The different functions of short and long thymic stromal lymphopoietin isoforms in autophagy-mediated asthmatic airway inflammation and remodeling

Asthma is a chronic respiratory disease characterized by airway inflammation and remodeling as well as hyper-responsiveness. Thymic stromal lymphopoietin (TSLP), which is a crucial inflammatory cytokine in immune homeostasis, consists of two isoforms, the long isoform lfTSLP and short isoform sfTSLP. The lfTSLP promotes inflammation and plays a pivotal role in asthma pathogenesis, while sfTSLP had been reported to have anti-asthma effects. Experiments have shown that lfTSLP could induce autophagy in hepatocytes. It is unknown whether lfTSLP or sfTSLP could influence autophagy and affect the progression of asthma. Using house dust mite (HDM)-stimulated airway smooth muscle cells as an in vitro model and HDM-induced asthma mice as in vivo model, we found that lfTSLP could induce autophagy and remodeling, while sfTSLP has the reverse effect. Strikingly, sfTSLP treatment in vivo reversed HDM-mediated activation of inflammation and airway remodeling, partly determined by autophagy change. These findings may help us understand the function of TSLP isoforms in the pathogenesis of asthma, and they support the use of drugs targeting sfTSLP and TSLP for asthma treatment.     

Skeletal and airway stability after mandibular setback in patients with mandibular prognathism: A systematic review

AimTo perform a systematic review to answer the clinical question “What are the longitudinal skeletal and airway changes after mandibular setback orthognathic procedures?”Materials and methodsA systematic search including computer search of different databases with specific keywords, manual search through three international journals and reference list search was performed. Articles that were reporting the skeletal and airway changes after mandibular setback orthognathic procedures were evaluated with five predetermined criteria.ResultsSix articles with a total of 217 patients entered the final review. All were rated to be of moderate bias risk. Four studies evaluated the skeletal and airway changes using two-dimensional (lateral) cephalometric radiographic imaging, whereas the other two studies used three-dimensional imaging with cone-beam computed tomography. In the two-dimensional studies, skeletal relapses from T0 (immediate postoperative) to T1 (postoperative 1–6 months) ranged from −2.14 mm to 0.30 mm, whereas skeletal relapses from T1 to T2 (postoperative 1 year) ranged from −0.90 mm to 1.23 mm. In the three-dimensional studies, skeletal relapse from T1 to T2 ranged from −0.26 mm to 1.53 mm. All included studies reported that there were no significant skeletal relapses after mandibular setback procedures. Regarding airway changes, airway changes from preoperative to T0/T1 ranged from −0.30 mm to −2.32 mm in the two-dimensional studies. Airway changes from T0 to T1 ranged from −0.70 mm to −1.63 mm, whereas airway changes from T1 to T2 ranged from 0.11 mm to 0.60 mm, respectively.ConclusionsThis systematic review showed there was insignificant skeletal relapse after mandibular setback orthognathic procedures. It was noted a small increase of the airway over the first post-operative year in studies using 2-dimensional radiography. However, such finding was not consistent in studies using 3-dimensional imaging with volumetric analysis of the airway changes.     

呼出气一氧化氮浓度检测的临床应用现状与进展

呼出气一氧化氮检测可有效评估呼吸系统疾病的炎症变化程度,鉴别诊断嗜酸性粒细胞型气道炎症,有助于哮喘患者长期个体化的监控管理;与肺功能等诊疗技术相互补充,减少支气管哮喘的临床误诊率。     

Evaluation of the influence of pulmonary hypertension in ultra-fast-track anesthesia technique in adult patients undergoing cardiac surgery

Objective

To evaluate the influence of pulmonary hypertension in the ultra-fast-track anesthesia technique in adult cardiac surgery.

Methods

A retrospective study. They were included 40 patients divided into two groups: GI (without pulmonary hypertension) and GII (with pulmonary hypertension). Based on data obtained by transthoracic echocardiography. We considered as the absence of pulmonary hypertension: a pulmonary artery systolic pressure (sPAP) <36 mmHg, with tricuspid regurgitation velocity <2.8 m/s and no additional echocardiographic signs of PH, and PH as presence: a sPAP >40 mmHg associated with additional echocardiographic signs of PH. It was established as influence of pulmonary hypertension: the impossibility of extubation in the operating room, the increase in the time interval for extubation and reintubation the first 24 hours postoperatively. Univariate and multivariate analyzes were performed when necessary. Considered significant a P value <0.05.

Results

The GI was composed of 21 patients and GII for 19. All patients (100%) were extubated in the operating room in a medium time interval of 17.58±8.06 min with a median of 18 min in GII and 17 min in GI. PH did not increase the time interval for extubation (P=0.397). It required reintubation of 2 patients in GII (5% of the total), without statistically significant as compared to GI (P=0.488).

Conclusion

In this study, pulmonary hypertension did not influence on ultra-fast-track anesthesia in adult cardiac surgery.     

Effect of Class III bone anchor treatment on airway

Objectives:To compare airway volumes and minimum cross-section area changes of Class III patients treated with bone-anchored maxillary protraction (BAMP) versus untreated Class III controls.Materials and Methods:Twenty-eight consecutive skeletal Class III patients between the ages of 10 and 14 years (mean age, 11.9 years) were treated using Class III intermaxillary elastics and bilateral miniplates (two in the infra-zygomatic crests of the maxilla and two in the anterior mandible). The subjects had cone beam computed tomographs (CBCTs) taken before initial loading (T1) and 1 year out (T2). Twenty-eight untreated Class III patients (mean age, 12.4 years) had CBCTs taken and cephalograms generated. The airway volumes and minimum cross-sectional area measurements were performed using Dolphin Imaging 11.7 3D software. The superior border of the airway was defined by a plane that passes through the posterior nasal spine and basion, while the inferior border included the base of the epiglottis to the lower border of C3.Results:From T1 to T2, airway volume from BAMP-treated subjects showed a statistically significant increase (1499.64 mm³). The area in the most constricted section of the airway (choke point) increased slightly (15.44 mm²). The airway volume of BAMP patients at T2 was 14136.61 mm³, compared with 14432.98 mm³ in untreated Class III subjects. Intraexaminer correlation coefficients values and 95% confidence interval values were all greater than .90, showing a high degree of reliability of the measurements.Conclusion:BAMP treatment did not hinder the development of the oropharynx.     

Relationships between pre-hospital characteristics and outcome in victims of foreign body airway obstruction during meals

ObjectiveThe purpose of this study is to determine the outcome of foreign body airway obstruction according to the initial actions taken for choking victims during meals.MethodsOur subjects were patients who became unresponsive or unconscious because of foreign body airway obstruction (FBAO) during meals in the presence of bystander witnesses. We investigated the associations between outcome and the following factors: age, gender, type of foreign body, chest compressions after the patient became unresponsive or unconscious, episode of cardiac arrest, efforts by a bystander to remove the foreign body, eating-related activities of daily living, time elapsed from the 119 call to arrival of emergency medical technicians (EMTs), and time elapsed from the 119 call to hospital arrival (primary endpoint).ResultsOf the 138 patients enrolled during the study period, 35 (25.4%) received chest compressions by bystanders after becoming unresponsive or unconscious and 69 (50.0%) suffered cardiac pulmonary arrest. Chest compressions by a bystander after the victim became unresponsive or unconscious (p < 0.0001) and no CPA (p < 0.0001) were significantly related to good outcome. Chest compressions by a bystander were both associated with good neurological outcome (odds ratio, 10.57; 95% CI, 2.472–65.059, p < 0.0001). No CPA after FBAO was another independent predictor (odds ratio, 50.512; 95% CI, 13.45–284.41; p < 0.0001), but efforts to remove the foreign body before the arrival of EMTs did not affect outcome.ConclusionChest compressions by a bystander, a support received by only 25% of the patients, proved to be essential for improved outcome for choking victims who became unresponsive or unconscious. Education for lay-rescuer response to choking might further improve overall outcome.     

Effect of Continuous Positive Airway Pressure Therapy on Glycemic Excursions and Insulin Sensitivity in Patients with Obstructive Sleep Apnea-hypopnea Syndrome and Type 2 Diabetes

Background:

For patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and type 2 diabetes mellitus (T2DM), the night sleep interruption and intermittent hypoxia due to apnea or hypopnea may induce glycemic excursions and reduce insulin sensitivity. This study aimed to investigate the effect of continuous positive airway pressure (CPAP) therapy in patients with OSAHS and T2DM.

Methods:

Continuous glucose monitoring system (CGMS) was used in 40 patients with T2DM and newly diagnosed OSAHS. The measurements were repeated after 30 days of CPAP treatment. Subsequently, insulin sensitivity and glycohemoglobin (HbA1c) were measured and compared to the pretreatment data.

Results:

After CPAP therapy, the CGMS indicators showed that the 24-h mean blood glucose (MBG) and the night time MBG were significantly reduced (P < 0.05 and P = 0.03, respectively). The mean ambulatory glucose excursions (MAGEs) and the mean of daily differences were also significantly reduced (P < 0.05 and P = 0.002, respectively) compared to pretreatment levels. During the night, MAGE also significantly decreased (P = 0.049). The differences between the highest and lowest levels of blood glucose over 24 h and during the night were significantly lower than prior to CPAP treatment (P < 0.05 and P = 0.024, respectively). The 24 h and night time durations of high blood glucose (>7.8 mmol/L and > 11.1 mmol/L) decreased (P < 0.05 and P < 0.05, respectively) after the treatment. In addition, HbA1c levels were also lower than those before treatment (P < 0.05), and the homeostasis model assessment index of insulin resistance was also significantly lower than before CPAP treatment (P = 0.034).

Conclusions:

CPAP therapy may have a beneficial effect on improving not only blood glucose but also upon insulin sensitivity in T2DM patients with OSAHS. This suggests that CPAP may be an effective treatment for T2DM in addition to intensive diabetes management.     

光动力治疗中央型支气管肺癌术后气道优质护理效果分析

目的:探讨接受光动力治疗中央型支气管肺癌患者术后进行优质气道护理的临床效果。方法:选取2011年1月至2014年1月收治的中央型支气管肺癌患者60例为研究对象,所有患者均接受光动力治疗方式,采用随机数字表法将患者分为对照组和实验组各30例,对照组接受常规气道吸痰护理,实验组接受优质气道护理方式,比较两组患者治疗前后生命体征、呼吸力学、并发症以及患者的满意度。结果:实验组患者的平均心率(HR)、血氧饱和度(SPO2)及平均气道压(Pmean)明显小于对照组,患者发生肺不张、肺部感染的概率较低,且实验组患者治疗效果更优,各组统计结果均具有显著性差异(P0.05)。结论:对接受光动力治疗中央型支气管肺癌患者进行术后优质气道护理可以明显提高患者的各项生命特征以及临床疗效,有效降低患者术后不良症状的发生。     

Orthodontic treatment in children to prevent sleep-disordered breathing in adulthood

The purpose of this article is to review human craniofacial growth and development, especially the growth of the mandible, to clarify the relationship between obstructive sleep apnea (OSA) syndrome and craniofacial abnormality, and finally, to propose the hypothesis that negative pressure produced in the chest of the OSA child inhibits the growth of the mandible. Recently, the development of diagnosis and treatment of OSA syndrome has progressed rapidly; however, the prevention of OSA syndrome was merely seen. Craniofacial abnormality is reported as one of the causes of OSA syndrome. If craniofacial abnormality is determined only by genetics, it is difficult to manage the craniofacial skeleton to prevent OSA syndrome. The role of epigenetic factors on craniofacial growth and development is still controversial. However, if we stand on the functional matrix hypothesis, we can manage not only growth of the mandible but also the craniofacial skeleton as a whole. The author proposes the hypothesis that the negative pressure produced in the chest prohibits the growth of the mandible even if the patients have a capacity for growth and development; therefore, if this negative pressure disappears because of the removal of the tonsil and/or adenoids or by an orthodontic treatment to make a patency of the airway, the mandible may grow normally, and we can prevent or reduce a number of OSA syndromes in the future.