Antitussive efficacy of the current treatment protocol for refractory chronic cough: our real-world experience in a retrospective cohort study

BACKGROUND: The management of refractory chronic cough (RCC) is a great challenge. Neuromodulators have long been used for RCC with imperfect efficacy. OBJECTIVES: We summarized the outcomes of the current treatments used at our specialist cough clinic, which provides a guideline-led service and real-world experience for the future management of RCC. DESIGN: This is a single-centre retrospective observational cohort study. METHODS: Consecutive RCC patients (the first clinic visit between January 2016 and May 2021) were included into this observational cohort study. Medical records in the Chronic Cough Clinical Research Database were fully reviewed using uniform criteria. The included subjects were followed-up for at least 6 months after the final clinic visit via instant messages with the link to self-scaled cough-associated questionnaires. RESULTS: Overall, 369 RCC patients were analysed with a median age of 46.6 years and a cough duration of 24.0 months. A total of 10 different treatments were offered. However, 96.2% of patients had been prescribed at least one neuromodulator. One-third of patients had alternative treatments prescribed given the poor response to the initial therapy and 71.3% favourably responded to at least one of the treatments. Gabapentin, deanxit, and baclofen had comparable therapeutic efficacy (56.0%, 56.0%, and 62.5% respectively; p = 0.88) and overall incidences of adverse effects (28.3%, 22.0%, and 32.3% respectively; p = 0.76). However, 19.1 (7.7-41.8) months after the last clinic visit, 65.0% reported improvement (24.9%) or control of their cough (40.1%); 3.8% reported a spontaneous remission and 31.2% still had a severe cough. Both HARQ (n = 97; p < 0.001) and LCQ (n = 58; p < 0.001) demonstrated marked improvement. CONCLUSION: Trying different neuromodulators is a pragmatic strategy for RCC, which helped around two-thirds of patients. Relapse is common on withdrawal or reduction of dosage. Novel medication for RCC is an urgent clinical need. PLAIN LANGUAGE SUMMARY: This is the first report that fully represented a guideline-led treatment protocol for refractory chronic cough (RCC) based on a large series of patients, which evaluated the short- and long-term effects of the currently available treatments for RCC. We found that the therapeutic trial of different neuromodulators is a pragmatic strategy, which helped around two-thirds of patients. Gabapentin, deanxit (flupentixol/melitracen), and baclofen had similar therapeutic outcomes. This study may offer real-world experience for the future management of RCC

Gastric Lavage in Acute Organophosphorus Pesticide poisoning (GLAOP) – a randomised controlled trial of multiple vs. single gastric lavage in unselected acute organophosphorus pesticide poisoning

BACKGROUND: Organophosphorus (OP) pesticide poisoning is the most common form of pesticide poisoning in many Asian countries. Guidelines in western countries for management of poisoning indicate that gastric lavage should be performed only if two criteria are met: within one hour of poison ingestion and substantial ingested amount. But the evidence on which these guidelines are based is from medicine overdoses in developed countries and may be irrelevant to OP poisoning in Asia. Chinese clinical experience suggests that OP remains in the stomach for several hours or even days after ingestion. Thus, there may be reasons for doing single or multiple gastric lavages for OP poisoning. There have been no randomised controlled trials (RCTs) to assess this practice of multiple lavages. Since it is currently standard therapy in China, we cannot perform a RCT of no lavage vs. a single lavage vs. multiple lavages. We will compare a single gastric lavage with three gastric lavages as the first stage to assess the role of gastric lavage in OP poisoning. METHODS/DESIGN: We have designed an RCT assessing the effectiveness of multiple gastric lavages in adult OP self-poisoning patients admitted to three Chinese hospitals within 12 hrs of ingestion. Patients will be randomised to standard treatment plus either a single gastric lavage on admission or three gastric lavages at four hour intervals. The primary outcome is in-hospital mortality. Analysis will be on an intention-to-treat basis. On the basis of the historical incidence of OP at the study sites, we expect to enroll 908 patients over three years. This projected sample size provides sufficient power to evaluate the death rate; and a variety of other exposure and outcome variables, including particular OPs and ingestion time. Changes of OP level will be analyzed in order to provide some toxic kinetic data. DISCUSSION: the GLAOP study is a novel, prospective cohort study that will explore to the toxic kinetics of OP and effects of gastric lavage on it. Given the poor information about the impact of gastric lavage on clinical outcomes for OP patients, this study can provide important information to inform clinical practice

Nanomechanical properties of Mg–Al intermetallic compounds produced by packed powder diffusion coating (PPDC) on the surface of AZ91E

A packed powder diffusion coating (PPDC) treatment produced two intermetallic layers on the surface of the commercial magnesium alloy AZ91E. The beta-phase (Mg17Al12) was immediately on top of the AZ91E, on top of which was the tau-phase (Mg-32(Al,Zn)(49)). Nanoindentation showed that the elastic modulus and hardness of each of the intermetallic compounds was significantly greater than that of the AZ91E substrate. Staircase displacement bursts occurred during nanoindentation of the intermetallic compounds, attributed to the combination of incipient plasticity at low loads, and the development of dislocation networks due to dislocation pile ups around the indentation at higher loads. Crystallographic analysis of beta phase orientations using EBSD showed that the nanomechanical properties of the intermetallic compound produced through PPDC treatment were isotropic. (C) 2013 Elsevier B.V. All rights reserved

Extraction of low horizontally and buccally impacted mandibular third molars by three ⁃ section methud

Objective This study aims to investigate the clinical effect of the improved extraction of low horizontally impacted mandibular third molars via a“three⁃section”method. Method Sixty patients with low horizontally impacted mandibular third molars on both sides were selected for this study. A high⁃frequency electrotome, a 45 degree high⁃speed turbine and a special long drill needle were used in the test group. The improvement was called“three section” , which meant that the tooth was cut into three parts; first, the middle part was taken, then the root, and then the crown. One month later, the other side (control) was extracted using the regular method (the tooth was cut in two parts, and the crown was re⁃ moved first). Operation time, swelling, pain, and limitations to mouth opening were carefully recorded and statistically ana⁃ lyzed. Results The time for the modified“three⁃section”method, which was used to remove the third molar embedded in the lower part of the lower jaw, was (10.05 ± 0.51) min, while the mean time for conventional extraction was (20.15 ± 0.88) min, and the difference was statistically significant (P < 0.01). There were significant differences (P < 0.01) in swell⁃ ing, pain and limitations to mouth opening between the test group and the control group. Conclusion The use of the “three⁃section”method to extract third molars horizontally embedded in the lower jaw is associated with a shorter opera⁃ tion time, reduced trauma and reduced postoperative reactions, and it has valuable clinical applications

Management of non-pharmacologic therapy for chronic refractory cough: Mechanism, composition, applicable population, and assessment

Chronic cough is common in the clinic and can seriously affect the quality of life of patients. Following the existing guidelines for treatment, refractory chronic cough is defined as a clinical condition in which the cause of the cough remains unclear after comprehensive examination and treatment, or the cause is clear but symptomatic treatment is ineffective.It has been found that non-pharmacologic therapy can effectively improve the quality of life and reduce the frequency of coughing for some patients with refractory chronic cough. Compared with pharmacological therapy, non-pharmacologic therapy has no obvious adverse effects; therefore, non-pharmacologic therapy has good application prospects in the diagnosis and treatment of refractory chronic cough. This paper summarizes the composition, indication, action and mechanism of non-pharmacologic therapy in the diagnosis and treatment of refractory chronic cough and prospects for research on non-pharmacologic therapy

LASER SPECTROSCOPY OF NiBr: ROTATIONAL ANALYSIS OF THE 2Π3/2−X2Π3/2^{2}\Pi_{3/2} - X^{2}\Pi_{3/2} TRANSITION

Author Institution: Department of Chemistry, The University of Hong Kong; Department of Chemistry, The University of Hong KongNiBr was produced in a supersonic free jet expansion in argon by the reaction of laser ablated nickel atom and bromoethane $(C_{2}H_{5}Br)$ vapour. High resolution laser induced fluorescence spectra between 724 and 810 nm have been obtained using a c.w. single frequency Ti:sapphire laser. 8 bands have been recorded and 3 were assigned to the $^{2}\Pi_{3/2}- X^{2}\Pi_{3/2}$ transition. Transition lines from four isotopic molecules: $^{58}Ni^{79}Br$, $^{58}Ni^{81}Br$, $^{60}Ni^{79}Br$ and $^{60}Ni^{81}Br$, are observed and analysed. Least squares fit of measured lines of each isotopic molecule was performed. Molecular constants of all four isotopic molecules will be reported. Acknowledgement: This work was carried out with support from the Hong Kong Research Grants Council

Evaluation methods and influencing factors of cough sensitivity

Increased cough sensitivity is an important mechanism of chronic cough, and the evaluation of cough sensitivity helps understand the mechanism of cough and explore better methods to reduce cough. Evaluation methods may be direct or indirect. Direct methods include mechanical stimulation and chemical stimulation, and indirect methods include laryngeal reflex test, questionnaires, and brain functional magnetic resonance imaging (fMRI). Chemical stimulation is the most common method, while the capsaicin cough challenge test is proven and widely used. In this article, we will compare evaluation methods and explore influencing factors of cough sensitivity