Excessive Granulation Research Articles

Identification of a novel variant in the LAMB3 gene in a patient with a distinct junctional epidermolysis bullosa laryngo-onycho-cutaneous syndrome phenotype.

Junctional epidermolysis bullosa (JEB) represents a rare mechanobullous genodermatosis, characterized by fragility and blister formation of the skin and mucous membranes. Within the JEB spectrum, laryngo-onycho-cutaneous (LOC) syndrome is a rare subtype that manifests with excess granulation tissue of the eyes, nails, skin, and larynx. Thus far, the LOC subtype has been linked predominantly to mutations in LAMA3, disrupting the epidermal basement membrane zone. We present a unique case of a congenitally affected female with numerous cutaneous eroded plaques, oral ulcers, nail dystrophy, and laryngeal involvement phenotypically consistent with the rare JEB LOC subtype. Genetic testing revealed a previously unreported homozygous variant in the LAMB3 gene (p.C316Y) highlighting a novel variant in the LAMB3 gene and its association with the LOC phenotype of JEB.

Mucoperiosteal and lacrimal sac flap anastomosis with ligating clips in revision dacryocystorhinostomy.

Although endoscopic dacryocystorhinostomy (EDCR) has been performed successfully in primary and revision cases, there has yet to be a consensus on the best surgical approach. Excessive granulation, adhesion, and fibrosis, the main causes of unsuccessful EDCR, should be expected more frequently in revision surgery. Anastomosis by ligating the nasal mucoperiosteum and lacrimal sac flaps with clips can minimise the surface of exposed bone, therefore, the possibility of stenosis and failure of the dacryocystorhinostomy. In 12 revision EDSR patients, ligating clips ensured an anatomical overlap of the mucoperiosteum and sac flap, providing a wider rhinostomy opening and straight epithelial lining.

The safety and effectiveness of the treatment of refractory post-intubation subglottic stenosis using short bronchial Dumon stent: a pilot study.

Post-intubation subglottic stenosis (PI-SGS) is a fatal disease which could result in partial or complete narrowing of the airway. Although airway stenting is commonly used as an alternative treatment for PI-SGS patients unsuitable for surgery, complications including stent migration and excessive granulation tissue formation are frequently encountered. Additionally, tracheotomy is necessary in patients undergoing T-tube placement. Therefore, it is necessary to further enhance the effectiveness of airway stenting in refractory PI-SGS. In this study, we aimed to evaluate the safety and effectiveness of utilizing short bronchial Dumon (BD) stents in managing refractory PI-SGS. PI-SGS patients who were not suitable for surgery and in whom previous interventional treatments had proven ineffective were enrolled. Short BD stents were inserted via rigid bronchoscopy under general anesthesia. Complications and outcomes were assessed by follow-ups. Fourteen patients were included and successful stent insertion was achieved in all cases. The median diameter and length of stents was 12 (0.25) and 33.5 (5) mm, respectively. During the 6-month follow-up period, complications were reported in five patients. Granulation tissue formation was the most frequently observed complication (4 in 14 patients, 28.57%), followed by stent migration (2 in 14 patients, 14.29%). Out of the total participants, 11 patients (78.57%) demonstrated good tolerance to the stent, while 3 (21.43%) required stent removal. Among these three patients, two finally underwent subsequent T-tube insertion after the removal. Twelve patients (85.71%) avoided the tracheotomy and T-tube insertion. The utilization of short BD stents appears to be a safe and effective approach for managing refractory PI-SGS. The complications and tolerability are acceptable.

P-164 The impact of oocyte morphological abnormalities on fertilization rate and blastocyst quality

Abstract Study question Do distinct morphological abnormalities in oocytes have an adverse effect on both fertilization rates and the quality of resulting blastocyst? Summary answer While most oocyte morphological abnormalities did not significantly affect outcomes, dark cytoplasmic color correlated with lower fertilization rates and the absence of good quality blastocysts What is known already Variability exists in the fertilization and developmental potential of mature (metaphase II - MII) human oocytes. A high-quality MII oocyte is characterized by a spherical shape, homogeneous cytoplasm, smooth appearance, a uniform zona pellucida (ZP), a normal-sized perivitelline space (PVS), and a single unfragmented polar body (PB). Dysmorphisms, such as variations in cytoplasmic features and anomalies in PVS size and PB regularity may occur. There are conflicting reports on the relationship between oocyte morphology and IVF outcomes. A recent meta-analysis highlighted associations between poor fertilization potential and specific dysmorphisms, including large/irregular PB, a large PVS, refractile bodies, and vacuoles. Study design, size, duration This study analyzed 367 MII oocytes obtained from 40 young patients. The fertilization rate (FR) and blastocyst quality (BQ) were compared among 132 dysmorphic and 235 normal MII oocytes (from October 2023 to January 2024). Dysmorphic oocytes were categorized as having a non-spherical shape, large PVS, PVS debris, abnormal ZP, fragmented PB, excess cytoplasmic granules, vacuoles, and dark cytoplasmic color. Participants/materials, setting, methods All MII oocyte denuded were examined under the microscope at x-400 magnification. Dysmorphic and normal oocytes were separated, injected, and cultured individually until day 5 under conditions of 37oC and 6% CO2. Fertilization was assessed 14 to 18 hours post-injection, and subsequent embryonic development was evaluated on day 2 and day 5. Blastocysts graded 4AA to 4BC are considered good quality, while those graded 4CC to 3CC are classified as fair quality. Main results and the role of chance The mean age of patients was 24.14 ± 3.77. In total, 36% of all oocytes exhibit at least one dysmorphism (n = 132). From the overall dataset analyzed, there was no significant difference (p > 0.9999) in FR between the normal 77.87% (183/235) and dysmorphic group of oocytes 78.03 (103/132). The odd ratio and 95% confidence interval are 0.9909 and 0.5957 to 1.633 respectively. However, this was not the same for oocytes with dark color cytoplasm. The presence of this dysmorphism significantly lowered FR (p = 0.0176) with an odd ratio of 5.544 (95% CI: 1.419 to 21.67). Similarly, the result showed no statistically significant difference (p = 0.1073) in the likelihood of obtaining a fair quality blastocyst between the normal oocytes 23.40% (55/235) and dysmorphic group of oocytes 15.79 (21/133). This was also the same for the likelihood of obtaining good quality blastocyst. There was no statistically significant difference (p = 0.1536) between the normal group 20.00% (47/235) and the dysmorphic group 26.52 (35/132). Oocyte with dark color cytoplasm gave no good quality blastocyst. Limitations, reasons for caution The exclusive use of oocytes from young patients may limit the generalizability of findings to a broader population of IVF patients. Also, the sample size may limit the study’s ability to detect subtle associations. A reason for caution when interpreting this study is its focus on morphological assessments alone. Wider implications of the findings The knowledge from our findings may contribute to optimizing oocyte selection strategies for intracytoplasmic sperm injection. Also, the knowledge could potentially be integrated into AI modules for oocyte morphological assessment. However, more studies would be required to develop a robust and scalable system Trial registration number Not applicable

Boron Nitride Nanosheets Induce Lipid Accumulation and Autophagy in Human Alveolar Lung Epithelial Cells Cultivated at Air-Liquid Interface.

Hexagonal boron nitride (hBN) is an emerging 2D material attracting significant attention due to its superior electrical, chemical, and therapeutic properties. However, inhalation toxicity mechanisms of hBN in human lung cells are poorly understood. Here, cellular interaction and effects of hBN nanosheets is investigated in alveolar epithelial cells cultured on porous inserts and exposed under air-liquid interface conditions for 24h. hBN is taken up by the cells as determined in a label-free manner via RAMAN-confocal microscopy, ICP-MS, TEM, and SEM-EDX. No significant (p > 0.05) effects are observed on cell membrane integrity (LDH release), epithelial barrier integrity (TEER), interleukin-8 cytokine production or reactive oxygen production at tested dose ranges (1, 5, and 10µgcm-2). However, it is observed that an enhanced accumulation of lipid granules in cells indicating the effect of hBN on lipid metabolism. In addition, it is observed that a significant (p < 0.05) and dose-dependent (5 and 10µgcm-2) induction of autophagy in cells after exposure to hBN, potentially associated with the downstream processing and breakdown of excess lipid granules to maintain lipid homeostasis. Indeed, lysosomal co-localization of lipid granules supporting this argument is observed. Overall, the results suggest that the continuous presence of excess intracellular lipids may provoke adverse outcomes in the lungs.

A multicenter observational study assessing the safety, feasibility, and complications of Bonastent in central airway obstruction.

Self-expandable metallic stents (SEMS) are increasingly used in the management of both malignant and nonmalignant airway stenosis. There are multiple stents available in the market; however, the current literature on the efficacy and safety of newly available 3rd generation SEMS (Bonastent) is extremely limited and only has data from single center studies. To report the efficacy and early (<7 days) and late (⩾7 days) complications in patients with central airway obstruction (CAO) treated with Bonastent placement at two institutions. We performed a retrospective analysis of data of consecutive patients who underwent therapeutic bronchoscopy and Bonastent placement at two tertiary care university hospitals between January 2019 and November 2023. Bonastent deployment was performed in the operating room. Stents were deployed using rigid or flexible bronchoscopy under direct visualization with a flexible bronchoscope and in conjunction with fluoroscopic guidance. We then analyzed the effectiveness, short-term, and long-term complications of Bonastent placement. A total of 107 Bonastents® were placed in 96 patients. The most common etiology of CAO was malignancy, 92.7% (n = 89), followed by excessive dynamic airway collapse (EDAC) and post-intubation tracheal stenosis. Seventy-three patients (76%) had improvement in symptoms or imaging within 7 days of stent placement, including successful liberation from mechanical ventilation in a patient with CAO. Early complications occurred in seven patients (two-airway bleeding, two-mucus plugging that improved with airway clearance, two-stent migrations, and one-cough).Late complications occurred in 23 patients (1-stent migration requiring revision bronchoscopy and replacement of airway stent, 11-mucus plugging, 6-granulation tissue, 2-pneumonia, 1-cough, 1-tumor ingrowth/stent fracture, 1-airway emergency due to excessive granulation tissue obstructing the distal end of the stent and had a failed cricothyroidotomy leading to death). Overall, the early complication rate was 7.3% (7/96) and late complication rate was 23.9% (23/96). Our study is the first multicenter study that found a good safety profile with a low complication rate after tracheobronchial Bonastent placement with improvement in symptoms soon after stent placement.

Phimosis in a cat: diagnosis, treatment and complications

Phimosis is the inability to advance the penis through the preputial orifice. This condition in its congenital form is infrequent in cats and has a low prevalence when compared to the canine condition. Diagnosis is based on the physical exam and the treatment of choice is often preputioplasty. The following case describes a six-week-old feline patient with signs of strangury, pollakiuria, excessive licking, and vocalizations when urinating. The physical exam encountered a significant stenosis of the preputial orifice. A circular preputioplasty was the therapy performed and three days later the patient presented with recurrent signs. Excessive granulation tissue was observed around the surgical wound, prompting further corrective surgery. This time the patient showed immediate resolution of the signs of distress that after 1 year have not recurred. The objective of this study is to contribute information about clinical-surgical decisions and the principle complications presented by cats with phimosis.

The role of crinophagy in quality control of the regulated secretory pathway

In specialized secretory cells that produce and release biologically active substances in a regulated fashion, tight control of both the quantity and quality of secretory material is of paramount importance. During crinophagy, abnormal, excess or obsolete secretory granules directly fuse with lysosomes to yield crinosomes, in which the delivered secretory material is degraded. Crinophagy maintains the proper intracellular pool of secretory granules, and it is enhanced when secretory material accumulates because of compromised secretion. Recent studies highlight that it can even degrade newly formed, nascent secretory granules that shed from the trans-Golgi network. This implies that crinophagy provides a quality control checkpoint acting at the formation of secretory vesicles, and this degradation mechanism might survey secretory granules throughout their maturation. Of note, a plethora of human disorders is associated with defective lysosomal clearance of secretory material via crinophagy or similar pathways, including macro- or micro-autophagic degradation of secretory granules (referred to here as macro- and micro-secretophagy, respectively). In our Review, we summarize key recent advances in this field and discuss potential links with disease.

Increased Intervals Between Paediatric Tracheostomy Tube Changes: Is it a Safe Technique?

To evaluate the safety of changing tracheostomy tubes every three months in paediatric patients and determine the occurrence of tube-related complications. Retrospective observational chart review was completed from 2018 to 2021 at a tertiary medical centre in Thailand. Tube associated complications were assessed with regards to interval length between tracheostomy tube changes. The rate of complication was compared with previous studies. Out of a total of 108 visits, the average interval between each tube change was 87 days. Of all encounters, 6.48% resulted in a tube-related complication. Of these seven visits, two had an admission for a respiratory infection within 30 days, three experienced accidental decannulation and two resulted in excess granulation tissue formation. A p-value of 0.8 was obtained from a chi-squared test. An interval of 90-days between paediatric tracheostomy tube changes does not increase the rate of tracheostomy tube related complications. This interval may be practical for those in resource limited settings.

A refashioned foley catheter: novel cost-effective available stent in pediatric laryngotracheal reconstruction

PurposePediatric laryngotracheal reconstruction (LTR) for laryngotracheal stenosis (LTS) mandates stenting in certain situations. This study presents a novel commercially available and cost-effective stent, a refashioned foley catheter.MethodsThis prospective clinical study was performed on pediatric cases with LTS up to 8 years. The study was performed in a tertiary referral center. The selection of the proper foley catheter size for age was explained. The atraumatic insertion maneuver of the stent was also shown in detail in different situations of LTS. The endoscopic removal of the stent was also described. The mean follow-up was 6.45 ± 1.3 months.ResultsThe study included 31 cases using the refashioned foley catheter stents. The study included 17 males and 14 females with a mean age of 3.45 ± 1.09. Subglottic stenosis was the most common cause of LTR in the study (74.2%) cases. The mean duration of stenting was 40.5 ± 3.7 days. Decannulation was achieved in 96.8% of cases. No stent complications were encountered like stent migration, excess granulation tissue, intractable aspiration, or pressure necrosis.ConclusionThe refashioned foley catheter is a novel, available, and inexpensive stent that can be utilized for LTR cases for pediatric LTS. The newly described stent is soft, pliable with atraumatic insertion and easy endoscopic removal with minimal complications.

Combinatorial prophylactic effect of phlorotannins with photobiomodulation against tracheal stenosis

Several conventional treatments are used to manage tracheal stenosis after intubation and surgical procedures; however, patients are at risk of restenosis because of the absence of effective preventative therapy. In this study, we evaluate the biomodulatory effect of PT-combined blue light (BL) PBM in tracheostomal stenosis-induced animal models. The PT-combined BL group showed a significant decrease in the fibrotic protein synthesis by downregulating the release of stenosis-triggering fibrotic signals, without cytotoxicity or thermal damage. Moreover, the combined treatment ameliorated excessive granulation and collagen formation, and consequently preserved the opening of the tracheostoma ten days after fenestration. The current study demonstrated the biomodulatory effect of PT-combined BL on human tracheal fibroblasts and tracheal fenestration rodent models. Hence, PT-combined BL has the potential to be an effective preventative treatment for tracheal stenosis but also as an alternative option for fibrotic disorders.

A Granulation Tissue Detection Model to Track Chronic Wound Healing in DM Foot Ulcers

Diabetes mellitus (DM) foot ulcer is a chronic wound and is highly related to the mortality and morbidity of infection, and might induce sepsis and foot amputation, especially during the isolation stage of the COVID-19 pandemic. Visual observation when changing dressings is the most common and traditional method of detecting wound healing. The formation of granulation tissues plays an important role in wound healing. In the complex pathophysiology of excess and unhealthy granulation induced by infection, oxygen supply may explain the wound healing process in DM patients with multiple complicated wounds. Thus, advanced and useful tools to observe the condition of wound healing are very important for DM patients with extremities ulcers. For this purpose, we developed an artificial intelligence (AI) detection model to identify the growth of granulation tissue of the wound bed. We recruited 100 patients to provide 219 images of wounds at different healing stages from 2 hospitals. This was performed to understand the wound images of inconsistent size, and to allow self-inspection on mobile devices, having limited computing resources. We segmented those images into 32 × 32 blocks and used a reduced ResNet-18 model to test them individually. Furthermore, we conducted a learning method of active learning to improve the efficiency of model training. Experimental results reveal that our model can identify the region of granulation tissue with an Intersection-over-Union (IOU) rate higher than 0.5 compared to the ground truth. Multiple cross-repetitive validations also confirm that the detection results of our model may serve as an auxiliary indicator for assessing the progress of wound healing. The preliminary findings may help to identify the granulation tissue of patients with DM foot ulcer, which may lead to better long-term home care during the COVID-19 pandemic. The current limit of our model is an IOU of about 0.6. If more actual data are available, the IOU is expected to improve. We can continue to use the currently established active learning process for subsequent training.

Allogeneic transplantation of epidermal cell sheets followed by endoscopic submucosal dissection to prevent severe esophageal stricture in a porcine model.

IntroductionEndoscopic submucosal dissection (ESD) is a minimally invasive treatment for early esophageal cancer. However, large mucosal defects after esophageal ESD result in refractory strictures. In the present study, we histologically evaluated the endoscopic transplantation of allogeneic epidermal cell sheets (ECSs) as a feasible therapy for preventing esophageal stricture after circumferential ESD in a porcine model.MethodsEpidermal cells were isolated from the skin tissue of allogeneic pigs and cultured on temperature-responsive cell culture inserts for 2 weeks. Transplantable ECSs were harvested by reducing the temperature and endoscopically transplanting the sheets to ulcer sites immediately after esophageal ESD. The engraftment of transplanted ECSs was then evaluated in two pigs at 7 days after transplantation. Next, ten pigs were divided into two groups to evaluate the endoscopic transplantation of allogeneic ECSs for the prevention of esophageal strictures after ESD. Allogeneic ECSs were transplanted immediately after esophageal ESD in the transplantation group (n = 5), whereas the control group (n = 5) did not undergo transplantation.ResultsMost of the transplanted allogeneic ECSs were successfully engrafted at the ulcer sites in the early phase. Fluorescence in situ hybridization analysis revealed that several allogeneic cells were present in the transplanted area at 7 days after ESD. At 14 days after ESD, significant differences in body weight loss, dysphagia scores, and mucosal strictures were observed between the control and transplantation groups. Transplanting allogeneic ECSs after esophageal ESD promotes mucosal healing and angiogenesis and prevents excessive inflammation and granulation tissue formation.ConclusionsEndoscopic and histological analyses revealed that allogeneic ECSs promoted artificial ulcer healing after ESD, preventing esophageal strictures after ESD.

Effect of Aloe vera gel on the healing of cutaneous wounds in donkeys

The efficiency of fresh Aloe vera gel was tested on the healing of large cutaneous wounds of the forelimbs in donkeys. Twelve adult donkeys from both sexes were used in this experimental study. They were divided into equal groups. A square shape cutaneous wound about 8*8cm, was induced on the lateral aspect of the forelimb exactly between humeral and knee joint. In group one, the induced wound was left without treatment, while in second group the wound was treated by local application of fresh Aloe vera gel. The evaluation of healing process results was based on monitoring the gross signs of wound healing, in addition to the study the histopathological changes at 15th, 30th, 45th postoperative days. In group one, the wound healing process was characterized by infection, congestion, inflammatory exudate, excessive granulation tissue formation, and no decrease in wound size, while in group two, the healing of wound was characterized by absence of granulation tissue overgrowth with decrease in wound size and little occurrence of infection and congestion. The histopathological observations in first group was showed intensive granulation tissue formation with massive infiltration of mononuclear inflammatory cells and delay of reepithelization, while in second group, overgrowth of granulation tissue was lesser, little infiltration of mononuclear inflammatory cells, rapid reepithelization with more maturation and stretching of collagen fibers. It was concluded that the Aloe vera gel can be used successfully as topical treatment to improve and enhance large cutaneous wound healing in donkeys.

A little bit of LOGIC goes a long way: Multidisciplinary management of LOGIC Syndrome‐associated oral manifestations

AbstractLOGIC syndrome (laryngeal and ocular granulation tissues in children from the Indian subcontinent), also known as Laryngo‐onycho‐cutaneous (LOC) syndrome, is a rare, autosomal recessive condition that is a subtype of junctional epidermolysis bullosa (JEB), primarily occurring in individuals of Punjabi ancestry. First observed by Shabbir et al in 1986, it has since been discovered that the syndrome is a result of autosomal recessive mutations in the LAMA3 gene. The clinical manifestations of the syndrome can be life threatening and are characterised by excessive granulation tissue deposition on the skin and mucous membranes including laryngeal, ocular and oral sites. Oral manifestations can drastically affect the quality of life. We present a case of LOGIC syndrome to highlight the importance of clinicians understanding the oral manifestations of the syndrome and implementing a multidisciplinary approach with good communication across specialities, including pathologists.

Airway complications in lung transplantation.

Airway complications (ACs) after lung transplantation remain an important source of morbidity and mortality despite significant advances in the surgical technics, leading to increased cost, and decrease quality of life. The incidences of ACs after lung transplantation range from 2% to 33%, even though most transplant centers have reported rates in the range of 7% to 8%. However, the reported rate of ACs has been inconsistent as a result of a lack of standardized airway definitions and grading protocols before the recent 2018 International Society for Heart and Lung Transplantation (ISHLT) proposed consensus guidelines on ACs after lung transplantation. The ACs include stenosis, perioperative and postoperative bronchial infections, bronchial necrosis and dehiscence, excess granulation tissue, and tracheobronchomalacia (TBM). Anastomosis infection, necrosis, or dehiscence typically develops within the first month after lung transplantation. The most frequent AC after lung transplantation is bronchial stenosis. Several risk factors have been proposed to the development of ACs after lung transplantation, including surgical anastomosis techniques, hypoperfusion, infections, donor and recipient factors, immunosuppression agents, and organ preservation. ACs might be prevented by early recognition of the airway pathology, using advance medical management, and interventional bronchoscopy procedures. Balloon bronchoplasty, cryotherapy, laser photo resection, electrocautery, high-dose endobronchial brachytherapy, and bronchial stents placement are the most frequent interventional bronchoscopic procedures utilized for the management of ACs.

Therapeutic efficiency of adipose-derived mesenchymal stem cells in healing of experimentally induced gastric ulcers in rats.

Gastric (peptic) ulcer is a major gastrointestinal disorder with high morbidity and mortality. While several drugs have been used to treat gastric ulcers, such as proton pump inhibitor-based triple therapy for Helicobacter pylori eradication, but hey result in adverse side effects. Therefore, development of new alternative therapies is desirable. Many recent studies have shown that mesenchymal stem cells (MSCs) might have an enhancing effect on the ulcerated gastric mucosa. The aim of this study is to evaluate the efficacy of MSCs in the treatment of indomethacin-induced gastric ulcer, and to compare it with the normal ulcer autohealing. This work was performed on 36 adult male albino rats, divided into four groups: Group I (control group), Group II (ulcer group), Group III (autohealing group), and Group IV (stem cells-treated group). The histological changes of gastric mucosa were examined in sections stained with H&E using light microscope for expression of vascular endothelial growth factors (VEGF) and proliferating cell nuclear antigen (PCNA) in immunohistochemical stained sections using image analyzer. The results from MSCs-treated group revealed restoration of the normal architecture of the gastric mucosa with comparison to the autohealing group which showed excessive granulation tissue and heavy cellular infiltration with disorganized architecture of the fundic mucosa. Immunohistochemical examination showed strong expression of both VEGF and PCNA in the MSCs-treated group. So it was concluded that MSCs accelerate gastric ulcer healing when injected intraperitoneally, compared to autohealing process which showed delayed healing.

Autophagy of mucin granules contributes to resolution of airway mucous metaplasia

Exacerbations of muco-obstructive airway diseases such as COPD and asthma are associated with epithelial changes termed mucous metaplasia (MM). Many molecular pathways triggering MM have been identified; however, the factors that regulate resolution are less well understood. We hypothesized that the autophagy pathway is required for resolution of MM by eliminating excess non-secreted intracellular mucin granules. We found increased intracellular levels of mucins Muc5ac and Muc5b in mice deficient in autophagy regulatory protein, Atg16L1, and that this difference was not due to defects in the known baseline or stimulated mucin secretion pathways. Instead, we found that, in mucous secretory cells, Lc3/Lamp1 vesicles colocalized with mucin granules particularly adjacent to the nucleus, suggesting that some granules were being eliminated in the autophagy pathway rather than secreted. Using a mouse model of MM resolution, we found increased lysosomal proteolytic activity that peaked in the days after mucin production began to decline. In purified lysosomal fractions, Atg16L1-deficient mice had reduced proteolytic degradation of Lc3 and Sqstm1 and persistent accumulation of mucin granules associated with impaired resolution of mucous metaplasia. In normal and COPD derived human airway epithelial cells (AECs), activation of autophagy by mTOR inhibition led to a reduction of intracellular mucin granules in AECs. Our findings indicate that during peak and resolution phases of MM, autophagy activity rather than secretion is required for elimination of some remaining mucin granules. Manipulation of autophagy activation offers a therapeutic target to speed resolution of MM in airway disease exacerbations.

Surgical outcomes in acute dacryocystitis patients undergoing endonasal endoscopic dacryocystorhinostomy with or without silicone tube intubation.

To establish the necessity of silicone tube intubation in acute dacryocystitis (AD) patients undergoing endonasal endoscopic dacryocystorhinostomy (En-DCR). Patients presenting with unilateral AD were randomly assigned to two treatment groups. En-DCR procedures were performed following lacrimal abscess formation, with the operation being performed with silicone intubation for patients in group B but not group A. Functional success was defined by an absence of additional AD episodes, no epiphora, and ostium patency as established via endoscopic evaluation or fluorescein irrigation. Operative success rates and demographic variables were compared between treatment groups. In total, 66 patients were analyzed in the present study (33 per group), with complete postoperative data having been successfully collected from 27 and 22 patients in group A and group B, respectively. All patients exhibited complete resolution of acute inflammation. Upon follow-up, granulation tissue was detected around the ostium at higher rates in group B (9/22, 40.9%) relative to group A (4/27, 14.8%). At the 12-month follow-up time point, patients in group A exhibited higher success rates (25/27, 92.6%) relative to patients in group B (20/22, 90.9%), but this difference was not significant. Cases of lacrimal passage reconstruction failure in both groups were attributed to excessive fibrous and/or granulation tissue formation proximal to the intranasal ostium. Given that these two operative approaches are associated with similar rates of operative success and in light of differences in granulation tissue formation, cost, and operative duration, these data do not support the routine silicone intubation of AD patients following En-DCR surgery.

Complications following secondary voice prosthesis insertion and impact of previous irradiation on their appearance.

The aim of this study was to analyze the complications following secondary voice prosthesis insertion and impact of previous irradiation on their appearance. This study included 106 totally laryngectomized patients who underwent secondary Provox 2 voice prosthesis insertion. Among them, 79 (74.5%) were irradiated. Surgery, prosthesis, fistula, and voice-related complications were analyzed and presented. Complications occurred in 23 (22%) patients. Fifteen of them were previously irradiated. There were no surgery-related complications. In the group of prosthesis-related complications, one patient had increased negative pressure during swallowing with extremely short prosthesis life time. There were 17 complications in the group of fistula related ones; 3 patients had excessive granulation tissue around the fistula and 14 patients experienced prosthesis displacement (7 had closed esophageal end of the fistula, 5 had the prosthesis turned sideways in an open fistula, one patient inhaled and one ingested the prosthesis). Tracheoesophageal voice was not established in 5 patients. Previous irradiation had no statistically significant influence on the complication rate (P = 0,251). The majority of complications following secondary voice prosthesis insertion are fistula-related ones, among which, displacement of the voice prosthesis is the most common. Previous irradiation does not significantly increase the risk of developing complications.