BACKGROUND: Patients who underwent lobectomy resection are prone to hypoxemia, and the vast majority present with type I respiratory failure. Thus, improvement of hypoxemia is one of the most important factors to facilitate postoperative recovery of patients. In this study, the superiority-inferiority of different oxygen inhalation methods were compared with high-flow nasal oxygen therapy (HFNO), noninvasive mechanical ventilation (NIMV) and nasal oxygen breath (NOB) in patients with hypoxemia after single-port video-assisted thoracoscopic (VATS) lobectomy, and the clinical efficacy of HFNO in these patients was further investigated. METHODS: A total of 180 patients from the Second Affiliated Hospital of Soochow University in China with hypoxemia who accepting single-port VATS lobectomy from June 2021 to March 2022 were randomly divided into three groups (n=60), which were treated with HFNO, NIMV and NOB, respectively. The results of arterial blood gas analysis, patient's comfort score and incidence of complications were observed before, 1 h, 6 h-12 h and after use. Statistical analyses were conducted using statistical program for social sciences 25.0 (SPSS 25.0), and P<0.05 was considered as statistical significance. RESULTS: For patients with hypoxemia after accepting single-port VATS lobectomy, HFNO was no less effective than NIMV (P=0.333), and both of whom could fast increase patients' partial pressure of oxygen/fraction of inspiration O₂ (PaO₂/FiO₂) compared to NOB (P<0.001). Besides, HFNO shows a great advantage in comfort degree and stay length (P<0.001, P=0.004), and incidence of complications were slightly lower than other groups (P=0.232). But it is worthy to note that HFNO is still slightly less effective than NIMV in patients with postoperative hypoxemia accompanied by elevated partial pressure of carbon dioxide (PaCO₂). CONCLUSIONS For patients with hypoxemia who accepting single-port VATS lobectomy, HFNO can be used as the first choice. However, for patients with postoperative hypoxemia accompanied by elevated PaCO₂, NIMV is still recommended to improve oxygenation.
Carbon Dioxide ; Humans ; Hypoxia/surgery* ; Lung Neoplasms/surgery* ; Oxygen ; Pneumonectomy/methods* ; Thoracic Surgery, Video-Assisted/methods*

OBJECTIVE: Keloids are exuberant cutaneous scars that form due to abnormal growth of fibrous tissue following an injury. The primary aim of this study was to assess the efficacy and mechanism of hyperbaric oxygen therapy (HBOT) to reduce the keloid recurrence rate after surgical excision and radiotherapy. METHODS: (1) A total of 240 patients were randomly divided into two groups. Patients in the HBOT group (O group) received HBOT after surgical excision and radiotherapy. Patients in the other group were treated with only surgical excision and radiotherapy (K group). (2) Scar tissue from recurrent patients was collected after a second operation. Hematoxylin and eosin (H&E) staining was used to observe keloid morphology. Certain inflammatory factors (interleukin-6 (IL-6), hypoxia-inducible factor-1α (HIF-1α), tumor necrosis factor-α (TNF-α), nuclear factor κB (NF-κB), and vascular endothelial growth factor (VEGF)) were measured using immunohistochemical staining. RESULTS: (1) The recurrence rate of the O group (5.97%) was significantly lower than that of the K group (14.15%), P<0.05. Moreover, patients in the O group reported greater satisfaction than those in the K group (P<0.05). (2) Compared with the recurrent scar tissue of the K group, the expression levels of the inflammatory factors were lower in the recurrent scar tissue of the O group. CONCLUSIONS Adjunctive HBOT effectively reduces the keloid recurrence rate after surgical excision and radiotherapy by improving the oxygen level of the tissue and alleviating the inflammatory process.
Adolescent ; Adult ; Female ; Humans ; Hyperbaric Oxygenation ; Hypoxia-Inducible Factor 1, alpha Subunit/blood* ; Inflammation ; Interleukin-6/blood* ; Keloid/surgery* ; Male ; Middle Aged ; NF-kappa B p50 Subunit/blood* ; Perfusion ; Recurrence ; Surveys and Questionnaires ; Tumor Necrosis Factor-alpha/blood* ; Vascular Endothelial Growth Factor A/blood* ; Young Adult

A 20-year-old female had undergone definitive surgical repair for pulmonary atresia with intact ventricular septum soon after birth. She was referred to our institution with the chief complaint of clubbing fingers. A thorough examination revealed platypnea-orthodeoxia syndrome due to an interatrial right-to-left shunt through a secundum atrial septal defect. Percutaneous closure with an Amplatzer Septal Occluder resulted in resolution of the syndrome.
Dyspnea/*diagnosis/*etiology/surgery ; Female ; Heart Defects, Congenital/complications/*surgery ; Heart Septal Defects, Atrial/*complications/*diagnosis/surgery ; Humans ; Hypoxia ; Pulmonary Atresia/complications/*surgery ; *Septal Occluder Device ; Syndrome ; Treatment Outcome

OBJECTIVETo observe the effect of one lung ventilation (OLV) preconditioning on perioperative oxygenation during pediatric video-assisted thoracoscopic surgeries (VATS).

METHODSA total of 171 children aged 5 days to 11 years underwent VATS for empyema dissection and abscess excisions (n=55), mediastinal tumor resection (n=34), repair of the diaphragmatic hernia or diaphragmatic plication (n=21), pulmonary lobectomy or biopsy (n=43), or esophageal disease (n=18). Of these patients, 127 were younger than 3 years of age. A 5-Fr pediatric endobronchial blocker was used for OLV with a delivered inspired oxygen fraction (FiO(2)) of 1.0. After lateral decubitus, a sequential protocol of a 5- to 8-min OLV preconditioning and a 5-min two lung ventilation (TLV) was performed followed by OLV again before incision for VATS. In cases of a SpO(2)<95% without malposition of the blocker during OLV, a 5 cm H(2)O positive end expiratory pressure was applied; TLV was maintained for a SpO(2)<90%.

RESULTSOLV provided good surgical conditions in 160 cases. Acceptable saturations were achieved in 166 cases during OLV. In 2 cases in empyema group and 3 in esophageal disease group, the ventilation protocol was converted to intermittent TLV during the operation due to hypoxemia. In esophageal disease group, the procedure and OLV duration, postoperative ventilation time and length of stay (LOS) were the longest among the groups, and the number of cases developing postoperative atelectasis was greater than that in diaphragmatic hernia and pulmonary disease groups. In empyema and esophageal disease groups, the oxygenation index (PaO(2)/FiO(2)) after total collapse of the lung in OLV and after extubation were lower than that in mediastinal tumor group (P<0.05 or 0.01).

CONCLUSIONA OLV preconditioning can maintain an acceptable oxygenation during pediatric OLV. A longer procedure and OLV duration is associated with a prolonged postoperative length of ventilation and LOS.

Blood Gas Analysis ; Child ; Child, Preschool ; Humans ; Hypoxia ; Infant ; Infant, Newborn ; Lung ; One-Lung Ventilation ; Positive-Pressure Respiration ; Respiration, Artificial ; Thoracic Surgery, Video-Assisted

BACKGROUNDIn China, tracheobronchial foreign body (TFB) aspiration, a major cause of emergency episode and accident death in children, remains a challenge for anesthetic management. Here, we share our experience and discuss the anesthetic consideration and management of patients with TFB aspiration.

METHODSThis was a single-institution retrospective study in children with an inhaled foreign body between 1991 and 2010 that focused on the complications following rigid bronchoscopy (RB). Data including the clinical characteristics of patients and TFB, anesthetic method, and postoperative severe complications were analyzed by different periods.

RESULTSDuring the 20-year study period, the charts of 3149 patients who underwent RB for suspected inhaled TFB were reviewed. There were 2079 male and 1070 female patients (1.94:1). A nut (84%) was the most commonly inhaled object. The study revealed a 9% (n = 284) overall rate of severe postoperative complications related to severe hypoxemia, laryngeal edema, complete laryngospasm, pneumothorax, total segmental atelectasis, and death with incidences of 3.2%, 0.9%, 1.3%, 0.3%, 0.3%, and 0.1%, respectively. The rates of preoperative airway impairment, negative findings of TFB, and adverse postoperative events have been on the rise in the past 5 years.

CONCLUSIONSThe survey results confirmed that hypoxemia remains the most common postoperative complication in different periods. Both controlled ventilation and spontaneous ventilation were effective during the RB extraction of the foreign body at our hospital in the modern technique period. An active respiratory symptom was commonly seen in the groups with negative findings.

Airway Obstruction ; complications ; diagnosis ; epidemiology ; surgery ; Bronchoscopy ; adverse effects ; Child ; Child, Preschool ; Female ; Foreign Bodies ; Humans ; Hypoxia ; diagnosis ; epidemiology ; etiology ; Male ; Retrospective Studies

The purpose of this study was to devise an expanded ischemic flap model and to investigate the role of AMD-3100 (Plerixafor, chemokine receptor 4 inhibitor) in this model by confirming its effect on mobilization of stem cells from the bone marrow. Male Sprague-Dawley rats were used as an animal research model. The mobilization of stem cells from the bone marrow was confirmed in the AMD-3100-treated group. The fractions of endothelial progenitor cells (EPC) and the vascular endothelial growth factor receptor (VEGFR) 2+ cells in the peripheral blood were increased in groups treated with AMD-3100. The expression of vascular endothelial growth factor (VEGF) was increased in response to expansion or AMD injection. The expression of stromal cell derived factor (SDF)-1 and VEGFR2 were increased only in unexpanded flap treated with AMD-3100. Treatment with AMD-3100 increased both the number and area of blood vessels. However, there were no statistically significant differences in the survival area or physiologic microcirculation in rats from the other groups. This endogenous neovascularization induced by AMD-3100 may be a result of the increase in both the area and number of vessels, as well as paracrine augmentation of the expression of VEGF and EPCs. However, the presence of a tissue expander under the flap could block the neovascularization between the flap and the recipient regardless of AMD-3100 treatment and expansion.
Animals ; Anti-HIV Agents/pharmacology ; Bone Marrow Cells/cytology ; Chemokine CXCL12/biosynthesis ; Endothelial Progenitor Cells/*cytology ; Hematopoietic Stem Cells/*cytology ; Heterocyclic Compounds/*pharmacology ; Hypoxia-Inducible Factor 1, alpha Subunit/metabolism ; Male ; Neovascularization, Physiologic ; Nitric Oxide Synthase Type III/metabolism ; Rats ; Rats, Sprague-Dawley ; Receptors, CXCR4/antagonists & inhibitors ; Surgical Flaps/*blood supply/surgery ; Tissue Expansion/*methods ; Vascular Endothelial Growth Factor A/biosynthesis ; Vascular Endothelial Growth Factor Receptor-2/biosynthesis/metabolism

OBJECTIVETo study the influence of bone marrow mesenchymal stem cells (MSCs) transplantation on hypoxic pulmonary hypertension (HPH) in rats.

METHODSSD rats MSCs were separated, cultivated, identified and labeled by the green fluorescence protein (GFP) gene virus and transplanted in vitro. Healthy male SD rats were randomly divided into four groups: Normal control group (NC group) and HPH group (eight rats respectively), HPH+ MSCs transplantation group and HPH+ VEGF+ MSCs transplantation group (twenty-four respectively). The test employed atmospheric intermittent low oxygen method to establish the rat model of pulmonary hypertension and stem cells were transferred and transplanted. The rats' mean pulmonary artery pressure (mPAP) was observed; right ventricular hypertrophy index (RVHI) was calculated; the morphological change of lung small artery in various groups of rats was observed under the microscope; the distribution of lung small artery and adenovirus transfection fluorescently labeled MSCs was observed under a fluorescent microscope after 7, 14 and 28 days when stem cell was transplanted.

RESULTSFor NC group, the mPAP (mmHg) was 15.5 +/- 1.5 after twenty-eight days while the mPAPs for HPH , MSCs and MSCs+ VEGF were 26.1 +/- 1.9, 21.6 +/- 2.7 and 20.1 +/- 2.9 respectively which were apparently higher than that of NC group (P < 0.01) and compared with HPH group (P < 0.01), which declined clearly. There was no significant difference between MSCs and MSCs+ VEGF. After twenty-eight days, RVHI for NC group was 0.28 +/- 0.02 while the RVHI for HPH, MSCs and MSCs + VEGF were 0.43 +/- 0.07, 0.34 +/- 0.03 and 0.35 +/- 0.01 respectively which was apparently higher than that of NC group (P < 0.01) but which was clearly lower than that of MSCs and MSCs+ VEGF (P < 0.05) and there was no significant difference between MSCs and MSCs + VEGF. For HPH group, pulmonary arteriole wall became apparently thicker, the lumen became significantly narrow and nearly obstructed after twenty-eight days, the endothelial cells were incomplete; compared with HPH group, pulmonary arteriole wall of MSCs group became thin, the lumen was smooth and the completeness of endothelial cells was improved. Whereas for MSCs and MSCs + VEGF, these changes were not significantly clear.

CONCLUSIONAfter MSCs transplantation, mPAP and RVHI decline sharply and lung small artery remodeling is improved which partially reverses HPH process; there is no significant difference between VEGF together with MSCs transplantation group and pure MSCs.

Animals ; Disease Models, Animal ; Hypertension, Pulmonary ; etiology ; metabolism ; surgery ; Hypoxia ; complications ; Male ; Mesenchymal Stem Cell Transplantation ; Rats ; Rats, Sprague-Dawley ; Vascular Endothelial Growth Factor A ; pharmacology

Humans ; Hypoxia-Inducible Factor-Proline Dioxygenases ; metabolism ; Ki-67 Antigen ; metabolism ; MicroRNAs ; metabolism ; Neoplasm Grading ; Neoplasm Staging ; Neprilysin ; metabolism ; Neuroendocrine Tumors ; classification ; diagnosis ; metabolism ; pathology ; surgery ; PAX8 Transcription Factor ; Paired Box Transcription Factors ; metabolism ; Pancreatic Neoplasms ; classification ; diagnosis ; metabolism ; pathology ; surgery ; Prognosis ; Tumor Suppressor Proteins ; metabolism

OBJECTIVETo study the clinicopathologic features of delayed radiation-induced brain injury after radiotherapy for brain tumor.

METHODSThe clinical, histopathologic and immunohistochemical features of 9 cases with delayed radiation-induced injury were evaluated.

RESULTSThe disease occurred from 6 months to 12 years after radiotherapy and often presented with headache and muscle weakness. Magnetic resonance imaging showed peripheral enhancing lesions with slight mass effect and surrounding edema. Microscopically, the major changes included coagulative necrosis, fibrinoid necrosis of vessels, vascular hyalinization with luminal stenosis and peripheral reactive gliosis. Immunostaining for hypoxia-inducible factors 1α was positive in reactive astrocytes.

CONCLUSIONSDelayed radiation-induced brain injury is a relatively common complication of radiation therapy. The lesion was frequently misdiagnosed as brain tumor. Correct diagnosis relies on clinical, radiologic and pathologic correlation.

Aged ; Brain Neoplasms ; radiotherapy ; Female ; Glioma ; radiotherapy ; Humans ; Hypoxia-Inducible Factor 1, alpha Subunit ; metabolism ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiation Injuries ; diagnosis ; diagnostic imaging ; metabolism ; pathology ; surgery ; Radiotherapy ; adverse effects ; Tomography, X-Ray Computed

Brief episodes of cerebral hypoxia-ischemia cause transient ischemic tolerance to subsequent ischemic events that are otherwise lethal. This study was conducted to evaluate the protective effect of hypoxic preconditioning on hypoxic-ischemic injury in the neonatal rat and the persistence of a protective window after hypoxic preconditioning. The rats were preconditioned with hypoxia (8% oxygen, 92% nitrogen) for three hours, subjected to ischemia using ligation of the right common carotid artery, and then exposed to another three hours of hypoxia. Using proton magnetic resonance spectroscopy, terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling (TUNEL) staining, and morphologic scores, this study shows that hypoxic preconditioning 6-hr to 1-day before hypoxic-ischemic injury increases survival rates and has neuroprotective effects against subsequent hypoxic-ischemic injury. The mechanism of the protective effects of hypoxic preconditioning in the newborn rat brain may involve downregulation of apoptotic cell death.
Animals ; Animals, Newborn ; Apoptosis ; Aspartic Acid/analogs & derivatives/analysis ; Brain/metabolism/pathology ; Carotid Arteries/surgery ; Creatine/analysis ; Hypoxia-Ischemia, Brain/metabolism/pathology/*physiopathology ; In Situ Nick-End Labeling ; Ischemic Preconditioning/*methods ; Magnetic Resonance Spectroscopy ; Rats ; Rats, Sprague-Dawley ; Survival Rate