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Chest Mar 2019Tracheobronchial injury is a rare but a potentially high-impact event with significant morbidity and mortality. Common etiologies include blunt or penetrating trauma and... (Review)
Review
Tracheobronchial injury is a rare but a potentially high-impact event with significant morbidity and mortality. Common etiologies include blunt or penetrating trauma and iatrogenic injury that might occur during surgery, endotracheal intubation, or bronchoscopy. Early recognition of clinical signs and symptoms can help risk-stratify patients and guide management. In recent years, there has been a paradigm shift in the management of tracheal injury towards minimally invasive modalities, such as endobronchial stent placement. Although there are still some definitive indications for surgery, selected patients who meet traditional surgical criteria as well as those patients who were deemed to be poor surgical candidates can now be managed successfully using minimally invasive techniques. This paradigm shift from surgical to nonsurgical management is promising and should be considered prior to making final management decisions.
Topics: Bronchi; Conservative Treatment; Humans; Minimally Invasive Surgical Procedures; Patient Selection; Stents; Trachea; Wounds and Injuries
PubMed: 30059680
DOI: 10.1016/j.chest.2018.07.018 -
Annals of Thoracic and Cardiovascular... Apr 2017This article is a continuation of previous reviews about the appropriate method for long-segment tracheal reconstruction. We attempted to cover the most recent,... (Review)
Review
This article is a continuation of previous reviews about the appropriate method for long-segment tracheal reconstruction. We attempted to cover the most recent, successful and promising results of the different solutions for reconstruction that are rather innovative and suitable for imminent clinical application. Latest efforts to minimize the limitations associated with each method have been covered as well. In summary, autologous and allogenic tissue reconstruction of the trachea have been successful methods for reconstruction experimentally and clinically. Autologous tissues were best utilized clinically to enhance revascularization, whether as a definitive airway or as an adjunct to allografts or tissue-engineered trachea (TET). Allogenic tissue transplantation is, currently, the most suitable for clinical application, especially after elimination of the need for immunosuppressive therapy with unlimited supply of tissues. Similar results have been reported in many studies that used TET. However, clinical application of this method was limited to use as a salvage treatment in a few studies with promising results. These results still need to be solidified by further clinical and long-term follow-up reports. Combining different methods of reconstruction was often required to establish a physiological rather than an anatomical trachea and have shown superior outcomes.
Topics: Allografts; Humans; Plastic Surgery Procedures; Regeneration; Stem Cell Transplantation; Surgical Flaps; Tissue Engineering; Tissue Scaffolds; Trachea; Treatment Outcome
PubMed: 28228614
DOI: 10.5761/atcs.ra.16-00251 -
The Journal of Thoracic and... Jan 2022
Topics: Humans; Lung; Respiration; Trachea
PubMed: 33422315
DOI: 10.1016/j.jtcvs.2020.11.127 -
Thorax May 1968Two cases of the rare condition of tracheobronchomegaly are reported. They occurred in people of completely different racial origin and residence. They showed the...
Two cases of the rare condition of tracheobronchomegaly are reported. They occurred in people of completely different racial origin and residence. They showed the characteristic features of this condition—loud, rasping, prolonged, remarkably ineffective cough, abnormally wide trachea and major bronchi, laxity of the cartilaginous rings and membranous part of these airways demonstrable on straight chest radiographs and bronchoscopy and confirmed at bronchography. Evidence is submitted of congenital aetiology.
Topics: Adult; Anthropometry; Bronchi; Bronchography; Bronchoscopy; Humans; Male; Trachea
PubMed: 5656767
DOI: 10.1136/thx.23.3.320 -
In Vivo (Athens, Greece) 2022Animals differ in the biochemical composition, attachments, and mechanical properties of tracheal cartilage. This study examined the biomechanical properties and...
BACKGROUND/AIM
Animals differ in the biochemical composition, attachments, and mechanical properties of tracheal cartilage. This study examined the biomechanical properties and morphological structure of the trachea of pigs, and rabbits as preclinical models.
MATERIALS AND METHODS
The trachea in pigs and rabbits can be divided into four regions, cranial cervical, middle cervical, thoracic inlet, and intra-thoracic parts.
RESULTS
The total number of tracheal rings in pigs and rabbits was 32-35 and 34-38 rings, respectively. The pig bronchus first branches from the trachea, reaching the cranial lobe of the lungs before branching to the main bronchus, while the rabbit bronchus branched after the main bronchus. A comparison of the posterior region of the crosssectional trachea shows that the rabbit has a C-shape with cartilage connected to the tracheal muscle, and the pig has the tracheal muscle covered with cartilage. The trachea of pigs and rabbits decreased in tracheal thickness and size from the thoracic inlet toward the lungs. The stress-strain in the longitudinal and transverse tensile test was higher in rabbits than in pigs. The tensile stress of the four regions was significantly different in the transverse tensile test (p<0.001). In the bending test, more force was required to bend pig than rabbit tracheas. Microscopic and scanning electron microscopy showed no structural differences in tracheal cartilage between the two species.
CONCLUSION
These results suggest that there is great variation in morphology and physical properties of the trachea in pigs and rabbits. We found porcine tracheas have similar biomechanical properties to those of humans.
Topics: Animals; Cartilage; Rabbits; Swine; Trachea
PubMed: 35738586
DOI: 10.21873/invivo.12884 -
American Journal of Transplantation :... Oct 2021Tracheal transplantation has been envisioned as a viable option for reconstruction of long-segment tracheal defects. We report the first human single-stage long-segment...
Tracheal transplantation has been envisioned as a viable option for reconstruction of long-segment tracheal defects. We report the first human single-stage long-segment tracheal transplantation. Narrow-band imaging and bronchoscopic biopsies demonstrate allograft vascularization and viable epithelial lining. The recipient was immunosuppressed with Tacrolimus, Mycophenolate mofetil, and corticosteroids. Six months after transplantation, the trachea is both functional and the patient is breathing without the need of a tracheostomy or stent.
Topics: Humans; Mycophenolic Acid; Plastic Surgery Procedures; Trachea; Transplantation, Heterotopic; Transplantation, Homologous
PubMed: 34236746
DOI: 10.1111/ajt.16752 -
Proceedings of the National Academy of... Oct 2018In its most basic conception, a novelty is simply something new. However, when many previously proposed evolutionary novelties have been illuminated by genetic,... (Review)
Review
In its most basic conception, a novelty is simply something new. However, when many previously proposed evolutionary novelties have been illuminated by genetic, developmental, and fossil data, they have refined and narrowed our concept of biological "newness." For example, they show that these novelties can occur at one or multiple levels of biological organization. Here, we review the identity of structures in the avian vocal organ, the syrinx, and bring together developmental data on airway patterning, structural data from across tetrapods, and mathematical modeling to assess what is novel. In contrast with laryngeal cartilages that support vocal folds in other vertebrates, we find no evidence that individual cartilage rings anchoring vocal folds in the syrinx have homology with any specific elements in outgroups. Further, unlike all other vertebrate vocal organs, the syrinx is not derived from a known valve precursor, and its origin involves a transition from an evolutionary "spandrel" in the respiratory tract, the site where the trachea meets the bronchi, to a target for novel selective regimes. We find that the syrinx falls into an unusual category of novel structures: those having significant functional overlap with the structures they replace. The syrinx, along with other evolutionary novelties in sensory and signaling modalities, may more commonly involve structural changes that contribute to or modify an existing function rather than those that enable new functions.
Topics: Animals; Biological Evolution; Birds; Fossils; Larynx; Phylogeny; Respiratory System; Trachea; Vocal Cords; Vocalization, Animal
PubMed: 30249637
DOI: 10.1073/pnas.1804586115 -
The Journal of Thoracic and... Jul 2014
Topics: Humans; Prostheses and Implants; Tissue Engineering; Trachea
PubMed: 24939025
DOI: 10.1016/j.jtcvs.2014.03.024 -
Anesthesiology Oct 2018
Topics: Adolescent; Bronchoscopy; Humans; Male; Mucopolysaccharidosis IV; Trachea
PubMed: 29771708
DOI: 10.1097/ALN.0000000000002268 -
The Journal of Surgical Research Jul 2021Extracellular matrix (ECM) bioscaffolds produced by decellularization of source tissue have been effectively used for numerous clinical applications. However,... (Comparative Study)
Comparative Study
BACKGROUND
Extracellular matrix (ECM) bioscaffolds produced by decellularization of source tissue have been effectively used for numerous clinical applications. However, decellularized tracheal constructs have been unsuccessful due to the immediate requirement of a functional airway epithelium on surgical implantation. ECM can be solubilized to form hydrogels that have been shown to support growth of many different cell types. The purpose of the present study is to compare the ability of airway epithelial cells to attach, form a confluent monolayer, and differentiate on homologous (trachea) and heterologous (urinary bladder) ECM substrates for potential application in full tracheal replacement.
MATERIALS AND METHODS
Porcine tracheas and urinary bladders were decellularized. Human bronchial epithelial cells (HBECs) were cultured under differentiation conditions on acellular tracheal ECM and urinary bladder matrix (UBM) bioscaffolds and hydrogels and were assessed by histology and immunolabeling for markers of ciliation, goblet cell formation, and basement membrane deposition.
RESULTS
Both trachea and urinary bladder tissues were successfully decellularized. HBEC formed a confluent layer on both trachea and UBM scaffolds and on hydrogels created from these bioscaffolds. Cells grown on tracheal and UBM hydrogels, but not on bioscaffolds, showed positive-acetylated tubulin staining and the presence of mucus-producing goblet cells. Collagen IV immunolabeling showed basement membrane deposition by these cells on the surface of the hydrogels.
CONCLUSIONS
ECM hydrogels supported growth and differentiation of HBEC better than decellularized ECM bioscaffolds and show potential utility as substrates for promotion of a mature respiratory epithelium for regenerative medicine applications in the trachea.
Topics: Adult; Animals; Bronchi; Cell Culture Techniques; Cell Differentiation; Cell Proliferation; Epithelial Cells; Extracellular Matrix; Female; Humans; Hydrogels; Male; Pilot Projects; Primary Cell Culture; Swine; Tissue Engineering; Tissue Scaffolds; Trachea; Transplantation, Heterologous; Transplantation, Homologous; Urinary Bladder; Young Adult
PubMed: 33691244
DOI: 10.1016/j.jss.2021.01.040