Airway Narrowing Research Articles

Comparison of single coronal thick-slab minimum intensity projection with flexible bronchoscopy for airway compression in children with lymphobronchial tuberculosis

To generate standardised coronal minimum intensity projection (MinIP) computed tomography (CT) reconstructions, and compare these with flexible bronchoscopy in children with lymphobronchial tuberculosis (LBTB). Standardised coronal MinIP reconstructions were performed from CT images in children with LBTB and the findings of three readers were compared with the reference standard, flexible bronchoscopy (FB), regarding airway narrowing. Intraluminal lesions, the site of the stenosis, and the degree of stenosis were also evaluated. The length of stenosis was evaluated by CT MinIP only. Sixty-five children (38 males; 58.5% and 27 females; 41.5%), with ages ranging from 2.5 to 144 months were evaluated. Coronal CT MinIP demonstrated a sensitivity of 96% and specificity of 89% against FB. The most common site of stenosis was the bronchus intermedius (91%), followed by the left main bronchus (85%), the right upper lobe bronchus RUL (66%), and the trachea (60%). Coronal CT MinIP reconstruction is useful in demonstrating airway stenosis in children with lymphobronchial TB, with high sensitivity and specificity. CT MinIP had additional advantages over FB in that it allowed objective measurement of the diameter of stenosis, measurement of the length of stenosis, and evaluation of post-stenotic segments of the airways and lung parenchymal abnormalities.

Airway allergy causes alveolar macrophage death, profound alveolar disorganization and surfactant dysfunction.

Respiratory disorders caused by allergy have been associated to bronchiolar inflammation leading to life-threatening airway narrowing. However, whether airway allergy causes alveolar dysfunction contributing to the pathology of allergic asthma remains unaddressed. To explore whether airway allergy causes alveolar dysfunction that might contribute to the pathology of allergic asthma, alveolar structural and functional alterations were analyzed during house dust mite (HDM)-induced airway allergy in mice, by flow cytometry, light and electron microscopy, monocyte transfer experiments, assessment of intra-alveolarly-located cells, analysis of alveolar macrophage regeneration in Cx3cr1 cre:R26-yfp chimeras, analysis of surfactant-associated proteins, and study of lung surfactant biophysical properties by captive bubble surfactometry. Our results demonstrate that HDM-induced airway allergic reactions caused severe alveolar dysfunction, leading to alveolar macrophage death, pneumocyte hypertrophy and surfactant dysfunction. SP-B/C proteins were reduced in allergic lung surfactant, that displayed a reduced efficiency to form surface-active films, increasing the risk of atelectasis. Original alveolar macrophages were replaced by monocyte-derived alveolar macrophages, that persisted at least two months after the resolution of allergy. Monocyte to alveolar macrophage transition occurred through an intermediate stage of pre-alveolar macrophage and was paralleled with translocation into the alveolar space, Siglec-F upregulation, and downregulation of CX3CR1. These data support that the severe respiratory disorders caused by asthmatic reactions not only result from bronchiolar inflammation, but additionally from alveolar dysfunction compromising an efficient gas exchange.

Cigarette smoke-initiated oxidative stress causes NF-κB activation and lung inflammation via E3 ligase Itch-mediated Txnip degradation

Abstract Chronic inflammatory lung diseases including chronic obstructive pulmonary disease (COPD) are characterized by pulmonary structural changes, narrowing of the small airways, and destruction of the lung parenchyma caused by the prolonged inflammation. Sustained inflammation mediated by macrophages is deliberated the critical role in COPD pathogenesis, while inductive mechanisms of the persistent inflammation remain unclear. In this study, we revealed that thioredoxin-interacting protein (Txnip) participated in cigarette smoke-incited NF-κB activation that potentially conducted pulmonary inflammation. Cigarette smoke extract markedly inhibited Txnip expression via an MAPKs-dependent regulation, which accompanied by iNOS/NO and COX-2 induction in RAW264.7 cells. The decreased Txnip was also detected in lung tissues and macrophages obtained from smoking mice, while a higher NF-κB activation and lung inflammation had arisen simultaneously. In addition, cigarette smoke-associated oxidative stress initiated the proteasomal degradation of Txnip followed by the MAPKs-regulated NF-κB activation concurrently. The expression of E3 ligase Itch was elevated in smoking mouse lungs and in hydrogen peroxide-stimulated cells, whereas specific silencing Itch significantly attenuated Txnip degradation as well as NF-κB activation. Moreover, Txnip was distinctly suppressed in lung tissues, bronchoalveolar lavage fluid cells and peripheral blood mononuclear cells obtained from patients with COPD. Accordingly, cigarette smoke-aroused oxidative stress induced Itch-mediated Txnip degradation and further NF-κB inflammation thereby enabling the COPD pathogenesis potentially. MOST 111-2314-B-038-120-MY3 and MOST 111-2320-B-038-012

Sex-dependent influence of LMAN1 on lung function and allergen-induced airway hyperresponsiveness

Abstract We recently reported LMAN1 as a regulatory receptor capable of downregulating NF-kB signaling in response to house dust mite (HDM) in vitro. In this follow up work, we have subjected WT and LMAN1 KO mice to a HDM model of allergic airway inflammation and assessed lung function and airway hyperreactivity (AHR). Given our previous in vitro findings, we had expected worsened disease in the absence of LMAN1. Interestingly, when mice were stratified by sex, we observed that while female, HDM-treated LMAN1 KO mice exhibited signs of enhanced airway narrowing and closure and enhanced AHR compared to their WT counterparts, male, HDM-treated LMAN1 KO mice showed the opposite trend. These sex-dependent effects appeared to be localized to the peripheral airways. We additionally characterized the type and extent of immune cell infiltration into the airway and highlight those features which might account for the gender-biased effects of LMAN1 on lung function in the setting of allergic asthma.

Distraction Osteogenesis as a reliable method in management of Obstructive Sleep Apnoea (OSA) secondary to TMJ Ankylosis: A Case Report.

Obstructive sleep apnoea (OSA) is identified as repetitive and intermittent upper airway collapse or narrowing during sleep. Skeletal advancement through maxillomandibular surgery remains the most effective surgical treatment for OSA but is radical with certain relapse rate. Distraction Osteogenesis of mandible is a single-jaw surgical treatment alternative to bi-jaw surgeries having lesser complications. This case report describes successful management of a 46-year-old patient who reported with a chief complain of obstruction in breathing while sleeping since one year. Obstructive Sleep Apnoea (OSA) secondary to a retrognathic mandible was the final diagnosis, which was successfully treated by Distraction Osteogenesis (DO) of the mandible. The case showed enhancement in airway by 13mm and marked forward movement of Point-B (SNB increased by 6 degrees). The Epworth Sleepiness Scale value decreased from 19mm to 8 mm indicating substantial increase in the airway with stable results after 18 months of follow-up (elimination of symptoms and subsequent sound sleep). Distraction osteogenesis is an effective and reliable method to treat obstructive sleep apnoea secondary to retrognathic mandible.

Efficacy of orofacial myofunctional therapy combined with myofascial release in patients with mild obstructive sleep apnoea: a randomized controlled trial.

Obstructive sleep apnoea (OSA) is characterized by repetitive narrowing and collapse of pharyngeal airway during sleep, leading to apnoea or hypopnoea. In this context, myofunctional therapy and myofascial release might be effective, despite the literature on the combination of these approaches is still scarce. This randomized controlled trial aimed to assess the efficacy of oro-facial myofunctional therapy combined with myofascial release in terms of functioning in patients with mild OSA. Patients aged from 40 to 80 years with diagnosis of mild OSA were randomly allocated into intervention group (oro-facial myofunctional therapy plus myofascial release) and control group (only oro-facial myofunctional therapy). At the baseline (T0), after 4 weeks (T1), and after 8 weeks (T2), the following outcomes were assessed: apnoea/hypopnoea index (AHI), average oxygen saturation (SpO2 ), sleep time spent with oxygen saturation < 90% (T90), snoring index, and Pittsburgh Sleep Quality Index (PSQI). Out of the 60 patients enrolled, 28 (aged 61.46 ± 8.74 years) complete the treatment in the intervention group and 24 (aged 60.42 ± 6.61 years) in the control group. There were no significant differences in AHI between groups. A significant difference was reported for ΔT0-T1 SpO2 (p = .01), T90 (p = .030), ΔT0-T1 and ΔT0-T2 snoring index (p = .026 and <.001 respectively), and ΔT0-T1 and ΔT0-T2 Pittsburgh Sleep Quality Index (p = .003 and <.001 respectively). Taken together, a combination of oro-facial myofunctional therapy and myofascial release showed a potential treatment for sleep quality in patients with mild OSA. Future studies are necessary to better investigate the role of these interventions in OSA patients.

Obstructive Sleep Apnea and Its Management: A Narrative Review.

Obstructive sleep apnea (OSA) is a disorder in which there is repeated collapse of the upper airway when the person is in sleep, which causes oxygen desaturation and interrupted sleep. While asleep, airway blockages and collapse are accompanied by awakenings with or without oxygen desaturation. OSA is a prevalent disorder, especially in people with known risk factors and other illnesses. Pathogenesis is variable, and the risk factors include low chest volume, erratic respiratory regulation, and muscular dysfunction in the upper airway dilators. The high-risk factors include overweight, male sex, aging, adenotonsillar hypertrophy, interruption of the menstrual cycle, preservation of liquids, and smoking. The signs are snoring, drowsiness, and apneas. A sleep history, assessment of symptoms, and physical examination are all part of the screening process for OSA, and the data can help determine which people need to be tested for the condition. The results of the polysomnogram or at-home sleep apnea test assist in determining the presence and severity of OSA. Still, it is seen many times that the accuracy of home sleep apnea tests is significantly less, so one should take an expert opinion for the same. OSA results in systemic hypertension, drowsiness, and driving accidents. It is additionally related to diabetes mellitus, congestive heart failure (CHF), cerebral infarction, and myocardial infarction, but the exact mechanism is not known. The preferred treatment is continuous positive airway pressure with 60-70% adherence. Other management options include reducing weight, therapy of oral appliances, and correcting any anatomical obstruction (narrow pharyngeal airway, adenoid hypertrophy, and mass in the pharynx). OSA indirectly causes headaches just after awakening and daytime sleepiness. However, there are no age boundaries in OSA as it can occur in any age group. Still, more prevalence is seen in individuals of more than 60 years of age.

A case of advanced hypopharyngeal cervical esophageal cancer treated by curative resection with management of tracheoesophageal fistula

Advanced esophageal cancer with tracheal invasion is fatal due to airway narrowing and the possibility of tracheoesophageal fistula (TEF) formation during the treatment process. If a TEF develops, palliative care is often chosen. It is very rare that curative treatment is performed including with chemoradiotherapy (CRT) or surgery in such cases. A 71-year-old man presented with dysphagia. He was diagnosed as having hypopharyngeal and cervical esophageal cancer with severe airway stenosis (cT4b [main bronchus, thyroid] N3 M0 cStage IIIC), and we initially created a tracheostomy. Second, we chose induction chemotherapy to avoid fistula formation by CRT, but after one course of chemotherapy, he developed a TEF due to remarkable tumor shrinkage. We strictly managed both his airway and nutrition by continuous suctioning over the cuff of the tracheal cannula and prohibiting swallowing of saliva and enteral nutrition via nasogastric tube. After three courses of chemotherapy were administered, we performed pharyngo-laryngo-esophagectomy followed by adjuvant chemotherapy. The patient remains alive and recurrence free at 9 years postoperatively. In cases of upper TEF caused by advanced hypopharyngeal and cervical esophageal cancer, radical treatment may be possible by effective induction chemotherapy combined with strict airway and nutritional management after prior tracheostomy.

Pre-treatment bronchoscopic evaluation in a case of relapsing polychondrits

BackgroundRelapsing polychondritis (RP) is a chronic and recurrent inflammatory disease of the cartilage tissues in the body. The cause of RP is unknown, and since it is a rare disease with symptoms that affect multiple organs, diagnosis is often delayed.Case presentationA 62-year-old woman with no smoking history visited our institution complaining of fever, cough, and dyspnoea. Chest CT showed a stenosis from the left main bronchus to the left lower lobe branch. Bronchoscopy visualised intense erythema and oedema at the left main bronchus, with airway narrowing. Biopsy of the ear revealed degenerative vitreous cartilage and fibrous connective tissue with a mild inflammatory cell infiltrate. She was subsequently diagnosed with RP and administered systemic corticosteroid therapy. Her symptoms improved rapidly, and post-treatment bronchoscopy revealed that although mild erythema of the airway epithelium remained, oedema markedly improved, and the airway stenosis was resolved.ConclusionsWe report a case where pre-treatment bronchoscopy was able to visually confirm RP at the acute stage. Since RP is difficult to diagnose, severe airway narrowing can occur prior to diagnosis. Therefore, to determine the stage of the disease, it is helpful to perform bronchoscopic observation before treatment. However, bronchoscopic observation before treatment should be performed by experienced bronchoscopists due to the risk of airway obstruction.

Mouth Puffing Phenomenon and Upper Airway Features May Be Used to Predict the Severity of Obstructive Sleep Apnea.

This study aimed to investigate (1) the role of mouth puffing phenomenon and upper airway features in obstructive sleep apnea (OSA) and (2) whether mouth-taping during sleep alleviated the severity of OSA. Seventy-one participants underwent a two-night home sleep test (the first day sleeping normally; the second day sleeping with their mouths being taped); their oximetry desaturation index (ODI) and mouth puffing signals (non-mouth puffing, complete mouth puffing, intermittent mouth puffing (IMP), and side mouth puffing) were detected by a validated fingertip pulse oximeter and a mouth puffing detector. The participants were grouped into the ODI-improved group and the ODI-not-improved group according to their sleeping test results. The radiograph was taken by cone-beam computed tomography and cephalometries. Upper airway features including airways, soft tissues, and oral cavity variables were measured. Participants with severe OSA showed a higher IMP percentage compared with those with normal, mild, and moderate OSA (severe: 33.78%, moderate: 22.38%, mild: 14.55%, normal: 0.31%, p < 0.001). In all participants, the ODI and the percentage of SpO2 under 90 (T90) were positively related to body mass index (BMI) (r = 0.310 and 0.333, respectively), while ODI and T90 were negatively correlated with the minimum width of the airway (r = -0.473 and -0.474, respectively); all mentioned relationships were significant (p < 0.05). IMP proportions were found to be higher in the half of participants whose ODI did not improve after mouth-taping and in those with severe OSA. Moreover, OSA patients with higher ODI, higher T90, and higher proportions of IMP were more likely to have a narrower upper airway.

Weight Loss for Obstructive Sleep Apnea: Pharmacological and Surgical Management

Obstructive sleep apnea (OSA) is a relatively common sleep disorder characterized by repetitive narrowing or obstruction of the upper airway, including the nasal cavity, pharynx, and larynx, during sleep. OSA can cause a variety of symptoms and/or complications, such as excessive daytime sleepiness, reduced concentration, hypertension, type II diabetes, and stroke. Accordingly, an accurate diagnosis and appropriate treatments are required for OSA. Obesity is an important risk factor for OSA and is characterized by the abnormal accumulation of fat in the body, including the upper airway. When the body weight increases, adipose tissue accumulates in the pharynx, which can narrow the diameter of the upper airway and lead to dysfunction of the pharynx dilator muscles. These changes caused by weight gain can cause or exacerbate OSA. Various therapeutic options exist for patients with overweight or obesity, including diet, behavioral modifications, exercise, pharmacological treatments, and surgical procedures. Of these, diet, behavioral modifications, and exercise constitute the first-line management for obesity. However, their results are relatively unsatisfactory, and pharmacotherapy and bariatric surgery are generally implemented in obese patients with OSA. Therefore, the purpose of this paper is to review pharmacological and surgical management strategies for obesity that are currently commonly used in overweight or obese adult patients with OSA.

A computational analysis on the impact of multilevel laryngotracheal stenosis on airflow and drug particle dynamics in the upper airway.

Laryngotracheal stenosis (LTS) is a type of airway narrowing that is frequently caused by intubation-related trauma. LTS can occur at one or multiple locations in the larynx and/or trachea. This study characterizes airflow dynamics and drug delivery in patients with multilevel stenosis. Two subjects with multilevel stenosis (S1 = glottis + trachea, S2 = glottis + subglottis) and one normal subject were retrospectively selected. Computed tomography scans were used to create subject-specific upper airway models. Computational fluid dynamics modeling was used to simulate airflow at inhalation pressures of 10, 25, and 40 Pa, and orally inhaled drug transport with particle velocities of 1, 5, and 10 m/s, and particle size range of 100 nm-40 µm. Subjects had increased airflow velocity and resistance at stenosis with decreased cross-sectional area (CSA): S1 had the smallest CSA at trachea (0.23 cm2) and resistance = 0.3 Pa·s/mL; S2 had the smallest CSA at glottis (0.44 cm2), and resistance = 0.16 Pa·s/mL. S1 maximal stenotic deposition was 4.15% at trachea; S2 maximal deposition was 2.28% at glottis. Particles of 11-20 µm had the greatest deposition, 13.25% (S1-trachea) and 7.81% (S2-subglottis). Results showed differences in airway resistance and drug delivery between subjects with LTS. Less than 4.2% of orally inhaled particles deposited at stenosis. Particle sizes with most stenotic deposition were 11-20 µm and may not represent typical particle sizes emitted by current-use inhalers.

Motor neuron involvement threatens survival in spinocerebellar ataxia type 1.

Motor neuron involvement threatens survival in spinocerebellar ataxia type 1.

Transport and deposition of beclomethasone dipropionate drug aerosols with varying ethanol concentration in severe asthmatic subjects

This study aims to assess the effects of varying an ethanol co-solvent on the deposition of drug particles in severe asthmatic subjects with distinct airway structures and lung functions using computational fluid dynamics. The subjects were selected from two quantitative computed tomography imaging-based severe asthmatic clusters, differentiated by airway constriction in the left lower lobe. Drug aerosols were assumed to be generated from a pressurized metered-dose inhaler (MDI). The aerosolized droplet sizes were varied by increasing the ethanol co-solvent concentration in the MDI solution. The MDI formulation consists of 1,1,2,2-tetrafluoroethane (HFA-134a), ethanol, and beclomethasone dipropionate (BDP) as the active pharmaceutical ingredient. Since HFA-134a and ethanol are volatile, both substances evaporate rapidly under ambient conditions and trigger condensation of water vapor, increasing the size of aerosols that are predominantly composed of water and BDP. The average deposition fraction in intra-thoracic airways for severe asthmatic subjects with (or without) airway constriction increased from 37%±12 to 53.2%±9.4 (or from 20.7%± 4.6 to 34.7%±6.6) when the ethanol concentration was increased from 1 to 10%wt/wt. However, when the ethanol concentration was further increased from 10 to 20%wt/wt, the deposition fraction decreased. This indicates the importance of selecting appropriate co-solvent amounts during drug formulation development for the treatment of patients with narrowed airway disease. For severe asthmatic subjects with airway narrowing, the inhaled aerosol may benefit from a low hygroscopic effect by reducing ethanol concentration to penetrate the peripheral region effectively. These results could potentially inform the selection of co-solvent amounts for inhalation therapies in a cluster-specific manner.

Decellularization compromises mechanical and structural properties of the native trachea

Tracheal replacement using tissue engineering technologies offers great potential to improve previously intractable clinical interventions, and interest in this area has increased in recent years. Many engineered airway constructs currently rely on decellularized native tracheas to serve as the scaffold for tissue repair. Yet, mechanical failure leading to airway narrowing and collapse remains a major cause of morbidity and mortality following clinical implantation of decellularized tracheal grafts. To understand better the factors contributing to mechanical failure in vivo, we characterized the histo-mechanical properties of tracheas following two different decellularization protocols, including one that has been used clinically. All decellularized tracheas deviated from native mechanical behavior, which may provide insights into observed in vivo graft failures. We further analyzed protein content by western blot and analyzed microstructure by histological staining and found that the specific method of decellularization resulted in significant differences in the depletion of proteoglycans and degradation of collagens I, II, III, and elastin. Taken together, this work demonstrates that the heterogeneous architecture and mechanical behavior of the trachea is severely compromised by decellularization. Such structural deterioration may contribute to graft failure clinically and limit the potential of decellularized native tracheas as viable long-term orthotopic airway replacements.

No: 5006 Large tube or narrow airway? Unanticipated difficult airway in an adult

No: 5006 Large tube or narrow airway? Unanticipated difficult airway in an adult

Three-dimensional evaluation of the pharyngeal airway space in patients with anterior open bite.

: This study aimed to three-dimensionally evaluate the pharyngeal airway space (PAS) of patients with anterior open bite (AOB) by using cone-beam computed tomography (CBCT) and compare the findings with those obtained in individuals with normal occlusion. : The open bite group (OBG, n = 25) consisted of patients with an anterior overbite of -3 mm or less, while the control group (n = 25) consisted of age- and sex-matched individuals with an anterior overbite of 1-3 mm, Angle Class I malocclusion (1° ≤ point A-nasion-point B angle ≤ 4°), and a normodivergent profile (22° ≤ Frankfort mandibular plane angle ≤ 28°). After the CBCT data were reconstructed into a three-dimensional image, the PAS was segmented into four parts, and the volume of each part was measured. Pharyngeal airway length (PAL) and the area and transverse width of the part showing minimal constriction were also measured. Pearson's correlation analysis was used to evaluate the correlation between changes in the PAS and the amount of anterior overbite. : The OBG showed a significantly narrower airway space in the nasopharyngeal, hypopharyngeal, and total airway volumes. The OBG also showed a significantly smaller area and transverse width of the part with minimal constriction. The OBG showed a significantly longer PAL, but there was no correlation between the amount of anterior overbite and the changes in PAS. : The PAS was associated with AOB. Patients with AOB had a narrower PAS and a smaller part showing minimal constriction.

Major clinical results of orthognathic surgery and maxillomandibular advancement in obstructive sleep apnea syndrome

Introduction: Obstructive sleep apnea involves obstruction or narrowing of an individual's airway during sleep and is associated with several comorbidities. Management can be surgical or nonsurgical, and Phase II of the Stanford Protocol for surgical management involves maxillomandibular advancement. Objective: It was to carry out a concise systematic review to present the main considerations and clinical results of orthognathic surgery in obstructive sleep apnea syndrome. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from September to November 2022 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 270 articles were found, 47 articles were evaluated and 23 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 35 studies at high risk of bias and 125 studies that did not meet the GRADE. Most studies showed homogeneity in their results, with I2 =95.9% &gt;50%. Maxillomandibular advancement surgery is a successful treatment for obstructive sleep apnea, but there are still concerns about the aesthetic results due to the great advances involved. The bimaxillary advancement osteotomy significantly increases the oropharyngeal volume and constricted surface areas, which remains stable between 6 months to 1 year postoperatively.

Clarifying sleep characteristics and analyzing risk factors of sleep disorders to promote a predictive, preventive, and personalized medicine in patients with burn scars

This study assessed sleep quality in patients with burn scars and investigated risk factors of sleep disorders to guide clinical therapy. From the strategy of predictive, preventive, and personalized medicine (PPPM/3PM), we proposed that risk assessment based on clinical indicators could prompt primary prediction, targeted prevention, and personalized interventions to improve the management of sleep disorders present in patients with burn scars. This retrospective study recruited patients with burn scars and healthy volunteers from the Shanghai Burn Treatment Center between 2017 and 2022. Relevant information and data, including demographic characteristics, scar evaluation, and sleep quality, were obtained through the hospital information system, classical scar scale, and self-report questionnaires. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and monitored using a cardiopulmonary-coupled electrocardiograph. Pain and pruritus were assessed using the visual analog scale (VAS). Scar appearance was assessed using the modified Vancouver scar scale (mVSS). The sample was comprised of 128 hypertrophic scar (HS) patients, with 61.7% males, a mean age of 41.1 ± 11.6years, and burn area of 46.2 ± 27.9% total body surface area (TBSA). Patients with PSQI ≥ 7 accounted for 76.6%, and the global PSQI score was 9.4 ± 4.1. Objective sleep data showed that initial enter deep sleep time, light sleep time, awakening time, light sleep efficiency, and sleep apnea index were higher but deep sleep time, sleep efficiency, and deep sleep efficiency were lower in HS patients than that in healthy controls. Preliminary univariate analysis showed that age, hyperplasia time of scar, narrow airway, microstomia, VAS for pain and pruritus, and mVSS total (comprised of pigmentation, vascularity, height and pliability) were associated with the PSQI score (p < 0.1). Multivariable linear regression showed narrow airway, VAS for pain and pruritus, and mVSS specifically height, were the risk factors for PSQI score (p < 0.1). This study model identified that narrow airway, pain, pruritus and scar appearance specifically height may provide excellent predictors for sleep disorders in HS patients. Our results provided a basis for the predictive diagnostics, targeted prevention, and individualized therapy of somnipathy predisposition and progression of HS patients in the setting of PPPM/3PM health care system, which contributed to a paradigm shift from reactive cure to advanced therapy.

Anesthesia mumps with airway obstruction after radical nephrectomy: A case report and literature review.

Anesthesia mumps have rarely been reported. This article presents the diagnosis and treatment of a case of anesthesia mumps with airway obstruction in the urology department and reviews previous cases of the disease. A 58-year-old man had a history of hypertension and diabetes, and his blood pressure and glucose levels were well controlled. He underwent laparoscopic radical nephrectomy for a right renal tumor. Postoperatively, a swelling of approximately 5 × 4 cm was observed in the left parotid region and left eyelid, no palpable crepitation was detected, and the skin overlying the left parotid gland was mildly hyperemic and tender. Enhanced computed tomography of the head and neck revealed obvious swelling of the laryngopharyngeal airway, and electronic laryngoscopy showed narrow airway. Laboratory test results including white blood cell count, C-reactive protein, serum amylase, and lipase levels were normal. Glycosylated hemoglobin level was 6.8%, and the salivary culture from Stensen's duct was negative. The patient was managed with endotracheal intubation and a ventilator to maintain breathing along with anti-infection, expectorant, and symptomatic treatment. The swelling in the left parotid gland gradually resolved without recurrence, and the patient was extubated on the 7th postoperative day. In this case, the pathophysiology of anesthesia mumps may have been related to the incorrect positioning of the thick short neck and the use of a head ring, which can result in the squeezing of vessels. In most cases, the salivary gland swelling resolves with observation and symptomatic treatment. In patients with anesthesia mumps, emergency airway management and careful observation are necessary if upper airway obstruction occurs. This case report should increase awareness of anesthesia mumps and its complications among anesthesiologists, surgeons, and postoperative caregivers.