JOURNAL OF PHYSIOLOGY AND PHARMACOLOGY 2015, 66, 1, 139-147
www.jpp.krakow.pl
E. TRYBUS1, T. KROL1, T. OBARZANOWSKI2, W. TRYBUS1, A. KOPACZ-BEDNARSKA1, M. OBARZANOWSKI3
CYTOLOGICAL ASSESSMENT OF THE EPITHELIAL CELLS
OF THE NASAL MUCOUS MEMBRANE AFTER LOCAL FLUTICASONE THERAPY
Department of Cell Biology and Electron Microscopy, Jan Kochanowski University, Kielce, Poland; 2Allergy Clinic, Military
Specialist Medical Clinic SP ZOZ, Kielce, Poland; 3Department of Urology, The Swietokrzyskie Oncology Center, Kielce, Poland
1
The majority of cytological studies concern the influence of glucocorticosteroids on cells involved in creating and
sustaining inflammation, such as eosinophils or neutrophils. Much less attention is devoted to epithelial cells. It should
also be noticed that glucocorticosteroid drugs administered nasally for local action can significantly change the
cytological image of the nasal mucous membrane. Therefore, the purpose of this research was to cytologically assess the
influence of topical fluticasone therapy on the nasal mucous membrane cells, with special attention for the changes in
the morphology of epithelial cells. The research samples were taken from patients with symptoms of chronic rhinitis and
suspected allergies. The research was a two-step process. In the first step, a smear was taken from the surface of the
nasal mucous membrane of the above-mentioned patients before the start of therapy and the obtained cytological image
was compared with a control image of the nasal mucous of healthy people. Step two involved the cytology of the same
patients after 4 weeks of fluticasone therapy, applied as a nasal aerosol in two doses of 50 µg to each nostril once per
day, in the combined daily dose of 200 µg (for adults and children aged 12 or more). Children aged between 4 and 12
were given a single dose of 50 µg to each nostril once per day, in a daily dose of 100 µg. Based on smears stained
according to the Papanicolaou and Pappenheim method, a qualitative and quantitative analysis of changes in the mucous
membrane of nasal cells was performed. The cytological assessment of nasal mucous membrane stains of patients with
chronic rhinitis before fluticasone treatment enabled a diagnosis of chronic infectious rhinitis, compared through the
presence of numerous neutrophils and bacteria. The studied samples did not show significant changes in the morphology
of epithelial cells, only a few cells with mild vacuolation changes of the cytoplasm were found. The use of fluticasone,
however, caused a significant decrease in the neutrophilia and the appearance of numerous epithelial cells with
intensified cytoplasm vacuolation in the sample. The results obtained allow us to conclude that standard fluticasone
therapy as administered nasally in aerosol form to patients with diagnosed nonallergic nasal mucous membrane
inflammation caused a significant reduction in the inflammation without showing cytological characteristics of damage
to the epithelium of the nasal mucous membrane. The intensified vacuolation observed in the cytoplasm of epithelial
cells, most prominently in the columnar cells, might suggest the stimulation of autophagic processes.
K e y w o r d s : topical glucocorticosteroid therapy, exfoliation cytology, nasal rhinitis, nasal mucous membrane cytogram,
vacuolation changes
INTRODUCTION
Synthetic glucocorticosteroids belong to a group of
compounds which are derivatives of adrenal cortex hormones
(cortisone, cortisol, corticosterone). Due to their suggested and
repeatedly proven strong anti-inflammatory, anti-allergic and
immunosuppressive properties (also when compared to natural
compounds) (1, 2), these compounds are currently used in nearly
all the medical fields and specialties. They form the base of
therapy for inflammatory diseases, including, among others, the
numerous diseases of the respiratory system, like the allergic,
seasonal or perennial rhinitis and nonallergic rhinitis (3-6). In
this case, the glucocorticosteroids, such as beclometasone,
budesonide, fluticasone propionate or mometasone fuorate are
administered locally in the form of nasal aerosols, inhalation
powders and water solutions (1, 7). Synthesizing
glucocorticosteroids for localized treatment ensured strong,
selective and simultaneously safe action, enabling high
concentrations of the drug with a minimalized risk of side effects
(with the appropriate application technique and proper dosage)
even with long-term administration (7-9).
Modern treatment of rhinitis mainly concentrates on actions
aiming to reduce the inflammation of nasal mucus. Numerous
reports show that the research on topical steroid drugs mainly
concentrate on the clinical symptoms related to the nose, such as
itching, rhinorrhea, obstruction, burning sensations, etc. (7) and
on the reactions of the immunological system (10-12).
Cytological assessment is concentrated on exogenous cells
which determine the type of the inflammation, such as
eosinophils or neutrophils (13-15). Far less attention, however, is
140
being paid to epithelial cells, which can determine the
morphological effects of the ongoing inflammation process (16)
or the administered treatment (17). It should also be stressed
that, depending on their type, glucocorticosteroids can have a
diversified influence on the cells of nasal mucous membrane
(18). The available literature provides numerous conflicting
information on this issue, which causes the mechanism of the
anti-inflammatory action of glucocorticosteroids to remain
partially unknown. Special attention should be also given to the
fact that, despite proper administration, applying such drugs in a
localized manner, nasally, together with orally administered
drugs, might change the cytological image of the nasal mucous
membrane (19).
The goal of the study was to cytologically assess the
influence of fluticasone on the cells of nasal mucous membrane,
with a special attention to the changes in the morphology of
pseudostratified epithelium cells, performed in vivo in standard
treatment conditions.
MATERIALS AND METHODS
Patients
The research was performed in cooperation with an allergist
from the Allergy Clinic, Military Specialist Medical Clinic SP
ZOZ in Kielce. The study was accepted by the Jan Kochanowski
University in Kielce Bio-ethical Committee (No. 45/2011).
The study group was 40 patients (17 women and 23 men), aged
5 – 30 (median 12.4) with chronic rhinitis with suspected of allergy.
The patients were qualified to participate in the study by a doctor
based on long-term, clinically homogenous symptoms, such as
runny or stuffy nose, nasal mucosa swelling, itching of nose.
The control group were 10 healthy people (5 women and 5
men) aged 5 – 22 (median 14.20) who were showing no
symptoms of rhinitis.
Methods of smear preparation and assessment
Two smears were taken from each patient with the use of a
sterile cytology brush, from the surface of the nasal mucous
membrane (exfoliative cytology), specifically from the inferior
nasal concha (1 cm from its front edge). The cells on the brush
were spread by hand on the slide with a single movement
parallel to the slide edges. The obtained smears was immediately
fixed in 96% ethanol and stained using the methods of
Papanicolaou and Pappenheim in order to differentiate
morphological changes (20, 21). Afterward the samples were
analyzed in a blind test using the Nikon ECLIPSE 80i light
microscope with a digital image analysis system Nikon Nis
Elements in the magnification of ×400. Changes in the nasal
mucous membrane of patients with rhinitis were analyzed based
on a control image obtained in smears taken from healthy
people. The results of the control group corresponded to the
description of healthy nasal mucosa published by TarchalskaKrynska (20). During the sample assessment, special attention
was given to the morphological changes of epithelial cells. These
concerned the morphological profile of the nucleus (change of
size, karyorrhexis, non-nucleated form), cytoplasm (structure,
changes of staining, vacuolation) and cell contour. In case of
diagnostic doubt, cells were examined under 1000×
magnification. In order to obtain the full picture, an assessment
of the percentage of various types of cells in the smears was
performed, according to the method of Tarchalska-Krynska (20).
The inflammatory cells counted were neutrophils and
eosinophils, and the epithelial cells counted were columnar cells,
goblet cells and squamous cells. In the microscope field of view,
all cell types (epithelial and inflammatory cells), as well as the
cells with morphological changes, were counted together, to a
total of 500 cells in the preparation. In order to obtain the most
reliable results, the cells were counted in three repetitions (total
counted: 1500 cells/preparation), and the final result was
averaged. Determining cytograms for all patients enabled the
emergence of 10 ill people (4 women and 6 men) aged 5 – 20
(median 11.7) with a similar cytological image, which became
the basis for their final qualification to the fluticasone treatment
group. In this group, there were 7 people with symptoms of
perennial rhinitis, accompanied by typical nasal symptoms.
Among the persons in 5 cases also demonstrated the profile of
atopic diseases such as atopic dermatitis and asthma with
symptoms from the conjunctiva (tearing, itching, burning) and
the presence of allergen-specific immunoglobulin E for House
Dust Mites D.P. (Dermatophagoides pteronyssinus) and D.F.
(Dermatophagoides farinae). The remaining 3 people
demonstrated characteristics of seasonal allergic rhinitis with
typical nasal symptoms as well as the lack of extra-nasal
symptoms and diseases associated and the presence of specific
IgE to grass, birch, alder and hazel allergens.
The assessment of cytological image after fluticasone
therapy was performed after 4 weeks of its use and compared to
cytology taken from the same patients before treatment.
Applied treatment
Fluticasone propionate in the form of a nasal aerosol was
locally applied nasally as two doses of 50 µg to each nostril once
per day, in the total daily dose of 200 µg (for adults and children
aged 12 or more), while children aged between 4 and 12 were
given a single dose of 50 µg to each nostril once per day, in a
total daily dose of 100 µg.
Statistical analysis
The statistical analysis of the results was performed using
the nonparametric chi2 test (STATISTICA 10.0, StatSoft
Poland). Differences were considered statistically significant at
P <0.05.
RESULTS
The assessment of the morphology of the nasal mucous
membrane of patients with rhinitis symptoms before treatment
was performed in reference to the smear from the mucous
membrane of patients from the control group, which was picked
as correct (Fig. 1a and 1b).
The analysis of smears from the nasal mucous membrane
showed significant differences in the cytological image of
patients with rhinitis before fluticasone treatment in comparison
to the control group results. The statistically significant change
was the presence of numerous cells of the stratified squamous
epithelium. 37.24 acidophilic cells were present (c2=35.45;
P=0.0000) (Fig. 4). These were large polygonal cells, with
translucent cytoplasm and a small pyknotic nucleus without a
visible chromatin structure or with nuclear shadows visible in
the center (Fig. 2d). Basophilic cells were present in a similar
number: 30.80 (c2=9.94; P=0.0016) (Fig. 4) and were
characterized by a large round nucleus with a slightly granular
structure (Figs. 2a, 2c and 2d). Some acidophilic cells were
characterized by the presence of nuclei with signs of breakdown
(Fig. 2d).
Another significant change was the disturbed ratio of
columnar to goblet cells, in favor of the goblet cells, caused by
a statistically significant decrease in the number of columnar
141
Fig. 1. The cytology of correct nasal epithelium under a light microscope. (a) Stained with the Papanicolaou method: 1-columnar cell of
the pseudostratified epithelium, 2-goblet cell, 3- acidophilic cell of the stratified squamous epithelium, 4-neutrophil. Magnification ×400.
(b) Stained with the Pappenheim method: 1-columnar cells of the pseudostratified epithelium, 2-goblet cells. Magnification ×400.
Fig. 2. The cytology of the nasal epithelium of patients with rhinitis before fluticasone treatment under a light microscope. (a) Stained with
the Pappenheim method: 1- columnar cells of the pseudostratified epithelium, 2-goblet cells, 3-acidophilic cells of the stratified squamous
epithelium. Magnification ×400. (b) Stained with the Papanicolaou method: 1-neutrophils, 2- eosinophil. Magnification ×400 (c) Stained
with the Pappenheim method: 1- basophilic cells of the stratified squamous epithelium, 2-bacteria, 3- vacuolation of cytoplasm of the
squamous epithelial cell. Magnification ×400. (d) Stained with the Papanicolaou method: 1- basophilic cells of the stratified squamous
epithelium, 2- basophilic cells of the squamous epithelium with karyorrhexis, 3-acidophilic cells of the stratified squamous epithelium, 4cell of the squamous epithelium with vacuolation, 5-free nucleus of a columnar cell of the pseudostratified epithelium. Magnification ×400.
cells to 18.54 (c2=476.25; P=0.0000) (Figs. 2a, 4 and 5).
Furthermore, fairly frequently occurring free nuclei of these
cells with very clear nucleoli could be observed (Fig. 2d).
The preparations also contained numerous bacteria, which
were loosely distributed or adhered to the surface of squamous
epithelial cells (Fig. 2c).
142
Fig. 3. The cytology of the nasal epithelium of patients with rhinitis after fluticasone treatment under a light microscope (a) Stained with
the Papanicolaou method: 1-columnar cells of the pseudostratified epithelium, 2-columnar cells with cytoplasm vacuolation, 3-goblet cells,
4-acidophilic cells of the stratified squamous epithelium. Magnification ×400. (b) Stained with the Papanicolaou method: 1- columnar cells
with a perinuclear halo, 2-acidophilic cells of the stratified squamous epithelium. 3- neutrophil. Magnification ×400. (c) Stained with the
Papanicolaou method: 1-columnar cells of the pseudostratified epithelium, 2-goblet cells. 3-cells of the stratified squamous epithelium.
Magnification ×400. (d) Stained with the Papanicolaou method: 1-cell of the stratified squamous epithelium with numerous vacuoles in the
cytoplasm, 2-cell of the squamous epithelium without changes, 3-neutrophils. Magnification ×400. (e) Stained with the Pappenheim
method: 1-cell of the squamous epithelium with a large vacuole with content, 2-neutrophil with signs of breakdown. Magnification ×400.
The dominant change was the statistically significant
increase in the number of neutrophils to 333.34 (c2=289.92;
P=0.0000) (Figs. 2b and 4). These granulocytes showed the
characteristics of poorly differentiated cytoplasm and of cell
nuclei contours. A statistically significant number (10.84) among
the observed inflammatory cells were also eosinophils
(c2=11.12; P=0.0009) (Figs. 2b and 4), while there were few
basophils, lymphocytes and monocytes (Fig. 4).
No significant changes in the morphology of epithelial cells
were shown, only the presence of 4.7 individual cells with
cytoplasmic vacuolation (Figs. 2c, 2d and 8).
Whereas the analysis of smears taken from the same patients
after fluticasone therapy showed the presence of few bacteria, as
well as a statistically significant reduction of the number of
inflammatory cells such as neutrophils, to 167.17 (c2=110.22;
P=0.0000) and eosinophils to 1.10 (c2=8.43; P=0.0037) (Fig. 6).
143
Fig. 4. Distribution of epithelial
and inflammatory cells in
smears of the nasal mucous
membrane of patients before
fluticasone treatment;
***
P<0.001;
**P<0.01
compared to control (chi2 test).
Abbreviations: cc, columnar
cells
of
pseudostratified
epithelium; gc, goblet cells; ae,
acidophilic cells of the
squamous stratified epithelium;
be, basophilic cells of the
squamous stratified epithelium;
N, neutrophils; E, eosinophils;
B, basophils; L, lymphocytes;
M, monocytes.
Fig. 5. Distribution of columnar
cells (cc) and goblet cells (gc) in
smears of the nasal mucous
membrane of patients before
fluticasone treatment;
*** P<0.001 compared to control
(chi2 test).
The studied granulocytes were showing characteristics of
serious breakdown (Figs. 3d, 3e).
At the same time, changes in the ratio of cells of
pseudostratified epithelial cells were observed, in the form of a
statistically significant increase in the number of columnar cells
to 214.70 (c2=217.16; P=0.0000) (Figs. 3c, 6 and 7) and the
equally statistically significant decrease in the number of goblet
cells to 27.96 (c2=18.44; P=0.0000) (Figs. 3c, 6 and 7).
A statistically significant increase in the number of
basophilic cells of the stratified squamous epithelium was also
shown, up to 60.60 (c2=10.77; P=0.0010) (Fig. 6), with a
statistically insignificant decrease of the number of acidophilic
cells to 28.17 (c2=1.33; P=0.2483) (Fig. 6). No significant
changes were noted in relation to the number of basophils,
lymphocytes and monocytes (Fig. 6).
Special attention was however drawn by the vacuolation
changes in the form of one large vacuole or numerous small
vacuoles in the cytoplasm of both columnar cells (Fig. 3a), and
squamous epithelial cells (Fig. 3d and 3e). A significant increase
in the number of vacuolated cells can be seen, up to 40.03, while
the smears of patients before treatment only 4.70 were shown
(c2=28.50; P=0.0000) (Fig. 8). Among the cells with vacuolation
changes, revealed the presence of forms with a perinuclear halo
(Fig. 3b).
DISCUSSION
Progress in diagnosing and treating allergic diseases is based
on the improved understanding of the mechanisms of these
diseases, the development of new drugs, as well as on the
improvement and broadening of indications regarding drugs
which are already in use (22). The pathomechanism of
inflammatory rhinitis is related to the inflow and activation of
cells - mastocytes, basophils, eosinophils, T lymphocytes and
neutrophils in the area of the inflammatory process (23, 24), and
144
Fig. 6. Distribution of epithelial and inflammatory cells in smears of the nasal mucous membrane of patients after fluticasone treatment;
*** P<0.001, ** P<0.01 compared to before treatment (chi2 test).
Fig. 7. Distribution of columnar
cells (cc) and goblet cells (gc) in
smears of the nasal mucous
membrane of patients before
and after fluticasone treatment;
*** P<0.001, compared to
before treatment (chi2 test).
its understanding allows us to correctly and justifiably use
specific drugs and therapeutic methods (25).
The cytological assessment of the smear from the surface of
the mucous membrane is, unlike the biopsy, a completely
noninvasive method, which can often be used in routine
ambulatory diagnostic. It can be performed in every situation, in
every patient of every age, and can be repeated numerous times
in the same person (26). The safety and lack of age limits are
confirmed by cytological studies in infants (27, 28). Since the
picture obtained in cytological studies is a reflection of the
processes taking place in the nasal mucous membrane, studies of
this type provide many new and significant information about
the type of the inflammatory reaction, as well allowing the
monitoring of the effectiveness of the implemented treatment
(24, 29 – 31). It should also be noted that the smear technique
obtains the highest total number of inflammatory cells
(approximately 3 – 4 times higher than in lavages and scrapings)
and epithelial cells (in this case almost 70%, while in lavages
42%), which was proven in studies comparing all three methods
of obtaining material for cytology (31, 32).
Without glucocorticosteroid drugs it would certainly be
difficult to imagine modern therapy of these diseases, the
pathogenesis of which is associated with the activation of
various inflammatory cells (33). Besides nasal mucosa diseases
145
Fig. 8. The number of cells with cytoplasm vacuolation in smears
from nasal mucous membrane taken from patients before and after
fluticasone treatment; *** P<0.001 compared to before treatment
(chi 2 test).
they are commonly used in the treatment of asthma, Crohn's
Disease or infant meconium aspiration syndrome (MAS), where
they, among other effects, significantly limit the influx of
inflammatory cells (34-36).
It should be remembered that these drugs control numerous
physiological processes in various organs and tissues and on many
levels, from the proliferation and differentiation of cells, to the
regulation of their metabolic activity and programmed death (37,
38). The cellular reaction to glucocorticosteroids is very diverse
and shows great variability in its specificity and sensitivity (39).
Glucocorticosteroids, independent on the form of
administration, can change the cytological image of the mucous
membrane, it should however be noted that these changes can be
beneficial or undesirable (19).
The cytological studies preformed on a group of patients
with rhinitis symptoms before their treatment, in comparison to
the control smears, clearly show a disturbance in the biocenosis
of the nasal mucous membrane. The presence of numerous
bacteria has been shown (Fig. 2c), as well as of granulocytes
with the predominance of neutrophils (Figs. 2b and 4). With the
assumption that a cytogram described as correct should contain
single neutrophils (13, 20, 25), the presented change suggests a
pathological state. Furthermore, the observed granulocytes
display the characteristics of poorly differentiated cytoplasm, as
well as contours of nuclei, which suggests a chronic state. In
acute inflammations granulocytes, existing as young forms, have
clear and intensively staining nuclei and well differentiated
cytoplasm (40).
Changes in the content of the cellular population of the nasal
mucous membrane are also a confirmation of the pathological
state. A disturbance in the ratio of columnar cells to goblet cells
has been noted, to the benefit of the goblet cells (Figs. 2a, 4, and
5), while in proper cytograms the columnar cells should
outnumber goblet cells by a ratio of 5 (25, 41, 42). The
mechanism contributing to the increase of goblet cells is their
over-proliferation, known as hyperplasia, which often
accompanies inflammation in the respiratory epithelium (43,
44). According to some authors, the hyperplasia of goblet cells
can accompany inflammation in which the dominant cell is the
neutrophil, like in the chronic inflammation of nasal mucous
membrane and rhinosinusitis with the exclusion of nasal polyps
(45). It should also be stressed that the studied material showed
the presence of free nuclei of columnar cells (Fig. 2d), which
was a result of intensive cytolitic processes, and is also an
example of changes commonly associated with a disturbed
biocenosis (40, 46).
The presence of very numerous cells of the squamous
stratified epithelium has also been confirmed (Figs. 2a, 2c, 2d
and 4). The prevalence of these cells, in different stages of
development, with the assumption that the material was properly
obtained, suggests a pathological state (41). Since the analyzed
smears showed a prevalence of cells originating from the deeper
strata of the epithelium (basophilic with a large round nucleus
with a mildly granular structure), it suggests a damage to the
upper layers of the epithelium (47). The breakdown of the
nucleus (karyorrhexis) observed in the basophilic cells is also,
together with an enlargement and a dissolution (karyolysis) of
this structure, a common occurrence in inflammation (40).
The obtained changes, especially the neutrophilic reaction,
indicate a chronic infectious rhinitis, in which neutrophils can
often be the only cells in the smear (48).
A comparison of the cytological image of patients with rhinitis
before treatment and the same patients after treatment with
fluticasone enabled the demonstration of significant differences in
epithelial reaction and number of inflammatory cells.
The consequence of the drug activity was the decrease of
inflammation of nasal mucosa, confirmed mainly through the
reduction of the number of neutrophils (Fig. 6), which can be
related to results of similar cytological studies with the use of
another glucocorticosteroid-mometasone in allergic rhinitis (19).
The observed decrease of goblet cells, with a simultaneous,
also statistically significant increase of the number of columnar
cells (the proper ratio of columnar to goblet cells) shows a gradual
regeneration of the nasal mucous membrane (Figs. 3c, 6 and 7).
The confirmation of the results obtained in relation to goblet cells
were the cytological studies of Lin et al. (18) on
glucocorticosteroids used in people with rhinitis and the longstanding research of Mygind (49) and Sorensen (50) on the activity
of budesonide based on the assessment of nasal mucous membrane
segments under an electron microscope. Whereas the stimulating
effect of glucocorticosteroids on columnar cells was shown in the
research on mometasone performed by Tarchalska-Krynska (19)
and Meltzer (51). Another confirmation of the beneficial effect of
topical glucocorticosteroid therapy on the proper proportion of
columnar to goblet cells comes from the results of our own
cytological studies on the use of budesonide (52, 53).
In comparison to the state before treatment, fluticasone
therapy did not influence the general number of squamous
stratified epithelial cells (Fig. 6), because an increase in
basophilic cells was obtained, together with a simultaneous
decrease in the number of acidophilic cells, which suggests a
low effectiveness of the drug in relation to cells of this type,
which had also been confirmed in other studies (20).
However, special attention has been drawn by the increase of
vacuolated epithelial cells (Fig. 8), mainly columnar. Some cells
were characterized by the presence of a single vacuole (Fig. 3e)
or numerous small vacuoles in the cytoplasm (Figs. 3a and 3d),
146
others were characterized by perinuclear vacuolation, a clear
nuclear halo (Fig. 3b). The intensified vacuolation of the cell
cytoplasm might suggest an induction of autophagic processes.
According to numerous reports, autophagy plays a significant
role in numerous aspects of inborn and adaptive immunity,
including, among others, the activation of the immunological
system, survival of infected cells (54) or the elimination of
intracellular pathogens, including bacteria and viruses (55, 56).
It should be stressed that according to numerous literature data,
autophagy can be associated not only with macrophages, but
also with cells not belonging to the immunological system (57).
Whereas the so called perinuclear halo effect, according to the
available literature, appears because of karyoplasm shrinkage
and can be the result of reversible cytoskeleton damage (58). In
our previous research we had confirmed the effectiveness of
topical glucocorticosteroid therapy in the treatment of nasal
mucosa diseases, however we have also revealed changes which
require further study. As described in professional literature (59),
the noninvasive study of nasal nitric oxide (NO) levels can be an
excellent supplementation of the cytological studies both in the
assessment of the inflammatory reaction of the nasal mucous
membrane and the reaction to anti-inflammatory treatment. As
shown in professional literature (60), the study design should
also include the fact that the very use of hypertonic saline
solution in nasal aerosol form can have a significant effect on the
nasal NO levels.
In summary, the obtained results of the cytological study of
nasal mucosa shows that therapy with fluticasone propionate
used in the dose of 100 µg to 200 µg in patients with diagnosed
chronic infectious reaction of nasal mucosa caused a significant
decrease of inflammation visible in the cytological image in the
form of reduction of bacteria and the accompanying nasal
neutrophilia. Simultaneously, no harmful action of the applied
glucocorticosteroid was observed, which was confirmed by the
lack of significant changes in the number of squamous epithelial
cells with a clearly increased number of columnar cells. Whereas
the observed escalation in vacuolation of these cells, with a
simultaneous lack of apoptosis characteristics, doesn't show the
characteristics of degenerative changes, but might suggest an
additional mechanism of glucocorticosteroids in nasal mucosa
inflammation.
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Conflict of interests: None declared.
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R e c e i v e d : December 6, 2013
A c c e p t e d : November 3, 2014
Author's address: Prof. Teodora Krol, Department of Cell
Biology and Electron Microscopy, Jan Kochanowski University,
15 Swietokrzyska Street, 25-381 Kielce.
E-mail: [email protected]