Research Status of TCM Rehabilitation in Chronic Obstructive Pulmonary Disease (COPD)

This paper mainly analyzes the application status of TCM rehabilitation in chronic obstructive pulmonary disease(COPD),hoping to provide support and help for clinical staff through this study,and promote the further development of COPD rehabilitation program.

Diagnosis and treatment of an elderly patient with 2019-nCoV pneumonia and acute exacerbation of chronic obstructive pulmonary disease in Gansu Province:A case report

BACKGROUND In December 2019,the first patient with 2019-novel coronavirus(2019-nCoV)was reported in Wuhan,China,and the disease spread rapidly across the country and surrounding countries within 2 mo.As of February 29,2020,a total of 91 confirmed cases had been reported in Gansu Province.This case report of the diagnosis and treatment of an elderly patient with 2019-nCoV pneumonia complicated by acute exacerbation of chronic obstructive pulmonary disease in Gansu Province aims to provide a better reference for the treatment of patients in the future.CASE SUMMARY The patient,a 94-year-old female,lived in Maiji District of Tianshui,Gansu Province,China.On January 30,2020,she was admitted to the Fourth People’s Hospital of Tianshui after 9 d of close contact with a patient with 2019-nCoV pneumonia.She was subsequently admitted to Gansu Provincial Hospital of Traditional Chinese Medicine for isolation and transferred to Tianshui Gansu Provincial Hospital of Infectious Diseases on February 3,2020 for treatment.Upon initial examination,her body temperature was 36.7°C,pulse was 80,breathing was 20,and blood pressure was 130/80 mmHg.She was conscious with normal development and normal nutrition.The pharynx was not red,and bilateral tonsils were not red and swollen.The lungs sounded slightly coarse with no dry or wet rales.The first symptoms were cough and fatigue on 2 February.The patient was hospitalized for 12 d.After active treatment,she was discharged on February 14 with a good prognosis.CONCLUSION A history of exposure to the affected area or patient is a major cause of 2019-nCoV infection,and population clustering is a high risk factor for transmission.Patients may not necessarily have respiratory system symptoms as the only clinical manifestation but may also have concomitant or first onset digestive symptoms.Attention should be paid to the prevention and treatment of multiple organ dysfunction syndrome.Nucleic acid testing is extremely important and needs to be repeated several times.Laboratory and auxiliary examination indicators during the first week of admission are extremely important.It is feasible to carry out dynamic and continuous index monitoring,which can predict and guide the prevention and treatment of multiple organ dysfunction and the prognosis of the disease.

Professor Chen Xianhai's experience of herb pairs in the treatment of pulmonary diseases

According to the theory of traditional Chinese medicine,based on the four properties and five flavors of traditional Chinese medicines,the lifting and lowering theory and channel tropism,Professor Chen combined with the theory of traditional Chinese medicine and constitution identification to prescribe for patients and used herb pairs to treat many kinds of pulmonary diseases.And he has achieved good clinical effect by"treatment methods selection according to syndromes".His experience in medication and compatibility mechanism are worthy of further exploration and promotion by scholars.

Treatment of patients with bosentan in postoperation of congenital heart disease with pulmonary arterial hypertension:a double-blind,randomized controlled trial

Objective Endothelin is a key role in the pathogenic of pulmonary arterial hypertension. High concentrations of endothelin 1 have been recorded in plasma and lungs of patients with pulmonary artery hypertension associated with congenital heart disease,and the concentrations of endothelin-1 was correlated with severity degree

Treat to target in Crohn’s disease:A practical guide for clinicians

A treat-to-target(T2T)approach applies the principles of early intervention and tight disease control to optimise long-term outcomes in Crohn's disease.The Selecting Therapeutic Targets in Inflammatory Bowel Disease(STRIDE)-II guidelines specify short,intermediate,and long-term treatment goals,documenting specific treatment targets to be achieved at each of these timepoints.Scheduled appraisal of Crohn’s disease activity against pre-defined treatment targets at these timepoints remains central to determining whether current therapy should be continued or modified.Consensus treatment targets in Crohn’s disease comprise combination clinical and patient-reported outcome remission,in conjunction with biomarker normalisation and endoscopic healing.Although the STRIDE-II guidelines endorse the pursuit of endoscopic healing,clinicians must consider that this may not always be appropriate,acceptable,or achievable in all patients.This underscores the need to engage patients at the outset in an effort to personalise care and individualise treatment targets.The use of non-invasive biomarkers such as faecal calprotectin in conjunction with cross-sectional imaging techniques,particularly intestinal ultrasound,holds great promise;as do emerging treatment targets such as transmural healing.Two randomised clinical trials,namely,CALM and STARDUST,have evaluated the efficacy of a T2T approach in achieving endoscopic endpoints in patients with Crohn’s disease.Findings from these studies reflect that patient subgroups and Crohn’s disease characteristics likely to benefit most from a T2T approach,remain to be clarified.Moreover,outside of clinical trials,data pertaining to the real-world effectiveness of a T2T approach remains scare,highlighting the need for pragmatic real-world studies.Despite the obvious promise of a T2T approach,a lack of guidance to support its integration into real-world clinical practice has the potential to limit its uptake.This highlights the need to describe strategies,processes,and models of care capable of supporting the integration and execution of a T2T approach in real-world clinical practice.Hence,this review seeks to examine the current and emerging literature to provide clinicians with practical guidance on how to incorporate the principles of T2T into routine clinical practice for the management of Crohn’s disease.

Treatment with neurohormonal inhibitors and prognostic outcome in pulmonary arterial hypertension with risk factors for left heart disease

BACKGROUND Despite major advances in pharmacologic treatment,patients with pulmonary arterial hypertension(PAH)still have a considerably reduced life expectancy.In this context,chronic hyperactivity of the neurohormonal axis has been shown to be detrimental in PAH,thus providing novel insights on the role of neurohormonal blockade as a potential therapeutic target.AIM To evaluate the application and prognostic effect of neurohormonal inhibitors(NEUi)in a single-center sample of patients with idiopathic PAH and risk factors for left heart disease.METHODS We analyzed data retrospectively collected from our register of right heart catheterizations performed consecutively from January 1,2005 to October 31,2018.Patients on beta-blocker,angiotensin-converting enzyme inhibitor,angiotensin receptor blocker or mineralocorticoid receptor antagonist at the time of right heart catheterization were classified as NEUi users and compared to NEUi nonrecipients.RESULTS Complete data were available for 57 PAH subjects:27 of those(47.4%)were taking at least one NEUi at the time of right heart catheterization and were compared with the remaining 36 NEUi non-recipients.NEUi users were older and had a higher cardiovascular risk profile compared to non-recipients.Additionally,NEUi non-users had a higher probability of dying during the course of follow-up than NEUi recipients(56.7%vs 25.9%,log-rank P=0.020).CONCLUSION The above data highlighted a subgroup of patients with PAH and comorbidities for left heart disease in which NEUi use has shown to be associated with improved survival.Future prospective studies are needed to identify the most appropriate therapeutic strategies in this subset population.

Early chronic obstructive pulmonary disease: Beyond spirometry

The significant healthcare burden associated with chronic obstructive pulmonary disease(COPD) is driving us to improve our understanding of the natural history of this disease. Historically, the focus has been largely centred on diagnosing and treating individuals with moderate and severe disease. However, it is now recognised that the speed of decline in lung function as measured by forced expiratory volume in 1 s occurs faster in the earlier stages of the disease process. As a result, a clearer understanding of the potential benefits of treatment in early COPD is needed. It is recognised that many patients with COPD remain undiagnosed in the community which has prompted global case-finding initiatives. In this review we discuss the difficulties in diagnosing COPD in its early stages, examine the roleof case-finding and look at the evidence for early intervention with therapeutic agents. There is a growing interest in the phenotypic variation amongst patients with COPD and we explore the role of phenotyping in early COPD and its potential benefits in providing a more individualised approach to COPD management. The majority of patients with COPD are known to die from non-respiratory causes such as cardiovascular disease. The mechanistic link is thought to relate to systemic inflammation, causing us to question whether earlier interventions could have a beneficial impact on the burden of co-morbidities for patients with COPD.

Consumption of gluten with gluten-degrading enzyme by celiac patients: A pilot-study

AIM:To assesses the safety and efficacy of Aspergillus niger prolyl endoprotease(AN-PEP)to mitigate the im-munogenic effects of gluten in celiac patients.METHODS:Patients with initial diagnosis of celiac disease as confirmed by positive serology with subtotal or total villous atrophy on duodenal biopsies who adhere to a strict gluten-free diet(GFD)resulting in normalised antibodies and mucosal healing classified as Marsh 0 orⅠwere included.In a randomised double-blind placebo-controlled pilot study,patients consumed toast(approximately 7 g/d gluten)with AN-PEP for 2 wk(safety phase).After a 2-wk washout period with adherence of the usual GFD,14 patients were randomised to gluten intake with either AN-PEP or placebo for 2 wk(efficacy phase).Measurements at baseline included complaints,quality-of-life,serum antibodies,immunophenotyping of T-cells and duodenal mucosa immunohistology.Furthermore,serum and quality of life questionnaires were collected during and after the safety,washout and efficacy phase.Duodenal biopsies were collected after the safety phase and after the efficacy phase.A change in histological evaluation according to the modified Marsh classification was the primary endpoint.RESULTS:In total,16 adults were enrolled in the study.No serious adverse events occurred during the trial and no patients withdrew during the trial.The mean score for the gastrointestinal subcategory of the celiac disease quality(CDQ)was relatively high throughout the study,indicating that AN-PEP was well tolerated.In the efficacy phase,the CDQ scores of patients consuming gluten with placebo or gluten with AN-PEP did not significantly deteriorate and moreover no differences between the groups were observed.During the efficacy phase,neither the placebo nor the AN-PEP group developed significant antibody titers.The IgA-EM concentrations remained negative in both groups.Two patients were excluded from entering the efficacy phase as their mucosa showed an increase oftwo Marsh steps after the safety phase,yet with undetectable serum antibodies,while 14 patients were considered histologically stable on gluten with AN-PEP.Also after the efficacy phase,no significant deterioration was observed regarding immunohistological and flow cytometric evaluation in the group consuming placebo compared to the group receiving AN-PEP.Furthermore,IgA-tTG deposit staining increased after 2 wk of gluten compared to baseline in four out of seven patients on placebo.In the seven patients receiving AN-PEP,one patient showed increased and one showed decreased IgA-tTG deposits.CONCLUSION:AN-PEP appears to be well tolerated.However,the primary endpoint was not met due to lack of clinical deterioration upon placebo,impeding an effect of AN-PEP.

Efficacy of thalidomide therapy in pediatric Crohn's disease with evidence of tuberculosis

AIM To evaluate the efficacy of thalidomide for treating troublesome cases of pediatric Crohn's disease(CD) with tuberculosis infection.METHODS A retrospective study of clinical outcome among children treated with thalidomide was conducted. All patients had evidence of tuberculosis infection with a failure of anti-tuberculosis treatment for more than one year,and were subsequently diagnosed with CD. All the patients received thalidomide treatment with a starting dose of 1.2-2.5 mg/kg per day. Remission was defined as pediatric CD activity index less than or equal to 10.RESULTS Ten patients with CD were treated with thalidomide at an average age of 7.2 years and followed up for a median of 22.2 mo. Clinical remission rate was 60% after 9-12 mo of thalidomide treatment. One patient with no response had an interleukin-10 receptor alpha gene mutation. Erythrocyte sedimentation rate,C-reactive protein and platelet count showed a dramatic decrease; hemoglobin level and weight improved significantly after thalidomide treatment when compared with the baseline values.CONCLUSION Thalidomide is an effective and safe drug for remission of CD in pediatric patients who have been treated for tuberculosis.

The influence of intestine-based treatment using Xuan Bai Cheng Qi Tang on the concentration of trace elements in the main organs of COPD rats

Objective:To test two theories from traditional Chinese medicine:'exterior -interior relationship between the lung and large intestine' and 'treating from the intestine principle for lung disorders'.The influence of intestine-based treatment using Xuan Bai Cheng Qi Tang (XBCQT) on the concentration of three trace elements-copper (Cu),zinc (Zn),and manganese (Mn)-was observed in the tissues of the lung,small intestine,large intestine,and stomach of rats suffering from chronic obstructive pulmonary disease (COPD).Methods:Thirty-five male Wistar rats were divided randomly and equally into five groups:control;model;Fei treatment (A);Chang treatment (B);and Fei-Chang treatment (C).A rat model of COPD was prepared by tracheal injection of lipopolysaccharide plus exposure to cigarette smoke.Treatments with medicinal herbs started day-22 of administration and exposure to cigarette smoke for 7 days.The control group and model group were administered physiologic (0.9%) saline solution via the stomach.After 7 days of intervention,the tissues of the lung,small intestine,large intestine,and stomach were removed.Inductively coupled plasma-atomic emission spectroscopy was used to detect the levels of Cu,Zn,and Mn in those tissues.Results:Compared with the control group,the Cu concentration in the tissues of the small intestine,large intestine,and stomach increased significantly in the model group (P <.05);the Mn concentration in the tissues of the lung,large intestine,and stomach increased significantly in the model group (P <.05);the Zn concentration in the tissues of the lung and large intestine decreased significantly in the model group (P <.05).In comparison of the model group:the Cu concentration in the tissues of the lung and large intestine decreased significantly in the B group (P <.05);the Mn concentration in the tissues of the lung,small intestine,and large intestine decreased significantly in the B group (P <.05);the Zn concentration in the tissues of the lung,small intestine,and large intestine increased significantly in the B group (P <.05).For the A group versus C group comparison,the Zn concentration in the tissues of the small intestine and stomach increased significantly in the latter (P <.05).Conclusion:This study showed that 'treating from the intestine' using Xuan Bai Cheng Qi Tang and its modified formulae can regulate the concentration of trace elements in the main organs of COPD rats.This may be one of the mechanisms for intestine-based treatment for COPD.

Postoperative diarrhea in Crohn's disease:Pathogenesis,diagnosis,and therapy

Diarrhea is a frequent symptom in postoperative patients with Crohn’s diseases(CD),and several different mechanisms likely account for postoperative diarrhea in CD.A targeted strategy based on a comprehensive understanding of postoperative diarrhea is helpful for better postoperative recovery.

Intestinal Behçet's disease: A review of clinical diagnosis and treatment

Behçet's disease(BD)is a chronic inflammatory disorder prone to frequent re-currences,with a high predilection for intestinal involvement.However,the ef-ficacy and long-term effects of surgical treatment for intestinal BD are unknown.In the current issue of World J Gastrointest Surg,Park et al conducted a retrospec-tive analysis of 31 patients with intestinal BD who received surgical treatment.They found that elevated C-reactive protein levels and emergency surgery were poor prognostic factors for postoperative recurrence,emphasizing the adverse impact of severe inflammation on the prognosis of patients with intestinal BD.This work has clinical significance for evaluating the postoperative condition of intestinal BD.The editorial attempts to summarize the clinical diagnosis and treatment of intestinal BD,focusing on the impact of adverse factors on surgical outcomes.We hope this review will facilitate more precise postoperative management of patients with intestinal BD by clinicians.

王书臣教授辨证治疗肺痿经验

特发性肺间质纤维化(Idiopathic pulmonary fibrosis, IPF)已成为国际化难题,患者多病情进展迅速、生活质量低下、生存期短,单用西医激素和免疫抑制剂或细胞因子抑制剂治疗,难以延缓或逆转肺纤维化的进展,同时诸多药物反应限制其应用。通过中医辨证论治结合现代中药药理,王书臣教授对特发性肺间质纤维化的中医病名、病因病机及治疗原则形成了自己独特的见解,认为重症患者当以“肺痿”命名更佳,提出“治肺痿如治中风”“治肺痿当祛风”“治痿当兼顾脾胃”“肺肾同治”等观点,临床中用于患者治疗,疗效确切,为提高患者生活质量提供了宝贵经验。

中国儿童肺动脉高压诊治现状

肺动脉高压是一类具有不同的病因和发病特点、多因素致病的疾病。中国儿童肺动脉高压最常见的类型是先天性心脏病相关肺动脉高压和特发性肺动脉高压。现重点介绍这两类疾病的诊治现状,同时介绍与儿童肺动脉高压相关的其他疾病,以及分析当前存在的问题和挑战,并对未来进行展望。

胸部定量CT对COPD患者治疗反应预测因素分析

目的分析胸部定量CT扫描对慢性阻塞性疾病(COPD)患者治疗反应的预测因素。方法回顾性分析2018年8月至2021年2月接受治疗COPD患者120例的临床资料,对其随访1年,根据肺功能检测结果将其分为有治疗反应组[n=24,第1秒用力呼气容积(FEV_(1))增加≥0.225 L]和非无治疗反应组(n=96,FEV_(1)增加<0.225 L)。对2组一般资料进行单因素分析,对其中差异有统计学意义的变量进行多因素Logistic回归分析,从而筛选出预测COPD患者治疗反应的因素。结果单因素分析结果显示,有治疗反应组和无治疗反应组在EI、ATI、Pi10、WA%、T方面的差异有统计学意义(P<0.05),而2组间性别比、年龄、体重指数、GOLD分期、入院肺功能检测的差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,Pi10为预测COPD患者治疗反应的因素(OR=2.321,P<0.05)。ROC曲线显示,Pi10在预测COPD患者治疗反应中具有极高的临床价值,ROC曲线显示,Pi10预测COPD患者治疗反应的曲线下面积为0.701,95%CI为0.610~0.781,约登指数为0.354,最佳截断值为4.65 mm,灵敏度为85.40%,特异度为50.00%。结论胸部定量CT扫描参数Pi10能够帮助预测COPD患者治疗反应。

从气血同治探讨慢性气道疾病的异病同治

支气管哮喘和慢性阻塞性肺疾病(简称慢阻肺)同属慢性气道炎症疾病,在病机和治法上有一定的相似性,其都可通过调节气血以恢复肺气宣肃,行使正常生理功能。针对肺的生理功能和气血的关系,探讨支气管哮喘和慢阻肺的共同病机:支气管哮喘的基本病机是痰伏于肺,外邪引动,痰气互结,肺失宣降,并可兼有瘀血阻络之象;慢阻肺的病机以久病肺虚为本,加之痰浊、水饮、瘀血等病理产物,使得肺失宣降,本虚标实的病机随病程持续进展;进而从气血同治角度探讨支气管哮喘和慢阻肺2种慢性气道疾病的异病同治,得出“气血同治,畅通气道”的治疗理念。结合成药的应用,分析以此病机为指导的丹龙口服液组方特点和功效主治,为丹龙口服液异病同治2种气道疾病提供理论依据。

基于辨病辨体探讨肺结节的中医治疗

肺结节因其检出率上升且有癌变风险而日益引起医患的重视。患者早期多无明显症状,通过辨证论治不足以获取足够的信息指导治疗,既不利于及早干预肺结节,又不利于患者改善预后、缓解焦虑情绪。辨病论治以肺结节发生、发展的自然规律为基础,针对病因采取最佳治疗原则;辨体论治则针对患者的体质差异而调整体质,辨病论治与辨体论治相结合可获得更多的诊疗信息,予患者及时有效的诊治,以延缓或阻碍肺结节发展并降低其癌变风险,丰富中医诊疗肺结节的思路。

基于“肺与大肠相表里”理论和“整体观念”探讨慢性肺系病合并功能性便秘的诊治思路

慢性肺系病和功能性便秘均是临床常见的难治性疾病,且易合并出现。对二者分别进行干预是现代医学的常规治疗模式,但疗效及安全性均不能令人满意。课题组在临床实践中发现,中医药治疗慢性肺系病合并功能性便秘具有独特的优势。笔者在中医“肺与大肠相表里”理论和“整体观念”指导下,提出慢性肺系疾病合并功能性便秘的病机涉及肺失宣肃致腑气不通、大肠传导失司致肺气上逆、脾失健运、肾精亏损、气血两虚、久病瘀滞等方面,治疗当以“肺肠合治”为总则,辅以健脾益肾、补气养血以扶本虚,行气化瘀以祛实邪,并据此整理临床常用方药,系统总结了本病的中医诊治思路。

基于“培土生金”与肠道微生态探讨慢性阻塞性肺疾病的针灸治疗思路

肠道微生态在机体防御感染,调节免疫和代谢等方面具有重要作用,与慢性阻塞性肺疾病(Chronic Obstructive Pulmonary Diseases,COPD)有密切关系。针灸在调节肠道菌群和防治COPD中均有较好的疗效,该文从针灸改善肠道菌群与防治COPD的古籍文献论述与现代研究文献入手,总结临床针灸治疗该病取穴规律,进一步探讨培土生金理论指导下的针灸取穴思路,临证选取手太阴、足太阴、足阳明经穴,以调理脾胃功能为主,辅以补肺,肺、脾、胃俞调理肺脾,定喘、膻中、中脘纳气平喘,根据五行相生理论选取太渊、太白穴,并结合全身兼证,随证(症)配穴。

肠道菌群对COPD合并骨质疏松症的作用机制及中医药防治研究进展

慢性阻塞性肺疾病(COPD)是最常见的慢性肺系疾病之一。而骨质疏松症(OP)是COPD最常见的合并症之一。近年来,肠道菌群(GM)与人体健康关系的研究日益深入,其与COPD合并骨质疏松症的发生、发展也引发了广泛关注。2000年第五次全国人口普查,我国进入老龄化阶段。老年人作为COPD合并骨质疏松症的主要发病群体,人口比例不断上升,探索COPD合并骨质疏松症的优化治疗方案成为临床及科研人员们的关注重点。以“肺与大肠相表里”为基础的“肺-肠”轴理论亦成为新的研究热点。本文基于“肺-肠”轴理论,根据COPD合并骨质疏松症的生理、病理特点,探讨调节肠道菌群在干预此类疾病中的重要性,旨在为COPD合并骨质疏松症患者探索新的防治思路,为进一步临床研究和推广提供理论支持。