Different dissecting orders of the pulmonary bronchus and vessels during right upper lobectomy are associated with surgical feasibility and postoperative recovery for lung cancer patients

Background: Right upper lobectomy(RUL) for lung cancer with di erent dissecting orders involves the most vari?able anatomical structures, but no studies have analyzed its e ects on postoperative recovery. This study compared the conventional surgical approach, VAB(dissecting pulmonary vessels first, followed by the bronchus), and the alter?native surgical approach, a BVA(dissecting the posterior ascending arterial branch first, followed by the bronchus and vessels) on improving surgical feasibility and postoperative recovery for lung cancer patients.Methods: According to the surgical approach, consecutive lung cancer patients undergoing RUL were grouped into a BVA and VAB cohorts. Their clinical, pathologic, and perioperative characteristics were collected to compare periop?erative outcomes.Results: Three hundred one patients were selected(109 in the a BVA cohort and 192 in the VAB cohort). The mean operation time was shorter in the a BVA cohort than in the VAB cohort(164 vs. 221 min, P < 0.001), and less blood loss occurred in the a BVA cohort(92 vs. 141 m L, P < 0.001). The rate of conversion to thoracotomy was lower in the a BVA cohort than in the VAB cohort(0% vs. 11.5%, P < 0.001). The mean duration of postoperative chest drainage was shorter in the a BVA cohort than in the VAB cohort(3.6 vs. 4.5 days, P rvival was n= 0.001). The rates of postoperative complica?tions were comparable(P = 0.629). The median overall suot arrived in both cohorts(P > 0.05). The median disease?free survival was comparable for all patients in the two cohorts(not arrived vs. 41.97 months) and for patients with disease recurrences(13.25 vs. 9.44 months)(both P > 0.05). The recurrence models in two cohorts were also comparable for patients with local recurrences(6.4% vs. 7.8%), distant metastases(10.1% vs. 8.3%), and both(1.8% vs. 1.6%)(all P > 0.05).Conclusions: Dissecting the right upper bronchus before turning over the lobe repeatedly and dissecting veins via the a BVA approach during RUL would promote surgical feasibility and achieve comparable postoperative recovery for lung cancer patients.

Emergency Treatment and Nursing Care of a Patient with Multiple Injuries and Right Main Bronchus Rupture

Objective: To investigate the rescue and nursing process of a trauma patient with multiple injuries and rupture of the right main bronchus. Methods: A patient with multiple injuries and rupture of the right main bronchus admitted to the emergency department of the Shenzhen Hospital of the University of Hong Kong was selected as the research object on December 11, 2019. Results: In this case, the medical team treated the patient under the guidance of ATLS (Advanced Traumatic Life Support), and for the first time in our department, we used bronchoscopy to replace the double-lumen endotracheal tube for left lung single-lung ventilation, finally the patient was successfully treated. Conclusion: Through a literature search, it is found that the main bronchus rupture is less common in clinical practice. In the trauma group, the use of fiberoptic bronchoscopy and the replacement of a double-lumen tracheal tube for left lung single-lung ventilation can improve the treatment rate of such patients and is worthy of clinical application.

Relaxant Effects of Quercetin and Rutin on Human Isolated Bronchus

Increasing epidemiological evidence supports the view, that quercetin has protective roles in a multitude of disease states in human who have a high intake of polyphenols. To investigate the ability of quercetin and its rutinoside, rutin, to modulate the relaxation of human airways smooth muscle and to determine the mechanism (s) of such relaxation, isolated human bronchus rings were suspended in individual organ baths, precontracted with acetylcholine or with histamine and the relaxing effects of quercetin and rutin were determined by measurement of isometric tension. Quercetin induced concentration-dependent relaxant responses on acetylcholine or histamine precontracted human bronchial rings and with almost equal effectiveness. In terms of potency (pD2) and efficacy (Emax), quercetin is more potent than rutin on relaxant responses of human bronchus. K+ and Ca2+ concentration-dependent contraction curves were inhibited after incubation with increasing concentrations of quercetin. Quercetin potentiated in a concentration-dependent manner the relaxant effects of isoprenaline or sodium nitroprusside. Rutin had no effect on K+-induced contraction and on relaxant activity of isoprenaline or sodium nitroprusside. Our results suggest that the bronchodilator effects of quercetin are modulated by an increase in cyclic nucleotide levels as well as an alteration in availability of Ca2+ to the contractile machinery.

Role of positron emission tomography in primary carcinoma ex pleomorphic adenoma of the bronchus: A case report

BACKGROUND Primary carcinoma ex pleomorphic adenoma arising from the tracheobronchial system is rarely reported.CASE SUMMARY We present a patient with primary carcinoma ex pleomorphic adenoma of the bronchus and review the associated literature for further comparison,including age,clinical manifestations,and diagnostic process.This patient had no history of neoplasms of the salivary gland.CONCLUSION Positron emission tomography played an important role in the staging work-up of primary carcinoma of ex pleomorphic adenoma.Long-term follow-up was necessary for further prognosis analysis.

Emergency repair of blunt traumatic bronchus injury presenting with massive air leak

Blunt traumatic tracheobronchial injury is rare,but can be potentially life-threatening.It accounts for only 0.5%-2%of all trauma cases.Patients may present with non-specific signs and symptoms,requiring a high index of suspicion with accurate diagnosis and prompt treatment.A 26-year-old female was brought into the emergency department after sustained a blunt trauma to the chest from a high impact motor vehicle accident.She presented with signs of respiratory distress and extensive subcutaneous emphysema from the chest up to the neck.Her airway was secured and chest drain was inserted for right sided pneumothorax.CT of the neck and thorax revealed a collapsed right middle lung lobe with a massive pneumothorax,raising the suspicion of a right middle lobe bronchus injury.Diagnosis was confirmed by bronchoscopy.In view of the difficulty in maintaining her ventilation and persistent pneumothorax with a massive air leak,immediate right thoracotomy via posterolateral approach was performed.The right middle lobar bronchus tear was repaired.There were no intra-or post-operative complications.She made an uneventful recovery.She was asymptomatic at her first month follow-up.A repeated chest X-ray showed expanded lungs.Details of the case including clinical presentation,imaging and management were discussed with an emphasis on the early uses of bronchoscopy in case of suspected blunt traumatic tracheobronchial injury.A review of the current literature of tracheobronchial injury management was presented.

Lung autotransplantation for treating bronchus neoplasms

Lung autotransplantation is a new procedure with pulmonary preservation for patients in the treatment of lung cancer. It was used to treat the stage III central lung cancer of the upper lobe in the patient presented herein when his pulmonary function could not withstand a pneumonectomy and the length of the resected bronchus or pulmonary artery was too long to perform a bronchovascular double sleeve lobectomy.1＇2 In order to preserve pulmonary tissue and improve the quality of life, we performed lung autotransplantation for a case.

Mediastinal lesions in children

The mediastinum is where thoracic lesions most frequently occur in young patients.The histological spectrum of diseases caused by the presence of several organs in the mediastinum is broad.Congenital lesions,infections,benign and malignant lesions,and vascular diseases are examples of lesions.Care should be taken to make the proper diagnosis at the time of diagnosis in order to initiate therapy promptly.Our task is currently made simpler by radiological imaging techniques.

Endoscopic identification of endoluminal esophageal landmarks for radial and longitudinal orientation and lesion location

AIM To characterize esophageal endoluminal landmarks to permit radial and longitudinal esophageal orientation and accurate lesion location.METHODS Distance from the incisors and radial orientation were estimated for the main left bronchus and the left atrium landmarks in 207 consecutive patients using white light examination. A sub-study was also performed using white light followed by endoscopic ultrasound(EUS) in 25 consecutive patients to confirm the findings.The scope orientation throughout the exam was maintained at the natural axis,where the left esophageal quadrant corresponds to the area between 6 and 9 o'clock. When an anatomical landmark was identified, it was recorded with a photograph and its quadrant orientation and distance from the incisors were determined. The reference points to obtain the distances and radial orientation were as follows: the midpoint of the left main bronchus and the most intense pulsatile zone of the left atrium. With the video processor system set to moderate insufflation, measurements were obtained at the end of the patients' air expiration.RESULTS The left main bronchus and left atrium esophageal landmarks were identified using white light in 99% and 100% of subjects at a mean distance of 25.8 cm(SD2.3), and 31.4 cm(SD 2.4) from the incisors, respectively. The left main bronchus landmark was found to be a tubular, concave, non-pulsatile, esophageal external compression, occupying approximately 1/4 of the circumference. The left atrium landmark was identified as a round, convex, pulsatile, esophageal external compression, occupying approximately 1/4 of the circumference. Both landmarks were identified using white light on the anterior esophageal quadrant. In the substudy, the left main bronchus was identified in 24(92%) patients at 25.4 cm(SD2.1) and 26.7 cm(SD 1.9) from the incisors, by white light and EUS, respectively.The left atrium was recognized in all patients at 30.5 cm(SD 1.9), and 31.6 cm(SD2.3) from the incisors, by both white light and EUS, respectively. EUS confirmed that the landmarks corresponded to these two structures, respectively, and that they were located on the anterior esophageal wall. The Bland-Altman plot demonstrated high agreement between the white light and EUS measurements.CONCLUSION This study provides an endoscopic characterization of esophageal landmarks corresponding to the left main bronchus and left atrium, to permit radial and longitudinal orientation and accurate lesion location.

Bronchial glomus tumor with calcification: A case report

BACKGROUND Glomus tumors(GTs),defined by modified smooth cells and normal glomus body cells,usually present with a small mass occurring in the soft tissue or dermis of an extremity,especially in the subungual region.However,other unusual sites,such as the respiratory tract,have also been reported.They are usually sporadic.Their imaging findings are usually nonspecific and likely to appear as a well-delineated round mass that usually lacks calcification.To our knowledge,we report the first case of bronchial GTs with calcification,reminding clinicians and radiologists that GT is one of the differential diagnoses when a calcified nodular mass is found.CASE SUMMARY We report a case of a 33-yr-old Chinese man with cough and sputum for 11 d and hemoptysis for 5 d.Chest computed tomography revealed a calcified nodular lesion on the compressed posterior wall of the lower left main bronchus and bronchiectasis in the lower lobe of the left lung.To confirm the characteristics of calcified nodules,we performed fiberoptic bronchoscopy.The tumor tissue from the biopsy of bronchial mucosal lesions established the diagnosis of GT.Because the patient had no life-threatening symptoms,he was not treated with surgery.Clinical follow-up for 25 mo showed that the patient survived well without any discomfort.CONCLUSION Bronchial GTs are usually not accompanied by calcification on computed tomography scans.To our knowledge,we report the first calcified bronchial GT.We recommend that clinicians consider GT as a possible differential diagnosis when a calcified mass of the bronchi is found.

IMAGE-BASED IN VIVO QUANTITATIVE ASSESSMENT OF HUMAN AIRWAY OPENING AND CONTR ACTILITY BY FIBER OPTICAL NA SOPH A RYNGOSCOPY IN HEALTHY AND ASTHMATIC SUBJECTS

Assessment of human airway humen opening is important in diagnosing and understanding the mechanisms of airway dysfunctions such as the excessive airway narrowing in asthma and chronic obstructive pulmonary disease(COPD).Although there are indirect methods to evaluate the airway calibre,direct in vivo measurement of the airway calibre has not been commonly available.With recent advent of the flexible fiber optical nasopharyngoscope with video recording it has become possible to directly visualize the passages of upper and lower airways.However,quan-titative analysis of the recorded video images has been technically challenging.Here,we describe an automatic image processing and analysis method that allows for batch analysis of the images recorded during the endoscopic procedure,thus facilitates image-based quantification of the airway opening.Video images of the airway lumen of volunteer subject were acquired using a fiber optical nasopharyngoscope,and subsequently processed using Gaussian smoothing filter,threshold segment ation,differentiation,and Canny image edge detection,respectively.Thus the area of the open airway lumen was identified and computed using.a predetermined converter of the image scale to true dimension of the imaged object.With this method we measured the opening/narrowing of the glottis during tidal breathing with or without making“Hee"sound or cough.We also used this met hod to measure the opening/narrowing of the primary bronchus of either healthy or asthmatic subjects in response to hist amine and/or albuterol treatment,which also provided an indicator of the airway contractility.Our results demonstrate that the image-based method accurately quantifed the area change waveform of either the glottis or the bronchus as observed by using the optical nasopharygoscope.Importantly,the opening/nar-rowing of the airway lumen generally correlated with the airAow and resistance of the airways,and could differentiate the level of airway contr actility between the healthy and asthmatic subjects.Thus,this quant itative assessment of airway opening may provide a useful tool to ssist clinical diagnosis of airway dysfunctions and understanding the mechanisms of associated pathophysiologies.

玉液润燥饮对肠容积及支气管平滑肌影响的实验研究

本文报道玉液润燥饮对小鼠肠容积及豚鼠支气管平滑肌的影响。结果表明，玉液润燥饮能增加小鼠肠容积，并能增加豚鼠离体支气管肺灌流量。提示其可能阻止肠内水份重吸收，增加肠粘膜分泌，并舒张支气管平滑肌，且毒性低。

Morphometrical findings among dysplasias of oral, cervical and bronchial regions

The purpose of this study was to compare among dysplasia of oral, uterine cervix and bronchus. Using a computer cytomorphometry cell measurement program, the study was based on a retrospective review of smear cases diagnosed with dysplasia of oral, bronchial and uterine cervix, from 2002 to 2010. For 50 - 70 cells from each lesion, nuclear (N) and cytoplasm (C) variables were assessed: area (A), diameter (D), irregularity (I), stain brightness and granularity. NA and ND were highest in OSCC and higher according to dysplastic grading. By contrast, CA and CD were lowest in severe dysplasia. The significant difference of N/C ratio was observed among OSCC to inflammation, mild and moderate dysplasias (p < 0.05). The N/C ratios of mild and moderate dysplasias were equal. Brightness and granularity values of OSCC cases were significantly higher than those of another (p < 0.05). About the difference between mild to moderate dysplasias, it was the easiest to detect of the uterine cervix. All severe dysplasias among the 3 regions were easily identified morphometrically. The deficient in the difference between inflammation to mild dysplasia and mild to moderate dysplasia were obtained in the oral mucosal lesion. The results displayed a significant variation in cytomorphometrical values among the 3 regions. N/C values for uterine cervix and bronchus were well distinguished in comparison with oral dysplasias. Screening of mild and moderate dysplasias requires experience which carries out the comprehensive judgment of the color.

The Efficacy Analysis of Transbronchoscopic Large Volume Lung Lavage in Treatment of Pneumoconiosis Complicated with Chronic Obstructive Pulmonary Disease

Objective:To evaluate the efficacy of transbronchoscopic large volume lung lavage in the treatment of pneumoconiosis complicated with chronic obstructive pulmonary disease(COPD).Methods:The clinical data of 80 patients with pneumoconiosis complicated with COPD admitted to our hospital from June 2017 to January 2019 were retrospectively analyzed.40 patients in the control group were treated with conventional drugs and 40 patients in the observation group treated with conventional drugs plus transbronchoscopic large-volume lung lavage.Dyspnea score and healthy quality of life were compared between the two groups.Results:the scores of dyspnea in the observation group were significantly lower than those in the control group at 12,24 and 48 weeks after treatment,and the(SGRQ)scores of George’s respiratory problems questionnaire in the observation group were significantly lower than those in the control group at 12,24 and 48 weeks after treatment.Conclusion:Thetransbronchoscopic large volume of lung lavage has a significant effect on the treatment of pneumoconiosis patients with COPD,which can effectively reduce the degree of dyspnea and improve the quality of life.

Asian,regional,and national burdens of respiratory tract cancers and associated risk factors from 1990 to 2019:A systematic analysis for the global burden of disease study 2019

Background:Respiratory cancer is the leading cause of cancer-related deaths worldwide,but its statistics vary between the East and West.This study aimed to estimate the burdens of tracheal,bronchus,and lung(TBL)cancer and larynx cancer and their attributable risks from 1990 to 2019 in Asia,and at regional and national levels.Methods:This research evaluated the incidence,mortality,years lived with disability,years of life lost,and disability-adjusted life years(DALYs)for respiratory tract cancers using the Global Burden of Diseases,Injuries,and Risk Factors Study(GBD)2019 database.Age-standardized rates were calculated for TBL cancer from 1990 to 2019,adjusted for smoking and socio-demographic index(SDI).Deaths from TBL cancer and larynx cancer attributable to each risk factor were estimated for 33 Asian countries.Results:The age-standardized incidence and death rates for TBL cancer in Asia declined from 2010 to 2019,while the incidence rate of larynx cancer increased.Smoking was the leading specific risk factor for deaths from both TBL and larynx cancers.The burden of TBL cancer in Asian countries was influenced by SDI and smoking,particularly among males in Central Asia.Deaths,DALYs,and incidences of larynx cancer in East Asia had not changed significantly over the past 30 years,but showed slight downward trends in males and both sexes combined,and an upward trend in females in recent years.Conclusions:The past decade saw increases in numbers of incident cases and deaths from TBL cancer and larynx cancer in Asia.SDI and smoking were the main factors influencing the disease burden of TBL cancer in Asian countries.This study highlights the need for tailored cancer control programs to address the burden of respiratory tract cancers in different Asian countries.

Respiratory manifestations in amyloidosis

Background Amyloidosis is a collection of diseases in which different proteins are deposited. Amyloid deposits occur in systemic and organ-limited forms. In both systemic and localized forms of the disease, lung can he involved. The aim of this study was to explore the different respiratory manifestations of amyloidosis. Methods Chest radiology, clinical presentations, bronchoscopic/laryngoscopic findings and lung function data of 59 patients with amyloidosis involving respiratory tract collected during January 1986 to March 2005, were analysed. Results Of the 16 cases with localized respiratory tract amyloidosis, 8 had the lesions in the trachea and the bronchi, 2 in the larynx and the trachea, 5 in the larynx and/or the pharynx, and 1 in the lung parenchyma. Of 43 systemic amyloidosis with respiratory tract involvement, 3 had the lesions in bronchi, 13 in lung parenehyma, 33 in pleura, 8 in mediastina, 1 in nose and 1 in pharynx. Chest X-rays were normal in most cases of tracheobronchial amyloidosis. CT, unlike chest X-rays, showed irregular luminal narrowing, airway wall thickening with calcifications and soft tissue shadows in airway lumen. Localized lung parenchymal amyloidosis presented as multiple nodules. Multiple nodular opacities, patch shadows and reticular opacities were the main radiological findings in systemic amyloidosis with lung parenchymal involvement. In pleural amyloidosis, pleural effusions and pleural thickening were detected. Mediastinal and/or hilar adenopathy were also a form of lung involvement in systemic amyloidosis. The major bronehoseopie findings of tracheobronchial amyloidosis were narrowing of airway lumen, while nodular, ＇ tumour like＇ or ＇ bubble like＇ masses, with missing or vague cartilaginous rings, were detected in about half of the patients. Conclusions Localized respiratory tract amyloidosis mostly affects the trachea and the bronchi. Chest X-rays are not sensitive to detect these lesions. Systemic amyloidosis often involves lung parenchyma and the pleura. Open lung biopsy or pleural biopsy should be performed for the diagnosis.

Interventional Bronchoscopic Therapy in Adult Patients with Tracheobronchial Mucoepidermoid Carcinoma

Background： Tracheobronchial mucoepidermoid carcinoma （MEC） is a rare airway tumor in adults for which surgery is considered a first-line treatment. However, some patients already lost the best opportunity of a surgical intervention when diagnoses are confirmed, and surgery causes considerable trauma resulting in partial loss of pulmonary function. Moreover, the tumor is resistant to radiotherapy and chemotherapy. These factors make the treatment of tracheobronchial MEC challenging. This study aimed to evaluate the safety and et^cacy ofinterventional bronchoscopic therapy in adult patients with tracheobronchial MEC. Methods： We retrospectively analyzed the clinical manifestations, bronchoscopic interventions, complications, and outcomes of 11 adult patients with tracheobronchial MEC. Paired t-test was used to analyze the parameters of the American Thoracic Society Dyspnea Index and the Karnofsky Score before and after the first interventional bronchoscopic therapy. Results： All tumors occurred in the main bronchus and were easily visualized by bronchoscopy. After interventional bronchoscopic therapy, the symptoms of all patients showed significant improvement. The American Thoracic Society Dyspnea Index decreased from 1.91 ± 1.22 to 0.27 ± 0.47 （t = 6.708, P 〈 0.001） and the Kamofsky Score increased from 78.18 ±16.62 to 95.46 ± 8.20 （t =-5.190, P 〈 0.001 ）. Bronchoscopic intervention did not result in serious complications or mortality. During the follow-up period between 3 and 96 months after the first therapy, the following results were noted： （ 1 ） among the eight patients with low-grade tracheobronchial MEC, only one patient had a relapse and agreed to surgical treatment; （2） among the three patients with high-grade tracheobronchial MEC, one patient required repeated bronchoscopic interventions, one patient died of pulmonary infection, and one patient died of systemic failure owing to tumor metastasis. Conclusions： Interventional bronchoscopic therapy, as an alternative treatment, shows promise in some adult patients with low-grade tracheobronchial MEC confined to the bronchus. However, for adult patients with high-grade tracheobronchial MEC, early diagnosis and surgical treatment are still strongly recommended.

Bronchial Sparganosis mansoni accompanied by abnormal hyperplasia diagnosed by bronchoscopy

Pulmonary sparganosis mansoni is rare in humans and bronchial sparganosis mansoni has not been reported. We reported a patient with a soft-tissue mass in the right hilum area on a chest computed tomography （CT） scan that was suspected of being lung cancer. Bronchoscopy identified sparganum larvae. Bronchial sparganosis mansoni accompanied by abnormal hyperplasia was diagnosed by histopathology. We introduced our experience and reviewed the clinical characteristics of three pulmonary sparganosis mansoni cases and three pleural cavity sparganosis mansoni cases that have been reported.