Rhinology最新文献

Background: Nasopharyngeal necrosis is a common sequela after treatment for nasopharyngeal carcinoma (NPC). This study aims to compare the effectiveness of the main interventions, endoscopic surgery and conservative therapy, on nasopharyngeal necrosis and identify potential beneficiaries.

Methodology: This retrospective study was conducted on patients with nasopharyngeal necrosis from September 2008 to December 2020 at the Cancer Hospital of Sun Yat-sen University. The overall survival (OS) of patients with nasopharyngeal necrosis and their mucosal healing status were assessed. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to balance confounding factors between the two groups.

Results: A total of 517 patients (124 females; 393 males) with nasopharyngeal necrosis were included in this analysis, among whom 287 received conservative therapy and 230 underwent endoscopic surgical treatment. In the unmatched cohort, the endoscopic surgery group had a higher 3-year OS rate than the conservative therapy group. Patients who underwent surgery had higher cure rates than did those who received conservative therapy. PSM and IPTW analyses yielded similar results. Multivariate analyses of the unmatched, PSM, and IPTW cohorts revealed that nasal endoscopic surgery was an independent protective factor for the OS of patients with nasopharyngeal necrosis.

Conclusions: In this retrospective research, endoscopic surgery demonstrated better efficacy than conservative therapy for nasopharyngeal carcinoma patients with nasopharyngeal necrosis, while conservative therapy may be preferred for patients with superficial mucosal necrosis.

This issue of our journal starts with an extremely interesting systematic review on the impact of CRS on cognition measured with objective global cognitive function tests like the Montreal Cognitive Assessment (MoCA) or Mini-Mental State Examination (MMSE).

We read with great interest the article by Hirayama et al. (1) and commend the authors on their comprehensive work, which presents an extensive dataset accompanied by robust statistical analyses and a detailed systematic review. This study is undoubtedly a significant contribution to the literature on frontal sinus surgery.

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is more common in children with limited CRSwNP (L-CRSwNP). L-CRSwNP shares similar clinical phenotypes with recurrent CRSwNP (R-CRSwNP). This study aimed to explore the molecular mechanisms of L- and R-CRSwNP in children.

Methodology: Compared clinical characteristics and RNA sequencing data of 20 L-CRSwNP and 5 R-CRSwNP in children. Paired analyzed RNA sequencing data of 6 children with L-CRSwNP polyps and mucosal tissue samples. Conducted GO and KEGG enrichment analyses. Identified hub genes through protein-protein interaction networks (PPI). Validated hub genes in L- and R-CRSwNP using real-time quantitative PCR (RT-qPCR), immunohistochemistry (IHC), and multiplex immunohistochemistry (mIHC).

Results: RNA-seq analysis of L- and R-CRSwNP polyp showed no differentially expressed genes (DEGs). RNA-seq paired analysis of L-CRSwNP identified 1419 DEGs. GO enrichment analysis showed significant enrichment for biological processes associated with neutrophils. ITGAM and FCGR3B were identified as hub genes by PPI analysis. RT-qPCR and IHC results suggested the expression levels of ITGAM and FCGR3B were significantly increased in L- and R-CRSwNP. mIHC results suggested ITGAM and FCGR3B were closely associated with neutrophils and M2 macrophages in L- and R-CRSwNP.

Conclusions: L- and R-CRSwNP in children exhibit similar clinical phenotypes and molecular mechanisms. ITGAM and FCGR3B are hub genes contributing to disease through neutrophil- and M2 macrophage-mediated phagosome pathway.

Background: Nasopharyngeal carcinoma (NPC) is notable not only for its distinct geographic and ethnic distribution but also for its metabolic alterations. A key feature of NPC is its reliance on aerobic glycolysis for energy production. This shift from oxidative phosphorylation to glycolysis provides cancer cells with a metabolic advantage, supporting rapid growth and survival. Targeting aerobic glycolysis has therefore emerged as a promising therapeutic strategy.

Methods: RT-qPCR, Western blot, IHC, and IF staining were used to examine gene and protein expression levels. Cell viability, proliferation, migration, and invasion were measured using the CCK-8 assay, colony formation assay, and transwell assay, respectively. Interactions among NPM1, PKM2, NSUN2, and YBX1 were examined using RIP, Co-IP, MeRIP, RNA pulldown, and dual-luciferase reporter assays. Aerobic glycolysis and oxidative phosphorylation (OXPHOS) levels were analyzed using the XF96 metabolic analyzer. Additionally, an in vivo mouse model of NPC was established for further validation.

Results: NPM1 was abnormally elevated in NPC tissues and cells. Silencing of NPM1 inhibited aerobic glycolysis, suppressed NPC progression and metastasis, and reduced PKM2 nuclear translocation. Mechanistically, NPM1 physically interacted with PKM2 to promote its nuclear localization, while the NSUN2/YBX1 axis upregulated NPM1 expression through m5C modification, stabilizing NPM1 mRNA.

Conclusion: The NSUN2-YBX1 axis induces m5C modification of NPM1, leading to increased NPM1 stability and its expression. This upregulation facilitates the nuclear translocation of PKM2, which promotes aerobic glycolysis and drives the proliferation and metastasis of NPC. These findings highlight the potential of targeting NPM1 as a novel therapeutic approach for NPC.

Biologics like dupilumab have revolutionized the management of patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma. However, topical corticosteroids, such as intranasal (INCS) and inhaled (ICS) corticosteroids still play a fundamental role in the management of these conditions. To this day, limited data is available on topical corticosteroids medication adherence combined with dupilumab in achieving CRSwNP and asthma symptom control. Considering the generally poor medication-adherence among chronic patients and the remarkable efficacy of dupilumab, we suspected low adherence to INCS and ICS.

I would like to welcome you to the August issue of Rhinology. In the latest issue of Rhinology, you will find high quality articles spanning the entire breadth of the field of rhinology. From studies on inflammatory sinus disease to skull base pathology, from medical to surgical treatments, every reader is sure to find studies of interest and applicability to their practice. For the focus of this editorial, I highlight for the reader the article by Le Bon et al., which describes the case of a patient with cystic fibrosis (CF) and chronic rhinosinusitis (CRS) with nasal polyps in whom concomitant NSAID-exacerbated respiratory disease (NERD) was uncovered after the initiation of triple combination CFTR modulatory therapy with elexacaftor-tezacaftor-ivacaftor (ETI).

Background: Intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC) can cause chronic rhinosinusitis (CRS), an underexplored side effect. This review aimed to determine the incidence and severity of CRS in NPC patients post-IMRT.

Methods: Electronic databases (PubMed, CINAHL, Embase, Cochrane Library, Web of Science) were searched for studies published from 2000 onwards. Eligible studies assessed CRS in NPC patients post-IMRT, using validated methods per EPOS 2020 (Lund-Mackay (LM) CT scoring, Lund-Kennedy (LK) endoscopic scoring, SNOT questionnaire). Meta-analysis was conducted using SPSS and R to quantify pooled CRS incidence and severity.

Results: Nine studies (n=1,478) were included, revealing distinct patterns in CRS development and severity. Patients without prior sinusitis showed significantly increased likelihood of developing CRS post-IMRT, while those with prior sinusitis had reduced odds due to a ceiling effect, as CRS was already present in 100% of these patients before IMRT. Both groups showed significant increases in CRS severity pre- and post-IMRT, with the LK and LM scoring methods showing the most substantial changes.

Conclusions: This review underscores the significant increases in both the incidence and severity of CRS in NPC patients post- IMRT. Clinicians should recognise the risk of CRS post-IMRT and recommend options to reduce the likelihood of CRS development.

Background: Sinonasal pathology can be complex and requires a systematic and meticulous approach. Artificial Intelligence (AI) has the potential to improve diagnostic accuracy and efficiency in sinonasal imaging, but its clinical applicability remains an area of ongoing research. This systematic review evaluates the methodologies and clinical relevance of AI in detecting sinonasal pathology through radiological imaging.

Methodology: Key search terms included "artificial intelligence", "deep learning", "machine learning", "neural network" and "paranasal sinuses". Abstract and full-text screening was conducted using predefined inclusion and exclusion criteria. Data were extracted on study design, AI architectures used (e.g., Convolutional Neural Networks (CNN), Machine Learning classifiers), and clinical characteristics, such as imaging modality (e.g., Computed Tomography (CT), Magnetic Resonance Imaging (MRI)).

Results: A total of 53 studies were analyzed, with 85% retrospective, 68% single-center, and 92.5% using internal databases. CT was the most common imaging modality (60.4%), and chronic rhinosinusitis without nasal polyposis (CRSsNP) was the most studied condition (34.0%). Forty-one studies employed neural networks, with classification as the most frequent AI task (35.8%). Key performance metrics included Area Under the Curve (AUC), accuracy, sensitivity, specificity, precision, and F1-score. Quality assessment based on CONSORT-AI yielded a mean score of 16.0 +- 2.

Conclusions: AI shows promise in improving sinonasal imaging interpretation. However, as existing research is predominantly retrospective and single-center, further studies are needed to evaluate AI’s generalizability and applicability. More research is also required to explore AI's role in treatment planning and post-treatment prediction for clinical integration.

Background: Data on risk factors for rhinogenic intracranial complications (RICs) including cerebral abscess have been limited. Using a nationwide database, the aim was to identify the factors related to mortality and delayed discharge.

Methodology: Data of 326 patients between 2012 and 2022 were extracted from a Japanese inpatient database. The main outcome was survival at discharge. In a subgroup analysis of the 316 surviving patients, the outcome was delayed discharge.

Results: The mortality rate was 3.1%. Logistic regression analyses identified intracerebral complications more than one surgical intervention and consciousness level evaluated by the Japan Coma Scale (JCS): JCS I and JCS ≥ II as risk factors for mortality. Concurrent interventions of intracranial and sinonasal drainage was identified as a factor associated with decreased risk.

Conclusions: Although RICs are rare, with decreasing mortality due to progress in imaging and clinical strategies, they remain the most severe complications of rhinosinusitis. Subdural and/or intracerebral abscess, consciousness level at admission, and more than one surgical intervention were found to be risk factors for mortality. Conversely, concurrent interventions, intracranial and sinonasal drainage, contributed to reducing this risk.