Zi Zhang

The bitter taste receptor T2R38 is an independent risk factor for chronic rhinosinusitis requiring sinus surgery

The bitter taste receptor T2R38 was recently described to play a role in upper airway innate mucosal defense. When activated by bacterial quorum‐sensing molecules, T2R38 stimulates the ciliated epithelial cells to produce nitric oxide (NO), resulting in bactericidal activity and an increase in mucociliary clearance (MCC). Polymorphisms within the T2R38 gene (TAS2R38) confer variability in activation of the receptor yielding dramatic differences in upper airway defensive responses (NO production and accelerated MCC) to microbial stimulation based on genotype. Our objective was to determine whether the nonprotective TAS2R38 polymorphisms, which render the receptor inactive, correlate with medically recalcitrant chronic rhinosinusitis (CRS) necessitating surgical intervention in the context of known risk factors, and thus identify whether the TAS2R38 genotype is an independent risk factor for patients undergoing functional endoscopic sinus surgery (FESS).

The effect of diabetes mellitus on chronic rhinosinusitis and sinus surgery outcome.

Patients with diabetes mellitus (DM) are known to be prone to infection. However, the association between diabetes and chronic rhinosinusitis (CRS) has not been well studied. We sought to determine the effects of DM on CRS culture results and quality of life (QOL) after functional endoscopic sinus surgery (FESS).

Clinical Factors Associated with Bacterial Biofilm Formation in Chronic Rhinosinusitis

Objectives. Bacterial biofilms appear to contribute to chronic rhinosinusitis. However, the mechanism behind biofilm formation in chronic rhinosinusitis remains poorly defined. The aim of this study is to evaluate clinical factors that may be associated with bacterial biofilm formation in chronic rhinosinusitis. Study Design. Cross-sectional study. Setting. Department of Otorhinolaryngology–Head and Neck Surgery at the Hospital of the University of Pennsylvania. Subjects and Methods. Five hundred eighteen patients with chronic rhinosinusitis were enrolled from 2007 to 2010. Samples were taken to evaluate for biofilm formation in vitro using a modified Calgary Biofilm Detection Assay. Clinical data were collected from chart review. Pearson’s χ2 and logistic regression were used for the analyses. Results. Of the patients, 108 (20.9%) showed biofilm formation in vitro. Bacterial biofilm formation in vitro was not significantly associated with polyps, allergy, Samter’s triad, sleep apnea, smoking status, age, or gender. However, it was significantly associated with positive culture results (odds ratio [OR] = 3.13; 95% confidence interval [CI], 1.85-5.29; P < .001), prior sinus surgeries (1.93; 1.01-3.69; P = .046), and nasal steroid use in the month prior to sample collection (2.09; 1.07-4.08; P = .030). Polymicrobial cultures, Pseudomonas aeruginosa, and Staphylococcus aureus comprised most of the samples. Conclusion. The results of this study suggest that the probability of bacterial biofilm formation is independent of many clinical factors considered to be risk factors for chronic rhinosinusitis. Further studies are needed to clarify the nature of the associations between prior sinus surgeries, nasal steroid use, and biofilm formation.

Quality of life improvement from sinus surgery in chronic rhinosinusitis patients with asthma and nasal polyps

It is unclear whether chronic rhinosinusitis (CRS) patients with both nasal polyps and asthma have different quality of life (QOL) improvement after functional endoscopic sinus surgery (FESS). We aimed to determine whether CRS patients with asthma and nasal polyps had a greater QOL improvement after FESS compared to patients without asthma or polyps.

Culture-inappropriate antibiotic therapy decreases quality of life improvement after sinus surgery.

Despite their widespread use, antibiotics have not been shown to improve chronic rhinosinusitis (CRS) outcomes. We aimed to determine whether culture‐inappropriate postoperative antibiotic therapy was associated with less quality‐of‐life (QOL) improvement following functional endoscopic sinus surgery (FESS).

Different clinical factors associated with Staphylococcus aureus and Pseudomonas aeruginosa in chronic rhinosinusitis

Staphylococcus aureus and Pseudomonas aeruginosa are common culture isolates in chronic rhinosinusitis (CRS). We aimed to determine whether they were associated with different clinical factors of CRS.

Biofilm-forming bacteria and quality of life improvement after sinus surgery.

It remains unclear how much chronic rhinosinusitis (CRS) patients with bacterial biofilms can benefit from functional endoscopic sinus surgery (FESS). We aimed to evaluate whether biofilm‐forming bacteria was associated with quality of life (QOL) improvement after FESS.

Coagulase-negative staphylococcus culture in chronic rhinosinusitis

Coagulase‐negative Staphylococcus (CoNS) is commonly isolated from patients with chronic rhinosinusitis (CRS). However, the role of CoNS in CRS remains controversial. We aimed to determine the association between positive CoNS culture at functional endoscopic sinus surgery (FESS) and CRS severity.

Bacteriology of inverted papilloma.

BACKGROUND Inverted papilloma (IP) is a benign lesion of the nasal cavity and paranasal sinuses. The aetiology of IP remains unclear. OBJECTIVE To assess whether the sinonasal bacteriology of patients with IP is different from the bacteriology of chronic rhinosinusitis (CRS) patients and if there are differences between primary and recurrent IP. METHODOLOGY A retrospective review of patients with IP at a tertiary referral centre. Intraoperative microbiology results from primary and revision IP resections were compared to each other and to published microbiology data from CRS patients. RESULTS Twenty-six cases of IP were identified with a total of 83 intraoperative cultures, of which 43 were positive. The most common isolates were coagulase negative Staphylococcus (SCN), Propionibacterium, Staphylococcus aureus, and Streptococcus. The trends in the prevalence of isolates were similar to those reported for CRS patients. Additionally, similar bacteriology was identified between primary and revision IP patients. CONCLUSION In our series, the most common bacterial isolates found in IP are similar to those of CRS, as is the prevalence of gram-negative organisms. Additionally, we did not demonstrate a difference between primary and recurrent IP. Our findings suggest that IP does not result from specific sinonasal microbial exposure.

The women in steady exercise research (WISER) survivor trial: The innovative transdisciplinary design of a randomized controlled trial of exercise and weight-loss interventions among breast cancer survivors with lymphedema

INTRODUCTION Breast cancer survivors face dual challenges: long term sequelae of treatment, and risk of recurrent disease. Obesity and a sedentary lifestyle complicate both challenges. The WISER Survivor trial assessed the effects of exercise and/or weight-loss on lymphedema, biomarkers of breast cancer recurrence, and quality of life. We report on the innovative transdisciplinary design of this trial and report attrition rates. METHODS This one year trial randomized breast cancer survivors who had a BMI of ≥25kg/m2, were sedentary and had breast-cancer-related-lymphedema to 1) exercise (weight training and aerobic exercise) 2) weight-loss 3) exercise and weight-loss 4) or control group. Innovative aspects included: adaptation of a community-based weight training program to a largely home-based program; use of a commercial meal replacement system as part of the lifestyle modification weight-loss program; inclusion of measures of cost-effectiveness to enable economic evaluations; and alignment with a parallel mouse model for breast cancer recurrence to enable transdisciplinary research. In this model, mice bearing dormant residual tumor cells, which spontaneously relapse, were placed on a high-fat diet. Overweight animals were randomly assigned to exercise, calorie restriction, both, or control group and followed for cancer recurrence. The animal model will guide mechanistic biomarkers to be tested in the human trial. RESULTS & DISCUSSION 351 participants were randomized; 13 experienced breast cancer recurrence during the trial. Of the 338 participants without recurrence, 83% completed the trial. The WISER Survivor trial will show the effects of exercise and weight-loss on lymphedema outcomes, biomarkers of recurrence and quality of life. NCT ClinicalTrials.gov registration #: NCT01515124.