Analysis of the Effect of Non-Invasive Positive Pressure Ventilation in Emergency Treatment of Severe Bronchial Asthma with Respiratory Failure

Objective:This study aims to evaluate the clinical efficacy of non-invasive positive pressure ventilation(NIPPV)in patients with severe bronchial asthma combined with respiratory failure.Methods:90 patients with severe bronchial asthma combined with respiratory failure between September 2022 and December 2023 were selected for the study and randomly divided into the experimental group(NIPPV-assisted treatment)and the control group.The differences between the two groups were compared in terms of total effective rate of treatment,days of clinical symptom disappearance,days of hospitalization,lung function indexes,incidence of adverse reactions,and quality of life.Results:Patients in the experimental group had a significantly higher total effective rate of treatment(97.78%)than the control group(75.56%).In terms of pulmonary function indexes,patients in the experimental group showed significant improvement after treatment,especially the increase in forced expiratory volume and forced vital capacity,while these improvements were not as obvious in the control group.In addition,the incidence of adverse reactions was significantly lower in the experimental group than in the control group,suggesting that the application of NIPPV is relatively safe.Quality of life assessment also showed that patients in the experimental group had significantly better quality of life than the control group after treatment.Conclusion:This study demonstrated the effectiveness of NIPPV as an adjunctive treatment for severe bronchial asthma combined with respiratory failure.NIPPV can improve lung function,reduce the incidence of adverse effects,increase the overall effectiveness of the treatment,and contribute to the improvement of patients'quality of life.Therefore,NIPPV should be regarded as an effective and safe treatment in clinical management,especially in patients with severe bronchial asthma combined with respiratory failure,where its application has potential clinical significance.

Early tracheotomy for acute severe asthma

BACKGROUND： Few studies have reported the effects of early tracheotomy in acute severe asthmatic patients. We report two patients with acute severe asthma who were successfully treated with early tracheotomy. METHODS：The two patients with acute severe asthma were retrospectively reviewed. They had been treated at the Department of Emergency and Critical Care, Renji Hospital, Shanghai Jiaotong University School of Medicine. RESULTS： They developed progressively hypercapnia and severe acidosis, and were not improved after conventional therapies. Early tracheotomy after mechanical ventilation decreased airway resistance and work of breathing, and corrected hypercapnia and acidosis. Adequate gas exchange was maintained after tracheotomy. The two patients were subsequently weaned from mechanical ventilation and discharged. CONCLUSION：Early tracheotomy could be a valuable approach in certain patients with severe asthma.

Primary intratracheal schwannoma misdiagnosed as severe asthma in an adolescent:A case report

BACKGROUND Primary intratracheal schwannoma is an extremely rare type of benign airway tumor,especially in adolescents.The presenting symptoms are typically prolonged cough and wheezing that can be misdiagnosed as asthma in adolescent patients.CASE A 16-year-old adolescent girl admitted to a local hospital with symptoms of an irritating cough and wheezing was diagnosed with bronchial asthma and treated with budesonide and formoterol.Over the next year,the patient's wheezing and coughing symptoms gradually worsened and the antiasthma treatment was ineffective.One week prior to this admission,the patient developed dyspnea after catching a cold and was transferred to our hospital with a diagnosis of severe asthma.However,chest computed tomography and bronchoscopy showed a mass in the trachea.Primary intratracheal schwannoma was diagnosed by biopsy.Her symptoms were relieved by endoscopic resection by electrosurgical snaring combined with argon plasma coagulation.No relapse occurred during an 18 mo follow-up.CONCLUSION Primary intratracheal schwannoma should be considered in the differential diagnosis in adolescents with recurrent asthma-like attacks.

Clinical and pathobiological heterogeneity of asthma—Mechanisms of severe and glucocorticoid-resistant asthma

It is increasingly recognized that asthma represents a syndrome, and there is clinical and pathobiological heterogeneity. Many genes are reported to be associated with asthma, and may be involved in the disease heterogeneity. Diverse cells, such as T helper 1 (Th1)-cells, Th2-cells, Th17-cells, airway epithelial cells, and innate and adaptive immunity associated cells, contribute to the pathobiology of asthma independently of each other or they can also coexist and interact. Although, generally, Th2 immunity is important in most asthma endotypes, non- Th2-driven inflammation tends to be difficult to manage. Recently, increased attention has been focused on severe asthma and glucocorticoid (GC)-resistant (GC-R) asthma, in which diverse inflammatory processes may be involved. Treatment approaches should take into account pathological differences.

Different levels of MUC5AC and MUC5B genes expression in severe allergic versus non-allergic asthma

Asthma affects about 330 million individuals worldwide while 10%of asthmatic patients develop the severe type.The two main phe­notypes of severe asthma are allergic and non-allergic.Notably,remodeling and mucus overexpression are hallmarks of severe asthma upon dysregulation of MUC5AC and MUC5B.In severe allergic asthma due to the initiation of the allergic cascade,immune cells are recruited and a large number of inflammatory mediators will be produced leading to the overexpression of MUC5AC and MUC5B in the airways.Moreover,the production of mediators including tumor necrosis factorα(TNF-α)and interleukin 13(IL-13)will cause airways’muscle proliferation.Both overproductions of mucin and muscle proliferation will lead to remodeling progression.On the other hand,in severe non-allergic asthma,fewer immune cells are involved but still,the expression of MUC5AC is enhanced.Howev­er,MUC5B might increase less than the amount of its expression in allergic phenotype due to the lower number of involved immune cells and mediators.In the non-allergic phenotype mediators such as interleukin 17(IL-17)and transforming growth factorβ(TGF-β)are responsible for muscle proliferation.The result of mucus overexpression and muscle proliferation is remodeling progression in the non-allergic severe asthma.Therefore,we hypothesize that MUC5AC and MUC5B overexpression in severe allergic asthma is greater than in severe non-allergic asthma.Hence,remodeling progression is more intensive in severe allergic asthma.In conclusion,given the central roles of MUC5AC and MUC5B in mediating the asthma severity,they can be treated as potential therapeutic targets in severe asthma.

Can omalizumab be used effectively to treat severe conjunctivitis in children with asthma?A case example and review of the literature

A 14-year-old girl with poorly controlled asthma attended the difficult-to-treat asthma clinic for review.Although she has eosinophilia and significantly raised immunoglobulin E levels,she is not currently a candidate for omalizumab(Xolair).She also suffers from chronic urticaria,eosinophilic eosophagitis and severe conjunctivitis.You wonder if omalizumab would be effective in treating her multiple atopic conditions,in particular her troublesome conjunctivitis.PubMed was searched using the following search terms:(Omalizumab)or(Xolair)and(conjunctivitis).Searches were conducted in November 2020.Abstracts were selected for full text review if the study population identified asthma as a comorbidity.Non-paediatric studies and those that were not written in English were excluded.The use of omalizumab has the potential to be effective in the treatment of conjunctivitis associated with asthma and other atopic conditions.However,research is needed to address the question,in the form of multicenter,double-blind randomized control trials.

Prevalence of Work-Aggravated Asthma among Bakery Workers in Abidjan (Cote d’Ivoire)

Introduction: Work-aggravated asthma is pre-existing or concomitant asthma whose symptoms are aggravated by the work environment. The aim of this study was to determine the prevalence of this pathology and its associated factors among bakery workers in Abidjan. Materials and Methods: This descriptive and analytical cross-sectional study was conducted over a period of four (4) months from 18 December 2019 to 18 April 2020. Two questionnaires were used, one on employees and the other on the indoor environment of bakeries. In addition, a spirometry test was performed on all bakery workers. Statistical analysis was performed using stata 15.1 software. Results: A total of 599 bakery employees, including bakers (59.73%), sales assistants/ cashiers (23.52%), cleaners (6.34%) and administrative staff (10.18%), were investigated. The mean age was 30.8 ± 8 years, with a sex ratio (M/F) = 2.2. Asthma symptoms were found in 95 (15.86%) employees, of whom 74 (77.9%) had work-related asthma and 11 (14.9%) had asthma aggravated by work. The factors associated with work-aggravated asthma were personal or family history of allergy or atopy [ORa = 3.75;CI95%: 1.56 - 8.93;p = 0.003], exposure to dust [ORa = 5.01;CI95%: 1.43 - 7.50;p = 0.011] and humidity level (60% - 70%) [ORa = 1.80;CI 95%: 0.99 - 3.28;p = 0.05]. Conclusion: Work-aggravated asthma is a reality in bakeries in Abidjan, with an estimated prevalence of 14.9%. Two of the three factors associated with this condition suggest a link with indoor air pollution. Combating air pollution in these establishments must therefore be a priority for the relevant authorities, in order to provide employees with a working environment that protects their health.

Severe asthma exacerbation:Changes in patient characteristics,management,and outcomes from 1997 to 2016 in 40 ICUs in the greater Paris area

Background Despite advances in asthma treatments,severe asthma exacerbation(SAE)remains a life-threatening condition in adults,and there is a lack of data derived from adult patients admitted to intensive care units(ICUs)for SAE.The current study investigated changes in adult patient characteristics,management,and outcomes of SAE over a 20-year period in 40 ICUs in the greater Paris area.Methods In this retrospective observational study,admissions to 40 ICUs in the greater Paris area for SAE from January 1,1997,to December 31,2016 were analyzed.The primary outcome was the proportion of ICU admissions for SAE during 5-year periods.Secondary outcomes were ICU and hospital mortality,and the use of mechanical ventilation and catecholamine.Multivariate analysis was performed to assess factors associated with ICU mortality.Results A total of 7049 admissions for SAE were recorded.For each 5-year period,the proportion decreased over time,with SAE accounting for 2.84%of total ICU admissions(n=2841)between 1997 and 2001,1.76%(n=1717)between 2002 and 2006,1.05%(n=965)between 2007 and 2011,and 1.05%(n=1526)between 2012 and 2016.The median age was 46 years(interquartile range[IQR]:32–59 years),55.41%were female,the median Simplified Acute Physiology Score II was 20(IQR:13–28),and 19.76%had mechanical ventilation.The use of mechanical ventilation remained infrequent throughout the 20-year period,whereas the use of catecholamine decreased.ICU and hospital mortality rates decreased.Factors associated with ICU mortality were renal replacement therapy,catecholamine,cardiac arrest,pneumothorax,acute respiratory distress syndrome,sepsis,and invasive mechanical ventilation(IMV).Non-survivors were older,had more severe symptoms,and were more likely to have received IMV.Conclusion ICU admission for SAE remains uncommon,and the proportion of cases decreased over time.Despite a slight increase in symptom severity during a 20-year period,ICU and hospital mortality decreased.Patients requiring IMV had a higher mortality rate.

Impact of Air Pollutants on Lung Function and Inflammatory Response in Asthma in Shanghai

Objective Air pollution is a leading public health issue.This study investigated the effect of air quality and pollutants on pulmonary function and inflammation in patients with asthma in Shanghai.Methods The study monitored 27 asthma outpatients for a year,collecting data on weather,patient self-management[daily asthma diary,peak expiratory flow(PEF)monitoring,medication usage],spirometry and serum markers.To explore the potential mechanisms of any effects,asthmatic mice induced by ovalbumin(OVA)were exposed to PM_(2.5).Results Statistical and correlational analyses revealed that air pollutants have both acute and chronic effects on asthma.Acute exposure showed a correlation between PEF and levels of ozone(O_(3))and nitrogen dioxide(NO_(2)).Chronic exposure indicated that interleukin-5(IL-5)and interleukin-13(IL-13)levels correlated with PM_(2.5)and PM_(10)concentrations.In asthmatic mouse models,exposure to PM_(2.5)increased cytokine levels and worsened lung function.Additionally,PM_(2.5)exposure inhibited cell proliferation by blocking the NF-κB and ERK phosphorylation pathways.Conclusion Ambient air pollutants exacerbate asthma by worsening lung function and enhancing Th2-mediated inflammation.Specifically,PM_(2.5)significantly contributes to these adverse effects.Further research is needed to elucidate the mechanisms by which PM_(2.5)impacts asthma.

Different timing for abdominal paracentesis catheter placement and drainage in severe acute pancreatitis complicated by intraabdominal fluid accumulation

BACKGROUND Non-surgical methods such as percutaneous drainage are crucial for the treatment of patients with severe acute pancreatitis(SAP).However,there is still an ongoing debate regarding the optimal timing for abdominal paracentesis catheter place-ment and drainage.AIM To explore the influence of different timing for abdominal paracentesis catheter placement and drainage in SAP complicated by intra-abdominal fluid accumu-lation.METHODS Using a retrospective approach,184 cases of SAP complicated by intra-abdominal fluid accumulation were enrolled and categorized into three groups based on the timing of catheter placement:group A(catheter placement within 2 d of symptom onset,n=89),group B(catheter placement between days 3 and 5 after symptom onset,n=55),and group C(catheter placement between days 6 and 7 after symptom onset,n=40).The differences in progression rate,mortality rate,and the number of cases with organ dysfunction were compared among the three groups.RESULTS The progression rate of group A was significantly lower than those in groups B and groups C(2.25%vs 21.82%and 32.50%,P<0.05).Further,the proportion of patients with at least one organ dysfunction in group A was significantly lower than those in groups B and groups C(41.57%vs 70.91%and 75.00%,P<0.05).The mortality rates in group A,group B,and group C were similar(P>0.05).At postoperative day 3,the levels of C-reactive protein(55.41±19.32 mg/L vs 82.25±20.41 mg/L and 88.65±19.14 mg/L,P<0.05),procalcitonin(1.36±0.51 ng/mL vs 3.20±0.97 ng/mL and 3.41±0.98 ng/mL,P<0.05),tumor necrosis factor-alpha(15.12±6.63 pg/L vs 22.26±9.96 pg/L and 23.39±9.12 pg/L,P<0.05),interleukin-6(332.14±90.16 ng/L vs 412.20±88.50 ng/L and 420.08±87.65ng/L,P<0.05),interleukin-8(415.54±68.43 ng/L vs 505.80±66.90 ng/L and 510.43±68.23ng/L,P<0.05)and serum amyloid A(270.06±78.49 mg/L vs 344.41±81.96 mg/L and 350.60±80.42 mg/L,P<0.05)were significantly lower in group A compared to those in groups B and group C.The length of hospital stay in group A was significantly lower than those in groups B and group C(24.50±4.16 d vs 35.54±6.62 d and 38.89±7.10 d,P<0.05).The hospitalization expenses in group A were also significantly lower than those in groups B and groups C[2.70(1.20,3.55)ten-thousand-yuan vs 5.50(2.98,7.12)ten-thousand-yuan and 6.00(3.10,8.05)ten-thousand-yuan,P<0.05).The incidence of complications in group A was markedly lower than that in group C(5.62%vs 25.00%,P<0.05),and similar to group B(P>0.05).CONCLUSION Percutaneous catheter drainage for the treatment of SAP complicated by intra-abdominal fluid accumulation is most effective when performed within 2 d of onset.

Computerized tomography-guided therapeutic percutaneous puncture catheter drainage-combined with somatostatin for severe acute pancreatitis: An analysis of efficacy and safety

BACKGROUND Severe acute pancreatitis(SAP),a condition with rapid onset,critical condition and unsatisfactory prognosis,poses a certain threat to human health,warranting optimization of relevant treatment plans to improve treatment efficacy.AIM To evaluate the efficacy and safety of computerized tomography-guided the-rapeutic percutaneous puncture catheter drainage(CT-TPPCD)combined with somatostatin(SS)in the treatment of SAP.METHODS Forty-two SAP patients admitted to The Second Affiliated Hospital of Fujian Medical University from June 2020 to June 2023 were selected.On the basis of routine treatment,20 patients received SS therapy(control group)and 22 patients were given CT-TPPCD plus SS intervention(research group).The efficacy,safety(pancreatic fistula,intra-abdominal hemorrhage,sepsis,and organ dysfunction syndrome),abdominal bloating and pain relief time,bowel recovery time,hospital stay,inflammatory indicators(C-reactive protein,interleukin-6,and pro-calcitonin),and Acute Physiology and Chronic Health Evaluation(APACHE)II score of both groups were evaluated for comparison.RESULTS Compared with the control group,the research group had a markedly higher total effective rate,faster abdominal bloating and pain relief and bowel recovery,INTRODUCTION Pancreatitis,an inflammatory disease occurring in the pancreatic tissue,is classified as either acute or chronic and is associated with high morbidity and mortality,imposing a socioeconomic burden[1,2].The pathogenesis of this disease involves early protease activation,activation of nuclear factor kappa-B-related inflammatory reactions,and infiltration of immune cells[3].Severe acute pancreatitis(SAP)is a serious condition involving systemic injury and subsequent possible organ failure,accounting for 20%of all acute pancreatitis cases[4].SAP is also characterized by rapid onset,critical illness and unsatisfactory prognosis and is correlated with serious adverse events such as systemic inflammatory response syn-drome and acute lung injury,threatening the health of patients[5,6].Therefore,timely and effective therapeutic inter-ventions are of great significance for improving patient prognosis and ensuring therapeutic effects.Somatostatin(SS),a peptide hormone that can be secreted by endocrine cells and the central nervous system,is in-volved in the regulatory mechanism of glucagon and insulin synthesis in the pancreas[7].It has complex and pleiotropic effects on the gastrointestinal tract,which can inhibit the release of gastrointestinal hormones and negatively modulate the exocrine function of the stomach,pancreas and bile,while exerting a certain influence on the absorption of the di-gestive system[8,9].SS has shown certain clinical effectiveness when applied to SAP patients and can regulate the severity of SAP and immune inflammatory responses,and this regulation is related to its influence on leukocyte apoptosis and adhesion[10,11].Computerized tomography-guided therapeutic percutaneous puncture catheter drainage(CT-TPPCD)is a surgical procedure to collect lesion fluid and pus samples from necrotic lesions and perform puncture and drainage by means of CT image examination and precise positioning[12].In the research of Liu et al[13],CT-TPPCD applied to pa-tients undergoing pancreatic surgery contributes to not only good curative effects but also a low surgical risk.Baudin et al[14]also reported that CT-TPPCD has a clinical success rate of 64.6%in patients with acute infectious necrotizing pan-creatitis,with nonfatal surgery-related complications found in only two cases,suggesting that this procedure is clinically effective and safe in the treatment of the disease.In light of the limited studies on the efficacy and safety of SS plus CT-TPPCD in SAP treatment,this study performed a relevant analysis to improve clinical outcomes in SAP patients.

Laccase/caffeic acid-catalyzed crosslinking coupled with galactomannan alters the conformational structure of ovalbumin and alleviates Th2-mediated allergic asthma

Ovalbumin(OVA)is the major allergenic protein that can induce T helper 2(Th2)-allergic reactions,for which current treatment options are inadequate.In this study,we developed a polymerized hypoallergenic OVA product via laccase/caffeic acid(Lac/CA)-catalyzed crosslinking in conjunction with galactomannan(Man).The formation of high molecular weight crosslinked polymers and the Ig G-binding were analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis(SDS-PAGE)and Western blotting.The study indicated that Lac/CA-catalyzed crosslinking plus Man conjugation substantially altered secondary and tertiary structures of OVA along with the variation in surface hydrophobicity.Gastrointestinal digestion stability assay indicated that crosslinked OVA exhibited less resistance in simulated gastric fluid(SGF)and simulated intestinal fluid(SIF).Mouse model study indicated that Lac-Man/OVA ameliorated eosinophilic airway inflammatory response and efficiently downregulated the expression of Th2-related cytokines(interleukin(IL)-4,IL-5,and IL-13),and upregulated IFN-γand IL-10 expression.Stimulation of bone marrow-derived dendritic cells with Lac-Man/OVA suppressed the expression of phenotypic maturation markers(CD80 and CD86)and MHC class II molecules,and suppressed the expression levels of proinflammatory cytokines.The knowledge obtained in the present study offers an effective way to acquire a hypoallergenic OVA product that can have a therapeutic effect in alleviating OVA-induced allergic asthma.

Evaluation of the Care of Children Aged 0 to 10 Years Hospitalized for Severe Malaria at the Tambacounda Health Center, Senegal

Introduction: Malaria remains a public health priority in Senegal, particularly in Tambacounda, where it is one of the main causes of child mortality. The objective of this work was to evaluate the care of children under 10 years of age hospitalized at the Tambacounda Health Center and the factors associated with recovery. Methods: An analytical, retrospective, and descriptive cross-sectional study with exhaustive recruitment of children 0 to 120 months hospitalized at the Tambacounda reference health center for severe malaria (according to WHO criteria) between 1 January 2018 and 31 December 2021 was performed. Data collection was done through a questionnaire. Records, hospitalization records, and treatment records were the sources of collection. Data entry and analysis were performed on Epi Info 7.2 and R. Results: A total of 481 children hospitalized with severe malaria were recruited. The highest number of cases was recorded in 2018 (33.05%). In the four years of the study, peaks were always observed between October and November and the highest peak in November 2020 with 95 cases. The mean age was 65.64 months with a standard deviation of 29.28 months and a predominance of male (53.43%). The majority of people were admitted from the outpatient clinic (57.79%) and the rest (42.21%) on the recommendation of a peripheral health post. All hospitalized patients had a positive RDT and/or a positive thick drop. However, the sharp decline at admission or during hospitalization was positive in 93.80% of patients in our series, negative in 5.20% and not achieved in 1.00%. Seizures and severe anemia topped the list of signs of severity with 45.94% and 8.11%, respectively. In terms of evolution, for all hospitalized patients, there were 81.29% recovery, 10.19% referral to the Tambacounda regional hospital center for hospitalization, 4.99% death, 0.83% discharge and 2.70% unknown evolution. There was a statistically significant association between recovery without referral from a health post (OR = 1.85), absence of 2 or more signs of severity (OR = 1.82), absence of seizures (OR = 1.51), prostration (OR = 2.78), cardiovascular shock (OR = 6.67), coma (OR = 7.69), lack of evidence of biological severity (OR = 3.70), and hypoglycemia with blood glucose less than 0.4 g/L (OR = 5.88). Conclusion: In addition to the routine malaria prevention and management strategies implemented in Tambacounda, and the early referral of cases of severe malaria from health posts to the health center, all children hospitalized for severe malaria with certain symptomatology such as coma, prostration, cardiovascular shock, etc. Seizures and/or hypoglycemia should be systematically referred to the regional hospital to increase their chance of recovery.

Inhibition of Bcl-6 Expression Ameliorates Asthmatic Characteristics in Mice

Objective The function of Bcl-6 in T follicular helper(Tfh)cell maturation is indispensable,and Tfh cells play a pivotal role in asthma.This study investigated the impact of Bcl-6 on asthmatic traits.Methods The microscopic pathological alterations,airway resistance(AR),and lung compliance(LC)were determined in asthmatic mice and Bcl-6 interference mice.The surface molecular markers of Tfh cells and the Bcl-6 mRNA and protein expression were determined by flow cytometry,RT-qPCR,and Western blotting,respectively.The relationships between the Tfh cell ratio and the IgE and IgG1 concentrations in peripheral blood mononuclear cells(PBMCs)and bronchoalveolar lavage fluid(BALF)were determined.Results Asthmatic inflammatory changes were observed in the lung tissue and were attenuated by Bcl-6 siRNA and dexamethasone(DXM).Asthmatic mice exhibited an increased AR and a decreased LC,while Bcl-6 siRNA or DXM mitigated these changes.The percentages of Tfh cells and eosinophils were significantly increased in the asthmatic mice,and they significantly decreased after Bcl-6 inhibition or DXM treatment.RT-qPCR and Western blotting analyses revealed that the Bcl-6 expression level in PBMCs was significantly higher in asthmatic mice,and it decreased following Bcl-6 inhibition or DXM treatment.The IgE expression in the serum and BALF and the B cell expression in PBMCs exhibited a similar trend.In asthmatic mice,the ratio of Tfh cells in the peripheral blood showed a strong positive correlation with the IgE levels in the serum and BALF,but not with the IgG1 levels.Conclusion The amelioration of airway inflammation and airway hyper-responsiveness is achieved through Bcl-6 suppression,which effectively hinders Tfh cell differentiation,ultimately resulting in a concurrent reduction in IgE production.

The role of ginseng as an anti-asthmatic agent

Introduction Asthma is an inflammatory obstructive respiratory lung disease characterized by limited airflow.It is estimated that more than 300 million people worldwide are affected by asthma,and this number is expected to increase over the next few years[1].Uncontrolled asthma is associated with a severely impaired quality of life and increased mortality rates[2].Other adverse effects of poorly controlled asthma include obesity,pneumonia.

Use of ketamine for severe asthma exacerbation in a pregnant patient with persistent bronchospasm:a case report

Background:Estimated 4%-8%of pregnancies are complicated by asthma.Adequate management in this population is critical to minimize complications.Patients presenting with asthma exacerbation are typically managed with standard bronchodilators and systemic corticosteroids.However,additional agents may be used in patients with refractory asthma exacerbation.Ketamine has been used in refractory bronchospasm,although its efficacy in published literature is heterogeneous.Case Presentation:We present a case of a pregnant patient with severe asthma exacerbation refractory to standard and salvage treatment who achieved termination of bronchospasm with ketamine infusion.Conclusion:After receiving ketamine infusion for several days,the patient had improved air flow and achieved successful extubation,without experiencing rebound bronchospasm.Although this individual clinical case alone cannot change guidelines or directives to use in refractory asthma exacerbations,it offers a possible treatment option to patients and providers in unusually severe cases with extenuating risk factors.

Asthma Attack Revealing Sickle Cell Disease

Sickle cell disease is a genetic disorder characterized by the presence of hemoglobin S (HbS) and a significant reduction in normal hemoglobin A (HbA) in red blood cells. In deoxygenated conditions, HbS molecules polymerize, causing vascular occlusions and hemolysis. Pulmonary complications associated with this disease result from vascular occlusion, ischemia-reperfusion, and inflammation. Literature reports that asthma is observed in 30% to 70% of patients with sickle cell disease. We present the case of a boy whose sickle cell disease diagnosis was established following an asthma attack.

Correlation between TGFβ1 Gene Polymorphism and Asthma in Baise, Guangxi Children

Objective: This research was to study the correlation between the rs1800469, rs1800470, rs2241712, rs224171 and rs4803455 of TGFβ1 gene and asthma in Baise, Guangxi children. This research also studied the relationship between serum concentration of TGFβ1 and childhood asthma. Method: From June 2022 to December 2023, 121 children had physical examination in affiliated Hospital of Youjiang Medical University for Nationalities were selected as control group and 118 children suffered from asthma in affiliated Hospital of Youjiang Medical University for Nationalities during the same period were selected as asthma group. Result: There was no correlation between rs1800469, rs1800470, rs2241712, rs2241715, rs4803455 and asthma in Baise, Guangxi children. Linkage disequilibrium analysis showed that there were strong linkage disequilibrium among rs1800469, rs1800470, rs2241712, rs2241715 and rs4803455. Their haplotypes had no significant correlation with childhood asthma. The serum concentration of TGFβ1 in asthma group was lower than that in control group (p β1 had no significant relationship with the genotypes of rs1800469, rs1800470, rs2241712, rs2241715 and rs4803455.

Superplasticity of fine-grained Mg-10Li alloy prepared by severe plastic deformation and understanding its deformation mechanisms

The superplastic behavior and associated deformation mechanisms of a fine-grained Mg-10.1 Li-0.8Al-0.6Zn alloy(LAZ1011)with a grain size of 3.2μm,primarily composed of the BCCβphase and a small amount of the HCPαphase,were examined in a temperature range of 473 K to 623 K.The microstructural refinement of this alloy was achieved by employing high-ratio differential speed rolling.The best superplasticity was achieved at 523 K and at strain rates of 10^(-4)-5×10^(-4)s^(-1),where tensile elongations of 550±600%were obtained.During the heating and holding stage of the tensile samples prior to tensile loading,a significant increase in grain size was observed at temperatures above 573 K.Therefore,it was important to consider this effect when analyzing and understanding the superplastic deformation behavior and mechanisms.In the investigated strain rate range,the superplastic flow at low strain rates was governed by lattice diffusion-controlled grain boundary sliding,while at high strain rates,lattice diffusion-controlled dislocation climb creep was the rate-controlling deformation mechanism.It was concluded that solute drag creep is unlikely to occur.During the late stages of deformation at 523 K,it was observed that grain boundary sliding led to the agglomeration of theαphase,resulting in significant strain hardening.Deformation mechanism maps were constructed forβ-Mg-Li alloys in the form of 2D and 3D formats as a function of strain rate,stress,temperature,and grain size,using the constitutive equations for various deformation mechanisms derived based on the data of the current tests.

The Association between GLP-1 Receptor-Based Agonists and the Incidence of Asthma in Patients with Type 2 Diabetes and/or Obesity:A Meta-Analysis

Objective Recent studies have indicated potential anti-inflammatory effects of glucagon-like peptide-1 receptor agonists(GLP-1RAs)on asthma,which is often comorbid with type 2 diabetes mellitus(T2DM)and obesity.Therefore,we conducted a meta-analysis to assess the association between the administration of glucagon-like peptide-1(GLP-1)receptor-based agonists and the incidence of asthma in patients with T2DM and/or obesity.Methods PubMed,Web of Science,Embase,the Cochrane Central Register of Controlled Trials,and Clinicaltrial.gov were systematically searched from inception to July 2023.Randomized controlled trials(RCTs)of GLP-1 receptor-based agonists(GLP-1RA,GLP-1 based dual and triple receptor agonist)with reports of asthma events were included.Outcomes were computed as risk ratios(RR)using a fixedeffects model.Results Overall,39 RCTs with a total of 85,755 participants were included.Compared to non-GLP-1 receptor-based agonist users,a trend of reduced risk of asthma was observed in patients with T2DM or obesity using GLP-1 receptor-based agonist treatments,although the difference was not statistically significant[RR=0.91,95%confidence interval(CI):0.68 to 1.24].Further Subgroup analyses indicated that the use of light-molecular-weight GLP-1RAs might be associated with a reduced the risk of asthma when compared with non-users(RR=0.65,95%CI:0.43 to 0.99,P=0.043).We also performed sensitivity analyses for participant characteristics,study design,drug structure,duration of action,and drug subtypes.However,no significant associations were observed.Conclusion Compared with non-users,a modest reduction in the incidence of asthma was observed in patients with T2DM or obesity using GLP-1 receptor-based agonist treatments.Further investigations are warranted to assess the association between GLP-1 receptor-based agonists and the risk of asthma.