In vitro study on the sealing effect of different shapes of cuff tracheal tubes under the lowest safe pressure / 中华危重病急救医学

Objective:To compare the effectiveness of cylindrical-shaped and conical-shaped cuff catheters for airway closure using different pressure measurement methods at the lowest safe pressure and to guide the clinical application.Methods:Twenty-four patients with endotracheal intubation admitted to the intensive care unit (ICU) of Guangxi Medical University Cancer Hospital from December 2021 to January 2022 were enrolled. Leakage test in vitro was performed on the secretion on the patients' cuff. The needle and plunger from 20 mL syringe was separated, the syringe was sealed with adhesive, and the syringe nozzle was filled thoroughly to create a tracheal model. Consecutively, both cylindrical-shaped and conical-shaped cuff catheters were inserted into the simulated trachea, and the cuff pressure was calibrated to 20 cmH 2O (1 cmH 2O≈0.098 kPa) before commencing the experiment. The viscosity of the secretion on the patients' cuff was classified (grade Ⅰ was watery subglottic secretion, grade Ⅱ was thick subglottic secretion, grade Ⅲ was gel-like subglottic secretion), and the same viscosity secretion was injected into the catheter cuff. Utilizing a self-control approach, intermittent pressure measurement was initially conducted on both the cylindrical-shaped and conical-shaped cuff by improved pressure measurement method (intermittent pressure measurement group), followed by continuous pressure measurement experiment (continuous pressure measurement group). The leakage volume of the three viscosity subglottic secretions and the values of cuff pressure measurement of different shaped cuff catheters at 4, 6, 8 hours of inflation were recorded. Results:A total of 180 retention samples were extracted from 24 patients with tracheal intubation during ventilation, with 90 samples in each of the two groups using different pressure measurement methods, and 30 samples of retention materials with different viscosities in each group. In the intermittent pressure measurement group, at 4 hours of inflation, all samples of secretion with grade Ⅰ and grade Ⅱ on cylindrical-shaped cuff leaked, while 3 samples of secretion with grade Ⅲ also leaked. For conical-shaped cuff, 28 samples of secretion with grade Ⅰ leaked, only 2 samples of secretion with grade Ⅱ leaked, and there was no leak for secretion with grade Ⅲ. At 6 hours of inflation, all samples of the three viscosity secretions on different shaped cuffs leaked. The leakage was gradually increased with the prolongation of inflation time. In the continuous pressure measurement group, at 4 hours of inflation, all samples of secretion with grade Ⅰ on cylindrical-shaped cuff leaked, while 29 samples of secretion with grade Ⅱ leaked, and there was no leak for secretion with grade Ⅲ. For the conical-shaped cuff, 26 samples of secretion with grade Ⅰ leaked, and there was no leak for secretion with grade Ⅱ and grade Ⅲ. At 6 hours of inflation, the conical-shaped cuff still had no leak for secretion with grade Ⅲ. As the inflation time prolonged, the leakage of subglottic secretion on different shaped cuffs in both groups was gradually increased. At 8 hours of inflation, all samples experienced leakage, but the leakage of subglottic secretion on different shaped cuffs in the continuous pressure measurement group was significantly reduced as compared with the intermittent pressure measurement group [leakage for secretion with grade Ⅲ (mL): 1.00 (0.00, 1.25) vs. 2.00 (1.00, 2.00) on the cylindrical-shaped cuff, 1.00 (0.00, 1.00) vs. 2.00 (2.00, 2.00) on the conical-shaped cuff, both P < 0.01]. The values of pressure measurement of cuffs with different shapes at different time points of inflation in the continuous pressure measurement group were within the set range (20-21 cmH 2O). The cuff pressure at 4 hours of inflation in the intermittent pressure measurement group was significantly lower than the initial value (cmH 2O: 18.3±0.6 vs. 20.0±0.0 in the cylindrical-shaped cuff, 18.4±0.6 vs. 20.0±0.0 in the conical-shaped cuff, both P < 0.01), and the cuff pressure in both shaped cuffs showed a significant decrease tendency as inflation time prolonged. However, there was no statistically significant difference in values of pressure measurement between the different shaped cuff catheters. Conclusions:Continuous pressure monitoring devices can maintain the effective sealing of conical-shaped cuff catheters at the lowest safe pressure. When using an improved pressure measurement method for intermittent pressure measurement and/or using a cylindrical cuff catheter, the target pressure should be set at 25-30 cmH 2O, and the cuff pressure should be adjusted regularly.

Expression and significance of Toll like receptor 2 and Toll like receptor 4 in chronic rhinosinusitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the role of the innate immune factors TLR2 and TLR4 in the pathogenesis of chronic rhinosinusitis (CRS) by detecting their expression in different clinical types of CRS and the normal control group.@*METHOD@#Immunohistochemistry was used to detect the expression of TLR2 and TLR4 respectively in 21 cases (chronic rhinosinusitis with nasal polyps, CRSwNP) group, 15 cases (chronic rhinosinusitis without nasal polyos, CRSsNP) group, 11 cases recurrent CRSwNP group and 13 cases control group. Positive cells were counted under the microscope artificially, Mann-Whitney U analysis was applied for the ranked data, and one-way anova analysis was adopted to analyze the experimental group and control group.@*RESULT@#(1) TLR2 and TLR4 expression had the same characteristics. Expression mainly concentrated in parts of the whole layer of epithelial basement membrane, cytoplasm of glandular cells, very few inflammatory cells such as monocytes and plasma cells in the cytoplasm, sometimes unknown cell nuclei positive expression. (2) The glandular cells were stained manual counting and color grading. TLR2 and TLR4 packet application Wilcoxon rank test Mann-Whitney U test analysis was not statistically significant (P > 0.05), measurement data within the group variance statistical difference between the groups (P < 0.05).@*CONCLUSION@#The Nasal mucosa can produce the innate immune factors TLR2 and TLR4. The different expression of TLR2 and TLR4 in the various clinical types of CRS suggests that they play the certain role in the pathogenesis of CRS.

Expression of TGF-beta1 and collagen fibers in chronic nasal-sinusitis nasal mucosa of patients / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#Explore the TGF-beta1 and collagen fibers in chronic nasal sinusitis each type and degree of expression of the normal control group and in the nasal mucosa epithelial tissue remodeling and the role of TGF-beta1 and collagen deposition relationship.@*METHOD@#Sixty-two patients experimental group (CRSwNP of 21 cases. CRSs NP group of 15 cases. 11 cases of recurrent nasal polyps; control group 15 cases specimens for immunohistochemistry and masson collagen staining. Manual counting the number of positive cells by the Mann-Whitney U test to analyze the expression in experimental group and the control group. Experimental group and control group between the single-factor analysis of variance with a One-Way ANOVA analysis.@*RESULT@#Experimental group and control group were expressed TGF-beta1 with collagen deposition. Which, TGF-beta1 in CRSsNP group was significantly lower than the control group (P < 0.05), CRSwNP group was significantly increased compared with CRSsNP group (P < 0.05); masson collagen staining, CRSsNP group was significantly lower than the control group (P < 0.01), recurrent nasal polyps group than in the control group was significantly increased (P < 0.05). TGF-beta1 and collagen staining masson positive correlation between (P < 0.01 ).@*CONCLUSION@#TGF-beta1 and collagen deposi tion and chronic nasal-sinusitis tissue remodeling has its relevance. Furthermore. TGF-beta1 expression increased with excessive deposition of collagen fibers also positively correlated.

Research progress in interleukin-22 treatment of malignant tumors / 中国肿瘤临床

Interleukin-22 (IL-22) is a member of the IL-10 family, which exhibits a similar structure and immune function with IL-10. IL-22 is mainly secreted by Th22, Th1, and Th17 cells, innate lymphoid cells (ILCs), and γδT and NKT cells. IL-22 is mainly in-volved in autoimmune diseases, malignant tumors, and infective diseases. As such, studies have focused on the function of IL-22 cyto-kine in the pathogenesis of various malignant tumors. Studies revealing the expression and pathogenesis of IL-22 in malignant tumors possibly provide a new method to treat and prevent malignant tumors. In our study, the discovery, structural characteristics, and func-tions of IL-22 in malignant tumors are reviewed.

Research progresses on the pathogenesis of bacterial biofilm in chronic rhinosinusitis / 临床耳鼻咽喉头颈外科杂志

The role of bacterial biofilms in the chronic diseases has been recognized more and more. The experts in the centers for disease control and prevention of the United States estimate that 65% of human bacterial infection is involved with the biofilms. In the recent study. it has been proved that there is a high correlation between the bacterial biofilm and the pathogenesis and prognosis of chronic rhinosinusitis(CRS). In order to elucidate the role of bacteria films in the pathogenesis of CRS, we reviewed various method of testing the bacterial biofilms in CRS, and summarized the related researches. Based on the detection researches and summaries, we conclude that bacterial biofilm can contribute to the continuance and development (diffusion and repeated) of CRS. It can lead to the continuous inflammation by influencing the immune system of the mucous membrane. While there is little research on the bacterial biofilm. Further researches will be needed for the exact mechanism of the bacterial biofilm in CRS. in order to find more effective therapeutic method and targets.

Expression and significance of surfactant A in nasal polyps of chronic rhinosinusitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To detect the expression and distribution of surfactant A (SP-A) in nasal polyps and to probe into its significance in the pathology of nasal polyps.@*METHOD@#Immunohistochemical staining and RT-PCR (reverse transcription polymerase chain reaction) were explored to detect SP-A in nasal polyps and controls.@*RESULT@#In nasal polyp tissues, SP-A expressed not only in the cytoplasm of the epithelium but also in the cytoplasm of the plasma cells. Moreover it expressed in the serous glands but not in the mucous glands. The expression of SP-A was distributed in the same location of turbinates. But the expression of SP-A between nasal polyps and turbinates differed significantly (P < 0.05). SP-A mRNA was detected in the nasal polyps and controls. The expression potency ratio of SP-A/beta-actin in nasal polyps was stronger than in turbinates (P < 0.05).@*CONCLUSION@#Both nasal polyps and nasal mucosa expressed SP-A mRNA and protein, but the expression was stronger in nasal polyps. The role of SP-A in the innate immunity may contribute to the pathogenesis of nasal polyps. SP-A may become the new target in the therapy of chronic rhinosinusitis.

Expression of toll-like receptors signaling pathway in chronic rhinosinusitis with nasal polyps / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the expression of Toll-like receptors (TLRs) signaling pathway in chronic rhinosinusitis (CRS) with nasal polyps.@*METHOD@#Gene microarray analysis was used to detect the expression of TLRs signaling pathway in CRS with nasal polyps.@*RESULT@#Of 19 differentially expressed (two fold changes), 4 genes were upregulated and 15 genes were downregulated.@*CONCLUSION@#The differentially expressed genes in TLRs signaling pathway may exert its effect in the pathogenesis of CRS. In addition, the roles of TLR9 and its agonists need further study.

Expression of Toll-like receptors signaling pathway in chronic rhinosinusitis with nasal polyps / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the expression of Toll-like receptors(TLRs)signaling pathway in chronic rhinosinusitis(CRS)with nasal polyps.Method:Gene microarray analysis was used to detect the expression of TLRs signaling pathway in CRS with nasal polyps.Result:Of 19 differentially expressed(two-fold changes),4genes were upregulated and 15 genes were downregulated.Conclusion:The differentially expressed genes in TLRs signaling pathway may exert its effect in the pathogenesis of CRS.In addition,the roles of TLR9 and its agonists need further study.