Anatomic findings in revision endoscopic sinus surgery: Case series and review of contributory factors

Background: It is recognized that patients who undergo endoscopic sinus surgery (ESS) do not always achieve control of their disease. The causes are multifactorial; variations in surgical practice have been identified as possible factors in refractory disease. Objective: To reflect on the frequent anatomic findings of patients with chronic rhinosinusitis (CRS) who require revision ESS. Methods: A retrospective review of patients who required revision ESS at a tertiary institution over a 3-year period. Patients for whom maximal medical therapy failed for CRS underwent computed tomography of the paranasal sinuses and image-guided surgery. Surgical records of anatomic findings were reviewed and analyzed. Results: Over 3 years, a total of 75 patients underwent revision procedures, 28% of all ESS performed in the unit. The most frequent finding was a residual uncinate process in 64% of the patients (n 48); other findings included a maxillary antrostomy not based on the natural ostium of the maxillary sinus in 47% (n 35), an oversized antrostomy in 29% (n 22), resected middle turbinates in 35% (n 26), middle meatal stenosis in 15% (n 11), synechiae in 29% (n 22), and osteitic bone that required drilling in 13% (n 10). Conclusion: Surgical technique can give rise to anatomic variations that may prevent adequate mucociliary clearance and medication delivery, which leads to failure in ESS in patients with CRS. This study demonstrated the surgical findings encountered in revision ESS that should be highlighted in the training of Ear, Nose and Throat surgeons to help prevent primary failure and reduce health care costs

Fibrosis Evaluation by Transient Elastography in Patients With Long-Term Sustained HCV Clearance

BACKGROUND: Reversibility of advanced fibrosis after HCV-clearance is an important goal of therapy. OBJECTIVES: Measuring liver stiffness (LS) by transient elastography (TE) might be helpful in this setting. PATIENTS AND METHODS: We evaluated 104 patients with biopsy-proven chronic hepatitis C (CHC) and sustained virological response (SVR) after Peg-Interferon (IFN) plus ribavirin since at least 18 months. HCV-eradication was confirmed searching for serum HCV-RNA (TMA® sensitivity > 5-10 IU/ml). Data from literature reported the best LS cut-off values for different stages of liver fibrosis were 7.1 kPa for Metavir stage 2 (F2), 9.5 kPa for F3 and 12.5 for cirrhosis (F4). RESULTS: TE was not reliable in four SVR obese patients. Metavir-stage of biopsy was F0-1 in 28, F2 in 47, F3 in 17 and F4 in eight patients. The median interval elapsed since achieving SVR was 36 months (range: 18-77, SD¬¬:18). Stratifying patients according to the histological stage assessed before treatment, a clear-cut gradient of LS values was observed from F0-1: median: 3.8 kPa (range: 3.5-4.9) to F2: 4.6 kPa (3.8-6.0), F3: 6.2 kPa (4.8-8.6) and F4: 8.4 kPa (6.2-9.2) (P = 0.001). Overall, 86 patients had lower values of LS than the expected LS values according to Metavir-stage. At multivariate logistic analysis γ-GT and histological steatosis were independently associated with persistence of higher values of LS. CONCLUSION: Long term responders to IFN-based therapies have lower LS values than those who are untreated and still viraemic. High levels of γ-GT and liver steatosis, all markers of insulin resistance, may hamper reduction of liver stiffness after HCV-clearance

Revealing the organic dye and mordant composition of Paracas textiles by a combined analytical approach

The object of this study is a wide selection of dyed cotton and camelid samples from an important collection of 2000-year-old Paracas textiles, now at the Museo Nacional de Arqueología, Antropología e Historia del Perú (MNAAHP; Lima; Peru) and at the National Museum of World Culture (NMWC; Gothenburg; Sweden). The threads, chosen as representative of the whole palette, were selected from eighteen different textiles. A combined spectroscopic and spectrometric analytical approach was selected to characterize the organic and inorganic composition of this wide set of samples. In particular, technical photography was used to gain a general overview of the samples, X-ray fluorescence (XRF) was employed for identifying the mordants and mapping the elemental distribution in the threads, while liquid chromatography coupled with diode array detector and with high-resolution mass spectrometry (HPLC–DAD, HPLC–HRMS) were used for characterizing organic dye composition. This study provides fundamental information on the mordants or other inorganic auxiliaries used in the dyeing processes, rarely investigated up to now, and to the varieties of vegetal sources employed in Paracas textiles. The widening of the Andean dyestuff database is highly important not only to acquire knowledge on Paracas culture, but also to ease the dye characterization of archaeological textiles from the Peruvian region and South American area in general.[Figure not available: see fulltext.]

Single-Molecule Localization Microscopy Reconstruction Using Noise2Noise for Super-Resolution Imaging of Actin Filaments

Single-molecule localization microscopy (SMLM) is a super-resolution imaging technique developed to image structures smaller than the diffraction limit. This modality results in sparse and non-uniform sets of localized blinks that need to be reconstructed to obtain a super-resolution representation of a tissue. In this paper, we explore the use of the Noise2Noise (N2N) paradigm to reconstruct the SMLM images. Noise2Noise is an image denoising technique where a neural network is trained with only pairs of noisy realizations of the data instead of using pairs of noisy/clean images, as performed with Noise2Clean (N2C). Here we have adapted Noise2Noise to the 2D SMLM reconstruction problem, exploring different pair creation strategies (fixed and dynamic). The approach was applied to synthetic data and to real 2D SMLM data of actin filaments. This revealed that N2N can achieve reconstruction performances close to the Noise2Clean training strategy, without having access to the super-resolution images. This could open the way to further improvement in SMLM acquisition speed and reconstruction performance

Assessing motor-related phenotypes of Caenorhabditis elegans with the wide field-of-view nematode tracking platform

Caenorhabditis elegans is a valuable model organism in biomedical research that has led to major discoveries in the fields of neurodegeneration, cancer and aging. Because movement phenotypes are commonly used and represent strong indicators of C. elegans fitness, there is an increasing need to replace manual assessments of worm motility with automated measurements to increase throughput and minimize observer biases. Here, we provide a protocol for the implementation of the improved wide field-of-view nematode tracking platform (WF-NTP), which enables the simultaneous analysis of hundreds of worms with respect to multiple behavioral parameters. The protocol takes only a few hours to complete, excluding the time spent culturing C. elegans, and includes (i) experimental design and preparation of samples, (ii) data recording, (iii) software management with appropriate parameter choices and (iv) post-experimental data analysis. We compare the WF-NTP with other existing worm trackers, including those having high spatial resolution. The main benefits of WF-NTP relate to the high number of worms that can be assessed at the same time on a whole-plate basis and the number of phenotypes that can be screened for simultaneously

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Tumefactive fibroinflammatory lesion of the frontal sinus

Objective: A 65-year-old man presented with a nine-month history of swelling in the midline of the forehead. After surgical intervention, this lesion was found to be a tumefactive fibroinflammatory lesion of the frontal sinus. This case report and review aims to report this new location for tumefactive fibroinflammatory lesion, and to discuss whether, in retrospect, there would have been alternative options to surgery.Methods: Case report and literature review.Results: Tumefactive fibroinflammatory lesions are rare. Although cases in the sinonasal tract have been described, none involving the frontal sinus have previously been reported. A review of the literature suggests that these lesions have an association with other fibroinflammatory lesions, and may be amenable to systemic steroid therapy.Conclusion: Each case should be managed on its merits, and a biopsy taken followed by subsequent screening for associated fibroinflammatory lesions. In the case of an isolated lesion, a surgical approach is probably favoured in a patient suitable for general anaesthesia

Allergic fungal rhinosinusitis – a new staging system

BACKGROUND: The existing Kupferberg post-operative endoscopic staging system for allergic fungal rhinosinusitis (AFRS) has 4 stages (0-3) based on the ‘global’ appearance of one side of the nose. Patients may however show visual improvement and yet remain at the same stage due to persistence in one sinus cavity, thus making the staging system ineffective. The aim of this study was to validate a new system that allows greater sensitivity in characterising the inflammation seen endoscopically. METHODOLOGY: A series of endoscopy videos of 50 patients with AFRS were retrospectively staged using a new ten-grade system, scoring each sinus cavity (maxillary, ethmoid, frontal and sphenoid) from 0-9 for increasing mucosal oedema and 1 point for the presence of fungal mucin giving a maximum score of 40 for each side of the nose. To assess reliability, 4 independent rhinologists were also asked to score the videos using the new system. RESULTS: A greater variety in the spectrum of mucosal disease was demonstrated with the new system allowing for a more descriptive analysis of its severity and its response, or lack of, to treatment. The inter-class correlation between the 6 total observers was 0.86 (95% CI: 0.83, 0.92). CONCLUSION: Use of the new staging system provides a more sensitive tool for following patients’ progress post-operatively in allergic fungal rhinosinusitis and in determining their response to treatment