ObjectiveTo investigate the effects of alcohol consumption status and labor intensity on the tolerance of patients undergoing bronchoscopy under mild to moderate sedation anesthesia. MethodsAdult patients scheduled for bronchoscopy under local anesthesia or mild to moderate sedation were included, and their clinical characteristics and bronchoscopy tolerance were recorded. The study compared changes in vital signs, severity of coughing, and procedure failure rates during bronchoscopy among patients with different drinking statuses (non-drinkers, former drinkers, and current drinkers) and different labor intensities (light, moderate, and heavy labor intensity) to assess the impact of drinking status and labor intensity on bronchoscopy tolerance.ResultsA total of 142 subjects were included in the study, with 50 patients receiving local anesthesia and 92 patients receiving mild to moderate sedation. Current drinkers had a higher procedure failure rate (2.9% vs. 1.9% vs. 25.0%, P<0.01, for non-drinkers, former drinkers, and current drinkers, respectively) and more significant intraoperative blood pressure drops (systolic pressure change, −3.5±9.1 vs. −0.2±8.1 vs. −9.3±17.9 mm Hg, P<0.01; diastolic pressure change, −0.5±5.6 vs. 2.9±7.9 vs. −3.2±12.4, P<0.05). Patients with moderate to heavy labor intensity also had higher procedure failure rates and more pronounced intraoperative blood pressure drops (procedure failure rate, 1.1% vs. 13.2% vs. 22.2%, P<0.01, for light, moderate, and heavy labor intensity, respectively; intraoperative systolic pressure change, −1.8±8.5 vs. 2.8±8.5 vs. −17.2±24.7 mm Hg, P<0.001; intraoperative diastolic pressure change, 1.3±6.4 vs. 0.2±6.7 vs. −8.1±17.2 mm Hg, P<0.01). The impact of drinking status and labor intensity on procedure tolerance was only observed in patients receiving mild to moderate sedation. After controlling for relevant confounding factors, current drinking and moderate to heavy labor intensity were identified as independent risk factors for procedure failure (current drinkers compared to non-drinkers or former drinkers, OR 47.2, 95%CI: 3.1-232.2, P<0.05; moderate to heavy labor intensity compared to low labor intensity, OR 25.7, 95%CI: 2.8-67.7, P<0.05).ConclusionsCurrent drinkers engaged in moderate to heavy labor intensity are less likely to tolerate bronchoscopy under mild to moderate sedation. It is essential to pay attention to the selection and evaluation of anesthesia methods, procedure types, and intraoperative monitoring for this population.
ObjectiveTo investigate the role of interleukin-25 (IL-25) and its receptor during allergen challenge test in allergic asthmatics as well as its underlining mechanism.MethodsFifteen allergic asthmatic patients with dual response in allergen challenge test were enrolled and blood samples were collected before and after challenge test. The expression levels of IL-25 receptor on the surface of eosinophils, plasma and intracellular IL-25 levels were measured by flow cytometry and enzyme-linked immunosorbent assay. Besides, the function of eosinophils from these patients was evaluated through the expression of type 2 cytokines, degranulation and chemotaxis after stimulation with IL-25.ResultsUpon allergen challenge, the expression of IL-17RB on the surface of eosinophils were increased from (7 426±2 824)/106 white blood cells to (19 446±5 593)/106 white blood cells (P<0.001). The expression of IL-17RA/RB on eosinophils were significantly increased from (4 508±1 360)/106 white blood cells to (9 025±3 166)/106 white blood cells (P<0.001). The plasma level of IL-25 increased from (650±45) pg/ml to (851±43) pg/ml (7 hours after allergen challenge) and (813±56) pg/ml (24 hours after allergen challenge) (P<0.001). The intracellular IL-25 expression of eosinophils was also upregulated from (10 398±1 909)/106 white blood cells to (147 684±46 222)/106 white blood cells (P<0.05). In vitro study, IL-25 (1 ng/ml) stimulated eosinophils for 2 hours promoted its expression of peroxidase [(12.5±4.2) ng/ml compared to control (1.26±0.4) ng/ml, P<0.05). The intracellular expression of IL-5 and IL-13 in eosinophils were also increased after stimulated by IL-25. IL-25 (1 pg/ml) stimulation compared to control could increase eosinophil migration in eotaxin [(36±3) vs. (69±5), P<0.05).ConclusionIL-25 and its receptor play a critical role in eosinophilic aggregation, activation and mobilization during allergic inflammation in allergic asthmatics.
Objective To investigate the feasibility and efficacy of the Flow-through chimeric anterolateral thigh perforator (ALTP) flap for one-stage repair and revascularization in complex defects of the extremities. Methods Between May 2014 and June 2017, 6 patients with soft tissue defects on the limbs combined with dead space, bone defects, or tendon and joint exposure, were reconstructed with the Flow-through chimeric ALTP flap. All 6 patients were male. The patients’ mean age was 44 years (range, 26-60 years). The mechanisms of injury were traffic accidents in 4 cases, wringer injury in 1 case, and bruise injury caused by heavy object in 1 case. The defects located at the lower extremity in 5 cases and at the upper extremity in 1 case. The area of the wound ranged from 7 cm×4 cm to 26 cm×10 cm. There were 3 cases of bone defect, 3 cases of joint and tendon exposure, 2 cases of chronic osteomyelitis, and 2 cases of main artery injury. The muscle flap was inserted into the deep dead space, with perforator flap for superficial defect. The area of perforator flap ranged from 10 cm×5 cm to 28 cm×11 cm and the area of muscle flap ranged from 5 cm×2 cm to 20 cm×5 cm. The defects on the donor sites were closed directly. Results All the flaps were survival without infection and vascular crisis. The wounds of recipient and donor sites healed at first intention. The patients were followed up 3- 24 months (mean, 10 months). Good color and texture of flaps was achieved. The reconstructed main artery patency was achieved and the end of the affected limb was well transported. Only linear scar left on the donor site on thigh with no malfunction. Conclusion The Flow-through chimeric ALTP flap can construct three-dimensional soft tissue defects without sacrificing the recipient vessels. The Flow-through chimeric ALTP flap is an reliable and ideal method for reconstruction of complex wounds in the limbs with dead space and with or without recipient major vessels injury.