2015年 · 第38卷第08期

In recent years, respiratory interventional technology has developed rapidly in China, and even our technical level in many fields has kept pace with the highest international level. After just a few years of development, China's respiratory interventional technology has shown unique Chinese characteristics, mainly in two aspects: (1) due to the limitations of equipment technology and economic conditions, Chinese doctors often combine their own limited conditions to innovate some effective methods to benefit patients; (2) Chinese patients tend to be more serious and complicated when seeing a doctor. Chinese doctors use the devices and consumables independently developed in China to flexibly solve problems for patients. The list of these two cases is too numerous, and the two articles on respiratory intervention published in this issue are typical of them.

In recent years, the detection technology of fractional exhaled nitric oxide (FeNO) has received extensive attention in clinical practice. Whether FeNO can recognize eosinophil inflammation and predict the response to inhaled corticosteroids (ICS) is fully affirmed by the results of domestic and foreign studies^[1,2]。 However, most of these studies are investigations of groups, and little attention is paid to individual differences. It has also been reported in the literature that FeNO is an immediate indicator reflecting the anti-inflammatory effect of ICS^[3]However, there have been no reports that ICS affects the onset time, maximum action time and maintenance time of FeNO. To this end, this study conducted a single-use ICS/long-acting beta₂Receptor agonists (long acting beta₂The pharmacodynamic test of receptor agonist (LABA) was carried out to observe the trend and regularity of FeNO immediately after administration, which provided preliminary laboratory basis for exploring the short-term response of FeNO to predict the long-term response to bronchial asthma (asthma) treatment.

The 2014 Global Asthma Initiative (GINA) clearly states that airway remodeling is one of the important mechanisms in the pathogenesis of bronchial asthma (asthma)^[1]。 The results show that the PI3K/AKT signaling pathway plays a key role in the growth and proliferation of airway smooth muscle by regulating hypoxia-inducible factor-1 α (HIF-1 α) and vascular endothelial growth factor (VEGF). mammalian target of rapamycin (mTOR) is an important downstream factor of the PI3K/AKT signaling pathway. The mTOR inhibitor sirolimus may have a therapeutic effect on airway remodeling in asthma. In this study, the effects of HIF-1 α and VEGF on airway remodeling in asthmatic rats and the effects of sirolimus were studied, so as to provide experimental data for the clinical treatment of airway remodeling in asthma.

Tracheal stenosis after tracheal intubation or tracheotomy is a common disease in the field of respiratory intervention. The clinical data of 27 patients with tracheal stenosis after tracheal intubation or tracheotomy admitted to Beijing Tiantan Hospital affiliated to Capital Medical University from January to December 2014 are summarized, so as to provide reference for the clinical work of respiratory interventionists.

Oxygen therapy is a commonly used clinical treatment, from severe illness to family, from infants to the elderly, to hospice care, and its wide application range involves almost every clinical discipline. However, how many doctors think about the benefits of oxygen inhalation to patients and whether it is also harmful when giving oxygen therapy? How much oxygen flow should be given, SaO₂In what range can levels be maintained to guarantee optimal efficacy? Whether oxygen concentration and SaO₂The higher the efficacy, the better? Any kind of clinical treatment has therapeutic effects and side effects, and the same is true of oxygen therapy. How to evaluate the advantages and disadvantages of oxygen therapy, and how to standardize and scientifically supply oxygen, this paper discusses the clinical and research results and some new viewpoints about oxygen therapy in recent years.

Refractory pneumothorax is a difficult clinical problem, which not only significantly increases the medical expenses of patients, prolongs the hospitalization period, but also causes pleural cavity or lung infection in severe cases, and even causes the death of patients. This paper summarizes the clinical data of 27 refractory pneumothorax cases, emphasizing the application of B-V231P-A double lumen balloon catheter in this technique.

Chronic obstructive pulmonary disease (COPD) is a serious respiratory disease with high morbidity, disability and mortality in the world. According to the World Health Organization (WHO), COPD is the fifth most common cause of death and ranks 10th among the diseases that place a heavy burden on patients^[1]。 COPD is usually accompanied by hypertension, diabetes, malignant tumor, osteoporosis and other extrapulmonary complications^[2], Ferguson et al.^[3]It was found that about 65% of COPD patients were complicated with osteoporosis; Another study found that with the progression of COPD, the incidence of osteoporosis gradually increased (the incidence of osteoporosis in GOLD stage III COPD patients was 9.6%, the incidence of osteoporosis in GOLD stage IV patients was 17.9%, and the incidence of osteoporosis in patients needing lung transplantation was as high as 59%)^[4,5]。 Osteoporosis and fracture not only seriously affect the quality of life of COPD patients, but also have a serious impact on the respiratory function of COPD itself. In clinical practice, the bone health of patients with COPD is a blind spot of clinical concern, and the diagnosis rate of osteoporosis and fracture in patients with COPD is still very low, only 5.9%^[6]。 Carter et al.^[7]It was found that vertebral fracture was diagnosed in only 2.6% of the 255 reports of initial examination of COPD outpatients, and upon re-evaluation it was found that up to 51.7% of COPD patients had vertebral fracture. Even if vertebral fracture is found during the examination, the awareness rate of patients is less than 1/3^[8]。

Tuberculosis is an infectious disease caused by MTB, a public health problem that seriously threatens human health, and is the second largest infectious disease that causes human death. In 2013, there are 9 million new cases of tuberculosis worldwide and 1.5 million deaths from tuberculosis^[1]Early diagnosis and early treatment are the key to controlling tuberculosis. tuberculin skin test (TST) based on delayed-type hypersensitivity (DTH) has been used in clinical practice for more than 100 years. PPD purified on the basis of old tuberculin (OT) as skin test reagent has improved the diagnostic specificity. However, due to the existence of more cross-antigens between PPD and bacillus calmette guerin (BCG) and non-tuberculosis mycobacterium (NTM), its specificity is low. Replacing PPD with MTB specific antigen can significantly improve the diagnostic specificity.

The measurement of airway hyperresponsiveness is a special ventilatory function test, which is closely related to the contents of Part II^[1]。

The 2015 American Thoracic Annual Conference was held May 16 – 21 at the Denver Convention Center in Colorado. The advances in interstitial lung disease at this annual meeting mainly included advances in the treatment of idiopathic pulmonary fibrosis (IPF) and understanding of connective tissue disease-associated interstitial lung disease (CTD-ILD).

A 44-year-old male, Han nationality, was admitted to the hospital on December 28, 2014 due to "cough and sputum for 1 month, aggravated for 1 d". One month ago, the patient had cough and expectoration after catching a cold. The sputum was yellow purulent sputum with blood in the sputum. He had no symptoms such as fever, chills, fatigue, chest pain and dyspnea. He took roxithromycin (specific dose unknown), and the cough was slightly relieved. The yellow purulent sputum turned into white sticky sputum. He went to the local hospital on 10 days and was given "azithromycin and xiyanping injection" for intravenous drip. The patient felt cough and expectoration without significant relief. 1 day ago, the patient felt that the above symptoms were aggravated. X-ray chest X-ray examination in our outpatient clinic showed high-density exudation in the lower lobe of the left lung (Figure 1)。 So with "lung shadow" in our department, since the onset of the disease, the spirit is good, the diet and sleep are poor, the urine and defecation are normal, and the weight has no obvious change. The patient had been in good health, had a history of smoking for 20 years, had been in good health, denied a history of tuberculosis, lived in an agricultural and animal husbandry group farm, and had a history of dog contact. Physical examination: temperature 36.7 ℃, pulse 80 beats/min, breathing 20 beats/min, blood pressure 120/70 mmHg (1 mmHg =0.133 kPa). The superficial lymph nodes were not palpable and swollen, the ear and nose were abnormal, the neck was soft, there was no resistance, and the thyroid gland was not large. The breathing sounds of both lungs were clear, and no dry and wet rales were heard. Heart rhythm, no murmur. The abdomen was flat and soft without tenderness, the liver and spleen were not reached under the costs, and there was no edema in both lower limbs. Preliminary diagnosis of admission: lung shadow to be examined, lung abscess? Lung cancer? Pulmonary hydatid

Recently, I had the honor to read "Effect of Budesonide on Expression of Thymic Stromal Lympopoietin Receptor in Dendritic Cells of Bronchial Asthma Mice" published in Chinese Journal of Tuberculosis and Respiratory Medicine, Issue 7, 2012.^[1]One article (hereinafter referred to as "the article"). In this article, the mice were divided into asthma group, budesonide intervention group and control group. To investigate the effects of budesonide on the thymic stromal lymphopoietin (TSLP) -dendritic cell (DC) pathway and Th2 polarization in bronchial asthma (asthma) mice and its mechanism. After reading benefit a lot, but also have the following questions, do not take the liberty to raise, and discuss with the author, discussion.

I would like to thank Xu Fengling and other readers for their contributions to this article^[1]The comments and suggestions made are replied below.