咳嗽“死脉”在肺癌预后中的临床应用

目的:探讨咳嗽“死脉”在肺癌预后中的临床应用.方法:通过查阅古籍,总结、归纳“死脉”的种类和其临床应用.结果:古医家论述的“死脉”之“死”是病重、难治的脉象,即中医古书论述的危重期,“死脉”和患者死亡没有必然的联系,但“死脉”可以作为肺癌预后的判断标准之一.结论:咳嗽“死脉”对肺癌预后有一定的指导作用.     

Recent advances towards the discovery of ORL-1 receptor agonists and antagonists

Since their discovery a decade ago, remarkable progress has been made toward understanding the biological function and significance of the opioid receptor-like-1 (ORL-1) receptor and its endogenous peptide ligand, nociceptin. The human nociceptin receptor, herein referred to as ORL-1, but also known as OP4 (the fourth member of opioid peptide receptor family) or nociceptin/orphanin FQ peptide (NOP) receptor, was first identified as an orphan opioid receptor with close homology to the classical μ-, κ-, and δ-opioid receptors. ORL-1 does not bind endogenous ligands of the other opioid receptors with high affinity, but instead prefers the 17 amino acid peptide nociceptin. The obvious homologies of ORL-1 to opioid receptors, and its ligand nociceptin to opioid peptide ligands, led to a period of intense investigation that resulted in a number of significant reports describing the biology of the receptor and ligand. The emerging pharmacological evidence from these reports suggests that ORL-1 agonists may be clinically useful for treatment of stress, anxiety, substance abuse (opioid and alcohol), anorexia, cachexia, cough, asthma, and possibly neuropathic pain/allodynia. The peripheral effects of nociceptin suggest that agonists may have utility in the treatment of gastrointestinal motility disorders, water retention, and hypertension. ORL-1 antagonists may be useful in enhancing cognitive function and treating locomotor disorders such as Parkinsonism. In addition to research into the fundamental biology of ORL-1 and nociceptin, noteworthy advances have been made in the discovery of new peptide and non-peptide agonists and antagonists of the ORL-1 receptor leading to a better understanding of its involvement in a variety of biological processes. This review highlights the rationale for the development of ORL-1 ligands and recent progress made by different research groups towards the development of peptidic and non-peptidic ORL-1 agonists or antagonists over the last four years. To add perspective on the commercial potential of this research area, the development status of advanced new molecules is addressed together with any pharmacological characterisation of these entities.     

止嗽散加减治疗外感咳嗽的疗效观察

目的观察止嗽散加减治疗外感咳嗽的疗效。方法2011年1月至2011年12月符合诊断标准的门诊病例100例，随机分为两组。治疗组采用止嗽散加减治疗，对照组口服枇杷止咳糖浆。结果治疗组总有效率96％，对照组总有效率80％，经统计学处理，两组差异有高度统计意义（P〈O．05）。结论止嗽散加减治疗外感咳嗽疗效显著。     

Benefits of delapril in hypertensive patients along the cardiovascular continuum

Angiotensin-converting enzyme inhibitors (ACEIs) are the first-line therapy for the treatment of hypertension. However, not all ACEIs are equal. Delapril is a nonsulfhydryl ACEI with unique properties. Delapril has a high lipophilicity and weak bradykinin potentiating action. As a result, delapril has a more potent inhibition capacity of vascular wall angiotensin-converting enzyme activity and a lower incidence of cough than enalapril or captopril. With regard to efficacy, delapril has a long-lasting antihypertensive effect with a trough/peak ratio that is in the upper range of different ACEIs and a positively high smoothness index. Thus, delapril effectively and smoothly reduces blood pressure over 24 h. Moreover, the benefits of delapril are not limited to hypertensive patients, but also in those with microalbuminuria, left ventricular hypertrophy, myocardial infarction or heart failure; delapril appears to be effective and well tolerated.     

Titration of Mechanical Insufflation–Exsufflation Optimal Pressure Combinations in Neuromuscular Diseases by Flow/Pressure Waveform Analysis

IntroductionThe aim of this study was to assess several air-pressure settings for MI–E to determine their effect on peak cough flow (PCF), and to compare the best pressures with those are more common used in the literature (±40 cmH₂O) in patients with neuromuscular disorders (NMD).MethodsAdults with NMD in whom MI–E was indicated were recruited. Assisted PCF was measured by an external pneumotachograph. The protocol included 9 PCF measures per patient: 1 baseline (non-assisted), 4 with increasing inspiratory pressures without negative pressure (10, 20, 30 and 40 cmH₂O or maximum tolerated), and then 4 adding expiratory pressures (?10, ?20, ?30 and ?40 cmH₂O or maximum tolerated) with maximum inspiratory pressure previously achieved.ResultsTwenty one patients were included, 61% with amyotrophic lateral sclerosis (ALS). Mean PCFs with recommended pressures (±40 cmH₂O) were lower than the scored in the individualized steps of the titration protocol (197.7 ± 67 l/min vs 214.2 ± 60 l/min, p < 0.05). Regarding subgroups, mean PCF_max values in ALS patients with bulbar symptoms were significantly higher than those achieved with recommended pressures (163.6 ± 80 vs 189 ± 66 l/min, p < 0.05).ConclusionThe PCF_max obtained with the protocol did not always match the recommended settings. It may be advisable to perform MI–E titration assessed by non-invasive PCF monitoring in patients with NMD, especially in ALS with bulbar involvement to improve the therapy detecting airway collapse induced by high pressures.     

不同细胞类型咳嗽变异型哮喘的临床特征分析

目的比较不同细胞类型的咳嗽变异型哮喘患者的临床特征差别。方法选择2014年12月至2017年3月在本院咳嗽门诊就诊的慢性咳嗽患者,遵循中国慢性咳嗽指南(2015版)诊治流程,在询问病史、临床症状和获得体征的基础上,进行血常规、胸片、肺通气功能+气道反应性、诱导痰细胞学分类等相关检查,依据检查结果和治疗反应,确定病因诊断,筛选出咳嗽变异型哮喘,依据诱导痰细胞学分类计数检查结果进行分组,比较不同细胞类型的成人咳嗽变异型哮喘患者的临床特征差别。结果共收集诊断明确且病因单一的成人咳嗽变异型哮喘患者114例,占所有慢性咳嗽患者的32.95%,其中男性56例(48.7%),女性58例(51.3%)。按细胞类型分类:嗜酸性粒细胞增多型23例(20.2%),中性粒细胞增多型53例(46.5%),寡细胞型14例(12.3%),混合细胞型24例(21.1%);分组比较显示:中性粒细胞增多型年龄最长(P=0.042),而嗜酸性粒细胞增高型患者的FeNo值水平最高(P<0.001);混合细胞型患者咳嗽时间最长(P=0.012),与寡细胞型相比较,混合细胞型患者有明确体育锻炼史(P=0.007)。结论不同细胞类型的成人咳嗽变异型哮喘患者的临床特征存在较明显的差别,可以用于指导临床疾病管理。     

酮替芬治疗感冒后咳嗽的系统评价

目的评价酮替芬治疗感冒后咳嗽临床疗效与安全性。方法检索主要中英文数据库从建库至2015年12月20日酮替芬治疗感冒后咳嗽随机对照试验研究,筛选合格研究。Cochrane评价员手册、Jadad评分法分别进行偏倚风险评价及质量评价。应用Rev Man5.3软件进行Meta分析。结果符合纳入标准的文献共3篇。Meta分析结果显示,酮替芬治疗感冒后咳嗽治疗组与对照组相比,临床疗效总有效率比值比(odds ratio,OR)为9.44,95%可信区间(confidence interval,CI)(2.81,31.70),差异有统计学意义(P=0.0003);不良反应OR为1.94,95%CI(0.40,9.54),差异无统计学意义(P=0.41)。结论酮替芬治疗感冒后咳嗽有显著临床疗效,但仍需更多高质量、大样本的临床研究来进一步验证。     

清肺止咳汤治疗肺热咳嗽32例

目的:探讨清肺止咳汤治疗肺热咳嗽的临床疗效。方法:将62名肺热咳嗽患者随机分为两组,对照组予常规抗感染、止咳化痰治疗,治疗组在常规治疗的同时予以清肺止咳汤治疗。结果:对照组治愈16例,好转8例,未愈6例,总有效率80.00%;治疗组治愈20例,好转10例,未愈2例,总有效率93.75%。结论:清肺止咳汤对治疗肺热咳嗽疗效显著。     

胡思荣辨治咳嗽经验

胡思荣辨治咳嗽,在继承了先贤整体论及辨证论治等核心思想的基础上,务实地补充了自己的新解。临证中擅长运用温病学理论,倡导和调气机的指导思想,从三焦气化功能角度辨证,采用宣降同用,化润并举,上下分消等法论治咳嗽,引入因时参辨,灵活施药,发挥中医"整体观念""辨证论治"之优势,临证思辨,效如桴鼓。