[Bronchoscopic intervention therapy for pulmonary mucormycosis with main bronchial occlusion: a case report].

Pulmonary mucormycosis is one of the most common types of mucormycosis. Tracheobronchial pulmonary mucormycosis primarily affects the tracheobronchial tree, causing lesions that can invade the airway mucosa and muscular layer, damaging the cartilage. It is characterised by acute onset, rapid progression, and high mortality rate, making clinical treatment challenging. This article reports the diagnosis and treatment of a patient with pulmonary mucormycosis complicated by left main bronchus occlusion. In addition to systemic treatment, which consisted mainly of an intravenous injection of amphotericin B combined with an oral suspension of posaconazole, the patient underwent multiple bronchoscopic interventions, including local infusion of amphotericin B under endoscopy, balloon dilation and silicone stent placement. After four months of comprehensive treatment, the therapeutic effect was satisfactory. This report demonstrates that bronchoscopic intervention therapy plays an important role in the comprehensive treatment of pulmonary mucormycosis, especially in preventing death from the progression to obstructive pneumonia.

[Safety and effectiveness of interventional bronchoscopy under general anesthesia in the elderly patients with central airway stenosis: a retrospective study].

We retrospectively reviewed the clinical data of patients aged 65 years and older with central airway stenosis who underwent therapeutic bronchoscopy under general anesthesia in Beijing Tiantan Hospital from January 2012 to September 2022. A total of 167 patients were included in the study. One or more comorbidities were present in 151 patients. The number of operation procedure was 230 times. Laryngeal mask ventilation under general anesthesia and electrotomy was the most common method of airway management and operation. The incidence of major complications was 5.2%. One patient with granular cell tumor died of major bleeding during stent removal. The primary malignant lesion, number of comorbidities, electrolyte disturbances and rigid bronchoscopy were risk factors for major complications, and the difference was statistically significant. The overall response rate was 99.4%. The airway stenosis grade, dyspnea score and KPS value were improved, and the differences were statistically significant. Interventional bronchoscopy under general anesthesia appeared to be safe and effective in patients aged 65 years and older with central airway stenosis. Age should not be a contraindication to interventional bronchoscopy.

[Efficacy and safety of Montgomery T-tube placement for benign complex subglottic tracheal stenosis: a retrospective analysis of 29 cases].

Objective: To analyze the efficacy and safety of Montgomery T-tube (T-tube) placement for benign complex subglottic tracheal stenosis. Methods: A retrospective analysis of the clinical data of 29 patients with benign complex subglottic tracheal stenosis receiving T-tube placement in Beijing Tiantan Hospital from May 2015 to December 2019. The causes were postintubation tracheal stenosis [27 cases (93.1%), including 21 cases (72.4%) of tracheal stenosis after tracheotomy, 6 cases (20.7%) of tracheal stenosis after tracheal intubation], cervical post-traumatic tracheal stenosis (1 case, 3.4%) and tuberculous tracheal stenosis (1 case, 3.4%), respectively. Three-dimensional reconstruction of tracheal computerized tomography (CT) and bronchoscopy were used to grade the stenosis according to Cotton-Myer classification system before bronchoscopic intervention. The degree of stenosis was Cotton-Myer grade Ⅱ (7 cases, 24.1%), grade Ⅲ (11 cases, 37.9%) and grade Ⅳ (11 cases, 37.9%), respectively. All cases received placement of T-tubes and follow-up. Fisher's exact test was used for comparison between groups. Results: T-tube placement was performed 39 times in 29 patients. T-tubes were successfully placed for 24 cases (82.8%). The main complication during the operation was tracheal mucosal tear (6 cases, 20.7%), which resolved in all cases within 2 weeks. The main postoperative complication was secretion retention (27 cases, 93.1%), which was relieved after home nebulization treatment in 26 cases; and followed by granulation hyperplasia, especially located in T-tube upper margin (12 cases, 41.4%), of which 8 cases were cured after bronchoscopic intervention. None of the patients had T-tube migration. There were no statistically significant differences in the success rate of T-tube placement and the incidence of major complications in patients with benign complex subglottic tracheal stenosis with different degrees of stenosis. After 18 months to 24 months of follow-up, attempt was made to remove the T-tube in 9 patients but failed in 4 patients. The failure was due to collapse of the airway after the T-tube was removed. Conclusion: T-tube placement is a safe and reliable treatment for benign complex subglottic tracheal stenosis with high efficiency and manageable complications.

[Efficacy and influencing factors of interventional bronchoscopy for the treatment of scarring airway stenosis: a multicenter retrospective investigation from China].

Objectives: To evaluate the efficacy of interventional bronchoscopy for the treatment of scarring airway stenosis and to analyze the influencing factors related to the success rate. Methods: Between January 2013 to December 2016, 301 patients with scarring airway stenosis treated by interventional bronchoscopy in 18 tertiary hospitals were reviewed retrospectively. The methods of interventional bronchoscopy included electric knife cutting, laser cauterization, balloon dilation, cryotherapy, local drug usage and/or stenting. Airway stenosis characteristics and patients' performance status at baseline and after interventional bronchoscopy were recorded. The interval days between the first two interventional bronchoscopy treatment (maintained patency time) and the final treatment efficacy were recorded. Results: The clinical stability rate of interventional bronchoscopy for the treatment of scarring tracheal stenosis was 67.8% (204/301) . Stenosis sites (OR 1.548; 95% CI: 1.038-2.307, P=0.032) , dyspnea index (OR 2.140; 95% CI: 1.604-2.855, P<0.001) , and interventional method (OR 0.458; 95% CI: 0.267-0.787, P=0.005) were independent predictors associated with the efficacy of interventional bronchoscopy treatment. Stenosis sites (OR 1.508; 95% CI: 1.273-1.787, P<0.001) , stenosis grade (OR 1.581; 95% CI: 1.029-2.067, P=0.001) , anesthesia method (OR 1.581; 95% CI: 1.029-2.067, P<0.001) , and local drug usage (OR 1.304; 95% CI: 1.135-1.497, P<0.001) were independent predictors associated with the maintained patency time after first interventional bronchoscopy treatment. Conclusion: Interventional bronchoscopy is a useful treatment method for scarring airway stenosis. Enough attention should be paid to influencing factors in order to improve treatment efficacy during the treatment process.

[A preliminary study of different methods of anesthesia for painless bronchoscopy].

Objective: This study aimed to explore a feasible method of anesthesia for painless bronchoscopy. Methods: A total of 120 patients receiving flexible bronchoscopy in Beijing Tiantan Hospital during the period from February, 8, 2018 to May, 4, 2018, were randomly divided into 3 groups, including group A (using lidocaine for local anesthesia), group B (using lidocaine + midazolam + fentanyl), and group C (using lidocaine + propofol + sufentanil). There were 41 patients in group A, 38 in group B and 41 in group C. The changes in systolic blood pressure, diastolic blood pressure, heart rate and pulse oxygen saturation(SpO(2)) in each group were recorded in different points of time. The safety of different methods of anesthesia was observed by recording vital signs and adverse events. Moreover, the visual analogue scale (VAS) was used to observe the patient's tolerance and satisfaction of the operation. Results: The intraoperative systolic blood pressure and diastolic blood pressure in group C were significantly lower than those in group A and B (P<0.05). Six cases in group C had hypotension, 3 of whom required vasoactive drugs. The differences of SpO(2) between the 3 groups showed no statistical significance (P>0.05), while patients in group C were prone to decrease in SpO(2). Eighteen patients in group C had hypoxemia during operation. But after treated with improving ventilation, the SpO(2) of those patients could be restored to normal. Compared with those in group C, patients in group A and group B showed significant discomfort, cough, and more pharyngeal pain (P<0.05). However, there were no significant differences in the degree of cough and pain between group A and group B (P>0.05). Most patients in group C had no uncomfortable sensation during the operation (P<0.05), and the willingness to re-examination was significantly higher than that in group A and group B (P<0.05). Conclusion: Propofol combined with sufentanil could achieve better painless effect, improve patient comfort and tolerance, and reduce intraoperative memory, but was prone to causing hypoxemia and hypotension. The decline of intraoperative SpO(2) could be corrected by establishing artificial airway, while the decrease of blood pressure could be corrected by applying vasoactive drugs, which were relatively safe.

[Advantages and disadvantages of preoperative artificial pneumothorax for medical thoracoscopy].

Objective: To expolre the indications, safety, advantages and disadvantages of performing artificial pneumothorax prior to medical thoracoscopy. Methods: Data of 152 patients undergoing medical thoracoscopy for pleural diseases in the Beijing Tiantan Hospital Affiliated to Capital Medical University from April 2007 to September 2014 were studied through retrospective analysis. According to the performance of artificial pneumothorax prior to medical thoracoscopy, the pleural space adhesions and the pleural effusions, patients were grouped into artificial pneumothorax group (107 cases) and non-artificial pneumothorax group (45 cases), adhesion group (102 cases) and non-adhesion group (50 cases), and few or no pleural effusion group (94 cases) and massive pleural effusion group (58 cases), respectively. The incidence of complications such as subcutaneous emphysema, pleural reaction, infection, aeroembolism and pulmonary injury/hemorrhage in different groups were compared, and the vital signs of patients were observed. Results were compared using the Chi square test. Results: After thoracoscopic examination, the definite diagnosis rates of artificial pneumothorax group and non- artificial pneumothorax group were 83.2% (89/107) and 93.3% (42/45) respectively, which showed no significant difference (χ(2)=2.744, P=0.098). Three cases of subcutaneous emphysema occurred in the artificial pneumothorax group, while all these 3 cases belonged to adhesion group, and one of them belonged to few or no pleural effusion group, and 2 of them belonged to massive pleural effusion group. No subcutaneous emphysema cases were observed in the non-adhesion group. In the non-artificial pneumothorax group, one case of lung trauma caused by trocar was observed, which belonged to adhesion group and few or no pleural effusion group; no lung puncture wound cases were observed in massive pleural effusion group and non-adhesion group. Other complications related to artificial pneumothorax and thoracoscopy, such as pleural reaction, infection, air embolism and pulmonary injury/hemorrhage, were not observed. No significant changes were found between the vital signs of patients before and after artificial pneumothorax. Conclusion: For pleural effusion or pleural disease patients with pleural space adhesion, the performance of artificial pneumothorax prior to operation was recommended. Artificial pneumothorax was not recommended for patients without pleural space adhesions.

[Effect of self-expanding bare metal stents of different diameters on the trachea of dogs].

Objective: To study the effect of self-expanding bare metal stents on the trachea of dogs, and therefore to provide useful information for choice of airway stents by interventional physicians. Methods: In this experiment, 8 beagles were randomly divided into 4 groups. Four self-expanding metal stents of different diameters (16, 18, 20 and 22 mm, respectively) were placed in the trachea of these beagles for 3 months and their impacts on normal trachea were observed. Results: In the 16 mm stent group (stent-to-airway diameter ratio 103%), good epithelialization was observed and the tracheal structure had no significant damage. In the 18 mm stent group (stent-to-airway diameter ratio 116%), slight granulation tissues were observed, but the cartilage and outer membrane were normal. In the 20 mm stent group (stent-to-airway diameter ratio 129%), severe granulation tissues were observed. Cartilage was damaged but outer membrane was normal. In the 22 mm stent group (stent-to-airway diameter ratio 142%), no obvious granulation tissues were found. Cartilage was normal, but outer membrane was ruptured. Conclusion: In a certain range, tracheal granulation tissues increased as the stent diameter increased. However, if the stent diameter continued to increase, a decreasing trend of tracheal granulation was observed, but severe tracheal injury by stent expansion force would occur.

[Airway metal stents removal by rigid bronchoscopy].

OBJECTIVE: To explore the techniques and related complication management of airway metal stents removal with rigid bronchoscope under general anesthesia. METHODS: We reviewed 20 patients who had received rigid bronchoscopic stents removal under general anesthesia from Jan. 2008 to Jan. 2015. The clinical data were analyzed retrospectively. The indications for stents removal and potential difficulties encountered, the relationship between techniques and related complications of stents removal were discussed and analyzed, and our experiences were summarized. RESULTS: The indications for airway metal stents removal included stent migration, fracture, and granulation related in-stent restenosis. Nineteen airway metal stents were removed from 20 patients, which included 9 covered metal stents, 6 without fragmentation and 3 with fragmentation. The average duration of stenting before removal was (7.4±6.9)months (5 days-24 months). Of the 11 uncovered metal stents, which had stayed in the airway for (10.2±7.0) months (20 days-24 months), 10 were removed successfully and 1 failed. Three of them were removed intact and 7 fragmented. Complications were as follows: airway bleeding requiring management (n=11), airway collapse (n=6), re-obstruction requiring temporary stent placement (n=5), postoperative tracheal intubation (n=1), mucosal tear with tracheoesophageal fistula (n=1), airway firing (n=1), airway obstruction, and death as a result of attempted stent removal (n=1). CONCLUSIONS: Airway metal stent removal is a high-risk operation. Indications for stents removal should be evaluated thoroughly and all the advantages and disadvantages should be evaluated. Once stent removal is decided, the type of the metal stent, the position of the stent implanted, the duration of stenting, and the extent of the stent embedded in granulation tissue should be carefully considered to assess the difficulty of the procedure. Dissection of the stent from the airway wall before extracting it can reduce complications such as airway bleeding, mucosal tear and airway obstruction. At the same time, a standby stent is needed to deal with possible airway collapse after stent removal. Removal of metal airway stents should only be performed by a proficient and experienced interventional pulmonology team to ensure successful operation and to improve patient safety.

MicroRNA-770-5p is involved in the development of diabetic nephropathy through regulating podocyte apoptosis by targeting TP53 regulated inhibitor of apoptosis 1.

OBJECTIVE: Diabetic nephropathy (DN) is a major diabetic micro-vascular complication, and podocyte apoptosis induced by high glucose (HG) is a typical early feature of DN. Studies have shown that microRNAs (miRNAs) play a crucial role in the pathogenesis of DN. The purpose of the current study was to explore the role and molecular mechanism of miR-770-5p in podocyte apoptosis in DN. PATIENTS AND MATERIALS AND METHODS: In vitro podocyte model of DN was conducted by treatment conditionally immortalized mouse podocytes with HG (30 mM D-glucose). The level of miR-770-5p in podocytes was detected using quantitative real-time PCR (qRT-PCR), and protein levels were measured using Western blot assay in our current study. The relationship between miR-770-5p and TP53 regulated inhibitor of apoptosis 1 (TRIAP1) was revealed by TargetScan and dual luciferase reporter assay. Cell proliferation ability and cell apoptosis were determined by using cell counting kit-8 (CCK-8) assay and flow cytometer (FCM), respectively. RESULTS: We found that miR-770-5p was significantly upregulated in podocytes under HG condition. TRIAP1 was a target gene of miR-770-5p and it was down-regulated in podocytes by HG treatment. Further analysis indicated that HG induced cell proliferation ability reduction, cell apoptosis enhancement and apoptotic peptidase activating factor 1(APAF1)/Caspase9 pathway exaltation in podocytes were prevented by miR-770-5p down-regulation. More importantly, the results showed that all the effects of miR-770-5p inhibitor on HG induced podocytes were eliminated by TRIAP1 silencing. S.-Z. Zhang, X.-J. Qiu, S.-S. Dong, L.-N. Zhou, Y. Zhu, M.-D. Wang, L.-W. Jin We showed that miR-770-5p was upregulated in the in vitro model of DN, and it might promote the development of DN through regulating podocyte apoptosis by targeting TRIAP1.

Spin and valley-dependent electron transport through arrays of ferromagnet on monolayer MoS2.

We theoretically study ballistic transport of Dirac fermions in MoS2 junction through arrays of barriers, of width [Formula: see text], in the presence of a tunable potential of height [Formula: see text] and an exchange field [Formula: see text]. The charge conductance as functions of [Formula: see text] and [Formula: see text], exhibits more conspicuous and sharpened oscillation as the number of barriers increase, due to the contribution of evanescent modes near the edges of the extremum conductance which are exponentially suppressed or enhanced. Furthermore, we found the valley-resolved conductance exhibits a similar oscillating behavior as the charge conductance for multiple barriers, but with inverse oscillatory phases for [Formula: see text] and [Formula: see text], accordingly, a high-efficiency fully valley polarized device is proposed in our system. Also, a perfect 100% spin polarized conductance is observed for 4 barriers and the polarized direction can be switched by changing the direction of exchange field. These findings not only benefit understanding of basic physics in monolayers MoS2, but also provide us a new way to generate a pure and high-efficiency spintronics and valleytronics.

Rapid and sensitive UPLC-MS/MS method for the determination of domperidone in human plasma and its application to pharmacokinetic study.

In this study, a simple, rapid and sensitive ultra performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) method is described for determination of domperidone in human plasma samples using oxcarbazepine as the internal standard (IS). Sample preparation was accomplished through protein precipitation with methanol, and chromatographic separation was performed on an Acquity BEH C18 column (2.1 mm×50 mm, 1.7 µm) with gradient profile at a flow of 0.45 mL/min. Mass spectrometric analysis was performed using a QTrap5500 mass spectrometer coupled with an electro-spray ionization (ESI) source in the positive ion mode. The MRM transition of m/z 426.3→175.2 was used to quantify for domperidone. The linearity of this method was found to be within the concentration range of 0.25-100.0 ng/mL for domperidone in human plasma. Only 1.5 min was needed for an analytical run. The method herein described was superior to previous methods and was successfully applied to the pharmacokinetic study of domperidone in healthy Chinese volunteers after oral administration.

Deletion detection for diagnosis of Duchenne muscular dystrophy in the Japanese population--comparison between the polymerase chain reaction and the Southern blot analysis.

We compared the efficacy of the multiplex PCR with that of the cDNA analysis for detection of deletions of the DMD gene in the Japanese patients. Thirty males with DMD from 27 Japanese families were studied by the multiplex PCR, and 24 of them were also investigated by Southern blot analysis. We used five dystrophin cDNA probes for deletion analysis. A total of 19 regions were amplified by the PCR to detect deletions, 9 regions by the method of Chamberlain et al. and another 10 regions by the method of Beggs et al. Deletions were detected in 14 (52%) out of 27 DMD families by the PCR. Southern blot analysis detected deletions in 14 (64%) out of 22 families. Thirteen (93%) of the 14 DMD families with deletions detected by Southern blotting were also confirmed by the multiplex PCR. Provided care is taken in cases where the deletion is limited to a single exon, the multiplex PCR appears to be an efficient and useful alternative to conventional Southern blot analysis for detecting deletions during the prenatal and postnatal diagnosis of DMD.