Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory disease of nasal cavity and paranasal sinuses characterized by inflammatory infiltration of nasal mucosa followed by damage to collagen framework, leading to tissue remodeling and polyp formation. Its pathogenetic mechanisms still remain obscure. To study appropriate trends, an evaluation of cellular immunity indices was carried out in twenty patients with the CRSwNP. Bilateral CRSwNP was clinically confirmed by endoscopic examination of nasal cavity and computed tomography scan of paranasal sinuses. In order to define the clinical phenotype of CRSwNP, allergy skin testing and a specific questioning were performed. As based on results of this study, the patients with CRSwNP were divided into following subgroups: CRSwNP + Asthma; CRSwNP + intolerance to non-steroid anti-inflammatory drugs (NSAIDs); CRSwNP + atopy. Common subpopulations of lymphocytes, such as CD3+, CD4+, CD8+, CD16+, CD19+, CD25+, CD27+, CD45+, CD45R0+, CD45RA+, CD56+ and CD127+ were detected in peripheral blood using flow cytometry techniques. Immunological data from 356 apparently healthy individuals were used as reference parameters for the control group. The study has revealed an increase in T regulatory (Treg) cells (CD4+CD25brightCD127lowtoneg), elevated absolute or relative amounts of NK cell numbers (CD3-CD16+CD56+) in parallel to sharply increased numbers of activated NKs (CD8+CD3-) in 100% of the patients, and higher absolute contents of memory B-cells (CD19+CD5-CD27+) in CRSwNP patients. When performing comparative analysis of immunological characteristics in peripheral blood between different subgroups (CRSwNP + Asthma; CRSwNP + intolerance to NSAIDs; CRSwNP+ atopy), and patients with uncomplicated CRSwNP (who didn’t have such pathology), we have proven significantly increased numbers of NKT lymphocytes (0.22±0.04), and decreased T lymphocyte activation index, i.e., a ratio of activated T helpers to memory T cells (CD4+CD45R0+) (24.4±1.72) among CRSwNP patients complicated by intolerance to NSAIDs. When comparing immunological characteristics of the patients with concomitant bronchial asthma to other subgroups, which have CRSwNP, or the patients with/without atopy, we have not detected any statistical differences for immune indexes studied (except elevation of blood eosinophils).

/pdf/pokazateli-kletochnogo-immuniteta-patsientov-s-khronicheskim-2a1h37kkyz.pdf

Показатели клеточного иммунитета пациентов с хроническим полипозным риносинуситом

Chronic rhinosinusitis (CRS) is a heterogeneous, multifactorial disease of unknown etiology, with an underlying deficient immune response to infectious and other triggers, leading to their incomplete elimination and persistence of inflammation Development of CRS is made possible by a deficient response of the innate immunity of nasal and paranasal sinus mucosa The main factors of non-specific defense system of nasal and paranasal mucosa are the function of cell junctions between epithelial cells, mucociliary clearance, pattern recognition receptors (PRRs), antigen presenting cells, and phagocytosis The multirowed ciliate epithelium of nasal and paranasal sinus mucosa is covered by a thick layer of mucus containing more than 200 proteins Changes in the qualitative composition of the nasal mucus in CRS manifests in overexpression of the main mucins MUC5AC and MUC5B and decreased synthesis of lactoferrin and lyzocin Ciliary dyskinesia or abnormalities in their microstructure lead to decreased efficacy of mucociliary clearance Diminished expression of proteins of tight junctions (TJ) ZO-1 and occluding results in decreased density of intercellular contacts and increased permeability of epithelial barrier In addition, CRS is characterized by deficient Tolllike receptors (TLR) 9, 2 and 4, as well as increased counts of M2 macrophages in the mucosa This results in suppressed phagocytosis and antimicrobial mucosal defense Lower levels of STAT3 protein causes an imbalanced reaction of innate and adaptive immune response and disordered reparation processes With abnormal functioning of all the above mentioned mechanisms, no immune elimination of infectious agents can take place, with increased susceptibility to viral and bacterial infections of the upper respiratory tract This opens the door to development of CRS, including that with polyps Investigation of the innate immunity factors would allow for predicting of inflammation in a given patient, as well as for development of new approaches to its conservative management

/pdf/mesto-vrozhdennogo-immuniteta-v-razvitii-khronicheskogo-3ljflllojc.pdf

Место врожденного иммунитета в развитии хронического риносинусита и перспективы тактики консервативного лечения

Chronic polypous rhinosinusitis does not subject to complete medicinal control; it is difficult to predict the prospects of the pathology development in each individual patient. Therefore, the search of new regimens of treatment of these patients is still in progress. An international consensus published in 2016, considers, inter alia, various groups of drugs for conservative treatment of polypous rhinosinusitis from the viewpoint of evidence-based medicine. We conducted a retrospective analysis of outpatient records and personal data of 1059 patients with polypous rhinosinusitis who underwent outpatient and inpatient treatment at the period from February 2016 to March 2018 in Moscow, Moscow Region and 26 regions of Russia. According to the results, in outpatient treatment, the basic therapy with intranasal glucocorticosteroids was performed in 92.4%, irrigation therapy – in 82.2% of cases, antihistamines were recommended in 79.4%. In case of hospitalization for surgical treatment, 16.6% of patients in Russian regions and 24% in Moscow Region had received no preliminary therapy for 6 months before hospitalization. In general, analyzing the management and treatment regimens of the patients with polypous rhinosinusitis, we found almost no deviations from the present-day domestic and foreign clinical guidelines. However, we observed prescription of some intranasal glucocorticosteroids, the leaflets of which contain no indications for polypous rhinosinusitis treatment.

/pdf/the-analysis-of-polypous-rhinosinusitis-treatment-regimens-3evdluld9t.pdf

The analysis of polypous rhinosinusitis treatment regimens in the Russian Federation

РОССИЙСКАЯ РИНОЛОГИЯ, 2, 2018 Термин «хронический риносинусит» (ХРС) упо­ требляется для обозначения целой группы пато­ логических состояний, возникающих по разным причинам и отличающихся многообразием последо­ вательности механизма развития воспаления слизи­ стой оболочки носа и околоносовых пазух. В зависи­ мости от присутствия или отсутствия полипов ХРС подразделяется на 2 группы: ХРС без полипов (CRSsNP) и ХРС с полипами (CRSwNP). Современ­ ные схемы лечения риносинусита базируются на ос­ нове этой фенотипической классификации, причем 38—51% пациентов остаются рефрактерными к стандартной терапии [1]. Оперативное лечение при CRSwNP зачастую не приводит к полному регрессу клинических симптомов, включая снижение обоня­ ния, и не гарантирует отсутствия рецидива [2]. НАУЧНЫЕ ОБЗОРЫ

The modern trends in the diagnostic search for and the treatment of chronic rhinosinusitis with nasal polyps

Acute rhinosinusitis is one of the most common outpatient diseases. The duration of antibiotic therapy in practice can be a cause of disagreement. The latest European guideline for rhinosinusitis EPOS 2020 does not specify clear terms for antibacterial therapy for acute bacterial rhinosinusitis, which suggests that they are determined by the attending physician based on the rate of regression of clinical manifestations in each specific clinical case. OBJECTIVE To analyze the treatment regimens of adult patients with acute rhinosinusitis in the system of the outpatient service of Administrative Directorate of the President of the Russian Federation in Moscow and compare these schemes with guidelines. MATERIAL AND METHODS A retrospective analysis of 2267 outpatient disease histories of patients who were on outpatient treatment with a diagnosis of acute rhinosinusitis treated by otorhinolaryngologists from 7 ambulance clinics for the period from January 2016 to May 2018 was performed. Diagnostic methods and treatment regimens of these patients were evaluated. RESULTS At the diagnostic stage, X-ray methods were recommended in 87% of cases, and ultrasound examination of the paranasal sinuses was performed in 4% of cases. Elimination and irrigation therapy was prescribed in 88.05% of cases (1996 people), maxillary sinus punctures were performed in 9.82% of cases, the average number of procedures was 2±1.3, treatment by displacement was performed in 31.8% of patients, the average number of procedures was 3±1.2. Antibiotic therapy was recommended in 77.4% of cases (1755 people), penicillin group drugs were prescribed in 41.5% of cases, macrolides in 30.5% of cases, cephalosporins in 20.7% of cases, and fluoroquinolones in 7.3% of cases. Intranasal glucocorticosteroids were submitted by 67.7% of patients (1535 people), mucolytics and mucoregulatory drugs - 41% of patients, decongestants for acute rhinosinusitis were recommended in 60.9% of cases, antihistamines - in 36.8% of cases. An average course of antibacterial therapy was 5.9±1.34 days, the recovery of the patients was observed on the background of complex treatment. CONCLUSIONS In general, in the system of the outpatient service of Administrative Directorate of the President of the Russian Federation, diagnostic and therapeutic measures are carried out in accordance with current clinical recommendations. There is a fairly high percentage of prescribing macrolides (30.5%) and fluoroquinolones (7.3%) in starting therapy, which is a violation of the principles of starting antibacterial therapy.

Analysis of current diagnostic and treatment approaches for acute rhinosinusitis according polyclinics data of the outpatient service of Administrative Directorate of the President of the Russian Federation

A review of the current problems of nasal polyposis has been presented. The results of an analysis mainly of foreign literature have been given, which is reflected in EPOS 2012.

[Chronic rhinosinusitis with nasal polyps. The recent trend in the studies of the pathogenesis, diagnosis and treatment of this disease].

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[Chronic rhinosinusitis with nasal polyps. The recent trend in the studies of the pathogenesis, diagnosis and treatment of this disease].