Role of carbon monoxide in electrically induced non-adrenergic, non-cholinergic relaxations in the guinea-pig isolated whole trachea

BACKGROUND AND PURPOSE: Nitric oxide (NO) and vasoactive intestinal peptide (VIP) are considered transmitters of non-adrenergic, non-cholinergic (NANC) relaxations in guinea-pig trachea, whereas the role of carbon monoxide (CO) is unknown. This study was designed to assess the participation of CO, and to investigate the localization of haem oxygenase-2 (HO-2), the CO-producing enzyme, in tracheal neurons. EXPERIMENTAL APPROACH: NANC responses to electrical field stimulation (EFS) at 3 and 10 Hz were evaluated in epithelium-free whole tracheal segments as intraluminal pressure changes. Drugs used were: L-nitroarginine methyl ester (L-NAME, 100 microM) to inhibit NO synthase (NOS), alpha-chymotrypsin (2 U ml(-1)) to inactivate VIP, zinc protoporphyrin-IX (ZnPP-IX, 10 microM) to inhibit HO-2, and 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ, 10 microM), a soluble guanylyl cyclase inhibitor. For immunohistochemistry, tissues were exposed to antibodies to PGP 9.5, a general neuronal marker, HO-2 and NOS, and processed with an indirect immunofluorescence method.Key results:alpha-Chymotrypsin did not affect NANC relaxations. ODQ inhibited NANC responses by about 60%, a value similar to that obtained by combining L-NAME and ZnPP-IX. The combination of ODQ, L-NAME and ZnPP-IX reduced the responses by 90%. Subpopulations of HO-2 positive neurons containing NOS were detected in tracheal sections. CONCLUSIONS AND IMPLICATIONS: In the guinea-pig trachea, NANC inhibitory responses at 3 and 10 Hz use NO and CO as main transmitters. Their participation is revealed following inhibition of NOS, HO-2 and soluble guanylyl cyclase. The involvement of CO as a relaxing transmitter paves the way for novel therapeutic approaches in the treatment of airway obstruction.     

Pulsating Suprasternal Lump: A Diagnostic and Management Dilemma

We report a 70-year-old female who complained of shortness of breath and a pulsating suprasternal lump. CT scan showed innominate artery dilatation. In addition, operative exposure showed tortuous arteries and a common origin of the left common carotid and innominate arteries. Surgical correction by innominate artery division and reimplantation at the ascending aorta was performed, and the patient’s symptoms completely disappeared after the procedure.     

预防性气管插管在急性中毒病人中的应用研究

目的：评价预防性气管插管在危重中毒病人洗胃时的疗效和价值。方法：140例危重中毒患采用预防性气管插管后洗胃，与100例未采用预防性气管插管洗胃的中毒病人进行对比。结果：采用预防性气管插管的140例危重中毒患均成功洗胃，而未采用预防性气管插管洗胃的100例危重中毒患中，有24例未成功洗胃，有13例死亡，死亡率为13％。结论：对重度中毒患应采用预防性气管插管后洗胃，可减少死亡率。     

人工气管重建气道的进展

气管病变行手术切除治疗存在超限切除后直接吻合困难等问题，人工气管作为替代物以重建气道是解决这一问题的有效方法。寻求理想的人工气管则成了国内外研究的重点，近年来的实验研究在人工气管的材料选用，吻合技术等方面取得了很大进展，为临床应用提供了广阔前景。     

直接气管内吸痰在婴幼儿心脏术后预防肺不张的应用

肺不张是婴幼儿心脏术常见的并发症,婴幼儿不能有效的咳嗽及排痰,使痰液积聚在气管及支气管内,造成呼吸道阻塞,形成肺不张。应用直接气管内吸痰可有效清除痰液,保持呼吸道通畅,预防肺不张的发生。我科在临床通过对35例术后婴幼儿实施此项护理并配以拍背、雾化吸氧等均得到满意疗效。本文主要介绍了直接气管内吸痰的方法、适应症及护理要点。     

沐舒坦、爱喘乐持续气道湿化在颅脑损伤气管切开患者中的应用

目的探讨湿化气道的有效方法，以保证呼吸道通畅，降低脑损伤气管切开后呼吸道并发症。方法将82例颅脑损伤气管切开后患者随机分为2组，实验组采用沐舒坦、爱喘乐加入生理盐水持续气道内滴注，对照组采用传统方法（庆大霉素、糜蛋白酶、地塞米松加入生理盐水）持续气道内滴注，比较2种方法湿化气道的效果。结果沐舒坦、爱喘乐持续气道湿化在湿化程度、预防刺激性咳嗽、气道黏膜出血和肺部感染方面显著优于传统方法（P〈0．05）。结论沫舒坦、爱喘乐持续气道涅化法优于传统方法，能达到满意湿化，减少气道并发症的发生。     

56例小儿气管异物临床急救与护理

气管、支气管异物是耳鼻咽喉科常见急诊.临床上处理不及时或不当可造成呼吸道梗阻,引起急性窒息和突然死亡.及时准确的判断、处理至关重要.现将我科2000年1月～2006年12月收治56例小儿气管异物的急救与护理报告如下.     

Tissue‐engineered trachea from a 3D‐printed scaffold enhances whole‐segment tracheal repair in a goat model

Traditional treatment therapies for tracheal stenosis often cause severe post‐operative complications. To solve the current difficulties, novel and more suitable long‐term treatments are needed. A whole‐segment tissue‐engineered trachea (TET) representing the native goat trachea was 3D printed using a poly(caprolactone) (PCL) scaffold engineered with autologous auricular cartilage cells. The TET underwent mechanical analysis followed by in vivo implantations in order to evaluate the clinical feasibility and potential. The 3D‐printed scaffolds were successfully cellularized, as observed by scanning electron microscopy. Mechanical force compression studies revealed that both PCL scaffolds and TETs have a more robust compressive strength than does the native trachea. In vivo implantation of TETs in the experimental group resulted in significantly higher mean post‐operative survival times, 65.00 ± 24.01 days (n = 5), when compared with the control group, which received autologous trachea grafts, 17.60 ± 3.51 days (n = 5). Although tracheal narrowing was confirmed by bronchoscopy and computed tomography examination in the experimental group, tissue necrosis was only observed in the control group. Furthermore, an encouraging epithelial‐like tissue formation was observed in the TETs after transplantation. This large animal study provides potential preclinical evidence around the employment of an orthotopic transplantation of a whole 3D‐printed TET.     

上胸椎椎弓根螺钉钉道与椎前重要结构解剖位置的CT评价

背景：上胸椎周围结构复杂,椎弓根横径相对较小,椎体前方存在重要组织脏器,螺钉偏离轴线或螺钉过长,置钉的安全性和有效性得不到保障,有必要对其周围重要结构做一了解。目的：分析上胸椎椎弓根螺钉轴线与椎体前重要毗邻结构的解剖位置关系。方法：对30例健康成人志愿者进行T 1-T 4平行椎弓根轴线CT扫描,观察椎弓根螺钉沿椎弓根轴线置入时椎体前方食管、气管、主动脉弓、颈动脉、椎动脉等结构的位置,测量每一椎体两侧椎弓根轴线与这些结构的最短距离。采用配对t检验进行分析。结果与结论：共240个测量参数被分析,T 1-3左侧椎弓根轴线与食管距离小,T2左侧椎弓根最小;T2-4右侧椎弓根轴线与气管距离小;T3,T4右侧椎弓根轴线与右主支气管距离小;颈动脉和椎动脉无损伤的危险性。62%的患者主动脉弓在T4平面,且无损伤危险性。提示左侧椎弓根螺钉易损伤食管,右侧椎弓根易损伤气管,颈动脉、椎动脉和主动脉弓不易损伤。上胸椎椎弓根螺钉置入前仔细分析CT数据可以确定易损伤结构的解剖位置。