BACKGROUND: Biodegradable (BD) stents made from polydioxanone have been used only in human airways. These stents combine the advantages of classical tracheal stents, and fewer side effects are expected due to their biocompatibility and their time-limited presence in airways. However, new clinical consequences have arisen. Here, the authors share their experiences with BD stents for tracheal indications, focusing on their safety and efficacy. METHODS: This was a retrospective review of a collected database of adult patients who underwent implantation of biodegradable tracheal stents between September 2013 and December 2022 at the Department of Respiratory Medicine of the 1st Faculty of Medicine in Prague and Thomayer University Hospital. The indications included functionally significant nonmalignant tracheal stenosis and tracheomalacia. Self-expandable, biodegradable, polydioxanone tracheal stents manufactured by ELLA-CS Ltd. (Hradec Kralove, Czech Republic) were implanted during rigid bronchoscopy under general anaesthesia. All patients were followed up in the department and were provided with the necessary care. The main efficacy and safety parameters and relationships were analysed using descriptive statistics and Fisher´s exact, Wilcoxon and Kruskal‒Wallis tests. RESULTS: A total of 65 stents were implanted in 47 adult patients. During the first two months after implantation, when adequate function was expected, the stent was found to be effective in 26 out of 39 patients who completed this period (66.7%). The clinical effectiveness reached 89.7%, as early restenoses were mostly mild and necessitated treatment in only 4 patients. The frequencies of significant mucostasis, migration and granulation tissue growth were 2.6%, 7.5% and 23.1%, respectively, during this period. Thirty-four participants completed the half-year follow-up period after the first or second stent insertion, and some were followed up beyond this period. Poor control of symptoms, the development of restenosis and the need for interventions were characteristic of this period as the stents degraded. Twenty-two patients who experienced remodelling or stabilization of the tracheal lumen achieved a stent-free state. Seven patients underwent subsequent surgical treatment. CONCLUSIONS: BD stents are safe and provide adequate tracheal support until they begin to degrade. The use of BD stents necessitates close monitoring of patients and accurate treatment of possible restenosis. TRIAL REGISTRATION: Based on project NT14146 - Biodegradable stents in the management of the large airways (2013-2015, MZ0/NT), registered on May 1, 2013, in the Research and Development and Innovation Information System of the Czech Republic and at ClinicalTrials.gov (reg. no. NCT02620319, December 2, 2015).
- Klíčová slova
- Biodegradable, Bronchoscopy, Interventional pneumology, Polydioxanone, Stents, Tracheal stenosis,
- MeSH
- bronchoskopie * MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- polydioxanon MeSH
- protézy - design MeSH
- retrospektivní studie MeSH
- senioři MeSH
- stenóza průdušnice * chirurgie MeSH
- stenty * MeSH
- trachea chirurgie MeSH
- tracheomalacie chirurgie MeSH
- vstřebatelné implantáty * MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
Liposomal carrier systems have emerged as a promising technology for pulmonary drug delivery. This study focuses on two selected liposomal systems, namely, dipalmitoylphosphatidylcholine stabilized by phosphatidic acid and cholesterol (DPPC-PA-Chol) and dipalmitoylphosphatidylcholine stabilized by polyethylene glycol and cholesterol (DPPC-PEG-Chol). First, the research investigates the stability of these liposomal systems during the atomization process using different kinds of nebulizers (air-jet, vibrating mesh, and ultrasonic). The study further explores the aerodynamic particle size distribution of the aerosol generated by the nebulizers. The nebulizer that demonstrated optimal stability and particle size was selected for more detailed investigation, including Andersen cascade impactor measurements, an assessment of the influence of flow rate and breathing profiles on aerosol particle size, and an in vitro deposition study on a realistic replica of the upper airways. The most suitable combination of a nebulizer and liposomal system was DPPC-PA-Chol nebulized by a Pari LC Sprint Star in terms of stability and particle size. The influence of the inspiration flow rate on the particle size was not very strong but was not negligible either (decrease of Dv50 by 1.34 μm with the flow rate increase from 8 to 60 L/min). A similar effect was observed for realistic transient inhalation. According to the in vitro deposition measurement, approximately 90% and 70% of the aerosol penetrated downstream of the trachea using the stationary flow rate and the realistic breathing profile, respectively. These data provide an image of the potential applicability of liposomal carrier systems for nebulizer therapy. Regional lung drug deposition is patient-specific; therefore, deposition results might vary for different airway geometries. However, deposition measurement with realistic boundary conditions (airway geometry, breathing profile) brings a more realistic image of the drug delivery by the selected technology. Our results show how much data from cascade impactor testing or estimates from the fine fraction concept differ from those of a more realistic case.
- Klíčová slova
- aerosol, deposition, inhalation, liposome, nebulizer, particle size, pulmonary drug delivery,
- MeSH
- 1,2-dipalmitoylfosfatidylcholin MeSH
- aerosoly MeSH
- aplikace inhalační MeSH
- bronchodilatancia * MeSH
- cholesterol MeSH
- design vybavení MeSH
- lékové transportní systémy MeSH
- lidé MeSH
- liposomy MeSH
- nebulizátory a vaporizátory MeSH
- trachea * MeSH
- velikost částic MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- 1,2-dipalmitoylfosfatidylcholin MeSH
- aerosoly MeSH
- bronchodilatancia * MeSH
- cholesterol MeSH
- liposomy MeSH
The numerical simulation of inhaled aerosols in medical research starts to play a crucial role in understanding local deposition within the respiratory tract, a feat often unattainable experimentally. Research on children is particularly challenging due to the limited availability of in vivo data and the inherent morphological intricacies. CFD solvers based on Finite Volume Methods (FVM) have been widely employed to solve the flow field in such studies. Recently, Lattice Boltzmann Methods (LBM), a mesoscopic approach, have gained prominence, especially for their scalability on High-Performance Computers. This study endeavours to compare the effectiveness of LBM and FVM in simulating particulate flows within a child's respiratory tract, supporting research related to particle deposition and medication delivery using LBM. Considering a 5-year-old child's airway model at a steady inspiratory flow, the results are compared with in vitro experiments. Notably, both LBM and FVM exhibit favourable agreement with experimental data for the mean velocity field and the turbulence intensity. For particle deposition, both numerical methods yield comparable results, aligning well with in vitro experiments across a particle size range of 0.1-20 µm. Discrepancies are identified in the upper airways and trachea, indicating a lower deposition fraction than in the experiment. Nonetheless, both LBM and FVM offer invaluable insights into particle behaviour for different sizes, which are not easily achievable experimentally. In terms of practical implications, the findings of this study hold significance for respiratory medicine and drug delivery systems - potential health impacts, targeted drug delivery strategies or optimisation of respiratory therapies.
- Klíčová slova
- Child airways, Finite Volume Method, In vitro measurement, Lattice Boltzmann Method, Particle deposition,
- MeSH
- aerosoly MeSH
- hydrodynamika * MeSH
- lidé MeSH
- počítačová simulace MeSH
- předškolní dítě MeSH
- trachea * anatomie a histologie MeSH
- velikost částic MeSH
- Check Tag
- lidé MeSH
- předškolní dítě MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- aerosoly MeSH
We present a case of a preterm neonate with a type IV laryngo-tracheo-oesophageal cleft, an uncommon congenital malformation, resulting from the failure of separation of the trachea and the oesophagus during fetal development, often associated with other deformities as well. Data in the literature shows that the long-term morbidity from the entity has declined over the last decades, even though prognosis remains unfavourable for types III and IV. This report emphasizes the complex issues neonatologists are faced with, when treating neonates with this rare disorder in the first days of life, what will raise suspicion of this rare medical entity, and that direct laryngoscopy/bronchoscopy finally depicts the exact extension of the medical condition. At the same time extensive evaluation for coexisting congenital anomalies should be performed. For all the above reasons, these neonates should be treated in specialized tertiary pediatric centers for multidisciplinary prompt management, which may improve, the outcome.
- Klíčová slova
- Laryngeal cleft, Laryngo-tracheo-oesophageal cleft, Laryngotracheal abnormalities, Neonates,
- MeSH
- dítě MeSH
- ezofágus diagnostické zobrazování chirurgie abnormality MeSH
- laryngoskopie MeSH
- larynx * diagnostické zobrazování chirurgie abnormality MeSH
- lidé MeSH
- novorozenec MeSH
- trachea diagnostické zobrazování chirurgie abnormality MeSH
- vrozené vady * MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- přehledy MeSH
The Indian crested porcupine (Hystrix indica) (ICP) is widely distributed in Asia; however, compared with other rodents, little is known about the structures of its respiratory system. The aim of this study was to evaluate the histomorphology of the lower respiratory portion of the ICP to provide a basis for the identification of the normal structure of this organ. The larynx, trachea and lungs of four carcasses of adult Indian crested porcupines (two males and two females) were dissected and fixed in 10% neutral-buffered formalin. The gross anatomy and histology of all specimens were evaluated. A macroscopic evaluation showed unique structures in the ICP respiratory system, including the presence of a chamber-like structure at the origin of the bronchi and a difference in epiglottis shape between males and females. Histologically, the stratified squamous epithelium covered the epiglottis and arytenoid cartilage, and the pseudostratified ciliated columnar epithelium covered the internal part of the thyroid and cricoid cartilages. Histomorphological studies showed a few goblet cells in the tracheal epithelium. In the bronchi and larger bronchioles, pseudostratified ciliated columnar epithelia were observed. Bronchi were surrounded by segments of cartilage. Distal bronchioles had a simple cuboidal/columnar epithelium with club (Clara) cells, lacked cartilaginous tissue in their walls and had a complete smooth muscle layer. These results revealed histomorphological differences between the ICP and other rodents.
- Klíčová slova
- Indian crested porcupine, larynx, lung, porcupine, respiratory system, trachea,
- MeSH
- bronchy MeSH
- dikobrazovití a urzonovití * MeSH
- epitel MeSH
- plíce MeSH
- trachea MeSH
- zvířata MeSH
- Check Tag
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
Cough is one of the most important defensive reflexes. However, extensive non- productive cough is a harmful mechanism leading to the damage of human airways. Cough is initiated by activation of vagal afferents in the airways. The site of their convergence is particularly the nucleus of the solitary tract (nTS). The second-order neurons terminate in the pons, medulla and spinal cord and there is also the cortical and subcortical control of coughing.Upper airway cough syndrome (UACS) - previously postnasal drip syndrome - is one of the most common causes of chronic cough together with asthma and gastroesophageal reflux. The main mechanisms leading to cough in patients with nasal and sinus diseases are postnasal drip, direct irritation of nasal mucosa, inflammation in the lower airways, upper airway inflammation and the cough reflex sensitization. The cough demonstrated by UACS patients is probably due to hypersensitivity of the upper airways sensory nerve or lower airways sensory nerve, or a combination of both. Further studies are needed to clarify this mechanism.
- MeSH
- chronická nemoc MeSH
- kapsaicin škodlivé účinky MeSH
- kašel chemicky indukované patofyziologie MeSH
- kationtové kanály TRPV agonisté fyziologie MeSH
- kationtový kanál TRPA1 agonisté fyziologie MeSH
- lidé MeSH
- nervové receptory účinky léků fyziologie MeSH
- nervus vagus účinky léků patofyziologie MeSH
- nosní sliznice účinky léků patofyziologie MeSH
- syndrom MeSH
- trachea účinky léků patofyziologie MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- kapsaicin MeSH
- kationtové kanály TRPV MeSH
- kationtový kanál TRPA1 MeSH
- TRPA1 protein, human MeSH Prohlížeč
- TRPV1 protein, human MeSH Prohlížeč
In order to clear airways and lungs defensive reflexes are provoked rather by the dynamic phase of mechanical stimulus. It is speculated that provocation of defensive response depends not only on stimulus duration but also on stimulus velocity. Fourteen adult rabbits were anaesthetized and tracheotomized. Mechanical stimulus was provoked by a mechanical probe introduced through the tracheotomy and rotated by a small electrical motor using a rotational velocity of 40 rpm/s and 20 rpm/s. Threshold, incidence and intensity of cough reflex (CR) were analyzed for each animal. Statistical comparisons between two velocities were performed using Friedman nonparametric test for repeated measurements. Results are median (25-75 %). The threshold of CR was significantly increased (p=0.005) from 350 ms (300-500 ms) to 550 ms (350-1150 ms) and the incidence of cough reflex was significantly reduced (p=0.002) from 50 % (19 50 %) to 0 % (0-25 %) when the rotational velocity of the mechanical probe was reduced by half. The findings of this study are of interest as they show that protective reflex cough, an important mechanism that allows clearing airways even during sleep or anesthesia, is tuned by mechanical stimulus velocity.
- MeSH
- dechový objem fyziologie MeSH
- fyzikální stimulace škodlivé účinky MeSH
- kašel etiologie patofyziologie MeSH
- králíci MeSH
- plíce patofyziologie MeSH
- reflex fyziologie MeSH
- trachea patofyziologie MeSH
- zvířata MeSH
- Check Tag
- králíci MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
The sinonasal mucosa has an essential role in defense mechanisms of the upper respiratory tract. The innate immune system presents the primary defense against noxious microorganisms followed by induction of the adaptive immune mechanisms as a consequence of the presence of pathogens. This well-known activation of adaptive immune system in response to presence of the antigen on mucosal surfaces is now broadly applicated in vaccinology research. Prevention of infectious diseases belongs to substantial challenges in maintaining the population health. Non-invasive, easily applicable mucosal vaccination purposes various research opportunities that could be usable in daily practice. However, the existence of multiple limitations such as rapid clearance of vaccine from nasal mucosa by means of mucociliary transport represents a great challenge in development of safe and efficient vaccines. Here we give an updated view on nasal functions with focus on nasal mucosal immunity and its potential application in vaccination in nearly future.
- MeSH
- aplikace intranazální MeSH
- lidé MeSH
- nosní sliznice účinky léků fyziologie MeSH
- respirační sliznice účinky léků fyziologie MeSH
- sliznice hrtanu účinky léků fyziologie MeSH
- slizniční imunita účinky léků fyziologie MeSH
- trachea účinky léků fyziologie MeSH
- vakcíny aplikace a dávkování MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- vakcíny MeSH
OBJECTIVE: Blunt thoracic aortic injury is life-threatening injury. High suspicion on this clinical condition can be made by initial chest X-ray on emergency department. The aim of study was to detect which other signs, except widened mediastinum, are specific for rupture of the thoracic aorta. METHODS: To the study were included all Triage positive patients primary headed from the scene of injury to the Trauma center Level I from January to December 2014 and which have performed chest X-ray on emergency department followed by CT of chest, abdomen and pelvis. On chest X-ray were evaluated diameter of superior mediastinum, deviation of trachea, deviation of left and right main bronchus, aortic arch, fracture of first or second rib on the left side and obliteration of aortopulmonary space. RESULTS: Totally n=208 patients were enrolled to the study. Seven patients had blunt thoracic aortic injury on CT angiography. All these patients had widened superior mediastinum more than 80 mm (p=0.021). Six patients with blunt thoracic aortic injury had obliteration of aortic arch (p=0.0001) and obliteration of aortopulmonary space (p=0.0001). CONCLUSION: All patients after high energy trauma with widened mediastinum together with obliteration of aortic arch and obliteration of aortopulmonary space on initial chest X-ray without initial CT, must be indicated to the CT after initial stop the bleeding procedures for the exclusion of traumatic rupture of thoracic aorta.
- MeSH
- aorta thoracica diagnostické zobrazování MeSH
- bronchy diagnostické zobrazování MeSH
- CT angiografie MeSH
- dospělí MeSH
- fraktury žeber diagnostické zobrazování MeSH
- kohortové studie MeSH
- lidé MeSH
- mediastinum diagnostické zobrazování MeSH
- polytrauma diagnostické zobrazování MeSH
- poranění hrudníku diagnostické zobrazování MeSH
- rentgendiagnostika hrudníku MeSH
- retrospektivní studie MeSH
- ruptura aorty diagnostické zobrazování MeSH
- skóre závažnosti úrazu MeSH
- trachea diagnostické zobrazování MeSH
- tupá poranění diagnostické zobrazování MeSH
- zkrácená stupnice závažnosti úrazů MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
