One case report of repeated chest tightness and palpitation cured after strengthening calcium supplementation / 中华内分泌外科杂志

The incidence of parathyroid hyperfunction is high and its clinical manifestations are diverse. Some patients develop chest tightness and palpitations as the main discomfort, which may be caused by the hypocalcemia and hypercalcemia related to negative calcium balance and parathyroid hyperfunction. We report a case of 53 years old male with parathyroid hyperfunction who was diagnosed with osteoporosis before and received conventional regular supplementation of vitamin D and calcium supplements. However, his condition worsened and he developed chest tightness and palpitation. After 1 month of sufficient supplementation of calcium, the symptoms of chest tightness and palpitation disappeared completely. Then we continued to provide the patients enough vitamin D and calcium supplementation actively. After 1 year of follow-up, the patient's condition was stable. His discomfort of chest tightness and palpitation never recurred, and all the bone metabolism indicators returned to normal.

Professor YAN Huimin's Experience in Pattern Identification and Treatment of Chest Tightness Variant Asthma in Children Based on the Method of Regulating Qi Movement / 中医杂志

To summarize the clinical experience of Professor YAN Huimin in pattern identification and treatment for chest tightness variant asthma in children with the method of regulating qi movement. It is believed that children's chest tightness variant asthma is mainly located in lungs and involves liver and spleen， and the core mechanism of the disease is disturbance of qi movement. On the basis of regulating qi， syndrome differentiation and treatment is conducted： for pattern of lung qi deficiency and cold， phlegm-fluid retention， the treatment is appropriate to tonify the lung and benefit qi， and warm phlegm-fluid， which commonly used in modified Yupingfeng Powder （玉屏风散） and Xiaoqinglong Decoction （小青龙汤）； for pattern of phlegm and qi binding constraint， the treatment is appropriate to soothe the liver and resolve constraint， and dissolve phlegm and dissipate masses， which commonly used in modified Banxia Houpo Decoction （半夏厚朴汤） and Jinlingzi Powder （金铃子散）； for pattern of qi deficiency and blood stasis， the treatment is appropriate to tonify the deficiency to reinforce healthy qi， and move qi to invigorate blood， which commonly used in modified Xuefu Zhuyu Decoction （血府逐瘀汤）. It is emphasised that during the treatment process， the developmental dynamics of the disease should be grasped， patterns and treat should be identified， and special attention to the changes of qi movement should be paid.

Diagnostic Value of Astograph Airway Responsiveness Measurement in Chest Suffocation Variant Asthma / 中国综合临床

Objective To investigate the diagnostic value of Astograph methacholine provocation test in patients with chest tightness variant asthma ( CTVA)??Methods From January 2011 to February 2017,156 patients with CTVA in outpatient or inpatient department of respiratory medicine of Kailuan General Hospital affiliated to North China University of Science and Technology were selected as case group ( chest tightness variant asthma group )??The control group were 361 non?asthmatic patients including interstitial lung disease ( 23 cases), coronary disease ( 157 cases), hypertensive cardiopathy ( 22 cases), myocardiosis (16 cases),congenital heart disease ( 3 cases),rheumatic valvular heart disease (6 cases), central airway disease (3 cases),thyromegaly (10 cases),mediastinal tumor (5 cases),thoracic or spinal deformity (8 cases),phrenoparalysis (2 cases) and vegetative nerve functional disturbance (106 cases)??All participants received pulmonay ventilation test, average daily and nightly variation rate of PEF ( Peak expiratory flow) or PEF weekly variability, Astograph methacholine provocation test ( forced expirataory volume in one second≥70% expectation),and other relevant examinations??The diagnostic value of Astograph methacholine provocation test on CTVA was assessed by analyzing the sensitivity, specificity, positive predictive value,negative predictive value,and Yunden index of Astograph methacholine airway??Results Compared with the control group (( 1??18 ± 0??44)%), theforced expiratory flow from 75% of Forced vital capcacity ( FEF75 ) index of CTVA group (( 1??29 ± 0??50 )%) had significant difference (, t＝ 2??96, P＝0??006)??The sensitivity,specificity,positive predictive value,negative predictive value,Yunden index,and diagnostic accuracy of Astograph methacholine provocation test on CTVA were 0??814,0??695,0??536,0??305, 0??509 and 0??731, respectively??Conclusion The sensitivity, negative predictive value, Yunden index and diagnostic accuracy of Astograph methacholine provocation test on CTVA were higher,whereas the specificity and positive predictive value were relatively lower,suggesting that Astograph methacholine provocation test had a reliable diagnostic value on CTVA,with lower false negative and higher false positive??

Two Cases of Chest Symptoms that Their Physical Strength got Better After Treatment with Tokito / 日本東洋医学雑誌

Tokito is a Kampo formulation for treating chest and/or abdominal pain symptoms of individuals with deficiency pattern and cold pattern. Here, we report cases of chest symptoms except pain. Case 1 was an 81-year-old man who presented with chest tightness, and Case 2 was a 77-year-old man who presented with palpitation. Their symptoms improved remarkably and their physical strength got better after treatment with tokito. Tokito comprises ginseng and astragalus root, the same as the one used in hochuekkito, which is a well-known qi-tonifying formulation. It is suggested that tokito is effective as qi-tonifying formulation for a variety of chest symptoms in patients with deficiency pattern and cold pattern.

Advance of diagnosis and treatment on chest tightness variant asthma in children / 中华实用儿科临床杂志

The chest tightness variant asthma (CTVA)is a new clinical variant of asthma,with chest tightness or sighing respiration as the main or only clinical manifestations,without wheezing,shortness of breath and other typical symptoms of asthma. And the patients with CTVA are likely to be misdiagnosed in clinical work. The clinical features are chest tightness existed persistently or repeatedly,symptoms lasting more than 8 weeks,the presence of airway hype-rresponsiveness or reversible airflow limitation confirmed by lung function examination,effective to the treatment of β agonists or inhaled corticosteroids,and other diseases should be excluded.

Characteristics of airway hyperresponsiveness in children with chest tightness variant asthma / 中华实用儿科临床杂志

Objective To analyze the characteristics of airway hyperresponsiveness and fractional exhaled ni-tric oxide (FeNO)in children with chest tightness variant asthma (CTVA)in comparison with cough variant asthma (CVA)and the typical asthma. Methods From January 2012 to June 2015,37 atypical asthma children with chest tightness as the sole presenting manifestation were selected as subjects (CTVA group). Meanwhile,100 children who were newly diagnosed as CVA and 100 children who were newly diagnosed as typical asthma were selected as control group. All of the children in 3 groups had completed FeNO measurement,spirometry and with either positive result of bronchial provocation test or positive result of bronchial dilation test. The differences in FeNO and spirometry data among 3 groups were analyzed. Results FeNO was 11. 0(6. 0,33. 0)ppb in CTVA group,but 28. 0(16. 0,52. 0) ppb in typical asthma group,which indicated that FeNO was significantly lower in CTVA group than that in typical asth-ma group (P < 0. 05). The accumulated provocative dose of methacholine resulted in a 20％ (PD20-FEV 1 )drop in forced expiratory volume in 1 second (FEV 1 ),which was 0. 480(0. 145,0. 663)mg in CTVA group and 0. 180 (0. 097, 0. 463)mg in typical asthma group. PD20-FEV 1 was significantly higher in CTVA group than that in typical asthma group,and the difference was statistically significant(P < 0. 05). FeNO was 18. 5(8. 0,34. 0)ppb and PD20-FEV 1 was 0. 330(0. 120,0. 730)mg in CVA group,which had no statistically significant differences between CTVA group and CVA group(all P > 0. 05). Conclusion CTVA children have lower airway hyperresponsiveness and lower FeNO than typical asthma children. CTVA children may have similar airway hyperresponsiveness as CVA children.

Characteristics of lung function and exhaled nitric oxide in atypical asthma children with chest tightness or sighing breath as sole manifestation / 国际儿科学杂志

Objective To study the characteristics of pulmonary function in atypical asthmatic children with chest tightness or sighing breath as the sole presenting manifestation,and explore the diagnostic values of fractional exhaled nitric oxide (FeNO) for the atypical asthma.Methods Seventy-nine atypical asthmatic children with chest tightness as the sole presenting manifestation during January 2012 to June 2015 were selected as subjects.All of the subjects performed spirometry,FeNO measurement,total serum IgE and specific IgE determination on their first visit,and with either positive bronchial provocation test or positive bronchial dilation test.As well as 100 healthy children who perfomred FeNO measurement were selected as control group during the same period.The pulmonary function data and FeNO values were analyzed in children who were finally confirmed as atypical asthma.Results In atypical asthma children,the abnormal rate of forced expiratory flow 50％,75％ (FEF50,FEF75) and maximum mid-expiratory flow (MMEF) were 27％,43％ and 33％.Methacholine provocation dose causing a 20％ fall in FEV1 (PD20-FEV1) were 0.41 (0.19 ～0.67)mg and were positively related with MMEF(r =0.301,P =0.007).FeNO concentration in atypical asthma patients were 13.0 × 10-9 (7.0 ×10-9 ～24.0 × 10-9),higher than that in control group(P ＜0.05).Significant correlations were found between FeNO and total serum IgE (r =0.672,P =0.001).No correlations were found between FeNO and FEV1 (P ＞0.05),between FeNO and FEV1/FVC％ (P ＞0.05) or between FeNO and PD20-FEV1 (P ＞0.05).The diagnostic values of FeNO for the atypical asthma were analyzed using the receiver operating characteristic curve,the area under the curve was 0.600.Conclusion The characteristics of pulmonary function in atypical asthma are hypofunction mainly in small airway and patients with lower MMEF had higher airway hyperresponsiveness.The diagnostic values of FeNO in atypical asthma are limited.