Multiparametric Analysis of Factors Associated With Eosinophilic Chronic Rhinosinusitis With Nasal Polyps.

Introduction: Previous studies have reported a diverse range of threshold values for blood eosinophilia. In addition, a single predictive biomarker for eosinophilic chronic rhinosinusitis (CRS) with nasal polyps (ECRSwNP) has not yet been identified. Objectives: The aim of this study is to compare the clinical characteristics of ECRSwNP and non-ECRSwNP to evaluate the preoperative risk of tissue eosinophilia of chronic rhinosinusitis with nasal polyps (CRSwNP) through a multiparametric statistical analysis. Methods: One hundred ten patients with evidence of chronic polypoid rhinosinusitis were included in this study and clinical records were retrospectively reviewed. Eosinophilic CRSwNP was diagnosed based on the presence of at least 10 eosinophils per high-power field. The demographic and clinical features of ECRSwNP and non-ECRSwNP are described. The values of blood eosinophilia as predictors of tissue eosinophilia have been identified using receiver operating characteristic curves. As the predictive value of the identified cutoff through regression analysis was low, we evaluated whether other risk factors could be statistically associated with ECRSwNP, and from this, a new predictive model was proposed for the identification of eosinophilic nasal polyps before surgery. Results: We found that the best method for predicting ECRSwNP is based on a model having asthma, blood eosinophil percentage, posterior ethmoid value in Lund-Mackay score, and modified Lund-Kennedy score as explanatory variables. Conclusions: This study provides new data for a better understanding of the polypoid CRS endotypes, and the proposed model allows the endotype to be identified preoperatively

Efficacy and use of benralizumab in patients with eosinophilic chronic rhinosinusitis

Abstract Chronic rhinosinusitis has a multifactorial etiology resulting from a dysfunctional interaction between various environmental factors and the host immune system. The patient of case report is affected by chronic rhinosinusitis with nasal polyps and a type 2 molecular pattern, has comorbid asthma and symptoms resistant to adequate medical and surgical therapy. The patient was treated with benralizumab, a mAb that binds IL-5Rα. The therapy resulted in a reduction in blood and tissue eosinophilia, but this was not associated with an improvement in the clinical and objective rhinological picture. Instead, at the lung level, there was a marked improvement in the control of severe asthma. Therefore, the patient was undergoing revision Full FESS in association with biological drug therapy. The patient showed an immediately improvement in the clinical and objective rhinological picture and this association allowed for control of the disease almost one year after surgery

A Rare Case of Hodgkin Lymphoma of the Maxillary Sinus.

Hodgkin lymphoma (HL) is an uncommon B-cell malignant disease. It usually presents with mediastinal and/or laterocervical lymph node localization, while primary extranodal HL is a rare entity giving rise to diagnostic and therapeutic challenges. It rarely presents as just extranodal localization, so its presence within the maxillary sinus without any lymphadenopathy is exceptional. Given the rarity of this localization, there is no standard treatment for maxillary sinus HL. We present a case of a patient with extranodal HL of the right maxillary sinus treated with primary surgery followed by adjuvant sequential chemoradiation therapy

Dupilumab in the treatment of severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP): A multicentric observational Phase IV real-life study (DUPIREAL)

Background Chronic rhinosinusitis with nasal polyps (CRSwNP) is associated with significant morbidity and reduced health-related quality of life. Findings from clinical trials have demonstrated the effectiveness of dupilumab in CRSwNP, although real-world evidence is still limited. Methods This Phase IV real-life, observational, multicenter study assessed the effectiveness and safety of dupilumab in patients with severe uncontrolled CRSwNP (n = 648) over the first year of treatment. We collected data at baseline and after 1, 3, 6, 9, and 12 months of follow-up. We focused on nasal polyps score (NPS), symptoms, and olfactory function. We stratified outcomes by comorbidities, previous surgery, and adherence to intranasal corticosteroids, and examined the success rates based on current guidelines, as well as potential predictors of response at each timepoint. Results We observed a significant decrease in NPS from a median value of 6 (IQR 5–6) at baseline to 1.0 (IQR 0.0–2.0) at 12 months (p < .001), and a significant decrease in Sino-Nasal Outcomes Test-22 (SNOT-22) from a median score of 58 (IQR 49–70) at baseline to 11 (IQR 6–21; p < .001) at 12 months. Sniffin' Sticks scores showed a significant increase over 12 months (p < .001) compared to baseline. The results were unaffected by concomitant diseases, number of previous surgeries, and adherence to topical steroids, except for minor differences in rapidity of action. An excellent-moderate response was observed in 96.9% of patients at 12 months based on EPOS 2020 criteria. Conclusions Our findings from this large-scale real-life study support the effectiveness of dupilumab as an add-on therapy in patients with severe uncontrolled CRSwNP in reducing polyp size and improving the quality of life, severity of symptoms, nasal congestion, and smell

Exploiting the Golden Ratio on Human Faces for Head-Pose Estimation

Abstract. In this paper, a novel method for automatic head pose estimation is presented. This is based on a geometrical model of the head, in which basic features for estimating the pose consist in eyes and nose coordinates only. Worth noting, the majority of state-of-the-art approaches requires at least five features. The novelty of our work is the exploitation of the Vitruvian man's proportions and the related "Golden Ratio". The "Vitruvian man" is the well-known master-work by Leonardo Da Vinci, never used for automatic head pose estimation. Proposed method is compared by experiments with state-of-the-art ones, and shows a competitive performance although its simplicity and its low computational complexity

A novel method for head pose estimation based on the "Vitruvian Man"

In video-surveillance and ambient intelligence applications, head-pose estimation is an important and challenging task. Basically, the problem lies in assessing the pose of the head according to three reference angles, that indicate the head rotation with respect to three orthogonal axes, and are named roll, yaw, and pitch angles. The problem becomes particularly difficult if only 2D video-sequences or still images are available, thus information about the depth of the scene is missing. This makes the computation of the pitch angle very difficult. State-of-the-art methods usually add the information on the pitch angle separately, and this makes them strongly dependent on the hardware used and the scene under surveillance. Moreover, some of them require large training sets with head poses data. Finally, the extraction of several features from the detected face is often necessary. Since head-pose estimation is only a (small) part of a video-surveillance system as a whole, it is necessary to find novel approaches which make the head-pose estimation as simple as possible, in order to allow their use in real-time. In this paper, a novel method for automatic head-pose estimation is presented. This is based on a geometrical model relying on the exploitation of the Vitruvian man’s proportions and the related “Golden Ratio”. Our approach reduces the number of features extracted, avoiding the need for a training set as well as information on the hardware used or the scene under control. Simple ratios among eyes and nose positions, according to the assumed “Golden Ratio”, are used to compute, in particular, the pitch angle. Proposed method performs competitively with respect to state-of-the-art approaches, without requiring their working constraints and assumptions

An unusual case of complicated rhinosinusitis of the sphenoid sinus involving the cavernous sinus and skull base: Endoscopic sinus surgery and medical therapy

Isolated sphenoid sinus diseases are generally asymptomatic and relatively uncommon with the potential for serious complications. Patients with this condition should be monitored closely and treated aggressively and either diagnostic or therapeutic intent is often indicated. In the management of a complex, life-threatening condition that involves many different fields of expertise, the otolaryngologist plays a key role in orchestrating different specialists and gaining direct access to the affected area, thus taking the first and essential step towards diagnosis and therapy. Because of the superiority of computed tomography in defining the bony margins and the superior soft tissue resolution of magnetic resonance imaging, these two techniques should be used in a complementary manner in the evaluation of isolated sphenoid sinus disease in addition to mapping the lesion better and identifying intracranial and intraorbital extent. We report an unusual case of isolated rhinosinusitis of the sphenoid sinus involving the cavernous sinus, pterygoid fossae and masticatory space in an immunocompetent patient