Endobronchial foreign body removal using fiberoptic bronchoscope together with gastroscope biopsy forceps: A case report.

RATIONALE: There are many difficult cases in the clinic because of the diversity of foreign bodies. The removal of a syringe cap is not so easy because there is always no hole at the closed end. PATIENT CONCERNS: A 54-year-old man suddenly developed dyspnea during his treatment in the hospital. DIAGNOSES: Foreign body in the left main bronchus. INTERVENTIONS: The foreign body was removed using fiberoptic bronchoscope together with gastroscope biopsy forceps. OUTCOMES: A repeat CT showed well inflation of left lung. LESSONS: The combined use of gastroscope biopsy forceps in trachea is more conducive to remove a foreign body similar to a syringe cap.

Upregulation of microRNA­16 alters the response to inhaled ß­agonists in patients with asthma though modulating expression of ADRB2.

MicroRNAs (miRNAs) are non­coding RNAs of ~22 nucleotides in length, which serve an important role in numerous diseases. Asthma is a chronic airway inflammatory disease, which is the most common chronic disease among children. The role of miRNA (miR)­16 in asthma is unclear. The objective of the present study was to examine the underlying molecular mechanism of the involvement of miR­16 in asthma. A total of 72 volunteers diagnosed with asthma consented to participate in the study, of whom 52 participants were identified to be sensitive to salmeterol and 20 participants were identified to be resistant to salmeterol. Receiver operating characteristic (ROC) curve analysis was performed to compare the expression levels of serum miR­16 between the sensitive and resistant groups, and to confirm the association between the expression level of serum miR­16 and forced expiratory volume in 1 sec (FEV1). In silico analysis, a luciferase assay, reverse transcription­quantitative polymerase chain reaction analysis and western blotting were performed to elucidate the molecular mechanism underlying the role of miR­16 in asthma. ROC results demonstrated that the serum miR­16 level may function as a biomarker to predict the response to salmeterol therapy, and the miR­16 expression level displayed a significant negative correlation with FEV1. According to the in silico analysis, adrenoreceptor ß­2 (ADRB2) was a direct target of miR­16, and it was further confirmed by luciferase assay that 25 nM miR­16 mimic had an inhibitory effect on the luciferase activity of the wild­type ADRB2 3' untranslated region (UTR); the inhibitory effect on the luciferase activity of the wild­type ADRB2 3'UTR was stronger with 50 nM miR­16 mimic, and strongest with 75 nM miR­16 mimic, whereas the luciferase activity of the mutant ADRB2 3'UTR in cells was similar following treatment with 0, 25, 50 or 75 nM miR­16 mimic. miR­16 reduced the mRNA and protein expression levels of ADRB2 in a dose­dependent manner. These results identified that miR­16 may be used as a predictive biomarker of therapeutic response in asthma.

Analysis of airway resistance and hypoxemia in overlap syndrome.

OBJECTIVES: To characterize overlap syndrome, investigate its impact on airflow limitation and blood oxygen condition, and detect the risk factors that affect its airway resistance.  METHODS: We reviewed retrospectively the clinical data of 158 patients with overlap syndrome (OS), chronic obstructive pulmonary disease (COPD), and obstructive sleep  apnea (OSA), treated in the Critical Care Medicine Department of the People's Hospital of Liaocheng, Liaocheng, China from May 2014 to March 2015. The lowest and average oxyhemoglobin saturation were measured using polysomnography. The pulmonary functions were tested using the cardiopulmonary measuring instruments, and the viscous resistance at oscillation frequencies of 5, 10, 15, 20 Hz was measured using the impulse oscillation system for all the patients.  RESULTS: The values of forced expiratory volume (FEV)1/FVC, FEV1% predicted, and the lowest SaO2 in the OS group were significantly lower than those in the OSA (p less than 0.01, p less than 0.01, p=0.01), or the COPD group (p=0.03, p=0.02, p=0.03, but the value of viscous resistance at 5 Hz was significantly higher than that in the 2 groups (p less than 0.01). Old age, body mass index, and smoking history were significantly correlated with the viscous resistance in OS patients, at an oscillation frequency of 5Hz (p=0.03, p=0.04).  CONCLUSION: The OS patients present with higher viscous resistance and more severe oxygen deficit, when compared with OSA and COPD patients, and weight decrease and smoking cessation are necessary for these patients.

Effects of Hyperbaric Oxygen Therapy on Inflammasome Signaling after Traumatic Brain Injury.

OBJECTIVE: Neuroinflammation plays an important role in secondary tissue damage after traumatic brain injury (TBI). Recently, the inflammasome-mediated inflammatory pathway has been observed in the inflammatory response of TBI. In this study, we investigated the influence of hyperbaric oxygen therapy (HBOT) on inflammasome activation after TBI. METHODS: The experimental mice were randomly divided into 4 groups as follows: sham-operated normobaric air (21% O2 at one absolute atmosphere), HBOT only, TBI + normobaric air and TBI + HBOT. Following the evaluation of motor deficits and brain edema, the expression of inflammasome components and effectors was measured by qRT-PCR and Western blotting. Moreover, alterations in IL-1ß, IL-18 and high-mobility group box 1 (HMGB1) were calculated by enzyme-linked immunosorbent assay at each time point after injury. RESULTS: HBOT improved motor score and reduced brain edema. Furthermore, it suppressed protein expression of inflammasome components and reduced the levels of IL-1ß and IL-18, accompanied by the reduction of HMGB1 in brain tissues and serum. CONCLUSION: These results suggest that HBOT may alleviate the inflammatory response after TBI by inhibiting the activation of inflammasome signaling.

Local thrombolytic therapy in severe cerebral venous sinus thrombosis during puerperium.

This study is to explore and evaluate the efficacy and safety of local thrombolytic therapy in superior sagittal sinus in patients with severe cerebral venous sinus thrombosis during puerperium, as well as the efficacy and safety of anti-platelet aggregation treatment for preventing recurrence. Twelve patients during postpartum period with cerebral venous sinus thrombosis were received local thrombolytic therapy by placing a micro-catheter at the distal end of superior sagittal sinus from January 2008 to December 2013. All the patients accepted mechanical thrombus maceration before local intrasinus thrombolytic therapy, and were treated with low molecular weight heparin in the acute phase. After local thrombolytic therapy, anti-platelet aggregation treatment was performed for 6 months. Follow-up data included lumber puncture, fundus examination and magnetic resonance venography (MRV) once per half year for 6-70 months. At discharge, the intracranial pressure of 12 patients reduced to below 200 mmH2O. DSA or MRV confirmed that superior sagittal sinus of 9 patients were smooth. The cortex venous and deep venous were recovered to normal. Superior sagittal sinus of 3 patients recanalized partly. Cortex venous and deep venous was compensated. The follow-up study indicated that no thrombosis and new neurological symptoms occurred among all patients. Local thrombolytic treatment is safe and effective in patients with severe cerebral venous sinus thrombosis during puerperium. The collateral circulation compensation is the main recovery factor. And it is also safe and effective for anti-platelet aggregation treatment to prevent recurrence of cerebral venous sinus thrombosis.