International Forum of Allergy & Rhinology最新文献

Background: Chronic rhinitis (CR) is currently recognized as a syndrome that manifests in different phenotypes. We aimed to establish an artificial intelligence system (quantitative assessment of nasal inflammatory cytology, QANIC) on the basis of whole-slide images (WSIs) to enable quantitative assessment of nasal inflammatory cells.

Methods: During the development phase of QANIC, we screened nasal secretion smears from 145 CR patients for deep learning and obtaining a robust model. Subsequently, QANIC was applied to an internal cohort (N = 881) and an independent external validation cohort comprising two clinical centers (N = 234). Cluster analysis was employed to analyze two inflammatory variables (nasal and blood eosinophil [Eos] percentages) to investigate the clinical characteristics and inflammatory patterns of different clusters.

Results: Three clusters of inflammatory phenotypes were defined in CR patients: Cluster 1 (high nasal and high blood Eoss, accounted for 17.14% and 16.24% in the two cohorts, respectively), Cluster 2 (high nasal but low blood Eoss, 45.86% and 45.30%), and Cluster 3 (low nasal and low blood Eoss, 37.00% and 38.46%). Compared to Cluster 3, Clusters 1 and 2 demonstrated more severe clinical symptoms and nasal Type 2 inflammation, along with a diagnostic advantage in identifying seasonal allergic rhinitis.

Conclusions: The QANIC marks the first time deep learning has been combined with WSIs for nasal cytology diagnosis. Subtyping rhinitis patients based on nasal cytology play an important role in monitoring inflammation dynamics and individualizing treatment.

Key points: High-risk dysplasia and multifocal attachment independently predict inverted papilloma recurrence. Novel nomogram generates individualized 3-, 6-, and 9-year recurrence risk estimates. Risk-stratified surveillance may optimize postoperative monitoring intensity and intervals.

Background: Acute invasive fungal sinusitis (AIFS) is a highly fatal infection affecting immunocompromised patients. While defects in innate immunity have been studied as the primary focus in AIFS, adaptive immunity has yet to be explored in this condition.

Methods: Sinonasal biopsies from consenting surgical patients were collected from 13 AIFS patients, 8 immunocompromised patients without fungal infection, and 4 healthy controls. B- and T-cell receptor (BCR/TCR) sequences were reconstructed from bulk transcriptome sequencing. Clonal homeostasis, repertoire diversity, and V gene usage were compared for both BCRs and TCRs. Somatic hypermutation (SHM) rates, isotype distribution, and biophysical properties of BCRs were further analyzed. Lastly, bulk transcriptomic deconvolution was performed to examine the abundance of adaptive immune cells in AIFS.

Results: Both B and T cells in AIFS exhibited increased clonal expansion, coupled with decreased receptor diversity compared with control groups. V gene usage in BCRs and TCRs demonstrated immunosuppression-associated and AIFS-specific patterns. SHM was decreased in AIFS compared with both healthy and immunocompromised controls, particularly in IgG and IgA BCRs. The light and heavy chains of BCRs in AIFS were biophysically distinct from those of controls. Bulk deconvolution reveals depletion of naïve and memory B cells, as well as CD4 and CD8 T cells in AIFS compared with immunosuppressed controls.

Conclusions: Our results suggest that adaptive immunity is dysregulated in AIFS. Further studies should focus on single-cell profiling to further dissect the cellular dynamics underlying this dysregulation. Recombinant cytokine therapies to boost adaptive responses represent promising medical therapies to complement surgical debridement and antifungal medications.

Background: Regional anesthesia is effective in alleviating postoperative pain and reducing the requirement for systemic pain medications. However, optimal postoperative pain management in endoscopic sinus surgery (ESS) remains challenging. This study investigated the potential pain-reducing outcomes of general anesthesia combined with a bupivacaine injection at the sphenopalatine ganglion (SPG) and an anterior ethmoid nerve block following ESS.

Methods: A double-blind randomized controlled trial that included 80 patients (18-75 years old) with chronic rhinosinusitis who underwent ESS was conducted. Either 0.5% bupivacaine or normal saline was injected into the anterior ethmoid nerve and SPG. The visual analog scale (VAS) pain score was assessed at 0, 1, 2, 4, 6, 8, 12, and 24 h following the surgical procedure. The timing of analgesic administration and any postoperative adverse effects of 0.5% bupivacaine were recorded.

Results: The VAS scores were significantly improved in the bupivacaine group at 1 h (95% confidence interval [CI] = 0.77-3.81, p = 0.004), 2 h (95% CI = 1.00-3.47, p = 0.001), 4 h (95% CI = 0.59-2.38, p = 0.002), and 6 h (95% CI = 0.22-2.28, p = 0.0019). Overall, the results showed a significant difference (95% CI = 0.51-1.74, p < 0.001).

Conclusions: Postoperative endoscopic SPG and anterior ethmoid nerve blocks with bupivacaine effectively reduce postoperative pain and minimize analgesic requirements after ESS.

Background: Chronic rhinosinusitis (CRS) is a heterogeneous inflammatory disorder frequently associated with impaired mucociliary clearance and bacterial infection. Individuals carrying a single cystic fibrosis transmembrane conductance regulator (CFTR) mutation exhibit partial CFTR dysfunction and are increasingly recognized as being at risk for CRS; however, the sinonasal phenotype and host-pathogen interactions in CF carriers remain poorly defined.

Methods: We characterized heterozygous ΔF508 CF rabbits (heterozygous, n = 6) compared with wild-type (WT) (n = 5). Baseline sinonasal structure was assessed by computed tomography and histology. CFTR function was measured by nasal potential difference (NPD) and Ussing chamber analysis of primary epithelial cultures, with or without CFTR modulators. Bacterial sinusitis was induced using Pseudomonas aeruginosa (PA14), followed by longitudinal imaging, bacterial quantification, histology, and PA14 RNA sequencing.

Results: Heterozygous rabbits demonstrated significant sinus hypoplasia compared with WT (mm³: heterozygous 77.9 vs. WT 108.1 mm³, p < 0.01) without spontaneous sinusitis. NPD revealed ∼50% reduction in chloride transport relative to WT (∆mV: heterozygous -15.5 vs. WT -35.8, p < 0.01). CFTR modulation partially restored chloride secretion in epithelial cells from heterozygous to ∼80% of WT (p < 0.0001). Following P. aeruginosa inoculation, heterozygous rabbits exhibited higher bacterial burden (p < 0.05), persistent radiographic opacification (week 4, p < 0.01), and delayed histologic recovery. PA14 RNAseq revealed a distinct transcriptional profile in the heterozygous sinonasal environment.

Conclusions: Heterozygous ΔF508 CF rabbits recapitulate key sinonasal features relevant to CF carriers, including reduced CFTR function, altered host defense, and impaired infection clearance. This model provides a translational platform for investigating CRS pathogenesis and evaluating CFTR-targeted therapies in CF carriers.

Background: Although shifts in nasal microbiota have been well-documented in inflammatory upper airway conditions, microbiota tumor-associated alterations remain uncharacterized. This study is the first to compare sinonasal microbiota profiles of patients with malignant tumors (MT), benign tumors (BT), and controls, offering insights into tumor-associated microbiomes.

Methods: This prospective, cross-sectional, observational study assessed intraoperative sinus swabs from 70 adult research participants (MT = 23, BT = 15, control = 32). Sinonasal microbial communities were characterized using 16S rRNA gene amplicon sequencing to determine if microbial community structures differed between groups.

Results: Tumor-associated sinonasal microbiota profiles showed clear dysbiosis, with reduced relative abundance of beneficial microbes and increased putative pathogenic taxa. Both MT and BT had significantly lower microbial diversity and distinct compositions compared to controls. MT samples had significantly higher relative abundance of Firmicutes and reduced relative abundance of Actinobacteria. These phylum-level alterations were accompanied by elevated proinflammatory microbial taxa, paired with reduced relative abundance of keystone, beneficial taxa consistent with healthy nasal microbiomes. Microbial communities in BT and MT samples were similar, but Alcaligenes was more abundant, and Corynebacterium was less abundant in MT than in BT.

Conclusion: This study observed that sinonasal microbial communities in MT exhibited marked dysbiosis with a reduction in the relative abundance of putative sinonasal commensal taxa compared to controls. These alterations were present to a lesser extent in BT. Future investigations should aim to determine whether these microbial shifts contribute to tumor development or represent secondary effects, with an aim to quantify their impact on outcomes and guide therapeutic strategies.