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Journal of Medical Case Reports Jun 2024Bronchobiliary fistulas are rare and difficult to treat. Peacock first reported this entity in 1850 while treating a patient with hepatic encopresis.
INTRODUCTION
Bronchobiliary fistulas are rare and difficult to treat. Peacock first reported this entity in 1850 while treating a patient with hepatic encopresis.
CASE PRESENTATION
A 67-year-old Chinese male patient presented to the outpatient clinic with a complaint of coughing up phlegm with chest tightness for 4 days with symptoms of intermittent bilirubin sputum with a sputum volume of about 500 ml per day but no symptoms of abdominal pain or jaundice and no yellow urine or steatorrhea. The examination revealed cyanosis of the lips and mouth, barrel chest, low breath sounds on the right side, and a large number of wet rales heard in both lungs. The imaging investigations were suggestive of bronchobiliary fistula. Therefore, the patient was operated on and discharged with no perioperative complications.
CONCLUSION
Bronchobiliary fistula should be considered diagnostically in patients with known liver disease who also experience trauma or medical treatment and cough up bile-colored sputum, regardless of the presence of concurrent infections, and in conjunction with radiological expertise to identify it. Here, we report a case of bronchobiliary fistula and a brief review of the literature on it.
Topics: Humans; Male; Bronchial Fistula; Biliary Fistula; Aged; Liver; Rupture; Tomography, X-Ray Computed
PubMed: 38910252
DOI: 10.1186/s13256-024-04620-1 -
BMC Medicine May 2024Prevalence of youth nicotine vaping has increased, heightening concerns around negative health effects. This study aimed to compare self-reported respiratory symptoms...
BACKGROUND
Prevalence of youth nicotine vaping has increased, heightening concerns around negative health effects. This study aimed to compare self-reported respiratory symptoms among youth by vaping behaviours.
METHODS
Participants (n = 39,214) aged 16-19 from the 2020 and 2021 International Tobacco Control Policy Evaluation Project (ITC) Youth Tobacco and Vaping Surveys (Canada, England, US). Weighted multivariable logistic regression assessed associations between reporting any of five respiratory symptoms in the past week (shortness of breath, wheezing, chest pain, phlegm, cough) and: past 30-day smoking and/or vaping; lifetime/current vaping. Among past-30-day vapers (n = 4644), we assessed associations between symptoms and vaping frequency, use of nicotine salts, usual flavour and device type(s).
RESULTS
Overall, 27.8% reported experiencing any of the five respiratory symptoms. Compared with youth who had only vaped, those who had only smoked had similar odds of symptoms [adjusted odds ratio, OR (95% confidence interval, CI): 0.97 (0.85-1.10)], those who both smoked and vaped had higher odds [1.26 (1.12-1.42)], and those who had done neither, lower odds [0.67 (0.61-0.72)]. Compared with those who had never vaped, past use, experimentation and current regular or occasional use were all associated with higher odds. Reporting usually using nicotine salts was associated with higher odds of symptoms [1.43 (1.22-1.68)] than non-salt but was often uncertain. Compared with tobacco flavour (including with menthol), menthol/mint and sweets flavours were associated with similar odds; fruit [1.44 (1.07-1.93)], multiple [1.76 (1.30-2.39)] and 'other' [2.14 (1.45-3.16)] flavours with higher odds. All device types were associated with similar odds.
CONCLUSIONS
Among youth, vaping was associated with increased reporting of past-week respiratory symptoms. Among those who vaped, some flavour types and potentially nicotine salts were associated with respiratory symptoms.
Topics: Humans; Vaping; Adolescent; Male; Female; Canada; England; Young Adult; Self Report; United States; Electronic Nicotine Delivery Systems; Prevalence; Respiratory Tract Diseases
PubMed: 38807205
DOI: 10.1186/s12916-024-03428-6 -
Frontiers in Pharmacology 2024Patients with sepsis are at an incremental risk of acute lung injury (ALI). Baiqian, also known as rhizoma et radix (Csrer), has anti-inflammatory properties and is...
Integrating UPLC-Q-Orbitrap MS with serum pharmacochemistry network and experimental verification to explore the pharmacological mechanisms of rhizoma et radix against sepsis-induced acute lung injury.
Patients with sepsis are at an incremental risk of acute lung injury (ALI). Baiqian, also known as rhizoma et radix (Csrer), has anti-inflammatory properties and is traditionally used to treat cough and phlegm. This study aimed to demonstrate the multicomponent, multitarget, and multi-pathway regulatory molecular mechanisms of Csrer in treating lipopolysaccharide (LPS)-induced ALI. The bioactive components of Csrer were identified by ultrahigh-performance liquid chromatography Q-Orbitrap mass spectrometry (UPLC-Q-Orbitrap MS). Active targets predicted from PharmMapper. DrugBank, OMIM, TTD, and GeneCards were used to identify potential targets related to ALI. Intersection genes were identified for Csrer against ALI. The PPI network was analysed to identify prime targets. GO and KEGG analyses were performed. A drug-compound-target-pathway-disease network was constructed. Molecular docking and simulations evaluated the binding free energy between key proteins and active compounds. The protective effect and mechanism of Csrer in ALI were verified using an ALI model in mice. Western blot, Immunohistochemistry and TUNEL staining evaluated the mechanisms of the pulmonary protective effects of Csrer. Forty-six bioactive components, one hundred and ninety-two potential cross-targets against ALI and ten core genes were identified. According to GO and KEGG analyses, the PI3K-Akt, apoptosis and p53 pathways are predominantly involved in the "Csrer-ALI" network. According to molecular docking and dynamics simulations, ten key genes were firmly bound by the principal active components of Csrer. The "Csrer-ALI" network was revealed to be mediated by the p53-mediated apoptosis and inflammatory pathways in animal experiments. Csrer is a reliable source for ALI treatment based on its practical components, potential targets and pathways.
PubMed: 38584603
DOI: 10.3389/fphar.2024.1261772 -
Heliyon Sep 2023The purpose of this study was to evaluate the protective effect of decoction on patients with chronic heart failure (CHF) based on the levels of soluble interleukin 1...
OBJECTIVE
The purpose of this study was to evaluate the protective effect of decoction on patients with chronic heart failure (CHF) based on the levels of soluble interleukin 1 receptor-like 1 (ST2).
METHODS
We included a total of 80 outpatients and inpatients with CHF who were undergoing treatment at the Shanghai Municipal Hospital of Traditional Chinese Medicine between March 2020 and March 2022. We randomly divided them into the observation group ( = 40) and the control group ( = 40). Patients in the control group received treatments as per conventional Western medicine, while those in the observation group were treated with the decoction in conjunction with Western medicine for eight consecutive weeks. We then compared the pre- and post-treatment levels of ST2 and N-terminal pro-brain natriuretic peptide (NT-proBNP) of the patients in the two groups.
RESULTS
There were no significant differences in the pre-treatment levels of ST2 and NT-proBNP indexes between the two groups ( > 0.05), while the post-treatment comparison between the two groups in terms of ST2 and NT-proBNP levels suggested that the effect in the observation group was better, with statistical significance ( < 0.05).
CONCLUSION
decoction was beneficial in patients with CHF, suggesting that it could be a promising and effective method for the treatment of CHF.
PubMed: 37810073
DOI: 10.1016/j.heliyon.2023.e19294 -
Journal of Cardiothoracic Surgery Mar 2024Pulmonary primitive neuroectodermal tumor (PNET), a member of the Ewing sarcoma family of tumors, is a rare malignancy that is associated with a grim prognosis. To date,... (Review)
Review
BACKGROUND
Pulmonary primitive neuroectodermal tumor (PNET), a member of the Ewing sarcoma family of tumors, is a rare malignancy that is associated with a grim prognosis. To date, fewer than 30 cases of pulmonary PNET have been reported. In this case report, we present the clinical details of a 12-year-old girl with pulmonary PNET who underwent surgical treatment. We also conducted an analysis and summary of other relevant studies and the surgical outcomes.
CASE PRESENTATION
In May 2018, a 12-year-old girl was admitted with symptoms of cough and blood-tinged phlegm. A computed tomography scan revealed a large mass, measuring 12.9 cm × 8.1 cm, in the right middle and lower lungs. A percutaneous lung biopsy confirmed poorly differentiated tumor cells with a nested growth pattern. Immunohistochemical staining demonstrated positive expression of CD99, CD56, Vimentin, and Synaptophysin. The patient was diagnosed with pulmonary PNET. Following three cycles of neoadjuvant chemotherapy, a substantial reduction in tumor volume was observed. Subsequently, the patient underwent a surgical procedure involving pneumonectomy and partial resection of the left atrium with the assistance of cardiopulmonary bypass. The patient was discharged 37 days after surgery. During a three-year follow-up period, she exhibited no signs of tumor recurrence and has successfully returned to school.
CONCLUSIONS
This case highlights the successful management of an advanced PNET with neoadjuvant chemotherapy, pneumonectomy, and partial resection of the left atrium employing cardiopulmonary bypass. The patient remained disease-free after three years. Our analysis of surgically treated cases indicates that neoadjuvant chemotherapy can contribute to improved prognoses for PNET patients. It is crucial to emphasize that complete surgical excision remains the cornerstone of treatment, underscoring the importance of surgeons considering radical surgical approaches whenever feasible for patients with pulmonary PNETs.
Topics: Female; Humans; Child; Neoplasm Recurrence, Local; Pneumonectomy; Neoadjuvant Therapy; Lung; Neuroectodermal Tumors, Primitive
PubMed: 38443970
DOI: 10.1186/s13019-024-02563-8 -
International Journal of General... 2024This study was to investigate the mechanism of action and clinical efficacy of fire-needle therapy in improving neurological function in patients with acute cerebral...
OBJECTIVE
This study was to investigate the mechanism of action and clinical efficacy of fire-needle therapy in improving neurological function in patients with acute cerebral infarction (identified as a wind-phlegm-blood stasis syndrome in traditional Chinese medicine).
METHODS
We included patients diagnosed with acute cerebral infarction (wind-phlegm-blood stasis syndrome) admitted to the Encephalopathy and Acupuncture Center of the Second Affiliated Hospital of Tianjin University of Chinese Medicine. We randomly allocated them into the treatment and control groups, with 45 cases in each group. Acupuncture treatments that focused on regulating the mind and dredging the collaterals were used in the control group, while the treatment group additionally received fire-needle therapy. Our indicators included the National Institutes of Health Stroke Scale (NIHSS) scores, the Fugl-Meyer Assessment (FMA) scale, peripheral blood tumor necrosis factor-α (TNF-α), interleukin-17 (IL-17), hypersensitivity C-reactive protein (hs-CRP), and intestinal metabolites short-chain fatty acids (SCFAs). We measured these indicators before treatment and 14 days after treatment.
RESULTS
The post-treatment NIHSS scores of the two groups were significantly reduced ( < 0.05), and the treatment group showed a more significant decline in the score when compared to the control group ( < 0.05). The treatment group showing significant improvement in the domains of reflex activity, mobility, cooperative movement, and finger movement ( < 0.05). Both groups showed a significant decrease in the IL-17 and hs-CRP levels ( < 0.05), with the treatment group demonstrating a significant declining trend when compared to the control group ( < 0.05). The levels of acetic acid, propionic acid, butyric acid, and valeric acid all increased significantly in the two groups ( < 0.05), with acetic acid and butyric acid increasing significantly in the treatment group when compared to the control group ( < 0.05). Clinical efficacy rate: 78.6% of patients in the treatment group had an excellent rate, whereas it was 30.0% in the control group, and the difference was statistically significant ( < 0.001).
CONCLUSION
Fire-needle therapy was effective in upregulating the SCFA content in patients with acute cerebral infarction (wind-phlegm-blood stasis syndrome), inhibiting the level of the inflammatory response, and improving the recovery of neurological functions.
CLINICAL REGISTRATION NUMBER
Registration website link: https://www.chictr.org.cn. Registration date: 2022/9/27. Registration number: ChiCTR2200064122.
PubMed: 38333018
DOI: 10.2147/IJGM.S450027 -
BMC Pulmonary Medicine Jan 2024Exposure to wood dust can cause respiratory symptoms, like cough, phlegm, breathlessness, and chest pain, reduce lung function.
BACKGROUND
Exposure to wood dust can cause respiratory symptoms, like cough, phlegm, breathlessness, and chest pain, reduce lung function.
OBJECTIVE
The objective of the study was to assess the prevalence of respiratory symptoms and associated factors among woodwork workers in Bahir-Dar city, Ethiopia.
METHODS
A comparative cross-sectional study was employed among 229 exposed and 228 unexposed groups. Participants for the study were selected using simple random sampling technique. The chronic respiratory symptoms were assessed using a questionnaire adopted from the American Thoracic Society. The data was entered using Epi-Data version 4.6 and export to SPSS version 22 for analysis. Poisson regression, Multivariate linear regression and multivariable logistic regression analysis were used to identify factors associated with woodworkers, general population and in pooled analysis.
RESULT
The prevalence of having at least one chronic respiratory symptom was higher among exposed group (59.4%) than unexposed group (18.0%) with PR = 3.03(95%CI: 2.45, 4.45). In woodworker; Not taking health and safety training(5.15,95%(CI:1.93-13.76),primary educational(3.85,95%,CI:(1.1,13.47), not using Mask(6.38, 95%CI:(2.69-15.76) & number of families(3.05,95%,CI:1.04-9.028), In general population; Number of family members(2.75, 95%CI:1.1-7.19)& lower monthly income (3.3, 95%CI: (1.49-7.4), and In pooled analysis; wood dust exposure status 14.36 95%, CI:(7.6-27.00),primary education(2.93,95%CI:1.24-6.92), number of families(3.46,95%CI:1.8-6.64), lower monthly income(2.13,95%CI:1.19-3.81), & smoking (6.65, 95%CI:1.19-36.9) were associated with respiratory symptom.
CONCLUSION
Prevalence of respiratory symptoms was higher among exposed group than unexposed group. Reduced wood dust exposure status, Provision of occupational safety and health training, use of respiratory protective devices is recommended to reduce respiratory symptoms among woodwork workers.
Topics: Humans; Cross-Sectional Studies; Prevalence; Ethiopia; Occupational Diseases; Occupational Exposure; Dust
PubMed: 38166969
DOI: 10.1186/s12890-023-02812-x -
Therapeutic Advances in Respiratory... 2024The relationships between spirometric assessment of lung function and symptoms (including exacerbations) in patients with asthma and/or chronic obstructive pulmonary... (Observational Study)
Observational Study
Relationships between symptoms and lung function in asthma and/or chronic obstructive pulmonary disease in a real-life setting: the NOVEL observational longiTudinal studY.
BACKGROUND
The relationships between spirometric assessment of lung function and symptoms (including exacerbations) in patients with asthma and/or chronic obstructive pulmonary disease (COPD) in a real-life setting are uncertain.
OBJECTIVES
To assess the relationships between baseline post-bronchodilator (post-BD) spirometry measures of lung function and symptoms and exacerbations in patients with a physician-assigned diagnosis of asthma and/or COPD.
DESIGN
The NOVEL observational longiTudinal studY (NOVELTY) is a global, prospective, 3-year observational study.
METHODS
Logistic regression analysis was used to evaluate relationships. Spirometry measures were assessed as percent predicted (%pred). Symptoms were assessed at baseline, and exacerbations were assessed at baseline and Year 1.
RESULTS
A total of 11,181 patients in NOVELTY had spirometry data (asthma, = 5903; COPD, = 3881; asthma + COPD, = 1397). A 10% lower post-BD %pred forced expiratory volume in 1 s (FEV) and forced vital capacity (FVC) - adjusted for age and sex - were significantly associated with dyspnea (modified Medical Research Council ⩾ grade 2), frequent breathlessness [St George's Respiratory Questionnaire (SGRQ)], frequent wheeze attacks (SGRQ), nocturnal awakening (Respiratory Symptoms Questionnaire; ⩾1 night/week), and frequent productive cough (SGRQ). Lower post-BD %pred FEV and, to a lesser extent, lower post-BD %pred FVC were significantly associated with ⩾1 physician-reported exacerbation at baseline or Year 1. This association was stronger in patients with COPD than in those with asthma.
CONCLUSION
In a real-life setting, reduced lung function is consistently associated with symptoms in patients with asthma, COPD, or asthma + COPD. The relationship with exacerbations is stronger in COPD only than in asthma.
TRAIL REGISTRATION
clinicaltrials.gov identifier: NCT02760329 (www.clinicaltrials.gov).
Topics: Humans; Male; Female; Pulmonary Disease, Chronic Obstructive; Middle Aged; Asthma; Longitudinal Studies; Aged; Prospective Studies; Forced Expiratory Volume; Spirometry; Lung; Vital Capacity; Adult; Disease Progression; Bronchodilator Agents; Surveys and Questionnaires; Logistic Models; Time Factors
PubMed: 38841799
DOI: 10.1177/17534666241254212 -
Journal of Community Hospital Internal... 2023Eosinophilic granulomatosis with polyangiitis (EGPA) also referred to as Churg-Strauss syndrome is a rare vasculitis of the small to medium vessels. We present a rare...
Eosinophilic granulomatosis with polyangiitis (EGPA) also referred to as Churg-Strauss syndrome is a rare vasculitis of the small to medium vessels. We present a rare case of acute coronary artery dissection brought on by EGPA, which generally has a poor prognosis. A 41-year-old male with history of bronchial asthma presented to the emergency room with a 2-week history of dyspnea, cough with clear phlegm, and fever. For the past eight months he had experienced episodes with similar symptoms relieved by steroids. CT chest showed bilateral upper lobe patchy opacities with extensive workup for infectious etiology being negative. He had peripheral eosinophilia with sinusitis. He had acute coronary syndrome and Coronary angiogram showed Right coronary artery dissection. After making a diagnosis of EGPA based on American college of Rheumatology criteria, he was successfully treated with high dose immunosuppression. Coronary artery dissection is a fatal and uncommon complication of EGPA which is usually diagnosed postmortem. Early recognition of this condition ante mortem and aggressive treatment can be lifesaving as demonstrated in our case.
PubMed: 37868681
DOI: 10.55729/2000-9666.1219 -
Frontiers in Medicine 2024Multiple targets are considered as the causes of ambient fine particulate matter [aerodynamic diameters of < 2.5 μm (PM)] induced lung function injury. Qiju granules...
INTRODUCTION
Multiple targets are considered as the causes of ambient fine particulate matter [aerodynamic diameters of < 2.5 μm (PM)] induced lung function injury. Qiju granules are derived from the traditional Chinese medicine (TCM) formula known as Qi-Ju-Di-Huang-Wan (Lycium, Chrysanthemum, and Rehmannia Formula, QJDHW), which has been traditionally used to treat symptoms such as cough with phlegm, dry mouth and throat, and liver heat. This treatment approach involves attenuating inflammation, oxidative stress, and fibrosis response. This study investigated the effects of Qiju granules on protecting lung function against PM exposure in a clinical trial.
METHODS
A randomized, double-blinded, and placebo-controlled trial was performed among 47 healthy college students in Hangzhou, Zhejiang Province in China. The participants were randomly assigned to the Qiju granules group or the control group based on gender. Clinical follow-ups were conducted once every 2 weeks during a total of 4 weeks of intervention. Real-time monitoring of PM concentrations in the individually exposed participants was carried out. Data on individual characteristics, heart rate (HR), blood pressure (BP), and lung function at baseline and during the follow-ups were collected. The effects of PM exposure on lung function were assessed within each group using linear mixed-effect models.
RESULTS
In total, 40 eligible participants completed the scheduled follow-ups. The average PM level was found to be 64.72 μg/m during the study period. A significant negative correlation of lung function with PM exposure concentrations was observed, and a 1-week lag effect was observed. Forced expiratory volume in one second (FEV), peak expiratory flow (PEF), maximal mid-expiratory flow (MMEF), forced expiratory flow at 75% of forced vital capacity (FVC) (FEF), forced expiratory flow at 50% of FVC (FEF), and forced expiratory flow at 25% of FVC (FEF) were significantly decreased due to PM exposure in the control group. Small airway function was impaired more seriously than large airway function when PM exposure concentrations were increased. In the Qiju granules group, the associations between lung function and PM exposure were much weaker, and no statistical significance was observed.
CONCLUSION
The results of the study showed that PM exposure was associated with reduced lung function. Qiju granules could potentially be effective in protecting lung functions from the adverse effects of PM exposure.
CLINICAL TRIAL REGISTRATION
identifier: ChiCTR1900021235.
PubMed: 38741765
DOI: 10.3389/fmed.2024.1370657