Whole-image deep learning models for CT diagnosis of nasal cavity and paranasal sinus diseases often underperform because they disregard anatomical heterogeneity. We hypothesized that anatomically partitioned deep learning would enhance diagnostic accuracy. A multicenter retrospective study enrolled 2947 CT examinations conducted from October 2019 to May 2022. From these, 150 patients were randomly selected for manual segmentation, covering 13 anatomical regions, including the bilateral nasal cavities, maxillary sinuses, anterior ethmoid sinuses, posterior ethmoid sinuses, sphenoid sinuses, frontal sinuses, and nasal septum. An nnU-Net v2 model was first used to perform automatic anatomical partitioning. Then, disease-specific networks were trained on the 13 anatomically segmented sinus subregions—each expanded by ten pixels—and compared with a whole-image classifier. External test data were used to evaluate sensitivity, specificity, and the area under the curve (AUC). The anatomically partition model based on nnU-Net v2 achieved an average Dice coefficient of 0.739 across the 13 anatomical regions. For the external test cohort using the model trained with anatomical partitioning, the average AUC value for the 13 anatomical partitions was 0.801, whereas for the model trained on the whole image, the average AUC value for the same 13 anatomical partitions was 0.587. DeLong’s test identified statistically significant improvements in AUC for 42 of the 73 diagnostic labels, with an average absolute increase of 0.214. Anatomically partitioned deep learning markedly improves the CT-based diagnosis of sinonasal diseases, providing more reliable lesion characterization than conventional whole-image approaches and demonstrating strong potential for routine clinical implementation. Question When whole-image deep learning models underperform across dozens of sinonasal pathologies, can an anatomically partitioned training strategy boost diagnostic performance on sinonasal CT? Findings Anatomically partitioned training decisively surpasses whole-image learning, delivering an average AUC improvement of 0.21 and establishing a potential framework for comprehensive sinonasal CT diagnosis. Clinical relevance This partitioned learning approach demonstrates a viable path for the clinical deployment of AI in sinonasal imaging, offering radiologists and rhinologists a reliable tool for multi-disease diagnosis that complements their expertise.

Objectives Anatomical factors of the sinuses significantly impact the progression of chronic rhinosinusitis (CRS). This study aims to investigate the correlation between morphological sinus features and the risk of CRS onset to provide evidence-based support for clinical management.Methods This multicenter study enrolled 716 CRS patients and 115 healthy individuals from January 2019 to December 2023. CRS patients were categorized into eosinophilic CRS (eCRS) and non-eosinophilic CRS (NeCRS) based on pathological results. The deep learning model nnU-Net v2 was trained for automated segmentation of sinuses. Morphological features were extracted and then screened using PyRadiomics. Subsequently, logistic regression, random forest, and multi-layer perceptron (MLP) were used to build CRS risk and subgroup evaluation models.Results CRS patients exhibited larger sinus volumes, surface areas, and multiple 2D/3D diameters compared to healthy individuals, while sphericity of maxillary and sphenoid sinuses was lower. A CRS risk prediction model was built using 20 morphological indicators. In the test cohort, the AUC values for the logistic regression, random forest, and MLP models were 0.884 (95% CI: 0.818-0.938), 0.890 (95% CI: 0.819-0.963), and 0.888 (95% CI: 0.822-0.952), respectively. Subgroup analysis showed that, although 18 indicators were selected for predicting the risk of CRS subtypes, the performance of all three models was relatively poor.Conclusions Multiple morphological sinus features are closely associated with the risk of CRS and could serve as significant indicators for assessing CRS risk. However, there are no significant differences in sinus morphology between eCRS and NeCRS patients.

IntroductionTo investigate the expression of classic markers of oxidative stress and the possible triggers, the expression of Nrf2, Keap1, and MAPK pathway-related proteins (JNK, p38MAPK, ERK) were evaluated in the hypoglossal nucleus under a rat model of chronic intermittent hypoxia (CIH).MethodsA total of 18 adult male Sprague-Dawley rats were randomly divided into 3 groups, including 2 CIH groups (3 weeks and 8 weeks, respectively) and a control group. The CIH groups were fed in low oxygen cabins, in which the fraction of oxygen volume circulated between 5% and 21%, while the control group was fed in atmospheric environment cabins. After 3 and 8 weeks, the expressions of Keap1, Nrf2, JNK, p38MAPK, and ERK in the hypoglossal nucleus of each group were observed by immunohistochemistry.ResultsImmunohistochemical analysis showed that Nrf2 expression in the CIH groups increased as the duration of hypoxia was prolonged. However, the Keap1 expression remained the same after 3 and 8 weeks of CIH. The expressions of JNK, p38MAPK, and ERK in the hypoglossal nucleus of the CIH groups were higher than those of the control group. The expressions of JNK, p38MAPK, and ERK in the CIH-8w group were higher than those of the CIH-3w group. The expressions of p-JNK and p-p38MAPK in the ventral nucleus were significantly higher than those in the dorsal nucleus in the CIH groups.DiscussionMAPK pathway is activated by CIH and may lead to the accumulation of Nrf2 in the hypoglossal nucleus. The different reactions of the ventral and dorsal nucleus to CIH may relate to their regulating effect on the upper airway muscle groups.

Recent research has identified the mitochondrial open reading frame of the 12S rRNA-c (MOTS-c) as a crucial mitochondrial peptide that significantly influences metabolic regulation, mimics the effects of exercise, and mitigates oxidative stress. This study aims to investigate the relationship between serum MOTS-c levels and obstructive sleep apnea (OSA) to enhance our understanding of the disease's pathophysiology. By elucidating this relationship, we hope to uncover new insights into the mechanisms underlying OSA and its associated metabolic complications. Seventy-seven participants were enrolled in this study, including 53 patients with OSA and 24 controls. We measured serum MOTS-c levels and collected participants' demographic characteristics, polysomnography (PSG) data, complete blood count (CBC) data, and sleep-related questionnaires. The study included 77 participants, consisting of 8 patients with mild OSA, 16 with moderate OSA, 29 with severe OSA, and 24 controls. The cohort comprised 26 women and 51 men. Analysis revealed that serum MOTS-c levels were significantly correlated with BMI, AHI (Apnea-Hypopnea Index), and ODI (Oxygen Desaturation Index), independent of age. Additionally, the severity of OSA was inversely related to serum MOTS-c levels, with lower levels observed in patients with more severe OSA. Variations in serum MOTS-c levels were also noted across different BMI classifications. Analysis of covariance (ANCOVA), with BMI as a covariate, demonstrated that the severity of OSA was an independent factor influencing serum MOTS-c levels. Serum MOTS-c levels correlate with both severity of OSA and BMI classification, suggesting that MOTS-c may have significant therapeutic potential for treating OSA.

Background Head and neck cancer (HNC) is a significant global health concern, with incidence rising after the age of 40. This study aims to analyze the trends in prevalence, incidence, mortality, and disability-adjusted life years (DALYs), focusing on regional and gender differences.Methods This research utilized data from the Global Burden of Disease (GBD) 2021 study. Key metrics such as the age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life years rate (ASDR) were analyzed. These metrics were used to examine trends from 1990 to 2021, focusing on gender and regional differences, and projections were made using the Nordpred method to predict future disease burdens up to 2045. The analysis covered 204 countries and regions and focused on cancers of the lip and oral cavity, nasopharynx, other pharynx, and larynx.Results From 1990 to 2021, the prevalence of HNC in the 40-64 age group nearly doubled, yet the ASPR remained stable. In contrast, ASIR, ASMR, and ASDR showed a decreasing trend. The analysis revealed significant gender differences, with males generally exhibiting higher ASIR, ASMR, and ASDR than females. However, the prevalence and incidence rates among females showed a faster increase in certain regions, particularly in lower SDI countries.Conclusion The study concludes that while the overall burden of HNC has shifted with a stable ASPR and decreasing ASIR, ASMR, and ASDR, gender-specific and region-specific strategies are essential to effectively address the risk factors associated with HNC.

Introduction: The World Health Organization declared an end to the global emergency status of COVID-19 in May of 2023. However, the impact of COVID-19 is far from over. Individuals who have recovered from COVID-19 continue to experience physiological, psychological, or cognitive symptoms, such as fatigue, shortness of breath, dizziness, and loss of smell or taste, known as long COVID. This review aims to describe the clinical characteristics of the upper respiratory tract infection (URTI) caused by SARS-CoV-2, and provide evidence for the prevention and treatment of SARS-CoV-2 infection by using nasal irrigation. COVID-19 and nasal irrigation: Nasal irrigation presents a promising adjunct to standard COVID-19 prevention and treatment protocols. This practice is theorized to diminish viral presence in the upper respiratory tract, a region identified as a primary site for SARS-CoV-2 replication and shedding. By facilitating the removal of viral particles and enhancing mucociliary clearance, nasal irrigation could potentially lessen the severity of URTI symptoms and slow transmission rates. The review consolidates current evidence of the efficacy and safety of this approach across various populations, underscoring its practicality in both preventive and therapeutic contexts. Conclusions: We recommend that saline nasal irrigation is an effective, safe and convenient strategy to prevent the transmission of SARS-CoV-2 and alleviate the symptoms of URTI across various age groups.

Masson瘤,也被称为血管内乳头状内皮细胞增生症,是一类血管组织来源的良性增生性病变,鼻腔鼻窦发病罕见.本文报道了一例鼻腔鼻窦Masson瘤.患者单侧鼻塞伴溢泪 6 月,肿物内镜下外观光滑界清,CT呈膨胀性生长,MR下肿物信号混杂,不均匀强化,血液学检查提示D-二聚体增高.经柯陆氏及鼻内镜径路切除肿物,经术后病理明确诊断.结合既往文献报道,发现鼻腔鼻窦Masson瘤多发生于上颌窦、筛窦和鼻腔,均为单侧发病但缺乏典型发病特征,一般经病理学检查确诊.其治疗以手术为主,预后较好.

目的 将淋巴瘤体积纳入鼻部结外NK/T细胞淋巴瘤预后相关的分析,验证肿瘤体积在预测淋巴瘤预后中的适用性.方法 分析了 41例诊断为鼻部结外NK/T细胞淋巴瘤的患者,所有患者均接受非蒽环类药物化疗.结合成像软件ITK-SNAP和PET/CT重建全身淋巴瘤病灶部位并计算肿瘤体积,将肿瘤体积纳入生存相关的COX回归分析.结果 所有患者的3年总生存率为87.8％,3年无进展生存率为58.5％.平均总肿瘤体积为22 358.9 mm3,平均鼻部肿瘤体积为15 010.8 mm3.根据COX多因素回归分析,年龄≥60岁、有＞2个结外侵犯部位、肿瘤体积＞17 618.3 mm3是影响无进展生存期的独立危险因素.结论 发病年龄、肿瘤体积和结外浸润部位是影响疾病预后的独立因素.大肿瘤体积的患者在治疗期间更有可能发生疾病进展.

OBJECTIVES:To evaluate the performance of texture analysis (TA) of diffusion kurtosis imaging (DKI) in differentiating malignant from benign sinonasal lesions, and its added value to the conventional imaging features.METHODS:Fifty-eight patients with malignant and 40 patients with benign sinonasal lesions were retrospectively enrolled. Conventional CT and MRI features were reviewed. Texture parameters were obtained and compared between two groups. Multivariate logistic regression analysis was used to identify the most valuable variables. Receiver operating characteristic curves were performed to assess the differentiating performance of independent variables and their combination.RESULTS:There were significant differences in tumor necrosis, bone erosion and soft tissue invasion between the two groups (all p < 0.05). There were significant differences in the 10th and entropy of Apparent diffusion coefficient map, the mean, 10th and entropy of D map, the mean and 90th of K map between the two groups (all p < 0.002). The bone erosion, entropy of D, and mean of K were independent variables associated with malignant tumors. Receiver operating characteristic analyses indicated that the combination of three features possessed better differentiating performance than bone erosion alone (p = 0.003).CONCLUSION:TA of DKI could supply incremental value to conventional imaging features for pre-operative differential diagnosis between benign and malignant sinonasal lesions.ADVANCES IN KNOWLEDGE:The present study is the first to combine conventional imaging features and the TA of DKI in the differential diagnosis between benign and malignant sinonasal lesions. Our findings suggest that TA of DKI could supply incremental value to conventional imaging features.

Objective:To explore the relationship between preoperative blood indexes, clinicopathological characteristics and prognosis of patients with laryngeal squamous cell carcinoma（LSCC）, and to establish a nomogram for predicting survival and recurrence time of LSCC patients. Methods:The clinical data of 530 patients with LSCC who received primary surgical treatment were analyzed retrospectively. The patients were randomly divided into training group and testing group according to the ratio of 7∶3. The nomograms of overall survival（OS） and recurrence-free survival（RFS） were constructed based on Cox regression model, and the nomograms were verified and compared with TNM stage. Results:The results of multivariate analysis showed that age, operation mode, tumor diameter, TNM stage, cervical lymph node metastasis, fibrinogen level and systemic immune inflammation index were significantly correlated with OS, while operation mode, tumor diameter, TNM stage, cervical lymph node metastasis, international normalized ratio, neutrophil to lymphocyte ratio and platelet to lymphocyte ratio were significantly correlated with RFS. The nomograms were constructed based on the above factors. The C-indexes of the nomograms of OS and RFS in the training group were 0.755 and 0.687, respectively, which were higher than those of TNM stage（0.657 and 0.582）. In the testing group, the C-indexes of OS and RFS nomograms were 0.717 and 0.646, respectively, which were higher than those of TNM stage（0.599 and 0.528）. The area under the receiver operating characteristic curves of these nomograms were also higher than TNM stage. The calibration curves showed that the models had good consistency. Decision curve analysis（DCA） showed that these nomograms had higher clinical benefit than TNM stage. Conclusion:Based on the independent prognostic factors, the predictive nomograms of OS and RFS at 1, 3 and 5 years after LSCC were constructed, which have certain clinical significance in guiding the individualized diagnosis and treatment of LSCC.

Background:Allergic rhinitis (AR) is a nasal inflammatory disease resulting from a complex interplay between genetic and environmental factors. The association between Toll-like receptor (TLR) signaling pathway and environmental factors in AR pathogenesis remains to be explored. This study aims to assess the genetic association of AR with single nucleotide polymorphisms (SNPs) in TLR signaling pathway, and investigate the roles of gene-gene and gene-environment interactions in AR.Methods:A total of 452 AR patients and 495 healthy controls from eastern China were enrolled in this hospital-based case-control study. We evaluated putatively functional genetic polymorphisms in TLR2, TLR4 and CD14 genes for their association with susceptibility to AR and related clinical phenotypes. Interactions between environmental factors (such as traffic pollution, residence, pet keeping) and polymorphisms with AR were examined using logistic regression. Models were stratified by genotype and interaction terms, and tested for the significance of gene-gene and gene-environment interactions.Results:In the single-locus analysis, two SNPs in CD14, rs2563298 (A/C) and rs2569191 (C/T) were associated with a significantly decreased risk of AR. Compared with the GG genotype, the GT and GT/TT genotypes of TLR2 rs7656411 (G/T) were associated with a significantly increased risk of AR. Gene-gene interactions (eg, TLR2 rs7656411, TLR4 rs1927914, and CD14 rs2563298) was associated with AR. Gene-environment interactions (eg, TLR4 or CD14 polymorphisms and certain environmental exposures) were found in AR cases, but they were not significant after Bonferroni correction.Conclusion:The genetic polymorphisms of TLR2 and CD14 and gene-gene interactions in TLR signaling pathway were associated with susceptibility to AR in this Han Chinese population. However, the present results were limited to support the association between gene-environment interactions and AR.

Background Genetic variants in GARP (also known as LRRC32) have been reported to have significant associations with asthma and eczema in special populations, but little is known about allergic rhinitis. This study purposes to evaluate the association of single nucleotide polymorphisms (SNPs) in GARP with house dust mite (HDM)-sensitized persistent allergic rhinitis (PER) in a population of Han Chinese. Methods In this hospital-based case–control study, 534 HDM-sensitized PER patients and 451 healthy controls were recruited from East China. In this population, six SNPs in GARP were identified. Serum total and specific IgE levels were measured with ImmunoCAP. Secondary structure and minimum free energy were predicted by RNAfold. Results rs79525962 was associated with the risk of HDM-sensitized PER (P < 0.05). The individuals with CT+TT genotype demonstrated a higher risk of HDM-sensitized PER than those with CC genotype (adjusted OR = 1.393, 95% CI = 1.019–1.904). The homozygous genotype CC of rs3781699 rendered a lower risk of HDM-sensitized PER than the wild-type genotype AA (adjusted OR = 0.646, 95% CI = 0.427–0.976); however, the genotype and allele frequencies of rs3781699 demonstrated no associations with HDM-sensitized PER (P > 0.05). rs79525962 increased the risk of HDM-sensitized PER in the subgroup aged ≥16 years (adjusted OR = 1.745, 95% CI = 1.103–2.760), and this high risk was also found in the females (adjusted OR = 1.708, 95% CI = 1.021–2.856). The G-C haplotype of rs1320646-rs3781699 rendered a lower risk of HDM-sensitized PER than the common haplotype G-A (adjusted OR = 0.819, 95% CI = 0.676–0.993). The secondary structure of GARP altered in response to different genotypes of rs79525962 and rs3781699. Conclusion SNP rs79525962 in the GARP gene marks a risk locus of HDM-sensitized PER in Chinese Hans.

To evaluate the value of texture analysis (TA) of conventional magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) in the differential diagnosis between sinonasal non-Hodgkin’s lymphoma (NHL) and squamous cell carcinoma (SCC). Forty-two patients with sinonasal SCC and 30 patients with NHL were retrospectively enrolled. TAs were performed on T2-weighted image (T2WI), apparent diffusion coefficient (ADC) and contrast-enhanced T1-weighted image (T1WI). Texture parameters, including mean value, skewness, kurtosis, entropy and uniformity were obtained and compared between sinonasal SCC and NHL groups. Receiver-operating characteristic (ROC) curves and logistic regression analyses were used to evaluate the diagnostic value and identify the independent TA parameters. The mean value and entropy of ADC, and mean value of contrast-enhanced T1WI were significantly lower in the sinonasal NHL group than those in the SCC group (all P < 0.05). ROC analysis indicated that the entropy of ADC had the best diagnostic performance (AUC 0.832; Sensitivity 0.95; Specificity 0.67; Cutoff value 6.522). Logistic regression analysis showed that the entropy of ADC (P = 0.002, OR = 26.990) was the independent parameter for differentiating sinonasal NHL from SCC. TA parameters of conventional MRI and DWI, particularly the entropy value of ADC, might be useful in the differentiating diagnosis between sinonasal NHL and SCC.

目的 观察针刺蝶腭神经节治疗肺气虚寒型持续性中重度变应性鼻炎(Allergic Rhinitis)的临床疗效.方法 将60例肺气虚寒型持续性中重度AR患者采用随机数字表法均分为观察组和对照组.观察组针刺蝶腭神经节,交替单侧针刺,每周2次,连续针刺4周.对照组使用盐酸氮卓斯汀鼻喷雾剂,每次每鼻孔2喷,早晚各一次,连用4周.采用鼻炎症状体征评分及鼻眼结膜炎生活质量调查问卷(RQLQ)评分判断临床疗效.结果 与治疗前相比,两组患者的鼻炎症状体征评分及RQLQ评分均显著降低(P<0.01).观察组除喷嚏评分与对照组无差异外,其他评分均较对照组明显降低(P<0.05).治疗4周后观察组显效率为46.7％,有效率为12％,无效率为13.3％,总有效率86.7％.对照组显效率为20％,有效率53.3％,无效率为26.7％,总有效率73.3％.两组比较有统计学差异(P<0.05).两组未见明显不良反应.结论 针刺蝶腭神经节可有效改善肺气虚寒型持续性中重度AR患者临床症状及生活质量,操作简单安全,依从性高,值得临床推广应用.

目的 分析阻塞性睡眠呼吸暂停综合征(OSAS)患者炎症细胞水平与睡眠呼吸监测参数的相关性.方法 114例OSAS患者根据睡眠呼吸暂停低通气指数(AHI)分为轻度(16例)、中度(29例)和重度(69例)三组;另选取60例健康体检者作为对照组.比较各组白细胞、淋巴细胞、单核细胞、中性粒细胞、嗜酸性粒细胞及嗜碱性粒细胞计数,并分析睡眠呼吸监测指标与炎症细胞水平的相关性.结果 四组间的白细胞计数、单核细胞计数、中性粒细胞计数差异有统计学意义(P＜0.05);与对照组相比,重度组白细胞计数、中性粒细胞计数增加(P＜0.05);与轻-中度组相比,重度组单核细胞计数、嗜酸性粒细胞计数增加(P＜0.05).OSAS患者AHI与最低血氧饱和度呈负相关(r=-0.660,P＜0.05),而与氧饱和度＜90％的时间、氧减指数、白细胞计数、单核细胞计数、中性粒细胞计数均呈正相关(r=0.755、0.885、0.206、0.213、0.200,P＜0.05);最低血氧饱和度与白细胞计数、中性粒细胞计数呈负相关(r=-0.162、-0.177,P＜0.05).结论 重度OSAS患者白细胞计数和中性粒细胞计数增加;睡眠呼吸监测参数结合白细胞和中性粒细胞计数可作为OSAS严重程度的预测因子.

Facial nerve schwannoma (FNS) is a benign, slow-growing schwannoma that originates from Schwann cells. Facial nerve schwannoma is the most common tumor of the facial nerve but rare and only accounts for 0.15% to 0.8% of intracranial neurinomas. It may be manifested as asymmetric hearing loss, facial palsy, and hemifacial spasm. A 56-year-old woman was transferred to our department, because of pain behind the right ear and spasm of the right lateral muscle for more than 2 years and pulsatile tinnitus for half a year. Based on the preoperative medical history, physical signs, and auxiliary examination, it was diagnosed with jugular foramen (JF) space-occupying lesion. We removed the tumor through the infratemporal fossa type A approach and found that the tumor originated from the facial nerve. After the tumor resection, sural nerve transplantation was performed. The patient demonstrated postoperative facial palsy (House-Brackman grade VI) and was smoothly discharged after good recovery. Facial nerve schwannoma rarely invades the JF, and the most common tumor in the JF is the glomus jugular tumor, followed by the posterior cranial schwannoma. They have common symptoms, making it difficult to obtain a correct diagnosis. Clinical data, medical history, and auxiliary examinations should be carefully analyzed to avoid misdiagnosis or mistreatment. Infratemporal fossa type A approach is an effective method for treating FNS of JF.

Background: Circular RNAs (circRNAs) are involved in inflammation; however, their role in allergic rhinitis (AR) remains unclear. In this study, we analyzed circRNA expression and identified a circRNA-miRNA-mRNA network through which circRNAs regulate AR pathogenesis. Methods: We analyzed circRNA, miRNA, and mRNA expression profiles in the nasal mucosa by high-throughput sequencing (HTS), using a fold-change >1.5 and p-value < 0.05 to pinpoint significantly differentially expressed (DE) circRNAs, miRNAs, and mRNAs in AR. A DEcircRNA-DEmiRNA-DEmRNA crosstalk network was then constructed using bioinformatics and statistical analysis. Gene ontology and Kyoto encyclopedia of genes and genomes pathway analyses were performed to identify the biological terms enriched in the network; whereas RT-PCR and Sanger sequencing were used to confirm the circRNAs. Results: A total of 264 DEcircRNAs were identified by HTS, including 120 upregulated and 144 downregulated in AR compared to controls. A DEcircRNA-DEmiRNA-DEmRNA crosstalk network was constructed with 17 miRNAs, 11 circRNAs, 29 mRNAs, and 64 interaction pairs. These genes were involved in the Wnt signaling pathway, TNF biosynthesis, inflammatory responses, the PI3K-Akt signaling pathway, and Toll-like receptors. Of the 11 DEcircRNAs, hsa_circ_0008668 and circTRIQK were upregulated, whereas hsa_circ_0029853 and circRNA_01002 were down-regulated in AR tissues. Sanger sequencing confirmed the back-splicing junctions of these circRNAs. Conclusions: We constructed a novel DEcircRNA-DEmiRNA-DEmRNA network for AR that pro -vides a basis for future studies to investigate its underlying molecular mechanisms.

目的 观察慢性间歇性缺氧(chronic intermittent hypoxia,CIH)条件下大鼠颏舌肌中5-HT(5-hydroxytryptamine)、5-HT 2A受体表达量的变化,以了解5-HT在CIH所致颏舌肌功能改变中的作用.方法 将20只雄性Sprague Dawley(SD)大鼠(8周龄,体重180～200g)随机均分为4组,即常氧组、CIH组(3周、5周和8周).CIH组低氧条件为舱内氧浓度在5％～21％之间循环,每天8小时.对照组氧浓度维持在21％.分别于3周、5周、8周后观察颏舌肌的形态改变、神经递质5-HT、5-HT 2A受体及RYR(Ryanodine receptor)、SERCA(sarcoendoplasmic reticulum Ca2+-transporting ATPase)的表达量.结果 HE染色显示CIH组颏舌肌肌纤维及细胞核排列杂乱,免疫组化显示5-HT在颏舌肌的表达量3周(P<0.05)、5周(P<0.05)、8周CIH(P<0.01)组均明显升高.5-HT 2A受体3～8周CIH表达量呈现上升趋势且在8周CIH时明显升高(P<0.01).颏舌肌RYR与SERCA表达量均呈下降趋势,从5周开始具有统计学意义.Western blot显示5-HT 2A受体蛋白表达量8周CIH时明显升高(P<0.05).结论 CIH导致伸舌肌颏舌肌5-HT及其受体5-HT 2A表达持续上调,RYR与SERCA表达下降.在一定阶段内,5-HT的代偿保护机制起着主导作用,从而在整体效应上维持咽腔开放.

Objective:To compare the clinical characteristics of chronic rhinosinusitis(CRS) with nasal polyps(CRSwNP) and without nasal polyps(CRSsNP), and to provide evidence for formulating rational treatment strategies.Methods:The clinical data of 225 patients suffering from CRS in Jiangsu and Anhui provinces who were hospitalized for endoscopic sinus surgery from November 2018 to December 2019, which included the preoperative blood routine, blood biochemistry, serum total IgE(tIgE), allergen specific IgE(sIgE), paranasal sinus CT, and postoperative histopathological examinations, were retrospectively analyzed for statistical analysis.Results:Of the 225 patients, 148(65.8%) were in the CRSwNP group and 77(34.2%) in the CRSsNP group. There were no significant differences in gender, age, length of hospital stay, differential leucocyte counts and biochemical indexes in peripheral blood between the two groups( P>0.05). In patients with CRSwNP and CRSsNP, the positive rate of serum sIgE against at least one of allergen was 34.5% and 40.3% respectively( P>0.05), among which dust mites were most common with a positive rate of 23.0% and 26.0% respectively( P>0.05). There were also no statistically significant differences in positive rates of serum tIgE and sIgE against 20 common allergens, as well as inhaled and ingested allergens between the CRSwNP and CRSsNP groups( P>0.05). In addition, no significant difference was found in distribution of serum allergen-sIgE concentrations between these two groups( P>0.05). However, the Lund-Mackay scores of paranasal sinus CT scans were significantly higher in the CRSwNP group than those in the CRSsNP group in terms of the sinuses, ostiomeatal complex and the total scores( P<0.05). Moreover, the positive rate of lymphocyte and plasma cell infiltration in the tissue were more than 60% in both groups, while eosinophil infiltration was significantly higher in the CRSwNP group(43.2%) than that in the CRSsNP group(22.1%; P<0.05). Conclusion:At present, lymphocyte and plasma cell inflammation is still dominant in patients with CRS in this region. However, the positive rate of eosinophil infiltration in polyp tissues was 43.2% in patients with CRSwNP, which needs to arouse our recognition and further attention. The total positive rate of allergen sensitization in CRSwNP and CRSsNP patients was 34.5% and 40.3% respectively, with no significant difference. And the major allergen is dust mites.