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.

Prevalence and Clinical Characteristics of Chronic Constipation in Senegalese Children

Introduction: Constipation is the infrequent emission of hard stools. It is common, most often of functional origin, with a prevalence ranging from 0.7% to 29.6%. The aim of our study was to investigate the prevalence of constipation in children undergoing paediatric gastroenterology. Methodology: This was a bi-centric retrospective study carried out at the Albert Royer Children’s Hospital and the Dalal Jamm Hospital Pediatrics Department. Children followed in the pediatric gastroenterology consultation during the period from January 1, 2013 to February 29, 2020 were included. Results: A total of 337 children (205 boys;60.83%) were included, representing a prevalence of 25%. The median age was 3 years 6 months. The 13 - 24 months age group was the most frequent (27.6%). Rare stools were the main reason for consultation (92.8%). Rare stools were noted in 92.88% of cases. Bristol types 1 and 2 accounted for 6.53% and 54.60% respectively. The main associated signs were abdominal pain (29.4%), followed by abdominal bloating (20.96%). Abdominal pain was functional in 73.58% of cases. Under treatment, 90.19% of children had a favorable outcome. Conclusion: Constipation is common in Senegalese children with a prevalence close to that reported in Western countries. In most case, it is functional with good prognostic.

Analysis on relationship of parameters such as R5 and MEFV with severity of chronic cough in 3 to 5 years old children by impulse oscillometry detection

Objective:The article aims to investigate the relationship of parameters such as airway vicosity resistance (R5) and maximal expiratory flow-volume curve (MEFV) with severity of chronic cough in 3 to 5 years old children by impulse oscillometry (IOS) detection when the oscillation frequency is 5Hz.Method: The article chooses eighty children with chronic cough who were diagnosed or treated in our hospital from March 2017 to March 2018 as the research group, and chooses 50 healthy children who had physical examination in our hospital as the control group. Children's asthma control test (C-ACT) is used to assess the disease severity of children. MEFV detection is carried out to the two groups of children to obtain the ratio of forced expiratory volume in one second and forced vital capacity (FEV1/FVC) and the peak expiratory flow (PEF). LsS inductance (X5) is detected by IOS when R5, the resonant frequency (Fres), and the oscillation frequency is 5Hz. The relationship of ACT score with MEFV and IOS indicators is analyzed by Pearson correlation. The receiver operating characteristic (ROC) curve is used to evaluate the diagnostic value of MEFV and IOS indicators to chronic cough. Results: The C-ACT score of the severe group is significantly lower than that of the control group (P<0.05). FEV1/FVC and PEF of the mild and severe groups are both lower than those of the control group, and FEV1/FVC and PEF of the severe group is lower than those of the mild group (P<0.05). Fres, R5 and X5 of the mild and severe groups are significantly higher than those of the control group, and Fres, R5 and X5 of the severe group are higher than the mild group (P<0.05). FEV1/FVC and PEF are positively correlated with C-ACT score (P<0.05), while Fres, R5 and X5 are negatively correlated with C-ACT score (P<0.05). FEV1/FVC and PEF respectively shows significant negative correlations with Fres, R5 and X5 (P<0.05). R5 has a self-high ROC value of 0.938, followed by Fres, which is 0.917. And the value of IOS diagnostic indicators is higher than MEFV indicators.Conclusion: FEV1 / FVC and PEF of children with chronic cough will decrease while Fres, R5 and X5 will increase, of which Fres, R5 and X5 have a higher correlation with the severity of cough symptoms, and ROC analysis results also show that R5 has the highest diagnostic value to 3~5 years old children with chronic cough.

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.

Impact of IL28B and OAS gene family polymorphisms on interferon treatment response in Caucasian children chronically infected with hepatitis B virus

AIM To investigate the impact of IL28 B and OAS gene polymorphisms on interferon treatment responses in children with chronic hepatitis B.METHODS We enrolled 52 children(between the ages of 4 and 18) with hepatitis B e antigen-negative chronic hepatitis B(CHB), who were treated with pegylated interferon alfa for 48 wk. Single nucleotide polymorphisms in the OAS1(rs1131476), OAS2(rs1293747),OAS3(rs2072136), OASL(rs10849829) and IL28B(rs12979860, rs12980275 and rs8099917) genes were studied to examine their associations with responses to IFN treatment in paediatric patients. We adopted two criteria for the therapeutic response, achieving an hepatitis B virus(HBV) DNA level < 2000 IU/m L and normalization of ALT activity(< 40 IU/L). To perform the analyses, we compared the patients in terms of achieving a partial response(PR) and a complete response(CR) upon measurement at the 24-wk posttreatment follow-up. RESULTS The PR and CR rates were 80.8% and 42.3%, respectively. Factors such as age, gender and liver histology had no impact on the type of response(partial or complete). A statistically significant relationship between higher baseline HBV DNA and ALT activity levels and lower rates of PR and CR was shown(P < 0.05). The allele association analysis revealed that only the IL-28 B rs12979860(C vs T) and IL28 B rs12980275(A vs G) markers significantly affected the achievement of PR(P = 0.021, OR = 3.3, 95%CI: 1.2-9.2 and P = 0.014, OR = 3.7, 95%CI: 1.3-10.1, respectively). However, in the genotype analysis, only IL-28 B rs12980275 was significantly associated with PR(AA vs AG-GG, P = 0.014, OR = 10.9, 95%CI: 1.3-93.9). The association analysis for CR showed that the TT genotype of IL28 B rs12979860 was present only in the no-CR group(P = 0.033) and the AA genotype of OASL rs10849829 was significantly more frequent in the noCR group(P = 0.044, OR = 0.26, 95%CI: 0.07-0.88). The haplotype analysis revealed significant associations between PR and CR and OAS haplotype(P = 0.0002 and P = 0.001, respectively), but no association with IL28 B haplotype was observed.CONCLUSION IL28 B and OAS polymorphisms are associated with different clinical outcomes in CHB children treated with interferon.

Lamivudine resistance in children with chronic hepatitis B

Currently, although lamivudine(LAM) has a low genetic barrier, only interferon-alpha and LAM are available as a first-line treatment in children with chronic hepatitis B(CHB). LAM is a potent inhibitor of hepatitis B virusdeoxyribonucleic acid(HBV-DNA) polymerase replication by termination of the proviral HBV-DNA chain. LAM has a good safety and tolerability profile in CHB patients with hepatic decompensation. However, the main disadvantages of this HBV reverse transcriptase inhibitor are:(1) pre-existing covalently closed circular DNA cannot be eradicated by LAM, thus relapse after therapy withdrawal is frequent; and(2) although the longer LAMtreatment induced the higher seroconversion rate, the risk of viral resistance increased through the selection of YMDD(tyrosine, methionine, aspartate, aspartate) motif. Insufficient suppression of viral replication leads to the emergence of resistant strains that could result in virological breakthrough which is usually followed by biochemical breakthrough. Mutant strains affects additional resistance and cross resistance, leading to drug resistance in a significant number of CHB patients. In this case, efficacy of more powerful anti-viral agents with higher genetic barrier against development of resistance is diminished. Furthermore, strains that are resistant to LAM could bring about vaccine escape mutants, decreasing the efficacy of HBV vaccine. A more potent drug with a high genetic barrier to resistance needs to be approved as the first-line treatment option for CHB in children.

Current treatment options and response rates in children with chronic hepatitis C

Vertical transmission has become the most common mode of transmission of hepatitis C virus (HCV) in children.The rate of perinatal transmission from an HCVinfected mother to her child ranges from 2% to 5% and the prevalence of HCV in children in developed countries ranges between 0.1% and 0.4%.Spontaneous viral clearance seems to be dependent on the genotype and has been reported between 2.4%-25%.For chronically infected patients,treatment with recombinant polyethylene glycol (PEG)-interferon α-2b and daily ribavirin has now been approved as standard treatment for children 2-17 years of age.In five large prospective studies,a total of 318 children and adolescents aged 3-17 years were treated either with subcutaneous PEG-interferon α-2b at a dose of 1-1.5 μg/kg or 60 μg/m2 once a week in combination with oral ribavirin (15 mg/kg per day) or PEG-interferon α-2a with ribavirin.Subjects with genotype 1 and 4 received the medication for 48 wk and individuals with genotype 2 and 3 mainly for 24 wk.Overall sustained viral response (SVR) was achieved in 193/318 (60.7%) of treated patients.Stratified for genotype;120/234 (51%) with genotype 1,68/73 (93%) with genotype 2/3,and 6/11 (55%) with genotype 4 showed SVR.Relapse rate was between 7.7% and 17%.Overall,treatment was well tolerated;how-ever,notable side effects were present in approximately 20%.According to recent experiences in the treatment of chronic hepatitis C in children and adolescents,a combination of PEG-interferon α with ribavirin has been found to be well tolerated and highly efficacious,particularly in individuals with genotype 2/3.Thus,this treatment can be recommended as standard of care until more effective treatment options will become available for genotype 1 patients.

Safety and efficacy of Hansenula-derived PEGylated-interferon alpha-2a and ribavirin combination in chronic hepatitis C Egyptian children

AIM: To investigate the safety and efficacy of a Hansenula-derived PEGylated (polyethylene glycol) interferon (IFN)-alpha-2a (Reiferon Retard) plus ribavirin customized regimen in treatment-na&#x000ef;ve and previously treated (non-responders and relapsers) Egyptian children with chronic hepatitis C infection.

Lamivudine therapy for children with chronic hepatitis B

AIM： To assess the effectiveness and side-effects of lamivudine therapy for children with chronic hepatitis B （CHB） who fail to respond to or have contraindications to interferon-α （IFN-α） therapy. METHODS： Fifty-nine children with CHB were treated with 100 mg lamivudine tablets given orally once daily for 12 too. Alanine aminotransferase （ALT） activity was evaluated monthly during the therapy and every 3 months after its discontinuation. HBe antigen, antiHBe antibodies, HBV DNA level in serum were evaluated at baseline and every six months during and after the lamivudine therapy. Sustained viral response （SVR） to lamivudine therapy was defined as permanent （not shorter than 6 mo after the end of the therapy）, namely ALl＂ activity normalization, seroconversion of HBeAg to anti-HBe antibodies, and undetectable viral HBV-DNA in serum （lower than 200 copies per mL）. The analysis of the side-effects of the lamivudine treatment was based upon interviews with the patients and their parents using a questionnaire concerning subjective and objective symptoms, clinical examinations, and laboratory tests performed during clinical visits monthly during the therapy, and every 3 mo after the therapy. RESULTS： ALT normalisation occurred in 47 （79.7%） patients between the first and 11^th mo of treatment （mean 4.4±2.95 mo, median 4.0 mo）, and in 18 （30.5%） of them after 2 mo of the therapy. There was no correlation between the time of ALT normalization and the children＇s age, the age of HBV infection, the duration of HBV infection, inflammation activity score （grading）, staging, ALT activity before treatment, serum HBV DNA level, and lamivudnie dose per kg of body weight. HBeAg/anti HBe seroconversion was achieved in 27.1% of cases.The higher rate of seroconversion was connected with lower serum HBV DNA level and longer duration of HBV infection. There was no connection between HBeAg/ anti HBeAb seroconversion and the children＇s age, age of HBV infection, grading, staging, ALT activity before treatment, and lamivudnie dose per kg of body weight. No complaints or clinical symptoms were observed during lamivudine therapy. Impairment of renal function or myelotoxic effect was noted in none of the patients. CONCLUSION： One year lamivudine therapy for children with chronic hepatitis B is effective and well tolerated. Seroconversion of HBeAg/HBeAb and SVR are connected with lower pre-treatment serum HBV DNA level.

Physical activity and exercise in children with chronic health conditions

In the last two or three decades,physical activity(PA) has gained increasing recognition as being essential for maintaining good health and improving quality of life for all ages.Children have traditionally been active in both free play and organized sports.However,there has been a recent decline in the PA levels among children for various reasons.This lifestyle change has resulted in increased obesity accompanied by a rise in diabetes and cardiovascular risk among otherwise healthy children.These lifestyle changes have been shown to be even more a problem when the child is already affected by a chronic disease.Due to medical limitations and contraindications,much care must be taken to make certain that these children are involved in the appropriate volume and intensity of exercise.The type of activity must also be given careful consideration to avoid undue risk for the child who may have problems such as poor balance,limited strength,poor vision,or cognitive disability.Further complications are either caused or exacerbated by lack of sufficient PA.The priority beyond concern for safety should be focused on ensuring the highest quality of life possible.The purpose of this review is to examine how PA can benefit children with selected chronic health conditions.

Serum vitamin D and vitamin-D-binding protein levels in children with chronic hepatitis B

BACKGROUND Vitamin D is an essential fat-soluble secosteroid hydroxylated by the liver to form the intermediate metabolite calcidiol{25-hydroxy vitamin D[25(OH)D]},which is a reliable indicator to investigate individual vitamin D status.Vitamin-D-binding protein(VDBP)is a multifunctional glycoprotein mainly synthesized in the liver and the major transport protein for vitamin D and its metabolites.Serum vitamin D and VDBP are both associated with hepatitis B.However,few studies have reported the relationship and clinical significance of vitamin D and VDBP with hepatitis B virus(HBV)replication and hepatic fibrosis in children with chronic hepatitis B(CHB).AIM To explore vitamin D and VDBP serum levels in children with CHB and the association of vitamin D and VDBP with HBV replication and hepatic fibrosis.METHODS We enrolled 204 children with CHB admitted to Hunan Children’Hospital in summer and autumn between 2018 and 2019 and 170 healthy controls.CHB patients included:164 hepatitis B e antigen(HBeAg)positive and 40 HBeAg negative;193 hepatitis B surface antigen(HBsAg)positive and 11 HBsAg negative;164 with detectable HBV deoxyribonucleic acid(DNA)and 40 with undetectable HBV DNA;131 with HBV genotype B and 23 with HBV genotype C;and 27 without hepatic fibrosis and 97 with hepatic fibrosis.Serum levels of 25(OH)D,VDBP,liver function markers,and other clinical parameters were collected to analyze their association with vitamin D and VDBP.Mann-Whitney U test,Kruskal-Wallis H test,or t test was used to analyze serum 25(OH)D and VDBP levels in different groups.Spearman rank correlation test was utilized to analyze the correlation of 25(OH)D and VDBP with other markers.Statistically significant factors determined by univariate analysis were further analyzed by binary multivariate logistic regression analysis.P<0.05 was considered statistically significant.RESULTS Children with CHB had lower serum 25(OH)D(56.64±17.89 nmoL/L)and VDBP[122.40(70.74-262.84μg/L)]levels than healthy controls had(P<0.001).Serum 25(OH)D and VDBP levels were significantly different among the different grades of hepatic fibrosis(P<0.05).VDBP levels in children with HBV genotype C,HBsAg,HBeAg,and detectable HBV DNA were significantly lower than those in children with HBV genotype B,no HBsAg,no HBeAg,and undetectable HBV DNA(P<0.05).Serum 25(OH)D level was negatively correlated with age and serum total bilirubin level(r=-0.396 and-0.280,respectively,P<0.001).Serum VDBP level was negatively correlated with HBV DNA(log10 IU/mL)(r=-0.272,P<0.001).Serum 25(OH)D level was not correlated with VDBP level(P>0.05).Univariate(P<0.05)and multivariate logistic regression analysis showed that low level of 25(OH)D(odds ratio=0.951,95%confidence interval:0.918-0.985)and high level of HBV DNA(odds ratio=1.445,95%confidence interval:1.163-1.794)were independently correlated with hepatic fibrosis(P<0.01).CONCLUSION Serum levels of 25(OH)D and VDBP are decreased in children with CHB.Serum VDBP level is negatively correlated with HBV replication.Low level of 25(OH)D is independently associated with hepatic fibrosis in children with CHB.There is no significant association between serum levels of 25(OH)D and VDBP.

Histological outcome of chronic hepatitis B in children treated with interferon alpha

AIM： To evaluate the effect of interferon alpha （IFN-α） treatment on the liver histology in children with chronic hepatitis B and to evaluate the usefulness of various histological scoring systems of liver histology in this group of patients. METHODS： Fibrosis stage and inflammation grade were assessed according to Batts and Ludwig, Ishak et al., and IETAVIR （only fibrosis stage） before and 12 mo after IFN-α treatment termination in 93 children aged 2-16 years with chronic hepatitis B. RESULTS： None of the three numerical scoring systems for liver fibrosis showed statistically significant differences in liver fibrosis, while evolution of inflammatory activity revealed statistically significant improvement in the whole group of children with chronic hepatitis B treated with IFN-α and in responders. Significantly positive correlations were found between fibrosis stage and inflammation grade in the respective scoring systems. CONCLUSION： Treatment with IFN-α did not improve histological fibrosis but decreased inflammatory activity in children with chronic hepatitis B. The three semiquantitative scoring systems seem to be comparable in the estimation of the inflammation grade and fibrosis stage in this group of children.

Liver tumors in children with chronic liver diseases

Liver tumors are rare in children,but the incidence may increase in some circumstances and particularly in chronic liver diseases.Most liver tumors consequent to chronic liver diseases are malignant hepatocellular carcinoma.Other liver tumors include hepatoblastoma,focal nodular hyperplasia,adenoma,pseudotumor,and nodular regenerative hyperplasia.Screening of suspected cases is beneficial.Imaging and surrogate markers of alpha-fetoprotein are used initially as noninvasive tools for surveillance.However,liver biopsy for histopathology evaluation might be necessary for patients with inconclusive findings.Once the malignant liver tumor is detected in children with cirrhosis,liver transplantation is currently considered the preferred option and achieves favorable outcomes.Based on the current evidence,this review focuses on liver tumors with underlying chronic liver disease,their epidemiology,pathogenesis,early recognition,and effective management.

Diagnostic accuracy of serum biochemical fibrosis markers in children with chronic hepatitis B evaluated by receiver operating characteristics analysis

METHODS： We determined the serum level of apolipoprotein A-I （APO A-I）, haptoglobin （HPT） and a-2 macroglobulin （A2I） with an automatic nephelometer in 63 children （age range 4-17 years, mean 10 years） with biopsy-verified chronic HBeAg-positive hepatitis B. Fibrosis stage and inflammation grade were assessed in a blinded fashion according to Batts and Ludwig. We defined mild liver fibrosis as a score ≤2 and advanced fibrosis as a score equal to 3. ROC analysis was used to calculate the power of the assays to detect advanced liver fibrosis （AccuROC, Canada）. RESULTS： Serum concentrations of APO A-I, HPT and A2M were not significantly different in patients with chronic hepatitis B compared to controls. However, APO A-I level of 1.19 ng/L had a sensitivity of 85.7% and a specificity of 60.7% （AUC = 0.7117, P = 0.035） to predict advanced fibrosis. All other serum biochemical markers and their combination did not allow a useful prediction. None of these markers was a good predictor of histologic inflammation. CONCLUSION： Apolipoprotein A-I may be a suitable serum marker to predict advanced liver fibrosis in children with chronic hepatitis B.

Serum neopterin levels in children with hepatitis-B-related chronic liver disease and its relationship to disease severity

AIM:To evaluate serum neopterin levels and their correlations with liver function tests and histological grade in children with hepatitis-B-related chronic liver disease. METHODS:The study population comprised 48 patients with chronic active hepatitis B,32 patients with hepatitis-B-related active liver cirrhosis and 40 normal controls. Serum neopterin was measured using an enzyme-linked immunosorbent assay. RESULTS:The mean ± SD serum neopterin levels were 14.2 ± 5.6 nmol/L in patients with chronic hepatitis,20.3 ± 7.9 nmol/L in patients with liver cirrhosis and 5.2 ± 1.4 nmol/L in control group. Serum neopterin levels were signif icantly higher in patients with chronic hepatitis (P = 0.005) and cirrhosis patients (P = 0.008),than in control subjects. Cirrhotic patients had signif icantly higher serum neopterin levels than patients with chronic hepatitis (P = 0.004). There was a positive correlation between serum neopterin levels and alanine aminotransferase levels in patients with chronic hepatitis (r = 0.41,P = 0.004) and cirrhotic patients (r = 0.39,P = 0.005). Positive correlations were detected between serum neopterin levels and inflammatory score in patients with chronic hepatitis (r = 0.51,P = 0.003) and cirrhotic patients (r = 0.49,P = 0.001). CONCLUSION:Our results suggest that serum neopterin levels can be considered as a marker of inflammatory activity and severity of disease in children with hepatitis-B-related chronic liver disease.

Chronic otitis media and subsequent hearing loss in children from the Himalayan region residing in Buddhist Monastic schools of Nepal

Objectives:The main objective of the study was to ascertain the prevalence of chronic otitis media and determine the corresponding hearing loss in children from Nepal’s Himalayan region now residing in Buddhist Monastic schools of Nepal.Methods:The study was conducted among children at Buddhist monastic school in different parts of Nepal.A total of 3174 children aged between 5 and 15 years,who were originally from the Himalayan region of Nepal and were currently residing in monastic schools,were screened for ear problems and hearing loss.They were examined by otoscope to diagnose chronic otitis media.Hearing was evaluated by pure tone audiometer,and 0.5e4 kHz air conduction hearing threshold was measured and documented.Results:Of the total of 3174 children who were screened for ear diseases and hearing loss,monks constituted 76.21%(n?2419)and Nuns 23.78%(n?755).Chronic otitis media was the most common otoscopic finding during the screening,and it affected a total of 344(10.83%)children.Out of these 344,hearing loss of varying degrees was observed in 5.42%(n?172)children.Conclusion:There is high prevalence of chronic otitis media in children belonging to the Himalayan region of Nepal,and it is the main cause of avoidable hearing loss.Timely diagnosis and treatment of chronic otitis media could prevent unnecessary hearing loss in these children.

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.

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.

TREATMENT OF COUGH IN CHILDREN BY CUPPING ON BACK

The author of the present paper hasachieved satisfactory results in the treatmentof 41 cases of cough in children by cuppingon the patient’s back. A report follows. Clinical data’ Of the 41 cases admitted,24 were male and the other 17 female. Theyoungest was one year old and the oldest 12.The shortest course of disease was one dayand the longest 10 months. As

External use of mirabilite to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis in children:A multicenter randomized controlled trial

BACKGROUND Acute pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography(ERCP).Currently,there is no suitable treatment for post-ERCP pancreatitis(PEP)prophylaxis.Few studies have prospectively evaluated interventions to prevent PEP in children.AIM To assess the efficacy and safety of the external use of mirabilite to prevent PEP in children.METHODS This multicenter,randomized controlled clinical trial enrolled patients with chronic pancreatitis scheduled for ERCP according to eligibility criteria.Patients were randomly divided into the external use of mirabilite group(external use of mirabilite in a bag on the projected abdominal area within 30 min before ERCP)and blank group.The primary outcome was the incidence of PEP.The secondary outcomes included the severity of PEP,abdominal pain scores,levels of serum inflammatory markers[tumor necrosis factor-alpha(TNF-α)and serum interleukin-10(IL-10)],and intestinal barrier function markers[diamine oxidase(DAO),D-lactic acid,and endotoxin].Additionally,the side effects of topical mirabilite were investigated.RESULTSA total of 234 patients were enrolled,including 117 in the external use of mirabilite group and theother 117 in the blank group.The pre-procedure and procedure-related factors were notsignificantly different between the two groups.The incidence of PEP in the external use ofmirabilite group was significantly lower than that in the blank group(7.7%vs 26.5%,P<0.001).The severity of PEP decreased in the mirabilite group(P=0.023).At 24 h after the procedure,thevisual analog scale score in the external use of mirabilite group was lower than that in the blankgroup(P=0.001).Compared with those in the blank group,the TNF-αexpressions weresignificantly lower and the IL-10 expressions were significantly higher at 24 h after the procedurein the external use of mirabilite group(P=0.032 and P=0.011,respectively).There were nosignificant differences in serum DAO,D-lactic acid,and endotoxin levels before and after ERCPbetween the two groups.No adverse effects of mirabilite were observed.CONCLUSIONExternal use of mirabilite reduced the PEP occurrence.It significantly alleviated post-proceduralpain and reduced inflammatory response.Our results favor the external use of mirabilite toprevent PEP in children.