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Evaluation of mucosal barrier disruption due to Staphylococcus lugdunensis and Staphylococcus epidermidis exoproteins in patients with chronic rhinosinusitis 评估慢性鼻窦炎患者因卢格登金黄色葡萄球菌和表皮葡萄球菌外蛋白而导致的粘膜屏障破坏。
IF 7.2 2区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-11-08 DOI: 10.1002/alr.23481
Mahnaz Ramezanpour PhD, Sholeh Feizi PhD, Hashan Dilendra Paththini Arachchige MSc, George Bouras LLB, Clare Cooksley PhD, Gohar Shaghayegh PhD, Peter-John Wormald MD, PhD, Alkis James Psaltis MD, PhD, Sarah Vreugde MD, PhD

Background

Chronic rhinosinusitis (CRS) is a persistent inflammatory condition of the sinus mucosa. While Staphylococcus aureus has been shown to play a significant role in mucosal barrier disruption in CRS patients, coagulase-negative staphylococci (CoNS) such as Staphylococcus epidermidis and Staphylococcus lugdunensis are also implicated in CRS pathophysiology. This study investigates the effects of exoproteins secreted by planktonic and biofilm forms of clinical isolates of S. epidermidis and S. lugdunensis on the nasal epithelial barrier.

Methods

Thirty-one clinical isolates of CoNS were grown in planktonic and biofilm forms, and their exoproteins were concentrated. The epithelial barrier structure was assessed by measuring transepithelial electrical resistance (TEER) and the permeability of fluorescein isothiocyanate-dextran. Toxicity and inflammatory response were also studied.

Results

Our findings demonstrate that exoproteins from all planktonic forms of S. lugdunensis disrupted the mucosal barrier, whereas only nine of 16 biofilm-derived exoproteins had similar effects. Conversely, 11 of 15 exoproteins from planktonic S. epidermidis significantly disrupted barrier integrity; however, biofilm exoproteins did not. The study also showed that some exoproteins from planktonic S. epidermidis significantly reduced cell viability, while exoproteins from planktonic and biofilm forms of S. lugdunensis and biofilm S. epidermidis did not induce any statistically significant change in cell viability. Notably, four of 16 biofilm exoproteins from S. lugdunensis induced higher interleukin-6 (IL-6) secretion, whereas none of the S. epidermidis isolates showed a significant increase in IL-6 secretion.

Conclusion

Our results suggest that CoNS exoproteins may contribute to CRS etiopathogenesis.

背景:慢性鼻窦炎(CRS)是鼻窦粘膜的一种持续性炎症。虽然金黄色葡萄球菌已被证明在 CRS 患者的粘膜屏障破坏中起着重要作用,但凝固酶阴性葡萄球菌(CoNS),如表皮葡萄球菌和卢格杜恩葡萄球菌也与 CRS 的病理生理学有关。本研究调查了表皮葡萄球菌和卢格杜恩葡萄球菌临床分离株的浮游和生物膜形态分泌的外蛋白质对鼻腔上皮屏障的影响:方法:以浮游生物和生物膜形式培养 31 株临床分离的 CoNS,并浓缩其外源性蛋白。通过测量经上皮电阻(TEER)和异硫氰酸荧光素-葡聚糖的渗透性来评估上皮屏障结构。此外还研究了毒性和炎症反应:结果:我们的研究结果表明,来自所有浮游形态 S. lugdunensis 的外切蛋白都会破坏粘膜屏障,而 16 种生物膜衍生的外切蛋白中只有 9 种具有类似作用。相反,来自浮游表皮葡萄球菌的 15 种外源蛋白中有 11 种会明显破坏屏障的完整性,而生物膜外源蛋白则不会。研究还表明,浮游表皮葡萄球菌的一些外显蛋白会显著降低细胞活力,而浮游和生物膜形式的卢格杜氏菌以及生物膜表皮葡萄球菌的外显蛋白不会引起细胞活力发生任何统计学意义上的显著变化。值得注意的是,在来自 S. lugdunensis 的 16 种生物膜外蛋白中,有 4 种能诱导白细胞介素-6(IL-6)分泌增加,而 S. epidermidis 分离物的 IL-6 分泌均无明显增加:结论:我们的研究结果表明,CoNS外源蛋白可能是CRS的发病机制之一。
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引用次数: 0
Guidance for the evaluation by payors of claims submitted using Current Procedural Terminology codes 95165, 95115, and 95117 付款人对使用当前程序术语代码 95165、95115 和 95117 提交的报销申请进行评估的指南。
IF 7.2 2区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-11-06 DOI: 10.1002/alr.23480
J. Allen Meadows MD, Gary N. Gross MD, Anita N. Wasan MD, Dole P. Baker MD, Amber Patterson MD, Robert Puchalski MD, Anil Nanda MD, Jami Lucas BS, J. Wesley Sublett MD, MPH, Paul V. Williams MD

This Guidance was jointly developed equally by the American Academy of Allergy Asthma and Immunology (AAAAI), the American Academy of Otolaryngic Allergy (AAOA), and the American College of Allergy, Asthma and Immunology (ACAAI) to advise insurance companies and other payors of the documentation that they should, and should not, require in their review of claims for payment for services covered by Current Procedural Terminology (CPT) codes 95165, 95115, and 95117. The goal of the Guidance is to assist payors to develop a process for reviewing claims submitted under these 3 codes in a manner that is efficient, fair, and not unduly burdensome. This document supersedes any document or manual published previously by the above organizations.

The Guidance is divided into 2 parts. The first part explains each of the 3 codes, the services that are covered by these codes, and the medical necessity of those services. The second part describes what the 3 organizations believe are reasonable requests for documentation and what we submit are unreasonable requests. It first addresses code 95165 and then codes 95115 and 95117.

The AAAAI, AAOA, and ACAAI recognize that it is reasonable for insurance companies and other payors to request documentation to show that a claim submitted under CPT code 95165, 95115, or 95117 is for a medically necessary service that has been performed and has been properly coded. Accordingly, in this Guidance, we have presented the documentation that in our judgment is reasonable for payors to request. This documentation is itself quite substantial.

At the same time, we respectfully submit that demands for several kinds of additional documentation that have been made by some insurers are unnecessary. These demands serve only to make the claims process less efficient and to impose an undue burden on the entity submitting the claim—at least when the payor has no sound reason to believe that a particular claimant has acted improperly. Whenever we have characterized a particular category of requested documentation as excessive, we have sought to explain the reasons for our position.

All 3 organizations would be pleased to meet with any payor that would like to discuss this Guidance. As noted at the outset, our goal is to work with payors to assist them in developing a process for review of claims under codes 95165, 95115, and 95117 that is efficient, fair, and not unduly burdensome.

The authors declare no conflicts of interest.

The authors have no funding sources to report.

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引用次数: 0
Surgery versus biologics for nasal polyposis: Perspective on contemporary data 鼻息肉病的手术治疗与生物制剂治疗:当代数据透视。
IF 7.2 2区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-11-05 DOI: 10.1002/alr.23486
Michael J. Ye MD, Rodney J. Schlosser MD, Zachary M. Soler MD, MS, Jonathan B. Overdevest MD, PhD, David A. Gudis MD
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引用次数: 0
Making “scents” of nutrients: Investigating the relationship between olfactory dysfunction and vitamin intake 制作营养素的 "气味":调查嗅觉功能障碍与维生素摄入量之间的关系。
IF 7.2 2区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-11-05 DOI: 10.1002/alr.23488
Sophie E. Yu BA, Youn Soo Jung PhD, Margaret B. Mitchell MD, MS-HPEd, Simon Chiang BS, Mitali Banerjee BS, Mengyuan Ruan MS, Tanujit Dey PhD, Sarah E. Fleet MD, Stella E. Lee MD

Key points

  • Decreased overall dietary consumption of micronutrients may be linked to an increased risk of olfactory dysfunction (OD) including subjective report of OD, subjective report of phantosmia, and objective OD.
  • Interactions were identified between these micronutrients, suggesting that outcomes may vary depending on the mixture of micronutrients taken.
要点:膳食中微量营养素总体摄入量的减少可能与嗅觉功能障碍(OD)风险的增加有关,包括主观报告的嗅觉功能障碍、主观报告的幻嗅和客观报告的嗅觉功能障碍。研究发现,这些微量营养素之间存在相互作用,这表明结果可能因所摄入的微量营养素混合物而异。
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引用次数: 0
Ambient particulate matter and frequency of outpatient visits for chronic rhinosinusitis in the United States 美国环境颗粒物与慢性鼻炎门诊就诊频率。
IF 7.2 2区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-10-30 DOI: 10.1002/alr.23477
Hong-Ho Yang BS, David Grimm MD, Esther Velasquez PhD, Peter H. Hwang MD

Background

Emerging evidence has underscored the harmful effects of air pollution on the upper airway. We investigated the relationship between ambient particulate matter (PM) level and the frequency of outpatient visits for chronic rhinosinusitis (CRS).

Methods

We conducted an ecological cohort study of US adults enrolled in The Merative MarketScan outpatient database from 2007 to 2020. For each geographical subunit (core-based statistical area [CBSA]), we calculated the annual rate of CRS-related outpatient visits per 1000 well-patient checkup visits (CRS-OV). Using data from the Environmental Protection Agency's Air Quality System, we mapped the rolling statistical average of daily PM2.5 and PM10 over the preceding year onto each CBSA × year combination. We employed multivariable negative binomial regression modeling to estimate the association between PM levels and subsequent CRS-OV.

Results

Across 3933 observations (CBSA × year combinations), encompassing ∼4 billion visits, the median CRS-OV was 164 (interquartile range 110–267). The mean PM2.5 level was 8.9 µg/m3 (SD 2.6) and the mean PM10 level was 20.2 µg/m3 (SD 7.2). Adjusting for patient demographics and respiratory comorbidities, a compounded rise in subsequent CRS-OV was observed with increasing PM levels. Each µg/m3 rise in PM2.5 independently predicted a 10% increase in CRS-OV (adjusted incidence rate ratio [aIRR]) 1.10, 95% confidence interval [CI] 1.08–1.13) and each µg/m3 rise in PM10 independently predicted a 3% increase in CRS-OV (aIRR 1.03, 95% CI 1.02–1.04).

Conclusion

Elevated ambient PM2.5 and PM10 levels are associated with a subsequent compounded increase in the frequency of CRS-OV, with PM2.5 predicting a more pronounced rise compared to PM10.

背景:新的证据强调了空气污染对上呼吸道的有害影响。我们研究了环境颗粒物(PM)水平与慢性鼻炎(CRS)门诊就诊频率之间的关系:我们对 2007 年至 2020 年期间加入 Merative MarketScan 门诊数据库的美国成年人进行了一项生态队列研究。对于每个地理分区(核心统计区 [CBSA]),我们计算了每 1000 名健康体检者中 CRS 相关门诊的年就诊率(CRS-OV)。利用环境保护署空气质量系统的数据,我们将前一年的每日 PM2.5 和 PM10 的滚动统计平均值映射到每个 CBSA × 年份组合上。我们采用多变量负二项回归模型来估计 PM 水平与随后的 CRS-OV 之间的关联:结果:在3933个观测值(CBSA × 年份组合)中,包含了40亿人次,CRS-OV的中位数为164(四分位距为110-267)。PM2.5的平均水平为8.9微克/立方米(标准差为2.6),PM10的平均水平为20.2微克/立方米(标准差为7.2)。根据患者的人口统计学特征和呼吸系统合并症进行调整后发现,随着 PM 水平的升高,随后的 CRS-OV 呈复合上升趋势。PM2.5每升高1微克/立方米,可独立预测CRS-OV增加10%(调整后发病率比[aIRR]为1.10,95%置信区间[CI]为1.08-1.13),PM10每升高1微克/立方米,可独立预测CRS-OV增加3%(aIRR为1.03,95%置信区间[CI]为1.02-1.04):结论:环境中 PM2.5 和 PM10 水平的升高与随后 CRS-OV 发生频率的复合增加有关,与 PM10 相比,PM2.5 预测的上升更为明显。
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引用次数: 0
Viral infection as an inciting event for development of chronic rhinosinusitis: A population-based study 病毒感染是慢性鼻炎发病的诱因:一项基于人群的研究。
IF 7.2 2区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-10-30 DOI: 10.1002/alr.23482
Najm S. Khan MBS, Heli Majeethia BS, Vincent Provasek PhD, Faizaan Khan BS, Zain Mehdi BA, Aatin K. Dhanda MD, Jeffrey T. Vrabec MD, Edward D. McCoul MD, MPH, FACS, FARS, Chadi A. Makary MD, FACS, Masayoshi Takashima MD, FACS, FARS, FAAOA, Omar G. Ahmed MD, FARS

Key points

  • Viral infections lead to a greater than twofold increased risk of developing chronic rhinosinusitis within 1 year.
  • Viral infections lead to a greater than twofold increased risk of developing chronic rhinosinusitis within 1 year.
  • Recurrent viral infections pose a greater risk of chronic rhinosinusitis than single episodes.
要点:病毒感染导致一年内患慢性鼻窦炎的风险增加两倍多。病毒感染导致 1 年内罹患慢性鼻炎的风险增加 2 倍以上。反复病毒感染比单次病毒感染引发慢性鼻炎的风险更大。
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引用次数: 0
Letter to the editor regarding “Role of social determinants of health on quality of life in pediatric chronic rhinosinusitis”: Enhancing patient-centered care in underdeveloped regions 就 "健康的社会决定因素对小儿慢性鼻炎患者生活质量的影响 "致编辑的信:在欠发达地区加强以患者为中心的护理。
IF 7.2 2区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-10-27 DOI: 10.1002/alr.23479
Huimin Du MMed, Tong Wu MMed
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引用次数: 0
Development and validation of the four-item Concise Aging adults Smell Test to screen for olfactory dysfunction in older adults 开发并验证用于筛查老年人嗅觉功能障碍的四项简明老年人嗅觉测试。
IF 7.2 2区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-10-27 DOI: 10.1002/alr.23476
Zachary M. Soler MD, MSc, Mathew J. Gregoski PhD, Preeti Kohli MD, Kristina A. LaPointe MSPH, Rodney J. Schlosser MD

Background

Olfactory dysfunction (OD) in the elderly is common and associated with numerous comorbidities, yet often underrecognized. This study sought to develop an instrument for widespread screening of this condition.

Methods

Demographic factors, comorbidities, and olfactory-related questions were examined in a focus group (N = 20) and development cohort (N = 190). The 4-item Concise Aging adults Smell Test (4-CAST) screening instrument was then developed to predict OD on Sniffin Sticks testing. An independent validation cohort (N = 147) was then examined to confirm ability of the 4-CAST to predict OD on Smell Identification Test 40 (SIT40).

Results

The most important variables for predicting olfactory loss in older subjects were age, type II diabetes status, Visual Analog Scale (VAS) of overall rating of smell, and VAS of impact of smell upon safety. In the development cohort, the 4-CAST model yielded predictive probability (area under the curve) of 0.805 (p < 0.001) for predicting the bottom 25th percentile on Sniffin Sticks. Results were similar in the validation cohort, as the 4-CAST accurately classified 83.8% subjects (area under the curve [AUC] 0.789, p < 0.001) in the bottom 25th percentile of SIT40 testing. The 4-CAST was able to accurately classify 89.4% of subjects with anosmia.

Conclusion

The 4-CAST is a quick screening instrument for predicting OD in older adults and has similar performance characteristics in independent populations using the two most common validated olfactory tests. Given the high prevalence of unrecognized olfactory loss in this population, this can be a useful tool for practitioners to determine which subjects may benefit from more extensive olfactory testing.

背景:老年人的嗅觉功能障碍(OD)很常见,与多种并发症相关,但往往未被充分认识。本研究旨在为广泛筛查这种疾病开发一种工具:方法:通过焦点小组(20 人)和发展队列(190 人)研究了人口统计学因素、合并症和嗅觉相关问题。然后开发了 4 项简明老龄成人嗅觉测试(4-CAST)筛查工具,用于预测嗅棒测试中的 OD。然后对一个独立的验证组群(N = 147)进行检查,以确认 4-CAST 预测嗅觉识别测试 40 (SIT40) OD 的能力:结果:预测老年受试者嗅觉丧失的最重要变量是年龄、II型糖尿病状态、嗅觉总体评分视觉模拟量表(VAS)和嗅觉对安全影响的视觉模拟量表。在开发队列中,4-CAST 模型的预测概率(曲线下面积)为 0.805(p 结论:4-CAST 是一种快速筛查嗅觉损失的方法:4-CAST 是预测老年人 OD 的快速筛查工具,在使用两种最常见的有效嗅觉测试的独立人群中具有相似的性能特征。鉴于老年人群中未被发现的嗅觉缺失发生率较高,该工具可作为从业人员的有用工具,用于确定哪些受试者可能受益于更广泛的嗅觉测试。
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引用次数: 0
A cradle-to-grave life cycle assessment of the endoscopic sinus surgery considering materials, energy, and waste 对内窥镜鼻窦手术进行从摇篮到坟墓的生命周期评估,考虑材料、能源和废物。
IF 7.2 2区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-10-27 DOI: 10.1002/alr.23474
Zeinab Mousania MS, Darpan Kayastha MD, Ryan A. Rimmer MD, John D. Atkinson PhD

Background

Operating rooms generate 1.8 million tons of waste annually, or 20%‒30% of the total healthcare waste in the United States. Our objective was to perform a life cycle assessment (LCA) for endoscopic sinus surgeries (ESSs) in order to analyze its environmental impact.

Methods

A comprehensive LCA of ESS was performed considering energy, climate, and water use impacts associated with the materials and processes used. It focuses on the ESS performed at a large tertiary academic hospital and then extends the impacts to consider annual US surgeries. The assessment considers end-of-life waste management at both landfills and incinerators.

Results

Single-use instrument production constitutes 89%‒96% of the total impacts throughout the life cycle of an ESS. Waste-to-energy incineration is shown to be a preferred end-of-life destination, as it recovers much of the input production energy of plastic items, ultimately reducing the input to 36%, although this is done at the expense of higher greenhouse gas emissions. For multi-use items, decontamination dominates environmental impact (>99% of totals), but consideration of reusable items reduces overall energy consumption and global warming potential (GWP) by 25%‒33%.

Conclusion

Single-use items dominate the total environmental impact of ESS. While multi-use items require additional decontamination over their lifetimes, results show that their incorporation reduces energy consumption and GWP by 25%‒33%, demonstrating the clear environmental benefit.

背景:手术室每年产生 180 万吨废物,占美国医疗废物总量的 20%-30%。我们的目标是对内窥镜鼻窦手术(ESS)进行生命周期评估(LCA),以分析其对环境的影响:对 ESS 进行了全面的生命周期评估,考虑了与所用材料和工艺相关的能源、气候和用水影响。评估重点是在一家大型三级学术医院进行的 ESS,然后将影响范围扩大到美国的年度手术。评估考虑了垃圾填埋场和焚化炉的报废废物管理:结果:一次性使用器械的生产占ESS整个生命周期总影响的89%-96%。结果表明,废物变能源焚烧是寿命终结时的首选处理方式,因为它可以回收塑料制品生产过程中的大部分输入能源,最终将输入能源减少到 36%,但这是以更高的温室气体排放为代价的。对于多用途物品,去污在环境影响中占主导地位(超过总量的 99%),但考虑到可重复使用的物品,总体能耗和全球升温潜能值(GWP)降低了 25%-33%:结论:一次性物品在 ESS 对环境的总影响中占主导地位。结论:一次性物品对环境的总影响占主导地位。虽然多用途物品在其生命周期内需要额外的净化,但结果表明,将其纳入其中可将能耗和全球升温潜能值降低 25%-33%,从而显示出明显的环境效益。
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引用次数: 0
Reply to the letter to the editor regarding “Role of Social Determinants of Health on Quality of Life in Pediatric Chronic Rhinosinusitis”: Enhancing patient-centered care in underdeveloped regions 回复有关 "健康的社会决定因素对小儿慢性鼻炎患者生活质量的影响 "的致编辑信:在欠发达地区加强以患者为中心的护理。
IF 7.2 2区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2024-10-27 DOI: 10.1002/alr.23478
Ryan S. Ziltzer MD, MPH, Sameer Shetty BS, Dominic Coutinho BS, Rafka Chaiban MD, MHCM, Chadi A. Makary MD
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引用次数: 0
期刊
International Forum of Allergy & Rhinology
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