BACKGROUND Current United States Food and Drug Administration(FDA)guidelines established since 2005 recommend the usage of silicone stents over metal stents due to the risk of complications associated with the older g...BACKGROUND Current United States Food and Drug Administration(FDA)guidelines established since 2005 recommend the usage of silicone stents over metal stents due to the risk of complications associated with the older generation of uncovered stents.Yet,with the advancement of technology,novel innovations of self-expanding metal stents(SEMS)have revolutionized the treatment of benign airway stenosis(BAS),where the insertion of SEMS is known to be easier than silicone stents.AIM To compare the efficacy and safety of covered SEMS against uncovered SEMS,and thereafter propose more direct trials comparing covered SEMS against silicone stents for consideration of revision of current FDA guidelines.METHODS A comprehensive literature review of MEDLINE and EMBASE was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.Of 3002 articles,64 publications met the eligibility criteria with a total of 900 patients(468 covered SEMS,432 uncovered SEMS).The collected data were analyzed using Statistical Package for the Social Sciences version 11.5.RESULTS Covered SEMS showed a higher success rate of insertion(98.6%vs 88.2%)and lower complication rates of infection(1.3%vs 13.2%),restenosis(1.5%vs 10.6%),stent fracture(2.6%vs 7.4%),bleeding(0%vs 5.8%),and pneumothorax(0%vs 2.8%)compared to uncovered SEMS.However,covered SEMS compared to uncovered SEMS showed higher complication rates of stent migration(12.4%vs 6.9%)and granulation tissue formation(26.5%vs 20.1%).CONCLUSION Our study suggests that covered SEMS are an effective,safe,and viable option in the treatment of BAS.Thus,further consideration regarding the utilization of covered SEMS over other forms of stent types is appropriate.展开更多
Imidacloprid,a neonicotinoid insecticide,is widelyused in agriculture as a safer alternative to highly toxicorganophosphates.It targets nicotinic acetylcholinereceptors in pests and is generally low in toxicity tohuma...Imidacloprid,a neonicotinoid insecticide,is widelyused in agriculture as a safer alternative to highly toxicorganophosphates.It targets nicotinic acetylcholinereceptors in pests and is generally low in toxicity tohumans.However,large ingestions can cause severe,life-threatening complications,with no establishedtreatment protocols.Though rarely fatal,imidaclopridpoisoning is increasingly reported in agricultural regions,particularly in Southeast Asia,with most cases involvingsuicide attempts.展开更多
BACKGROUND MURCS association,an acronym for Müllerian duct aplasia/hypoplasia,congenital renal agenesis/ectopia,and cervical somite dysplasia,presents unique anaesthetic challenges,particularly for airway control...BACKGROUND MURCS association,an acronym for Müllerian duct aplasia/hypoplasia,congenital renal agenesis/ectopia,and cervical somite dysplasia,presents unique anaesthetic challenges,particularly for airway control due to cervical spine anomalies.This case report adds to the limited literature by detailing airway management strategies in a paediatric patient with MURCS,emphasising the need for thorough preoperative evaluation and curated planning.CASE SUMMARY This report describes the successful anaesthetic and airway management of a 6-year-old girl with MURCS undergoing dental extraction.To address the complexities of the patient’s condition,a multidisciplinary approach involving comprehensive preoperative assessment,meticulous planning,and advanced airway management techniques was adopted.CONCLUSION This report emphasizes individualized anesthetic strategies and interprofessional collaboration for managing rare congenital syndromes.展开更多
Objective:To explore the application effect of high-fidelity simulation teaching in the training of emergency management for difficult airways among anesthesia nursing students,providing practical references for enhan...Objective:To explore the application effect of high-fidelity simulation teaching in the training of emergency management for difficult airways among anesthesia nursing students,providing practical references for enhancing their clinical emergency response capabilities.Methods:Eighty-four anesthesia nursing students who interned in the Department of Anesthesiology of our hospital from September 2023 to March 2024 were selected as the research subjects.They were randomly divided into a control group(n=42)and an observation group(n=42)using the random number table method.The control group adopted the traditional teaching mode(theoretical lectures+video demonstrations),while the observation group adopted the high-fidelity simulation teaching mode.After the training,the theoretical assessment scores,operational assessment scores,emergency response capability scores,and teaching satisfaction of the two groups of students were compared.Results:The observation group scored significantly higher than the control group in both theoretical assessment(90.35±4.82)points and practical assessment(92.17±3.96)points,with scores of(79.26±5.78)points and(81.34±5.21)points,respectively,in the control group.The differences were statistically significant(p<0.05).The observation group also scored higher than the control group in all dimensions of emergency response capabilities and total scores,including airway assessment(18.92±2.05)points vs.(14.56±2.37)points,equipment selection(19.15±1.83)points vs.(13.89±2.24)points,operation execution(19.36±1.78)points vs.(14.23±2.41)points,teamwork(18.73±2.11)points vs.(13.98±2.53)points,and total score(76.16±6.84)points vs.(56.66±7.92)points.All differences were statistically significant(p<0.05).The teaching satisfaction rate in the observation group was 97.62%(41/42),significantly higher than that in the control group at 78.57%(33/42),with a statistically significant difference(p<0.05).Conclusion:High-fidelity simulation teaching can effectively enhance the theoretical knowledge,practical skills,and emergency response capabilities of anesthesia nursing students in managing difficult airways,as well as improve teaching satisfaction.It is an efficient clinical teaching model for anesthesia nursing and is worthy of promotion and application.展开更多
BACKGROUND In critical care practice,difficult airway management poses a substantial challenge,necessitating urgent intervention to ensure patient safety and optimize outcomes.Extracorporeal membrane oxygenation(ECMO)...BACKGROUND In critical care practice,difficult airway management poses a substantial challenge,necessitating urgent intervention to ensure patient safety and optimize outcomes.Extracorporeal membrane oxygenation(ECMO)is a potential rescue tool in patients with severe airway compromise,although evidence of its efficacy and safety remains limited.AIM To review the local experience of using ECMO support in patients with difficult airway management.METHODS This retrospective case series study includes patients with difficult airway management who required ECMO support at a tertiary hospital in a Middle Eastern country.RESULTS Between 2016 and 2023,a total of 13 patients required ECMO support due to challenging airway patency in the operating room.Indications for ECMO encompassed various diagnoses,including tracheal stenosis,external tracheal compression,and subglottic stenosis.Surgical interventions such as tracheal resection and anastomosis often necessitated ECMO support to maintain adequate oxygenation and hemodynamic stability.The duration of ECMO support ranged from standby mode(ECMO implantation is readily available)to several days,with relatively infrequent complications observed.Despite the challenges encountered,most patients survived hospital discharge,highlighting the effectiveness of ECMO in managing difficult airways.CONCLUSION This study underscores the crucial role of ECMO as a life-saving intervention in selected cases of difficult airway management.Further research is warranted to refine the understanding of optimal management strategies and improve outcomes in this challenging patient population.展开更多
Objective:To explore the effect of continuous positive airway pressure(CPAP)therapy on daytime sleepiness and cognitive function in patients with moderate to severe obstructive sleep apnea-hypopnea syndrome(OSAHS).Met...Objective:To explore the effect of continuous positive airway pressure(CPAP)therapy on daytime sleepiness and cognitive function in patients with moderate to severe obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods:From January to December 2024,60 patients with moderate to severe OSAHS were enrolled and randomly divided into an observation group and a control group,with 30 patients in each group.The observation group received CPAP combined with routine intervention,while the control group only received routine intervention,with a course of 3 months for both groups.Results:After 3 months of intervention,the observation group showed significantly better improvements in the frequency and duration of daytime sleepiness as well as all dimensions of cognitive function compared with the control group,and the differences were statistically significant(P<0.05).Conclusion:CPAP therapy can effectively relieve daytime sleepiness in patients with moderate to severe OSAHS,and significantly improve memory,attention and logical thinking ability.The comprehensive intervention effect is superior to simple routine management.展开更多
Background:Mechanical ventilation(MV)provides life support for patients with severe respiratory distress but can simultaneously cause ventilator-induced lung injury(VILI).However,due to a poor understanding of its mec...Background:Mechanical ventilation(MV)provides life support for patients with severe respiratory distress but can simultaneously cause ventilator-induced lung injury(VILI).However,due to a poor understanding of its mechanism,there is still a lack of effective remedies for the often-deadly VILI.Recent studies indicate that the stretch associated with MV can enhance the secretion of extracellular vesicles(EVs)and induce endoplasmic reticulum(ER)stress in airway smoothmuscle cells(ASMCs),both of which can contribute to VILI.But whetherMVassociated stretch enhances the secretion of EVs via ER stress in ASMCs as an underlying mechanism of VILI remains unknown.Methods:In this study,we exposed cultured human ASMCs to stretch(13%strain)and mouse models to MV at tidal volume(18 mL/kg).Subsequently,the amount of secreted EVs in the culture medium of ASMCs and the bronchoalveolar lavage fluid(BALF)of mousemodels was quantitatively evaluated by ultracentrifugation,transmission electron microscopy,Western blot,flow cytometry,and nanoparticle tracking analysis.The cultured ASMCs and the lung tissues of mouse models were assessed for expression of biomarkers of EVs(cluster of differentiation antigen 63,CD63),ER stress(heat shock protein family A member 5,HSPA5),and EVs regulating molecule Rab27a by immunofluorescence microscopy,immunohistochemistry(IHC)and enzyme-linked immunosorbent assay(ELISA),respectively.MicroRNAs(miRNAs)in EVs from ASMCs were measured with miRNA whole genome sequencing(miRNA-Seq).Results:We found that stretch enhanced EV secretion from cultured ASMCs.In addition,the cultured ASMCs and the mouse models were either or not pretreated with ER stress inhibitor(tauroursodeoxycholic acid,TUDCA)/EV secretion inhibitor(GW4869)prior to stretch or MV.We found that MV-associated stretch enhanced the expression of CD63,HSPA5,and Rab27a in cultured ASMCs and BALF/lung tissues of mousemodels,which could all be attenuated with TUDCA/GW4869 pretreatment.miRNA-Seq data show that differentially expressed miRNAs in EVsmainlymodulate gene transcription.Furthermore,the EVs fromcultured ASMCs under stretch tended to enhance detachment and expression of inflammatory cytokines,i.e.,transforming growth factor-β1(TGF-β1),interleukin-10(IL-10)in cultured airway epithelial cells.The expression of TGF-β1 and IL-10 in BALF of the mouse models also increased in response to MV,which was attenuated together with partial improvement of lung injury by pretreatment with TUDCA,GW4869/Rab27a siRNAs.Conclusion:Taken together,our data indicate thatMV-associated stretch can enhance the secretion of EVs from ASMCs via ER stress signaling to mediate airway inflammation and VILI,which provides new insight for further exploring EVs for the diagnosis and treatment of VILI.展开更多
The deposition characteristics of nasal formulations directly determine the efficacy of the drugs,whilst the complexity of human nasal airway structure encumbers quantitative evaluation of nasal spatial deposition.Mal...The deposition characteristics of nasal formulations directly determine the efficacy of the drugs,whilst the complexity of human nasal airway structure encumbers quantitative evaluation of nasal spatial deposition.Male and female standard nasal airway structure models were calculated from computed tomography data of 128 Chinese Han nationality using statistical shape model.The deposition evaluation devices were further designed,and an imaging method was then employed to obtain drug deposition information.Furthermore,drug spatial deposition atlases were proposed by UV unwrapping,a mathematical mapping procedure flattening three-dimensional(3D)information to two-dimension bidirectionally,to achieve quantification of drug deposition fractions in the regions of interest.Moreover,the feasibility and universality of this method were verified by correlating it with the chemical quantitative results and computational fluid dynamic simulation of drug deposition of mometasone furoate nasal spray and hydroxypropyl methylcellulose nasal powder,respectively.Finally,the unique drug spatial deposition atlases of these two formulations in the male and female evaluation devices were generated,respectively.In summary,the standard nasal airway structure models of the Chinese Han nationality and the drug spatial deposition atlases provide scientific tools for the formulation optimization and quality control of nasal formulations.展开更多
Obstructive sleep apnea(OSA)and coronary artery disease(CAD)frequently coexist,forming a bidirectional pathophysiological loop that amplifies cardiovascular risk.Intermittent hypoxemia in OSA patients promotes endothe...Obstructive sleep apnea(OSA)and coronary artery disease(CAD)frequently coexist,forming a bidirectional pathophysiological loop that amplifies cardiovascular risk.Intermittent hypoxemia in OSA patients promotes endothelial dysfunction,systemic inflammation,oxidative stress,and sympathetic activation,thereby accelerating atherogenesis,whereas myocardial ischemia and ventricular dysfunction in CAD patients can further destabilize upper-airway patency and exacerbate OSA.Continuous positive airway pressure(CPAP)is the standard therapy for OSA and reliably restores sleep architecture;however,large randomized trials have reported inconsistent effects on major adverse cardiovascular events,particularly in patients with established CAD.This mini review synthesizes contemporary data on CPAP across diverse OSA–CAD clinical scenarios,delineates patient phenotypes most likely to achieve cardiovascular benefit and identifies contexts in which CPAP provides limited protection.On the basis of these findings,we propose pragmatic recommendations for patient selection,adherence monitoring and optimization of CPAP therapy and highlight key research priorities,including extended follow-up,adherence-enhancing strategies and multimodal interventions.Clarifying the circumstances under which CPAP is cardioprotective will enable more precise management of patients with OSA,with or without concomitant CAD.展开更多
Objective:To analyze the treatment effect of standardized bronchoscopic interventional therapy(i.e.,interventional therapy)on airway stenosis.Methods:Forty patients with airway stenosis admitted to the hospital betwee...Objective:To analyze the treatment effect of standardized bronchoscopic interventional therapy(i.e.,interventional therapy)on airway stenosis.Methods:Forty patients with airway stenosis admitted to the hospital between September 2022 and September 2024 were selected and randomly divided into two groups using a random number table.The experimental group received interventional therapy,while the reference group received conventional treatment.The total effective rate,degree of airway stenosis,shortness of breath score,and lung function indicators were compared.Results:The total effective rate in the experimental group was higher than that in the reference group.The proportion of mild stenosis in the degree of airway stenosis was higher in the experimental group than in the reference group.The shortness of breath score was lower in the experimental group than in the reference group.The lung function indicators were better in the experimental group than in the reference group(P<0.05).Conclusion:Interventional therapy is effective for patients with airway stenosis,as it can reduce the degree of stenosis,improve symptoms of shortness of breath,and protect patients’lung function.展开更多
Introduction: Foreign bodies (FB) in the lower airways (LAs) constitute a potentially life-threatening emergency requiring immediate management. The objective of our study was to describe the patient pathway and manag...Introduction: Foreign bodies (FB) in the lower airways (LAs) constitute a potentially life-threatening emergency requiring immediate management. The objective of our study was to describe the patient pathway and management of foreign bodies in the lower airways. Methodology: This was a descriptive study with retrospective data collection conducted over a 6-year period (January 1, 2014, to December 31, 2019) in the ENT and Head and Neck Surgery Department of Donka National Hospital. Results: We observed a prevalence of 1.79%. The average age was 5.71 years, with a sex ratio of 1.2. However, 82.61% of the cases originated from rural areas. We noted that 78.83% of patients were referred after visiting 1 to 2 healthcare facilities (75.36%). The consultation delay was 3 days. Penetration syndrome was present in 98.56% of cases. The foreign body incidents occurred during play in 54.84% and during meals in 29.09% of cases. Radiographs were performed in 93.9% of cases. Endoscopy was used for both diagnostic and therapeutic purposes in all patients. The foreign bodies were located in the trachea (37.68%), larynx (26.08%), and bronchi (21.73%). Non-organic foreign bodies were predominant (52.17%). Postoperative outcomes were uncomplicated in 95.98% of cases, and the lethality rate was 2.85%. Conclusion: The pathway of patients with foreign bodies in the airways remains unpredictable in our context due to parental hesitations. Early management reduces morbidity and mortality rates.展开更多
Inflammatory diseases are often chronic and recurrent,and current treatments do not typically remove underlying disease drivers1.T cells participate in a wide range of inflammatory diseases such as psoriasis2,Crohn...Inflammatory diseases are often chronic and recurrent,and current treatments do not typically remove underlying disease drivers1.T cells participate in a wide range of inflammatory diseases such as psoriasis2,Crohn's disease3,oesophagitis4 and multiple sclerosis5,6,and clonally expanded antigen-specific T cells may contribute to disease chronicity and recurrence,in part by forming persistent pathogenic memory.Chronic rhinosinusitis and asthma are inflammatory airway diseases that often present as comorbidities7.Chronic rhinosinusitis affects more than 10%of the general population8.Among these patients,20-25%would develop nasal polyps,which often require repeated surgical resections owing to a high incidence of recurrence9.Whereas abundant T cells infiltrate the nasal polyps tissue10,11,T cell subsets that drive the disease pathology and promote recurrence are not fully understood.By comparing T cell repertoires in nasal polyp tissues obtained from consecutive surgeries,here we report that persistent CD8^(+)T cell clones carrying effector memory-like features colonize the mucosal tissue during disease recurrence,and these cells characteristically express the tryptase Granzyme K(GZMK).We find that GZMK cleaves many complement components,including C2,C3,C4 and C5,that collectively contribute to the activation of the complement cascade.GZMK-expressing CD8^(+)T cells participate in organized tertiary lymphoid structures,and tissue GZMK levels predict the disease severity and comorbidities better than well-established biomarkers such as eosinophilia and tissue interleukin-5.Using a mouse asthma model,we further show that GZMK-expressing CD8^(+)T cells exacerbate the disease in a manner dependent on the proteolytic activity of GZMK and complements.Genetic ablation or pharmacological inhibition of GZMK after the disease onset markedly alleviates tissue pathology and restores lung function.Our work identifies a pathogenic CD8^(+)memory T cell subset that promotes tissue inflammation and recurrent airway diseases by the effector molecule GZMK and suggests GZMK as a potential therapeutic target.展开更多
<b>Background:</b> Emergency endotracheal intubations (EEI) performed outside of operating theatre (OT) tend to be more challenging and associated with higher risk of complications. In 2011, with the objec...<b>Background:</b> Emergency endotracheal intubations (EEI) performed outside of operating theatre (OT) tend to be more challenging and associated with higher risk of complications. In 2011, with the objective of improving patient outcomes, we set up an Emergency Airway Service (EAS) at our 1000-bed regional hospital, with the aim of providing specialized assistance for outside of OT difficult airway management. <b>Method:</b> A retrospective audit of EAS activation from 12/9/2016 and 27/10/2020 was conducted. EAS forms and electronic medical records were reviewed. We collected information on patient characteristics, EAS activation characteristics and its outcomes. Descriptive analysis method was used to present the collected data. <b>Results:</b> There were a total of 275 activations, of which 268 were analysed. Reasons for activation were anticipated difficult intubation (42.2% n = 113), failed intubation attempt (52.6%, n = 141) and advanced intubation equipment required (5.2% n = 14). Intubation was attempted in 261/268 (97.4%) cases by the EAS team. Of these, 255 (97.7%) cases were successful while 6 (2.3%) cases failed intubation. Of the successful intubations by the EAS team, 208/255 (81.5%) were successful on the first attempt. Out of the 6 unsuccessful intubation cases, 1 case required a rescue cricothyroidotomy and 4 cases required an open tracheostomy. Intubation was deemed easy by the EAS team in 170/261 (65.1%) cases. 64/170 (37.6%) cases were intubated with a video laryngoscope (VL). There were 85 cases (32.3%) classified as difficult intubation by the EAS specialist, 13/85 (15.3%) were intubated using only VL, 54/85 (63.5%) cases were intubated using VL with style/bougie. <b>Conclusion:</b> Audit results showed that providing an experienced and well-equipped team of airway specialists round-the-clock to assist in difficult and potentially difficult endotracheal intubations is justifiable and may reduce complications associated with EEI.展开更多
Neck trauma with a traumatized airway can be challenging for airway management, as the neck is a vital structure. Case Report: We are reporting on a 33-year-old male worker who suffered an industrial accident. A steel...Neck trauma with a traumatized airway can be challenging for airway management, as the neck is a vital structure. Case Report: We are reporting on a 33-year-old male worker who suffered an industrial accident. A steel cord severely hit his neck. He was brought to our ER immediately. Upon arrival, he was conscious with stable vital signs. A physical examination revealed that his Adam’s apple was penetrated, and the adjacent soft tissue and structures were visible. A CT scan showed an anterior and left lateral neck penetrating injury with an open wound, exposure of the thyroid cartilage, a left thyroid cartilage fracture, and pneumoderma. He was urgently taken to the operating theater for airway stabilization and underwent six hours of exploration of the laryngopharyngeal cavity and closure of the laryngopharyngeal defect. He was then sent to the ICU. After two months in the hospital, he regularly follows up in the outpatient department. Conclusion: Effective decision-making for neck trauma with a compromised airway is crucial to ensure the patient’s safety.展开更多
Background: Airway inflammation is the core pathological process of asthma, with the key inflammatory regulators incompletely defined. Recently, fibroblast growth factor 2(FGF2) has been reported to be an inflammatory...Background: Airway inflammation is the core pathological process of asthma, with the key inflammatory regulators incompletely defined. Recently, fibroblast growth factor 2(FGF2) has been reported to be an inflammatory regulator;however, its role in asthma remains elusive. This study aimed to investigate the immunomodulatory role of FGF2 in asthma.Methods: First, FGF2 expression was characterised in clinical asthma samples and the house dust mite(HDM)-induced mouse chronic asthma model. Second, recombinant mouse FGF2(rm-FGF2) protein was intranasally delivered to determine the effect of FGF2 on airway inflammatory cell infiltration. Third, human airway epithelium-derived A549 cells were stimulated with either HDM or recombinant human interleukin-1β(IL-1β) protein combined with or without recombinant human FGF2. IL-1β-induced IL-6 or IL-8 release levels were determined using enzyme-linked immunosorbent assay, and the involved signalling transduction was explored via Western blotting.Results: Compared with the control groups, the FGF2 protein levels were significantly upregulated in the bronchial epithelium and alveolar areas of clinical asthma samples [(6.70±1.79) vs.(16.32±2.40), P=0.0184;(11.20±2.11) vs.(21.00±3.00), P=0.033, respectively] and HDM-induced asthmatic mouse lung lysates [(1.00±0.15) vs.(5.14±0.42),P<0.001]. Moreover, FGF2 protein abundance was positively correlated with serum total and anti-HDM IgE levels in the HDM-induced chronic asthma model(R^(2)=0.857 and 0.783, P=0.0008 and 0.0043, respectively). Elevated FGF2protein was mainly expressed in asthmatic bronchial epithelium and alveolar areas and partly co-localised with infiltrated inflammatory cell populations in HDM-induced asthmatic mice. More importantly, intranasal instillation of rm-FGF2 aggravated airway inflammatory cell infiltration [(2.45±0.09) vs.(2.88±0.14), P=0.0288] and recruited more subepithelial neutrophils after HDM challenge [(110.20±29.43) cells/mm^(2) vs.(238.10±42.77) cells/mm^(2), P=0.0392]without affecting serum IgE levels and Th2 cytokine transcription. In A549 cells, FGF2 was upregulated through HDM stimulation and promoted IL-1β-induced IL-6 or IL-8 release levels [up to(1.41±0.12)-or(1.44±0.14)-fold change vs.IL-1β alone groups, P=0.001 or 0.0344, respectively]. The pro-inflammatory effect of FGF2 is likely mediated through the fibroblast growth factor receptor(FGFR)/mitogen-activated protein kinase(MAPK)/nuclear factor kappa B(NF-κB)pathway.Conclusions: Our findings suggest that FGF2 is a potential inflammatory modulator in asthma, which can be induced by HDM and acts through the FGFR/MAPK/NF-κB pathway in the airway epithelial cells.展开更多
Objective To evaluate the feasibility of the Shikani Optical Stylet （SOS）-guided inmbation through a new Intubafing Laryngeal Airway （ILA） in anticipated difficult airways caused by scar contracture of the face an...Objective To evaluate the feasibility of the Shikani Optical Stylet （SOS）-guided inmbation through a new Intubafing Laryngeal Airway （ILA） in anticipated difficult airways caused by scar contracture of the face and neck. Methods Thirty-three adult patients with anticipated difficult airways undergoing selective faciocervical scar plastic surgery under general anesthesia were enrolled in this study. After anesthesia induction, a size 2.5, 3.5 or 4.5 ILA was inserted. Following good lung ventilation being verified, the SOS preloaded with an endotracheal tube was inserted via the ILA. Once the clear vocal cords came into view under the SOS, the endotracheal tube was advanced through glottis into the trachea. Results The ILA provided an effective airway in all patients, lntubation was successful at the first attempt on 22/33 （66.7%） occasions and at the second attempt on 6/33 （18.2%）. Intubation failed in 5 （15.1%） patients who suffered from severe limitation of head extension due to scar contracture of the neck. These patients＇ tracheas were finally intubated using a fibreoptic bronchoscope via the ILA. Conclusions The SOS-guided intubating method via the ILA is a feasible technique in patients with scar contracture of the face and neck. However, in patients with severe limitation of head extension, the use of SOS cannot be recommended. The SOS can be used as an alternative apparatus when the fibreoptic bronchoscope is not available.展开更多
BACKGROUND:Airway foreign bodies(AFBs)is an interdisciplinary area between emergency medicine,pediatrics and otolaryngology.It is a life-threatening condition that is not infrequently seen;however,it is poorly covered...BACKGROUND:Airway foreign bodies(AFBs)is an interdisciplinary area between emergency medicine,pediatrics and otolaryngology.It is a life-threatening condition that is not infrequently seen;however,it is poorly covered in medical literature.Accidental aspiration of an element into airways is a widespread clinical scenario among children under 3 years,predominantly males.Moreover,it is the leading cause of infantile deaths and the fourth one among preschool children.DATA RESOURCES:A systemic search was conducted in July 2015 using Pub Med/Pub Med Central Database of The National Center for Biotechnology Information(NCBI)(http://www.ncbi.nlm.nih.gov/).A total of 1 767 articles were identified and most of them were meta-analyses,systematic reviews,and case series.Those thoroughly discussing assessment and management of AFBs were retrieved.RESULTS:AFBs episodes may be either witnessed or missed.Presence of a witness for the inhalation is diagnostic.The later usually present with persistent active cough.A classical triad of paroxysmal cough,wheezing,and dyspnoea/decreased air entry was reported,though many presentations have inconsistent findings.Hence,diagnosis requires high index of clinical suspicion.Flexible fibro-optic bronchoscopy is the gold standard of diagnosis,whereas inhaled objects are best retrieved by rigid bronchoscopes.CONCLUSIONS:Close supervision of pediatrics is the hallmark of prevention.Caregivers should ensure a safe surrounding milieu,including the toys their offspring play with.Immediate complications result from direct obstruction or injury by the inhaled object.Alternatively,prolonged lodging traps air and induces inflammatory response causing atelectesis and pneumonia,respectively.展开更多
BACKGROUND In growing patients with skeletal discrepancies,early assessment of functional factors can be vital for the restoration of normal craniofacial growth.AIM To compare airway volumes in patients with mandibula...BACKGROUND In growing patients with skeletal discrepancies,early assessment of functional factors can be vital for the restoration of normal craniofacial growth.AIM To compare airway volumes in patients with mandibular retrognathism with the normal anteroposterior skeletal relationship,thereby assessing the association between cephalometric variables and airway morphology.METHODS Cone-beam computed tomography volume scans,and lateral cephalograms,3-dimensional airway volume and cross-sectional areas of 120 healthy children(54 boys and 66 girls mean age 15.19±1.28)which were done for orthodontic assessment were evaluated.The subjects were divided into 2 groups based on the angle formed between point A,Nasion and point B(ANB)values and cephalometric variables(such as anterior and posterior facial height,gonial angle etc.)airway volumes,and cross-sectional measurements were compared using independent t tests.Pearson’s correlation coefficient test was used to detect any relationship of different parts of the airway and between airway volume and 2-dimensional cephalometric variables.RESULTS Means and standard deviations for cephalometric,cross-sectional,and volumetric variables were compared.ANB,mandibular body length and facial convexity were statistically highly significant(P<0.01)whereas condylion to point A,nasal airway and total airway volume(P<0.05)were statistically significant.The nasal airway volume and the superior pharyngeal airway volume had a positive correlation(P<0.01),nasal airway was correlated to middle(P<0.05)and total airway superior had a relation with middle(P<0.05),inferior and total airway(P<0.05),middle was related to all other airways;inferior was also related to all the airways except nasal.Lateral cephalometric values were positively correlated with the airway volume with Frankfurt Mandibular Plane Angle and facial convexity showed significant correlations with total airway volume(P<0.05).Additionally,ANB angle was significantly correlated with total airway volume and superior airway(P<0.05).CONCLUSION The mean total airway volume in patients with retrognathic mandible was significantly smaller than that of patients with a normal mandible.展开更多
Cough is one of the most common symptoms observed in patients presenting with COVID-19,persisting for an extended duration following SARS-CoV-2 infection.We aim to describe the distribution of airway microbiota and ex...Cough is one of the most common symptoms observed in patients presenting with COVID-19,persisting for an extended duration following SARS-CoV-2 infection.We aim to describe the distribution of airway microbiota and explore its role in patients with post-CovID-19 chronic cough.A total of 57 patients experiencing persistent cough after infection were recruited during the Omicron wave of SARS-CoV-2 in China.Airway microbiota profiling is assessed in nasopharyngeal swab,nasal lavage,and induced sputum samples at 4 and 8 weeks after SARS-CoV-2 infection.Our findings reveal that bacterial families Staph-ylococcaceae,Corynebacteriaceae,and Enterobacteriaceae are the most prevalent in the upper airway,while Streptococcaceae,Lachnospiraceae,and Prevotellaceae emerge as the most prevalent bacterial families in the lower airway.An increase in the abundance of Staphylococcus in nasopharyngeal swab samples and of Streptococcus in induced sputum samples is observed after one month.Furthermore,the abundance of Staphylococcus identified in nasopharyngeal swab samples at the baseline period emerges as an insightful predictor for improvement in cough severity.In conclusion,dynamic alterations in the airway microbial composition may contribute to the post-coviD-19 chronic cough progression,while the compositional signatures of nasopharyngeal microbiota could reflect the improvement of this disease.展开更多
An airway pressure and flow data acquisition system is developed to investigate the approach to building the bi-level positive airway pressure BiPAP in a ventilator.A number of experiments under different breathing si...An airway pressure and flow data acquisition system is developed to investigate the approach to building the bi-level positive airway pressure BiPAP in a ventilator.A number of experiments under different breathing situations and states are conducted and the experimental data are recorded.According to the data from these experiments the variation characteristics of the pressure and flow are analyzed using Matlab. The data analysis results show that the pressure increases while the flow decreases in the expiratory phase contrarily the pressure decreases while the flow increases in the inspiratory phase during the apnea state both the pressure and the flow remain unchanged. According to the above variation characteristics of breath a feedback-based method for creating bi-level positive airway pressure is proposed. Experiments are implemented to verify the BiPAP model. Results demonstrate that the proposed method works effectively in following respiration and caters well to most polypnea and apnea events.展开更多
文摘BACKGROUND Current United States Food and Drug Administration(FDA)guidelines established since 2005 recommend the usage of silicone stents over metal stents due to the risk of complications associated with the older generation of uncovered stents.Yet,with the advancement of technology,novel innovations of self-expanding metal stents(SEMS)have revolutionized the treatment of benign airway stenosis(BAS),where the insertion of SEMS is known to be easier than silicone stents.AIM To compare the efficacy and safety of covered SEMS against uncovered SEMS,and thereafter propose more direct trials comparing covered SEMS against silicone stents for consideration of revision of current FDA guidelines.METHODS A comprehensive literature review of MEDLINE and EMBASE was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.Of 3002 articles,64 publications met the eligibility criteria with a total of 900 patients(468 covered SEMS,432 uncovered SEMS).The collected data were analyzed using Statistical Package for the Social Sciences version 11.5.RESULTS Covered SEMS showed a higher success rate of insertion(98.6%vs 88.2%)and lower complication rates of infection(1.3%vs 13.2%),restenosis(1.5%vs 10.6%),stent fracture(2.6%vs 7.4%),bleeding(0%vs 5.8%),and pneumothorax(0%vs 2.8%)compared to uncovered SEMS.However,covered SEMS compared to uncovered SEMS showed higher complication rates of stent migration(12.4%vs 6.9%)and granulation tissue formation(26.5%vs 20.1%).CONCLUSION Our study suggests that covered SEMS are an effective,safe,and viable option in the treatment of BAS.Thus,further consideration regarding the utilization of covered SEMS over other forms of stent types is appropriate.
文摘Imidacloprid,a neonicotinoid insecticide,is widelyused in agriculture as a safer alternative to highly toxicorganophosphates.It targets nicotinic acetylcholinereceptors in pests and is generally low in toxicity tohumans.However,large ingestions can cause severe,life-threatening complications,with no establishedtreatment protocols.Though rarely fatal,imidaclopridpoisoning is increasingly reported in agricultural regions,particularly in Southeast Asia,with most cases involvingsuicide attempts.
基金Supported by Far-Eastern Memorial Hospital,No.FEMH-2025-C-016.
文摘BACKGROUND MURCS association,an acronym for Müllerian duct aplasia/hypoplasia,congenital renal agenesis/ectopia,and cervical somite dysplasia,presents unique anaesthetic challenges,particularly for airway control due to cervical spine anomalies.This case report adds to the limited literature by detailing airway management strategies in a paediatric patient with MURCS,emphasising the need for thorough preoperative evaluation and curated planning.CASE SUMMARY This report describes the successful anaesthetic and airway management of a 6-year-old girl with MURCS undergoing dental extraction.To address the complexities of the patient’s condition,a multidisciplinary approach involving comprehensive preoperative assessment,meticulous planning,and advanced airway management techniques was adopted.CONCLUSION This report emphasizes individualized anesthetic strategies and interprofessional collaboration for managing rare congenital syndromes.
基金Mechanism of HSP90 Regulating DRP1 Acetylation-Induced Mitochondrial Dynamics Imbalance in Endothelial Cells Promoting Atherosclerosis Progression,Shaanxi Provincial People’s Hospital(Project No.:2025JCYBBQN-1163)。
文摘Objective:To explore the application effect of high-fidelity simulation teaching in the training of emergency management for difficult airways among anesthesia nursing students,providing practical references for enhancing their clinical emergency response capabilities.Methods:Eighty-four anesthesia nursing students who interned in the Department of Anesthesiology of our hospital from September 2023 to March 2024 were selected as the research subjects.They were randomly divided into a control group(n=42)and an observation group(n=42)using the random number table method.The control group adopted the traditional teaching mode(theoretical lectures+video demonstrations),while the observation group adopted the high-fidelity simulation teaching mode.After the training,the theoretical assessment scores,operational assessment scores,emergency response capability scores,and teaching satisfaction of the two groups of students were compared.Results:The observation group scored significantly higher than the control group in both theoretical assessment(90.35±4.82)points and practical assessment(92.17±3.96)points,with scores of(79.26±5.78)points and(81.34±5.21)points,respectively,in the control group.The differences were statistically significant(p<0.05).The observation group also scored higher than the control group in all dimensions of emergency response capabilities and total scores,including airway assessment(18.92±2.05)points vs.(14.56±2.37)points,equipment selection(19.15±1.83)points vs.(13.89±2.24)points,operation execution(19.36±1.78)points vs.(14.23±2.41)points,teamwork(18.73±2.11)points vs.(13.98±2.53)points,and total score(76.16±6.84)points vs.(56.66±7.92)points.All differences were statistically significant(p<0.05).The teaching satisfaction rate in the observation group was 97.62%(41/42),significantly higher than that in the control group at 78.57%(33/42),with a statistically significant difference(p<0.05).Conclusion:High-fidelity simulation teaching can effectively enhance the theoretical knowledge,practical skills,and emergency response capabilities of anesthesia nursing students in managing difficult airways,as well as improve teaching satisfaction.It is an efficient clinical teaching model for anesthesia nursing and is worthy of promotion and application.
文摘BACKGROUND In critical care practice,difficult airway management poses a substantial challenge,necessitating urgent intervention to ensure patient safety and optimize outcomes.Extracorporeal membrane oxygenation(ECMO)is a potential rescue tool in patients with severe airway compromise,although evidence of its efficacy and safety remains limited.AIM To review the local experience of using ECMO support in patients with difficult airway management.METHODS This retrospective case series study includes patients with difficult airway management who required ECMO support at a tertiary hospital in a Middle Eastern country.RESULTS Between 2016 and 2023,a total of 13 patients required ECMO support due to challenging airway patency in the operating room.Indications for ECMO encompassed various diagnoses,including tracheal stenosis,external tracheal compression,and subglottic stenosis.Surgical interventions such as tracheal resection and anastomosis often necessitated ECMO support to maintain adequate oxygenation and hemodynamic stability.The duration of ECMO support ranged from standby mode(ECMO implantation is readily available)to several days,with relatively infrequent complications observed.Despite the challenges encountered,most patients survived hospital discharge,highlighting the effectiveness of ECMO in managing difficult airways.CONCLUSION This study underscores the crucial role of ECMO as a life-saving intervention in selected cases of difficult airway management.Further research is warranted to refine the understanding of optimal management strategies and improve outcomes in this challenging patient population.
文摘Objective:To explore the effect of continuous positive airway pressure(CPAP)therapy on daytime sleepiness and cognitive function in patients with moderate to severe obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods:From January to December 2024,60 patients with moderate to severe OSAHS were enrolled and randomly divided into an observation group and a control group,with 30 patients in each group.The observation group received CPAP combined with routine intervention,while the control group only received routine intervention,with a course of 3 months for both groups.Results:After 3 months of intervention,the observation group showed significantly better improvements in the frequency and duration of daytime sleepiness as well as all dimensions of cognitive function compared with the control group,and the differences were statistically significant(P<0.05).Conclusion:CPAP therapy can effectively relieve daytime sleepiness in patients with moderate to severe OSAHS,and significantly improve memory,attention and logical thinking ability.The comprehensive intervention effect is superior to simple routine management.
基金funded by the Natural Science Foundation of China(NSFC),Grants No.12072048 to M.L.,12272063,and 11532003 to L.D.partially supported by the Science and Technology Innovation Leading Plan of High-Tech Industry in Hunan Province,China,Grant No.2020SK2018 to L.D.
文摘Background:Mechanical ventilation(MV)provides life support for patients with severe respiratory distress but can simultaneously cause ventilator-induced lung injury(VILI).However,due to a poor understanding of its mechanism,there is still a lack of effective remedies for the often-deadly VILI.Recent studies indicate that the stretch associated with MV can enhance the secretion of extracellular vesicles(EVs)and induce endoplasmic reticulum(ER)stress in airway smoothmuscle cells(ASMCs),both of which can contribute to VILI.But whetherMVassociated stretch enhances the secretion of EVs via ER stress in ASMCs as an underlying mechanism of VILI remains unknown.Methods:In this study,we exposed cultured human ASMCs to stretch(13%strain)and mouse models to MV at tidal volume(18 mL/kg).Subsequently,the amount of secreted EVs in the culture medium of ASMCs and the bronchoalveolar lavage fluid(BALF)of mousemodels was quantitatively evaluated by ultracentrifugation,transmission electron microscopy,Western blot,flow cytometry,and nanoparticle tracking analysis.The cultured ASMCs and the lung tissues of mouse models were assessed for expression of biomarkers of EVs(cluster of differentiation antigen 63,CD63),ER stress(heat shock protein family A member 5,HSPA5),and EVs regulating molecule Rab27a by immunofluorescence microscopy,immunohistochemistry(IHC)and enzyme-linked immunosorbent assay(ELISA),respectively.MicroRNAs(miRNAs)in EVs from ASMCs were measured with miRNA whole genome sequencing(miRNA-Seq).Results:We found that stretch enhanced EV secretion from cultured ASMCs.In addition,the cultured ASMCs and the mouse models were either or not pretreated with ER stress inhibitor(tauroursodeoxycholic acid,TUDCA)/EV secretion inhibitor(GW4869)prior to stretch or MV.We found that MV-associated stretch enhanced the expression of CD63,HSPA5,and Rab27a in cultured ASMCs and BALF/lung tissues of mousemodels,which could all be attenuated with TUDCA/GW4869 pretreatment.miRNA-Seq data show that differentially expressed miRNAs in EVsmainlymodulate gene transcription.Furthermore,the EVs fromcultured ASMCs under stretch tended to enhance detachment and expression of inflammatory cytokines,i.e.,transforming growth factor-β1(TGF-β1),interleukin-10(IL-10)in cultured airway epithelial cells.The expression of TGF-β1 and IL-10 in BALF of the mouse models also increased in response to MV,which was attenuated together with partial improvement of lung injury by pretreatment with TUDCA,GW4869/Rab27a siRNAs.Conclusion:Taken together,our data indicate thatMV-associated stretch can enhance the secretion of EVs from ASMCs via ER stress signaling to mediate airway inflammation and VILI,which provides new insight for further exploring EVs for the diagnosis and treatment of VILI.
基金funded by the National Natural Science Foundation of China(No.82273863).
文摘The deposition characteristics of nasal formulations directly determine the efficacy of the drugs,whilst the complexity of human nasal airway structure encumbers quantitative evaluation of nasal spatial deposition.Male and female standard nasal airway structure models were calculated from computed tomography data of 128 Chinese Han nationality using statistical shape model.The deposition evaluation devices were further designed,and an imaging method was then employed to obtain drug deposition information.Furthermore,drug spatial deposition atlases were proposed by UV unwrapping,a mathematical mapping procedure flattening three-dimensional(3D)information to two-dimension bidirectionally,to achieve quantification of drug deposition fractions in the regions of interest.Moreover,the feasibility and universality of this method were verified by correlating it with the chemical quantitative results and computational fluid dynamic simulation of drug deposition of mometasone furoate nasal spray and hydroxypropyl methylcellulose nasal powder,respectively.Finally,the unique drug spatial deposition atlases of these two formulations in the male and female evaluation devices were generated,respectively.In summary,the standard nasal airway structure models of the Chinese Han nationality and the drug spatial deposition atlases provide scientific tools for the formulation optimization and quality control of nasal formulations.
文摘Obstructive sleep apnea(OSA)and coronary artery disease(CAD)frequently coexist,forming a bidirectional pathophysiological loop that amplifies cardiovascular risk.Intermittent hypoxemia in OSA patients promotes endothelial dysfunction,systemic inflammation,oxidative stress,and sympathetic activation,thereby accelerating atherogenesis,whereas myocardial ischemia and ventricular dysfunction in CAD patients can further destabilize upper-airway patency and exacerbate OSA.Continuous positive airway pressure(CPAP)is the standard therapy for OSA and reliably restores sleep architecture;however,large randomized trials have reported inconsistent effects on major adverse cardiovascular events,particularly in patients with established CAD.This mini review synthesizes contemporary data on CPAP across diverse OSA–CAD clinical scenarios,delineates patient phenotypes most likely to achieve cardiovascular benefit and identifies contexts in which CPAP provides limited protection.On the basis of these findings,we propose pragmatic recommendations for patient selection,adherence monitoring and optimization of CPAP therapy and highlight key research priorities,including extended follow-up,adherence-enhancing strategies and multimodal interventions.Clarifying the circumstances under which CPAP is cardioprotective will enable more precise management of patients with OSA,with or without concomitant CAD.
文摘Objective:To analyze the treatment effect of standardized bronchoscopic interventional therapy(i.e.,interventional therapy)on airway stenosis.Methods:Forty patients with airway stenosis admitted to the hospital between September 2022 and September 2024 were selected and randomly divided into two groups using a random number table.The experimental group received interventional therapy,while the reference group received conventional treatment.The total effective rate,degree of airway stenosis,shortness of breath score,and lung function indicators were compared.Results:The total effective rate in the experimental group was higher than that in the reference group.The proportion of mild stenosis in the degree of airway stenosis was higher in the experimental group than in the reference group.The shortness of breath score was lower in the experimental group than in the reference group.The lung function indicators were better in the experimental group than in the reference group(P<0.05).Conclusion:Interventional therapy is effective for patients with airway stenosis,as it can reduce the degree of stenosis,improve symptoms of shortness of breath,and protect patients’lung function.
文摘Introduction: Foreign bodies (FB) in the lower airways (LAs) constitute a potentially life-threatening emergency requiring immediate management. The objective of our study was to describe the patient pathway and management of foreign bodies in the lower airways. Methodology: This was a descriptive study with retrospective data collection conducted over a 6-year period (January 1, 2014, to December 31, 2019) in the ENT and Head and Neck Surgery Department of Donka National Hospital. Results: We observed a prevalence of 1.79%. The average age was 5.71 years, with a sex ratio of 1.2. However, 82.61% of the cases originated from rural areas. We noted that 78.83% of patients were referred after visiting 1 to 2 healthcare facilities (75.36%). The consultation delay was 3 days. Penetration syndrome was present in 98.56% of cases. The foreign body incidents occurred during play in 54.84% and during meals in 29.09% of cases. Radiographs were performed in 93.9% of cases. Endoscopy was used for both diagnostic and therapeutic purposes in all patients. The foreign bodies were located in the trachea (37.68%), larynx (26.08%), and bronchi (21.73%). Non-organic foreign bodies were predominant (52.17%). Postoperative outcomes were uncomplicated in 95.98% of cases, and the lethality rate was 2.85%. Conclusion: The pathway of patients with foreign bodies in the airways remains unpredictable in our context due to parental hesitations. Early management reduces morbidity and mortality rates.
文摘Inflammatory diseases are often chronic and recurrent,and current treatments do not typically remove underlying disease drivers1.T cells participate in a wide range of inflammatory diseases such as psoriasis2,Crohn's disease3,oesophagitis4 and multiple sclerosis5,6,and clonally expanded antigen-specific T cells may contribute to disease chronicity and recurrence,in part by forming persistent pathogenic memory.Chronic rhinosinusitis and asthma are inflammatory airway diseases that often present as comorbidities7.Chronic rhinosinusitis affects more than 10%of the general population8.Among these patients,20-25%would develop nasal polyps,which often require repeated surgical resections owing to a high incidence of recurrence9.Whereas abundant T cells infiltrate the nasal polyps tissue10,11,T cell subsets that drive the disease pathology and promote recurrence are not fully understood.By comparing T cell repertoires in nasal polyp tissues obtained from consecutive surgeries,here we report that persistent CD8^(+)T cell clones carrying effector memory-like features colonize the mucosal tissue during disease recurrence,and these cells characteristically express the tryptase Granzyme K(GZMK).We find that GZMK cleaves many complement components,including C2,C3,C4 and C5,that collectively contribute to the activation of the complement cascade.GZMK-expressing CD8^(+)T cells participate in organized tertiary lymphoid structures,and tissue GZMK levels predict the disease severity and comorbidities better than well-established biomarkers such as eosinophilia and tissue interleukin-5.Using a mouse asthma model,we further show that GZMK-expressing CD8^(+)T cells exacerbate the disease in a manner dependent on the proteolytic activity of GZMK and complements.Genetic ablation or pharmacological inhibition of GZMK after the disease onset markedly alleviates tissue pathology and restores lung function.Our work identifies a pathogenic CD8^(+)memory T cell subset that promotes tissue inflammation and recurrent airway diseases by the effector molecule GZMK and suggests GZMK as a potential therapeutic target.
文摘<b>Background:</b> Emergency endotracheal intubations (EEI) performed outside of operating theatre (OT) tend to be more challenging and associated with higher risk of complications. In 2011, with the objective of improving patient outcomes, we set up an Emergency Airway Service (EAS) at our 1000-bed regional hospital, with the aim of providing specialized assistance for outside of OT difficult airway management. <b>Method:</b> A retrospective audit of EAS activation from 12/9/2016 and 27/10/2020 was conducted. EAS forms and electronic medical records were reviewed. We collected information on patient characteristics, EAS activation characteristics and its outcomes. Descriptive analysis method was used to present the collected data. <b>Results:</b> There were a total of 275 activations, of which 268 were analysed. Reasons for activation were anticipated difficult intubation (42.2% n = 113), failed intubation attempt (52.6%, n = 141) and advanced intubation equipment required (5.2% n = 14). Intubation was attempted in 261/268 (97.4%) cases by the EAS team. Of these, 255 (97.7%) cases were successful while 6 (2.3%) cases failed intubation. Of the successful intubations by the EAS team, 208/255 (81.5%) were successful on the first attempt. Out of the 6 unsuccessful intubation cases, 1 case required a rescue cricothyroidotomy and 4 cases required an open tracheostomy. Intubation was deemed easy by the EAS team in 170/261 (65.1%) cases. 64/170 (37.6%) cases were intubated with a video laryngoscope (VL). There were 85 cases (32.3%) classified as difficult intubation by the EAS specialist, 13/85 (15.3%) were intubated using only VL, 54/85 (63.5%) cases were intubated using VL with style/bougie. <b>Conclusion:</b> Audit results showed that providing an experienced and well-equipped team of airway specialists round-the-clock to assist in difficult and potentially difficult endotracheal intubations is justifiable and may reduce complications associated with EEI.
文摘Neck trauma with a traumatized airway can be challenging for airway management, as the neck is a vital structure. Case Report: We are reporting on a 33-year-old male worker who suffered an industrial accident. A steel cord severely hit his neck. He was brought to our ER immediately. Upon arrival, he was conscious with stable vital signs. A physical examination revealed that his Adam’s apple was penetrated, and the adjacent soft tissue and structures were visible. A CT scan showed an anterior and left lateral neck penetrating injury with an open wound, exposure of the thyroid cartilage, a left thyroid cartilage fracture, and pneumoderma. He was urgently taken to the operating theater for airway stabilization and underwent six hours of exploration of the laryngopharyngeal cavity and closure of the laryngopharyngeal defect. He was then sent to the ICU. After two months in the hospital, he regularly follows up in the outpatient department. Conclusion: Effective decision-making for neck trauma with a compromised airway is crucial to ensure the patient’s safety.
基金supported by grants awarded to YY by the National Natural Science Foundation of China (81870019, 82170029)the Guangdong Provincial Natural Science Foundation (2018A030313554)+3 种基金the Innovation Research Team for Basic and Clinical Studies on Chronic Liver Diseases of 2018 High-Level Health Teams of ZhuhaiYKQ by the National Natural Science Foundation of China (82002612)the Chinese Postdoctoral Science Foundation (2019M660211)ZGC by the Science and Technology Program of Guangzhou,China (201704020179)。
文摘Background: Airway inflammation is the core pathological process of asthma, with the key inflammatory regulators incompletely defined. Recently, fibroblast growth factor 2(FGF2) has been reported to be an inflammatory regulator;however, its role in asthma remains elusive. This study aimed to investigate the immunomodulatory role of FGF2 in asthma.Methods: First, FGF2 expression was characterised in clinical asthma samples and the house dust mite(HDM)-induced mouse chronic asthma model. Second, recombinant mouse FGF2(rm-FGF2) protein was intranasally delivered to determine the effect of FGF2 on airway inflammatory cell infiltration. Third, human airway epithelium-derived A549 cells were stimulated with either HDM or recombinant human interleukin-1β(IL-1β) protein combined with or without recombinant human FGF2. IL-1β-induced IL-6 or IL-8 release levels were determined using enzyme-linked immunosorbent assay, and the involved signalling transduction was explored via Western blotting.Results: Compared with the control groups, the FGF2 protein levels were significantly upregulated in the bronchial epithelium and alveolar areas of clinical asthma samples [(6.70±1.79) vs.(16.32±2.40), P=0.0184;(11.20±2.11) vs.(21.00±3.00), P=0.033, respectively] and HDM-induced asthmatic mouse lung lysates [(1.00±0.15) vs.(5.14±0.42),P<0.001]. Moreover, FGF2 protein abundance was positively correlated with serum total and anti-HDM IgE levels in the HDM-induced chronic asthma model(R^(2)=0.857 and 0.783, P=0.0008 and 0.0043, respectively). Elevated FGF2protein was mainly expressed in asthmatic bronchial epithelium and alveolar areas and partly co-localised with infiltrated inflammatory cell populations in HDM-induced asthmatic mice. More importantly, intranasal instillation of rm-FGF2 aggravated airway inflammatory cell infiltration [(2.45±0.09) vs.(2.88±0.14), P=0.0288] and recruited more subepithelial neutrophils after HDM challenge [(110.20±29.43) cells/mm^(2) vs.(238.10±42.77) cells/mm^(2), P=0.0392]without affecting serum IgE levels and Th2 cytokine transcription. In A549 cells, FGF2 was upregulated through HDM stimulation and promoted IL-1β-induced IL-6 or IL-8 release levels [up to(1.41±0.12)-or(1.44±0.14)-fold change vs.IL-1β alone groups, P=0.001 or 0.0344, respectively]. The pro-inflammatory effect of FGF2 is likely mediated through the fibroblast growth factor receptor(FGFR)/mitogen-activated protein kinase(MAPK)/nuclear factor kappa B(NF-κB)pathway.Conclusions: Our findings suggest that FGF2 is a potential inflammatory modulator in asthma, which can be induced by HDM and acts through the FGFR/MAPK/NF-κB pathway in the airway epithelial cells.
文摘Objective To evaluate the feasibility of the Shikani Optical Stylet （SOS）-guided inmbation through a new Intubafing Laryngeal Airway （ILA） in anticipated difficult airways caused by scar contracture of the face and neck. Methods Thirty-three adult patients with anticipated difficult airways undergoing selective faciocervical scar plastic surgery under general anesthesia were enrolled in this study. After anesthesia induction, a size 2.5, 3.5 or 4.5 ILA was inserted. Following good lung ventilation being verified, the SOS preloaded with an endotracheal tube was inserted via the ILA. Once the clear vocal cords came into view under the SOS, the endotracheal tube was advanced through glottis into the trachea. Results The ILA provided an effective airway in all patients, lntubation was successful at the first attempt on 22/33 （66.7%） occasions and at the second attempt on 6/33 （18.2%）. Intubation failed in 5 （15.1%） patients who suffered from severe limitation of head extension due to scar contracture of the neck. These patients＇ tracheas were finally intubated using a fibreoptic bronchoscope via the ILA. Conclusions The SOS-guided intubating method via the ILA is a feasible technique in patients with scar contracture of the face and neck. However, in patients with severe limitation of head extension, the use of SOS cannot be recommended. The SOS can be used as an alternative apparatus when the fibreoptic bronchoscope is not available.
文摘BACKGROUND:Airway foreign bodies(AFBs)is an interdisciplinary area between emergency medicine,pediatrics and otolaryngology.It is a life-threatening condition that is not infrequently seen;however,it is poorly covered in medical literature.Accidental aspiration of an element into airways is a widespread clinical scenario among children under 3 years,predominantly males.Moreover,it is the leading cause of infantile deaths and the fourth one among preschool children.DATA RESOURCES:A systemic search was conducted in July 2015 using Pub Med/Pub Med Central Database of The National Center for Biotechnology Information(NCBI)(http://www.ncbi.nlm.nih.gov/).A total of 1 767 articles were identified and most of them were meta-analyses,systematic reviews,and case series.Those thoroughly discussing assessment and management of AFBs were retrieved.RESULTS:AFBs episodes may be either witnessed or missed.Presence of a witness for the inhalation is diagnostic.The later usually present with persistent active cough.A classical triad of paroxysmal cough,wheezing,and dyspnoea/decreased air entry was reported,though many presentations have inconsistent findings.Hence,diagnosis requires high index of clinical suspicion.Flexible fibro-optic bronchoscopy is the gold standard of diagnosis,whereas inhaled objects are best retrieved by rigid bronchoscopes.CONCLUSIONS:Close supervision of pediatrics is the hallmark of prevention.Caregivers should ensure a safe surrounding milieu,including the toys their offspring play with.Immediate complications result from direct obstruction or injury by the inhaled object.Alternatively,prolonged lodging traps air and induces inflammatory response causing atelectesis and pneumonia,respectively.
文摘BACKGROUND In growing patients with skeletal discrepancies,early assessment of functional factors can be vital for the restoration of normal craniofacial growth.AIM To compare airway volumes in patients with mandibular retrognathism with the normal anteroposterior skeletal relationship,thereby assessing the association between cephalometric variables and airway morphology.METHODS Cone-beam computed tomography volume scans,and lateral cephalograms,3-dimensional airway volume and cross-sectional areas of 120 healthy children(54 boys and 66 girls mean age 15.19±1.28)which were done for orthodontic assessment were evaluated.The subjects were divided into 2 groups based on the angle formed between point A,Nasion and point B(ANB)values and cephalometric variables(such as anterior and posterior facial height,gonial angle etc.)airway volumes,and cross-sectional measurements were compared using independent t tests.Pearson’s correlation coefficient test was used to detect any relationship of different parts of the airway and between airway volume and 2-dimensional cephalometric variables.RESULTS Means and standard deviations for cephalometric,cross-sectional,and volumetric variables were compared.ANB,mandibular body length and facial convexity were statistically highly significant(P<0.01)whereas condylion to point A,nasal airway and total airway volume(P<0.05)were statistically significant.The nasal airway volume and the superior pharyngeal airway volume had a positive correlation(P<0.01),nasal airway was correlated to middle(P<0.05)and total airway superior had a relation with middle(P<0.05),inferior and total airway(P<0.05),middle was related to all other airways;inferior was also related to all the airways except nasal.Lateral cephalometric values were positively correlated with the airway volume with Frankfurt Mandibular Plane Angle and facial convexity showed significant correlations with total airway volume(P<0.05).Additionally,ANB angle was significantly correlated with total airway volume and superior airway(P<0.05).CONCLUSION The mean total airway volume in patients with retrognathic mandible was significantly smaller than that of patients with a normal mandible.
基金This study was supported by the Guangdong Basic and Applied Basic Research Foundation(2022B1515120055)the National Natural Science Foundation of China(82341060 and 82170024).
文摘Cough is one of the most common symptoms observed in patients presenting with COVID-19,persisting for an extended duration following SARS-CoV-2 infection.We aim to describe the distribution of airway microbiota and explore its role in patients with post-CovID-19 chronic cough.A total of 57 patients experiencing persistent cough after infection were recruited during the Omicron wave of SARS-CoV-2 in China.Airway microbiota profiling is assessed in nasopharyngeal swab,nasal lavage,and induced sputum samples at 4 and 8 weeks after SARS-CoV-2 infection.Our findings reveal that bacterial families Staph-ylococcaceae,Corynebacteriaceae,and Enterobacteriaceae are the most prevalent in the upper airway,while Streptococcaceae,Lachnospiraceae,and Prevotellaceae emerge as the most prevalent bacterial families in the lower airway.An increase in the abundance of Staphylococcus in nasopharyngeal swab samples and of Streptococcus in induced sputum samples is observed after one month.Furthermore,the abundance of Staphylococcus identified in nasopharyngeal swab samples at the baseline period emerges as an insightful predictor for improvement in cough severity.In conclusion,dynamic alterations in the airway microbial composition may contribute to the post-coviD-19 chronic cough progression,while the compositional signatures of nasopharyngeal microbiota could reflect the improvement of this disease.
基金The National Natural Science Foundation of China(No.51275090)the Science and Technology Support Program of Jiangsu Province(No.BE2011608)the Program for Special Talent in Six Fields of Jiangsu Province(No.2008144)
文摘An airway pressure and flow data acquisition system is developed to investigate the approach to building the bi-level positive airway pressure BiPAP in a ventilator.A number of experiments under different breathing situations and states are conducted and the experimental data are recorded.According to the data from these experiments the variation characteristics of the pressure and flow are analyzed using Matlab. The data analysis results show that the pressure increases while the flow decreases in the expiratory phase contrarily the pressure decreases while the flow increases in the inspiratory phase during the apnea state both the pressure and the flow remain unchanged. According to the above variation characteristics of breath a feedback-based method for creating bi-level positive airway pressure is proposed. Experiments are implemented to verify the BiPAP model. Results demonstrate that the proposed method works effectively in following respiration and caters well to most polypnea and apnea events.
