BACKGROUND Mediastinal emphysema is a condition in which air enters the mediastinum between the connective tissue spaces within the pleura for a variety of reasons.It can be spontaneous or secondary to chest trauma,es...BACKGROUND Mediastinal emphysema is a condition in which air enters the mediastinum between the connective tissue spaces within the pleura for a variety of reasons.It can be spontaneous or secondary to chest trauma,esophageal perforation,medi-cally induced factors,etc.Its common symptoms are chest pain,tightness in the chest,and respiratory distress.Most mediastinal emphysema patients have mild symptoms,but severe mediastinal emphysema can cause respiratory and circulatory failure,resulting in serious consequences.CASE SUMMARY A 75-year-old man,living alone,presented with sudden onset of severe epigastric pain with chest tightness after drinking alcohol.Due to the remoteness of his residence and lack of neighbors,the patient was found by his nephew and brought to the hospital the next morning after the disease onset.Computed tomography(CT)showed free gas in the abdominal cavity,mediastinal emph-ysema,and subcutaneous pneumothorax.Upper gastrointestinal angiography showed that the esophageal mucosa was intact and the gastric antrum was perforated.Therefore,we chose to perform open gastric perforation repair on the patient under thoracic epidural anesthesia combined with intravenous anesthesia.An operative incision of the muscle layer of the patient's abdominal wall was made,and a large amount of subperitoneal gas was revealed.And a continued incision of the peritoneum revealed the presence of a perforation of approx-imately 0.5 cm in the gastric antrum,which we repaired after pathological examination.Postoperatively,the patient received high-flow oxygen and cough exercises.Chest CT was performed on the first and sixth postoperative days,and the mediastinal and subcutaneous gas was gradually reduced.CONCLUSION After gastric perforation,a large amount of free gas in the abdominal cavity can reach the mediastinum through the loose connective tissue at the esophageal hiatus of the diaphragm,and upper gastrointestinal angiography can clarify the site of perforation.In patients with mediastinal emphysema,open surgery avoids the elevation of the diaphragm caused by pneumoperitoneum compared to laparoscopic surgery and avoids increasing the mediastinal pressure.In addition,thoracic epidural anesthesia combined with intravenous anesthesia also avoids pressure on the mediastinum from mechanical ventilation.展开更多
Mechanical ventilation (MV) devices help patients with lung disorders to breathe.Improper setting for MV devices lead to further lung injuries.Therefore,investigating influence of ventilator device settings on healthy...Mechanical ventilation (MV) devices help patients with lung disorders to breathe.Improper setting for MV devices lead to further lung injuries.Therefore,investigating influence of ventilator device settings on healthy and diseased alveolar sacs mechanics could prevent injuries while in use.To this aim,three-dimensional (3D) models for healthy and emphysematous alveolar sacs with and without acute respiratory distress syndrome (ARDS) were developed,and computational fluid dynamics (CFD) analysis and fluid-solid interaction (FSI) approach were employed to study the influence of alveolar sacs wall motion,tidal volume (TV) setting and disease on alveolar sac mechanics.The recirculation region was only monitored in alveolar sacs with rigid wall.Observations demonstrated an increase in compliance during air inhalation into the emphysematous alveolar sacs.Induced air penetrated deeper into healthy alveolar sacs compared to the emphysematous model and recommended TV for chronic obstructive pulmonary disease (COPD) increased applied strain,stress and wall shear stress (WSS) on emphysematous alveolar sacs.In addition,recommended TVs for patients with ARDS decreased strain and stress,but did not influence applied WSS significantly.In general,increasing TV raised stress and strain level and led to deeper air penetration into the alveolar sacs.Afterwards,lower TV decreased strain,stress and WSS for patients who had both ARDS and emphysema.This study can provide invaluable insights about diseased alveolar sacs mechanics and evaluate importance of ventilator devices setting in different disease conditions.展开更多
BACKGROUND Many cases of emphysema associated with blow-out fractures occur before surgery due to trauma.However,emphysema can occur even after surgery,and most of such cases are managed conservatively and allowed to ...BACKGROUND Many cases of emphysema associated with blow-out fractures occur before surgery due to trauma.However,emphysema can occur even after surgery,and most of such cases are managed conservatively and allowed to resolve.Swelling in the periorbital area due to emphysema that occurs after surgery can make early recovery difficult.CASE SUMMARY Herein,we describe a case of postoperative subcutaneous emphysema that was treated using a simple needle aspiration method.A 48-year-old male patient visited the hospital with a blow-out fracture of the left medial orbital wall and nasal bone fracture.One day postoperatively,swelling and crepitus in the left periorbital area were observed,and follow-up computed tomography showed emphysema in the left periorbital subcutaneous area.Needle aspiration using an 18-gauge needle and syringe was used to relieve the emphysema.The symptoms of sudden swelling improved immediately,and no recurrence was observed.CONCLUSION We conclude that needle aspiration is a useful method that could help in relieving symptom,resolving discomfort,and enabling early return to daily life in patients with postoperative subcutaneous emphysema.展开更多
BACKGROUND Subcutaneous emphysema is a well-known complication of oral surgery,especially during mandibular wisdom tooth extraction.However,subcutaneous emphysema secondary to dental procedures such as crown preparati...BACKGROUND Subcutaneous emphysema is a well-known complication of oral surgery,especially during mandibular wisdom tooth extraction.However,subcutaneous emphysema secondary to dental procedures such as crown preparation is rare.The main symptom of emphysema is swelling and crepitus on palpation.Uncontrolled emphysema may spread along the fascial planes and cause deep space infections or a pneumomediastinum.CASE SUMMARY In this paper,we report a 34-year-old female who underwent upper molar tooth preparation for crowns and subsequently developed extensive subcutaneous emphysema on the retromandibular angle on two different occasions.The treatment plan for this patient involved close observation of the airway,and administration of dexamethasone and antibiotics via intravenous drip or orally.Ice bag compression was quickly applied and medication was prescribed to alleviate discomfort and promote healing.Although the main reason is unclear,the presence of a fissure in the molar is an important clue which may contribute to the development of subcutaneous emphysema during crown preparation.It is imperative for dental professionals to recognize such pre-disposing factors in order to minimize the risk of complications.CONCLUSION This case highlights the need for prompt diagnosis and management of subcutaneous emphysema because of the risk of much more serious complications.Awareness of relatively“benign”subcutaneous emphysema during any dental procedure is critical not only for inexperienced dentists,but also for those who work in rural and remote settings as members of surgical teams.In this study,we review the clinical presentation,mechanism,and differential diagnosis of subcutaneous emphysema.展开更多
Background:Delayed mediastinal emphysema with subcutaneous emphysema after extubation is rarely reported in current literature.Symptomatic treatment is considered effective for management.Case presentation:We report a...Background:Delayed mediastinal emphysema with subcutaneous emphysema after extubation is rarely reported in current literature.Symptomatic treatment is considered effective for management.Case presentation:We report a case of a 56-year-old female with longstanding rheumatoid arthritis under corticosteroid therapy who developed mediastinal emphysema with subcutaneous emphysema 2 days after recovering from general anesthesia for orthopedic surgery treating a femoral neck fracture.The patient received aggressive subcutaneous decompression and symptomatic management.Results:The patient’s condition improved after treatment.Based on computed tomography scan results,we hypothesize that the longstanding rheumatoid arthritis may have resulted in fragile lung tissue.Violent postoperative coughing likely caused rupture of small airways,leading to mediastinal emphysema.Conclusions:It is crucial to preoperatively assess the risk of airway injury in high-risk patients with longstanding rheumatoid arthritis.Delayed postoperative mediastinal emphysema should be carefully evaluated and managed aggressively to avoid exacerbation or life-threatening scenarios.Further research is warranted to elucidate the pathology and guide perioperative management in these patients.展开更多
AIM To assess the efficacy of CO2 insufflation for reduction of mediastinal emphysema(ME) immediately after endoscopic submucosal dissection(ESD).METHODS A total of 46 patients who were to undergo esophageal ESD were ...AIM To assess the efficacy of CO2 insufflation for reduction of mediastinal emphysema(ME) immediately after endoscopic submucosal dissection(ESD).METHODS A total of 46 patients who were to undergo esophageal ESD were randomly assigned to receive either CO2 insufflation(CO2 group, n = 24) or air insufflation(Air group, n = 22). Computed tomography(CT) was carried out immediately after ESD and the next morning. Pain and abdominal distention were chronologically recorded using a 100-mm visual analogue scale(VAS). The volume of residual gas in the digestive tract was measured using CT imaging. RESULTS The incidence of ME immediately after ESD in the CO2 group was significantly lower than that in the Air group(17% vs 55%, P = 0.012). The incidence of ME the next morning was 8.3% vs 32% respectively(P= 0.066). There were no differences in pain scores or distention scores at any post-procedure time points. The volume of residual gas in the digestive tract immediately after ESD was significantly smaller in the CO2 group than that in the Air group(808 m L vs 1173 m L, P = 0.013).CONCLUSION CO2 insufflation during esophageal ESD significantly reduced postprocedural ME. CO2 insufflation also reduced the volume of residual gas in the digestive tract immediately after ESD, but not the VAS scores of pain and distention.展开更多
AIM: To performed remains a subject of debate and is the principal aim of the study. METHODS: This retrospective analysis included 73 patients with emphysema(2000-2012). The outcomes of patients undergoing single-lung...AIM: To performed remains a subject of debate and is the principal aim of the study. METHODS: This retrospective analysis included 73 patients with emphysema(2000-2012). The outcomes of patients undergoing single-lung transplantation(SL)(n = 40) or double-lung transplant(DL)(n = 33) were compared in a Cox multivariate analysis to study the impact of the technique, postoperative complications and acute and chronic rejection on survival rates. Patients were selected for inclusion in the waiting list according to the International Society of Heart Lung Transplantation criteria. Pre and postoperative rehabilitation and prophylaxis, surgical technique and immunosuppressive treatment were similar in every patients. Lung transplantation waiting list information on a national level and retrospective data on emphysema patient survival transplanted in Spain during the study period, was obtained from the lung transplantation registry managed by the National Transplant Organization(ONT). RESULTS: Both groups were comparable in terms of gender and clinical characteristics. We found significant differences in the mean age between the groups, the DL patients being younger as expected from the inclusion criteria. Perioperative complications occurred in 27.6% SL vs 54% DL(P = 0.032). Excluding perioperative mortality, median survival was 65.3 mo for SL and 59.4 mo for DL(P = 0.96). Bronchiolitis obliterans and overall 5-year survival were similar in both groups. Bacterialrespiratory infection, cytomegalovirus and fungal infection rates were higher but not significant in SL. No differences were found between type of transplant and survival(P = 0.48). To support our results, national data on all patients with emphysema in waiting list were obtained(n = 1001). Mortality on the waiting list was 2.4% for SL vs 6.2% for DL. There was no difference in 5 year survival between 235 SL and 430 DL patients transplanted(P = 0.875).CONCLUSION: Our results suggest that SL transplantation in emphysema produce similar survival than DL with less postoperative complication and significant lower mortality in waiting list.展开更多
BACKGROUND Dental extraction is a common operation in oral surgery and is usually accompanied by pain,swelling,and local infection.The application of high-speed air turbines increases the comfort of alveolar surgery a...BACKGROUND Dental extraction is a common operation in oral surgery and is usually accompanied by pain,swelling,and local infection.The application of high-speed air turbines increases the comfort of alveolar surgery and makes it more minimally-invasive.However,high-speed gas can enter the subcutaneous tissue of the face and neck or even the chest and mediastinum,which is a serious iatrogenic complication.CASE SUMMARY We describe two cases of severe subcutaneous and mediastinal emphysema caused by high-speed turbine splitting during dental extraction.The first case involved a 34-year-old man who complained of swelling of the face,mild chest tightness,and chest pain after dental extraction.Computed tomography(CT)scan showed a large amount of gas in the neck,chest wall,and mediastinum.The second case involved a 54-year-old woman who complained of swelling and pain of the neck after dental extraction.CT showed a large amount of gas collected in the neck and mediastinum.Both of them used high-speed turbine splitting during dental extraction.CONCLUSION High-speed turbine splitting during dental extraction may lead to severe subcutaneous and mediastinal emphysema.Dentists should carefully operate to avoid emphysema.If emphysema occurs,CT can be used to improve the diagnosis.The patient should be informed,and the complications dealt with carefully.展开更多
Pneumorrhachis(PR), or epidural emphysema, denotes the presence of air in the spinal epidural space. It can be associated with a variety of etiologies, including trauma; recent iatrogenic manipulations during surgical...Pneumorrhachis(PR), or epidural emphysema, denotes the presence of air in the spinal epidural space. It can be associated with a variety of etiologies, including trauma; recent iatrogenic manipulations during surgical, anesthesiological and diagnostic interventions;malignancy and its associated therapy. It usually represents an asymptomatic epiphenomenon but also can be symptomatic by itself, as well as by its underlying pathology, and rarely can be fatal. The pathogenesis and etiology of PR are varied and can sometimes be a diagnostic challenge. As such, there are no standard guidelines for the management of symptomatic PR and its treatment is often individualized. Here, we present a case of a 14-year-old boy treated for leukemia who developed this complication and whether chemotherapy related or not, it proved to be fatal for him. To our knowledge, this is the first case in the literature of this complication with acute lymphoblastic leukemia.展开更多
AIM: To investigate whether the predominant emphysema type is associated with the high resolution computed tomography(HRCT) pattern of fibrosis in combined pulmonary fibrosis and emphysema(CPFE).METHODS: Fifty-three s...AIM: To investigate whether the predominant emphysema type is associated with the high resolution computed tomography(HRCT) pattern of fibrosis in combined pulmonary fibrosis and emphysema(CPFE).METHODS: Fifty-three smokers with upper lobe emphysema and lower lobe pulmonary fibrosis on- HRCT-were retrospectively evaluated. Patients were stratified into 3 groups according to the predominant type of emphysema: Centrilobular(CLE), paraseptal(PSE), CLE = PSE. Patients were also stratified into 3 other groups according to the predominant type of fibrosis on HRCT: Typical usual interstitial pneumonia(UIP), probable UIP and nonspecific interstitial pneumonia(NSIP). HRCTs were scored at 5 predetermined levels for the coarseness of fibrosis(Coarseness), extent of emphysema(emphysema), extent of interstitial lung disease(Tot Ext ILD), extent of reticular pattern not otherwise specified(Ret NOS), extent of ground glass opacity with traction bronchiectasis(extG GOBx), extent of pure ground glass opacity and extent of honeycombing. HRCT mean scores, pulmonary function tests, diffusion capacity(DLCO) and systolic pulmonary arterial pressure were compared among the groups.RESULTS: The predominant type of emphysema was strongly correlated with the predominant type of fibrosis. The centrilobular emphysema group exhibited a significantly higher extent of emphysema(P < 0.001) and a lower extent of interstitial lung disease(P < 0.002), reticular pattern not otherwise specified(P < 0.023), extent of ground glass opacity with traction bronchiectasis(P < 0.002), extent of honeycombing(P < 0.001) and coarseness of fibrosis(P < 0.001) than the paraseptal group. The NSIP group exhibited a significantly higher extent of emphysema(P < 0.05), total lung capacity(P < 0.01) and diffusion capacity(DLCO)(P < 0.05) than the typical UIP group. The typical UIP group exhibited a significantly higher extent of interstitial lung disease, extent of reticular pattern not otherwise specified, extent of ground glass opacity with traction bronchiectasis, extent of honeycombing and coarseness of fibrosis(0.039 > P > 0.000). Although the pulmonary arterial pressure was higher in typical UIP group relative to the NSIP group, the difference was not statistically significant.CONCLUSION: In CPFE patients, paraseptal emphysema is associated more with UIP-HRCT pattern and higher extent of fibrosis than centrilobular emphysema.展开更多
We describe an impressive and rare case of surgical emphysema after minimally invasive rectal surgery. This case reports on a patient who developed mas-sive retroperitoneal, intraperitoneal and subcutaneous emphysema ...We describe an impressive and rare case of surgical emphysema after minimally invasive rectal surgery. This case reports on a patient who developed mas-sive retroperitoneal, intraperitoneal and subcutaneous emphysema directly following a transanal endoscopic microsurgery(TEM) procedure for a rectal intramuco-sal carcinoma. Free intra-abdominal air after gastro-intestinal surgery can be a sign of a bowel perforation or anastomotic leakage. This is a serious complication often requiring immediate surgery. In our patient an abdominal computed tomography-scan with rectal con-trast showed no signs of a rectal perforation. Therefore this emphysema was caused by the insufflation of CO2 gas in the rectum during the TEM-procedure. Conserva-tive treatment resulted in an uneventful recovery. With the increasing usage of TEM for rectal lesions we ex-pect this complication to occur more often. After ruling out a full thickness rectal wall perforation in patients with surgical emphysema following TEM, conservative treatment is the treatment of choice.展开更多
Rationale: There is accumulating evidence that a group of stem/progenitor cells (SPCs) maintain alveolar epithelial integrity. Pulmonary emphysema is characterized by the histological finding of the loss of alveolar e...Rationale: There is accumulating evidence that a group of stem/progenitor cells (SPCs) maintain alveolar epithelial integrity. Pulmonary emphysema is characterized by the histological finding of the loss of alveolar epithelial integrity along with corresponding bronchiolar fibrosis. Objectives: Based on the concept of autopoiesis (the capacity to produce oneself), we proposed a mathematical model in the maintenance of alveolar epithelial integrity as related to the genesis of pulmonary emphysema and fibrosis. Methods: A tessellation automaton model was used to describe the autopoietic dynamics of the bronchiolo-alveolar epithelial surface. The alveolar septal volume en-closed by the epithelial surface is a distributed system of discrete elements, which move by random walk in the manner of Brownian motion. Assuming that the numbers of components and events in the automaton are large, an approximate theoretical treatment in terms of differential equations is possible, allowing a set of partial differential equations to be produced. Results: 1) Assuming the loss of progenitor cells through the epithelial-mesenchymal transition (EMT), a sharp bifurcation between two qualitatively distinct regions of the phase space (one that is repaired completely, and another that has disappeared entirely) clearly appeared. 2) Thus, from the system of discrete and spatial partial differential equations, we obtained a system of ordinary differential equations in equilibrium conditions that defined a close relationship between the degree of emphysema, the density of alveolar septal fibroblasts, and the mean concentration of SPCs. Conclusions: A mathematical model of the autopoietic maintenance of the alveolar epithelial surface suggested a close relationship between alveolar emphysema and fibrosis and EMT in lungs affected by chronic obstructive pulmonary disease.展开更多
Subcutaneous emphysema is a condition that results from introduction of air into soft tissues. In head and neck, it is commonly observed following fractures of paranasal sinuses. Less frequently, it may occur during s...Subcutaneous emphysema is a condition that results from introduction of air into soft tissues. In head and neck, it is commonly observed following fractures of paranasal sinuses. Less frequently, it may occur during surgical procedures for tooth removal, when air from dental hand-pieces is forced into surgical site. Depending on its extension, it may involve vital spaces such as mediastinum. This specific finding may induce life-threatening situations. The aim of this article is to establish the incidence of subcutaneous emphysema among 10,779 impacted third molar surgical procedures and report the cases in which such complications had occurred. In this retrospective study, data collected from 10,779 third molar extraction procedures performed at Piracicaba School of Dentistry were evaluated for the occurrence of subcutaneous emphysema. Two cases of subcutaneous emphysema (0.018%) occurred following extraction of impacted third molars. Both were associated with mandibular tooth and related to the use of dental air hand-piece. One of the cases involved submandibular and buccal spaces while the other involved buccal and canine spaces. Regression of emphysema occurred spontaneously and postoperative recovery was uneventful. Subcutaneous emphysema following impacted third molar extractions is rare and strongly associated with the use of air turbines. Follow-up and preservation are the treatments of choice, but clinicians should be aware about the possibility of microbial spreading through facial spaces.展开更多
Emphysema and influenza directly affect alveolar sacs and cause problems in lung performance during the breathing cycle. In this study, the effects of Emphysema and Influenza on alveolar sac’s air flow characteristic...Emphysema and influenza directly affect alveolar sacs and cause problems in lung performance during the breathing cycle. In this study, the effects of Emphysema and Influenza on alveolar sac’s air flow characteristics are investigated through Computational Fluid Dynamics (CFD) simulation. Both normal and Emphysemic alveolar sac models with varying collapsed volumes resulting from influenza virus replication were developed. Maximum, area average pressure, and wall shear stress (WSS) in collapsed and open alveolar sacs models were compared. It was found that a collapse at half of the volume at the bottom of the alveolar sacs’ models would cause a decrease in average and maximum pressure values and yield higher WSS values for fluid flow during the breathing cycle. On the other hand, a quarter volume collapse at the bottom and side of the model resulted in higher values for average and maximum pressure and WSS. Additionally, results also showed that a combination of alveolar sacs closure and Emphysema would generally lead to an increase in fluid pressure and average WSS during breathing. Maximum WSS was observed during exhalation and maximum WSS decrease occurred during inhalation. Findings are in good agreement with previous studies and suggest that emphysema and influenza virus affect fluid flow and may contribute to alveolar sac closure. However, more realistic simulations should include the fluid-solid interaction studies.展开更多
Chronic obstructive lung disease(COPD),predominantly emphysema,causes several thoracic anatomical and hemodynamic changes which may cause changes in various electrocardiographic parameters.A 12-lead electrocardiogram(...Chronic obstructive lung disease(COPD),predominantly emphysema,causes several thoracic anatomical and hemodynamic changes which may cause changes in various electrocardiographic parameters.A 12-lead electrocardiogram(ECG),which is often a part of routine evaluation in most clinical settings,may serve as a useful screening modality for diagnosis of COPD or emphysema.Our current article aims to provide a comprehensive review of the electrocardiographic changes encountered in COPD/emphysema utilizing published PubMed and Medline literature database.Several important ECG changes are present in COPD/emphysema and may serve as a good diagnostic tool.Verticalization of Pvector,changes in QRS duration,pattern recognition of precordial R-wave progression and axial shifts can be considered some of the most valuable markers among other changes.In conclusion,12-lead surface electrocardiogram can serve as a valuable tool for the diagnosis of COPD and/or emphysema.An appropriate knowledge of these ECG changes can not only help in the diagnosis but can also immensely help in an appropriate clinical management of these patients.展开更多
The relations between mRNA expression of basic fibroblast growth factor (bFGF) and the changes in collagen Ⅰand collagen Ⅲ in pulmonary tissues from a single intratracheal instillation of papain induced emphysema in...The relations between mRNA expression of basic fibroblast growth factor (bFGF) and the changes in collagen Ⅰand collagen Ⅲ in pulmonary tissues from a single intratracheal instillation of papain induced emphysema in rats were investigated. Wistar rats ( n =42) were randomly divided into normal group and emphysema model 1, 3, 5, 7, 15, 30 day groups ( n =6 in each group). The rat model of emphysema was induced by a single intratracheal instillation of papain. The results of immunohistochemistry SABC and in situ hybridization with bFGF probe were quantitatively analyzed to examine the changes of collagen Ⅰand collagen Ⅲ and bFGF mRNA expression in lung tissues and the percent of positive expression of bFGFmRNA in alveolar macrophages. The results were as follows: (1) In the emphysema model groups the optical densities of collagen Ⅰand collagen Ⅲ began to increase after 3 days, reached the highest at the 7 th day, and began to reduce at the 15 th day; (2) No expression of bFGFmRNA in pulmonary tissues was detectable in the normal group. The positive expression of bFGFmRNA was detectable in lung tissues one day after the intratracheal instillation of papain. The average optical densities reached the peak (41.895±7.017) at the 7th day, significantly higher than in the normal group (0.581±0.139, P <0.01). The positive expression of bFGFmRNA in lung tissues began to reduce at the 15th day; (3) Positive expression of bFGFmRNA in alveolar macrophages of instillation papain rats was detectable 3 days after the intratracheal instillation of papain, and reached the highest at the 7th day with the percent of positive expression of bFGF mRNA in alveolar macrophages being 70.13±11.21, higher than in the normal group (5.12±0.18, P <0.01); (4) The expression of bFGF mRNA in the lung tissues and macrophages was postively related with the changes in collagen Ⅰ and collagen Ⅲ ( P <0.01 or P <0.05) respectively. It was suggested that the up regulation of bFGF mRNA expression during the development of emphysema can lead pulmonary interstitial fibrosis, which may take part in the injury and repair and the lung tissue reconstruction.展开更多
OBJECTIVE The present study aimed to investigate the relationship between Wnt/β-catenin and Nrf2 signaling pathways,and understanding the mechanisms underlying the process of inflammatory in chronic obstructive pulmo...OBJECTIVE The present study aimed to investigate the relationship between Wnt/β-catenin and Nrf2 signaling pathways,and understanding the mechanisms underlying the process of inflammatory in chronic obstructive pulmonary disease(COPD),which was a serious disease of respiratory system.METHODS We duplicate the emphysema model with porcine pancreatic elastase(PPE)in Nrf2-/-and WT mouse for 21d,and intraperitoneal injection of Li Cl,the activator of Wnt/β-catenin signaling pathway from 14 d to the end.Hematoxylin and eosin(H&E)staining was performed to assess the histopathologic level,and immunohistochemistry(IHC)for Mac-3(the marker of macrophagocyte)and Ly6G(the marker of neutrophil)was used to observe the inflammatory infiltrate,while the levels of Wnt/β-catenin and Nrf2 signaling pathways related proteins heme oxygenase-1(HO-1),NAD(P)H:quinone oxidoreductase 1(NQO1),and the expression of inflammatory cytokine interleukin-6(IL-6)were detected by Western blotting of lung tissues.In vitro,cigarette smoke extract(CSE)-treated normal human bronchial epithelial(NHBE)cells,cell viability was examined by MTT assay,and then we treated recombinant human Wnt3a,si Nrf2 and si Wnt3a to measure the expression of Wnt3a,β-catenin,Nrf2,HO-1,NQO-1,and IL-6.Cellular immunofluorescence staining was employed to identify the nuclear translocation of Nrf2.RESULTS We found that the Li Cl-treated group has markedly decreased the damage of alveolar structure and inflammatory signs than the model group of WT mice rather than Nrf2-/-group.It also seen that Li Cl not only increasedβ-catenin,but it also led to a comparable increase in Nrf2,HO-1,NQO1,and decrease of IL-6 compared with WT model groups but except to Nrf2-/-group in vivo.And it showed that Wnt3atreatment has significantly increased the nuclear translocation of Nrf2 and the expression of HO-1 and NQO1,reduced the IL-6 release,while there has no significance when Nrf2 was blocked in CSE-induced NHBE cells.CONCLUSION Our results demonstrated that Wnt3a/β-catenin significantly balanced oxidative stress and attenuated inflammation reaction by promoting Nrf2 nuclear translocation and activity.展开更多
The subcutaneous cervicofacial emphysema is a rare and serious disease. There is a wide variety of etiologic factors for subcutaneous cervicofacial emphysema. As an maitrisable factor, the use of hydrogen peroxide 3% ...The subcutaneous cervicofacial emphysema is a rare and serious disease. There is a wide variety of etiologic factors for subcutaneous cervicofacial emphysema. As an maitrisable factor, the use of hydrogen peroxide 3% as an irrigant to newly operated tissue plans may cause emphysema. We report here a case with iatrojenic cervicofacial emphysema, occurred after the irrigation of hydrogen peroxide 3% to the drilled teeth root during dental treatment.展开更多
Gas in the leg is not always a gas gangrene. Abdominal infection with gas forming organisms may spread to the thigh & leg. We report a case of critically ill patient who presented to the emergency department with ...Gas in the leg is not always a gas gangrene. Abdominal infection with gas forming organisms may spread to the thigh & leg. We report a case of critically ill patient who presented to the emergency department with features suggestive of septic arthritis of the left hip. Assessment and further intervention revealed subcutaneous emphysema of the leg secondary to an infection of a previously asymptomatic staghorn calculus. X-ray of the abdomen showed a left renal stone and gas in the soft tissue planes of the left retroperitoneal space while X-ray of the left femur showed gas in the soft tissue planes of the left hip region and whole thigh with no bony or joint abnormality. Such case has not been reported in English literature before. Physicians and surgeons should be aware of this condition that could be fatal but curable by early intervention.展开更多
Introduction: “RC-Prep”, a chemo-mechanical preparation for root canals, includes EDTA and urea peroxide as ingredients. For lubrication and its chelating effect, RC-Prep is useful as an adjunct in root canal enlarg...Introduction: “RC-Prep”, a chemo-mechanical preparation for root canals, includes EDTA and urea peroxide as ingredients. For lubrication and its chelating effect, RC-Prep is useful as an adjunct in root canal enlargement. Furthermore, its cleaning action, due to its foaming properties in combi-nation with sodium hypochlorite, can be useful in root canal treatment in many situations. Methods: In a case of upper gingiva swelling, we used sodium hypochlorite with RC-Prep in the treatment of an infected root canal of the left maxillary premolar at the first visit. Within 2 min after use, the patient’s face became swollen. We kept the root canal open, and conducted a CT scan to investigate. Results: We diagnosed subcutaneous emphysema and prescribed 1 week of pain killers and antibiotics. The pain and swelling in the face finally resolved at 11 days after the incident. Conclusions: The cause of the emphysema was considered to have been the use of a sodium hypo-chlorite solution after using RC-Prep for an opened root apex.展开更多
文摘BACKGROUND Mediastinal emphysema is a condition in which air enters the mediastinum between the connective tissue spaces within the pleura for a variety of reasons.It can be spontaneous or secondary to chest trauma,esophageal perforation,medi-cally induced factors,etc.Its common symptoms are chest pain,tightness in the chest,and respiratory distress.Most mediastinal emphysema patients have mild symptoms,but severe mediastinal emphysema can cause respiratory and circulatory failure,resulting in serious consequences.CASE SUMMARY A 75-year-old man,living alone,presented with sudden onset of severe epigastric pain with chest tightness after drinking alcohol.Due to the remoteness of his residence and lack of neighbors,the patient was found by his nephew and brought to the hospital the next morning after the disease onset.Computed tomography(CT)showed free gas in the abdominal cavity,mediastinal emph-ysema,and subcutaneous pneumothorax.Upper gastrointestinal angiography showed that the esophageal mucosa was intact and the gastric antrum was perforated.Therefore,we chose to perform open gastric perforation repair on the patient under thoracic epidural anesthesia combined with intravenous anesthesia.An operative incision of the muscle layer of the patient's abdominal wall was made,and a large amount of subperitoneal gas was revealed.And a continued incision of the peritoneum revealed the presence of a perforation of approx-imately 0.5 cm in the gastric antrum,which we repaired after pathological examination.Postoperatively,the patient received high-flow oxygen and cough exercises.Chest CT was performed on the first and sixth postoperative days,and the mediastinal and subcutaneous gas was gradually reduced.CONCLUSION After gastric perforation,a large amount of free gas in the abdominal cavity can reach the mediastinum through the loose connective tissue at the esophageal hiatus of the diaphragm,and upper gastrointestinal angiography can clarify the site of perforation.In patients with mediastinal emphysema,open surgery avoids the elevation of the diaphragm caused by pneumoperitoneum compared to laparoscopic surgery and avoids increasing the mediastinal pressure.In addition,thoracic epidural anesthesia combined with intravenous anesthesia also avoids pressure on the mediastinum from mechanical ventilation.
基金the National Science Foundation of USA(Grant CMMI-1430379).
文摘Mechanical ventilation (MV) devices help patients with lung disorders to breathe.Improper setting for MV devices lead to further lung injuries.Therefore,investigating influence of ventilator device settings on healthy and diseased alveolar sacs mechanics could prevent injuries while in use.To this aim,three-dimensional (3D) models for healthy and emphysematous alveolar sacs with and without acute respiratory distress syndrome (ARDS) were developed,and computational fluid dynamics (CFD) analysis and fluid-solid interaction (FSI) approach were employed to study the influence of alveolar sacs wall motion,tidal volume (TV) setting and disease on alveolar sac mechanics.The recirculation region was only monitored in alveolar sacs with rigid wall.Observations demonstrated an increase in compliance during air inhalation into the emphysematous alveolar sacs.Induced air penetrated deeper into healthy alveolar sacs compared to the emphysematous model and recommended TV for chronic obstructive pulmonary disease (COPD) increased applied strain,stress and wall shear stress (WSS) on emphysematous alveolar sacs.In addition,recommended TVs for patients with ARDS decreased strain and stress,but did not influence applied WSS significantly.In general,increasing TV raised stress and strain level and led to deeper air penetration into the alveolar sacs.Afterwards,lower TV decreased strain,stress and WSS for patients who had both ARDS and emphysema.This study can provide invaluable insights about diseased alveolar sacs mechanics and evaluate importance of ventilator devices setting in different disease conditions.
基金Supported by Soonchunhyang research fund,No.2023-0024.
文摘BACKGROUND Many cases of emphysema associated with blow-out fractures occur before surgery due to trauma.However,emphysema can occur even after surgery,and most of such cases are managed conservatively and allowed to resolve.Swelling in the periorbital area due to emphysema that occurs after surgery can make early recovery difficult.CASE SUMMARY Herein,we describe a case of postoperative subcutaneous emphysema that was treated using a simple needle aspiration method.A 48-year-old male patient visited the hospital with a blow-out fracture of the left medial orbital wall and nasal bone fracture.One day postoperatively,swelling and crepitus in the left periorbital area were observed,and follow-up computed tomography showed emphysema in the left periorbital subcutaneous area.Needle aspiration using an 18-gauge needle and syringe was used to relieve the emphysema.The symptoms of sudden swelling improved immediately,and no recurrence was observed.CONCLUSION We conclude that needle aspiration is a useful method that could help in relieving symptom,resolving discomfort,and enabling early return to daily life in patients with postoperative subcutaneous emphysema.
基金Supported by Shenzhen Science and Technology Program,No.JCYJ20220530165409022.
文摘BACKGROUND Subcutaneous emphysema is a well-known complication of oral surgery,especially during mandibular wisdom tooth extraction.However,subcutaneous emphysema secondary to dental procedures such as crown preparation is rare.The main symptom of emphysema is swelling and crepitus on palpation.Uncontrolled emphysema may spread along the fascial planes and cause deep space infections or a pneumomediastinum.CASE SUMMARY In this paper,we report a 34-year-old female who underwent upper molar tooth preparation for crowns and subsequently developed extensive subcutaneous emphysema on the retromandibular angle on two different occasions.The treatment plan for this patient involved close observation of the airway,and administration of dexamethasone and antibiotics via intravenous drip or orally.Ice bag compression was quickly applied and medication was prescribed to alleviate discomfort and promote healing.Although the main reason is unclear,the presence of a fissure in the molar is an important clue which may contribute to the development of subcutaneous emphysema during crown preparation.It is imperative for dental professionals to recognize such pre-disposing factors in order to minimize the risk of complications.CONCLUSION This case highlights the need for prompt diagnosis and management of subcutaneous emphysema because of the risk of much more serious complications.Awareness of relatively“benign”subcutaneous emphysema during any dental procedure is critical not only for inexperienced dentists,but also for those who work in rural and remote settings as members of surgical teams.In this study,we review the clinical presentation,mechanism,and differential diagnosis of subcutaneous emphysema.
基金This work was supported by the Chen Xiao-ping Foundation for the Development of Science and Technology of HuBei Province:“Rui”special research fund[grant number CXPJJH1200000-07-113]。
文摘Background:Delayed mediastinal emphysema with subcutaneous emphysema after extubation is rarely reported in current literature.Symptomatic treatment is considered effective for management.Case presentation:We report a case of a 56-year-old female with longstanding rheumatoid arthritis under corticosteroid therapy who developed mediastinal emphysema with subcutaneous emphysema 2 days after recovering from general anesthesia for orthopedic surgery treating a femoral neck fracture.The patient received aggressive subcutaneous decompression and symptomatic management.Results:The patient’s condition improved after treatment.Based on computed tomography scan results,we hypothesize that the longstanding rheumatoid arthritis may have resulted in fragile lung tissue.Violent postoperative coughing likely caused rupture of small airways,leading to mediastinal emphysema.Conclusions:It is crucial to preoperatively assess the risk of airway injury in high-risk patients with longstanding rheumatoid arthritis.Delayed postoperative mediastinal emphysema should be carefully evaluated and managed aggressively to avoid exacerbation or life-threatening scenarios.Further research is warranted to elucidate the pathology and guide perioperative management in these patients.
文摘AIM To assess the efficacy of CO2 insufflation for reduction of mediastinal emphysema(ME) immediately after endoscopic submucosal dissection(ESD).METHODS A total of 46 patients who were to undergo esophageal ESD were randomly assigned to receive either CO2 insufflation(CO2 group, n = 24) or air insufflation(Air group, n = 22). Computed tomography(CT) was carried out immediately after ESD and the next morning. Pain and abdominal distention were chronologically recorded using a 100-mm visual analogue scale(VAS). The volume of residual gas in the digestive tract was measured using CT imaging. RESULTS The incidence of ME immediately after ESD in the CO2 group was significantly lower than that in the Air group(17% vs 55%, P = 0.012). The incidence of ME the next morning was 8.3% vs 32% respectively(P= 0.066). There were no differences in pain scores or distention scores at any post-procedure time points. The volume of residual gas in the digestive tract immediately after ESD was significantly smaller in the CO2 group than that in the Air group(808 m L vs 1173 m L, P = 0.013).CONCLUSION CO2 insufflation during esophageal ESD significantly reduced postprocedural ME. CO2 insufflation also reduced the volume of residual gas in the digestive tract immediately after ESD, but not the VAS scores of pain and distention.
文摘AIM: To performed remains a subject of debate and is the principal aim of the study. METHODS: This retrospective analysis included 73 patients with emphysema(2000-2012). The outcomes of patients undergoing single-lung transplantation(SL)(n = 40) or double-lung transplant(DL)(n = 33) were compared in a Cox multivariate analysis to study the impact of the technique, postoperative complications and acute and chronic rejection on survival rates. Patients were selected for inclusion in the waiting list according to the International Society of Heart Lung Transplantation criteria. Pre and postoperative rehabilitation and prophylaxis, surgical technique and immunosuppressive treatment were similar in every patients. Lung transplantation waiting list information on a national level and retrospective data on emphysema patient survival transplanted in Spain during the study period, was obtained from the lung transplantation registry managed by the National Transplant Organization(ONT). RESULTS: Both groups were comparable in terms of gender and clinical characteristics. We found significant differences in the mean age between the groups, the DL patients being younger as expected from the inclusion criteria. Perioperative complications occurred in 27.6% SL vs 54% DL(P = 0.032). Excluding perioperative mortality, median survival was 65.3 mo for SL and 59.4 mo for DL(P = 0.96). Bronchiolitis obliterans and overall 5-year survival were similar in both groups. Bacterialrespiratory infection, cytomegalovirus and fungal infection rates were higher but not significant in SL. No differences were found between type of transplant and survival(P = 0.48). To support our results, national data on all patients with emphysema in waiting list were obtained(n = 1001). Mortality on the waiting list was 2.4% for SL vs 6.2% for DL. There was no difference in 5 year survival between 235 SL and 430 DL patients transplanted(P = 0.875).CONCLUSION: Our results suggest that SL transplantation in emphysema produce similar survival than DL with less postoperative complication and significant lower mortality in waiting list.
文摘BACKGROUND Dental extraction is a common operation in oral surgery and is usually accompanied by pain,swelling,and local infection.The application of high-speed air turbines increases the comfort of alveolar surgery and makes it more minimally-invasive.However,high-speed gas can enter the subcutaneous tissue of the face and neck or even the chest and mediastinum,which is a serious iatrogenic complication.CASE SUMMARY We describe two cases of severe subcutaneous and mediastinal emphysema caused by high-speed turbine splitting during dental extraction.The first case involved a 34-year-old man who complained of swelling of the face,mild chest tightness,and chest pain after dental extraction.Computed tomography(CT)scan showed a large amount of gas in the neck,chest wall,and mediastinum.The second case involved a 54-year-old woman who complained of swelling and pain of the neck after dental extraction.CT showed a large amount of gas collected in the neck and mediastinum.Both of them used high-speed turbine splitting during dental extraction.CONCLUSION High-speed turbine splitting during dental extraction may lead to severe subcutaneous and mediastinal emphysema.Dentists should carefully operate to avoid emphysema.If emphysema occurs,CT can be used to improve the diagnosis.The patient should be informed,and the complications dealt with carefully.
文摘Pneumorrhachis(PR), or epidural emphysema, denotes the presence of air in the spinal epidural space. It can be associated with a variety of etiologies, including trauma; recent iatrogenic manipulations during surgical, anesthesiological and diagnostic interventions;malignancy and its associated therapy. It usually represents an asymptomatic epiphenomenon but also can be symptomatic by itself, as well as by its underlying pathology, and rarely can be fatal. The pathogenesis and etiology of PR are varied and can sometimes be a diagnostic challenge. As such, there are no standard guidelines for the management of symptomatic PR and its treatment is often individualized. Here, we present a case of a 14-year-old boy treated for leukemia who developed this complication and whether chemotherapy related or not, it proved to be fatal for him. To our knowledge, this is the first case in the literature of this complication with acute lymphoblastic leukemia.
文摘AIM: To investigate whether the predominant emphysema type is associated with the high resolution computed tomography(HRCT) pattern of fibrosis in combined pulmonary fibrosis and emphysema(CPFE).METHODS: Fifty-three smokers with upper lobe emphysema and lower lobe pulmonary fibrosis on- HRCT-were retrospectively evaluated. Patients were stratified into 3 groups according to the predominant type of emphysema: Centrilobular(CLE), paraseptal(PSE), CLE = PSE. Patients were also stratified into 3 other groups according to the predominant type of fibrosis on HRCT: Typical usual interstitial pneumonia(UIP), probable UIP and nonspecific interstitial pneumonia(NSIP). HRCTs were scored at 5 predetermined levels for the coarseness of fibrosis(Coarseness), extent of emphysema(emphysema), extent of interstitial lung disease(Tot Ext ILD), extent of reticular pattern not otherwise specified(Ret NOS), extent of ground glass opacity with traction bronchiectasis(extG GOBx), extent of pure ground glass opacity and extent of honeycombing. HRCT mean scores, pulmonary function tests, diffusion capacity(DLCO) and systolic pulmonary arterial pressure were compared among the groups.RESULTS: The predominant type of emphysema was strongly correlated with the predominant type of fibrosis. The centrilobular emphysema group exhibited a significantly higher extent of emphysema(P < 0.001) and a lower extent of interstitial lung disease(P < 0.002), reticular pattern not otherwise specified(P < 0.023), extent of ground glass opacity with traction bronchiectasis(P < 0.002), extent of honeycombing(P < 0.001) and coarseness of fibrosis(P < 0.001) than the paraseptal group. The NSIP group exhibited a significantly higher extent of emphysema(P < 0.05), total lung capacity(P < 0.01) and diffusion capacity(DLCO)(P < 0.05) than the typical UIP group. The typical UIP group exhibited a significantly higher extent of interstitial lung disease, extent of reticular pattern not otherwise specified, extent of ground glass opacity with traction bronchiectasis, extent of honeycombing and coarseness of fibrosis(0.039 > P > 0.000). Although the pulmonary arterial pressure was higher in typical UIP group relative to the NSIP group, the difference was not statistically significant.CONCLUSION: In CPFE patients, paraseptal emphysema is associated more with UIP-HRCT pattern and higher extent of fibrosis than centrilobular emphysema.
文摘We describe an impressive and rare case of surgical emphysema after minimally invasive rectal surgery. This case reports on a patient who developed mas-sive retroperitoneal, intraperitoneal and subcutaneous emphysema directly following a transanal endoscopic microsurgery(TEM) procedure for a rectal intramuco-sal carcinoma. Free intra-abdominal air after gastro-intestinal surgery can be a sign of a bowel perforation or anastomotic leakage. This is a serious complication often requiring immediate surgery. In our patient an abdominal computed tomography-scan with rectal con-trast showed no signs of a rectal perforation. Therefore this emphysema was caused by the insufflation of CO2 gas in the rectum during the TEM-procedure. Conserva-tive treatment resulted in an uneventful recovery. With the increasing usage of TEM for rectal lesions we ex-pect this complication to occur more often. After ruling out a full thickness rectal wall perforation in patients with surgical emphysema following TEM, conservative treatment is the treatment of choice.
文摘Rationale: There is accumulating evidence that a group of stem/progenitor cells (SPCs) maintain alveolar epithelial integrity. Pulmonary emphysema is characterized by the histological finding of the loss of alveolar epithelial integrity along with corresponding bronchiolar fibrosis. Objectives: Based on the concept of autopoiesis (the capacity to produce oneself), we proposed a mathematical model in the maintenance of alveolar epithelial integrity as related to the genesis of pulmonary emphysema and fibrosis. Methods: A tessellation automaton model was used to describe the autopoietic dynamics of the bronchiolo-alveolar epithelial surface. The alveolar septal volume en-closed by the epithelial surface is a distributed system of discrete elements, which move by random walk in the manner of Brownian motion. Assuming that the numbers of components and events in the automaton are large, an approximate theoretical treatment in terms of differential equations is possible, allowing a set of partial differential equations to be produced. Results: 1) Assuming the loss of progenitor cells through the epithelial-mesenchymal transition (EMT), a sharp bifurcation between two qualitatively distinct regions of the phase space (one that is repaired completely, and another that has disappeared entirely) clearly appeared. 2) Thus, from the system of discrete and spatial partial differential equations, we obtained a system of ordinary differential equations in equilibrium conditions that defined a close relationship between the degree of emphysema, the density of alveolar septal fibroblasts, and the mean concentration of SPCs. Conclusions: A mathematical model of the autopoietic maintenance of the alveolar epithelial surface suggested a close relationship between alveolar emphysema and fibrosis and EMT in lungs affected by chronic obstructive pulmonary disease.
文摘Subcutaneous emphysema is a condition that results from introduction of air into soft tissues. In head and neck, it is commonly observed following fractures of paranasal sinuses. Less frequently, it may occur during surgical procedures for tooth removal, when air from dental hand-pieces is forced into surgical site. Depending on its extension, it may involve vital spaces such as mediastinum. This specific finding may induce life-threatening situations. The aim of this article is to establish the incidence of subcutaneous emphysema among 10,779 impacted third molar surgical procedures and report the cases in which such complications had occurred. In this retrospective study, data collected from 10,779 third molar extraction procedures performed at Piracicaba School of Dentistry were evaluated for the occurrence of subcutaneous emphysema. Two cases of subcutaneous emphysema (0.018%) occurred following extraction of impacted third molars. Both were associated with mandibular tooth and related to the use of dental air hand-piece. One of the cases involved submandibular and buccal spaces while the other involved buccal and canine spaces. Regression of emphysema occurred spontaneously and postoperative recovery was uneventful. Subcutaneous emphysema following impacted third molar extractions is rare and strongly associated with the use of air turbines. Follow-up and preservation are the treatments of choice, but clinicians should be aware about the possibility of microbial spreading through facial spaces.
文摘Emphysema and influenza directly affect alveolar sacs and cause problems in lung performance during the breathing cycle. In this study, the effects of Emphysema and Influenza on alveolar sac’s air flow characteristics are investigated through Computational Fluid Dynamics (CFD) simulation. Both normal and Emphysemic alveolar sac models with varying collapsed volumes resulting from influenza virus replication were developed. Maximum, area average pressure, and wall shear stress (WSS) in collapsed and open alveolar sacs models were compared. It was found that a collapse at half of the volume at the bottom of the alveolar sacs’ models would cause a decrease in average and maximum pressure values and yield higher WSS values for fluid flow during the breathing cycle. On the other hand, a quarter volume collapse at the bottom and side of the model resulted in higher values for average and maximum pressure and WSS. Additionally, results also showed that a combination of alveolar sacs closure and Emphysema would generally lead to an increase in fluid pressure and average WSS during breathing. Maximum WSS was observed during exhalation and maximum WSS decrease occurred during inhalation. Findings are in good agreement with previous studies and suggest that emphysema and influenza virus affect fluid flow and may contribute to alveolar sac closure. However, more realistic simulations should include the fluid-solid interaction studies.
文摘Chronic obstructive lung disease(COPD),predominantly emphysema,causes several thoracic anatomical and hemodynamic changes which may cause changes in various electrocardiographic parameters.A 12-lead electrocardiogram(ECG),which is often a part of routine evaluation in most clinical settings,may serve as a useful screening modality for diagnosis of COPD or emphysema.Our current article aims to provide a comprehensive review of the electrocardiographic changes encountered in COPD/emphysema utilizing published PubMed and Medline literature database.Several important ECG changes are present in COPD/emphysema and may serve as a good diagnostic tool.Verticalization of Pvector,changes in QRS duration,pattern recognition of precordial R-wave progression and axial shifts can be considered some of the most valuable markers among other changes.In conclusion,12-lead surface electrocardiogram can serve as a valuable tool for the diagnosis of COPD and/or emphysema.An appropriate knowledge of these ECG changes can not only help in the diagnosis but can also immensely help in an appropriate clinical management of these patients.
基金This project was supported by a grant from EducationMinistry for higher education excellent teachers projection(2 0 0 0 )
文摘The relations between mRNA expression of basic fibroblast growth factor (bFGF) and the changes in collagen Ⅰand collagen Ⅲ in pulmonary tissues from a single intratracheal instillation of papain induced emphysema in rats were investigated. Wistar rats ( n =42) were randomly divided into normal group and emphysema model 1, 3, 5, 7, 15, 30 day groups ( n =6 in each group). The rat model of emphysema was induced by a single intratracheal instillation of papain. The results of immunohistochemistry SABC and in situ hybridization with bFGF probe were quantitatively analyzed to examine the changes of collagen Ⅰand collagen Ⅲ and bFGF mRNA expression in lung tissues and the percent of positive expression of bFGFmRNA in alveolar macrophages. The results were as follows: (1) In the emphysema model groups the optical densities of collagen Ⅰand collagen Ⅲ began to increase after 3 days, reached the highest at the 7 th day, and began to reduce at the 15 th day; (2) No expression of bFGFmRNA in pulmonary tissues was detectable in the normal group. The positive expression of bFGFmRNA was detectable in lung tissues one day after the intratracheal instillation of papain. The average optical densities reached the peak (41.895±7.017) at the 7th day, significantly higher than in the normal group (0.581±0.139, P <0.01). The positive expression of bFGFmRNA in lung tissues began to reduce at the 15th day; (3) Positive expression of bFGFmRNA in alveolar macrophages of instillation papain rats was detectable 3 days after the intratracheal instillation of papain, and reached the highest at the 7th day with the percent of positive expression of bFGF mRNA in alveolar macrophages being 70.13±11.21, higher than in the normal group (5.12±0.18, P <0.01); (4) The expression of bFGF mRNA in the lung tissues and macrophages was postively related with the changes in collagen Ⅰ and collagen Ⅲ ( P <0.01 or P <0.05) respectively. It was suggested that the up regulation of bFGF mRNA expression during the development of emphysema can lead pulmonary interstitial fibrosis, which may take part in the injury and repair and the lung tissue reconstruction.
基金The project supported by National Natural Science Foundation of China(81274172,81473267,30801535,81470003)
文摘OBJECTIVE The present study aimed to investigate the relationship between Wnt/β-catenin and Nrf2 signaling pathways,and understanding the mechanisms underlying the process of inflammatory in chronic obstructive pulmonary disease(COPD),which was a serious disease of respiratory system.METHODS We duplicate the emphysema model with porcine pancreatic elastase(PPE)in Nrf2-/-and WT mouse for 21d,and intraperitoneal injection of Li Cl,the activator of Wnt/β-catenin signaling pathway from 14 d to the end.Hematoxylin and eosin(H&E)staining was performed to assess the histopathologic level,and immunohistochemistry(IHC)for Mac-3(the marker of macrophagocyte)and Ly6G(the marker of neutrophil)was used to observe the inflammatory infiltrate,while the levels of Wnt/β-catenin and Nrf2 signaling pathways related proteins heme oxygenase-1(HO-1),NAD(P)H:quinone oxidoreductase 1(NQO1),and the expression of inflammatory cytokine interleukin-6(IL-6)were detected by Western blotting of lung tissues.In vitro,cigarette smoke extract(CSE)-treated normal human bronchial epithelial(NHBE)cells,cell viability was examined by MTT assay,and then we treated recombinant human Wnt3a,si Nrf2 and si Wnt3a to measure the expression of Wnt3a,β-catenin,Nrf2,HO-1,NQO-1,and IL-6.Cellular immunofluorescence staining was employed to identify the nuclear translocation of Nrf2.RESULTS We found that the Li Cl-treated group has markedly decreased the damage of alveolar structure and inflammatory signs than the model group of WT mice rather than Nrf2-/-group.It also seen that Li Cl not only increasedβ-catenin,but it also led to a comparable increase in Nrf2,HO-1,NQO1,and decrease of IL-6 compared with WT model groups but except to Nrf2-/-group in vivo.And it showed that Wnt3atreatment has significantly increased the nuclear translocation of Nrf2 and the expression of HO-1 and NQO1,reduced the IL-6 release,while there has no significance when Nrf2 was blocked in CSE-induced NHBE cells.CONCLUSION Our results demonstrated that Wnt3a/β-catenin significantly balanced oxidative stress and attenuated inflammation reaction by promoting Nrf2 nuclear translocation and activity.
文摘The subcutaneous cervicofacial emphysema is a rare and serious disease. There is a wide variety of etiologic factors for subcutaneous cervicofacial emphysema. As an maitrisable factor, the use of hydrogen peroxide 3% as an irrigant to newly operated tissue plans may cause emphysema. We report here a case with iatrojenic cervicofacial emphysema, occurred after the irrigation of hydrogen peroxide 3% to the drilled teeth root during dental treatment.
文摘Gas in the leg is not always a gas gangrene. Abdominal infection with gas forming organisms may spread to the thigh & leg. We report a case of critically ill patient who presented to the emergency department with features suggestive of septic arthritis of the left hip. Assessment and further intervention revealed subcutaneous emphysema of the leg secondary to an infection of a previously asymptomatic staghorn calculus. X-ray of the abdomen showed a left renal stone and gas in the soft tissue planes of the left retroperitoneal space while X-ray of the left femur showed gas in the soft tissue planes of the left hip region and whole thigh with no bony or joint abnormality. Such case has not been reported in English literature before. Physicians and surgeons should be aware of this condition that could be fatal but curable by early intervention.
文摘Introduction: “RC-Prep”, a chemo-mechanical preparation for root canals, includes EDTA and urea peroxide as ingredients. For lubrication and its chelating effect, RC-Prep is useful as an adjunct in root canal enlargement. Furthermore, its cleaning action, due to its foaming properties in combi-nation with sodium hypochlorite, can be useful in root canal treatment in many situations. Methods: In a case of upper gingiva swelling, we used sodium hypochlorite with RC-Prep in the treatment of an infected root canal of the left maxillary premolar at the first visit. Within 2 min after use, the patient’s face became swollen. We kept the root canal open, and conducted a CT scan to investigate. Results: We diagnosed subcutaneous emphysema and prescribed 1 week of pain killers and antibiotics. The pain and swelling in the face finally resolved at 11 days after the incident. Conclusions: The cause of the emphysema was considered to have been the use of a sodium hypo-chlorite solution after using RC-Prep for an opened root apex.
