Mast cells in citric acid-induced cough of guinea pigs

It was demonstrated previously that mast cells play an important role in citric acid (CA)-induced airway constriction. To investigate the role of mast cells in CA-induced cough, three experiments were carried out in this study. In the first experiment, 59 guinea pigs were employed and we used compound 48/80 to deplete mast cells, cromolyn sodium to stabilize mast cells, MK-886 to inhibit leukotriene synthesis, pyrilamine to antagonize histamine H(1) receptor, methysergide to antagonize serotonin receptor, and indomethacin to inhibit cyclooxygenase. In the second experiment, 56 compound 48/80-pretreated animals were divided into two parts; the first one was used to test the role of exogenous leukotriene (LT) C(4), while the second one to test the role of exogenous histamine in CA-induced cough. Each animal with one of the above pretreatments was exposed sequentially to saline (baseline) and CA (0.6 M) aerosol, each for 3 min. Then, cough was recorded for 12 min using a barometric body plethysmograph. In the third experiment, the activation of mast cells upon CA inhalation was investigated by determining arterial plasma histamine concentration in 17 animals. Exposure to CA induced a marked increase in cough number. Compound 48/80, cromolyn sodium, MK-886 and pyrilamine, but not indomethacin or methysergide, significantly attenuated CA-induced cough. Injection of LTC(4) or histamine caused a significant increase in CA-induced cough in compound 48/80-pretreated animals. In addition, CA inhalation caused significant increase in plasma histamine concentration, which was blocked by compound 48/80 pretreatment. These results suggest that mast cells play an important role in CA aerosol inhalation-induced cough via perhaps mediators LTs and histamine.     

How does lobeline injected intravenously produce a cough?

In order to examine, whether the lobeline-induced cough is a true reflex or a voluntary effort to get rid of its irritating sensations in the upper respiratory tract, we systematically studied the cough response to lobeline, of subjects who were unable to make conscious discriminations i.e. were either comatose (n=4) or anaesthetized (n=5). 8 microg/kg lobeline injected into the right atrium of one and 29 microg/kg intravenously (i.v.) into another evenly and spontaneously breathing comatose subject produced a cough after 4s and 12s, respectively. Cough was repeatable and showed a dose response relationship i.e., its latency decreasing and its duration/intensity increasing with the dose. In a third subject, capable only of weak spontaneous respiration, a relatively high dose injected into the right atrium (44 microg/kg) generated a pronounced cough-like respiratory movement superimposed on the artificial ventilation and also during the apnoea after disconnecting the pump. No respiratory response was evoked in a fourth subject who had no evidence of brainstem reflexes. In five normals, cough was elicited with a mean dose of 35+/-5 microg/kg i.v. (latency 14+/-2 s; duration 10+/-3 s). After thiopental anaesthesia, injecting 41+/-7 microg/kg produced a cough within 13+/-2 s that lasted for 12+/-2 s. It may be noted that neither the later dose nor the latency or duration of cough that it produced were significantly different from the pre anaesthesia values (P>0.05). These two sets of results show unequivocally that the lobeline-induced cough is evoked reflexly; its magnitude in the conscious state could vary by subjective influences. We discuss the likelihood of its origin from juxtapulmonary capillary receptors.     

Fast three-dimensional numerical hemolysis approximation

The in vivo implantation of a mechanical device contributes to hemodynamic disturbances, which are responsible for damage to the membranes of red blood cells that in turn can lead to their rupture (hemolysis). It is important to ascertain at the design stage of such mechanical devices that they are innocuous to blood. Because there is no in vivo hemolysis index, we concentrated our efforts on the in vitro hemolysis index of the American Society for Testing and Material (ASTM) standard. We present in this work a framework for minimizing medical device-induced hemolysis by the development of a numerical method for predicting hemolysis similar to that used in in vitro experiments. The method is based on a novel interpretation of the Giersiepen-Wurzinger blood damage correlation that replaces the computation of blood damage along the streamline by a volume integration of a damage function over the computational domain. We assess the behavior and accuracy of this methodology with 3D examples.     

Molecular adsorbents recirculating system dialysis for liver insufficiency and sepsis following right ventricular assist device after cardiac surgery

We report a case of right heart failure (RHF) and sepsis with liver insufficiency in a 70-year-old patient after coronary artery bypass graft surgery. Three hours after surgery the patient suddenly developed therapy refractory cardiac arrest caused by RHF. He had to have emergency surgery, under which the graft to the right coronary artery was revised and a right ventricular assist device was implanted. Heart function recovered and the assist device was explanted on day 1 after surgery. Thoracic closure was performed on day 5 after surgery. The patient went into septic shock on day 11. Liver dysfunction developed postoperatively and worsened the course of sepsis. Therefore, MARS (molecular adsorbents recirculating system) dialysis was performed once on day 20 after surgery. Liver function improved after MARS therapy and the patient recovered from sepsis. On day 46 the patient was transferred from the ICU of another hospital to one of the peripheral wards, to be finally discharged on day 67.     

Physiologic-insensitive left ventricular assist predisposes right-sided circulatory failure: a pilot simulation and validation study

Right-sided circulatory failure (RSCF) is a serious complication in 15-30% of patients receiving a left ventricular assist device (LVAD). It is hypothesized that left ventricular support which lacks physiologic properties predisposes to RSCF. An integral computer simulation and experimental validation protocol was performed. The results suggest that with conventional insensitive left ventricular support right-sided circulatory function is compromised, which may form a substrate for the onset or progress of RSCF. Feedback control of the LVAD could provide a means to counter this problem. A control concept for the LVAD which aims to preserve right-sided circulatory function, while supporting peripheral perfusion, is proposed     

Traumatic abdominal hernia caused by cough,presenting with intestinal obstruction

A case of traumatic abdominal hernia is reported in a patient with a history of chronic cough. After a bout of coughing 3 months prior to her presentation, the patient developed a large herniation on the left lateral side of the abdomen. The patient presented with intestinal obstruction due to the herniation. A CT scanning confirmed the hernia and showed a peritoneal defect with herniation of most of the intestine on the left lateral side of the abdomen. An emergency midline laparotomy was performed, and the defect was corrected.     

Improvement of laryngopharyngeal reflux symptoms after laparoscopic Hill repair

BACKGROUND: People with proven gastroesophageal reflux disease may also experience symptoms such as voice loss, chronic cough, globus, and sore throat. These laryngopharyngeal reflux symptoms have been reported to respond to prolonged proton pump inhibitor therapy, but the Hill approach to resolving these specific individual symptoms has not been widely reported in surgical literature. METHODS: This clinical outcome study is an analysis of symptom improvement in 145 patients who underwent laparoscopic Hill hiatal hernia repair. A standardized questionnaire was used to score eight gastroesophageal reflux disease symptoms and four laryngopharyngeal reflux symptoms. Also, each patient's primary chief complaints were analyzed. RESULTS: Gastroesophageal reflux and laryngopharyngeal reflux symptoms significantly improved (P < 0.01) compared with preoperative symptoms. Each patient's primary chief complaints improved as well. CONCLUSIONS: This clinical outcome analysis documents symptomatic improvement of laryngopharyngeal reflux and gastroesophageal reflux. Likewise, when these laryngopharyngeal reflux symptoms are chief complaints, with proven gastroesophageal reflux disease, the Hill approach to symptom resolution is likely to be successful.     

藏药四臣止咳颗粒剂的药效学研究

目的：观察藏药四臣止咳颗粒剂的药效作用及机理。方法：采用咳嗽、炎症、发热等动物模型观察其止咳、抗炎、解热作用。结果：该制剂在6.7g生药/kg、13.4g生药/kg、26.8g生药/kg剂量下,各剂量组均能显著的抑制浓氨水诱发的小鼠咳嗽（P〈0.01）,中、大剂量组均能显著的抑制二氧化硫诱发的小鼠咳嗽（P〈0.01）;在8.14g生药/kg、16.28g生药/kg剂量下能显著的抑制枸橼酸诱发的豚鼠咳嗽（P〈0.01）,对大鼠和小鼠的急性炎症反应有抗炎作用,对家兔发热有轻度的解热作用。结论：证实了四臣止咳颗粒剂的止咳作用及其机理。     

糖皮质激素和奥亭止咳露2周疗法对胃-食管反流性咳嗽的筛查作用

目的:探索糖皮质激素和奥亭止咳露短期试验性治疗对胃-食管反流性咳嗽(GERC)的筛查作用.方法:以糖皮质激素和奥亭止咳露治疗98例不明原因慢性咳嗽患者,疗程2周.应用(leicester cough questionnaire,LCQ)测量治疗前后咳嗽程度的改变.对于治疗后LCQ总评分升高值小于3分的病例判为GERC可能,给予检查和/或针对性治疗.结果:本组98例中75例治疗后咳嗽明显减轻,治疗后LCQ总评分升高值大于等于3分,治疗前后LCQ总评分有高度显著性差异(P<0.001),其中仅3例被确定为GERC;23例治疗后咳嗽轻度减轻或未减轻,治疗后LCQ总评分升高值小于3分,治疗前后LCQ总评分无显著性差异(P>0.05),其中14例被确定为GERC.试验性方案治疗无效病例中所含GERC,明显多于治疗有效病例中所含GERC.结论:糖皮质激素和奥亭止咳露2周疗法对GERC具有一定的筛查作用.     

百日咳典型表现中英文描述的比较和（类）百日咳综合征诊断的建议

百日咳（pertussis或whooping cough）这个疾病的中英文名称分别从病程和咳嗽性状两个不同侧面概括了疾病的重要临床特征。在典型百日咳临床描述方面，中英文用词意义不完全一致，如痉挛性咳嗽与paroxysmal cough、痉咳期与paroxysmal stage/phase、“回勾”与whoop等，有的英文描述在中文描述中还没有出现。该文拟通过比较中英文对典型百日咳临床表现的描述差异，为临床认识百日咳提供更为全面的信息，并对建立在典型百日咳临床表现基础上的（类）百日咳综合征的诊断提出建议，以促进临床规范诊疗。