Analysis of airway structural parameters in Han Chinese adults: a prospective cross-sectional study.

INTRODUCTION: Establishing reference ranges for central airway parameters and exploring their influencing factors in Han Chinese non-smoking adults. METHODS: This prospective cross-sectional study was conducted on Han Chinese non-smoking adults who underwent chest CT scans at the Tongzhou Campus of Dongzhimen Hospital Affiliated with the Beijing University of Chinese Medicine between September 2022 and November 2022. The SYNAPSE 3D image analysis software was utilized, enabling the extraction of critical parameters such as central airway length, airway wall thickness (AWT), airway lumen area (ALA), and subcarinal angle (SCA). Pearson's correlation coefficient analysis and multiple linear regression analysis methods were employed to evaluate the relationship between central airway parameters and age, sex, weight, and height. RESULTS: The study encompassed 888 Han Chinese non-smoking adults, comprising 456 females and 432 males. Significant sex differences were noted in central airway length, AWT, and ALA, with measurements in males exceeding those in females (p < 0.01) with no significant difference in SCA. Correlation analyses unveiled relationships between central airway parameters and age, sex, weight, and height. During multiple linear regression analyses, no conclusive evidence emerged to demonstrate the independent or combined explanatory or predictive capacity of the aforementioned variables for central airway length and SCA. Although sex has a significant impact on AWT and ALA, its capability in explanation or prediction remains limited. The conclusions drawn from the primary analysis receive reinforcement from the outcomes of sensitivity analyses. CONCLUSION: Establishing the distribution range of central airway parameters in non-smoking Han Chinese adults. It observed significant sex differences in these parameters, except for the SCA. However, the study found that the predictive or explanatory power of age, sex, weight, and height for central airway parameters was either limited or non-significant.

Morbimortalidade por doenças do aparelho respiratório no brasil: um estudo ecológico / Morbimortality from respiratory system diseases in Brazil: an ecological study / Morbimortalidad por enfermedades del sistema respiratorio en Brasil: un estudio ecológico

Introdução:As doenças do aparelho respiratório se configuram como o segundo principal motivo de internações hospitalares no Brasil entre 2013 e 2017. Objetivo:Analisar a morbimortalidade de doenças do aparelho respiratório da população brasileira, segundo faixa etária,no período compreendido entre os anos de 2015 a 2019. Metodologia:Trata-se de um estudo do tipo ecológico, retrospectivo, realizado sobre o território brasileiro. Os dados foram coletados a partir do Departamento de Informática do Sistema Único de Saúde, nas seções de Morbidade Hospitalar, de Mortalidade e População Residente. Foram analisados os dados entre 2015 a 2019 e de todas as faixas etárias. Resultados:Ao investigar a mortalidade por doenças do sistema respiratório entre os anos de 2015 e 2019, as cinco causas mais frequentes foram: influenza e pneumonia; doenças crônicas das vias aéreas inferiores; outras doenças do aparelho respiratório; outras doenças respiratórias que afetam principalmente interstício; doenças pulmonares devidas a agentes externos, nessa ordem. Enquanto as cinco causas de morbidades mais frequentes foram: pneumonia; outras doenças do aparelho respiratório; bronquite, enfisema e outras doenças pulmonares obstrutivas crônicas; asma; bronquite aguda e bronquiolite aguda. Conclusões:Verificou-se que a pneumonia, influenza, doenças respiratórias do trato inferior e outras doenças crônicas respiratórias foram as mais prevalentes entre a população respectivamente. Dentre o público mais acometido, foi possível constatar que o público infantil e a população idosa foram os mais atingidos tanto na mortalidade quanto na morbidade (AU).

Introduction:Introduction: Respiratory diseases are the second main reason for hospital admissions in Brazil between 2013 and 2017. Objective:To analyze the morbidity and mortality of respiratory diseases of the Brazilian population, according to age group, in the period from 2015 to 2019. Methodology:This is an ecological, retrospective study conducted on the Brazilian territory. Data were collected from the Informatics Department of the Unified Health System, in the Sections of Hospital Morbidity, Mortality and Resident Population. Data were analyzed between 2015 and 2019 and all age groups. Results:When investigating mortality from respiratory system diseases between 2015 and 2019, the five most frequent causes were: influenza and pneumonia; chronic diseases of the lower airways; other diseases of the respiratory system; other respiratory diseases that mainly affect interstitium; diseases due to external agents, in that order. Conclusions:It was found that pneumonia, influenza, respiratory diseases of the lower tract and other chronic respiratory diseases were the most prevalent among the population, respectively. Among the most affected public, it was possible to observe that the child's public and the elderly population were the most affected in both mortality and morbidity (AU).

Introducción: Las enfermedades respiratorias son la segunda razón principal de los ingresos hospitalarios en Brasil entre 2013 y 2017. Objetivo: Analizar la morbilidad y mortalidad de las enfermedades respiratorias de la población brasileña, según el grupo de edad, en el período comprendido entre 2015 y 2019.Metodología: Se trata de un estudio ecológico y retrospectivo realizado en territorio brasileño. Los datos fueron recogidos del Departamento de Informática del Sistema Unificado de Salud, en las Secciones de Morbilidad Hospitalaria, Mortalidad y Población Residente. Los datos se analizaron entre 2015 y 2019 y todos los grupos de edad. Resultados: Al investigar la mortalidad por enfermedades del sistema respiratorio entre 2015 y 2019, las cinco causas más frecuentes fueron: gripe y neumonía; enfermedades crónicas de las vías respiratorias inferiores; otras enfermedades del sistema respiratorio; otras enfermedades respiratorias que afectan principalmente al intersticio; enfermedades debidas a agentes externos, en ese orden.Mientras que las cinco causas más frecuentes de morbilidad fueron: neumonía; otras enfermedades del sistema respiratorio; bronquitis, enfisema y otras enfermedades pulmonares obstructivas crónicas; asma; bronquiolitis aguda y bronquiolitis aguda. While the five most frequent causes of morbidities were: pneumonia; other diseases of the respiratory system; bronchitis, emphysema and other chronic obstructive pulmonary diseases; asthma; acute bronchitis and acute bronchiolitis. Conclusiones: Se encontróque la neumonía, la influenza, las enfermedades respiratorias de las vías inferiores y otras enfermedades respiratorias crónicas eran las más prevalentes entre la población, respectivamente. Entre el público más afectado, se pudo observar que el público del niño y la población de edad avanzada eran los más afectados tanto en la mortalidad como en la morbilidad (AU).

Comparison of VividTrac, King Vision and Macintosh laryngoscopes in normal and difficult airways during simulated cardiopulmonary resuscitation among novices.

INTRODUCTION: Early endotracheal intubation improves neurological outcomes in cardiopulmonary resuscitation, although cardiopulmonary resuscitation is initially carried out by personnel with limited experience in a significant proportion of cases. Videolaryngoscopes might decrease the number of attempts and time needed, especially among novices. We sought to compare videolaryngoscopes with direct laryngoscopes in simulated cardiopulmonary resuscitation scenarios. MATERIALS AND METHODS: Forty-four medical students were recruited to serve as novice users. Following brief, standardized training, students executed endotracheal intubation with the King Vision®, Macintosh and VividTrac® laryngoscopes, on a cardiopulmonary resuscitation trainer in normal and difficult airway scenarios. We evaluated the time to and proportion of successful intubation, the best view of the glottis, esophageal intubation, dental trauma and user satisfaction. RESULTS: In the normal airway scenario, significantly shorter intubation times were achieved using the King Vision® than the Macintosh laryngoscope. In the difficult airway scenario, we found that the VividTrac® was superior to the King Vision® and Macintosh laryngoscopes in the laryngoscopy time. In both scenarios, we noted no difference in the first-attempt success rate, but the best view of the glottis and dental trauma, esophageal intubation and bougie use were more frequent with the Macintosh laryngoscope than with the videolaryngoscopes. The shortest tube insertion times were achieved using the King Vision® in both scenarios. CONCLUSION: All providers achieved successful intubation within three attempts, but we found no device superior in any of our scenarios regarding the first-attempt success rate. The King Vision® was superior to the Macintosh laryngoscope in the intubation time in the normal airway scenario and noninferior in the difficult airway scenario for novice users. We noted significantly less esophageal intubation using the videolaryngoscopes than using the Macintosh laryngoscope in both scenarios. Based on our results, the KingVision® might be recommended over the VividTrac® and Macintosh laryngoscopes for further evaluation.

Anatomic and histologic analysis of paca larynx (Cuniculus paca, Linnaeus 1766) / [Análise anatômica e histológica da laringe da paca (Cuniculus paca, Linnaeus 1766)]

Paca (Cuniculus paca) has encouraged research as an experimental model both in the human medicine and veterinary, as well as the economic exploitation of its meat cuts, which favored its zootechnical use. There are no anatomical, microscopic descriptions and measurements of the larynx in this rodent. Eight pacas were dissected from the wild animal's sector of the Faculty of Agricultural and Veterinary Sciences of the University of the State of São Paulo. The larynx was observed located in the ventral region of the neck, ventral to the esophagus, connecting the pharynx to the trachea, with cylindrical and irregular shape. Laryngeal cartilages (epiglottic, thyroid, cricoid and arytenoid) are interconnected and have different shapes. Thyroid showed greater length and width, compared to the others. Laryngeal cartilages were submitted to histological processing and stained with hematoxylin-eosin and Masson's trichrome. The epiglottic cartilage was stained with toluidine blue. Laryngeal cartilages thyroid, cricoid and the lower portion of the arytenoids are of hyaline origin and, in contrast, the epiglottis and the upper portion of the arytenoids are elastic. This latter cartilage demonstrated taste buds. The results will be able to auxiliate in veterinary care and as well as the conservation programs for this rodent.(AU)

A paca (Cuniculus paca) tem encorajado inúmeras pesquisas, tornando-a modelo experimental tanto em humanos como na veterinária, além da exploração econômica de seus cortes cárneos, que favoreceu diretamente sua importância zootécnica. Não há descrições anatômicas, microscópicas e mensurações da laringe desse roedor. Foram dissecadas oito laringes de pacas, provenientes do setor de Animais Silvestres da Faculdade de Ciências Agrárias e Veterinárias - Universidade Estadual Paulista. Observou-se que a laringe localiza-se na região ventral do pescoço, ventral ao esôfago, conectando a faringe à traqueia, possuindo formato cilíndrico e irregular. As cartilagens laríngeas (epiglote, tireóide, cricóide e aritenóidea) são interligadas e possuem formatos variados. A cartilagem tireóide demonstrou-se maior em comprimento e largura, comparativamente às demais. As cartilagens laríngeas foram submetidas a processamento histológico e coradas em hematoxilina-eosina e tricrômio de Masson. A cartilagem epiglote foi corada em azul de toluidina. As cartilagens laríngeas tireóide, cricóide e a porção inferior das aritenóides são de origem hialina; em contrapartida, a epiglote e a porção superior das aritenóides, de origem elástica. Esta última cartilagem demonstrou corpúsculos gustativos. Os resultados poderão auxiliar tanto nos atendimentos veterinários quanto nos programas de conservação desse roedor.(AU)

The evaluation of maximum condyle-tragus distance can predict difficult airway management without exposing upper respiratory tract; a prospective observational study.

BACKGROUND: Routine preoperative methods to assess airway such as the interincisor distance (IID), Mallampati classification, and upper lip bite test (ULBT) have a certain risk of upper respiratory tract exposure and virus spread. Condyle-tragus maximal distance(C-TMD) can be used to assess the airway, and does not require the patient to expose the upper respiratory tract, but its value in predicting difficult laryngoscopy compared to other indicators (Mallampati classification, IID, and ULBT) remains unknown. The purpose of this study was to observe the value of C-TMD to predict difficult laryngoscopy and the influence on intubation time and intubation attempts, and provide a new idea for preoperative airway assessment during epidemic. METHODS: Adult patients undergoing general anesthesia and tracheal intubation were enrolled. IID, Mallampati classification, ULBT, and C-TMD of each patient were evaluated before the initiation of anesthesia. The primary outcome was intubation time. The secondary outcomes were difficult laryngoscopy defined as the Cormack-Lehane Level > grade 2 and the number of intubation attempts. RESULTS: Three hundred four patients were successfully enrolled and completed the study, 39 patients were identified as difficult laryngoscopy. The intubation time was shorter with the C-TMD>1 finger group 46.8 ± 7.3 s, compared with the C-TMD<1 finger group 50.8 ± 8.6 s (p<0.01). First attempt success rate was higher in the C-TMD>1 finger group 98.9% than in the C-TMD<1 finger group 87.1% (P<0.01). The correlation between the C-TMD and Cormack-Lehane Level was 0.317 (Spearman correlation coefficient, P<0.001), and the area under the ROC curve was 0.699 (P<0.01). The C-TMD < 1 finger width was the most consistent with difficult laryngoscopy (κ = 0.485;95%CI:0.286-0.612) and its OR value was 10.09 (95%CI: 4.19-24.28), sensitivity was 0.469 (95%CI: 0.325-0.617), specificity was 0.929 (95%CI: 0.877-0.964), positive predictive value was 0.676 (95%CI: 0.484-0.745), negative predictive value was 0.847 (95%CI: 0.825-0.865). CONCLUSION: Compared with the IID, Mallampati classification and ULBT, C-TMD has higher value in predicting difficult laryngoscopy and does not require the exposure of upper respiratory tract. TRIAL REGISTRATION: The study was registered on October 21, 2019 in the Chinese Clinical Trial Registry ( ChiCTR1900026775 ).

Vocal tract physiology and its MRI evaluation / Fisiología del tracto vocal y su evaluación por resonancia magnética

Introduction. The rapid technological evolution in Magnetic Resonance Imaging (MRI) has recently offered a great opportunity for the analysis of voice production.Objectives. This article is aimed to describe main physiological principles at the base of voice production (in particular of vocal tract), and an overview about liter-ature on MRI of the vocal tract. This is presented in order to analyze both present results and future perspectives.Method. A narrative review was performed by searching the MeSH terms "vocal tract" and "MRI" in Pub Med database. Then, the obtained studies were subse-quently selected by relevancy.Results. Main fields described in literature concern technical feasibility and op-timization of MRI sequences, modifications of vocal tract in vowel or articulatory phonetics, modifications of vocal tract in singing, 3D reproduction of vocal tract and segmentation, and describing vocal tract in pathological conditions.Conclusions. MRI is potentially the best method to study the vocal tract physi-ology during voice production. Most recent studies have achieved good results in representation of changes in the vocal tract during emission of vowels and singing. Further developments in MR technique are necessary to allow an equally detailed study of faster movements that participate in the articulation of speaking, which will allow fascinating perspectives in clinical use.

Introducción. La rápida evolución tecnológica en la resonancia magnética (MRI) ha ofrecido recientemente una gran oportunidad para el análisis de la producción de voz.Objetivos. Este artículo tiene como objetivo describir los principales principios fisiológicos en la base de la producción de la voz (en particular, del tracto vocal) y una descripción general de la literatura sobre resonancia magnética del tracto vocal. Esto se presenta con el fin de analizar tanto los resultados actuales como las perspectivas futuras.Método. Se realizó una revisión narrativa mediante la búsqueda de los términos MeSH "tracto vocal" y "MRI" en la base de datos PubMed. Los estudios obtenidos se seleccionaron posteriormente por relevancia.Resultados. Los campos principales descritos en la literatura se refieren a la viabi-lidad técnica y optimización de secuencias de resonancia magnética, modificaciones del tracto vocal en una vocal o fonética articulatoria, modificaciones del tracto vocal en el canto, reproducción 3D del tracto vocal y segmentación y descripción del tracto vocal en condiciones patológicas.Conclusiones. La resonancia magnética es potencialmente el mejor método para estudiar la fisiología del tracto vocal en el momento de la producción de la voz. Los estudios más recientes han obtenido buenos resultados en la representación de cambios en el tracto vocal durante la emisión de vocales y el canto. Se necesitan más desarrollos en la técnica de RM para permitir un estudio igualmente detallado de los movimientos más rápidos que participan en la articulación del habla, lo que permi-tirá perspectivas fascinantes en el uso clínico.

Lung function evaluation through computerized tomography and 3D reconstruction of airways: a body mass index pilot study / Evaluación de la función pulmonar mediante tomografía computarizada y reconstrucción 3D de las vías respiratorias: estudio piloto del índice de masa corporal

SUMMARY: Obesity is a worldwide epidemic that has become a risk factor for the development of respiratory problems, meaning it is necessary to generate models that assess lung function in obese patients for proper treatment. The objective of this study was to evaluate a model for analyzing respiratory function according to body composition, by analyzing the structure and function of the airways by computed tomography (CT). Lung function and body fat percentage (BF%) were measured in three male subjects (25 ± 6 years), with different body mass index (BMI; normal, overweight, obese). A third-dimensional (3D) reconstruction of the airways was performed using CT. Trachea, right and left main bronchi and anterior segmental bronchus of the right and left lung were measured. Three measurement points were established for each structure, and the average value of these three points was used for the analysis. An increase in the thickness of the airways wall of the left and right main bronchi and right segmental bronchus was observed as BMI and BF% increased. The same was observed for the percentage of airway wall area (%AWA) and airway resistance in the main and segmental bronchi. The proposed 3D reconstruction model and the three-point analysis simplified image assessment and allowed to observe the problems caused by obesity in lung function.

RESUMEN: La obesidad es una epidemia mundial, la que se ha transformado en un factor de riesgo en el desarrollo problemas respiratorios. Al respecto, generar modelos de evaluación de la función pulmonar en pacientes obesos es relevante para su adecuado tratamiento. El objetivo de este trabajo fue evaluar un modelo de la estructura y función de las vías aéreas (VA) con tomografía computarizada (TC) que permita analizar su compor- tamiento de acuerdo a la composición corporal. A tres sujetos de sexo masculino (25±6 años), de distinto índice de masa corporal (IMC; normal, sobrepeso, obeso), se les midió función pulmonar y porcentaje de grasa corporal (% GC). A través de TC se realizó una reconstrucción en tercera dimensión (3D) de las VA. Se realizaron mediciones de las VA de la tráquea, bronquios principales derecho e izquierdo y bronquio segmentario anterior del pulmón derecho e izquierdo. Para cada estructura se establecieron tres puntos de medición, el valor utilizado para los análisis fue el promedio de estos tres puntos. En los tres participantes se observó un aumento del grosor de la pared de las vías aéreas de los bronquios principal derecho e izquierdo y bronquio segmentario derecho a medida que aumenta el IMC y el % GC. Por otra parte, el porcentaje de área de la pared de las vías aéreas (% APVA) se comportó de la misma manera para ambos bronquios principales y segmentarios. La resistencia de las vías aéreas (RVA), tanto general como específica, aumentó en paralelo con el % APVA en los bronquios principales y segmentarios. A través de un modelo de reconstrucción 3D de la estructura de la VA por TC, evaluando tres puntos, se pudo observar los problemas que trae la obesidad a la función pulmonar simplificando el análisis de imagen.

Air Breathing in an Exceptionally Preserved 340-Million-Year-Old Sea Scorpion.

Arachnids are the second most successful terrestrial animal group after insects [1] and were one of the first arthropod clades to successfully invade land [2]. Fossil evidence for this transition is limited, with the majority of arachnid clades first appearing in the terrestrial fossil record. Furthermore, molecular clock dating has suggested a Cambrian-Ordovician terrestrialization event for arachnids [3], some 60 Ma before their first fossils in the Silurian, although these estimates assume that arachnids evolved from a fully aquatic ancestor. Eurypterids, the sister clade to terrestrial arachnids [4-6], are known to have undergone major macroecological shifts in transitioning from marine to freshwater environments during the Devonian [7, 8]. Discoveries of apparently subaerial eurypterid trackways [9, 10] have led to the suggestion that eurypterids were even able to venture on land and possibly breathe air [11]. However, modern horseshoe crabs undertake amphibious excursions onto land to reproduce [12], rendering trace fossil evidence alone inconclusive. Here, we present details of the respiratory organs of Adelophthalmus pyrrhae sp. nov. from the Carboniferous of Montagne Noire, France [13], revealed through micro computed tomography (µ-CT) imaging. Pillar-like trabeculae on the dorsal surface of each gill lamella indicate eurypterids were capable of subaerial breathing, suggesting that book gills are the direct precursors to book lungs while vascular ancillary respiratory structures known as Kiemenplatten represent novel air-breathing structures. The discovery of air-breathing structures in eurypterids indicates that characters permitting terrestrialization accrued in the arachnid stem lineage and suggests the Cambrian-Ordovician ancestor of arachnids would also have been semi-terrestrial.

Radiological indicators to predict the application of assistant intubation techniques for patients undergoing cervical surgery.

BACKGROUND: We aimed to distinguish the preoperative radiological indicators to predict the application of assistant techniques during intubation for patients undergoing selective cervical surgery. METHODS: A total of 104 patients were enrolled in this study. According to whether intubation was successfully accomplished by simple Macintosh laryngoscopy, patients were divided into Macintosh laryngoscopy group (n = 78) and Assistant technique group (n = 26). We measured patients' radiographical data via their preoperative X-ray and MRI images, and compared the differences between two groups. Binary logistic regression model was applied to distinguish the meaningful predictors. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to describe the discrimination ability of indicators. The highest Youden's index corresponded to an optimal cut-off value. RESULTS: Ten variables exhibited significant statistical differences between two groups (P <  0.05). Based on logistic regression model, four further showed correlation with the application of assistant techniques, namely, perpendicular distance from hard palate to tip of upper incisor (X2), atlanto-occipital gap (X9), angle between a line passing through posterior-superior point of hard palate and the lowest point of the occipital bone and a line passing through the anterior-inferior point and the posterior-inferior point of the second cervical vertebral body (Angle E), and distance from skin to hyoid bone (MRI 7). Angle E owned the largest AUC (0.929), and its optimal cut-off value was 19.9° (sensitivity = 88.5%, specificity = 91.0%). the optimal cut-off value, sensitivity and specificity of other three variables were X2 (30.1 mm, 76.9, 76.9%), MRI7 (16.3 mm, 69.2, 87.2%), and X9 (7.3 mm, 73.1, 56.4%). CONCLUSIONS: Four radiological variables possessed potential ability to predict the application of assistant intubation techniques. Anaesthesiologists are recommended to apply assistant techniques more positively once encountering the mentioned cut-off values.

Comparison of the MultiViewScope Stylet Scope and the direct laryngoscope with the Miller blade for the intubation in normal and difficult pediatric airways: A randomized, crossover, manikin study.

BACKGROUND: Managing difficult pediatric airway is challenging. The MultiViewScope (MVS) Stylet Scope is reported to be useful in difficult pediatric airway. In this randomized crossover study, we compared the effectiveness of the MVS Stylet Scope to a standard direct laryngoscope with Miller #1 blade in simulated normal and difficult airways. METHODS: Fifteen expert anesthesiologists and Fifteen anesthesiology residents participated in the study. Participants were asked to perform intubation with the Airsim Baby manikin first, and then with the Airsim Pierre Robin manikin. Participants in each group used the intubation devices in a randomized order. The primary outcome was the time of successful intubation. The secondary outcomes were the force exerted on the incisors during intubation, Cormack-Lehane scale, the difficulty of intubation. RESULTS: There were no differences between MVS Stylet Scope and Direct laryngoscope in the time of successful intubation by the expert anesthesiologists or the anesthesiology residents in a normal or difficult pediatric airway. MVS Stylet Scope significantly improved the force exerted on the incisors during intubation in the expert anesthesiologists or the anesthesiology residents in a normal or difficult pediatric airway. MVS Stylet Scope significantly improved Cormack-Lehane scale, and the difficulty of intubation with difficult pediatric airway situation in both expert anesthesiologists and anesthesiology residents. CONCLUSIONS: Although less forces on the incisors and improved view of glottis were observed with the MVS Stylet Scope, MVS Stylet Scope did not shorten the time of intubation. The results of this study mean that the MVS Stylet Scope may be a less invasive airway devise than the direct laryngoscope with the Miller blade in the pediatric airway management. For the next step, we need to evaluate the MVS Stylet Scope in the real patients as an observational study.

Computed tomographic and radiologic anatomy of the lower respiratory tract in the red-foot tortoise (Chelonoidis carbonaria) / Anatomia radiológica e por tomografia computadorizada do trato respiratório inferior no jabuti-piranga (Chelonoidis carbonaria)

The diagnosis of several diseases in chelonians is a challenge in the veterinary clinic, because a detailed physical examination with auscultation and palpation is difficult due the presence of carapace and plastron. Imaging analysis such as radiography and computed tomography (CT) have been shown to be beneficial for diagnosis, prognosis and treatment in numerous animal species. Thus, this study aimed to identify and describe the structures of the lower respiratory tract in red-foot tortoises, by computed tomography, radiography and gross anatomy in twelve red-foot tortoises (Chelonoidis carbonaria), adults and of both sexes. The lower respiratory tract in these animals comprised the larynx, trachea, bronchi and the lungs. The presence of epiglottic cartilage was not observed in the animals studied. CT allowed the observation of the intrapulmonary part of the bronchi, which was accompanied by large intrapulmonary blood vessels. The lungs presented a reticulated parenchyma, without lobulations. Each lung had a small chamber located near the cranial and caudal poles. These structures were identified in CT and 3D CT reconstructions and these could suggest that these chambers could be non-respiratory structures, and could be comparable to the air sacs of birds. This study establishes normal CT anatomy of the lower respiratory tract of the red-foot tortoise; and may be used as a reference in the assessment of respiratory disorders in this tortoise.(AU)

O diagnóstico de diversas afecções em quelônios é um desafio para a clínica veterinária, já que um exame físico detalhado com auscultação e palpação é difícil devido à presença da carapaça e do plastrão. A radiografia e a tomografia computadorizada (TC) tem se mostrado benéficas para o diagnóstico, prognóstico e tratamento em muitas espécies animais. Assim, este estudo teve por objetivo identificar e descrever as estruturas do trato respiratório inferior no jabuti-piranga por meio da tomografia computadorizada, radiografia e anatomia em 12 jabutis-piranga (Chelonoidis carbonara), adultos e de ambos os sexos. Nos animais estudados, o trato respiratório inferior consistiu da laringe, traqueia, brônquios e os pulmões. A cartilagem epiglote não foi observada. A TC permitiu a observação da parte intrapulmonar dos brônquios, a qual estava acompanhada dos vasos sanguíneos intrapulmonares. Os pulmões possuíam um parênquima reticulado, sem lobações. Cada pulmão tinha uma pequena câmara localizada junto aos pólos cranial e caudal. Estas estruturas foram identificadas na TC e na reconstrução 3D a partir da TC e poderiam ser estruturas não-respiratórias, podendo ser comparadas aos sacos aéreos das aves. Este estudo identificou a anatomia normal por meio da TC do trato respiratório inferior do jabuti-piranga, o que pode ser usado como referência para diagnóstico de desordens respiratórias nesta espécie.(AU)

3-D airway analysis related to facial morphology / Análisis 3-D de la vía aerea relacionado con la morfología facial

The aim of this investigation was to define the volume and area of the airway in subjects with Class II and Class III skeletal deformity. A cross-sectional study was designed including subjects with facial deformity defined by Steiner's analysis in subjects with indication of orthognathic surgery who presented diagnosis by cone beam computerised tomography. We determined the measurements of maximum area, minimum area and volume of the airway. The data were compared using Spearman's test, with statistical significance defined as p<0.05. 115 subjects were included: 61.7 % Class II and 38.3 % Class III, mean age 27.8 years (± 11.6). A significant difference was observed in the area and volume measurements in the groups studied, with significantly smaller measurements found in Class II (p=0.034). The minimum area was 10.4 mm2 smaller in Class II patients than in Class III, while the general volume of the airway was 4.1 mm3 smaller in Class II than in Class III. We may conclude that Class II subjects present a smaller airway volume than Class III subjects.

El objetivo de esta investigación de definir el volumen y área de vía aérea en sujetos con deformidad esqueletal clase II y III. Se diseñó un estudio de corte transversal incluyendo sujetos con deformidad facial definida según análisis de Stainer en sujetos con indicación de cirugía ortognática que presentaran una tomografía computadorizada de haz cónico como elemento diagnóstico; en este examen se determinaron medidas de área mayor, menor de vía aérea y volumen presente; los datos fueron comparados utilizando pruebas estadísticas con el test de spearman considerando el valor de p<0,05 para definir significancia estadística. 115 sujetos fueron incluidos, siendo 61,7 % de tipo clase II y 38,3 % de sujetos clase III, con una edad promedio de 27,8 años (± 11,6). Se observó una diferencia significativa en mediciones de area y volumen en los grupos estudiados, siendo el grupo de clase II significativamente menor (p=0,034). El área de menor tamaño fue 10,4 mm2 en pacientes clase II que en pacientes clase III, mientras que el volumen general de la vía área fue 4,1 menor en los clase II que en los clase III. Es posible concluir que los sujetos de clase II presentan menor volumen de vía área que los sujetos clase III.

Relación entre la posición del primer molar superior con el diámetro de vías aéreas superiores propuestos por Mc Namara / Relation between the psition of the first upper molar with the diameter of the upper airways proposed by Mc Namara

El propósito de este trabajo fue determinar una vinculación entre la permeabilidad de las vías aéreas superiores, con la clase II dentaria en pacientes que hayan completado su crecimiento. Los parámetros utilizados para determinarlo fueron: el cefalograma de Mc Namara en lo que respecta a vías aéreas superiores y la posición del primer molar superior según la clasificación propuesta por Angle. Los datos para evaluarlo se obtienen mediante una teleradiografía lateral de cráneo o pruebas que pueden realizarse incluso en el consultorio. La muestra del presente trabajo estuvo conformada por 100 teleradiografías de pacientes con clase II dentaria. La obstrucción respiratoria que presentan determinados pacientes podría considerarse como un factor predisponente en el desarrollo de la formación de una maloclusión, aunque no necesariamente todos los insuficientes respiratorios presentan algún tipo de anomalía dentoesqueletal, este vínculo entre forma y función resulta muy importante a la hora del diagnóstico, pronóstico y la planificación del tratamiento

The purpose of this study was to determine a link between upper airways permeability and dental class II in patients who have finished their growth. The parameters used for establishing them were: Mc Namara's cephalometrics with regard to the upper airways, and the position of the first upper molar according to Angle's classification. The information to evaluate it was obtained either via lateral teleradiography of the skull or tests which can be done in the office. The sample was composed of 100 teleradiography of patients with dental class II. The breathing obstruction could be considered a predisposing factor in the increase of the formation of a bad occlusion, yet not every insufficient breather has some kind of skeletal tooth anormaly; thus, establishing the link between shape and function is a determining factor at the time of giving the correct diagnosis and prognosis, and of deciding on the best treatment

STANDING COMPUTED TOMOGRAPHY IN NONANESTHETIZED LITTLE PENGUINS (EUDYPTULA MINOR) TO ASSESS RESPIRATORY SYSTEM ANATOMY AND MONITOR DISEASE.

Multidetector computed tomography (MDCT) scans were performed in clinically healthy, nonanesthetized, standing little penguins (Eudyptula minor) to determine reference ranges for air-sac and lung volumes, as well as lung density. Five of 15 clinically healthy birds were diagnosed with pulmonary granulomas on initial MDCT scans. Granulomas were not readily apparent on radiographs, even in cases where the entire normal pulmonary parenchymal architecture was effaced on the MDCT scan. Serial MDCT scans after antifungal and antimycobacterial therapies demonstrated a response to treatment. MDCT scanning in nonanesthetized little penguins proved to be a well-tolerated, non-invasive imaging modality for respiratory diseases that are otherwise difficult to diagnose, including aspergillosis and mycobacteriosis.

An ADAMTS3 missense variant is associated with Norwich Terrier upper airway syndrome.

In flat-faced dog breeds, air resistance caused by skull conformation is believed to be a major determinant of Brachycephalic Obstructive Airway Syndrome (BOAS). The clinical presentation of BOAS is heterogeneous, suggesting determinants independent of skull conformation contribute to airway disease. Norwich Terriers, a mesocephalic breed, are predisposed to Upper Airway Syndrome (UAS), a disease whose pathological features overlap with BOAS. Our health screening clinic examined and scored the airways of 401 Norwich terriers by laryngoscopy. Genome-wide association analyses of UAS-related pathologies revealed a genetic association on canine chromosome 13 (rs9043975, p = 7.79x10-16). Whole genome resequencing was used to identify causal variant(s) within a 414 kb critical interval. This approach highlighted an error in the CanFam3.1 dog assembly, which when resolved, led to the discovery of a c.2786G>A missense variant in exon 20 of the positional candidate gene, ADAM metallopeptidase with thrombospondin type 1 motif 3 (ADAMTS3). In addition to segregating with UAS amongst Norwich Terriers, the ADAMTS3 c.2786G>A risk allele frequency was enriched among the BOAS-susceptible French and (English) Bulldogs. Previous studies indicate that ADAMTS3 loss of function results in lymphoedema. Our results suggest a new paradigm in the understanding of canine upper airway disease aetiology: airway oedema caused by disruption of ADAMTS3 predisposes dogs to respiratory obstruction. These findings will enhance breeding practices and could refine the prognostics of surgical interventions that are often used to treat airway obstruction.

Respiratory immune system and consequences due to particulate matter in air pollution / Sistema inmune respiratorio y consecuencias de contaminación aérea por materia particulada

The respiratory system is commonly known for being responsible for gaseous exchange. However, chronic exposure to air born pollution increases each year the number of asthma, chronic obstructive pulmonary disease (COPD), and lung cancer cases, which compels us to view the lung as a vulnerable organ due to the fact that because of its nature it enters in contact with substances present in the environment. Fortunately, the immune response mechanism acts locally in the lung in order to modulate the inflammatory response and to facilitate the clearance of inhaled pathogens, as well as volatile organic compounds (VOCs), metals, sulphur and nitrogen oxides, ozone and particulate matter (PM). Expanding our understanding of the molecular mechanisms underlying inflammation and pathology induced by airborne contaminant particles in the long term can help to develop strategies to reduce the risks of exposure to some of the most hazardous air pollutants, as well as to reduce the toxicity of nanomaterials and may also help to identify therapeutic targets to be used in the preventive treatment of susceptible groups.

El sistema respiratorio es comúnmente conocido por ocuparse del intercambio gaseoso; sin embargo, la exposición crónica a contaminantes del aire aumenta cada año el número de casos nuevos de asma, enfermedad pulmonar obstructiva crónica (EPOC) y cáncer de pulmón, lo que nos obliga a ver el pulmón como un órgano vulnerable, ya que por su naturaleza entra en contacto con sustancias presentes en el medio ambiente. Afortunadamente, el mecanismo de respuesta inmune actúa localmente en el pulmón para modular respuestas inflamatorias y para facilitar el aclaramiento de patógenos inhalados, así como de compuestos orgánicos volátiles (VOCs, por sus siglas en inglés), metales, óxidos de azufre y nitrógeno, ozono y materia particulada (PM, por sus siglas en inglés). Ampliar nuestra comprensión de los mecanismos moleculares que subyacen a la inflamación y a la patología inducida por partículas contaminantes en las vías respiratorias a largo plazo puede ayudar a desarrollar estrategias para reducir los riesgos de exposición a algunos de los contaminantes atmosféricos más peligrosos, así como a reducir la toxicidad de los nanomateriales y quizás pueda también ayudar a identificar objetivos terapéuticos que se puedan utilizar en el tratamiento preventivo de grupos susceptibles.

How to use the videofluoroscopy swallow study in paediatric practice.

In paediatric practice feeding, eating, drinking and swallowing difficulties are present in up to 1% of children. Dysphagia is any disruption to the swallow sequence that results in compromise to the safety, efficiency or adequacy of nutritional intake. Swallowing difficulties may lead to pharyngeal aspiration, respiratory compromise or poor nutritional intake. It causes sensory and motor dysfunction impacting on a child's ability to experience normal feeding. Incoordination can result in oral pharyngeal aspiration where fluid or food is misdirected and enters the airway, or choking where food physically blocks the airway The incidence is much higher in some clinical populations, including children with neuromuscular disease, traumatic brain injury and airway malformations. The prevalence of dysphagia and aspiration-related disease is increasing secondary to the better survival of children with highly complex medical and surgical needs. This article aims to outline the indications for performing videofluoroscopy swallow (VFS). This includes the technical aspects of the study, how to interrupt a VFS report and some of the limitations to the study.

Predictors of difficult airway in a Chinese surgical population: the gender effect.

BACKGROUND: Compared with men, women often have a shorter interincisor distance and a shorter thyromental distance but are less likely to have difficult airway. The hypothesis is that the prediction criteria of difficult airway differ between men and women. The aim of this study was to investigate differences in the prediction criteria of anatomic predictors for difficult airways in men and women. METHODS: We enrolled adult patients who underwent general anesthesia and tracheal intubation. The interincisor distance, thyromental distance, modified Mallampati test results, upper lip bite test results, and tongue thickness of each patient were evaluated prior to the initiation of anesthesia. The primary outcome was difficult tracheal intubation. Receiver operating characteristic (ROC) curve analysis and Youden's index were used to determine the criteria for predictors in men and women. RESULTS: In total, 1059 men and 1195 women were examined. Compared with women, men had a higher incidence of difficult tracheal intubation (P<0.001). The cut-off values for predicting difficult tracheal intubation of the interincisor distance, thyromental distance, modified Mallampati test results, upper lip bite test results, and tongue thickness determined by Youden's index were ≤38 mm, ≤70 mm, >3, >2, and >62 mm, respectively, for men, and ≤33 mm, ≤65 mm, >2, >1, and >60 mm, respectively, for women. CONCLUSIONS: The optimal cut-off values of predictors of difficult airway differ between males and females.