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1.
Plant Cell ; 36(7): 2587-2606, 2024 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-38536743

RESUMO

Cold stress affects plant immune responses, and this process may involve the salicylic acid (SA) signaling pathway. However, the underlying mechanism by which low-temperature signals coordinate with SA signaling to regulate plant immunity remains unclear. Here, we found that low temperatures enhanced the disease resistance of Arabidopsis thaliana against Pseudomonas syringae pv. tomato DC3000. This process required INDUCER OF CBF EXPRESSION 1 (ICE1), the core transcription factor in cold-signal cascades. ICE1 physically interacted with NONEXPRESSER OF PATHOGENESIS-RELATED GENES 1 (NPR1), the master regulator of the SA signaling pathway. Enrichment of ICE1 on the PATHOGENESIS-RELATED GENE 1 (PR1) promoter and its ability to transcriptionally activate PR1 were enhanced by NPR1. Further analyses revealed that cold stress signals cooperate with SA signals to facilitate plant immunity against pathogen attack in an ICE1-dependent manner. Cold treatment promoted interactions of NPR1 and TGACG-BINDING FACTOR 3 (TGA3) with ICE1 and increased the ability of the ICE1-TGA3 complex to transcriptionally activate PR1. Together, our results characterize a critical role of ICE1 as an indispensable regulatory node linking low-temperature-activated and SA-regulated immunity. Understanding this crucial role of ICE1 in coordinating multiple signals associated with immunity broadens our understanding of plant-pathogen interactions.


Assuntos
Proteínas de Arabidopsis , Arabidopsis , Regulação da Expressão Gênica de Plantas , Doenças das Plantas , Imunidade Vegetal , Pseudomonas syringae , Ácido Salicílico , Transdução de Sinais , Ácido Salicílico/metabolismo , Proteínas de Arabidopsis/metabolismo , Proteínas de Arabidopsis/genética , Arabidopsis/genética , Arabidopsis/imunologia , Arabidopsis/microbiologia , Arabidopsis/metabolismo , Imunidade Vegetal/genética , Pseudomonas syringae/patogenicidade , Pseudomonas syringae/fisiologia , Doenças das Plantas/microbiologia , Doenças das Plantas/imunologia , Doenças das Plantas/genética , Resistência à Doença/genética , Temperatura Baixa , Fatores de Transcrição de Zíper de Leucina Básica/metabolismo , Fatores de Transcrição de Zíper de Leucina Básica/genética , Fatores de Transcrição/metabolismo , Fatores de Transcrição/genética , Regiões Promotoras Genéticas/genética
2.
Plant Physiol ; 191(4): 2519-2533, 2023 04 03.
Artigo em Inglês | MEDLINE | ID: mdl-36715300

RESUMO

ABSCISIC ACID-INSENSITIVE3 (ABI3) and ABI5 are 2 crucial transcription factors in abscisic acid (ABA) signaling, and their homeostasis at the protein level plays a decisive role in seed germination and subsequent seedling growth. Here, we found that PLANT U-BOX 8 (PUB8), a U-box E3 ubiquitin ligase, physically interacts with ABI3 and ABI5 and negatively regulates ABA responses during early Arabidopsis (Arabidopsis thaliana) seedling growth. Loss-of-function pub8 mutants were hypersensitive to ABA-inhibited cotyledon greening, while lines overexpressing PUB8 with low levels of ABI5 protein abundance were insensitive to ABA. Genetic analyses showed that ABI3 and ABI5 were required for the ABA-sensitive phenotype of pub8, indicating that PUB8 functions upstream of ABI3 and ABI5 to regulate ABA responses. Biochemical analyses showed that PUB8 can associate with ABI3 and ABI5 for degradation through the ubiquitin-mediated 26S proteasome pathway. Correspondingly, loss-of-function of PUB8 led to enhanced ABI3 and ABI5 stability, while overexpression of PUB8 impaired accumulation of ABI3 and ABI5 in planta. Further phenotypic analysis indicated that PUB8 compromised the function of ABI5 during early seedling growth. Taken together, our results reveal the regulatory role of PUB8 in modulating the early seedling growth by controlling the homeostasis of ABI3 and ABI5.


Assuntos
Proteínas de Arabidopsis , Arabidopsis , Ácido Abscísico/farmacologia , Ácido Abscísico/metabolismo , Plântula/metabolismo , Proteínas de Arabidopsis/metabolismo , Ubiquitina-Proteína Ligases/genética , Ubiquitina-Proteína Ligases/metabolismo , Fatores de Transcrição de Zíper de Leucina Básica/genética , Fatores de Transcrição de Zíper de Leucina Básica/metabolismo , Germinação/genética , Transdução de Sinais , Arabidopsis/metabolismo , Regulação da Expressão Gênica de Plantas , Sementes/genética
3.
Heart Vessels ; 39(7): 640-645, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38310515

RESUMO

OBJECTIVE: To assess whether a new strategy for the choice of inferior vena cava filter placed would improve filter retrieval rates at our institution. METHODS: Consecutive patients who underwent retrievable filter placement for temporary embolic protection between January 2021 and January 2023 were considered for study inclusion. Risk factors for nonretrieval of short-term filters were identified in patients receiving filters between January 2021 and January 2022 (prestrategy group). For patients treated between February 2022 and January 2023 (poststrategy group), a long-term filter was recommended for those with these risk factors, and a short-term filter was recommended for those without these risk factors. RESULTS: The study population included 303 patients (prestrategy group, n = 154; poststrategy group, n = 149). Long-term immobilization (odds ratio [OR] = 38.000; 95% confidence interval [CI]: 6.858-210.564), active cancer (OR = 17.643; 95% CI: 5.462-56.993), and venous thromboembolism detected in the intensive care unit (OR = 28.500; 95% CI: 7.419-109.477) were identified as independent risk factors for nonretrieval of short-term filters. The total retrieval rate was significantly higher in the poststrategy group (87.2%) than in the prestrategy group (72.7%; P = 0.002); the short-term filter retrieval rate was also significantly higher in the poststrategy group (84.5%) than in the prestrategy group (68.5%; P < 0.001). CONCLUSION: The proposed strategy for filter choice based on risk factors for short-term filter nonretrieval can accurately identify patients who need long-term filter placement while also increasing the retrieval rates for both short-term filters retrieval rates and overall retrieval rates.


Assuntos
Remoção de Dispositivo , Filtros de Veia Cava , Humanos , Filtros de Veia Cava/efeitos adversos , Remoção de Dispositivo/métodos , Feminino , Masculino , Fatores de Risco , Estudos Retrospectivos , Pessoa de Meia-Idade , Idoso , Embolia Pulmonar/prevenção & controle , Fatores de Tempo , Veia Cava Inferior/diagnóstico por imagem , Desenho de Prótese
4.
Ann Vasc Surg ; 99: 349-355, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37852367

RESUMO

BACKGROUND: To assess the characteristics of Option and Denali filters and to identify associations between these characteristics in each filter type. METHODS: Consecutive patients who underwent Option or Denali filter placement between August 2019 and August 2022 were included in this retrospective study. RESULTS: A total of 119 patients (Option, n = 60; Denali, n = 59) were included. The retrieval rates were 45.0% for Option filters and 40.7% for Denali filters. The incidence of tilt at placement was higher for Option filters (76.7%) than for Denali filters (11.9%; P < 0.001). The tilt angle of Option filters at placement was correlated with the common iliac vein-inferior vena cava (CIV-IVC) angle. The incidence of tilt angle change after placement was higher for Option filters (74.1%) than for Denali filters (8.3%; P = 0.001). The IVC contraction rate after retrieval of Option is less than Denali (22.2% vs. 87.5%, P < 0.001). The median fluoroscopy time during Option filter retrieval was longer than during Denali filter retrieval. The fluoroscopic time was related to tilt angle during retrieval of Option filters. CONCLUSIONS: Option filters are more likely than Denali filters to tilt at placement, and the tilt angle of Option filters is more prone to change after placement. The tilt angle at placement in Option filters is related to the CIV-IVC angle. Option filters require a longer fluoroscopic time during retrieval than Denali filters, and this increased fluoroscopic time is related to the tilt angle. Denali is more likely to cause IVC constriction after placement.


Assuntos
Filtros de Veia Cava , Humanos , Estudos Retrospectivos , Resultado do Tratamento , Remoção de Dispositivo , Fatores de Tempo , Veia Cava Inferior/diagnóstico por imagem
5.
J Vasc Interv Radiol ; 32(1): 49-55, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33248917

RESUMO

PURPOSE: To investigate the safety and effectiveness of primary conservative therapy for patients with symptomatic isolated mesenteric artery dissection (IMAD) with a severely compressed true lumen and/or a large dissecting aneurysm. MATERIALS AND METHODS: A total of 35 consecutive patients (all men; median age, 53 y) with symptomatic IMAD with a severely compressed true lumen and/or a large dissecting aneurysm but without intestinal necrosis or arterial rupture who were treated with primary conservative therapy between November 2018 and February 2020 were assessed. A severely compressed true lumen was defined as luminal stenosis > 70%. A large dissecting aneurysm was defined as dissecting aneurysm diameter ≥ 1.5 times larger than the normal mesenteric artery diameter. RESULTS: There was a strong positive relationship among abdominal pain, degree of luminal stenosis, and length of dissection (R = 0.811; P < .001). Conservative treatment was successful in all patients. Abdominal pain was eliminated within 4.7 d ± 4.8 (range, 2-31 d) in all patients, within 3.6 d ± 1.2 (range, 2-6) in the 31 patients with minor or moderate abdominal pain, and within 13.3 d ± 11.9 (range, 6-31 d) in the 4 patients with severe abdominal pain. Complete or partial remodeling of the mesenteric artery was achieved in 6 (17.1%) and 29 (82.9%) patients, respectively, during 8.6 mo ± 4.3 of follow-up. CONCLUSIONS: Primary conservative therapy can be used safely and effectively in patients with symptomatic IMAD with a severely compressed true lumen and/or a large dissecting aneurysm but without intestinal necrosis or arterial rupture.


Assuntos
Dor Abdominal/prevenção & controle , Dissecção Aórtica/terapia , Tratamento Conservador , Artéria Mesentérica Inferior , Artéria Mesentérica Superior , Oclusão Vascular Mesentérica/terapia , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adulto , Idoso , Dissecção Aórtica/complicações , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/fisiopatologia , China , Tratamento Conservador/efeitos adversos , Humanos , Masculino , Artéria Mesentérica Inferior/diagnóstico por imagem , Artéria Mesentérica Inferior/fisiopatologia , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/fisiopatologia , Oclusão Vascular Mesentérica/complicações , Oclusão Vascular Mesentérica/diagnóstico por imagem , Oclusão Vascular Mesentérica/fisiopatologia , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
6.
Ann Vasc Surg ; 61: 371-376, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31394218

RESUMO

BACKGROUND: The aim of this study is to retrospectively evaluate the safety and effectiveness of forceps-assisted removal of difficult-to-retrieve filters. METHODS: Patients who underwent forceps-assisted removal of difficult-to-retrieve filters (filters that could not be successfully removed with the standard loop-snare technique) between February 2008 and February 2019 were included in this study. Patients underwent forceps-assisted filter removal either immediately after failed loop-snare removal (same procedure) or at a later time (separate procedure). Data regarding success rate, X-ray exposure time, and complications were recorded. RESULTS: A total of 27 patients (14 men, 13 women; mean age 57.9 ± 12.6 years) were included in this study. The mean indwelling time of the filters was 10.9 ± 10.7 months. All filters were successfully removed. The mean X-ray exposure time was 25.9 ± 12.7 min (range 8-55) for all patients; the mean X-ray exposure times were 10.2 ± 2.3 min (range 8-14) for the 5 patients who underwent forceps-assisted filter removal in a separate procedure and 29.5 ± 11.2 min (range 15-55) for the 22 patients who underwent forceps-assisted filter removal immediately after failure of the loop-snare technique (P < 0.001). Two patients (8.3%) experienced extravasation of contrast material and needed no additional treatment. No major complications occurred. CONCLUSIONS: Forceps-assisted filter retrieval can be used to safely and effectively remove difficult-to-retrieve filters.


Assuntos
Remoção de Dispositivo/instrumentação , Implantação de Prótese/instrumentação , Instrumentos Cirúrgicos , Filtros de Veia Cava , Adulto , Idoso , Remoção de Dispositivo/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dados Preliminares , Doses de Radiação , Exposição à Radiação , Radiografia Intervencionista , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
7.
Mol Ecol ; 24(4): 851-62, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25581246

RESUMO

Many species exhibit transgenerational plasticity by which environmental cues experienced by either parent can be transmitted to their offspring, resulting in phenotypic variants in offspring to match ancestral environments. However, the manner by which paternal experiences affect offspring plasticity through epigenetic inheritance in animals generally remains unclear. In this study, we examined the transgenerational effects of population density on phase-related traits in the migratory locust Locusta migratoria. Using an experimental design that explicitly controls genetic background, we found that the effects of crowd or isolation rearing on phase plasticity could be inherited to the offspring. The isolation of gregarious locusts resulted in reduced weight in offspring eggs and altered morphometric traits in hatchlings, whereas crowding of solitarious locusts exhibited opposite effects. The consequences of density changes were transmitted by both maternal and paternal inheritance, although the expression of paternal effects was not as pronounced as that of maternal effects. Prominent expression of heat-shock proteins (Hsps), such as Hsp90, Hsp70 and Hsp20.6, could be triggered by density changes. Hsps were significantly upregulated upon crowding but downregulated upon isolation. The variation in parental Hsp expression was also transmitted to the offspring, in which the pattern of inheritance was consistent with that of phase characteristics. These results revealed a paternal effect on phase polyphenism and Hsp expression induced by population density, and defined a model system that could be used to study the paternal epigenetic inheritance of environmental changes.


Assuntos
Epigênese Genética , Proteínas de Choque Térmico/genética , Locusta migratoria/genética , Animais , Meio Ambiente , Feminino , Genes de Insetos , Padrões de Herança , Locusta migratoria/anatomia & histologia , Masculino , Óvulo/fisiologia , Fenótipo , Densidade Demográfica
8.
Hepatogastroenterology ; 61(135): 2042-6, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25713908

RESUMO

PURPOSE: To evaluate the efficacy and safety of supplemental transcatheter arterial chemoembolization (TACE) through the extrahepatic collateral omental artery (OA) for hepatocellular carcinoma (HCC). METHODS: We retrospective evaluated extrahepatic collateral OA on 34 patients, among 1826 patients with HCC who had undergone TACE. TACE of the OA was performed, and the dosage of emulsion was judged by tumor size and achievement of stagnant arterial flow. RESULTS: Blood supply from the OA was demonstrated at the initial TACE in 7 patients, and after several TACE (mean 2.8th) sessions in 27 patients. The technical success rate was 100%. Total occlusion of the OA collateral was achieved in 85.3%. On one month later, complete, more than 50% and less than 50% uptake of iodized oil in the tumor were in 12, 16, and 6 patients, respectively. Alpha-fetoprotein level 1 month later was significantly lower than pre-procedure (P<0.05). There was no serious complication that related to the omental embolization. The cumulative survival rates at 6, 12 months were 94.1%, 85.3%, respectively. CONCLUSION: TACE of the OA is safe and reduce the incidence of post-TACE recurrence and/or residual of HCC, and could improve the therapeutic effect of TACE in the treatment of HCC.


Assuntos
Carcinoma Hepatocelular/irrigação sanguínea , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica , Circulação Colateral , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/terapia , Omento/irrigação sanguínea , Adulto , Idoso , Artérias/fisiopatologia , Carcinoma Hepatocelular/sangue , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Quimioembolização Terapêutica/efeitos adversos , Quimioembolização Terapêutica/mortalidade , Feminino , Humanos , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento , alfa-Fetoproteínas/metabolismo
9.
Sci China Life Sci ; 67(6): 1242-1254, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38478296

RESUMO

RNA N6-methyladenosine (m6A), as the most abundant modification of messenger RNA, can modulate insect behaviors, but its specific roles in aggregation behaviors remain unexplored. Here, we conducted a comprehensive molecular and physiological characterization of the individual components of the methyltransferase and demethylase in the migratory locust Locusta migratoria. Our results demonstrated that METTL3, METTL14 and ALKBH5 were dominantly expressed in the brain and exhibited remarkable responses to crowding or isolation. The individual knockdown of methyltransferases (i.e., METTL3 and METTL14) promoted locust movement and conspecific attraction, whereas ALKBH5 knockdown induced a behavioral shift toward the solitary phase. Furthermore, global transcriptome profiles revealed that m6A modification could regulate the orchestration of gene expression to fine tune the behavioral aggregation of locusts. In summary, our in vivo characterization of the m6A functions in migratory locusts clearly demonstrated the crucial roles of the m6A pathway in effectively modulating aggregation behaviors.


Assuntos
Adenosina , Locusta migratoria , Metiltransferases , Animais , Adenosina/metabolismo , Adenosina/análogos & derivados , Locusta migratoria/genética , Locusta migratoria/fisiologia , Locusta migratoria/metabolismo , Metiltransferases/metabolismo , Metiltransferases/genética , Comportamento Animal/fisiologia , Encéfalo/metabolismo , Encéfalo/fisiologia , Transcriptoma , Homólogo AlkB 5 da RNA Desmetilase/metabolismo , Homólogo AlkB 5 da RNA Desmetilase/genética , Regulação da Expressão Gênica , Proteínas de Insetos/genética , Proteínas de Insetos/metabolismo , Gafanhotos/genética , Gafanhotos/fisiologia , Gafanhotos/metabolismo
10.
Curr Biol ; 2024 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-39406243

RESUMO

The brown planthopper (BPH) is the most destructive insect pest in rice. Through a stylet, BPH secretes a plethora of salivary proteins into rice phloem cells as a crucial step of infestation. However, how various salivary proteins function in rice cells to promote insect infestation is poorly understood. Among them, one of the salivary proteins is predicted to be a carbonic anhydrase (Nilaparvata lugens carbonic anhydrase [NlCA]). The survival rate of the NlCA-RNA interference (RNAi) BPH insects was extremely low on rice, indicating a vital role of this salivary protein in BPH infestation. We generated NlCA transgenic rice plants and found that NlCA expressed in rice plants could restore the ability of NlCA-RNAi BPH to survive on rice. Next, we produced rice plants expressing the ratiometric pH sensor pHusion and found that NlCA-RNAi BPH induced rapid intracellular acidification of rice cells during feeding. Further analysis revealed that both NlCA-RNAi BPH feeding and artificial lowering of intracellular pH activated plant defense responses and that NlCA-mediated intracellular pH stabilization is linked to diminished defense responses, including reduced callose deposition at the phloem sieve plates and suppressed defense gene expression. Given the importance of pH homeostasis across the kingdoms of life, discovery of NlCA-mediated intracellular pH modulation uncovered a new dimension in the interaction between plants and piercing/sucking insect pests. The crucial role of NlCA for BPH infestation of rice suggests that NlCA is a promising target for chemical or trans-kingdom RNAi-based inactivation for BPH control strategies in plants.

11.
Plant Sci ; 332: 111728, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37160206

RESUMO

Soil salinity causes crop losses worldwide. Root hairs are the primary targets of salt stress, however, the signaling networks involved in the precise regulation of root hair growth and development by salinity are poorly understood. Here, we confirmed that salt stress inhibits the number and length of root hairs in Arabidopsis. We found that the master regulator of root hair development and growth, the RHD6 transcription factor, is involved in this process, as salt treatment largely compromised root hair overaccumulation in RHD6-overexpressing plants. Yeast-two-hybrid and co-immunoprecipitation analyses revealed that RHD6 physically interacts with ABF proteins, the master transcription factors in abscisic acid signaling, which is involved in tolerance to several stresses including salinity. Phenotypic analyses showed that ABF proteins, which function upstream of RHD6, positively modulate the salinity-induced inhibition of root hair development. Further analyses showed that ABF3 suppresses the transcriptional activation activity of RHD6, thereby regulating the expression of genes related to root hair development. Overexpression of ABF3 reduced the root hair-overgrowing phenotype of RHD6-overexpressing plants. Collectively, our results demonstrate an essential signaling module in which ABF proteins directly suppress the transcriptional activation activity of RHD6 to reduce the length and number of root hairs under salt stress conditions.


Assuntos
Proteínas de Arabidopsis , Arabidopsis , Arabidopsis/metabolismo , Proteínas de Arabidopsis/genética , Proteínas de Arabidopsis/metabolismo , Salinidade , Fatores de Transcrição/genética , Fatores de Transcrição/metabolismo , Regulação da Expressão Gênica , Regulação da Expressão Gênica de Plantas , Plantas Geneticamente Modificadas/genética , Raízes de Plantas/metabolismo , Fatores de Transcrição Hélice-Alça-Hélice Básicos/metabolismo
15.
Cell Prolif ; 54(3): e12986, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33432610

RESUMO

OBJECTIVES: Mitophagy is considered to be a key mechanism in the pathogenesis of intestinal ischaemic reperfusion (IR) injury. NOD-like receptor X1 (NLRX1) is located in the mitochondria and is highly expressed in the intestine, and is known to modulate ROS production, mitochondrial damage, autophagy and apoptosis. However, the function of NLRX1 in intestinal IR injury is unclear. MATERIALS AND METHODS: NLRX1 in rats with IR injury or in IEC-6 cells with hypoxia reoxygenation (HR) injury were measured by Western blotting, real-time PCR and immunohistochemistry. The function of NLRX1-FUNDC1-NIPSNAP1/NIPSNAP2 axis in mitochondrial homeostasis and cell apoptosis were assessed in vitro. RESULTS: NLRX1 is significantly downregulated following intestinal IR injury. In vivo studies showed that rats overexpressing NLRX1 exhibited resistance against intestinal IR injury and mitochondrial dysfunction. These beneficial effects of NLRX1 overexpression were dependent on mitophagy activation. Functional studies showed that HR injury reduced NLRX1 expression, which promoted phosphorylation of FUN14 domain-containing 1 (FUNDC1). Based on immunoprecipitation studies, it was evident that phosphorylated FUNDC1 could not interact with the mitophagy signalling proteins NIPSNAP1 and NIPSNAP2 on the outer membrane of damaged mitochondria, which failed to launch the mitophagy process, resulting in the accumulation of damaged mitochondria and epithelial apoptosis. CONCLUSIONS: NLRX1 regulates mitophagy via FUNDC1-NIPSNAP1/NIPSNAP2 signalling pathway. Thus, this study provides a potential target for the development of a therapeutic strategy for intestinal IR injury.


Assuntos
Isquemia/metabolismo , Proteínas de Membrana/metabolismo , Mitocôndrias/metabolismo , Proteínas Mitocondriais/metabolismo , Mitofagia/fisiologia , Traumatismo por Reperfusão Miocárdica/metabolismo , Animais , Autofagia/fisiologia , Intestinos/patologia , Masculino , Ratos Sprague-Dawley
20.
Anesth Analg ; 109(4): 1079-84, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19762735

RESUMO

BACKGROUND: Removal of an airway foreign body (FB) is usually performed by rigid bronchoscopy under general anesthesia, but the choice of anesthesia and ventilation techniques varies greatly among anesthesiologists and institutions. Hypoxemia is the most commonly observed adverse event during rigid bronchoscopy. It is influenced by a variety of factors including the patient's medical condition, the type of surgical procedure, and the anesthetic technique. In the current study, we investigated risk factors that statistically correlate with intraoperative or postoperative hypoxemia in young patients undergoing rigid bronchoscopy. METHODS: From January 2007 to December 2008, 384 children younger than 5-yr-of-age subjected to rigid bronchoscopy for FB removal were included in the study. The detailed clinical information and perioperative adverse events were recorded. Surgical outcomes and incidence of perioperative adverse events were compared among different ventilation modes (spontaneous ventilation, manual intermittent positive pressure ventilation, and manual jet ventilation) and different anesthetic techniques (total IV anesthesia and inhaled anesthesia). An amalgamated dataset was used for the analysis of factors that correlated with perioperative hypoxemia. RESULTS: In children who received total IV anesthesia with spontaneous ventilation during rigid bronchoscopy, we observed more intraoperative body movement and breath holding, significantly longer duration of emergence from anesthesia, lower percentage of successful FB removal, and more postoperative laryngospasm. Children in the manual jet ventilation group had the least occurrence of intraoperative hypoxemia. Five factors strongly correlated with intraoperative hypoxemia. Younger age, plant seed as the type of FB, longer surgical duration, pneumonia before the procedure, and spontaneous ventilation mode significantly increased the risk of intraoperative hypoxemia, whereas manual jet ventilation mode decreased it. Two factors were associated with postoperative hypoxemia: plant seed as a FB and prolonged duration of emergence from anesthesia. CONCLUSION: We identified risk factors associated with intraoperative or with postoperative hypoxemia in rigid bronchoscopy which included patient age, type of FB, duration of surgical procedure, pneumonia before the procedure, ventilation mode, and duration of emergence from anesthesia. These results provide evidence that will help clinicians to reduce the incidence of hypoxemia in high-risk children.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Broncoscopia/efeitos adversos , Corpos Estranhos/cirurgia , Hipóxia/etiologia , Fatores Etários , Anestesia/efeitos adversos , Período de Recuperação da Anestesia , Pré-Escolar , Feminino , Humanos , Lactente , Modelos Logísticos , Masculino , Razão de Chances , Pneumonia/complicações , Estudos Prospectivos , Respiração Artificial/efeitos adversos , Medição de Risco , Fatores de Risco , Fatores de Tempo
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