***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE The aim of this study was to evaluate the clinical efficacy and the effects on decreasing the recurrence of AFRS ( allergic fungal rhinosinusitis ) of a budesonide inhalation suspension delivered via transnasal nebulization to patients following endoscopic sinus surgery . SUBJECTS AND METHODS Thirty-five patients were recruited into this study . Final diagnoses were reached using Bent and Kuhn 's criteria . The eligible patients were r and omly divided into two groups : the budesonide transnasal nebulization group ( group A ) and the topical nasal steroids group ( group B ) . Nasal symptoms , Lund-Mackay scores , and Kupferberg grade s were evaluated before surgery , after surgery and during the follow-up to assess the effects of these two approaches . RESULTS A total of 30 patients with AFRS who were eligible were included in the study . Four of the 15 patients in group B ( 26.67 % ) developed recurrent disease , whereas no patients in group A developed recurrent disease . This difference was statistically significant ( p=0.032 ) . CONCLUSION Nebulized budesonide is an effective and safe treatment for patients with AFRS following endoscopic sinus surgery , as evidence d by the reduced recurrence rate observed in the budesonide transnasal nebulization group relative to the topical nasal steroids group BACKGROUND There is little evidence on the efficacy of glucocorticoid transnasal nebulization therapy in patients with eosinophilic chronic rhinosinusitis with nasal polyps ( CRSwNP ) . OBJECTIVE We sought to evaluate the immunologic and remodeling effects of budesonide transnasal nebulization in patients with eosinophilic CRSwNP . METHODS Sixty patients with eosinophilic CRSwNP were r and omized to receive budesonide or placebo treatment for 14 days by means of transnasal nebulization in a double-blind manner . Endoscopic polyp size scores ( maximum = 6 points , Kennedy score ) and visual analog scale scores for nasal symptoms were assessed before and after treatment . Similarly , polyp sample s were evaluated for inflammatory cytokines , matrix metalloproteinases ( MMPs ) , and tissue inhibitors of metalloproteinases ( TIMPs ) by using an immunoassay ; collagen by using histochemistry ; eosinophils by using hematoxylin and eosin stain ; and T-cell subsets by using flow cytometry . RESULTS Budesonide transnasal nebulization significantly reduced polyp size compared with placebo ( mean difference between groups , -0.73 units ; 95 % CI , -1.15 to -0.32 units ; P = .002 ) and improved symptoms . Polyp IL-5 and eotaxin expression decreased significantly , whereas TGF-β and IL-10 expression increased . Expression of IFN-γ and IL-17 was not altered . Budesonide transnasal nebulization consistently reduced eosinophil infiltration and TH2 cell frequency and increased natural regulatory T-cell and type 1 regulatory T-cell frequencies . Indices of remodeling , including albumin , MMP-2 , MMP-7 , MMP-8 , and MMP-9 , were significantly decreased , whereas collagen deposition and TIMP-1 , TIMP-2 , and TIMP-4 levels were significantly increased . Budesonide transnasal nebulization did not suppress the hypothalamic-pituitary-adrenal axis or cause any serious side effects . CONCLUSION Short-term budesonide transnasal nebulization is an effective and safe treatment option in patients with eosinophilic CRSwNP , achieving clinical improvement by regulating remodeling , cytokine expression , and T-cell subset distribution tion of both CP and cisplatin . Hypersensitivity to mannitol was reported as a cause of apparent hypersensitivity to cisplatin . 6 In case 2 the result of a skin test with mannitol was negative , whereas the result of a skin test with the commercial formulation containing CP and mannitol was positive , suggesting that CP was solely responsible for the hypersensitivity reaction . In addition to the clinical tolerance induced by the desensitization protocol , skin responses to intradermal CP  diminished . As shown in Table I , the ratio between wheal sizes of CP and histamine decreased more than 3.5 times after the desensitization . The observation of wheal- and -flare responses becoming negative has already been described in penicillin desensitization . 7 This phenomenon supports an antigen-specific desensitization . The rate at which the drug concentration increases in the extracellular fluid seems to be the most important factor in a successful outcome of desensitization . As suggested by our two patients , this rate can differ in each individual case . We conclude that the 4-hour desensitization protocol may not be suitable for all patients allergic to CP  , whereas a modified prolonged protocol seems to be more tolerable . Until further data have been accumulated , the short protocol may be at tempted initially but should be replaced by the prolonged protocol if adverse effects appear . The prolonged protocol seems to be both safe and efficacious with regard to anti tumor activity Objectives : Rhinosinusitis and polyposis are difficult to treat in patients with Samter 's triad ; they commonly recur despite sinus surgery , antibiotics , and /or nasal steroids . The present study assesses the efficacy of a multimodal regimen that includes topical corticosteroids and antibiotics delivered through a hydroxyethyl cellulose gel and by nebulization . Methods : Eleven patients with Samter 's triad who had polyposis and rhinosinusitis that recurred despite endoscopic sinus surgery were treated with a 6-week course of multimodal topical therapy consisting of a hydroxyethyl cellulose gel that releases corticosteroids and antibiotics , topical nebulization of corticosteroids and antibiotics , saline solution rinses , and sinus debridement . Clinical outcomes were evaluated by Lund-Kennedy endoscopic and symptom scores . Histologic assessment was evaluated by hematoxylin and eosin staining before and after treatment . Results : Both Lund-Kennedy symptom and endoscopic scores showed a progressive and statistically significant decline throughout the course of treatment , reaching at 6 weeks 42 % of the pretreatment values ( p = 0.005 ) for the Lund-Kennedy symptom score and 34 % ( p = 0.002 ) for the endoscopic score , respectively ; however , the significance of the improvement was lost with time . Conclusions : Topical gel therapy improves clinical symptoms , endoscopic findings , and sinus membrane histologic features in patients with refractory Samter 's triad , but the improvement is transient , suggesting that a longer therapeutic period might be needed OBJECTIVES To compare the distribution patterns of topical medication delivery systems in the sinonasal region and upper respiratory tract after functional endoscopic sinus surgery . STUDY DESIGN Prospect i ve descriptive evaluation . METHODS Four topical delivery systems ( spray bottle , atomizer , nebulizer , and bulb syringe ) were studied . Using a dye solution as a marker , we independently applied the four topical delivery systems to a population of patients with chronic rhinosinusitis who had undergone functional endoscopic sinus surgery . The anatomic distributions were videotaped using flexible fiberoptic endoscopy . Three blinded observers independently rated the anatomic distribution of dye using a 4 point scale . Statistical analysis was performed using analysis of variance ( ANOVA ) and Dunn posttesting . RESULTS Seven participants completed the study . All participants had undergone bilateral maxillary antrostomies , bilateral total ethmoidectomies , and bilateral sphenoidotomies . Five sinonasal sites and the larynx were evaluated for dye deposition . Interobserver agreement reached 95.6 % . There was no statistical difference between the atomizer and spray bottle . The bulb syringe was statistically superior to the nebulizer in all sinonasal sites and statistically superior to the atomizer and spray bottle in the ethmoidal region . Dye was rarely seen within the larynx . CONCLUSIONS The delivery systems tested were shown to have significant differences in their capability to place dye in specific sinonasal areas . Because topical medications are commonly administered to postoperative patients , these differences may have important clinical implication OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity This study evaluated 1‐year outcomes in patients with chronic rhinosinusitis ( CRS ) who were considered surgical c and i date s by study criteria and elected either medical management or endoscopic sinus surgery ( ESS ) . In addition , some patients initially enrolled in the medical treatment arm crossed over to the surgery arm during the study period and their respective outcomes are evaluated BACKGROUND Systemic glucocorticoids are often used in the treatment of chronic rhinosinusitis with nasal polyps ( CRSwNP ) , and osteoporosis is a well-known complication to steroid treatment , associated with significant morbidity . Nevertheless , the burden of steroid induced osteoporosis is unknown in patients with CRSwNP . We aim ed to assess the risk of acquiring osteoporosis caused by oral steroids in patients with CRSwNP , and provide recommendations on future research and guidelines . METHODOLOGY Cochrane Review Data base , EMBASE , Ovid Medline , and PubMed were search ed for studies including adult patients with CRSwNP treated with oral steroids .  Outcomes were Bone Mineral Density ( BMD ) and prevalence of fractures in relation to dose and duration of oral steroids . In addition , we review ed general guidelines for treatment with oral steroids . RESULTS We identified two studies ( n=243 ) that met the inclusion criteria . Doses and duration s of oral steroids were over 5 mg/day for more than 3 months and 1 mg/kg body weight/day for 6 to 10 days for 4 or more courses/year . The prevalence of low bone mass was 39 % and 61 % , respectively . It was not possible to quantify the overall risk of osteoporosis induced by oral steroids from the studies . No studies evaluated prevalence of fracture . CONCLUSIONS Registry studies and r and omized controlled trials would be needed to assess the risk of osteoporosis in CRSwNP patients and future guidelines should include recommendations regarding preventive treatment and recommendations on doses and duration s of oral steroids PURPOSE To quantify the amount of aerosol deposited in different parts of the airways with a commercially available nasal sonic jet nebulizer ( NJN ) using a sound effect , and to compare its performance with a new nasal mesh nebulizer ( NMN ) . METHODS Seven healthy non-smoking male volunteers aged 21 - 36 years with a mean weight of 77±10 kg were included in this single-center study . Both nebulizer systems were loaded with (99m)Tc-DTPA and scintigraphies were performed with a gamma camera .  Particle size distribution of the aerosols produced by the two nebulizer systems was measured . RESULTS There was no statistical difference between the two nebulizers in terms of fraction of particles smaller than 5 μm ( 44±4 % vs 45±2 % ) ( p>0.9 ) . Aerosol deposition in the nasal region was 73±10 % ( % of aerosol deposited in airways ) with the NJN , and 99±3 % with the NMN ( p=0.01 ) . Total nasal deposition was 9.6±1.9 % of the nebulizer charge with the NJN and 28.4±8.9 % with the NMN ( p=0.01 ) . 0.5±0.3 % of the nebulizer charge was deposited in the maxillary sinuses with the NJN , compared to 2.2±1.6 % with the NMN 
    Output:
    
The presence of polyps improved the efficacy of the nebulization .
This way of delivery appears not convincing regarding antibiotics .
Few side effects were noted in the retrieved studies and only for nebulized antibiotics .
CONCLUSIONS This systematic review highlighted that based on the present literature nebulization is not better than nasal spray to the delivery of corticosteroids due to the positive results on symptoms , endoscopic appearance and histological outcomes .
For antibiotics delivery , the nebulization is not of added value