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
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
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: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
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
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
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
Although various anti-inflammatory medications,such as ephedrine,are employed to manage cough-variant asthma,their underlying mechanisms are yet to be fully understood.Recent studies suggest that exosomes derived from...Although various anti-inflammatory medications,such as ephedrine,are employed to manage cough-variant asthma,their underlying mechanisms are yet to be fully understood.Recent studies suggest that exosomes derived from airway epithelial cells(AECs)contain components like messenger RNAs(mRNAs),micro-RNAs(miRNAs),and long noncoding RNA(lncRNA),which play roles in the occurrence and progression of airway inflammation.This study investigates the influence of AEC-derived exosomes on the efficacy of ephedrine in treating cough-variant asthma.We established a mouse model of asthma and measured airway resist-ance and serum inflammatory cell levels.Real-time polymerase chain reaction(RT-qPCR),Western blotting,and enzyme-linked im-munosorbent assay(ELISA)analyses were used to assess gene and protein expression levels.Exosomes were isolated and character-ized.RNA immunoprecipitation(RIP)and RNA pull-down assays were conducted to examine the interaction between hnRNPA2B1 and lnc-TRPM2-AS1.In the ovalbumin(OVA)-challenged mouse model,ephedrine treatment reduced inflammatory responses,air-way resistance,and Th1/Th2 cell imbalance.Exosomes from OVA-treated AECs showed elevated levels of lnc-TRPM2-AS1,which were diminished following ephedrine treatment.The exosomal lnc-TRPM2-AS1 mediated the Th1/Th2 imbalance in CD4^(+)T cells,with its packaging into exosomes being facilitated by hnRNPA2B1.This study unveils a novel mechanism by which ephedrine ameli-orates OVA-induced CD4^(+)T cell imbalance by suppressing AEC-derived exosomal lnc-TRPM2-AS1.These findings could provide a theoretical framework for using ephedrine in asthma treatment.展开更多
Background:Obstructive sleep apnea(OSA)is highly common in patients with coronary artery disease(CAD)and it is a strong predictor of subsequent cardiovascular events.However,whether treatment with continuous positive ...Background:Obstructive sleep apnea(OSA)is highly common in patients with coronary artery disease(CAD)and it is a strong predictor of subsequent cardiovascular events.However,whether treatment with continuous positive airway pressure(CPAP)can decrease this risk remains controversial.Methods:PubMed,EMBASE,the Cochrane Library,and ClinicalTrials.gov were systematically searched to identify randomized clinical trials reporting cardiovascular events from database inception to February 12,2022.Results:Four trials with 3043 participants were included.The median follow-up duration ranged from 3 to 4.75 years.Compared with usual care alone,CPAP was not associated with decreased MACCE risk(RR 0.96,95%CI 0.77–1.21,P=0.75),and the results were consistent regardless of CPAP adherence(≥4 hours/night vs.<4 hours/night,RR 0.48,95%CI 0.20–1.16).Similarly,no significant differences were observed between groups in the risks of all-cause death(RR 0.81,95%CI 0.52–1.26),cardiovascular death(RR 0.70,95%CI 0.36–1.33),myocardial infarction(RR 1.08,95%CI 0.73–1.60),revascularization(RR 1.03,95%CI 0.77–1.38),and cerebrovascular events(RR 0.77,95%CI 0.23–2.61).Conclusion:Existing evidence does not support an association between CPAP treatment and decreased risk of recur-rent cardiovascular events in patients with CAD and OSA,regardless of adherence to CPAP.展开更多
In the field of airway management,there is no national registry in Germany that captures data on emergency airway management.To improve quality,one needs to know the data first.Examples include gender,age,indications ...In the field of airway management,there is no national registry in Germany that captures data on emergency airway management.To improve quality,one needs to know the data first.Examples include gender,age,indications for emergency airway management,level of education,the intubating department,the intubation method,and other factors that can serve as a basis for quality improvement changes.展开更多
BACKGROUND More and more evidence-based practices are emerging,but researchers mostly focus on short-term effects,resulting in evidence-based practices not being applied in the clinic in the long term.In this study,we...BACKGROUND More and more evidence-based practices are emerging,but researchers mostly focus on short-term effects,resulting in evidence-based practices not being applied in the clinic in the long term.In this study,we took the evidence-based practice of perioperative airway management in elderly fracture patients as an example and adopted a descriptive phenomenological approach to understand the influencing factors of its sustainability to provide a reference basis for promoting the continuity of evidence-based practice in the clinic.AIM To explore factors influencing the persistence of evidence-based practice in perioperative airway management in elderly patients with fractures.METHODS This study was qualitative research.Nine nurses who implemented evidencebased practice in the orthopedic ward of a tertiary comprehensive hospital in Shanghai from September 2023 to October 2023 were selected using purposive sampling as research subjects.Semi-structured interviews were conducted with them,and the data were analyzed using the Colaizzi phenomenological analysis method based on the three dimensions and ten factors of the NHS sustainability model.RESULTS Three main themes and ten subthemes were identified:Process aspects(benefits to patients,benefits to nurses,lack of follow-up,complex processes);staff aspects(insufficient human resources,inadequate training and education,lack of leadership support);and organizational environment aspects(inadequate infrastructure,poor patient compliance,poor doctor cooperation).CONCLUSION Human resources,training and education,leadership support,infrastructure,and patient-physician collaboration are important factors influencing the sustainability of evidence-based practice for perioperative airway management in older patients with fractures.展开更多
BACKGROUND There is limited literature on managing the airway of patients with linear immunoglobulin A(IgA)bullous dermatosis,a rare mucocutaneous disorder that leads to the development of friable bullae.Careful clini...BACKGROUND There is limited literature on managing the airway of patients with linear immunoglobulin A(IgA)bullous dermatosis,a rare mucocutaneous disorder that leads to the development of friable bullae.Careful clinical decision making is necessary when there is a risk of bleeding into the airway,and a multidisciplinary team approach may lead to decreased patient morbidity during these high-risk scenarios,especially when confronted with an unusual cause for bleeding.CASE SUMMARY A 45-year-old African American female presented to our ambulatory surgical center for right corneal transplantation due to corneal perforation after blunt trauma in the setting of cicatricial conjunctivitis and diffuse corneal neovascularization from linear IgA bullous dermatosis.The diagnosis of IgA dermatosis was recent,and the patient had been lost to follow-up.The severity of the disease and extent of airway involvement was unknown at the time of the surgery.Significant airway bleeding was noticed upon intubation and the otorhinolaryngology team had to be called to the operating room.The patient required transfer to the intensive care unit where a multidisciplinary team was involved in her case.The patient was extubated on postoperative day 4.CONCLUSION A multidisciplinary approach to treating this disease is the best course of action before a surgical procedure.In our case,key communication between the surgery,anesthesia,and dermatology teams led to the quick and safe treatment of our patient’s disease.Ambulatory surgery should not be considered for these cases unless they are in full remission and there is no mucous membrane involvement.展开更多
Objective: To investigate the effects of Yanghe Pingchuan Granules on airway remodeling in asthmatic rats, and to explore the mechanism of Interleukin-6/Janus kinase 2/ Signal transducing activator of transcription 3(...Objective: To investigate the effects of Yanghe Pingchuan Granules on airway remodeling in asthmatic rats, and to explore the mechanism of Interleukin-6/Janus kinase 2/ Signal transducing activator of transcription 3(IL-6/JAK2/STAT3) signal axis. Methods: We separated 42 healthy male SD rats into two groups, a control group (7) and a model group (35).The model group was sensitized with a combination of ovalbumin (OVA) and aluminum hydroxide for 2 weeks, while the control group was given an equal amount of physiological saline.After 2 weeks, the modeling group was randomly divided into Model group, Yanghe Pingchuan Granules high, medium and low dose groups and Dexamethasone group, each group consisted of 7 animals. After 4 weeks, OVA atomization and gavage were used for stimulation and treatment. Yanghe Pingchuan Granules high, middle and low groups were given 15.48, 7.74, 3.87 g∙kg-1 Yanghe Pingchuan Granules daily, dexamethasone group was given 0.0625 mg∙kg-1 dexamethasone daily, and the other groups were given the same amount of normal saline. HE, PAS and Masson staining were used to observe the lung histopathological changes in rats. The levels of interleukin-6, IL-23 and IL-17A were detected by ELISA. The expression levels of JAK-2, P-JAK2, STAT3 and P-STAT3 in lung tissues were detected by Western blot. Real-time quantitative polymerase chain reaction (qRT-PCR) was used to detect the mRNA expression levels of IL-6, JAK2 and STAT3 in rat lung tissue. Results: The lung tissue structure of the model group was severely damaged compared to the control group, accompanied by a great many of inflammatory cell infiltration, goblet cell hyperplasia, subepithelial collagen fiber deposition and airway epithelial thickening were more obvious. The expressions of IL-6, IL- 23 and IL-17A in serum were significantly increased (P<0.01), the protein expression levels of JAK-2, P-JAK2, STAT3 and P-STAT3 and the mRNA expression levels of IL-6, JAK2 and STAT3 in lung tissue were significantly increased (P<0.01);Compared with the model group, inflammatory cell infiltration, goblet cell proliferation, subepithelial collagen fiber deposition and airway epithelial thickening were significantly reduced in each administration group, and the expressions of IL-6, IL-23 and IL-17A in serum were significantly decreased (P< 0.01). The protein expression levels of JAK-2, P-JAK2, STAT3 and P-STAT3 and mRNA expression levels of IL-6, JAK2 and STAT3 in lung tissue were significantly decreased (P<0.01). Conclusion: Yanghe Pingchuan Granules can significantly alleviate airway remodeling in asthmatic rats, and its mechanism may be through inhibiting the IL-6/JAK2/STAT3 signal axis.展开更多
BACKGROUND Electronic cigarettes(ECs)have been promoted as alternatives to traditional cigarettes.To investigate ECs’effects on respiratory system,especially in patients with respiratory diseases.METHODS We randomly ...BACKGROUND Electronic cigarettes(ECs)have been promoted as alternatives to traditional cigarettes.To investigate ECs’effects on respiratory system,especially in patients with respiratory diseases.METHODS We randomly selected 25 smokers with stable moderate asthma and matched them with 25 healthy smokers.All were subjucted to pulmonary function tests(PFTs),impulse oscillometry(IOS),fraction exhaled Nitric Oxide(FeNO),exhaled breathe condensate(EBC)and biomarker measurements before and after vaping one nicotinecontaining EC.RESULTS The increase in FeNO 30 minutes after EC,reflecting airway inflammation,significantly correlated with increase of residual volume(RV),total lung capacity,respiratory impedance at 5 Hz(Z5Hz)and respiratory resistance at 5 and 20 Hz(R5Hz and R20Hz).No significant correlations were found between EBC biomarkers'changes and respiratory mechanics.CONCLUSION This is the first study demonstrating that the changes in airway inflammation caused by EC have direct effects in respiratory mechanics of asthmatic patients.展开更多
Objective:Lung adenocarcinoma exhibits diverse genetic and morphological backgrounds,in addition to considerable differences in clinical pathology and molecular biological characteristics.Among these,the phenomenon of...Objective:Lung adenocarcinoma exhibits diverse genetic and morphological backgrounds,in addition to considerable differences in clinical pathology and molecular biological characteristics.Among these,the phenomenon of spread through air space(STAS),a distinct mode of lung cancer infiltration,has rarely been reported.Therefore,this study aimed to explore the relationship between STAS tumor cells and the clinical and molecular characteristics of patients with lung adenocarcinoma,as well as their impact on prognosis.Methods:This study included 147 patients who were diagnosed with lung adenocarcinoma at the Inner Mongolia Autonomous Region Cancer Institute between January 2014 and December 2017.Surgical resection specimens were retrospectively analyzed.Using univariate and multivariate Cox analyses,we assessed the association between STAS and the clinicopathological features and molecular characteristics of patients with lung adenocarcinoma.Furthermore,we investigated the effects on patient prognosis.In addition,we developed a column–line plot prediction model and performed internal validation.Results:Patients with positive STAS had a significantly higher proportion of tumors with a diameter≥2 cm,with infiltration around the pleura,blood vessels,and nerves,and a pathological stage>IIB than in STAS-negative patients(P<0.05).Cox multivariate survival analysis revealed that clinical stage,STAS status,tumor size,and visceral pleural invasion were independent prognostic factors influencing the 5-year progression-free survival in patients with lung adenocarcinoma.The predictive values and P values from the Hosmer-Lemeshow test were 0.8 and 0.2,respectively,indicating no statistical difference.Receiver operating characteristic curve analysis demonstrated areas under the curve of 0.884 and 0.872 for the training and validation groups,respectively.The nomogram model exhibited the best fit with a value of 192.09.Conclusions:Clinical stage,pleural invasion,vascular invasion,peripheral nerve invasion,tumor size,and necrosis are independent prognostic factors for patients with STAS-positive lung adenocarcinoma.The nomogrambased on the clinical stage,pleural invasion,vascular invasion,peripheral nerve invasion,tumor size,and necrosis showed good accuracy,differentiation,and clinical practicality.展开更多
Objective: To explore the effect of evidence-based quality control circle (QCC) in improving the implementation rate of airway management measures in adult critically ill patients. Methods: Based on the Joanna Briggs ...Objective: To explore the effect of evidence-based quality control circle (QCC) in improving the implementation rate of airway management measures in adult critically ill patients. Methods: Based on the Joanna Briggs Institute (JBI) evidence-based health care model, the best evidence of airway management in adult critically ill patients was obtained and applied to the clinic. Results: The total implementation rate of airway management measures in adult critically ill patients increased from 23.62% before the implementation of quality control circle to 88.82%, and the pulmonary infection rate in critically ill patients decreased from 42.31% to 21.74%, with statistical significance between the two groups (P 0.05). Conclusion: Evidence-based quality control circle activities can standardize the practice standards of airway management in critically ill patients, reduce the occurrence of patients’ airway related complications, and improve clinical outcomes.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
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
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.
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.
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.
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supported by The Scientific Research Project of Traditional Chinese Medicine in Hunan Province(No.A2024027)The National Inheritance Studio of Distinguished Veteran TCM Experts(Letter of National Traditional Chinese Medicine Education[2022]No.75)Natural Science Foundation of Hunan Province(Nos.2021JJ40422,2023JJ60260).
文摘Although various anti-inflammatory medications,such as ephedrine,are employed to manage cough-variant asthma,their underlying mechanisms are yet to be fully understood.Recent studies suggest that exosomes derived from airway epithelial cells(AECs)contain components like messenger RNAs(mRNAs),micro-RNAs(miRNAs),and long noncoding RNA(lncRNA),which play roles in the occurrence and progression of airway inflammation.This study investigates the influence of AEC-derived exosomes on the efficacy of ephedrine in treating cough-variant asthma.We established a mouse model of asthma and measured airway resist-ance and serum inflammatory cell levels.Real-time polymerase chain reaction(RT-qPCR),Western blotting,and enzyme-linked im-munosorbent assay(ELISA)analyses were used to assess gene and protein expression levels.Exosomes were isolated and character-ized.RNA immunoprecipitation(RIP)and RNA pull-down assays were conducted to examine the interaction between hnRNPA2B1 and lnc-TRPM2-AS1.In the ovalbumin(OVA)-challenged mouse model,ephedrine treatment reduced inflammatory responses,air-way resistance,and Th1/Th2 cell imbalance.Exosomes from OVA-treated AECs showed elevated levels of lnc-TRPM2-AS1,which were diminished following ephedrine treatment.The exosomal lnc-TRPM2-AS1 mediated the Th1/Th2 imbalance in CD4^(+)T cells,with its packaging into exosomes being facilitated by hnRNPA2B1.This study unveils a novel mechanism by which ephedrine ameli-orates OVA-induced CD4^(+)T cell imbalance by suppressing AEC-derived exosomal lnc-TRPM2-AS1.These findings could provide a theoretical framework for using ephedrine in asthma treatment.
基金funded by grants from National Key R&D Program of China(2022YFC2505600)the Training Program for Outstanding Young Scholars in Beijing Anzhen Hospital,Capital Medical University(AZ2023-YQ-03).
文摘Background:Obstructive sleep apnea(OSA)is highly common in patients with coronary artery disease(CAD)and it is a strong predictor of subsequent cardiovascular events.However,whether treatment with continuous positive airway pressure(CPAP)can decrease this risk remains controversial.Methods:PubMed,EMBASE,the Cochrane Library,and ClinicalTrials.gov were systematically searched to identify randomized clinical trials reporting cardiovascular events from database inception to February 12,2022.Results:Four trials with 3043 participants were included.The median follow-up duration ranged from 3 to 4.75 years.Compared with usual care alone,CPAP was not associated with decreased MACCE risk(RR 0.96,95%CI 0.77–1.21,P=0.75),and the results were consistent regardless of CPAP adherence(≥4 hours/night vs.<4 hours/night,RR 0.48,95%CI 0.20–1.16).Similarly,no significant differences were observed between groups in the risks of all-cause death(RR 0.81,95%CI 0.52–1.26),cardiovascular death(RR 0.70,95%CI 0.36–1.33),myocardial infarction(RR 1.08,95%CI 0.73–1.60),revascularization(RR 1.03,95%CI 0.77–1.38),and cerebrovascular events(RR 0.77,95%CI 0.23–2.61).Conclusion:Existing evidence does not support an association between CPAP treatment and decreased risk of recur-rent cardiovascular events in patients with CAD and OSA,regardless of adherence to CPAP.
文摘In the field of airway management,there is no national registry in Germany that captures data on emergency airway management.To improve quality,one needs to know the data first.Examples include gender,age,indications for emergency airway management,level of education,the intubating department,the intubation method,and other factors that can serve as a basis for quality improvement changes.
基金The study was reviewed and approved by the Ethics Committee of Shanghai Tongren Hospital(Approval Number:Tongren Lun Audit 2022-075-01).
文摘BACKGROUND More and more evidence-based practices are emerging,but researchers mostly focus on short-term effects,resulting in evidence-based practices not being applied in the clinic in the long term.In this study,we took the evidence-based practice of perioperative airway management in elderly fracture patients as an example and adopted a descriptive phenomenological approach to understand the influencing factors of its sustainability to provide a reference basis for promoting the continuity of evidence-based practice in the clinic.AIM To explore factors influencing the persistence of evidence-based practice in perioperative airway management in elderly patients with fractures.METHODS This study was qualitative research.Nine nurses who implemented evidencebased practice in the orthopedic ward of a tertiary comprehensive hospital in Shanghai from September 2023 to October 2023 were selected using purposive sampling as research subjects.Semi-structured interviews were conducted with them,and the data were analyzed using the Colaizzi phenomenological analysis method based on the three dimensions and ten factors of the NHS sustainability model.RESULTS Three main themes and ten subthemes were identified:Process aspects(benefits to patients,benefits to nurses,lack of follow-up,complex processes);staff aspects(insufficient human resources,inadequate training and education,lack of leadership support);and organizational environment aspects(inadequate infrastructure,poor patient compliance,poor doctor cooperation).CONCLUSION Human resources,training and education,leadership support,infrastructure,and patient-physician collaboration are important factors influencing the sustainability of evidence-based practice for perioperative airway management in older patients with fractures.
文摘BACKGROUND There is limited literature on managing the airway of patients with linear immunoglobulin A(IgA)bullous dermatosis,a rare mucocutaneous disorder that leads to the development of friable bullae.Careful clinical decision making is necessary when there is a risk of bleeding into the airway,and a multidisciplinary team approach may lead to decreased patient morbidity during these high-risk scenarios,especially when confronted with an unusual cause for bleeding.CASE SUMMARY A 45-year-old African American female presented to our ambulatory surgical center for right corneal transplantation due to corneal perforation after blunt trauma in the setting of cicatricial conjunctivitis and diffuse corneal neovascularization from linear IgA bullous dermatosis.The diagnosis of IgA dermatosis was recent,and the patient had been lost to follow-up.The severity of the disease and extent of airway involvement was unknown at the time of the surgery.Significant airway bleeding was noticed upon intubation and the otorhinolaryngology team had to be called to the operating room.The patient required transfer to the intensive care unit where a multidisciplinary team was involved in her case.The patient was extubated on postoperative day 4.CONCLUSION A multidisciplinary approach to treating this disease is the best course of action before a surgical procedure.In our case,key communication between the surgery,anesthesia,and dermatology teams led to the quick and safe treatment of our patient’s disease.Ambulatory surgery should not be considered for these cases unless they are in full remission and there is no mucous membrane involvement.
基金The Sixth Batch of Special Support Plans in Anhui Province(No.dlPtzjh20200050)Key Natural Science Research Project of Higher Education Institutions in Anhui Province(No.KJ2020A0426)。
文摘Objective: To investigate the effects of Yanghe Pingchuan Granules on airway remodeling in asthmatic rats, and to explore the mechanism of Interleukin-6/Janus kinase 2/ Signal transducing activator of transcription 3(IL-6/JAK2/STAT3) signal axis. Methods: We separated 42 healthy male SD rats into two groups, a control group (7) and a model group (35).The model group was sensitized with a combination of ovalbumin (OVA) and aluminum hydroxide for 2 weeks, while the control group was given an equal amount of physiological saline.After 2 weeks, the modeling group was randomly divided into Model group, Yanghe Pingchuan Granules high, medium and low dose groups and Dexamethasone group, each group consisted of 7 animals. After 4 weeks, OVA atomization and gavage were used for stimulation and treatment. Yanghe Pingchuan Granules high, middle and low groups were given 15.48, 7.74, 3.87 g∙kg-1 Yanghe Pingchuan Granules daily, dexamethasone group was given 0.0625 mg∙kg-1 dexamethasone daily, and the other groups were given the same amount of normal saline. HE, PAS and Masson staining were used to observe the lung histopathological changes in rats. The levels of interleukin-6, IL-23 and IL-17A were detected by ELISA. The expression levels of JAK-2, P-JAK2, STAT3 and P-STAT3 in lung tissues were detected by Western blot. Real-time quantitative polymerase chain reaction (qRT-PCR) was used to detect the mRNA expression levels of IL-6, JAK2 and STAT3 in rat lung tissue. Results: The lung tissue structure of the model group was severely damaged compared to the control group, accompanied by a great many of inflammatory cell infiltration, goblet cell hyperplasia, subepithelial collagen fiber deposition and airway epithelial thickening were more obvious. The expressions of IL-6, IL- 23 and IL-17A in serum were significantly increased (P<0.01), the protein expression levels of JAK-2, P-JAK2, STAT3 and P-STAT3 and the mRNA expression levels of IL-6, JAK2 and STAT3 in lung tissue were significantly increased (P<0.01);Compared with the model group, inflammatory cell infiltration, goblet cell proliferation, subepithelial collagen fiber deposition and airway epithelial thickening were significantly reduced in each administration group, and the expressions of IL-6, IL-23 and IL-17A in serum were significantly decreased (P< 0.01). The protein expression levels of JAK-2, P-JAK2, STAT3 and P-STAT3 and mRNA expression levels of IL-6, JAK2 and STAT3 in lung tissue were significantly decreased (P<0.01). Conclusion: Yanghe Pingchuan Granules can significantly alleviate airway remodeling in asthmatic rats, and its mechanism may be through inhibiting the IL-6/JAK2/STAT3 signal axis.
文摘BACKGROUND Electronic cigarettes(ECs)have been promoted as alternatives to traditional cigarettes.To investigate ECs’effects on respiratory system,especially in patients with respiratory diseases.METHODS We randomly selected 25 smokers with stable moderate asthma and matched them with 25 healthy smokers.All were subjucted to pulmonary function tests(PFTs),impulse oscillometry(IOS),fraction exhaled Nitric Oxide(FeNO),exhaled breathe condensate(EBC)and biomarker measurements before and after vaping one nicotinecontaining EC.RESULTS The increase in FeNO 30 minutes after EC,reflecting airway inflammation,significantly correlated with increase of residual volume(RV),total lung capacity,respiratory impedance at 5 Hz(Z5Hz)and respiratory resistance at 5 and 20 Hz(R5Hz and R20Hz).No significant correlations were found between EBC biomarkers'changes and respiratory mechanics.CONCLUSION This is the first study demonstrating that the changes in airway inflammation caused by EC have direct effects in respiratory mechanics of asthmatic patients.
基金Funded by the Health Science and Technology Program of Inner Mongolia Autonomous Region(no.202201061)Supported by the Joint Project of theMillion Science and Technology Initiatives of Inner Mongolia Medical University(no.YKD2020KJBW(LH)057).
文摘Objective:Lung adenocarcinoma exhibits diverse genetic and morphological backgrounds,in addition to considerable differences in clinical pathology and molecular biological characteristics.Among these,the phenomenon of spread through air space(STAS),a distinct mode of lung cancer infiltration,has rarely been reported.Therefore,this study aimed to explore the relationship between STAS tumor cells and the clinical and molecular characteristics of patients with lung adenocarcinoma,as well as their impact on prognosis.Methods:This study included 147 patients who were diagnosed with lung adenocarcinoma at the Inner Mongolia Autonomous Region Cancer Institute between January 2014 and December 2017.Surgical resection specimens were retrospectively analyzed.Using univariate and multivariate Cox analyses,we assessed the association between STAS and the clinicopathological features and molecular characteristics of patients with lung adenocarcinoma.Furthermore,we investigated the effects on patient prognosis.In addition,we developed a column–line plot prediction model and performed internal validation.Results:Patients with positive STAS had a significantly higher proportion of tumors with a diameter≥2 cm,with infiltration around the pleura,blood vessels,and nerves,and a pathological stage>IIB than in STAS-negative patients(P<0.05).Cox multivariate survival analysis revealed that clinical stage,STAS status,tumor size,and visceral pleural invasion were independent prognostic factors influencing the 5-year progression-free survival in patients with lung adenocarcinoma.The predictive values and P values from the Hosmer-Lemeshow test were 0.8 and 0.2,respectively,indicating no statistical difference.Receiver operating characteristic curve analysis demonstrated areas under the curve of 0.884 and 0.872 for the training and validation groups,respectively.The nomogram model exhibited the best fit with a value of 192.09.Conclusions:Clinical stage,pleural invasion,vascular invasion,peripheral nerve invasion,tumor size,and necrosis are independent prognostic factors for patients with STAS-positive lung adenocarcinoma.The nomogrambased on the clinical stage,pleural invasion,vascular invasion,peripheral nerve invasion,tumor size,and necrosis showed good accuracy,differentiation,and clinical practicality.
文摘Objective: To explore the effect of evidence-based quality control circle (QCC) in improving the implementation rate of airway management measures in adult critically ill patients. Methods: Based on the Joanna Briggs Institute (JBI) evidence-based health care model, the best evidence of airway management in adult critically ill patients was obtained and applied to the clinic. Results: The total implementation rate of airway management measures in adult critically ill patients increased from 23.62% before the implementation of quality control circle to 88.82%, and the pulmonary infection rate in critically ill patients decreased from 42.31% to 21.74%, with statistical significance between the two groups (P 0.05). Conclusion: Evidence-based quality control circle activities can standardize the practice standards of airway management in critically ill patients, reduce the occurrence of patients’ airway related complications, and improve clinical outcomes.
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.
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.
