The nose is a structure of both cosmetic and functional importance. Cutaneous lesions of the nose occasionally represent a diagnostic challenge and involve the expertise of several specialties from dermatology, otolaryngology—head and neck surgery, infectious disease, and pathology, among others. We present a review of salient features of malignant and benign cutaneous nasal lesions which are of importance to physicians treating these complicated pathologies.
Uveitis, characterized by intraocular inflammation, has significant management challenges due to its diverse etiologies and complicated pathophysiology. The current first-line treatments primarily aim to calm inflammation with the underlying causes unaffected, often associated with systemic side effects, limited long-term efficacy, and disease recurrence. Gene therapies, as powerful therapeutic approaches, have been applied to treat various genetic and non-genetic diseases. However, the development of gene therapy for uveitis has been investigated less. This review discusses the possible targets and therapeutic approaches for uveitis gene therapy by analyzing some research examples in exogenous gene expression, RNAi, antisense therapy, and the CRISPR gene editing system. Furthermore, we discuss the limitations of listed gene therapies for uveitis and propose future research directions and potential strategies to overcome current challenges.
Purpose: To explore the optimal surgical excision treatment for external auditory canal (EAC) cholesteatoma involving the posterior wall and partial mastoid process.
Methods: This study included 115 inpatients (152 ears) diagnosed with EAC cholesteatoma involving posterior wall and partial mastoid from April 2022 to April 2024. Each patient underwent a canal-wall-up mastoidectomy, canaloplasty, and tympanoplasty. Preoperative clinical symptoms and hearing were compared with postoperative outcomes during follow-ups.
Results: All patients achieved a dry-ear status and remained relapse-free over the 0.5-2 years' follow-ups. The most salient improvements were observed in hearing loss, oltagia, and aural fullness after the surgical intervention.
Conclusion: For EAC cholesteatoma with the posterior canal wall and partial mastoid invasion, canal-wall-up mastoidectomy with reconstruction of the posterior canal wall is preferable, provided there are no severely extensive cholesteatomas present in the mastoid.
Introduction: Nasal alar defects pose significant challenges due to the nose's central role in facial aesthetics and function. Various causes, including skin cancer resection, necessitate effective reconstruction techniques. Despite several available methods, identifying an ideal approach remains elusive.
Methods: This study introduces a single-stage reconstruction technique employing the nasolabial-folded-flap (NFL) with conchal cartilage support. A structured patient questionnaire evaluated functional and aesthetic outcomes, pain, healing and satisfaction. The survey involved six patients who underwent nasal reconstruction using this approach in 12 months.
Results: Patients expressed high satisfaction with functional and aesthetic outcomes. Functional aspects received very satisfactory ratings (mean 1.7), with aesthetically appealing results (mean 2). Reconstructed noses harmonized well with patients' faces (mean 2), with a moderate impact on daily activities (mean 2.7). Mild pain was occasionally reported (median 2.2) and healing was perceived as very successful (median 1.5). Patients were highly satisfied with care and support (median 1) and felt adequately informed (median 1.5). They strongly recommended this reconstruction technique to others (median 1).
Discussion: The NFL with conchal cartilage support proves versatile and cosmetically pleasing in single-stage reconstruction for full-thickness nasal alar defects. Patients demonstrated a strong willingness to recommend this approach to individuals with similar defects, showcasing its potential advantages. Despite limitations, our findings underscore the prospects of this technique in nasal reconstruction.
Purpose: Allergic rhinitis (AR) is a pervasive global health problem, imposing a major economic burden and causing disability worldwide. Tongqiao-Biyan granule (TBG) has gained popularity in China for the treatment of AR. This study aimed to elucidate the molecular mechanism underlying TBG's efficacy in treating AR.
Methods: The Traditional Chinese Medicine pharmacological database was utilized to identify the main ingredients in TBG and their corresponding target genes. ARrelated target genes were identified using the GeneCards, OMIM, and DrugBank databases. The Gene Ontology (GO) network, Kyoto Encyclopedia of Genes and Genomes (KEGG), and target protein-protein interaction (PPI) network were employed to analyze the molecular mechanisms. The top five hub genes were selected for molecular docking with the top five ranked compounds to confirm their interaction in TBG when used in the treatment of AR.
Results: A total of 7 active ingredients from TBG, 784 predicted targets of TBG, and 945 AR targets were obtained. Analysis via the GO and KEGG databases revealed that TBG can act on AR by modulating inflammatory responses and promoting cell migration. PPI network analysis and molecular docking results suggested that phellopterin, quercetin, luteolin, denudatin B, and cleomiscosin A in TBG may alleviate the AR symptoms by interacting with key proteins such as TNF, AKT1, STAT3, VEGFA, and EGFR.
Conclusions: TBG modulates numerous targets across diverse signaling pathways in the AR therapy. Our results furnish a theoretical foundation for further exploring TBG's pharmacological mechanism in AR treatment.
Background: Understanding the complex three-dimensional (3D) anatomy of the nasal cavity, paranasal sinuses, and skull base, is difficult but essential for otolaryngology trainees, especially for endoscopic techniques. There is no effective teaching tool at the junior resident or medical student level allowing visualization and manipulation of these structures in 3D.
Objective: To create an interactive 3D app modeling the sinus and skull base for use by junior trainees learning surgical anatomy.
Methods: Using Adobe Photoshop, Cinema 4D, and ZBrush, surgeon and medical illustration teams collaborated to develop a tool combining schematic representation of relevant anatomy with radiologic and endoscopic correlates. This was then incorporated into a web application. Twenty-one junior residents and medical students were recruited to use the app, and pre-and post-app self-assessments and experience surveys were conducted to assess didactic efficacy.
Results: We created an online-compatible fully manipulatable schematic 3D representation of the nasal cavity, paranasal sinuses, and anterior skull base that is capable of anatomic layering. This schematic is presented alongside representative de-identified radiologic images and surgical principles with corresponding highlighted diagrammatic structures to demonstrate clinically relevant radiologic and endoscopic anatomy. There was a statistically significant improvement in anatomical knowledge in all 13 questions assessing didactic efficacy, with 85.7% of participants providing overall positive feedback.
Conclusions: Acknowledging the didactic utility in an early validation study with junior trainees, this sinus anatomy teaching tool offers a low-cost and highly accessible modality capable of demonstrating complex anatomical relationships to trainees learning sinus and endoscopic endonasal skull base surgery.
Background: Cataract, the leading cause of blindness worldwide, can significantly impair visual function.
Purpose: This study investigated the association between cataract-related falls among the elderly population in the Central region of Ghana.
Methods: The prospective cohort study among cataract patients aged 65 years and older, using purposive sampling to select facilities and consecutive sampling to recruit participants.
Results: The study achieved a 40% successful follow-up rate at 3 months post-surgery. Among the 500 older adult patients, 131 (26.2%) reported falls before undergoing cataract surgery. Of the 200 patients who had 24.0% falls pre-operatively, the prevalence of falls 3 months after surgical intervention was 16%. Demographics were not significantly associated with the risk of falling before cataract surgery (p > 0.05). However, participants with chronic conditions were 2.18 times more likely to fall than those without chronic conditions. Patients with hypertension (2.23 times) and diabetes (2.49 times) had higher risk of fall compared to those without these conditions. Additionally, patients with retinal conditions (2.86 times), and those with balance problems (1.86 times) were more prone to falling before surgical intervention than their counterparts without.
Conclusion: The study highlights the significant impact of cataract surgery in reducing fall prevalence among older adults.