Purpose: The outcome of performing a tracheostomy in patients with coronavirus disease (COVID-19) seems promising based on the reported 30-day survival rate. However, long-term outcomes are still lacking. Therefore, our aim in this study was to evaluate the long-term outcomes of tracheostomy performed in critically ill COVID-19 patients. Methods: This was a retrospective analysis of 27 COVID-19 patients on whom tracheostomy was performed between February 28, 2020, and April 7, 2020, at Tongji Hospital (Wuhan, China). Patients' clinical characteristics, complications, and outcomes were analyzed. Results: All patients underwent successful bedside tracheostomy. Thirteen patients (48.1%) were successfully weaned off ventilation within 1 month. The survival rate at one, three, and nine months after tracheostomy were 63.0%, 37.0%, and 29.6%, respectively. At nine months after tracheostomy, 8/27 patients had survived, with five (62.5%) being discharged home while the remaining were dependent on nursing care. Conclusion: The survival rate of COVID-19 patients who underwent tracheotomy decreased markedly from 1 to 3 months after tracheotomy, remaining stable between 3 and 9 months. Medical support is much needed for COVID-19 patients over the first 90 days after tracheotomy.

Background Although subsequent anti-inflammatory treatments are indispensable for patients with chronic rhinosinusitis (CRS) undergoing sinus surgery, few studies have explored the factors influencing the efficacy of postoperative anti-inflammatory treatment. Objective We aimed to develop prediction models for the response to glucocorticoid- and macrolide-based postoperative therapy in CRS patients. Methods We performed a post-hoc analysis of our previous study comparing the efficacy of fluticasone propionate and clarithromycin in the postoperative treatment of CRS patients. Clinical characteristics and treatment outcome information were collected. In addition, diseased sinonasal mucosal tissues obtained during surgery were processed for Bio-Plex analysis of protein levels of 34 biomarkers. Classification trees were built to predict refractory CRS based on clinical characteristics and biological markers for patients treated with fluticasone propionate or clarithromycin. A random forest algorithm was used to confirm the discriminating factors that formed the classification trees. Results One year after surgery, 22.7% of the patients (17/75) treated with fluticasone propionate, and 24.3% of those (18/74) treated with clarithromycin were diagnosed with refractory CRS. Nasal tissue IL-8 and IgG3 levels and headache VAS scores in the fluticasone propionate group, and nasal tissue IgG4 levels and overall burden of symptoms VAS scores in the clarithromycin group, were identified as discriminating factors forming the classification tree to predict refractory CRS. The overall predictive accuracy of the model was 89.3% and 87.8% for fluticasone propionate- and clarithromycin-based postsurgical treatment, respectively. Conclusions Classification trees built using clinical and biological parameters could be helpful in identifying patients with poor response to fluticasone propionate- and clarithromycin-based postoperative treatment.

This study examined the potential roles of CC10 (Clara cell 10-kD protein) and ILC2s (type 2 innate lymphoid cells) in allergic rhinitis (AR). After ovalbumin was used to construct the AR model, microarray analysis was performed to reveal the key differentially expressed genes. The phenotypic changes of nasal mucosa were examined by H&E staining. Western blot analysis, qRT-PCR, ELISA and immunohistochemistry were performed to identify the levels of cytokines. The lineage markers (CD127 and CD117) of ILC2s were detected using immunofluorescence. The microarray analysis and qRT-PCR results showed that CC10 overexpression inhibited the expression of A20, BAFF, and IL-4 R in vivo. Also, CC10 overexpression was found to ameliorate the damage of nasal mucosa in AR mice. Investigations revealed that the ILC2s were activated in AR mice and AR patients with high levels of IgE, IgG1, IL-4, IL-5, IL-13, IL-25, and IL-33. Moreover, CD127+ was found to activate ILC2s. However, CC10 overexpression suppressed the activation of ILC2s. In conclusion, this research suggested that CC10 could suppress the activation of ILC2s to attenuate the damage of nasal mucosa and that CD127+ may be a biomarker of the activation of ILC2s in AR mice and AR patients.

Objective Hemangioma is a common benign tumor in the head and neck. The therapeutic effect by conventional treatment was not very satisfactory. The purpose of this study is to explore the surgical strategy of low-temperature plasma radiofrequency in the treatment of hemangioma located in the nasal cavity, pharynx, and larynx. Methods The clinical data of 29 cases with hemangioma in nasal cavity, pharynx, and larynx treated by low-temperature plasma radiofrequency ablation were retrospectively analyzed. The strategy of ablation before resection was performed for 16 cases of nasal capillary hemangioma. The other 13 cases of cavernous hemangioma in the pharynx and larynx were treated by the strategy of direct ablation. Results All 29 patients underwent a successful operation with minimal intraoperative bleeding and no postoperative bleeding complications. There was no nasal septum perforation, dyspnea, dysphagia, dysphonia, or other complications. The patients were followed up for more than 3 years without recurrence. Conclusion Low-temperature plasma radiofrequency is a practical, minimally invasive, and accurate method for treating hemangiomas in the nasal cavity, pharynx, and larynx. For capillary hemangiomas, the strategy of ablation before resection may be an effective way to reduce bleeding, and for cavernous hemangiomas, the strategy of direct ablation is a simple and efficient method.

Background Tracheostomy, as an aerosol-generating procedure, is considered as a high-risk surgery for health care workers (HCWs) during the coronavirus disease (COVID-19) pandemic. Current recommendations are to perform tracheostomy after a period of intubation of > 14 days, with two consecutive negative throat swab tests, to lower the risk of contamination to HCWs. However, specific data for this recommendation are lacking. Therefore, this study aimed to evaluate viral shedding into the environment, including HCWs, associated with bedside tracheostomy in the intensive care unit. Methods Samples obtained from the medical environment immediately after tracheostomy, including those from 19 surfaces, two air samples at 10 and 50 cm from the surgical site, and from the personal protective equipment (PPE) of the surgeon and assistant, were tested for the presence of severe acute respiratory syndrome coronavirus 2 in eight cases of bedside tracheostomy. We evaluated the rate of positive tests from the different samples obtained. Results Positive samples were identified in only one of the eight cases. These were obtained for the air sample at 10 cm and from the bed handrail and urine bag. There were no positive test results from the PPE samples. The patient with positive samples had undergone early tracheostomy, at 9 days after intubation, due to a comorbidity. Conclusions Our preliminary results indicate that delayed tracheostomy, after an extended period of endotracheal intubation, might be a considerably less contagious procedure than early tracheostomy (defined as < 14 days after intubation).

BACKGROUND:Cold-inducible RNA-binding protein (CIRP) is a newly identified damage-associated molecular pattern molecule. Its roles beyond promoting inflammation and in human diseases are poorly understood. This study aimed to investigate the involvement of CIRP in chronic rhinosinusitis with nasal polyps (CRSwNP).METHODS:Immunohistochemistry, quantitative RT-PCR, and ELISA were used to detect the expression of CIRP and matrix metalloproteinases (MMPs) in sinonasal mucosal samples and nasal secretions. Human nasal epithelial cells (HNECs) and THP-1 cells, a human monocytic/macrophage cell line, were cultured to explore the regulation of CIRP expression and MMP expression.RESULTS:Cytoplasmic CIRP expression in nasal epithelial cells and CD68+ macrophages in sinonasal tissues, and CIRP levels in nasal secretions were significantly increased in both patients with eosinophilic and noneosinophilic CRSwNP as compared to those in control subjects. IL-4, IL-13, IL-10, IL-17A, TNF-α, Dermatophagoides pteronyssinus group 1, and lipopolysaccharide induced the production and secretion of CIRP from HNECs and macrophages differentiated from THP-1 cells. CIRP promoted MMP2, MMP7, MMP9, MMP12, and vascular endothelial growth factor A (VEGF-A) production from HNECs, macrophages differentiated from THP-1 cells, and polyp tissues, which was inhibited by the blocking antibody for Toll-like receptor 4, but not advanced glycation end products. The expression of MMPs and VEGF-A in tissues correlated with CIRP levels in nasal secretions in patients with CRSwNP.CONCLUSIONS:The upregulated production and release of CIRP from nasal epithelial cells and macrophages may contribute to the edema formation in both eosinophilic and noneosinophilic CRSwNP by inducing MMP and VEGF-A production from epithelial cells and macrophages.

Safety and efficacy of tracheostomy in COVID-19 patients: a preliminary retrospective study of 14 casesKeypointsThe outbreak of COVID-19 in Wuhan, China, since December, 2019, has become a pandemic.This highly infectious disease increases the risk of converting to acute progressive respiratory failure, which needs the treatment with invasive mechanical ventilation, including tracheostomy.Up to now, there is no data describing tracheostomy cases in COVID-19 pandemic.we retrospectively analyzed 14 cases of critically ill COVID-19 patients with tracheostomy, concentrating on surgical indication, complication, procedure and precaution.Bedside open tracheostomy in COVID-19 patients is a relatively safe procedure for skilled surgeons under appropriate precautions, and the critically ill patients may benefit from it.Introduction The outbreak of Corona Virus Disease 2019 (COVID-19) has become a pandemic. It has been reported that in an early study, about 20% COVID-19 hospitalized patients developed into acute respiratory distress syndrome (ARDS) and required invasive mechanical ventilation.1 For some patients on prolonged intubation, tracheostomy may be considered as an important option for optimal respiratory care. Although recent several articles described the principles and procedures of tracheostomy on COVID-19 patients,2,3 there is no data describing tracheostomy cases in COVID-19 pandemic. In this study, we retrospectively analyzed 14 cases of COVID-19 patients with tracheostomy in [removed for blind peer review], the only designated hospital which still has a dozen intubated patients in [removed for blind peer review], concentrating on surgical indication, complication, procedure and precaution.

BackgroundIn this study we aimed to identify inflammatory patterns and predictors associated with clinical outcomes in chronic rhinosinusitis with nasal polyps (CRSwNP) patients with different blood and tissue eosinophilia.MethodsA total of 535 CRSwNP patients were enrolled, and the expression of 35 biomarkers, together with eosinophil and neutrophil counts in nasal polyps, were analyzed in a subset of 249 patients. Patients were stratified on the basis of blood (≥0.5 × 109/L) and tissue (>10%) eosinophilia. Logistic regression models were applied to identify predictors of uncontrolled disease at least 1 year after surgery. Uncontrolled disease was defined according to the European Position Paper on Rhinosinusitis and Nasal Polyps 2020.ResultsAmong 535 patients, 38.5% showed inconsistent blood and tissue eosinophilia. In 249 CRSwNP patients, subjects with concomitant blood and tissue eosinophilia (group 1) showed marked mucosal type 2 inflammation, characterized by high levels of interleukin (IL)‐5, IL‐13, and eotaxin‐1, whereas subjects with normal blood and tissue eosinophil levels (group 4) demonstrated significant local neutrophilic inflammation with high expression of granulocyte colony‐stimulating factor and subjects with selective tissue eosinophilia (group 2) showed intermediate and mixed eosinophilic and neutrophilic inflammation. Subjects with isolated blood eosinophilia (group 3) showed low expression of vascular endothelial growth factor and IL‐10. Asthma, prior sinus surgery, and blood eosinophilia were the top 3 predictors for postsurgical uncontrolled disease. For subgroup analysis, sex in group 1, asthma in group 2, tissue IL‐10 and immunoglobulin E in group 3, and prior sinus surgery in group 4 were the strongest predictors of uncontrolled disease, respectively.ConclusionDifferent blood and tissue eosinophilia revealed distinct tissue inflammatory patterns in CRSwNP patients.

BACKGROUND:The mechanisms underlying mucosal eosinophilia in chronic rhinosinusitis with nasal polyps (CRSwNP) remain poorly clarified. The nervous system and neuropeptides play an important role in the regulation of immune response. Herein we explore the expression and function of hemokinin-1 (HK-1), a newly identified tachykinin, along with its receptor neurokinin 1 receptor (NK1R) in CRSwNP.METHODS:HK-1, NK1R, and C-C motif chemokine ligand 24 (CCL24) expression in nasal tissues (53 eosinophilic CRSwNP, 32 non-eosinophilic CRSwNP, and 33 controls) was investigated by quantitative reverse transcript polymerase chain reaction (RT-PCR) and immunofluorescence staining. THP-1, a human monocytic leukemia cell line, and eosinophilic polyp tissues were stimulated with HK-1. Cells, tissues, and culture supernatants were subsequently collected for detection of the production of various inflammatory cytokines and chemokines by quantitative RT-PCR and enzyme-linked immunoassay.RESULTS:HK-1 and NK1R mRNA and protein expression were upregulated in eosinophilic and non-eosinophilic nasal polyps compared with control tissues, with eosinophilic polyps demonstrating a higher upregulation compared with that of non-eosinophilic polyps. Eosinophils constituted the major source of HK-1, whereas macrophages were the predominant cell type exhibiting NK1R in eosinophilic polyps. HK-1 induced CCL24 production from macrophages differentiated from THP-1 cells; this was abolished by an NK1R antagonist. HK-1 also induced CCL24 production from ex vivo-cultured eosinophilic nasal polyps. CCL24 was expressed by macrophages in eosinophilic but not non-eosinophilic polyps. The expression level of HK-1 correlated with CCL24 expression and tissue eosinophilia in eosinophilic nasal polyps.CONCLUSION:Eosinophil-derived HK-1 induces CCL24 production from macrophages and therefore exaggerates eosinophilic inflammation in CRSwNP.

BACKGROUND:With the extensive development of endoscopic sinus surgery, iatrogenic medial rectus muscle injury should be treated with caution. Traditional methods to repair a ruptured medial rectus need an anterior orbitotomy approach, with more injury and difficulty in finding the posterior end of the ruptured medial rectus. OBJECTIVE:To explore a new method to repair a ruptured medial rectus. METHODS:Eight cases of iatrogenic medial rectus rupture after endoscopic sinus surgery were reviewed from July 2015 to January 2019. Assisted by image-guided navigation, the ruptured medial rectus was sutured under an endoscopic endonasal orbital approach. Two methods were designed to suture the ruptured medial rectus. Optic nerve and orbital decompression were performed in 5 cases with visual impairment. The extent of exotropia and diplopia were followed up for 5 to 33 months after surgery. RESULTS:With the help of image guidance, the posterior and anterior ends of the ruptured medial rectus of all patients were pinpointed, and operations using medial rectus anastomosis were successfully completed in 7 patients. The exotropia of these patients was corrected, and they have recovered. The vision of 2 patients recovered. There were no minor or major complications intraoperatively or postoperatively. CONCLUSION:Assisted by image-guided navigation, medial rectus anastomosis under an endoscopic endonasal orbital approach is a feasible method. The key to preventing orbital complications is strict professional training, including identification of the Onodi air cell and correct application of powered instrumentation.

BACKGROUND Chronic rhinosinusitis (CRS) can be divided to CRS without nasal polyps (CRSsNP) and eosinophilic and non-eosinophilic CRS with nasal polyps (CRSwNP). There is little evidence on the efficacy of glucocorticoids and macrolides in different phenotypic patients. The aim of this study was to compare the benefit of glucocorticoids and macrolides following endoscopic sinus surgery (ESS) in different phenotypic CRS. METHODS This study was a prospective single-blind comparative effectiveness trial. A total of 187 Chinese patients with CRS were stratified to CRSsNP and eosinophilic and non-eosinophilic CRSwNP group and then randomized to receive fluticasone propionate nasal spray at 200 microgram or clarithromycin tablet at 250 mg once daily for 3 months after ESS. Oral prednisone was given as a rescue therapy after the stop of study medication. Patients were assessed before ESS and 1, 3, 6 and 12 months after dosing. Symptom severity was scored by patients using visual analog scale method and endoscopic findings were scored by the senior physician blinded to treatment according to European Position Paper on Rhinosinusitis and Nasal polyps 2012. RESULTS The total and individual symptom scores, and total and individual endoscopic domain scores were reduced significantly after ESS in both medication groups, whereas no significant difference was observed for two medications at most follow-up visits in each subtype of CRS. No difference in the frequency of subjects with rescue therapy or refractory CRS was found between two medication groups either. CONCLUSIONS We could not show significant difference of effect between fluticasone propionate and clarithromycin in the post-operative treatment for CRSsNP and eosinophilic and non-eosinophilic CRSwNP patients.

Background Although increased accumulation of neutrophils has been noted in chronic rhinosinusitis (CRS), the function and regulation of neutrophils in CRS are largely unknown. IL-36 family cytokines may play an important role in neutrophilic inflammation. Objective This study sought to investigate the expression and function of IL-36 cytokines in CRS. Methods Quantitative RT-PCR, immunohistochemistry, immunofluorescence, and ELISA were used to investigate the expression of IL-36 cytokines and IL-36 receptor (IL-36R) in sinonasal mucosa. The expression of IL-36R on neutrophils in polyps and blood was measured by flow cytometry. Purified blood neutrophils were cultured to investigate the regulation of IL-36R expression. The cleavage of IL-36γ was detected by Western blotting. Dispersed nasal polyp cells were treated with IL-36γ with or without elastase inhibitor and dexamethasone. Results Neutrophil infiltration and expression of IL-36 cytokines and IL-36R were upregulated in both CRS with and without nasal polyps. IL-36γ was the most abundant isoform and mainly expressed by epithelial cells in CRS. Neutrophils were the principal IL-36R+ cell type in polyps. IL-36R expression was almost absent in blood neutrophils and upregulated by IL-6, IL-1β, and Dermatophagoides pteronyssinus group 1. Elastase activity was increased in polyps and degraded full-length IL-36γ. Consistently, the levels of cleaved IL-36γ were increased in polyps. Full-length IL-36γ promoted the production of matrix metalloproteinase 9; IL-17A; and chemokine (C-X-C motif) ligands 1, 2, and 8 from dispersed nasal polyp cells, which was abolished by elastase inhibitor. The proinflammatory effect of IL-36γ was not suppressed by dexamethasone. Conclusions Increased production and activation of IL-36γ may act on neutrophils and further exaggerate neutrophilic inflammation in CRS.

Objective To investigate the clinical features,diagnosis and treatment of sinusitis with orbital complications and the indications for surgical treatment of sinusitis with subperiosteal abscess(Chandler Ⅲ).Methods In this retrospective study,33 patients with sinusitis and orbital complications were enrolled and the clinical characteristics and treatment outcomes of these patients were examined.Especially,the differences in clinical manifestations were analyzed between patients who underwent conservative treatment and surgical treatment after failure of conservative treatment.Results Thirty-three patients were grouped according to the Chandler stage system:5 cases in stage Ⅰ,11 cases in stage Ⅱ,16 cases in stage Ⅲ and 1 case in stage Ⅳ.The effective rates of conservative treatment for patients in stage I,stage Ⅱ and stage Ⅲ were 20.0%,27.3% and 31.3%,respectively.Patients in stage Ⅲ were more likely to have proptosis(> 4 mm),decreased vision,ophthalmoplegia,diplopia and elevated intraocular pressure in conservative plus surgical treatment group than in conservative treatment group.For patients in stage Ⅲ,the length,width and height of subperiosteal abscess measured on the CT image were significantly less in conservative treatment group than in conservative plus surgical treatment group.All patients recovered well except two patients with impaired visual acuity.No patients relapsed in 6-month follow-up.Conclusion For patients with sinusitis and orbit complications in stage Ⅰ and Ⅱ,conservative treatment could be tried for the first 48 h.Surgery should be performed if the conservative treatment is not effective.The conservative treatment could first be attempted in adult patients at stage Ⅲ who have no manifestations of proptosis(> 4 mm),decreased vision,ophthalmoplegia,diplopia,elevated intraocular pressure,or abscess height > 0.50 cm on CT images.During 48 h surveillance,surgery should be performed quickly for those who have no improvement or the above-mentioned symptoms.Patients at stage Ⅳ should be given surgical treatment in priority.

BACKGROUND:The role of atopy to aeroallergens in chronic rhinosinusitis without nasal polyps (CRSsNP) remains unclear. This study aimed to investigate the mucosal immunopathologic characteristics of CRSsNP with and without atopy to inhalant allergens.METHODS:Thirteen nonatopic CRSsNP patients, 9 atopic CRSsNP patients, and 11 nonatopic control subjects were enrolled in this study. The expression of type 1, 2, and 17 cytokines, growth factors, and chemokines for T cell subsets and granulocytes in sinonasal mucosa was detected using Bio-Plex suspension chip technology or enzyme-linked immunosorbent assay (ELISA). Subjective symptoms were scored on a visual analogue scale (VAS), while disease severity on computed tomography (CT) was graded by the Lund-Mackay CT scoring system.RESULTS:There was no significant difference in VAS and CT scores between atopic and nonatopic CRSsNP. Compared with control, both atopic and nonatopic CRSsNP demonstrated increased interferon γ (IFN-γ) levels in sinonasal mucosa. In contrast, although no difference in interleukin 5 (IL-5), IL-13 and eotaxin-1 expression, or mucosal eosinophil infiltration, was found between the control and whole CRSsNP group, atopic CRSsNP manifested an increased expression of IL-5, IL-13 and eotaxin-1, as well as an enhanced infiltration of mucosal eosinophils in comparison with control and nonatopic CRSsNP. Mucosal eosinophil infiltration correlated with IL-5 and eotaxin-1 expression. No difference in IL-12, IL-4, IL-6, IL-17A, IL-8, myeloperoxidase, "regulated upon activation normal T cell expressed and presumably secreted" (RANTES), or chemokine (C-X-C motif) ligand 10 (CXCL10) protein expression was found among control, atopic CRSsNP, and nonatopic CRSsNP.CONCLUSION:Atopic and nonatopic CRSsNP have distinct mucosal immunopathologic profiles. CRSsNP is a heterogeneous disorder consisting of multiple groups of biological subtypes, or "endotypes," which may argue for different therapeutic strategies.

随着医疗技术和解剖学的发展,鼻内镜技术不再局限于单纯的鼻窦炎和其框架的手术,已扩大到颅底和眼眶等区域病变的外科治疗,即扩大的经鼻内镜径路手术(expanded endonasal approach,EEA),它是指经鼻孔到达整个腹侧颅底的手术技术.EEA可以理解为经鼻、内镜、颅底手术(endonasal endoscopic skull base surgery,EESBS),这种经颅底开颅手术(craniectomy from below)与传统的经显微镜开颅手术相比,具有视野清晰、视角灵活、直达病变部位、脑组织牵拉创伤小、缩短住院时间、面部无瘢痕及提高患者生活质量等明显优势[1-5].正是由于EESBS所具备的以上优势,引起了鼻科及神经外科医师的共同关注.美国鼻科协会进行的问卷调查显示,EESBS已广泛应用到该协会成员的临床实践中,以致于建议修改手术术语编码和报销方式以适应这种发展[6-7].学者们也指出合格的内镜颅底外科人才的培养也要适应这种发展[1-5].

目的:采用TOPO TA克隆技术构建及鉴定人CC10基因表达载体,并在支气管上皮细胞系BEAS-2B细胞中获得稳定表达,初步探讨CC10在呼吸道上皮细胞炎症反应中的作用.方法:提取人下鼻甲组织的总RNA,逆转录反应生成cDNA,再用PCR方法扩增出含人CC10编码区全长的DNA片段,将PCR产物直接连接到pcDNA3.1N5-His TOPO TA载体中,转化至大肠杆菌后经筛选鉴定出CC10表达载体,用脂质体法将CC10质粒转染到BEAS-2B,细胞免疫荧光法检测CC10蛋白的表达.随后用促炎细胞因子IL-1β刺激转染空质粒和CC10质粒的BEAS-2B细胞,用实时定量RT-PCR和ELISA检测炎性趋化因子RANTESmRNA和蛋白的表达.结果:目的基因与TOPO TA载体在室温下5 min的连接反应效率91.7％,用酶切法鉴定质粒并测序,人CC10基因成功克隆到真核细胞表达载体pcDNA3.1中,CC10蛋白在BEAS-2B细胞中无表达,但在体外转染CC10质粒后CC10蛋白表达明显增高.转染CC10质粒的BEAS-2B细胞可抑制IL-1β诱导的RANTES mRNA和蛋白的表达.结论:利用TOPOTA克隆技术可高效、快速的构建人CC10基因表达载体,并能够在BEAS-2B细胞中获得稳定表达,CC10蛋白在呼吸道上皮细胞中可发挥抗炎作用.

目的:探讨可吸收性止血颗粒(Arista AH)在鼻内镜下经口腺样体吸切术创面止血上的应用效果.方法:54例腺样体肥大患者行鼻内镜下经口腺样体吸切术,随机分为四组,A组20例(压迫止血后喷洒Arista AH),B组15例(压迫止血后双极电凝止血),C组7例(压迫止血后Merocel高膨胀海绵填塞),D组12例(仅压迫止血).比较四组患者的止血时间、术后出血、咽痛持续时间、恢复正常通气时间等指标,同时采用视觉模拟评分法记录止血难度的主观评估.结果:A组手术时间、止血难度均低于B组、D组,差异具有统计学意义(P＜0.05),与C组无统计学差异(P＞0.05).而A组术后出血发生率低于D组(P＜0.05),与B组、C组无统计学差异.A组咽痛持续时间低于B组、C组,差异具有统计学意义(P＜0.05),与D组无统计学差异(P＞0.05).而A组恢复正常通气时间与B组、D组无统计学差异(P＞0.05).结论:可吸收性止血颗粒可用于鼻内镜下经口腺样体吸切术创面止血,具有快速简便、安全有效的特点.

Objective To explore the regulatory effect of miRNA on B-cell activating factor (BAFF) in chronic eosinophilic rhinosinusitis with nasal polyp (Eso CRSwNP).Methods Ten nasal mucosal samples were collected from Eso CRSwNP patients who were admitted and treated in our hospital between January 2012 and February 2013.Normal nasal mucosal tissues (n =10) served as control.The miRNA-targeting BAFF was predicted by bioinformatics tools.Immunohistochemistry and real time polymerase chain reaction (RT-PCR) were used to assess the protein expression of BAFF and the predicted miR-NA.The correlation between the predicted miRNA and BAFF was analyzed.Results Down-regulated expression of let-a was confirmed in Eos CRSwNP,while the BAFF protein expression was increased.Let-a was positively correlated with BAFF in nasal epithelia.Conclusions Let-a might contribute to mucosal eosinophilia in eosinophilic CRSwNP via targeting BAFF.

Background Clara cell 10-kDa protein (CC10) is a multifunctional protein with anti-inflammatory and immunomodulatory effects. Induction of CC10 expression by gene transfection may possess potential therapeutic effect. Nuclear factor κB (NF-κB) plays a key role in the inflammatory processes of airway diseases. Method/Results To investigate potential therapeutic effect of CC10 gene transfection in controlling airway inflammation and the underlying intracellular mechanisms, in this study, we constructed CC10 plasmid and transfected it into bronchial epithelial cell line BEAS-2B cells and CC10 knockout mice. In BEAS-2B cells, CC10's effect on interleukin (IL)-1β induced IL-8 expression was explored by means of RT-PCR and ELISA and its effect on NF-κB classical signaling pathway was studied by luciferase reporter, western blot, and immunoprecipitation assay. The effect of endogenous CC10 on IL-1β evoked IL-8 expression was studied by means of nasal explant culture. In mice, CC10's effect on IL-1β induced IL-8 and nuclear p65 expression was examined by immunohistochemistry. First, we found that the CC10 gene transfer could inhibit IL-1β induced IL-8 expression in BEAS-2B cells. Furthermore, we found that CC10 repressed IL-1β induced NF-κB activation by inhibiting the phosphorylation of IκB-α but not IκB kinase-α/β in BEAS-2B cells. Nevertheless, we did not observe a direct interaction between CC10 and p65 subunit in BEAS-2B cells. In nasal explant culture, we found that IL-1β induced IL-8 expression was inversely correlated with CC10 levels in human sinonasal mucosa. In vivo study revealed that CC10 gene transfer could attenuate the increase of IL-8 and nuclear p65 staining in nasal epithelial cells in CC10 knockout mice evoked by IL-1β administration. Conclusion These results indicate that CC10 gene transfer may inhibit airway inflammation through suppressing the activation of NF-κB, which may provide us a new consideration in the therapy of airway inflammation.