De Yun Wang

Distinct immunopathologic characteristics of various types of chronic rhinosinusitis in adult Chinese

BACKGROUND Chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP) is reported to be different in inflammatory patterns of the sinonasal mucosa in white patients. Studies in nonwhite populations may further be helpful to understand the pathogenic mechanisms of CRS. OBJECTIVE To investigate the immunopathologic profiles of CRSwNP and CRSsNP in adult Chinese. METHODS Histologic characteristics of surgical samples were analyzed in 50 controls, 94 CRSsNP patients, and 151 CRSwNP patients. Tissue samples from 17 controls, 36 CRSsNP patients, and 45 CRSwNP patients were stained for CD3, CD4, CD8, CD20, CD68, myeloperoxidase, and dendritic cell lysosome-associated membrane protein. Expression profiles of transcription factors of T-cell subsets in relation to cytokines and a marker of natural killer T cell (Valpha24) were examined by means of quantitative RT-PCR. RESULTS Over half of CRSwNP patients presented noneosinophilic inflammation. CRSwNP had a higher number of eosinophils, plasma cells, and CD3(+), CD8(+), CD20(+), and CD68(+) cells and a lower myeloperoxidase expression rate than CRSsNP. Expression levels of transcription factors and cytokines of T(H)1/T(H)2/T(H)17 were increased, whereas the expression rate of Forkhead box p3 and TGF-beta1 was decreased in both CRSsNP and CRSwNP compared with controls. Comparing CRSsNP and CRSwNP, CRSsNP had higher levels of IFN-gamma expression, whereas only eosinophilic CRSwNP demonstrated an enhanced expression of GATA-3 and IL-5. Compared with noneosinophilic CRSwNP, an exaggerated T(H)2/T(H)17 reaction and Valpha24 expression were found in eosinophilic CRSwNP. CONCLUSION Both Chinese CRSsNP and CRSwNP patients demonstrate impaired regulatory T cell function and enhanced T(H)1/T(H)2/T(H)17 responses. CRSsNP is confirmed to be a predominant T(H)1 milieu, whereas T(H)2 skewed inflammation with predominant T(H)17 reactions, and infiltration of natural killer T cells can be demonstrated only in eosinophilic CRSwNP, but not in noneosinophilic CRSwNP.

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008

J. Bousquet, N. Khaltaev, A. A. Cruz, J. Denburg, W. J. Fokkens, A. Togias, T. Zuberbier, C. E. Baena-Cagnani, G. W. Canonica, C. van Weel, I. Agache, N. A t-Khaled, C. Bachert, M. S. Blaiss, S. Bonini, L.-P. Boulet, P.-J. Bousquet, P. Camargos, K.-H. Carlsen, Y. Chen, A. Custovic, R. Dahl, P. Demoly, H. Douagui, S. R. Durham, R. Gerth van Wijk, O. Kalayci, M. A. Kaliner, Y.-Y. Kim, M. L. Kowalski, P. Kuna, L. T. T. Le, C. Lemiere, J. Li, R. F. Lockey, S. Mavale-Manuel , E. O. Meltzer, Y. Mohammad, J. Mullol, R. Naclerio, R. E. O Hehir, K. Ohta, S. Ouedraogo, S. Palkonen, N. Papadopoulos, G. Passalacqua, R. Pawankar, T. A. Popov, K. F. Rabe, J. Rosado-Pinto, G. K. Scadding, F. E. R. Simons, E. Toskala, E. Valovirta, P. van Cauwenberge, D.-Y. Wang, M. Wickman, B. P. Yawn, A. Yorgancioglu, O. M. Yusuf, H. Zar Review Group: I. Annesi-Maesano, E. D. Bateman, A. Ben Kheder, D. A. Boakye, J. Bouchard, P. Burney, W. W. Busse, M. Chan-Yeung, N. H. Chavannes, A. Chuchalin, W. K. Dolen, R. Emuzyte, L. Grouse, M. Humbert, C. Jackson, S. L. Johnston, P. K. Keith, J. P. Kemp, J.-M. Klossek, D. Larenas-Linnemann, B. Lipworth, J.-L. Malo, G. D. Marshall, C. Naspitz, K. Nekam, B. Niggemann, E. Nizankowska-Mogilnicka, Y. Okamoto, M. P. Orru, P. Potter, D. Price, S. W. Stoloff, O. Vandenplas, G. Viegi, D. Williams

Pharmacologic and anti-IgE treatment of allergic rhinitis ARIA update (in collaboration with GA2LEN)

The pharmacologic treatment of allergic rhinitis proposed by ARIA is an evidence‐based and step‐wise approach based on the classification of the symptoms. The ARIA workshop, held in December 1999, published a report in 2001 and new information has subsequently been published. The initial ARIA document lacked some important information on several issues. This document updates the ARIA sections on the pharmacologic and anti‐IgE treatments of allergic rhinitis. Literature published between January 2000 and December 2004 has been included. Only a few studies assessing nasal and non‐nasal symptoms are presented as these will be discussed in a separate document.

Assessment of septal deviation effects on nasal air flow: A computational fluid dynamics model

The purpose of this article is to analyze the effects of septal deviation on the aerodynamic air flow pattern compared with that of a normal nose by computational fluid dynamics (CFD) tools.

Identification of shared and unique immunoglobulin E epitopes of the highly conserved tropomyosins in Blomia tropicalis and Dermatophagoides pteronyssinus

Background Tropomyosin belongs to a class of highly conserved proteins in invertebrates and vertebrates. The invertebrate tropomyosins are allergenic in man with high IgE cross‐reactivity and have been therefore referred to as pan‐allergens.

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

Isam Alobid, MD, PhD1, Nithin D. Adappa, MD2, Henry P. Barham, MD3, Thiago Bezerra, MD4, Nadieska Caballero, MD5, Eugene G. Chang, MD6, Gaurav Chawdhary, MD7, Philip Chen, MD8, John P. Dahl, MD, PhD9, Anthony Del Signore, MD10, Carrie Flanagan, MD11, Daniel N. Frank, PhD12, Kai Fruth, MD, PhD13, Anne Getz, MD14, Samuel Greig, MD15, Elisa A. Illing, MD16, David W. Jang, MD17, Yong Gi Jung, MD18, Sammy Khalili, MD, MSc19, Cristobal Langdon, MD20, Kent Lam, MD21, Stella Lee, MD22, Seth Lieberman, MD23, Patricia Loftus, MD24, Luis Macias‐Valle, MD25, R. Peter Manes, MD26, Jill Mazza, MD27, Leandra Mfuna, MD28, David Morrissey, MD29, Sue Jean Mun, MD30, Jonathan B. Overdevest, MD, PhD31, Jayant M. Pinto, MD32, Jain Ravi, MD33, Douglas Reh, MD34, Peta L. Sacks, MD35, Michael H. Saste, MD36, John Schneider, MD, MA37, Ahmad R. Sedaghat, MD, PhD38, Zachary M. Soler, MD39, Neville Teo, MD40, Kota Wada, MD41, Kevin Welch, MD42, Troy D. Woodard, MD43, Alan Workman44, Yi Chen Zhao, MD45, David Zopf, MD46

A review of the implications of computational fluid dynamic studies on nasal airflow and physiology.

BACKGROUND Computational fluid dynamics has been adapted to studying nasal aerodynamics. AIM To review current literature on CFD studies, with an emphasis on normal nasal airflow, the impact of sinonasal pathology on airflow, and implications on nasal physiology. The objective is to provide the rhinologists with a greater understanding of nasal airflow and how symptomatology of sinonasal disease may be explained via CFD simulations. RESULTS The nasal valve region redirects inspiratory airstreams over the inferior turbinate in a high turbulent kinetic energy, which is important in heat and moisture exchange. The bulk of airflow occurs in the common meatus with small streams traversing the olfactory groove, increasing during sniffing. Septal deviation and enlarged inferior turbinate causes redistribution of airflow, changes in intranasal pressure and increased turbulence. High velocity airflow and wall shear stress at the septal perforation causes desiccation and mucosal damage. The airflow within an atrophic nasal cavity is predominantly laminar with minimal contact with nasal mucosa. The inferior turbinate is an important organ for air conditioning and preservation during surgery is highlighted. CONCLUSIONS Despite some limitations of CFD simulations, this technology has improved understanding of the complex nasal anatomy and the implications of disease and surgery on physiology.

Rhinitis: do diagnostic criteria affect the prevalence and treatment?

Background: Rhinitis is one of the worlds most common health problems. Diagnostic criteria used in community surveys may affect reported prevalence and treatment.

Changes of airflow pattern in inferior turbinate hypertrophy : A computational fluid dynamics model

Background Nasal obstruction (NO) is a very common symptom, but its effect on nasal physiology has not been fully understood. We performed this study to determine the effect of severity of NO due to inferior turbinate hypertrophy on airflow pattern using the computational fluid dynamics simulations. Methods A three-dimensional nasal cavity model was constructed from the MRI scans of a healthy human subject. Nasal cavities corresponding to healthy, moderate, and severe NO was simulated by enlarging the inferior turbinate geometrically, which can be documented by approximately one-third reduction of the minimum cross-sectional area (1.453 cm2 in the healthy nose) for the moderate (0.873 cm2) and two-thirds (0.527 cm2) for the severe obstruction. Results Total negative pressure through the nasal cavity increased during the inspiratory phase by almost twofold (-19 Pa) and threefold (-33 Pa) for moderate and severe blockage, respectively, compared with the increase of total negative pressure of -10 Pa in a healthy nose. In cases of moderate and severe blockage, a higher velocity and shear stress was observed at the nasopharynx and dorsal region of the nasal cavity. Moreover, nasal valve function will not exist in severe NO because of the changes of airflow pattern at the original nasal valve location. Conclusion Impairment of nasal airflow and physiology is evidenced in NO caused by inferior turbinate hypertrophy. Data of this study may help in predicting the aerodynamic effects of surgical correction of the inferior turbinate hypertrophy.

A clinical survey on compliance in the treatment of rhinitis using nasal steroids.

Background:  In the treatment of persistent rhinitis, the observed efficacy with intranasal steroids in clinical practice often falls short of that reported in clinical trials. We postulate that this could be due to patient non‐compliance and thus designed this study to evaluate the impact of patient compliance on the efficacy of treatment in patients with persistent rhinitis.