Total Airway Research Articles

Evaluation of You-Gui-Wan critical compounds inhibiting ALOX-5 and HDC gene expression in RBL-2H3 cells using a fractional factorial design

Ethnopharmacological relevanceThe traditional Chinese medicine (TCM) You-Gui-Wan (YGW) has been used to treat asthma for hundreds of years. Aim of the studyYGW is composed of 10 types of medicinal materials. However, the immune mechanism of YGW in asthma treatment has not been elucidated. Therefore, this study investigated asthma symptoms attenuated by YGW and the underlying immune regulatory mechanism. Materials and methodsIntratracheal (i.t.) stimulation of BALB/c mice with Dermatophagoides pteronyssinus (Der p) was performed once per week (40 μL, 2.5 μg/μL). For six consecutive weeks, different doses of YGW (0.2 g/kg and 0.5 g/kg) were orally administered 30 min before stimulation with Der p. After the last stimulation, airway hyperreactivity, lung gene expression, and total immunoglobulin E (IgE) in blood were evaluated using a whole-body plethysmograph system, real-time PCR, and ELISA, respectively. In addition, DNP-IgE/DNP-BSA was added to stimulate mast cells (RBL-2H3), and YGW or various compound compositions (Trial) were added to RBL-2H3 cells for 30 min to evaluate the effects of the drug on mast cell degranulation and on gene expression. JMP 5.1 software was used to design and analyze YGW's critical compounds by which it inhibited ALOX-5 and HDC gene expression in RBL-2H3 cells. ResultsYGW significantly decreased serum total IgE levels and airway hyperresponsiveness in asthmatic mice. YGW also reduced the gene expression of IL-6, TNF-α, IL-4, IL-13, and COX-2 in the lungs of asthmatic mice and RBL-2H3 cells. YGW and the compound (Trial 21) present in YGW inhibited the gene expression of ALOX-5 and HDC in RBL-2H3 cells. ConclusionThe experimental results indicate that YGW exhibits anti-airway hyperresponsiveness and specific immunomodulatory effects. In addition, YGW synergistically inhibits ALOX-5 and HDC gene expression in mast cells through a combination of 21 compounds, including luteolin, quercetin, and β-carotene.

Understanding the Impact of Pulmonary Rehabilitation on Airway Resistance in Patients with Severe COPD: A Single-Center Retrospective Study

We investigated the effect of pulmonary rehabilitation (PR) on airway resistance in chronic obstructive pulmonary disease (COPD) patients with severe airway obstruction and hyperinflation. This retrospective cohort study was conducted with data from severe COPD cases with those who underwent an 8-week PR program. Main inclusion criteria were having severe airflow obstruction (defined as a forced expiratory volume in one second (FEV1) <50%) and plethysmographic evaluation findings being compatible with hyperinflation supporting the diagnosis of emphysema (presence of hyperinflation defined as functional residual capacity ratio of residual volume to total lung capacity (RV/TLC) >120%). Primary outcomes were airway resistance (Raw) and airway conductance (Gaw) which were measured by body plethysmography, and other measurements were performed, including 6-minute walk test (6-MWT), modified Medical Research Council dyspnea scale (mMRC) and COPD assessment test (CAT). Twenty-six severe and very severe COPD patients (FEV1, 35.0 ± 13.1%; RV/TLC, 163.5 ± 29.4) were included in the analyses, mean age 62.6 ± 5.8 years and 88.5% males. Following rehabilitation, significant improvements in total specific airway resistance percentage (sRawtot%, p = 0.040) and total specific airway conductance percentage (sGawtot%; p = 0.010) were observed. The post-rehabilitation mMRC scores and CAT values were significantly decreased compared to baseline results (p < 0.001 and p < 0.001, respectively). Although there were significant improvements in 6-MWT value (p < 0.001), exercise desaturation (ΔSaO2, p = 0.026), the changes in measured lung capacity and volume values were not significant. We concluded that PR may have a positive effect on airway resistance and airway conductance in COPD patients with severe airflow obstruction.

Study on Asymmetric Deformation Law and Surrounding Rock Control Technology of High Stress Soft Rock Crossing Roadway

In order to solve the problem of asymmetric large deformation of high-stress soft rock crossing roadway under complex geological conditions in deep mines, taking the 2# total return airway of 76.2# section of Wuyang Coal Mine as the engineering background, the causes of asymmetric deformation and failure of soft rock crossing roadway in deep mines were summarized and analyzed by means of field investigation, theoretical analysis and numerical simulation, and the asymmetric high-efficiency support technology with large row spacing was studied. The results show that the lithology of roadway strata is the main cause of asymmetric deformation and failure of roadway. The shape change of roadway is not the main influencing factor of asymmetric deformation of roadway, but for the control of roadway surrounding rock, the straight wall semi-circular arch roadway is better than the rectangular roadway. The field industrial test shows that after adopting the new support design scheme, the displacement of the roof and floor of the roadway is reduced by 86.39% compared with the original support design scheme, and the displacement of the two sides of the roadway is reduced by 86.05% compared with the original support design scheme, which can ensure the normal and safe production of the roadway during the service period, and provide reference for the support design of other similar geological conditions.

Relationship of Age and Gender with Total Serum Immunoglobulin E Levels in Adults- A Cross-sectional Study

Introduction: Immunoglobulin E (IgE) plays a crucial role in various allergic diseases. These antibodies are produced in response to allergenic environmental stimuli, and their blood levels strongly correlate with allergy manifestations. Elevated IgE levels have been considered a powerful predictor of future asthma development. While several studies have explored the association between total serum IgE levels and demographic and environmental factors, no such study has been conducted in this region of India. Aim: To estimate total serum IgE levels and examine their association with age and gender in the adult population of Haryana, India. Materials and Methods: A cross-sectional study was conducted in the Department of Respiratory Medicine, Adesh Medical College and Hospital, Shahabad (M), Kurukshetra, Haryana, India. The records of patients, who visited the department between September 2015 and December 2020 were screened. Data on serum total IgE levels, age, and gender were collected from 360 patients (21-80 years, both sexes) with available information. Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version 23.0 software. Results: The mean age of the study participants was 36.80±18.30 years. Out of total 360 patients included, 198 (55%) were males and 162 (45%) were females. Male gender (odds ratio=1.68) was a significant (p&lt;0.05) independent risk factor, while age ≤30 years (odds ratio=1.68) and age 31-50 years (odds ratio=1.15) were insignificant (p&gt;0.05) risk factors for abnormal serum total IgE levels. Conclusion: Significant gender variation was observed in total serum IgE levels, while age showed insignificant variation. Physicians should consider these factors when examining the relationship between serum total IgE levels, allergy markers, and airways disease.

Evaluation of pharyngeal airway volume three-dimensionally in various sagittal skeletal patterns - Systematic review.

To investigate the pharyngeal airway volume in different anteroposterior skeletal malocclusions. This study was prepared according to the Cochrane criteria for creating a systematic review and meta-analysis and confirms the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. This search was conducted to answer the patient/population, intervention, comparison and outcomes (PICO) question: To evaluate (outcome) and compare (comparison) whether there is a difference in airway volume in patients (participants) with different skeletal malocclusions diagnosed using 3D data (intervention).The first two authors extracted the data from the included studies and assessed the risk of bias in the individual studies using the Newcastle-Ottawa scale. Meta-analysis was done using STATA version 16, which compared various three-dimensional pharyngeal airway parameters in skeletal Class II and skeletal Class III malocclusions with that of skeletal class I malocclusion. Out of 370 articles from the initial search, 17 articles were included in the systematic review. Out of 17 studies, 12 eligible studies were included in the quantitative synthesis. The nasopharynx, oropharynx, hypopharynx, and total airway volume were increased in skeletal Class I malocclusion compared to that of skeletal Class II malocclusion and decreased in comparison to skeletal Class III malocclusion. The moderate quality of evidence indicates the total airway volume, oropharynx, and hypopharynx are largest in skeletal Class III compared to Class I and Class II skeletal malocclusion.

Effects of Benralizumab on Three-Dimensional Computed Tomography Analysis in Severe Eosinophilic Asthma

Introduction: Benralizumab, an anti-interleukin-5 receptor chain monoclonal antibody, is used to treat severe asthma and control asthma symptoms or exacerbations. The aim of this study was to examine the changes in airway morphology using computed tomography (CT) images in accordance with clinical efficacy following the administration of benralizumab. Methods: The clinical efficacy of benralizumab was evaluated in 11 patients with severe asthma by analyzing the changes in parameters, such as the asthma control test, asthma quality of life questionnaire, pulmonary function, and exacerbation count. We also investigated the airway wall thickness of the right bronchus (B1) and the total airway count (TAC) using CT images. Results: Most patients treated with benralizumab showed improvements in asthma symptoms and exacerbations. CT imaging analyses showed a decrease in the right B¹ airway wall thickness and an increase in the TAC. Correlations between blood eosinophil count and changes in CT imaging were observed. Discussion/Conclusion: The data suggested that benralizumab has the potential to improve airway wall thickening and ventilation by alleviating the obstruction and clearing an obstructed airway.

Airway Detection in COPD at Low-Dose CT Using Deep Learning and Multiparametric Freeze and Grow.

To present and validate a fully automated airway detection method at low-dose CT in patients with chronic obstructive pulmonary disease (COPD). In this retrospective study, deep learning (DL) and freeze-and-grow (FG) methods were optimized and applied to automatically detect airways at low-dose CT. Four data sets were used: two data sets consisting of matching standard- and low-dose CT scans from the Genetic Epidemiology of COPD (COPDGene) phase II (2014-2017) cohort (n = 2 × 236; mean age ± SD, 70 years ± 9; 123 women); one data set consisting of low-dose CT scans from the COPDGene phase III (2018-2020) cohort (n = 335; mean age ± SD, 73 years ± 8; 173 women); and one data set consisting of low-dose, anonymized CT scans from the 2003 Dutch-Belgian Randomized Lung Cancer Screening trial (n = 55) acquired by using different CT scanners. Performance measures for different methods were computed and compared by using the Wilcoxon signed rank test. At low-dose CT, 56 294 of 62 480 (90.1%) airways of the reference total airway count (TAC) and 32 109 of 37 864 (84.8%) airways of the peripheral TAC (TACp), detected at standard-dose CT, were detected. Significant losses (P < .001) of 14 526 of 76 453 (19.0%) airways and 884 of 6908 (12.8%) airways in the TAC and 12 256 of 43 462 (28.2%) airways and 699 of 3882 (18.0%) airways in the TACp were observed, respectively, for the multiprotocol and multiscanner data without retraining. When using the automated low-dose CT method, TAC values of 347, 342, 323, and 266 and TACp values of 205, 202, 289, and 141 were observed for those who have never smoked and participants at Global Initiative for Chronic Obstructive Lung Disease stages 0, 1, and 2, respectively, which were superior to the respective values previously reported for matching groups when using a semiautomated method at standard-dose CT. A low-cost, automated CT-based airway detection method was suitable for investigation of airway phenotypes at low-dose CT.Keywords: Airway, Airway Count, Airway Detection, Chronic Obstructive Pulmonary Disease, CT, Deep Learning, Generalizability, Low-Dose CT, Segmentation, Thorax, LungClinical trial registration no. NCT00608764 Supplemental material is available for this article. © RSNA, 2022.

Physiological impacts of computed tomography airway dysanapsis, fractal dimension, and branch count in asymptomatic never smokers.

Dysanapsis, a mismatch between airway tree caliber and lung size, contributes to a large variation in lung function on spirometry in healthy subjects. However, it remains unclear whether other morphological features of the airway tree could be associated with the variation in lung function independent of dysanapsis. This study used lung cancer screening chest computed tomography (CT) and spirometry data from asymptomatic never smokers. Dysanapsis and the complexity of airway tree geometry were quantified on CT by measuring airway to lung ratio (ALR) and airway fractal dimension (AFD). Moreover, total airway count (TAC), ratio of airway luminal surface area to volume (SA/V), longitudinal tapering and irregularity of the radius of the internal lumen from the central to peripheral airways (Tapering index and Irregularity index) were quantified. In 431 asymptomatic never smokers without a history of lung diseases, lower ALR was associated with lower forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity (FEV1/FVC). The associations of ALR with AFD and TAC (r = 0.41 and 0.13) were weaker than the association between TAC and AFD (r = 0.64). In multivariable models adjusted for age, sex, height, and mean lung density, lower AFD and TAC were associated with lower FEV1 and FEV1/FVC independent of ALR, whereas SA/V and Tapering index were not. These results suggest that the smaller airway tree relative to a given lung size and the lower complexity of airway tree shape, including lower branch count, are independently associated with lower lung function in healthy subjects.NEW & NOTEWORTHY This study showed that fractal dimension and total airway count of the airway tree on computed tomography are associated with lung function on spirometry independent of a smaller airway for a given lung size (dysanapsis) in asymptomatic never smokers without a history of lung diseases. In addition to dysanapsis, the morphometric complexity of the airway tree and the airway branch count may cause a substantial variation of lung function in these subjects.

ABCL-286 Abrupt Obstruction of the Central Airway by a Relapse of Thyroid Gland Diffuse Large B-Cell Lymphoma: An Unusual Presentation

Primary thyroid lymphoma is a rare neoplasm comprising 1%-5% of all thyroid malignancies and 1%-7% of all extra-nodal lymphomas. Most thyroid lymphomas are of B-cell origin. Sharing a rare case of relapsed primary thyroid gland diffuse large B-cell lymphoma (DLBCL) and its diagnostic and therapeutic outcome, emphasizing the airway obstruction event. A case report. In March 2019, a 69-year-old man was admitted to our hospital with the following results of the thyroid gland biopsy-HP/Dg. High-grade DLBCL of the thyroid gland (CD20+, CD23+, Ki67=95%) was led by the endocrinologist because of the swelling symptoms around the neck and the changes in the thyroid gland ultrasound. The patient had no family history of any chronic or malignant disorders. Since the patient's laboratory tests and physical examination findings were normal, we decided to immediately start treating him with RCHOP protocol. After 8 rounds of chemotherapy, the patient was stable, and we planned to continue with maintenance therapy. Unfortunately, the patient came back before suggested with severe dyspnea, and the neck CT revealed a paravertebral/retrotracheal mass of 10.4×9.7×8.0 cm that was dislocating the trachea in the anterior plan and compromising the trachea and esophagus in T2 level. In the following days, there was an exacerbation of the dyspnea leading to total airway obstruction with SpO2 decreasing below 65%, and we needed to intubate the patient. Immediately after that, a tracheostomy was performed by an otorhinolaryngologist. When the patient's condition stabilized, we decided to treat his relapse with 4 cycles of salvage therapy-R-ESHAP-because of the lack of a transplant procedure in our country. After salvage chemotherapy, a PET-CT revealed no pathological FDG absorption, and a repeated neck CT showed a total reduction of the retrotracheal mass. The patient is still being followed every 6 months and has been in complete remission ever since. Seventeen months after completing the R-ESHAP treatment protocol, the patient is still in remission with no signs of disease and a normal CT scan. Despite the rare presentation of DLBCL, optimal early management and a multidisciplinary approach had a great impact on the patient's prognosis.

IMPULSE OSCILLOMETRY IDENTIFIES DISTINCT ASTHMA PHENOTYPES ON CLUSTER ANALYSIS

IMPULSE OSCILLOMETRY IDENTIFIES DISTINCT ASTHMA PHENOTYPES ON CLUSTER ANALYSIS

Validation of a Finite Element Model for Clinical and Virtual Evaluation of the Changes in Airway Dimensions Following Class III Bimaxillary Orthognathic Surgery.

The aim of this study was to evaluate pharyngeal airway changes in adult skeletal Class III cases whose bimaxillary surgical treatments were planned with different amounts of maxillary and mandibular movement using lateral cephalometric radiographs and finite element analysis (FEA). Our null hypothesis was that bimaxillary orthognathic surgery in which maxillary forward movement (MF) is greater than mandibular backward movement (MB) will result in more expansion of the pharyngeal airway. A total of 31 individuals (11 females, 20 males) with class III skeletal deformity were included in the study. Patients who underwent bimaxillary orthognathic surgery with greater maxillary advancement (MF > MB) were categorized in Group 1 (n = 15), and those with greater mandibular set-back (MB > MF) as Group 2 (n = 16). Changes in airway dimensions were evaluated from lateral cephalometric radiographs. In addition, FEA modeling was used to determine pharyngeal airway changes with 5 different MF/MB combinations performed in skeletal class III bimaxillary surgeries. Nasopharyngeal and oropharyngeal airway dimensions increased in direct proportion to the amount of MF. Hypopharyngeal volume decreased compared to preoperative value in direct proportion to the decrease in MB. According to the FEA models, total pharyngeal airway volume decreased when MF was less than or equal to MB, was nearly unchanged when MF was 2mm greater than MB, and increased when MF was 4mm greater than MB. The results of FEA and lateral cephalometric analysis were compatible. Our results supported the null hypothesis. We concluded that when possible, planning slightly more maxillary advancement than mandibular set-back will not have an adverse impact on the airway. Although the skeletal deformity only causes forward displacement of the mandible, dividing the skeletal correction between the maxilla and mandible may be considered to avoid the risk to patients' quality of life in terms of respiratory function.

Luminal mucus plugs are spatially associated with airway wall thickening in severe COPD and asthma: A single-centered, retrospective, observational study

BackgroundAirway wall thickening and excess airway mucus occur in asthma and chronic obstructive pulmonary disease (COPD), but few studies have investigated the relationship between them. Our objective was to determine the association between computed tomography (CT) airway wall thickening in segmental airways proximal to airways with or without mucus plugging in patients with asthma and COPD. MethodsMucus plugging was scored using a CT bronchopulmonary segment-based scoring system in asthma and COPD patients. For each of the 19 segmental airways, a mucus plug was defined as complete occlusion of one or more of the daughter branches (sub-segmental airways) by mucus. CT airway measurements were generated for each of the 19 segmental airways: wall-area-percentage (WA%), lumen area (LA), and total airway count (TAC) (VIDA Diagnostics Inc.). Multivariable logistic regression models were constructed for the presence of mucus plugs with corresponding CT measurement and adjusted by covariates; each of the 19 segments was treated as a nested variable. ResultsA total of 33 participants were evaluated. Participants had a mean age of 60 ± 15yrs and there were n = 14 (42%) males. There were 16 (48%) participants with a diagnosis of asthma and 17 (52%) with a COPD diagnosis. The mean FEV1 was 53 ± 21%pred and FEV1/FVC was 54 ± 15%. The mean mucus score in all participants was 15 ± 4 (min = 0, max = 19). Multivariable logistic regression analysis showed the presence of airway mucus was significantly associated with increased CT WA% (β = 7.30, p = 0.004) and reduced TAC (β = −0.06, p = 0.045). ConclusionsThere was increased airway wall thickness and reduced airway counts on CT in segments where there was a distal mucus plug compared to segments without mucus plugs in asthma and COPD.

Three-dimensional volumetric changes in the airway of growing unilateral complete cleft lip and palate patients after bone-anchored maxillary protraction

This prospective controlled study evaluates volumetric, length, and average cross-sectional area (aCSA) airway changes in growing patients with unilateral complete cleft lip and palate after 1.5 years of bone-anchored maxillary protraction therapy. Thirty-five growing unilateral complete cleft lip and palate patientswith maxillary deficiency were included (aged 11.3 ± 0.5 years). Cone-beam computed tomography scans were obtained before bone-anchored maxillary protraction (BAMP) therapy and after 1.5 years. Agrowing group without cleft (n= 18) patients served as a control group at 1.5 years posttreatment (aged 13.1 ± 1.2 years). Volumetric, length, and aCSA changes of the total airway, nasopharynx (NP), middle pharynx, and inferior pharynx airway were evaluated. After 1.5 years of BAMP therapy, a significant increase was observed in the total airway volume and the NP (P<0.01). The middle and inferior pharynx showed an insignificant tendency of volumetric increase. Compared with the control group, a significantly larger airway volume could be observed in the total airway and NP (P<0.05). The aCSA of the NP increased significantly compared with pretreatment. The total airway and NP volumes significantly increased in growing subjects with cleft lip and palate after 1.5 years of BAMP therapy to a level comparable to a control group without cleft. Volumetric increase in the NP in the BAMP group is mainly attributed to the increase in its cross-sectional area. BAMP can therefore be recommended as an effective therapy for patients with cleft lip and palate with positive effects on airway development.

Three-Dimensional Evaluation of Upper Airway Changes After Bimaxillary Surgery of Skeletal Class 3 Patients.

The aim of this study was to evaluate the 3-dimensional changes in upper airway space of class 3 patients after surgery with sleep-related breathing disturbance. This is a retrospective cohort study included 25 patients who had undergone bimaxillary orthognathic surgery with maxillary advancement and mandibular setback for skeletal class 3 deformity. The changes in minimum axial area, nasopharyngeal and oropharyngeal airway volume were determined by cone-beam computed tomography images, as well as the sleep parameters by polysomnography preoperatively and postoperatively. The impacts of mandibular setback and maxillary advancement amounts on the airway structures were evaluated and compared with other parameters. The results show that pharyngeal volume measurement means were found to be significantly increased postoperatively ( P <0.05). No significant difference was observed in the mean values of minimum axial area and sleep parameters after the operation ( P> 0.05). A positive relationship was determined between the oropharyngeal volume and minimum axial area changes at a rate of 60% ( r : 0.600). No relationship was revealed between airway volume changes and polysomnographic parameters. An increase in the total airway volume and no postoperative sleep-related disturbance symptoms were observed in the patients treated by maxillary advancement and mandibular setback surgery.

Mechanical effects of obesity on central and peripheral airway resistance in nonasthmatic early pubescent children.

In children, obesity typically reduces functional residual capacity (FRC), which reduces airway caliber and increases airway resistance. Whether these obesity-related changes in respiratory function can alter bronchodilator responsiveness is unknown. To investigate bronchodilator responsiveness in nonasthmatic children with and without obesity. Seventy nonasthmatic children, 8-12 years old, without (n = 19) and with (n = 51) obesity, completed spirometry, impulse oscillometry, and airway resistance measurements through plethysmography pre/post 360 µg of inhaled albuterol. FRC was assessed pre albuterol. A two-way analysis of variance determined the effects of obesity (group) and inhaled albuterol (pre-post) on outcome measures. FRC (%total lung capacity) was 16% lower in children with obesity compared with those without obesity. There was no significant group by pre-post albuterol interaction on any outcome variables. Albuterol inhalation reduced total, central and peripheral airway resistance and increased airway reactance (i.e., less negative) to a similar degree in children with and without obesity. In children with obesity, airway resistance was increased whether measured by impulse oscillometry or plethysmography. However, once airway resistance was adjusted for lung volumes (i.e., specific airway resistance or sRaw ), there were no differences between children with and without obesity. In addition, significant but moderate associations were detected between chest mass and FRC (r = -0.566; p < 0.001), FRC and total airway resistance (i.e., Raw ; r = -0.445; p < 0.001). In nonasthmatic early pubescent children, obesity increases total, central, and peripheral respiratory system resistance. However, the added respiratory system resistance and low lung volume breathing with obesity are not sufficient to reduce bronchodilator responsiveness.

Association of orofacial dysfunction and sleep disordered breathing among Indian primary school children

IntroductionSleep-disordered breathing (SDB) ranges from partial obstruction of the upper airway resulting in snoring to total upper airway obstruction leading to obstructive sleep apnea. The impairment in the dynamics of the stomatognathic system is termed as orofacial dysfunction. This study investigates the prevalence of orofacial dysfunction and sleep-disordered breathing in primary school children and identifies their correlation. MethodsA total of 560 forms were distributed to 8 primary schools in Belagavi city. Among them, 482 parents responded (86% response rate), which included 239 boys (49.58%) and 243 girls (50.41%). All the participants were screened for orofacial dysfunction using Nordic Orofacial Dysfunction Test-screening (NOT-S) and sleep-disordered breathing using the Pediatric Sleep Questionnaire (PSQ). ResultA positive direct correlation of sleep-disordered breathing with orofacial dysfunction (r = 0.47; p ≤ 0.001) was noted. A total of 41(8.58%) children were found to be at risk of sleep-disordered breathing with a score less than or equal to eight, based on (PSQ) Pediatric Sleep Questionnaire, and 156 (32.6%) children showed symptoms of orofacial dysfunction based on Nordic Orofacial Test–Screening (NOT-S). ConclusionThe study demonstrates that around 32.6% of children had orofacial dysfunction symptoms, and 8.58% of children were at risk for sleep-disordered breathing, girls having a greater risk as compared to boys. There was a positive correlation between orofacial dysfunction and sleep-disordered breathing among children aged 6–12 years.

Protective Effects of Platycodin D3 on Airway Remodeling and Inflammation via Modulating MAPK/NF-κB Signaling Pathway in Asthma Mice.

Background Asthma is a disease with airway hyperresponsive and airway inflammation. Platycodin D is a triterpenoid saponin extracted from Platycodon grandiflorus root, which has various pharmacological activities. The study mainly explored the effects of platycodin D3 (PD3) in airway remodeling and inflammation of asthma. Methods The ovalbumin (OVA)-induced asthma mice were given PD3 (20 mg/kg, 40 mg/kg, and 80 mg/kg) in different groups. The asthma mice administrated with dexamethasone (DXM) were enrolled as the positive control group, and the normal control mice and asthma model mice separately received the same volume of saline. Mouse airway lung dynamic compliance (Cdyn) and total airway resistance (RL) were measured by the EMKA animal lung function analysis system. The inflammation factor levels were estimated by ELISA. Histopathological changes were tested by HE and PAS staining. The protein and phosphorylation levels of NF-κBp65, p38, ERK1/2, and JNK1/2 were detected by Western blot. Results In asthmatic mice, PD3 enhanced the airway Cdyn and decreased RL to improve the airway hyperreactivity and alleviated the pathological injury of lung tissues. In addition, PD3 could reduce the infiltration of inflammatory cells in BALF and suppress the levels of eotaxin, IL-4, IL-5, IL-13, IFN-γ, and IgE. Furthermore, PD3 treatment inhibited the phosphorylation of NF-κBp65, p38, ERK1/2, and JNK1/2 proteins in asthma mice. Conclusion PD3 treatment alleviated the airway remodeling and inflammation in asthmatic mice, which might be related to downregulating the phosphorylated proteins in the MAPK/NF-κB signaling pathway.

Three-dimensional evaluation of pharyngeal airway and maxillary arch in mouth and nasal breathing children with skeletal Class I and II

ObjectiveThis study aimed to investigate whether the subjects with mouth breathing (MB) or nasal breathing (NB) with different sagittal skeletal patterns showed different maxillary arch and pharyngeal airway characteristics.MethodsCone-beam computed tomography scans from 70 children aged 10 to 12 years with sagittal skeletal Classes I and II were used to measure the pharyngeal airway, maxillary width, palatal area, and height. The independent t-test and the Mann–Whitney U test were used for the intragroup analysis of pharyngeal airway and maxillary arch parameters.ResultsIn the Skeletal Class I group, nasopharyngeal airway volume (P < 0.01), oropharyngeal airway volume (OPV), and total pharyngeal airway volume (TPV) (all P < 0.001) were significantly greater in subjects with NB than in those with MB. Furthermore, intermolar width, maxillary width at the molars, intercanine width, maxillary width at the canines, and palatal area were significantly larger in subjects with NB than in those with MB (all P < 0.001). In the Skeletal Class II group, OPV, TPV (both P < 0.05) were significantly greater in subjects with NB than in those with MB. No significant differences in pharyngeal airway parameters in the MB group between subjects with Skeletal Class I and those with Skeletal Class II.ConclusionRegardless of sagittal Skeletal Class I or II, the pharyngeal airway and maxillary arch in children with MB differ from those with NB. However, the pharyngeal airway was not significantly different between Skeletal Class I and II in children with MB.

Comparison of C-MAC vs. McGrath video laryngoscopes on glottic exposure and endotracheal intubation success with stylet usage in obese patients.

Cases of obesity are rising in parallel with the number of obese patients scheduled for anesthesia in which difficult airway is encountered. Video laryngoscopes (VL) have emerged as a popular device for the management of patients with difficult airway. The present study compares the success rate of intubation in obese patients using stylet in the ramped position using either a McGrath or C-MAC VLs. Class II/III obese patients who were intubated with either McGrath (Group M, n=50) or C-MAC (Group C, n=50) laryngoscopes were assessed for the presence of difficult airway using the Difficult Airway Assessment tool, the Airway Difficulty Score and the Total Airway Score. The intubation attempts were made after the best glottic view, direct and indirect Cormack-Lehane (CL) score, and intubation time were recorded. In the event of failure, a further intubation attempt was made using a styled, and the intubation time was again recorded. If the intubation failed again, a third attempt was made using a C-MAC D-Blade. The Intubation Difficulty Scale score was recorded after the intubation. There was no statistically significant difference between groups in terms of demographic data, the number of patients with decreased CL score, the number of attempts required for intubation, or the first and second intubation time. The ADS Score, TAS Score, CL Score DL, and CL Score IN were found to be important risk factors for a second intubation requirement, and the cut-off value was found to be 8.50 for the ADS Score and 4.50 for the TAS Score in these patients. In the 38 patients who required a second intubation attempt, the procedure was successful in all, but one patient required a third attempt of intubation with C-MAC D-blade. Both McGrath and C-MAC were effective and comparable for best glottic view with no failed intubation. It was concluded that regardless of the type of video laryngoscope used, the use of a stylet in the first intubation attempt increases the success of intubation.

Analysis of Pulmonary Function in Thymoma Subjects: A 20-Year Retrospective Cohort Study.

Thymoma is the most common tumor of the anterior mediastinum. However, the correlation between thymoma stage and pulmonary function was not assessed. Our objective in this study was to describe the pulmonary function in thymoma subjects stratified with different staging systems. A total of 143 subjects with a diagnosis of thymoma who underwent extended thymectomy for thymoma between January 2001 and December 2019 were reviewed retrospectively. All the subjects experienced pulmonary function tests (PFTs) using Master Screen PFT system and total respiratory resistance measurement. We evaluated 143 subjects with a diagnosis of thymoma; the significant differences were observed in mean values of vital capacity, inspiratory volume (IC), total lung capacity (TLC), ratio of residual volume to total lung capacity (RV/TLC), forced vital capacity, forced expiratory volume in 1 second, ratio of forced expiratory volume in 1 second to forced vital capacity, peak expiratory flow, peak inspiratory flow, maximum ventilation volume, total airway resistance, and diffusing capacity for carbon monoxide (DLCO) across upper airway obstruction classification. PFTs of subjects with varying Masaoka stages are different. RV and RV/TLC of subjects in stages III and IV were higher than those of normal level, while DLCO of subjects in stage IV was lower than the normal level, and the mean level of IC showed significant difference between stage II and stage III. The pulmonary function patterns of thymoma subjects significantly correlate with tumor location and size rather than clinical Masaoka stage.