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Critical importance of tracheal tube cuff pressure management

World Journal of Anesthesiology 2015年第2期4卷 10-12页

作者： Taoyuan Robert Feng Ying Ye d John doyle Cleveland Clinic lerner College of Medicine of Case Western Reserve University Cleveland Clinic department of General Anesthesia Cleveland Clinic Abu Dhabi

The ideal range for tracheal tube cuff pressures is usually taken to be between 20 to 30 cm H2 O. This is easily measured with a cuff pressure manometer and should be measured in each instance. The importanceof tracheal tube cuff pressures is highlighted by the spectrum of airway complications that can occur with incorrect cuff pressures. High cuff pressures can result in complications ranging from sore throat and hoarseness to tracheal stenosis, necrosis, and even rupture. In such cases, the postulated causative factor is diminished blood flow to tracheal mucosa due to excessive cuff pressure on the tracheal wall. This hypothesized ischemic injury then produces healing fibrosis months or even years later. On the other hand, cuff pressures that are too low place the patient at risk for aspiration of gastric contents and consequently, aspiration pneumonitis and pneumonia. This is why the authors recommend that cuff pressures be measured following all intubations.

关键词： Tracheal tube cuff pressure Tracheal injury Tracheal stenosis Patient safety Intubation

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Anesthesia for bronchoscopic amniotic membrane grafting to treat non-healing bronchial dehiscence

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World Journal of Anesthesiology 2015年第2期4卷 39-43页

作者： Taoyuan Robert Feng Thomas R Gildea d John doyle Cleveland Clinic lerner College of Medicine Respiratory Institute Cleveland Clinic department of General Anesthesia Anesthesiology Institute Cleveland Clinic Abu Dhabi

Airway complications after lung transplantation remain a significant cause of morbidity and mortality. Many of these occur at the anastomotic sites, which are susceptible due to poor collateral circulation. Of the possible complications, bronchial dehiscence is particularly formidable. These cases have been successfully treated bronchoscopically with metallic stents, which likely promote healing through granulation tissue formation. However, limited options exist in cases where the dehiscence fails to heal following stent placement. Here, we present the case report of a 65-year-old male who developed bronchial dehiscence status post bilateral lung transplantation for idiopathic pulmonary fibrosis that failed to heal with simple stent placement. Eventually, the patient underwent amniotic membrane grafting with stenting as a novel therapy for non-healing bronchial dehiscence, for which we describe the anesthetic management. His anesthetic plan included inhalational induction with sevoflurane, propofol infusion for total intravenous anesthesia, rocuronium for muscle relaxation, and closed-circuit assisted ventilation. His existing tracheostomy was used as the airway for oxygenation and induction. In summary, our anesthetic plan for the lung transplant patient was effective; future amniotic membrane grafting for bronchial dehiscence through bronchoscopy may follow a similar technique. Ultimately, the choice of anesthesia in this patient population requires judicious consideration of the requirements of the procedure as well as the pathophysiology of the transplanted lung.

关键词： Bronchial dehiscence Amniotic membrane Grafting Bronchoscopy Lung transplantation Anesthesia

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Identification of a novel genetic locus on chromosome 8p21.1-q11.23 for IBGC disease

Identification of a novel genetic locus on chromosome 8p21.1...

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湖北省遗传学会第八次代表大会暨学术讨论会

作者： Xiaohua dai,~(1#)Xiaoniu Cui,~(1#) Yong Gao,~(1#)Zhenping Xu,~(1,2)Juan Liu,~1 Yulei Li,~2 Haibo Xu,~3 Mugen Liu,~1 Qing K Wang,~(1,4*) and Jing Yu Liu~(1*) 1 Key Laboratory of Molecular Biophysics of the Ministry of Education,College of Life Science and Technology,Center for Human Genome Research,Huazhong University of Science and Technology, 430074,Wuan,Hubei,P.R.China 2 department of Life Science and Technique,Xinxiang Medical University,Xinxiang,453003,China 3 department of Radiology,Union Hospital of Huazhong University of Science and Technology,Wuhan,430074,China 4 department of Molecular Cardiology,lerner Research Institute,Cleveland Clinic,Cleveland 44195,USA

Idiopathic basal ganglia calcification(IBGC) is a neurodegenerative syndrome that is characterized by basal ganglia and extrabasal ganglia calcifications,and usually inherited in an autosomal dominant *** date,two genetic loci for IBGC disease were identified on chromosome 14q and 2q,but genetic heterogeneity clearly *** this study,a large Chinese family with autosomal dominant IBGC disease was *** analysis excluded the 14ql3 and 2q37 loci and other known related genes with extrapyramidal disease in the nervous system,including ApoE,Tau,ACT,BChE-K, APP,PS1,PS2 and *** larger family was then characterized by genome-wide linkage analysis to identify a novel genetic locus for IBGC *** linkage was identified with markers on chromosome 8p21.1-q11.23 with a maximum LOd score of *** mapping defined the new genetic locus within a 25.0 cM region between markers d8S1809 and *** studies of the candidate genes at the 8p21.1-q11.23 locus may lead to identity of a specific gene with IBGC.

关键词： Idiopathic basal ganglia calcification(IBGC) Linkage analysis Novel genetic locus

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强化与标准血压控制对痴呆的影响:随机临床试验

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中华高血压杂志 2019年第4期27卷 367-367页

作者：刘青叶鹏 Williamson Jd Pajewski NM Auchus AP Bryan RN Chelune G Cheung AK Cleveland ML Coker LH Crowe MG Cushman WC Cutler JA davatzikos C desiderio L Erus G Fine LJ Gaussoin SA Harris d Hsieh MK Johnson KC Kimmel PL Tamura MK Launer LJ lerner AJ Lewis CE Martindale-Adams J Moy CS Nasrallah IM Nichols LO Oparil S Ogrocki PK Rahman M Rapp SR Reboussin dM Rocco MV Sachs BC Sink KM Still CH Supiano MA Snyder JK Wadley VG Walker J Weiner dE Whelton PK Wilson VM Woolard N Wright JT Jr Wright CB SPRINT MINd investigators for theSPRINT research group

目前还没有有效的治疗方法来降低轻度认知障碍和痴呆的风险。该文旨在探讨强化血压控制对老年痴呆风险的影响。研究人员在美国和波多黎各102个地点对年龄≥50岁有高血压但无糖尿病或脑卒中史的成人进行随机临床试验。于2010年11月8日开... 详细信息

目前还没有有效的治疗方法来降低轻度认知障碍和痴呆的风险。该文旨在探讨强化血压控制对老年痴呆风险的影响。研究人员在美国和波多黎各102个地点对年龄≥50岁有高血压但无糖尿病或脑卒中史的成人进行随机临床试验。于2010年11月8日开始,于2015年8月20日提前停止,获得其主要观察指标(复合心血管事件)和全因死亡率的数据。认知观察指标随访的最后日期为2018年7月22日。

关键词：随机临床试验老年痴呆血压控制轻度认知障碍标准心血管事件治疗方法研究人员

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肌萎缩侧索硬化症病人上运动神经元密度评估:基于MR的可行性研究

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国际医学放射学杂志 2018年第4期 483-483页

作者： J.Chen V.Kostenko E.P.Pioro B.d.Trapp 刘小新 department of Neurosciences Lerner Research InstituteCleveland Clinic

目的验证MR成像是否可以评估肌萎缩侧索硬化症（ALS）病人的原始运动皮质（PMC）运动神经元（MN）密度。材料与方法 2012年—2014年,11例ALS病人（年龄35;1岁;女7例,男4例）死亡后（3.2;.6 h,平均5.5 h）立即行颅脑MRI扫描。随后将死者... 详细信息

目的验证MR成像是否可以评估肌萎缩侧索硬化症（ALS）病人的原始运动皮质（PMC）运动神经元（MN）密度。材料与方法 2012年—2014年,11例ALS病人（年龄35;1岁;女7例,男4例）死亡后（3.2;.6 h,平均5.5 h）立即行颅脑MRI扫描。随后将死者大脑取出,并定量分析右侧PMC（RPMC）的MN密度。测量MR影像上RPMC各项指标（厚度、体积和磁化转移率）。采用回归模型根据RPMC和整体MR成像指标（脑和组织体积）评估MN密度,同时评价临床变量。并按照上述MRI扫描策略对ALS病人进行活体扫描（6例患有ALS;年龄54;6岁;男女各3例）。结果 RPMC的平均MN密度变化较大,变化率超过3倍范围,因此通过标准化的灰质体积线性函数进行评估（校正R;=0.51,P=0.008;大多数病人,误差<10%）。当仅考虑散发型ALS时,标准化RPMC和白质体积线性函数评估MN密度（校正R;=0.98,P=0.01;所有病人,误差<10%）。活体数据分析检测到随病程延长MN密度减少。结论终末期ALS病人PMC平均MN密度差异较大,可能由疾病异质性导致。MR成像可能成为MN密度评估的一种手段。

关键词： MR ALS PMC 肌萎缩侧索硬化

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