Novel Therapy for Acquired Tracheomalacia with a Tissue-Engineered Extraluminal Tracheal Splint and Autologous Mesenchymal-Derived Chondrocytes

Abstract Introduction Acquired tracheomalacia (ATM) is characterized by a loss of structural strength of the tracheal framework, resulting in airway collapse during breathing. Near half of the patients undergoing prolonged invasive mechanical ventilation will suffer tracheal lesions. Treatment for ATM includes external splinting with rib grafts, prosthetic materials, and tracheal resection. Failure in the use of prosthetic materials has made reconsidering natural origin scaffolds and tissue engineering as a suitable alternative. Objective To restore adequate airway patency in an ovine model with surgicallyinduced ATM employing a tissue-engineered extraluminal tracheal splint (TE-ETS). Methods In the present prospective pilot study, tracheal rings were partially resected to induce airway collapse in 16 Suffolk sheep (Ovis aries). The TE-ETS was developed with autologous mesenchymal-derived chondrocytes and allogenic decellularized tracheal segments and was implanted above debilitated tracheal rings. The animals were followed-up at 8, 12, and 16 weeks and at 1-year postinsertion. Flexible tracheoscopies were performed at each stage. After sacrifice, a histopathological study of the trachea and the splint were performed. Results The TE-ETS prevented airway collapse for 16 weeks and up to 1-year postinsertion. Tracheoscopies revealed a noncollapsing airway during inspiration. Histopathological analyses showed the organization of mesenchymal-derived chondrocytes in lacunae, the proliferation of blood vessels, and recovery of epithelial tissue subjacent to the splint. Splints without autologous cells did not prevent airway collapse. Conclusion It is possible to treat acquired tracheomalacia with TE-ETS without further surgical removal since it undergoes physiological degradation. The present study supports the development of tissue-engineered tracheal substitutes for airway disease.

Association between atmospheric particulate matters and outpatient visits for respiratory disorders in Jiaxing City of Zhejiang Province from 2019 to 2021： a time series analysis / 上海预防医学

ObjectiveTo explore the effect of exposure to atmospheric particulate matters on the outpatient visits of respiratory disorders in Jiaxing City，Zhejiang Province. MethodsDaily air pollutant monitoring data，meteorological data and outpatient visits of respiratory disorders in Jiaxing City from 2019 to 2021 were collected．A generalized additive model was applied to evaluate the effect and laggeel effect of the concentrations of atmospheric particulates for outpatient visits of respiratory disorders after adjusting for secular trend， day-of-the-week effect， holiday effect， and meteorological variables. ResultsThe daily average concentrations of PM2.5， PM10， O3 and NO2 exceeded the standard， and the proportion of days exceeding the standard was 3.4%， 1.3%， 11.0% and 0.8%， respectively. Every 10 μg·m-3 increase in PM2.5 concentration showed the strongest effects on the daily outpatient visits of respiratory disorders， adult and childhood respiratory disorders all on lag07 with ER（95%CI） being 2.29%（1.35%‒3.24%）， 2.31% （1.39%‒3.23%） and 2.65 % （1.36%‒3.96%）， respectively. The maximum ER of outpatient visits for respiratory disorders in children was higher than that in adults. Every 10 μg·m-3 increase in PM10 concentration showed the strongest effects on the daily outpatient visits of respiratory disorders on lag07， adult respiratory disorders on lag06 and childhood respiratory disorders on lag07 with ER（95%CI） being 1.42% （0.87%‒1.96%）， 1.49%（0.99%‒1.99%） and 1.61% （0.87%‒2.36%）， respectively. The results of double-pollutant model showed that the effect of atmospheric particulate reduced after O3 was introduced into the model. ConclusionThere are a short-term effect and a laggeel effect of atmospheric particulate on the outpatient visits of respiratory disorders. It is necessary to strengthen the health protection of the respiratory system of the population， especially the children.

Nilavaagai Chooranam – A Siddha Herbal Medicine

Siddha system is mainly experienced in the Southern part of India. It is one of the most primitive traditional medicines in the world which treats not only the body but also the mind and the soul. The word Siddha derived from Tamil words “Siddhi” which means “An object to be Attained “or “perfection” or “heavenly bliss”. The aim of this review article is to explore the scientific literary evidences for the therapeutic usage of “Nilavaagai chooranam” for respiratory illness (Swasakasam, Iya noi) as mentioned in Siddha literature Siddha vaidaya Thirattu and to focus on the Pharmacological activity for the healing nature of the drug. Most of the raw drugs used for the preparation of Nilavaagai chooranam have Broncho dilatory activity, Anti-microbial activity, Anti-inflammatory activity, Immunomodulatory activity, Anti-histamine activity hence justifying its usage in respiratory ailments.

Periodontitis and periodontopathogens in individuals hospitalized in the intensive care unit: a case-control study

Abstract The aim of the present study was to compare periodontal conditions between intensive care unit (ICU) in-patients and non-ICU patients through clinical and microbiological periodontal parameters. This case-control study included 88 individuals hospitalized in ICU and 176 non-hospitalized controls. All individuals underwent a complete periodontal examination and microbiological sampling. The total bacterial load and counts of Porphyromonas gingivalis, Treponema denticola and Aggregatibacter actinomycetemcomitans were evaluated using qPCR. Data were analyzed through the Chi-square, Fisher exact, and t-Student tests, and the Spearman correlation, as appropriate. The prevalence of periodontitis was 39.7% among controls and 59.0% among ICU in-patients (OR=2.18; p=0.002). ICU in-patients had a significantly higher occurrence of cardiovascular disease (p=0.002; OR=2.20) and history of periodontal disease (p=0.031; OR=1.92) than controls. Bacterial counts of A. actinomycetemcomitans, T. denticola and P. gingivalis were significantly higher in ICU in-patients with periodontitis than in controls. The correlation between periodontal parameters and microbiological findings among cases and controls showed a significant and positive correlation between: total bacteria load and % of sites with probing depth (PD) ≥ 4 mm (cases: r=0.22 and controls: r=0.13) and P. gingivalis and % sites with bleeding on probing (BOP) (cases: r=0.22 and controls: r=0.23). Thus, ICU in-patients presented a higher prevalence of periodontitis and worse periodontal condition (higher mean plaque index, BOP, clinical attachment level ≥3 mm, and sites with PD 4 to 6 mm).

Resumo O objetivo deste estudo foi comparar as condição periodontais entre pacientes internados em Unidade de terapia intensiva (UTI) e indivíduos não hospitalizados através de parâmetros periodontais clínicos e microbiológicos. Este estudo caso-controle incluiu 88 indivíduos hospitalizados em UTI e 176 controles não hospitalizados. Todos os indivíduos foram submetidos a um exame periodontal completo e amostragem microbiológica. A carga bacteriana total e as contagens de Porphyromonas gingivalis, Treponema denticola e Aggregatibacter actinomycetemcomitans foram avaliadas utilizando qPCR. Os dados foram analisados, conforme apropriado, por meio dos testes de Qui-quadrado, Fisher exato, t-Student, Mann-Whitney e correlação de Spearman. A prevalência de periodontite foi de 39,7% entre os controles e de 59,0% entre pacientes internados em UTI (OR=2,18, IC 95%: 1,29-3,68; p=0,002). Pacientes admitidos na UTI apresentram significativamente uma maior ocorrência de doença cardiovascular (p=0,002, OR=2,20) e história de doença periodontal (p=0,031; OR=1,92) do que os controles. As contagens bacterianas de A. actinomycetemcomitans, T. denticola e P. gingivalis foram significativamente maiores nos pacientes em UTI com periodontite do que nos controles. A correlação entre os parâmetros clínicos periodontais e os achados microbiológicos entre casos e controles mostrou correlação significativa e positiva entre: carga bacteriana total e % de sítios com profundidade de sondagem (PS) ≥4 mm (casos: r=0,22 e controles: r=0,13) e P. gingivalis e % de sítios com sangramento à sondagem (SS) (casos: r=0,22 e controles: r=0,23). Pacientes internados na UTI apresentaram maior prevalência de periodontite e pior condição periodontal (maior média de índice de placa, SS, de sítios com nível de inserção clínica ≥ 3mm e PS de 4 a 6 mm) do que os controles.

Atypical bovine interstitial pneumonia in a semi-intensive beef cattle system / Pneumonia intersticial atípica em bovinos de corte criados em semi confinamento

ABSTRACT: The aim of the present study was to describe an outbreak of atypical interstitial pneumonia affecting 15 Angus cattle aged 7-30 months in the south of Rio Grande do Sul. The clinical course of the disease was approximately 1-3 days. The cattle were kept in the native field and had received feed containing the remains of wafers from a food factory before the outbreak. Clinical signs included dyspnea and abdominal breathing, with a clinical evolution period of up to 3 days. Nine animals presented apathy and respiratory difficulty and died within 24h, while three animals exhibited a clinical evolution period of 36-48h. Three other animals died without any clinical signs. The main macroscopic lesions were observed in the lungs, which did not collapse at the opening of the thoracic cavity and showed a rubbery consistency. On the cut surface, the organs were firm and dark red, with marked distension of the interlobular septa due to edema. Histopathological analysis revealed thickening of the interlobular pulmonary septa; interstitial edema and emphysema; mild mononuclear cell, eosinophil, and neutrophil infiltration; areas of type II pneumocyte proliferation, and thickening of the alveolar walls. Fibrin was observed in the alveolar lumen with the formation of hyaline membranes. On the basis of macroscopic and histological examinations and epidemiological data, a final diagnosis of atypical interstitial pneumonia was made. Although, the cause of the disease has not been identified, it is believed that the bran wafer meal contained ingredients that were not suitable for animals, consequently triggering the disease.

RESUMO: Descreve-se um surto de pneumonia intersticial atípica diagnosticado no Sul do Rio Grande do Sul, afetando 15 bovinos da raça Angus, entre 7 e 30 meses de idade, de um total de 400 animais. Os bovinos estavam em campo nativo e recebiam farelo de bolacha proveniente de uma fábrica de produtos alimentícios. Os sinais clínicos caracterizaram-se por dispneia e respiração abdominal. Nove animais apresentaram apatia e dificuldade respiratória morrendo em 24 horas, em três bovinos a evolução clínica foi de 36 a 48 horas e outros três morreram sem observação de qualquer sinal clínico. As principais lesões macroscópicas foram observadas nos pulmões, que não colapsavam na abertura da cavidade torácica e apresentavam consistência elástica. Na superfície de corte o órgão era firme e vermelho escuro com acentuada distensão dos septos interlobares e interlobulares por edema. Histologicamente, havia espessamento dos septos interlobulares pulmonares, edema e enfisema intersticial, infiltrado inflamatório discreto de células mononucleares, eosinófilos e neutrófilos, áreas de proliferação de pneumócitos tipo II e espessamento das paredes alveolares. Havia fibrina na luz alveolar e formação de membranas hialinas. As lesões macroscópicas e histológicas, associadas aos dados epidemiológicos, permitiram o diagnóstico de pneumonia intersticial atípica. Apesar de não ter sido identificada a causa da enfermidade acredita-se que o farelo de bolacha, com ingredientes não adequados a alimentação animal e em forma de farelo, possa ter desencadeado a doença.

Respiratory Disorders Among Workers in Slaughterhouses

BACKGROUND: Workers in slaughterhouses are exposed to a wide range of biological contaminants, such as bacteria and fungi, due to their working environment. This study aimed to assess the prevalence of respiratory disorders among workers in slaughterhouses. METHODS: This study was conducted on 81 workers in slaughterhouses and 81 healthy office workers as a reference group. The American Thoracic Society standard respiratory symptoms questionnaire was used to determine the prevalence of respiratory disorders. Besides, lung function tests were conducted using a calibrated spirometer at the beginning (preshift) and at the end (postshift) of the 1st working day. Single-stage Anderson sampler was used to measure the concentration of bioaerosols in different parts of slaughterhouses. RESULTS: The prevalence of respiratory disorders, such as cough, productive cough, breathlessness, phlegm, and wheezing, was 3.17, 4.02, 3.07, 4.66, and 3.94 times, respectively, higher among workers in slaughterhouses compared with the reference group. CONCLUSION: The prevalence of respiratory disorders was significantly higher among workers in slaughterhouses. Thus, the significant reduction in the percentage predicted lung function among workers in slaughterhouses might be associated with exposure to bioaerosols in their work environment.

Mechanical ventilation of the common respiratory disease in the newborn: principles and strategies / 中国小儿急救医学

Clinicians should be now able to customize ventilatory strategies to the specific pathophysioiogy of the newborn with respiratory disorders.This paper focused on the various strategies that may be employed to manage the wide range of respiratory disorders encountered by preterm and term newborn infants,including respiratory distress syndrome of the very(extremely) low birth weight infants,meconium aspiration syndrome,persistent pulmonary hypertension of the newborn,bronchopulmonary dysplasia,pneumothorax and pulmonary hemorrhage.

Pulmonary Toxocariasis Mimicking Invasive Aspergillosis in a Patient with Ulcerative Colitis

A 45-year-old-male who had underlying ulcerative colitis and presented with fever and dry cough. Initially, the patient was considered to have invasive aspergillosis due to a positive galactomannan assay. He was treated with amphotericin B followed by voriconazole. Nevertheless, the patient deteriorated clinically and radiographically. The lung biopsy revealed eosinophilic pneumonia, and ELISA for Toxocara antigen was positive, leading to a diagnosis of pulmonary toxocariasis. After a 10-day treatment course with albendazole and adjunctive steroids, the patient recovered completely without any sequelae. Pulmonary toxocariasis may be considered in patients with subacute or chronic pneumonia unresponsive to antibiotic agents, particularly in cases with eosinophilia.

The Risk of Deep Vein Thrombosis of the Lower Extremities in Patients with Chronic Respiratory Disorders, based on the Results of Ultrasonography Screening / The Japanese Journal of Rehabilitation Medicine

We screened patients with chronic respiratory disorders for deep vein thrombosis (DVT) of the lower extremities using ultrasonography. These patients require pulmonary rehabilitation because of their physical disabilities and the reduction in their activities of daily living (ADL). The average soleus vein diameter, which is the reported source of most DVTs, was 6.1±1.5 mm in the control group, 6.8±2.1 mm in the home oxygen therapy (HOT) patients, and 7.0±1.6 mm in the non-HOT patients. The soleus vein diameters in the HOT and non-HOT patients were significantly greater than in the control group (<i>p</i>=0.003). The prevalence of calf DVTs in the HOT patients was significantly higher than in the non-HOT patients (14.3 % vs. 2.0 %, <i>p</i>=0.027). Therefore, patients with chronic respiratory disorders are at greater risks of developing DVT. Furthermore, it appears that not only the deterioration in ADL but also the presence of respiratory disorders and a hypoxic state may influence the onset of DVT in HOT patients. Chronic respiratory disorder is thought to be one of the risk factors for DVT. Therefore, preventive measures, such as ultrasonographic screening examinations, daily living guidance, and physical therapy, are important for patients with chronic respiratory disorders.