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Treatment of Larynxderived Cough with Modified Zhisousan

目的：觀察古方止嗽散加味治療喉源性咳嗽的療效。方法：采用加味止嗽散治療喉源性咳嗽116例，并設西藥對照組113例。結果：治療組有效率87.3%，對照組有效率68.2%，兩組比較有顯著差異(Plt;0.01)。治療組不良反應例數為零；對照組不良反應例數約占10.2%。結論：加味止嗽散具有疏風宣肺、清熱解毒、利咽祛痰、益氣養陰、扶正祛邪、抗病毒、抗菌、抗炎和增強免疫功能等功效，為治療喉源性咳嗽的有效方藥。

Cough due to gastroesophageal reflux

胃食管反流(GER)是指胃酸和其他胃內容物反流進入食管，正常人存在一定程度的反流，稱為生理性反流。GER 可以引起臨床癥狀，甚至組織病理學的改變。當出現胃燒灼、反酸、胸骨后疼痛等臨床癥狀和(或)組織病理學的改變時，也被稱為胃食管反流病(GERD)。以慢性咳嗽為主要臨床表現的GERD稱為胃食管反流性咳嗽(GERC)。2006年蒙特利爾會議提出了反流性咳嗽綜合征的定義 。GERC 是慢性咳嗽的常見原因，發生率為5％~41％ ，存在一定的地區差異。歐美報道極為常見，而日本極為少見，國內 GERC占慢性咳嗽病因的12％。

咳嗽、活動后氣促伴左側胸腔積液

Chinese expert consensus on the diagnosis and treatment of chronic cough after lung surgery

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.

Therapeutic Effect of BCG-PSN on Children CVA

目的：觀察卡介菌多糖核酸注射液在小兒咳嗽變異性哮喘治療應用的療效。方法：將本科40例咳嗽變異性哮喘患兒，隨機分為治療組和對照組(各20例)。治療組給予BCG-PSN+必可酮氣霧劑，對照組：給予單用必可酮氣霧劑吸入，連續吸入6周，觀察療效，并進行統計學處理。結果：治療組總有效率為95%，對照組總有效率為70%，統計學處理總有效率有顯著差異(Plt;0.01)。結論：卡介菌多糖核酸(polysaccharide nucleic acidfraction of BCG，BCG-PSN)能有效地控制咳嗽變異性哮喘(CVA)的呼吸道的反復感染，提高免疫功能；與必可酮配合，能有效地控制CVA的復發。

Chronic cough and risk of cerebrovascular disease: a prospective cohort study

Objective To explore the association between cough patterns and cerebrovascular disease risk, and to provide epidemiological evidence for the early diagnosis and prevention of cerebrovascular disease. Methods During the period from 2010 to 2012 in Guizhou Province, a multi-stage proportional stratified cluster sampling method was used to recruit people with the inclusion criteria of the study into a cohort and a baseline questionnaire for demographic information, lifestyle, and disease history was administered. The incidence of cerebrovascular disease was followed up from 2016 to 2020. Results A total of 4804 subjects were followed up, and 4589 (53.5% were female) subjects were enrolled in final investigation. Compared with non-chronic cough group, there was no statistical significance in the risk of cerebrovascular diseases (P>0.05), however, chronic cough (the risk ratio was 2.00 and the 95% confidence interval ranged from 1.08 to 3.69) was twice as likely to develop cerebrovascular disease as non-cough. Conclusions People with chronic cough are more likely to develop cerebrovascular disease than people without cough. More attention to the management and control of cough should be paid to avoid chronic cough, so as to reduce the risk of cerebrovascular diseases.

臨床病理討論——反復咳嗽、發熱、肺部陰影8個月

病歷摘要 患者女性，37歲。因“反復咳嗽20 d，發熱15 d”于2008年8月6日第一次入院。患者于2008年1月因“發熱、咳嗽”住當地醫院，胸部CT示左上肺占位及右下肺背段陰影，行“左上肺葉切除術”。術后當地醫院病理結果考慮炎性假瘤。入我院前20 d無誘因出現咳嗽，呈陣發性干咳，咳嗽劇烈時伴右側胸痛。15 d前出現發熱,體溫38 ℃左右，發熱時伴明顯頭痛。在當地醫院就診，查血常規：白細胞（WBC）總數8.11×109/L，中性粒細胞（N）0.785。胸部CT檢查：①左上肺術后；②右上肺多發團塊狀及斑片狀高密度影。痰培養檢出“白色念珠菌”。給予乳酸左氧氟沙星、頭孢替安、氟康唑治療無好轉來我院診治。否認鴿糞接觸史。

Risk factors and prevention strategies for chronic cough after robotic versus video-assisted thoracic surgery in non-small cell lung cancer patients

ObjectiveTo analyze risk factors for chronic cough after minimally invasive resection of non-small cell lung cancer (NSCLC) and explore the possible prevention measures.MethodsA total of 128 NSCLC patients who received minimally invasive resection in 2018 in our hospital were enrolled, including 63 males and 65 females with an average age of 60.82±9.89 years. The patients were allocated into two groups: a robot-assisted thoracic surgery (RATS) group (56 patients) and a video-assisted thoracic surgery (VATS) group (72 patients). Chronic cough was assessed by visual analogue scale (VAS), meanwhile, other perioperative indicators were compared between the two groups. Univariate and multivariate logistic regression analyses were performed to identify risk factors for postoperative chronic cough and explore the prevention strategies.ResultsOverall, 61 (47.7%) patients were diagnosed with chronic cough after surgery, including 25 (44.6%) patients in the RATS group and 36 (50.0%) patients in the VATS group, and the difference was not statistically significant (P>0.05). Compared with the VATS group, the RATS group got shorter endotracheal intubation time (P=0.009) and less blood loss (P<0.001). The univariate analysis showed that age (P=0.014), range of surgery (P=0.021), number of dissected lymph nodes (P=0.015), preoperative cough (P=0.006), endotracheal intubation time (P=0.004) were the influencing factors for postoperative chronic cough. The multivariate analysis showed that age <57 years (OR=3.006, 95%CI 1.294-6.986, P=0.011), preoperative cough (OR=3.944, 95%CI 4.548-10.048, P=0.004), endotracheal intubation time ≥172 min (OR=2.316, 95%CI 1.027-5.219, P=0.043), lobectomy (OR=2.651, 95%CI 1.052-6.681, P=0.039) were the independent risk factors for chronic cough.ConclusionThere is no statistical difference in postoperative chronic cough between the RATS and VATS groups. The RATS group gets less blood loss and shorter endotracheal intubation time. Patients with younger age (<57 years), preoperative cough, lobectomy, and longer duration of endotracheal intubation (≥172 min) are more likely to have chronic cough after surgery.

Differential gene expressions in peripheral blood mononuclear cells between Th2-driven classical asthma and cough variant asthma

Objective To reveal the differences in gene expression levels between Th2-driven classical asthma (CA) and Th2-driven cough variant asthma (CVA) in order to investigate the pathogenesis of asthma further. Methods Clinical data were collected from asthmatic patients in the Department of Respiratory and Critical Care of Sichuan Provincial People's Hospital from June 1, 2018, to December 31, 2019. The healthy control (HC) group was healthy adults from the physical examination center. Gene expression of peripheral blood mononuclear cells (PBMCs) in the CA group, CVA group, and HC group was determined by full-length transcriptome sequencing. Differential genes were screened by GO, KEGG analysis, and protein-protein interaction (PPI) network analysis. The results of interaction network analysis were visualized by Cytoscape. Finally, the candidate genes were verified by real-time quantitative polymerase chain reaction (RT-PCR). ResultsA total of 31 patients with asthma were included in the study, including 20 patients in the CA group and 11 patients in the CVA group. According to serum total IgE > 60 IU/mL and fractional exhaled nitric oxide (FeNO) > 40 ppb as the screening condition, 9 cases of Th2-driven CA and 5 cases of Th2-driven CVA were screened for analysis. Gene expression analysis showed 300 differentially expressed genes between the Th2-driven CA group and the Th2-driven CVA group, among which 155 genes were up-regulated, and 145 were down-regulated. GO enrichment analysis showed that differential genes were mainly enriched in drug response, nitrogen compound biosynthesis, cytoplasmic matrix, protein binding, ATP binding, etc. KEGG pathway analysis showed that differential genes were mainly concentrated in 2-oxy-carboxylic acid metabolism and cytotoxic signaling pathways mediated by natural killer cells. PPI analysis revealed extensive protein interactions between different genes. Ten candidate genes were screened for RT-PCR verification and finally found that CLU, GZMB, PPBP, PRF1, PTGS1, and TMSB4X were significantly differentially expressed between the Th2-driven CA group and the Th2-driven CVA group. Conclusions Asthma's occurrence results from the interaction of many genes and pathways. CLU, GZMB, PPBP, PRF1, PTGS1, and TMSB4X genes may be essential in developing Th2-driven CVA to Th2-driven CA.

Feature Extraction for Cough-sound Recognition Based on Principle Component Analysis and Non-uniform Filter-bank

Cough recognition provides important clinical information for the treatment of many respiratory diseases. A new Mel frequency cepstrum coefficient (MFCC) extracting method has been proposed on the basis of the distributional characteristics of cough spectrum. The whole frequency band was divided into several sub-bands, and the energy coefficient for each band was obtained by method of principle component analysis. Then non-uniform filter-bank in Mel frequency is designed to improve the extracting process of MFCC by distributing filters according to the spectrum energy coefficients. Cough recognition experiment using hidden Markov model was carried out, and the results showed that the proposed method could effectively improve the performance of cough recognition.