Variation in Human Research Ethics Committee and governance processes throughout Australia: a need for a uniform approach.

Background: In Australia, ethics committees across different states vary in application, requirement and process for the ethical review and approval for clinical research. This may lead to confusion and delays in the enablement of multicentre research projects. This study explores the effect of differing processes for Ethics and Governance in the establishment of the CovidSurg-Cancer study during the global COVID-19 pandemic.

Comparative bibliometric analysis of publications by past Royal Australasian College of Surgeons research scholarship recipients.

Background: The Royal Australasian College of Surgeons awards scholarships to surgeons, surgical trainees and recipients focused on developing their clinical knowledge and improving outcomes for patients. A bibliometric analysis of research scholarship recipients publications and h-index scores was conducted to understand the benefits of receiving these scholarships.

Methods: A bibliometric analysis of Royal Australasian College of Surgeons scholarship recipients in 2015 was performed using Open Researcher and Contributor ID (ORCID), Scopus, Google Scholar, ResearchGate, LinkedIn and PubMed to identify the number of publications, h-index scores, field-weighted citation impact and the relative citation ratio.

Part 2: Blockchain technology in health care.

Blockchain technology is one of the many disruptive technologies of the Fourth Industrial Revolution that will irrevocably change the way we live and work. These technologies are well embedded in the areas of global finance, health care and defence, to name a few. This review focuses on the relevance of blockchain technology to health care.

Part 1: Artificial intelligence technology in surgery.

Artificial intelligence (AI) is one of the disruptive technologies of the fourth Industrial Revolution that is changing our work practices. This technology is in use in highly diverse industries including health care, defence, insurance and e-commerce. This review focuses on the relevance of AI to surgery.

Screening and testing for COVID-19 before surgery.

Background: Preoperative screening for coronavirus disease 2019 (COVID-19) aims to preserve surgical safety for both patients and surgical teams. This rapid review provides an evaluation of current evidence with input from clinical experts to produce guidance for screening for active COVID-19 in a low prevalence setting.

Methods: An initial search of PubMed (until 6 May 2020) was combined with targeted searches of both PubMed and Google Scholar until 1 July 2020.

Personal protective equipment and evidence-based advice for surgical departments during COVID-19.

Background: Inconsistencies regarding the use of appropriate personal protective equipment (PPE) have raised concerns for the safety of surgical staff during the coronavirus disease 2019 (COVID-19) pandemic. This rapid review synthesizes the literature and includes input from clinical experts to provide evidence-based guidance for surgical services.

Methods: The rapid review comprised of targeted searches in PubMed and grey literature.

Safe surgery during the coronavirus disease 2019 crisis.

Background: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has created a global pandemic. Surgical care has been impacted, with concerns raised around surgical safety, especially in terms of laparoscopic versus open surgery. Due to potential aerosol transmission of SARS-CoV-2, precautions during aerosol-generating procedures and production of surgical plume are paramount for the safety of surgical teams.

The use of chitosan-dextran gel shows anti-inflammatory, antibiofilm, and antiproliferative properties in fibroblast cell culture.

Background: Chitosan-dextran gel has been used as an antihemostatic agent and antiadhesive agent after endoscopic sinus surgery. Because Staphylococcus aureus biofilms have been implicated in recalcitrant chronic rhinosinusitis, this study aimed to further investigate the (i) anti-inflammatory, (ii) bacterial biofilm inhibition, (iii) antiproliferative effects, and (iv) wound-healing properties of chitosan and chitosan-dextran gel.

Methods: Fibroblasts were isolated from human nasal tissue and were used to determine the effects of chitosan and chitosan-dextran gel on (i) cell proliferation, (ii) wound healing, (iii) inflammation in fibroblast cultures challenged with superantigens S.

The microbiome of chronic rhinosinusitis: culture, molecular diagnostics and biofilm detection.

Background: Bacteria and fungi are believed to influence mucosal inflammation in chronic rhinosinusitis (CRS). However their presence and relationship to disease is debated. This study used multiple detection methods to compare microbial diversity and microbial abundance in healthy and diseased sinonasal mucosa.

Bacterial-induced epithelial damage promotes fungal biofilm formation in a sheep model of sinusitis.

Background: Fungal biofilms have been discovered in chronic rhinosinusitis (CRS) patients, but factors contributing to their establishment are obscure. A recent animal study showed bacterial co-inoculation was required. We examine the role of 4 bacterial species and a cilia toxin on fungal biofilm formation in a sheep sinusitis model.

Noninvasive Staphylococcus aureus biofilm determination in chronic rhinosinusitis by detecting the exopolysaccharide matrix component poly-N-acetylglucosamine.

Background: The role that bacterial biofilms might play in recalcitrant forms of chronic rhinosinusitis (CRS) is increasingly being recognized. However, the detection of bacteria existing in this form, using standard culture, is limited by their unique metabolically inactive properties. All current biofilm diagnostic modalities require invasive mucosal biopsies, which limit their use to the operating theatre.

Fungicidal activity of lysozyme is inhibited in vitro by commercial sinus irrigation solutions.

Background: Lysozyme is an innate immune peptide with bactericidal and fungicidal activity (FA). Despite increased expression of lysozyme protein in chronic rhinosinusitis (CRS) sinus mucosa, CRS patients experience repeated bacterial and/or fungal infections. Commercial sinus irrigation solutions are often used to provide symptomatic relief.

Aspergillus fumigatus biofilm on primary human sinonasal epithelial culture.

Background: Bacterial biofilms have been implicated in chronic rhinosinusitis (CRS). However, direct evidence in support of fungal biofilms in sinus disease is lacking in the literature. This study was designed to develop and characterize an in vitro Aspergillus fumigatus biofilm model on primary human sinonasal epithelial cell culture.

Human lysozyme has fungicidal activity against nasal fungi.

Background: The cationic antimicrobial peptide lysozyme is the most prevalent innate immune protein in nasal secretions but there is a paucity of research regarding its role in paranasal sinus disease. Lysozyme is generally regarded as an antibacterial agent; however, some data suggest activity toward yeast. This study was designed to determine if lysozyme displays fungicidal activity toward fungi commonly identified in patients with chronic rhinosinusitis (CRS) or fungal sinusitis.

Methylglyoxal-infused honey mimics the anti-Staphylococcus aureus biofilm activity of manuka honey: potential implication in chronic rhinosinusitis.

Objectives/hypothesis: Low pH, hydrogen peroxide generation, and the hyperosmolarity mechanisms of antimicrobial action are ubiquitous for all honeys. In addition, manuka honey has been shown to contain high concentrations of methylglyoxal (MGO), contributing the relatively superior antimicrobial activity of manuka honey compared to non-MGO honeys. In high concentrations, manuka honey is effective in killing Staphylococcus aureus biofilms in vitro.

Aberrant mucin glycoprotein patterns of chronic rhinosinusitis patients with bacterial biofilms.

Background: Increasingly bacterial biofilms have been implicated in chronic rhinosinusitis (CRS), and conventional treatment methods have failed to completely eradicate biofilms. (1) Terminal sialic acids present on sinus mucosal glycoproteins are targets for bacterial adherence and biofilm formation. (2) A subpopulation of CRS patients is more susceptible to biofilm formation due to aberrant terminal sialic residue distribution patterns of glycoproteins on their mucosa.

Immunomodulatory effect of cytosine-phosphate-guanosine (CpG)-oligonucleotides in nonasthmatic chronic rhinosinusitis: an explant model.

Background: The use of cytosine-phosphate-guanosine-oligodeoxynucleotides (CpG-ODNs) or immunostimulatory sequences (ISSs) in the treatment of airway diseases is gaining interest. Binding of the CpG-ODN ligand to Toll-like receptor 9 (TLR9) triggers a shift from a Th2- to a Th1-type response in the target tissue. In this study, we explored the potential use of CpG-ODN to dampen the predominantly Th2-driven chronic inflammatory state in our cohort of patients.

Effect of nerve growth factor and keratinocyte growth factor on wound healing of the sinus mucosa.

The healing of the sinuses after sinus surgery is often compromised by the development of adhesions. The aim of this study was to determine whether nerve growth factor (NGF) and keratinocyte growth factor (KGF) aid epithelial and fibroblast wound healing after surgery. Two in vitro models were used to compare their effect on wound closure rates and expression of cell adhesion (E-cadherin), tight junction formation (zona occludens-1), cell proliferation (proliferative cell nuclear antigen and Ki67), and ciliogenesis (Foxj1 and beta tubulin IVb) genes by real-time reverse transcription polymerase chain reaction.

A sheep model for the study of biofilms in rhinosinusitis.

Background: Bacterial biofllms have been shown in chronic diseases such as cystic fibrosis, cholesteatoma, and otitis media with effusion. Recently, their detection on the mucosal tissue of sinusitis patients has implicated them in the pathogenesis of this condition. We present an animal model using sheep experimentally infected with Staphylococcus aureus to study the possible association between biofilm and sinusitis.

Response of peripheral blood lymphocytes to fungal extracts and staphylococcal superantigen B in chronic rhinosinusitis.

Background: Previous studies have suggested that chronic rhinosinusitis may result from a hypersensitivity response of the nasal mucosa to the presence of fungal antigens or staphylococcal superantigens in the nasal mucus. Both of these groups of antigens are present so frequently in the nasal mucus of patients with chronic rhinosinusitis that their presence together is likely to be a common event.

Objective: The objective of this study was to determine whether the combined presence of fungal antigens and staphylococcal superantigens exert a synergistic proinflammatory effect on peripheral blood lymphocytes from patients with chronic rhinosinusitis.

Do nasal polyps and inverted papilloma have similar disorders in cell cycle regulation?

Background: The aim of this study was to determine the expression of cell cycle regulation genes in patients with inverted papilloma (IP) and compare this with expression in patients with nasal polyps (NPs).

Methods: Tissue from 18 patients with IP and 5 patients with NPs were stained by immunohistochemistry techniques for p53 and p27. Measurement of the gene expression was performed by three assessors, who we blinded with respect to the specimens.