Rosmarinic acid improves tracheal smooth muscle responsiveness and lung pathological changes in ovalbumin-sensitized rats

Objective:To evaluate the effect of rosmarinic acid on tracheal smooth muscle responsiveness and lung pathological changes in ovalbumin-sensitized rats.Methods:Rats were randomly divided into six groups:the control group,the asthmatic group,and the asthmatic groups treated with dexamethasone(1 mg/kg;oral gavage)or three doses of rosmarinic acid(0.5,1,and 2 mg/kg;oral gavage).For induction of asthma,rats received intraperitoneal injections and inhalation of ovalbumin.After 21 days,bronchoalveolar lavage fluid and lung samples were collected for histopathological analyses.Moreover,total and differential white blood cell counts were determined.Results:The rosmarinic acid-treated group had significantly lower tracheal smooth muscle responses to methacholine than the asthmatic group.In addition,rosmarinic acid reduced white blood cell count and the percentages of eosinophils,monocytes,and neutrophils while increasing the percentage of lymphocytes.Ovalbumin-induced lung pathological changes were significantly improved by treatment with rosmarinic acid.Conclusions:Rosmarinic acid improves tracheal smooth muscle responsiveness and lung pathological changes in ovalbumin-sensitized rats.

Liver abscess and tracheal fistula induced by transcatheter arterial chemoembolization for hepatocellular carcinoma:A case report

BACKGROUND Transarterial chemoembolization(TACE)is a standard treatment for intermediate-stage hepatocellular carcinoma(HCC).The complications of TACE include biliary tract infection,liver dysfunction,tumor lysis syndrome,biloma,partial intestinal obstruction,cerebral lipiodol embolism,etc.There are few reports about tracheal fistula induced by TACE.CASE SUMMARY A 42-year-old man came to our hospital with cough and expectoration for 1 month after TACE for HCC.Laboratory test results showed abnormalities of albumin,hemoglobin,prothrombin time,C-reactive protein,D-dimer,and prothrombin.Culture of both phlegm and liver pus revealed growth of Citrobacter flavescens.Computed tomography showed infection in the inferior lobe of the right lung and a low-density lesion with gas in the right liver.Liver ultrasound showed that there was a big hypoechoic liquid lesion without blood flow signal.Drainage for liver abscess by needle puncture under ultrasonic guidance was performed.After 1 month of drainage and anti-infection therapy,the abscess in the liver and the infection in the lung were reduced obviously,and the symptom of expectoration was relieved.CONCLUSION Clinicians should be alert to the possibility of complications of liver abscess and tracheal fistula after TACE for HCC.Drainage for liver abscess by needle puncture under ultrasonic guidance could relieve the liver abscess and tracheal fistula.

Analysis of the Application Effect of Tracheal Stent Placement in the Nutritional Support Treatment of Tracheoesophageal Fistula

Objective:To evaluate and analyze the application effect of tracheal stent placement in nutritional support therapy for tracheoesophageal fistula.Methods:Clinical data of 32 patients who underwent nutritional support therapy for tracheoesophageal fistula in our hospital from September 2021 to September 2022 were collected,and all patients underwent tracheal silicone stenting,comparing dyspnea classification and Karnofsky score before and after stenting,and conducting post-treatment follow-up.Results:In 32 patients with tracheoesophageal fistula,dyspnea grading improved from grades III and IV to grades 0 to II.Before treatment,10 patients(31.06%)were in grade IV,17 patients(53.12%)were in grade III,and five patients(15.62)were in grade II;after treatment,13 patients(40.63%)were in grade I,12 patients(37.50%)were in grade I,and seven patients(21.87%)were in grade 0(P<0.05);Karnofsky score(37.52±4.86 before treatment)improved significantly to 71.39±8.24 one week after treatment(P<0.05).Nine patients with tracheoesophageal fistula were placed with silicone Y14-10-10 stent,11 with silicone 18-14-14 stent,three with silicone Y15-12-12,and seven with silicone stent 16-13-13.Conclusion:Silicone tracheobronchial stent placement for the treatment of tracheoesophageal fistula is technically feasible,simple,and safe,with reliable near-term efficacy,and is worthy of popularization and application.

Intraoperative photodynamic therapy for tracheal mass in non-small cell lung cancer:A case report

BACKGROUND Tracheal neoplasms represent less than 0.1%of all malignancies and have no established treatment guidelines.Surgical resection with reconstruction is the primary treatment.This study demonstrates successful treatment of concurrent lung and tracheal tumors using surgical excision and intraoperative photodynamic therapy(PDT),highlighting the effectiveness and safety of this approach.CASE SUMMARY A 74-year-old male with a history of smoking and chronic obstructive pulmonary disease was diagnosed with tracheal squamous cell carcinoma and right lower lobe adenocarcinoma.A multidisciplinary team created a treatment plan involving tumor resection and PDT.The tracheal tumor was removed through a tracheal incision and this was followed by intraluminal PDT.The trachea was repaired and a right lower lobectomy was performed.The patient received a second PDT treatment postoperatively and was discharged 10 d after the tracheal surgery,without complications.He then underwent platinum-based chemotherapy for lymphovascular invasion of lung cancer.Three-month postoperative bronchoscopy revealed normal tracheal mucosa with a scar at the resection site and no evidence of tumor recurrence in the trachea or lung.CONCLUSION Our case of concurrent tracheal and lung cancers was successfully treated with surgical excision and intraoperative PDT which proved safe and effective in this patient.

Management of Tracheal Stenosis in Sub-Saharan Medicalized Context: Real Challenge about Two Clinical Cases

Introduction: Post-intubation tracheal stenosis (STPI) is a complication of ventilatory assistance by intubation and/or tracheotomy. Her frequency is estimated between 10% to 20%. The treatment of choice remains surgery. It is based on tracheal resection-anastomosis which guarantees satisfactory and reliable long-term results. Objectives: To determine the frequency of post-intubation tracheal stenosis, to specify the diagnostic and therapeutic methods, to determine the complications and the evolution. Material and methods: This was a study carried out in the ENT and head and neck surgery department of the University Hospital Center Gabriel TOURE. Our study focused on two (02) cases of post-intubation tracheal stenosis (STPI) collected during a period of 1 year (January 2021 to December 2021). Results: They are all acquired, secondary to an intubation. The two (02) cases benefited from a tracheal anastomosis resection, the indications of which were specified and the results and complications evaluated. Conclusion: Our results show that resection anastomosis remains the reference treatment for STPI.

Rapid response to radiotherapy in unresectable tracheal adenoid cystic carcinoma:A case report

BACKGROUND Adenoid cystic carcinoma(ACC)occurs mainly in the head and neck.Tracheal ACC(TACC)is uncommon.Primary resection is recommended as the main treatment of choice,and radiotherapy is considered for residual disease in the postoperative setting.Definitive radiotherapy is an alternative approach to cure unresectable TACC.As the status of radiosensitivity in TACC is uncertain,the evidence for radiotherapy in unresectable TACC is not well established,especially in terms of the optimal dosage and its response evaluation.Herein,we report a case of locally advanced TACC.CASE SUMMARY A 49-year-old woman was diagnosed with TACC,which included a range of lesions arising in the upper trachea extending caudally 2 cm to 7 cm of the glottis.She was treated with definitive radiotherapy,given the low likelihood of complete resection of the disease.Due to the indolent growth and the propensity for infiltration along the airways,the scheduled radiation dose of 76 Gy in 38 fractions with 6-MV X-ray delivered by intensity-modulated radiotherapy was conducted to the primary tumor volume.After irradiation of 40 Gy,the patient’s dyspnea on exertion was dramatically relieved and bronchoscopy revealed that the previous large polypoid intra-luminal mass was significantly eliminated,with near-complete response.The patient completed two phases of scheduled radiotherapy,and acute reactions to treatment included subjective chest tightness and grade 2 esophagitis,managed medically.After 5 years of treatment,the patient is alive without recurrent disease,and there were no serious late radiation esophagus and lung damage,with only slight dysphagia without perforation and fistula.CONCLUSION Taken together,TACC is uncommon and the treatment of unresectable TACC is challenging.This case indicated that patients with unresectable TACC who rapidly respond to radiation may benefit from primary radical radiotherapy.Radiotherapy may be considered an effective alternative treatment modality.

Using ketamine in a patient with a near-occlusion tracheal tumor undergoing tracheal resection and reconstruction: A case report

BACKGROUND Tracheal tumors may cause airway obstruction and pose a significant risk to ventilation and oxygenation.Due to its rarity,there is currently no established protocol or guideline for anesthetic management of resection of upper tracheal tumors,therefore individualized strategies are necessary.There are limited number of reports regarding the anesthesthetic management of upper tracheal resection and reconstruction(TRR)in the literature.We successfully used intravenous ketamine to manage a patient with a near-occlusion upper tracheal tumor undergoing TRR.CASE SUMMARY A 25-year-old female reported progressive dyspnea and hemoptysis.Bronchoscopy showed an intratracheal tumor located one tracheal ring below the glottis,which occluded>90%of the tracheal lumen.The patient was scheduled for TRR.Considering the risk of complete airway collapse after the induction of general anesthesia,we decided to secure the airway with a tracheostomy with spontaneous breathing.The surgeons needed to transect the trachea 1-2 cartilage rings below and above the tumor borders:a time-consuming process.Coughing and movement needed be minimized;thus,we added intravenous ketamine to local anesthetic infiltration.After tracheostomy,an endotracheal tube was placed into the distal trachea,and general anesthesia was induced.The surgeons resected four cartilage rings with the tumor attached and anastomosed the posterior tracheal wall.We performed a video-laryngoscopy to place a new endotracheal tube.Finally,the surgeons anastomosed the anterior tracheal walls.The patient was extubated uneventfully.CONCLUSION Ketamine showed great advantages in the anesthesia of upper TRR by providing analgesia with minimal respiratory depression or airway collapse.

Tracheal tube misplacement in the thoracic cavity:A case report

BACKGROUND Penetrating neck injuries require prompt recognition,diagnosis and management of critical airways.This case demonstrates an emergent situation that a“medical negligence”was avoided with the aid of end-tidal carbon dioxide(ETCO2)waveform.CASE SUMMARY We report a case of malposition of the endotracheal tube into the right hemithoracic cavity for cervical knife trauma,resulting in pneumothorax.Tube placement was not confirmed during emergency airway management,and the patient was directly transferred to the emergency operation room.Assisted by ETCO2 and imaging examinations,the anesthetist timely noticed the absence of ETCO2 waveform and resolved this urgent situation before anesthesia induction.CONCLUSION This case emphasizes the necessity of ETCO2 waveform and/or X-ray confirmation of endotracheal intubation even in emergent situations.

Endotracheal Cuff Pressures Generated by Different Members of the Anaesthesia Services in a Ghanaian Teaching Hospital

Background: The main function of the endotracheal tube (ETT) cuff is to ensure a tight seal between the tracheal wall and the endotracheal tube to prevent stomach contents from entering the trachea during ventilation thus preventing aspiration. Whereas excessive inflation of the cuff is associated with complications as a result of impaired blood supply to the trachea mucosa, low inflation pressure puts the patient at risk of aspiration. This study sought to find the accuracy of correctly estimating the cuff pressure and whether experience has effect on the accuracy. Methods: After approval from the Ethics Committee, we observed 199 patients who had general anaesthesia and had been intubated at the Komfo Anokye Teaching Hospital,KumasiGhana. Anaesthesia practitioners were blinded to the study. The endotracheal cuff pressure was measured using a low pressure manometer. The experience of the Anaesthetist was also noted. Results: Only 26% of the cuff pressures measured were within the acceptable range of 20-30 cm H2O. 4.5% of the pressures measured were below the acceptable minimum value of20 cm H2O hence exposing the patient to the risk of aspiration. 68% of the cuff pressures measured were above the maximum pressure of30 cm H2O. Physician anaesthetists were likely to inflate the cuff correctly. They had average inflation pressures of24 cm H2O with minimum and maximum inflation pressures of15 cm H2O and32 cm H2O respectively. Resident physician anaesthetists inflate the endotracheal pressures moderately high, an average of41.64 cm H2O. Nurse anaesthetists and student nurse anaesthetists had a tendency to overinflate the endotracheal cuff above the recommended range of 20-30 cm H2O. Their mean inflating pressures were 64.7 and 68.54 respectively. Conclusion: ETT cuff pressures measured by the low pressure aneroid manometer in patients undergoing general anaesthesia in Komfo Anokye Teaching Hospital are routinely high and are significantly higher when inflated by nurse anaesthetists, student nurse anaesthetists and Anaesthesia residents.

Use of Platelet Rich Plasma (PRP) in the Treatment of Acute Post Intubation Tracheal Rupture: Report of Two Cases

The use of PRP involves a complex network of molecular events which accelerate tissue regenera-tion due to its richness in growth factors plus a variety of biologic mediators. Several communica-tions tell us about its usefulness on the dental implantology field, plastic surgery, orthopedics and peripheral nerve regeneration after trauma. We have presented our successful experience of its use in pneumology when treating severe hemoptysis, respiratory fistulae, spontaneous pneumothorax and one tracheal rupture. In this article we present two cases of post intubation tracheal rupture successfully treated with the local instillation of PRP on one of them and with the injection of PRP along the lips of the tracheal wound on the other. Tracheal rupture is a rare but life threatening complication of emergency intubation requiring an effective response in order to avoid the risk of patient death due to secondary mediastinitis and sepsis. Up to now there is no general consensus in the treatment of this condition and alternatives in use are not universally accepted. The use of local autologous PRP in our experience has demonstrated a favorable performance in such cases, turning it in a highly promising tool for the treatment of conditions such as this, in which a rapidly effective and minimally invasive handling is required.

Laryngotracheal Stenosis Following Intubation for COVID-19 Pneumonia: A Report of Two Cases

Benign laryngotracheal stenosis (LTS) is a debilitating and potentially life-threatening condition that is commonly caused by iatrogenic events as a result of endotracheal intubation or tracheostomy. Numerous cases are being published for patients with coronavirus disease 2019 (COVID-19) who end up with severe LTS after prolonged intubation or tracheostomy. Here, we presented two cases of LTS due to prolonged intubation after severe COVID-19 pneumonia. The characteristic of these two cases is that both of them needed second time intubation and were readmitted because of severe dyspnoea and all the workup for post-COVID-19 complications were investigated except the LTS which was later diagnosed after one month of suffering of these patients.

Expression of pIgR in the tracheal mucosa of SHIV/SIV-infected rhesus macaques

Polymeric immunoglobulin receptors（pIgR） are key participants in the formation and secretion of secretory Ig A（S-Ig A）, which is critical for the prevention of microbial infection and colonization in the respiratory system. Although increased respiratory colonization and infections are common in HIV/AIDS, little is known about the expression of pIgR in the airway mucosa of these patients. To address this, the expression levels of pIgR in the tracheal mucosa and lungs of SHIV/SIV-infected rhesus macaques were examined by real-time RTPCR and confocal microscopy. We found that the levels of both PIGR m RNA and pIgR immunoreactivity were lower in the tracheal mucosa of SHIV/SIVinfected rhesus macaques than that in non-infected rhesus macaques, and the difference in pIgR immunoreactivity was statistically significant. IL-17 A, which enhances pIgR expression, was also changed in the same direction as that of pIgR. In contrast to changes in the tracheal mucosa, pIgR and IL-17 A levels were higher in the lungs of infected rhesus macaques. These results indicated abnormal pIgR expression in SHIV/SIV, and by extension HIV infections, which might partially result from IL-17 A alterations and might contribute to the increased microbial colonization and infection related to pulmonary complications in HIV/AIDS.

Development and Mechanical Properties of a Novel Woven Artificial Tracheal Stent

In this paper, the development of existing artificial tracheal stents was briefly introduced. Their structures, strengths and weaknesses were analyzed. A new woven artificial tracheal stent that used leno-based construction was designed and fabricated at last. Additionally, a preliminary mechanical study was carried out on the new artificial tracheal stent, such as the radial supporting force and the elastic restoring force, making foundation for application of the new artificial tracheal stent.

Iatrogenic esophago-tracheal fistula:Challenges in diagnosis and management

Esophageo-tracheal fistula is a rare condition,and in most cases such fistulas are caused by malignant disease or emergency endotracheal intubation.A case where a wrapped tablet produced a fistula between the esophagus and trachea is described.The patient is a male born in 1938 who swallowed a tablet without unwrapping it.The patient was treated with selfexpanding metal stents(SEMS),but closure of the fistula was not achieved.Different examinations and treatment options are discussed.Surgical treatment for this condition has demonstrated considerable mortality and morbidity.In some cases closure of the fistula can be achieved by use of SEMS.Although we advise treatment of such cases with SEMS,in some cases treatment with stents will prove troublesome and the risk/benefit analysis will have to be reevaluated.

Reconstruction of the thoracic tracheal defects with portions of deepithelialized myocutaneous flaps after resection of a large tumor

Objective： To study the possibility of using portions of deepithelialized myocutaneous flaps to the reconstruction of thoracic tracheal defects after resection of a large tumor. Methods： From June 2007 to June 2012, five cases of defects of the thoracic trachea were reconstructed by applying portions of deepithelialized myocutaneous flaps. The patients were 27-61 years old with 4 male cases and 1 female. The cervical trachea ranged in diameter from 4-8.5 cm with circumferences of approximately 1/3-2/5 of the bronchial circumference. Results： M1 five patients with thoracic tracheal defects after resection of a large tumor were cured of portions of deepithelialized myocutaneous flaps, with no tracheal stricture remaining and vomica successfully eliminated. During the first 1 to 3 months after the operation, bronchoscopy showed that the tracheal lumens were smooth, and the visible skin of the musculocutaneous flaps became gray and exhibited a small amount of white discharge. Conclusions： Despite this being a small series and short follow-up, this thoracic tracheal reconstruction with portions of deepithelialized myocutaneous flaps shows encouraging preliminary results and could be an alternative to other methods for the treatment of carefully selected patients with thoracic tracheal defects.

Treatment of primary tracheal schwannoma with endoscopic resection:A case report

BACKGROUND Schwannoma is a benign tumor originating from the peripheral nerve sheath.The clinical symptoms of tracheal schwannoma depend on the location of the tumor,and the most common clinical symptoms are cough and hemoptysis.The most effective treatment for benign tumors is complete resection of the primary lesion at an early stage.Our experience has demonstrated that primary tracheal schwannoma can be safely excised with a high-frequency electric knife in a minimally invasive manner.CASE SUMMARY We report a 61-year-old asymptomatic woman who underwent chest computed tomography(CT),which accidentally found an intraluminal tracheal mass without enlarged lymph nodes.Then,the patient underwent bronchoscopy,which found that the tracheal mass originated from the left wall of the upper trachea,was less than 1.5 cm in size,immovable,smooth and 4 cm away from the vocal cord,resulting in partial upper respiratory tract obstruction.Treatment was performed using an endoscopic resection for en bloc removal of the tracheal mass.The diagnosis was primary tracheal schwannoma.A follow-up was performed after endoscopic surgery,and bronchoscopy and thoracic CT were used to monitor whether there was a recurrence.At present,there is no evidence of recurrence,and the patient had a good quality of life.Endoscopic resection may be effective and safe in the treatment of primary tracheal schwannoma.CONCLUSION Primary tracheal schwannoma is a very rare benign tumor.In this case,we cured it by complete endoscopic resection.

Comparison of Hemodynamic Responses Associated with Tracheal Intubation Under Various Induction Doses of Remifentanil and Propofol

.Background: The optimal dose of propofol and remifentanil induction to minimize the cardiovascular response associated with tracheal intubation may exist. We investigated the cardiovascular response associated with tracheal intubation when various continuous induction doses of remifentanil in combination with propofol were used. Methods: Seventy- five patients were randomly allocated into 1 of 3 groups: the R-0.4 P-1 group (remifentanil 0.4 μg/kg/min and propofol 1 mg/kg);the R-0.5 P-1 group (remifentanil 0.5 μg/kg/min and propofol 1 mg/kg);and the R-0.4 P-2 group (remifentanil 0.4 μg/kg/min and propofol 2 mg/kg). One minute after remifentanil infusion commenced, a bolus of propofol was injected. Rocuronium 1 mg/kg was administered 1 min after propofol injection following loss of consciousness. Controlled ventilation was then performed for 2 min, and the trachea was intubated 4 min after the start of the remifentanil infusion. The infusion rate of remifentanil was decreased to 0.1 μg/kg/min after intubation. Blood pressure (BP) and heart rate (HR) were measured during this period until 5 min after tracheal intubation. Results: The changes in BP response due to tracheal intubation in the R-0.4 P-1 group were greater than those in the other 2 groups, whereas the HR responses to tracheal intubation were similar among the 3 groups. Conclusion: The combination of remifentanil 0.4 μg/kg/min and propofol 1 mg/kg led to an exaggerated cardiovascular response to tracheal intubation compared with the other combination groups.

Anesthetic challenges in ventilating patients with tracheal diverticulum: Case reports and review of literature

The spectrum of disorders involving the tracheobronchial tree is diverse and tracheal diverticulum is an extremely rare entity accounting for 1%-2% of cases. Tracheal diverticulum is mainly asymptomatic and discovered incidentally either on radiological examination or at autopsy. We hereby report two cases of tracheal diverticulum with hoarseness in one case and dysphagia in the second case, where intubation was difficult in both cases. However, laryngeal mask airway was inserted successfully in case one and endotracheal intubation using a smaller size intubation tube in case two.

Construction of a telomerase-immortalized porcine tracheal epithelial cell model for swine-origin mycoplasma infection

Primary porcine tracheal epithelial cells(PTECs) are an appropriate model for studying the molecular mechanism of various porcine respiratory diseases, including swine-origin mycoplasmas, which are isolated from respiratory tract of pigs and mainly found on the mucosal surface surrounding swine trachea. However, the short proliferation ability of primary PTECs greatly limits their lifespan. In this study, primary PTECs were carefully isolated and cultured, and immortal PTECs were constructed by transfecting primary PTECs with the recombinant constructed plasmid pEGFPhTERT containing human telomerase reverse transcriptase(hTERT). Immortal PTECs(hTERT-PTECs) maintained both the morphological and functional characteristics of primary PTECs, as indicated by the expression of cytokeratin 18, cellcycle analysis, proliferation assay, Western blotting, telomerase activity assay, karyotype analysis and quantitative RTPCR. Compared to primary PTECs, hTERT-PTECs had an extended replicative lifespan, higher telomerase activity, and enhanced proliferative activity. In addition, this cell line resulted in a lack of transformed and grown tumors in nude mice, suggesting that it could be safely applied in further studies. Moreover, hTERT-PTECs were vulnerable to all swineorigin mycoplasmas through quantitative analysis as indicated by 50% color changing unit(CCU_(50)) calculation, and no significant differences of adhesion ability between primary and immortal PTECs were observed. For the representative swine mycoplasma Mycoplasma hyopneumoniae(Mhp), except for DNA copies quantitative real-time PCR assay, indirect immunofluorescence assay and Western blotting analysis also depicted that hTERT-PTECs was able to adhere to different Mhp strains of different virulence. In summary, like primary PTECs, hTERT-PTECs could be widely used as an adhesion cell model for swine-origin mycoplasmas and in infection studies of various porcine respiratory pathogens.

IN VIVO-I:VITRO TRANSFORMATION SYSTEM OF RAT TRACHEAL EPITHELIAL CELLS

An in vivo-in vitro transformation system was establi-shed in primary rat tracheal epithelial cells(RTE) whichwere cultured in serum-free F12 medium with the additionof growth factors.Carcinogens were given in vivo by subcu-taneous injection or intratracheal instillation.About 7days after carcinogen exposure,RTE cells were cultured inserum-free medium and then selected in serum-containingmedium.Transformed colonies were counted 5-6 weeks afterthe plating of RTE cells.