Objectives The Lund-Mackay (LM) staging system for Chronic Rhinosinusitis (CRS) does not correlate with clinical parameters, likely due to its coarse scale. We developed a “Modified Lund Mackay” (MLM) system, which uses a 3D, computerized method to quantify the volume of mucosal inflammation in the sinuses, and sought to determine whether the MLM would correlate with symptoms and disease-specific quality of life. Methods We obtained Total Nasal Symptom Score (TNSS) and Sinonasal Outcomes Test (SNOT-22) data from 55 adult subjects immediately prior to sinus imaging. The volume of each sinus occupied by mucosal inflammation was measured using MATLAB algorithms created using customized, image analysis software after manual outlining of each sinus. Linear regression was used to model the relationship between the MLM and SNOT-22 and TNSS. Correlation between the LM and MLM was tested using Spearman's rank correlation coefficient. Results Adjusting for age, gender, and smoking, a higher symptom burden was associated with increased sinonasal inflammation as captured by the MLM (β=0.453, p<0.013). As expected due to the differences in scales, the LM and MLM scores were significantly different (p<0.011). No association between MLM and SNOT-22 scores was found. Conclusions The MLM is one of the first imaging-based scoring systems that correlates with sinonasal symptoms. Further development of this custom software, including full automation and validation in larger samples, may yield a biomarker with great utility for both treatment of patients and outcomes assessment in clinical trials.

Background Traditional methods of staging chronic rhinosinusitis (CRS) through imaging do not differentiate between degrees of partial mucosal sinus inflammation, thus limiting their utility as imaging biomarkers. We hypothesized that software-aided, quantitative measurement of sinus inflammation would generate a metric of disease burden that would correlate with clinical parameters in patients with suspected sinus disease. Methods Adults with rhinologic complaints undergoing CT imaging were recruited at an urban, academic, tertiary care center (n=45 with Lund-Mackay [LM] scores ≥ 4). 3D volumetric image analysis was performed using a semi-automated method to obtain a “Chicago-modified Lund-Mackay” (Chicago MLM) score, which provides a continuous scale to quantify extent of opacification. Linear regression was used to test the association of the Chicago MLM score with concurrent symptoms (total nasal symptom scores [TNSS]) and disease-specific quality of life (Sinonasal Outcome Test-22 [SNOT22]). Results Chicago MLM scores were significantly associated with both symptoms (p=0.037) and disease-specific quality of life (p=0.007). Inflammation in the ethmoid and sphenoid sinuses appeared to influence these associations. These findings were even more robust when analysis was limited to patients with more severe disease (LM>6). Conclusions The quantitative measurement of sinus inflammation by computer-aided 3D analysis correlates modestly with both symptoms and disease-specific quality of life. Posterior sinuses appear to have the greatest impact on these findings, potentially providing an anatomic target for clinicians to base therapy. The Chicago MLM score is a promising imaging biomarker for clinical and research use.

Objective: The aim of the study was to review the different etiologies and outcomes of patients with hepatic artery velocities greater than 200 cm/s. Methods: This retrospective study included 88 hospitalized patients in whom anglecorrected proper hepatic artery flow velocities greater than 200 cm/s were obtained during an abdominal ultrasonographic examination. Peak systolic hepatic artery flow velocities, hepatic artery resistance index, and portal vein flow velocities were evaluated. The patients were then allocated to one of four groups based on their primary underlying diagnosis: structural liver disease, nonstructural liver disease, generalized infection, or miscellaneous. Results: The median hepatic artery velocity was similar for all groups, ranging from 226 to 238 cm/s. The maximum portal venous velocities were not significantly different between groups. No lab values were statistically different between the groups, except total bilirubin that was greater in the nonstructural liver disease group (8 mg/ dL). Overall, 9/88 (10.2%) of patients with elevated hepatic artery velocity died within 30 days of their ultrasonographic examination. Conclusion: Elevated hepatic artery velocity greater than 200 cm/s in hospitalized patients is not specific to primary hepatobiliary disease but may indicate acute hepatic dysfunction from other causes such as infection or sepsis.

It is widely known that patients with chronic rhinosinusitis (CRS) commonly suffer from sleep disruption. Many of these patients have the associated diagnosis of obstructive sleep apnea (OSA). However, little is known about the risk factors for developing OSA in the CRS population. This study aims to identify these risk factors. METHODS: We performed a cohort study of 1004 patients with confirmed diagnostic criteria for CRS. Patient charts were reviewed to identify those with sleep study confirmed OSA. Patient charts were further reviewed for demographic information (age, ethnicity, race, sex, BMI) and medical history including: duration of CRS, presence of nasal polyps, number of endoscopic sinus surgeries, asthma, asthma hospitalizations, asthma ED visits, AERD, allergic rhinitis, eczema, food allergy, GERD, GERD treatment, anosmia and Lund-Mackay score (LMS). RESULTS: 970 patients were included. Logistic or linear regression analyses were performed to correct for BMI. Blacks were at higher risk for OSA (20.7% vs. 10.5% in Latinos and 8% in whites). Higher age was associated with higher risk for OSA. Male gender was a risk factor for OSA (14.2% in Male vs 9.4% Female). OSA was more common in CRSsNP patients. In CRSsNP cases, OSA was associated with GERD and duration of CRS. 25% of male CRSsNP patients above 40 had OSA; this prevalence increased to 40% in male black CRSsNP patients above 40yrs. CONCLUSIONS: Patients with CRS should be screened for OSA. Especially male, black CRSsNP cases who are older than 40 years old.