Objective To analyze the disease burden and trends of tracheal, bronchus, and lung cancer (TBL) attributable to occupational carcinogens in China from 1990 to 2021, in order to provide reference for the prevention and control of TBL in China. Methods Based on the Global Burden of Disease database 2021, with occupational carcinogens as relevant risk factors and tracheal, bronchus, and lung cancer as the study diseases, data on mortality and disability-adjusted life years (DALYs) attributable to occupational carcinogens in China from 1990 to 2021 were extracted and age-standardized. Joinpoint regression models were used to calculate the annual percent change (APC) and average annual percent change (AAPC). Hiplot was used to visualize the distribution of disease burden by gender and age. The grey model GM (1, 1) was used to predict the disease burden and trends of TBL attributable to occupational carcinogens in China from 2022 to 2031. Results From 1990 to 2021, the overall mortality rate, DALYs rate, age-standardized mortality rate, and age-standardized DALYs rate of TBL attributable to occupational carcinogens in China increased from 1.85/100 000,53.93/100 000, 2.64/100 000, and 69.50/100 000 in 1990 to 5.22/100 000, 129.29/100 000, 3.49/100 000, and 83.80/100 000in 2021, respectively. The growth rates were 182.16%, 139.74%, 32.20%, and 20.58%, respectively. Joinpoint regression analysis showed that the AAPC values of overall mortality rate, DALYs rate, age-standardized mortality rate, and age-standardized DALYs rate of TBL attributable to occupational carcinogens in China from 1990 to 2021 were 3.41%, 2.87%, 0.92%, and 0.62%, respectively (all P<0.001), showing an overall upward trend, with higher values in females than in males. In 2021, the overall mortality rate of TBL attributable to occupational carcinogens in China gradually increased with age, with high mortality rates mainly concentrated in those aged ≥65 years, and higher rates in males than in females. The overall DALYs rate showed a trend of increasing first and then slowly decreasing with age, peaking at 65-69 years old, with higher rates in males than in females. The grey prediction model GM (1, 1) showed that the predicted values of mortality rate, DALYs rate, age-standardized mortality rate, and age-standardized DALYs rate of TBL attributable to occupational carcinogens in China from 2022 to 2031 all showed an upward trend. By 2031, the predicted values of mortality rate, DALYs rate, age-standardized mortality rate, and age-standardized DALYs rate will reach 7.19/100 000, 175.63/100 000, 4.16/100 000, and 93.64/100 000, respectively. Conclusion From 1990 to 2021, the mortality rate, DALYs rate, age-standardized mortality rate, and age-standardized DALYs rate of TBL attributable to occupational carcinogens in China all showed an upward trend. Males and the elderly are the main populations affected by the disease burden of TBL attributable to occupational carcinogens in China. It is necessary to strengthen the prevention and control of occupational carcinogens and promote health education.
ObjectiveTo study the feasibility of using propofol and remifentanil for tracheal intubation in patients who are awake, and investigate the influence of tracheal intubation on such vital signs as blood pressure and heart rates. MethodsEighty ASA I-Ⅱ patients who underwent general anesthesia in our hospital between December 2012 and April 2013 were randomly divided into two groups. Patients in group A received fentanyl-propofol, while patients in group B received remifentanyl-propofol-lidocaine. There was no significant difference between the two groups in gender, age, and body weight (P>0.05). Conventional intubation induction method was used for group A:0.05-0.10 mg/kg midazolam, 4 μg/kg fentanyl, 1.0-1.5 mg/kg propofol, and 0.6-0.9 mg/kg atracurium were given and tracheal intubation was performed after muscle relaxation. Group B patients were treated with remifentanyl propofol-lidocaine compound liquid slow intravenous injection, and compound cricothyroid membrane puncture method before endotracheal intubation. We observed the two groups of patients for vital signs before and after induction, and choking cough reactions. ResultsPatients in both the two groups were all able to complete tracheal intubation. Circulation change and incidence of tachycardia in patients of group A were significantly higher than those in group B (P<0.05). The rates of bradycardia, hypoxemia, and choking cough response were low in both groups with no statistically significant difference (P>0.05). ConclusionRemifentanyl propofol-lidocaine compound liquid can be safely used for implementation of endotracheal intubation in patients who are awake, and the hemodynamic stability can be maintained.
In cases where a tracheal injury exceeds half the length of the adult trachea or one-third of the length of the child trachea, it becomes difficult to perform end-to-end anastomosis after tracheal resection due to excessive tension at the anastomosis site. In such cases, tracheal replacement therapy is required. Advances in tissue engineering technology have led to the development of tissue engineering tracheal substitutes, which have promising applications. Hydrogels, which are highly hydrated and possess a good three-dimensional network structure, biocompatibility, low immunogenicity, biodegradability, and modifiability, have had wide applications in the field of tissue engineering. This article provides a review of the characteristics, advantages, disadvantages, and effects of various hydrogels commonly used in tissue engineering trachea in recent years. Additionally, the article discusses and offers prospects for the future application of hydrogels in the field of tissue engineering trachea.
Objective To assess the effectiveness and safety of laryngeal mask airway (LMA) and endotracheal tube (ETT) for airway management in pediatric general anesthesia. Methods Randomized controlled trials were collected through electronic searches of the PubMed, The Cochrane Library, EMbase, CBM, WanFang Data, VIP, CNKI from the date of establishment to November 2010. All the related data that matched the standards were abstracted by two reviewers independently. The quality of the included trials was evaluated according to the Cochrane Handbook 5.0. RevMan 5.0 software was used for meta-analysis of the complications, success of insertion on the first attempt and hemodynamic changes. Results A total of 39 trials involving 2 612 patients were included. The results of meta-analyses showed that LMA was superior to ETT in terms of less cough (RR=0.21, 95%CI 0.15 to 0.28, Plt;0.000 01), laryngospasm or bronchospasm (RR=0.37, 95%CI 0.18 to 0.77, P=0.008) and agitation (RR=0.14, 95%CI 0.09 to 0.22, Plt;0.000 01) during emergency. The incidence of postoperative sore throat (RR=0.32, 95%CI 0.19 to 0.55, Plt;0.000 1), hoarse voice (RR=0.09, 95%CI 0.03 to 0.27, Plt;0.000 1), nausea and vomiting (RR=0.46, 95%CI 0.26 to 0.80, P=0.006) was significantly lower in the LMA group. The hemodynamic changes during insertion and extraction of LMA were more stable than ETT, such as the heart rate changes in insertion, extraction and post-extraction period (SMD= –1.18, 95%CI –1.59 to –0.77, Plt;0.000 01; SMD= –1.29 95%CI –1.72 to –0.86, Plt;0.000 01; and SMD= –1.51 95%CI –2.15 to –0.87, Plt;0.000 01, respectively) and the MAP changes in insertion, extraction and post-extraction period (SMD= –1.21, 95%CI –1.39 to –1.02, Plt;0.000 01; SMD= –1.31, 95%CI –1.77 to –0.85, Plt;0.000 01; and SMD= –0.85, 95%CI –1.24 to –0.46, Plt;0.000 1, respectively); but no significant differences in postoperative regurgitation and aspiration (RR=3.00, 95%CI 0.62 to 14.61, P=0.17) and successful insertion on the first attempt (RR=0.99, 95%CI 0.94 to 1.05, P=0.84) were found between the LMA and ETT groups. Conclusion Current evidence indicates that the laryngeal mask airway is superior to endotracheal tube in terms of fewer complications during emergency and after operation as well as stable hemodynamic changes. So, it is a selective, safe and effective airway management for children.
ObjectiveTo investigate the expression of histone deacetylase 2 (HDAC2) in animal model of benign tracheal stenosis, and explore the mechanism of HDAC2 in development of tracheal stenosis.MethodsEighteen rabbits were randomly divided into a blank control group, a model group, and an erythromycin group, with 6 rats in each group. The model group and the erythromycin group underwent tracheostomy, the inner wall of trachea was brushed back and forth with a nylon brush for more than 20 times to induce benign tracheal stenosis. From 7 days before surgery to 9 days after surgery, the model group received gavage with saline, the erythromycin group received gavage with low-dose erythromycin in dose of 15 mg·kg–1·d–1, and the control group did not receive any treatment. On the 10th day after operation, all the rabbits were sacrificed and the trachea was cut to measure the tracheal stenosis. RNA and protein were extracted from the granulation tissue in the stenosis and the relative mRNA expressions of HDAC2, interleukin (IL)-6 and IL-8 in the granulation tissue were detected by real-time fluorescence quantitative PCR. The relative expression of HDAC2 protein was detected by Western blot.ResultsCompared with the blank control group, the tracheal stenosis in the model group was more obvious [(84.60±1.14)% vs.(27.00±6.44)%], the mRNA and protein expressions of HDAC2 were decreased (0.29±0.07 vs. 1.00±0.00, 0.20±0.02 vs. 0.49±0.04), the mRNA expressions of IL-6 and IL-8 were up-regulated (4.22±0.67 vs. 1.00±0.00, 162.72±23.23 vs.1.00±0.00). Compared with the model group, tracheal stenosis in the erythromycin group was relieved [(64.00±12.25)% vs. (84.60±1.14)%], the mRNA and protein expressions of HDAC2 were increased (0.42±0.14 vs. 0.29±0.07, 0.43±0.01 vs. 0.20±0.02), the mRNA expressions of IL-6 and IL-8 were decreased (0.72±0.24 vs. 4.22±0.67, 130.22±7.93 vs. 162.72±23.23). All the differences were statistically significant (all P<0.05). The Pearson correlation coefficient between tracheal stenosis and HDAC2 mRNA relative expression was –0.96 (P<0.05).ConclusionsThe down-regulation of HDAC2 expression in model of benign tracheal stenosis is related to the occurrence and development of tracheal stenosis. The low dose of erythromycin may be used to treat benign tracheal stenosis by up-regulating expression of HDAC2 and thus inhibiting the inflammatory disorder during tracheal injury repair.
Objective To estimate the degree of the angle between left principal bronchus and trachea, and it is correlative with the pulmonary function in the patients with rheumatic mitral valve disease. Methods According to various degree of angles between left principal bronchus and trachea,53 patients were divided into three groups, group 1: angle between left principal bronchus and trachea less than 50 degree, group 2: between 50 and 64 degree, group 3: between 65 and 79 degree. The pulmonary function tests,ultrasonic cardiography and left principal bronchus X-ray tomographic film were carried out in three groups before operation. Compare pulmonary function data with different angle between left principal bronchus and trachea in three groups. Results Exception of vital capacity ,residual volume and total lung capacity,the rest markers of lung function showed significant differences (Plt;0.05) in three groups. The correlation of the angle between left principal bronchus and trachea and the ratio of residual volume and total lung capacity among three groups were positively correlative, and the other parameters of lung function were negatively correlative (Plt;0.01). Conclusion The degree of the angle between left principal bronchus and trachea is positively correlative with the extent of pulmonary function impairing.
ObjectiveTo systematically review the efficacy and safety of laryngeal mask versus endotracheal tubes for laparoscopic surgery.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and CBM databases were electronically searched to collect the randomized controlled trials (RCTs) about the efficacy and safety of laryngeal mask versus endotracheal tubes for laparoscopic surgery from inception to April, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 16 RCTs involving 1 593 patients were included. The results of meta-analysis showed that: there was no significant difference in the success rate of the first insertion (RR=0.99, 95%CI 0.96 to 1.02, P=0.55). The airway pressure of patients whose position were head higher than foot was significantly lower in the laryngeal mask group than in the tracheal intubation group (MD=–1.20, 95%CI –1.81 to –0.59, P=0.000 1), but there was no significant difference between two groups in reverse position patients (MD=0.48, 95%CI –0.90 to 1.87, P=0.49). The incidence of sore throat (RR=0.58, 95%CI 0.46 to 0.74, P<0.000 01), the incidence of blood stain (RR=0.48, 95%CI 0.30 to 0.77, P=0.002), the incidence of laryngeal spasm/bronchial spasm (OR=0.30, 95%CI 0.11 to 0.80, P=0.02) and the incidence of cough/hiccup (RR=0.10, 95%CI 0.07 to 0.15, P<0.000 01) in the laryngeal mask group were significantly lower than those in the tracheal intubation group.ConclusionThe current evidence shows that compared with tracheal intubation, laryngeal mask can effectively reduce airway pressure of patients whose position are head higher than foot. The risks of various complications are significant higher in tracheal intubation in laparoscopic surgery. Laryngeal mask can maintain patients' normal respiratory functions while reduce damage and do not increase the occurrence of reflux aspiration. Due to limited quantity and quality of the included studies, more high quality studies are needed to verify above conclusion.
ObjectiveTo investigate the safety and feasibility of laryngeal mask general anesthesia as a replacement of tracheal intubation general anesthesia in the "three-port" thoracoscopic thymectomy via subxiphoid and subcostal arch for thymoma patients without myasthenia.MethodsFrom January 2018 to June 2019, clinical data of patients with thymoma who underwent the novel "three-port" operation in our institution were analyzed retrospectively. The patients were divided into two groups according to the anesthesia methods, including a tracheal intubation general anesthesia group and a laryngeal mask general anesthesia group. There were 70 patients in the tracheal intubation general anesthesia group, including 42 males and 28 females, with an average age of 45.83±15.89 years. There were 39 patients in the laryngeal mask general anesthesia group, including 26 males and 13 females, with an average age of 43.31±15.64 years. The clinical data of the two groups were compared.ResultsThe baseline characteristics of the patients in the two groups were well balanced (P>0.05). No massive bleeding, conversion to thoracotomy, postoperative myasthenia or death occurred in those patients. No patient with laryngeal mask anesthesia had a conversion to tracheal intubation anesthesia during the operation. There was no significant difference in the operation time, intraoperative bleeding, intraoperative maximum partial pressure of CO2, lowest partial pressure of oxygen and anesthesia effect score between the two groups (P>0.05). There was also no statistical difference in postoperative aspiration, gastrointestinal discomfort, length of hospital stay, pain score and patient satisfaction degree between the two groups (P>0.05). However, the anesthesia time before operation and the time of awake after anesthesia in the laryngeal mask anesthesia group were significantly shorter than those in the tracheal intubation general anesthesia group (P<0.05), and the incidence of transient arrhythmia, laryngeal discomfort and hoarseness in the laryngeal mask general anesthesia group was significantly lower than that in the tracheal intubation general anesthesia group (P<0.05).ConclusionThe "three-port" thoracoscopic thymectomy via subxiphoid and subcostal arch under laryngeal mask general anesthesia is safe and feasible in the treatment of thymoma without myasthenia, and can be recommended routinely.
ObjectiveTo explore the predictive factors for extubation in mechanically ventilated patients with moderate to severe traumatic brain injury (TBI). MethodsMechanically ventilated adult patients with moderate to severe brain injuries admitted to the People’s Hospital of Hunan province were selected between April 2020 and March 2022. The general data, neurological function and airway protective ability of the patients were collected. The patients were divided into successful extubation and failed extubation groups based on extubation outcomes. The differences in various indicators between the two groups were compared. Univariate and multivariate logistic regression analyses were conducted to determine the influencing factors for tracheal tube extubation in patients with moderate to severe TBI. Receiver operating characteristic (ROC) curves were plotted to analyze the predictive value of each indicator for extubation in TBI patients. ResultsA total of 263 patients with moderate to severe TBI were included in the analysis, with 183 patients in the successful extubation group and 80 patients in the failed extubation group. The successful extubation group had higher Glasgow coma scale (GCS) and cough peak flow (CPF) compared to the failed extubation group. The incidence of ventilator-associated pneumonia (VAP), duration of mechanical ventilation, length of ICU stay, and length of hospital stay were all lower in the successful extubation group. Univariate and multivariate logistic regression analyses showed that the predictive factors for tracheal tube extubation in patients with moderate to severe TBI were CPF and GCS at the time of extubation. Adjusting for confounding factors, every 1 L/min increase in CPF at the time of extubation reduced the risk of extubation failure by 2% [odds ratio (OR) = 0.98, 95% confidence interval (CI) 0.97 - 0.99], and every 1-point increase in GCS reduced the risk of extubation failure by 12% (OR = 0.88, 95%CI 0.79 - 0.98). ROC curve analysis showed that CPF, GCS, GCS eye, and GCS motor had predictive value for tracheal tube extubation in patients with moderate to severe TBI. When patients simultaneously met the criteria of GCS≥8 (GCS motor≥5, GCS eye≥3) and CPF ≥68.5 L/min, the diagnostic value for predicting successful extubation was highest, with an area under the ROC curve of 0.946 (95%CI 0.917 - 0.975), sensitivity of 0.850, and specificity of 0.907. ConclusionCPF ≥ 68.5 L/min and GCS ≥ 8 have clinical guiding value for successful extubation in mechanically ventilated patients with moderate to severe traumatic brain injury.
Objective To construct a new composite artificial trachea and to investigate the feasibility of trachea repair and reconstruction with the new composite artificial trachea transplantation in dogs. Methods The basic skeleton of the new composite artificial trachea was polytetrafluoroethylene vascular prosthesis linked with titanium rings at both ends. Dualmesh was sutured on titanium rings. Sixteen dogs, weighing (14.9 ± 2.0) kg, female or male, were selected. The 5 cm cervical trachea was resected to prepare the cervical trachea defect model. The trachea repair and reconstruction was performed with the new composite artificial trachea. Then fiberoptic bronchoscope examination, CT scan and three-dimensinal reconstruction were conducted at immediate, 1 month, and 6 months after operation. Gross observation and histological examination were conducted at 14 months to evaluate the repair and reconstruction efficacy. Results No dog died during operation of trachea reconstruction. One dog died of dyspnea at 37, 41, 55, 66, 140, and 274 days respectively because of anastomotic dehiscence and artificial trachea displacement; the other 10 dogs survived until 14 months. The fiberoptic bronchoscope examination, CT scan and three-dimensinal reconstruction showed that artificial tracheas were all in good location without twisting at immediate after operation; mild stenosis occurred and anastomoses had slight granulation in 6 dogs at 1 month; severe stenosis developed and anastomosis had more granulation in 1 dog and the other dogs were well alive without anastomotic stenosis at 6 months. At 14 months, gross observation revealed that outer surface of the artificial trachea were encapsulated by fibrous connective tissue in all of 10 dogs. Histological examination showed inflammatory infiltration and hyperplasia of fibrous tissue and no epithelium growth on the inner wall of the artificial trachea. Conclusion The new composite artificial trachea can be used to repair and reconstruct defect of the trachea for a short-term. Anastomotic infection and dehiscence are major complications and problems affecting long survival.