American Journal of Rhinology & Allergy最新文献

{"title":"Improving the Accuracy of Maxillary Sinus Balloon Dilation Using Virtual Reality Navigation: A Proof-of-Concept Study.","authors":"Dennis M Tang,&nbsp;Kevin Grafmiller,&nbsp;Satyan B Sreenath,&nbsp;Arthur Wu,&nbsp;William C Yao,&nbsp;Raj Sindwani","doi":"10.1177/19458924231164844","DOIUrl":"https://doi.org/10.1177/19458924231164844","url":null,"abstract":"<p><strong>Background: </strong>The ability to reliably and accurately cannulate the natural ostium of the maxillary sinus during balloon sinus dilation (BSD) has been criticized. Conventional computed tomography (CT)-guided navigation systems are helpful when dilating other sinuses, but they fail to provide meaningful feedback to guide accurate dilation of the maxillary sinus.</p><p><strong>Objective: </strong>This study explores the potential impact of a new navigation system with virtual reality (VR) functionality on successful BSD of the maxillary sinus.</p><p><strong>Methods: </strong>Using the established methodology, a cadaveric evaluation of the accuracy of maxillary BSD with a VR-equipped navigation system and balloon was undertaken. The natural ostium was landmarked on CT images with a beacon, and a VR intrasinus camera view was used to guide balloon dilation by a team of 2 rhinologists. Following the procedure, uncinectomies were performed to directly assess the accuracy of dilation. Standardized video clips with a 30° endoscopic view of the area were reviewed by 3 blinded rhinologists from different institutions who were not part of the procedures. Dilation of the natural ostium was scored as \"successful,\" \"unsuccessful,\" or \"unsure.\"</p><p><strong>Results: </strong>Sixteen maxillary BSDs were completed in 8 cadavers using VR navigation. The medial wall of the maxillary sinus showing the natural ostium as well as any accessory ostia were readily visualized and labeled with a beacon in all cases using the 3D virtual rendering feature. Dilations were scored using a standardized rubric. Any \"unsure\" responses from the reviewers were categorized as \"unsuccessful\" for analysis purposes. The accuracy rate for dilation of the maxillary sinus natural ostium was 77%. Despite the use of cadaveric tissues, a fair interrater agreement (kappa 0.21) was achieved.</p><p><strong>Conclusion: </strong>Using VR navigation appears to improve the accuracy of cannulating the natural ostium during maxillary BSD, which could lead to better outcomes. Further study in live subjects is warranted.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":"37 4","pages":"464-469"},"PeriodicalIF":2.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10004305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MiR-214 Expression Is Elevated in Chronic Rhinosinusitis Mucosa and Regulates Lipopolysaccharide-Mediated Responses in Undifferentiated Human Nasal Epithelial Cell Culture.","authors":"Zhou Wang,&nbsp;Dong Lin,&nbsp;Yuxiang Zhao,&nbsp;Hui Liu,&nbsp;Ting Yang,&nbsp;An Li","doi":"10.1177/19458924231152683","DOIUrl":"https://doi.org/10.1177/19458924231152683","url":null,"abstract":"Background Chronic rhinosinusitis (CRS) is an inflammatory disorder of the upper airways. MicroRNAs (miRs) are reported to regulate several diverse physiological and pathological processes. Objective This study aimed to evaluate the impact of miR-214 on lipopolysaccharide (LPS)-mediated inflammation, and mucin 5AC (MUC5AC) expression in human nasal epithelial cells. Methods The expression of miR-214 was detected in CRS with polyps (CRSwNP) and CRS without polyps (CRSsNP) tissues. Cells were treated with LPS and a miR-214 inhibitor. The level of miR-214 was detected by quantitative real-time reverse transcriptase-PCR (qRT-PCR). The inflammatory cytokines (IL-6, IL-8, TNF, and IL-1β) and MUC5AC production were determined by qRT-PCR and ELISA. MUC5AC protein level was detected using western blot. Similarly, we determined the relationship between miR-214 and Sirtuin 1 (SIRT1) using the Dual luciferase activity assay. Results miR-214 was increased in CRSwNP and CRSsNP tissues. LPS triggered the expression of miR-214, while miR-214 inhibition diminished the level of miR-214. MiR-214 inhibition prevented LPS-mediated the production of inflammatory cytokines. LPS treatment augmented MUC5AC mRNA, protein levels, and secretion, whereas miR-214 loss inhibited MUC5AC production in the presence of LPS. SIRT1 is a direct target of miR-214. Impairing SIRT1 by siRNA (siSIRT1) or EX527 (a selective SIRT1 inhibitor) reversed the effects of miR-214 inhibitor on inflammation and MUC5AC expression. Furthermore, miR-214 depression inhibited the STAT3/GDF15 pathway via targeting SIRT1. Upregulation of STAT3 or GDF15 partly abolished the anti-inflammatory roles of miR-214 inhibitor. Conclusion Taken together, miR-214 regulates LPS-mediated inflammation and MUC5AC expression via targeting SIRT1, and STAT3/GDF15 may involve in the regulation of miR-214 inhibitor on inflammation and MUC5AC expression.","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":"37 4","pages":"391-401"},"PeriodicalIF":2.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9647563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"This Summer, Think Like a Vagabond.","authors":"Sanjeet V Rangarajan","doi":"10.1177/19458924231180674","DOIUrl":"https://doi.org/10.1177/19458924231180674","url":null,"abstract":"I am excited and honored to introduce the July 2023 issue of the American Journal of Rhinology and Allergy. As this issue finds its way to your desk, those of us in the northern hemisphere are enjoying the throes of summer. For many of us, summer brings warm temperatures, time off for longawaited vacations, and fuller homes as students take a break from school or college. Many of us in medicine more specifically recall July as a time of transition, when newly graduated residents take their first step into independent practice, fellows arrive in our institutions to hone their craft, and freshly minted interns take a stab (literally) at learning what it truly means to be a physician. For me, summer brings memories of growing up in Michigan, the birthplace of the American automotive industry, where I spent my summers playing, working, or taking the occasional road trip. When I was asked to introduce this summer edition of AJRA, an illustrative piece of Midwestern lore came to mind which, to me, mirrors the quest for innovation shared by our authors and readers alike. In the early 20th century, a few friends embarked on a series of legendary summer road trips across the United States. Between 1915 and 1924, their adventures took them from vast expanses of Great Lakes coastline to the Florida Everglades and many places in between. As they camped across the country, they found that they shared a penchant for innovation, and the trips became catalysts for remarkable conversations and fresh ideas which influenced their work upon returning home. One of these “fresh ideas” was to call themselves the Vagabonds. Today, the Vagabonds are better known to us as Thomas Edison, Harvey Firestone, and Henry Ford. The Vagabonds embodied the spirit of progress as they blended Edison’s inventive mind, Ford’s revolutionary approach to manufacturing, and Firestone’s tire expertise to leave an indelible mark on the automotive industry while road tripping down America’s first byways. The story of the Vagabonds serves as a reminder of the profound impact that friendship, enduring bonds, and collective ambition can have on inspiring progress. In the same way, the AJRA community’s pursuit of progress is driven by an inherent curiosity and a desire to improve patients’ lives. The impact of technology on our field cannot be overstated, and in this issue of AJRA we present several articles in which technological innovation is highlighted. Artificial intelligence (AI) represents one of the most highly publicized and discussed topics not just in rhinology, but across all fields. Since the introduction of natural language models such as ChatGPT at the end of 2022, AI has entered the public consciousness so rapidly and universally that it represents one of the most important themes of this year. In this issue, Osie et al examine AI in the field of rhinology in their timely scoping review. Their manuscript examines the current literature and highlights opportunities for future inves","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":"37 4","pages":"381-383"},"PeriodicalIF":2.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9679825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Scoping Review of Artificial Intelligence Research in Rhinology.","authors":"Gabriel Osie,&nbsp;Rhea Darbari Kaul,&nbsp;Raquel Alvarado,&nbsp;Gregory Katsoulotos,&nbsp;Janet Rimmer,&nbsp;Larry Kalish,&nbsp;Raewyn G Campbell,&nbsp;Raymond Sacks,&nbsp;Richard J Harvey","doi":"10.1177/19458924231162437","DOIUrl":"https://doi.org/10.1177/19458924231162437","url":null,"abstract":"<p><strong>Background: </strong>A considerable volume of possible applications of artificial intelligence (AI) in the field of rhinology exists, and research in the area is rapidly evolving.</p><p><strong>Objective: </strong>This scoping review aims to provide a brief overview of all current literature on AI in the field of rhinology. Further, it aims to highlight gaps in the literature for future rhinology researchers.</p><p><strong>Methods: </strong>OVID MEDLINE (1946-2022) and EMBASE (1974-2022) were searched from January 1, 2017 until May 14, 2022 to identify all relevant articles. The Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews checklist was used to guide the review.</p><p><strong>Results: </strong>A total of 2420 results were identified of which 62 met the eligibility criteria. A further 17 articles were included through bibliography searching, for a total of 79 articles on AI in rhinology. Each year resulted in an increase in the number of publications, from 3 articles published in 2017 to 31 articles published in 2021. Articles were produced by authors from 22 countries with a relative majority coming from the USA (19%), China (19%), and South Korea (13%). Articles were placed into 1 of 5 categories: phenotyping/endotyping (n = 12), radiological diagnostics (n = 42), prognostication (n = 10), non-radiological diagnostics (n = 7), surgical assessment/planning (n = 8). Diagnostic or prognostic utility of the AI algorithms were rated as excellent (n = 29), very good (n = 25), good (n = 7), sufficient (n = 1), bad (n = 2), or was not reported/not applicable (n = 15).</p><p><strong>Conclusions: </strong>AI is experiencing an increasingly significant role in rhinology research. Articles are showing high rates of diagnostic accuracy and are being published at an almost exponential rate around the world. Utilizing AI in radiological diagnosis was the most published topic of research, however, AI in rhinology is still in its infancy and there are several topics yet to be thoroughly explored.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":"37 4","pages":"438-448"},"PeriodicalIF":2.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10273866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9671002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Allergic Rhinitis in Preschoolers: A Systematic Review of Diagnostics.","authors":"Alana F Diniz,&nbsp;Juliana Ap Ribeiro,&nbsp;Georgia Vag Lira,&nbsp;Emanuel Sc Sarinho","doi":"10.1177/19458924221149267","DOIUrl":"https://doi.org/10.1177/19458924221149267","url":null,"abstract":"<p><strong>Background: </strong>Most studies that seek to analyze the prevalence of allergic rhinitis do not include preschool children and the diagnosis in this age group is difficult.</p><p><strong>Objective: </strong>Identify complementary tests to the diagnosis of allergic rhinitis in preschool children and verify if there is scientific robustness to propose a diagnostic algorithm for this condition in this age group.</p><p><strong>Methods: </strong>Systematic review of the literature in four databases: SCIELO, PubMed/MEDLINE, LILACS and SCOPUS. Each article was initially chosen by title, abstract and by the keywords \"allergic rhinitis,\" \"diagnosis\" and \"preschool.\" Those articles selected entered the complete reading and data extraction phase. The study was registered in the International Prospective Register of Systematic Reviews under number CRD42020207053.</p><p><strong>Results: </strong>Fourteen articles were suitable for analysis. In the assessment using <i>Quality Assessment of Diagnostic Accuracy Studies</i> - 2, all studies had at least one domain considered \"high risk\" or \"undetermined risk.\" Seven reports of nasal cytology, seven of specific IgE, four of immediate hypersensitivity skin test, one of nasal nitric oxide, three of total IgE and one of urinary leukotriene E4 were found. Eight articles evaluated more than one diagnostic test.</p><p><strong>Conclusion: </strong>There are no defined criteria for the diagnosis of allergic rhinitis in preschool children. Nasal cytology, serum specific IgE and immediate hypersensitivity skin test were the most used tests. A reliable diagnostic criterion in this age group is necessary so that in the future it is possible to propose a diagnostic algorithm for allergic rhinitis in preschool children.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":"37 3","pages":"360-368"},"PeriodicalIF":2.6,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9996396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-Hospital Cost Comparison for Open Versus Endoscopic Endonasal Approach for Meningioma Resection.","authors":"Arjun K Parasher,&nbsp;David K Lerner,&nbsp;Stephen P Miranda,&nbsp;Jennifer E Douglas,&nbsp;Jordan T Glicksman,&nbsp;Tyler Alexander,&nbsp;Theodore Lin,&nbsp;Darren Ebesutani,&nbsp;Michael Kohanski,&nbsp;John Y K Lee,&nbsp;Phillip B Storm,&nbsp;Bert W O'Malley,&nbsp;Daniel Yoshor,&nbsp;James N Palmer,&nbsp;M Sean Grady,&nbsp;Nithin D Adappa","doi":"10.1177/19458924221145893","DOIUrl":"https://doi.org/10.1177/19458924221145893","url":null,"abstract":"<p><strong>Objective: </strong>To determine the in-hospital cost implications of an endoscopic expanded endonasal approach (EEEA) for meningioma resection relative to the open transcranial approach.</p><p><strong>Methods: </strong>All anterior skull base meningioma surgeries performed over a period from January 1^st, 2015 to October 31th, 2017 were evaluated. The electronic medical record was reviewed for patient factors, tumor characteristics, and cost variables associated with each hospital stay and univariate analysis was performed using R software. All cost data were converted into August 2021-equivalent dollar amounts using the United States Bureau of Labor Statistics consumer price index.</p><p><strong>Results: </strong>Thirty-five patients met study criteria, including 27 patients undergoing an open transcranial approach and 8 undergoing an EEEA. Average length of stay for patients undergoing an open approach was 9.3 days compared to 5.6 within the EEEA group (<i>P</i> = .126). The average total in-hospital cost of patient undergoing an EEEA was $35417.1 compared to $46406.9 among patients undergoing an open transcranial approach (<i>P</i> = .168). On univariate analysis, the cost of an open transcranial approach relative to the EEEA was $10989.8 (<i>P</i> = .411).</p><p><strong>Conclusions: </strong>The open transcranial approach remained the dominant surgical approach to anterior skull base meningiomas over our study time period. However, despite limited patient numbers the EEEA was associated with decreased total in-hospital costs.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":"37 3","pages":"324-329"},"PeriodicalIF":2.6,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9262011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of CRSsNP Proteome Using a Highly Multiplexed Approach in Nasal Mucus.","authors":"Vanessa-Vivien Pesold,&nbsp;Olaf Wendler,&nbsp;Lisa Morgenthaler,&nbsp;Franziska Gröhn,&nbsp;Sarina K Mueller","doi":"10.1177/19458924221136651","DOIUrl":"https://doi.org/10.1177/19458924221136651","url":null,"abstract":"<p><strong>Background: </strong>Chronic rhinosinusitis without nasal polyps (CRSsNP) represents a phenotype of CRS, whose immunological mechanisms are still unclear. So far there are neither suitable biomarkers to determine the course of the disease nor an individual therapy.</p><p><strong>Objective: </strong>The purpose of this study was to characterize the CRSsNP endotype by identifying and validating non-invasive proteomic biomarkers.</p><p><strong>Methods: </strong>A highly-multiplexed proteomic array consisting of antibodies against 2000 proteins was used to identify proteins that are differentially expressed in the nasal mucus of the CRSsNP and control groups (n = 7 per group). The proteins identified to be most differentially expressed were validated in matched nasal mucus samples using western blots and enzyme-linked immunosorbent assay (ELISA). Validation was also done in a second cohort using western blots (CRSsNP n = 25, control n = 23) and ELISA (n = 30 per group). Additionally, immunohistochemistry in CRSsNP and control tissue samples was performed to characterize the selected proteins further.</p><p><strong>Results: </strong>Out of the 2000 proteins examined, 7 from the most differentially expressed proteins were chosen to be validated. The validation results showed that 4 proteins were significantly upregulated in CRSsNP mucus, including macrophage inflammatory protein-1beta (MIP-1β), resistin, high mobility group box 1 (HMGB1), and forkhead box protein 3 (FOXP3). Cartilage acidic protein 1 (CRTAC1) was not significantly upregulated. Two proteins were significantly downregulated including scavenger receptor class F member 2 (SCARF2) and P-selectin. All proteins selected are mainly associated with inflammation, cell proliferation/differentiation, apoptosis and cell-cell or cell-matrix interaction.</p><p><strong>Conclusion: </strong>Proteomic analysis of CRSsNP and control mucus has confirmed known and revealed novel disease-associated proteins that could potentially serve as a new biosignature for CRSsNP. Analysis of the associated pathways will specify endotypes of CRSsNP and will lead to an improved understanding of the pathophysiology of CRSsNP. Furthermore, our data contribute to the development of a reproducible, non-invasive, and quantitative \"liquid biopsy\" for rhinosinusitis.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":"37 3","pages":"348-359"},"PeriodicalIF":2.6,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9616820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Value and Clinical Application of Nasal Fractional Exhaled Nitric Oxide in Subjects with Allergic Rhinitis.","authors":"Aishah Harizah Abdullah Alwi,&nbsp;Farah Dayana Zahedi,&nbsp;Salina Husain,&nbsp;Aneeza Khairiyah Wan Hamizan,&nbsp;Baharudin Abdullah","doi":"10.1177/19458924221145084","DOIUrl":"https://doi.org/10.1177/19458924221145084","url":null,"abstract":"<p><strong>Purpose: </strong>Nitric oxide (NO) is a potential marker in the diagnosis and monitoring of treatment for the management of patients with allergic rhinitis (AR). The study aimed to determine the value of nasal fractional exhaled nitric oxide (FeNO) in the diagnosis and treatment response of AR patients.</p><p><strong>Methods: </strong>The participants were divided into control and allergic rhinitis groups based on the clinical symptoms and skin prick tests. The AR group was treated with intranasal corticosteroid after the diagnosis. The nasal fractional exhaled nitric oxide (FENO) levels were compared between control and AR groups. In the AR group, the visual analogue scale (VAS), Nasal Obstruction Symptoms Evaluation (NOSE) questionnaire, and nasal fractional exhaled nitric oxide (FeNO) were assessed pre- and post-treatment.</p><p><strong>Results: </strong>One hundred ten adults were enrolled. The nasal FeNO level was significantly higher in AR compared to control (<i>p</i> < 0.001). Both the subjective (VAS and NOSE), both (<i>p</i> <i><</i> 0.01) and objective (nasal FeNO, <i>p</i> < 0.001) assessments showed significant different pre- and post-treatment. The threshold level of nasal FeNO in the diagnosis of AR was 390.0 ppb (sensitivity of 73% and specificity of 80%) based on the receiver operator characteristic curve.</p><p><strong>Conclusion: </strong>Nasal FeNO level is significantly higher in AR compared to control group with significant difference pre- and post-treatment. The findings suggest nasal FeNO can serve as an adjunct diagnostic tool together with the monitoring of treatment response in AR.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":"37 3","pages":"307-312"},"PeriodicalIF":2.6,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9631206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Topical Intranasal Insulin Enhances Healing of Nasal Mucosa: An Experimental Animal Study.","authors":"Çağrı Külekci,&nbsp;Serdar Özer,&nbsp;Selin Önen,&nbsp;Petek Korkusuz,&nbsp;Taner Yılmaz","doi":"10.1177/19458924221139018","DOIUrl":"10.1177/19458924221139018","url":null,"abstract":"<p><strong>Objective: </strong>Aim of this study was to evaluate the effect of topical intranasal insulin on healing of nasal mucosa in a rat model.</p><p><strong>Methods: </strong>Forty-eight Wistar rats, weighing between 250 and 300 g and aged 10-12 weeks were used and randomized into two equal groups. 1.9 mm curette was introduced through the left nostril and 1.9 mm mucosa from the left nasal septum was curetted. Postoperatively, animals in the control group received 1 mL of physiologic saline, 3 times a day in a nasal irrigation fashion. Animals in the experimental group received 1 mL of 5 IU/mL regular insulin in saline solution. Subjects were sacrificed after 5, 10, and 15 days and macroscopic and histomorphometric evaluations were performed.</p><p><strong>Results: </strong>There were no mucosal synechiae and septal perforation macroscopically. Histological examination revealed that the defect size reduction was 21% in the saline group versus 56% in the insulin group on the fifth day (<i>p</i> = 0.006). There was 62% defect reduction in the saline group versus 79% in the insulin group on the 10th day (<i>p</i> = 0.034). On the 15th day, only 67% of saline group animals had complete defect closure, whereas 100% of animals treated with insulin had complete closure (92% vs 100% mucosal defect reduction, <i>p</i> = 0.036). Both edema and inflammation were less in the insulin group on 15th day (<i>p</i> = 0.006; <i>p</i> = 0.023, respectively).</p><p><strong>Conclusion: </strong>The results from this study support the safety and efficacy of topical insulin on wound healing in the literature. This study could guide further experimental studies that examine human sinonasal wound healing.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":"37 3","pages":"284-290"},"PeriodicalIF":2.6,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9621370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Allegations of Failure to Obtain Informed Consent in Otolaryngology: Evidenced-Based Recommendations for Sinus Surgeons.","authors":"Christian G Fritz,&nbsp;Dominic J Romeo,&nbsp;Anne S Lowery,&nbsp;Karthik Rajasekaran","doi":"10.1177/19458924221148566","DOIUrl":"https://doi.org/10.1177/19458924221148566","url":null,"abstract":"<p><strong>Background: </strong>Informed consent requires preoperative discussion of surgical risks, complications, and alternative treatment options. Allegations of incomplete informed consent are common in the field of otolaryngology.</p><p><strong>Objectives: </strong>Analyze outcomes and case variables in cases of alleged informed consent failure involving otolaryngologists.</p><p><strong>Methods: </strong>A legal research database containing state and federal case records from across the United States was retrospectively reviewed for malpractice claims involving informed consent and otolaryngology.</p><p><strong>Results: </strong>Among the 128 informed consent cases identified, 72.6% resulted in favorable verdicts for otolaryngologists. Functional endoscopic sinus surgery (FESS) was the most common source of informed consent litigation in the field of otolaryngology, with an incidence four-fold higher than the next most litigated procedure of uvulopalatopharyngoplasty (21.9% vs 5.4%). The top four factors cited in FESS-related cases were CSF leak (10), inadequate discussion of alternative therapies (4), diplopia (3), and meningitis (3). Cases resulting in a transient injury were significantly less likely to result in a payment from a plaintiff verdict or settlement (9.1%) as compared to payment-rates among cases involving permanent complications (34.6%) (<i>p</i> = 0.005).</p><p><strong>Conclusions: </strong>Failure to obtain informed consent is an important factor in medical malpractice litigation. This report identifies specific, actionable recommendations aimed at protecting sinus surgeons from liability and ensuring that patients are better informed.</p>","PeriodicalId":7650,"journal":{"name":"American Journal of Rhinology & Allergy","volume":"37 3","pages":"330-336"},"PeriodicalIF":2.6,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9262639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}