Search Results (4,790)

Although radiotherapy is a cornerstone in the management of several pediatric malignancies, its administration in children poses unique anesthetic challenges. Unlike adults, pediatric patients, particularly younger children, often require repeated sedation or general anesthesia to ensure immobility and reduce psychological distress during daily treatment sessions that may extend over several weeks. This narrative review summarizes current evidence on anesthetic strategies for children undergoing radiotherapy, focusing on clinical indications, pharmacological approaches, safety considerations, and organizational aspects. We discuss the main sedation and anesthesia techniques used in non-operating room anesthesia (NORA) settings, including deep sedation with midazolam, propofol, ketamine, and dexmedetomidine, as well as general anesthesia with laryngeal mask airway management. Particular attention is given to the cumulative effects of repeated anesthetic exposure, airway management challenges in remote radiation environments, and the risk of respiratory and hemodynamic complications. The review also highlights the importance of individualized, protocol-driven management, rapid recovery strategies, and continuous remote monitoring systems. Non-pharmacological interventions and audiovisual-assisted techniques are also discussed as potential strategies to reduce anesthesia requirements in selected patients. A multidisciplinary approach involving anesthesiologists, radiation oncologists, nurses, psychologists, and technical staff is essential to optimize safety, treatment adherence, and overall quality of care. Tailored anesthetic management, supported by standardized protocols and specialized pediatric expertise, remains crucial to balancing procedural efficacy with short- and long-term safety in this vulnerable population. Full article

Allergic asthma is a prevalent chronic inflammatory disease of the airways whose pathogenesis has traditionally been attributed to localized immune dysfunction within the lung. However, accumulating evidence from microbiome research supports a broader system-level perspective in which cross-organ interactions contribute to disease susceptibility and progression. In particular, the gut–lung axis has emerged as a key regulatory pathway linking intestinal microbial ecology, immune development, and respiratory health. This review synthesizes current epidemiological, mechanistic, and experimental evidence supporting the role of gut microbiota dysbiosis in allergic asthma. We examine how early-life environmental and nutritional exposures and gut microbiota establishment during critical developmental windows shape long-term immune tolerance and asthma susceptibility. We then summarize characteristic features of asthma-associated gut dysbiosis and discuss how microbial-derived metabolites, including short-chain fatty acids, tryptophan metabolites, pro-allergic lipid mediators such as 12,13-dihydroxy-9Z-octadecenoic acid, and bacterial-derived histamine, modulate distal airway immune responses through epigenetic, receptor-mediated, and immune trafficking mechanisms. Particular emphasis is placed on the role of diet as a key upstream regulator of gut microbiota composition and metabolic function. Finally, we evaluate experimental and translational studies targeting the gut–lung axis, including dietary modulation, microbiome-targeted interventions such as fecal microbiota transplantation, and emerging postbiotic approaches. Collectively, current evidence indicates that gut microbial composition and metabolic function are critical determinants of respiratory immune homeostasis. Targeting the gut–lung axis through nutrition- and microbiome-based strategies offers a promising avenue for the prevention and precision treatment of allergic asthma. Full article

Background: Ultrasonography (US) has emerged as a non-invasive method for anatomical and functional evaluation of upper airway structures in adult obstructive sleep apnea (OSA). However, its role in severity stratification, dynamic assessment, elastographic characterization, and therapeutic monitoring remain to be investigated. Background/Objectives: The goal herein is thus to systematically review and synthesize available evidence on US assessment in adults with OSA, including structural parameters, dynamic measurements, correlation with the apnea–hypopnea index (AHI), integration with artificial intelligence, and evaluation of myofunctional therapy outcomes. Methods: A PRISMA-compliant systematic review of 19 studies (2007–2025) was conducted, evaluating US in adult patients with polysomnography-diagnosed OSA. Observational, pilot, case–control, and exploratory studies were included. Risk of bias was assessed using the National Institutes of Health Quality Assessment Tool for observational studies. Due to methodological heterogeneity, a structured qualitative meta-analytic synthesis was performed. Results: The tongue base was the most frequently studied structure. Increased tongue thickness, area, and stiffness were consistently associated with higher AHI. Elastography revealed increased intrinsic rigidity in patients with OSA. Dynamic US correlated with drug-induced sleep endoscopy findings and hyoid displacement. Machine learning integration improved severity prediction. A single study evaluated anatomical changes following myofunctional therapy, representing a nascent research area. US may become a complementary, non-invasive tool for anatomical and functional assessment of upper airway structures in adult OSA. Conclusions: Further standardization of acquisition protocols and well-designed longitudinal studies are needed to clarify the clinical role of US in phenotyping and therapeutic monitoring. Full article

Background: Industrial activities may contribute to airway diseases, particularly chronic obstructive pulmonary disease (COPD) and asthma, which are major respiratory health problems with geographically variable prevalence. The objective of this study was to assess the prevalence of COPD and asthma and to examine factors associated with impaired pulmonary function among workers and residents of the Navanakorn Industrial Zone, Thailand. Methods: A cross-sectional study was performed from September 2025 to January 2026 among adults aged ≥18 years who were employed in or residing within the Navanakorn Industrial Zone. Data collected included demographic characteristics, comorbidities, respiratory symptoms, chest radiographic findings, and spirometric parameters, including forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), and bronchodilator responsiveness (BDR). COPD was defined as the presence of respiratory symptoms in conjunction with at least one risk factor and a post-bronchodilator FEV₁/FVC < 70%. Asthma was defined by the presence of respiratory symptoms with a positive BDR. Results: Among the 373 participants (65.4% female; mean age 55.0 ± 13.6 years), the prevalence of COPD and asthma was 4.3% and 5.4%, respectively. Abnormal chest radiographic findings were present in 8.6%, while abnormal pulmonary function was identified in 30.8%. Lung function abnormalities included airway obstruction (12.9%), restrictive patterns (9.7%), mixed defects (2.1%), and small airway disease (6.2%). A positive BDR was detected in 2.4% of participants. Multivariable logistic regression analysis demonstrated older age, male sex, a history of asthma, and the presence of chest tightness as independent predictors of abnormal lung function. Conclusions: COPD and asthma were prevalent among individuals working or living in the industrial zone, and abnormal pulmonary function—particularly obstructive defects—was common. Older age, male sex, a history of asthma, and respiratory symptoms were associated with a greater risk of lung function impairment, underscoring the importance of targeted surveillance and preventive strategies in industrial environments. Full article

Background: Eyelid reconstruction is particularly challenging because of the delicate anatomy and its critical functional and aesthetic roles. Although various methods have been described for anterior and posterior lamellar repairs, no standardized approach has been established. We developed a single-stage technique integrating reconstruction of both lamellae. Methods: This retrospective case series included seven consecutive patients who underwent full-thickness eyelid reconstruction between 2012 and 2024. Patients were included if they had full-thickness defects requiring reconstruction of both lamellae, underwent reconstruction using a nasal septal chondromucosal graft combined with a large local flap, and had at least 12 months of follow-up. The posterior lamella was reconstructed using nasal septal chondromucosal grafts, and the anterior lamella using large local flaps. Donor sites were managed using various methods. Results: All patients (7/7) achieved complete graft survival without partial or total graft loss. All patients achieved complete eyelid closure without lagophthalmos, and no cases of ectropion, corneal complications, or graft failure were observed. Buccal mucosal grafting demonstrated the most favorable donor-site outcomes, with uneventful healing and no septal perforation or airway-related complications. Conclusions: This single-stage approach combining chondromucosal grafts and local flaps is a feasible and reproducible option for selected patients, providing reliable structural support and satisfactory functional outcomes. Full article

Chronic Obstructive Pulmonary Disease (COPD) is characterized by persistent inflammation and structural alterations in the lung triggered mainly by oxidative stress. Colonization by the opportunistic fungus Pneumocystis has been associated with worse clinical outcomes in COPD, yet its role in airway remodeling remains unclear. To this end, an elastase-induced COPD model was established, followed by colonization with Pneumocystis. Lung tissue was analyzed histologically and molecularly to assess epithelial thickness, alveolar morphometric parameters (mean linear intercept [MLI], D₀, D₁, D₂), inflammation, collagen deposition, and the expression of remodeling and oxidative stress markers. Emphysematous damage parameters MLI, D₀, D₁, and D₂ were markedly elevated in co-exposed animals, indicating enhanced alveolar enlargement. Animals with COPD and Pneumocystis colonization showed a significant increase in airway inflammation compared with control, COPD, and Pneumocystis groups. Airway epithelial thickness, mucus metaplasia, and collagen deposition exhibited a summative increase in the COPD/Pneumocystis group. Redox-responsive markers, such as superoxide dismutase (SOD) and catalase, were upregulated. Moreover, protein and mRNA levels of nuclear factor erythroid 2–related factor 2 (Nrf2) and its downstream gene heme oxygenase-1 (Hmox1) were significantly increased, with the strongest activation observed in co-exposed animals. Integrative correlation analysis showed that Pneumocystis burden positively correlated with lung damage, inflammation, and epithelial remodeling. These structural alterations were accompanied by coordinated activation of the antioxidant pathway Nrf2. Taken together, Pneumocystis colonization is associated with enhanced pulmonary remodeling and modulation of antioxidant signaling in experimental COPD, promoting structural and molecular changes that may contribute to disease progression. These findings suggest that Pneumocystis acts as an amplifying factor in COPD-associated lung damage. Full article

Asthma is a chronic respiratory disease characterized by airway hyperresponsiveness, obstruction, and persistent inflammation, arising from complex interactions among genetic, epigenetic, immune, and environmental factors. To elucidate the stage-specific molecular mechanisms underlying asthma progression, we constructed candidate genome-wide genetic and epigenetic networks (GWGENs) of human cells through large-scale biological database mining. Using a system order detection scheme, false-positive interactions were pruned to identify real GWGENs corresponding to three clinical stages of asthma: quiet, exacerbation, and follow-up. Core GWGENs were subsequently extracted from each real network using the principal network projection (PNP) method to highlight dominant regulatory structures and pathogenic pathways. Based on the inferred core networks, key stage-specific biomarkers were identified and further explored as potential drug targets. Drug–target relationships were investigated by integrating gene expression perturbation profiles from the Connectivity Map (cMap), comprising microarray data for 14,207 genes across 1327 compounds. This network-guided analysis enabled the qualitative design of multi-molecule drug combinations tailored to each disease stage. Our results suggest that asthma onset is associated with reduced innate immunity, increased disease susceptibility, and impaired endothelial barrier recovery influenced by microenvironmental factors such as cigarette smoke and lipopolysaccharides, together with genetic and epigenetic alterations. During the exacerbation stage, enhanced differentiation of T cells toward the T helper 2 lineage contributes to airway inflammation and tissue injury. In the follow-up stage, T helper 1–mediated responses are linked to mucus hypersecretion, airway obstruction, and sustained inflammation. Collectively, these findings demonstrate that a systems-level, network-based framework can uncover stage-specific pathogenic mechanisms of asthma and provide hypothesis-generating insights for network-informed drug repurposing strategies. Full article

Air pollution represents a critical yet modifiable factor influencing the recurrence and progression of upper-airway infections. This review explores the molecular, immunological, and environmental mechanisms linking airborne pollutants to recurrent sinus and respiratory tract inflammation. Particular focus is placed on pollutant-induced oxidative stress, epithelial barrier disruption, alterations in the microbiome, and immune dysregulation, which collectively heighten disease susceptibility. Integrating recent advances in exposomics, multi-omics, and artificial intelligence, the discussion highlights new approaches to unravel exposure–response pathways and identify predictive biomarkers. Future directions emphasize precision exposure assessment, interventional strategies to improve air quality, and the emerging framework of “clean-air medicine” to guide prevention and policy. Overall, this synthesis underscores the urgent need for multidisciplinary collaboration across environmental science, molecular biology, and clinical research to mitigate the growing burden of pollution-related airway disease and promote sustainable respiratory health. Full article

Achromobacter spp. are opportunistic pathogens in people with cystic fibrosis (PwCF), yet the role of the upper airways in their persistence and adaptation remains poorly understood. We investigated whether the sinonasal compartment may act as reservoir and evolutionary niche for Achromobacter spp. during airway infection. Twenty-two isolates obtained from paired nasal lavage and sputum samples of seven PwCF were analysed by whole-genome sequencing. Within each PwCF, identical clone types were detected in both airway compartments, supporting bacterial exchange between upper and lower airways. Despite clonal relatedness, substantial genomic diversification was observed between paired isolates. Genomic signatures indicative of elevated mutation rates were detected in a high number of isolates (73%) and in both airway compartments, highlighting widespread genomic diversification across the respiratory tract. Mobilome analysis revealed compartment-specific variations in insertion sequences, prophages, and integrative elements, suggesting genome plasticity. Additionally, mutation in an aspartate kinase gene was consistently associated with loss of biofilm formation in vitro, highlighting a potential link between this pathway and biofilm phenotype. Overall, our findings indicate that upper and lower airways represent interconnected but partially independent ecological niches where Achromobacter populations can diverge during colonization, supporting the view that both compartments contribute to their persistence and evolution in CF airways. Full article

The combined arch theory provides an effective means for designing support parameters in roadways within loose and fractured surrounding rock. A clear understanding of the internal stress evolution during the load-bearing process of the combined arch is of guiding significance for optimizing roadway support. Taking the 11308 return airway of a mine in Inner Mongolia as the engineering background, this study adopts a combined research approach of theoretical calculation, numerical simulation and laboratory testing. It systematically investigates the internal stress evolution of the anchored combined arch load-bearing structure in roadways with loose and fractured surrounding rock. The load-bearing capacity and failure characteristics of the anchored combined arch under different roof support schemes are explored and analyzed. An optimized support scheme for the loose and fractured roof is proposed and applied in the field, and the monitoring results verify its effectiveness. The results indicate that bolt density is a key factor affecting the load-bearing performance of the combined arch. As bolt spacing decreases, the vertical stress concentration in the anchored structure increases, and its deformation resistance is enhanced. During the stage from load-bearing to failure of the combined arch, the changes in vertical and horizontal stresses within the arch become more stable, and the load-bearing capacity is significantly improved. Comparison between the model test results and theoretical calculations shows good agreement, verifying the rationality of the theoretical calculations. Pressure sensors were pre-installed in the laboratory model to monitor the vertical stress changes in the anchored structure throughout the loading process, and numerical simulations confirmed the stress concentration effect of the combined arch. It was also found that the instability of the anchored structure is controlled by the shear plane at the arch feet. Finally, the bolt spacing in the 11308 return airway of the Inner Mongolia mine was optimized to 0.7 m, and field monitoring was introduced. The maximum roof surface settlement displacement was 15 mm, and the maximum roof separation was 3 mm, confirming that these parameters can meet the roadway stability requirements. Full article

This study presents the development and numerical investigation of a full-section fog curtain dust suppression system installed in the return airway of a fully mechanized longwall mining face, designed to mitigate airborne dust emissions escaping from the return airway during coal extraction. To optimize nozzle selection, comparative experiments were conducted under varying water pressure conditions. A porous medium model was employed to represent the dust capture mesh, enabling a systematic analysis of the pressure drop and airflow resistance characteristics across a range of wind velocities; the model parameters—viscous resistance coefficient (D) and inertial resistance coefficient (C₂)—were calibrated accordingly. Subsequently, coupled computational fluid dynamics simulations of fog dispersion and airflow fields were performed using a validated full-scale geometric model of the fully mechanized mining face. The influence of mesh pore size—via its effect on droplet size distribution uniformity—on the spatial distribution and velocity profile of the airflow field was quantitatively evaluated. The results show that the optimal spray nozzle was the fan-shaped atomizing spray nozzle, with a selected water pressure of 0.6 MPa. The droplet concentration in the porous media section increased from 0.026 kg∙m⁻³ to 0.052 kg∙m⁻³, and the volume share increased from 51.5% to 74.5%. The concentration of the filtered droplet increased from 0.00067 kg∙m⁻³ to 0.0013 kg∙m⁻³, and the size of particles adsorbed by the porous media increased from 140 μm in the proportion of most particles to 0.0013 kg∙m⁻³. The proportion of most particles above 140 μm was reduced to a range of 0–80 μm, and the optimal pore size was selected to be 100 mesh. Dust measurements were conducted at different measuring points in the return airway of the 25212 comprehensive mining face in the Hongliulin North plate area. The overall dust removal rates at points A, B, and C reached 88.90%, 83.71%, and 84.85%, and the respiratory dust removal rates reached 81.24%, 79.39%, and 80.33%, respectively, indicating that dust removal is effective. Full article

Cigarette smoke (CS) is the primary risk factor for the development of chronic obstructive pulmonary disease (COPD). Investigating the impact of CS on human airway epithelium is important for understanding COPD development and combating its effects. While some studies show that long exposure to CS activates inflammasome formation in airway epithelium, leading to cytokines’ maturation and release, its acute effect on inflammation regulation requires further elucidation. Due to the importance of acute cellular responses in modulating cell survival and controlling inflammatory outcomes, we examined the effect of acute cigarette smoke extract exposure on human bronchial epithelial cells. Due to the high reactive oxygen species content in CS, we hypothesize that acute CS exposure activates the integrated stress response (ISR) pathway leading to stress granules (SG) formation to facilitate oxidative stress resolution and promote cell survival. Immunostaining, fluorescence confocal imaging, quantitative analyses, and immunoblotting were performed to test our hypothesis. We report here that acute exposure to CS extract triggers canonical SG formation by activating the ISR pathway via the PERK/eIF2α arm in a reactive oxygen species-dependent manner. SG formation is abolished upon inhibiting PERK or eIF2α function, or by scavenging oxidants prior to smoke exposure. Characterizing SG formation in terms of measuring SG size and abundance and the sequestration of the SG marker G3BP1 reveals that SG formation is maximal at 15% CS extract exposure for 2 h and undergoes gradual disassembly at longer exposure times. This is closely dependent on cytoplasmic p-eIF2α levels. These results demonstrate that acute exposure to CS activates the protective ISR pathway to potentially reduce the detrimental effects of CS and promote stress resolution and cell survival. Full article

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is increasingly recognized as a contributor to cognitive decline and a potential risk factor for neurodegeneration. Previous studies have also identified various associated comorbidities such as vascular dysfunction, metabolic alterations, and neuroinflammatory changes. Positive airway pressure (PAP) therapy has been associated with cognitive improvement in some studies, but its long-term effects on cognitive function remain uncertain. This study employs a prospective, observational, longitudinal cohort design to examine longitudinal associations between disease severity, PAP therapy and cognition. Additionally, we aim to examine the relationships between cognitive dysfunction, brain structure and associated OSA-related risk factors. A total of 100 eligible participants with mild to severe OSA will be recruited. All participants will undergo comprehensive assessments at baseline and after 12 months, including neurological, pulmonary, and ear, nose and throat clinical examinations, polysomnography, neuropsychological testing, brain magnetic resonance imaging with volumetry, anthropometric measurements, blood and saliva sampling for the assessment of the selected laboratory parameters, gut microbiome analysis, and evaluation of endothelial function and baroreflex sensitivity. This study may improve understanding of how PAP therapy and OSA-related pathophysiological processes influence cognitive outcomes. Full article

Lung cancer remains the leading cause of cancer mortality worldwide, with most cases diagnosed at advanced stages. Conventional tissue biopsy is invasive, and low-dose CT (LDCT) screening—although effective—faces practical and logistical limitations. Liquid biopsy has emerged as a minimally invasive approach to capture tumor-derived material, including circulating tumor DNA (ctDNA), cells, and extracellular vesicles (EVs). Among EVs, exosomes and their microRNA (miRNA) cargo offer a stable, disease-specific signal. Airway-proximal fluids such as bronchial aspirate and bronchoalveolar lavage fluid (BALF) are in direct contact with the tumor microenvironment and may contain higher concentrations of tumor-derived exosomal miRNAs compared with blood. This review synthesizes the limited but promising evidence for exosomal miRNAs in bronchial aspirate and BALF as diagnostic and prognostic biomarkers in lung cancer, examines methodological and standardization challenges, and discusses potential integration into clinical workflows, with particular emphasis on Romania’s lung cancer epidemiology and healthcare context. While only two primary studies in the last five years have explored BALF exosomal miRNAs, these data justify further multicenter investigations aligned with MISEV2023 guidelines. Integrating airway-proximal exosomal miRNA analysis into bronchoscopy procedures could enhance diagnostic precision in resource-limited health systems and support the transition towards personalized thoracic oncology. Full article

Background/Objectives: Optimal specimen collection is essential for accurate diagnostic tests for upper airway infections. Rapid antigen diagnostic tests (RDTs) are commonly used for SARS-CoV-2 testing, yet the optimal sampling depth remains unclear. This study aimed to compare the diagnostic sensitivity and patient discomfort associated with two nasal swab depths: 2 cm (anterior nasal) and 4 cm (proposed mid-turbinate). Methods: In this randomized, paired clinical trial conducted at a public COVID-19 test center in Copenhagen, Denmark, 309 adults presenting for SARS-CoV-2 RT-PCR testing were enrolled. Each participant underwent bilateral nasal sampling using RDTs: one nostril with a 2 cm swab and the other with a 4 cm swab, randomized by side. RT-PCR from oropharyngeal swabs served as the reference standard. Discomfort was rated using a 10-point visual analog scale (VAS). Results: Among the 309 participants, 57 (18.4%) tested positive for SARS-CoV-2 by RT-PCR. RDT sensitivity was 62.1% (95% CI: 48.4–74.5%) for 2 cm swabs and 70.2% (95% CI: 56.6–81.6%) for 4 cm swabs, a non-significant difference (p = 0.34). Among symptomatic individuals, sensitivity increased to 74.4% (2 cm) and 86.0% (4 cm), though the difference also remained non-significant (p = 0.17). Discomfort scores were significantly higher for the 4 cm swab (mean VAS: 5.2) compared to 2 cm (mean VAS: 3.8; p < 0.001). Conclusions: While not statistically significant, deeper mid-turbinate swabbing (4 cm) showed higher diagnostic sensitivity than anterior nasal swabbing (2 cm), especially in symptomatic individuals. However, this came at the cost of increased discomfort. These findings highlight the importance of balancing diagnostic performance and patient tolerability in pandemic testing strategies. The study contributes valuable evidence to inform future guideline development, particularly regarding swab technique, test accuracy, and feasibility in clinical and public health settings. Full article