Successful tracheostomy decannulation after complete or sensory incomplete cervical spinal cord injury.

STUDY DESIGN: Retrospective study. OBJECTIVES: To report the successful tracheostomy decannulation/extubation in cervical spinal cord injury (C-SCI) patients. SETTING: Tertiary university hospital, pulmonary rehabilitation center. METHODS: Complete or sensory incomplete C-SCI patients who had received invasive acute phase respiratory management, and succeeded in decannulation/extubation became candidates of this study. Retrospective review was conducted on the transitions of the respiratory status. RESULTS: Sixty-two patients (M: 55, F: 7) were identified. Traumatic etiologies accounted for 93.5%, and mean onset age was 47.6±15.8 years. Sixty patients (96.8%) had undergone tracheostomy and the other two received endotracheal intubation during acute phase. All patients succeeded in decannulation/extubation after employing mechanically assisted coughing and noninvasive mechanical ventilation (NIV). Mean time since tracheostomy to decannulation was 7.0±14.5 months. Of the 60 tracheostomized patients, 12 succeeded in decannulation without applying long-term NIV, 31 switched to continuous NIV after decannulation. Fifteen patients totally weaned off from ventilators after NIV. Two patients who once succeeded in decannulation were re-tracheostomized. For the 31 patients with continuous NIV, mean hours of daily need for ventilatory support had reduced from 15.3±8.0 to 5.7±5.7 h at final follow-ups. CONCLUSION: Complete or sensory incomplete C-SCI patients, even with high neurological level can be successfully decannulated through NIV and aggressive use of mechanically assisted coughing. Undesirable tracheostomy can be avoided by employing the noninvasive respiratory management.

Improvement of intact human lipocortin-I production in Saccharomyces cerevisiae by inhibiting proteolysis.

Human lipocortin-I (hLC1), when was expressed as a secretory product in Saccharomyces cerevisiae, was cleaved to a significant extent by endoproteolytic processing, resulting in the accumulation of des1-26-hLC1 in the culture supernatant. This proteolytic cleavage was inhibited significantly by the addition of high concentrations of l-arginine and l-lysine, with a resultant marked improvement in the yield of intact hLC1. When the hLC1 was expressed in S. cerevisiae mutants deficient in one or two of the following endoproteases, Kex2p, Mkc7p and Yps1p (Yap3p), the mutants exhibited no reduction in the extent of hLC1 proteolysis, indicating that these endoproteases are not involved in the proteolytic cleavage of hLC1.