BACKGROUND Boerhaave syndrome,or spontaneous esophageal rupture,is a rare and lifethreatening emergency,typically caused by a sudden increase in esophageal pressure due to violent coughing or vomiting.Early diagnosis ...BACKGROUND Boerhaave syndrome,or spontaneous esophageal rupture,is a rare and lifethreatening emergency,typically caused by a sudden increase in esophageal pressure due to violent coughing or vomiting.Early diagnosis is challenging as its symptoms often resemble those of other diseases.Understanding its pathological features and treatment strategies is therefore critical for clinical practice.CASE SUMMARY This report describes a case of spontaneous esophageal rupture triggered by violent coughing in a 55-year-old male with a history of smoking and hypertension.Following severe coughing,the patient developed chest pain,vomiting,and respiratory distress.Initial clinical evaluation was inconclusive,with a suspected diagnosis of cardiovascular or gastrointestinal conditions.After further examination,the diagnosis of spontaneous esophageal rupture was confirmed.Chest X-ray,computed tomography,and endoscopy revealed a rupture in the lower esophagus,along with mediastinal abscess and pleural effusion.Laboratory tests showed mild infection markers.The patient underwent surgical repair of the esophageal rupture(approximately 3 cm in length)with mediastinal drainage.Postoperatively,the patient’s temperature normalized within 3 days,respiratory function improved,and pleural effusion significantly decreased.After two weeks of treatment,the patient was discharged without complications and had a favorable prognosis.The study suggests that while violent coughing is a rare trigger,it can lead to severe damage,and imaging techniques play a crucial role in diagnosis.CONCLUSION Spontaneous esophageal rupture presents significant diagnostic and therapeutic challenges.Early recognition and timely intervention are crucial for improving prognosis.This case highlights the importance of imaging and surgical treatment,offering new insights for managing similar cases and providing valuable clinical guidance.展开更多
Objective:To investigate the suppressive effect of dexmedetomidine on the cough reflex during tracheal extubation in pediatric patients undergoing general anesthesia and its impact on vital signs.Methods:A total of 60...Objective:To investigate the suppressive effect of dexmedetomidine on the cough reflex during tracheal extubation in pediatric patients undergoing general anesthesia and its impact on vital signs.Methods:A total of 60 pediatric patients undergoing elective surgery admitted to our hospital from January to August 2025 were selected and randomly divided into an observation group and a control group,with 30 cases in each group,using a random number table method.The control group received an intravenous infusion of 0.9% sodium chloride injection 30 minutes before the end of surgery,while the observation group received an intravenous pump infusion of dexmedetomidine(1μg/kg,diluted to 4μg/ml with normal saline).The severity of cough(graded from 0 to 3)and vital signs,including heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),and pulse oxygen saturation(SpO₂),were recorded 5 minutes before extubation,at the time of extubation,and 5 minutes after extubation in both groups.Results:The severity of cough in the observation group was significantly milder than that in the control group(P<0.05),with a significantly higher proportion of grade 0 cough in the observation group(23.33%vs 3.33%).At extubation and five minutes post-extubation,the observation group exhibited significantly lower HR,SBP,and DBP than the control group(P<0.05).In contrast,SpO_(2)levels remained comparable between the groups(P>0.05).Conclusion:Dexmedetomidine can effectively suppress the cough reflex during tracheal extubation in pediatric patients undergoing general anesthesia,reduce the severity of cough,stabilize hemodynamic parameters,and has no significant impact on respiratory function,demonstrating good clinical safety.展开更多
Objective:To investigate the predictive value of diaphragm thickening fraction(DTF)combined with cough peak expiratory flow(CPEF)on the success rate of weaning from mechanical ventilation.Methods:The clinical data of ...Objective:To investigate the predictive value of diaphragm thickening fraction(DTF)combined with cough peak expiratory flow(CPEF)on the success rate of weaning from mechanical ventilation.Methods:The clinical data of patients undergoing invasive mechanical ventilation via oral endotracheal intubation in the ICU of our hospital from January 2022 to December 2023 were studied.All patients underwent a 30-minute spontaneous breathing trial(SBT)using low-level pressure support ventilation(PSV)after meeting the clinical weaning screening criteria.Among them,150 patients who met the clinical weaning criteria were weaned from the ventilator.They were divided into a successful weaning group(n=100)and a failed weaning group(n=50)based on the weaning outcome.Clinical data,including age,gender,APACHE II score,duration of mechanical ventilation,DTF,and CPEF,were collected from 150 patients.The differences in clinical data between the two groups were compared,and the correlation between DTF,CPEF,and the success rate of weaning was analyzed.Results:There were no significant differences between the two groups in gender ratio(χ^(2)=0.884,P=0.347>0.05),age(t=0.350,P=0.727>0.05),and APACHE II score(t=1.295,P=0.197>0.05),but there was a significant difference in the duration of mechanical ventilation(t=3.766,P<0.001).The DTF and CPEF values in the successful weaning group were significantly higher than those in the failed weaning group(P<0.05).ROC curves were drawn to predict the weaning results using DTF,CPEF,and the combination of DTF and CPEF.The results showed that the specificity of the combination of DTF and CPEF was comparable to that of either metric alone,but the sensitivity and AUC were significantly higher than those of either metric alone.Conclusion:The combination of DTF and CPEF can be used as an effective indicator to evaluate the weaning efficacy of mechanically ventilated patients,which has important clinical significance for guiding clinical weaning treatment,improving the success rate of weaning,reducing the incidence of ventilator-associated pneumonia,and shortening the length of hospital stay.展开更多
Objective To observe the clinical efficacy of Wentong needling method in the treatment of long-term cough cases after common cold. Methods Wentong needling method was used in the treatment of 30 cases with long-term c...Objective To observe the clinical efficacy of Wentong needling method in the treatment of long-term cough cases after common cold. Methods Wentong needling method was used in the treatment of 30 cases with long-term cough after common cold. Acupoints including Quchi （曲池 LI 11, left side）, Hegu （合谷, LI 4, left side）, Lieque （列缺, LU 7, right side）, Fenglong （丰隆＇, ST 40, right side）, Chize （尺泽, LU 5, right side）, Zusanli （足三里, ST 36, right side）, Zhaohai （照海, KI 6, left side）, Taichong （太冲h, LR 3, both sides）, and Waiqiu （外丘, GB 36, left side） were selected. The treatment was given every other day. After one treatment course, the relation between the long-term cough cases after common cold and Wentong needling method clinical efficacy was observed from aspects of different ages, disease duration and disease degree. Results There were 18 cured cases （60.0%）, 8 markedly effective cases （26.7%）, 4 effective cases （13.33%）, and 0 invalid case （0.0%）. The total effective rate was 200%. The treatment efficacy of cough patients after common cold of less than 24 months was better than that of more than 24 months. Along with the increasing of age, the cured and markedly effective rate was of certain downward tendency. Along with the increasing of treatment times, the cured and markedly effective rate increased. Conclusion The clinical efficacy of Wentong needling method is obvious in the treatment of long-term cough cases after common cold.展开更多
OBJECTIVE:To investigate the efficacy of Chaihu Ji Sang Decoction(CJSD),(a modification of Xiao Chaihu Tang(Minor Decoction of Bupleurum) was evaluated in patients with post-infection cough(PIC).Its effect on cough re...OBJECTIVE:To investigate the efficacy of Chaihu Ji Sang Decoction(CJSD),(a modification of Xiao Chaihu Tang(Minor Decoction of Bupleurum) was evaluated in patients with post-infection cough(PIC).Its effect on cough reflex sensitivity(CRS) was also described.METHODS:One hundred and eighteen patients with PIC were enrolled and randomly divided into an experimental group and control group(54 patients in each group).The experimental group was given CJSD orally,and the control group was given cetirizine hydrochloride for 7 d.Cough symptom scores and TCM symptom scores were compared before and after treatment.Efficacy,cough onset time,recurrence,and adverse drug reactions were additionally evaluated.Finally,CRS was evaluated before and after treatment of PIC patients in the experimental group.RESULTS:Fifty-two patients in the experimental group and fifty control patients completed the study.Cough symptom scores and the TCM symptom scores of the two groups were significantly improved after treatment,however cough symptoms in the experimental group 1(0,2) were significantly lower than the control group 2(1,2) after treatment(P < 0.05).Similarly,TCM symptom scores 4(0,7) in the experimental group were significantly lower than the control group 6(3,12)(P < 0.01).Overall,the effective rate of the experimental treatment(84.60%) was significantly higher than that of the control treatment(68.00%)(P < 0.01).The onset time of efficacy of the experimental treatment was one day faster than the control treatment [2(2,3) d vs 3(2,3) d,P < 0.01].The relapse rate in the experimental group(9.09%) was lower than that of the control group(29.41%)(P < 0.05).39 PIC patients in the experimental group completed a capsaicin cough challenge test before treatment.The lgC2 and lg C5 of the experimental group prior to treatment was 1.19(0.59,1.49) and 1.80(1.49,2.10),respectively.The lgC2,lg C5 of the healthy control group was 1.49(0.89,2.40) and 2.70(2.40,3.00),respectively.The differences in lgC2 and lg C5 between experimental group and healthy groups were significant at this time point(both P < 0.01).After treatment,34 patients in the experimental group received re-examination.lg C5 increased from 1.80(1.49,2.10) to 2.10(1.49,3.00).CRS after treatment/re-examination was significantly lower than those of baseline in the experimental group(P < 0.05).CONCLUSION:CJSD could effectively improve the clinical symptoms of PIC patients,with demonstrable low recurrence and safety.CJSD also significantly decreased the CRS in patients with PIC.展开更多
Objective:This study mainly explores the clinical effect of dispelling wind,eliminating lung and relieving cough combined with western medicine in the treatment of cough variant asthma.Methods:80 children with cough v...Objective:This study mainly explores the clinical effect of dispelling wind,eliminating lung and relieving cough combined with western medicine in the treatment of cough variant asthma.Methods:80 children with cough variant asthma accepted by our hospital from January 2018 to December 2020 were randomly selected for the study and divided into two groups.One group was the reference group(40 cases)treated with procaterol hydrochloride tablets and montelukast sodium,and the other group was the research group(40 cases)・The method of eliminating wind,eliminating lung and relieving cough was combined with procaterol hydrochloride tablets and montelukast sodium to observe and compare the curative effects of the two groups.Results:There was no significant difference in TCM symptom score and eosinophil(EOS)count between the two groups before treatment(P>0.05);After treatment,the TCM symptom scores of coughs,pharyngeal itching,expectoration,nasal congestion and nasal itching in the research group were lower than those in the reference group,and the EOS count was lower than that in the reference group(P<0.05);The effective rate of research group was higher than that of reference group(P<0.05).Conclusions:For children with cough variant asthma,Qufeng Sufei cough relieving method combined with procaterol hydrochloride and montelukast sodium can improve children's symptoms and reduce eosinophil count.展开更多
目的介绍一种有助于诊断急性阑尾炎的新体征。方法回顾性分析110例经病理证实的急性阑尾炎病人的“咳嗽征”、“呼吸疼痛征”以及“结肠充气试验”的阳性率,采用2χ检验统计比较。结果“Cough S ign”获得了96.4%的较高的阳性率,阳性率...目的介绍一种有助于诊断急性阑尾炎的新体征。方法回顾性分析110例经病理证实的急性阑尾炎病人的“咳嗽征”、“呼吸疼痛征”以及“结肠充气试验”的阳性率,采用2χ检验统计比较。结果“Cough S ign”获得了96.4%的较高的阳性率,阳性率与其它两种试验比较有显著性差异(P<0.05)。结论该方法诊断急性阑尾炎简单、实用,有较高的阳性诊断率,有助于诊断急性阑尾炎。展开更多
Cough variant is a common disease of the respiratory system and can lead to a unique type of asthma.The disease has no obvious symptoms such as wheezing nor shortness of breath.Coughing is the main clinical symptom,as...Cough variant is a common disease of the respiratory system and can lead to a unique type of asthma.The disease has no obvious symptoms such as wheezing nor shortness of breath.Coughing is the main clinical symptom,as it causes airway hyper-responsiveness.Traditional Chinese medicine(TCM)has a unique understanding of this disease,and the effect is obvious after treatment,as it's based on symptom differentiation.This article takes the concept of“mild fluid retention”from“The Synopsis of the Golden Chamber”as an entry point,briefly describes the relationship between cough variant and mild fluid retention,as well as the diagnosis and treatment of Chinese medicine.展开更多
Director Zhang Hongxing is a famous traditional Chinese medicine(TCM)doctor in Shandong province and a teacher in the Famous TCM Expert Studio in Dezhou city.He has rich clinical experience and considerable experience...Director Zhang Hongxing is a famous traditional Chinese medicine(TCM)doctor in Shandong province and a teacher in the Famous TCM Expert Studio in Dezhou city.He has rich clinical experience and considerable experience in the treatment of common clinical chronic coughs.Director Zhang Hongxing believes that chronic cough belongs to the category of"wind cough"and"long-term cough"according to TCM.TCM diagnosis should start from the four aspects of "wind evil residing in lung","liver"?"spleen and stomach",and"yang deficiency".Starting from viewing the human body as an organic whole,distinguish between deficiency or excess in cold and heat,and clinical treatment for cough should focus on dispelling"wind",regulating the functions of liver,spleen,and stomach,and supplementing the body's yang.Formulate treatment based on different categorization,and modify prescription according to the symptoms,and the treatment effects are remarkable.展开更多
AIM:To evaluate the efficacy and safety of baclofen for treatment of refractory gastroesophageal reflux-induced chronic cough (GERC) unresponsive to standard anti-reflux therapy. METHODS:Sixteen patients with refracto...AIM:To evaluate the efficacy and safety of baclofen for treatment of refractory gastroesophageal reflux-induced chronic cough (GERC) unresponsive to standard anti-reflux therapy. METHODS:Sixteen patients with refractory GERC were given an 8-wk course of baclofen 20 mg three times a day as an add-on therapy to omeprazole. Changes in the cough symptom score, cough threshold to capsaicin, reflux symptom score and possible adverse effects were determined after treatment. The variables of multi-channel intraluminal impedance combined with pH monitoring were compared between responders and non-responders to baclofen. RESULTS:Twelve of 16 patients completed treatment. Cough disappeared or improved in 56.3% (9/16)of patients, including 6 patients with acid refluxinduced cough (66.7%) and 3 patients with non-acid reflux-induced cough (33.3%). With baclofen treatment, the cough symptom score began to decrease at week 2, was clearly decreased at week 6 and reached a minimum at week 8. At the end of therapy, the lowest concentration of capsaicin required for induction of ≥ 2 and ≥ 5 coughs increased from 0.98 (1.46) to 1.95 (6.82) μmol/L (Z = -2.281, P = 0.024) and from 1.95 (7.31) to 7.8 (13.65) μmol/L (Z = -2.433, P = 0.014), respectively, and the reflux symptom score decreased from 8.0 ± 1.6 to 6.8 ± 0.8 (t = 2.454, P = 0.023). The number of acid reflux episodes was significantly lower in responders than in non-responders. The main adverse effects were somnolence, dizziness and fatigue. CONCLUSION:Baclofen is a useful, but suboptimal treatment option for refractory GERC.展开更多
AIM： To compare two different daily doses of lansoprazole given for 12 weeks and to assess the role of gastrointestinal （GI） investigations as criteria for selecting patients. METHODS： Out of 45 patients referred ...AIM： To compare two different daily doses of lansoprazole given for 12 weeks and to assess the role of gastrointestinal （GI） investigations as criteria for selecting patients. METHODS： Out of 45 patients referred for unexplained chronic persistent cough, 36 had at least one of the GI investigations （endoscopy, 24-h esophageal pH- metry and a 4-week trial of proton pump inhibitor （PPI） therapy） positive and were randomly assigned to receive either 30 mg lansoprazole o.d. or 30 mg lansoprazole b.i.d, for 12 weeks. Symptoms were evaluated at baseline （visit 1） after the PPI test （visit 2） and after the 12-week lansoprazole treatment period （visit 3）. RESULTS： Thirty-five patients completed the study protocol. Twenty-one patients （60.0%） reported complete relief from their cough with no difference between the two treatment groups （58.8% and 61.1% had no cough in 30 mg lansoprazole and 60 mg lansoprazole groups, respectively）. More than 80% of the patients who had complete relief from their cough at the end of the treatment showed a positive response to the PPI test. CONCLUSION： Twelve weeks of lansoprazole treatment even at a standard daily dose, is effective in patients with chronic persistent cough. A positive response to an initial PPI test seems to be the best criterion for selecting patients who respond to therapy.展开更多
OBJECTIVE:To evaluate the efficacy and safety of stimulating acupoints in subjects with childhood cough variant asthma(CVA).METHODS:A Meta-analysis of randomized controlled trials(RCTs) about the comparison between ac...OBJECTIVE:To evaluate the efficacy and safety of stimulating acupoints in subjects with childhood cough variant asthma(CVA).METHODS:A Meta-analysis of randomized controlled trials(RCTs) about the comparison between acupoint sticking therapy and non-acupoint sticking therapy for childhood CVA was conducted.The trials' quality and risk bias were assessed using the Cochrane Handbook tool.Odds ratio(OR) or risk ratio(RR) with 95% confidence intervals(CIs),mean differences(MDs) or standardized mean differences(SMDs) of a random-effects model were calculated.Heterogeneity was assessed by P value and I2 statistics.RESULTS:Thirteen studies were included in our review,indicating that the total effective rate of stimulating-acupoint group is better than that of control group [RR 1.19,95% CI(1.13-1.26),P < 0.00001].The recurrence rate in two years [RR 0.31,95%CI(0.19-0.51),P < 0.000 01] and cough duration[MD =-2.42,95% CI(-3.75,-1.09),P = 0.0004]of childhood CVA in stimulating-acupoint group were significantly lower than those in control group.Besides,stimulating acupoints can reduce the level of Ig E [SMD =-0.75,95% CI(-1.21,-0.30),P = 0.001] and EOS [SMD =-0.36,95% CI(-0.92,0.21),P = 0.22].CONCLUSION:Our findings suggest that stimulating acupoints had positive effects on childhood CVA and was relatively safe treatment.However,more RCTs with more useful indicators are warrant to confirm the current findings.展开更多
Objective： Fentanyl-induced cough （FIC） is a common complication with a reported incidence from 18.0% to 74.4% during general anesthesia induction. FIC increases the intrathoracic pressure and risks of postoper- at...Objective： Fentanyl-induced cough （FIC） is a common complication with a reported incidence from 18.0% to 74.4% during general anesthesia induction. FIC increases the intrathoracic pressure and risks of postoper- ative nausea and vomiting, yet available treatments are limited. This study was designed to investigate whether ad- ministering fentanyl via a slow intravenous fluid line can effectively alleviate FIC during induction of total intravenous general anesthesia. Methods： A total number of 1200 patients, aged 18-64 years, were enrolled, all of whom were American Society of Anesthesiologists （ASh,） grade I or II undergoing scheduled surgeries. All patients received total intravenous general anesthesia, which was induced sequentially by midazolam, fentanyl, propofol, and cisatracurium injection. Patients were randomly assigned to receive fentanyl 3.5 pg/kg via direct injection （control group） or via a slow intravenous fluid line. FIC incidence and the severity grades were analyzed with the Mann-Whitney test. Other adverse reactions, such as hypotension, hypertension, bradycardia, tachycardia, hypoxemia, vomiting, and aspiration, during induction were also observed. The online clinical registration number of this study was ChiCTR-IOR-16009025. Re- sults： Compared with the control group, the incidence of FIC was significantly lower in the slow intravenous fluid line group during induction （9.1%, 95% confidence interval （CI）： 6.7%-11.4% vs. 55.9%, 95% CI： 51.8%-60.0%, P=0.000）, as were the severity grades （P=0.000）. There were no statistical differences between the two groups with regard to other adverse reactions （P〉0.05）. Conclusions： The administration of fentanyl via a slow intravenous fluid line can alleviate FIC and its severity during induction for total intravenous general anesthesia. This method is simple, safe, and reliable, and deserves clinical expansion.展开更多
OBJECTIVE:To systematically investigate the clinical effectiveness and safety of traditional Chinese herbs(TCHs)as an alternative to conventional medicine(CM)in children with cough variant asthma(CVA).METHODS:Randomiz...OBJECTIVE:To systematically investigate the clinical effectiveness and safety of traditional Chinese herbs(TCHs)as an alternative to conventional medicine(CM)in children with cough variant asthma(CVA).METHODS:Randomized controlled trial(RCT)studies that were published from their inceptions to March 31,2020,were identified from the electronic databases of China National Knowledge Infrastructure,Wangfang,Pub Med,and Cochrane Central Library.The primary outcome of the review was the total effective rate(TER),and the secondary outcomes were immunoglobulin E(Ig E),peak expiratory flow(PEF),adverse drug reactions,and relapse rates of interventions.RESULTS:For the Meta-analysis,13 studies involving 992 children with CVA were included.In terms of TER and Ig E,the experimental interventions of TCH,when compared with the control interventions of CM,on pediatric CVA were found to be significantly effective(P<0.0001),whereas for spirometry,PEF was not significantly improved in the TCH group(P=0.48).The incident rates of adverse drug reaction and relapse were found to be significantly lower in the TCH group than those in the CM group(P=0.02 and P<0.0001,respectively).CONCLUSION:Compared with CM therapy,the effects of TCH therapy on pediatric CVA were significantly beneficial in terms of TER and Ig E,but not for PEF,and the methodological quality of included studies was poor.Therefore,the results should be interpreted with caution.More randomized controlled trials with rigorous experimental methodologies are required for objectivity in the future.展开更多
Refractory chronic cough due to gastroesophageal reflux is a trouble some condition unresponsive to thestandard medical anti-reflux therapy. Its underlying mechanisms may include incomplete acid suppression, non-acid ...Refractory chronic cough due to gastroesophageal reflux is a trouble some condition unresponsive to thestandard medical anti-reflux therapy. Its underlying mechanisms may include incomplete acid suppression, non-acid reflux, transient lower esophageal sphincter relaxations and esophageal hypersensitivity. The diagnosis of this disorder depends on both the findings of multi-channel intraluminal impedance-pH monitoring and the subsequent intensified anti-reflux therapy. The strategies of pharmacological treatment for refractory chronic cough due to reflux include the optimization of proton pump inhibitors and add-on therapies with histamine H2 receptor antagonists, baclofen and gabapentin. However, the further study is needed to satisfy its management.展开更多
AIM:To evaluate the association between genetic polymorphisms and angiotensin converting enzyme in-hibitor (ACEI)-related cough,and the race-or ethnicity-related difference in the prevalence of cough attributed to ACE...AIM:To evaluate the association between genetic polymorphisms and angiotensin converting enzyme in-hibitor (ACEI)-related cough,and the race-or ethnicity-related difference in the prevalence of cough attributed to ACEI therapy.METHODS:We conducted a search in PubMed,EM-BASE,Cinahl,and the Cochrane Database without language limitation.A database of 11 studies on ACEI-related cough,with detailed information regarding ACE I/D or bradykinin B 2 receptor polymorphisms,was created.Eligible studies were synthesized using meta-analysis methods,including cumulative meta-analysis.A subgroup analysis was also performed using ethnicity.RESULTS:Six studies were included on ACE I/D poly-morphism (398 Caucasians,723 East Asians),and three studies were included on bradykinin B 2 receptor poly-morphism (300 East Asians).The distribution of ACE genotypes showed significant differences in the entire population (P=0.004) and in East Asians (P=0.005)but not in Caucasians (P=0.23).Allelic frequencies of ACE showed significant differences in East Asians [odds ratio (OR)=1.49 (1.11-2.02)].The meta-analysis with a random effects model showed a significant associa-tion between ACE allele I/D and ACEI-related cough [random effects (RE) OR=1.49 (1.11-2.02),P=0.009] in East Asians,but not in Caucasians [RE OR=0.90 (0.60-1.35)].The allelic frequencies of the bradykinin B 2 receptor gene were significantly different [OR=2.25 (1.42-3.57)].The distributions of the T/C genotypes of the bradykinin B 2 receptor gene were significantly dif-ferent (χ 2=8.366,P=0.015).The meta-analyses re-vealed that there was a significant association between the bradykinin B 2 receptor allele and ACEI-related cough in East Asians [RE OR=2.29 (1.42-3.69),P=0.001].CONCLUSION:ACE I/D and Bradykinin B 2 receptor polymorphisms contributed to the risk of ACEI-related cough in East Asians,but a negative association be-tween ACE I/D polymorphism and ACEI-related cough was observed in Caucasians.展开更多
Breathing is an intrinsic natural behavior and physiological process that maintains life.The rhythmic exchange of gases regulates the delicate balance of chemical constituents within an organism throughout its lifespa...Breathing is an intrinsic natural behavior and physiological process that maintains life.The rhythmic exchange of gases regulates the delicate balance of chemical constituents within an organism throughout its lifespan.However,chronic airway diseases,including asthma and chronic obstructive pulmonary disease,affect millions of people worldwide.Pathological airway conditions can disrupt respiration,causing asphyxia,cardiac arrest,and potential death.The innervation of the respiratory tract and the action of the immune system confer robust airway surveillance and protection against environmental irritants and pathogens.However,aberrant activation of the immune system or sensitization of the nervous system can contribute to the development of autoimmune airway disorders.Transient receptor potential ion channels and voltage-gated Na+channels play critical roles in sensing noxious stimuli within the respiratory tract and interacting with the immune system to generate neurogenic inflammation and airway hypersensitivity.Although recent studies have revealed the involvement of nociceptor neurons in airway diseases,the further neural circuitry underlying airway protection remains elusive.Unraveling the mechanism underpinning neural circuit regulation in the airway may provide precise therapeutic strategies and valuable insights into the management of airway diseases.展开更多
BACKGROUND Cough variant asthma(CVA)is one of the most common respiratory diseases in children,which has a serious impact on the quality of life and daily activities of children.For severe CVA,immunomodulatory drugs a...BACKGROUND Cough variant asthma(CVA)is one of the most common respiratory diseases in children,which has a serious impact on the quality of life and daily activities of children.For severe CVA,immunomodulatory drugs are needed.AIM To evaluate the efficacy of salmeterol combined with budesonide in the treatment of pediatric CVA.METHODS 130 children with CVA from January 2020 to December 2022 were prospectively selected and randomly divided into an observation group(salmeterol combined with budesonide)and a control group(budesonide combined with a placebo).Compare the clinical efficacy of two groups before and after intervention.The evaluation parameters include cough frequency score,nocturnal cough arousal,and lung function indicators.Serum inflammatory markers,immune function markers and airway anatomical indicators were also measured.RESULTS After the intervention,the total effective rate of the observation group was significantly higher than that of the control group,and the cough frequency score and the night cough wake rate of the observation group were lower than that of the control group,with a statistically significant difference.In addition,the changes of lung function indicators,serum markers and immune function markers in the observation group were better than those in the control group.CONCLUSION The clinical efficacy of salmeterol combined with Budesonide in the treatment of CVA is better than that of Budesonide alone.展开更多
OBJECTIVE:To formulate the first clinical practice guideline for the treatment of cough using Chinese medicine based on the grading of recommendations assessment,development,and evaluation(GRADE)systematic approach,in...OBJECTIVE:To formulate the first clinical practice guideline for the treatment of cough using Chinese medicine based on the grading of recommendations assessment,development,and evaluation(GRADE)systematic approach,including clinical evidence,evaluation of ancient literature,and expert consensus.METHODS:In the process of development,the regulation of"evidence-based,consensus-assisted,and empirical"was followed,and a comprehensive systematic approach of recommendation assessment,GRADE,evidence-based evaluation,expert consensus,and the Delphi method was used.In the process of guideline development,evidence-based evaluation of ancient literature was included for the first time,and clinical evidence was fully integrated with clinical expert consensus.RESULTS:The clinical practice guidelines for the treatment of cough with Chinese herbal medicine were developed after a comprehensive consideration of evidence-based evaluation and expert opinions.The guideline recommendations focused on recommending herbal compound decoctions and Chinese patent medicines for cough in different conditions.Based on the GRADE systematic approach,we conducted an evidence-based evaluation of the recommended Chinese patent medicines one by one;meanwhile,the expert consensus method was used to unify the recommendations of both.CONCLUSION:Based on clinical evidence,ancient literature evaluation,and expert consensus,a clinical practice guideline for Traditional Chinese Medicine(TCM)in the treatment of cough was developed,providing the first current clinical practice guideline for domestic and foreign TCM and Western medicine practitioners,especially respiratory professionals at home and abroad.展开更多
基金Supported by Guangzhou Municipal Science and Technology Bureau,No.SL2024AD3JD0112.
文摘BACKGROUND Boerhaave syndrome,or spontaneous esophageal rupture,is a rare and lifethreatening emergency,typically caused by a sudden increase in esophageal pressure due to violent coughing or vomiting.Early diagnosis is challenging as its symptoms often resemble those of other diseases.Understanding its pathological features and treatment strategies is therefore critical for clinical practice.CASE SUMMARY This report describes a case of spontaneous esophageal rupture triggered by violent coughing in a 55-year-old male with a history of smoking and hypertension.Following severe coughing,the patient developed chest pain,vomiting,and respiratory distress.Initial clinical evaluation was inconclusive,with a suspected diagnosis of cardiovascular or gastrointestinal conditions.After further examination,the diagnosis of spontaneous esophageal rupture was confirmed.Chest X-ray,computed tomography,and endoscopy revealed a rupture in the lower esophagus,along with mediastinal abscess and pleural effusion.Laboratory tests showed mild infection markers.The patient underwent surgical repair of the esophageal rupture(approximately 3 cm in length)with mediastinal drainage.Postoperatively,the patient’s temperature normalized within 3 days,respiratory function improved,and pleural effusion significantly decreased.After two weeks of treatment,the patient was discharged without complications and had a favorable prognosis.The study suggests that while violent coughing is a rare trigger,it can lead to severe damage,and imaging techniques play a crucial role in diagnosis.CONCLUSION Spontaneous esophageal rupture presents significant diagnostic and therapeutic challenges.Early recognition and timely intervention are crucial for improving prognosis.This case highlights the importance of imaging and surgical treatment,offering new insights for managing similar cases and providing valuable clinical guidance.
文摘Objective:To investigate the suppressive effect of dexmedetomidine on the cough reflex during tracheal extubation in pediatric patients undergoing general anesthesia and its impact on vital signs.Methods:A total of 60 pediatric patients undergoing elective surgery admitted to our hospital from January to August 2025 were selected and randomly divided into an observation group and a control group,with 30 cases in each group,using a random number table method.The control group received an intravenous infusion of 0.9% sodium chloride injection 30 minutes before the end of surgery,while the observation group received an intravenous pump infusion of dexmedetomidine(1μg/kg,diluted to 4μg/ml with normal saline).The severity of cough(graded from 0 to 3)and vital signs,including heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),and pulse oxygen saturation(SpO₂),were recorded 5 minutes before extubation,at the time of extubation,and 5 minutes after extubation in both groups.Results:The severity of cough in the observation group was significantly milder than that in the control group(P<0.05),with a significantly higher proportion of grade 0 cough in the observation group(23.33%vs 3.33%).At extubation and five minutes post-extubation,the observation group exhibited significantly lower HR,SBP,and DBP than the control group(P<0.05).In contrast,SpO_(2)levels remained comparable between the groups(P>0.05).Conclusion:Dexmedetomidine can effectively suppress the cough reflex during tracheal extubation in pediatric patients undergoing general anesthesia,reduce the severity of cough,stabilize hemodynamic parameters,and has no significant impact on respiratory function,demonstrating good clinical safety.
文摘Objective:To investigate the predictive value of diaphragm thickening fraction(DTF)combined with cough peak expiratory flow(CPEF)on the success rate of weaning from mechanical ventilation.Methods:The clinical data of patients undergoing invasive mechanical ventilation via oral endotracheal intubation in the ICU of our hospital from January 2022 to December 2023 were studied.All patients underwent a 30-minute spontaneous breathing trial(SBT)using low-level pressure support ventilation(PSV)after meeting the clinical weaning screening criteria.Among them,150 patients who met the clinical weaning criteria were weaned from the ventilator.They were divided into a successful weaning group(n=100)and a failed weaning group(n=50)based on the weaning outcome.Clinical data,including age,gender,APACHE II score,duration of mechanical ventilation,DTF,and CPEF,were collected from 150 patients.The differences in clinical data between the two groups were compared,and the correlation between DTF,CPEF,and the success rate of weaning was analyzed.Results:There were no significant differences between the two groups in gender ratio(χ^(2)=0.884,P=0.347>0.05),age(t=0.350,P=0.727>0.05),and APACHE II score(t=1.295,P=0.197>0.05),but there was a significant difference in the duration of mechanical ventilation(t=3.766,P<0.001).The DTF and CPEF values in the successful weaning group were significantly higher than those in the failed weaning group(P<0.05).ROC curves were drawn to predict the weaning results using DTF,CPEF,and the combination of DTF and CPEF.The results showed that the specificity of the combination of DTF and CPEF was comparable to that of either metric alone,but the sensitivity and AUC were significantly higher than those of either metric alone.Conclusion:The combination of DTF and CPEF can be used as an effective indicator to evaluate the weaning efficacy of mechanically ventilated patients,which has important clinical significance for guiding clinical weaning treatment,improving the success rate of weaning,reducing the incidence of ventilator-associated pneumonia,and shortening the length of hospital stay.
文摘Objective To observe the clinical efficacy of Wentong needling method in the treatment of long-term cough cases after common cold. Methods Wentong needling method was used in the treatment of 30 cases with long-term cough after common cold. Acupoints including Quchi （曲池 LI 11, left side）, Hegu （合谷, LI 4, left side）, Lieque （列缺, LU 7, right side）, Fenglong （丰隆＇, ST 40, right side）, Chize （尺泽, LU 5, right side）, Zusanli （足三里, ST 36, right side）, Zhaohai （照海, KI 6, left side）, Taichong （太冲h, LR 3, both sides）, and Waiqiu （外丘, GB 36, left side） were selected. The treatment was given every other day. After one treatment course, the relation between the long-term cough cases after common cold and Wentong needling method clinical efficacy was observed from aspects of different ages, disease duration and disease degree. Results There were 18 cured cases （60.0%）, 8 markedly effective cases （26.7%）, 4 effective cases （13.33%）, and 0 invalid case （0.0%）. The total effective rate was 200%. The treatment efficacy of cough patients after common cold of less than 24 months was better than that of more than 24 months. Along with the increasing of age, the cured and markedly effective rate was of certain downward tendency. Along with the increasing of treatment times, the cured and markedly effective rate increased. Conclusion The clinical efficacy of Wentong needling method is obvious in the treatment of long-term cough cases after common cold.
基金the Third Batch of National Excellent TCM Clinician Training Project[No.(2012)148)]Chen Kezhen Integrated Traditional Chinese and Western Medicine Development Fund(CKJ2012018)+1 种基金2014 Fujian Province Health and Family Planning Commission Youth Research Projects(No.2014-1-82)Fujian Provincial Key Laboratory of Pulmonary Diseases Construction Project(2013-internal medicine-5)
文摘OBJECTIVE:To investigate the efficacy of Chaihu Ji Sang Decoction(CJSD),(a modification of Xiao Chaihu Tang(Minor Decoction of Bupleurum) was evaluated in patients with post-infection cough(PIC).Its effect on cough reflex sensitivity(CRS) was also described.METHODS:One hundred and eighteen patients with PIC were enrolled and randomly divided into an experimental group and control group(54 patients in each group).The experimental group was given CJSD orally,and the control group was given cetirizine hydrochloride for 7 d.Cough symptom scores and TCM symptom scores were compared before and after treatment.Efficacy,cough onset time,recurrence,and adverse drug reactions were additionally evaluated.Finally,CRS was evaluated before and after treatment of PIC patients in the experimental group.RESULTS:Fifty-two patients in the experimental group and fifty control patients completed the study.Cough symptom scores and the TCM symptom scores of the two groups were significantly improved after treatment,however cough symptoms in the experimental group 1(0,2) were significantly lower than the control group 2(1,2) after treatment(P < 0.05).Similarly,TCM symptom scores 4(0,7) in the experimental group were significantly lower than the control group 6(3,12)(P < 0.01).Overall,the effective rate of the experimental treatment(84.60%) was significantly higher than that of the control treatment(68.00%)(P < 0.01).The onset time of efficacy of the experimental treatment was one day faster than the control treatment [2(2,3) d vs 3(2,3) d,P < 0.01].The relapse rate in the experimental group(9.09%) was lower than that of the control group(29.41%)(P < 0.05).39 PIC patients in the experimental group completed a capsaicin cough challenge test before treatment.The lgC2 and lg C5 of the experimental group prior to treatment was 1.19(0.59,1.49) and 1.80(1.49,2.10),respectively.The lgC2,lg C5 of the healthy control group was 1.49(0.89,2.40) and 2.70(2.40,3.00),respectively.The differences in lgC2 and lg C5 between experimental group and healthy groups were significant at this time point(both P < 0.01).After treatment,34 patients in the experimental group received re-examination.lg C5 increased from 1.80(1.49,2.10) to 2.10(1.49,3.00).CRS after treatment/re-examination was significantly lower than those of baseline in the experimental group(P < 0.05).CONCLUSION:CJSD could effectively improve the clinical symptoms of PIC patients,with demonstrable low recurrence and safety.CJSD also significantly decreased the CRS in patients with PIC.
文摘Objective:This study mainly explores the clinical effect of dispelling wind,eliminating lung and relieving cough combined with western medicine in the treatment of cough variant asthma.Methods:80 children with cough variant asthma accepted by our hospital from January 2018 to December 2020 were randomly selected for the study and divided into two groups.One group was the reference group(40 cases)treated with procaterol hydrochloride tablets and montelukast sodium,and the other group was the research group(40 cases)・The method of eliminating wind,eliminating lung and relieving cough was combined with procaterol hydrochloride tablets and montelukast sodium to observe and compare the curative effects of the two groups.Results:There was no significant difference in TCM symptom score and eosinophil(EOS)count between the two groups before treatment(P>0.05);After treatment,the TCM symptom scores of coughs,pharyngeal itching,expectoration,nasal congestion and nasal itching in the research group were lower than those in the reference group,and the EOS count was lower than that in the reference group(P<0.05);The effective rate of research group was higher than that of reference group(P<0.05).Conclusions:For children with cough variant asthma,Qufeng Sufei cough relieving method combined with procaterol hydrochloride and montelukast sodium can improve children's symptoms and reduce eosinophil count.
文摘目的介绍一种有助于诊断急性阑尾炎的新体征。方法回顾性分析110例经病理证实的急性阑尾炎病人的“咳嗽征”、“呼吸疼痛征”以及“结肠充气试验”的阳性率,采用2χ检验统计比较。结果“Cough S ign”获得了96.4%的较高的阳性率,阳性率与其它两种试验比较有显著性差异(P<0.05)。结论该方法诊断急性阑尾炎简单、实用,有较高的阳性诊断率,有助于诊断急性阑尾炎。
文摘Cough variant is a common disease of the respiratory system and can lead to a unique type of asthma.The disease has no obvious symptoms such as wheezing nor shortness of breath.Coughing is the main clinical symptom,as it causes airway hyper-responsiveness.Traditional Chinese medicine(TCM)has a unique understanding of this disease,and the effect is obvious after treatment,as it's based on symptom differentiation.This article takes the concept of“mild fluid retention”from“The Synopsis of the Golden Chamber”as an entry point,briefly describes the relationship between cough variant and mild fluid retention,as well as the diagnosis and treatment of Chinese medicine.
文摘Director Zhang Hongxing is a famous traditional Chinese medicine(TCM)doctor in Shandong province and a teacher in the Famous TCM Expert Studio in Dezhou city.He has rich clinical experience and considerable experience in the treatment of common clinical chronic coughs.Director Zhang Hongxing believes that chronic cough belongs to the category of"wind cough"and"long-term cough"according to TCM.TCM diagnosis should start from the four aspects of "wind evil residing in lung","liver"?"spleen and stomach",and"yang deficiency".Starting from viewing the human body as an organic whole,distinguish between deficiency or excess in cold and heat,and clinical treatment for cough should focus on dispelling"wind",regulating the functions of liver,spleen,and stomach,and supplementing the body's yang.Formulate treatment based on different categorization,and modify prescription according to the symptoms,and the treatment effects are remarkable.
基金Supported by National Natural Science Foundation of China, No. 81170079Shanghai Shenkang Hospital Development Center Project, No. SHDC12012211
文摘AIM:To evaluate the efficacy and safety of baclofen for treatment of refractory gastroesophageal reflux-induced chronic cough (GERC) unresponsive to standard anti-reflux therapy. METHODS:Sixteen patients with refractory GERC were given an 8-wk course of baclofen 20 mg three times a day as an add-on therapy to omeprazole. Changes in the cough symptom score, cough threshold to capsaicin, reflux symptom score and possible adverse effects were determined after treatment. The variables of multi-channel intraluminal impedance combined with pH monitoring were compared between responders and non-responders to baclofen. RESULTS:Twelve of 16 patients completed treatment. Cough disappeared or improved in 56.3% (9/16)of patients, including 6 patients with acid refluxinduced cough (66.7%) and 3 patients with non-acid reflux-induced cough (33.3%). With baclofen treatment, the cough symptom score began to decrease at week 2, was clearly decreased at week 6 and reached a minimum at week 8. At the end of therapy, the lowest concentration of capsaicin required for induction of ≥ 2 and ≥ 5 coughs increased from 0.98 (1.46) to 1.95 (6.82) μmol/L (Z = -2.281, P = 0.024) and from 1.95 (7.31) to 7.8 (13.65) μmol/L (Z = -2.433, P = 0.014), respectively, and the reflux symptom score decreased from 8.0 ± 1.6 to 6.8 ± 0.8 (t = 2.454, P = 0.023). The number of acid reflux episodes was significantly lower in responders than in non-responders. The main adverse effects were somnolence, dizziness and fatigue. CONCLUSION:Baclofen is a useful, but suboptimal treatment option for refractory GERC.
文摘AIM： To compare two different daily doses of lansoprazole given for 12 weeks and to assess the role of gastrointestinal （GI） investigations as criteria for selecting patients. METHODS： Out of 45 patients referred for unexplained chronic persistent cough, 36 had at least one of the GI investigations （endoscopy, 24-h esophageal pH- metry and a 4-week trial of proton pump inhibitor （PPI） therapy） positive and were randomly assigned to receive either 30 mg lansoprazole o.d. or 30 mg lansoprazole b.i.d, for 12 weeks. Symptoms were evaluated at baseline （visit 1） after the PPI test （visit 2） and after the 12-week lansoprazole treatment period （visit 3）. RESULTS： Thirty-five patients completed the study protocol. Twenty-one patients （60.0%） reported complete relief from their cough with no difference between the two treatment groups （58.8% and 61.1% had no cough in 30 mg lansoprazole and 60 mg lansoprazole groups, respectively）. More than 80% of the patients who had complete relief from their cough at the end of the treatment showed a positive response to the PPI test. CONCLUSION： Twelve weeks of lansoprazole treatment even at a standard daily dose, is effective in patients with chronic persistent cough. A positive response to an initial PPI test seems to be the best criterion for selecting patients who respond to therapy.
基金The key Science and Technology Projects of Zhejiang Province(Research and Application of Key Techniques for Prevention and Treatment of Allergic Diseases of the Respiratory Tract by Summer Treatment of Winter Disease of Acupoint Application,No.2014C03046-2)
文摘OBJECTIVE:To evaluate the efficacy and safety of stimulating acupoints in subjects with childhood cough variant asthma(CVA).METHODS:A Meta-analysis of randomized controlled trials(RCTs) about the comparison between acupoint sticking therapy and non-acupoint sticking therapy for childhood CVA was conducted.The trials' quality and risk bias were assessed using the Cochrane Handbook tool.Odds ratio(OR) or risk ratio(RR) with 95% confidence intervals(CIs),mean differences(MDs) or standardized mean differences(SMDs) of a random-effects model were calculated.Heterogeneity was assessed by P value and I2 statistics.RESULTS:Thirteen studies were included in our review,indicating that the total effective rate of stimulating-acupoint group is better than that of control group [RR 1.19,95% CI(1.13-1.26),P < 0.00001].The recurrence rate in two years [RR 0.31,95%CI(0.19-0.51),P < 0.000 01] and cough duration[MD =-2.42,95% CI(-3.75,-1.09),P = 0.0004]of childhood CVA in stimulating-acupoint group were significantly lower than those in control group.Besides,stimulating acupoints can reduce the level of Ig E [SMD =-0.75,95% CI(-1.21,-0.30),P = 0.001] and EOS [SMD =-0.36,95% CI(-0.92,0.21),P = 0.22].CONCLUSION:Our findings suggest that stimulating acupoints had positive effects on childhood CVA and was relatively safe treatment.However,more RCTs with more useful indicators are warrant to confirm the current findings.
文摘Objective： Fentanyl-induced cough （FIC） is a common complication with a reported incidence from 18.0% to 74.4% during general anesthesia induction. FIC increases the intrathoracic pressure and risks of postoper- ative nausea and vomiting, yet available treatments are limited. This study was designed to investigate whether ad- ministering fentanyl via a slow intravenous fluid line can effectively alleviate FIC during induction of total intravenous general anesthesia. Methods： A total number of 1200 patients, aged 18-64 years, were enrolled, all of whom were American Society of Anesthesiologists （ASh,） grade I or II undergoing scheduled surgeries. All patients received total intravenous general anesthesia, which was induced sequentially by midazolam, fentanyl, propofol, and cisatracurium injection. Patients were randomly assigned to receive fentanyl 3.5 pg/kg via direct injection （control group） or via a slow intravenous fluid line. FIC incidence and the severity grades were analyzed with the Mann-Whitney test. Other adverse reactions, such as hypotension, hypertension, bradycardia, tachycardia, hypoxemia, vomiting, and aspiration, during induction were also observed. The online clinical registration number of this study was ChiCTR-IOR-16009025. Re- sults： Compared with the control group, the incidence of FIC was significantly lower in the slow intravenous fluid line group during induction （9.1%, 95% confidence interval （CI）： 6.7%-11.4% vs. 55.9%, 95% CI： 51.8%-60.0%, P=0.000）, as were the severity grades （P=0.000）. There were no statistical differences between the two groups with regard to other adverse reactions （P〉0.05）. Conclusions： The administration of fentanyl via a slow intravenous fluid line can alleviate FIC and its severity during induction for total intravenous general anesthesia. This method is simple, safe, and reliable, and deserves clinical expansion.
文摘OBJECTIVE:To systematically investigate the clinical effectiveness and safety of traditional Chinese herbs(TCHs)as an alternative to conventional medicine(CM)in children with cough variant asthma(CVA).METHODS:Randomized controlled trial(RCT)studies that were published from their inceptions to March 31,2020,were identified from the electronic databases of China National Knowledge Infrastructure,Wangfang,Pub Med,and Cochrane Central Library.The primary outcome of the review was the total effective rate(TER),and the secondary outcomes were immunoglobulin E(Ig E),peak expiratory flow(PEF),adverse drug reactions,and relapse rates of interventions.RESULTS:For the Meta-analysis,13 studies involving 992 children with CVA were included.In terms of TER and Ig E,the experimental interventions of TCH,when compared with the control interventions of CM,on pediatric CVA were found to be significantly effective(P<0.0001),whereas for spirometry,PEF was not significantly improved in the TCH group(P=0.48).The incident rates of adverse drug reaction and relapse were found to be significantly lower in the TCH group than those in the CM group(P=0.02 and P<0.0001,respectively).CONCLUSION:Compared with CM therapy,the effects of TCH therapy on pediatric CVA were significantly beneficial in terms of TER and Ig E,but not for PEF,and the methodological quality of included studies was poor.Therefore,the results should be interpreted with caution.More randomized controlled trials with rigorous experimental methodologies are required for objectivity in the future.
基金Supported by The National Natural Science Foundation of China,Nos.81170079 and 81470276Shanghai Shenkang Hospital Development Center,No.SHDC12012211
文摘Refractory chronic cough due to gastroesophageal reflux is a trouble some condition unresponsive to thestandard medical anti-reflux therapy. Its underlying mechanisms may include incomplete acid suppression, non-acid reflux, transient lower esophageal sphincter relaxations and esophageal hypersensitivity. The diagnosis of this disorder depends on both the findings of multi-channel intraluminal impedance-pH monitoring and the subsequent intensified anti-reflux therapy. The strategies of pharmacological treatment for refractory chronic cough due to reflux include the optimization of proton pump inhibitors and add-on therapies with histamine H2 receptor antagonists, baclofen and gabapentin. However, the further study is needed to satisfy its management.
文摘AIM:To evaluate the association between genetic polymorphisms and angiotensin converting enzyme in-hibitor (ACEI)-related cough,and the race-or ethnicity-related difference in the prevalence of cough attributed to ACEI therapy.METHODS:We conducted a search in PubMed,EM-BASE,Cinahl,and the Cochrane Database without language limitation.A database of 11 studies on ACEI-related cough,with detailed information regarding ACE I/D or bradykinin B 2 receptor polymorphisms,was created.Eligible studies were synthesized using meta-analysis methods,including cumulative meta-analysis.A subgroup analysis was also performed using ethnicity.RESULTS:Six studies were included on ACE I/D poly-morphism (398 Caucasians,723 East Asians),and three studies were included on bradykinin B 2 receptor poly-morphism (300 East Asians).The distribution of ACE genotypes showed significant differences in the entire population (P=0.004) and in East Asians (P=0.005)but not in Caucasians (P=0.23).Allelic frequencies of ACE showed significant differences in East Asians [odds ratio (OR)=1.49 (1.11-2.02)].The meta-analysis with a random effects model showed a significant associa-tion between ACE allele I/D and ACEI-related cough [random effects (RE) OR=1.49 (1.11-2.02),P=0.009] in East Asians,but not in Caucasians [RE OR=0.90 (0.60-1.35)].The allelic frequencies of the bradykinin B 2 receptor gene were significantly different [OR=2.25 (1.42-3.57)].The distributions of the T/C genotypes of the bradykinin B 2 receptor gene were significantly dif-ferent (χ 2=8.366,P=0.015).The meta-analyses re-vealed that there was a significant association between the bradykinin B 2 receptor allele and ACEI-related cough in East Asians [RE OR=2.29 (1.42-3.69),P=0.001].CONCLUSION:ACE I/D and Bradykinin B 2 receptor polymorphisms contributed to the risk of ACEI-related cough in East Asians,but a negative association be-tween ACE I/D polymorphism and ACEI-related cough was observed in Caucasians.
文摘Breathing is an intrinsic natural behavior and physiological process that maintains life.The rhythmic exchange of gases regulates the delicate balance of chemical constituents within an organism throughout its lifespan.However,chronic airway diseases,including asthma and chronic obstructive pulmonary disease,affect millions of people worldwide.Pathological airway conditions can disrupt respiration,causing asphyxia,cardiac arrest,and potential death.The innervation of the respiratory tract and the action of the immune system confer robust airway surveillance and protection against environmental irritants and pathogens.However,aberrant activation of the immune system or sensitization of the nervous system can contribute to the development of autoimmune airway disorders.Transient receptor potential ion channels and voltage-gated Na+channels play critical roles in sensing noxious stimuli within the respiratory tract and interacting with the immune system to generate neurogenic inflammation and airway hypersensitivity.Although recent studies have revealed the involvement of nociceptor neurons in airway diseases,the further neural circuitry underlying airway protection remains elusive.Unraveling the mechanism underpinning neural circuit regulation in the airway may provide precise therapeutic strategies and valuable insights into the management of airway diseases.
文摘BACKGROUND Cough variant asthma(CVA)is one of the most common respiratory diseases in children,which has a serious impact on the quality of life and daily activities of children.For severe CVA,immunomodulatory drugs are needed.AIM To evaluate the efficacy of salmeterol combined with budesonide in the treatment of pediatric CVA.METHODS 130 children with CVA from January 2020 to December 2022 were prospectively selected and randomly divided into an observation group(salmeterol combined with budesonide)and a control group(budesonide combined with a placebo).Compare the clinical efficacy of two groups before and after intervention.The evaluation parameters include cough frequency score,nocturnal cough arousal,and lung function indicators.Serum inflammatory markers,immune function markers and airway anatomical indicators were also measured.RESULTS After the intervention,the total effective rate of the observation group was significantly higher than that of the control group,and the cough frequency score and the night cough wake rate of the observation group were lower than that of the control group,with a statistically significant difference.In addition,the changes of lung function indicators,serum markers and immune function markers in the observation group were better than those in the control group.CONCLUSION The clinical efficacy of salmeterol combined with Budesonide in the treatment of CVA is better than that of Budesonide alone.
基金National Key R&D Plan:Development of International Standards for Traditional Chinese Medicine Technology(No.2019YFC1712003)。
文摘OBJECTIVE:To formulate the first clinical practice guideline for the treatment of cough using Chinese medicine based on the grading of recommendations assessment,development,and evaluation(GRADE)systematic approach,including clinical evidence,evaluation of ancient literature,and expert consensus.METHODS:In the process of development,the regulation of"evidence-based,consensus-assisted,and empirical"was followed,and a comprehensive systematic approach of recommendation assessment,GRADE,evidence-based evaluation,expert consensus,and the Delphi method was used.In the process of guideline development,evidence-based evaluation of ancient literature was included for the first time,and clinical evidence was fully integrated with clinical expert consensus.RESULTS:The clinical practice guidelines for the treatment of cough with Chinese herbal medicine were developed after a comprehensive consideration of evidence-based evaluation and expert opinions.The guideline recommendations focused on recommending herbal compound decoctions and Chinese patent medicines for cough in different conditions.Based on the GRADE systematic approach,we conducted an evidence-based evaluation of the recommended Chinese patent medicines one by one;meanwhile,the expert consensus method was used to unify the recommendations of both.CONCLUSION:Based on clinical evidence,ancient literature evaluation,and expert consensus,a clinical practice guideline for Traditional Chinese Medicine(TCM)in the treatment of cough was developed,providing the first current clinical practice guideline for domestic and foreign TCM and Western medicine practitioners,especially respiratory professionals at home and abroad.
