RESUMEN
Chronic rhinosinusitis (CRS) has been known as a disease with strong infectious and inflammatory components for decades. The recent advancement in methods identifying microbes has helped implicate the airway microbiome in inflammatory respiratory diseases such as asthma and COPD. Such studies support a role of resident microbes in both health and disease of host tissue, especially in the case of inflammatory mucosal diseases. Identifying interactive events between microbes and elements of the immune system can help us to uncover the pathogenic mechanisms underlying CRS. Here we provide a review of the findings on the complex upper respiratory microbiome in CRS in comparison with healthy controls. Furthermore, we have reviewed the defects and alterations of the host immune system that interact with microbes and could be associated with dysbiosis in CRS.
Asunto(s)
Microbiota , Mucosa Nasal/microbiología , Rinitis/microbiología , Sinusitis/microbiología , Animales , Asma/genética , Asma/inmunología , Asma/metabolismo , Asma/microbiología , Bacterias/clasificación , Bacterias/genética , Biopelículas , Enfermedad Crónica , Susceptibilidad a Enfermedades , Hongos/clasificación , Hongos/genética , Predisposición Genética a la Enfermedad , Interacciones Huésped-Patógeno , Humanos , Metagenoma , Metagenómica , Mucosa Nasal/inmunología , Mucosa Nasal/metabolismo , Mucosa Respiratoria/inmunología , Mucosa Respiratoria/microbiología , Rinitis/genética , Rinitis/inmunología , Rinitis/metabolismo , Rinitis/terapia , Sinusitis/genética , Sinusitis/inmunología , Sinusitis/metabolismo , Sinusitis/terapia , Staphylococcus aureus/fisiología , Virus/clasificación , Virus/genéticaRESUMEN
BACKGROUND: Pneumatic dilatation is the first line therapy in achalasia, but half of patients relapse within 5 years of therapy and require further dilatations. AIM: To assess whether botulinum toxin injection before pneumatic dilatation is superior to pneumatic dilatation alone in achalasia patients. METHODS: Newly diagnosed achalasia patients were randomly assigned to receive botulinum toxin 1 month before pneumatic dilatation (botulinum toxin-pneumatic dilatation group: 27 patients with median age of 38) or to undergo pneumatic dilatation alone (pneumatic dilatation group: 27 patients with median age of 30). Response to therapy was assessed by clinical and objective methods at various intervals. RESULTS: One-year remission rate of patients in botulinum toxin-pneumatic dilatation group was 77% compared with 62% in pneumatic dilatation group (P = 0.1). In pneumatic dilatation group, the oesophageal barium volume significantly (P < 0.001) decreased at 1 month, but this reduction did not persist over 1-year follow-up. Botulinum toxin-pneumatic dilatation group showed a significant (P < 0.001) reduction in barium volume at the various times intervals post-treatment. In the botulinum toxin-pneumatic dilatation group, 10/11 (91%) patients over 40 were in remission at 1 year, comparing with only five of nine (55%) cases in pneumatic dilatation group (P = 0.07). CONCLUSION: Injection of botulinum toxin before pneumatic dilatation does not significantly enhance the efficacy of pneumatic dilatation.
Asunto(s)
Antidiscinéticos/administración & dosificación , Toxinas Botulínicas/administración & dosificación , Cateterismo/métodos , Acalasia del Esófago/terapia , Adulto , Factores de Edad , Antidiscinéticos/efectos adversos , Bario/análisis , Toxinas Botulínicas/efectos adversos , Cateterismo/efectos adversos , Acalasia del Esófago/fisiopatología , Esfínter Esofágico Inferior/efectos de los fármacos , Esfínter Esofágico Inferior/fisiopatología , Esófago/química , Esófago/fisiopatología , Femenino , Humanos , Inyecciones , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Recurrencia , Resultado del TratamientoRESUMEN
BACKGROUND: K-ras mutations are a key step in colorectal cancer progression. Such mutations have been widely studied in case series from Western countries but there are few data on the rate and spectrum of mutations in tumors from countries where the epidemiological features of the disease are different. PATIENTS AND METHODS: Tumor samples from 182 Iranian colorectal cancer patients (170 sporadic cases and 12 HNPCC cases) were screened for K-ras mutations at codons 12, 13 and 61 by sequencing analysis. The cases were also characterized for microsatellite instability at mononucleotide repeats by PCR and fragment analysis, and classified according to microsatellite instability status. The frequency and the spectrum of K-ras mutations were compared with those observed in a series of colorectal cancer patients from Italy. RESULTS: K-ras mutations were observed in 68/182 (37.4%) cases. Mutation frequencies were similar in HNPCC-associated, sporadic MSI-H and sporadic microsatellite-stable (MSS) tumors. However, the G13D substitution was more frequent in HNPCC (3/4, 75%) and sporadic MSI-H (7/11, 63.6%) tumors compared to sporadic MSS tumors (11/53, 20.4%) (P <0.01). Comparison of mutations in the two series from Iran and Italy showed a significantly higher frequency of G13D among Italian patients. CONCLUSIONS: While the frequency of K-ras mutations could be similar, the mutational spectrum could be differentially influenced by genetic and environmental factors.