potency of these effects has not been well defined. The anticholinergic properties of brompheniramine, chlorpheniramine, and atropine were assessed in an in vitro model of human nasal mucosal glandular secretion. Methacholine was used as a cholinergic agonist to stimulate glandular secretion of 7F10-mucin. These drugs (0.01-1000 microM) or vehicle (saline) were added to explant cultures with and without 100 microM methacholine. 7F10-mucin concentrations were measured in culture supernatants after 2-hour incubations. The effective dose reducing methacholine-induced secretion (ED50) was determined. ED50 was 0.25 microM for atropine, 4.10 microM for brompheniramine, and 4.63 microM for chlorpheniramine. None of the anticholinergic drugs changed spontaneous glandular exocytosis. Brompheniramine and chlorpheniramine are equipotent anticholinergic agents in human nasal mucosa in vitro. Atropine was 16 to 19 times more potent.

Neuropeptide innervation and neuroendocrine cells in allergic rhinitis and chronic hypertrophic rhinitis

BACKGROUND

The neuropeptides and neuroendocrine cells are proven to exist in the human nasal mucosa. However, the pathophysiological and neuroimmunological roles of regulatory peptides in human nasal diseases require further investigation.

OBJECTIVES

To investigate and compare the functional morphology and quantify the tissue concentration of regulatory peptides in the nasal mucosas of normal, allergic rhinitis (AR) and chronic hypertrophic rhinitis (CHR) subjects.

METHODS

Human inferior turbinate mucosa specimens from 28 patients with AR, 25 patients with CHR and 15 patients without any nasal diseases were investigated. Using immunohistochemistry and radioimmunoassays, we detected the presence, distribution and concentrations of various neuropeptides (vasoactive intestinal peptides [VIP], neuropeptide Y [NPY], substance P [SP], calcitonin gene-related peptides [CGRP]) and general neuroendocrine markers (neurone-specific enolase, chromogranin A and somatostatin). Quantitative analysis of the stained fibres and cells were performed using a graphic AutoCAD program.

RESULTS

The presence and distribution of NPY, CGRP, and SP nerve fibres and neuroendocrine cells were similar among the three subject groups. AR subjects had significantly higher VIP and SP tissue concentrations. VIP fibres had highest density in AR subjects and these fibers predominantly innervated vessels. In CHR, VIP fibres primarily innervated glands.

CONCLUSIONS

VIP and SP may play an important neuroimmunological role in the pathogenesis of AR. VIP may lead to the hypertrophic changes of submucosal glands in the pathogenesis of CHR.

Assessment of cell surface glycoconjugates in normal, benign and malignant human nasal mucosa

Aberrant glycosylation of proteins is a common characteristic of neoplastic changes. No reports exist relating cell surface glycoconjugates to normal, benign and malignant human nasal mucosa. Using lectin affinity histochemistry, glycoconjugate reactivities for peanut agglutinin (PNA), concanavalin A (Con A), Griffonia simplicifolia agglutinin II (GSA-II), soy bean agglutinin (SBA) and Ulex europaeus agglutinin l (UEA-I) were analysed in the following groups: normal, benign (polyp, papilloma, and inverted papilloma) and malignant (squamous cell carcinoma (SCC) alone, SCC arising in inverted papilloma, and adenocarcinoma). The positive rate of lectin staining was evaluated using a quantitative AutoCAD programme. We correlated glycoconjugate expression to clinical features, diagnosis, and malignant transformation. The positive rate of PNA after neuraminidase pre-treatment (NA-PNA) staining was higher in inverted papilloma, while all-negative in polyp and papilloma. NA-PNA staining may be used as a differential diagnostic tool. Both inverted papilloma portions and SCC portions of the SCC synchronized with inverted papilloma subjects showed similar Con A and NA-PNA staining patterns. The biological characteristics define inverted papilloma as a pre-malignant neoplasm. The positive rate of PNA staining was significantly higher in inverted papilloma (inverted papilloma transformed to SCC) compared to inverted papilloma alone. Hence, PNA staining may predict malignant transformation of inverted papilloma. However, further investigations are required to prove this possibly worthwhile prognostic marker.

Lectin immunohistochemistry study of nasal inverted papilloma and associated neoplasms

BACKGROUND

We aimed to investigate the tumor biology of nasal IP and identify the biological characteristics associated with early diagnosis and malignant transformation.

MATERIALS AND METHODS

Lectins immunohistochemistry were performed on inverted papilloma (IP), and associated neoplasms. IP synchronized with polyp or squamous cell carcinoma (SCC) and IP metachronized with SCC were analyzed and correlated to clinical information.

RESULTS

Canavalia ensiformis (ConA) and Arachis hypogaea (PNA) with neuraminidase pretreatment (NA-PNA) showed similar staining in both the IP and SCC portions of the IP synchronized with SCC. The IP and polyp portions of an IP synchronized polyp had positive NA-PNA staining, while papilloma and polyps alone had negative staining. Strong NA-PNA staining in the IP (transformed to SCC) showed significant differences from IP.

CONCLUSION

These biological characteristics define IP as a premalignant neoplasm. NA-PNA staining may be helpful for an early detection of IP. Strong NA-PNA staining in IP may predict malignant transformation.

Recovery of non-invasive Aspergillus sinusitis by endoscopic sinus surgery

No previous data regarding non-invasive Aspergillus sinusitis (NIAS) treated by endoscopic sinus surgery (ESS) has stated any relevance to pre-operative evaluations, disease entities, and the reversibility of symptoms and the sinus mucosa. This prospective study of 31 patients with NIAS and treated by ESS (Strammberger's method) was designed to tackle the above problems. All patients were followed post-operatively by endoscopy once a week. The most refractory symptom was post-nasal dripping. The other symptoms such as foul odour showed progressive improvement by the second post-operative week. Prolonged saccharin time and disease history longer than two years showed the warning signs of a poor recovery. Most patients belonged to the chronic indolent sinusitis group with 55.5% having a complete recovery within the 9th to 12th post-operative weeks. Most patients of allergic Aspergillus sinusitis manifested a recurrent course within months following a post-ESS silent period. All patients of aspergilloma completely recovered prior to the 8th post-operative week.

Neuropeptidergic innervation of human nasal mucosa in various pathological conditions

This study aims to investigate the roles of neuropeptides in the pathophysiology of human nasal diseases. By using immunohistochemistry and radioimmunoassay, we detected the presence, distribution and concentrations of the following neuropeptides in human nasal tissue: vasoactive intestinal peptides (VIP), neuropeptide Y (NPY), substance P (SP), and calcitonin gene-related peptides (CGRP). This was performed in human nasal inferior turbinate mucosa from 20 patients with allergic rhinitis, twenty-five patients with chronic hypertrophic rhinitis and 10 patients without any nasal disease conditions. The presence and distribution of NPY. CGRP and SP fibers among the three subject groups displayed no evident differences. VIP fibers were densely stained around the vessels in the allergic group. In contrast, these fibers were more prominently distributed around the submucosal glands of the chronic hypertrophic rhinitis group. The concentration of VIP and SP in human nasal inferior turbinate showed a significant increase in allergic subjects. Thus, VIP may be revelant to the hypertrophic changes of the nasal mucosa. Both SP and VIP may play significant neuroimmunological roles in the pathogenesis of allergic rhinitis.

Effect of nitroblue tetrazolium on NO synthase and motor function of opossum esophagus

Nitric oxide mediates neuromuscular events in the opossum esophagus. The NADPH diaphorase stain is used to localize nitric oxide synthase-containing enteric neurons. Cells stain by the NADPH diaphorase technique because they reduce nitroblue tetrazolium to the visible formazan. The effects of nitroblue tetrazolium on neuromuscular function and nitric oxide synthase of esophageal muscle were studied. The NADPH diaphorase stain was performed. Nitroblue tetrazolium inhibited lower esophageal sphincter relaxation, abolished the latency gradient of the off response, and inhibited nitric oxide synthase. The NADPH diaphorase technique stained myenteric plexus nerve cell bodies and nerve processes. Nitroblue tetrazolium is not a nonspecific muscle or nerve toxin, as nerve-mediated cholinergic responses, responses to exogenous nitric oxide, and responses to myogenic stimulation were maintained after nitroblue tetrazolium abolished the off response and lower esophageal sphincter relaxation. Nitroblue tetrazolium inhibits nitric oxide-mediated events and nitric oxide synthase. It stains neurons in the esophageal myenteric plexus.

Triterpenoid glycosides from Adina rubella

Two new triterpenoid glycosides, quinovic acid-3 beta-O-beta-D- glucopyranosyl-(1-->4)-alpha-L-rhamnopyranoside and quinovic acid-3 beta-O-beta-D-glucopyranosyl-(1-->3)-beta-D-fucopyranoside (named rubelloside A and B, respectively), were isolated from roots of Adina rubella. Their structures were elucidated by spectral and chemical means. Rubelloside B exhibited immunological enhancement.

Macrophages in degradation of collagen/hydroxylapatite(CHA), beta-tricalcium phosphate ceramics (TCP) artificial bone graft. An in vivo study

The macrophages mediated biodegradation of two biomaterials, collagen/hydroxylapatite (CHA) and beta-tricalcium phosphate ceramics (TCP), was studied in 24 male Kunming mice and 20 male C57BL/6 mice with histopathologic, histochemical and ultrastructural observation. It was demonstrated that macrophages infiltrated after CHA, TCP were implanted. The macrophages could be differentiated from fibroblasts and the other infiltrated cells for special cellular profile and strong acid phosphatase activity. Morphologically, monocyte-macrophages and infused multinuclear giant cell degraded CHA and TCP by phagocytosis and extracellular resorption. The carbonic anhydrase activity of macrophages was demonstrated by histochemical technique. It suggested that macrophages secreted H+ and accomplished the decalcification of calcium phosphate compound of CHA and TCP. We conclude that macrophages are the main mediating cells which degraded CHA and TCP intracellularly and extracellularly.

Normalization of maxillary sinus mucosa after FESS. A prospective study of chronic sinusitis with nasal polyps

To observe the normalization of antral mucosa after FESS, 71 patients suffering from chronic sinusitis with nasal polyps were enrolled in this study. Pre-operative profiles including history, allergy skin test, and saccharin time test were done. Endoscopic findings of the antral mucosa were divided into 3 groups: polyposis, oedema, and thickening. The time sequence required for normalization of the mucosa was observed through the antromeatal opening. A patient's history of more than seven years, a saccharin time longer than 36 min, and polyposis of antral mucosa are ominous signs for recovery. The most frequent endoscopic finding of maxillary sinusitis is oedema and many of the sinus units (42%) gained complete recovery during the third month. Pre-operative profiles and endoscopic findings during surgery can serve as a reference of recovery time and treatment modality.

Transformation of mucosal secretory elements in chronic maxillary sinusitis after endoscopic sinus surgery

To evaluate the secretory element transformation of maxillary sinus mucosa after endoscopic sinus surgery (ESS), I enrolled 20 patients. Five normal antral mucosae were used as controls, and 15 antral mucosae were investigated according to pathologic and secretory patterns. The post-ESS mucosa was evaluated at the 16th week, when gross recovery appeared. Specimens from the rear wall of the antrum were observed under a scanning electron microscope (x2,000). A significant decrease of goblet cells and increase of glands was illustrated in the sinusitis cases, especially the polypoid and purulent groups. In post-ESS cases, the number of goblet cells is about the same as in controls, but the number of gland openings is higher. My conclusions were that 1) the repair of the antral mucosa requires more time than gross recovery and 2) post-ESS follow-up should be longer than 16 weeks to prevent recurrence.

Presence of neuropeptides in human nasal polyps

The pathophysiological effects of non-cholinergic, non-adrenergic neuropeptides are well known in the nasal mucosa, but unclear in the polyps. Since the pathophysiological roles of neuropeptides depend on their presence in the target tissue, specimens of nasal polyps were removed from 20 patients and examined for the presence of vasoactive intestinal peptide (VIP), neuropeptide Y (NPY), dopamine-beta-hydroxylase (DBH), substance P (SP) and calcitonin gene-related peptide (CGRP). To visualize these neuropeptide fibers, immunohistochemical staining by the peroxidase-anti-peroxidase method and color reaction by Nickel enhancement of diaminobenzidine (DAB) were used. Fine varicose neuropeptides immunostained fibers were predominantly distributed in the pedicle of the polyps. No neuropeptides were found in the mucosal epithelium and subepithelium. NPY fibers were predominantly seen around the thick wall vessels, whereas the VIP fibers were mainly to be found in close proximity to the submucosal glands and fairly close to the vessels. SP or CGRP fibers were not found in the polyps. VIP and NPY in the pedicle of the polyps may be present in connection with mucosal inflammation, tissue edema and cystic degeneration of the glands in the early stage of polyp formation. Thus these neuropeptides may contribute to the development and growth of nasal polyps.

An ultrastructural observation of macrophages in rabbits' radius callus

The ultrastructure of macrophages in rabbits' radius callus at the 14th and 31st day after fracture had been observed in the study. It was found that macrophages mostly appeared in the early stage callus where there were inflammation, clot, and bone chips. Commonly seen macrophages were active phagocytes with single nucleus, but they could evolve to form multinuclear macrophages or fuse into foreign body giant cells. We are therefore led to conclude that the functions performed by macrophages in healing callus are to phagocytize and digest damaged cellular fragments, small bone chips, clot and foreign body; to disrupt larger dead bone matrix extracellularly and to resorb them by microvilli-like processes on the surface of foreign body giant cells.

Freezing of phosphocholine headgroup in fully hydrated sphingomyelin bilayers and its effect on the dynamics of nonfreezable water at subzero temperatures

Differential scanning calorimetry (DSC) and nuclear magnetic resonance (NMR) spectroscopy are applied to characterize the nonfreezable water molecules in fully hydrated D2O/sphingomyelin at temperatures below 0 degrees C. Upon cooling, DSC thermogram displays two thermal transitions peaked at -11 and -34 degrees C. The high-temperature exothermic transition corresponds to the freezing of the bulk D2O, and the low-temperature transition, which has not previously been reported, can be ascribed to the freezing of the phosphocholine headgroup in the lipid bilayer. The dynamics of nonfreezable water are also studied by 2H NMR T1 (spin-lattice relaxation time) and T2e (spin-spin relaxation time obtained by two pulse echo) measurements at 30.7 MHz and at temperatures down to -110 degrees C. The temperature dependence of the T1 relaxation time is characterized by a distinct minimum value of 2.1 +/- 0.1 ms at -30 degrees C. T2e is discontinuous at temperature around -70 degrees C, indicating another freezing-like event for the bound water at this temperature. Analysis of the relaxation data suggest that nonfreezable water undergoes both fast and slow motions at characteristic NMR time scales. The slow motions are affected when the lipid headgroup freezes.