Congenital laryngo-tracheo-esophageal clefts: updates from a quaternary care pediatric airway unit.

PURPOSE: To review the operative techniques, outcomes, and complications following surgery in pediatric patients with laryngo-tracheo-esophageal clefts (LTEC). We describe a new combined approach to treat long LTECs. METHODS: Twenty-five patients underwent surgical repair for LTEC from March 2012 to July 2022 at our hospital. Every patient underwent a diagnostic endoscopy under general anesthesia and spontaneous ventilation to assess the LTEC and synchronous aero-digestive comorbidities/malformations. All patients underwent at least one surveillance endoscopy after the repair at our institution. RESULTS: The patients had multiple other malformations, specifically gastro-intestinal, synchronous airway, and cardiac. The cleft distribution according to the modified Benjamin and Inglis classification was type I (n = 5, 20%), type II (n = 6, 24%), type IIIa (n = 8, 32%), type IIIb (n = 4, 16%), and type IVa (n = 2, 8%). The median follow-up was 44.6 months. Five patients (20%) had undergone previous cleft corrective surgery(s). Seven patients (28%) had partial to complete breakdown of the repair, needing additional intervention(s), and two required a combined-open plus endoscopic repair. Preoperatively, most patients (n = 18, 72%) needed a feeding assistance. At latest follow-up, feeding assistance was weaned off in 13 out of 18 patients, which was a 72% improvement. Ten patients (40%) needed ventilation assistance before the surgery. Post-operatively, ventilatory assistance was weaned off in 6 patients, meaning a 60% improvement. CONCLUSION: LTEC are rare malformations, and their management needs precise diagnosis, appropriate surgical planning, and execution, and dedicated post-operative care. Primary and revision repair of long clefts with tracheal extension may require a combined approach.

Sequencing of the Lumbricus terrestris genome reveals degeneracy in its erythrocruorin genes.

The erythrocruorin of Lumbricus terrestris (LtEc) is a relatively large macromolecular assembly that consists of at least four different hemoglobin subunits (A, B, C, and D) and four linker subunits (L1, L2, L3, and L4). The complexity and stability of this large structure make LtEc an attractive hemoglobin-based oxygen carrier that could potentially be used as a substitute for donated red blood cells. However, the sequences of the LtEc subunit sequences must be determined before a scalable recombinant expression platform can be developed. The goal of this study was to sequence the L. terrestris genome to identify the complete sequences of the LtEc subunit genes. Our results revealed multiple homologous genes for each subunit (e.g., two homologous A globin genes; A1 and A2), with the exception of the L4 linker. Some of the homologous genes encoded identical peptide sequences (C1 and C2, L1a and L1b), while cDNA and mass spectrometry experiments revealed that some of the homologs are not expressed (e.g., A2). In contrast, multiple sequences for the B, D, L2, and L4 subunits were detected in LtEc samples. These observations reveal novel degeneracy in LtEc and other annelids, along with some new revisions to its previously published peptide sequences.

Endoscopic repair of laryngotracheoesophageal clefts.

BACKGROUND/PURPOSE: In Japan, surgical repair of a laryngotracheoesophageal cleft (LTEC) typically consists of the anterior approach, with the lateral approach as an alternative. Endoscopic surgery to repair the tracheoesophageal septum has been reported, and this study reviewed our experience treating several cases of LTEC endoscopically. METHODS: Endoscopic repair of LTEC was performed in 7 patients (3 boys, 4 girls; age range 4 months to 2 years 10 months; mean age 11 months; mean weight at surgery 7.23 kg; weight range 3.85-12.24 kg) between 2009 and 2014. LTEC was type I in 5 patients and types II and IV in 1 patient each. The patient with type IV was first operated on by the lateral approach, and the remaining cleft, which level was type III, was repaired endoscopically. Postoperative outcomes were retrospectively studied. RESULTS: Endoscopic surgery was successful in all patients. All 6 patients with types I and II LTEC were extubated easily, while in the patient with type IV LTEC, it was difficult to remove the tracheostomy cannula because of tracheomalacia. Postoperatively, tracheostomy cannulation became more stable, and the patient is gradually being weaned off the ventilator. All patients could be fed orally without difficulty postoperatively. CONCLUSIONS: Endoscopic surgery provides a view from the cephalic aspect permitting the surgeon to form a normal larynx with only minimal risk of complications.

A Ambiência em ILPI a partir da percepção de idosos com doença de Alzheimer e de cuidadores / The Ambience in LTEC from the Elderly Perception with Alzheimer's Disease and Caregivers / La Ambiencia en ITE desde la Percepción de Personas Mayores con la Enfermedad de Alzheimery Cuidadores

Ambiência em ILPI1é mais do que espaço físico, pois apresenta características tais como sua funcionalidade, privacidade, autonomia e acolhimento. Os objetivos da pesquisa foram levantar e analisar as características dos microambientes de ILPIs, através das opiniões da tríade idoso / cuidador / profissional. O método utilizado foi estudo de caso, e Análise de Conteúdo, de Bardin. Por fim, destacou-se que o ambiente possui diversas características importantes para a moradia do idoso com a doença.(AU)

Ambiance at LTEC2is much more than environment, because introduces functionality, privacy, autonomy and reception. The objectives were to raise and analyze the characteristics of the microenvironments of LTEC, through the opinions of old person / caregiver / professional triad. The method was case study and Bardin Content Analysis. Finally, it comes out that the environment has several important features for the elderly living with this disease.(AU)

La ambiencia en ITE3es más que un espacio físico, se presenta la funcionalidad, la privacidad, la autonomía y la recepción. Los objetivos de la investigación fueron crear y analizar las características de los microambientes de ITEs través de las opiniones de la tríada ancianos / cuidador / profesional. El método utilizado fue el estudio de caso y análisis de contenido de Bardin. Por último, se destacó que el ambiente tiene varias características importantes para la vivienda para ancianos con la enfermedad.(AU)

A Ambiência em ILPI a partir da percepção de idosos com doença de Alzheimer e de cuidadores / The Ambience in LTEC from the Elderly Perception with Alzheimer's Disease and Caregivers / La Ambiencia en ITE desde la Percepción de Personas Mayores con la Enfermedad de Alzheimer y Cuidadores

Ambiência em ILPI1 é mais do que espaço físico, pois apresenta características tais como sua funcionalidade, privacidade, autonomia e acolhimento. Os objetivos da pesquisa foram levantar e analisar as características dos microambientes de ILPIs, através das opiniões da tríade idoso / cuidador / profissional. O método utilizado foi estudo de caso, e Análise de Conteúdo, de Bardin. Por fim, destacou-se que o ambiente possui diversas características importantes para a moradia do idoso com a doença.

Ambiance at LTEC2 is much more than environment, because introduces functionality, privacy, autonomy and reception. The objectives were to raise and analyze the characteristics of the microenvironments of LTEC, through the opinions of old person / caregiver / professional triad. The method was case study and Bardin Content Analysis. Finally, it comes out that the environment has several important features for the elderly living with this disease.

La ambiencia en ITE3 es más que un espacio físico, se presenta la funcionalidad, la privacidad, la autonomía y la recepción. Los objetivos de la investigación fueron crear y analizar las características de los microambientes de ITEs través de las opiniones de la tríada ancianos / cuidador / profesional. El método utilizado fue el estudio de caso y análisis de contenido de Bardin. Por último, se destacó que el ambiente tiene varias características importantes para la vivienda para ancianos con la enfermedad.