Healthcare pathway discovery and probabilistic machine learning.

Background And Purpose: Healthcare pathways define the execution sequence of clinical activities as patients move through a treatment process, and they are critical for maintaining quality of care. The aim of this study is to combine healthcare pathway discovery with predictive models of individualized recovery times. The pathway discovery has a particular emphasis on producing pathway models that are easy to interpret for clinicians without a sufficient background in process mining.

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.

A randomized trial of mupirocin sinonasal rinses versus saline in surgically recalcitrant staphylococcal chronic rhinosinusitis.

Objectives/hypothesis: Chronic rhinosinusitis (CRS) recalcitrant to surgery is a frustrating clinical entity. Recently, mupirocin sinonasal rinses have been suggested as an efficacious treatment alternative in these patients where Staphylococcus aureus infection is demonstrated. To our knowledge, how best to treat this S aureus reservoir has not been previously evaluated in a double-blinded, randomized, placebo-controlled trial.

A sheep model to investigate the role of fungal biofilms in sinusitis: fungal and bacterial synergy.

Background: The role of fungi in the spectrum of chronic rhinosinusitis (CRS) is poorly understood. Fungal biofilms have recently been discovered in CRS patients. We have developed an animal model for the investigation of sinonasal fungal biofilms.

What is the origin of Staphylococcus aureus in the early postoperative sinonasal cavity?

Background: Despite increasing evidence of a role for Staphylococcus aureus (S. aureus) biofilms in chronic rhinosinusitis (CRS), the origin of this organism in the postsurgical sinonasal cavity had been unclear. Recently, we suggested that the increased culture rate of S.

Can bottle design prevent bacterial contamination of nasal irrigation devices?

Background: Saline nasal irrigation is a mainstay in the medical management of chronic rhinosinusitis (CRS) with proven efficacy. However, bacterial contamination of irrigation bottles has recently been reported and this may contribute to recurrent infections. Sterilization is effective but could a change in bottle design obviate the need for regular sterilization?

Methods: A total of 20 stable CRS patients were given a NasalCare® (Techworld Corporation, Inc.

Microbiological outcomes following mupirocin nasal washes for symptomatic, Staphylococcus aureus-positive chronic rhinosinusitis following endoscopic sinus surgery.

Background: Persistent infection following endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) is a frustrating entity for the patient and rhinologist alike. Mupirocin nasal washes have been proposed as an efficacious treatment in such patients. Two small studies have reported excellent short-term posttreatment outcomes; however, the long-term microbiological outcomes following treatment are not known; likewise, the rate of mupirocin-resistance following treatment has not been explored.

Patient-reported olfactory function following endoscopic sinus surgery with modified endoscopic Lothrop procedure / Draf 3.

Objectives/hypothesis: The Modified Endoscopic Lothrop procedure (MELP) or Draf 3 is a complex procedure, performed for chronic frontal sinusitis that is refractory to standard functional endoscopic sinus surgery. The procedure involves drilling of the frontal T (formed by the septum and middle turbinate`s attachment to the skull base) onto the olfactory fossa often with exposure of the first olfactory neuron and may affect olfactory function. This study was performed to assess patients` subjective sense of smell following this procedure.

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.

Do biofilms contribute to the initiation and recalcitrance of chronic rhinosinusitis?

Chronic rhinosinusitis is a common disease whose underlying aetiopathogenesis has not been completely understood. Amongst a range of other potential environmental triggers in this disease, a role has recently been proposed for bacterial biofilms. Adopting the biofilm paradigm to explain the initiation and maintenance of this disease may help to clarify previous inconsistencies in this disease that have resulted in the role of bacteria being questioned.

Different biofilms, different disease? A clinical outcomes study.

Objectives/hypothesis: A potential role for biofilms in Chronic Rhinosinusitis (CRS) has been proposed, and the adverse impact they have on disease severity and postoperative outcomes has also been well described. Recent advances have allowed the species within the biofilms of CRS patients to be clearly characterized. This study investigates whether different biofilm species have different disease outcomes.

Targeted imaging modality selection for bacterial biofilms in chronic rhinosinusitis.

Objectives/hypothesis: Biofilms are increasingly recognized as having an etiological role in chronic rhinosinusitis (CRS). Research into biofilms in CRS currently relies on microscopic imaging techniques, none of which are universally accepted. This study compares LIVE/DEAD BacLight (Invitrogen Corp.

Efficacy of different techniques of sinonasal irrigation after modified Lothrop procedure.

Background: Postoperative irrigation after endoscopic sinus surgery and endoscopic modified Lothrop procedure is used to remove nasal crusts and to improve wound healing. To evaluate the optimal application protocol for irrigation of the frontal sinus, a prospective cadaver study was performed.

Methods: An endoscopic modified Lothrop procedure and complete sphenoethmoidectomy were performed in 19 heads.

Pre- and postoperative sinus penetration of nasal irrigation.

Objective/hypothesis: Endoscopic sinus surgery is an accepted treatment for medically recalcitrant chronic rhinosinusitis. Effective saline douching may improve long-term outcomes of chronic rhinosinusitis but is often impaired by postoperative ostial stenosis. The aim of this study is to determine a critical ostial size at which douching solution reliably enters the sinus cavities.

Effects of a novel chitosan gel on mucosal wound healing following endoscopic sinus surgery in a sheep model of chronic rhinosinusitis.

Introduction: Postoperative bleeding and adhesion formation remain the two major problems after endoscopic sinus surgery (ESS). This study investigates the effect on adhesion formation and wound healing in a sheep model of chronic sinusitis of three topical agents: recombinant tissue factor (rTF, Dade Innovin, Marburg, Germany), poly-ethylene glycol (SprayGel, Confluent Surgical, Waltham, MA), and a novel chitosan-dextran derivative gel (CD, Department of Chemistry, University of Otago, Dunedin, New Zealand).

Methods: Twenty sheep with chronic sinusitis underwent ESS with standardized mucosal injuries created on the lateral nasal wall and the ethmoid region.

Standardized video-endoscopy and surgical field grading scale for endoscopic sinus surgery: a multi-centre study.

Background: Bleeding is a major concern in endoscopic sinus surgery (ESS), as it may impede surgical progress and is often associated with complications. To improve the study and management of intraoperative bleeding, a standardized method of recording bleeding during ESS is needed. The aim of this study was to develop a standardized method of documenting bleeding in ESS and of grading the surgical field.

Fungal allergens induce cathelicidin LL-37 expression in chronic rhinosinusitis patients in a nasal explant model.

Background: Fungus is thought to play an important role in some subgroups of chronic rhinosinusitis (CRS) patients with eosinophilic mucus (EMCRS). The cathelicidin LL-37 is an important innate defense peptide with antimicrobial activity but its responses in CRS and EMCRS patients have not been established. We investigated the innate immune responses of LL-37 in nasal tissue from CRS and EMCRS patients to fungal allergen challenge.

Surfactant protein d expression in chronic rhinosinusitis patients and immune responses in vitro to Aspergillus and alternaria in a nasal explant model.

Objectives/hypothesis: Common fungi have been implicated in the pathogenesis of chronic rhinosinusitis (CRS) with eosinophilic mucus (EMCRS). Surfactant protein (SP)-D plays an important role in the immune response to Aspergillus fumigatus in the lungs. We sought to determine whether SP-D is expressed in nasal mucosa and investigated the response of SP-D in vitro to fungal allergens.

Endoscopic anterior ethmoidal artery ligation: a cadaver study.

Objective: The objective of this study was to investigate the radiologic and endoscopic anatomy of the anterior ethmoidal canal (AEC) and feasibility of endoscopic ligation of the anterior ethmoidal artery (AEA).

Study Design: The authors conducted a prospective analysis of computed tomography (CT) of the paranasal sinuses and endoscopic cadaver dissection.

Methods: Twenty-two cadaver heads had CT scans of the paranasal sinuses.

A checklist for components of operating room suites.

Planning an operating room (OR) is a complex process, and it is common to find that essential items are overlooked. A checklist may be one measure for preventing this. An example of this is presented.

What surgeons want in operating rooms.

The wishes of surgeons for their operating rooms (ORs) are similar in principle to those of other workers for their work place - to be able to do their work accurately, productively, safely, and with satisfaction. To determine these wishes 40 Australian surgeons were asked what changes they would like in their operating rooms. From their responses there were 349 separate comments defined.

A prospective single-blind randomized controlled study of use of hyaluronic acid nasal packs in patients after endoscopic sinus surgery.

Background: The aim of this study was to determine whether there was any benefit or detrimental consequences of placing a hyaluronic acid pack (Merogel) into the middle meatus after endoscopic sinus surgery (ESS).

Methods: A randomized controlled blinded study was performed in 42 patients with chronic sinusitis undergoing ESS. The patients were randomized to receive Merogel on one side and no packing on the other side.

The effect of a hyaluronic acid-based nasal pack on mucosal healing in a sheep model of sinusitis.

Background: A hyaluronic acid-based nasal pack has been shown previously to have a beneficial effect on mucosal healing in a healthy sheep model. However, endoscopic sinus surgery (ESS) usually is performed in the presence of infection and inflammation. The aim of this study was to examine the efficacy of hyaluronic acid-based nasal packing on mucosal healing in a sheep model of chronic sinusitis.

The effect of the total intravenous anesthesia compared with inhalational anesthesia on the surgical field during endoscopic sinus surgery.

Background: Bleeding during endoscopic sinus surgery (ESS) may increase complications and negatively effect the surgery and its outcome. The aim of this study was to compare the surgical field in patients in whom total intravenous anesthesia (TIVA) is used as opposed to inhalation anesthesia. A prospective randomized controlled trial was performed.

Fungal-specific humoral response in eosinophilic mucus chronic rhinosinusitis.

Objectives/hypothesis: An immunoglobulin (Ig)E-mediated allergic pathogenesis is presumed in allergic fungal sinusitis (AFS), yet extensive polyps and eosinophilic mucus (EM) in the paranasal sinuses may also occur in the absence of allergy. Although a noninvasive fungal pathogenesis is presumed in all chronic rhinosinusitis with EM (EMCRS), fungal-specific nonallergic immune responses have not been thoroughly investigated. We tested the hypothesis that there is a fungal-specific humoral response in EMCRS and that it is not confined to IgE.