Differences in the anatomy of the lower respiratory tract in selected species of the order Testudines

The lower airways of turtles consist of the larynx, trachea and bronchi. Due to incomplete information about the anatomical structure of the lower respiratory tract in turtles, we decided to explore this topic more deeply. The material for this study included 95 turtle cadavers. Terrestrial tortoises were represented by 63 individuals from 8 species, aquatic and semi-aquatic turtles by 32 individuals from 11 species. The sex ratio was 54 females to 41 males. In addition to the anatomical autopsies and assessments of the macroscopic structures, numerous measurements were performed. The length, width and height of the larynx and trachea, and the length of the bronchi were measured. We found clinical significance in two parameters. The first one is the formation of the rima glottidis, which is significantly shorter and narrower in the aquatic turtles than in the terrestrial tortoises. It follows that for these species, we should use a smaller diameter of endotracheal cannula for intubation. The second parameter is a very short trachea in tortoises of the genus Testudo. The length of the trachea is only a few centimetres, which significantly increases the risk of intubation into one bronchus only.

PRIMER REPORTE DE LESIONES PARASITARIAS COMPATIBLES CON Oslerus osleri (COBBOLD, 1876) EN AGUARÁ GUAZÚ, Chrysocyon brachyurus (ILLIGER, 1811) DE LA PROVINCIA DE SANTA FE.

The necropsy of 5 specimens of C. brachyurus which were accidentally run over on different routes in the north-central province of Santa Fe. All of these had multiple whitish nodules with a cystic appearance between the distal third of the trachea and bronchi containing parasites arranged in the shape of a ball inside. Morphological identification of adult’s nematodes and larvae eggs from females was performed, where it was possible to identify typical characters of the species O. osleris. Likewise, the lungs were increased in consistency, with petechial and multifocal ecchymosis and the presence of whitish nodules scattered throughout the parenchyma. Two of the canids had an increase in the size of the bronchial lymph nodes. The inspection of the respiratory system together with the observation of lesions and the nematodes found inside with their corresponding measurements, are compatible with the species O. osleri, which would imply the first report of this parasite in wild canids from Argentina.

Incidental operating room fire from a breathing circuit warmer system: a case report

Background An airway-associated fire in an operating room can have devastating consequences for patients. Breathing circuit warmers (BCWs) are widely used to provide heated and humidified anesthetic gases and eventually prevent hypothermia during general anesthesia. Herein, we describe a case of a BCW-related airway fire. Case presentation In this case, an electrical short within a BCW wire caused a fire inside the circuit. Simultaneously, the fire was extinguished, ventilation was stopped, and the endotracheal tube was disconnected from the BCW. The patient was exposed to the fire for less than 10 s, resulting in burns to the trachea and bronchi. Immediately after airway burn, bronchoscopy showed no edema or narrowing except for soot in the trachea and both main bronchus. After the inhalation burn event, prophylactic antibiotics, bronchodilator, mucolytics nebulizer, and corticosteroid nebulizer were started. On bronchoscopy 3 days after the inhalation burn, mucosal erythematous edema was observed and the inflammatory reaction worsened. The inflammatory reaction showed aggravation for up to 2 weeks, and then gradually recovered, and the epithelium and mucous membrane of the upper respiratory tract returned to normal after 4 weeks. Eventually, the patient recovered without long-term complications and was successfully discharged. Conclusions This is the first report of a fire caused by BCW. We wanted to share our experience of how we responded to an airway-related fire in an OR and treated the patient. It cannot be overemphasized that the electrical medical appliance associated with the airways are fatal to the patient in the event of a fire, so caution should always be exercised.

The larynx

The larynx, trachea and bronchi develop embryologically from the foregut in the form of an outpouching during the fourth week of gestation. The larynx bridges the gap from the base of the tongue above, to the trachea below lying within the hypopharynx. It sits in the neck spanning the distance from the third to sixth cervical vertebrae. It is a complex respiratory organ composed of a cartilage framework, ligaments, intrinsic and extrinsic muscles and is lined by an epithelial mucous membrane continuous above with the pharynx and below with the trachea. Its primary function is protection of the lower respiratory tract against aspiration. It allows the generation of a high intrathoracic pressure required for coughing, straining and lifting (Valsalva manoeuvre) and phonation. The anatomy of the larynx can either be considered by its surgical division of the supraglottis, glottis and subglottis (these landmarks are important in the consideration of cancer spread).

Use of photobiomodulation therapy for the evolution of immunomodulatory markers and physiological parameters in patients with covid-19

The study aimed to evaluate the effectiveness of laser therapy for the evolution of immunomodulatory markers and physiological parameters in patients with COVID-19 with moderate to high risk of death. Twenty seriously diagnosed patients with COVID-19 were selected for the study, which were divided into two groups: control (who did not receive the treatment) and laser (who received the treatment), selected through non-blind randomization. The laser was administered in five areas: pulmonary area, face, tonsillar fossae, trachea, and bronchi. The treatment was monitored throughout its duration, six days. Laboratory tests were collected daily in both groups and several parameters were measured. We tested the difference between the days with paired tests and tested the correlation of the parameters with time using Pearson's correlation. In the laser group, patients showed a constant improvement in partial arterial oxygen pressure (PaO2) when compared to patients in the control group. Therefore, when thinking about intervening in the pathophysiology of the disease, one should take into account the use of techniques or drugs that can act both in restricting the most pernicious phase of the inflammatory cascade and in modulating all events related to the evolution of COVID- 19.

Rupture of contralateral mainstem bronchus during uniportal video-assisted thoracoscopy surgery lobectomy and 3 successful cases of repair

Background Our goal was to discuss the treatment for rupture of contralateral mainstem bronchus during uniportal video-assisted thoracoscopy surgery (uniportal VATS) lobectomy. Case presentation We analyzed clinical data of 3 cases of rupture of contralateral mainstem bronchus during uniportal VATS. Surgical repair was performed immediately under an uniportal VATS during operation, as a result, 3 cases of bronchial rupture all were repaired successfully, and we continued to complete lobectomy and systemic lymph node dissection. Reexamination was performed after 1 week, and no fistula was found in trachea and bronchi through a fiberoptic bronchoscopy. The time range for indwelling the chest tube is 6–9 days, and the hospital stay is 8–10 days. No abnormality was observed on chest radiography when the 3 patients returned to the hospital 1 month after the operation for the second reexamination. Conclusions Instant surgical repair is recommended to the treatment of bronchial rupture in thoracic surgery. It is safe and feasible to repair bronchial tear with uniportal VATS.

Observation of Synchronous Primary Multiple Carcinoid of the Trachea and Main Bronchus

Carcinoid tumors are rare malignant neoplasms of the respiratory system. They belong to neuroendocrine tumors with a low degree of (G1, G2) malignancy. Even less common is the primary multiplicity of these tumors in the trachea and bronchi, which can complicate the only radical, surgical treatment. We present an observation of a 75-year-old patient who was able to diagnose a carcinoid of the cervical trachea and left main bronchus in a timely manner, determine the exact localization and prevalence of the tumor, and successfully conduct surgical treatment in 2 stages.

A tandem-repeat dimeric RBD protein-based COVID-19 vaccine ZF2001 protects mice and nonhuman primates

A safe, efficacious and deployable vaccine is urgently needed to control COVID-19 pandemic. We report here the preclinical development of a COVID-19 vaccine candidate, ZF2001, which contains tandem-repeat dimeric receptor-binding domain (RBD) protein with alum-based adjuvant. We assessed vaccine immunogenicity and efficacy in both mice and non-human primates (NHPs). ZF2001 induced high levels of RBD-binding and SARS-CoV-2 neutralizing antibody in both mice and NHPs, and also elicited balanced TH1/TH2 cellular responses in NHPs. Two doses of ZF2001 protected Ad-hACE2-transduced mice against SARS-CoV-2 infection, as detected by reduced viral RNA and relieved lung injuries. In NHPs, vaccination of either 25 μg or 50 μg ZF2001 prevented infection with SARS-CoV-2 in lung, trachea and bronchi, with milder lung lesions. No evidence of disease enhancement is observed in both models. ZF2001 is being evaluated in the ongoing international multi-center Phase 3 trials (NCT04646590) and has been approved for emergency use in Uzbekistan.