Histopathologic parameters as predictors of response to endoscopic sinus surgery in nonallergic patients with chronic rhinosinusitis

OBJECTIVE: To estimate the predictable value of histopathologic parameters in chronic rhinosinusitis (CRS) for response to endoscopic sinus surgery (ESS). - - - - - STUDY DESIGN: Symptomatology was rated in 100 patients prior to as well as 12 and 24 months after surgery. Specimens taken during the procedure were examined and scored for goblet cells, subepithelial thickening, mast cells, and eosinophils. Multiple regression analysis was performed to predict the total score of subjective symptoms before treatment by histopathologic parameters. The correlation between histopathologic parameters and postoperative symptoms was then evaluated. - - - - - RESULTS: Goblet cells were the best predictor correlating with 5 symptoms. Subepithelial thickening correlated with 4 symptoms. Mast cell infiltration correlated with 3 symptoms. Eosinophilic infiltration correlated with only one symptom (P<0.05). - - - - - CONCLUSION: Certain histopathologic parameters in CRS are predictive of favorable response to ESS. - - - - - SIGNIFICANCE: Pathologic evaluation may help the ENT surgeon to predict the persistence of certain CRS symptoms after ESS, even in patients at low risk for surgical failure. - - - - - EBM rating: C-4

Road User Charging – Pricing Structures.

This project considers the extent to which the public could cope with complex price or tariff structures such as those that might be considered in the context of a national congestion pricing scheme. The key elements of the brief were: • to review existing studies of road pricing schemes to assess what information and evidence already exists on the key issues; • to identify what can be learned about pricing structures from other transport modes and other industries and in particular what issues and conclusions might be transferable; • to improve the general understanding of the relationship between information and people’s ability to respond; and • to recommend what further research would be most valuable to fill evidence gaps and enable conclusions to be drawn about an effective structure