Superior laryngeal nerve block for treatment of throat pain and cough following laryngeal herpes zoster:A case report

BACKGROUND Herpes zoster is caused by reactivation of latent varicella-zoster virus infection within the sensory nerve ganglion of the spinal or cranial nerves.Laryngeal herpes zoster is rare and involves superior laryngeal nerve,which leads to several complications such as throat pain,and cough.CASE SUMMARY Patient concerns:A 52-year old woman presented with a 70 d history of throat pain and a 67 d history of non-productive cough.Three days after onset of pain,she was diagnosed with laryngeal herpes zoster.Flexible nasolaryngoscopy revealed multiple white ulcerated lesions on the left hemi epiglottis and the left supraglottic area.She was prescribed with 750 mg famciclovir a day for 7 d,and 150 mg pregabalin,100 mg tramadol and 10 mg nortriptyline a day for 67 d.However,despite of these medications,she complained of pain and persistent cough.Therefore,superior laryngeal nerve block under ultrasound guidance was performed.Three days after the intervention,the throat pain and cough disappeared.The patient remained symptom-free at 3 mo follow-up.CONCLUSION A superior laryngeal nerve block can be an effective option for treatment of pain and cough following laryngeal herpes zoster.

Efficacy ofβ2-adrenergic receptor agonist combined with corticosteroid in the treatment of children with cough variant asthma

BACKGROUND Cough variant asthma(CVA)is one of the most common respiratory diseases in children,which has a serious impact on the quality of life and daily activities of children.For severe CVA,immunomodulatory drugs are needed.AIM To evaluate the efficacy of salmeterol combined with budesonide in the treatment of pediatric CVA.METHODS 130 children with CVA from January 2020 to December 2022 were prospectively selected and randomly divided into an observation group(salmeterol combined with budesonide)and a control group(budesonide combined with a placebo).Compare the clinical efficacy of two groups before and after intervention.The evaluation parameters include cough frequency score,nocturnal cough arousal,and lung function indicators.Serum inflammatory markers,immune function markers and airway anatomical indicators were also measured.RESULTS After the intervention,the total effective rate of the observation group was significantly higher than that of the control group,and the cough frequency score and the night cough wake rate of the observation group were lower than that of the control group,with a statistically significant difference.In addition,the changes of lung function indicators,serum markers and immune function markers in the observation group were better than those in the control group.CONCLUSION The clinical efficacy of salmeterol combined with Budesonide in the treatment of CVA is better than that of Budesonide alone.

SRC:Superior Robustness of COVID-19 Detection from Noisy Cough Data Using GFCC

This research is focused on a highly effective and untapped feature called gammatone frequency cepstral coefficients(GFCC)for the detection of COVID-19 by using the nature-inspired meta-heuristic algorithm of deer hunting optimization and artificial neural network(DHO-ANN).The noisy crowdsourced cough datasets were collected from the public domain.This research work claimed that the GFCC yielded better results in terms of COVID-19 detection as compared to the widely used Mel-frequency cepstral coefficient in noisy crowdsourced speech corpora.The proposed algorithm's performance for detecting COVID-19 disease is rigorously validated using statistical measures,F1 score,confusion matrix,specificity,and sensitivity parameters.Besides,it is found that the proposed algorithm using GFCC performs well in terms of detecting the COVID-19 disease from the noisy crowdsourced cough dataset,COUGHVID.Moreover,the proposed algorithm and undertaken feature parameters have improved the detection of COVID-19 by 5%compared to the existing methods.

A systemaic review and meta-analysis of traditional Chinese medicine in the treatment of chronic cough

Objective: To systematically evaluate the safety and efficacy of traditional Chinese medicine (TCM) in the treatment of chronic cough. Methods: Databases CNKI, WanFang Data, VIP, CBM, PubMed, Web of Science, Cochrane Library from inception to February 2021 were electronically searched by two researchers, to collect randomized controlled trials (RCTs) of traditional Chinese medicine in the treatment of chronic cough, UACS/PNDS, CVA, EB, AC, GERD and other types of cough. Revman 5.3 software was used to analyze and summarize the collected literature, and the methodological quality of the included studies was evaluated by the bias risk assessment scale of Cochrance Collaboration Network. Results: A total of 26 articles involving 2 820 patients, with 1 420 in the experimental group and 1 400 in the control group were included. The results of meta-analysis showed that compared to the control group which was treated with western medicine alone, TCM significantly improved the clinical effective rate [RR=1.20, 95% CI(1.16,1.25), P<0.000 01], alleviated cough syndrome score [SMD=-0.83, 95% CI(-1.21,-0.44)], and enhenced the score of quality of life [MD=-2.18, 95%CI(1.63,2.74), P<0.000 01];at the same time, the experimental group was better than the control group in improving lung function and reducing the time of cough relief. In terms of safety, a total of 24 patients in 5 literatures had adverse reactions, but the symptoms were mild and could be relieved quickly. In addition, there was no significant difference in adverse reactions between the control group and the experimental group, showing good safety. Conclusion: TCM treatment can significantly improve the cure rate of cough, reduce cough score, improve systemic symptoms, relieve psychological anxiety, improve lung function, and improve cough symptoms rapidly, with good safety.

Experimental study on the regulation effect of Qiaoqin Qingfei agent on cough variant asthma based on airway neurogenic inflammation

Objective:To investigate the mechanism of regulation of airway neurogenic inflammation by Qiaoqin Qingfei agent in rats with cough variant asthma(CVA).Methods:48 SD rats were randomly divided into blank group,model group,montelukast sodium group(1.05 mg/kg)and high,medium and low dose groups(26,13,6.5 g/kg),with 8 rats in each group.The rat CVA model was established by the method of ovalbumin(OVA)combined with aluminum hydroxide(Al(OH)3)sensitization and repeated stimulation.From the second day of sensitization,the rat CVA model was given by gavage for 28 days.The pathological changes of lung tissue were observed under microscope by HE staining.The content changes of nerve growth factor(NGF)and substance P(SP)in alveolar lavage fluid(BALF)were determined by double-antibody sandwich ABC-ELISA,and the protein expression levels of NGF and SP in lung tissue were detected by immunohistochemistry.Results:Pathological findings showed significant inflammatory manifestations in the model group,and the inflammatory infiltration in the high-dose,medium-dose and low-dose groups of Qiaoqin Qingfei agent and montelukast sodium groups were alleviated to varying degrees.Compared with blank group,the protein expression levels of NGF and SP in lung tissue of model group were significantly increased(P<0.01).Compared with model group,the protein expression levels of NGF and SP in lung tissue and the contents of NGF and SP in alveolar lavage fluid in high-dose,medium-dose and low-dose groups and montelukast sodium group were significantly decreased(P<0.05).Conclusion:Qiaoqin Qingfei agent may reduce airway inflammation and relieve cough variant asthma by regulating the protein expression levels of NGF and SP in airway neurogenic inflammation.

Effect of glycyrrhetinic acid on Th1/Th2 balance in cough variant asthma mice

Objective:To evaluate the therapeutic effect of Glycyrrhetinic Acid on cough variant asthma(CVA)mice and to investigate the possible mechanism in reducing lung inflammation.Methods:48 young female Balb/c mice were divided into Control,CVA,Prednisone Acetate,Glycyrrhetinic Acid high-dose,Glycyrrhetinic Acid middle-dose and Glycyrrhetinic Acid lowdose groups randomly,with 8 mice in each group.The CVA mice model was established by ovalbumin(OVA)sensitization and OVA challenge,the animal asthma behavior was observed after drug administration,and the index of the lung of mice were recorded.The level of OVAsIgE in the bronchoalveolar lavage fluid(BALF)was tested by ELISA.The pathological changes of the lung tissue were observed by Hematoxylin and Eosin(H&E)staining.The protein expressions of T-bet,IFN-γ,Gata3,IL-4 and IL-13 in the lung tissue were determined by Western blot.Results:Compared with the CVA group,the index of lung of mice,the OVA-sIgE level in BALF and expression levels of Th2-related factor in the lung tissue of mice in Prednisone Acetate and Glycyrrhetinic Acid groups were significantly decreased(P<0.05 or P<0.01),the infiltration of inflammatory cells in the lung tissue was reduced,while expressions of Th1-related factor in the lung tissue was significantly increased(P<0.05 or P<0.01).Conclusion:Glycyrrhetinic acid has therapeutic effect on CVA mice,the underlying mechanism of Glycyrrhetinic acid alleviating lung impairment and airway inflammation may be associated with mediating the Th1/Th2 imbalance in the lung tissue.

I COUGH综合气道管理在肝癌患者围术期中的应用

目的:探讨I COUGH综合气道管理对肝癌手术患者呼吸道并发症的临床作用。方法:选取2015年1月至2016年6月本院外科行开放手术的肝癌患者113例进行研究,分为实验组53例与对照组60例,实验组围术期应用I COUGH综合气道管理,对照组围术期应用常规气道管理,对比分析两组间的术后呼吸系统并发症发生率和术后平均住院日。结果:实验组的肺不张发生率显著低于对照组(χ2=4.875,P=0.027),但其他呼吸系统并发症发生率并无显著差异(χ2=0.841,P>0.05)。实验组的术后平均住院日显著短于对照组(t=2.557,P=0.012),且实验组肺不张患者术后平均住院日显著短于对照组肺不张患者(t=2.099,P=0.044)。结论:I COUGH综合气道管理能够有效预防肝癌开放手术术后肺不张的发生,并且能够缩短此类并发症相关的术后平均住院日,从而减轻患者的经济负担。

Clinical Analysis of Dispelling Wind,Eliminating Lung and Relieving Cough Combined with Western Medicine in the Treatment of Cough Variant Asthma in Children

Objective:This study mainly explores the clinical effect of dispelling wind,eliminating lung and relieving cough combined with western medicine in the treatment of cough variant asthma.Methods:80 children with cough variant asthma accepted by our hospital from January 2018 to December 2020 were randomly selected for the study and divided into two groups.One group was the reference group(40 cases)treated with procaterol hydrochloride tablets and montelukast sodium,and the other group was the research group(40 cases)・The method of eliminating wind,eliminating lung and relieving cough was combined with procaterol hydrochloride tablets and montelukast sodium to observe and compare the curative effects of the two groups.Results:There was no significant difference in TCM symptom score and eosinophil(EOS)count between the two groups before treatment(P>0.05);After treatment,the TCM symptom scores of coughs,pharyngeal itching,expectoration,nasal congestion and nasal itching in the research group were lower than those in the reference group,and the EOS count was lower than that in the reference group(P<0.05);The effective rate of research group was higher than that of reference group(P<0.05).Conclusions:For children with cough variant asthma,Qufeng Sufei cough relieving method combined with procaterol hydrochloride and montelukast sodium can improve children's symptoms and reduce eosinophil count.

cough sign在急性阑尾炎诊断中的意义

目的介绍一种有助于诊断急性阑尾炎的新体征。方法回顾性分析110例经病理证实的急性阑尾炎病人的“咳嗽征”、“呼吸疼痛征”以及“结肠充气试验”的阳性率,采用2χ检验统计比较。结果“Cough S ign”获得了96.4%的较高的阳性率,阳性率与其它两种试验比较有显著性差异(P<0.05)。结论该方法诊断急性阑尾炎简单、实用,有较高的阳性诊断率,有助于诊断急性阑尾炎。

A Brief Analysis on the Characteristics of Chinese Medicine and Treatment for Cough Variant

Cough variant is a common disease of the respiratory system and can lead to a unique type of asthma.The disease has no obvious symptoms such as wheezing nor shortness of breath.Coughing is the main clinical symptom,as it causes airway hyper-responsiveness.Traditional Chinese medicine(TCM)has a unique understanding of this disease,and the effect is obvious after treatment,as it's based on symptom differentiation.This article takes the concept of“mild fluid retention”from“The Synopsis of the Golden Chamber”as an entry point,briefly describes the relationship between cough variant and mild fluid retention,as well as the diagnosis and treatment of Chinese medicine.

Analysis of Zhang Hongxing's Clinical Experience in Treating Chronic Cough

Director Zhang Hongxing is a famous traditional Chinese medicine(TCM)doctor in Shandong province and a teacher in the Famous TCM Expert Studio in Dezhou city.He has rich clinical experience and considerable experience in the treatment of common clinical chronic coughs.Director Zhang Hongxing believes that chronic cough belongs to the category of"wind cough"and"long-term cough"according to TCM.TCM diagnosis should start from the four aspects of "wind evil residing in lung","liver"?"spleen and stomach",and"yang deficiency".Starting from viewing the human body as an organic whole,distinguish between deficiency or excess in cold and heat,and clinical treatment for cough should focus on dispelling"wind",regulating the functions of liver,spleen,and stomach,and supplementing the body's yang.Formulate treatment based on different categorization,and modify prescription according to the symptoms,and the treatment effects are remarkable.

Therapeutic efficacy of baclofen in refractory gastroesophageal reflux-induced chronic cough

AIM:To evaluate the efficacy and safety of baclofen for treatment of refractory gastroesophageal reflux-induced chronic cough (GERC) unresponsive to standard anti-reflux therapy. METHODS:Sixteen patients with refractory GERC were given an 8-wk course of baclofen 20 mg three times a day as an add-on therapy to omeprazole. Changes in the cough symptom score, cough threshold to capsaicin, reflux symptom score and possible adverse effects were determined after treatment. The variables of multi-channel intraluminal impedance combined with pH monitoring were compared between responders and non-responders to baclofen. RESULTS:Twelve of 16 patients completed treatment. Cough disappeared or improved in 56.3% (9/16)of patients, including 6 patients with acid refluxinduced cough (66.7%) and 3 patients with non-acid reflux-induced cough (33.3%). With baclofen treatment, the cough symptom score began to decrease at week 2, was clearly decreased at week 6 and reached a minimum at week 8. At the end of therapy, the lowest concentration of capsaicin required for induction of ≥ 2 and ≥ 5 coughs increased from 0.98 (1.46) to 1.95 (6.82) μmol/L (Z = -2.281, P = 0.024) and from 1.95 (7.31) to 7.8 (13.65) μmol/L (Z = -2.433, P = 0.014), respectively, and the reflux symptom score decreased from 8.0 ± 1.6 to 6.8 ± 0.8 (t = 2.454, P = 0.023). The number of acid reflux episodes was significantly lower in responders than in non-responders. The main adverse effects were somnolence, dizziness and fatigue. CONCLUSION:Baclofen is a useful, but suboptimal treatment option for refractory GERC.

Proton pump inhibitor treatment of patients with gastroesophageal reflux-related chronic cough:A comparison between two different daily doses of lansoprazole

AIM： To compare two different daily doses of lansoprazole given for 12 weeks and to assess the role of gastrointestinal （GI） investigations as criteria for selecting patients. METHODS： Out of 45 patients referred for unexplained chronic persistent cough, 36 had at least one of the GI investigations （endoscopy, 24-h esophageal pH- metry and a 4-week trial of proton pump inhibitor （PPI） therapy） positive and were randomly assigned to receive either 30 mg lansoprazole o.d. or 30 mg lansoprazole b.i.d, for 12 weeks. Symptoms were evaluated at baseline （visit 1） after the PPI test （visit 2） and after the 12-week lansoprazole treatment period （visit 3）. RESULTS： Thirty-five patients completed the study protocol. Twenty-one patients （60.0%） reported complete relief from their cough with no difference between the two treatment groups （58.8% and 61.1% had no cough in 30 mg lansoprazole and 60 mg lansoprazole groups, respectively）. More than 80% of the patients who had complete relief from their cough at the end of the treatment showed a positive response to the PPI test. CONCLUSION： Twelve weeks of lansoprazole treatment even at a standard daily dose, is effective in patients with chronic persistent cough. A positive response to an initial PPI test seems to be the best criterion for selecting patients who respond to therapy.

Refractory chronic cough due to gastroesophageal reflux: Definition, mechanism and management

Refractory chronic cough due to gastroesophageal reflux is a trouble some condition unresponsive to thestandard medical anti-reflux therapy. Its underlying mechanisms may include incomplete acid suppression, non-acid reflux, transient lower esophageal sphincter relaxations and esophageal hypersensitivity. The diagnosis of this disorder depends on both the findings of multi-channel intraluminal impedance-pH monitoring and the subsequent intensified anti-reflux therapy. The strategies of pharmacological treatment for refractory chronic cough due to reflux include the optimization of proton pump inhibitors and add-on therapies with histamine H2 receptor antagonists, baclofen and gabapentin. However, the further study is needed to satisfy its management.

Angiotensin-converting enzyme and bradykinin gene polymorphisms and cough:A meta-analysis

AIM:To evaluate the association between genetic polymorphisms and angiotensin converting enzyme in-hibitor (ACEI)-related cough,and the race-or ethnicity-related difference in the prevalence of cough attributed to ACEI therapy.METHODS:We conducted a search in PubMed,EM-BASE,Cinahl,and the Cochrane Database without language limitation.A database of 11 studies on ACEI-related cough,with detailed information regarding ACE I/D or bradykinin B 2 receptor polymorphisms,was created.Eligible studies were synthesized using meta-analysis methods,including cumulative meta-analysis.A subgroup analysis was also performed using ethnicity.RESULTS:Six studies were included on ACE I/D poly-morphism (398 Caucasians,723 East Asians),and three studies were included on bradykinin B 2 receptor poly-morphism (300 East Asians).The distribution of ACE genotypes showed significant differences in the entire population (P=0.004) and in East Asians (P=0.005)but not in Caucasians (P=0.23).Allelic frequencies of ACE showed significant differences in East Asians [odds ratio (OR)=1.49 (1.11-2.02)].The meta-analysis with a random effects model showed a significant associa-tion between ACE allele I/D and ACEI-related cough [random effects (RE) OR=1.49 (1.11-2.02),P=0.009] in East Asians,but not in Caucasians [RE OR=0.90 (0.60-1.35)].The allelic frequencies of the bradykinin B 2 receptor gene were significantly different [OR=2.25 (1.42-3.57)].The distributions of the T/C genotypes of the bradykinin B 2 receptor gene were significantly dif-ferent (χ 2=8.366,P=0.015).The meta-analyses re-vealed that there was a significant association between the bradykinin B 2 receptor allele and ACEI-related cough in East Asians [RE OR=2.29 (1.42-3.69),P=0.001].CONCLUSION:ACE I/D and Bradykinin B 2 receptor polymorphisms contributed to the risk of ACEI-related cough in East Asians,but a negative association be-tween ACE I/D polymorphism and ACEI-related cough was observed in Caucasians.

Persistent cough as a paraneoplastic presenting symptom in six patients with renal cell carcinoma

Objective:With today’s modern imaging modalities,patients diagnosed with renal cell carcinoma(RCC)rarely present symptomatically.In some cases,however,they can develop paraneoplastic syndromes with associated symptoms.To date,only three cases of RCC presenting with chronic dry cough have been reported.We describe six patients who presented with cough that improved following radical nephrectomy.Methods:A retrospective review of patients undergoing partial or radical nephrectomy for renal masses between January 2015 and March 2016 was performed,and patients presenting with a cough were examined.Results:Six patients presented with chronic cough and were discovered to have a large renal mass.Postoperative spontaneous resolution of cough was noted in all but one patient,in whom coughing was reduced and limited to the mornings.Cough duration ranged from 3 months to just over a year.All patients were treated with radical nephrectomy,which was cytoreductive in four patients.Average tumor size was 10.9 cm(SD=2.2 cm).Five of the tumors had clear cell pathology,and every tumor was Fuhrman grade IV,unifocal,and demonstrated necrosis.Sarcomatoid features were reported in four of the tumors.Conclusion:Our study presents the largest series of patients with RCC who presented with a chronic cough that was significantly improved following radical nephrectomy.We believe the cause of cough is multifactorial and further investigation is needed to clearly elucidate the etiology.

Cough as a neurological sign:What a clinician should know

Cough is a common respiratory complaint driving patients to seek medical advice.Besides being a fundamental respiratory sign,it is also a crucial neurological sign.There are three main types of coughs:Reflex cough(typeⅠ),voluntary cough(typeⅡ),and evoked cough(typeⅢ).Cough is a reflex predominantly mediated by control centers in the respiratory areas of the brainstem,modulated by the cerebral cortex.Cough reflex sensitivity could be increased in many neurological disorders such as brainstem space-occupying lesions,medullary lesions secondary to Chiari typeⅠmalformations,tics disorders such as Tourette's syndrome,somatic cough,cerebellar neurodegenerative diseases,and chronic vagal neuropathy due to allergic and non-allergic conditions.Meanwhile,cough sensitivity decreases in multiple sclerosis,brain hypoxia,cerebral hemispheric stroke with a brainstem shock,Parkinson's disease,dementia due to Lewy body disease,amyotrophic lateral sclerosis,and peripheral neuropathy as diabetic neuropathy,hereditary sensory and autonomic neuropathy typeⅣ,vitamin B12,and folate deficiency.Arnold's nerve ear-cough reflex,syncopal cough,cough headache,opioids-associated cough,and cough-anal reflex are signs that could help diagnose underlying neurological conditions.Cough reflex testing is a quick,easy,and cheap test performed during the cranial nerve examination.In this article,we reviewed the role of cough in various neurological disorders that increase or decrease cough sensitivity.

Investigation of the active components and mechanism of Sanao Decoction in treating chronic cough by network pharmacology and molecular docking

Objective To investigate the active components and mechanism of Sanao Decoction(三拗汤,SAD)in treating chronic cough based on network pharmacology and molecular docking.Methods Active components and their targets were obtained from the Traditional Chinese Medicine Systems and Pharmacology Database and Analysis Platform(TCMSP),Bioinformatics Analysis Tool for Molecular mech ANism of Traditional Chinese Medicine(BATMAN-TCM)database,and the literature.The component-target regulatory network and protein-protein interaction(PPI)network were constructed by Cytoscape 3.7.2,and a bioinformatics analysis was performed to identify the significant pathways and their relevant targets.Molecular docking of the core active components and relevant targets was performed.Results A total of 98 active components of SAD and the corresponding 113 drug targets were identified.The component-target regulatory network and PPI network were successfully established.Results of the bioinformatics analysis indicated that 2281 Gene Ontology(GO)terms were enriched in chronic cough,including 2062 terms were in biological processes,77 in cellular components,and 142 in molecular functions,and top 20 significant pathways in Kyoto Encyclopedia of Genes and Genomes(KEGG)analysis.Molecular docking study demonstrated that quercetin,luteolin,kaempferol,and naringenin were in good agreement with the corresponding targets.Conclusion The active compounds of SAD,such as quercetin,luteolin,kaempferol,and naringenin,may act on AKT1,MAPK1,RELA,EGFR,and Bcl-2 and regulate the PI3 K-Akt signaling pathway,AGE-RAGE signaling pathway,and fluid shear stress and atherosclerosis pathway to exert the effects of anti-inflammatory,anti-airway remodeling,anti-oxidant stress effects,and repair airway damage,thus treating chronic cough.

Effects of Huaiqihuang Granule on immunoglobulin, T lymphocyte subsets and cytokines in children with cough variant asthma

Objective:To observe the effect of Huaiqihuang granule on immunoglobulin, T lymphocyte subsets and cytokines in children with cough variant asthma (CVA). Methods:80 cases of children with CVA were enrolled in our hospital from June 2015 to June 2016, and were randomly divided into study group and control group. Two groups were both given salbutamol aerosol powder. On this basis, the control group was given Montelukast Sodium Chewable Tablets, while the study group was treated with Huaiqihuang granules. The interleukin 4 (IL-4), interferon-γ(IFN-γ), IgA, IgG and IgE levels and CD4+, CD8+T lymphocyte ratio analyze in children after 3 months of treatment. Results:There were no significant differences between the two groups before treatment (P>0.05). Both IgA and IgG were significantly higher in the two groups after treatment, while IgE was significantly lower (P<0.05). Compared with the control group, the IgA and IgG in the study group were significantly higher than those in the control group (P<0.05), while IgE was significantly lower (P<0.05). After treatment, compared with the control group, the proportion of CD4+ and CD4+/CD8+ in the study group were significantly lower than that of the control group, and the CD8+ratio increased more significantly (P<0.05). After treatment, IL-4 decreased significantly, while IFN-γand IFN-γ/IL-4 were significantly increased (P<0.05), IL-4 level of the study group decreased significantly compared with the control group, and IFN-γincreased significantly compared with the control group, and the level of IFN-γ/IL-4 after treatment was significantly higher than that of the control group (P<0.05). Conclusions: Huaiqihuang granule can improve humoral immunity and cellular immunity of children with CVA, and can adjust the immune cells balance of Th1/Th2, and improve the immune function and prognosis of children with CVA.

TWENTY-EIGHT CASES OF INTRACTABLE COUGH TREATED WITH MOVING CUPPING

Twenty-eight cases of intractable cough were treated with moving cupping method. Theresults showed that 17 cases were cured, 7 cases markedly effective and 4 cases ineffective. The totaleffective rate was 85.7%.