Acute laryngeal obstruction is one of the most common diseases in Department of ENT, and it can cause suffocation without prompt treatment. Methods by using Nasopharyngofiberoscope guided tracheal intubation treatment of a case of acute laryngeal obstruction patients in a timely manner. This method is well tolerated, less trauma, high success rate, in the shortest time to improve the patient's ventilation, for the next step of the treatment to win the time.
Airway Obstruction ; surgery ; Humans ; Intubation, Intratracheal ; Larynx ; physiopathology

Adult ; Airway Obstruction ; physiopathology ; Asthma ; physiopathology ; Electrocardiography ; Female ; Humans ; Male ; Middle Aged

Airway Obstruction ; complications ; etiology ; physiopathology ; Asphyxia ; etiology ; physiopathology ; Fibroma ; complications ; pathology ; Humans ; Infant, Newborn ; Oropharyngeal Neoplasms ; complications ; pathology ; Rare Diseases

OBJECTIVETo investigate the obstructive site and the dynamic change of the upper airway in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) during sleep and wakefulness.

METHODSAfter being deprived of sleeping for 20 hours, sequential midline sagittal images of the upper airway were obtained in 21 patients during sleep and wakefulness with dynamic MRI. The obstructive state was studied according to hypopnea (< 10 s) and apnea (> or = 10 s). The length of obstruction site was measured and the dynamic characteristics of obstruction was observed. Statistical analysis was performed with paired t-test.

RESULTSThe obstruction at the level of the palatopharynx in patients with hypopnea during wakefulness was similar to that in patients with apnea during sleep. The maximal length [(6.61 +/- 1.23) cm], the minimal length [(0.95 +/- 0.22) cm] and maximal length difference [(5.66 +/- 1.27) cm] related to apnea during sleep were longer than those correlated with hypopnea [(2.99 +/- 0.51) cm, (0.72 +/- 0.23) cm, (2.27 +/- 0.67) cm, respectively] in wakefulness. (P < 0.01).

CONCLUSIONSThe obstruction of upper airway during sleep is dynamic and multilevel in patients with OSAHS. To a certain degree, hypopnea during wakefulness can give a clue to the obstructive state during sleep.

Adult ; Airway Obstruction ; diagnosis ; physiopathology ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Sleep Apnea, Obstructive ; diagnosis ; physiopathology

Under hypoxia condition, microRNA （miRNA） can interact with transcription factors for regulating the cell metabolism, angiogenesis, erythropoiesis, cellular proliferation, differentiation and apoptosis. The biological processes above may play an important role in mechanical asphyxia death. This article reviews the regulating function of miRNA under hypoxia condition and the influence of hypoxia to biosynthesis of miRNA, which may provide some new ideas to the research of miRNA on determining the cause of mechanical asphyxia death in the field of forensic medicine.
Accidents ; Airway Obstruction/physiopathology* ; Apoptosis ; Asphyxia/pathology* ; Cause of Death ; Death ; Forensic Medicine ; Humans ; Hypoxia/physiopathology* ; MicroRNAs/metabolism* ; Oxygen

OBJECTIVETo evaluate the clinical value of localization of upper airway obstructive site with pressure measurements and Friedman staging system in preoperative upper airway reconstructive surgery for obstructive sleep apnea-hypopnea syndrome (OSAHS), and to evaluate the value of Friedman staging system in predicting the upper airway obstructive site.

METHODSOne hundred and three patients with snoring, daytime sleepiness diagnosed as OSAHS by polysomnography were first classified using Friedman staging system, and then examined using whole night recording, including airway continuous pressure measurements (Apnea Graph, AG). AG transducer catheter containing two pressure and two temperature sensors used for obstruction site determination and detection of apnea events during sleep. Obstructive sites were divided into upper (retropalatal region) or lower level (retroglossal region). Using constituent ratio to reflect the obstructive proportion of different levels so as to find the correlation between Friedman staging system and localization of upper airway obstructive site with pressure measurements performed during sleep, and to evaluate the clinical value of Friedman staging system in predicting the severity of OSAHS.

RESULTSThere was statistically significant difference in the constituent ratio of retroglossal obstruction determined by AG, according to Friedman staging system, Friedman tongue position (FTP) and tonsil size grading (F = 13.876, 7.655, 10.207 respectively, P < 0.05). The constituent ratio of retroglossal obstruction between stage IV and I, II, III (P < 0.01) was significantly different. With the increasing of Friedman staging, the constituent ratio of retroglossal obstruction had the tendency of increasing. The constituent ratio of retroglossal obstruction between FTP grade 2 and grade 3, grade 4 (P < 0.05) was significantly different. With the increasing of FTP grading, the constituent ratio of retroglossal obstruction had the tendency of increasing. The constituent ratio of retroglossal obstruction between the Friedman tonsil size grade 4 and grade 1, grade 3 (P < 0.01), grade 2 (P < 0.05) was significantly different.

CONCLUSIONSFriedman staging system, in particular the FTP grading, had a correlation with upper airway pressure measurements (AG) in determination of the lower level of upper airway obstructive site, especially the retroglossal region, which could predict the main localization of upper airway obstructive site identified by upper airway pressure measurements during the sleep.

Adult ; Aged ; Airway Obstruction ; classification ; diagnosis ; physiopathology ; Female ; Humans ; Male ; Manometry ; Middle Aged ; Sleep Apnea, Obstructive ; diagnosis ; physiopathology ; Snoring ; physiopathology ; Transducers, Pressure ; Young Adult

OBJECTIVE: To investigate the relationship between the subjective sensation of nasal obstruction and the corresponding objective parameters of acoustic rhinometry. METHOD: Three hundred and sixty-five patients with nasal diseases were divided into two groups: one group included 220 cases with nasal obstruction, and the second group of 145 cases without nasal obstruction. Seventy healthy adults were selected as control. Each one were assessed for nasal minimal cross-sectional area (NMCA), volume of nasal cavity (NV), nasal airway resistance (NAR) and distance of the minimal cross section area from the nostril (DCAN) by using acoustic rhinometry, and the subjective test were performed using the VAS scores. The results were statistically analyzed. RESULT: NV, DCAN and NAR had a significant difference between nasal obstruct group and control group (P < 0.05). The VAS score had linear correlation with NMCA, NV, DCAN and NAR, and the correlation coefficient were R(NAR) = 0.7385, R(NV) = -0.853 2, R(NMCA) = -0.745 4 and R(DCAN) = 0.369 7, respectively. CONCLUSION Since NAR and NV coincide with the subjective perception of patients with nasal obstruction, they can be used as the sensitive parameters to evaluate subjective symptoms of patients.
Adult ; Aged ; Airway Resistance ; Case-Control Studies ; Humans ; Male ; Middle Aged ; Nasal Obstruction ; physiopathology ; Rhinometry, Acoustic ; Young Adult

OBJECTIVE: To determine whether there was agreement between the short daytime ApneaGraph (dAG) and nocturnal ApneaGraph (nAG) in diagnosing sleep respiratory events initially and identifying the site of obstruction in airway. METHOD: Twenty four patients diagnosed OSAHS by PSG were enrolled. The apnea-hypopnea index (AHI), apnea index (AI), obstructive apnea-hypopnea index (OAHI), central apnea hypopnea index (CAHI), mixed apnea index (MAHI), lowest oxygen saturation (LSaO2) and the proportion of upper/lower obstruction (UPPER, LOWER) of patients were measured using both dAG and nAG. RESULT: There were no significant differences between nAG and dAG for the following parameters: AHI, AI, CAHI, MAHI, OAHI, the proportion of upper/lower obstruction, or LSaO2 (P>0.05). There were significant positive correlations between nAG and dAG with regard to AHI, AI, MAHI, OAHI, the proportion of upper/lower obstruction , LSaO2 except CAHI. CONCLUSION The dAG has similar results with nAG in early diagnosis of sleep respiratory events and identifying the level of airway obstruction. The time-saving dAG is of considerable referential importance in diagnosis of sleep respiratory events and analysing the level of airway obstruction.
Adult ; Airway Obstruction ; Exercise Test ; methods ; Female ; Humans ; Male ; Middle Aged ; Polysomnography ; methods ; Sleep ; Sleep Apnea, Obstructive ; diagnosis ; physiopathology

BACKGROUNDThe assessment of regional pulmonary ventilation and perfusion is essential for the evaluation of a variety of lung disorders. Pulmonary ventilation MRI using inhaled oxygen as a contrast medium can be obtained with a clinical MR scanner, without additional equipment, and has been demonstrated to be a feasible means of assessing ventilation in animal models and some clinical patients. However, few studies have reported on MR ventilation-perfusion imaging. In this study, we evaluated the usefulness of oxygen-enhanced ventilation in combination with first-pass Gd-DTPA-enhanced perfusion MRI in a canine model of pulmonary embolism and airway obstruction.

METHODSPeripheral pulmonary embolisms were produced in eight dogs by intravenous injection of gelfoam strips at the pulmonary segmental arterial level, and airway obstructions were created in five of the dogs by inserting a self-designed balloon catheter into a secondary bronchus. Oxygen-enhanced MR ventilation images were produced by subtracting images from before and after inhalation of pure oxygen. Pulmonary perfusion MR images were acquired with a dynamic three-dimensional fast gradient-echo sequence. MR ventilation and perfusion images were read and contrasted with results from general examinations of pathological anatomy, ventilation-perfusion scintigraphy, and pulmonary angiography.

RESULTSRegions identified as having airway obstructions matched using both MR ventilation and perfusion imaging, but regions of pulmonary embolisms were mismatched. The area of airway obstruction defects was smaller using MR ventilation imagery than that using ventilation scintigraphy. Abnormal perfusion regions due to pulmonary embolisms were divided into defective regions and reduced regions based on the time course of signal intensity changes. In the diagnosis of pulmonary embolisms with the technique of ventilation and perfusion MRI, sensitivity and specificity were 75.0% and 98.1%, respectively, and the diagnostic results of this MRI technique were in agreement with the results of ventilation-perfusion scintigraphy and pulmonary angiography (K: 0.899, 0.743).

CONCLUSIONSOxygen-enhanced ventilation in combination with pulmonary perfusion MRI can be used to diagnose abnormalities of airways and blood vessels in the lungs, and can provide regional functional information with high spatial and temporal resolution. This method possesses great potential value for clinical applications.

Airway Obstruction ; diagnosis ; physiopathology ; Animals ; Disease Models, Animal ; Dogs ; Gadolinium DTPA ; Magnetic Resonance Imaging ; Oxygen ; pharmacology ; Pulmonary Circulation ; Pulmonary Embolism ; diagnosis ; physiopathology ; Respiration

OBJECTIVETo investigate the correlation between subjective assessment from clinician and patients and the objective measurement from active posterior rhinomanometry and acoustic rhinometry.

METHODSClinician and patients' assessment of nasal patency was achieved by visual analogue scale (VAS). Objective measurement included active posterior rhinomanometry and acoustic rhinometry. The mean of clinician's assessment and patients' VAS was compared by using paired-samples t-test. The correlation between unilateral nasal airflow resistance and unilateral nasal airway volume, unilateral minimal cross section area, and also subjective assessment and objective measurement of nasal patency were analysed by using Spearman correlation analysis in total patients.

RESULTSIn total of 316 patients, pre-decongestion and post-decongestion, unilateral nasal airflow resistance and unilateral nasal airway volume, unilateral minimal cross section area had significant negative correlation respectively (P = 0.000). The mean of clinician's assessment and patients' VAS had significant difference (P < 0.001) before and after decongestion. Clinician's assessment had significant positive correlation with patients' VAS, nasal airflow resistance, and significant negative correlation with nasal airway volume, minimal cross section area of nasal cavity before and after decongestion (P = 0.000). Patients' VAS had significant positive correlation with nasal airflow resistance, and significant negative correlation with nasal airway volume, minimal cross section area of nasal cavity before and after decongestion (P = 0.000). The correlation coefficients from clinician's assessment and objective measurements were greater than those from patients VAS and objective measurements.

CONCLUSIONSThe parameter of active posterior rhinomanometry had significant negative correlation with the parameters of acoustic rhinometry. Clinician assessment of nasal patency had significant positive correlation with patients' VAS; both of them had significant correlation with the parameters of rhinomanometry and acoustic rhinometry. Clinician's assessment was more objective and reliable to the parameters of objective measurement than patients' VAS.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Airway Resistance ; Female ; Humans ; Male ; Middle Aged ; Nasal Cavity ; physiopathology ; Nasal Obstruction ; diagnosis ; physiopathology ; Rhinometry, Acoustic ; Young Adult