2014年 · 第37卷第02期

Since 2005, the author has applied for academician of Chinese Academy of Engineering for three consecutive times. Although all of them have successfully obtained the candidacy qualification and entered the second round of selection, they have lost the election three times because of the lack of talent and learning and the lack of skill. Based on the principle of seeking truth from facts and transmitting positive energy, this article talks about some views on the selection and management of academicians without worry and freely from the perspective of a loser who does not intend to continue to apply. Readers are invited to criticize and correct.

Peach talisman bid farewell to the old year, flying snow to welcome the new year, on the occasion of the new year, to all readers to pay respects to the old age!

Obesity is a chronic disease of human beings. In addition to all kinds of inconvenience brought by obesity to human body, many diseases closely related to obesity are also seriously endangering human health. obesity hypoventilation syndrome (OHS) is a respiratory disorder closely related to obesity. It has been paid more and more attention because of its unique pathophysiological mechanism and possible secondary cardiovascular and cerebrovascular diseases. Coincidentally, another respiratory disease closely related to obesity, obstructive sleep apnea syndrome (OSAS) and OHS are also inextricably related. There are many similarities and similarities between them in the causes, pathophysiological mechanisms and clinical manifestations, but they are not completely consistent. They are still two independent diseases. This paper now combines relevant literature at home and abroad, and tries to make a simple analysis of the similarities and differences between them from several different angles.

Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory disease characterized by incomplete reversibility of airflow restriction. The prevalence rate among people over 40 years old in China is over 8%^[1], the prevalence of asymptomatic people is higher^[2]。 The disease has a wide clinical disease spectrum, and targeted intervention according to different phenotypes is an important part of clinical decision-making in the diagnosis and treatment of COPD. In recent years, with the development of sleep respiratory medicine, it has been clear that the incidence of sleep disordered breathing (SDB) including sleep apnea, sleep hypoventilation and unexplained nocturnal hypoxemia in patients with COPD is very high, which has an important influence on the occurrence and development of respiratory failure. It is one of the topics that need to be considered in the treatment and long-term management of acute exacerbation of patients with COPD, but unfortunately, this point has not been paid attention to^[3]。 The clinical diagnosis and treatment characteristics of overlap syndrome (OS) in patients with COPD complicated with SDB are reviewed.

Obstructive sleep apnea syndrome (OSAS) is closely related to atherosclerosis, hypertension, coronary heart disease, arrhythmia, cerebral thrombosis, cerebral hemorrhage, diabetes and other diseases^[1]The cycling process of hypoxia-reoxygenation occurs repeatedly during sleep, forming the core pathophysiological feature of the disease, namely chronic intermittent hypoxemia (CIH). CIH can induce a series of inflammatory and oxidative stress responses, leading to systemic damage, especially OSAS-related cardiovascular and cerebrovascular complications, and vascular endothelial damage is the common pathological basis of these diseases^[2]。 Peripheral blood cells are in direct contact with vascular endothelium and are important inflammatory cells. The influence of CIH on blood cells directly or indirectly affects the damage and repair of vascular endothelium, and then affects the occurrence and development of cardiovascular and cerebrovascular complications. The following is a brief review of the research in this field.

The diaphragm is the main respiratory muscle of the human body, which bears 60% ~80% of the ventilation needs. Dysfunction of diaphragm may lead to decreased exercise endurance, dyspnea, sleep breathing disorder, etc. It is one of the important pathophysiological mechanisms of respiratory failure. In addition to neuromuscular injury, chronic obstructive pulmonary disease (COPD), bronchial asthma (asthma for short) or chronic heart failure can cause abnormal central sensitivity, muscle fiber damage or diaphragmatic dysfunction due to abnormal ventilation, drug use (such as glucocorticoids, antibiotics and sedatives, etc.), mechanical ventilation^[1,2]。 Therefore, the assessment of diaphragm function is not only helpful for disease diagnosis, but also can be used for lung function assessment and withdrawal guidance of patients with COPD and heart failure. This article reviews the research progress of comprehensive assessment methods of diaphragm function.

At present, many protective immunological mechanisms against MTB infection have been found, but the study of immune response in tuberculosis, especially the production of local immune mediators and the induction mechanism of different immune cells in human tuberculosis, is still lagging behind. The immune cells in tuberculosis research mainly come from peripheral blood, which cannot truly reflect the specific immune response in infected tissue or granuloma microenvironment. The experimental data of clinical samples of tuberculosis patients in vitro can more truly reflect the local immune status, so it is more important to strengthen the study of the interaction between host and pathogen in local tissues of MTB infection.

Bronchial asthma (asthma for short) is a chronic allergic inflammatory disease of the airway, which is characterized by airway inflammation and airway hyperresponsiveness. Its main clinical manifestations include recurrent wheezing, dyspnea, cough, expectoration and other symptoms. The pathogenesis of asthma is very complex and involves many factors, among which a large number of inflammatory cells and various cytokines in the host body play an extremely important role. At present, the role of adaptive immune response in the development of chronic inflammation in asthma, especially Th2 cells, has been widely regarded as one of the central links in the process of asthma attack. However, recent research results show that the host innate immune system also plays a key role in the pathogenesis of asthma. In this paper, the role and possible mechanism of a newly discovered class of cells-innate lymphoid cells in asthma are described.

China is the world's largest producer and consumer of tobacco. According to 2010 data, there are 301 million smokers in China, and more than 1 million people die of tobacco-related diseases every year. WHO has listed tobacco dependence as a disease in the International Classification of Diseases (ICD-10, F17.20), confirming that tobacco is the biggest threat to human health at present, and nicotine addiction is the root cause of tobacco dependence. At present, effective methods that can significantly increase the long-term smoking cessation rate include: smoking cessation advice, smoking cessation counseling, smoking cessation hotline and drug treatment, among which drug treatment includes nicotine replacement therapy (NRT), bupropion hydrochloride extended-release tablets and varenicline^[1,2]。 In recent years, a new product for smoking cessation, an electronic cigarette, has appeared on the market, which functions through an electronic nicotine delivery system (ENDS). It is a battery-powered device that provides vaporized nicotine, which may reduce the need for smokers to smoke cigarettes^[3,4]。

OSAHS can cause multi-system target organ damage and pathophysiological changes including brain damage, and often have clinical manifestations such as cognitive impairment, endocrine disorders and apnea^[1,2]。 myelin basic protein (MBP) is a biomarker of oligodendrocyte damage in the brain^[3]Amyloid precursor protein^[4](amyloid precursor protein, APP) And enkephalin^[5]It plays an important role in brain injury of Alzheimer's disease, stroke and other diseases. Oxidative stress caused by intermittent hypoxia is one of the important causes of brain injury in OSAHS^[6]。 In this study, the mRNA expression of MBP, APP and enkephalin in three brain tissues related to cognition, endocrine and respiration in hippocampus, hypothalamus and brainstem of rats was measured in the rat model of intermittent hypoxia, and the effects of reduced glutathione (GSH) on these factors, cognitive function and oxidative stress indexes in rats were measured, which provided theoretical guidance for clinical exploration of the pathogenesis and clinical intervention of OSAHS brain injury.

China is a major country of drug-resistant tuberculosis, and the number of new cases of multi-drug resistant tuberculosis every year ranks second in the world^[1]。 Isoniazid is the chemical drug of choice for the treatment of tuberculosis and plays an important role in the effective control of tuberculosis. However, at present, the resistance rate of isoniazid is the highest among all anti-tuberculosis drugs and higher among patients with repeated treatment of tuberculosis^[2,3]。 Isoniazid p-aminosalicylic acid (Pa) is an anti-tuberculosis drug synthesized from isoniazid and sodium p-aminosalicylic acid (PAS) by a special method. It has certain effect on isoniazid-resistant strains and has less adverse reactions^[4,5]Some clinicians regard it as one of the important drugs to replace isoniazid in the treatment of patients with retreatment, drug-resistant tuberculosis and multidrug-resistant tuberculosis, but it lacks effective basic research basis to support it. We used Roche proportional method to detect the resistance of Pa and isoniazid in 194 MTB strains, and used the microplate Alma blue cell proliferation and cytotoxicity assay (Alarma blue method) to detect their MIC, and compared the anti-MTB activities of the two drugs in vitro, so as to explore the clinical value of Pa in drug-resistant tuberculosis.

Chronic obstructive pulmonary disease (COPD) is a chronic progressive disease related to smoking, which can induce the destruction of lung parenchyma and produce emphysema^[1]。 Our research group has demonstrated from cellular and animal experiments that persistent endoplasmic reticulum stress response in COPD model can initiate the apoptotic program, which is manifested by increased expression of endoplasmic reticulum stress-specific apoptotic molecules CCAAT/enhancer-binding protein-homologous protein (CHOP) and cysteine-containing cysteinyl aspartate specific proteinase (caspase-12)^[2]。

Pulmonary tuberculosis is a chronic infectious disease, which can produce a variety of specific antibodies against various antigens of MTB in the course of disease. Therefore, serological detection has become an auxiliary method for pulmonary tuberculosis diagnosis. In recent years, immunological diagnosis has gradually attracted people's attention, and people have paid more attention to finding specific antigens with diagnostic value from MTB secreted proteins. MTB resuscitation factor (Rpf) protein is the first secreted protein that can restore the growth and reproduction ability of dormant MTB, which can cause strong immune response^[1,2]。 We established a new method to detect serum MTB resuscitation factor IgG antibody (rPFE-Ab) by using resuscitation factor antibody as a marker in the diagnosis of pulmonary tuberculosis, and explored its application value in the diagnosis of pulmonary tuberculosis.

Since February 2013, severe pneumonia cases of unknown cause have been found in East China^[1]H7N9 avian influenza virus (AIV) was diagnosed on March 31, 2013 after isolation and identification of pathogens^[2]。 This paper reports the epidemiological data, clinical manifestations, laboratory examinations, imaging features, fetal monitoring and clinical therapeutic effect of a pregnant woman with H7N9 avian influenza admitted to the People's Hospital affiliated to Jiangsu University in April 2013.

Refractory pneumothorax is a clinical problem in the treatment of spontaneous pneumothorax, and some patients should not undergo surgical treatment. In recent decade, selective bronchial occlusion (SBO) has become more and more popular in clinical practice as a new therapeutic method. Zeng Yiming et al^[1]Watanabe, et al^[2]Tmvalin, etc.^[3]The successful experience in the treatment of refractory pneumothorax with autologous blood, bronchial plug and pulmonary volume reduction valve (one-way valve) was reported. We used balloon exploration and selective bronchial autologous blood occlusion to treat refractory pneumothorax, but there are still some patients with large pleural rupture with unsatisfactory efficacy. Recently, we used autologous blood occlusion and expansion sponge in a patient with refractory pneumothorax, and the efficacy was good, which is reported as follows.

From November 16th to 17th, 2013, the 4th National Academic Conference on Interstitial Lung Disease of Chinese Medical Association, sponsored by Respiratory Disease Branch of Chinese Medical Association and Respiratory Disease Branch of Guizhou Medical Association, and undertaken by Guizhou People's Hospital and Guizhou Institute of Respiratory Diseases, was held in Guiyang, Guizhou Province. A total of 154 papers were received at the conference, and more than 500 representatives from all over the country attended the conference. 10 experts with great achievements in the research of interstitial diseases made wonderful reports on the basic and clinical research of various diffuse interstitial lung diseases.

The central airway refers to the trachea, the main bronchus and the right middle bronchus. In recent years, 881 cases of central airway malignant tumors were treated with bronchoscopy, and some new ideas were put forward, which were verified by clinic.

It is explicitly recommended in the Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease (COPD) and the Guidelines for Diagnosis and Treatment^[1,2,3]High-dose inhaled glucocorticoids (ICS) combined with long-acting beta can be used in patients with moderate to severe COPD (groups C and D) at risk of repeated acute exacerbations₂-receptor agonist (LABA) therapy. The results have proved that although ICS treatment cannot reduce the mortality rate of COPD patients, it can reduce the number of acute exacerbations of COPD and improve lung function, and the systemic adverse reactions are less than that of oral glucocorticoid^[4]。

Segmental tracheal resection and reconstruction is the last resort to treat complicated tracheal stenosis and tracheal tumors. Recently, the author found that four adolescent patients in Beijing Jiangong Hospital suddenly suffered from severe dyspnea, large airway obstruction and dyspnea after large-segment tracheectomy. In view of this phenomenon, we put forward a hypothesis: threaded tube phenomenon, which is now reported as follows.

Flexible bronchoscopy is an important means for clinical diagnosis and treatment of respiratory diseases. Commonly used anesthesia methods include local anesthesia, local anesthesia combined with intravenous sedation and analgesia and general anesthesia. General anesthesia can avoid patient's discomfort and reduce the influence of patient's body movement on operation. The use of laryngeal mask in flexible bronchoscopy has been successfully reported^[1,2]At present, intubation laryngeal masks are mostly used. The i-gel laryngeal mask is a single-use silicone laryngeal mask that does not require inflation and has been used in flexible bronchoscopy in few studies. In this study, the feasibility and safety of I-gel laryngeal mask in flexible bronchoscopy were investigated by comparing the effect of I-gel laryngeal mask in flexible bronchoscopy.

The goal of mechanical ventilation is to provide and/or improve alveolar ventilation, oxygenation, respiratory mechanics and even comfort. Most of the early positive pressure ventilators can only provide constant pressure ventilation, but the constant pressure ventilation at this time is essentially pressure switching ventilation, and the airflow output by the ventilator is mostly constant airflow. When the airway pressure reaches the preset value, the ventilator stops the air supply and turns to exhalation. Due to the influence of respiratory compliance and airway resistance, the inhaled tidal volume and inspiratory time are not constant during pressure switched ventilation, so it is difficult to be applied in clinical practice. Pressure-controlled ventilation (PCV) in the modern sense refers to a type of ventilation mode with pressure limitation and time switching. The ventilator outputs decreasing airflow to ensure that the airway pressure is maintained at a preset level throughout the inspiratory phase.

The third event of Beijing Young Respiratory Scholars Salon in 2013 was held on October 31, 2013. This event was hosted by Dr. Huang Hui, Department of Respiratory Affairs, Peking Union Medical College Hospital. The participating doctors discussed the hot issues and innovations of the 2013 Dalian Respiratory Annual Conference, so as to comprehensively popularize the content of this year's Respiratory Annual Conference and deepen young doctors' understanding of the content of the 2013 Respiratory Annual Conference.

Jaundice (including hemolytic jaundice, hepatic jaundice, obstructive jaundice) is the yellowing of the skin, mucous membranes, and sclera due to elevated levels of bilirubin in the serum. Normal bilirubin does not exceed 17.1 μ mol/L, and when the bilirubin level is 17.1~34.2 μ mol/L, it is not easy to detect clinically, which is called invisible jaundice. When it exceeds 34.2 μ mol/L, visible jaundice will appear with the naked eye, manifesting as yellowing of the skin, mucosa and sclera, but the sclera of both eyes is the first to appear yellowing. Why is this? I wonder how many people who read this essay have seriously thought about it, so I suggest that readers may wish to think about it for a while, and if they really don't understand it, it is not too late to read the essay below.

In recent years, respiratory interventional therapy has become the first-line therapy for benign airway stenosis. However, although simple interventional therapy can quickly open the obstructed airway, it will also cause secondary damage to the airway structure, and excess granulation tissue and scar formed during the damage repair process often make stenosis recurrent. Topical application of mitomycin can inhibit granulation tissue hyperplasia, which is an emerging adjuvant therapy for the treatment of cicatricial stenosis. However, its effectiveness is still controversial, and the appropriate concentration is not clear. In this experiment, the inhibitory effect of mitomycin on cell proliferation was observed at the level of cytology in vitro after obtaining human airway granulation tissue fibroblasts by primary culture, and the dose-effect relationship was preliminarily explored, so as to provide experimental reference for clinical formulation of optimized topical medication regimen.

Integrin-linked kinase (ILK) is a highly conserved serine-threonine protein kinase involved in cell regulation, including cell migration and invasion, and is overexpressed in a variety of tumors and involved in tumor cell metastasis. matrix metalloproteinases (MMPs) promote tumor invasion and migration by degrading components of the extracellular matrix. Nuclear factor-κ B (NF-κ B) is a transcription factor that regulates the expression of MMP, and inhibiting the expression of NF-κ B can reduce the expression of MMP-9 in human cervical cancer cells and breast cancer cells. In this study, the expression of MMP-9 and NF-κ B in human lung cancer cell line (A549), which was stably transfected with ILK, was examined to investigate the role and related mechanism of ILK in tumor cell migration and invasion.