Targeted delivery of inhalable drug particles in the tracheobronchial tree model of a pediatric patient with bronchopneumonia: A numerical study.

Pneumonia is a common cause of hospitalization and death in children worldwide. Inhalation therapy is one of the methods treating pneumonia However, there are limited studies that distinguish between the physiology of children and adults, especially with respect to targeted drug delivery. A tracheobronchial (TB) tree model of an 11-year-old child with bronchopneumonia is selected as a testbed for in silico trials of targeted drug delivery. The airflow and particle transport are solved by the computational fluid dynamics method at an airflow rate of 15 LPM. The results indicate that the distribution of deposited particles shows aggregation on the particle release map. Point-source aerosol release (PSAR) method can significantly reduce the deposition efficiency (DE) of particles in the TB tree model. Specifically, the PSAR method can reduce the DE of large particles (i.e., 7.5 µm and 10 µm) by 7.57% and 9.61%, respectively. This enables rapid design of patient-specific treatment for different population age groups and different airway diseases.

Septoplasty Effect on the Enhancement of Airflow Distribution and Particle Deposition in Nasal Cavity: A Numerical Study.

The surgery outcomes after fixing nasal airway obstruction (NAO) are sometimes not satisfactory in improving ventilations of airflow. A case study is presented in this paper with computational fluid dynamics applied to determine the key factors for successful septoplasty plans for a patient with a deviated nasal septum. Specifically, airflow, as well as particle transport and deposition were predicted in a pre-surgery nasal cavity model reconstructed from patient-specific Computer Tomography (CT) images and two post-surgery nasal cavity models (i.e., VS1 and VS2) with different virtual surgery plans A and B. Plan A corrected the deviated septal cartilage, the perpendicular plate of the ethmoid bone, vomer, and nasal crest of the maxilla. Plan B further corrected the obstruction in the nasal vestibule and caudal nasal septal deviation based on Plan A. Simulations were performed in the three nose-to-throat airway models to compare the airflow velocity distributions and local particle depositions. Numerical results indicate that the VS2 model has a better improvement in airflow allocation between the two sides than the VS1 model. In addition, the deposition fractions in the VS2 model are lower than that in both the original and VS1 models, up to 25.32%. The better surgical plan (i.e., Plan B) reduces the particle deposition on the convex side, but slightly increases the deposition on the concave side. However, the overall deposition in the nasal cavity is reduced.

miR-486-5p Serves as a Diagnostic Biomarker for Sepsis and Its Predictive Value for Clinical Outcomes.

BACKGROUND: As a molecular detection method, miRNA can quickly diagnose and prevent diseases, intervene in disease as early as possible, and reduce mortality. This study was to investigate the potential clinical diagnostic and predictive significance of miR-486-5p in sepsis and its correlation with inflammation and disease severity. METHODS: The serum miR-486-5p in 108 sepsis, 60 pneumonia-infected, and 101 healthy controls were detected by RT-qPCR. Spearman coefficient detects the correlation between serum miRNA and disease severity indicators (APACHE II, SOFA scores), and inflammation indicators (CRP, PCT), respectively. The diagnostic significance of miR-486-5p in sepsis was analyzed by the ROC curve. Kaplan-Meier estimator and Cox regression hazards analysis of the predictive significance of serum miR-486-5p in 28-day survival from sepsis. RESULTS: Serum miR-486-5p was increased in sepsis patients compared with healthy control and pneumonia-infected patients (P < 0.001). And increased serum miR-486-5p was positively associated with disease severity (SOFA score and APACHE II score) and inflammation (CRP and PCT). Serum miR-486-5p can not only identify sepsis patients from healthy controls (AUC = 0.914) but also significantly distinguish sepsis patients from pneumonia-infected patients (AUC = 0.814), showing good potential as a diagnostic biomarker for sepsis. In addition, serum miR-486-5p was an independent predictor of 28-day survival (log-rank P = 0.012), and patients with high levels of miR-486-5p had a poorer overall 28-day survival (HR = 3.057, 95% CI = 1.385-17.817, P = 0.014). CONCLUSION: miR-486-5p is a potential diagnostic biomarker for sepsis, and its high level is significantly correlated with the disease severity and inflammation. In addition, miR-486-5p were predictive risk factors for 28-day survival in sepsis patients.

[Manganese-enhanced magnetic resonance imaging for studying olfactory dysfunction in rats].

OBJECTIVE: To study the olfactory function in rats by manganese-enhanced magnetic resonance imaging (MEMRI) and explore the regeneration of olfactory system from the imaging. METHODS: Thirty-five adult male Sprague-Dawley (SD) rats were randomly divided into three groups. Twenty rats with bilateral nasal instillation of TritonX-100 were used as olfactory dysfunction model group (M group). The rats in this group received menthocamphorate stimulation. Ten rats with bilateral nasal instillation of sterile saline were used as olfactory normal group (N group), and were randomly divided into two groups:one group received menthocamphorate stimulation (N1 group), another group received odorless air (N2 group). The remaining five rats were used as the blank control (control group). All images were acquired with a 7.0 T micro-MR scanner. Signal-to-noise ratios (SNR) in the olfactory bulb (OB) were measured by Image J. RESULTS: MEMRI could clearly show the normal olfactory pathway in rats. MEMRI displayed a reversible change during the stages of olfactory recovery after injury. For the olfactory dysfunction model group (M group), the total volume of rat olfactory bulb at the initial, the 10th day, the 20th day, the 30th day and the 60th day were (49.44 ± 0.81), (32.85 ± 0.79), (27.78 ± 1.07), (35.89 ± 1.04), (43.63 ± 1.13) mm(3) respectively. At the 20th day after olfactory injury, the SNR in the OB was the lowest for 9.78 ± 0.07, when at the 60th day, the SNR recovered to 30.68 ± 1.01, which increased to near normal (N1group, 33.08 ± 0.15; N2 group, 31.31 ± 1.12), the SNR had no significant difference among the three groups (F = 3.04, P > 0.05). CONCLUSION: The MEMRI is an objective method to detect the olfactory function, and the olfactory system has the regenerative property after injury.

[Ethmoid sinus foreign body long-term residence in one case].

Ethmoid sinus foreign body can be divided into endogenous and exogenous, the clinically referred mostly belonging to the exogenous foreign body. The exogenous ethmoid sinus foreign body generally has a history of facial trauma, its clinical manifestations are associated with the foreign body size, nature, residence time and location. Using X-ray, CT scan can further confirm the diagnosis. Removing the ethmoid sinus foreign body may have a better therapeutic effect by endoscopic sinus surgery. Here we report a rare case of foreign body in the ethmoid sinus.

[Expression of BDNF mRNA in nasal mucosa with allergic rhinitis rat model].

OBJECTIVE: To evaluate the role of brain-derived neurotrophic factor (BDNF) in allergic rhinitis of rat. METHOD: Thirty SD rats free of disease were randomly divided into two groups. A model of allergic rhinitis rat was established by using ovalbumin intraperitoneal immunization and intranasal antigen challenge. The nasal mucosa from 18 out of 20 AR models as well as 10 normal controls were studied for expression of BDNF mRNA by reverse transcription-polymerase chain reaction (RT-PCR). RESULT: BDNF/beta-actin ratio in AR models was significantly higher than control (0.49+/-0.07 vs 0.28+/-0.01, P<0.05). CONCLUSION: BDNF played an important role in the development of allergic rhinitis of rat.

[Management of sinonasal inverted papilloma: endoscopic excision vs traditional procedures].

OBJECTIVE: To evaluate the effect of endoscopic resection and traditional procedure in the management of sinonasal inverted papilloma with a staging system based on endoscopic examination of the nasal cavity and computed tomography (CT) scan evaluation. METHODS: Two hundred and twenty-two patients with sinonasal inverted papilloma treated surgically were retrospectively reviewed. There were 23 cases in stage I; 119 cases in stage II; 65 cases in stage III and 15 cases in stage IV. Among these patients, 122 cases were treated endoscopically; 100 cases were treated by traditional surgical techniques, including 56 cases with lateral rhinotomy; 27 cases with intranasal approach and 15 cases with Caldwell-Luc technique. RESULTS: The inverted papilloma was removed completely and no serious complications were encountered by all four kinds of techniques used. With an average follow-up of 3. 8 years, the recurrence rate for endoscopic group was 14.8% (18/122, four patients were in group I; nine in group II; four in group III; and one patient in group IV. No recurrence was found in group III who underwent endoscopic excision combined with Caldwell-Luc procedure. The recurrence rate for lateral rhinotomy group was 33. 9% (19/56, one patients in group I; six in group II; nine in group III; three in group IV). The recurrence rate for intranasal approach group was 51.9% (14/27, two patients were in group I; ten in group II; and two in group III). The recurrence rate for Caldwell-Luc procedure group was 29.4% (5/17, all in group II and group III). Regardless of approaches, patients who had primary resection had a recurrence of 26. 8%, whereas those with secondary resection had a recurrence of 20. 9% (P = 0.39). CONCLUSIONS: The endoscopic surgical technique was proved to be a better method for treating sinonasal inverted papilloma in stage I and stage II. Better results for patients in stage III would be achieved by combining endoscopic technique with Caldwell-Luc procedure. As to patients with stage IV, radical external approaches should be considered.

[Partial laryngectomy for ninety-eight patients with glottic carcinoma of the larynx].

OBJECTIVE: To investigate the therapeutic results after various kinds of partial laryngectomy for patients with glottic carcinoma of the larynx. METHODS: From January 1980 to Mar 2004, 98 patients with glottic carcinoma of the larynx were treated by various kinds of partial laryngectomy. The types of operation varied according to stage of the lesion: vertical or frontovertical partial laryngectomy for T1b, T2 and T1a with invasion of anterior commissura, Tuker's operation or supracricoid partial laryngectomy for T1b, T2 or those with invasion of over half of contralateral cord, and extended vertical partial laryngectomy with resection of arytenoids for T3, or with invasion of ipsilateral arytenoids cartilage without involving postcricoid mucosa or posterior commissura. Totally, vertical partial laryngectomy was carried out for 76 patients, extended vertical partial laryngectomy for 7, supracricoid partial laryngectomy for 3 and Tucker's operation for 12. One stage unilateral neck dissection was performed in 5 patients and postoperative radio-therapy was supplemented to 5 (dose 60 Gy). For laryngeal function restoration, pectoro-hyomyo-flap and cricohyoidoepi glotopexy procedures were also performed for some patients. The clinical data of these patients were retrospectively analyzed. RESULTS: The 3- and 5-year survival rate was 86.5% (64/74) and 81.7% (49/60), respectively. The total decannulation rate was 94.9% (93/98), though fifteen patients had had symptoms of aspiration. Swallowing function of all patients recovered to the normal level. The phonation of all patients was restored to various degrees and they were able to communicate socially. CONCLUSION: The 3- and 5-year survival rates of partial laryngectomy for patients with glottic carcinoma of the larynx are comparable to the results achieved by total laryngectomy, but the quality of life of the patents much better. Complete resection of the tumor and simultaneous preservation of respiratory and vocal function whenever possible by partial laryngectomy is very important for improving patients' life quality. With a suitable size and good blood supply, the sternohyoid muscle flap of unipedical and half-thickness instead of whole thickness is ideal in the reconstruction of laryngeal defect after vertical partial laryngectomy.