Bronchoscopy-Guided Intervention Therapy With Extracorporeal Membrane Oxygenation Support for Relapsing Polychondritis With Severe Tracheobronchomalacia: A Case Report and Literature Review

Relapsing polychondritis is an immune disorder of unknown etiology involving multiple systems that is characterized by persistent inflammation and destruction of cartilage, including the ears, nose, costal, joint, and airways. Airway involvement caused by relapsing polychondritis is common, and tracheobronchomalacia is the most serious complication, which is life-threatening. Currently, the exact mechanism of relapsing polychondritis with tracheobronchomalacia is unknown. Although glucocorticoids and immunosuppressive agents are administered, failures often occur. Currently, bronchoscopy-guided intervention therapy used in tracheobronchomalacia caused by chronic obstructive pulmonary disease or other etiology has gradually increased, but bronchoscopy-guided intervention therapy with extracorporeal membrane oxygenation assist used in tracheobronchomalacia caused by relapsing polychondritis has not been reported. Here, we report a case of relapsing polychondritis with severe tracheobronchomalacia. Although drug therapy was provided and airway stent implantation was performed, the tracheal stenosis was further aggravated. Because conventional anesthesia and mechanical ventilation cannot meet the needs of bronchoscopy-guided intervention therapy or guarantee sufficient safety. The intervention treatment was performed with the support of extracorporeal membrane oxygenation, which was successfully completed without obvious complications. The symptoms were significantly improved, and the patient was discharged uneventfully.

Vancomycin-Loaded Polycaprolactone Electrospinning Nanofibers Modulate the Airway Interfaces to Restrain Tracheal Stenosis

Site-specific release of therapeutics at the infected trachea remains a great challenge in clinic. This work aimed to develop a series of vancomycin (VA)-loaded polycaprolactone (PCL) composite nanofiber films (PVNF-n, n = 0, 1, and 5, respectively) via the electrospinning technique. The physiochemical and biological properties of PVNF-n were evaluated by a series of tests, such as FT-IR, XRD, SEM-EDS, and antibacterial assay. The PVNF-n samples displayed a typical network structure of fibers with random directions. VA was successfully introduced into the PCL nanofibers and could be sustained and released. More importantly, PVNF-5 showed relatively good antibacterial activity against both methicillin-resistant Staphylococcus aureus (MRSA) and Streptococcus pneumoniae (SPn). Thus, PVNF-5 was covered onto the self-expandable metallic stent and then implanted into a New Zealand rabbit model to repair tracheal stenosis. Compared to a metallic stent, a commercial pellosil matrix–covered stent, and a PVNF-0–covered metallic stent, the PVNF-5–covered airway stent showed reduced granulation tissue thickness, collagen density, α-SMA, CD68, TNF-α, IL-1, and IL-6 expression. In conclusion, this work provides an anti-infection film–covered airway stent that in site restrains tracheal stenosis.

A Parametric Tool for Studying a New Tracheobronchial Silicone Stent Prototype: Toward a Customized 3D Printable Prosthesis

The management of complex airway disorders is challenging, as the airway stent placement usually results in several complications. Tissue reaction to the foreign body, poor mechanical properties and inadequate fit of the stent in the airway are some of the reported problems. For this reason, the design of customized biomedical devices to improve the accuracy of the clinical results has recently gained interest. The aim of the present study is to introduce a parametric tool for the design of a new tracheo-bronchial stent that could be capable of improving some of the performances of the commercial devices. The proposed methodology is based on the computer aided design software and on the finite element modeling. The computational results are validated by a parallel experimental work that includes the production of selected stent configurations using the 3D printing technology and their compressive test.

Sequential Treatment of Severe Airway Stenosis Caused by Esophageal Cancer by Using Airway Stent Implantation and Arterial Infusion Chemotherapy

Purpose: This study was aimed at investigating the safety and efficacy of airway stent implantation and transarterial infusion chemotherapy for the treatment of severe airway stenosis caused by esophageal cancer. Methods: Data of patients with advanced esophageal cancer complicated by severe airway stenosis treated with airway stent implantation and transarterial infusion chemotherapy were retrospectively analyzed. Furthermore, dyspnea, clinical efficacy, adverse reactions, and survival were evaluated. Results: Of the 71 patients included, 28, 43, 34, 35, and 2 patients had grade III dyspnea, grade IV dyspnea before airway stenting, grade I dyspnea, grade III dyspnea, and grade III dyspnea after airway stenting, respectively. After airway stent implantation and 1–3 courses of transarterial infusion chemotherapy, complete response, partial response, and stable disease were noted in 11, 41, and 19 patients, respectively. Total objective response rate (ORR) and disease control rate (DCR) were 73.2% and 100.0%, respectively. During follow-up, 32, 24, and 10 patients died of organ failure, tumor-related respiratory failure, and gastrointestinal bleeding, respectively. The median survival time was 8 months, and the 1-year survival rate was 40.8%.Conclusions: Airway stent implantation combined with arterial infusion chemotherapy is safe and effective in the sequential treatment of esophageal cancer with severe airway stenosis.