Establishment of a Predictive Model for Chronic Cough after Pulmonary Resection / 中国肺癌杂志

BACKGROUND@#Chronic cough after pulmonary resection is one of the most common complications, which seriously affects the quality of life of patients after surgery. Therefore, the aim of this study is to explore the risk factors of chronic cough after pulmonary resection and construct a prediction model.@*METHODS@#The clinical data and postoperative cough of 499 patients who underwent pneumonectomy or pulmonary resection in The First Affiliated Hospital of University of Science and Technology of China from January 2021 to June 2023 were retrospectively analyzed. The patients were randomly divided into training set (n=348) and validation set (n=151) according to the principle of 7:3 randomization. According to whether the patients in the training set had chronic cough after surgery, they were divided into cough group and non-cough group. The Mandarin Chinese version of Leicester cough questionnare (LCQ-MC) was used to assess the severity of cough and its impact on patients' quality of life before and after surgery. The visual analog scale (VAS) and the self-designed numerical rating scale (NRS) were used to evaluate the postoperative chronic cough. Univariate and multivariate Logistic regression analysis were used to analyze the independent risk factors and construct a model. Receiver operator characteristic (ROC) curve was used to evaluate the discrimination of the model, and calibration curve was used to evaluate the consistency of the model. The clinical application value of the model was evaluated by decision curve analysis (DCA).@*RESULTS@#Multivariate Logistic analysis screened out that preoperative forced expiratory volume in the first second/forced vital capacity (FEV1/FVC), surgical procedure, upper mediastinal lymph node dissection, subcarinal lymph node dissection, and postoperative closed thoracic drainage time were independent risk factors for postoperative chronic cough. Based on the results of multivariate analysis, a Nomogram prediction model was constructed. The area under the ROC curve was 0.954 (95%CI: 0.930-0.978), and the cut-off value corresponding to the maximum Youden index was 0.171, with a sensitivity of 94.7% and a specificity of 86.6%. With a Bootstrap sample of 1000 times, the predicted risk of chronic cough after pulmonary resection by the calibration curve was highly consistent with the actual risk. DCA showed that when the preprobability of the prediction model probability was between 0.1 and 0.9, patients showed a positive net benefit.@*CONCLUSIONS@#Chronic cough after pulmonary resection seriously affects the quality of life of patients. The visual presentation form of the Nomogram is helpful to accurately predict chronic cough after pulmonary resection and provide support for clinical decision-making.

Study on mechanism and Huanglong Mixture in the treatment of children with cough variant asthma and experimental verification based on network pharmacologic analysis / 国际中医中药杂志

Objective:To study the the mechanism of action of Huanglong Mixture in the treatment of cough variant asthma (CVA) in children based on the IL-4/signal transduction and activator of transcription 6 (STAT6) signaling pathway using network pharmacology methods, molecular docking techniques, and in vitro cell experiments.Methods:The components and targets of various TCM components in Huanglong Mixture were searched in TCMSP database, HERB database and literature, and the disease targets of CVA were found in Gene Cards database, OMIM database, DrugBank database and PharmGkb database. The STRING database was used to construct the protein-protein interaction network, and Cytoscape 3.9.1 was used for topology analysis to screen out the core targets. The disease-drug-component-target network was constructed to screen out the core components. The KEGG enrichment analysis and GO enrichment analysis of the intersection targets were performed using Metascape software. PDB protein database, PubChem, Autodock and R language were used for molecular docking verification of core targets and core drug components. Finally, rat primary airway smooth muscle cells were cultured, modeled with interleukin-4 (IL-4), and p-STAT6 expression in the cytoplasm and nucleus was detected by Western blot.Results:A total of 122 effective components were obtained, including quercetin, kaempferol, luteolin and so on. The core targets included JUN, ESR1, TP53, MYC, HIF1, etc. GO enrichment analysis involved biological processes such as response to external stimuli, response to oxygen levels, positive regulation of protein phosphorylation, and regulation of cellular stress response. KEGG enrichment analysis showed that the main pathways of Huanglong Mixture in treating CVA included advanced glycation end product-glycation end product receptor (AGE-RAGE) signaling pathway, phosphatidylinositol-3-kinase-protein kinase B (PI3K-Akt) signaling pathway, tumor necrosis factor (TNF) signaling pathway, Janus kinase/signal transduction activation factor (JAK-STAT) signaling pathway. Molecular docking found that the core targets and core drug components had good combination. Cell experiments also confirmed that Huanglong Mixture could inhibit p-STAT6 entering the nucleus.Conclusions:The effective components and targets of Huanglong Mixture in the treatment of CVA are successfully predicted. The mechanism of Huanglong Mixture in the treatment of children with CVA may be related to the inhibition of IL-4/STAT6 signaling pathway.

Discussion on the effects of glycyrrhetinic acid on cough variant asthma mice by adjusting Th2 deviation based on molecular docking technique / 国际中医中药杂志

Objective:To evaluate the therapeutic effect of glycyrrhetinic acid on cough variant asthma (CVA) mice based on molecular docking technique; To explore the possibility of its treatment for cough variant asthma.Methods:The software of Autodock Vina was used for molecular docking. The mice were divided into control group, model group, prednisone acetate group, glycyrrhetinic acid high-, medium-, and low-dosage groups according to the random number table method, with 8 mice in each group. Except for the blank control group, all other groups were induced by egg protein to establish cough variant asthma models. Glycyrrhetinic acid high-, medium-, and low-dosage groups were orally administered glycyrrhetinic acid suspension at 20, 10, and 5 mg/kg, while the prednisone acetate group was orally administered prednisone acetate at 5 mg/kg. The blank control group and model group were orally administered equal volumes of physiological saline, once per day for 14 consecutive days. The animal asthma behavior was observed after drug administration. The secretion of bronchial mucus in lung tissue were observed by AB-PAS staining and the index of spleen were recorded. The protein expressions of Gata3, IL-4 and IL-13 in the spleen tissue were determined by Western blot.Results:Molecular docking results showed that glycyrrhetinic acid had good binding ability to Th2-related factors Gata3, IL-4 and IL-13. Results of animal experiment showed that compared with the model group, the mucus secretion decreased in glycyrrhetinic acid groups, the index of the spleen of mice obviously decreased, protein expression levels of IL-4 and IL-13 in the spleen tissue of mice in glycyrrhetinic acid high-, medium-, and low-dosage groups decreased ( P<0.05), and Gata3 in glycyrrhetinic acid medium- and low-dosage groups decreased ( P<0.05). Conclusion:Glycyrrhetinic acid can correct the shift of Th2 in the immune system of cough variant asthma mice and has a certain therapeutic effect.

Effects of Maxing Shigan Decoction on IL-6/STAT3 Signaling Pathway and TRPV1 Receptor in Rats with Cough Variant Asthma / 广州中医药大学学报

Objective To investigate the therapeutic effects and mechanisms of Maxing Shigan Decoction on cough variant asthma(CVA)rats.Methods Sixty rats were randomly divided into normal group,model group,low and high dose groups of Maxing Shigan Decoction,and high-dose of Maxing Shigan Decoction + signal transducer and activator of transcription 3(STAT3)activator Colivelin(Col)group,12 rats in each group.Except for the normal group,the CVA model was constructed by intraperitoneal injection of ovalbumin combined with moxa fumigation in all other groups of rats.After the corresponding treatment,the rats were observed for signs and cough counts,airway resistance(RE)was detected by pulmonary function meter,eosinophils(EOS)were counted by Diff-Quik staining,histopathological features of the lungs and bronchial tubes were observed by hematoxylin-eosin(HE)staining method,and the lung tissues were detected by enzyme-linked immunosorbent assay(ELISA)for monocyte chemotactic protein 1(MCP-1),and tumor necrosis factor α(TNF-α),and the protein expression levels of interleukin 6(IL-6),STAT3,and transient receptor potential vanilloid-1 channel(TRPV1)were detected by Western Blot.Results Compared with the normal group,rats in the model group showed obvious asthma symptoms,severe inflammatory cell infiltration was seen in the lung tissue,bronchial epithelial cell necrosis,ciliated adhesion,mucus,and RE,EOS number,MCP-1 and TNF-α contents,and protein expression levels of IL-6,STAT3,TRPV1 were elevated(P＜0.05);compared with the model group,rats in the low-and high-dose groups of Maxing Shigan Decoction showed significant improvement in asthma symptoms,reduction in lung and bronchial injury,and dose-dependent reduction in RE,EOS number,MCP-1 and TNF-α contents,and protein expression levels of IL-6,STAT3,and TRPV1(P＜0.05);compared with the high-dose group of Maxing Shigan Decoction,the rats in the high-dose Maxing Shigan Decoction+Col group showed increased asthma,increased lung and bronchial injury,and increased RE,EOS number,MCP-1 and TNF-α contents,and protein expression levels of IL-6,STAT3,and TRPV1(P＜0.05).Conclusion Maxing Shigan Decoction can effectively improve cough variant asthma in rats,and its mechanism is related to the inhibition of IL-6/STAT3 signaling pathway and the high expression of TRPV1.

Clinical Analysis of Sangxing Zhike Prescription for the Treatment of Postinfectious Cough of Warm Dryness Invading the Lung Type / 广州中医药大学学报

Objective To observe the clinical efficacy and safety of Sangxing Zhike Prescription in treating postinfectious cough(PIC)of warm dryness invading the lung type.Methods A total of 66 PIC patients with warm dryness invading the lung type who were admitted to the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2020 to June 2022 were randomly divided into a treatment group and a control group,with 33 patients in each group.The treatment group was given Sangxing Zhike Prescription combined with Compound Methoxyphenamine Capsules,and the control group was given Compound Methoxyphenamine Capsules combined with Chinese medicine placebo.The course of treatment covered 7 days.The changes in the Visual Analogue Scale(VAS)scores of the severity of cough,the scores of cough symptom,and the scores of traditional Chinese medicine(TCM)syndrome in the two groups were observed before and after the treatment.After treatment,the clinical efficacy and safety in the two groups were evaluated.Results(1)During the trial,one case fell off from the treatment group and 4 cases fell off from the control group,and eventually 61 cases completed the observation,of which 32 cases were in the treatment group and 29 cases were in the control group.(2)After 7 days of treatment,the total effective rate of the treatment group was 84.38%(27/32)and that of the control group was 58.62%(17/29),and the intergroup comparison(tested by chi-square test)showed that the therapeutic efficacy of the treatment group was significantly superior to that of the control group(P＜0.05).(3)After treatment,the VAS scores of the severity of cough,and the scores of daytime cough,nighttime cough of the Cough Symptom Score Scale as well as the overall cough scores in the two groups were significantly lower than those before treatment(P＜0.05 or P＜0.01),and the reduction of the VAS scores and the overall cough symptom scores in the treatment group was significantly superior to that in the control group(P＜0.05).(4)After treatment,obvious improvement was presented in the scores of TCM symptoms of cough,throat itching,dry throat,foreign body sensation in the throat,sore throat and pharyngeal signs as well as total TCM syndrome scores in the treatment group when compared with the pre-treatment period(P＜0.01),whereas in the control group,only the scores of cough,throat itching,dry throat,and sore throat and the total TCM syndrome scores were improved compared with the pre-treatment period(P＜0.05 or P＜0.01).The post-treatment intergroup comparison showed that the treatment group was significantly superior to the control group in improving the scores of throat itching,foreign body sensation in the throat,and pharyngeal signs as well as total TCM syndrome scores(P＜0.05 or P＜0.01).(5)During the treatment process,no significant adverse reactions occurred in both groups,or no abnormal changes were shown in the safety indexes such as blood routine test,liver and kidney functions of the patients.Conclusion Sangxing Zhike Prescription combined with Compound Methoxyphenamine Capsules exerts certain effect in treating patients with PIC of warm dryness invading the lung type,and its efficacy is significantly superior to that of Compound Methoxyphenamine Capsules treatment alone with relatively high safety profile.

Effect of ultra-low dose dexmedetomidine on cough during anesthesia recovery period in elderly pa-tients / 临床麻醉学杂志

Objective To explore the effect of ultra-low dose dexmedetomidine on cough during an-esthesia recovery period in elderly patients undergoing carotid artery stenting(CAS).Methods A total of 111 elderly patients,75 males and 36 females,aged≥65 years,BMI 18-32 kg/m2,ASA physical statusⅡ or Ⅲ,diagnosed with asymptomatic unilateral severe carotid artery stenosis and scheduled for CAS,were randomly assigned to two groups using a random number table:the dexmedetomidine group(group D,n = 55)and the control group(group C,n = 56).Group D was given dexmedetomidine 0.2-0.5 μg/kg before anesthesia induction,and dexmedetomidine was intravenously infused at a ultra-low dose(0.1-0.2 μg·kg-1·h-1)after anesthesia induction to 30 minutes before the end of the operation,while group C did not receive any dexmedetomidine.The anesthesia regimen and intraoperative medication were the same for both groups.The MAP and HR were recorded 15 minutes before anesthesia induction(T0),5 minutes after anesthesia induction(T1),5 minutes before stent implantation(T2),5 minutes after stent implantation(T3),and 5 minutes after tracheal extubation(T4).The dosage of intraoperative propofol and remifentanil,cough and agitation during anesthesia recovery period,respiratory depression(SpO2＜90%),extubation time,postoperative puncture infection,VAS pain score 24 hours after surgery,and postoperative nausea and vomiting were recorded.Results Compared with group C,MAP was significantly decreased at T1 and T2,increased at T3 and T4,and HR was significantly decreased at T1,T3,and T4 in group D(P＜0.05).Compared with group C,the intraoperative use of propofol and remifentanil was significantly decreased,and the incidence of cough and agitation during anesthesia recovery period was significantly decreased in group D(P＜0.05).There was no statistically significant difference in the incidence of respiratory depression,ex-tubation time,VAS pain score 24 hours after surgery,and postoperative nausea and vomiting between the two groups.None of the recruited patients experienced infection at the puncture site.Conclusion Ultra-low dose dexmedetomidine can effectively maintain intraoperative hemodynamic stability,reduce the incidence of cough and agitation during anesthesia recovery period,and does not increase other postoperative adverse re-actions,enhancing anesthesia recovery quality in elderly patients undergoing CAS.

Clinical effect of procaterol hydrochloride combined with Xiaokechuan capsule in the treatment of cough variant asthma and its impact on serological indicators and airway function of children / 新乡医学院学报

Objective To explore the clinical effect of procaterol hydrochloride combined with Xiaokechuan capsule in the treatment of cough variant asthma(CVA)and its impact on serological indicators,airway function of children.Methods A total of 124 children with CVA admitted to the Zigong First People's Hospital from March 2019 to April 2022 were selected as the research subjects.The children were divided into control group and observation group according to random number table method,with 62 cases in each group.The children in the control group were treated with procaterol hydrochloride,and the children in the observation group were treated with procaterol hydrochloride and Xiaokechuan capsule for two weeks.The clinical efficacy of children was compared between the two groups after treatment.The cough scores during the day and night of children were evaluated in the two groups before and 2 weeks after treatment.The serum high mobility group protein B1(HMGB1),Toll like receptor 4(TLR4),nuclear factor-κB(NF-κB),interleukin-4(IL-4),interferon-γ(INF-γ)levels of children in the two groups were measured by enzyme linked immunosorbent assay before and 2 weeks after treatment,and the ratio of INF-γ/IL-was calculated.The 25％maximal expiratory flow-volume(MEF25),50％maximal expiratory flow-volume(MEF50),75％maximal expiratory flow-volume(MEF75)of children in the two groups were measured by lung function detector before and 2 weeks after treatment.The adverse reactions of children in the two groups were recorded during treatment.Results The total effective rate of children in the control group and observation group was 82.26％(51/62)and 95.16％(59/62),respectively;the total effective rate of children in the observation group was significantly higher than that in the control group(P＜0.05).There was no significant difference in cough scores during the day and night of children between the two groups before treatment(P＞0.05);the cough scores during the day and night of children after treatment were significantly lower than those before treatment in the two groups(P＜0.05);after treatment,the cough scores during the day and night of children in the observation group were significantly lower than those in the control group(P＜0.05).There was no significant difference in serum HMGB1,TLR4,NF-κB levels of children between the two groups before treatment(P＞0.05);the serum HMGB1,TLR4,NF-κB levels of children after treatment were significantly lower than those before treatment in the two groups(P＜0.05);after treatment,the serum levels of HMGB1,TLR4,and NF-κB of children in the observation group were significantly lower than those in the control group(P＜0.05).There was no significant difference in MEF25,MEF50,and MEF75 of children between the two groups before treatment(P＞0.05);the MEF25,MEF50,and MEF75 of children after treatment were significantly higher than those before treatment in the two groups(P＜0.05);after treatment,the MEF25,MEF50,and MEF75 of children in the observation group were significantly higher than those in the control group(P＜0.05).There was no significant difference in serum IL-4,INF-γ levels and the ratio of INF-γ/IL-4 of children between the two groups before treatment(P＞0.05);the serum IL-4 level of children after treatment were significantly lower than those before treatment,the INF-γ level and the ratio of INF-γ/IL-4 were significantly higher than those before treatment in the two groups(P＜0.05);after treatment,the serum IL-4 level of children in the observation group was significantly lower than that in the control group,the INF-γ level and the ratio of INF-γ/IL-4 were significantly higher than those in the control group(P＜0.05).All children had good drug tolerance during the treatment period,and no significant adverse drug reactions were observed.Conclusion The combination of Xiaokechuan capsules and procaterol hydrochloride has a significant therapeutic effect for pediatric CVA,and its mechanism of action may be related to the regulation of HMGB1-TLR4-NF-κB signal pathway.

Observation of azithromycin sequential therapy combined with pediatric massage on chronic cough after mycoplasma pneumoniae infection in children / 中国药师

Objective To explore the clinical efficacy of azithromycin sequential therapy(AST)combined with infantile massage(IM)in children with chronic cough after mycoplasma pneumoniae infection(CCAMP)phlegm-heat closed lung syndrome(PHCLS),and provide a new scheme for the clinical diagnosis and treatment of CCAMP.Methods The study retrospectively collected children with CCAMP-PHCLS diagnosed in the Second Affiliated Hospital of Guangzhou University of Chinese Medicine from March 2022 to March 2023.According to the treatment regimes,the children were divided into AST group and AST+IM group.The differences in cough symptoms integral and inflammatory factors(IL-6,PCT and CRP)between the two groups of CCAMP-PHCLS children were observed and compared.In addition,the total time to disappearance of clinical symptoms/signs,negative conversion of serum MP antibody(MP-IgM),total treatment response rate and incidence of adverse reactions were compared between the two groups.Results A total of 98 CCAMP-PHCLS children were collected,49 in each group.There were no significant differences between the AST+IM group and AST group in daytime cough symptoms points,nighttime cough symptoms points,serum IL-6 content,serum PCT content,and serum CRP content before treatment(P>0.05).After treatment,the daytime cough symptoms,serum IL-6,serum PCT and serum CRP in both groups significantly decreased compared to before treatment,and the above indicators in the AST+IM group were lower than those in the AST group(P<0.05).In terms of clinical characteristics,CCAMP-PHCLS children lost cough,fever and lung rales in the AST+IM group were shorter than the AST group(P<0.05),and the MP-IgM conversion rate was significantly higher than the AST group(P<0.05).In addition,in terms of clinical efficacy and safety,the total response rate of CCAMP-PHCLS in the AST+IM group was significantly higher than that in the AST group(P<0.05),while the incidence of adverse reactions of CCAMP-PHCLS in the AST+IM group was significantly lower than that in the AST group(P<0.05).Conclusion IM combined with AST has significant efficacy and high safety in children with CCAMP.The potential possible mechanism is that IM mediate production of inflammatory factors,and improves airway inflammation,thus alleviating clinical symptoms and signs.

Study on Data Mining of Cough Medical Records Treated by Xin'an Doctors Based on Syndrome-drugs / 中国中医药信息杂志

Objective To study the syndrome-drug association rule and the medication law of cough medical cases treated by Xin'an doctors using the data mining method;To provide reference for the treatment of cough.Methods The medical records of Xin'an doctors were collected and summarized.The frequency analysis,topology analysis and Louvain clustering analysis were used to conduct data mining research on syndrome types and prescriptions,and the relationship between syndrome types and prescriptions in cough treatment medical records and the law of drug composition in prescriptions were discussed.Results A total of 525 medical cases were included,and 26 kinds of syndromes were obtained,such as wind-heat invading lung,phlegm-dampness holding lung,lung qi deficiency.There were 243 kinds of Chinese materia medica involved,and 18 kinds of Chinese materia medica were with more than 70 times in frequency.The main properties were cold,warm and mild,and the main tastes were sweet,bitter and pungent,mainly in lung meridian,or the main properties were mild and warm and the main taste was sweet,mainly in spleen and stomach meridian.There were 25 categories in efficacy,which were mainly tonics and heat-clearing medicine.30 core medicines and core medicinal networks were obtained,such as Glycyrrhizae Radix et Rhizoma,Poria and Armeniacae Semen Amarum.The core drug combination of main syndromes of exogenous cough and excess syndrome and deficient syndrome of endogenous cough were obtained by syndrome-drug clustering analysis.Conclusion Xin'an doctors have distinctive characteristics in the diagnosis and treatment of cough diseases,and pay attention to the use of the methods of"strengthening the basic and promoting original qi","nourishing yin and protecting yin","cultivating the soil and promoting gold"and the inheritance of the prescriptions on the basis of cough relieving,phlegm resolving,and syndrome-based treatment.

Association between environmental exposure and hormone-sensitive cough in patients with chronic cough / 中华全科医师杂志

Objective:To explore the association between environment exposure and hormone-sensitive cough in patients with chronic cough.Methods:Clinical data of 197 patients with chronic cough visited outpatient clinic of the Second Affiliated Hospital of Guangzhou Medical University from June 2016 to June 2021 were retrospectively analyzed, including 130 cases of corticosteroid responsive cough (CRC, 66.0%) and 67 cases of non-corticosteroid responsive cough (NCRC, 34.0%). The association between living environment exposure and hormone sensitivity was examined with a binary logistic regression analysis.Results:Among 197 patients with chronic cough, there were 82 males (41.6%) and 115 females (58.4%). 75.1% (148/197) had a history of smoking, and 16.8% (33/197) had a history of allergies. 66.0% (130/197) lived in the city center, 18.3% (36/197) had a chemical factory around their place of residence, 11.2% (22/197) renovated their homes within the first six months of the disease, 15.7% (31/197) purchase new furniture, 54.3% (107/197) plant flowers and plants in their houses, 21.3% (42/197) keep pets in their houses, 79.2% (156/197) had lived in their houses for more than 2 years, 71.1% (140/197) had cockroaches in their houses, 16.2% (32/197) had mold in their houses, 83.3% (164/197) had a frequency of air conditioning cleaning exceeds 2 months per time.There were 130 patients (66.0%) with CRC and 67 patients (34.0%) with NCRC.Binary logistic regression analysis showed that living close to the main road ( OR=2.296, 95% CI: 1.350-3.904, P=0.002), living near chemical factories ( OR=3.322, 95% CI: 2.158-5.573, P<0.001), history of allergy ( OR=2.175, 95% CI: 1.165-4.058, P=0.015), purchasing new furniture within 6 months ( OR=2.828, 95% CI: 1.402-5.706, P=0.004), cotton and linen curtains ( OR=1.875, 95% CI: 1.038-3.388, P=0.037) were positively correlated with CRC; while down and wool pillowcases and quilts ( OR=0.142, 95% CI: 0.033-0.602, P=0.008; OR=0.207, 95% CI: 0.067-0.640, P=0.006) and low ventilation frequency ( OR=0.281, 95% CI: 0.131-0.603, P=0.001) were negatively correlated with CRC. Conclusion:Hormone-sensitive cough patients account the most of chronic cough cases, and there are differences in the living environment exposure between CRC and NCRC patients, which provides information for corresponding interventions to prevent and manage CRC.

Clinical Experience of Dispelling Wind,Clearing Heat and Resolving Dampness in the Treatment of Post-COVID-19 Cough / 浙江中医药大学学报

[Objective]To summarize the clinical experience of Professor WANG Zhen in the treatment of post-Corona Virus Disease 2019(COVID-19)cough.[Methods]Through the way of recording and sorting out medical cases,referring to domestic and foreign literature,this paper expounded the clinical experience of Professor WANG Zhen from three aspects:pathogenesis,prescription and medical cases.[Results]Professor WANG Zhen believes that the cause of post-COVID-19 cough is epidemic Qi,and the cause of the disease is wind and dampness-heat.The prescription experience is to dispel wind and relieve external symptoms,open the orifices and soothe the throat,clear heat and resolve dampness in tri-Jiao,and take into account both individual variability and symptoms and causes.Two medical cases are reported,the patient complained of post-COVID-19 cough,and Professor WANG Zhen mainly dispelled wind,cleared heat and resolved dampness,supplemented by nourishing Yin,invigorating the spleen,tonifying the kidney and dispersing blood stasis,with a comprehensive prescription and accurate curative effect.[Conclusion]Professor WANG Zhen accurately grasps the pathogenesis of post-COVID-19 cough,the treatment method is clear,the use of traditional Chinese medicine is rational,the therapeutic effect is obvious,and his clinical experience is valuable.

ZHANG Guoliang's Experience in Treating Cough in Convalescent Period of COVID-19 / 浙江中医药大学学报

[Objective]To introduce the clinical experience of Director ZHANG Guoliang,a famous and highly-experienced traditional Chinese medicine practitioner,in treating cough in convalescent period of Corona Virus Disease 2019(COVID-19)with exterior and interior differentiation therapy.[Methods]Based on the relevant discussions on epidemic diseases and coughs by doctors of all ages and the experience of more than 300 COVID-19 patients treated by Director ZHANG himself,the understanding of Director ZHANG on the etiology and pathogenesis of cough in convalescent period of COVID-19 was expounded,and his experience in treating cough in convalescent period of COVID-19 with exterior and interior differentiation therapy was summarized,and a typical case was interpreted.[Results]Director ZHANG believes that treatment of cough in convalescent period of COVID-19 should start from the disease location.The disease is located in the nose and pharynx,and the exterior treatment method is adopted,focusing on ventilating the lung and dissolving phlegm,dispelling wind and relieving cough.In clinical practice,a combination of Banxia Houpu Decoction and Zhisou Powder is commonly used,added or subtracted according to the symptoms.The disease is located in the trachea and lungs,and the interior treatment method is adopted,and the phlegm turbidity(phlegm heat)accumulation in lung syndrome focuses on clearing the lungs and dissolving phlegm,relieving cough and asthma,added or subtracted Maxing Shigan Decoction,Qianjin Weijing Decoction combined with Tingli Dazao Xiefei Decoction are often used.Qi and Yin deficiency syndrome should clear the lungs and dissolve phlegm,invigorate Qi and nourish Yin,generally use added or subtracted Zhuye Shigao Decoction combined with Shengmai Drink.The medical case attached belonged to the phlegm and pharyngeal syndrome,Director ZHANG first treated with ventilating the lung and resolving phlegm,dispelling wind and relieving cough,then strengthening the spleen and invigorating Qi,drying dampness and resolving phlegm,and finally achieved good results.[Conclusion]Director ZHANG's unique opinion and clinical experience in the treatment of cough in convalescent period of COVID-19 with exterior and interior differentiation therapy are worth learning and promoting.

Use of central neuromodulators in chronic cough / 中国临床药理学与治疗学

Chronic cough is a common condition that imposes significant physical, psychological, and social burdens on patients. Although chronic cough is often associated with underlying conditions such as asthma, gastroesophageal reflux disease, and eosinophilic bronchitis, some patients experience uncontrollable coughing that is difficult to attribute to a specific cause. Many of these patients exhibit clinical features of cough hypersensitivity syndrome, providing new directions for research into the treatment of chronic cough. As the pathophysiological mechanisms of chronic cough are further elucidated, treatment approaches for chronic cough are entering a new stage of development. This article summarizes and discusses the mechanisms and clinical evidence of central neuromodulators used in the treatment of chronic cough, suggesting promising clinical applications for these drugs in the future.

Experimental study on pharmacodynamics of Su Bei Zhi Ke granules (SBZKG) for acute tracheobronchitis / 中国临床药理学与治疗学

AIM: To observe the effect of Su Bei Zhi Ke granules (SBZKG) on acute tracheobronchitis (Syndrome of Wind-cold Attacking Lung). METHODS: Mouse ear swelling experiment and mouse abdominal capillary permeability experiment was used to observe its anti-inflammatory effect. Cough test in mice induced by ammonia water, and phlegm test in rats were used to observe the expectorant and antitussive effects of phenol red test in mice. We used the mortality rate experiment of infected mice to observe its antibacterial and antiviral effects. RESULTS: Compared with the contral group, the large and medium dose groups of SBZKG both reduced mouse auricle swelling (P<0.05) and increased swelling inhibition rate, reducing mouse abdominal capillary permeability (P<0.05, P<0.01). SBZKG can increase the phenol red sputum output in the respiratory tract of mice (P<0.01), prolong the cough incubation period of mice, reduce the number of coughs in mice (P<0.05, P<0.01), and increase the sputum output in rats (P<0.05, P<0.01). SBZKG can reduce the mortality rate of mice infected with bacteria and viruses. CONCLUSION: SBZKG has certain anti-inflammatory, antitussive, expectorant, antibacterial and antiviral effects, and has certain therapeutic effects on acute tracheobronchitis.

Regulation of Immune Balance by Traditional Chinese Medicine in Treatment of Cough Variant Asthma： A Review / 中国实验方剂学杂志

Cough variant asthma （CVA） is a chronic respiratory disease with cough as its main symptom. The occurrence of CVA is closely related to non-specific airway inflammation， and its pathogenesis involves environmental， genetic， immune， and other factors. In recent years， the advantages of traditional Chinese medicine （TCM） in the treatment of CVA have attracted the attention of experts and scholars in China and abroad， especially its prominent role in regulating immune balance， relieving cough symptoms in CVA patients， and reducing recurrence. T Helper cells 1 （Th1）， T helper cells 2 （Th2）， T helper cells 17 （Th17）， and regulatory T cells （Treg） are derived from CD4+ T cells. Immune imbalance of Th1/Th2 and Th17/Treg is a new hotspot in the pathogenesis of CVA and a potential key target in the treatment of CVA by TCM. Th cell subsets are in dynamic balance under physiological conditions， maintaining respiratory immune homeostasis in which pro-inflammatory cytokines and anti-inflammatory cytokines are balanced. Immature helper T cells （Th0） can be differentiated into Th1， Th2， Th17， Treg， and other cell subsets due to cytokine types in the microenvironment in the stage of CVA maturation. The proliferation of Th2 cells leads to eosinophilic airway inflammation. Excessive differentiation of Th17 cells induces neutrophil airway inflammation. Th1/Th2 and Th17/Treg cells are mutually restricted in number and function， and the immune imbalance of Th1/Th2 and Th17/Treg is easy to aggravate the generation of inflammatory response. Restoring immune balance is particularly important for the airway anti-inflammatory therapy of CVA. In this paper， the imbalance of Th1/Th2 and Th17/Treg and the pathogenesis of CVA were systematically expounded. Meanwhile， the latest research on the regulation of immune imbalance by TCM compound， single TCM， and its effective ingredients in the treatment of CVA was reviewed. It provides ideas and references for revealing the scientific connotation of TCM regulating immune balance therapy of CVA， as well as the development of clinical treatment and basic research of CVA.

Chinese expert consensus on the diagnosis and treatment of chronic cough after lung surgery / 中国胸心血管外科临床杂志

@# In recent years, the number of lung surgeries has increased year by year, and the number of patients with postoperative cough has also increased gradually. Chronic cough after lung surgery seriously affects patients' quality of life and surgical outcome, and has become one of the clinical problems that clinicians need to solve. However, there is currently no guideline or consensus for the treatment of chronic cough after lung surgery in China, and there is no standardized treatment method. Therefore, we searched databases such as PubMed, Web of Science, CNKI, and Wanfang databases ect. from 2000 to 2023 to collected relevant literatures and research data, and produced the first expert consensus on chronic cough after lung surgery in China by Delphi method. We gave 11 recommendations from five perspectives including timing of chronic cough treatment, risk factors (surgical method, lymph node dissection method, anesthesia method), prevention methods (preoperative, intraoperative, postoperative), and treatment methods (etiological treatment, cough suppressive drug treatment, traditional Chinese medicine treatment, and postoperative physical therapy). We hope that this consensus can improve the standardization and effectiveness of chronic cough treatment after lung surgery, provide reference for clinical doctors, and ultimately improve the quality of life of patients with chronic cough after lung surgery.

Metoprolol for prevention of bucking at orotracheal extubation: a double-blind, placebo-controlled randomised trial

Abstract Background: Respiratory responses to extubation can cause serious postoperative complications. Beta-blockers, such as metoprolol, can interfere with the cough pathway. However, whether metoprolol can effectively control respiratory reflexes during extubation remains unclear. The objective of this study is to evaluate the efficacy of intravenous metoprolol in attenuating respiratory responses to tracheal extubation. Methods: Randomized, double-blinded, placebo-controlled trial. Setting: Tertiary referral center located in Brasília, Brazil. Recruitment: June 2021 to December 2021. Sample: 222 patients of both sexes with an American Society of Anesthesiologists (ASA) physical status I-III aged 18-80 years. Patients were randomly assigned to receive intravenous metoprolol 5 mg IV or placebo at the end of surgery. The primary outcome was the proportion of patients who developed bucking secondary to endotracheal tube stimulation of the tracheal mucosa during extubation. Secondary outcomes included coughing, bronchospasm, laryngospasm, Mean Blood Pressure (MAP), and Heart Rate (HR) levels. Results: Two hundred and seven participants were included in the final analysis: 102 in the metoprolol group and 105 in the placebo group. Patients who received metoprolol had a significantly lower risk of bucking (43.1% vs. 64.8%, Relative Risk [RR = 0.66], 95% Confidence Interval [95% CI 0.51-0.87], p = 0.003). In the metoprolol group, 6 (5.9%) patients had moderate/severe coughing compared with 33 (31.4%) in the placebo group (RR = 0.19; 95% CI 0.08-0.43, p < 0.001). Conclusion: Metoprolol reduced the risk of bucking at extubation in patients undergoing general anesthesia compared to placebo.

Exploring the Feasibility of a Comprehensive Screening for Voice and Swallowing Function in Post-Extubation Patients: A Pilot Study

Objectives: This pilot study aimed to identify and test a battery of time-efficient and cost-effective voice and swallowing screening tools for post-extubated patients in Chile. Methods: A panel of four experts selected and rated voice and swallowing screening tools. Seven measures were selected: smoothed cepstral peak prominence (CPPS) and maximum phonation time (MPT) for voice assessment, Volume-Viscosity Swallow Test (V-VST) for swallowing, voluntary and reflex peak cough flow for cough assessment, Eating Assessment Tool-10 (EAT-10), and Vocal Symptom Scale (VoiSS) for patient-reported outcomes. These tools were applied to four post-extubation patients within 48-72 hours post-hospital discharge, alongside the assessment of 17 matched controls. Results: Post-extubation patients showed significantly shorter MPT, lower CPPS values, increased V-VST dysphagia signs, reduced voluntary peak cough flow, and more pronounced symptoms on both the VoiSS and EAT-10 compared to controls. Limitations: The study had a modest sample size and relied solely on clinical screening tools. Value: This pilot study suggests a feasible and cost-effective approach to voice and swallowing screening for post-extubation patients, valuable in resource-constrained settings. Conclusion: While these accessible tools are not gold-standard assessments, they offer valuable insights and can guide future research. This study underscores the potential of selected tools in facilitating early detection of voice and swallowing disorders in post-extubation patients.

Objetivos: Este estudio piloto tuvo como objetivo identificar y probar una batería de herramientas de detección de problemas de voz y deglución que fueran eficientes en cuanto a tiempo y costo para pacientes chilenos postextubados. Métodos: Un panel de cuatro expertos seleccionó y evaluó herramientas de detección de voz y deglución. Se seleccionaron siete medidas: prominencia de pico cepstral suavizado (CPPS) y tiempo máximo de fonación (TMF) para la evaluación de la voz, prueba de volumen-viscosidad (V-VST) para la deglución, flujo máximo voluntario y reflejo de la tos para evaluar la tos, Eating Assessment Tool-10 (EAT-10) y la Escala de Sintomas Vocales (ESV) para los resultados informados por los pacientes. Estas herramientas se aplicaron a cuatro pacientes postextubados (48-72 horas), junto con la evaluación de 17 controles pareados. Resultados: Los pacientes postextubados mostraron un TMF y CPPS significativamente más bajos, aumento de los indicios de disfagia en la V-VST, reducción del flujo máximo de la tos y síntomas más pronunciados tanto en la ESV como en la EAT-10 en comparación con los controles. Limitaciones: El estudio tuvo un tamaño de muestra reducida y se basó únicamente en herramientas de detección clínica. Valor: Este estudio piloto sugiere un enfoque factible y rentable para la detección de problemas de voz y deglución en pacientes postextubados, valioso en entornos con recursos limitados. Conclusión: Aunque ese abordaje no sustituye a las evaluaciones de referencia, ofrece información valiosa y puede guiar futuras investigaciones que busquen facilitar la detección temprana de los trastornos de la voz-deglución en pacientes postextubados.

Mecánica Tusígena / Cough Mechanics

El control neurológico de la tos o la neurofisiología de la tos, implica una serie de eventos complejos en el sistema nervioso que coordinan y desencadenan este reflejo protector pulmonar. Esta intrincada red de señales nerviosas y coordinación muscular se origina en los receptores de la tos, pasa por el centro de la tos en el bulbo raquídeo y finalmente activa los músculos necesarios para la adecuada eliminación del agente irritante. Este mecanismo involucra, la detección del estímulo por receptores especializados, transducción de señales que viajan a lo largo de fibras nerviosas aferentes hacia el sistema nervioso central, centro integrador a nivel del bulbo raquídeo, en el centro de la tos es donde se procesa las señales de los receptores y se coordina la respuesta. La integración de las señales y la respuesta radica en este centro de la tos y en la corteza cerebral quien regula y modula la tos. El control neuronal cortical de la tos implica la participación consciente y voluntaria de la corteza cerebral en la percepción, regulación y adaptación de la tos. La coordinación muscular requiere que la señal viaje por vías nerviosas eferentes motoras hacia los músculos involucrados, la contracción muscular se integra en una secuencia específica que desencadena las fases de la tos, inspiración máxima, compresión y expulsiva.

The neurological control of cough, or the neurophysiology of cough, involves a series of complex events in the nervous system that coordinate and trigger this lung protective reflex. This intricate network of nerve signals and muscle coordination originates from the cough receptors, passes through the cough center in the medulla oblongata, and finally activates the muscles necessary for proper elimination of the irritant. This mechanism involves the detection of the stimulus by specialized receptors, transduction of signals that travel along afferent nerve fibers towards the central nervous system, integrating center at the level of the medulla oblongata, in the cough center is where the signals are processed. receptors and the response is coordinated. The integration of signals and response resides in this cough center and in the cerebral cortex, which regulates and modulates coughing. Cortical neural control of cough involves the conscious and voluntary participation of the cerebral cortex in the perception, regulation, and adaptation of cough. Muscle coordination requires that the signal travel through efferent motor nerve pathways to the muscles involved; muscle contraction is integrated into a specific sequence that triggers the cough, maximum inspiration, compression, and expulsive phases.

Conocimiento y manejo de cuidados respiratorios especializados en pacientes con enfermedades neuromusculares en unidades de cuidado intensivo: aproximación por encuesta a profesionales de la salud

Introducción: En las enfermedades neuromusculares la disminución de la capacidad vital se relaciona con dismunición de la capacidad tusígena y luego ventilatoria, la combinación de ambas genera complicaciones graves por falla ventilatoria. En los pacientes que son intubados, limita la extubación, sino se realizan cuidados respiratorios especializados. El conocimiento y aplicación de los profesionales que atienden a estos pacientes en cuidados intensivos resulta esencial. Objetivos: Reportar el conocimiento y aplicación especializada de cuidados respiratorios en enfermedades neuromusculares en las Unidades de Cuidados Intensivos. Materiales y métodos: Estudio cualitativo, descriptivo de corte transversal, no probabilístico, a criterio. La población accesible fueron profesionales de la Salud de las Unidades de Cuidados Intensivos, y el análisis de las respuestas de una encuesta estructurada, enviada a distintos profesionales a nivel mundial. Resultados: Se incluyeron los cuestionarios de 41 profesionales, el 34% de los profesionales reportaron la utilización regular de Asistente Mecánico de la Tos; 22% refirieron la utilización regular de apilamiento de aire; 31% reportaron la utilización regular de Asistencia Ventilatoria No Invasiva, 56.1% de los profesionales afirmaron conocer la diferencia entre Ventilación No Invasiva y Soporte Ventilatorio No Invasivo, 34% de los profesionales refirieron tener formación especializada en el área. Conclusión: Pese a existir una alta proporción de profesionales con conocimiento especializado, un grupo importante no los aplica rutinariamente. La justificación es principalmente por la dificultad de adquisición y financiación de los equipos necesarios.

Introduction: In neuromuscular diseases, the decrease in vital capacity relates to decreased coughing and then ventilatory capacity, the combination of both generating serious complications due to ventilatory failure. In intubated patients, the extubation process is difficult unless specialized respiratory care is provided. The knowledge and treatment application of the professionals who care for these patients in intensive care is of outmost importance. Objectives: Report the knowledge and specialized application of respiratory care in neuromuscular diseases in Intensive Care Units. Materials and methods: Qualitative, descriptive, cross-sectional, non-probabilistic study, at criteria. The accessible population were Health professionals from the Intensive Care Units, and the analysis of the responses of a structured survey, sent to different professionals worldwide. Results: The questionnaires of 41 professionals were included, 34% of the professionals reported the regular use of the Mechanical Cough Assistant; 22% reported the regular use of air stacking; 31% reported the regular use of Non-Invasive Ventilatory Assistance. 56.1% of the professionals stated that they knew the difference between Non-Invasive Ventilation and Non-Invasive Ventilatory Support, 34% of the professionals reported having specialized training in the area. Conclusion: Despite the existence of a high proportion of professionals with specialized knowledge, an important group does not routinely apply them. The justification is mainly due to the difficulty of acquiring and financing the necessary equipment.