{"title":"Age-Group Subanalyses in TriNetX: A Critique and Re-Analysis","authors":"Ming-Chin Lan, Joshua Wang","doi":"10.1002/alr.70057","DOIUrl":"10.1002/alr.70057","url":null,"abstract":"","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":"15 11","pages":"1327-1328"},"PeriodicalIF":6.8,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dipesh Gyawali, Thomas Mundy, Majid Hosseini, Morteza Bodaghi, Akio Fujiwara, Sejal Shyam Bhatia, Kayla Baker, Elena Bartolone, Dhara Patel, Henry Chu, Raju Gottumukkala, Jonathan Bidwell, Edward D. McCoul
Background
Sinusitis is a prevalent disease for which nasal endoscopy (NE) is an optimal diagnostic modality. However, NE accuracy is limited by inter-operator variability in landmark identification and localization of mucus that is necessary for sinusitis diagnosis. We sought to develop a novel multi-class machine learning (ML) framework that detects anatomical landmarks and structures for sinusitis assessment as supported by clinical best practices.
Methods
A total of 3513 NE images from 452 patients were manually annotated by four physicians for three classes: middle turbinate (MT), inferior turbinate (IT), and mucus. A YOLOv11-nano model was trained for multi-class detection and segmentation. We developed a rule-based logic for middle meatus localization, implementing a clinical algorithm that applies anatomy Intersection over Union (IoU) and conditional logic for sinusitis diagnosis. The system was validated on 178 images from 50 patients with chronic rhinosinusitis without polyps (CRSsNP) with benchmarking of real-time performance.
Results
The multi-class detection and segmentation model achieved > 75% F1 score for detecting turbinates with mucus. The clinical algorithm achieved 75.0% sensitivity, 76.0% specificity, and 75.2% accuracy for sinusitis classification, with a F1 score of 81.8%, approaching the accuracy of a trained otolaryngologist. The framework achieved near real-time performance at > 20fps on GPU device, demonstrating suitability for integration into live clinical workflows.
Conclusion
This novel ML-driven diagnostic framework with a rule-based clinical algorithm enhances decision-making for diagnosing sinusitis with NE. By reducing inter-operator variability, achieving performance comparable to otolaryngologists, and enabling real-time processing for non-specialists, this work holds potential for standardizing care and improving patient outcomes. Future research will focus on expanding to different sinusitis phenotypes and prospective real-time implementation in clinical settings.
{"title":"Machine Learning-Enhanced Clinical Decision Support for Diagnosing Sinusitis With Nasal Endoscopy","authors":"Dipesh Gyawali, Thomas Mundy, Majid Hosseini, Morteza Bodaghi, Akio Fujiwara, Sejal Shyam Bhatia, Kayla Baker, Elena Bartolone, Dhara Patel, Henry Chu, Raju Gottumukkala, Jonathan Bidwell, Edward D. McCoul","doi":"10.1002/alr.70045","DOIUrl":"10.1002/alr.70045","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sinusitis is a prevalent disease for which nasal endoscopy (NE) is an optimal diagnostic modality. However, NE accuracy is limited by inter-operator variability in landmark identification and localization of mucus that is necessary for sinusitis diagnosis. We sought to develop a novel multi-class machine learning (ML) framework that detects anatomical landmarks and structures for sinusitis assessment as supported by clinical best practices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 3513 NE images from 452 patients were manually annotated by four physicians for three classes: middle turbinate (MT), inferior turbinate (IT), and mucus. A YOLOv11-nano model was trained for multi-class detection and segmentation. We developed a rule-based logic for middle meatus localization, implementing a clinical algorithm that applies anatomy Intersection over Union (IoU) and conditional logic for sinusitis diagnosis. The system was validated on 178 images from 50 patients with chronic rhinosinusitis without polyps (CRSsNP) with benchmarking of real-time performance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The multi-class detection and segmentation model achieved > 75% F1 score for detecting turbinates with mucus. The clinical algorithm achieved 75.0% sensitivity, 76.0% specificity, and 75.2% accuracy for sinusitis classification, with a F1 score of 81.8%, approaching the accuracy of a trained otolaryngologist. The framework achieved near real-time performance at > 20fps on GPU device, demonstrating suitability for integration into live clinical workflows.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This novel ML-driven diagnostic framework with a rule-based clinical algorithm enhances decision-making for diagnosing sinusitis with NE. By reducing inter-operator variability, achieving performance comparable to otolaryngologists, and enabling real-time processing for non-specialists, this work holds potential for standardizing care and improving patient outcomes. Future research will focus on expanding to different sinusitis phenotypes and prospective real-time implementation in clinical settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":"16 2","pages":"152-161"},"PeriodicalIF":6.8,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12863022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yeong-In Jo, Jee Won Moon, Joo-Hoo Park, Hwa Eun Yang, Subin Cho, Hyeongguk Son, Hyun-Woo Yang, Il-Ho Park
Background
Eosinophilic chronic rhinosinusitis with nasal polyps (eCRSwNP) is characterized by persistent sinonasal inflammation and marked eosinophilic infiltration. Although the relationship between eosinophils and NP formation has been extensively studied, the mechanisms governing eosinophil transepithelial migration into the nasal mucosa remain poorly understood. Cadherin-26 (CDH26), an epithelial adhesion molecule that binds to integrins α4 (ITGA4) and αE, has been implicated in eosinophilic inflammation and may play a critical role in eosinophil recruitment and tissue infiltration.
Objective
This study aimed to investigate the role and underlying mechanism of CDH26 in facilitating eosinophil transepithelial migration in patients with eCRSwNP.
Methods
Single-cell ribonucleic acid (RNA) sequencing and immunohistochemistry (IHC) were performed on nasal tissues from patients with eCRSwNP, non-eCRSwNP, chronic rhinosinusitis without nasal polyps (CRSsNP), and healthy controls to evaluate CDH26 expression. Human primary nasal epithelial cells (hPNECs) were stimulated in vitro with interleukin-4 (IL-4) or IL-13, and CDH26 expression was assessed via reverse transcription polymerase chain reaction (RT-PCR), western blotting, and IHC. The effect of IL-4 receptor blockade using Dupilumab was evaluated in monolayer cultures. ITGA4 expression in EoL-1 eosinophil-like cells was measured by flow cytometry, and their interaction with recombinant CDH26 was evaluated using cell adhesion and Transwell migration assays.
Results
CDH26 expression was significantly upregulated in eCRSwNP tissues compared to that in other groups. IL-4 and IL-13 stimulation induced CDH26 expression in hPNECs, which was dose-dependently inhibited by Dupilumab. EoL-1 cells expressed ITGA4 and adhered to recombinant CDH26 in vitro. Th2 cytokine stimulation enhanced EoL-1 cell transepithelial migration, which was significantly reduced by CDH26 knockdown or Dupilumab treatment.
Conclusion
Th2 cytokine-induced upregulation of epithelial CDH26 facilitates eosinophil transepithelial migration, potentially via ITGA4 interaction. Thus, CDH26 may represent a novel therapeutic target for managing eCRSwNP.
{"title":"Cadherin-26 Facilitates Transepithelial Migration of Eosinophils in Eosinophilic Chronic Rhinosinusitis","authors":"Yeong-In Jo, Jee Won Moon, Joo-Hoo Park, Hwa Eun Yang, Subin Cho, Hyeongguk Son, Hyun-Woo Yang, Il-Ho Park","doi":"10.1002/alr.70044","DOIUrl":"10.1002/alr.70044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Eosinophilic chronic rhinosinusitis with nasal polyps (eCRSwNP) is characterized by persistent sinonasal inflammation and marked eosinophilic infiltration. Although the relationship between eosinophils and NP formation has been extensively studied, the mechanisms governing eosinophil transepithelial migration into the nasal mucosa remain poorly understood. Cadherin-26 (CDH26), an epithelial adhesion molecule that binds to integrins α4 (ITGA4) and αE, has been implicated in eosinophilic inflammation and may play a critical role in eosinophil recruitment and tissue infiltration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to investigate the role and underlying mechanism of CDH26 in facilitating eosinophil transepithelial migration in patients with eCRSwNP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Single-cell ribonucleic acid (RNA) sequencing and immunohistochemistry (IHC) were performed on nasal tissues from patients with eCRSwNP, non-eCRSwNP, chronic rhinosinusitis without nasal polyps (CRSsNP), and healthy controls to evaluate CDH26 expression. Human primary nasal epithelial cells (hPNECs) were stimulated in vitro with interleukin-4 (IL-4) or IL-13, and CDH26 expression was assessed via reverse transcription polymerase chain reaction (RT-PCR), western blotting, and IHC. The effect of IL-4 receptor blockade using Dupilumab was evaluated in monolayer cultures. ITGA4 expression in EoL-1 eosinophil-like cells was measured by flow cytometry, and their interaction with recombinant CDH26 was evaluated using cell adhesion and Transwell migration assays.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>CDH26 expression was significantly upregulated in eCRSwNP tissues compared to that in other groups. IL-4 and IL-13 stimulation induced CDH26 expression in hPNECs, which was dose-dependently inhibited by Dupilumab. EoL-1 cells expressed ITGA4 and adhered to recombinant CDH26 in vitro. Th2 cytokine stimulation enhanced EoL-1 cell transepithelial migration, which was significantly reduced by CDH26 knockdown or Dupilumab treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Th2 cytokine-induced upregulation of epithelial CDH26 facilitates eosinophil transepithelial migration, potentially via ITGA4 interaction. Thus, CDH26 may represent a novel therapeutic target for managing eCRSwNP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":"16 2","pages":"138-151"},"PeriodicalIF":6.8,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12863020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145292063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alison J. Yu, Chau Phung, Krithika Kuppusamy, Alexa M. Finuoli, Maria C. Espinosa, Jennifer E. Douglas, Michael A. Kohanski, Nithin D. Adappa, Noam A. Cohen, John V. Bosso, James N. Palmer, Alan D. Workman
Background
More extensive endoscopic sinus surgery (ESS) has been shown to correlate with better disease control for chronic rhinosinusitis with nasal polyps (CRSwNP). The Completion of Surgery Index (CoSI) is a recently developed radiologic scoring system that assesses the extent of surgery, where CoSI <70 (previous incomplete surgery) correlated with greater sino-nasal outcome test (SNOT-22) improvement after revision surgery. However, the benefit of complete surgery on asthma outcomes has not been defined. Here, we evaluated the impact of CoSI on SNOT-22 and Asthma Control Test (ACT) improvements after surgery in CRSwNP with asthma.
Methods
CRSwNP patients with asthma who underwent ESS between January 2018 and December 2023 were identified. Subjects were placed into two groups based on the preoperative CT scans: CoSI <70 (previous incomplete surgery) and CoSI 70 or greater (previous complete surgery). SNOT-22 and ACT data were collected at baseline and over 2 years postoperatively.
Results
Seventy CRSwNP patients with comorbid asthma underwent revision surgery, of which 49 (70.0%) patients had a preoperative CoSI <70. The CoSI <70 group had a greater average SNOT-22 improvement than the CoSI 70 or greater group from baseline to 2 years postoperatively (30.8 ± 20.5 vs. 20.4 ± 14.9, p = 0.042). In uncontrolled asthma, the average ACT improvement was significantly greater for the CoSI <70 group than the CoSI 70 or greater group (3.9 ± 2.2 vs. 0.88 ± 1.4, p = 0.029).
Conclusion
Preoperative CoSI <70 was associated with significantly greater long-term improvements in SNOT-22 and ACT after revision surgery than CoSI 70 or greater group, supporting the need for complete surgery in CRSwNP with asthma.
{"title":"The Completeness of Surgery Index Predicts Success in CRSwNP With Asthma by SNOT-22 and Asthma Control Test","authors":"Alison J. Yu, Chau Phung, Krithika Kuppusamy, Alexa M. Finuoli, Maria C. Espinosa, Jennifer E. Douglas, Michael A. Kohanski, Nithin D. Adappa, Noam A. Cohen, John V. Bosso, James N. Palmer, Alan D. Workman","doi":"10.1002/alr.70043","DOIUrl":"10.1002/alr.70043","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>More extensive endoscopic sinus surgery (ESS) has been shown to correlate with better disease control for chronic rhinosinusitis with nasal polyps (CRSwNP). The Completion of Surgery Index (CoSI) is a recently developed radiologic scoring system that assesses the extent of surgery, where CoSI <70 (previous incomplete surgery) correlated with greater sino-nasal outcome test (SNOT-22) improvement after revision surgery. However, the benefit of complete surgery on asthma outcomes has not been defined. Here, we evaluated the impact of CoSI on SNOT-22 and Asthma Control Test (ACT) improvements after surgery in CRSwNP with asthma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>CRSwNP patients with asthma who underwent ESS between January 2018 and December 2023 were identified. Subjects were placed into two groups based on the preoperative CT scans: CoSI <70 (previous incomplete surgery) and CoSI 70 or greater (previous complete surgery). SNOT-22 and ACT data were collected at baseline and over 2 years postoperatively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventy CRSwNP patients with comorbid asthma underwent revision surgery, of which 49 (70.0%) patients had a preoperative CoSI <70. The CoSI <70 group had a greater average SNOT-22 improvement than the CoSI 70 or greater group from baseline to 2 years postoperatively (30.8 ± 20.5 vs. 20.4 ± 14.9, <i>p</i> = 0.042). In uncontrolled asthma, the average ACT improvement was significantly greater for the CoSI <70 group than the CoSI 70 or greater group (3.9 ± 2.2 vs. 0.88 ± 1.4, <i>p</i> = 0.029).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Preoperative CoSI <70 was associated with significantly greater long-term improvements in SNOT-22 and ACT after revision surgery than CoSI 70 or greater group, supporting the need for complete surgery in CRSwNP with asthma.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":"16 2","pages":"132-137"},"PeriodicalIF":6.8,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Felix E. Fernández-Penny, Katherine Mozingo, Abdullah Bhurgri, Hector A. Perez, Sarah Samorodnitsky, Ashton E. Lehmann, Ian M. Humphreys, Waleed M. Abuzeid, Aria Jafari
{"title":"Patient and Procedural Predictors of Early Recovery Quality After Endoscopic Endonasal Surgery","authors":"Felix E. Fernández-Penny, Katherine Mozingo, Abdullah Bhurgri, Hector A. Perez, Sarah Samorodnitsky, Ashton E. Lehmann, Ian M. Humphreys, Waleed M. Abuzeid, Aria Jafari","doi":"10.1002/alr.70037","DOIUrl":"10.1002/alr.70037","url":null,"abstract":"","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":"15 12","pages":"1412-1415"},"PeriodicalIF":6.8,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alessandro Vinciguerra, Francesca Caspani, Marco Valentini, Anna Maria Camarda, Salvatore Provenzano, Eric W. Wang, Cem Meço, Marco Ferrari, Pavol Surda, Semi Harrabi, Fernando Augusto Batista Campos, Javier Martin Broto, B. Ashleigh Guadagnolo, Pierina Navarria, Ali Hosni, Nadia Hindi, Antoine Italiano, Daniel M. Trifiletti, Bernd Kasper, Benjamin Verillaud, Alberto Schreiber, Paolo Castelnuovo, Piero Nicolai, Iacopo Dallan, Matias Chacon, Shirley Y. Su, Juliette Thariat, Claudia Valverde, Matt Lechner, Jean Yves Blay, Maria Rosaria Fiore, Jean Anderson Eloy, Mehdi Brahmi, James N. Palmer, Victor Castro Oliden, Daniela Greto, Iwona Lugowska, Angelo Paolo Dei Tos, Thibaut van Zele, Alkis J. Psaltis, Paolo Giovanni Casali, Armelle Dufresne, Claudia Sangalli, Christos Georgalas, Ester Orlandi, Peter-John Wormald, Philippe Herman, Ricardo Carrau, Ehab Y. Hanna, Lisa Licitra, Mario Turri-Zanoni, Paolo Battaglia
Introduction
Sinonasal sarcomas are exceedingly rare entities, constituting less than 7% of head and neck sarcomas. Their complex histology needs specialized treatment, which is often based on multimodal approaches including surgery, radiation therapy, and/or chemotherapy. This manuscript aims to gather expert opinions to establish common management principles for sinonasal sarcomas.
Methods
This international consensus followed a modified Delphi method in seven steps, including statements definition by the core group, expert panel recruitment, and a two-round survey. Sixty-two statements on sinonasal sarcoma management were developed. Experts from multiple continents participated, and results were anonymized and analyzed between March and May 2025.
Results
A total of 44 invited experts were recruited, 43.2% otorhinolaryngologists/head and neck surgeons, 31.8% medical oncologists, and 25% radiation oncologists. Participants varied in age and experience, representing Europe (70.5%), North America (18.2%), South America (6.8%), and Asia (4.5%). Among all histologies, biphenotypic sarcoma, chondrosarcoma, leiomyosarcoma, and myofibrosarcoma are principally treated with an upfront surgical management, differently from Ewing sarcoma and rhabdomyosarcoma in which chemotherapy, eventually associated with radiotherapy, is often chosen. In the remaining histologies (angiosarcoma, liposarcoma, malignant peripheral nerve sheath tumor [MPNST], osteosarcoma, and synovial sarcoma), a precise multimodal treatment is less standardized and needs to be discussed on a case-by-case basis.
Conclusion
Sinonasal sarcomas require a histology-driven approach to determine upfront treatment, whether surgical, medical, or multimodal. Despite this structured strategy, prognosis remains highly variable across subtypes. Multidisciplinary evaluation and individualized management in referral centers are crucial to address the biological diversity and anatomical complexity of these rare malignancies.
{"title":"Sinonasal Sarcomas Management: An International Consensus Statement","authors":"Alessandro Vinciguerra, Francesca Caspani, Marco Valentini, Anna Maria Camarda, Salvatore Provenzano, Eric W. Wang, Cem Meço, Marco Ferrari, Pavol Surda, Semi Harrabi, Fernando Augusto Batista Campos, Javier Martin Broto, B. Ashleigh Guadagnolo, Pierina Navarria, Ali Hosni, Nadia Hindi, Antoine Italiano, Daniel M. Trifiletti, Bernd Kasper, Benjamin Verillaud, Alberto Schreiber, Paolo Castelnuovo, Piero Nicolai, Iacopo Dallan, Matias Chacon, Shirley Y. Su, Juliette Thariat, Claudia Valverde, Matt Lechner, Jean Yves Blay, Maria Rosaria Fiore, Jean Anderson Eloy, Mehdi Brahmi, James N. Palmer, Victor Castro Oliden, Daniela Greto, Iwona Lugowska, Angelo Paolo Dei Tos, Thibaut van Zele, Alkis J. Psaltis, Paolo Giovanni Casali, Armelle Dufresne, Claudia Sangalli, Christos Georgalas, Ester Orlandi, Peter-John Wormald, Philippe Herman, Ricardo Carrau, Ehab Y. Hanna, Lisa Licitra, Mario Turri-Zanoni, Paolo Battaglia","doi":"10.1002/alr.70038","DOIUrl":"10.1002/alr.70038","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Sinonasal sarcomas are exceedingly rare entities, constituting less than 7% of head and neck sarcomas. Their complex histology needs specialized treatment, which is often based on multimodal approaches including surgery, radiation therapy, and/or chemotherapy. This manuscript aims to gather expert opinions to establish common management principles for sinonasal sarcomas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This international consensus followed a modified Delphi method in seven steps, including statements definition by the core group, expert panel recruitment, and a two-round survey. Sixty-two statements on sinonasal sarcoma management were developed. Experts from multiple continents participated, and results were anonymized and analyzed between March and May 2025.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 44 invited experts were recruited, 43.2% otorhinolaryngologists/head and neck surgeons, 31.8% medical oncologists, and 25% radiation oncologists. Participants varied in age and experience, representing Europe (70.5%), North America (18.2%), South America (6.8%), and Asia (4.5%). Among all histologies, biphenotypic sarcoma, chondrosarcoma, leiomyosarcoma, and myofibrosarcoma are principally treated with an upfront surgical management, differently from Ewing sarcoma and rhabdomyosarcoma in which chemotherapy, eventually associated with radiotherapy, is often chosen. In the remaining histologies (angiosarcoma, liposarcoma, malignant peripheral nerve sheath tumor [MPNST], osteosarcoma, and synovial sarcoma), a precise multimodal treatment is less standardized and needs to be discussed on a case-by-case basis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Sinonasal sarcomas require a histology-driven approach to determine upfront treatment, whether surgical, medical, or multimodal. Despite this structured strategy, prognosis remains highly variable across subtypes. Multidisciplinary evaluation and individualized management in referral centers are crucial to address the biological diversity and anatomical complexity of these rare malignancies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":"16 1","pages":"55-69"},"PeriodicalIF":6.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12761347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xiaohan Sun MMed, Mahnaz Ramezanpour, Jordan Hall, Emma Barry, Alkis J. Psaltis, Peter-John Wormald, Sarah Vreugde
Background
Chronic rhinosinusitis (CRS) is a chronic inflammatory disease that is associated with polymicrobial infections, often involving S. aureus and P. aeruginosa. It is unclear whether the polymicrobial context plays a role in exacerbating epithelial damage, inflammation, and resistance to therapy.
Methods
S. aureus and P. aeruginosa (n = 3 each) biofilms were established in a Transwell system, followed by the extraction of P. aeruginosa conditioned media and application to an air–liquid interface (ALI) model of human nasal epithelial cells (HNECs). Transepithelial electrical resistance (TEER) and FITC dextran paracellular permeability tests evaluated the epithelial integrity. Colony-forming unit (CFU) counting, protease activity assay, and pyocyanin and pyoverdine quantification were used to test the proliferation and production of virulence factors of the bacteria.
Results
Cocultures of P. aeruginosa and S. aureus isolated from the same patient reduced HNEC TEER values, had an earlier onset of HNEC barrier disruption, and increased paracellular permeability compared to monocultures of P. aeruginosa. P. aeruginosa proliferation was enhanced, and protease activity increased significantly. The production of pyoverdine increased significantly in the same patient cocultures, while the pyocyanin levels remained unchanged.
Conclusions
These results indicate a role of within-host evolution in shaping P. aeruginosa-mediated virulence in the context of polymicrobial biofilms. This supports the need to develop strategies directed at disrupting interspecies synergies that culminate in the formation of polymicrobial biofilms associated with CRS for the purpose of improving disease management and therapeutic efficacy.
{"title":"Patient-Specific Coculture of S. aureus and P. aeruginosa Enhances Epithelial Barrier Disruption and Virulence in CRS","authors":"Xiaohan Sun MMed, Mahnaz Ramezanpour, Jordan Hall, Emma Barry, Alkis J. Psaltis, Peter-John Wormald, Sarah Vreugde","doi":"10.1002/alr.70036","DOIUrl":"10.1002/alr.70036","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chronic rhinosinusitis (CRS) is a chronic inflammatory disease that is associated with polymicrobial infections, often involving <i>S. aureus</i> and <i>P. aeruginosa</i>. It is unclear whether the polymicrobial context plays a role in exacerbating epithelial damage, inflammation, and resistance to therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p><i>S. aureus</i> and <i>P. aeruginosa</i> (<i>n</i> = 3 each) biofilms were established in a Transwell system, followed by the extraction of <i>P. aeruginosa</i> conditioned media and application to an air–liquid interface (ALI) model of human nasal epithelial cells (HNECs). Transepithelial electrical resistance (TEER) and FITC dextran paracellular permeability tests evaluated the epithelial integrity. Colony-forming unit (CFU) counting, protease activity assay, and pyocyanin and pyoverdine quantification were used to test the proliferation and production of virulence factors of the bacteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Cocultures of <i>P. aeruginosa</i> and <i>S. aureus</i> isolated from the same patient reduced HNEC TEER values, had an earlier onset of HNEC barrier disruption, and increased paracellular permeability compared to monocultures of <i>P. aeruginosa</i>. <i>P. aeruginosa</i> proliferation was enhanced, and protease activity increased significantly. The production of pyoverdine increased significantly in the same patient cocultures, while the pyocyanin levels remained unchanged.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These results indicate a role of within-host evolution in shaping <i>P. aeruginosa</i>-mediated virulence in the context of polymicrobial biofilms. This supports the need to develop strategies directed at disrupting interspecies synergies that culminate in the formation of polymicrobial biofilms associated with CRS for the purpose of improving disease management and therapeutic efficacy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":"16 1","pages":"43-54"},"PeriodicalIF":6.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12761362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Farhoud Faraji, Michael G. Brandel, David R. Santiago-Dieppa, Thomas L. Beaumont, Adam S. DeConde
{"title":"Projectile Embedded in the Tuberculum Sellae","authors":"Farhoud Faraji, Michael G. Brandel, David R. Santiago-Dieppa, Thomas L. Beaumont, Adam S. DeConde","doi":"10.1002/alr.70042","DOIUrl":"10.1002/alr.70042","url":null,"abstract":"","PeriodicalId":13716,"journal":{"name":"International Forum of Allergy & Rhinology","volume":"15 11","pages":"1316-1318"},"PeriodicalIF":6.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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