Recent studies have indicated the usefulness of endoscopic endonasal transsphenoidal approach (EETSA). A few studies have reported on the postoperative nasal symptoms of patients who have undergone EETSA. Therefore, we adopted a rhinologic perspective to compare preoperative and postoperative nasal symptoms after performing a binostril, four-hand EETSA. Patients who were scheduled to undergo binostril, four-hand EETSA underwent preoperative nasal evaluation using the Nasal Obstruction Symptom Evaluation (NOSE), Sino-Nasal Outcome Test-20 (SNOT-20), and a visual analogue scale (VAS) to assess several nasal symptoms. Repeat testing was performed 6 months postoperatively. Paired Student's t tests were used to compare preoperative and postoperative scores. A total of 142 patients who underwent a binostril, four-hand EETSA were included in this study. We found no statistically significant differences between preoperative and postoperative NOSE, total SNOT-20 scores, or scores on the VAS for nasal obstruction, sneezing, rhinorrhea, snoring, or facial pain. However, VAS of olfactory change increased significantly after EETSA (p < 0.05). The binostril, four-hand EETSA would be a useful method because it permits operative manipulability and a wide visual field for skull base lesions. However, rhinologists must consider postoperative nasal symptoms and perform a proper preoperative examination, especially with regard to the olfactory function, and inform patients scheduled for EETSA of potential postoperative changes.

PurposeAll-trans retinoic acid (ATRA) modulates immune responses by affecting T cells. Several studies have revealed that allergic inflammation of the lower airways is negatively associated with the vitamin A concentration. However, the role of ATRA in allergic inflammation of the upper airways is unclear. We investigated the effects of ATRA in an allergic rhinitis mouse model.MethodsBALB/c mice except control groups (CON group) were sensitized with and challenged intra-nasally with Dermatophagoides farina (AR group). The ATRA groups were administered ATRA intraperitoneally. The steroid groups were administered steroid intranasally (ST group). Allergic symptoms and the average eosinophil number were counted. Cytokines and transcription factors were measured by Real-Time PCR and Western blotting. Der f-specific immunoglobulin E (IgE) was measured. Flow cytometry results of CD4+CD25+Foxp3+ T cells were analyzed.ResultsThe symptom scores were lower in the ATRA group than in the AR group and higher than in the CON group. The levels of IgE were lower in the ATRA group than in the AR group and higher than in the CON and ST groups. The levels of Foxp3, TGF-β, and IL-10 mRNA, as well as the percentage of CD4+CD25+Foxp3+ T cells, were higher in the ATRA group than in theAR group. In the ATRA group the levels of IFN-γ mRNA were higher, and the levels of GATA-3 and IL-4 mRNA, and ROR-γt were lower. In Western blotting analyses, the expression patterns of all factors, except Foxp3, showed similar to those of mRNA expression.ConclusionsATRA has anti-allergic effects in an allergic rhinitis model, and its underlying mechanisms mainly include the induction of regulatory T cells and the inhibition of Th2 responses.

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