薄层CT多征象联合多平面重组诊断气管支气管结核

目的 观察薄层CT多征象联合多平面重组(MPR)诊断气管支气管结核(TBTB)的价值。方法 回顾性分析234例接受胸部薄层CT扫描的TBTB患者并行MPR,观察病变直接与间接表现;比较轴位平扫CT(直接观察法)与其联合MPR(联合观察法)的诊断效能。结果 直接观察法诊断TBTB的敏感度、特异度、阳性预测值、阴性预测值及准确率分别为38.88%(201/517)、98.13%(1 789/1 823)、85.53%(201/235)、84.99%(1 789/2 105)及85.04%(1 990/2 340),联合观察法上述各项分别为91.10%(471/517)、98.85%(1 802/1 823)、95.54%(471/493)、97.51%(1 802/1 848)及97.14%(2 273/2 340);2种方法间敏感度、阳性预测值、阴性预测值及准确率差异均有统计学意义(P均<0.001),而特异度差异无统计学意义(P>0.05)。结论 根据薄层CT多征象联合MPR可有效诊断TBTB。

瑞马唑仑复合艾司氯胺酮用于严重气管受压患者清醒气管插管1例

本文报道1例巨大甲状腺肿物致气管严重受压的老年患者的围术期气道管理。采用瑞马唑仑复合艾司氯胺酮镇静镇痛,在清醒镇静和充分表面麻醉下使用纤维支气管镜行气管插管,过程平稳,效果满意。瑞马唑仑复合艾司氯胺酮镇静镇痛为该类患者制定个体化麻醉管理方案提供了新的思路。

胎儿三血管气管切面动脉导管弓左侧血管的鉴别诊断

目的:探讨三血管气管切面(three-vessel trachea view, 3VT)动脉导管弓(ductus arteriosus arch,DAA)左侧血管的超声鉴别诊断流程、主要切面和鉴别要点。方法:回顾性分析我院胎儿心脏超声检查过程中,3VT切面于DAA左侧探及血管的胎儿34例。总结形成DAA左侧血管的疾病类型,归纳鉴别诊断的流程、主要切面和鉴别要点。所有病例均采用出生后新生儿心脏超声证实。结果:(1)根据形成3VT切面DAA左侧血管的病因,将研究对象分为五组:双侧上腔静脉组21例(bilateral superior vena cava, BSVC, 61.8%)、孤立性永存左上腔静脉组2例(isolated left superior vena cava, ILSVC, 5.9%)、左无名静脉弓下走行组3例(subaortic left brachiocephalic vein, SLBCV, 8.8%)、心上型肺静脉异位引流的垂直静脉组3例(vertical vein, VV, 8.8%)和动脉导管壁瘤样膨出组5例(aneurysm of ductus arteriosus, ADA,14.7%)。(2) BSVC鉴别要点是左上腔静脉回流至冠状静脉窦或左心房;ILSVC鉴别要点是仅探及左上腔静脉,右上腔静脉缺如;SLBCV鉴别要点是左无名静脉从主动脉弓下穿行;VV鉴别要点是VV血流方向为从下至上,背离心脏;ADA鉴别要点是动脉导管壁呈瘤样膨出,其频谱为动脉频谱。结论:胎儿3VT切面上DAA左侧血管的鉴别诊断包括BSVC、ILSVC、SLBCV、VV和ADA。超声医师掌握各个疾病的鉴别诊断流程和鉴别要点有助于提高对相关畸形的产前检出和诊断能力。

气管黏液表皮样癌误诊为气管异物1例

1临床资料患儿,男,5岁,因进食后呛咳、发现气管异物4 h于2022-06-17就诊于昆明市儿童医院。患儿家属代诉患儿进食鸡蛋时不慎误吸,随后出现频繁、剧烈呛咳,伴喘息。随即于当地医院就诊,行胸部CT示气管近隆突部2.2 cm处见0.9 cm×0.8 cm稍高密度影,考虑异物(图1A)。诊断为主气管异物梗阻,未行处理,由救护车送至我院ICU。查体:一般情况欠佳,双肺呼吸音粗,可闻及少许痰鸣音,未闻及哮鸣音。入院诊断:气管内异物、呼吸道感染。患儿入ICU后为防止烦躁加重气管异物位置变化,给予舒芬太尼、右美托咪定和丙泊酚持续镇静镇痛,给予头孢唑林钠、奥美拉唑以及地奈德和吸入用盐酸氨溴索雾化。

基于Unet+Attention的胸部CT影像支气管分割算法

目前肺气管分割中,由于CT图像灰度分布复杂,分割目标像素近似,易造成过分割;而且肺气管像素较少,难以得到更多目标特征,造成细小肺气管容易被忽略。针对这些难点,本研究提出结合Unet网络和注意力机制的肺气管分割算法,注意力机制使用的是关注通道域和空间域的卷积块注意力模型(CBAM),该模型提高了气管特征权重。在损失函数方面,针对原始数据中正负样本失衡的问题,引入focal loss损失函数,该函数对标准交叉熵损失函数进行了改进,使难分类样本在训练过程中得到更多关注;最后通过八连通域判断将孤立点去除,保留较大的几个连通域,即最后的肺气管部分。选用由合作医院提供的24组CT影像和43组CTA影像,共计26157张切片图像作为数据集,进行分割实验。结果表明,分割准确率能够达到0.86,过分割率和欠分割率均值为0.28和0.39。经过注意力模块和损失函数的消融实验,在改进前的准确率、过分割率和欠分割率分别为0.81、0.30、0.40,可见其分割效果均不如Unet+Attention方法。与其他常用方法在相同条件下进行比较后,在保证过分割率和欠分割率不变的情况下,所提出的算法得到了最高的准确率,较好地解决了细小气管分割不准确的问题。

1例小脑后下动脉瘤术后并发气道塌陷患者的护理

小脑后下动脉瘤属于后循环动脉瘤之一,包括从小脑后下动脉和椎动脉交界处发出的动脉所产生的动脉瘤,位置毗邻脑干和后组颅神经,瘤体多为非囊状。小脑后下动脉瘤的发生率低,由于特殊的解剖位置及瘤体形态,导致手术治疗难度较大,术后易产生多种严重并发症。临床上常见的手术治疗方式有开颅动脉瘤夹闭术、单纯血管内介入栓塞治疗、血管搭桥术。文章总结1例小脑后下动脉瘤介入栓塞术后并发气道塌陷患者的护理,主要包括气道塌陷高风险识别、气道塌陷的疾病观察及紧急抢救、气道置管期间集束化气道管理、术后拔除气管插管前的评估及护理、气管插管拔管后预见性护理及观察。患者经过积极的抢救和护理,病情好转,转康复医院继续治疗。

基于谱效关系的款冬花祛痰活性成分研究

目的:研究款冬花提取物的高效液相色谱指纹图谱与祛痰作用的谱效关系,筛选款冬花的祛痰活性成分。方法:采用高效液相色谱法建立款冬花提取物的指纹图谱并获得其化学成分含量信息,采用小鼠酚红排泌模型获得款冬花提取物的祛痰药效指标信息,采用偏最小二乘回归法对款冬花提取物的化学成分含量信息与祛痰药效指标信息进行谱效相关分析。结果:初步判断芦丁、异槲皮苷、绿原酸、新绿原酸、隐绿原酸、异绿原酸A、异绿原酸B、异绿原酸C及峰3成分、峰17成分构成款冬花的祛痰活性成分群。结论:款冬花的祛痰作用是多成分共同作用的结果。本研究结果可为关联药效的款冬花质量标准的建立提供参考。

雾化吸入艾司氯胺酮对全身麻醉气管插管患者术后咽喉痛的影响

目的探讨雾化吸入艾司氯胺酮对全身麻醉气管插管(全麻插管)患者术后咽喉痛(POST)的影响。方法选择择期在全麻插管仰卧位下行手术治疗的66例患者作为研究对象,采用随机数字表法将患者分为艾司氯胺酮组(S组)和对照组(C组),每组33例。S组接受艾司氯胺酮25 mg加生理盐水4 mL雾化吸入15 min,C组接受生理盐水5 mL雾化吸入15 min。比较两组患者雾化吸入前即刻、麻醉诱导前即刻、麻醉诱导后5 min、麻醉诱导后30 min、麻醉诱导后60 min、拔除气管导管时、出麻醉复苏室(PACU)时的平均动脉压(MAP)及心率,拔除气管导管后2 h、4 h、8 h、12 h、24 h的POST发生情况,以及不良反应发生情况。结果两组不同时间点MAP及心率差异均无统计学意义(P>0.05)。与雾化吸入前即刻比较,麻醉诱导后5 min、麻醉诱导后30 min、麻醉诱导后60 min、拔除气管导管时、出PACU时C组MAP降低,麻醉诱导前即刻、麻醉诱导后5 min、麻醉诱导后30 min、麻醉诱导后60 min、拔除气管导管时、出PACU时S组MAP及两组心率降低(P<0.05)。S组拔除气管导管后4 h、8 h、12 h、24 h的POST发生率及严重程度低于C组(P<0.05)。S组有1例患者出现恶心呕吐,C组有2例患者出现恶心呕吐,两组不良反应发生率差异无统计学意义(P>0.05)。结论麻醉前雾化吸入艾司氯胺酮可减少全麻插管患者POST的发生率,减轻POST的严重程度,且不良反应发生率低。

应用不同型号气管导管行气管插管对颅脑损伤患者拔管后误吸的影响研究

目的比较应用不同型号气管导管行气管插管(ETT)对颅脑损伤患者拔管后误吸的影响。方法前瞻性纳入2020-05—2021-06于郑州某三甲医院ICU收治的行ETT的颅脑损伤患者(行ETT已超过48 h)。插管24 h内按气管导管型号分为A组(≤7.0 mm)、B组(7.5 mm)和C组(≥8.0 mm)。拔管后6 h内,以纤维支气管镜检查所见,并取口腔和气管标本的量化值α淀粉酶及胃蛋白酶A作为生物学误吸标本,统计误吸发生情况。结果共纳入150例患者,每组50例。3组患者的临床资料差异无统计学意义(P>0.05)。拔管6 h后患者的α淀粉酶水平及胃蛋白酶A浓度为A组<B组<C组,差异有统计学意义(P<0.05);本研究所有患者的胃蛋白酶A均≤200 ng/mL,α淀粉酶≤3314UI/L。纤维支气管镜及生物标记物阳性率均为A组<B组<C组,差异有统计学意义(P<0.05)。纤维支气管镜阳性率≤生物学标本检出阳性率,各组胃蛋白酶检出阳性率均>α淀粉酶,差异有统计学意义(P<0.05)。结论对颅脑损伤患者应用较大型号气管导管行ETT与拔管后发生误吸风险相关;使用较小型号的气管导管可降低拔管后误吸的风险。

Prosthetic reconstruction of the trachea:A historical perspective

This review discusses the history of tracheal reconstruction; from early work to future challenges. The focus is primarily on prosthetic tracheal reconstruction in the form of intraluminal stents, patch repairs, circumferential repairs and replacement of the trachea. A historical perspective of materials used such as foreign materials, autografts, allografts, xenografts and techniques, along with their advantages and disadvantages, is provided.

Carcinoma ex pleomorphic adenoma of the trachea: A case report

BACKGROUND Carcinoma ex pleomorphic adenoma (CXPA) is defined as a malignant salivary gland tumor arising from a primary or recurrent pleomorphic adenoma.Only three cases of CXPA of the trachea have been reported in the literature.CASE SUMMARY We report a case of tracheal CXPA in a 55-year-old woman,who presented with a more than 3-mo history of progressive dyspnea.Computed tomography of the neck and thorax revealed an inhomogeneous,broad-based lesion arising from the tracheal wall on the right side.Endoscopy revealed a subglottic neoplasm causing up to 90% luminal stenosis.The tumor was resected using a highfrequency electrosurgical snare combined with argon plasma coagulation.Histopathology and immunohistochemistry revealed that the tumor was a CXPA of the trachea.CONCLUSION We report the fourth case of tracheal CXPA,and present the first instance of resection of CXPA using high-frequency electrosurgical snare and laser ablation.We also discuss the pathogenesis,diagnosis,histopathology,and systemic therapy of this rare disease.

A Laminar Flow Model for Mucous Gel Transport in a Cough Machine Simulating Trachea: Effect of Surfactant as a Sol Phase Layer

In this paper, a planar three layer quasisteady laminar flow model is proposed in a cough machine which simulates mucous gel transport in model trachea due to mild forced expiration. The flow is governed by the time dependent pressure gradient generated in trachea due to mild forced expiration. Mucous gel is represented by a viscoelastic Voigt element whereas sol phase fluid and air are considered as Newtonian fluids. For fixed airflow rate, it is shown that when the viscosity of mucous gel is small, mucous gel transport decreases as the elastic modulus increases. However, elastic modulus has negligible effect on large gel viscosity. It is also shown that for fixed airflow rate and fixed airway dimension, mucous gel transport increases with the thickness of sol phase fluid and this increase is further enhanced as the viscosity of sol phase fluid decreases. The effect of surfactant is studied by considering sol phase as surfactant layer which causes slip at the wall and interface of sol phase and mucous gel. It is found that in the presence of surfactant mucous gel transport is enhanced.

Tracheal relaxation of five medicinal plants used in Mexico for the treatment of several diseases

Objective:To assess the relaxant effect of several organic extracts obtained from Agastache mexicana(A.mexicana),Cochlospermum vitifolium(C.vitifolium),Cordia morelosana(C.morelosana),Lepechinia caulescens(L.caulescens)and Talauma mexicana(71 mexicana)used in Mexican traditional medicine for the treatment of several diseases.Methods:Extracts were obtained by maceration at room temperature using hexane,dicliloromethane and methanol for each plant material.The organic extracts were evaluated ex vivo to determine their relaxant activity on the contractions induced by carbaehol(cholinergic receptor agonist,1μmol/L in isolated rat tracheal rings.Results:A total of 15 extracts were evaluated(three for each species).All test samples showed significant relaxant effect,in a concentration-dependent manner,on the contractions induced by 1μmol/L carbachol,with exception of extracts from C.morelosana.Active extracts were less potent than theophylline[phosphodiesterase inhibitor,EC_(50):(28.79±0.82)μg/mL]that was used as positive control.Concentration-response curves revealed that the extracts with more significant effects were dichloromethanic extracts of T.mexhxma[E_(max):(103.03±3.32)%and EC_(50):(159.39±3.72)μg/mL)and C.vitifolium[Emax:(106.58±2.42)%and EC_(50):(219.54±7.61)μg/mL].Finally,hexanic and dichloromethanic extracts from A.mexicana were fully effective but less potent than T.mexicana,and C.vitifolium.Conclusions:Less polar extracts obtained from A.mexicana,71 mexicana and C.vitifolium exhibited greater relaxant effect on tracheal rat rings,which allows us to suggest them as sources for the isolation of bioactive molecules with potential therapeutic value in the treatment of asthma.

Regeneration and Differentiation of Hamster Tracheal Epithelium Used Anti--Brdu Monoclonal Antibody After Mechanical Injury

The ventral quadrant of the tracheal epithelium of the hamster,about one fourth of tracheal mucosa, was denuded by a venous needle reformed.The stains were made with HE, PAS, and PAS-anti Brdu immunohis-tochemic technique. At the 0 h circumference cell number (CCN) was 927. 25.From 6 h post injured the viable cells changed in shapes and migrated from themargin to wound site. By 24 h the wound area was completely covered by a sin-gle layer of non-ciliated flattened cells, then an expotential increassing in cellregeneration occured in wound site by 48 h. The CCN had been restored to thelevel of control (1373), and the proliferative cell, composed of polygonal epi-dermoid metaplasia, 3～4 layers and reached a peak (338.8). The secretoryand ciliated cells appeared gradually from 72 h post injury, the epithelium re-stored to the normal epithelial architecture by one week post injury. In our pre-sent study either in control and non-injured epithelium or in all stages of woundsite about 70% of the Brdu positive cells contained small or confluent PAS posi-tive granules were observed. This fact indicated that secretory cells play a im-portant role in proliferation after mechanical injury and maintaining the normaltracheal pseudostratified epithelium.

Synchronous primary cancers of trachea and esophagus and ventricular tachycardia

The incidence of multiple primary cancers involving trachea is rare. We present a case of synchronous double primary cancer of trachea and esophagus in a 70-year-old woman, with a special symptom of ventricular tachycardia and no/a/story of smoking and alcohol drinking. Biopsies （tom multiple loci demonstrated the patient had primary small cell cancer of trachea and squamous cell carcinoma in situ of esophagus. The patient was successfully treated with four cycles of chemotherapy consisting of etoposide and earboplatin （EC） followed by thoracic radiotherapy （60 Gy in 30 fractions, in 6 weeks）, and was evaluated to have complete response of tumor. To our knowledge, there is no synchronous cancer of trachea and esophagus has been reported in English literature, and our experience showed sequential EC chemotherapy and radiotherapy provided an effective treatment to control both cancers.

An Active Endoscopy Robotic System for Direct Tracheal Inspection

The development of active endoscopy techniques is one important area of medical robot.This paper designed a new flexible and active endoscopy robotic system for direct tracheal inspection.The mobile mechanism of the robot is based on the inchworm movement actuated by pneumatic rubber actuator.There are five air chambers controlled independently,by adjusting pressures in air chambers,the robot can move in a straight mode or in a bending mode.The inspection sensors and some therapy surgery tools can be equipped in the front of the robot.The prototype was made and its mechanical characteristics were analyzed.The robot could move smoothly in a small plastic tube,and the robot is respectable to be used for inspection in human trachea directly.

Cryopreservation of the Trachea Can Reduce Its Antigenicity in Various Species

Background: Cryopreserved tracheal allograft has been used successfully for esophageal replacement in the canine model. The working hypothesis was cryopreservation decreases antigenicity but epithelial desquamation remains. However, cryopreservation of human tracheal samples collected at tracheostomy, resulted in no significant desquamation. The aim of this study was to examine the extent of desquamation of the epithelial layer of cryopreserved animal tracheas and find a reason for decreased antigenicity of cryopreserved canine and pig’s trachea. Methods: 5 cm long tracheal segments were removed from 6 dogs and 125 pigs and stored in liquid nitrogen for 21 days. Cross section samples were taken from the end of the segment, 1 cm from the end and at the middle of the segment. Histological examination was performed using haematoxyllineosin and MHC-II antigen specific antibody staining. Changes in histological structure were analyzed. Results: General histological morphology of samples changed after cryopreservation. The percentage of intact epithelium and the overall intensity of immune-staining increased significantly from the ends to the middle of the segments, but the intensity of immune-staining showed no difference in the remaining epithelial cells. Conclusion: Cryopreservation damages the epithelial cells, but does not influence the cell’s antigenicity or cause desepithelisation. The main effect is a retraction of the epithelial layer from the ends to the midpart and this effect may be protection against organ rejection. Based on our canine and pig results a 5 cm, long tracheal segment seems to be a promising organ for human esophageal replacement.

Immunohistochemical characterization of the rabbit tracheal cartilages

The objective of this study was to immunohistochemically elucidate the major extracellular matrix constituents of rabbit tracheal cartilage. The impetus for this project is the need for crucial design and validation criteria for tissue engineering juxtaposed with the conspicuous lack of trachea extracellular matrix data in the literature. Tracheal tissue specimens were harvested from New Zealand White rabbits, and were immunostained for collagen I, collagen II, aggrecan and decorin;and a Verhoeff-Van Gieson stain was performed to visualize elastin. The most striking result was the highly organized relationship between distinct fibrous (containing collagen I, decorin and elastin) and hyaline-like (containing collagen II and aggrecan) regions of the tracheal wall. The tracheal cartilage stained strongly with collagen II throughout, with periodic bands of aggrecan in the tracheal arches, meaning that there were areas void of aggrecan immunostaining alternating with areas with strong aggrecan immunostaining. In contrast, the periphery of the cartilage and the perichondrium itself exhibited strong collagen I staining and no collagen II staining. Elastin fibers and decorin were also detected along the periphery of the cartilage in the perichondrium and corresponded highly with the distribution of collagen I staining. The body of the rabbit trachea is therefore composed of a hyaline-cartilage structure primarily made of collagen II and bands of aggrecan, surrounded by a fibrous region composed of elastin and collagen I, indicative of a flexible tissue with distinct regions of compressive integrity. This information will be a valuable reference to future tissue engineering efforts in the creation of a biosynthetic substitute for laryngotracheal reconstruction.

Construction and Identification of Mammary Gland-specific Expression Vector of Bovine Tracheal Antimicrobial Peptide (TAP)

[ Objective] This study aimed to construct nmnmm_ry gland-specific expression vector of bovine tracheal antimicrobial peptide （TAP） gene. [ Method] TAP gene of dairy cattle was amplified from the mammary gland tissue by RT-PCR using a pair of primers which were designed according to bovine TAP cDNA se- quence （NM_174776） in GenBank, and then cloned into pMD19-T Simple vector for sequencing. The recombinant plasmid was digested using EcoRI and KpnI, the target gene fragment was recovered and inserted into general mammary gland-specific expression vector pBLG-EGFP harboring enhanced green fluorescent protein （ EGFP）, and transfected into bovine mammary epithelial cells （bMEC）, COS-7 cells and lactating rabbit mmmnary gland tissue by lipofectin transfection. The ex- pression of green fluorescent protein in transfected cells was detected under fluorescence microscopy, and the expression of TAP mRNA in rabbit mammary gland tis- sue was detected by semi-quantity RT-PCR. [ Result] The constructed mammary gland-specific expression vector pBLG-EGFP-TAP specifically expressed EGFP in transfected bMECs. In addition, semi-quantitative RT-PCR result showed that the expression level of TAP mRNA in rabbit mammary gland tissue was significantly enhanced after transfeeted with pBLG-EGFP-TAP. [ Conclusion] The mammary gland-specific expression vector pBLG-EGFP-TAP was successfully constructed, which provided important materials for further investigation of expression characteristics of TAP gene and prevention of bovine mastitis by using genetic engineering technology.

Pleomorphic adenoma of the trachea:A case report and review of the literature

BACKGROUND Pleomorphic adenoma(PA)is the most common benign tumor that occurs in the salivary glands;however,tracheobronchial PA is rarely observed.To the best of our knowledge,fewer than 50 cases have been reported in the literature.We report a 49-year-old woman who had been treated for asthma for 2 years before being diagnosed with PA of the trachea.CASE SUMMARY A 49-year-old woman was referred to our hospital due to dyspnea upon exertion and chronic cough with wheezing for 2 years.Laboratory tests showed an elevated white blood cell count,absolute neutrophil count,and percentage of neutrophils.A chest computerized tomography scan showed a well-defined,softtissue density lesion measuring 2.4 cm×2.1 cm in the lower trachea.Flexible bronchoscopy revealed that nearly 90%of the tracheal lumen was obstructed.The histopathological and immunohistochemistry features suggested PA of the trachea.Furthermore,we review the characteristics of 29 patients with tracheobronchial PA over the last 30 years.CONCLUSION Tracheobronchial PA occurs without gender predominance,mostly in the lower or upper trachea,and has a low recurrence rate.The median age at diagnosis is 48 years.The most common symptoms are cough,stridor,dyspnea,and wheezing.