2015年 · 第38卷第02期

The Chinese Medical Association (hereinafter referred to as the Society) was founded in Shanghai in February 1915, and it has just celebrated its 100th anniversary. She not only has an impressive history, but also covers a wide range of specialties. It is the most influential and authoritative academic organization in the medical field of China, especially in the hearts of clinical workers. In the 1980s, when I first joined the society, almost all clinicians regarded it as a glory to "find a role" in the society and/or publish "a few words" in their journals, and some even regarded it as a lifelong goal, quite literally. Looking back at the past, I can say that every bit of academic progress is related to the society, and more closely related to the guidance and encouragement of the society predecessors. On the occasion of the centenary birthday of the society that nurtured my growth, the author feels a lot. I only review the history of the society and look forward to its future based on my own experience.

The Chinese Medical Association was established on February 5, 1915. Yan Fuqing, the first president, issued the Declaration of the Chinese Medical Association, which introduced the establishment process and explained the purpose of the Chinese Medical Association-to consolidate the friendship between doctors, respect medical ethics and medical rights, popularize medical health, and contact Huayang Medicine. In November 1915, the first issue of the first volume of Chinese Medical Journal was officially published. It was both Chinese and English, and Mr. Wu Liande was the editor-in-chief. In addition to publishing several medical papers, the first issue of Chinese Medical Journal also published the Declaration of Chinese Medical Association and Examples and Supplementary Regulations of Chinese Medical Association. By the end of 1915, the number of members of the Chinese Medical Association had grown to 232.

It has been 26 years since my honorable father-Qiu Zuyuan left me. During these 26 years, his excellent qualities have always pushed me, and his behavior, voice and smile are still deeply etched in my heart.

The prevalence of chronic obstructive pulmonary disease (COPD) among people aged 40 and over in China is 8.2%, and the proportion of COPD patients with grade I and II (mild and moderate) in severity is as high as 70.7%. However, these patients have almost no shortness of breath (including shortness of breath after activity), or only chronic cough, expectoration and other symptoms. Because patients tend to ignore the above-mentioned mild symptoms, only 35.1% of patients have ever been diagnosed with COPD, and the diagnosis rate is far lower than the prevalence rate. Of all patients, fewer than 25% had voluntarily visited a doctor^[1]。 Patients encountered by doctors in clinic often seek medical attention when they have symptoms such as shortness of breath after activity or even shortness of breath in a quiet state. These symptomatic COPD patients, their lung function (FEV₁% of the projected value) is at least less than 60%, even in patients with mild COPD (grade I), despite their FEV₁However, the ratio of airway volume and surface area was significantly increased, indicating that airway wall thickening already existed^[2]。 The results of the study found that^[3], early FEV in patients with COPD₁The annual decline rate is more rapid, and the underlying FEV₁Patients with % ≥50% of the estimated value, whose FEV₁The annual decline rate is – 47.0 to – 49.0 ml/year, which is much greater than the basal FEV₁% of estimated value<– 23.0 to – 28.4 ml/year in 30% of patients. In recent years, the most exciting progress in the field of prevention and treatment of COPD is the full recognition that COPD is a disease that can be prevented and treated. However, early intervention for COPD is far from enough. In view of this, some scholars have proposed the "5P" mode of prevention and treatment of COPD^[4]That is, predictive, preventive, pre-symptomatic, personalized, and participatory.

Chronic obstructive pulmonary disease (COPD) is a common disease that seriously endangers human health, with high morbidity and mortality rates worldwide, and leads to a heavy economic burden on patients and their families. According to the National Health and Nutrition Survey (NHANES), the prevalence of mild COPD is 6.9% and moderate COPD is 6.6% among Americans aged 25 to 75^[1]。 A survey of 20 245 adults in 7 regions in China showed that the prevalence of COPD among people over 40 years old was as high as 8.2%^[2]。 According to the global burden of disease study, it is estimated that COPD will be the third leading cause of death worldwide in 2020^[3]。 The World Bank and the World Health Organization predict that COPD will rank fifth in the world's medical burden by 2020^[2]。 The risk factors causing COPD include environmental factors and individual susceptibility factors, which interact with each other. Smoking is by far the most important risk factor for COPD worldwide. PM2.5 air pollution is also an important cause of COPD in China. Other important risk factors include long-term bronchial asthma, passive smoking, biofuels, occupational exposure, socioeconomic status and genetic predisposition.

Electrocardiogram is a basic cardiac examination technique, which has been used for the diagnosis of pulmonary heart disease for more than 40 years, but the value of chronic obstructive pulmonary disease (COPD) is less understood. Although some scholars have summarized the characteristics of ECG in chronic lung diseases since the birth of ECG technology^{[1,2,3,4,5,6]}Such as pulmonary P wave, right atrial enlargement, right ventricular hypertrophy, right bundle branch block, clockwise transposition, right deviation of electric axis, SⅠSⅡSⅢ mode, arrhythmia, etc., but most of them are still related to pulmonary heart disease, but the sensitivity and/or specificity to COPD are poor. For many years, foreign studies have found that the most correlated ECG index with COPD/emphysema is the verticalization of frontal P-axis^{[7,8,9,10,11,12,13,14]}It can even be used as an independent screening index for COPD, but there has been a lack of attention to this problem in China. The gold standard for COPD diagnosis is pulmonary function tests^[15]However, at present, the popularity rate of lung function tests in rural and primary hospitals in China is still very low^[16]If convenient, non-invasive and widely popular electrocardiogram can be used as a screening method for COPD, it will undoubtedly have certain practical significance for the diagnosis and treatment of COPD in China at this stage. The relevant research results of p-axis verticalization are summarized as follows.

pulmonary artery hypertension refers to a type of disease in which pulmonary vascular resistance and pressure continue to rise due to restricted pulmonary blood flow, resulting in right heart hypertrophy and eventually right heart failure. hypoxic pulmonary vasoconstriction (HPV) is the mechanism that causes the increase of pulmonary artery pressure in the early stage, mainly manifested by the contraction of pulmonary artery smooth muscle cells (PASMCs). In the later stage, pulmonary vascular remodeling (PVR) is considered to be the main pathophysiological changes causing pulmonary arterial hypertension, including the proliferation and apoptosis imbalance of vascular endothelial cells, PASMCs and adventitial cells, with PASMCs proliferation and hypertrophy being the most significant. In the above-mentioned pathogenesis of pulmonary hypertension, hypoxia-induced potassium ion channel dysfunction in PASMCs plays a very important role.

medical thoracoscopy has the advantages of small injury, high safety and low cost. It is mainly suitable for the diagnosis of pleural diseases, and has extremely high diagnostic value for patients with unexplained pleural effusion. However, as this technology is more and more widely used in clinic, due to the diverse manifestations of pleural lesions, it is often difficult for doctors to accurately distinguish benign and malignant lesions under the microscope, and it is also difficult to find atypical hyperplasia or early malignant lesions. The diagnostic specificity of pleural lesions observed by surgeons was only 21%^[1,2]。 How to further improve the accuracy of microscopic diagnosis is a new challenge faced by thoracoscopic diagnosis technology^[3]。 In the past ten years, with the continuous development of endoscopy, computer and optical technology, new technologies such as fluorescence and narrow band imaging (NBI) have been applied to many disciplines such as gynecology and gastroenterology. These techniques improve the diagnostic sensitivity, especially for early tumor exploration and the determination of malignant lesions. Some foreign scholars have applied related techniques to thoracoscopic surgery, but there are no reports in China. The application of fluorescence and narrowband imaging techniques in thoracoscopy is summarized as follows.

Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are common diseases of the respiratory system. When they occur at the same time, they are called overlap syndrome (OS). Flenley^[1]The concept of OS was proposed for the first time, and it was suggested that transient severe nocturnal hypoxia occurred in "purple swelling" COPD patients during REM sleep. These patients also had hypoxia and carbon dioxide retention when they were awake and without oxygen. Current studies of airway resistance in OS show that patients with OS not only have peripheral airway obstruction caused by repeated bronchial inflammation, but also have increased upper airway resistance caused by upper airway stenosis, relaxation and posterior position of soft tissue and tongue base of upper airway during sleep, soft palate, tongue falling into the pharyngeal cavity and close to the posterior pharyngeal wall^[2]。 There are also related studies showing that upper airway resistance increases significantly in OS patients compared with those with slow lung obstruction^[3,4,5]。 The purpose of this paper is to investigate the characteristics and influencing factors of airway resistance in patients with different degrees of OS.

The mdig gene (mineraldust-inducedgene), also known as mina-53 and nucleoprotein 52, was first isolated from coal miners' lung macrophages in 2005^[1,2,3]。 It is highly expressed in lung cancer, breast cancer, colon cancer, esophageal cancer, gastric cancer, hepatocellular carcinoma, lymphoma and renal cell carcinoma, and is a potential new oncogene^[4]。 Arsenic (As) or arsenides are well-known carcinogens^[5], but the mechanism of arsenic carcinogenesis is unclear. Available data suggest that arsenic trichloride can activate mitogen-activated protein kinase (MAPK)^[6]Transcriptional activator AP-1^[7]p53^[8]and nuclear factor-κ B^[9]and other signaling pathways to exert carcinogenic effects. Silica particles and tobacco smoke can induce high expression of mdig gene in human bronchial epithelial cells, but the relationship between arsenide and mdig gene expression is still unclear. This study investigated the relationship between arsenic trichloride and mdig gene expression and the pathogenesis of occupational and environmental arsenic trichloride exposure.

Bronchial asthma (asthma) is a worldwide heterogeneous disease that usually manifests as chronic airway inflammation and affects about 1% to 18% of the population in different countries^[1]More than 300 million people worldwide suffer from asthma^[2]。 Some studies have shown that most asthma patients worldwide have not yet received proper and reasonable prevention and treatment in accordance with the requirements of the Global Asthma Initiative (GINA)^[3,4,5]。 In recent years, the incidence of asthma is on the rise in the world, and the incidence of asthma in China is increasing year by year^[6,7]The social burden caused by disease is increasing, and research on the pathogenesis, diagnosis and treatment of asthma is also a focus of medical research^[8,9,10]。 According to the 2011 AIM results, among these countries/regions surveyed in the Asia-Pacific region, the situation of asthma patients in China is not optimistic^[11,12]。 At present, there are very few national surveys on asthma. This study selects data from China from AIM survey, describes the current situation of asthma patients in China from many aspects, and compares it with the overall situation in Asia-Pacific region to explore the unique characteristics of asthma in China and potential influencing factors.

OSAHS is a common clinical sleep breathing disorder. Its pathophysiological basis is that the abnormal structure and function of the upper airway lead to repeated intermittent hypoxia during sleep, which causes oxidative stress and inflammatory reaction in the body, induces the expression of related susceptible genes and the synthesis of bioactive substances such as inflammatory proteins, and then causes systemic damage to multiple organs^[1]。 In recent years, it has been found that there are different degrees of neuroendocrine changes in patients with OSAHS, and the dysfunction of hypothalamic-pituitary-adrenal (HPA) axis is more prominent^[2,3,4]However, its specific mechanism is still unclear, and there is currently no effective drug for prevention and treatment. Therefore, we selected the rat model of intermittent hypoxia to simulate the pathophysiological process of hypoxia-reoxygenation in OSAHS patients, and investigated the effects of oxidative stress and inflammatory response caused by intermittent hypoxia exposure on the ultrastructure and function of HPA axis; The antioxidant reduced glutathione (GSH) was used to investigate the effect of GSH on HPA axis in rats with intermittent hypoxia.

Penicilliosis marneffei (PSM) is caused by Penicilliosis marneffei (Penicilliummarneffei, PM) a deep fungal infectious disease caused by infection^[1]Common in Southeast Asia, China is more frequent in Guangxi and Guangdong. PM is a conditional pathogen, and people with low immune function are vulnerable to infection. There are few reports in the literature of patients with non-human immunodeficiency virus (HIV) infection, especially those with tracheobronchial infection. At the same time, the diagnosis is very difficult and easy to be misdiagnosed. An example of the present report is as follows.

Pulmonary hydatidosis is often caused by Echinococcus tapeworm, which is a common endemic disease. However, pulmonary hydatidosis combined with Aspergillus infection is mostly a case report in foreign literatures. The clinical data of two patients with pulmonary hydatid complicated with Aspergillus infection admitted to our hospital are sorted out and reviewed in combination with the literature as follows, so as to provide reference for the diagnosis and treatment of this kind of disease.

Bronchogenic cysts are caused by the abnormal development of the tracheobronchial tree during the embryonic period. They are not rare diseases, but they lack clinical and imaging specificity and are easily misdiagnosed. The clinical data, imaging features and treatment of 24 adult intrathoracic bronchogenic cysts confirmed by surgery and pathology in our hospital from July 2009 to April 2014 are retrospectively analyzed, and are reported as follows.

A 27-year-old female was admitted to the hospital mainly for "repeated hemoptysis for 1 1/2 years". Past physical fitness. The patient developed hemoptysis without obvious trigger 1 1/2 years ago, and had chest enhanced CT, but the cause of hemoptysis could not be found. Thereafter, hemoptysis is intermittent, which is more induced after infection, emotional agitation, cough or vigorous activity. When the amount of hemoptysis is high, there are dozens of milliliters, and when the amount is small, there is only blood in the sputum. More than ten days before admission, the patient again developed hemoptysis without obvious trigger. After bronchoscopy in an external hospital, a tension of blood vessel was found in the right middle bronchus, and he was referred to our hospital.

A 17-year-old male was admitted to the hospital on 20 May 2014 due to "cough and chest tightness after upper respiratory tract infection for 15 d". The patient had no fever, cough of purulent sputum and night sweats, no chest pain and hemoptysis, no decrease in activity endurance, and no nighttime asthma or aggravation of cough. No history of drug food allergy, no history of smoking, denied history of tuberculosis, no history of smoking. Anterior and lateral radiographs of the chest in the external hospital reported spherical lesions in the lower lobe of the left lung, with multiple satellite lesions around it, which considered the possibility of pulmonary tuberculosis. Admission physical examination: body temperature 36.6 ℃, blood pressure 120/80 mmHg (1 mmHg =0.133 kPa), no cyanosis of the lips, no swelling of superficial lymph nodes; There was no distension in the jugular vein, symmetrical thorax, coarse breathing sounds in both lungs, and no dry and wet rales were heard; The heart rate was 72 beats/min, the heart rhythm was uniform, and no murmur was heard in the auscultation area of each valve; The liver and spleen are not large, there is no edema in both lower limbs, and there are no pestle-like fingers. Laboratory tests: blood routine, coagulation routine, tumor markers, G test, GM test, PPD test, procalcitonin, ESR, C-reactive protein, cryptococcus neoantigen detection, sputum culture, sputum detection of acid-fast bacilli, etc. Blood gas analysis showed pH 7.38, PaO₂was 88 mmHg, PaCO₂was 73 mmHg, SaO₂97%, 25 mmol/L for AB, 46 mmol/L for BB, and the carbon dioxide binding force (CO₂CP) was 26 mmol/L. A plain chest CT scan was performed on 20 May 2014 (Figure 1，Figure 2) shows left pneumonia, the left lower lobe occupies space, and enhanced CT scan is recommended. The initial diagnosis was a space-occupying lesion in the lower lobe of the left lung. An enhanced chest CT scan was performed on 26 May 2014, and the imaging department diagnosed pulmonary vascular malformation (Figure 3，Figure 4）。 Most doctors in the department diagnosed pulmonary arteriovenous fistula (PAVF), and a few doctors considered pulmonary sequestration, on the grounds that the malformed blood vessels and descending aorta were simultaneously enhanced in the arterial phase during the enhancement scan, and there appeared to be a communicating branch (Figure 5), analyzing the malformed blood supply from the systemic descending aorta, not the pulmonary artery. Subsequently, the Imaging Department, Interventional Department and Thoracic Surgery Department were organized to conduct multidisciplinary joint consultation in the hospital. Some doctors suggested DSA examination. DSA is the gold standard for diagnosing pulmonary vascular malformations, but it is an invasive examination and has certain risks. The Imaging Department performed multislice spiral CT angiography (MSCTA), which showed the spatial anatomy, vascular composition and direction of malformed blood vessels from all angles^[1]（Figure 6、Figure 7、Figure 8), finally diagnosed as congenital descending aortopulmonary fistula (congenital descending aorta pulmonary vein fistula, cDAPVF).

The first international cough conference (China) was held in Guangzhou on November 7-9, 2013. This conference was jointly organized by Guangzhou Institute of Respiratory Diseases, State Key Laboratory of Respiratory Diseases and the First Affiliated Hospital of Guangzhou Medical University. Professor Zhong Nanshan, an academician of the Chinese Academy of Engineering, chaired the conference, and Professor Kian Fan Chuang, chairman of the British Cough Forum, Professor Peter Dicpinigaitis, chairman of the American Cough Conference, and Professor Lai Kefang served as the chairmen of the joint conference. Nearly 500 delegates from around the globe attended the conference. This conference is the first large-scale international academic exchange conference with the theme of cough held in China. The contents of the conference include eight topics, including the mechanism of cough, common and rare causes of cough, respiratory viral infection and cough, treatment and clinical research methods of cough, interpretation of cough diagnosis and treatment guidelines and challenges faced by cough research. This article will briefly introduce the main contents of the topic on cough mechanism and guideline interpretation in this conference as follows.

Although most teaching hospitals have used hospital information system to collect and process clinical medical information of patients, there are not many effective storage, integration, retrieval, reuse and analysis of clinical data for medical teaching and clinical research^[1]。 Clinical database is based on computer technology, systematically collecting, storing and managing the information of patients with certain diseases, so as to achieve the purposes of data storage, multi-party sharing, medical teaching, basic research and clinical research^[2]。 A detailed and complete clinical database helps to investigate disease epidemiology, analyze disease development patterns, screen patients for research, monitor and improve medical quality, help medical decision-making, etc^[3]。 There are currently a large number of sepsis databases worldwide, and we screened the literature according to the following criteria: (1) the databases are held by institutions with credibility; (2) Collect data for adults, with a large and representative sample size; (3) The data has been publicly released or can be retrieved through Google and Pubmed. The sepsis database is reviewed as follows. For the related articles of these databases, we do not list them one by one, but give a brief introduction to their representative works.

Bronchial asthma (asthma) is one of the common chronic respiratory diseases, and its prevalence has increased year by year in recent years worldwide^[1]。 On the basis of the "Guidelines for Asthma Prevention and Treatment" revised in 2003 in China, the Asthma Group of the Respiratory Branch of the Chinese Medical Association revised the "Guidelines for Prevention and Treatment of Bronchial Asthma (Definition, Diagnosis, Treatment and Management Plan of Bronchial Asthma)" with reference to the 2006 edition of the Global Asthma Prevention and Treatment Initiative (GINA) and the results of evidence-based medicine research at home and abroad in recent years.^[1](hereinafter referred to as the "Guide"). It provides a guiding document for the prevention and treatment of asthma in China, and has achieved an important role in standardizing the diagnosis and treatment of asthma, improving the control level of asthma and improving the quality of life of patients.

This issue of the magazine published a letter from Lu Huiyu and other readers on "The application of aerosolized inhaled glucocorticoids in acute asthma attacks". In view of the fact that the questions raised are representative among the majority of clinicians, as one of the experts who participated in the writing of China's "Guidelines for the Prevention and Treatment of Bronchial Asthma" (hereinafter referred to as "Asthma Guidelines"), I now answer their questions as follows, for reference only.

mucosal-associated invariant T cells (MAIT cells) are a new class of natural immune-like T cells. The T cell receptor of human MAIT cells consists of a constant V α 7.2-J α 33 chain and a limited β chain, which can be identified by specific V α 7.2 monoclonal antibodies and CD161 molecules. Previous studies have shown that MAIT cells play a key immunoprotective role in bacterial and fungal infections, but the role in active tuberculosis patients is unclear. In this paper, the characteristics and functions of MAIT cells in active tuberculosis patients, latent infections and normal healthy controls were studied. It was found that the proportion of MAIT cells in peripheral blood of active tuberculosis patients was significantly lower than that of normal controls and latent infections; The proportion of MAIT cells in pleural effusion of patients with tuberculous pleurisy was similar to that of patients with pulmonary tuberculosis, while the proportion of MAIT cells in peritoneal effusion of patients with tuberculous peritonitis was significantly higher than that of pleural effusion. The expression of CD69 in MAIT cells of active tuberculosis patients and healthy controls was significantly increased after stimulation with Mycobacterium tuberculosis H37Rv lysate and BCG, and the production of IFN-γ and TNF-α was also increased after BCG stimulation, suggesting that MAIT cells could be activated by TB-specific antigens and produce effector molecules. There was no significant difference in MAIT production of IFN-γ and TNF-α between tuberculosis patients and normal healthy controls after PMA/ionomycin stimulation; When stimulated by E. coli, the production of IFN-γ and TNF-α in MAIT cells of tuberculosis patients was significantly lower than that of normal controls, suggesting the existence of functional defects. The expression of PD-1 (programmed death-1), PD-L1, PD-L2, LAG-3, BTLA, Tim-3, CD160 and CD244 in MAIT cells by flow cytometry showed that only PD-1 expression in MAIT cells of active tuberculosis patients was significantly higher than that of normal healthy controls. The expression of IFN-γ in MAIT cells of tuberculosis patients was significantly increased after PD-1 receptor-specific monoclonal antibody was used to block PD-1 signaling pathway, suggesting that the function of MAIT cells was regulated by PD-1.

Congenital pulmonary venous atresia is a very rare congenital disease, which is more common in infants and young children. The main clinical manifestations are repeated hemoptysis, respiratory tract infection and dyspnea after activity. This article reports a rare adult case of congenital left pulmonary vein atresia complicated with bronchial varices admitted to the respiratory department of Drum Tower Hospital affiliated to Nanjing University School of Medicine on July 12, 2012, in order to improve the understanding of this rare disease by clinicians.

Zhang Y, Yang Y, Wang C, et al. Chest, 2014, 146:650-658

Kabrhel C, Okechukwu I, Hariharan P, et al. Thorax, 2014.

Koo S, Thomas HR, Daniels SD, et al. Clin Infect Dis, 2014.