I.-Chun Kuo

Airway injury is a life-threatening condition requiring immediate intervention. Tracheal perforation in patients with relapsing polychondritis (RP) and tracheobronchomalacia (TBM) is extremely rare, posing significant management challenges. Here, we describe the successful placement of a silicone Y-stent via rigid bronchoscopy under venovenous extracorporeal membrane oxygenation (ECMO) to address this complex clinical scenario. We present the case of a 29-year-old female with RP and tracheostomy tube dependence who developed tracheal rupture, resulting in acute respiratory failure. To stabilize her condition, venovenous ECMO was initiated, and a silicone Y-stent was successfully placed via rigid bronchoscopy. The patient achieved full recovery, and the stent was removed 10 months later, revealing complete airway healing. This case highlights the effectiveness of silicone Y stenting and venovenous ECMO as viable salvage strategies for severe airway injuries in RP patients. Our findings demonstrate the safety and feasibility of this approach in managing complex airway conditions, offering a potential treatment option for similar cases.

Objectives: Subglottic stenosis (SGS) is a challenging complication post‐airway interventions. Effective preventive strategies lack sufficient evidence. This study investigated the preventive effect of inhalation therapy with dexamethasone/ciprofloxacin on acute SGS in a rabbit model.Methods: Twenty New Zealand White rabbits underwent subglottic injury via endoscopy and received inhalation therapy twice daily starting on the injury day. Group 1 (n = 4) received saline for 5 days and was sacrificed on day 5; Group 2 (n = 4) received dexamethasone/ciprofloxacin for 5 days and was sacrificed on day 5; Group 3 (n = 4) received the same therapy for 5 days and survived for one week, and was sacrificed on day 15; Group 4 (n = 4) received the therapy for 10 days and was sacrificed on day 15; Group 5 (n = 4) received the therapy for 10 days and survived for one week, and was sacrificed on day 22. Rabbits underwent repeat endoscopy and were euthanized at the designated time point. Histological measurements were analyzed statistically.Results: Histological analysis revealed median cricoid lumen measurements of 20.01 ± 1.42 mm² for group 1, 17.94 ± 3.05 mm² for group 2, 14.84 ± 2.55 mm² for group 3, 17.18 ± 5.31 mm² for group 4, and 11.87 ± 5.68 mm² for group 5. No significant differences were found between treatment and control groups (p = 0.486) or between 5‐day and 10‐day treatments (p = 0.686). Multivariate statistical analysis indicated that cessation of inhalation therapy (p < 0.05) and prolonged survival (p < 0.05) were associated with shorter cricoid lumen measurements.Conclusion: Short‐term dexamethasone/ciprofloxacin inhalation does not prevent acute SGS. No improvements in cricoid lumen diameter were found. Extended survival correlated with shorter cricoid lumen, suggesting SGS progression is time dependent.Level of Evidence: NA.

Objectives: Our aim was to investigate the diagnostic challenges and management of relapsing polychondritis (RP) with airway involvement, highlighting the need for accurate diagnosis and effective intervention to prevent severe complications. Methods: In this retrospective study, medical records from January 2011 through June 2024 at a single tertiary-care institution were reviewed. This study was approved by the institutional review board. A total of 34 patients were diagnosed with RP, among whom 4 presented with significant airway complications. This study focused on these four patients, detailing their clinical presentations, diagnostic processes, and outcomes following various interventions. Results: All patients were initially misdiagnosed with asthma and later developed severe airway issues necessitating interventions such as tracheotomy and endotracheal intubation. Diagnostic imaging, microlaryngoscopy and bronchoscopy (MLB) were crucial for identifying subglottic stenosis and other airway alterations. Treatments included high-dose steroids, rituximab, and surgical interventions such as balloon dilation and tracheostomy. Only one patient could be decannulated; the other three remained dependent on tracheostomy and experienced significant complications due to emergency medical interventions. Conclusions: RP can manifest with nonspecific respiratory symptoms similar to asthma, which may delay correct diagnosis and appropriate treatment, leading to critical airway complications. The early, precise identification of RP, particularly with airway involvement, is vital. MLB and dynamic expiratory CT scans play significant roles in clinical diagnosis and management. A multidisciplinary approach involving otolaryngologists, rheumatologists, and pulmonologists is essential for optimizing patient outcomes and minimizing complications.

Electrocardiogram (ECG) is the primary basis for the diagnosis of cardiovascular diseases. However, the amount of ECG data of patients makes manual interpretation time-consuming and onerous. Therefore, the intelligent ECG recognition technology is an important means to decrease the shortage of medical resources. This study proposes a novel classification method for arrhythmia that uses for the very first time a three-heartbeat multi-lead (THML) ECG data in which each fragment contains three complete heartbeat processes of multiple ECG leads. The THML ECG data pre-processing method is formulated which makes use of the MIT-BIH arrhythmia database as training samples. Four arrhythmia classification models are constructed based on one-dimensional convolutional neural network (1D-CNN) combined with a priority model integrated voting method to optimize the integrated classification effect. The experiments followed the recommended inter-patient scheme of the Association for the Advancement of Medical Instrumentation (AAMI) recommendations, and the practicability and effectiveness of THML ECG data are proved with ablation experiments. Results show that the average accuracy of the N, V, S, F, and Q classes is 94.82%, 98.10%, 97.28%, 98.70%, and 99.97%, respectively, with the positive predictive value of the N, V, S, and F classes being 97.0%, 90.5%, 71.9%, and 80.4%, respectively. Compared with current studies, the THML ECG data can effectively improve the morphological integrity and time continuity of ECG information and the 1D-CNN model of ECG sequence has a higher accuracy for arrhythmia classification. The proposed method alleviates the problem of insufficient samples, meets the needs of medical ECG interpretation and contributes to the intelligent dynamic research of cardiac disease.