Dong Yang

This case report describes a successful oral-to-nasal endotracheal tube exchange using a combined video laryngoscopy and fiberoptic bronchoscopy (FOB) technique in a 48-year-old patient with Crouzon syndrome following modified Le Fort III osteotomy and Le Fort I osteotomy. Severe midfacial disruption, bleeding, and secretions precluded the use of FOB alone. The video laryngoscope provided a continuous glottic view and enabled suctioning, while guiding the FOB into the trachea alongside the existing tube. The exchange was completed smoothly within 5 minutes without desaturation. This hybrid approach is an effective strategy for managing difficult airway exchange in complex maxillofacial surgery.

Asthma is frequently accompanied by anxiety disorders, yet the mechanisms linking asthma to neuropsychiatric symptoms remain poorly defined. Here, we inves

Airway hyperresponsiveness (AHR) is often associated with mood disorders such as anxiety and depression which makes the airway symptoms more complicated and refractory. However, the underlying mechanisms remain unclear. This study investigated whether this was related to the activation of microglia in the hippocampus. Female Balb/c mice were randomly assigned into an AHR model induced by ovalbumin (OVA) and an anxiety model induced by chronic restraint stress (CRS). Anxiety-like behavior was assessed by open field test, elevated plus maze and tail suspension test. Airway resistance following methacholine inhalation was measured by using the FlexiVent apparatus. Hematoxylin and eosin, periodic acid-Schiff as well as Masson trichrome were performed to evaluate inflammatory cell infiltration in the lung tissue. In addition, the status of microglia in the hippocampus was evaluated by immunofluorescence, while the activation of inflammation signaling pathway was assessed by Western blots. Compared with the Control group, mice in OVA and CRS groups exhibited higher airway resistance, spent less time in the center area of the open field and the open arms of the elevated plus maze, and showed increased immobility time in the tail suspension test. Microglia in hippocampus exhibited pronounced morphological alterations, increased expression of activation markers Iba1 and CD86, and upregulation of the NLRP3 inflammasome pathway. Minocycline treatment significantly reduced the airway resistance and anxiety-like behavior in OVA mice, while also inhibiting activation of the NLRP3 inflammasome pathway. This study provides evidence for the comorbidity between AHR and anxiety, potentially mediated by hippocampal microglial activation and the NLRP3/Caspase-1/IL-1β pathway. These findings enhance our understanding of the underlying mechanisms, and offer potential targets for treating AHR-related anxiety.

Aims: Although a key intervention for advanced Prostate Cancer, Androgen Deprivation Therapy has been associated with cognitive dysfunction, a phenomenon that has been largely attributed to systemic metabolic alterations and neuroinflammation. Nonetheless, the precise role of gut microbiota in ADT‐induced cognitive impairment remains unclear, forming the basis of this study. Our aim is to explore the correlation between changes in gut metabolism and cognitive dysfunction following ADT in prostate cancer. Methods: A subcutaneous PC3 tumor‐bearing mouse model of ADT‐induced cognitive dysfunction was established. Behavioral tests (OFT, NORT, and Y‐maze) were conducted to assess cognitive performance. Gut microbiota composition, fecal, and hippocampal bile acid profiles were analyzed by 16S rRNA sequencing and targeted metabolomics. To investigate potential mechanisms, we further supplemented ADT‐susceptible (ADT‐su) mice with Taurodeoxycholic acid (TDCA) via oral gavage and inhibited ERK1/2 signaling with PD98059, followed by behavioral testing and Western blot analysis of hippocampal Takeda G‐protein coupled Receptor 5 (TGR5) and ERK1/2 expression. Results: Hierarchical clustering analysis revealed ADT‐induced cognitive impairment in a subset of mice (ADT‐susceptible and ADT‐unsusceptible). These mice exhibited gut microbiota dysbiosis, featuring the depletion of bile acid‐transforming taxa, including Bacteroides spp. and Clostridium scindens . Additionally, FMT from ADT‐su mice to pseudo‐germ‐free mice efficiently transferred cognitive deficits and altered hippocampal bile acid profiles, confirming gut microbiota's causal role in ADT‐induced neurocognitive decline. Notably, both gut and hippocampal TDCA levels were significantly decreased in ADT‐su mice. Mechanistically, TDCA supplementation improved cognitive performance and upregulated hippocampal TGR5 and p‐ERK1/2 expression, while ERK1/2 inhibition by PD98059 partially reversed these effects. Conclusion: Our findings suggest that gut microbiota‐mediated bile acid dysregulation, particularly reduced TDCA, contributes to ADT‐induced cognitive dysfunction via impaired TGR5‐ERK1/2 signaling. Targeting this pathway may represent a novel therapeutic strategy to mitigate cognitive impairment in prostate cancer patients undergoing ADT.

Purpose: To observe the effect of ultrasound-guided single right stellate ganglion block (SGB) on postoperative first night sleep in patients undergoing maxillofacial surgery. Methods: This study included 120 participants who underwent maxillofacial surgery under general anesthesia from 11 April 2023 to 31 August 2024. These participants were divided into three groups, namely blank control group, 1% lidocaine group, and 2% lidocaine group, with 40 patients in each group. Their blood pressure, heart rate, blood oxygen saturation, and the visual analog scale (VAS) scores were recorded before the operation (baseline), immediately after awakening, immediately after arrival at the anesthesia intensive care unit (AICU), 1 h after arrival at the AICU, and 2 h after arrival at the AICU. The Richard–Campbell Sleep Questionnaire (RCSQ) was used to evaluate the sleep quality in the three patient groups on the first night after surgery. Complications associated with SGB and the number of sedative analgesic medication doses supplemented on the first postoperative night were recorded. Results: The RCSQ scores of the blank control group, 1% lidocaine group, and 2% lidocaine group were 44.5 (33.3, 62.0), 67.0 (54.0, 87.9), and 96.0 (65.8, 100.0), respectively, and the scores gradually increased (comparison among three groups: P < 0.0001). There was a statistical difference among the three groups in the gradual slowing down of heart rate after extubation and wakefulness, immediately after arrival at the AICU, 1 h after arrival at the AICU, and 2 h after arrival at the AICU. There were no significant complications of SGB in the three groups. The 1% and 2% lidocaine group reduced the number of postoperative sufentanil remedies. Conclusion: Ultrasound-guided single right SGB effectively improved the quality of postoperative first night sleep according to RCSQ and reduced stress reactions within 2 h in patients undergoing maxillofacial surgery. Notably, the efficacy of 4 mL of 2% lidocaine was superior to that of 4 mL of 1% lidocaine, making it a safe and effective method for improving postoperative sleep.

Goldenhar syndrome is a congenital disease that involves an absence or underdevelopment of structures that arise from the first and second pharyngeal arches and more or less severe extracranial anomalies. A variety of supraglottic malformations may be observed, including mandibular hypoplasia, mandibular asymmetry and micrognathia. Subglottic airway stenosis (SGS), which can cause difficulties in airway management during the perioperative period, is seldom emphasized in literature descriptions of Goldenhar syndrome, but can be clinically significant. An 18-year-old female with a history of Goldenhar syndrome presented for placement of a right mandibular distractor, right retroauricular dilator, and stage I transfer of a prefabricated expanded flap under general anesthesia. During tracheal intubation, the endotracheal tube (ETT) met resistance unexpectantly when attempting to pass through the glottis. Subsequently, we attempted the procedure with a smaller size ETT but again met resistance. With fiberoptic bronchoscope, we found that the whole segment of the trachea and bilateral bronchi were obvious narrow. Given the finding of unexpected severe airway stenosis and the associated risks with proceeding with the surgery, the operation was cancelled. We removed the ETT once the patient was fully awake. Anesthesiologists should be aware of this clinical finding when evaluating the airway of a patient with Goldenhar syndrome. Coronal and sagittal measurements on computerized tomography (CT) and three-dimensional image reconstruction can be used to evaluate the degree of subglottic airway stenosis and measure the diameter of the trachea.

Background Goldenhar syndrome is a congenital disease that involves an absence or underdevelopment of structures that arise from the first and second pharyngeal arches and more or less severe extracranial anomalies. A variety of supraglottic malformations may be observed, including mandibular hypoplasia, mandibular asymmetry and micrognathia. Subglottic airway stenosis (SGS), which can cause difficulties in airway management during the perioperative period, is seldom emphasized in literature descriptions of Goldenhar syndrome, but can be clinically significant. Case presentation An 18-year-old female with a history of Goldenhar syndrome presented for placement of a right mandibular distractor, right retroauricular dilator, and stage I transfer of a prefabricated expanded flap under general anesthesia. During tracheal intubation, the endotracheal tube (ETT) met resistance unexpectantly when attempting to pass through the glottis. Subsequently, we attempted the procedure with a smaller size ETT but again met resistance. With fiberoptic bronchoscope, we found that the whole segment of the trachea and bilateral bronchi were obvious narrow. Given the finding of unexpected severe airway stenosis and the associated risks with proceeding with the surgery, the operation was cancelled. We removed the ETT once the patient was fully awake. Conclusions Anesthesiologists should be aware of this clinical finding when evaluating the airway of a patient with Goldenhar syndrome. Coronal and sagittal measurements on computerized tomography (CT) and three-dimensional image reconstruction can be used to evaluate the degree of subglottic airway stenosis and measure the diameter of the trachea.