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Sedaghat AR, Fokkens WJ, Lund VJ, Hellings PW, Kern RC, Reitsma S, Toppila-Salmi S, Bernal-Sprekelsen M, Mullol J, Gevaert P, Teeling T, Alobid I, Anselmo-Lima WT, Baroody FM, Cervin A, Cohen NA, Constantinidis J, De Gabory L, Desrosiers M, Harvey RJ, Kalogjera L, Knill A, Landis BN, Meco C, Philpott CM, Ryan D, Schlosser RJ, Senior BA, Smith TL, Tomazic PV, Zhang L, Hopkins C. Consensus criteria for chronic rhinosinusitis disease control: an international Delphi Study. Rhinology 2023; 61:519-530. [PMID: 37804121 DOI: 10.4193/rhin23.335] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) disease control is a global metric of disease status for CRS. While there is broad acceptance that it is an important treatment goal, there has been inconsistency in the criteria used to define CRS control. The objective of this study was to identify and develop consensus around essential criteria for assessment of CRS disease control. METHODS Modified Delphi methodology consisting of three rounds to review a list of 24 possible CRS control criteria developed by a 12-person steering committee. The core authorship of the multidisciplinary EPOS 2020 guidelines was invited to participate. RESULTS Thirty-two individuals accepted the invitation to participate and there was no dropout of participants throughout the entire study (3 rounds). Consensus essential criteria for assessment of CRS control were: overall symptom severity, need for CRS-related systemic corticosteroids in the prior 6 months, severity of nasal obstruction, and patient-reported CRS control. Near-consensus items were: nasal endoscopy findings, severity of smell loss, overall quality of life, impairment of normal activities and severity of nasal discharge. Participants’ comments provided insights into caveats of, and disagreements related to, near-consensus items. CONCLUSIONS Overall symptom severity, use of CRS-related systemic corticosteroids, severity of nasal obstruction, and patient-reported CRS control are widely agreed upon essential criteria for assessment of CRS disease control. Consideration of near-consensus items to assess CRS control should be implemented with their intrinsic caveats in mind. These identified consensus CRS control criteria, together with evidence-based support, will provide a foundation upon which CRS control criteria with wide-spread acceptance can be developed.
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Affiliation(s)
- A R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - W J Fokkens
- Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - V J Lund
- Royal National ENT Hospital, University College London Hospital NHS Foundation Trust, London, UK
| | - P W Hellings
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, KU Leuven, Belgium
| | - R C Kern
- Department of Otorhinolaryngology, Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - S Reitsma
- Department of Otorhinolaryngology and Head and Neck Surgery, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - S Toppila-Salmi
- Department of Otorhinolaryngology, Kuopio University Hospital and University of Eastern Finland, Finland and Department of Allergy, Inflammation Center, Helsinki University Hospital and University of Helsinki, Finland
| | | | - J Mullol
- Rhinology Unit and Smell Clinic, ENT Department, Hospital Clinic, FRCB-IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia, Spain
| | - P Gevaert
- Department of Otorhinolaryngology, Ghent University, Ghent, Belgium
| | - T Teeling
- Patient representative, Task Force Healthcare, WTC Den Haag, The Netherlands
| | - I Alobid
- Rhinology and Skull Base Unit, ENT Department, Hospital Clinic, Universitat de Barcelona, August Pi i Sunyer Biomedical Research Institute, CIBERES, Barcelona, Spain
| | - W T Anselmo-Lima
- Division of Otorhinolaryngology, Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirao Preto Medical School-University of Sao Paulo, Sao Paulo, Brazil
| | - F M Baroody
- Department of Otorhinolaryngology-Head and Neck Surgery, The University of Chicago Medicine and the Comer Children’s Hospital, Chicago, IL, USA
| | - A Cervin
- Department of Otorhinolaryngology, Head and Neck Surgery, Royal Brisbane and Women's Hospital; Faculty of Medicine, University of Queensland, Brisbane, Australia and Department of Clinical Sciences, Lund University, Lund, Sweden
| | - N A Cohen
- Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA
| | - J Constantinidis
- 1st Department of ORL, Head and Neck Surgery, Aristotle University, AHEPA Hospital, Thessaloniki, Greece
| | - L De Gabory
- Rhinology and Plastic Surgery Unit, Otorhinolaryngology, Head and Neck Surgery and Pediatric ENT Department, CHU ux, Hospital Pellegrin, Centre F-X Michelet, Bordeaux, France
| | - M Desrosiers
- Department of ORL-HNS, Universitat de Montreal, Montreal, Canada
| | - R J Harvey
- Rhinology and Skull Base Department, Applied Medical Research Centre, UNSW (Conjoint) and Macquarie University (Clinical), Sydney, Australia
| | - L Kalogjera
- Department of Otorhinolaryngology/Head and Neck Surgery, Zagreb School of Medicine; University Hospital Center, Sestre milosrdnice,Zagreb, Croatia
| | - A Knill
- Patient representative, Sinus UK, London, UK
| | - B N Landis
- Rhinology-Olfactology Unit, Otorhinolaryngology Department, University Hospital of Geneva, Geneva, Switzerland
| | - C Meco
- Department of Otorhinolaryngology, Head and Neck Surgery, Ankara University, Ankara, Turkey and Department of Otorhinolaryngology, Head and Neck Surgery, Salzburg Paracelsus Medical University, Salzburg, Austria
| | - C M Philpott
- Rhinology and ENT Research Group, Norwich Medical School, University of East Anglia, Norwich, UK and Norfolk and Waveney ENT Service, James Paget University Hospital, Great Yarmouth and Norfolk and Norwich University Hospital, Norwich, UK
| | - D Ryan
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, UK and International Primary Care Respiratory Group, Edinburgh, Scotland, UK
| | - R J Schlosser
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - B A Senior
- Department of Otolaryngology - Head and Neck Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - T L Smith
- Division of Rhinology and Sinus Surgery, Oregon Sinus Center, Oregon Health
| | - P V Tomazic
- Department of Otorhinolaryngology, Medical University of Graz, Graz, Austria
| | - L Zhang
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China and Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China and Beijing Institute of Otolaryngology, Beijing Laboratory of Allergic Diseases, Beijing Key Laboratory of Nasal Diseases, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, China and Research Unit of Diagnosis and T
| | - C Hopkins
- Department of Otolaryngology and Head Neck Surgery, Guys and St Thomas’ Hospital, London, UK
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Hellings PW, Fokkens WJ, Orlandi R, Adriaensen GF, Alobid I, Baroody FM, Bjermer L, Senior BA, Cervin A, Cohen NA, Constantinidis J, De Corso E, Desrosiers M, Diamant Z, Douglas RG, Gane S, Gevaert P, Han JK, Harvey RJ, Hopkins C, Kern RC, Landis BN, Lee JT, Lee SE, Leunig A, Lund VJ, Bernal-Sprekelsen M, Mullol J, Philpott C, Prokopakis E, Reitsma S, Ryan D, Salmi S, Scadding G, Schlosser RJ, Steinsvik A, Tomazic PV, Van Staeyen E, Van Zele T, Vanderveken O, Viskens AS, Conti D, Wagenmann M. The EUFOREA pocket guide for chronic rhinosinusitis. Rhinology 2023; 61:85-89. [PMID: 36507741 DOI: 10.4193/rhin22.344] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chronic rhinosinusitis (CRS) is known to affect around 5 % of the total population, with major impact on the quality of life of those severely affected (1). Despite a substantial burden on individuals, society and health economies, CRS often remains underdiagnosed, under-estimated and under-treated (2). International guidelines like the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) (3) and the International Consensus statement on Allergy and Rhinology: Rhinosinusitis 2021 (ICAR) (4) offer physicians insight into the recommended treatment options for CRS, with an overview of effective strategies and guidance of diagnosis and care throughout the disease journey of CRS.
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Affiliation(s)
- P W Hellings
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Allergy and Clinical Immunology Research Group, Leuven, Belgium; University Hospitals Leuven, Department of Otorhinolaryngology, Leuven, Belgium; University Hospital Ghent, Department of Otorhinolaryngology, Laboratory of Upper Airways Research, Ghent, Belgium; Department of otorhinolaryngology and head/neck surgery, Amsterdam University Medical Centres, location AMC, University of Amsterdam, Amsterdam, The Nethe
| | - W J Fokkens
- Department of otorhinolaryngology and head/neck surgery, Amsterdam University Medical Centres, location AMC, University of Amsterdam, Amsterdam, The Netherland
| | - R Orlandi
- Rhinology and Skull Base, Department of Otorhinolaryngology, Hospital Clinic, Universidad de Barcelona, Centro Medico Teknon, Barcelona, Spain
| | - G F Adriaensen
- Department of otorhinolaryngology and head/neck surgery, Amsterdam University Medical Centres, location AMC, University of Amsterdam, Amsterdam, The Netherland
| | - I Alobid
- Rhinology and Skull Base, Department of Otorhinolaryngology, Hospital Clinic, Universidad de Barcelona, Centro Medico Teknon, Barcelona, Spain
| | - F M Baroody
- The University of Chicago Medicine, Chicago, IL, United States
| | - L Bjermer
- Dept of Respiratory Medicine and Allergology, Skane University Hospital, Lund, Sweden
| | - B A Senior
- Division of Rhinology, Allergy, and Endoscopic Skull Base Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A Cervin
- The university of Queensland Centra for Clinical Research, Herston, Australia; Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - N A Cohen
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - J Constantinidis
- 1st Department of ORL, Head and Neck Surgery, Aristotle University, AHEPA Hospital, Thessaloniki, Greece
| | - E De Corso
- Department of Otolaryngology Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCSS, Universita; Cattolica Sacro Cuore, Rome, Italy
| | - M Desrosiers
- Department of Otolaryngology-Head and Neck Surgery, Universita de Montreal, Montreal, Canada
| | - Z Diamant
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Allergy and Clinical Immunology Research Group, Leuven, Belgium; Dept of Respiratory Medicine and Allergology, Skane University Hospital, Lund, Sweden; Department Clinical Pharmacy and Pharmacology, University Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - R G Douglas
- Department of Surgery, The University of Auckland, New Zealand
| | - S Gane
- Royal National Ear, Nose and Throat and Eastman Dental Hospitals, London, United Kingdom
| | - P Gevaert
- University Hospital Ghent, Department of Otorhinolaryngology, Laboratory of Upper Airways Research, Ghent, Belgium
| | - J K Han
- Department of Otolaryngology and Head and Neck Surgery at Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - R J Harvey
- Rhinology and Skull Base, Applied Medical Research Center, Department of Otolaryngology and Head and Neck Surgery at Eastern Virginia Medical School, Norfolk, Virginia, USA; Faculty of medicine and heath sciences, Macquarie University, Sydney, Australia
| | - C Hopkins
- Ear, Nose and Throat Department, Guys and St. Thomas Hospital, London, United Kingdom
| | - R C Kern
- Department of Otolaryngology, Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA; Division of Allergy-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - B N Landis
- Hopitaux Universitaires de Geneve, Geneve, Geneve, Switzerland
| | - J T Lee
- Brigham and Women's Hospital, Harvard Medical School, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Section of Rhinology and Skull Base Surgery, Massachusetts, USA
| | - S E Lee
- Department of Head and Neck Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - A Leunig
- Rhinology Center, Munich and ENT-Clinic, Munich, Germany
| | - V J Lund
- Royal National Throat, Nose and Ear Hospital, UCLH, London, UK
| | | | - J Mullol
- Rhinology Unit and Smell Clinic, ENT Department, Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBERES. Barcelona, Catalonia, Spain
| | - C Philpott
- NIHR UCLH Biomedical research Centre, London, UK; Ear Institute, University College London, London, UK
| | - E Prokopakis
- Department of Otorhinolaryngology, University of Crete School of Medicine, Heraklion, Greece
| | - S Reitsma
- Department of otorhinolaryngology and head/neck surgery, Amsterdam University Medical Centres, location AMC, University of Amsterdam, Amsterdam, The Netherland
| | - D Ryan
- Usher institute, University of Edinburgh, Edinburgh, UK
| | - S Salmi
- Medicum, Haartman Institute, University of Helsinki, Helsinki, Finland; Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - G Scadding
- Royal National Ear, Nose and Throat and Eastman Dental Hospitals, London, United Kingdom
| | - R J Schlosser
- Department of Otolaryngology Head and Neck surgery, Medical University of South Carolina, Charleston, SC, USA
| | | | - P V Tomazic
- Department of Otorhinolaryngology, Medical University of Graz, Graz, Austria
| | - E Van Staeyen
- University Hospitals Leuven, Department of Otorhinolaryngology, Leuven, Belgium
| | - T Van Zele
- University Hospital Ghent, Department of Otorhinolaryngology, Laboratory of Upper Airways Research, Ghent, Belgium
| | - O Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium; Department of ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium; Multidisciplinary Sleep Disorder Center, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - A-S Viskens
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Allergy and Clinical Immunology Research Group, Leuven, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium
| | | | - M Wagenmann
- Department of Otorhinolaryngology, Universitatsklinikum Disseldorf, Dusseldorf, Germany
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Osie G, Wegrecki K, Alvarado R, Campbell RG, Kalish L, Rimmer J, Sacks R, Harvey RJ. Features of inhalant allergy on nasal endoscopy: a systematic review and meta-analysis. Rhinology 2022; 60:335-346. [PMID: 35726828 DOI: 10.4193/rhin22.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Nasal endoscopy is increasingly accessible to ENT surgeons. The characteristics of the allergic upper airway are not well recognised. METHODOLOGY MEDLINE (1946-2021), EMBASE (1974-2021), and the Cochrane Library were searched on 16th November 2021 to identify articles that reported endoscopic findings of patients with documented allergy who had undergone nasal endoscopy. The review followed the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. Meta-analysis was performed by pooling sensitivities and specificities using the hierarchical summary receiver operating characteristics model. RESULTS A total of 4108 articles were identified, of which 15 manuscripts met the inclusion criteria. The included studies involved 4660 patients who had undergone nasal endoscopy. Middle turbinate (diffuse/polypoid) oedema (sensitivity 58.0%, specificity 84.5%), watery secretions (sensitivity 65.7%, specificity 76.5%), inferior turbinate hypertrophy (sensitivity 86.2%, specificity 32.2%), and unspecified turbinate hypertrophy (sensitivity 82.0%, specificity 42.9%) were identified as the features with the highest predictive value of inhalant allergy. CONCLUSIONS Diffuse or polypoid oedema of the middle turbinate or watery secretions seen on nasal endoscopy can be a useful adjunct in the identification and diagnosis of inhalant allergy. These clinical features should be part of the diagnostic workup for patients that includes a clinical history and surrogate markers of allergic sensitisation from the skin and serum.
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Affiliation(s)
- G Osie
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - K Wegrecki
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - R Alvarado
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia
| | - R G Campbell
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia.,Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.,Department of Otolaryngology Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - L Kalish
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia.,Department of Otolaryngology, Head and Neck Surgery, Concord General Hospital, University of Sydney, Australia.,Faculty of Medicine, University of Sydney, Australia
| | - J Rimmer
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia.,Woolcock Institute, University of Sydney, Australia.,Faculty of Medicine, Notre Dame University, Sydney, Australia
| | - R Sacks
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.,Department of Otolaryngology, Head and Neck Surgery, Concord General Hospital, University of Sydney, Australia.,Faculty of Medicine, University of Sydney, Australia
| | - R J Harvey
- Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, Sydney, Australia.,Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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Lyons LA, Buckley RM, Harvey RJ. Mining the 99 Lives Cat Genome Sequencing Consortium database implicates genes and variants for the Ticked locus in domestic cats (Felis catus). Anim Genet 2021; 52:321-332. [PMID: 33780570 PMCID: PMC8252059 DOI: 10.1111/age.13059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 12/12/2022]
Abstract
Tabby patterns of fur coats are defining characteristics in wild and domestic felids. Historically, three autosomal alleles at one locus (Tabby): Abyssinian (Ta ; a.k.a. ticked), mackerel (Tm ; a.k.a. striped) and blotched (tb ; a.k.a. classic, blotched) were thought to control these patterns in domestic cats and their breeds. Currently, at least three loci influence cat tabby markings, two of which are designated Tabby and Ticked. The Tabby locus is laeverin (LVRN) and affects the mackerel and blotched patterns. The unidentified gene for the Ticked locus on cat chromosome B1 was suggested to control the presence or absence of the ticked pattern (Tabby - Abyssinian (Ta ; a.k.a. ticked). The cat reference genome (Cinnamon, the Abyssinian) has the ticked phenotype and the variant dataset and coat phenotypes from the 99 Lives Cat Genome Consortium (195 cats) were used to identify candidate genes and variants associated with the Ticked locus. Two strategies were used to find the Ticked allele(s), one considered Cinnamon with the reference allele or heterozygous (Strategy A) and the other considered Cinnamon as having the variant allele or heterozygous (Strategy B). For Strategy A, two variants in Dickkopf Wnt Signaling Pathway Inhibitor 4 (DKK4), a p.Cys63Tyr (B1:41621481, c.188G>A) and a less common p.Ala18Val (B1:42620835, c.53C>T) variant are suggested as two alleles influencing the Ticked phenotype. Bioinformatic and molecular modeling analysis suggests that these changes disrupt a key disulfide bond in the Dkk4 cysteine-rich domain 1 or Dkk4 signal peptide cleavage respectively. All coding variants were excluded as Ticked alleles using Strategy B.
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Affiliation(s)
- L. A. Lyons
- Department of Veterinary Medicine and SurgeryCollege of Veterinary MedicineUniversity of Missouri – ColumbiaColumbiaMO65211USA
| | - R. M. Buckley
- Department of Veterinary Medicine and SurgeryCollege of Veterinary MedicineUniversity of Missouri – ColumbiaColumbiaMO65211USA
| | - R. J. Harvey
- School of Health and Behavioural SciencesUniversity of the Sunshine CoastSippy DownsQld4558Australia
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Ho J, Li W, Grayson JW, Alvarado R, Rimmer J, Sewell WA, Harvey RJ. Systemic medication requirement in post-surgical patients with eosinophilic chronic rhinosinusitis. Rhinology 2021; 59:59-65. [PMID: 32720937 DOI: 10.4193/rhin20.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Eosinophilic chronic rhinosinusitis (eCRS) is contemporarily managed by surgical creation of a 'neo-sinus' cavity and corticosteroid irrigations. While most patients gain control of their disease with this approach, similar to preventive inhaler therapy in asthma, some patients need systemic therapies. This study aimed to define those patients needing ongoing systemic therapy for eCRS. METHODS Consecutive adult patients (>18 years) who were seen at a tertiary referral clinic, diagnosed as eCRS and underwent endoscopic sinus surgery were included. Patients were followed up for a minimum of 12 months. All patients had a simple neo- sinus cavity surgically created and used initially a once daily topical corticosteroid irrigation maintenance therapy. Patients who re- quired long term systemic oral corticosteroids and/or biologic therapy were compared to those who remained on topical control. RESULTS 222 patients with eCRS were assessed (follow-up 2.76 years). Long term systemic therapy was required in 5.4% of pa- tients. Receiver operating curve analysis predicted local treatment failure at an eosinophil count cut-off level 0.455x109/L. Asthma, atopy and aspirin sensitivity also predicted long term systemic therapy. There were no associations with nasal polyposis or revi- sion surgery. Multivariate logistic regression showed elevated blood eosinophil count >0.455 x109/L was 9.27 times more likely to require for systemic medication. CONCLUSION Pre-operative blood eosinophil count >0.45 x109/L was associated with failure of local therapy following contem- porary management of eCRS. The quantitative value of serum eosinophilia may be a useful predictor of disease progression and those patients in need of systemic therapies, such as biologic agents.
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Affiliation(s)
- J Ho
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia;St Vincent’s Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - W Li
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - J W Grayson
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Raquel Alvarado
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - J Rimmer
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia; Woolcock Institute, University of Sydney, Sydney, Australia; Faculty of Medicine, Notre Dame University, Sydney, Australia
| | - W A Sewell
- St Vincent’s Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia; Immunology Division, Garvan Institute of Medical Research, Sydney, Australia
| | - R J Harvey
- Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, Toppila-Salmi S, Bernal-Sprekelsen M, Mullol J, Alobid I, Terezinha Anselmo-Lima W, Bachert C, Baroody F, von Buchwald C, Cervin A, Cohen N, Constantinidis J, De Gabory L, Desrosiers M, Diamant Z, Douglas RG, Gevaert PH, Hafner A, Harvey RJ, Joos GF, Kalogjera L, Knill A, Kocks JH, Landis BN, Limpens J, Lebeer S, Lourenco O, Meco C, Matricardi PM, O'Mahony L, Philpott CM, Ryan D, Schlosser R, Senior B, Smith TL, Teeling T, Tomazic PV, Wang DY, Wang D, Zhang L, Agius AM, Ahlstrom-Emanuelsson C, Alabri R, Albu S, Alhabash S, Aleksic A, Aloulah M, Al-Qudah M, Alsaleh S, Baban MA, Baudoin T, Balvers T, Battaglia P, Bedoya JD, Beule A, Bofares KM, Braverman I, Brozek-Madry E, Richard B, Callejas C, Carrie S, Caulley L, Chussi D, de Corso E, Coste A, El Hadi U, Elfarouk A, Eloy PH, Farrokhi S, Felisati G, Ferrari MD, Fishchuk R, Grayson W, Goncalves PM, Grdinic B, Grgic V, Hamizan AW, Heinichen JV, Husain S, Ping TI, Ivaska J, Jakimovska F, Jovancevic L, Kakande E, Kamel R, Karpischenko S, Kariyawasam HH, Kawauchi H, Kjeldsen A, Klimek L, Krzeski A, Kopacheva Barsova G, Kim SW, Lal D, Letort JJ, Lopatin A, Mahdjoubi A, Mesbahi A, Netkovski J, Nyenbue Tshipukane D, Obando-Valverde A, Okano M, Onerci M, Ong YK, Orlandi R, Otori N, Ouennoughy K, Ozkan M, Peric A, Plzak J, Prokopakis E, Prepageran N, Psaltis A, Pugin B, Raftopulos M, Rombaux P, Riechelmann H, Sahtout S, Sarafoleanu CC, Searyoh K, Rhee CS, Shi J, Shkoukani M, Shukuryan AK, Sicak M, Smyth D, Sindvongs K, Soklic Kosak T, Stjarne P, Sutikno B, Steinsvag S, Tantilipikorn P, Thanaviratananich S, Tran T, Urbancic J, Valiulius A, Vasquez de Aparicio C, Vicheva D, Virkkula PM, Vicente G, Voegels R, Wagenmann MM, Wardani RS, Welge-Lussen A, Witterick I, Wright E, Zabolotniy D, Zsolt B, Zwetsloot CP. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology 2020; 58:1-464. [PMID: 32077450 DOI: 10.4193/rhin20.600] [Citation(s) in RCA: 539] [Impact Index Per Article: 134.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise . The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com.
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Affiliation(s)
- W J Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - V J Lund
- Royal National Throat, Nose and Ear Hospital, UCLH, London, UK
| | - C Hopkins
- Ear, Nose and Throat Department, Guys and St. Thomas Hospital, London, United Kingdom
| | - P W Hellings
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands.,Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, KU Leuven, Belgium.,Upper Airways Research Laboratory and ENT Department, University Hospital Ghent, Ghent, Belgium
| | - R Kern
- Department of Otorhinolaryngology - Head and Neck Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - S Reitsma
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - S Toppila-Salmi
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | | | - I Alobid
- Rhinology and Skull Base Unit, ENT Department, Hospital Clinic de Barcelona, Universidad de Barcelona, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
| | - W Terezinha Anselmo-Lima
- Division of Otorhinolaryngology, Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Ribeirao Preto Medical School-University of Sao Paulo, Sao Paulo, Brazil
| | - C Bachert
- Upper Airways Research Laboratory and ENT Department, University Hospital Ghent, Ghent, Belgium.,Division of ENT Diseases, CLINTEC, Karolinska Institute, University of Stockholm, Stockholm, Sweden
| | - F Baroody
- Department of Otorhinolaryngology-Head and Neck Surgery, The University of Chicago Medicine and the Comer Children's Hospital, Chicago, IL, USA
| | - C von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Hospital, Copenhagen, Denmark
| | - A Cervin
- Department of Otorhinolaryngology, Head and Neck Surgery, Royal Brisbane and Women's Hospital.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - N Cohen
- Department of Otorhinolaryngology - Head and Neck Surgery, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA
| | - J Constantinidis
- 1st Department of ORL, Head and Neck Surgery, Aristotle University, AHEPA Hospital, Thessaloniki, Greece
| | - L De Gabory
- Rhinology and Plastic Surgery Unit, Otorhinolaryngology, Head and Neck Surgery and Pediatric ENT Department, CHU de Bordeaux, Hospital Pellegrin, Centre F-X Michelet, Bordeaux, France
| | - M Desrosiers
- Department of ORL-HNS, Universite de Montreal, Montreal, Canada
| | - Z Diamant
- Dept of Respiratory Medicine and Allergology, Skane University in Lund, Sweden.,Research Director Respiratory and Allergy, at QPS-Netherlands, Groningen, Netherlands.,Affiliate to Charles University, Dept of Respiratory Diseases, in Prague, Czech Republic
| | - R G Douglas
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - P H Gevaert
- Department of Otorhinolaryngology, Ghent University, Ghent, Belgium
| | - A Hafner
- University of Zagreb Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - R J Harvey
- Rhinology and Skull Base Department, Applied Medical Research Centre, UNSW (Conjoint) and Macquarie University (Clinical), Sydney, Australia
| | - G F Joos
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - L Kalogjera
- ENT Department, Zagreb School of Medicine.,University Hospital Center "Sestre milosrdnice", Zagreb, Croatia
| | - A Knill
- Patient representative, Opuscomms, London, UK
| | - J H Kocks
- Department of Inhalation Medicine, Observational Pragmatic Research Institute, Singapore
| | - B N Landis
- Rhinology-Olfactology Unit, Otorhinolaryngology Department, University Hospital of Geneva, Geneva, Switzerland
| | - J Limpens
- Medical Information Specialist, Medical Library, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - S Lebeer
- Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - O Lourenco
- FCS - UBI Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal
| | - C Meco
- Department of Otorhinolaryngology, Head and Neck Surgery, Ankara University, Ankara, Turkey.,Department of Otorhinolaryngology, Head and Neck Surgery, Salzburg Paracelsus Medical University, Salzburg, Austria
| | - P M Matricardi
- Department of Pediatric Pneumology and Immunology, Charite - Universitatsmedizin Berlin, Berlin, Germany
| | - L O'Mahony
- Departments of Medicine and Microbiology, APC Microbiome Ireland, National University of Ireland, Cork, Ireland
| | - C M Philpott
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK.,ENT Department, James Paget University Hospital, Great Yarmouth, UK
| | - D Ryan
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,Optimum Patient Care, Cambridgeshire, UK
| | - R Schlosser
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of South Carolina, Charleston, USA
| | - B Senior
- UNC Otorhinolaryngology / Head and Neck Surgery, Division of Rhinology, Allergy, and Endoscopic Skull Base Surgery and Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - T L Smith
- Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head Neck Surgery, Oregon Health and Science University, Portland, OR, USA
| | - T Teeling
- Patient representative, Task Force Healthcare, WTC Den Haag, The Netherlands
| | - P V Tomazic
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
| | - D Y Wang
- Department of Otorhinolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - D Wang
- Rhinology Division, ENT Department.,Eye and ENT Hospital, Fudan University, Shanghai, China
| | - L Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Beijing, China
| | - A M Agius
- Department of Medicine and Surgery in the University of Malta
| | | | - R Alabri
- ENT Division, Surgery Department, College of Medicine and Health and Sciences, Sultan Qaboos University, Muscat, Oman
| | - S Albu
- Department of Otorhinolaryngology, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - A Aleksic
- ENT Department, University Clinical Centre, University of Banja Luka, Bosnia and Herzegovina
| | - M Aloulah
- ENT Department, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - M Al-Qudah
- Department of Otorhinolaryngology, Jordan University of Science and Technology, Irbid, Jordan
| | - S Alsaleh
- Department of Otorhinolaryngology - Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - M A Baban
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Sulaimani, Sulaimayniha, Iraq
| | - T Baudoin
- Dept. of ORL-HNS Sisters of Mercy University Medical Center, School of Medicine University of Zagreb, Croatia
| | - T Balvers
- Department of Neurology, Leiden University Medical Center (LUMC)
| | - P Battaglia
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - J D Bedoya
- Department of Otorhinolaryngology, Universidad de Antioquia, Medellin, Colombia
| | - A Beule
- Department of Otorhinolaryngology, University Clinic of Munster, Germany
| | - K M Bofares
- Department of Otorhinolaryngology, Omar Al-Moukhtar University, Albyeda, Libya
| | - I Braverman
- Department of Otorhinolaryngology - Head and Neck Surgery, Hillel Yaffe Medical Center, Israel
| | - E Brozek-Madry
- Department of Otorhinolaryngology, Medical University of Warsaw, Poland
| | - B Richard
- Department of ENT, Makerere University, Kampala, Uganda
| | - C Callejas
- Department of Otorhinolaryngology, Pontificia Catholic University, Santiago, Chile
| | - S Carrie
- Department of Otorhinolaryngology, Head and Neck Surgery, Newcastle University, United Kingdom
| | - L Caulley
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Ottawa,Toronto, Canada
| | - D Chussi
- Department of Otorhinolaryngology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - E de Corso
- Department of Otorhinolaryngology , La Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - A Coste
- ORL et Chirurgie Cervico-Faciale, Universite Paris-Est Creteil (UPEC), France
| | - U El Hadi
- Department of Otorhinolaryngology, American University of Beirut, Lebanon
| | - A Elfarouk
- Department of Otorhinolaryngology, Cairo University, Egypt
| | - P H Eloy
- Department of ENT, CHU UCL Namur, Yvoir, Belgium
| | - S Farrokhi
- Department of Immunology and Allergy, The Persian Gulf Tropical Medicine Research Center.,The Persian Gulf Biomedical Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - G Felisati
- Department of Head and Neck, University of Milan, Italy
| | - M D Ferrari
- Department of Neurology, Leiden University Medical Center (LUMC)
| | - R Fishchuk
- Department of ENT- Organs Microsurgery, Central city clinical hospital of lvano-Frankivsk city council, Ivano-Frankivsk, Ukraine
| | - W Grayson
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Alabama Birmingham, USA
| | - P M Goncalves
- ENT Department, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - B Grdinic
- ENT Department, General Hospital, Pula, Pula, Croatia
| | - V Grgic
- ENT Department, Zagreb School of Medicine.,University Hospital center 'Sestre milosrdnice', Zagreb, Croatia
| | - A W Hamizan
- Department of Otorhinolaryngology, University Kebangsaan, Kuala Lumpur, Malasyia
| | - J V Heinichen
- Department of ENT of Hospital de Clinicas, Facultad de Ciencias Medicas, Universidad Nacional de Asuncion, Paraguay
| | - S Husain
- Department of Otorhinolaryngology, Head and Neck Surgery, National University of Malaysia, Kuala Lumpur, Malaysia
| | - T I Ping
- Department ORLHNS, University Malaysia Sarawak, Kuching, Malaysia
| | - J Ivaska
- Clinic of Ear, Nose, Throat and Eye diseases, Vilnius University, Lithuania
| | - F Jakimovska
- ENT Department of Medical Faculty, St Cyril and Methodius University of Skopje, North Macedonia
| | - L Jovancevic
- Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Centre of Vojvodina, Faculty of Medicine, University of Novi Sad, Serbia
| | - E Kakande
- Department of ENT Surgery, Mulago National Referral Hospital Kampala, Uganda
| | - R Kamel
- Department of Otorhinolaryngology, Head and Neck Surgery, Cairo University, Egypt
| | - S Karpischenko
- ENT Department, Director of Saint Petersburg Research Institute of Ear, Throat , Nose and Speech.,Professor and Chairman of First Pavlov State Medical University, Saint Petersburg, Russia
| | - H H Kariyawasam
- Department of Allergy and Clinical Immunology, Royal National ENT Hospital, London, England
| | - H Kawauchi
- 96. Department of Otorhinolaryngology, Shimane University, Matsue, Shimane, Japan
| | - A Kjeldsen
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Southern Denmark, Odense, Denmark
| | - L Klimek
- Center of Rhinology and Allergology, Wiesbaden, Hesse, Germany
| | - A Krzeski
- Department of Otorhinolaryngology, Warsaw Medical University, Warsaw, Poland
| | - G Kopacheva Barsova
- Department of Otorhinolaryngology, University If Medicine, st. Ciril and Methodius, Skopje
| | - S W Kim
- Department of Otorhinolaryngology, Head and Neck Surgery, Kyung Hee University, Seoul, South Korea
| | - D Lal
- Department of Otorhinolaryngology, Head and Neck Surgery, Mayo Clinic in Arizona, Phoenix, Arizona, USA
| | - J J Letort
- Department of Otorhinolaryngology, Pontifica Catholic University of Ecuador, Quito, Ecuador
| | - A Lopatin
- Department of Otorhinolaryngology, Policlinic No.1- Senior ENT Consultant and Surgeon.,President of Russian Rhinologic Society, Moscow, Russia
| | | | - A Mesbahi
- Department of Facial Surgery, Khodadoust Hospital, Ordibehesht Hospital, Shiraz, Iran
| | - J Netkovski
- Department of Otorhinolaryngology-Head and Neck Surgery, St. Cyril and Methodius, Skopje, Republic of North Macedonia
| | - D Nyenbue Tshipukane
- Department of Otorhinolaryngology, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - A Obando-Valverde
- Department of Otorhinolaryngology and Surgery, Hospital Mexico, University of Costa Rica, San Jose, Costa Rica
| | - M Okano
- Department of Otorhinolaryngology, International University of Health and Welfare, Narita , Japan
| | - M Onerci
- Department of Otorhinolaryngology, Hacettepe, Ankara, Turkey
| | - Y K Ong
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Singapore, National University Hospital, Singapore
| | - R Orlandi
- Department of Otorhinolaryngology, University of Utah, Salt Lake City, Utah, USA
| | - N Otori
- Department of Otorhinolaryngology at The Jikei University School of Medicine,Tokyo, Japan
| | - K Ouennoughy
- Department of Otorhinolaryngology-Head and Neck Surgery, Saad Dahleb Blida 1, Blida, Algeria
| | - M Ozkan
- Department of Otorhinolaryngology, University of Health Sciences, Ankara City Hospital, Turkey
| | - A Peric
- Department of Otorhinolaryngology, Military Medical Academy, Faculty of Medicine, University of Defense, Belgrade, Serbia
| | - J Plzak
- Department of Otorhinolaryngology, Head and Neck Surgery, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - E Prokopakis
- Department of Otorhinolaryngology, University of Crete School of Medicine, Heraklion, Crete, Greece
| | - N Prepageran
- Department of ENT, University Malaya, Kuala Lumpur, Malaysia
| | - A Psaltis
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - B Pugin
- Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - M Raftopulos
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands.,Royal Australian College of Surgeons, Trainee Representative (Australia)
| | - P Rombaux
- Department of Otorhinolaryngology, University of Louvain, Brussels, Belgium
| | - H Riechelmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Ulm, Baden-Wurttemberg, Germany
| | - S Sahtout
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - C-C Sarafoleanu
- ENT and H NS Department, Santa Maria Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - K Searyoh
- Surgery Ear, Nose and Throat Unit, School of Medicine and Dentistry, University of Ghana, Korle-Bu Teaching Hospital, Accra, Ghana
| | - C-S Rhee
- Department of Otorhinolaryngology, Head and Neck Surgery, Seoul, Seoul National University, Seoul, Korea
| | - J Shi
- Department of Rhinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - M Shkoukani
- Department of Otorhinolaryngology, Head and Neck Surgery, Cleveland Clinic Abu Dhabi, United Arab Emirates
| | - A K Shukuryan
- Department of Otorhinolaryngology, Yerevan State Medical University, Yerevan, Armenia
| | - M Sicak
- Department of Otorhinolaryngology, Head and Neck Surgery, Central Military Hospital, Slovakia, Slovak Health University Bratislava and Catholic University, Ruzom berok, Slovakia
| | - D Smyth
- Department of Otorhinolaryngology, Head and Neck Surgery, Royal College of Surgeons in Ireland and University College Cork, Waterford, Ireland
| | - K Sindvongs
- Department of Otorhinolaryngology, Chulalongkorn University, Bangkok, Thailand
| | - T Soklic Kosak
- University Medical Centre Ljubljana, Department of Otorhinolaryngology and Cervicofacial Surgery, University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| | - P Stjarne
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - B Sutikno
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Airlangga, Surabaya, Indonesia
| | - S Steinsvag
- Department of ORL, University of Bergen, Norway
| | - P Tantilipikorn
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - S Thanaviratananich
- Department of Otorhinolaryngology, Head and Neck Surgery, Cleveland Clinic Abu Dhabi, United Arab Emirates
| | - T Tran
- Department of ENT Hospital of Ho Chi Minh city, Faculty of medicine of Ho Chi Minh city Vietnam National University, Vietnam
| | - J Urbancic
- Department of Otorhinolaryngology and cervicofacial surgery, UMC Ljubljana, University of Ljubljana, Medical Faculty, Ljubljana, Slovenia
| | - A Valiulius
- Department of Children's diseases, Vilnius University Medical Faculty, Institute of Clinical Medicine, Vilnius, Lithuania
| | - C Vasquez de Aparicio
- Department of Paediatric Surgery, National Hospital Benjamin Bloom, National University of El Salvador, San Salvador, El Salvador
| | - D Vicheva
- Department of Otorhinolaryngology, Medical University Plovdiv, Bulgaria
| | - P M Virkkula
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki, University Hospital, Helsinki, Finland
| | - G Vicente
- Department of Otolaryngology, St. Luke's Medical Centre, Quezon City, The Philippines
| | - R Voegels
- Department of Otorhinolaryngology, University of Sao Paulo, Sau Paulo, Brazil
| | - M M Wagenmann
- Department of Otorhinolaryngology, Dusseldorf University Hospital, Dusseldorf, German
| | - R S Wardani
- Department of Otorhinolaryngology Head and Neck Surgery, Dr. Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia
| | - A Welge-Lussen
- Department of Otorhinolaryngology, University Hospital Basel, University Basel, Switzerland
| | - I Witterick
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Ottawa,Toronto, Canada
| | - E Wright
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - D Zabolotniy
- State Institution of O.S. Kolomiychenko Institute of Othorhnilarungology of National Academy of Medical Sciences of Ukraine, Kiev, Ukraine
| | - B Zsolt
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Szeged, Hungary
| | - C P Zwetsloot
- Department of Neurology, Dijklander Ziekenhuis, Purmerend, The Netherlandsn
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Oakley GM, Christensen JM, Sacks R, Earls P, Harvey RJ. Characteristics of macrolide responders in persistent post-surgical rhinosinusitis. Rhinology 2018; 56:111-117. [PMID: 29476191 DOI: 10.4193/rhin17.049] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The anti-inflammatory effects of long term low dose macrolide therapy have shown benefit in the management of diffuse panbronchiolitis. Dramatic responses to macrolide in the upper airway are seen but our understanding of the patient phenotype predisposing to macrolide response in chronic rhinosinusitis (CRS) is poor. METHODS A case control study was performed in a tertiary level rhinology practice of consecutive chronic rhinosinusitis patients placed on a 3-month low dose macrolide therapy after failing at least 3 months of corticosteroid irrigation therapy post-endoscopic sinus surgery. Patients were defined as a macrolide responder when having near normal endoscopy after a 3-month period of clarithromycin treatment. Patient characteristics of smoking, asthma, atopy status, revision surgery, symptom severity (SNOT-22) along with biomarkers from serum and tissue histopathology results were compared between groups. RESULTS Of twenty-eight consecutive macrolide treated patients, 19 responders were compared to 9 non-responders. The groups were similar in age, female gender, non-smoking, asthma, and atopy. Macrolide response was associated with a lack of tissue eosinophilia (more than 10/HPF) and lower serum eosinophilia. Neutrophil expression was similar in tissue and serum. Squamous metaplasia was overexpressed in non-responders. CONCLUSION Low tissue and serum eosinophilia, and absence of tissue squamous metaplasia may predict a CRS phenotype suitable to a trial of long-term macrolide therapy when surgery and topical therapy has failed.
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Affiliation(s)
- G M Oakley
- Department of Surgery, Division of Otolaryngology Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA
| | - J M Christensen
- Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - R Sacks
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - P Earls
- Department of Anatomical Pathology, St. Vincents Hospital, Sydney, Australia
| | - R J Harvey
- Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
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8
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Affiliation(s)
- D D Davis
- Department of Plant Pathology and Environmental Microbiology, The Pennsylvania State University, University Park, 16802
| | - R J Harvey
- Department of Plant Pathology and Environmental Microbiology, The Pennsylvania State University, University Park, 16802
| | - M C Aime
- Department of Botany and Plant Pathology, Purdue University, West Lafayette, IN 47907
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9
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Parthasarathi K, Christensen JM, Alvarado R, Barham HP, Sacks R, Harvey RJ. Airflow and symptom outcomes between allergic and non-allergic rhinitis patients from turbinoplasty. Rhinology 2018; 55:332-338. [PMID: 28888024 DOI: 10.4193/rhin16.210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Inferior turbinate procedures are applied to relieve medically refractory nasal obstruction. However, the nature of congestion differs between allergic(AR) and non-allergic rhinitis(NAR). This study compares surgical outcomes between AR and NAR patients. METHODOLOGY A case-control study of patients undergoing turbinate with or without septoplasty surgery for nasal obstruction was performed. Patient reported outcomes were: nasal obstruction, global nasal function(GNF), and sino-nasal outcome test(SNOT-22) with rhinitis, facial symptom, sleep and psychological sub-scores. Nasal peak inspiratory flow(NPIF) assessed nasal airflow. Measurements were obtained preoperatively and 3 months postoperatively. RESULTS 190 patients were assessed. AR had worse obstruction and worse GNF. All outcomes improved post-surgery; nasal obstruction, GNF, SNOT-22, rhinitis-symptoms, facial-symptoms, sleep-function, psychological-function and NPIF. GNF improvement was greater in AR. NPIF improvement was similar between groups. CONCLUSIONS Both AR and NAR patients gained benefit from surgery to relieve nasal obstruction. AR patients demonstrate greater improvement in GNF score but allergy management may contribute to this.
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Affiliation(s)
- K Parthasarathi
- 1. Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, University of New South Wales, Sydney, Australia 2. St Vincents Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - J M Christensen
- Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - R Alvarado
- Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - H P Barham
- 1. Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, University of New South Wales, Sydney, Australia; 3. Department of Otolaryngology Head and Neck Surgery, Louisiana State University, New Orleans, Louisiana, Unite
| | - R Sacks
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - R J Harvey
- 1. Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, University of New South Wales, Sydney, Australia; 2. St Vincents Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia; 4. Facult
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Ebenezer JA, Christensen JM, Oliver BG, Oliver RA, Tjin G, Ho J, Habib AR, Rimmer J, Sacks R, Harvey RJ. Periostin as a marker of mucosal remodelling in chronic rhinosinusitis. Rhinology 2017. [PMID: 28667737 DOI: 10.4193/rhin16.215] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although extracellular matrix (ECM) proteins are associated with irreversible lower airway changes, the relationship with upper airway remodelling which occurs during chronic rhinosinusitis (CRS) is poorly understood. This study assessed the expression of ECM proteins periostin, fibulin-1, fibronectin and collagenIV in nasal mucosa of patients with and without histologic features of remodelling. METHODS A cross-sectional study of sinonasal mucosal biopsies taken from patients, undergoing surgery for CRS was performed, where patients were grouped according to remodelling, defined by basement membrane thickening (BMT over 7.5 micrometer) and subepithelial fibrosis. An overall view and three random fields of immunostained tissue sections that included epithelium, basement membrane and submucosa, were imaged using Zeiss Zen software. The area and intensity of positive staining were scored by two blinded observers, using a 12-point ordinal scale of weak to strong. RESULTS 65 patients (47.6 +/- 13.4years, 44.6% female) were assessed. Patients were grouped as controls 26.2%, BMT/no fibrosis 38.5% or BMT and fibrosis 33.8%. Stronger grade of periostin expression was associated with remodelling changes and tissue eosinophilia over 10/HPF. Fibulin-1, fibronectin and collagenIV did not differ. CONCLUSION Periostin expression was associated with the presence of BMT, fibrosis and tissue eosinophilia and may identify patients undergoing remodelling changes.
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Affiliation(s)
- J A Ebenezer
- Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, UNSW, Sydney, Australia
| | - J M Christensen
- Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, UNSW, Sydney, Australia
| | - B G Oliver
- Woolcock Institute, University of Sydney, Sydney, Australia
| | - R A Oliver
- Surgical and Orthopaedic Research laboratory, UNSW, Sydney, Australia
| | - G Tjin
- Woolcock Institute, University of Sydney, Sydney, Australia
| | - J Ho
- Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, UNSW, Sydney, Australia
| | - A R Habib
- Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, UNSW, Sydney, Australia
| | - J Rimmer
- Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, UNSW, Sydney, Australia
| | - R Sacks
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - R J Harvey
- Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, UNSW, Sydney, Australia
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Ebenezer JA, Christensen JM, Oliver BG, Oliver RA, Tjin G, Ho J, Habib AR, Rimmer J, Sacks R, Harvey RJ. Periostin as a marker of mucosal remodelling in chronic rhinosinusitis. Rhinology 2017; 55:234-241. [PMID: 28667737 DOI: 10.4193/rhino16.215] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although extracellular matrix (ECM) proteins are associated with irreversible lower airway changes, the relationship with upper airway remodelling which occurs during chronic rhinosinusitis (CRS) is poorly understood. This study assessed the expression of ECM proteins periostin, fibulin-1, fibronectin and collagenIV in nasal mucosa of patients with and without histologic features of remodelling. METHODS A cross-sectional study of sinonasal mucosal biopsies taken from patients, undergoing surgery for CRS was performed, where patients were grouped according to remodelling, defined by basement membrane thickening (BMT over 7.5 micrometer) and subepithelial fibrosis. An overall view and three random fields of immunostained tissue sections that included epithelium, basement membrane and submucosa, were imaged using Zeiss Zen software. The area and intensity of positive staining were scored by two blinded observers, using a 12-point ordinal scale of weak to strong. RESULTS 65 patients (47.6 +/- 13.4years, 44.6% female) were assessed. Patients were grouped as controls 26.2%, BMT/no fibrosis 38.5% or BMT and fibrosis 33.8%. Stronger grade of periostin expression was associated with remodelling changes and tissue eosinophilia over 10/HPF. Fibulin-1, fibronectin and collagenIV did not differ. CONCLUSION Periostin expression was associated with the presence of BMT, fibrosis and tissue eosinophilia and may identify patients undergoing remodelling changes.
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Affiliation(s)
- J A Ebenezer
- Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, UNSW, Sydney, Australia
| | - J M Christensen
- Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, UNSW, Sydney, Australia
| | - B G Oliver
- Woolcock Institute, University of Sydney, Sydney, Australia
| | - R A Oliver
- Surgical and Orthopaedic Research laboratory, UNSW, Sydney, Australia
| | - G Tjin
- Woolcock Institute, University of Sydney, Sydney, Australia
| | - J Ho
- Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, UNSW, Sydney, Australia
| | - A R Habib
- Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, UNSW, Sydney, Australia
| | - J Rimmer
- Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, UNSW, Sydney, Australia
| | - R Sacks
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - R J Harvey
- Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, UNSW, Sydney, Australia
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Snidvongs K, Dalgorf D, Kalish L, Sacks R, Pratt E, Harvey RJ. Modified Lund Mackay Postoperative Endoscopy Score for defining inflammatory burden in chronic rhinosinusitis. Rhinology 2017; 52:53-59. [PMID: 24618629 DOI: 10.4193/rhino13.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The Lund Mackay Postoperative Endoscopy Score (LMES) for chronic rhinosinusitis (CRS) is a poor measure of the patient experience. A proposed Modified Lund Mackay Postoperative Endoscopy Score (MLMES) aims to better describe the inflammatory burden in CRS. METHODS A prospective study on CRS patients having endoscopic sinus surgery (ESS) was conducted. Endoscopy was recorded at the 6th and the 12th week post-op. The MLMES recorded changes in mucosa, mucus and purulence for each of the maxillary, ethmoid, sphenoid, frontal sinuses and olfactory fossa in post-ESS cavities. The correlation between MLMES and visual analogue scale of total rhinosinusitis symptoms, global anchor score of nasal function, Sino-Nasal Outcome Test 22 (SNOT-22) and nasal symptom score was analyzed. The inter-observer reliability, intra-observer reliability and correlation between the change in MLMES and in subjective measures were also investigated. RESULTS Thirty patients were assessed. The MLMES significantly correlated with visual analogue scale, SNOT-22, global anchor and nasal symptom score. The change in MLMES correlated with the change in SNOT-22 and nasal symptom score. The inter-observer and intra-observer reliability were excellent. CONCLUSION Objectives measurements for post-ESS patients can be reconsidered to represent the cumulative inflammatory burden of all sinuses. The proposed MLMES represents total sinus inflammatory burden and correlates well with patient reported outcome measures.
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13
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Rom DI, Christensen JM, Alvarado R, Sacks R, Harvey RJ. The impact of bitter taste receptor genetics on culturable bacteria in chronic rhinosinusitis. Rhinology 2017; 55:90-94. [PMID: 28214914 DOI: 10.4193/rhin16.181] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Extra-oral bitter taste receptors have been associated with innate bacterial defence mechanisms. Genetic variation in T2R38 functionality has been shown to be associated with susceptibility to upper respiratory tract infections and chronic rhinosinusitis (CRS). We sought to independently assess the influence of bitter taste receptor genotype on the presence of culturable bacteria in the sinuses. METHODOLOGY A cross-sectional analysis of patients with CRS undergoing surgery was performed. Middle meatal nasal swabs were sent for microbiological evaluation at the time of the procedure. Mucosal biopsies were taken and sent for bitter taste receptor genotype analysis. Sequencing of 3 polymorphisms in the TAS2R38 gene was performed to identify genotypes as super-tasters (PAV/PAV), non-tasters (AVI/AVI) or heterozygous expression (PAV/AVI). The presence of culturable organisms and common pathogens were compared with bitter taste receptor genotypes. RESULTS 25 patients (age 52.4 +/- 18.28 years, 51% female) were assessed. Super-tasters comprised 16% of the group, 24% were non-tasters and 48% had heterozygous expression. A cultured pathogen was grown in 48% of patients; 32% gram-positive, 20% gram-negative, 28% grew Staphylococcus aureus and 12% Pseudomonas aeruginosa. A non-taster genotype was predictive of colonised pathogens. Tissue eosinophilia (more than 10 HPF) was seen in 48%. CONCLUSION Even in a small sample of patients with CRS, non-taster T2R38 genotype appears to predict the presence of culturable bacteria colonising the sinus cavity at the time of surgery for their condition. A genetic link to patients more likely to become infected is likely.
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Affiliation(s)
- D I Rom
- Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, University of New South Wales, Sydney, NSW, Australia
| | - J M Christensen
- Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, University of New South Wales, Sydney, NSW, Australia
| | - R Alvarado
- Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, University of New South Wales, Sydney, NSW, Australia
| | - R Sacks
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - R J Harvey
- Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, University of New South Wales, Sydney, NSW, Australia
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Leason SR, Barham HP, Oakley G, Rimmer J, DelGaudio JM, Christensen JM, Sacks R, Harvey RJ. Association of gastro-oesophageal reflux and chronic rhinosinusitis: systematic review and meta-analysis. Rhinology 2017; 55:3-16. [PMID: 28214353 DOI: 10.4193/rhino16.177] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Gastro-oesophageal reflux disease (GORD) has been implicated in the development of chronic rhinosinusitis (CRS). The association of GORD with CRS is systematically assessed from the medical literature. METHODOLOGY Embase and MEDLINE were searched using a comprehensive strategy limited to English language and Human subjects. Any study with original data on the experimental, diagnostic, treatment or prognostic association of CRS with GORD was included. Studies without a control group, case reports and review articles were excluded. RESULTS The search returned 958 records, with an additional 10 found from bibliographic lists; this produced 32 studies. The included studies (n=32) consisted of studies reporting pathogenic factors (n=20), epidemiological association (n=8), prognostic interactions (n=3), and a combination of these outcomes (n=1). Potential pathogenic roles for GORD in CRS were supported; CRS subjects had greater prevalence of intranasal Helicobacter pylori and acid reflux than subjects without CRS. CRS is more prevalent in GORD sufferers than those without GORD. Evidence is conflicting for GORD as a factor in CRS treatment failure. CONCLUSION The results support a significant association of GORD with CRS. Physicians should be cognizant of the potential for acid and non-acid reflux as a driving factor in CRS.
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Affiliation(s)
- S R Leason
- Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - H P Barham
- Department of Otolaryngology Head and Neck Surgery, Louisiana State University, New Orleans, LO, USA
| | - G Oakley
- Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - J Rimmer
- St Vincents Clinic, St Vincents Hospital, Sydney, Australia
| | - J M DelGaudio
- Division of Rhinology and Sinus Surgery, Department of Otolaryngology, Emory University School of Medicine, Atlanta, GA, USA
| | - J M Christensen
- Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - R Sacks
- Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - R J Harvey
- Rhinology and Skull Base Research Group, St Vincents Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
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Rimmer J, Hellgren J, Harvey RJ. Simulated postnasal mucus fails to reproduce the symptoms of postnasal drip in rhinitics but only in healthy subjects. Rhinology 2015; 53:129-134. [PMID: 26030035 DOI: 10.4193/rhino14.210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Post nasal drip (PND) is a very common symptom associated with upper respiratory tract disorders. While easy to visualize, the concept of PND due to an increased volume of secretions which move from the posterior nasal choanae into the posterior nasopharynx/oropharynx may be overly simplistic. PND could also be associated with altered viscosity of nasal secretions. An alternative hypothesis is that the sensation of PND is due to mucosal inflammation resulting in heightened cough or irritant throat sensory dysfunction. The impact of viscous secretions on the symptoms of PND is assessed. METHODS Healthy subjects and rhinitis patients were recruited. Patients were asked about PND symptoms with a 9 item PNDSS questionnaire at baseline and after the insertion of two different viscosities of artificial mucus utilizing hydroxypropyl methylcellulose at 1% and 4%. RESULTS Sixty six patients were recruited. As expected, rhinitics had an increased sense of PND compared to healthy subjects at baseline. However, only healthy subjects could detect the increased viscosity of secretions and where rhinitics failed to respond. Cough was not induced in either group. CONCLUSION The mechanisms of PND in chronic patients and those with rhinitis are likely to have other aetiologies other than simply increased or more viscous secretions.
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Affiliation(s)
- J Rimmer
- Department of Otolaryngology, Head and Neck Surgery, Monash Health, Melbourne, Victoria, Australia and Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - J Hellgren
- Department of Otorhinolaryngology, University of Gothenburg, Göteborg, Vaestra Goetaland, Sweden
| | - R J Harvey
- Department of Otolaryngology, Head and Neck Surgery, Monash Health, Melbourne, Victoria, Australia and Department of Surgery, Monash University, Melbourne, Victoria, Australia.,Rhinology and Skull Base Research Group, St Vincent’s Centre for Applied Medical Research, University of New South Wales, Sydney, Australia,Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
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Lowrie M, Garden OA, Hadjivassiliou M, Harvey RJ, Sanders DS, Powell R, Garosi L. The Clinical and Serological Effect of a Gluten-Free Diet in Border Terriers with Epileptoid Cramping Syndrome. J Vet Intern Med 2015; 29:1564-8. [PMID: 26500168 PMCID: PMC4895653 DOI: 10.1111/jvim.13643] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/28/2015] [Accepted: 09/15/2015] [Indexed: 11/27/2022] Open
Abstract
Background Canine epileptoid cramping syndrome (CECS) is a paroxysmal movement disorder of Border Terriers (BTs). These dogs might respond to a gluten‐free diet. Objectives The objective of this study was to examine the clinical and serological effect of a gluten‐free diet in BTs with CECS. Animals Six client‐owned BTs with clinically confirmed CECS. Methods Dogs were prospectively recruited that had at least a 6‐month history of CECS based on the observed phenomenology (using video) and had exhibited at least 2 separate episodes on different days. Dogs were tested for anti‐transglutaminase 2 (TG2 IgA) and anti‐gliadin (AGA IgG) antibodies in the serum at presentation, and 3, 6, and 9 months after the introduction of a gluten‐free diet. Duodenal biopsies were performed in 1 dog. Results Serum TG2 IgA titers were increased in 6/6 BTs (P = .006) and AGA IgG titers were increased in 5/6 BTs at presentation compared to those of controls (P = .018). After 9 months, there was clinical and serological improvement in all BTs with CECS strictly adhering to a gluten‐free diet (5/5). One dog had persistently increased antibody titers. This dog scavenged horse manure. On the strict introduction of a gluten‐free diet this dog also had an improved clinical and serological response. The diet‐associated improvement was reversible in 2 dogs on completion of the study, both of which suffered a relapse of CECS on the re‐introduction of gluten. Conclusions Canine epileptoid cramping syndrome in BTs is a gluten‐sensitive movement disorder triggered and perpetuated by gluten and thus responsive to a gluten‐free diet.
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Affiliation(s)
- M Lowrie
- Davies Veterinary Specialists, Hitchin, UK
| | - O A Garden
- Department of Clinical Sciences and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - M Hadjivassiliou
- Department of Neurology, Royal Hallamshire Hospital, Sheffield, UK
| | - R J Harvey
- Department of Pharmacology, UCL School of Pharmacy, London, UK
| | - D S Sanders
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK
| | - R Powell
- Powell Torrance Diagnostic Services, Higham Gobion, UK
| | - L Garosi
- Davies Veterinary Specialists, Hitchin, UK
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Ho J, Bailey M, Zaunders J, Mrad N, Sacks R, Sewell W, Harvey RJ. Group 2 innate lymphoid cells (ILC2s) are increased in chronic rhinosinusitis with nasal polyps or eosinophilia. Clin Exp Allergy 2015; 45:394-403. [PMID: 25429730 DOI: 10.1111/cea.12462] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 11/16/2014] [Accepted: 11/17/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a heterogeneous disease with an uncertain pathogenesis. Group 2 innate lymphoid cells (ILC2s) represent a recently discovered cell population which has been implicated in driving Th2 inflammation in CRS; however, their relationship with clinical disease characteristics has yet to be investigated. OBJECTIVE The aim of this study was to identify ILC2s in sinus mucosa in patients with CRS and controls and compare ILC2s across characteristics of disease. METHODS A cross-sectional study of patients with CRS undergoing endoscopic sinus surgery was conducted. Sinus mucosal biopsies were obtained during surgery and control tissue from patients undergoing pituitary tumour resection through transphenoidal approach. ILC2s were identified as CD45(+) Lin(-) CD127(+) CD4(-) CD8(-) CRTH2(CD294)(+) CD161(+) cells in single cell suspensions through flow cytometry. ILC2 frequencies, measured as a percentage of CD45(+) cells, were compared across CRS phenotype, endotype, inflammatory CRS subtype and other disease characteristics including blood eosinophils, serum IgE, asthma status and nasal symptom score. RESULTS 35 patients (40% female, age 48 ± 17 years) including 13 with eosinophilic CRS (eCRS), 13 with non-eCRS and 9 controls were recruited. ILC2 frequencies were associated with the presence of nasal polyps (P = 0.002) as well as high tissue eosinophilia (P = 0.004) and eosinophil-dominant CRS (P = 0.001) (Mann-Whitney U). They were also associated with increased blood eosinophilia (P = 0.005). There were no significant associations found between ILC2s and serum total IgE and allergic disease. In the CRS with nasal polyps (CRSwNP) population, ILC2s were increased in patients with co-existing asthma (P = 0.03). ILC2s were also correlated with worsening nasal symptom score in CRS (P = 0.04). CONCLUSION AND CLINICAL RELEVANCE As ILC2s are elevated in patients with CRSwNP, they may drive nasal polyp formation in CRS. ILC2s are also linked with high tissue and blood eosinophilia and have a potential role in the activation and survival of eosinophils during the Th2 immune response. The association of innate lymphoid cells in CRS provides insights into its pathogenesis.
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Affiliation(s)
- J Ho
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, NSW, Australia
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Abstract
OBJECTIVES To characterise the phenotype of Border terriers suspected to be affected by canine epileptoid cramping syndrome and to identify possible contributing factors. METHODS Owners of Border terriers with suspected canine epileptoid cramping syndrome were invited to complete an online questionnaire. The results of these responses were collated and analysed. RESULTS Twenty-nine Border terriers were included. Most affected dogs had their first episode before 3 years of age (range: 0·2 to 7·0 years). The majority of episodes lasted between 2 and 30 minutes (range: 0·5 to 150 minutes). The most frequent observations during the episodes were difficulty in walking (27 of 29), mild tremor (21 of 29) and dystonia (22 of 29). Episodes most frequently affected all four limbs (25 of 29) and the head and neck (21 of 29). Borborygmi were reported during episodes in 11 of 29 dogs. Episodes of vomiting and diarrhoea occurred in 14 of 29, with 50% of these being immediately before or after episodes of canine epileptoid cramping syndrome (7 of 14). Most owners (26 of 29) had changed their dog's diet, with approximately 50% (14 of 26) reporting a subsequent reduction in the frequency of episodes. CLINICAL SIGNIFICANCE This study demonstrates similarities in the phenotype of canine epileptoid cramping syndrome to paroxysmal dystonic choreoathetosis, a paroxysmal dyskinesia reported in humans. This disorder appears to be associated with gastrointestinal signs in some dogs and appears at least partially responsive to dietary adjustments.
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Affiliation(s)
- V Black
- Davies Veterinary Specialists, Higham Gobion
| | - L Garosi
- Davies Veterinary Specialists, Higham Gobion
| | - M Lowrie
- Davies Veterinary Specialists, Higham Gobion
| | - R J Harvey
- Department of Pharmacology, UCL School of Pharmacy, London
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Chung SK, Bode A, Cushion TD, Thomas RH, Hunt C, Wood SE, Pickrell WO, Drew CJG, Yamashita S, Shiang R, Leiz S, Longardt AC, Raile V, Weschke B, Puri RD, Verma IC, Harvey RJ, Ratnasinghe DD, Parker M, Rittey C, Masri A, Lingappa L, Howell OW, Vanbellinghen JF, Mullins JG, Lynch JW, Rees MI. GLRB is the third major gene of effect in hyperekplexia. Hum Mol Genet 2013. [DOI: 10.1093/hmg/ddt147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Snidvongs K, McLachlan R, Chin D, Pratt E, Sacks R, Earls P, Harvey RJ. Osteitic bone: a surrogate marker of eosinophilia in chronic rhinosinusitis. Rhinology 2013; 50:299-305. [PMID: 22888488 DOI: 10.4193/rhino12.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Causes of osteitis in chronic rhinosinusitis (CRS) other than previous surgery are poorly defined. Patients with eosinophilic CRS (ECRS) have more severe disease and poorer outcomes despite repeated surgery. Associations between osteitis and markers of ECRS are not well described. METHODS A cross-sectional study of CRS patients undergoing sinus surgery was conducted. Osteitis was scored radiologically using previously published measures. Associations between osteitis and histopathology, symptoms, endoscopy, CT mucosal score and seromarkers were analyzed. RESULTS Eighty-eight patients were assessed of whom forty-five had osteitis. Patients undergoing revision surgery recorded higher osteitis scores. Patients with mucosal eosinophilia had higher osteitis score than those without. Patients with osteitis had higher serum eosinophil. Similar relationships were also found in primary surgery. Osteitis was associated with endoscopic and radiologic, but not symptomatic disease severity. CONCLUSIONS Osteitis is associated with tissue and serum eosinophilia in both patients with and without prior surgery. Patients with these features may benefit from post-operative corticosteroid therapy to prevent osteitis.
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Videler WJ, Badia L, Harvey RJ, Gane S, Georgalas C, van der Meulen FW, Menger DJ, Lehtonen MT, Toppila-Salmi SK, Vento SI, Hytönen M, Hellings PW, Kalogjera L, Lund VJ, Scadding G, Mullol J, Fokkens WJ. Lack of efficacy of long-term, low-dose azithromycin in chronic rhinosinusitis: a randomized controlled trial. Allergy 2011; 66:1457-68. [PMID: 21884529 DOI: 10.1111/j.1398-9995.2011.02693.x] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In persistent chronic rhinosinusitis (CRS), conventional treatment is often insufficient. Long-term, low-dose administration of macrolides has been suggested as a treatment option. The MACS (Macrolides in chronic rhinosinusitis) study is a randomized placebo-controlled trial evaluating the efficacy of azithromycin (AZM) in CRS. METHODS We describe a group of patients with recalcitrant CRS with and without nasal polyps unresponsive to optimal medical and (in 92% also) surgical treatment. Patients were treated with AZM or placebo. AZM was given for 3 days at 500 mg during the first week, followed by 500 mg per week for the next 11 weeks. Patients were monitored until 3 months post-therapy. The assessments included Sino-Nasal Outcome Test-22 (SNOT-22), a Patient Response Rating Scale, Visual Analogue Scale (VAS), Short Form-36 (SF-36), rigid nasal endoscopy, peak nasal inspiratory flow (PNIF), Sniffin' Sticks smell tests and endoscopically guided middle meatus cultures. RESULTS Sixty patients with a median age of 49 years were included. Fifty per cent had asthma and 58% had undergone revision sinus surgery. In the SNOT-22, Patient Response Rating Scale, VAS scores and SF-36, no significant difference between the AZM and the placebo groups was demonstrated. Nasal endoscopic findings, PNIF results, smell tests and microbiology showed no relevant significant differences between the groups either. CONCLUSION At the investigated dose of AZM over 3 months, no significant benefit was found over placebo. Possible reasons could be disease severity in the investigated group, under-dosage of AZM and under-powering of the study. Therefore, more research is urgently required.
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Affiliation(s)
- W J Videler
- Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, the Netherlands
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Gill JL, James VM, Carta E, Harris D, Topf M, Scholes SFE, Hateley G, Harvey RJ. Identification of congenital muscular dystonia 2 associated with an inherited GlyT2 defect in Belgian Blue cattle from the United Kingdom. Anim Genet 2011; 43:267-70. [PMID: 22486497 DOI: 10.1111/j.1365-2052.2011.02255.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Two newborn Belgian Blue calves from a farm in the United Kingdom exhibited lateral recumbency, low head carriage and transient muscle spasms following tactile or auditory stimulation. DNA sequence analysis indicated that both calves were homozygous for the recessive congenital muscular dystonia type 2 (CMD2) mutation (c.809T>C, p.Leu270Pro) in SLC6A5, encoding the neuronal glycine transporter GlyT2. Further testing of animals from the index farm and a sample of Belgian Blue sires revealed an unexpectedly high frequency of CMD2 carriers. This implies that linked quantitative trait loci may be influencing the prevalence of CMD2 in the estimated 55,000 Belgian Blue cattle in the United Kingdom. We have therefore developed new inexpensive tests for the CMD2 allele that can be used to confirm diagnosis, identify carriers and guide future breeding strategy, thus avoiding animal distress/premature death and minimizing the future economic impact of this disorder.
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Affiliation(s)
- J L Gill
- Department of Pharmacology, The School of Pharmacy, London, UK.
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Vanhaesebrouck AE, Shelton GD, Garosi L, Harcourt-Brown TR, Couturier J, Behr S, Harvey RJ, Jeffery ND, Matiasek K, Blakemore WF, Granger N. A novel movement disorder in related male Labrador Retrievers characterized by extreme generalized muscular stiffness. J Vet Intern Med 2011; 25:1089-96. [PMID: 21781161 DOI: 10.1111/j.1939-1676.2011.0757.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To describe the clinical phenotype of a new motor disorder in Labrador Retrievers. ANIMALS AND METHODS Case series study. Seven young male Labrador Retrievers presented for evaluation of stiff gait. RESULTS All affected dogs had generalized muscular stiffness, persistent at rest and resulting in restricted joint movements. They showed a forward flexed posture, festinating gait, and bradykinesia. Signs developed between 2 and 16 months of age and tended to stabilize in adulthood. Needle electromyogram in the conscious state showed continuous motor unit activity in resting epaxial and proximal limb muscles. This activity was abolished by general anesthesia. Muscle and nerve histopathology was normal. In 2 dogs necropsied, astrocytosis was evident throughout the spinal cord gray matter, reticular formation and caudate nuclei. Decreased neuronal counts were selectively found in the spinal cord Rexed's lamina VII, but not in VIII and IX. Pedigree analysis showed that the affected dogs were from 5 related litters. CONCLUSIONS AND CLINICAL IMPORTANCE This new hypertonicity syndrome in Labrador Retrievers is unique because of the selective distribution of the histological lesions, the lack of progression in adulthood, and its exclusive occurrence in male dogs. Pedigree analysis suggests an X-linked hereditary disease, although other modes of inheritance cannot be ruled out with certainty. We hypothesize that altered output from basal nuclei and reticular formation together with motor neuron disinhibition caused by a decreased number of spinal cord interneurons leads to the muscular stiffness.
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Affiliation(s)
- A E Vanhaesebrouck
- Department of Veterinary Medicine, The Queen's Veterinary School Hospital, University of Cambridge, Cambridge, UK.
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Rajalu M, Müller UC, Caley A, Harvey RJ, Poisbeau P. Plasticity of synaptic inhibition in mouse spinal cord lamina II neurons during early postnatal development and after inactivation of the glycine receptor α3 subunit gene. Eur J Neurosci 2009; 30:2284-92. [DOI: 10.1111/j.1460-9568.2009.07018.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Harvey RJ, Lund VJ. Biofilms and chronic rhinosinusitis: systematic review of evidence, current concepts and directions for research. Rhinology 2007; 45:3-13. [PMID: 17432062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
INTRODUCTION Chronic rhinosinusitis (CRS) possesses the hallmarks of biofilm mediated disease. This paper represents a systematic review of the published evidence for biofilms as the mediator of the inflammation in CRS. Current concepts on biofilm formation and properties, treatment strategies and directions for research are discussed. METHODS A systematic review of the published literature for biofilms and their role in chronic rhinosinusitis was undertaken. Both Medline (1966-2006) and Embase (1988-2006) were searched until November 2006 which yielded 652 articles, 13 of which provided original research of biofilms in CRS. RESULTS There were 7 studies demonstrating biofilm morphology in mucosal samples from human CRS patients. One study showed similar evidence for biofilms in an animal model of CRS. FISH techniques with CLSM were employed in one study to demonstrate biofilm formation in situ by S. pneumoniae, S. aureus, H. influenza and P. aeruginosa. In vitro biofilm forming capacity of microbiological samples, after culture, was assessed in two studies. Correlation with a clinical outcome was also made in these papers. One study demonstrated biofilm growth in removed frontal sinus stents. CONCLUSIONS Biofilms are associated with CRS, however, little research is available to define their role in the pathogenic process. There is tremendous potential for future research. Biofilms may be a significant factor in the inflammatory process.
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Affiliation(s)
- R J Harvey
- Rhinology Research Unit, The Royal National Throat, Nose and Ear Hospital, London, United Kingdom.
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Abstract
The importance of an adequate meatoplasty is often emphasised in mastoid surgery. However, bigger is not always better, as an excessively widened external meatus can be cosmetically unacceptable, provide little extra benefit for cleaning, be an obstacle to the good fitting of hearing aids and expose the mastoid cavity to exaggerated caloric effect.The problems created by an overly large meatus can occasionally be difficult to manage, prompting consideration of reduction of the meatus. We describe the use of a pedicled, post-auricular skin flap to achieve reduction of an excessively large meatus.
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Affiliation(s)
- R J Harvey
- Department of Otolaryngology/Skull Base Surgery, St Vincent's Hospital, Sydney, NSW, Australia.
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Abstract
1. Extracellular field potentials and single unit responses have been recorded from the inferior olive of the cat following stimulation of the surface of the contralateral paramedian lobule of the cerebellum, and of the ipsilateral cerebral cortex. 2. Cerebellar stimulation results in antidromic invasion of inferior olivary neurones via the climbing fibres. These responses are followed by synaptic discharges which may be generated through climbing fibre recurrent collaterals. 3. Precise histological controls have shown that these responses to stimulation of the paramedian lobule are located in the ventral lamella of the principal olive. 4. Unifocal stimulation of the sensori-motor cortex with surface-anodal pulses evokes synaptically generated discharges of neurones in the central lamella, with a latency of 8-9 msec. The area of cortex yielding responses has been mapped at chosen stimulus intensities and the limitations of the maps have been discussed. 5. It has been shown that the initial excitatory responses obtained from either cortex are followed by an inhibition which lasts about 100 msec, and gives way to a period of recovery or facilitation. This, in turn, is succeeded by a further period of inhibition. Possible neural substrates for these changes have been discussed.
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Affiliation(s)
- B D Armstrong
- Department of Physiology, Australian National University, Canberra, Australia
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Abstract
BACKGROUND Alzheimer's disease is the most common cause of dementia in older people. One of the aims of therapy is to inhibit the breakdown of a chemical neurotransmitter, acetylcholine, by blocking the relevant enzyme. This can be done by a group of chemicals known as cholinesterase inhibitors. OBJECTIVES The objective of this review is to assess whether donepezil improves the well-being of patients with dementia due to Alzheimer's disease. SEARCH STRATEGY The Cochrane Dementia and Cognitive Improvement Group's Specialized Register was searched using the terms 'donepezil', 'E2020' and 'Aricept' on 12 June 2005. This Register contains up-to-date records of all major health care databases and many ongoing trial databases. Members of the Donepezil Study Group and Eisai Inc were contacted. SELECTION CRITERIA All unconfounded, double-blind, randomized controlled trials in which treatment with donepezil was compared with placebo for patients with mild, moderate or severe dementia due to Alzheimer's disease. DATA COLLECTION AND ANALYSIS Data were extracted by one reviewer (JSB), pooled where appropriate and possible, and the pooled treatment effects, or the risks and benefits of treatment estimated. MAIN RESULTS 23 trials are included, involving 5272 participants. Most trials were of 6 months or less duration in selected patients. Available outcome data cover domains including cognitive function, activities of daily living, behaviour , global clinical state and health care resource costs. For cognition there is a statistically significant improvement for both 5 and 10 mg/day of donepezil at 24 weeks compared with placebo on the ADAS-Cog scale (-2.01 points MD, 95%CI -2.69 to -1.34, p<0.00001); -2.80 points, MD 95% CI -3.74 to -2.10, p<0.00001) and for 10 mg/day donepezil compared with placebo at 52 weeks (1.84 MMSE points, 95% CI, 0.53 to 3.15, p=0.006). The results show some improvement in global clinical state (assessed by a clinician) in people treated with 5 and 10 mg/day of donepezil compared with placebo at 24 weeks for the number of patients showing improvement or no change (OR 2.18, 95% CI 1.53 to 3.11, p=<0.0001, OR 2.38, 95% CI 1.78 to 3.19, p<0.00001). Benefits of treatment were also seen on measures of activities of daily living and behaviour, but not on the quality of life score . There were significantly more withdrawals before the end of treatment from the 10 mg/day (but not the 5 mg/day) donepezil group compared with placebo which may have resulted in some overestimation of beneficial changes at 10 mg/day. Benefits on the 10 mg/day dose were marginally larger than on the 5 mg/day dose. Two studies presented results for health resource use, and the associated costs. There were no significant differences between treatment and placebo for any item, the cost of any item, and for the total costs, and total costs including the informal carer costs. A variety of adverse effects were recorded, with more incidents of nausea, vomiting, diarrhoea, muscle cramps, dizziness, fatigue and anorexia (significant risk associated with treatment) in the 10 mg/day group compared with placebo but very few patients left a trial as a direct result of the intervention. AUTHORS' CONCLUSIONS People with mild, moderate or severe dementia due to Alzheimer's disease treated for periods of 12, 24 or 52 weeks with donepezil experienced benefits in cognitive function, activities of daily living and behaviour. Study clinicians rated global clinical state more positively in treated patients, and measured less decline in measures of global disease severity. There is some evidence that use of donepezil is neither more nor less expensive compared with placebo when assessing total health care resource costs. Benefits on the 10 mg/day dose were marginally larger than on the 5 mg/day dose. Taking into consideration the better tolerability of the 5 mg/day donepezil compared with the 10 mg/day dose, together with the lower cost, the lower dose may be the better option. The debate on whether donepezil is effective continues despite the evidence of efficacy from the clinical studies because the treatment effects are small and are not always apparent in practice .
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Affiliation(s)
- J Birks
- University of Oxford, Department of Clinical Geratology, Radcliffe Infirmary, Woodstock Road, Oxford, UK, OX2 6HE.
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Abstract
OBJECTIVES To determine the prevalence of dementia in people under the age of 65 in a large catchment area, and use these figures to estimate the number of younger people affected by dementia in the UK. DESIGN Epidemiological catchment area prevalence survey. SETTING The London boroughs of Kensington and Chelsea, Westminster, and Hillingdon with a total population of 567500 people. PARTICIPANTS All residents of the catchment area with dementia, where the illness began before the age of 65 years. Participants were notified to the study by medical and care professionals. The diagnosis and age of onset was established from all available health and social care records. In total, 227 people were identified, of whom 185 fulfilled the inclusion criteria of having a dementia which started before their 65th birthday. MAIN OUTCOME MEASURES Diagnosis of dementia and differential diagnosis of the cause of the dementia. RESULTS The prevalence of dementia in those aged 30-64 was 54.0 per 100000 (95% CI 45.1 to 64.1 per 100000). For those aged 45-64 years, the prevalence was 98.1 per 100000 (95% CI 81.1 to 118.0 per 100000). From the age of 35 onwards, the prevalence of dementia approximately doubled with each 5 year increase in age. Extrapolating these figures nationally suggests that there are 18319 (15296-21758) people with dementia under the age of 65 in the UK. CONCLUSIONS The study confirms previous "guestimates" of the number of younger people affected by dementia in UK. The prevalence figures generated are robust, and are supported by other smaller and targeted prevalence surveys. The prevalence figures provided by this study will allow health planners to accurately estimate need and plan services.
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Affiliation(s)
- R J Harvey
- Imperial College London and the Institute of Neurology (UCL), London, UK.
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McNulty MJ, Hutabarat RH, Findlay JWA, Devereux K, Knick VC, Harvey RJ, Molina L. Pharmacokinetics and tissue distribution of the nonadecapeptide Moli1901 in rats and mice. Xenobiotica 2003; 33:197-210. [PMID: 12623761 DOI: 10.1080/0049825021000022320] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
1. Administration of aerosolized, radiolabelled Moli1901 (duramycin, 2622U90), a 19 amino acid polycyclic peptide, to rats resulted in the deposition of high amounts of radiolabel in the respiratory tract, with deposited radiolabel persisting almost unchanged through 7 days after dosing. Little to no radiolabel was present in the bloodstream of these rats. 2. Rats absorbed little radiolabel after p.o. administration, with nearly all of the dose excreted in the faeces by 2 days after dosing. 3. At 7 days following an intravenous dose, rats excreted 54% of the radiolabel in faeces and 5.4% in the urine, with 44% remaining in the carcass, primarily in the liver (33%). 4. Following an intratracheal instillation dose to rats, radiolabel was eliminated from the pulmonary system with a half-life of 64 days. Excretion was almost exclusively via faeces, with an elimination half-life of 52 days. Plasma and blood concentrations in these animals were uniformly <1 ng eq. ml(-1) at all sampling times. 5. Results in mice given intravenous and oral doses were consistent with those observed in rats. 6. Prolonged retention of Moli1901 in pulmonary tissue supports its use in the treatment of respiratory diseases.
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Affiliation(s)
- M J McNulty
- GlaxoSmithKline, Inc., Research Triangle Park, NC 27709, USA
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Janssen JC, Beck JA, Campbell TA, Dickinson A, Fox NC, Harvey RJ, Houlden H, Rossor MN, Collinge J. Early onset familial Alzheimer's disease: Mutation frequency in 31 families. Neurology 2003; 60:235-9. [PMID: 12552037 DOI: 10.1212/01.wnl.0000042088.22694.e3] [Citation(s) in RCA: 232] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Three causative genes have been identified for autosomal dominant AD. OBJECTIVE To determine the proportion of patients with early onset AD with a positive family history accounted for by mutations in these genes. METHODS A mutational analysis of the amyloid precursor protein (APP), presenilin 1 (PSEN1), and presenilin 2 (PSEN2) genes was performed in 31 probands with probable or definite AD from UK families with an age at onset (AAO) <61 years. RESULTS The mean AAO was 46.9 years (median 45 years; range 33 to 60 years). The majority of patients (23 of 31; 74%) fulfilled recognized criteria for autosomal dominant inheritance. In 17 (55%) probands the authors identified eight novel PSEN1 sequence variants and eight recognized pathogenic mutations. In 4 (13%) probands the authors identified one novel APP sequence variant (H677R) and two recognized mutations. Thus in this series 21 of 31 (68%) probands were associated with a sequence variant in APP or PSEN1. Nine of the 11 (82%) probands with neuropathologically confirmed AD who additionally fulfilled recognized criteria for autosomal dominant inheritance were associated with a sequence variant in APP or PSEN1. The 10 patients in whom the authors were unable to identify a mutation in APP, PSEN1, or PSEN2 were older than the probands with sequence variants (55.4 vs 44.7 years: p = 0.001). CONCLUSIONS Sequence variants in APP and PSEN1 accounted for the majority of neuropathologically confirmed autosomal dominant early onset AD; no mutations in PSEN2 were detected. There may be a further genetic factor involved in the etiology of autosomal dominant early onset AD.
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Affiliation(s)
- J C Janssen
- Dementia Research Group, Department of Clinical Neurology, Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
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Abstract
BACKGROUND Propentofylline is a novel therapeutic agent for dementia that readily crosses the blood-brain barrier and acts by blocking the uptake of adenosine and inhibiting the enzyme phosphodiesterase. In vitro and in vivo its mechanism of action appears to be twofold; it inhibits the production of free radicals and reduces the activation of microglial cells. It therefore interacts with the inflammatory processes that are thought to contribute to dementia, and given its mechanism of action is a possible disease modifying agent rather than a purely symptomatic treatment. OBJECTIVES To determine the clinical efficacy and safety of propentofylline for people with dementia. SEARCH STRATEGY The trials were identified from a search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 5 February 2003. Aventis, the manufacturing pharmaceutical company, was asked for data from unpublished studies but declined to enter into correspondence. SELECTION CRITERIA Unconfounded double-blind randomized controlled trials of propentofylline compared with a placebo or another treatment group. DATA COLLECTION AND ANALYSIS There were detailed reports of only four of the nine included studies. The efficacy of propentofylline was reviewed for undifferentiated dementia as there were not enough data to attempt a subgroup analysis for the types of dementia. MAIN RESULTS The following statistically significant treatment effects in favour of propentofylline are reported. Cognition at 3, 6 and 12 months including MMSE at 12 months. [MD 1.2, 95%CI 0.12 to 2.28, P=0.03] Severity of dementia at 3, 6 and 12 months including CGI at 12 months [MD -0.21, 95%CI -0.39 to -0.03, P=0.03]. Activities of Daily Living (NAB) at 6 and 12 months [MD -1.20, 95%CI -2.22 to -0.18, P=0.02]. Global Assessment (CGI) at 3 months [MD -0.48, 95% CI -0.75 to -0.21, P=0.0006], but not at later times. Tolerability There were minimal data on adverse effects and drop-outs. There were a statistically significant treatment effects in favour of placebo at 12 months, for the number of dropouts, [OR=1.43, 95%CI 1.04 to 1.90, P=0.03]. REVIEWER'S CONCLUSIONS There is limited evidence that propentofylline might benefit cognition, global function and activities of daily living of people with Alzheimer's disease and/or vascular dementia. The meta-analyses reported here are far from satisfactory as a summary of the efficacy of propentofylline, considering the unpublished information on another 1200 patients in randomized trials that exists. Unfortunately Aventis has been unwilling to correspond with the authors, significantly limiting the scope of this review.
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Affiliation(s)
- M Frampton
- 4 Edwin Terrace, Mellifont Avenue, Dun Laoire, Co. Dublin, Ireland.
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Abstract
BACKGROUND Frontotemporal lobar degeneration (FTLD) is commonly associated with behavioural disturbances such as disinhibition and aggression; these often result in the use of neuroleptic medication. METHODS All available case notes of patients attending a specialist cognitive disorders clinic with a diagnosis of FTLD were selected. This gave 100 subjects (62 male, 38 female). RESULTS In 61 patients significant behavioural disturbances were present. Of these patients, 24 had been prescribed neuroleptics. Significant extrapyramidal side effects were reported in eight patients (33%); in five patients these were severe enough to cause severe mobility problems and in one patient resulted in impaired consciousness. In some instances the extrapyramidal side effects took weeks to wear off. CONCLUSION These results suggest that patients with FTLD may, as in Lewy body dementia, be particularly sensitive to the extrapyramidal side effects of neuroleptics. We suggest that neuroleptics should be used cautiously in FTLD and treatment should be started at low doses avoiding depot preparations until further prospective studies have been performed.
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Affiliation(s)
- Y A L Pijnenburg
- Department of Clinical Neurology, Institute of Neurology, London, UK
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Høgh P, Smith SJ, Scahill RI, Chan D, Harvey RJ, Fox NC, Rossor MN. Epilepsy presenting as AD: neuroimaging, electroclinical features, and response to treatment. Neurology 2002; 58:298-301. [PMID: 11805262 DOI: 10.1212/wnl.58.2.298] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Three patients with progressive memory impairment initially attributed to AD underwent serial neuropsychometry, MRI, and EEG. Registered serial MRI volumetric analysis showed no loss of whole or regional brain volume. EEG revealed temporal lobe spike activity and antiepileptic treatment was optimized. Memory functions improved with antiepileptic medication in all three patients. The demonstration of temporal lobe spike activity in patients with progressive memory impairment is an indication for a trial of antiepileptic medication.
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Affiliation(s)
- P Høgh
- Dementia Research Group, Department of Clinical Neurology, Institute of Neurology, Queen Square, London, UK
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Piechotta K, Weth F, Harvey RJ, Friauf E. Localization of rat glycine receptor alpha1 and alpha2 subunit transcripts in the developing auditory brainstem. J Comp Neurol 2001; 438:336-52. [PMID: 11550176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Glycine receptors (GlyRs), aside from GABA(A) receptors, mediate fast postsynaptic inhibition in the mammalian nervous system. Spatial and temporal expression of the genes encoding ligand-binding alpha subunits (alpha1-alpha4) and the structural beta subunit leads to the formation of various GlyR isoforms. Currently, the idea of the GlyRs containing the "adult" alpha1 subunit replacing those with the "neonatal" alpha2 subunit during early postnatal development predominates. Here, we describe the patterns of expression of the GlyR alpha1 and alpha2 subunit genes in the rat auditory brainstem between postnatal day (P) 0 and P20, by using both nonradioactive and radioactive in situ hybridization. We show that the alpha1 subunit mRNA appears throughout the auditory brainstem during the first 8 postnatal days, which resembles the time of onset described within the spinal cord. In the rostral auditory nuclei (nuclei of the lateral lemniscus and inferior colliculus), the alpha1 subunit transcript appears later (P8) than in the caudal nuclei (cochlear nuclear complex and superior olivary complex; P0). Surprisingly, we found that low levels of the alpha2 subunit transcript are present in the auditory brainstem at birth and persist throughout the period analyzed. However, alpha2 subunit mRNA is present at high levels in other neonatal brainstem structures, such as cranial motor nuclei. Therefore, we conclude that the changes in GlyR composition in the auditory brainstem deviate from the classic alpha2 to alpha1 subunit switch observed in spinal cord. Our data suggest that genes for other GlyR subunits (e.g., alpha3 and alpha4) may be expressed during early development in the auditory brainstem.
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Affiliation(s)
- K Piechotta
- Zentrum der Physiologie, Klinikum Universität Frankfurt, D-60596 Frankfurt, Germany
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Janssen JC, Lantos PL, Fox NC, Harvey RJ, Beck J, Dickinson A, Campbell TA, Collinge J, Hanger DP, Cipolotti L, Stevens JM, Rossor MN. Autopsy-confirmed familial early-onset Alzheimer disease caused by the l153V presenilin 1 mutation. Arch Neurol 2001; 58:953-8. [PMID: 11405810 DOI: 10.1001/archneur.58.6.953] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Three affected individuals are described from a small English kindred with early-onset autosomal dominant familial Alzheimer disease (FAD) caused by a leucine-to-valine change at codon 153 (L153V) of the presenilin 1 (PSEN1) gene. METHODS Clinical information on the pedigree was collected directly from family members and from hospital records. Samples of DNA were screened by means of direct sequencing of all coding exons of PSEN1. One patient underwent neuropathological examination. RESULTS Mean age at onset of symptoms was 35.3 years (95% confidence interval [CI], 34.6-36.0 years); at death, 44.0 years (95% CI, 39.1-48.9 years). Mean duration of illness was 8.3 years (95% CI, 4.7-11.9 years). Myoclonus was a late feature in 1 patient; seizures were not reported in any subjects. Spastic paraparesis and extrapyramidal signs were absent. The neuropsychometric profile of 1 patient showed relatively preserved naming skills in the setting of global cognitive deficits. Results of neuropathological examination demonstrated the signature lesions of Alzheimer disease and the presence of occasional cortical Lewy bodies. CONCLUSIONS The PSEN1 L153V mutation lies in the main mutation cluster of PSEN1 in the second transmembrane domain. It causes early-onset FAD with clinical features similar to those of other reported FAD pedigrees.
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Affiliation(s)
- J C Janssen
- Dementia Research Group, Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, England
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Abstract
The functional pharmacology of receptors composed of the chicken brain GABA(A) receptor gamma 4 subunit and the mammalian GABA(A) receptor alpha 3 and beta2 subunits was studied by heterologous expression in Xenopus laevis oocytes using the two electrode voltage-clamp technique. GABA-evoked currents had an EC(50) of 180+/-30 microM. Responses were blocked by the competitive and non-competitive GABA(A) receptor antagonists, bicuculline methochloride and picrotoxin. Sodium pentobarbital reversibly potentiated the current several-fold, and Zn(2+) ions blocked the current with high potency (IC50=20 microM). GABA-evoked currents were potentiated by the benzodiazepine site full agonists flunitrazepam and triazolam and less by the partial agonists abecarnil and bretazenil. The inverse agonists methyl-beta-carboline-3-carboxylate (beta-CCM) and methyl 6,7-dimethoxy-4-ethyl-beta-carboline-3-carboxylate (DMCM) reduced the current. However, the imidazobenzodiazepine Ro 15-4513, which acts as an inverse agonist at mammalian alphaxbetaygamma2 GABA(A) receptors (where x=1, 2, 3 or 5, and y=1, 2 or 3), acted as a positive agonist at the gamma 4 subunit-containing receptors.
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Affiliation(s)
- I C Forster
- Physiologisches Institut der Universität Zürich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland.
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Abstract
Aggressive children show deficits and biases in their social information processing. Cognitions based on early experience and social schemas are also related to development and maintenance of aggressive behavior. Social reasoning can be linked to these aspects of social cognition, impacting on the situational cues individuals encode, their interpretations of events, and influencing response decisions. Past experience also influences development of social reasoning and social schema. Despite this, current discussion of the links between cognition and aggression rarely involves consideration of the influence of social reasoning. In this review, domain theory (E. Turiel, 1978, 1983) underpins an examination of links between social reasoning and aggression using empirical evidence drawn from research on the social reasoning of normal and aggressive children. Children as young as 3 appear to use consistent patterns of social reasoning when making judgments about transgressions and other social events, and these patterns are linked to social reasoning domains. We propose that aggressive children access information from the underlying social reasoning domains differently than their prosocial peers. This in turn affects their decision making and subsequent behavior in social situations. Our review explores developmental and clinical implications of the proposal and provides directions for future research.
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Affiliation(s)
- R J Harvey
- Department of Psychology, University of Western Australia, Nedlands, Western Australia, 6907, Australia.
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Janssen JC, Hall M, Fox NC, Harvey RJ, Beck J, Dickinson A, Campbell T, Collinge J, Lantos PL, Cipolotti L, Stevens JM, Rossor MN. Alzheimer's disease due to an intronic presenilin-1 (PSEN1 intron 4) mutation: A clinicopathological study. Brain 2000; 123 ( Pt 5):894-907. [PMID: 10775535 DOI: 10.1093/brain/123.5.894] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We describe 21 affected individuals from a kindred with early-onset autosomal dominant familial Alzheimer's disease caused by an intronic presenilin-1 mutation (in intron 4). Mean age at onset of symptoms was 37.4 years [95% confidence interval (CI): 36.6-38.2 years], mean age at death was 44.7 years (95% CI: 43.1-46.3 years) and mean duration of illness was 7.3 years (95% CI: 5.9-8.7 years). Myoclonus and seizures were prominent features of this pedigree. In the four cases for whom neuropsychometric data were available, verbal memory impairment preceded visual memory deficits; naming was relatively preserved until late in the disease. One of these four cases underwent serial volumetric MRI scans demonstrating in vivo brain tissue loss of 3.9% (38.9 ml, annualized rate of atrophy: 1. 7%) over 22 months of follow-up. The four individuals who had necropsies demonstrated the neuropathological hallmarks of Alzheimer's disease. Apolipoprotein E (APOE) status was assessed in five individuals: the case with the youngest age at onset at 33 years of age was found to be homozygous epsilon4/epsilon4, > 1 SD below the mean age of onset for those of known APOE genotype (36.4 +/- 2.3 years, mean +/- SD), and > 2 SDs below the mean age of onset for the pedigree as a whole (37.4 +/- 1.7 years, mean +/- SD). APOE genotype may therefore modulate age at onset in this pedigree.
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Affiliation(s)
- J C Janssen
- Dementia Research Group, Institute of Neurology, London, UK
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Fox NC, Cousens S, Scahill R, Harvey RJ, Rossor MN. Using serial registered brain magnetic resonance imaging to measure disease progression in Alzheimer disease: power calculations and estimates of sample size to detect treatment effects. Arch Neurol 2000; 57:339-44. [PMID: 10714659 DOI: 10.1001/archneur.57.3.339] [Citation(s) in RCA: 278] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To evaluate the rate of brain atrophy calculated from serial magnetic resonance imaging (MRI) registration as a surrogate marker of disease progression for use in clinical trials in Alzheimer disease (AD). METHODS Eighteen patients with mild to moderate AD and 18 age-matched normal controls underwent 2 MRI brain scans separated by a 12-month interval. Each individual's later scan was registered to their first scan, and the volume of cerebral tissue loss calculated directly from the registered and subtracted MRI scan pairs. The mean and SD of the rate of brain volume changes were used to estimate the sample sizes that would be needed in a clinical trial with a drug anticipated to modify disease progression by varying degrees. Comparable sample size estimates were performed with data for other methods of monitoring rates of brain atrophy, extracted from published papers. RESULTS The mean (SD) rate of brain atrophy for the patients with AD was 2.37% (1.11%) per year, while in the control group it was 0.41% (0.47%) per year. Based on these figures, to have 90% power to detect a drug effect equivalent to a 20% reduction in the rate of atrophy, 207 patients would be needed in each treatment arm. This assumes a 1-year placebo-controlled trial with a 10% patient dropout rate, and that 10% of scan pairs are unusable. CONCLUSION Registration of serial MRI volume images provides a powerful method of quantification of brain atrophy that can be used to monitor progression of AD in clinical trials.
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Affiliation(s)
- N C Fox
- Department of Clinical Neurology, Institute of Neurology, London, England
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Harvey RJ, Schmieden V, Von Holst A, Laube B, Rohrer H, Betz H. Glycine receptors containing the alpha4 subunit in the embryonic sympathetic nervous system, spinal cord and male genital ridge. Eur J Neurosci 2000; 12:994-1001. [PMID: 10762330 DOI: 10.1046/j.1460-9568.2000.00993.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Inhibitory glycine receptors (GlyRs) are known to mediate postsynaptic inhibition in spinal cord, brain stem and some higher brain regions. Several developmentally and regionally regulated GlyR isoforms exist, which result from a differential expression of the GlyR alpha (alpha1-alpha4) and beta subunit genes. Currently, very little is known about GlyRs containing the alpha4 subunit, whose existence was predicted from a partial genomic sequence. Here, we describe the isolation of complementary DNA (cDNA) sequences for the mouse and chick GlyR alpha4 subunits. We show that a mouse GlyR alpha4 subunit full-length cDNA directs the formation of functional homo-oligomeric strychnine-sensitive GlyRs in Xenopus laevis oocytes and mammalian cells, and that these resemble GlyRs composed of the alpha1 subunit in pharmacological profile and single-channel properties. In situ hybridization reveals high levels of GlyR alpha4 subunit transcripts in the embryonic (E13) chick spinal cord, lumbosacral sympathetic ganglia and dorsal root ganglia. The avian GlyR alpha4 subunit gene also shows male-specific expression in the developing genital ridge. The pharmacological profile of alpha4 subunit-containing receptors and deduced location of the avian GlyR alpha4 subunit are consistent with it being a component of the embryonic excitatory GlyRs previously identified in sympathetic neurons. Our data also suggest a novel role for GlyRs in the maturation of reproductive organs.
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Affiliation(s)
- R J Harvey
- Abteilung Neurochemie, Max-Planck-Institut für Hirnforschung, Deutschordenstrasse 46, 60528 Frankfurt am Main, Germany
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Fox NC, Jenkins R, Leary SM, Stevenson VL, Losseff NA, Crum WR, Harvey RJ, Rossor MN, Miller DH, Thompson AJ. Progressive cerebral atrophy in MS: a serial study using registered, volumetric MRI. Neurology 2000; 54:807-12. [PMID: 10690967 DOI: 10.1212/wnl.54.4.807] [Citation(s) in RCA: 131] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the potential of registered volumetric MRI in measuring rates of atrophy in MS. BACKGROUND Pathologic and imaging studies suggest that the development of permanent neurologic impairment in MS is associated with progressive brain and spinal cord atrophy. Atrophy has been suggested as a potential marker of disease progression. Conventional atrophy measurements requiring manual outlining are time-consuming and subject to reproducibility problems. Registration of serial MRI may offer a useful alternative in that cerebral losses may be measured directly from automated subtraction of brain volumes. METHODS Twenty-six patients with MS and 26 age- and gender-matched controls had two volumetric brain MR studies 1 year apart. Baseline brain and ventricular volumes were measured using semiautomated techniques, and follow-up scans were registered to baseline. Rates of cerebral atrophy were calculated directly from the registered scans. RESULTS Baseline brain volumes in the MS group were smaller (mean difference 78 mL [95% CI 13 to 143; p = 0.02]) and ventricular volumes greater (mean difference 12 mL [95% CI 6 to 18; p < 0.001]) than controls. The rate of cerebral atrophy in the MS group (0.8% per year) was over twice that of controls (0.3%), and the rate of ventricular enlargement was five times greater than the controls (1.6 versus 0.3 mL/year). CONCLUSION Progressive cerebral atrophy is an important feature of MS. Registration-based measurements are sensitive and reproducible, allowing progressive atrophy to be detected within 1 year and may have potential as a marker of progression in monitoring therapeutic trials.
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Affiliation(s)
- N C Fox
- Dementia Research Group, Institute of Neurology, London, UK
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Jenkins R, Fox NC, Rossor AM, Harvey RJ, Rossor MN. Intracranial volume and Alzheimer disease: evidence against the cerebral reserve hypothesis. Arch Neurol 2000; 57:220-4. [PMID: 10681081 DOI: 10.1001/archneur.57.2.220] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Total intracranial volume (TIV) measurement commonly is used to correct for variations in premorbid brain size in imaging studies of cerebral structures in Alzheimer disease (AD). This assumes no intrinsic difference in TIV between patients and control subjects and that TIV measurements are unaffected by cerebral atrophy. However, an autopsy study has suggested that a larger premorbid brain may protect against AD onset. A recent computed tomographic study lent support to this by finding a correlation between intracranial size and age at onset of AD in women. OBJECTIVE To investigate the relationship between TIV and sporadic and familial AD. DESIGN Retrospective case study. SETTING Specialist dementia clinic. PATIENTS Eighty-five patients with AD and 52 healthy volunteers. MAIN OUTCOME MEASURES Age at symptom onset and TIV measured using a semiautomatic interactive thresholding technique on magnetic resonance imaging spanning the entire intracranial cavity. RESULTS Reproducibility measurement was high (intrarater coefficient of variation, 1.2%; interrater coefficient of variation, 0.7%). Unlike brain atrophy in the patients with AD, TIV did not vary over time. Mean TIV did not differ significantly between any of the subject groups. There was no association between TIV and age or age at symptom onset. The only significant predictor of TIV was sex. CONCLUSIONS Measurements of TIV are independent of atrophy and can be used safely to adjust for differences in head size in studies of cerebral structure in AD. Premorbid brain size does not differ between patients with familial and sporadic AD and controls and does not delay disease onset.
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Affiliation(s)
- R Jenkins
- Department of Clinical Neurology, Institute of Neurology, London, England
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Chan JH, Chamberlain SD, Biron KK, Davis MG, Harvey RJ, Selleseth DW, Dornsife RE, Dark EH, Frick LW, Townsend LB, Drach JC, Koszalka GW. Synthesis and evaluation of a series of 2'-deoxy analogues of the antiviral agent 5,6-dichloro-2-isopropylamino-1-(beta-L-ribofuranosyl)-1H-benzimidazole (1263W94). Nucleosides Nucleotides Nucleic Acids 2000; 19:101-23. [PMID: 10772705 DOI: 10.1080/15257770008032999] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A series of 2'-deoxy analogues of the antiviral agent 5,6-dichloro-2-isopropylamino-1-(beta-L-ribofuranosyl)-1H-benzimidazole (1263W94) were synthesized and evaluated for activity against human cytomegalovirus (HCMV) and for cytotoxicity. The 2-substituents in the benzimidazole moiety correspond to those that were used in the 1263W94 series. In general, as was found in the 1263W94 series, cyclic and branched alkylamino groups were needed for potent activity against HCMV. Three analogues 3a, 3b and 3d were as potent as 1263W94. Further evaluation of two analogues, 3a and 3b, suggested that these 2'-deoxy analogues may act via a novel mechanism of action similar to that of 1263W94. These 2'-deoxy analogues generally lacked cytotoxicity in vitro. Pharmacokinetic parameters in mice and protein binding properties of 3a were quite similar to 1263W94. However, the oral bioavailability of 3a was only half of that observed for 1263W94.
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Affiliation(s)
- J H Chan
- Division of Chemistry, Glaxo Wellcome Inc., Research Triangle Park, NC 27709, USA
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Freeman GA, Selleseth DW, Rideout JL, Harvey RJ. Benzimidazole 2'-isonucleosides: design, synthesis, and antiviral activity of 2-substituted-5,6-dichlorobenzimidazole 2'-isonucleosides. Nucleosides Nucleotides Nucleic Acids 2000; 19:155-74. [PMID: 10772707 DOI: 10.1080/15257770008033001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
2,5,6-Trihalogenated benzimidazole-beta-D-ribofuranosyl nucleosides and 2-substituted amino-5,6-dichlorobenzimidazole-beta-L-ribofuranosyl nucleosides are potent and selective inhibitors of human cytomegalovirus (HCMV). The D-ribofuranosyl analogs are metabolized rapidly in vivo rendering them unsuitable as drug candidates. The primary source of instability is thought to be the anomeric bond. The synthesis of a series of chemically stable benzimidazole-2'-isonucleosides is presented. The synthetic schemes employed are based on nucleophilic displacements of a 2'-tosylate from carbohydrate intermediates with 2-bromo-5,6-dichlorobenzidazole. 2-Bromo and 2-isopropyl amino analogs with 3'- and 5'-oxo and deoxy substitutions were prepared. The benzimidazole-2-'isonucleosides presented here demonstrated reduced activity against HCMV when compared to other D-ribofuranosyl benzimidazole analogs. In addition, they were not found to be inhibitors of HIV.
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Affiliation(s)
- G A Freeman
- Division of Medicinal Chemistry, GlaxoWellcome Research, North Carolina 27709, USA
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Abstract
BACKGROUND Neuroleptic drugs are controversial treatments in dementia, with evidence accumulating that they may hasten clinical decline. Despite these concerns, they are commonly prescribed for elderly and demented patients. Thioridazine, a phenothiazine neuroleptic, is one of the most commonly prescribed. It has often been a preferred agent because it is thought to produce relatively less frequent motor side effects. The drug has significant sedative effects, and it is thought that these are the main mechanism of action in calming and controlling the patient. However, pharmacologically, it also has marked anticholinergic properties that could potentially have a detrimental effect on cognitive function. OBJECTIVES To determine the evidence on which the use of thioridazine in dementia is based in terms of: 1) efficacy in controlling symptoms 2) cognitive outcome for the patient 3) safety SEARCH STRATEGY The Cochrane Controlled Trials Register and other electronic databases were searched using the terms 'thioridazine', 'melleril', 'dementia' and 'old age'. In addition, Novartis, the pharmaceutical company that developed and markets thioridazine, was approached and asked to release any published or unpublished data they had on file. SELECTION CRITERIA Unconfounded, single-blind or double-blind, randomised trials were identified in which treatment with thioridazine was administered for more than one dose and compared to an alternative intervention in patients with dementia of any aetiology. Trials in which allocation to treatment or comparator were not truly random, or in which treatment allocation was not concealed were reviewed but are not included in the data analysis. DATA COLLECTION AND ANALYSIS Data were extracted independently by the reviewers (VC, CAK and RJH). For continuous and ordinal variables, the main outcome measures of interest were the final assessment score and the change in score from baseline to the final assessment. The assessment scores were provided by behavioural rating scales, clinical global impression scales, functional assessment scales, psychometric test scores, and frequency and severity of adverse events. Data were pooled where appropriate or possible, and the Peto odds ratio (95%CI) or the weighted mean difference (95%CI) estimated. Where possible, intention to treat data were used. MAIN RESULTS The meta-analysis showed that, compared with placebo, thioridazine reduced anxiety symptoms as evidenced by changes on the Hamilton Anxiety Scale. However, there was no significant effect on clinical global change, and a non-significant trend for higher adverse effects with thioridazine. Compared to diazepam, thioridazine was superior in terms of some anxiety symptoms, with similar adverse effects. Global clinical evaluation scales mostly did not favour either treatment. Compared to chlormethiazole, thioridazine was significantly inferior when assessed on some items of the CAPE and the Crichton Geriatric Behavioural Rating Scales. Thioridazine was also associated with significantly more dizziness. No superiority for thioridazine was shown in comparisons with etoperidone, loxapine or zuclopenthixol. REVIEWER'S CONCLUSIONS Very limited data are available to support the use of thioridazine in the treatment of dementia. If thioridazine were not currently in widespread clinical use, there would be inadequate evidence to support its introduction. The only positive effect of thioridazine when compared to placebo is the reduction of anxiety. When compared to placebo, other neuroleptics, and other sedatives it has equal or higher rates of adverse effects. Clinicians should be aware that there is no evidence to support the use of thioridazine in dementia, and its use may expose patients to excess side effects.
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Affiliation(s)
- V Kirchner
- Dementia Research Group, Institute of Neurology, The National Hospital for Neurology & Neurosurgery, Queen Square, London, UK, WC1N 3BG.
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Abstract
1. Whole-cell glycine-activated currents were recorded from human embryonic kidney (HEK) cells expressing wild-type and mutant recombinant homomeric glycine receptors (GlyRs) to locate the inhibitory binding site for Zn2+ ions on the human alpha1 subunit. 2. Glycine-activated currents were potentiated by low concentrations of Zn2+ (<10 microM) and inhibited by higher concentrations (>100 microM) on wild-type alpha1 subunit GlyRs. 3. Lowering the external pH from 7.4 to 5.4 inhibited the glycine responses in a competitive manner. The inhibition caused by Zn2+ was abolished leaving an overt potentiating effect at 10 microM Zn2+ that was exacerbated at 100 microM Zn2+. 4. The identification of residues involved in the formation of the inhibitory binding site was also assessed using diethylpyrocarbonate (DEPC), which modifies histidines. DEPC (1 mM) abolished Zn2+-induced inhibition and also the potentiation of glycine-activated currents by Zn2+. 5. The reduction in glycine-induced whole-cell currents in the presence of high (100 microM) concentrations of Zn2+ did not increase the rate of glycine receptor desensitisation. 6. Systematic mutation of extracellular histidine residues in the GlyR alpha1 subunit revealed that mutations H107A or H109A completely abolished inhibition of glycine-gated currents by Zn2+. However, mutation of other external histidines, H210, H215 and H419, failed to prevent inhibition by Zn2+ of glycine-gated currents. Thus, H107 and H109 in the extracellular domain of the human GlyR alpha1 subunit are major determinants of the inhibitory Zn2+ binding site. 7. An examination of Zn2+ co-ordination in metalloenzymes revealed that the histidine- hydrophobic residue-histidine motif found to be responsible for binding Zn2+ in the human GlyR alpha1 subunit is also shared by some of these enzymes. Further comparison of the structure and location of this motif with a generic model of the GlyR alpha1 subunit suggests that H107 and H109 participate in the formation of the inhibitory Zn2+ binding site at the apex of a beta sheet in the N-terminal extracellular domain.
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Affiliation(s)
- R J Harvey
- Department of Pharmacology and Department of Pharmaceutical Chemistry, The School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK
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Selai CE, Trimble MR, Rossor MN, Harvey RJ. Effectiveness of rivastigmine in Alzheimer's disease. Patients' view on quality of life should be assessed. BMJ 1999; 319:641-2. [PMID: 10523095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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