{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T03:03:07Z","timestamp":1791946987782,"version":"4.3.4"},"reference-count":32,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2015,5,26]],"date-time":"2015-05-26T00:00:00Z","timestamp":1432598400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Allergy"],"published-print":{"date-parts":[[2015,8]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n \n Chronic rhinosinusitis (\n CRS<\/jats:styled-content>\n ) can be classified into\n CRS<\/jats:styled-content>\n with nasal polyps (\n CRS<\/jats:styled-content>\n w\n NP<\/jats:styled-content>\n ) and\n CRS<\/jats:styled-content>\n without nasal polyps (\n CRS<\/jats:styled-content>\n s\n NP<\/jats:styled-content>\n ).\n CRS<\/jats:styled-content>\n w\n NP<\/jats:styled-content>\n displays more intense eosinophilic infiltration and the presence of Th2 cytokines. Mucosal eosinophilia is associated with more severe symptoms and often requires multiple surgeries because of recurrence; however, even in eosinophilic\n CRS<\/jats:styled-content>\n (\n ECRS<\/jats:styled-content>\n ), clinical course is variable. In this study, we wanted to set objective clinical criteria for the diagnosis of refractory\n CRS<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This was a retrospective study conducted by 15 institutions participating in the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (\n JESREC<\/jats:styled-content>\n ). We evaluated patients with\n CRS<\/jats:styled-content>\n treated with endoscopic sinus surgery (\n ESS<\/jats:styled-content>\n ), and risk of recurrence was estimated using Cox proportional hazard models. Multiple logistic regression models and receiver operating characteristics curves were constructed to create the diagnostic criterion for\n ECRS<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n We analyzed 1716 patients treated with\n ESS<\/jats:styled-content>\n . To diagnose\n ECRS<\/jats:styled-content>\n , the\n JESREC<\/jats:styled-content>\n scoring system assessed unilateral or bilateral disease, the presence of nasal polyps, blood eosinophilia, and dominant shadow of ethmoid sinuses in computed tomography (\n CT<\/jats:styled-content>\n ) scans. The cutoff value of the score was 11 points (sensitivity: 83%, specificity: 66%). Blood eosinophilia (>5%), ethmoid sinus disease detected by\n CT<\/jats:styled-content>\n scan, bronchial asthma, aspirin, and nonsteroidal anti\u2010inflammatory drugs intolerance were associated significantly with recurrence.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n We subdivided\n CRS<\/jats:styled-content>\n w\n NP<\/jats:styled-content>\n in non\u2010\n ECRS<\/jats:styled-content>\n , mild, moderate, and severe\n ECRS<\/jats:styled-content>\n according to our algorithm. This classification was significantly correlated with prognosis. It is notable that this algorithm may give useful information to clinicians in the refractoriness of\n CRS<\/jats:styled-content>\n before\n ESS<\/jats:styled-content>\n or biopsy.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/all.12644","type":"journal-article","created":{"date-parts":[[2015,5,6]],"date-time":"2015-05-06T11:14:20Z","timestamp":1430910860000},"page":"995-1003","source":"Crossref","is-referenced-by-count":691,"title":["Novel scoring system and algorithm for classifying chronic rhinosinusitis: the\n JESREC<\/scp>\n Study"],"prefix":"10.1111","volume":"70","author":[{"given":"T.","family":"Tokunaga","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology Head & Neck Surgery University of Fukui Fukui Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Sakashita","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Head & Neck Surgery University of Fukui Fukui 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