2014年 · 第37卷第08期

Tracheal stenosis is one of the most common acute and severe diseases in respiratory diseases, which can cause dyspnea, asphyxia, and even life-threatening. The common causes of benign tracheal stenosis are after tracheal intubation, tracheotomy, tracheal tuberculosis and lung transplantation^[1,2]The main causes of tracheal stenosis abroad are after tracheal intubation (or tracheotomy) and lung transplantation, while the main causes of tracheal stenosis in China are after tracheal intubation (or tracheotomy) and tracheal tuberculosis. Tracheal intubation is the most important cause of benign tracheal stenosis, accounting for about 1/3 of all causes^[2]。

Rigid bronchoscopy (rigid bronchoscopy for short) is a highly skilled surgical technique that combines intraairway visibility and therapeutic manipulation with patient ventilation. Modern hard lens has been developed from direct vision technology to high-definition electronic video images, which can provide clear visual images of the larynx, trachea and the proximal end of bronchial tree. At the same time, an end-expiratory carbon dioxide concentration monitoring device has been added, which makes it wider in application range, safer and more reliable in operation, and has become an indispensable and important tool for current airway interventional therapy. At present, the respiratory departments of many hospitals in China have purchased hard lenses. Now, the types of hard lenses and several problems that should be paid attention to in the operation process are introduced as follows.

Bronchial challenge test is a method to induce airway smooth muscle contraction by chemical, physical, biological and other artificial stimulation, and to judge whether or not bronchial constriction and its degree by the change of lung function indexes. It is the most commonly used and accurate clinical examination to detect airway hyperresponsiveness^[1]。 Currently, the Global Asthma Initiative (GINA)^[2]China's Guidelines for the Prevention and Treatment of Bronchial Asthma^[3]And "Guidelines for the Diagnosis and Treatment of Cough"^[4]The positive bronchial challenge test is listed as one of the important diagnostic conditions for atypical bronchial asthma or cough variant asthma, and it is also one of the important methods to evaluate the efficacy of asthma treatment.

extracorporeal membrane oxygenation (ECMO) is one of the extracorporeal life support (ECLS) technologies, which is used to partially or completely replace the cardiopulmonary function of patients, so as to buy time for the diagnosis and treatment of primary diseases^[1]。 Although ECMO has become an important life support technology accessible by the bedside in developed countries, it started late in China. In the early stage, it was mainly used in the field of heart disease. The application in the field of respiratory failure began in 2009 with the prevalence of the new type of influenza A (H1N1) in China and the concentration of severe cases. At present, many hospitals have begun to apply ECMO to the treatment of severe respiratory failure. However, considering that ECMO is a life support technology with high cost, complex technology and many complications, the Respiratory Branch of Chinese Medical Association, together with units with certain application experience in China, drafted this document in combination with the actual situation in China, in order to standardize the clinical application of ECMO in the treatment of adult respiratory failure.

Transbronchoscopic one-way valve pulmonary volume reduction (BLVR) is a minimally invasive interventional procedure developed on the basis of surgical pulmonary volume reduction (LVRS) in patients with severe emphysema. At present, the efficacy of BLVR in the treatment of heterogeneous emphysema has been confirmed by many clinical trials, and this technology has also been used in the treatment of refractory recurrent pneumothorax and other diseases.

Chronic obstructive pulmonary disease (COPD) is one of the most concerned public health problems in the world, and has become the third leading cause of death in China. The prevalence of COPD in people over 40 years old is 8.2%^[1]。 COPD is a disease characterized by irreversible airflow restriction, and smoking is the main cause. Acute exacerbation of COPD and COPD complications accelerate the course of COPD and seriously affect the quality of life of patients. At present, the pathogenesis of COPD has not been elucidated, and the construction of animal models of COPD is helpful to study the pathogenesis of COPD, so as to achieve better prevention and treatment of COPD. In recent years, several new animal models of COPD have emerged, and new progress has been made in the research of animal models of acute exacerbation of COPD and COPD complications. We summarize the current research progress of COPD animal models as follows.

Bronchial asthma (abbreviated as asthma) is a chronic airway inflammatory disease with genetic susceptibility involved in multiple genes. The pathogenesis involves a variety of inflammatory cells, inflammatory mediators and complex cytokine network. Allergen (allergen) -induced airway eosinophil infiltration, airway hyperresponsiveness and airway remodeling as significant clinical features of asthma^[1]。 Th1/Th2 shift is the most important immunological abnormality in asthma, which is characterized by increased number and hyperfunction of Th2 subsets, decreased number and decreased function of Th1 subsets^[2]。 Nitric oxide (NO) is a gas signaling molecule with multiple biological effects, and its regulatory effects on asthma show both advantages and disadvantages. Nitric oxide synthase (NOS) is a key enzyme that catalyzes the production of nitric oxide from L-arginine (L-Arg). Various NOS isoenzymes are regulated by different genes and play different pathophysiological roles. Among them, endogenous nitric oxide produced by constitutive NOS catalysis plays a protective role against bronchospasm and airway remodeling, while inducible NOS-derived nitric oxide leads to bronchoconstriction, airway inflammation and airway remodeling, which is closely related to the onset of asthma. Arginase (Arg) is another catalytic enzyme that promotes the catabolism of L-Arg. The mutual regulation of Arg and NOS plays an important role in airway inflammatory diseases such as asthma^[3,4]。 This article will review the biological characteristics of NOS and ARG and their relationship with the pathogenesis of asthma, and the research progress of the interaction between NOS and ARG in the treatment of asthma.

Idiopathic pulmonary fibrosis (IPF) is a fatal interstitial pulmonary disease (ILD) of unknown etiology. The incidence is increasing year by year, and the prognosis is the worst among idiopathic ILD. There is no effective treatment yet. In recent years, more and more studies have shown that the progression of IPF is closely related to the abnormal activation of the pulmonary regional angiotensin (RAS) system. Angiotensin converting enzyme 2 (ACE2) protein is an important negative regulator of lung local RAS system. By inhibiting lung local RAS system, it can alleviate alveolar epithelial damage, inhibit lung tissue abnormal repair, inhibit inflammatory response and other processes. The possible therapeutic effects of ACE2 in lung injury models and myocardial, kidney, liver and pancreatic fibrosis models have been reported, suggesting that the application of ACE2 may provide new targets for the treatment of IPF. Relevant studies are summarized as follows.

pleuroparenchymal fibroelastosis (PPFE) is a rare novel idiopathic interstitial pneumonia (IIP)^[1]There are only some scattered cases reported internationally, and there are no such cases in China. A newly diagnosed case of PPFE in our hospital is reported as follows to improve the understanding of the disease.

exogenous lipoid pneumonia (ELP) is a rare chronic lung disease, and ELP with imaging similar to lung cancer of both lungs is rare. A case admitted to Xiangya Hospital of Central South University in December 2010 is reported as follows.

The 18th World Bronchoscopy Congress was held in Kyoto, Japan from 13 to 16 April 2014, a joint meeting of the World Association of Bronchology and Interventional Pulmonology and the International Broncho-Esophageal Association (Joint meeting of The World Association for Bronchology and Interventional Pulmonology & The International Bronchoesophagology Society), It is held every 2 years. The full name of The meeting should be The 18^thWorld Congress of Bronchology and Interventional Pulmonology (WCBIP) & World Congress of Bronchoesophagology (WCBE)^thWCBIP/WCBE.

Recently, ATS and ERS jointly issued an official statement entitled "The Position of Pulmonologists in the Diagnosis and Management of Lung Cancer" (referred to as the statement). The statement pointed out that lung cancer is the leading cause of death of cancer patients worldwide, but with the development of lung cancer diagnosis and treatment methods, it is expected to reduce the mortality rate of lung cancer in the future. Targeted therapy, as a promising treatment, can improve the survival rate of lung cancer patients, but it requires the acquisition of sufficient histological specimens, which requires respiratory doctors to play an active role in lung cancer screening, diagnosis, staging, treatment and management.

Case data: A 20-year-old college student was diagnosed with asthma and allergic rhinitis in childhood, mainly manifested as cough and chest tightness. The nighttime symptoms appeared on average 3 to 4 times a month, and required 2 to 3 times a week with salbutamol. He plays tennis a lot, but after a match begins, there is usually a respite. During the 2013 pollen season, he went to the emergency department for an acute asthma attack, but was not hospitalized, and his FEV₁% of the projected value is 93%. How should this case be evaluated and treated?

Chronic obstructive pulmonary disease (COPD) is a disease characterized by airflow restriction, which is not completely reversible and progressively developed^[1]。 Under the influence of predisposing factors (such as infection, air pollution or climate change, etc.), COPD may have acute exacerbation (acute exacerbation of COPD). Invasive mechanical ventilation is required when conventional oxygen therapy or non-invasive ventilation support is not effective^[1]。

Pulmonary function examination has become one of the important contents in the diagnosis, differential diagnosis and efficacy evaluation of respiratory diseases, and the pulmonary function room undertakes a lot of work tasks every day. Most of China's pulmonary function instruments are imported from abroad, and they have some limitations in the operation software of pulmonary function, and they can't be connected and shared with the outpatient appointment system and reporting system of hospitals. Moreover, our workflow has many repetitive operations, such as repetitive computer input and password guidance. Manually shouting passwords and manual computer input, technicians are prone to work fatigue and low work efficiency.

The 2nd Beijing Young Respiratory Scholars Salon in 2014 was held on May 29th, 2014. The theme of this salon was "Diagnosis of Lung Infection: Clinical-Testing Hand in Hand", which was presided over by Dr. Shen Ning, Department of Respiratory and Critical Care Medicine, Peking University Third Hospital.

British health agencies first announced two cases of cat-borne tuberculosis on March 27, 2013. Experts advise people to be more vigilant. Starting in 2013, the Public Health Agency of England and the Animal Health and Veterinary Laboratory Authority investigated nine cats infected with tuberculosis bacteria in Berkshire and Hampshire, southern England, and conducted tuberculosis screening on 24 people who had come into contact with these sick cats. As a result, two people were diagnosed with active tuberculosis and two others were in incubation period. The Mycobacterium tuberculosis isolated from the already diagnosed patients is highly consistent with those isolated from the sick domestic cat, so it is inferred that these two patients were infected with tuberculosis by domestic cat infection.

In this issue, readers are invited to focus on the diagnosis and treatment plan and the key content of interventional respiratory disease.