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: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
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 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
Cough is one of the most common symptoms observed in patients presenting with COVID-19,persisting for an extended duration following SARS-CoV-2 infection.We aim to describe the distribution of airway microbiota and ex...Cough is one of the most common symptoms observed in patients presenting with COVID-19,persisting for an extended duration following SARS-CoV-2 infection.We aim to describe the distribution of airway microbiota and explore its role in patients with post-CovID-19 chronic cough.A total of 57 patients experiencing persistent cough after infection were recruited during the Omicron wave of SARS-CoV-2 in China.Airway microbiota profiling is assessed in nasopharyngeal swab,nasal lavage,and induced sputum samples at 4 and 8 weeks after SARS-CoV-2 infection.Our findings reveal that bacterial families Staph-ylococcaceae,Corynebacteriaceae,and Enterobacteriaceae are the most prevalent in the upper airway,while Streptococcaceae,Lachnospiraceae,and Prevotellaceae emerge as the most prevalent bacterial families in the lower airway.An increase in the abundance of Staphylococcus in nasopharyngeal swab samples and of Streptococcus in induced sputum samples is observed after one month.Furthermore,the abundance of Staphylococcus identified in nasopharyngeal swab samples at the baseline period emerges as an insightful predictor for improvement in cough severity.In conclusion,dynamic alterations in the airway microbial composition may contribute to the post-coviD-19 chronic cough progression,while the compositional signatures of nasopharyngeal microbiota could reflect the improvement of this disease.展开更多
Lianhua Qingke tablets,a patented traditional Chinese medicine that has validated clinical efficacy for treating cough caused by severe acute respiratory syndrome coronavirus 2 infection,lack rigorous evidence-based r...Lianhua Qingke tablets,a patented traditional Chinese medicine that has validated clinical efficacy for treating cough caused by severe acute respiratory syndrome coronavirus 2 infection,lack rigorous evidence-based research evaluating their effect on long coronavirus disease(COVID)cough.A randomized,double-blind,placebo-controlled,multicenter clinical study was conducted among patients with long COVID cough from 19 hospitals and 23 community health centers in China.Patients were randomized 1:1 to receive either Lianhua Qingke tablets or placebo orally for 14 days(four tablets,1.84 g,three times a day).The primary endpoint indicator was the disappearance of cough,with the remission of cough also considered.Among 482 randomized patients,480(full analysis set 480;per-protocol set 470;safety set 480)were included in the primary analysis.According to the full analysis,the time until cough disappearance was significantly shorter in the trial group than in the control group,with a significant increase in the 14-day cough disappearance rate.Accordingly,the time to cough remission was significantly shorter in the trial group than in the control group.The change in the total symptom score was significantly greater in the trial group than in the control group on days 7 and 14,consistent with the results indicated by the visual analog scale(VAS)and cough evaluation test(CET)scores.No serious adverse events were recorded during the study.Lianhua Qingke tablets significantly improved the clinical symptoms of patients with long COVID cough.展开更多
The bio-control potential of rhizospere bacteria Pseudomonas fluorescens against plant-parasite nematode had been demonstrated. P. fluorescens had shown the effect to enhance tobacco resistance to root-knot nematode M...The bio-control potential of rhizospere bacteria Pseudomonas fluorescens against plant-parasite nematode had been demonstrated. P. fluorescens had shown the effect to enhance tobacco resistance to root-knot nematode Meloidogyne incognita. Inoculation with P. fluorescens in tobacco could lead to significant reductions in the number of juveniles that penetrated tobacco root and further life stage development of the juveniles. The number of juveniles penetrated into tobacco root in treatment with P. fluorescens is significantly different from CK at 2DAI,6DAI,8DAI and 10 DAI. Significant reduction and delayed development of juveniles that penetrated into tobacco root and treated were observed in treatment at14 DAI,21DAI,28 DAI and 35 DAI. In addition,P. fluorescens treatment leads to a significant reduction in the number of eggs per egg-mass at 35 DAI. The results show P. fluorescens induced a continuously suppression on root-knot nematode M. incognita throughout their entire early infection phase of root penetration,subsequent life stage development and reproduction.展开更多
目的观察咳喘镇定汤在小儿咳嗽变异性哮喘治疗中的作用及对患儿嗜酸性粒细胞计数(eosinophil count,EOS)、白介素-23(interleukin-23,IL-23)/辅助性T细胞17(helper T cells17,Th17)轴的影响。方法选取2020年8月—2023年2月收治的小儿咳...目的观察咳喘镇定汤在小儿咳嗽变异性哮喘治疗中的作用及对患儿嗜酸性粒细胞计数(eosinophil count,EOS)、白介素-23(interleukin-23,IL-23)/辅助性T细胞17(helper T cells17,Th17)轴的影响。方法选取2020年8月—2023年2月收治的小儿咳嗽变异性哮喘患儿104例,将患儿采用简单随机法分为两组。常规组给予止咳化痰、抗炎、平喘等常规治疗,咳喘镇定汤组在常规组基础上采用咳喘镇定汤辅助治疗。检测组间及组内T淋巴亚群、EOS、巨噬细胞炎症蛋白-1α(macrophage inflammatory protein-1α,MIP-1α)、Clara细胞分泌蛋白16(clara cell secreted protein 16,CC-16)、嗜酸细胞活化趋化因子(Eotaxin)、IL-23/Th17轴、小气道功能水平。评估组间及组内咳嗽症状评分、中医证候评分差异。统计组间疗效和不良反应。结果治疗前T淋巴亚群、CC-16、Eotaxin等差异无统计学意义(P>0.05)。两组治疗后CD_(8)^(+)、EOS、MIP-1α、Eotaxin降低,CC-16、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)升高,咳喘镇定汤组治疗后CD_(8)^(+)、EOS、MIP-1α、Eotaxin低于常规组,CC-16、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)高于常规组(P<0.05)。治疗前比较IL-23/Th17轴差异无统计学意义(P>0.05)。两组治疗后IL-23、Th17、白介素-17(interleukin-17,IL-17)降低,咳喘镇定汤组治疗后IL-23/Th17轴低于常规组(P<0.05)。治疗前相关评分无差异(P>0.05)。两组治疗后咳嗽症状评分、中医证候评分降低,咳喘镇定汤组治疗后咳嗽症状评分、中医症候评分低于常规组(P<0.05)。治疗前小气道功能无差异(P>0.05)。两组治疗后小气道功能升高,咳喘镇定汤组治疗后小气道功能高于常规组(P<0.05)。咳喘镇定汤组治愈13例,显效和有效共35例,总有效率92.31%高于常规组,差异有统计学意义(P<0.05)。结论咳喘镇定汤可通过调控小儿咳嗽变异性哮喘患儿IL-23/Th17轴,改善T淋巴亚群和小气道功能,减轻咳嗽症状,提高疗效。展开更多
Objective:To explore the presence of inflammatory memory in the lung tissue of mice with cough variant asthma(CVA)and the mechanism of Wuhu decoction in preventing and treating CVA.Methods:Among the 90 SPF-grade femal...Objective:To explore the presence of inflammatory memory in the lung tissue of mice with cough variant asthma(CVA)and the mechanism of Wuhu decoction in preventing and treating CVA.Methods:Among the 90 SPF-grade female BALB/c mice,20 were randomly selected as the blank group,while the remaining 70 were sensitized by intraperitoneal injection of ovalbumin(OVA)combined with aluminum hydroxide and then exposed to OVA by nebulization to establish the CVA mouse model.From the conctrol group and the model group,10 mice were randomly selected to detect airway responsiveness using an animal ventilator.Successfully modeled mice were then randomly divided into 7 groups:a CVA model group,a CVA re-challenge group,low-,medium-,and high-dose Wuhu decoction groups,and a positive control(dexamethasone)group,with 10 mice in each group.After 30 days of rest,except for the conctrol group and the model group,mice in the other groups underwent a second OVA nebulization challenge and received corresponding drug interventions once a day for 10 consecutive days before further analysis.Pathological changes in lung tissue were observed using periodic acid-schiff(PAS)and Masson staining methods.Serum levels of tumor necrosis factor-α(TNF-α),interleukin-4(IL-4),interferon-γ(IFN-γ),and interleukin-10(IL-10)were detected using enzyme-linked immunosorbent assay(ELISA).The expression of T-bet mRNA and GATA-3 mRNA in lung tissue was determined by real-time quantitative polymerase chain reaction(Real-time PCR).Results:The results of airway responsiveness indicated successful establishment of the model.Compared with the control group,the model group exhibited severalkey pathological changes including inflammatory cellinfiltration around the lung tissue,epithelialmetaplasia,airway collagen deposition,increased airway mucus accumulation index and airway collagen deposition index(P<0.05),elevated serum TNF-αand IL-4 expression(P<0.05),decreased IFN-γand IL-10 levels(P<0.05),decreased T-bet mRNA levels(P<0.05),increased GATA-3 mRNA levels(P<0.05),and a reduced T-bet mRNA/GATA-3 mRNA ratio(P<0.05)in lung tissue.When compared to the CVA re-challenge group,the Wuhu decoction groups and the dexamethasone group effectively alleviated pathological changes in lung tissue,reduced the airway mucus accumulation index and airway collagen deposition index(P<0.05),decreased serum TNF-αand IL-4 expression(P<0.05),increased serum IFN-γand IL-10 levels(P<0.05),upregulated T-bet mRNA levels(P<0.05),downregulated GATA-3 mRNA levels(P<0.05),and increased the T-bet mRNA/GATA-3 mRNA ratio(P<0.05)in lung tissue.Conclusion:The lung tissue of mice with cough variant asthma exhibits inflammatory memory,and Wuhu decoction may intervene in this inflammatory memory by restoring the balance between T-bet and GATA-3,thereby correcting the imbalance in Th1/Th2 immunity and exerting a preventive and therapeutic effect on cough variant asthma.展开更多
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: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.
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.
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.
基金This study was supported by the Guangdong Basic and Applied Basic Research Foundation(2022B1515120055)the National Natural Science Foundation of China(82341060 and 82170024).
文摘Cough is one of the most common symptoms observed in patients presenting with COVID-19,persisting for an extended duration following SARS-CoV-2 infection.We aim to describe the distribution of airway microbiota and explore its role in patients with post-CovID-19 chronic cough.A total of 57 patients experiencing persistent cough after infection were recruited during the Omicron wave of SARS-CoV-2 in China.Airway microbiota profiling is assessed in nasopharyngeal swab,nasal lavage,and induced sputum samples at 4 and 8 weeks after SARS-CoV-2 infection.Our findings reveal that bacterial families Staph-ylococcaceae,Corynebacteriaceae,and Enterobacteriaceae are the most prevalent in the upper airway,while Streptococcaceae,Lachnospiraceae,and Prevotellaceae emerge as the most prevalent bacterial families in the lower airway.An increase in the abundance of Staphylococcus in nasopharyngeal swab samples and of Streptococcus in induced sputum samples is observed after one month.Furthermore,the abundance of Staphylococcus identified in nasopharyngeal swab samples at the baseline period emerges as an insightful predictor for improvement in cough severity.In conclusion,dynamic alterations in the airway microbial composition may contribute to the post-coviD-19 chronic cough progression,while the compositional signatures of nasopharyngeal microbiota could reflect the improvement of this disease.
基金supported by National Multidisciplinary Innovation Team Project of Traditional Chinese Medicine(ZYYCXTD-D-202201)Beijing Key Specialized Department for Major Epidemic Prevention and Control(Construction ProjectJingweiyi[2019]161).
文摘Lianhua Qingke tablets,a patented traditional Chinese medicine that has validated clinical efficacy for treating cough caused by severe acute respiratory syndrome coronavirus 2 infection,lack rigorous evidence-based research evaluating their effect on long coronavirus disease(COVID)cough.A randomized,double-blind,placebo-controlled,multicenter clinical study was conducted among patients with long COVID cough from 19 hospitals and 23 community health centers in China.Patients were randomized 1:1 to receive either Lianhua Qingke tablets or placebo orally for 14 days(four tablets,1.84 g,three times a day).The primary endpoint indicator was the disappearance of cough,with the remission of cough also considered.Among 482 randomized patients,480(full analysis set 480;per-protocol set 470;safety set 480)were included in the primary analysis.According to the full analysis,the time until cough disappearance was significantly shorter in the trial group than in the control group,with a significant increase in the 14-day cough disappearance rate.Accordingly,the time to cough remission was significantly shorter in the trial group than in the control group.The change in the total symptom score was significantly greater in the trial group than in the control group on days 7 and 14,consistent with the results indicated by the visual analog scale(VAS)and cough evaluation test(CET)scores.No serious adverse events were recorded during the study.Lianhua Qingke tablets significantly improved the clinical symptoms of patients with long COVID cough.
文摘The bio-control potential of rhizospere bacteria Pseudomonas fluorescens against plant-parasite nematode had been demonstrated. P. fluorescens had shown the effect to enhance tobacco resistance to root-knot nematode Meloidogyne incognita. Inoculation with P. fluorescens in tobacco could lead to significant reductions in the number of juveniles that penetrated tobacco root and further life stage development of the juveniles. The number of juveniles penetrated into tobacco root in treatment with P. fluorescens is significantly different from CK at 2DAI,6DAI,8DAI and 10 DAI. Significant reduction and delayed development of juveniles that penetrated into tobacco root and treated were observed in treatment at14 DAI,21DAI,28 DAI and 35 DAI. In addition,P. fluorescens treatment leads to a significant reduction in the number of eggs per egg-mass at 35 DAI. The results show P. fluorescens induced a continuously suppression on root-knot nematode M. incognita throughout their entire early infection phase of root penetration,subsequent life stage development and reproduction.
文摘目的观察咳喘镇定汤在小儿咳嗽变异性哮喘治疗中的作用及对患儿嗜酸性粒细胞计数(eosinophil count,EOS)、白介素-23(interleukin-23,IL-23)/辅助性T细胞17(helper T cells17,Th17)轴的影响。方法选取2020年8月—2023年2月收治的小儿咳嗽变异性哮喘患儿104例,将患儿采用简单随机法分为两组。常规组给予止咳化痰、抗炎、平喘等常规治疗,咳喘镇定汤组在常规组基础上采用咳喘镇定汤辅助治疗。检测组间及组内T淋巴亚群、EOS、巨噬细胞炎症蛋白-1α(macrophage inflammatory protein-1α,MIP-1α)、Clara细胞分泌蛋白16(clara cell secreted protein 16,CC-16)、嗜酸细胞活化趋化因子(Eotaxin)、IL-23/Th17轴、小气道功能水平。评估组间及组内咳嗽症状评分、中医证候评分差异。统计组间疗效和不良反应。结果治疗前T淋巴亚群、CC-16、Eotaxin等差异无统计学意义(P>0.05)。两组治疗后CD_(8)^(+)、EOS、MIP-1α、Eotaxin降低,CC-16、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)升高,咳喘镇定汤组治疗后CD_(8)^(+)、EOS、MIP-1α、Eotaxin低于常规组,CC-16、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)高于常规组(P<0.05)。治疗前比较IL-23/Th17轴差异无统计学意义(P>0.05)。两组治疗后IL-23、Th17、白介素-17(interleukin-17,IL-17)降低,咳喘镇定汤组治疗后IL-23/Th17轴低于常规组(P<0.05)。治疗前相关评分无差异(P>0.05)。两组治疗后咳嗽症状评分、中医证候评分降低,咳喘镇定汤组治疗后咳嗽症状评分、中医症候评分低于常规组(P<0.05)。治疗前小气道功能无差异(P>0.05)。两组治疗后小气道功能升高,咳喘镇定汤组治疗后小气道功能高于常规组(P<0.05)。咳喘镇定汤组治愈13例,显效和有效共35例,总有效率92.31%高于常规组,差异有统计学意义(P<0.05)。结论咳喘镇定汤可通过调控小儿咳嗽变异性哮喘患儿IL-23/Th17轴,改善T淋巴亚群和小气道功能,减轻咳嗽症状,提高疗效。
文摘Objective:To explore the presence of inflammatory memory in the lung tissue of mice with cough variant asthma(CVA)and the mechanism of Wuhu decoction in preventing and treating CVA.Methods:Among the 90 SPF-grade female BALB/c mice,20 were randomly selected as the blank group,while the remaining 70 were sensitized by intraperitoneal injection of ovalbumin(OVA)combined with aluminum hydroxide and then exposed to OVA by nebulization to establish the CVA mouse model.From the conctrol group and the model group,10 mice were randomly selected to detect airway responsiveness using an animal ventilator.Successfully modeled mice were then randomly divided into 7 groups:a CVA model group,a CVA re-challenge group,low-,medium-,and high-dose Wuhu decoction groups,and a positive control(dexamethasone)group,with 10 mice in each group.After 30 days of rest,except for the conctrol group and the model group,mice in the other groups underwent a second OVA nebulization challenge and received corresponding drug interventions once a day for 10 consecutive days before further analysis.Pathological changes in lung tissue were observed using periodic acid-schiff(PAS)and Masson staining methods.Serum levels of tumor necrosis factor-α(TNF-α),interleukin-4(IL-4),interferon-γ(IFN-γ),and interleukin-10(IL-10)were detected using enzyme-linked immunosorbent assay(ELISA).The expression of T-bet mRNA and GATA-3 mRNA in lung tissue was determined by real-time quantitative polymerase chain reaction(Real-time PCR).Results:The results of airway responsiveness indicated successful establishment of the model.Compared with the control group,the model group exhibited severalkey pathological changes including inflammatory cellinfiltration around the lung tissue,epithelialmetaplasia,airway collagen deposition,increased airway mucus accumulation index and airway collagen deposition index(P<0.05),elevated serum TNF-αand IL-4 expression(P<0.05),decreased IFN-γand IL-10 levels(P<0.05),decreased T-bet mRNA levels(P<0.05),increased GATA-3 mRNA levels(P<0.05),and a reduced T-bet mRNA/GATA-3 mRNA ratio(P<0.05)in lung tissue.When compared to the CVA re-challenge group,the Wuhu decoction groups and the dexamethasone group effectively alleviated pathological changes in lung tissue,reduced the airway mucus accumulation index and airway collagen deposition index(P<0.05),decreased serum TNF-αand IL-4 expression(P<0.05),increased serum IFN-γand IL-10 levels(P<0.05),upregulated T-bet mRNA levels(P<0.05),downregulated GATA-3 mRNA levels(P<0.05),and increased the T-bet mRNA/GATA-3 mRNA ratio(P<0.05)in lung tissue.Conclusion:The lung tissue of mice with cough variant asthma exhibits inflammatory memory,and Wuhu decoction may intervene in this inflammatory memory by restoring the balance between T-bet and GATA-3,thereby correcting the imbalance in Th1/Th2 immunity and exerting a preventive and therapeutic effect on cough variant asthma.
