Search Results (1,134)

Background: Eosinophilic chronic rhinosinusitis (ECRS) is characterized by refractory nasal polyps and severely impaired mucociliary clearance (MCC). The molecular mechanisms underlying the modulation of mucociliogenesis following IL-4/13 blockade with dupilumab remain poorly understood, notwithstanding its proven clinical efficacy. Methods: Bulk RNA Barcoding and sequencing (BRB-seq) was performed on nasal polyp tissues collected from healthy controls (n = 6), patients with non-ECRS (n = 8), and patients with ECRS both before and four weeks after dupilumab treatment (n = 9) to identify the early molecular drivers underlying ciliary regeneration. Comprehensive gene-set scoring systems were developed to evaluate multiciliogenesis master regulators, master regulators of core/ciliary planar cell polarity (PCP) and PCP components. Interaction scores for epithelial-derived cytokines—thymic stromal lymphopoietin (TSLP), IL-25, and IL-33—were calculated based on ligand and cognate receptor subunit expression. Results: The ciliary master regulatory hierarchy (e.g., FOXJ1, RFX2/3), PCP components (CELSR1 and the ciliogenesis and planar polarity effector (CPLANE) module: FUZ, INTU, WDPCP), and structural ciliogenesis pathways were robustly restored following IL-4/13 blockade. The TSLP interaction score correlated with global mucosal damage, serving as a trigger for compensatory multiciliogenesis. The pre-treatment IL-33 interaction score emerged as a significant predictor of transcriptomic ciliary recovery (p < 0.05). DNASE1L3—the primary endonuclease for degrading eosinophilic extracellular traps (EETs)—remained persistently downregulated post-treatment. Conclusions: IL-4/13 blockade successfully restores the structural and directional “hardware” of the respiratory epithelium but fails to rectify the enzymatic “software” required for mucus degradation. This “residual molecular scar” may explain the persistent mucus hyperviscosity observed in some ECRS patients even after clinical polyp resolution. Full article

Background/Objectives: Chronic inflammatory conditions are increasingly conceptualized within biopsychosocial frameworks in which psychological processes shape illness experience and health-related quality of life (HRQoL). This study examined sex- and gender-related differences in emotional burden among patients with chronic rhinosinusitis with nasal polyps (CRSwNP), focusing on sleep disturbance as a potential factor associated with emotional distress. Methods: In a cross-sectional sample of 111 adults with CRSwNP, participants underwent clinical assessment and completed the Sino-Nasal Outcome Test. Independent-samples analyses examined sex differences in symptom severity and HRQoL domains. Hierarchical regression models tested whether emotional distress remained associated with sex after accounting for disease severity and sleep impairment. An exploratory mediation analysis with bootstrapped confidence intervals examined whether sleep disturbance accounted for this association. Results: Women reported greater emotional distress and sleep impairment than men despite comparable disease severity. Sex explained initial variance in emotional burden, while sleep impairment was the strongest predictor. Sex differences remained significant in the fully adjusted model. Mediation analyses suggested that sleep disturbance may be statistically associated with the relationship between sex and emotional distress. Conclusions: Emotional burden in CRSwNP reflects sex- and gender-related processes beyond clinical severity. Sleep disturbance may represent an important factor associated with emotional distress, supporting biopsychosocial models and integrated care. Full article

Background: Eustachian Tube Dysfunction (ETD) presents significant diagnostic challenges, particularly in patients with chronic nasal disease, which often mimic or complicate ETD symptoms. Tubomanometry (TMM) is emerging as an objective tool for diagnosing ETD, but its application in patients with concurrent nasal pathologies remains underexplored. Methods: One hundred patients with concurrent ETD and chronic nasal disease were recruited. They were categorized into three groups: chronic rhinitis (35 patients, group A), nasal septal deviation (31 patients, group B) and chronic rhinosinusitis with polyps (34 patients, group C). Treatments included nasal irrigation, septoplasty, and nasal polypectomy with functional endoscopic sinus surgery, respectively. The TMM parameters (R, C2 and C2–C1 scores) were assessed before and after interventions. The patient reported outcome measures (ETDQ-7 and NOSE scores) were also recorded and statistically correlated with TMM measures. Results: Group A showed improvements in R, C2 and C2–C1 scores and mild post-treatment reductions in ETDQ-7 and NOSE scores. Similar improvements were observed in Group B, with significant symptom reduction post-septoplasty, particularly on the side of the nasal septal deviation. Group C demonstrated the greatest improvement, with significant improvements in TMM values and substantial reductions in both ETDQ-7 and NOSE scores. The statistical results revealed correlations between the treatment of nasal pathologies and ETDQ-7 and NOSE scores. Conclusions: All TMM parameters improved in each group following the nasal intervention. This study highlights the utility of TMM in evaluating ETD in the context of chronic nasal disease and suggests that treating underlying nasal conditions can significantly alleviate ETD symptoms. Full article

Introduction: Obesity and colorectal cancer risk relationship is well-documented and bariatric surgery has become one of the most common surgical operations for losing weight. There is no guideline suggestion for the candidates of bariatric surgery for routine screening of colorectal cancer. The aim of this systematic review is to evaluate the place and necessity of screening colonoscopy before weight loss surgery under the light of published articles. Methods: A systematic literature review was conducted in accordance with PRISMA guidelines using electronic databases of PubMed and Google Scholar. The protocol was registered in the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY; registration number: INPLASY202630078). No restrictions were applied regarding the publication dates of the articles. We performed the PRISMA guidelines for systematic review and the PICOS framework was employed. Results: A total of 623 patients, 365 women and 258 men, underwent routine colonoscopy before bariatric surgery in three cohort studies. The average age and body mass index of the patients were 47.4 ± 10.4 (range 14–87) and 43.7 ± 7.1 kg/m², respectively. A total of 57 (9.1%) histologically confirmed pathologies were found during colonoscopy, 51 adenomatous polyps (8.1%) and six (1.0%) colorectal cancers. Five of the six CRC patients (83%) were over 45 years of age and three (50%) of them were over 60 years of age. Conclusions: The decision to screen bariatric surgery candidates for colorectal cancer should be individualized, based on age (≥45 years), family history, symptomatology, and comorbidities (inflammatory bowel disease). Bariatric surgeons should strongly consider colorectal cancer screening as part of preoperative workup in eligible patients. Full article

Juvenile Polyposis Syndrome (JPS) is an autosomal dominant disorder characterized by multiple gastrointestinal polyps and an increased risk of cancer, most commonly associated with mutations in the tumor suppressor gene Smad4. However, substantial phenotypic variability exists among individuals carrying identical mutations, suggesting the presence of genetic modifiers. In this study, we used the genetically diverse Collaborative Cross (CC) mouse population crossed with Smad4 knockout mice to identify loci influencing intestinal polyp development. A cohort of 260 F1 mice derived from 14 CC lines was assessed for polyp number and size across intestinal segments. Quantitative trait locus (QTL) mapping revealed several significant loci, including regions on chromosomes 16, 14, and 12, which were designated Ipsl1, Ipsl2, and Ipsl3 for Intestinal Polyposis Susceptibility locus (Ipsl), respectively, in the full population, as well as additional sex-specific loci in male and female cohorts. Pathway enrichment analysis of genes within these regions highlighted functional associations with immune signaling, ubiquitin–proteasome degradation, and metabolic regulation. Candidate genes, including STAM2, PSMD6, NAMPT, and CACNB4, emerged as potential modifiers of polyp susceptibility. These findings highlight the complex genetic architecture underlying JPS phenotypes and provide candidate loci for future functional and translational investigations. Full article

Background/Objectives: This study aimed to describe cumulative reproductive outcomes across three embryo transfer (ET) cycles after hysteroscopic endometrial polypectomy using a hysteroscopic tissue removal system (HTRS) and to identify determinants of cumulative and per-cycle pregnancy. Methods: In this single-center retrospective cohort study, we included infertile women who underwent HTRS-based endometrial polypectomy between January 2023 and December 2024 and subsequently initiated at least one ET cycle. Patients were followed from ET1 through ET3. The primary endpoint was the cumulative clinical pregnancy rate (CCPR) within three ET cycles. In the observed cumulative analysis, treatment discontinuation was considered as non-pregnancy. Kaplan–Meier (KM) analysis was used to estimate the cumulative pregnancy probability, with treatment discontinuation considered as censoring. Multivariate logistic regression and generalized estimating equations were used to identify patient-level and cycle-level predictors. Results: Among 100 patients, 79 achieved clinical pregnancy within three ET cycles (CCPR 79.0%). The KM estimate at ET3 was 87.4%, and the cumulative live birth rate was 65.0%. Pregnancy rates declined with advancing maternal age (≤34 years, 91.9%; 35–39 years, 78.3%; ≥40 years, 52.9%). Maternal age independently predicted lower cumulative pregnancy and lower per-cycle pregnancy probability, whereas blastocyst transfer was associated with a higher probability of pregnancy per cycle. Conclusions: In women who underwent ET after HTRS polypectomy, cumulative pregnancy across three ET cycles was relatively high; however progression to live birth declined with advancing maternal age. As no non-surgical comparison group was included, these findings should be interpreted as descriptive rather than causal. Full article

Interleukin-5 (IL-5) has long been positioned as a lineage-restricted cytokine primarily responsible for eosinophil differentiation and survival. However, emerging mechanistic and clinical evidence supports a broader conceptual shift: IL-5 should no longer be viewed solely as an eosinophil growth factor, but as a context-dependent regulator embedded within dynamic airway immune networks. Drawing on advances in eosinophil subset biology, receptor signaling, and tissue-level immune crosstalk, this review reframes IL-5 biology through the lens of systems-level inflammatory regulation across airway and systemic eosinophilic diseases. Recent data reveal functional heterogeneity between resident and inflammatory eosinophil subsets, challenging the assumption that blood eosinophilia uniformly reflects pathogenic activity. In parallel, functional IL-5 receptor expression has been identified on multiple structural and immune cell populations—including epithelial cells, mast cells, plasma cells, basophils, neutrophils, and fibroblasts—supporting a broader tissue-signaling paradigm. Experimental and translational studies further link IL-5 to epithelial integrity, airway remodeling, and mucus pathology, suggesting structural and network-level effects beyond simple eosinophil depletion. Comparative analyses across asthma, chronic rhinosinusitis with nasal polyps, and COPD demonstrate that eosinophilic inflammation is biologically heterogeneous and context-dependent. While IL-5-targeted therapies yield consistent benefit in severe asthma, therapeutic responses in other airway diseases appear to be shaped by local tissue architecture and mixed inflammatory programs. Together, these observations illustrate a paradigm shift from pathway-specific inhibition toward network-informed disease control and highlight key areas for future mechanistic investigation. Full article

Eosinophils are multifunctional granulocytes that reside constitutively within mucosal tissues, where they engage in bidirectional communication with the epithelial cells lining the respiratory and gastrointestinal (GI) tracts. Once regarded solely as terminal effectors of the type 2 immunity, eosinophils are now recognized as key regulators of epithelial homeostasis and barrier integrity. Epithelial cells initiate crosstalk by releasing the alarm cytokines such as interleukin (IL)-33, thymic stromal lymphopoietin (TSLP), and IL-25, which drive eosinophil recruitment, activation, and tissue retention. Conversely, eosinophils modulate epithelial function through the release of granule proteins, cytokines, and growth factors with both damaging and reparative consequences. In the airway, this crosstalk underpins the pathogenesis of eosinophilic asthma and chronic rhinosinusitis with nasal polyps (CRSwNP), in part via eosinophil-derived mediators that disrupt tight junction integrity and fuel remodeling. In the GI tract, homeostatic eosinophils support villous architecture, epithelial turnover, and goblet cell differentiation through microbiota-driven IL-33 signals and neuropeptide-mediated neuroimmune pathways, whereas dysregulated crosstalk promotes eosinophilic esophagitis (EoE) and inflammatory bowel disease (IBD). This review synthesizes recent research to delineate the molecular mechanisms of eosinophil–epithelial crosstalk across mucosal compartments, highlight tissue-specific differences and shared mechanistic themes, and discuss the implications of these findings for targeted therapy. Full article

Inflammation at the superior airway level has multiple manifestations, and allergic rhinitis and chronic rhinosinusitis with or without polyps are two of the most frequent and troublesome of them, with innate and adaptive immunity being implicated. Dendritic cells, epithelial cells, neutrophils, macrophages, mucosal mast cells, eosinophils, basophils, innate lymphoid cells (ILCs), and NK cells are the players in innate immunity, while regulatory T (Treg), TH1, TH2, TH17, T follicular helper, and B cells are components of the adaptative immune system. Th9 cells, a subset of T helper cells discovered in 2008 that produce interleukin-9 (IL-9), play a vital role in the adaptive immune response and have advantageous and harmful effects in different diseases due to the induction pattern. We queried international databases for current, up-to-date information regarding the interplay between interleukin 9 (IL-9) and helper T cells (especially Th9 cells), and by other immune cells. Interleukin-9 has multiple immunological functions, acting on various target cells through its specific receptor (IL-9R), such as the following: the regulation of allergic (Th2-type) immune responses; effects on epithelial and mucosal cells, mast cells, and eosinophils; chronic inflammation; and autoimmunity. Thus, there is a further need to translate laboratory findings into clinical practice regarding IL-9. Full article

Colorectal cancer screening is challenged by variations in polyp morphology, indistinct polyp boundaries, and the high computational costs associated with current models. To address these issues, a lightweight medical image segmentation model, WCEDSAM, has been developed. WCEDSAM is based on a modified, compact version of MedSAM, which incorporates a Wavelet Transform-based component to extract and separate overlapping features at the pixel level. Additionally, a DSConv-ECA module is positioned before the ViT encoder to capture local features efficiently while reducing parameter count and enhancing inter-channel communication. Experimental results demonstrate that WCEDSAM achieves top performance on five public datasets, including Kvasir-SEG and CVC-ClinicDB, with 15.38 million parameters, achieving mean Dice (mDice) scores of 0.9383 on Kvasir-SEG and 0.9376 on CVC-ClinicDB. Cross-domain evaluations yield mDice scores of 0.9189 on CVC-ColonDB, 0.8961 on CVC-300, and 0.7765 on ETIS datasets, respectively, substantially outperforming other methods such as UNet++ and TransUNet. Full article

Early detection and accurate segmentation of colorectal polyps during colonoscopy are crucial for the prevention of colorectal cancer. However, automated polyp segmentation remains challenging because of high inter-class variance, complex intestinal backgrounds, and blurred boundaries. To address these issues while maintaining computational efficiency, DSF-BRNet was developed for endoscopic polyp segmentation. In this framework, a Dual-Gated Semantic Fusion (DSF) module is introduced to reduce spatial misalignment between cross-level features and to provide a more reliable semantic basis for lesion localization. To further alleviate boundary ambiguity, a High-Frequency Boundary Refinement (HBR) module is used to sharpen segmentation contours under aligned semantic guidance. Together, these components form an Align-then-Refine framework in which semantic localization is strengthened before boundary refinement is performed. Experiments on four public benchmark datasets—Kvasir-SEG, CVC-ClinicDB, CVC-ColonDB, and ETIS-LaribPolypDB—showed competitive performance with favorable computational efficiency. Mean Dice scores of 0.943 on CVC-ClinicDB and 0.818 on ETIS-LaribPolypDB were achieved, with 25.55 M parameters and an inference speed of 80.08 FPS. These results indicate that accurate semantic localization and fine boundary preservation can be achieved simultaneously, suggesting that the method may be promising for real-time computer-aided diagnosis (CAD). Full article

Introduction: Colorectal cancer remains a leading cause of cancer-related morbidity and mortality, with adenomatous polyps representing a common precursor. Post-polypectomy polyp recurrence represents a significant risk of colorectal cancer, driving periodic colonoscopy surveillance and polypectomy as needed. In this study, we explore a multimodal machine learning approach that integrates endoscopic imaging with clinical and pathology data to improve recurrence risk prediction and support individualized surveillance planning. Methods: We developed and evaluated a multimodal artificial intelligence (AI) model to predict post-polypectomy colorectal polyp recurrence using the ERCPMP-v5 dataset. The cohort included 217 patients with 796 high-resolution endoscopic RGB images and 21 endoscopic videos; video data were converted to still frames at 2 frames per second. Images and frames were resized to 224 × 224 pixels and normalized. Patient-level demographic, morphological (Paris, Kudo Pit, JNET), anatomical, and pathological variables were encoded using standard scaling for continuous features and one-hot encoding for categorical features. Visual representations were extracted using a pretrained Vision Transformer backbone (ViT-Base-Patch16-224) with frozen weights. Structured metadata (79 variables) was encoded using a multilayer perceptron. A late fusion framework used image and metadata representations to generate a recurrence probability via a sigmoid classifier; probabilities were thresholded at 0.5 for binary prediction. Model performance was evaluated on a held-out test set using accuracy, precision, recall, F1-score, and area under the receiver operating characteristic curve (AUC). We additionally compared fusion performance with image-only and metadata-only baselines. Predicted probabilities were translated to surveillance recommendations using risk tiers: low risk (0.00 ≤ p < 0.20), moderate risk (0.20 ≤ p < 0.50), and high risk (p ≥ 0.50). Results: On the test set, the multimodal fusion model achieved 90.4% accuracy, 86.7% precision, 83.1% recall, 84.9% F1-score, and an AUC of 0.920. The image-only model achieved 84.6% accuracy (AUC 0.880), and the metadata-only model achieved 81.9% accuracy (AUC 0.850), indicating improved performance with multimodal fusion. Risk stratification enabled surveillance recommendations of 1–3 years for low risk, 6–12 months for moderate risk, and 3–6 months for high risk. Conclusions: A late-fusion multimodal model integrating endoscopic imaging with structured clinical and pathology variables demonstrated excellent performance for predicting post-polypectomy recurrence and generated actionable risk-based surveillance intervals. This approach may support individualized follow-up planning and more efficient allocation of surveillance resources, while prioritizing timely evaluation for patients at higher predicted risk. Full article

In recent years, deep learning has been applied more and more to medical image analysis. One such application of deep learning is the automated polyp detection in colonoscopy with the target of reducing miss rates. This study presents a comprehensive evaluation of nine state-of-the-art object detection models for colonic polyp detection: YOLOv8, YOLOv9, YOLOv10, YOLO11, YOLO12, YOLO26, RT-DETR, YOLO-World, and YOLOE. The models were evaluated on three publicly available datasets: CVC-ClinicDB, CVC-ColonDB, and ETIS-LaribPolypDB. All models were trained under standardized conditions using identical hyperparameters and data augmentation strategies to guarantee fair comparison. Performance was evaluated using multiple metrics: mAP@50, mAP@50–95, F1 score, precision, recall, inference time, and computational cost. YOLO11 demonstrated the best overall performance, achieving mAP@50 scores of 0.995, 0.944, and 0.978 on the three datasets respectively, while maintaining the fastest inference time of approximately 150 ms per image and the third-lowest computational cost at 21.3 GFLOPs. Cross-dataset generalization experiments revealed a significant loss of performance, with mAP@50 dropping by 20–40% when models were tested on an unseen dataset, highlighting the challenge of true generalization with limited datasets. Statistical analysis by polyp size showed that while all models achieved F1 scores exceeding 0.95 for large polyps, performance decreased to 0.60–0.85 for small polyps, indicating a limitation in detecting small lesions. The analysis of failure modes showed that missed detections, false positives and boundary errors constitute 60–75% of all failures, suggesting that domain adaptation of object detection models may be required. Full article

Background: The study aims to analyze the safety and efficacy of Mepolizumab and Dupilumab in the treatment of patients affected by severe chronic rhinosinusitis not controlled with nasal polyposis (CRSwNP) from a tertiary care regional referral center, with the aim of improving the concept of personalized medicine. Methods: A retrospective study was conducted on 72 adult patients selected for biologic therapy according to EPOS/EUFOREA criteria. The patients received either Mepolizumab or Dupilumab. Primary endpoints were reduction in nasal polyp size, improvement in disease-specific quality of life (sinonasal outcome test-22, visual analog scale), olfactory recovery, and asthma control. Secondary outcomes were the assessment of adverse events. Results: Both monoclonal antibodies significantly improved nasal polyps score (NPS), sinonasal outcome test-22 (SNOT-22), and asthma control test (ACT) over time, with no statistically significant differences between Mepolizumab and Dupilumab. In contrast, blood eosinophil counts showed significant differences: Dupilumab was associated with a transient increase in eosinophil levels (absolute Δ = 660.08% Δ = 9%; p < 0.001), while Mepolizumab produced a marked reduction (absolute Δ = 192.52% Δ = 2%; p < 0.001). Both treatments were well tolerated, with only mild adverse events reported. Conclusions: Mepolizumab and Dupilumab are both effective and safe in improving sinonasal symptoms and quality of life in severe uncontrolled CRSwNP. While improvements in NPS, SNOT-22, and ACT scores were comparable, Mepolizumab achieved a significant reduction in eosinophil counts, whereas Dupilumab was associated with faster clinical improvement but a transient eosinophilia. These findings suggest that biologic choice may be guided by individual patient profiles and inflammatory patterns. Full article

Background/Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type 2 inflammatory disease frequently associated with recurrence after endoscopic sinus surgery (ESS). Although biologic therapies such as dupilumab have demonstrated efficacy in severe CRSwNP, the optimal timing of treatment initiation in relation to surgery remains unclear. This study aimed to evaluate the clinical outcomes of early postoperative initiation of dupilumab after revision ESS using a multidimensional assessment of disease control. Methods: This retrospective observational study included adult patients with severe CRSwNP treated with dupilumab at a tertiary referral centre. All patients had undergone at least two previous ESS procedures and initiated dupilumab within 30 days following revision surgery. Clinical outcomes were assessed at baseline and after 12 months, including Nasal Polyp Score (NPS), Sinonasal Outcome Test-22 (SNOT-22), nasal congestion and olfactory visual analogue scale (VAS) scores, and asthma control in patients with comorbid asthma. Treatment response was evaluated using a multidomain assessment. Results: Ten patients were included. After 12 months, significant improvements were observed in NPS (from 4.7 ± 2.3 to 0.4 ± 1.0; p = 0.0019) and SNOT-22 (from 61.9 ± 17.3 to 26.5 ± 14.7; p = 0.0019). Nasal congestion and olfactory VAS scores also improved significantly. Most patients (70%) achieved an excellent multidimensional response, while 30% showed a moderate response. No patients required systemic corticosteroids or revision surgery during follow-up. Conclusions: Early postoperative initiation of dupilumab after revision ESS was associated with improvements in endoscopic findings, symptom severity, and quality of life. These findings suggest that the early postoperative period may represent a therapeutic window in selected patients with severe recurrent CRSwNP. However, results should be interpreted with caution and considered hypothesis-generating. Full article