Effect of traditional Chinese and western medicine combined with lung rehabilitation training on pulmonary function in patients with chronic obstructive pulmonary disease complicated with chronic cor pulmonale and evaluation of efficacy.

OBJECTIVES: To investigate the effect and efficacy of traditional Chinese and western medicine combined with lung rehabilitation training on pulmonary function in patients with chronic obstructive pulmonary disease(COPD) complicated with chronic cor pulmonale. METHODS: Totally 200 COPD patients with chronic cor pulmonale in our hospital were selected as research objects. The 100 patients in control group were managed by conventional western medicine combined with lung rehabilitation training, and another 100 patients in observation group were treated with traditional Chinese and western medicine combined with lung rehabilitation training. The pulmonary function (modified British Medical Research Council (mMRC) Dyspnea Scale, COPD Assessment Tests (CAT), BODE index (body-mass, airflow obstruction, dyspnea, and exercise capacity), pulmonary function-related indexes (FEV1, FVC, FEV1/FVC, and FEV1/Pred), and blood gas analysis indicators (paO2, PaCO2, SaO2 and PH value)) and curative effect (the effectiveness, Satisfaction Test, Quality of Life Score, and TCM Syndrome Integral) before and after treatment within or between groups were compared. RESULTS: Before treatment, the pulmonary function and curative effect (Quality of Life Score and TCM Syndrome Integral) parameters showed no significant difference between the two groups, which indicated there was a comparability between the two groups. After treatment, all parameters of pulmonary function and curative effect displayed better results in observation group than in control group. Compared with the results before treatment, pulmonary function and curative effect revealed better in both groups after treatment, and more visible improvement trends were found in observation group. CONCLUSIONS: Traditional Chinese and western medicine combined with lung rehabilitation training displayed better results on lung function and curative effect than conventional western medicine combined with lung rehabilitation training in patients with COPD complicated with chronic cor pulmonale (Tab. 8, Ref. 43). Text in PDF www.elis.sk Keywords: traditional Chinese and western medicine combined, lung rehabilitation training, chronic obstructive pulmonary disease, pulmonary function, curative effect.

Serum apelin as a novel non-invasive marker for subclinical cardiopulmonary complications in children and adolescents with sickle cell disease.

BACKGROUND: Cardiovascular involvement represents a leading cause of mortality and morbidity in sickle cell disease (SCD). Apelin is a peptide involved in the regulation of cardiovascular function. AIM: To determine serum apelin among 40 children and adolescents with SCD compared with 40 healthy controls and assess its relation to markers of hemolysis, iron overload as well as cardiopulmonary complications. METHODS: SCD patients, in steady state and asymptomatic for heart disease, were studied stressing on hydroxyurea/chelation therapy, hematological profile, serum ferritin and apelin levels. Full echocardiographic study including assessment of biventricular systolic function and pulmonary artery pressure was done. RESULTS: Apelin levels were significantly lower in SCD patients compared with controls (P<0.001). Cardiopulmonary complications were encountered in 30% of patients. Apelin was significantly decreased among patients with cardiopulmonary disease (P=0.006) whether those at risk of pulmonary hypertension (P=0.018) or patients with heart disease (P=0.043). Hydroxyurea-treated patients had higher apelin levels than untreated ones (P=0.001). Apelin was negatively correlated to lactate dehydrogenase, indirect bilirubin, serum ferritin, end systolic diameter, tricuspid regurgitant jet velocity, right ventricle systolic pressure, pulmonary vascular resistance and tissue Doppler imaging S wave. Apelin cutoff value of 1650ng/L could significantly detect the presence of cardiopulmonary complications in SCD with 90.9% sensitivity and 72.4% specificity. CONCLUSION: Apelin is a promising marker for screening of SCD patients at risk of cardiopulmonary disease because it is altered during the early subclinical stage of cardiac affection. A combination of apelin and echocardiography provides a reliable method to assess cardiopulmonary affection in young SCD patients.

[Investigation on response of the patient-reported outcome scale of the main-symptoms of chronic obstructive pulmonary disease complicated with pulmonary heart disease].

OBJECTIVE: To select appropriate descriptors for response of the patient-reported outcome (PRO) scale for the main symptoms of patients with chronic obstructive pulmonary disease (COPD) complicated with pulmonary heart disease. METHODS: A cross-sectional investigation was carried out. Five equidistant ordinal descriptive words in the PRO scale of main symptoms for COPD complicated with pulmonary heart disease were selected. There were 32 alternative words in the questionnaire. Thirty respondents were required to place each descriptive word on a 10-centimeter line according to where they considered each descriptive word should be placed. Then, the line was measured by ruler; average, standard deviation and median were calculated by excel software; the authors finally chose the five equidistant words which accurately reflect the degree of main symptoms. RESULTS: The five most appropriate descriptive words were selected; they were "never", "seldom", "half-partly sometimes", "very often" and "always". CONCLUSION: These selected decorated words are suitable for the PRO scale for patients with COPD complicated with pulmonary heart disease.

[Electrostimulation of the skeletal muscles in rehabilitation of patients with chronic cor pulmonale: effects on arrhythmogenesis and vegetative status].

AIM: To investigate effects of electrostimulation of the skeletal muscles (EMS) on vegetative status and arrhythmogenesis in patients with chronic cor pulmonale (CCP). MATERIAL AND METHODS: 101 CCP patients (age 59 +/- 1.2 years) were examined with loading tests, 24-h ECG and blood pressure monitoring to assess disturbances and variability of cardiac rhythm, blood pressure. The study group patients (n = 54) have undergone EMS of large skeletal muscles in addition to standard rehabilitation. The control group (n = 47) received standard treatment. RESULTS: A course of EMS raised strength of the muscles of the upper and lower limbs and exercise tolerance of the lower limb muscles in the study group, bicycle exercise and 6-min walk tolerance, reduced the number of atrial and ventricular extrasystoles. The test group lowered the low-frequency component at night (p = 0.021) and in maximal spectrum power reflecting enhancement of parasympathetic activity in this time. CONCLUSION: EMS had no arrhythmogenic action, but had a positive effect on vegetative status of CCP patients.

Factores pronósticos en la EPOC / Prognostic factors in Chronic Obstructive Pulmonary Disease

Prolongar la supervivencia de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) es, y ha sido durante décadas, un objetivo complicado. Sin embargo, poco a poco esta percepción empieza a cambiar. De la mano de un mejor conocimiento etiopatogénico de la enfermedad, del análisis de las causas de muerte y sobre todo de la identificación de diversos factores pronósticos, se van dando pasos firmes que permiten afrontar el futuro con mayor optimismo. La presente revisión pretende analizar de forma pormenorizada los principales determinantes pronósticos que se han descrito en la literatura médica y valorar sus posibles implicaciones terapéuticas. Tradicionalmente se ha aceptado que el volumen espiratorio forzado en el primer segundo y su descenso acelerado a lo largo del tiempo era uno de los mejores predictores de mortalidad. Este hecho condicionó durante décadas el objetivo terapéutico en la EPOC. Sin embargo, hoy sabemos que la EPOC es una enfermedad con múltiples dimensiones, algunas de las cuales tienen importantes consecuencias pronósticas. La hiperinsuflación pulmonar, la tolerancia al esfuerzo, las exacerbaciones, la comorbilidad y las manifestaciones sistémicas, especialmente las resultantes de la esfera cardiovascular, son dimensiones que en los últimos años se han revelado como potentes predictores de muerte. El sustrato inflamatorio, tanto local como sistémico, parece estar detrás de muchas de estas manifestaciones y por ello merece especial consideración. Estos nuevos factores pronósticos tienen la virtud de ser potencialmente modificables, lo que subraya la necesidad de planificar intervenciones terapéuticas orientadas a revertir sus efectos cambiando de alguna forma la estrategia tradicional

Efforts over the last few decades to extend the life expectancy of patients with chronic obstructive pulmonary disease (COPD) have faced difficulties, but our perception of the problems involved is now starting to change. Improvements in our understanding of the pathogenic and etiological mechanisms of the disease, analysis of the causes of death, and, in particular, identification of the relevant prognostic factors have resulted in firm advances that allow us to face the future with greater optimism. The aim of this review is to provide a detailed analysis of the chief prognostic factors described in the literature and to evaluate the therapeutic implications of these findings. The traditional view maintained that the accelerated decline in forced expiratory volume in 1 second over time was one of the best predictors of mortality, and this belief has for decades determined the strategies used to treat COPD. However, we now know COPD to be a multidimensional disease and are aware that some of its other manifestations have important prognostic implications. Lung hyperinflation, exercise tolerance, exacerbations, comorbidity, and systemic manifestations­in particular those related to the cardiovascular system­have all been shown in recent years to be strong predictors of mortality. The inflammatory substrate, whether local or systemic, merits special consideration because it appears to be the cause of many of these manifestations. These newly identified prognostic factors are of great interest in that it may be possible to moderate their influence, a circumstance that highlights the need to change the traditional treatment approach and devise therapeutic interventions oriented towards reversing the effects of these factors

Barotrauma and decompression illness of the inner ear: 46 cases during treatment and follow-up.

INTRODUCTION: Diving accidents affecting the inner ear are much more common than was once thought. Among the 319 patients treated in our clinic between January 2002 and November 2005, 46 cases involved 44 divers with symptoms of acute inner ear disorders. The objective of the present article is to investigate the symptoms of the acute disorders and assess any residual damage. STUDY DESIGN: Retrospective case analysis. MATERIALS AND METHODS: The medical records were used to study the cases of 18 divers treated for inner ear decompression illness on 20 occasions and 26 divers who had inner ear barotrauma. The symptoms of the disorder at the beginning of treatment, latency period before the first therapeutic measures, kind of initial therapy, symptoms after the accident, and hearing and balance functions at the last examination in our clinic were assessed. Divers with inner ear decompression illness were examined via means of transcranial or carotid Doppler ultrasonography for the presence of a vascular right-to-left (R/L) shunt. RESULTS: Of 18 divers with inner ear decompression illness, 17 reported vertigo as the main symptom. In one diver, the inner ear decompression illness was manifested bilaterally. The divers with inner ear decompression illness had been treated with hyperbaric oxygen therapy in 14 of 20 cases; the average latency period before the start of therapy was 40 hours (median, 10 h). In 15 (83%) of 18 patients, a large R/L shunt was detected, and in 14 (78%) of 18 patients, residual cochleovestibular damage was detected. Only 9 of 26 patients with inner ear barotrauma mentioned feeling dizzy, and in no patient was vertigo the main symptom. Twenty-one patients complained of tinnitus, whereas 20 complained of hearing loss. The hearing loss ranged from an unobtrusive difference of 10 dB between the ears up to complete deafness. Three patients were subjected to tympanoscopy because of suspected rupture of the round window membrane. Of patients with inner ear barotrauma, 78% had residual cochleovestibular damage. CONCLUSION: We describe for the first time a patient with bilateral manifestation of inner ear decompression illness. Inner ear decompression illness is frequently associated with a R/L shunt; therefore, after a diving accident, the patient's fitness to dive should be assessed via a specialist in diving medicine. Both decompression illness and barotrauma of the inner ear result in residual cochleovestibular damage in more than three of four patients.

[Clinical study of pulmonary encephalopathy with integrated traditional Chinese and Western medicine].

OBJECTIVE: To explore the clinical effectiveness of integrated traditional Chinese and Western medicine (TCM-WM) on pulmonary encephalopathy. METHODS: Eight three patients of pulmonary encephalopathy were allocated randomly into the TCM-WM group and the control group. The therapeutic method for the control group including continuous low flow oxygen intake with mechanical ventilation available when necessary, antiasthmatics and expectorants improve ventilation, sufficient and combined intravenous infusion of antibiotics, and prescription of diuretics for dehydration under the therapeutic principle of mild, small dosage, combined and intermittent in use. For the TCM-WM group, besides above-mentioned medication, Chinese medicine of clear up the Heat and toxin, tranquilizing, restore consciousness and induce resuscitation, bactericiding and expelling their toxin. The anti-pulmonary-encephalopathy injection was given as soon as possible. RESULTS: The total effective rate of the TCM-WM group reached 83.0% and was higher than that of the control group (63.9%) significantly (P < 0.05). Time for restoring consciousness in the former was also shorter than that of the latter significantly (P < 0.01). CONCLUSION: This study provided both method and experience for the treatment of pulmonary encephalopathy with TCM-WM.

Treatment of acute exacerbation of chronic cor pulmonale with fei xin ling syrup.

30 cases of chronic cor pulmonale with acute exacerbation were treated with Fei Xin Ling Syrup compared with 30 similar cases treated with Western modern drugs as controls. The Chinese herbal drug modality was found to be superior to the administration of modern drugs in the control group in overall therapeutic effects, with regard to the symptoms of coughing, tachypnea, phlegm production, edema, and the prevention of heart and respiratory failure. Rheological studies in part of the patients also indicated that the Chinese herbal prescription improved the blood circulation.

[Calcium and phosphorus levels in serum and urine of patients with chronic cor pulmonale complicated with respiratory insufficiency].

The levels of Ca and P in serum and urine, and the renal functions: Ccr. TRCa and TRP were determined in 43 patients with chronic Cor Pulmonale complicated with respiratory insufficiency. The results showed that the level of SCa decreased in 72.1% (31/43) and after correction by serum protein 58.1% (25/43). The SP was normal in 60.5%, (26/43). UCa and UP reduced in 62.8% (27/43) and 88.4% (38/43) respectively.

[Ventricular arrhythmias in patients with cor pulmonale].

This paper reported the results of 24 hours continuous ECG, day time and overnight arterial blood gas/pH and serum electrolytes in 20 patients with cor pulmonale, in order to investigate the rule of changes of ventricular arrhythmias (VA). The results were as follows: (1) Incidence of VA in 24 hours Holter Monitoring was 100%. (2) Frequent VPBs were increased significantly in period of acute attack (40%, P less than 0.05). (3) Non-sustained VT in the nocturnal (40%) was more than the day time in period of attack (P less than 0.05). (4) Relationship between VA and variables in period of attack: PaCO2 (r = 0.90) greater than arterial blood pH (r = -0.87) greater than PaO2 (r = -0.63); in relieved period VA were only related to serum potassium (r = -0.86). The authors speculated the severity of VA in period of attack was related with worse of arterial blood gas/pH, cardiac dysfunction and compensated enhance of sympathetic activity. It seems that the view accorded with theory of Yin-Yang in TCM.

Arrhythmias in patients with chronic obstructive pulmonary disease.

Cardiac arrhythmias are commonly associated with chronic obstructive lung disease and these arrhythmias can impair arterial blood oxygenation. The etiology of the arrhythmias is multifactorial. The treatment of the arrhythmias is largely the treatment of the deranged physiology and the underlying pulmonary disease. The association of arrhythmias with chronic obstructive lung disease portends a poor prognosis.

How to detect and treat arrhythmias in chronic lung disease.

Investigators suspect that arrhythmias are behind the high incidence of sudden death in patients with severe chronic bronchitis and emphysema. Continuous electrocardiographic monitoring may help boost survival statistics, since it has repeatedly shown its ability to detect irregularities that standard ECGs miss. So-called benign arrhythmias, such as atrial fibrillation, frequent ventricular premature contractions, and atrial flutter, are anything but harmless. In patients whose heart and lung function is already impaired by severe airway obstruction, these rhythm disorders can rapidly progress to a fatal cardiac arrest. Deciding how to treat the arrhythmia depends on the type of disturbance and the patient's clinical status. Direct-current shock or antiarrhythmic drugs can turn the tide in a desperately ill patient with acute respiratory failure. Correction of coexisting metabolic and ventilatory disorders often is crucial to successful therapy.