Cough variant asthma is a special type of asthma, of which the only or main symptom is cough, and it is the main cause of chronic cough. Early diagnosis and treatment can prevent cough variant asthma developing into typical asthma. This article summarizes the progress in pathogenesis, diagnosis and assessment, treatment, and prognosis of cough variant asthma, aiming to improve the prevention and treatment of this disease, and increase the patients’ quality of life.
Objective To investigate the blood clotting dysfunction of invasive pulmonary aspergillosis(IPA)and the therapeutic effect of low molecular hepafin in a mouse model．Methods The neutropenic IPA mouse model was constructed by being given cyclophosphamide to depress immunologic function，and then intranasally challenged with Aspergillus fumigatus conidia．(1)Blood clotting function were assessed by bleeding time，clotting time，platelet count and antithrombase-III(AT-III)activity．Seventy-two mice were randomly assigned into 4 groups．Group A received only normal saline．group B received normal saline to substitute the cycloph0sphamide，and the rest equal to group D．Group C received normal saline to substitute the AspergiUus fumigatus conidia suspension，and the rest equal to group D．Group D(model group)received cyclophosphamide(intraperitoneally，150 mg／kg，d4，d1)and Aspergillus fumigatus conidia suspension(intranasally，40 μL／mouse，1．5×10∧5／mL，d0)．Six mice were randomly sacrificed in each group for analysis of blood clotting function per 24 h after inoculation for 3 times．(2)Therapeutic effect of low molecular heparin was determined by survival time of IPA mice．One hundred and eighteen mice were randomly assigned into 4 groups after challenged with 6×10 conidia／mouse and received one of the following regimens daily from dl to d7 after challenge，vehicle(group E，n=29)，low molecular heparin(group F，n=30，subcutaneous injection，1000 IU／kg，qd×7 d)，amphotericin B(group G，n=29，intraperitoneal，1 m kg，qd×7 d)，low molecular heparin plus amphotericin B(group H，n=30)．Mice survivals were recorded once daily to d21 after innoculation．Results (1)AT-III activity of group D decreased significantly 24 h after innoculation．Bleeding time and clotting time decreased significantly and AT—III activity decreased sequentially 48 h after innoculation．The platelet decreased significantly 72 h after innoculation，and bleeding time shoaened further．Clotting time was longer than that 0f 48 h．but still shorter than norm al and AT-III activity decreased sequentially．There were significant differences when comparing group D with group A，B and C(all Plt;0.01)．And there was no significant difference between group A，B and C(all Pgt;0．05)．(2)Survival analysis indicated that the therapeutic effect of low molecular hepafin plus amphotericin B was better than that of amphotericin B or low molecular heparin alone．No therapeutic effect was found in group F(group E vs group F，Pgt;0．05，both group E and group F compared with group H，P lt;0．01．Group H vs group G，P lt;0．05．Both group E and group F compared with group G，P lt;0．05)．Conclusions The results suggest that there is blood clotting dysfunction in IPA mice and AT—III activity may be an early index to monitor the disfunction．Compared with the therapeutic effect of amphoterinein B alone，low molecular hepafin plus amphoterincin B can prolong survival of neutropenic IPA mice
Objective To investigate the clinical outcome of sensory reconstruction about the functional perforator flap for repairing the complex defects on the limbs. Methods A retrospective analysis was conducted on 21 patients with limb complex defects admitted between March 2018 and January 2023. There were 12 males and 9 females, with a median age of 36 years (range, 19-62 years). The wounds were on the upper limbs (hands) in 13 cases and the lower limbs (feet) in 8 cases. Five patients with tumor/scar, and the left defects after en-bloc resection of the tumor lesion and scar were repaired immediately. The remaining 16 cases were acute/chronic wounds, undergoing the emergent debridement and vacuum sealing drainage placement, and the left defects were repaired with flaps during second-stage operation. The size of the defects ranged from 5.5 cm×4.5 cm to 17.0 cm×12.0 cm. The donor sites were located on the thoracic and back in 4 cases, the anterior lateral thigh in 6 cases, and the feet in 11 cases. All flaps were functional perforator flaps with sensory nerve. The donor sites were closed directly or repaired with skin grafting. At last follow-up, the sensation of flap and the muscle strength of recipient site were evaluated according to the British Medical Research Council (BMRC) sensory grading (S0-S4) and muscle strength grading (M0-M5) criteria. Results Twenty flaps survived completely without significant complication, and partial edge necrosis was observed in 1 flap, which healed after the debridement and skin grafting. The donor and recipient sites healed by first intention. All patients were followed up 10-18 months (mean, 12 months). At last follow-up, the flaps with satisfactory shape and soft texture were observed, and no abnormal hair growth or pigmentation occurred. The sensation of flap was evaluated as S1 in 2 cases, S2 in 7, S3 in 9, and S4 in 3. The muscle strength of recipient site was evaluated as M2 in 4 cases, M3 in 9, M4 in 5, and M5 in 3. Only linear scars were left at the donor site. Conclusion The functional perforator flap with sensory nerve is beneficial for early sensation reconstruction for repairing the complex defects on the limbs, and could reconstruct the functional subunit structure defect in one stage. The short-term functional follow-up results are satisfactory.
Objective To investigate the clinical application of relaying lateral gastrocnemius artery perforator flap in reconstruction of the donor defect after distally sural flap transferring. Methods Between January 2014 and January 2016, 12 cases with foot and ankle defects were treated. There were 10 males and 2 females with an average age of 23.4 years (mean, 14-52 years). The injury was caused by motorcycle accident in 7 cases and traffic accident in 5 cases. The injury located at left limb in 7 cases and right limb in 5 cases. The size of soft tissue ranged from 10 cm×4 cm to 12 cm×6 cm. The disease duration was 2-84 hours (mean, 26.2 hours). The foot and ankle defects were reconstructed by distally sural flaps, then the flap donor sites were reconstructed with relaying lateral gastrocnemius artery perforator flap at the same stage. The size of distally sural flap ranged from 11 cm×5 cm to 13 cm×7 cm. The size of relaying flap ranged from 7 cm×4 cm to 10 cm×6 cm. Results All flaps survived uneventfully. All recipient sites and donor sites healed smoothly. No vascular crisis, wound dehiscence, or evident swelling occurred. All patients were followed up 6-14 months (mean, 12.4 months) with satisfied esthetic and functional results in recipient and donor sites. There were only linear scar on the donor sites. The color and contour was satisfying, the function of calf and foot were not affected. Conclusion The relaying lateral gastrocnemius artery perforator flap combined with distally sural flap is an idea choice to reconstruct foot and ankle defect, which can avoid donor site skin grafting, minimize donor site morbidity.
ObjectivesTo systematically review the clinical efficacy of ultrasound-guided percutaneous lavage (UGPL) for calcifying tendinitis of rotator cuff.MethodsPubMed, The Cochrane Library, EMbase, WanFang Data, CBM, VIP and CNKI databases were electronically searched to collect the randomized controlled trials (RCTs) of ultrasound-guided percutaneous irrigation for calcifying tendinitis of rotator cuff from inception to September 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 7 RCTs involving 587 patients were included. The results of meta-analysis showed that: there were significant differences between the UGPL group and extracorporeal shock wave therapy (ESWT) group in 12-month follow-up visual analogue scale (VAS) (MD=–1.96, 95%CI –2.18 to –1.75, P<0.000 01), the average particle size of the calcium deposition (MD=–3.13, 95%CI –5.05 to –1.22,P<0.001), the calcification disappearance rate (RR=1.65, 95%CI 1.36 to 2.01,P<0.000 01). However, there were no significant differences between the two groups in 6-week follow-up VAS (MD=–0.85, 95%CI –2.84 to 1.14,P=0.40), and the complications (RR=1.20, 95%CI 0.03 to 49.69, P=0.93).ConclusionsCurrent evidence shows that UGPL has certain clinical effect for the calcifying tendinitis of rotator cuff. Compared with ESWT, UGPL may be superior in clinical pain relief and calcification clearance. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo explore the effectiveness of iliac myocutaneous flap pedicled with deep circumflex iliac artery (DCIA) on the repair of lower limb composite defect wounds with cavity. MethodsA retrospective analysis of 7 patients with lower limb composite defect wounds treated between March 2017 and September 2020 was conducted, including 4 males and 3 females, aged 24-58 years, with a median age of 37 years. The causes of injury were machine twisting injury in 2 cases, fall from height injury in 2 cases, and traffic accident injury in 3 cases. According to Gustilo-Anderson classification, there were 1 case of type Ⅲa, 4 cases of type Ⅲb, and 2 cases of type Ⅲc (combined with anterior tibial artery rupture); according to AO/Orthopaedic Trauma Association (AO/OTA) classification, there were 2 cases of type 42-C3, 2 cases of type 43-A2, and 3 cases of type 43-B1. The time from injury to admission ranged from 2 to 10 hours, with an average of 6 hours. Tibial bone defect and surrounding soft tissue defect with deep cavity were left after primary emergency debridement. In the second stage, according to the characteristics of the wound, the three-dimensional repair of the composite defect was designed with DCIA embedded iliac myocutaneous flap. The size of the iliac flap was 2.0 cm×2.0 cm×2.0 cm to 7.0 cm×3.0 cm×2.5 cm, and the size of the flap was 12.0 cm×8.0 cm to 21.0 cm×13.0 cm. The internal oblique muscle flap was harvested in size of 3.0 cm×2.0 cm×2.0 cm to 5.5 cm×4.0 cm×4.0 cm. The donor site was primarily closed. ResultsAll the flaps survived after operation, except for 1 case of partial necrosis of the flap edge, which healed after secondary skin grafting, and the donor and recipient wounds healed by first intention. All patients were followed up 16-24 months, with an average of 18 months. The broken end of the bone defect healed well, and the healing time was 8-10 months, with an average of 7.3 months. At last follow-up, the shape of the flap was satisfactory, the texture was soft, and there was no abnormal hair growth, pigmentation, and so on. Only linear scar was left in the donor site, and no complication such as abdominal hernia occurred. According to Paley fracture healing scoring system, bone healing was rated as excellent in 5 cases and good in 2 cases. The limb function was satisfactory, and full weight bearing was achieved at 12-16 months after operation. According to the lower extremity functional scale (LEFS), 6 cases were excellent and 1 case was good. Conclusion The iliac myocutaneous flap pedicled with DCIA is flexible in design and highly free in tissue composition, which can repair the composite defect wound of lower limbs with deep cavity in a three-dimensional way, and repair the limb shape and reconstruct weight-bearing function to the greatest extent.
ObjectiveTo explore the effectiveness and advantage of three-dimensional (3D) printing technology in treatment of internal or external ankle distal avulsed fracture.MethodsBetween January 2015 and January 2017, 20 patients with distal avulsed fracture of internal or external ankle were treated with the 3D guidance of shape-blocking steel plate fixation (group A), and 18 patients were treated with traditional plaster external fixation (group B). There was no significant difference in gender, age, injury cause, disease duration, fracture side, and fracture type between 2 groups (P>0.05). Recording the fracture healing rate, fracture healing time, the time of starting to ankle functional exercise, residual ankle pain, and evaluating ankle function recovery of both groups by the American Orthopaedic Foot and Ankle Society (AOFAS) score.ResultsAll patients were followed up 8-24 months, with an average of 15.5 months. In group A: all incisions healed by first intention, the time of starting to ankle functional exercise was (14±3) days, fracture healing rate was 100%, and the fracture healing time was (10.15±2.00) weeks. At 6 months, the AOFAS score was 90.35±4.65. Among them, 13 patients were excellent and 7 patients were good. All patients had no post-operative incision infection, residual ankle pain, or dysfunction during the follow-up. In group B: the time of starting to ankle functional exercise was (40±10) days, the fracture healing rate was 94.44%, and the fracture healing time was (13.83±7.49) weeks. At 6 months, the AOFAS score was 79.28±34.28. Among them, 15 patients were good, 2 patients were medium, and 1 patient was poor. During the follow-up, 3 patients (16.67%) had pain of ankle joint with different degrees. There were significant differences in the postoperative fracture healing rate, fracture healing time, the time of starting to ankle functional exercise, and postoperative AOFAS score between 2 groups (P<0.05).ConclusionApplication of 3D printing technology in treatment of internal or external ankle distal avulsed fracture is simple, safe, reliable, and effective. In particular, it is an ideal treatment for avulsed fracture.
ObjectiveTo evaluate the accuracy of the new dynamic approach in the measurement of respiratory mechanics with different pressure support (PS) level during pressure support ventilation (PSV) via oral-nasal mask.MethodsThe Respironics V60 ventilator was connected to a ASL5000 lung simulator, which simulate lung mechanics in patients with chronic obstructive pulmonary disease ［system compliance (Crs)=50 mL/cm H2O, airway resistance (Raw)=20 cm H2O/(L·s), inspiratory time (TI)=1.6 s, breathing rate=15 beats per minute］. PSV were applied with different levels of PS ［positive end-expiratory pressure=5 cm H2O, PS=5/10/15/20/25 cm H2O) and back-up rate=10 beats per minute］. Measurements were conducted at system leaks with 25 – 28 L/min. The performance characteristics and patient-ventilator asynchrony were assessed, including flow, airway pressure, time and workload. Crs and Raw were calculated by using new dynamic approach.ResultsTidal volume (VT) was increased with increasing PS level ［(281.45±4.26)mL at PS 5 cm H2O vs. (456.81±1.91)mL at PS 10 cm H2O vs. (747.45±3.22)mL at PS 20 cm H2O, P<0.01］. Severe asynchronous was occurred frequently when PS is at 25 cm H2O. Inspiration cycling criterion (CC) was up-regulated accompanied by increasing PS level ［(15.62±3.11)% at 5 cm H2O, vs. (24.50±0.77)% at 20 cm H2O, P<0.01］. Premature cycling was always existed during PSV when PS < 20 cm H2O, which could be eliminated as PS level increasing. Delay cycling was found when PS was at 20 cm H2O, and cycling delay time was (33.60±15.91)ms (P<0.01). The measurement of Crs was (46.19±1.57)mL/cm H2O with PS at 10 cm H2O, which was closer to the preset values of simulated lung. The underestimate of Crs was observed during high level PS support. The calculation of inspiratory and expiratory resistance was approximate to 20 cm H2O/(L·s) when PS level was exceeded 15 cm H2O.ConclusionsThe new dynamic approach can continuously assess the respiratory mechanics during non-invasive ventilation, which is no need to interrupt the patient's spontaneous breathing. Higher inspiratory flow during PSV is beneficial for Raw measurement, whereas the accuracy of Crs was influenced by the value of actual VT.
Objective To investigate the effectiveness of the wrap-around great toe flap combined with medial plantar artery perforator flap (MPAP) for repairing the completely degloved fingers. Methods Between February 2018 and December 2019, 12 patients with the completely degloved fingers caused by machine strangulation were admitted. There were 9 males and 3 females with a median age of 32 years (range, 18-42 years). The injured finger was index finger in 7 cases, middle finger in 3 cases, and ring finger in 2 cases. The skin was avulsed from the metacarpophalangeal joint level, with the intact tendon and joint. The interval between injury and admission was 1-8 hours (mean, 5 hours). All fingers were taken debridement during the emergency operation. The size of the skin defect ranged from 8.0 cm×5.0 cm to 12.0 cm×7.5 cm. After flap thinning, the wrap-around great toe flap (8.0 m×2.0 cm-12.0 cm×3.5 cm) and MPAP (8.0 cm×4.0 cm-12.0 cm×5.5 cm) were used to repair the degloved finger. The donor sites were repaired with the full-thickness skin graft or the flap. Results All flaps and skin grafts survived completely without significant complications and the wounds at recipient and donor sites healed by first intention. All patients were followed up 12-16 months (mean, 14 months). The texture, appearance, and color of the affected fingers were close to those of normal fingers, and the nails grew normally. At last follow-up, the mean two-point discrimination of the flap was 9 mm (range, 8-10 mm), and the sensation of the injured finger recovered to S3-S4. And 10 cases were rated as excellent and 2 cases as good according to the Michigan Hand Outcomes Questionnaire (MHQ). There was no complication such as pain from walking or skin ulceration at the donor site. The American Orthopaedic Foot and Ankle Society (AOFAS) score was excellent in 9 cases and good in 3 cases. Conclusion Treating for the completely degloved fingers, the wrap-around great toe flap combined with MPAP can obtain good effectiveness in the respect of the sensation, function, and appearance.
ObjectiveTo investigate the current situation of stress load and professional benefit of hemodialysis nurses during the outbreak period and the remission period of coronavirus disease 2019 (COVID-19) epidemic, and discuss the differences in stress load and professional benefit of hemodialysis nurses between the two periods.MethodsIn February 2020, 119 hemodialysis nurses from three hemodialysis centers in Sichuan Province were selected as the respondents. Using the Stress Overload Scale and the Questionnaire of Nurses’ Perceived Professional Benefits, questionnaire survey was conducted in February 2020 and April 2020, respectively. Paired-sample t test was used for analysis.ResultsA total of 109 valid questionnaires were collected. The scores of stress load of hemodialysis nurses in outbreak period and remission stage were 3.00±1.26 and 2.17±1.16, respectively, of which the scores of event load dimension were 3.49±1.15 and 2.31±1.27, respectively, and the scores of individual vulnerability dimension were 2.59±1.19 and 2.05±1.06, respectively; the professional benefit scores of hemodialysis nurses in outbreak and remission were 4.19±0.83 and 4.21±0.78, respectively. The difference in stress load of the same group of hemodialysis nurses between different time periods was statistically significant (P<0.05), while there was no significant difference in professional benefit (P>0.05).ConclusionsDuring the outbreak of COVID-19 epidemic, the stress load of hemodialysis nurses was ata medium level, and that in the remission stage of COVID-19 epidemic was at a low level; the professional benefit of nurses in the outbreak and remission period was at a high level. The stress load status of hemodialysis nurses was different between different periods of the epidemic. We should take incentive mechanism or targeted psychological intervention measures to improve the professional benefit level of nurses.