2014年 · 第37卷第05期

Most of the clinical guidelines issued by the United States and Europe are based on abundant evidence-based medicine, which have a profound impact on countries all over the world, including China. In recent years, the author has invested more energy in infectious diseases, especially respiratory infections. I have emphasized more than once before that due to the differences in the distribution and drug resistance of pathogenic microorganisms between countries and regions, we must not copy European and American guidelines and mechanically apply them to our country, and must be based on the research results of our country. I also strongly disagree. As soon as new guidelines are promulgated in Europe and the United States, China will immediately convene experts in various names to translate and imitate these guidelines, and "concoct" China's simplified version. In order to publish them first, some contents will inevitably be false. The people who organized the "formulation" happily preached everywhere that the first guidelines or consensus in this field had been formulated for the people of China. As a result of this, the "consensus" floods, the content is not serious, unscientific and different versions contradict each other, which leaves the majority of clinicians at a loss. The application value of very few guidelines can even be compared with the "masterpiece""Yuezi" in Song Dandan's sketch.

Bronchial asthma (asthma for short) is a chronic inflammatory disease of the airway involving a variety of cells (including inflammatory cells and structural cells of the airway) and cellular components. Although standardized treatment and self-management of asthma have played a significant effect in controlling acute asthma attacks, since there is no effective cure, even well-controlled asthma patients have common psychological problems, and anxiety and depression, as important concomitant diseases, are related to the degree of asthma control and prognosis^[1]。 Anxiety disorders are 6 times more common in asthma patients than in the general population^[2]。 Further findings show that the mechanism of asthma and anxiety comorbidity may be related to shared genetic vulnerability. The neuropeptide S (NPS) -neuropeptide S receptor 1 (NPS-NPSR1) system may play a genetic linkage role in these two diseases^[3,4,5]。

obstructive sleep apnea syndrome (OSAS) is characterized by repeated collapse of the upper airway during sleep, repeated apnea and hypopnea at night, intermittent hypoxia at night, causing a series of clinical symptoms such as headache in the morning, dry mouth, daytime drowsiness and fatigue, memory loss, etc., often combined with hypertension, diabetes, cardiovascular and cerebrovascular diseases and kidney diseases.

The application value of theophylline drugs in chronic obstructive pulmonary disease (COPD) has been controversial. In the 2013 edition of the Global Strategy for the Diagnosis, Management and Prevention of COPD (COPD Global Strategy), it is used as a second-line therapeutic drug. However, in domestic clinical practice, aminophylline is often used to treat patients with acute exacerbation of COPD, even for patients in stable phase. In recent years, more and more attention has been paid to the mechanism of airway mucus hypersecretion in the pathogenesis of COPD. This study aims to further explore the mechanism of aminophylline in the prevention and treatment of COPD from the perspective of airway inflammation and mucus hypersecretion.

In recent years, gamma-interferon release test has been widely used for rapid diagnosis of MTB infection, and relevant guidelines have been developed in several countries such as the United States, Australia, Japan and South Korea^[1]However, there is still a lack of large sample research in China. T-SPOT.TB is a new gamma-interferon release test approved by the US Food and Drug Administration in 2008. This method uses early secretory antigenic target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10) as MTB-specific stimulating antigens, so it is not affected by BCG vaccination and most non-tuberculous mycobacterial infections, and has a good application prospect in China, a big country of BCG vaccination. This study retrospectively analyzed the clinical data of 556 cases detected by T-SPOT.TB, aiming to evaluate the clinical value of T-SPOT.TB in the diagnosis of active tuberculosis.

In recent years, the results of research on the pathological mechanism of OSAHS show that OSAHS is a chronic inflammatory process. Patients with intermittent apnea cause hypoxia/reoxygenation injury, which increases inflammatory factors in the body, such as IL-6, tumor necrosis factor-α (TNF-α), hypoxia inducible factor-1 (HIF-1 α), etc., which cause vascular endothelial injury and even systemic inflammatory response, and has an important influence on the occurrence and development of OSAHS-related complications such as cardiovascular and cerebrovascular diseases. However, the pathogenesis of OSAHS-related cardiovascular and cerebrovascular diseases is not yet clear. MicroRNA is a regulatory molecule for various physiological and pathological processes in organisms, which can regulate various physiological processes such as tissue development, virus defense, organ formation, cell proliferation and apoptosis, and fat metabolism. The results indicate that various microRNAs play an important role in the process of inflammatory response, such as miR-200b involved in the regulation of HIF-1 α^[1], miR-181b is associated with vascular inflammatory disease^[2]While both miR – 15b and miR – 23a are involved in the regulation of apoptotic mechanisms^[3,4]。 In this study, real-time PCR technique was used to screen and preliminarily verify the levels of these four miRNAs (miR-181b, miR-15b, miR-200b and miR-23a) in the serum of patients with OSAHS, and the miRNAs with the most significant differential expression were selected for further refinement analysis, and their expression and significance in patients with OSAHS of different degrees were observed and discussed.

Activation of calpain m – calpain degrades the skeletal proteins of cells and participates in the apoptotic process^[1]。 This study investigated whether m-calpain was involved in the apoptosis and muscle atrophy of skeletal muscle cells in chronic obstructive pulmonary disease (COPD) model rats.

Aspergillus fumigatus is a common conditional pathogen that causes invasive aspergillosis (IA), which is a fatal disease in immunocompromised patients. In recent years, the drug resistance rate of Aspergillus fumigatus has increased rapidly, and azole cross-resistant and multi-resistant strains have appeared. How to effectively control IA caused by drug-resistant Aspergillus fumigatus has become a clinical problem^[1]。 Cinnamaldehyde is an aldehyde organic compound extracted from cinnamon. The results show that cinnamaldehyde has antifungal effects, but whether it has anti-drug-resistant Aspergillus fumigatus has not been reported. In this study, the effect of cinnamaldehyde on drug-resistant Aspergillus fumigatus was preliminarily discussed, and the results are reported as follows.

Ground-glass opacity (GGO) is a uniform, thin, increased density shadow on high-resolution CT without masking the internal vessel and bronchial structures^[1]。 With the widespread application of spiral CT, the detection rate of focal ground-glass opacity (fGGN) in lung is increasing gradually. fGGN is considered to be closely related to lung adenocarcinoma^[2]Therefore, it has attracted more and more attention from clinicians and imaging doctors. The characteristics and pathological findings of fGGN spiral CT in multiple neoplasms were retrospectively analyzed to improve the understanding of these diseases.

A 76-year-old female was admitted to the hospital on 16 May 2012 due to "dry cough for 2 years, intermittent holding of breath for 1 year, aggravated for 2 months". The patient developed intermittent dry cough without trigger 2 years ago, the cough was aggravated when drinking water, and there was no cough when eating dry food. The symptoms could be relieved after oral or intravenous antibiotics in the local hospital. Inspiratory dyspnea occurred intermittently 1 year ago, which could be relieved by itself and was not diagnosed and treated. Six months ago, when I had a dry cough, I suddenly suffered from wheezing, inspiratory dyspnea, coughed up a yellow hard solid the size of a jujube core and a small amount of white sticky sputum and improved. "Intrabronchial lumen" stones were seen under bronchoscopy in an external hospital, but they could not be removed (details unknown). Thereafter, he took traditional Chinese medicine for treatment. Two months ago, cough and sputum were worse than before, accompanied by fever, and was diagnosed as pulmonary infection in another hospital, which improved after antibiotic treatment. Has a history of hypertension for 20 years, tuberculosis was discovered more than 40 years ago, and appendectomy was performed more than 20 years ago. History of foreign body inhalation denied. Physical examination: The superficial lymph nodes of the whole body were not palpable and swollen, the breathing sound of the right lung was slightly lower, and no obvious dry and wet rales were heard in both lungs. No abnormalities were found in the heart and abdomen. Laboratory test: peripheral blood leukocyte was 12.03×10⁹/L, 0.61 for neutrophils, 128 g/L for hemoglobin and 199×10 for platelets⁹/L, ESR was 47 mm/1 h, CRP was 20.89 mg/L, liver and kidney function was normal. PPD was strongly positive. Chest CT showed atelectasis in the middle lobe of the right lung, changes in bronchopneumonia in the lower lobe of the right lung, patchy high-density shadows in the middle segment, middle lobe and lower lobe of the right lung, multiple calcifications in the right lung, multiple swollen lymph nodes in the mediastinum and right hilum, and partial calcification (Figure 1)。

penicilliosis marneffei (PSM) is caused by penicilliosis marneffei (Penicillium marneffeiInvasive deep fungal diseases caused by infection, mostly occurring in AIDS people. In recent years, cases of PSM in healthy people have been reported one after another. The clinical manifestations of these patients are complex, the positive rate of early etiological examination is low, and the misdiagnosis and mistreatment often occur, and the mortality rate is high. Two cases of PSM confirmed by PM found by histopathology in normal subjects and died after ineffective treatment with various antifungal drugs were reported, so as to attract the attention of clinicians.

Pulmonary sequestration is a rare congenital abnormality of lung development. Pulmonary sequestration accounts for 0.15% ~6.4% of congenital lung malformations^[1]。 The rate of misdiagnosis and missed diagnosis is high due to low incidence, insufficient understanding of the disease by clinicians and limitation of examination methods. Pulmonary sequestration lacks specific clinical manifestations, and is more common with repeated pulmonary infection and hemoptysis, while patients with combined cancer are rarely reported. A case of pulmonary sequestration complicated with carcinogenesis is reported as follows.

Acinetobacter baumanniiacinetobacter baumanii, AB) are conditionally pathogenic bacteria that can be colonized at multiple sites in hospitalized patients^[1]It has become one of the main pathogenic bacteria of nosocomial infections in China^[2]The most common site of infection is the lung, which is an important pathogen of nosocomial pneumonia (HAP), especially ventilator-associated pneumonia (VAP)^[3]。 For multi-drug resistant Acinetobacter baumannii (MDR-AB), especially pan-drug resistant Acinetobacter baumannii (PDR-AB) and fully drug resistant Acinetobacter baumannii (PR-AB) infections, there is still a lack of effective clinical treatment measures. From August 2012 to September 2013, 6 cases of MDR-AB and PDR-AB infection were treated with tigecycline-based combination medication in the respiratory intensive care unit (RICU) of Fuzhou Pulmonary Hospital of Fujian Medical University, and 4 cases achieved satisfactory results, which are reported below.

In my first week in the bronchoscopy room at Cleveland Hospital, I attended a small lecture every Wednesday. This time, Professor Abdel Malak, director of anesthesia in the sedation center and bronchoscopy room, told it about the application of carbon dioxide map (capnography). In the subsequent observation, I noticed that the most basic bronchoscopy operations here should be performed under sedation, and every patient should monitor the carbon dioxide map during the operation, whether it is nasal tube oxygen inhalation or mask oxygen supply, while this monitoring in our country is generally only used for intraoperative monitoring of general anesthesia. Tutors Professor Mehta and Professor Abdelmalak knew that my focus this year would be bronchoscopy-related technologies, and they also hoped that I could bring new information and ideas back to China. Therefore, with their help and guidance, I studied the relevant contents of carbon dioxide map in depth, hoping to share it with you.

Children aged 0~6 in China must be vaccinated with BCG, hepatitis B and DPT according to the prescribed immunization procedures and the "vaccination work norms" (referred to as the norms for short) to prevent and control the occurrence of diseases. The Pharmacopoeia of the People's Republic of China (2010 Edition) Part III (referred to as the Pharmacopoeia for short) also includes 25 vaccines for immunization programming. However, there are inconsistencies between the pharmacopoeia and the regulations on the use of vaccines. One of them is that infants and young children over 3 months of age need to do PPD test first when vaccinated with BCG.

It is well known that proper use of ventilators helps to improve ventilation, correct hypoxia and carbon dioxide retention, and is an important tool in clinical rescue and treatment of respiratory failure caused by various causes. Both oxygen and carbon dioxide are important blood gases, which are closely related to the acid-base balance of the body. Therefore, ventilator not only improves pulmonary ventilation, but also affects the acid-base balance of the body. Its mechanism is related to many factors, such as underlying diseases and regulation of ventilator parameters. Understanding the effects of mechanical ventilation on acid-base balance and its mechanisms can help to better interpret the changes in blood gas outcomes and adopt corresponding management strategies.

The establishment of a relatively uniform genotyping method of M. tuberculosis is of great significance to grasp the genetic characteristics of epidemic strains in China and evaluate the recent transmission of tuberculosis in various regions. Variable tandem repeat (VNTR) typing of Mycobacterium tuberculosis has been widely used worldwide. The 15/24-site VNTR (VNTR-15/24) proposed by Philip Supply et al. in 2006 is the most widely used scheme at present, but the resolution of this scheme for the highly endemic Beijing family strains in China is low. In order to establish a typing scheme suitable for the characteristics of clinical strains of Mycobacterium tuberculosis in China, we systematically evaluated the resolution and reliability of 25 VNTR loci in clinical strains of Mycobacterium tuberculosis circulating in different regions of China, and selected a set of "9+3" VNTR loci combinations with few loci and high resolution, which are suitable for popularization and application in China.

China TB Electronic Registration and Reporting System is an information management system based on the case information of pulmonary tuberculosis patients and real-time reporting through the Internet. It was put into use in 2005, and it was in operation for about 4 years at the same time as the original paper reporting system. In 2009, it replaced the paper reporting system and covered about 3,200 tuberculosis prevention and control institutions in China. In 2010, the system was optimized and updated, and the collection function of drug resistance and floating population information was added.

Nowadays, cancer has become the first cause of human death. Especially in recent years, the incidence and mortality of lung cancer have increased rapidly, so that people talk about cancer. But do you know where the word cancer came from?

Professor Wang Zengli, a famous medical educator and respiratory expert in China, one of the founders of respiratory medicine in our hospital, and a professor and doctoral supervisor of respiratory medicine in West China Clinical Medical College/West China Hospital of Sichuan University, died of illness at 14: 03 on March 27, 2014 at the age of 80.

Song Dandan's "masterpiece""Yue Zi" and the extremely rigorous academic literature "guide" and "expert consensus" in the medical field can be described as irrelevant. However, Professor Liu Youning, the editor-in-chief of this journal, found that sometimes there are similarities between the two. Professor Liu took "early and late onset of hospital-acquired pneumonia" as an example in the column of "Editor-in-Chief's Essay", hoping that the formulation of medical-related guidelines or consensus in China should be more rigorous and more rigorous!