2011年 · 第34卷第01期

The sound of firecrackers is one year old, and the new year is here again. On the occasion of the New Year, all the members of the editorial department of this magazine wish you all the best and good health in the new year!

OSAHS is closely related to cardiovascular diseases. Intermittent hypoxia and repeated micro-arousal caused by OSAHS can lead to structural or functional damage of blood vessels and ultimately promote cardiovascular and cerebrovascular diseases. Some scholars have found that the positive predictive value of the above-mentioned risk factors is only 50% in current detection methods, and vascular function detection in OSAHS patients is of great significance to predict the occurrence of vascular diseases. Therefore, this paper intends to introduce the noninvasive vascular function detection method and its clinical application in OSAHS.

At present, the etiology, pathogenesis, clinical manifestations, comorbidities, differential diagnosis, treatment and prognosis of COPD and obstructive sleep apnea (OSA) have been deeply understood, but the pathogenesis, clinical manifestations, harm and treatment of the coexistence of the two diseases, namely overlapping syndrome, are not much known or paid enough attention to.

Since December 2009, he has been promoted as editor-in-chief, and has been working hard to improve the appeal and readability of the magazine. Li Wenhui, deputy editor-in-chief and director of the editorial department, referred to the successful experience of brother publications, and suggested to open this column to provide a relatively relaxed platform for the editor-in-chief with wide content. The author had to gladly obey the order. As for what name to choose for this column, it has taken a lot of twists and turns. For example, using "message" may seem too serious and reserved, and it is also suspected that the editor-in-chief will be placed above the readers unconsciously; If you use "miscellaneous talk" and worry about giving people inconsistent with "mainstream", it will be regarded as "murmur". "Essay" requires the author to be relaxed and open, but also to have some self-discipline. Good words are good for the ear, and all opinions and remarks of knowledgeable people should come from the heart, and should not be mixed with hypocrisy and sensationalism. As an intellectual, it is the most valuable thing to be able to truly regardless of gains and losses, dare to speak out, be full of bones and make a sound. Of course, as the editor-in-chief of an official publication, he must also consider the impact of the publication on society and the public, both celebrating progress and criticizing current malpractices. The above creed can be used as the motto of this section.

It is generally believed that Th17 cells are involved in the occurrence and development of airway remodeling in bronchial asthma (asthma for short) through specific secretion of interleukin (IL) -17. In this process, IL-17 plays a role as an upstream molecule, but its downstream effector molecules are still unclear. Heparin-binding epidermal growth factor (HB-EGF) is a member of the epidermal growth factor (EGF) family. After binding to epidermal growth factor receptor (EGFR), it can initiate corresponding signaling pathways to promote the proliferation of various airway components. It is one of the most important downstream molecules in the process of airway remodeling in asthma. Recently, it has been found that the HB-EGF/EGFR pathway can be used as a downstream pathway of IL-17 to participate in the pathogenesis of autoimmune diseases such as osteoarthritis, rheumatoid arthritis, chronic enteritis and psoriasis. We assume that since the HB-EGF/EGFR pathway can be involved in the pathogenesis of autoimmune diseases as a downstream molecule of IL-17, does it also affect the airway remodeling process induced by Th17 cells similarly?

OSAHS is a common disease with potential danger, mainly manifested by repeated apnea and intermittent hypoxemia during sleep; chronic intermittent hypoxia (CIH) is an important pathophysiological basis of OSAHS^[1]。 The incidence of OSAHS is 2% to 4% in adults, 20% to 40% in the elderly ≥65 years old, more than 50% of obese patients are complicated with OSAHS, and the 5-year mortality rate of untreated severe OSAHS patients is 11% to 13%^[2,3,4,5]。 In recent years, OSAHS has been paid more and more attention because of its high mortality and serious harm to multiple organs and systems in the whole body.

Ultrasound is an important imaging diagnostic technology. Because the lungs contain gas, ultrasound has great limitations in the diagnosis and treatment of lung diseases. Respiratory doctors are often more accustomed to using X-ray, chest CT and magnetic resonance imaging (MRI). But ultrasound has unique advantages over other imaging techniques^[1,2]It can achieve good results in the diagnosis and treatment of peripheral lung tumors^[3,4]。 With the rapid development of ultrasound technology in recent years, new technologies and equipment such as ultrasound microbubble carrier, contrast-enhanced ultrasound and intracavity ultrasound are improved day by day. Current ultrasound techniques used in pulmonary diseases can be roughly divided into three categories: endoscopic ultrasound through the trachea or esophagus, drug delivery and contrast enhancement using ultrasound microbubble technique, and surface ultrasound.

Cysteinyl leukotriene (LT) is an important mediator of inflammation in bronchial asthma (asthma). It is a leukotriene receptor antagonist that can inhibit the inflammatory pathway of leukotriene. It has been used to control asthma attacks, but the clinical efficacy of some patients is found to be not ideal. How to recognize the role of leukotrienes in the development of airway inflammation? Can bronchial challenge tests using leukotrienes as challengers more specifically measure airway inflammation and objectively evaluate the efficacy of leukotriene receptor antagonists (LTRAs), thus exploring the relationship between leukotrienes and asthma in essence? The results of relevant research at home and abroad are summarized as follows.

Lung cancer is the leading cause of cancer death in the world, but its pathogenesis has not been fully understood so far. Factors related to the incidence of lung cancer have been reported in previous literature, including smoking, occupational factors, environmental pollution, viral infection, genetic background and genetic susceptibility to lung cancer. Recent results show that foreign chemical metabolism, DNA repair, cell cycle regulation and related gene polymorphisms may be related to the development of lung cancer^[1]。

Glucocorticoid-resistant asthma (SRA) belongs to the category of refractory asthma, which is a major problem faced by clinicians. Cofilin-1 as actin depolymerization factor/filament protein (ADF/cofilin)^[1]A member of the family, in addition to actin depolymerization factor, can also affect the distribution and function of hormone receptors^[2,3]The expression of filatin-1 in peripheral blood of SRA patients was significantly higher than that of hormone-sensitive asthma (SSA) patients, suggesting its potential as a predictor of hormone therapy responsiveness. This study mainly analyzed the correlation between the responsiveness of hormone therapy and the expression of peripheral blood filatin-1 in asthmatic patients in Guangzhou, and explored the possibility of filatin-1 as a predictor of hormone therapy responsiveness.

Bronchial asthma (asthma for short) is a chronic inflammatory disease of the airway involved in a variety of inflammatory cells and cellular components^[1]In its pathogenesis, the recognition of allergens by T cells and the activation of T cells are the key initiating links^[2]。 Notch is a single transmembrane receptor protein that plays an important role in the development and differentiation of T cells^[3,4,5]。 Recent findings suggest that Jagged1 interacts with Notch receptors on CD₄⁺T cells induce lung cells to secrete interleukin (IL) -4 and lead to airway inflammation^[6]。 This study investigated the role of Jagged1 in the pathogenesis of asthma by detecting the expression of Jagged1 in lung tissue of asthmatic mice and intervening with Jagged1 antisense oligonucleotide.

Professor Zhu Guiqing (1908-1983) is a leading expert in respiratory medicine and tuberculosis in China. He was from Wuxing (now Huzhou), Zhejiang Province. He graduated from Union Medical College in 1937 and was a lecturer and associate professor at Union Medical College. After the founding of the People's Republic of China, he successively served as senior lecturer, associate professor, professor, deputy director of internal medicine and director of respiratory medicine in Union Medical College, Peking Union Medical College Hospital and China Union Medical University, executive director of China Anti-tuberculosis Association, and deputy director of Tuberculosis Branch of Chinese Medical Association. He has deep attainments in the research of Mycobacterium tuberculosis, the diagnosis and differential diagnosis of respiratory diseases, and has unique insights in the clinical classification of tuberculosis and the clinical characteristics of lung cancer. Editor-in-chief of China's first "Respiratory Medicine".

An 11-year-old female was admitted to the hospital on 14 July 2009 due to "fever for 5 d, abdominal pain and melena for 1 d". The child developed fever without obvious trigger 5 days ago, with a maximum body temperature of 40 ℃, no fear of cold and chills, occasional choking and cough after eating, no expectoration, chest tightness, chest pain and nasal congestion, and no rash and convulsions. The local hospital gave intravenous antibiotic treatment, but the fever did not alleviate. The patient had sudden hematemesis 1 day ago, bright red in color, about 50 ml in volume, melena 3 times, 20~30 g/time, accompanied by headache, dizziness, periumbilical paroxysmal pain, no right lower abdominal metastasis, abdominal distension, diarrhea and tenesme, etc., and was admitted to Hangzhou First People's Hospital. In the past, it was easy to catch repeated colds and fever since childhood. He visited other hospitals many times and was diagnosed with pneumonia. Every time he was given symptomatic treatment such as anti-infection, he was discharged after his symptoms improved. Has a history of recurrent abdominal pain and hematemesis at age 2. The patient was previously 32 weeks premature with a birth weight of 1.8 kg and the other of the twins died shortly after delivery.

The incidence of pulmonary thromboembolism (PTE) is high, the diagnosis rate is low, but the mortality rate is high. Statistics from 1979 to 1999 in the United States show that the incidence of PTE in hospitalized patients is 0.4%^[1], an estimated 600,000 new cases per year in the United States^[2]。 At present, PTE studies are mainly limited to the proximal level of central PTE, and the autopsy results show that peripheral pulmonary thromboembolism (PPTE) is not uncommon^[3,4]。 However, due to the lack of examination tools for peripheral pulmonary arteries, even if clinical patients have typical characteristics, such as unexplainable shortness of breath, hypoxemia and unexplained pulmonary hypertension, it is still difficult to confirm the diagnosis due to the lack of objective basis. Most patients with PPTE often confirm the cause during autopsy. At present, there is a lack of adequate understanding of the natural course, clinical characteristics and pathophysiology of PPTE.

OSAHS is a common respiratory disorder that can cause multi-system damage. Continuous positive airway pressure (CPAP) is currently recognized as the most effective treatment. Long-term regular use can reduce daytime drowsiness, reduce the risk of cardiovascular events, and improve the quality of life^[1]。 However, the results of several studies show that^[2,3,4]Compliance with CPAP treatment is poor. In order to explore ways to improve patient compliance, a follow-up survey is conducted on the compliance of OSAHS patients treated with CPAP.

Rock salt aerosol therapy (halotherapy), also known as salt therapy, is a non-drug therapy originating from Eastern Europe. In recent years, it has been gradually used to treat respiratory diseases and allergic diseases, and has attracted more and more attention of clinicians. Fuzhou Pulmonary Hospital treated 168 patients with bronchial asthma (referred to as asthma) with combined salt therapy and conventional inhalation therapy, which are reported as follows.

Sleep apnea, as an important new field of respiratory disease, has become an important part of daily respiratory disease work from its emergence to its development, from the initial exploratory work in a few hospitals to the addition of numerous hospitals and doctors all over the country. In its development, it has experienced its beginning and climax, during which hundreds of thousands of patients have been diagnosed and standardized treatment. With the promotion of the Sleep Respiratory Diseases Group, the diagnosis and treatment guidelines for this disease were developed^[1]Carried out multi-disciplinary joint social education and doctors re-education, published a large number of monographs on sleep respiratory diseases, conducted national multi-center research and wrote the "Expert Consensus on Sleep Apnea and Cardiovascular Diseases"^[2]And has done fruitful work. After more than 20 years of efforts, China has a considerable clinical and scientific research team in the field of sleep apnea, mainly in respiratory, otolaryngological and stomatological departments, and is becoming the main force and leading force in the field of sleep apnea, playing an increasingly important role in promoting the development of sleep apnea in China.

The third academic activity of Beijing Interventional Respiratory Disease Collaborative Group was held in Beijing on August 12, 2010. The theme of this event is "Ultrasound Bronchoscopy Guided Transmural Lymph Node Needle Aspiration Biopsy (EBUS-TBNA)". The event was hosted by Director Wang Guangfa of Peking University First Hospital, and young and middle-aged experts from Beijing Chaoyang Hospital, Peking Union Medical College Hospital, People's Liberation Army General Hospital, Peking University First Hospital and Beijing Tiantan Hospital actively participated. The speeches at the meeting were enthusiastic and covered a wide range of contents.

The 6th event of Beijing Young Respiratory Scholars Salon in 2010 was held in the conference room on the 5th floor of Chinese Medical Association on August 26th, 2010. This event was hosted by Dr. Wang Juan, Department of Respiratory Medicine, Beijing Tiantan Hospital, with the theme of "Interventional Treatment of Intracavitary Airway Diseases".

Time flies, it's another new year, and Happy New Year dear readers and authors!