Publications by authors named "Xinni Xu"

10 Publications

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Precision Medicine in Chronic Rhinosinusitis: Where Does Allergy Fit In?

Handb Exp Pharmacol 2021 Jun 4. Epub 2021 Jun 4.

Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.

Chronic rhinosinusitis (CRS) is a clinical syndrome stemming from persistent inflammation of the sinonasal mucosa. Phenotypically, it is traditionally and widely described according to the presence or absence of polyps. While this distinction is simple to use, it has little bearing on prognosis and treatment, for CRS is essentially an inflammatory disease resulting from dysregulated interaction between a multitude of host and environmental factors. Allergy is merely one of them and, like many of the proposed aetiologies, has been subject to much debate which will be discussed here. As our understanding of CRS continues to evolve, previous so-called conventional wisdom about phenotypes (e.g. CRS with nasal polyps is associated with Type 2 inflammation) is being challenged, and new phenotypes are also emerging. In addition, there is growing interest in defining the endotypes of CRS to deliver precise and personalised treatment, especially pertaining to the development of biologics for the group of severe, difficult-to-treat CRS patients. A proposed model of precision medicine tailored to management of CRS will also be introduced to readers, which can be continually modified to adapt to new discoveries about this exciting condition.
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http://dx.doi.org/10.1007/164_2021_489DOI Listing
June 2021

Highlights in the advances of chronic rhinosinusitis.

Allergy 2021 May 4. Epub 2021 May 4.

Department of Otorhinolaryngology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands.

Chronic rhinosinusitis (CRS) is a complex upper airway inflammatory disease with a broad spectrum of clinical variants. As our understanding of the disease pathophysiology evolves, so too does our philosophy towards the approach and management of CRS. Endotyping is gaining favour over phenotype-based classifications, owing to its potential in prognosticating disease severity and delivering precision treatment. Endotyping is especially useful in challenging CRS with nasal polyposis cases, for whom novel treatment options such as biologicals are now available. The latest European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS2020) reflects these changes with updated rhinosinusitis classifications and new integrated care pathways. With the coronavirus disease 2019 (COVID-19) pandemic, physicians and rhinologists have to balance the responsibility of managing their patients' upper airway while adequately protecting themselves from droplet and aerosol transmission. This review summarises the key updates from EPOS2020, endotype-based classification and biomarkers. The role of biologicals in CRS and the lessons we can draw from their use in severe asthma will be examined. Finally, the principles of CRS management during COVID-19 will also be discussed.
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http://dx.doi.org/10.1111/all.14892DOI Listing
May 2021

Magnetic Resonance Imaging Study of the Pericranial Flap and Its Local Effects Following Endoscopic Craniofacial Resection.

Laryngoscope 2021 01 23;131(1):E90-E97. Epub 2020 Jun 23.

Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Singapore.

Objectives/hypothesis: To describe the magnetic resonance imaging (MRI) characteristics of the pericranial flap, changes in the pericranial flap thickness over time, presence of frontal sinus opacification, and presence of frontal lobe herniation into the nasal cavity.

Study Design: Retrospective case series.

Methods: Seventeen consecutive endoscopic craniofacial resections with pericranial flap reconstruction performed at a tertiary hospital from 2010 to 2019 were reviewed. Sixty-eight serial MRI scans were evaluated.

Results: All pericranial flaps consistently featured a homogenous appearance on T1-weighted sequence and enhanced with contrast. On T2-weighted sequence, the skull base reconstruction demonstrated four layers of alternating hypo- and hyperintensity, which corresponded with the inlay synthetic graft or neodura (hypointense), loose areolar tissue (hyperintense), fibrous pericranium (hypointense), and nasal mucosa or granulation tissue (hyperintense). The mean pericranial flap thickness was 9.9 mm. In thicker flaps, the loose areolar layer contributed the bulk of the thickness. Of 13 patients who underwent three or more serial MRI scans, 11 flaps (84.6%) were stable and two (15.4%) had >50% reduction in their original thickness over time. Thirteen of 17 (76.5%) patients had frontal sinus opacification on follow-up. None developed frontal sinus mucoceles or frontal lobe herniation.

Conclusions: The pericranial flap has a distinctive MRI appearance, especially on T2-weighted sequence. The thickness of the flap remains relatively stable over time for most patients even following radiotherapy. It is a sturdy flap that is able to support the frontal lobe. Frontal sinus obstruction is common, although complications from this appear to be rare.

Level Of Evidence: 4 Laryngoscope, 131:E90-E97, 2021.
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http://dx.doi.org/10.1002/lary.28735DOI Listing
January 2021

An intriguing 'cyst' of the ear.

J Clin Pathol 2021 Jan 8;74(1):e2. Epub 2020 Jun 8.

Pathology, National University Hospital, Singapore.

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http://dx.doi.org/10.1136/jclinpath-2020-206475DOI Listing
January 2021

Role of adjunctive treatment strategies in COVID-19 and a review of international and national clinical guidelines.

Mil Med Res 2020 05 5;7(1):22. Epub 2020 May 5.

Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.

The coronavirus disease (COVID-19) pandemic has led to a global struggle to cope with the sheer numbers of infected persons, many of whom require intensive care support or eventually succumb to the illness. The outbreak is managed by a combination of disease containment via public health measures and supportive care for those who are affected. To date, there is no specific anti-COVID-19 treatment. However, the urgency to identify treatments that could turn the tide has led to the emergence of several investigational drugs as potential candidates to improve outcome, especially in the severe to critically ill. While many of these adjunctive drugs are being investigated in clinical trials, professional bodies have attempted to clarify the setting where the use of these drugs may be considered as off-label or compassionate use. This review summarizes the clinical evidence of investigational adjunctive treatments used in COVID-19 patients as well as the recommendations of their use from guidelines issued by international and national organizations in healthcare.
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http://dx.doi.org/10.1186/s40779-020-00251-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7199873PMC
May 2020

An endoscopic anatomical study of the levator veli palatini and its relationship to the parapharyngeal internal carotid artery.

Head Neck 2020 08 11;42(8):1829-1836. Epub 2020 Feb 11.

Department of Otolaryngology - Head & Neck Surgery, National University Hospital, Singapore.

Background: The objectives of this study are to describe the levator veli palatini (LVP) as a landmark for the parapharyngeal internal carotid artery (pICA) and the endoscopic course of the pICA.

Methods: Cadaver dissection and illustrative case study.

Results: Seven cadaveric heads (12 sides) were dissected. In all 12 sides, the LVP was consistently located between the Eustachian tube and the pICA near the skull base, making the LVP just anterior to and the closest structure to the pICA. The distance between the pICA and the nares ranged from 9.0 to 12.7 cm. The distance between the pICA and the midpoint of the nasopharynx ranged from 1.9 to 3.7 cm. The case study illustrated the applicability of these findings.

Conclusion: The LVP is a reliable and precise landmark for the pICA. A safe working distance to the pICA is 1.9 cm from the midpoint of the nasopharynx and 9.0 cm from the nares.
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http://dx.doi.org/10.1002/hed.26101DOI Listing
August 2020

Novel findings in immunopathophysiology of chronic rhinosinusitis and their role in a model of precision medicine.

Allergy 2020 04 11;75(4):769-780. Epub 2019 Oct 11.

Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.

Our understanding of the pathophysiology of chronic rhinosinusitis (CRS) is continuously evolving. The traditional description of CRS in terms of two phenotypes based on the presence or absence of nasal polyps belies the underlying intricate immunopathophysiological processes responsible for this condition. CRS is being increasingly recognized as a disease spectrum encompassing a range of inflammatory states in the sinonasal cavity, with non-type 2 inflammatory disease on one end, type 2 inflammatory, eosinophil-heavy disease on the other and an overlap of both in different proportions in between. Abundance in research on the immune mechanisms of CRS has revealed various new endotypes that hold promise as biomarkers for the development of targeted therapies in severe, uncontrolled CRS. The introduction of precision medicine to manage this chronic, complex condition is a step forward in providing individualized care for all patients with CRS. In this review, the latest research on the pathophysiology of CRS with a focus on potential novel biomarkers and treatment options over the last 2 years are summarized and integrated into a suggested model of precision medicine in CRS.
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http://dx.doi.org/10.1111/all.14044DOI Listing
April 2020

Effectiveness of long-term using statins in COPD - a network meta-analysis.

Respir Res 2019 Jan 23;20(1):17. Epub 2019 Jan 23.

Lanzhou University, Basic Medical College, Lanzhou, Gansu, 730000, People's Republic of China.

Objectives: To evaluate the effectiveness of long-term treatment of statins for chronic obstructive pulmonary disease (COPD), and to answer which one is better.

Methods: General meta-analysis was performed to produce polled estimates of the effect of mortality, inflammatory factors, and lung function index in COPD patients by the search of PubMed, Web of Science, Embase, and China National Knowledge Infrastructure for eligible studies. A network meta-analysis was performed to synthetically compare the effectiveness of using different statins in COPD patients.

Results: General meta-analysis showed that using statins reduced the risk of all-cause mortality, heart disease-related mortality and COPD acute exacerbation (AECOPD) in COPD patients, the RR (95% CI) were 0.72 (0.63,0.84), 0.72 (0.53,0.98) and 0.84 (0.79,0.89), respectively. And using statins reduced C-reactive protein (CRP) and pulmonary hypertension (PH) in COPD patients, the SMD (95% CI) were - 0.62 (- 0.52,-0.72) and - 0.71 (- 0.85,-0.57), respectively. Network meta-analysis showed that Fluvastatin (97.7%), Atorvastatin (68.0%) and Rosuvastatin (49.3%) had higher cumulative probability than other statins in reducing CRP in COPD patients. Fluvastatin (76.0%) and Atorvastatin (75.4%) had higher cumulative probability than other satins in reducing PH in COPD patients.

Conclusions: Using statins can reduce the risk of mortality, the level of CRP and PH in COPD patients. In addition, Fluvastatin and Atorvastatin are more effective in reducing CRP and PH in COPD patients.
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http://dx.doi.org/10.1186/s12931-019-0984-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343315PMC
January 2019

Delayed Breakdown of an Onlay Pericranial Flap Following Endoscopic Craniofacial Resection.

J Craniofac Surg 2017 Jun;28(4):1021-1023

*Department of Otolaryngology-Head and Neck Surgery †Division of Neurosurgery, National University Hospital, Singapore.

The pericranial flap is a well-vascularized, robust flap that is used to reconstruct anterior skull base defects following resection of skull base tumors. Failure of this flap is uncommon. However when it occurs, the consequences are potentially disastrous and it poses a challenge to further reconstruction. The authors report the first patient of onlay pericranial flap breakdown following endoscopic craniofacial resection. Possible contributing factors are identified and further management is discussed. With the endoscopic approach being increasingly utilized for craniofacial resection, it is imperative to be mindful of these factors to minimize the risks of onlay pericranial flap failure.
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http://dx.doi.org/10.1097/SCS.0000000000003676DOI Listing
June 2017

Endoscopic Endonasal Resection of Recurrent Nasopharyngeal Mucoepidermoid Carcinoma.

J Craniofac Surg 2016 Jun;27(4):1053-5

Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Singapore.

Nasopharyngeal mucoepidermoid carcinoma is a rare entity, for which surgical resection is the treatment of choice. The open technique is considered the standard approach, but this often results in significant morbidities such as trismus, dysphagia, and neurologic deficits. The advent of endoscopic endonasal techniques has made endoscopic resection a viable alternative to the open approach in terms of access, adequacy of resection, and lesser surgical morbidity. The authors describe a patient of recurrent nasopharyngeal mucoepidermoid carcinoma that was resected entirely endoscopically. The authors also present a literature review of this little-known disease and a comparison between the endoscopic and open approach.
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http://dx.doi.org/10.1097/SCS.0000000000002618DOI Listing
June 2016