Postoperative instructions after endoscopic sinus surgery: is there a consensus?

BACKGROUND: Most endoscopic sinus surgeons instruct their patients to avoid certain activities during the postoperative period. Due to the scarcity of empirical data on this issue, most instructions are based on surgeons’ personal insights. In this study we evaluated if restrictions for performing specific activities have a consensus among endoscopic sinus surgeons. METHODOLOGY: A nationwide survey was conducted among experienced Israeli endoscopic sinus surgeons. Participants were asked to note the optimal postoperative time restrictions of 25 different activities. RESULTS: The response rate was 30/36 (83%). Surgeons’ responses regarding time restrictions of specific activities postoperatively showed high variance. The greatest variance was noted for using a hair dryer, light physical activities, nose blowing, driving a car, having sexual intercourse, eating/drinking hot food or beverages, taking hot showers and drinking alcohol. CONCLUSIONS: The time restrictions given by endoscopic sinus surgeons for specific activities postoperatively vary greatly among them. The study findings call upon rhinology boards to establish consensus-based guidelines for postoperative management after endoscopic sinus surgery.

Comparison of CT and adjusted MRI for evaluating paranasal sinuses surgical key landmarks

Background: Sinus CT is the imaging technique of choice for planning endoscopic sinus surgery (ESS). Although MRI has a better soft tissue demonstration, it is not commonly used for ESS due to suboptimal bone demonstration. We hypothesised that adjustment of certain MRI parameters, would allow better demonstration of bones and enable the surgeon to adequately identify surgical landmarks. Methodology: Twenty patients identified as candidates for ESS underwent CT and adjusted MRI exams of the paranasal sinuses (40 in total). rhinologist and a neuroradiologist independently compared and graded 46 bony structures (23 on each side) in each patient's CT and MRI. Overall, 920 anatomical structures were graded by each observer (1840 structures in total). Statistical analysis included overall and per variable grading distribution for each observer, and overall agreement. Results: MRI images were equal, or superior to CT for assessing paranasal anatomy in 66.8% and 86.4% of structures evaluated by the rhinologist and neuroradiologist, respectively. Overall agreement between observers (77%) was moderate. Conclusion: The rhinologist prefers CT demonstration of bony structures, while the neuroradiologist prefers MRI. Still, with the MRI protocol used in this study, according to both, most bony structures are well demonstrated by MRI.

Alterations of microRNAs throughout the malignant evolution of cutaneous squamous cell carcinoma: the role of miR-497 in epithelial to mesenchymal transition of keratinocytes

Skin carcinogenesis is known to be a multi-step process with several stages along its malignant evolution. We hypothesized that transformation of normal epidermis to cutaneous squamous cell carcinoma (cSCC) is causally linked to alterations in microRNAs (miRNA) expression. For this end we decided to evaluate their alterations in the pathologic states ending in cSCC. Total RNA was extracted from formalin fixed paraffin embedded biopsies of five stages along the malignant evolution of keratinocytes towards cSCC: Normal epidermis, solar elastosis, actinic keratosis KIN1-2, advanced actinic keratosis KIN3 and well-differentiated cSCC. Next-generation small RNA sequencing was performed. We found that 18 miRNAs are overexpressed and 28 miRNAs are underexpressed in cSCC compared to normal epidermis. miR-424, miR-320, miR-222 and miR-15a showed the highest fold change among the overexpressed miRNAs. And miR-100, miR-101 and miR-497 showed the highest fold change among the underexpressed miRNAs. Heat map of hierarchical clustering analysis of significantly changed miRNAs and principle component analysis disclosed that the most prominent change in miRNAs expression occurred in the switch from 'early' stages; normal epidermis, solar elastosis and early actinic keratosis to the 'late' stages of epidermal carcinogenesis; late actinic keratosis and cSCC. We found several miRNAs with 'stage specific' alterations while others display a clear 'gradual', either progressive increase or decrease in expression along the malignant evolution of keratinocytes. The observed alterations focused in miRNAs involved in the regulation of AKT/mTOR or in those involved in epithelial to mesenchymal transition. We chose to concentrate on the evaluation of the molecular role of miR-497. We found that it induces reversion of epithelial to mesenchymal transition. We proved that SERPINE-1 is its biochemical target. The present study allows us to further study the pathways that are regulated by miRNAs along the malignant evolution of keratinocytes towards cSCC.

Analysis of transcription of the Staphylococcus aureus aerobic class Ib and anaerobic class III ribonucleotide reductase genes in response to oxygen

Staphylococcus aureus is a gram-positive facultative aerobe that can grow in the absence of oxygen by fermentation or by using an alternative electron acceptor. To investigate the mechanism by which S. aureus is able to adapt to changes in oxygen concentration, we analyzed the transcriptional regulation of genes that encode the aerobic class Ib and anaerobic class III ribonucleotide reductase (RNR) systems that are responsible for the synthesis of deoxyribonucleotides needed for DNA synthesis. The S. aureus class Ib RNR nrdIEF and class III RNR nrdDG genes and their regulatory regions were cloned and sequenced. Inactivation of the nrdDG genes showed that the class III RNR is essential for anaerobic growth. Inhibition of aerobic growth by hydroxyurea showed that the class Ib RNR is an oxygen-dependent enzyme. Northern blot analysis and primer extension analysis demonstrated that transcription of class III nrdDG genes is regulated by oxygen concentration and was at least 10-fold higher under anaerobic than under aerobic conditions. In contrast, no significant effect of oxygen concentration was found on the transcription of class Ib nrdIEF genes. Disruption or deletion of S. aureus nrdDG genes caused up to a fivefold increase in nrdDG and nrdIEF transcription under anaerobic conditions but not under aerobic conditions. Similarly, hydroxyurea, an inhibitor of the class I RNRs, resulted in increased transcription of class Ib and class III RNR genes under aerobic conditions. These findings establish that transcription of class Ib and class III RNR genes is upregulated under conditions that cause the depletion of deoxyribonucleotide. Promoter analysis of class Ib and class III RNR operons identified several inverted-repeat elements that may account for the transcriptional response of the nrdIEF and nrdDG genes to oxygen.

Relations of basic arithmetic and motor skills in deaf elementary school children

3 segregated groups of Arab and Jewish deaf children of CA 10;9 (n = 28) were compared with a group of hearing Arab first graders (CA = 6;10, n = 32) on tests of basic arithmetic, static balance control, and the ability to suppress synkinetic finger movements. The hearing-impaired performed as well on arithmetic tasks and on the tests of synkinetic control as their normal peers who were four years younger, while on static balance they were even inferior to the latter. Significant correlations were found between the basic arithmetic and motor skills, within the hearing as well as within the hearing-impaired groups; these remained significant even within the small subgroups of the latter. As these results cannot be accounted for by low intelligence and neurological disturbances, or by direct or indirect effects of deficient language development, the assumption is supported that some type of neurological immaturity, unrelated to hearing loss, interferes with the acquisition of numerical skills in deaf children.