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The role of revision sinus surgery in the initiation of dupilumab therapy: A real-world study of molecular and cellular features 鼻窦翻修手术在启动杜必鲁单抗治疗中的作用:分子和细胞特征的真实世界研究。
IF 7.2 2区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-07-03 DOI: 10.1002/alr.23401
Abigail Gaffar MS, Abdul Rahman Alenezi MD, Kathleen M. Kelly MD, Heather M. Kulaga MS, Hsin-Tzu Keng MS, Amy Smith BA, Andrew P. Lane MD

Key points

  • A persistent type 2 endotype signature exists in recalcitrant chronic rhinosinusitis with nasal polyps mucosa on dupilumab.
  • Revision sinus surgery immediately prior to dupilumab reduces long-term interleukin (IL)-4/IL-13 tissue mRNA.
  • Pre-dupilumab revision surgery is associated with reduced tissue eosinophils and GATA-3+ cells.
要点:在使用杜普鲁单抗的顽固性慢性鼻窦炎伴鼻息肉粘膜中存在持续的2型内型特征。在使用杜匹单抗前立即进行鼻窦翻修手术可减少白细胞介素 (IL)-4/IL-13 组织 mRNA 的长期存在。杜比卢单抗前的鼻窦翻修手术与组织嗜酸性粒细胞和 GATA-3+ 细胞减少有关。
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引用次数: 0
Inhalational exposure history is associated with differential sinonasal gene expression profiles and clinical outcomes in chronic rhinosinusitis patients: A pilot study 吸入接触史与慢性鼻炎患者鼻窦基因表达谱和临床结果的差异有关:一项试点研究。
IF 7.2 2区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-07-03 DOI: 10.1002/alr.23403
Cameron P. Worden MD, Brian D. Thorp MD, Charles S. Ebert Jr. MD, MPH, Cristine N. Klatt-Cromwell MD, Brent A. Senior MD, Adam J. Kimple MD, PhD, Meghan E. Rebuli PhD, Ilona Jaspers PhD

Key points

  • Inhalational exposure (IE) history assessment is important and may guide chronic rhinosinusitis disease management.
  • Combined exposure status was the most significant factor across differential gene expression analyse
  • IE history was associated with pro-inflammatory transcriptome changes and worse clinical outcomes.
要点:吸入性暴露(IE)史评估非常重要,可指导慢性鼻炎的疾病管理。综合暴露状态是影响不同基因表达的最重要因素。
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引用次数: 0
Advances in noncoding RNA in children allergic rhinitis 儿童过敏性鼻炎的非编码 RNA 研究进展。
IF 7.2 2区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-06-30 DOI: 10.1002/alr.23393
Shuman Li MM, Hongtao Cui MD, Huina Lu MD, Shan Zheng MD, Chao Yuan MM

Background: A chronic condition that significantly reduces a child's quality of life is allergic rhinitis (AR). The environment and allergens that the body is regularly exposed to can cause inflammatory and immunological reactions, which can change the expression of certain genes Epigenetic changes are closely linked to the onset and severity of allergy disorders according to mounting amounts of data. Noncoding RNAs (ncRNAs) are a group of RNA molecules that cannot be converted into polypeptides. The three main categories of ncRNAs include microRNAs (miRNAs), long noncoding RNAs (lncRNAs), and circular RNAs (circRNAs). NcRNAs play a crucial role in controlling gene expression and contribute to the development of numerous human diseases. Methods: Articles are selected based on Pubmed's literature review and the author's personal knowledge. The largest and highest quality studies were included. The search selection is not standardized. Results: Recent findings indicate that various categories of ncRNAs play distinct yet interconnected roles and actively contribute to intricate gene regulatory networks. Conclusion: This article demonstrates the significance and progress of ncRNAs in children's AR. The database covers three key areas: miRNAs, lncRNAs, and circRNAs. Additionally, potential avenues for future research to facilitate the practical application of ncRNAs as therapeutic targets and biomarkers will be explore.

背景:过敏性鼻炎(AR)是一种严重降低儿童生活质量的慢性疾病。人体经常接触的环境和过敏原会引起炎症和免疫反应,从而改变某些基因的表达。根据越来越多的数据显示,表观遗传学变化与过敏性疾病的发病和严重程度密切相关。非编码 RNA(ncRNA)是一组不能转化为多肽的 RNA 分子。ncRNA 主要分为三类,包括微小 RNA(miRNA)、长非编码 RNA(lncRNA)和环状 RNA(circRNA)。NcRNAs 在控制基因表达方面起着至关重要的作用,并导致多种人类疾病的发生:根据 Pubmed 的文献综述和作者的个人知识选择文章。纳入了规模最大、质量最高的研究。搜索选择没有标准化:最近的研究结果表明,各类 ncRNA 发挥着不同但相互关联的作用,并对错综复杂的基因调控网络做出了积极贡献:本文展示了ncRNAs在儿童AR中的重要性和进展。该数据库涵盖三个关键领域:miRNAs、lncRNAs 和 circRNAs。此外,还将探讨未来研究的潜在途径,以促进 ncRNAs 作为治疗靶点和生物标志物的实际应用。
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引用次数: 0
Efficacy of the nasal airflow-inducing maneuver in the olfactory rehabilitation of laryngectomy patients: A systematic review and meta-analysis 鼻气流诱导法在喉切除术患者嗅觉康复中的疗效:系统回顾与荟萃分析。
IF 7.2 2区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-06-30 DOI: 10.1002/alr.23391
Kurtis Young MD, Frances T. Morden MD, Quinton Blount MD, Austin Johnson DO, Sameer Kejriwal BS, Hannah Bulosan BS, Elliott J. Koshi MD, Marianne Abouyared MD, Farrah Siddiqui MD, Jee-Hong Kim MD

Introduction

This is the first systematic review and meta-analysis to investigate the effectiveness of the nasal airflow-inducing maneuver (NAIM) in olfactory rehabilitation for total laryngectomy (TL) patients.

Methods

We conducted a systematic literature search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The inclusion criteria required that patients must have undergone a TL with subsequent NAIM training for at least 2 weeks and olfactory evaluation. The impact of NAIM on olfactory outcomes compared to that at baseline was measured. Olfactory measures included the Sniffin’ Sticks Test, Smell Disk Test, Scandinavian Odor Identification Test, and Quick Odor Detection Test. The primary outcome measures were the proportion of patients with normosmia at baseline and after intervention.

Results

Seven studies from 2000 to 2023 comprising a total of 290 TL patients met the inclusion criteria. The meta-analysis revealed that prior to intervention, the pooled proportion of patients with normosmia was 0.16 (95% confidence interval [CI]: 0.09‒0.27, p = 0.01). After intervention, the same proportion increased to 0.55 (95% CI: 0.45‒0.68, p = 0.001). Among the included patients, 88.3% were initially anosmic or hyposmic, which was reduced to 48.9% after NAIM practice, with 51.1% achieving normosmia. The percent improvement was not found to be significantly associated with the timing of intervention post-TL (p = 0.18).

Conclusions

NAIM increased the proportion of patients who achieved normosmia in TL patients. NAIM stands out as a safe, easily teachable maneuver with promising results. Further efforts are warranted to provide specific recommendations and guidelines for the use of NAIM in clinical practice.

简介:这是首次对鼻气流诱导法(NAIM)在全喉切除术(TL)患者嗅觉康复中的有效性进行系统回顾和荟萃分析:我们按照《系统综述和元分析首选报告项目》(Preferred Reporting Items for Systematic Reviews and Meta-Analyses,PRISMA)指南进行了系统文献检索。纳入标准要求患者必须接受过 TL,随后接受了至少 2 周的 NAIM 训练和嗅觉评估。与基线相比,NAIM 对嗅觉结果的影响得到了衡量。嗅觉测量包括嗅棒测试、嗅盘测试、斯堪的纳维亚气味识别测试和快速气味检测测试。主要结果指标是基线和干预后嗅觉正常患者的比例:从 2000 年到 2023 年的七项研究共纳入了 290 名 TL 患者,符合纳入标准。荟萃分析显示,在干预前,正常泌尿患者的总比例为 0.16(95% 置信区间 [CI]:0.09-0.27,P = 0.01)。干预后,这一比例增至 0.55(95% 置信区间:0.45-0.68,p = 0.001)。在纳入的患者中,88.3%最初为无尿或低尿,NAIM实践后降至48.9%,51.1%达到正常尿量。研究发现,改善比例与TL后的干预时间无明显关系(p = 0.18):结论:NAIM提高了TL患者达到正常泌尿状态的比例。NAIM是一种安全、易学的操作方法,具有良好的效果。我们需要进一步努力,为在临床实践中使用 NAIM 提供具体的建议和指导。
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引用次数: 0
The association between olfactory subdomains and frailty: A prospective case‒control study investigation 嗅觉子域与虚弱之间的关系:前瞻性病例对照研究调查。
IF 7.2 2区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-06-28 DOI: 10.1002/alr.23398
Michael Z. Cheng MD, Varun Vohra BS, Hang Wang MS, Akhil Katuri BS, Jacqueline M. Langdon MS, Qian-Li Xue PhD, Nicholas R. Rowan MD

Background

Amidst the rise of frailty among a globally aging population, olfactory decline has emerged as a harbinger of frailty and mortality in population-level studies. However, the relationships between frailty and the olfactory subdomains of identification (OI), discrimination (OD), and threshold (OT) remain unexplored. This study prospectively examined the association between olfactory subdomains and the physical frailty phenotype (PFP) to investigate olfactory evaluation as a means of frailty screening.

Methods

A case‒control study of 45 frail and 45 non-frail individuals matched by age and sex. OT, OD, OI (range 0‒16), and composite sum (threshold, discrimination, and identification scores [TDI], range 0‒48) were measured with Sniffin’ Sticks. PFP was defined by presence of three or more criteria: physical inactivity, self-reported exhaustion, muscle weakness, slow gait, and unintentional weight loss. Conditional logistic regression evaluated associations between olfactory subdomains and frailty.

Results

Ninety individuals with mean age of 83.1 ± 4.9 years, 60% female (n = 54), and 87.8% white (n = 79) were included. Olfactory scores were significantly lower in the frail group for OI (9.2 vs. 12.1, p < 0.001), OD (8.1 vs. 11.6, p < 0.001), OT (4.4 vs. 8.5, p < 0.001), and TDI (21.7 vs. 32.2, p < 0.001) than in the non-frail group. A single-point decrease in olfactory score was associated with increased odds of frailty in OT (odds ratio [OR]: 2.21, 95% confidence interval: [1.22, 3.98]), OD (OR: 2.19, 95% CI: [1.32, 3.65]), OI (OR: 2.29, 95% CI: [1.19, 4.39]), and TDI (OR: 1.54, 95% CI: [1.14, 2.08]).

Conclusion

The robust association between olfactory subdomain scores and frailty suggests that olfaction may be an accessible signifier of frailty. Future studies should investigate this relationship longitudinally to assess predictive relationships.

背景:随着全球老龄化人口中虚弱人群的增加,嗅觉衰退已成为人群研究中虚弱和死亡率的先兆。然而,虚弱与识别(OI)、辨别(OD)和阈值(OT)等嗅觉子域之间的关系仍未得到探讨。本研究对嗅觉亚域与身体虚弱表型(PFP)之间的关系进行了前瞻性研究,以探讨将嗅觉评估作为虚弱筛查手段的可能性:方法:对 45 名体弱者和 45 名非体弱者进行病例对照研究。使用嗅觉棒测量了OT、OD、OI(范围0-16)和综合总分(阈值、辨别和识别分数[TDI],范围0-48)。PFP的定义是存在三个或三个以上的标准:缺乏体力活动、自我报告的疲惫、肌肉无力、步态缓慢和无意中体重减轻。条件逻辑回归评估了嗅觉子域与虚弱之间的关联:90名患者的平均年龄为(83.1 ± 4.9)岁,60%为女性(n = 54),87.8%为白人(n = 79)。体弱组的嗅觉得分明显低于 OI 组(9.2 分对 12.1 分,P嗅觉子域得分与体弱之间的密切联系表明,嗅觉可能是体弱的一个易识别标志。未来的研究应纵向调查这种关系,以评估预测关系。
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引用次数: 0
Contemporary practice patterns for chronic rhinosinusitis with nasal polyps 慢性鼻炎伴鼻息肉的当代治疗模式。
IF 7.2 2区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-06-27 DOI: 10.1002/alr.23392
Noel F. Ayoub MD, MBA, Firas Sbeih MD, Benjamin S. Bleier MD

Key points

  • Data on current practice patterns for the management of chronic rhinosinusitis with nasal polyps, including which medications are deemed by otolaryngologists to better manage patient symptoms, are limited.

  • This study demonstrated that contemporary practice patterns are largely consistent with published clinical consensus statements.

  • Off-label nasal steroid irrigations and dupilumab are the most commonly used topical and systemic therapies for chronic rhinosinusitis with nasal polyps, respectively.

要点:有关目前治疗慢性鼻炎合并鼻息肉的实践模式(包括耳鼻喉科医生认为哪些药物能更好地控制患者症状)的数据十分有限。本研究表明,当前的实践模式与已发表的临床共识声明基本一致。标签外鼻腔类固醇冲洗和杜比卢单抗分别是治疗慢性鼻炎伴鼻息肉最常用的局部和全身疗法。
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引用次数: 0
Intralesional cidofovir injections for the treatment of multifocal exophytic sinonasal papilloma 治疗多灶性鼻窦外生乳头状瘤的西多福韦区域内注射。
IF 7.2 2区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-06-27 DOI: 10.1002/alr.23399
Florian Chatelet MD, Alessandro Vinciguerra MD, Morgane Marc MD, Philippe Herman MD, PhD, Benjamin Verillaud MD, PhD

Key points

  • Intralesional cidofovir injections in combination with surgery is an effective treatment for recurrent multifocal sinonasal exophytic papilloma.
  • No malignant transformation has been observed in our experience.
  • Anosmia is a potential side effect that patients should be aware of.
要点:西多福韦区域内注射结合手术是治疗复发性多灶性鼻窦外生乳头状瘤的有效方法。在我们的经验中,没有观察到恶性转化。无嗅是一种潜在的副作用,患者应注意。
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引用次数: 0
Efficacy of a RADA-16 peptide hydrogel versus chitosan-based polymer in improving patient comfort during postoperative debridement: A randomized controlled trial RADA-16 肽水凝胶与壳聚糖聚合物在改善术后清创期间患者舒适度方面的功效:随机对照试验。
IF 7.2 2区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-06-27 DOI: 10.1002/alr.23395
Kevin Hur MD, Amila Adili MPH, Benjamin Tam BA, Kevin Herrera BS, Aditi Agarwal MBBS, Dale Rice MD, Elisabeth Ference MD, MPH, Bozena Wrobel MD, David Conley MD

Background

Bioresorbable nasal packing is associated with a decreased incidence of adhesions and bleeding postoperatively after endoscopic sinus surgery (ESS). However, discomfort during postoperative debridement is still a major area of concern for patients. Our objective was to compare the efficacy of a peptide hydrogel to that of a chitosan-based polymer in reducing pain during debridement after ESS.

Methods

A prospective, multicenter, randomized, blinded trial was conducted in adults undergoing bilateral total ethmoidectomy for chronic rhinosinusitis. Participants served as their own controls with each subject receiving the hydrogel in a randomized ethmoid cavity and chitosan-based polymer in the contralateral ethmoid cavity. Participants were evaluated at 1, 4, and 12 weeks postoperatively. Pain during debridement as well as endoscopic evaluation of mucosal healing and hemostasis were measured.

Results

Thirty patients who underwent ESS were included in this trial. During the week 1 postoperative debridement, patients reported significantly less pain on the hydrogel-treated side compared to the chitosan-based polymer-treated side. There were no significant differences in bleeding severity, Lund–Kennedy scores, debridement time, or need for further intervention between the two groups.

Conclusion

This study demonstrated the efficacy of a peptide hydrogel in minimizing pain during postoperative debridement.

背景:生物可吸收鼻腔填料可降低内窥镜鼻窦手术(ESS)术后粘连和出血的发生率。然而,术后清创过程中的不适感仍是患者关注的主要问题。我们的目的是比较多肽水凝胶和壳聚糖聚合物在减轻ESS术后清创过程中疼痛的效果:我们对因慢性鼻炎接受双侧乙状结肠全切除术的成人进行了一项前瞻性、多中心、随机、盲法试验。受试者作为自己的对照组,每个受试者在随机的乙状结肠腔中接受水凝胶,在对侧乙状结肠腔中接受壳聚糖基聚合物。参与者在术后 1 周、4 周和 12 周接受评估。对清创时的疼痛以及粘膜愈合和止血的内窥镜评估进行了测量:30名接受ESS手术的患者参与了此次试验。在术后第 1 周的清创过程中,与壳聚糖基聚合物处理的一侧相比,水凝胶处理的一侧患者的疼痛明显减轻。两组患者在出血严重程度、伦德-肯尼迪评分、清创时间或是否需要进一步干预方面没有明显差异:这项研究证明了多肽水凝胶在减轻术后清创疼痛方面的功效。
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引用次数: 0
Nasal endoscopy: What have we been missing? 鼻内窥镜检查:我们错过了什么?
IF 7.2 2区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-06-27 DOI: 10.1002/alr.23394
Edward D. McCoul MD, MPH, Vinayak Ganeshan MD, Thinh Nguyen MD

Despite the widespread adoption of nasal endoscopy (NE) in the evaluation of sinonasal disease, its diagnostic potential may still be underutilized. Developments in endoscopic technology have led to significant improvements in video quality and maneuverability. However, there is concern that NE continues to be used primarily for the identification of gross pathology, with relative neglect of more subtle findings such as surface features of inflammation and mucus. With fewer technical limitations to perceive these abnormalities, there is potential to greatly improve the diagnostic value of NE. The reader is herein asked to consider several important visual nuances encountered during NE, with the hope that this engenders an appreciation of the versatility of NE as a diagnostic tool.

尽管鼻内窥镜(NE)被广泛用于鼻窦疾病的评估,但其诊断潜力可能仍未得到充分利用。内窥镜技术的发展使视频质量和可操作性有了显著提高。然而,令人担忧的是,内窥镜仍主要用于识别大体病变,而相对忽视了更细微的发现,如炎症和粘液的表面特征。如果能减少感知这些异常的技术限制,就有可能大大提高 NE 的诊断价值。在此,我们要求读者考虑在 NE 过程中遇到的几个重要的视觉细微差别,希望这能使读者对 NE 作为诊断工具的多功能性有所了解。
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引用次数: 0
Spending, utilization, and coverage for chronic rhinosinusitis with nasal polyposis therapies among Medicare Advantage beneficiaries 医疗保险优势受益人在慢性鼻炎伴鼻息肉治疗方面的支出、使用情况和保险范围。
IF 7.2 2区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-06-25 DOI: 10.1002/alr.23362
Akash M. Bhat BS, Zachary M. Soler MD, MSc, Vinay K. Rathi MD, MBA, Rodney J. Schlosser MD

Key points

  • CRSwNP-specific mean total annual spending ranged from $5,837 (EDS-FLU) to $28,058 (dupilumab).
  • Most CRSwNP patients receiving biologics had comorbid asthma and did not undergo sinus surgery.
  • While biologics were covered by most Medicare Part D plans, only 37% of plans covered EDS-FLU.
要点:CRSwNP特异性年平均总支出从5837美元(EDS-FLU)到28058美元(dupilumab)不等。大多数接受生物制剂治疗的 CRSwNP 患者合并有哮喘,且未接受鼻窦手术。虽然大多数医疗保险 D 部分计划都涵盖了生物制剂,但只有 37% 的计划涵盖了 EDS-FLU。
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引用次数: 0
期刊
International Forum of Allergy & Rhinology
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