2015年 · 第38卷第04期

Diffuse panbronchiolitis (DPB) is a race-related disease that was first discovered in Japan. Because there is almost no such disease in European and American countries, it was recognized by the international academic community many years later. DPB is also known as the disease of Asians, but no pathologically diagnosed DPB cases have been reported in mainland China prior to our case report. There are no cases reported in mainland China with a population of 1.3 billion, but it is obviously wrong to be called an Asian disease. Professor Kudo of Showa University in Japan, who discovered erythromycin therapy, was very anxious about this, so Professor Zhu Yuanjue took the lead in China and Japanese experts jointly set up a cooperative group to detect DPB patients in mainland China as soon as possible.

Lung cancer is one of the highest morbidity and mortality malignant tumors in the world. Most lung cancer patients who see a doctor due to symptoms are advanced and have poor prognosis. In some countries, the 5-year survival rate of lung cancer patients has reached more than 20%, but in China, it is far lower than this. Therefore, it is necessary to screen early lung cancer through low-dose CT (LDCT) to improve this situation. Recent research results show that LDCT annual screening can detect stage 0-I lung cancer, and the survival rate of 10 years after surgical resection can reach 92%. All untreated stage I patients will die within 5 years. However, LDCT screening for early lung cancer can really "benefit" patients is still controversial. Therefore, it is necessary to fully discuss the right and wrong of LDCT screening for lung cancer in combination with the current situation in China, so as to provide reference opinions for clinical work.

At present, lung cancer has ranked first in the cause of tumor-related death. The research results on lung cancer change every year, but the views of early screening, early diagnosis and early treatment of lung cancer remain unchanged. The results of the 2011 National Lung Screening Trial (NLST) in the United States confirmed that Lung cancer Screening can reduce the fatality rate of Lung cancer^[1]。 The latest National Comprehensive Cancer Network (NCCN) guidelines in 2015 emphasize that low-dose CT screening in high-risk smokers can reduce the fatality rate of lung Cancer by 20%, but the false positive rate of such screening is as high as 24%^[2]。 Over-diagnosis and over-treatment of pulmonary nodules increase the economic burden of social medical care and the psychological burden of patients. Therefore, the judgment of benign and malignant pulmonary nodules has become a major challenge for clinicians.

Bronchial lung cancer (abbreviated as lung cancer) is a malignant tumor with the highest morbidity and mortality rate in the world, with 1.4 million deaths every year, accounting for 18% of all malignant tumors. Professor Peto, a famous British oncologist, predicted that if China does not control smoking and control air pollution in time, there will be more than 1 million new lung cancer patients every year by 2025^[1]。 About 75% of lung cancer patients in China are advanced at the time of diagnosis, and the 5-year survival rate is about 15.6%. This situation is not only related to the lack of screening, but also to the lack of scientific methods to identify lung nodules. Therefore, in order to improve the long-term survival rate of lung cancer patients, it is necessary to formulate a practical consensus on the diagnosis and treatment of lung nodules, and widely promote it to produce twice the result with half the effort^[2,3,4]。

Lung volume refers to the amount of gas in the lungs, that is, the total volume of the respiratory tract and alveoli, reflecting the space for external breathing. During breathing, lung volume changes with respiratory muscle movement, thoracic expansion and retraction. Lung volume is the basis of lung ventilation and ventilation function, which has important clinical significance. Lung volume also changes when thoracopulmonary diseases and diseases involving respiratory muscles cause changes in lung volume, changes in thoracic and lung elastic retraction. Pneumometers can check indexes such as volume without residual gas (such as vital capacity), but a complete lung volume test needs to be measured by plethysmography or gas dilution. For patients who cannot cooperate with pulmonary function tests, radiographic imaging or pulmonary radionuclide tests can also be used to estimate lung volume.

In recent years, with the popularization of chest CT, the detection rate of ground glass opacity (GGO) in the lungs has increased significantly, and some GGO is related to early lung cancer, especially bronchioloalveolar carcinoma (BAC), so clinicians pay more attention to GGO. At present, lung cancer is the first cause of cancer death in the world. Unfortunately, many patients are in advanced stage when they are found in clinic. Only 15% of patients have the chance of surgery, and the 5-year survival rate after surgery is only 15%^[1]。 According to statistics, the 5-year survival rate of patients with stage IV lung cancer is only about 2%, and the 5-year survival rate of early detection and surgical resection of stage I lung cancer is 54% ~73%^[2]While the 5-year survival rate of patients with early lung cancer manifested by GGO can reach 100%^[3]。 Therefore, the correct recognition and treatment of pulmonary GGO is of great significance to the early diagnosis, treatment and prognosis of lung cancer.

Streptococcus viridis (Streptococci viridans group(SVG), also known as Streptococcus haemolyticus A, is a group of widely heterogeneous bacteria belonging to the genus Streptococcus. Typical bacteria are alpha hemolytic facultative anaerobic cocci, arranged in pairs or chains, positive for Gram staining, negative for bile bacteriolysis test and Optochin test. Because the serological reaction of SVG is different from that of traditional biochemical reaction, there is little progress in taxonomy and strain identification technology, and the classification is confusing. Facklam^[1]SVG was classified as Streptococcus mutans (S.mutans), Streptococcus salivarius (S.salivarius), Streptococcus slow (S.mitis), Streptococcus sanguinis type I and type II (S.sanguistypes Ⅰ and II), Streptococcus milleri (S.Millers Group), Streptococcus bovis (S.bovis), Streptococcus deacidificans (S.acidominus), Streptococcus tuberculosis (S.morbillorum) and Streptococcus lactis (S.uberis), wherein S. milleri in turn includes S. intermedius (S.intermedius), Streptococcus anginae (S.anginosus) and Streptococcus constellationis (S.constellatus)。

Bronchial asthma (asthma) is a chronic airway disease characterized by infiltration of inflammatory cells and inflammatory mediators, airway hyperresponsiveness and airway remodeling. At present, the incidence of asthma is increasing year by year, and it has become one of the diseases that seriously threaten public health worldwide. According to epidemiological surveys, refractory asthma accounts for 5% to 10% of asthma diseases, but it is the main type of asthma patients with high mortality and severe economic burden^[1]。 The 2014 ERS/ATS Expert Consensus on Refractory asthma refers to refractory asthma as severe asthma and defines it as "asthma with a clear diagnosis of asthma and standardized treatment and management for more than 3 months, which requires high doses of inhaled glucocorticoids (ICS) plus another control drug (or oral hormone) and is still not well controlled"^[2]。

In recent years, the global tuberculosis epidemic has shown an upward trend, and the incidence of tuberculous meningitis (tuberculosis), which is the more serious of extrapulmonary tuberculosis, has also increased year by year. Spinal tuberculosis is the most common bone and joint tuberculosis, accounting for about 5% to 6%^[1]Often combined with other organ tuberculosis, such as tuberculosis, hematogenous disseminated pulmonary tuberculosis and renal tuberculosis. Because of the location of the lesion and pathological changes, the patients with tuberculosis combined with spinal tuberculosis are more serious, with many complications and complications, and high disability and mortality rate. If it is not detected in time in clinical work, it can lead to serious complications such as paralysis and even endanger the patient's life. The data of 21 cases of tuberculosis complicated with spinal tuberculosis admitted to the Tuberculosis Department of Beijing Chest Hospital affiliated to Capital Medical University in the past 4 years were retrospectively analyzed, so as to provide reference for early clinical detection and rational treatment.

Langerhans 'cell histiocytosis' LCH is a group of rare and unknown histiocytic diseases characterized by proliferation, infiltration and granulomatous formation of a large number of Langerhans histiocytes, leading to organ dysfunction. According to the extent of organ involvement, LCH is classified into single organ involvement, multiple organ involvement, and multiple system involvement. The clinical data and outcomes of 2 patients with LCH admitted to the Department of Respiratory Medicine of Changzhou Second People's Hospital affiliated to Nanjing Medical University from May 2012 to November 2013 are reported below to improve the understanding of this disease.

EBUS-TBNA plays an important role in the diagnosis and staging of lung cancer, but its application in benign diseases is rarely studied. A patient with mediastinal cyst was recently diagnosed and treated with EBUS-TBNA in our hospital, which is reported as follows.

A 61-year-old female was admitted to the hospital on 13 August 2012 due to "repeated coughing and expectoration for 2 months". The patient developed paroxysmal cough without trigger 2 months ago, coughing a small amount of white phlegm, no fever, no chest pain, hemoptysis, shortness of breath, no night sweats, and loss of appetite. He went to the local hospital 2 days ago, and the chest CT showed "multiple nodules in both lungs, considering multiple metastases in both lungs and a small amount of pleural effusion on both sides". The patient has lost about 5 kg of weight since the onset of the disease. Six years ago, he underwent surgical treatment in a local hospital for "thyroid nodule" (pathology unknown); "Hypertension" for 2 years, taking "Annezhen", blood pressure was well controlled. Family history of hereditary disease denied. Admission physical examination: body temperature 36.3 ℃, blood pressure 122/75 mmHg (1 mmHg =0.133 kPa), pulse 78 beats/min, breathing 18 beats/min, consciousness, unpalpable superficial lymph nodes, no cyanosis of the lips, no deformity of the thorax, clear breathing sounds in both lungs, and no dry or wet rales. No pestle fingers (toes). Admission diagnosis: Multiple nodules in both lungs and the nature of the mass to be investigated.

From 21 to 23 November 2014, the 9th Academic Conference on Bronchial Asthma (Asthma) of the Chinese Medical Association was held in Nanjing. Professor Zhong Nanshan, a leading figure in China's respiratory field and academician of Chinese Academy of Engineering, all expert members of the 9th Asthma Group of Chinese Medical Association, Professor Huang Shaoguang and Professor Wang Guangjie, old experts in asthma, Professor James Lee of Mayo Clinic in the United States, former chairman of the Global Eosinophil Research Society, and more than 500 experts from all over the country gathered together to successfully conclude the 2-d meeting.

Idiopathic pulmonary hypertension (IPAH) is characterized by insufficient perfusion of the pulmonary circulation and results in an imbalance in the ventilation/blood flow (V/Q) ratio and a decrease in the effectiveness of gas exchange in the lungs. Cardiopulmonary exercise test can accurately measure gas exchange, and has been used in the diagnosis, treatment evaluation, prognosis prediction and other aspects of IPAH patients. The Oxygen Uptake Efficiency Platform (OUEP) is the latest indicator of oxygen uptake efficiency, which has clear advantages in assessing the severity of functional impairment and predicting case mortality and morbidity in patients with left or right heart failure. This study aimed to analyze the characteristics of OUEP in patients with IPAH and compare it with traditional indicators such as the slope of oxygen uptake efficiency (OUES). We retrospectively analyzed cardiopulmonary exercise tests, resting lung function, and hemodynamic results in 32 patients with IPAH, with 16 healthy volunteers serving as controls. We will be continuous 90 s VO₂The maximum mean of/VE is defined as OUEP; After logarithmic transformation of VE and VO₂It has a linear relationship, and its slope is OUES. The results showed that the measured values, measured values/predicted values % of OUEP, OUES and other cardiopulmonary exercise indexes in the IPAH group were significantly lower than those in the control group (P<0.000 1)。 VO in the IPAH and control groups₂With the increase of exercise intensity, VO2/VE reached the maximum peak platform (OUEP) near the anaerobic threshold, and then gradually decreased. VO in the IPAH group₂The absolute values of/VE were significantly lower than those of the normal controls during the rest period, warm-up period, anaerobic threshold and peak exercise (P<0.000 1), a compensatory increase in VE may be the underlying mechanism. OUEP (% found/expected) in the IPAH group and New York Cardiac Function Classification (r＝–0.724，P<0.005), total pulmonary vascular resistance (r＝–0.694，P<0.005), diffusion function (r＝0.577，P<0.000 1) and ventilation effectiveness (VE/VCO2 min) were significantly correlated (r＝–0.902，P<0.000 1), while OUES did not. In addition, the coefficient of variation (COV) of OUEP was lower than that of OUES (20.9% vs 34.3%). The results of this study show that the measurement method of OUEP is simple and feasible, and can be used for accurate and objective quantitative assessment of gas exchange abnormalities in patients with IPAH, which is more advantageous than the traditional oxygen uptake efficiency index OUES.

Macrolide antibiotics such as roxithromycin have been used in the treatment of bronchial asthma (asthma), but the specific mechanism is still unclear. This study aimed to investigate the intervention of roxithromycin in transforming growth factor – β 1 (TGF – β 1) -mediated proliferation of airway smooth muscle cells and its effect on caveolin – 1 expression. In this study, a rat model of chronic airway remodeling was established with reference to the methods of previous literature, and then rat airway smooth muscle cells were isolated and cultured in vitro. The concentration of TGF-β 1 secreted by airway smooth muscle cells was detected by ELISA, the proliferation of airway smooth muscle cells was detected by CCK-8 method, and the expression of Caveolin-1, P-Akt and P-ERK1/2 proteins in each group was detected by Western blot method. The results showed that compared with the normal group, the secretion of TGF-β 1 by airway smooth muscle cells in asthma group was significantly increased, and TGF-β 1 could significantly promote the proliferation of airway smooth muscle cells. Roxithromycin, pathway inhibitor PD98059, wortmannin and β-CD all inhibited the proliferation of airway smooth muscle cells. During the proliferation of airway smooth muscle cells stimulated by TGF-β 1, the expression of p-ERK1/2 and p-AKT peaks after 20 min stimulation, and roxithromycin can inhibit this process. In addition, TGF-β 1 can down-regulate the expression of caveolin-1 protein, while pathway inhibitors and roxithromycin can increase its expression. The results of this study suggest that roxithromycin can inhibit TGF-β 1-induced activation of ERK1/2 and AKT pathways, and can down-regulate the expression of caveolin-1 protein, which may be the potential mechanism of roxithromycin in the treatment of chronic inflammatory diseases including asthma.