Objectives Previous studies have shown that hot saline solution (HSS) nasal irrigation is effective against nasal bleeding and is used to treat nasal hemorrhage. In a pilot study, we evaluated hot saline nasal irrigation in comparison to a routinely used nasal packing in terms of self-reported complications and mucosal healing after functional endoscopic sinus surgery. Methods Patients undergoing surgery for bilateral chronic rhinosinusitis received polyvinyl acetate (PVA) nasal packing in the left nostril, and the right nostril was rinsed with 47°C sterile saline immediately after surgery. Patients' experiences of pain, bleeding, and other types of uncomfortable experiences were measured using a visual analog scale for each nostril before, during, and immediately after nasal packing removal. Two weeks post-surgery, the assessments were repeated including an endoscopic evaluation of the mucosa by the surgeon. Results Twenty-seven patients completed the study. Prior to removal of the packing, the patients experienced significantly more pain and other uncomfortable experiences in the nostril treated with nasal packing, as compared to the nostril solely rinsed with hot saline. After removal, patients reported significantly more uncomfortable experiences from the packing treated nostril. Two weeks post-surgery, no difference in mucosal healing was observed between the two nostrils. Conclusions The results from this study indicate that irrigation with HSS could be an alternative postoperative treatment to conventional PVA nasal packing. Hot saline irrigation may contribute to patients experiencing improved control of postoperative bleeding, pain, and less suffering of other causes as well as health-economic benefits, without affecting the mucosal healing up to 2 weeks post-surgery. Level of Evidence 1b

Altered biosynthesis of eicosanoids is linked to type 2 inflammation in chronic rhinosinusitis with nasal polyps (CRSwNP), but their role in recalcitrant NPs is unclear. We sought to identify endotypes that are linked to recalcitrant CRSwNP, based on eicosanoids, their biosynthetic enzymes, and receptors as well as cytokines and the presence of eosinophils and mast cells in recurrent NPs. Mucosal tissue collected at the time of sinus surgery from 54 patients with CRSwNP and 12 non-CRS controls were analysed for leukotriene (LT) E4, prostaglandin (PG) D2, 15(S)-hydroxyeicosatetraenoic acid (15(S)-HETE) and 17 cytokines with ELISAs and Bio-Plex immunoassays. Patient subgroups were identified by cluster analysis and the probability of NP recurrence were tested with logistic regression analyses. Gene expressions were analysed with qPCR. Tryptase and eosinophil-derived neurotoxin (EDN) were measured with ELISAs as indications of the presence of mast cells and eosinophils, respectively. Clustering of patients showed that an inflammatory signature characterised by elevated LTE₄, PGD₂, 15(S)-HETE and IL-13 was associated with NP recurrence. Previous NP surgery as well as aspirin-exacerbated respiratory disease were significantly more common among these patients. Expression of cyclooxygenase 1 was the only gene associated with NP recurrence. Levels of EDN, but not tryptase, were significantly higher in patients with recurrent NPs. Distinguishing endotypes that include LTE₄, PGD₂, 15HETE and conventional biomarkers of type 2 inflammation could help predict recurrent nasal polyposis and thus identify cases of recalcitrant CRSwNP.

Background: Stress may have an impact on the course of inflammatory bowel disease (IBD), but evidence is still lacking regarding a potential association between perceived (subjective) stress and objectively measured stress, and whether patients’ levels of stress in relapse differ from those in remission. The aim of this study was to investigate patients’ level of stress in relapse and in remission. Methods: Twenty-three patients with active IBD participated in the study. Cortisol was assessed in saliva and in blood to obtain objective measurements. For subjective meas-urements, the patients completed the Short Health Scale (SHS) and Perceived Stress Scale (PSS) questionnaires. Physiological measurements were taken and questionnaires com-pleted at the beginning of relapse and when the patient was classified as being in re-mission. Relapses and remissions were determined by endoscopic examination and faecal calprotectin. Results: Cortisol levels did not differ between measurements in active disease and in remission. PSS showed no differences between the two measurements, but on both oc-casions medium-high levels of stress were shown. Inflammatory cytokines IL-6 and IL-8 showed significantly lowered values at remission. Conclusion: This study demonstrated moderate levels of perceived stress in patients with IBD, both during active disease and remission. However, no evidence of elevated ob-jective stress was found when levels of cortisol in saliva were measured. Further research is needed to establish the possible association between stress and IBD and how it affects patients.

Background: Stress may have an impact on the course of inflammatory bowel disease (IBD), but evidence is still lacking regarding a potential association between perceived (subjective) stress and objectively measured stress and whether patients’ levels of stress in relapse differ from those in remission. The aim of this study was to investigate patients’ level of stress in relapse and in remission. Methods: Twenty-three patients with active IBD participated in the study. Cortisol was assessed in saliva and in blood to obtain objective measurements. For subjective measurements, the patients completed the Short Health Scale (SHS) and Perceived Stress Scale (PSS) questionnaires. Physiological measurements were taken, and questionnaires were completed at the beginning of relapse and when the patient was classified as being in remission. Relapses and remissions were determined by endoscopic examination and faecal calprotectin. Results: Cortisol levels did not differ between measurements in active disease and in remission (7.50 ± 5.52 vs. 5.55 ± 2.65). PSS showed no differences between the two measurements (13 vs. 16, p-value 0.83). Inflammatory cytokines IL-6 (1.97 ± 2.47 vs. 0.72 ± 0.43, p < 0.05) and IL-8 (6.84 ± 3.57 vs. 2.94 ± 2.79, p < 0.001) were significantly lower during remission compared with active disease. Conclusions: This study demonstrated low to moderate levels of perceived stress in patients with IBD during active disease and remission. The results also showed significantly elevated levels of the pro-inflammatory cytokines IL-6 and IL-8 in serum during relapse compared with remission. However, no evidence of elevated objective stress was found when levels of cortisol in saliva were measured. Further research is needed to establish the possible association between stress and IBD and how it affects patients.