Preliminary study on the material basis for expectorant and cough relief effects of the fruits of Phellodendron chinense var. glabriusulum Schneid / 中国药房

OBJECTIVE To explore the material basis and mechanism of expectorant and cough relief effects of the fruits of Phellodendron chinense var. glabriusulum Schneid. METHODS The expectorant and cough relief effects of volatile oil and water decoction of the fruits of P. chinense var. glabriusulum Schneid. were studied by ammonia water cough induction and drug expectorant model mice experiments； GC-MS and UPLC-MS technologies were used to identify its volatile oils and non-volatile components of the fruits of P. chinense var. glabriusulum Schneid. The active ingredients， core targets and pathways of expectoration and cough relief were analyzed by network pharmacology. RESULTS The volatile oil （0.8， 0.2 g/kg， calculated by volatile oil） and water decoction （12， 3 g/kg， calculated by crude drug） of the fruits of P. chinense var. glabriusulum Schneid. both had obvious expectorant and cough relief effects， and showed obvious dose-dependent relationship. A total of 38 volatile oil components were identified from the medicinal herbs， and the relative percentage contents of 8 components were greater than 1%， such as α -pinene， myrcene， β -caryophyllene， germanene D， isospathulenol； a total of 69 non-volatile oil components were identified， mainly including phenolic compounds， alkaloids， and flavonoids. The active ingredients screened from the identified components included 13 compounds such as α-pinene， myrcene， chlorogenic acid， luteolin， berberine. There were a total of 55 intersection targets with diseases， and the core targets were tumor necrosis factor （TNF）， epidermal growth factor receptor （EGFR）， vascular endothelial growth factor A （VEGFA）， serine/threonine kinase proteins （AKT1） and Toll-like receptor 4 （TLR4）. The molecular docking results showed that the active ingredients and the core targets had good binding ability. GO functional analysis found that the targets were significantly enriched in biological processes such as the reaction affecting lipopolysaccharides， the positive regulation of peptidyl serine phosphorylation， and the positive regulation of the biosynthesis process of nitric oxide. KEGG pathway enrichment analysis found that the targets were significantly enriched in the signaling pathways such as cancer， non-small cell lung cancer， proteoglycans in cancer. CONCLUSIONS Fruits of P. chinense var. glabriusulum Schneid. have obvious expectorant and cough relief effects， and its material basis may be α-pinene， myrcene， chlorogenic acid， luteolin， berberine， etc.， and mainly act on TNF， EGFR， VEGFA， AKT1， TLR4 and its significantly enriched signaling pathway.

Adaptation and acceptability testing of the Expector® vibration vest in horses / Adaptação e teste de aceitabilidade do colete de vibração Expector® em equinos

The project is based on a test of a thoracic vibration vest prototype, adapted to equines by the Expector® vest's company, on healthy animals. Ten (10) equines were used in the project, male or female, adults, healthy, belonging to FMVZ-USP or private owners. Each animal went through two phases: A and B. Phase A consisted of the placement of the vest without turning on the vibrators, evaluating the animal's acceptability, facility, adaptation to the animal's body, and discomfort due to the vest's use. Phase B included the placement of the vest and turning on the vibrators, evaluating the animal's acceptability, reaction to the vibrators, and, if present, to which velocity/type of vibration, and the presence of adverse effects. Both phases were done three times on separate days. The behavioral parameters: "placement facility" and "adaptation to the animal's body" were observed. In phase B, the response to the vibration was classified from 0 to 5. The answer was evaluated on low and high intensities for the four vibration types. The heart rate (HR) and respiratory rate (RR) were also evaluated at the beginning and end of each repetition. The animals' HR was kept on normal, except for one animal on one day of the test. Concerning the RR, most animals presented moments of tachypnea. On the experiment's first day, 100% of grade Great to "facility of placement" and "adaptation to the animal's body" was obtained, but on days 2 and 3 this value dropped to 90% due to alterations in one animal's responses. Regarding vibration's responses, 77.3% were evaluated as no discomfort (grade 0), 17.1% little discomfort (grade 1), 3.3% medium discomfort (grade 2), 0.4% great discomfort (grade 3), 0.21% extreme discomfort (grade 4), and 1.6% non-acceptance of the vest (grade 5). Some possible changes on the prototype were also verified to be suggested to the manufacturer, such as the change of the buckle and the use of wireless control. Vest use appears promising for equine respiratory physiotherapy, considering the acceptability was good, and its efficiency on the expectoration of diseased animals must be tested.

O projeto consistiu no teste de um protótipo de colete de vibração torácica, adaptado aos equinos pela empresa do colete Expector®, em animais saudáveis. Foram utilizados 10 equinos, machos ou fêmeas, adultos, saudáveis, pertencentes à FMVZ-USP e a proprietários particulares. Cada animal passou por duas fases: A e B. A Fase A consistiu na colocação do colete sem ligar os vibradores, avaliando-se a aceitabilidade do animal; facilidade; adaptação ao corpo do animal e incômodo do mesmo à sua presença. Já a Fase B contava com a colocação do colete e funcionamento dos vibradores, avaliando-se a aceitabilidade do animal; reação aos vibradores e, se presente, a qual velocidade/tipo de vibração; presença de reações ou efeitos adversos. As duas fases foram realizadas em triplicata em dias separados. Foram observados os parâmetros comportamentais "facilidade de colocação" e "adaptação ao corpo do animal". Na fase B, a resposta à vibração foi classificada de 0 a 5. A resposta foi avaliada nas intensidades baixa e alta para os quatro diferentes tipos de vibração. Foram avaliadas também as frequências cardíaca (FC) e respiratória (FR) no início e final de cada repetição. A FC dos animais se manteve dentro do intervalo de normalidade, com exceção de um animal em um dia de avaliação. Em relação à FR, a maioria apresentou momentos de taquipneia. No primeiro dia de experimento obteve-se 100% de avaliação Ótima para "facilidade de colocação" e "adaptação ao corpo do animal", mas nos dias 2 e 3 esse valor caiu para 90% devido à alteração na resposta de um animal. Em relação à resposta à vibração, 77,3% das respostas foram avaliadas como nenhum incômodo (nota 0), 17,1% pouco incômodo (nota 1), 3,3% médio incômodo (nota 2), 0,4% muito incômodo (nota 3), 0,21% incômodo extremo (nota 4) e 1,6% não aceitação do colete (nota 5). Foram também verificadas algumas possíveis mudanças no protótipo a serem sugeridas ao fabricante, como mudança do tipo de fivela e uso de controle sem fio. A utilização do colete parece ser muito promissora para a fisioterapia respiratória em equinos, visto que a aceitabilidade foi muito boa, devendo-se agora realizar a avaliação de sua eficácia na expectoração de animais enfermos.(AU)

Prevalence and influencing factors of respiratory symptoms among people aged 40 years and above in China / 中华流行病学杂志

Objective: To investigate the prevalence and influencing factors on respiratory disease related symptoms (coughing, expectoration, persistent coughing and persistent expectoration) in Chinese people ≥40 years old. Methods: Data was collected from 162 surveillance points in the China Non-communicable and Chronic Disease Surveillance Project in 2010. A total number of 56 066 people, aged ≥40 years, were selected by multi-stage cluster random sampling method in this study. The prevalence rates of coughing, expectoration, persistent coughing and persistent expectoration were calculated according to gender by χ(2) test. Multivariate logistic regression model was used to analyze the related influencing factors. Results: The prevalence rates of coughing, persistent coughing, expectoration and persistent expectoration in men were significantly higher than that in women (P<0.01). The prevalence rate of respiratory symptoms was positively correlated with age and duration and amount of cigarette smoking (P<0.01), while negatively correlated with participants'education level (P<0.01). Results from multivariate logistic regression analysis showed that gender, age, education level, smoking-related parameters, areas of residency (in urban or rural areas), etc. were appeared as influencing factors on the prevalence of respiratory symptoms. Conclusion: The symptoms of chronic respiratory diseases appeared prevalent in Chinese population aged ≥40 years. Factors as older age, living in the central/western regions and smoking-related parameters were identified as of higher risks.

Application of cluster nursing on expectoration in mechanical ventilation patients after craniocerebral injury / 中国中西医结合急救杂志

Objective To explore the effect of using cluster nursing measures on expectoration in mechanical ventilation patients after craniocerebral operation. Methods Convenient sampling and controlled trials at not the same period were used. Sixty-seven mechanical ventilation patients after craniocerebral operation were selected as the research objects in Department of Neurosurgery Intensive Care Unit (ICU) of the First Hospital Affiliated to Wenzhou Medical College. Thirty-two patients treated from June 2015 to June 2016 were assigned in the control group, and they were given routine respiratory nursing care; 35 patients admitted and treated from July 2006 to July 2017 were included in the intervention group, and they were given evidence-based cluster nursing intervention measures on the basis of routine care. The differences in expectoration effect, arterial blood gas analysis index, incidence of pulmonary infection and prognosis of patients in two groups were compared. Results Compared with control group, the amount of expectoration in the intervention group was significantly increased (mL/d: 49.69±9.45 vs. 33.72±10.63, P < 0.05), while the daily number of sputum suction (times: 21.57±2.31 vs. 28.76±22.66), the time needed for each sputum suction(s: 6.81±1.74 vs. 9.28±2.52), respiratory frequency (bpm: 26.26±1.83 vs. 28.58±1.36), incidence of pulmonary infection [0 vs. 12.5% (4/32)], time of mechanical ventilation (days: 6.37±2.51 vs. 8.92±3.32), time of ICU stay (days: 7.49±3.87 vs. 10.33±2.12), time of hospital stay (days: 10.31±1.99 vs. 14.56±3.57), fatality rate [8.6% (3/35) vs. 21.9% (7/32)] in the intervention group were significantly decreased (all P < 0.05); after treatment the arterial partial pressure of oxygen (PaO2) and pulse oxygen saturation degree (SpO2) were significantly increased than those before treatment, and the arterial partial pressure of carbon dioxide (PaCO2) was significantly decreased than that before treatment, and the degrees of improvement in the intervention group on 5 days were significantly better than those in the control group [PaO2(mmHg, 1 mmHg = 0.133 kPa): 60.89±3.44 vs. 57.34±2.49, PaCO2(mmHg): 41.06±4.32 vs. 45.22±4.78, SpO2: 0.986±0.030 vs. 0.963±0.023, all P < 0.05]. Conclusion The cluster nursing measures can effectively improve the expectoration effect for mechanical ventilation patients after craniocerebral surgery, reduce the mortality and incidence of pulmonary infection, shorten the stay in ICU and improve the prognosis, suggesting that the measures be worthy to be applied widely in clinics.

Prevalence and influencing factors of respiratory symptoms among people aged 40 years and above in China / 中华流行病学杂志

Objective To investigate the prevalence and influencing factors on respiratory disease related symptoms (coughing,expectoration,persistent coughing and persistent expectoration) in Chinese people ≥40 years old.Methods Data was collected from 162 surveillance points in the China Non-communicable and Chronic Disease Surveillance Project in 2010.A total number of 56 066 people,aged ≥40 years,were selected by multi-stage cluster random sampling method in this study.The prevalence rates of coughing,expectoration,persistent coughing and persistent expectoration were calculated according to gender by x2 test.Multivariate logistic regression model was used to analyze the related influencing factors.Results The prevalence rates of coughing,persistent coughing,expectoration and persistent expectoration in men were significantly higher than that in women (P＜ 0.01).The prevalence rate of respiratory symptoms was positively correlated with age and duration and amount of cigarette smoking (P＜0.01),while negatively correlated with participants' education level (P＜0.01).Results from multivariate logistic regression analysis showed that gender,age,education level,smoking-related parameters,areas of residency (in urban or rural areas),etc.were appeared as influencing factors on the prevalence of respiratory symptoms.Conclusion The symptoms of chronic respiratory diseases appeared prevalent in Chinese population aged ≥40 years.Factors as older age,living in the central/western regions and smoking-related parameters were identified as of higher risks.

Effect of Massage at Tiantu (CV22) in Promoting Cough and Expectoration in Craniocerebral Trauma Patients / 上海针灸杂志

Objective To observe the effect of massage at Tiantu (CV22) in promoting expectoration in craniocerebral trauma patients, and to lessen complications. Method Fifty craniocerebral trauma patients after extubation were randomized into a control group and a treatment group, 25 cases each. The control group was intervened by nebulization plus tapping back to promote cough and expectoration, while the treatment group was additionally given massage at Tiantu. For successive 3 days, the oxygen saturation, atelectasis and arrhythmias were observed and recorded before and after treatment in the morning, at midday and night, as well as the re-intubation rate, cough and expectoration induced by the treatment in the morning, at midday and night during the 3 days. Result The total effective rate in causing cough and expectoration and the increase of oxygen saturation in the treatment group were significantly higher than those in the control group, while the occurrence of complications including atelectasis and arrhythmias and re-intubation rate in the treatment group were significantly lower than those in the control group (P<0.05). Conclusion Massage at Tiantu is helpful to enhance the oxygen saturation and promote cough and expectoration in craniocerebral trauma patients, and it can lessen the occurrence of complications, thus worth applying in clinic.

A comparative study on the effects of high-frequency chest well oscillation expectoration and machincal expectoration on VAP and time for withdrawing MV system / 实用医学杂志

Objective To evaluate the effect of high-frequency chest well oscillation expectoration system on ventilator-associated pneumonia (VAP) and time for withdrawing mechanical ventilation (MV) system in ICU patients with invasive mechanical ventilation (IMV). Methods 100 ICU patients with IMV were divided into observationgroup (n = 50) and control group (n = 50). The high-frequency chest well oscillation expectoration was used in the former group and the mechanical vibration expectoration was used in the latter. The two groups were compared in terms of amount of sputum, vital signs (heart rate, breathing, systolic blood pressure and blood oxygen saturation), time for withdrawing MV system and VAP rate. Results On days 1, 2, 3, 4 and 5, the amount of sputum in the observationgroup was (33.5 ± 4.2)mL/d, (41.1 ± 3.0)mL/d, (38.2± 3 .5) mL/d, (34.8 ± 2.5) mL/d and (31.1 ± 2.1) mL/d, and those of the control group respectively was (27.4 ± 3.1) mL/d, (30.3 ± 3.6) mL/d, (28.1 ± 2.2) mL/d, (25.7±1.8)mL/d and (20.8 ± 1.7)mL/d. The differences between the two groups were statistically significant (P 0.05). The time for withdrawing MV system in the observationgroup and the control group respectively was (5.8 ± 2.2)d and (9.5 ± 1.8)d, (P < 0.05). The rates of VAP in the observationgroup and the control group respectively was 30.0% (15/50) and 52.0% (26/50), with significant difference between them (P < 0.05). Conclusion The high-frequency chest well oscillation expectoration for ICU patients with invasive mechanical ventilation can promote sputum expectoration , improve blood oxygen saturation , shorten the time for withdrawing the ventilator, and prevent the incidence of VAP.

Effects of two expectoration methods on pulmonary complications and hypoxemia in esophageal cancer patients having undergone radical resection with video-assisted thoracoscopic surgery / 现代临床护理

Objective To compare the effects of expectoration by high frequency back tapping with both hands and traditional expectoration by tapping back with a single hand on pulmonary complications in esophageal cancer patients having undergone radical resection with video-assisted thoracoscopic surgery (VATS). Methods Sixty patients after radical resection for esophageal cancer with VATS from May 2013 to January 2014 were set as the control group, in which expectoration by tapping the back with a single hand. Another 60 patients after radical resection for esophageal cancer with VATS from February 2014 to July 2014 were set as the observation group, in which the expectoration by high frequency tapping the back with both hands. The two groups were compared in terms of pulmonary complications. Result The incidence of atelectasis and pulmonary infection in the observation group were lower than those with a single hand in the control group (all P<0.05). Conclusion For the patients having undergone radical resection of esophageal carcinoma with VATS, the expectoration with high frequency back tapping with both hands is more effective in lowering atelectasis rate than that with a single hand.

Effect of Digital Acupressure plus Mechanical Sputum Expectoration on the Rehabilitation of Patients with Stroke-associated Pneumonia / 上海针灸杂志

Objective To observe the effect of digital acupressure plus mechanical sputum expectoration on the rehabilitation of patients with stroke-associated pneumonia. Method Forty-six patients with stroke-associated pneumonia were randomized into a treatment group of 22 cases and a control group of 24 cases. The treatment group was intervened by digital acupressure plus mechanical sputum expectoration, while the control group was by mechanical sputum expectoration alone. The simplified version of Clinical Pulmonary Infection Score (CPIS), Fugl-Meyer assessment scale, and modified Barthel Index (BI) were adopted for evaluation before and after intervention. Result After treatment, CPIS, Fugl-Meyer and BI scores were changed significantly in both groups (P<0.01). There were significant differences in comparing the CPIS, Fugl-Meyer and BI scores between the two groups after intervention (P<0.05). After intervention, the two groups showed a negative correlation between CPIS score and Fugl-Meyer score, as well as between CPIS score and BI score. Conclusion Digital acupressure plus mechanical sputum expectoration can effectively improve the pulmonary symptoms in patients with stroke-associated pneumonia, benefiting the rehabilitation of the post-stroke patients.

Analysis of the effect of comfort nursing care on 72 cases of children with pneumonia by using mechanical assisted expectoration / 中国现代医生

Objective To study the effect of comfort nursing care on children with pneumonia using mechanical assisted expectoration. Methods 72 cases of children with pneumonia treated in our hospital from June 2013 to June 2014 were selected as the research object and were randomly divided into mechanical drainage group (group A,n=40) and tradi-tional sputum group (group B,n=32) according to simple sampling method. Patients in group B were treated with con-ventional nursing combined with artificial beating expectoration program while patients in group A received comfort nursing care regimen combined with row phlegm machine. The cough days of the patients in two groups and the time of pulmonary rales disappearance and the time of hospitalization were compared. The sputum satisfaction and acceptance were recorded. Results ①After the treatment,the cough time,the time of pulmonary rales disappearance and the time of hospitalization time in group A were (4.13±0.78) days, (3.72±1.29) days and (6.23±2.15) days, which were signifi-cantly better than those in the group B [(6.21±1.12) days, (5.89±1.44) days and (9.99±2.32) days]. The differences between the two groups were obvious(P<0.05); ②The phlegm satisfaction and acceptance in group A were 82.50%and 92.50%, which were significantly higher than those in group B (43.75% and 59.38%). The differences between groups were obvious(P<0.05). Conclusion The expectoration effect of the comfortable nursing program combined with the row phlegm machine in the treatment of children with pneumonia. The comfortable nursing plan combined with row phlegm machine is remarkable and also its treatment compliance is higher ,which is worth the clinical promotion.

Changes and treatment of cough and expectoration in the patients with lung cancer after airway stent placements / 第三军医大学学报

Objective To evaluate the changes and clinic countermeasures of cough and expectoration in the patients with lung cancer after airway stent placements. Methods With the fibrobronchoscope, metal stents were placed in tracheas, main bronchia or right intermediary bronchia. It was compared that the degrees of cough and expectoration difficulties, the volumes and mucin content of sputa and lung functions before the placements, within 3 d and 1 to 2 months after operation. Results Within postoperative 3 days, the patients coughed more frequently, but VC, FEV_(1) and PEF were improved significantly. In postoperative 1 to 2 months, the degrees of cough were close to preoperative degrees, lung functions kept on improved conditions, but expectoration difficulties, volumes and mucin contents of sputa increased markedly, especially in the patients with tectorial membrane stents. Proper stents and reasonable treatment including use of antitussive, apophlegmatisant and antibiotics could decrease the degrees of cough within postoperative 3 days, and expectoration difficulties, volumes and mucin contents of sputa in postoperative 1 to 2 months. Conclusion To the patients with malignant central airway constriction, metal stent placement would improve ventilative functions but bring difficulties for cough and expectoration. The side complications would be relieved through corresponding treatments.

Effect of Indoor Environmental Factors on Respiratory Symptoms in Children and Teenagers Aged 4-17 Years in Urban Area of Shanghai / 环境与健康杂志

Objective To explore the effects of indoor environmental factors on the respiratory symptoms in children aged 4-17 years. Methods A cross-sectional survey of indoor environmental factors related respiratory symptoms in 6 551 children and teenagers aged 4-17 years was conducted throughout urban area of Shanghai in 2007. The information was obtained on certain aspects of the family socioeconomic status (SES) and other confounding factors,and the associations between indoor environmental factors and respiratory symptoms were analyzed. Results After controlling confounders,parent smoking,the house or the classroom nearby roads (