2010年 · 第33卷第01期

Chinese Journal of Tuberculosis and Respiration was founded in 1953, and has gone through 57 glorious years. This journal was originally a special issue on tuberculosis, named Chinese Journal of Tuberculosis. With the efforts of Professor Mu Kuijin and others, it was changed to Chinese Journal of Tuberculosis and Respiratory Diseases in September 1978. In 1987, it was officially supervised by China Association for Science and Technology and sponsored by Chinese Medical Association, and became the official journal of Tuberculosis Branch and Respiratory Diseases Branch of Chinese Medical Association. At the same time, the title of the journal was simplified to Chinese Journal of Tuberculosis and Respiratory Diseases. For many years, Chinese Journal of Tuberculosis and Respiratory has been included in more than a dozen famous foreign retrieval systems and databases, such as American Medical Index and Its Database (IM/Medline) and American Biological Abstracts. Since 1992, he has been awarded many awards and honorary titles by Chinese Medical Association, China Association for Science and Technology, State Press and Publication Administration and other superior units, such as "Double Effect Journal", "Hundred Chinese Outstanding Academic Journals", "Excellent Journals", etc. Among dozens of professional journals sponsored by the Chinese Medical Association, the Chinese Journal of Tuberculosis and Respiration has always been among the best. I still remember when I was just out of college, if someone around me could publish a paper in the Chinese Journal of Tuberculosis and Respiration, it might be the same as now.Lancet、New EnglandPapers published in the paper are no different, and they also attract attention and envy. Even today, with the endless emergence of Chinese medical academic journals, Chinese Journal of Tuberculosis and Respiration is still respected and loved by the majority of readers in this profession for its rigor, authority and close integration with clinical practice.

Pleural effusion is a manifestation of many diseases in the pleura. Qualitative diagnosis of pleural effusion is very important. Whether its diagnosis is correct or not directly affects whether patients can get timely treatment. The main causes of pleural effusion are tuberculosis, malignant tumors, inflammatory reactivity and congestive heart failure. Combined with clinical manifestations and pleural effusion analysis, most patients can be diagnosed, but the diagnosis of some refractory effusions is difficult.

The emergence of endobronchial ultrasound (EBUS) scanning is a milestone development of respiratory endoscopy technology. ultrasound probes are used to enter the airway through fiberoptic bronchoscope for scanning imaging, and the changes of tissue structure of tracheal wall, adjacent lung tissue outside the lumen and mediastinum are detected. High-definition imaging of the bronchial wall and adjacent tissue structures within about 4 cm, including the mediastinum, can be performed. The visual field of the endoscope was extended from the intraluminal to the extraluminal airway, from the large airway to the small airway with a peripheral diameter of 1.4~2 mm, which greatly expanded the visual field and working range of the endoscope.

Central airway stenosis refers to the stenosis of the trachea, left and right main bronchus and right middle bronchus due to various diseases. Emergency interventional therapy is often required due to significant clinical symptoms that may cause significant impairment of pulmonary ventilatory function. According to its etiology, it can be roughly divided into benign and malignant stenosis. Compared with malignant stenosis, benign stenosis is more difficult to deal with. It is mainly due to the long survival period of patients, and patients and their families often hope to obtain relief of long-term symptoms. At the same time, long-term complications of treatment are more likely to occur. The treatment of adolescent patients also needs to consider the problem of growth and development. In addition, compared with malignant diseases, patients and their families have higher expectations for curative effect, and it is difficult to accept short-term and long-term serious complications caused by surgery. Therefore, the management of benign central airway stenosis is a difficult point in the field of interventional respiratory disease.

Intraairway ultrasound technology has been applied in clinical practice in the early 1990s^[1]The early ultrasound probe was a radial probe, which was mainly used to observe the fine structure of the tracheal wall and surrounding tissues, so as to evaluate the condition of the tracheal wall and the degree of influence of tracheal tumors or other lesions^[2]。 At the same time, because the mediastinum, hilar and lung peripheral lesions can be displayed, after the lesion site is determined, the ultrasound probe is removed, and then the biopsy forceps are used to perform biopsy at the determined site, which can improve the accuracy of trans-bronchial needle aspiration biopsy for lymph node staging of lung cancer, and can also replace the biopsy of lung peripheral lesions guided by chest X-ray^[2,3]。 However, due to the characteristics of the radiation probe, these operations cannot be completed under real-time monitoring of ultrasound images.

rigid bronchoscopy (rigid bronchoscopy) is the foundation of interventional pulmonology. For more than 100 years, rigid lenses have become an interventional therapeutic tool shared by surgical and pulmonary specialists. With the help of the channel provided by the hard scope, surgeries such as the grabbing of foreign bodies in the airway, the management of life-threatening hemoptysis, the dilatation of tracheobronchial stenosis, the diagnosis and resection of tumors, and the implantation of tracheobronchial stents can be performed.

I had the honor to read the paper published by Professor Zhang Jie "Methodological Study on Placing Domestic Ni-Ti Memory Alloy Stent in Severe Airway Stenosis"^[1]Thank you very much to Professor Zhang for his work in this area, and also to them for publishing their experience in this journal for everyone to learn and learn from, especially how to place the stent. Professor Zhang Jie provided many technical details, which are of great significance to the popularization of this technology in China. However, at the same time, we also noticed that in Professor Zhang Jie's article, metal stents were placed in 12 cases of benign lesions, including 4 cases of inflammatory granulation hyperplasia with tracheomalacia, 3 cases of pleomorphic adenoma, 2 cases of tracheomalacia, 2 cases of recurrent tracheochondritis and 1 case of tracheoesophageal fistula, which once again made us pay attention to the controversial topic of choosing metal stents for the treatment of benign central airway lesions.

Since the invention of flexible bronchoscope for more than 50 years, bronchoscopy technology has developed rapidly. Especially in the past 20 years, the innovation and application of new instruments, new materials and new technologies have gradually formed a new technical system of interventional bronchoscopy technology. Its diagnosis and treatment scope involves various fields of respiratory medicine such as pulmonary tumors, infectious diseases, critical care medicine, bronchial asthma and COPD, pulmonary interstitial diseases, and has involved thoracic surgery, otolaryngology and other fields. At present, interventional bronchoscopy, together with other interventional techniques in pulmonary diseases, forms a new discipline in respiratory diseases.

Abnormal methylation of CpG islands in gene promoters often leads to silencing of tumor suppressor gene expression, which has been shown to play an important role in the development of many tumors. As a novel tumor suppressor gene, Ras-related region family 1A gene (RASSF1A) has been found to have high methylation rate and expression loss in lung cancer and many malignant tumors. However, Ras protein-specific guanylate releasing factor 2 (RASGRF2) has only been reported to have a high frequency of methylation and expression loss in pancreatic cancer cell lines. The results showed that the methylation of tumor suppressor gene promoter is common in lung tumors, and RASGRF2 is abundantly expressed in lung tissues. Therefore, we studied its expression in lung cancer in order to determine the methylation of RASGRF2 in non-small cell lung cancer (NSCLC) and compare its methylation status with that of RASSF1A in NSCLC.

In early April 2009, a human infection caused by influenza A (H1N1) virus containing three influenza virus gene fragments, swine, avian and human, was first reported in the United States and Mexico, and rapidly spread around the world. As of June 17, 2009, 88 countries and regions have reported cases of infection.

In the past 20 years, with the development of minimally invasive diagnostic methods and techniques such as fine needle aspiration biopsies (FNAB), the application of FNAB in the diagnosis of pulmonary and mediastinal lymph node lesions has become more and more popular^[1,2,3,4,5]。 Intrapulmonary masses and mediastinal lymph nodes can be guided by endobronchial ultrasound (EBUS), percutaneous ultrasound or CT to perform FNAB extrathoracic or endobronchial. Although FNAB has a clear role in the differentiation of intrapulmonary masses and mediastinal lymph node lesions, the extent to which it benefits patients is still controversial, and there are still many methods to optimize the operation of FNAB.

Since 1977, Professor Irwin of the United States published the first review on chronic cough^[1]Countries pay more and more attention to the diagnosis and treatment of chronic cough, and at the same time, some epidemiological investigations have been carried out, involving the risk factors, incidence, etiological diagnosis and quality of life investigations of chronic cough, etc. Europe, America, Japan and China have successively formulated guidelines for the diagnosis and treatment of chronic cough. The epidemiological data of chronic cough are scarce in China. This article reviews the epidemiology of chronic cough.

COPD is a chronic airway inflammatory disease. Overexpression of inflammatory mediators and cytokines is associated with abnormal regulation of inflammatory genes. Acetylation of core histones is involved in the activation and transcription of inflammatory genes, which are catalyzed by histone acyltransferase (HAT) and histone deacetylase (HDAC), respectively. Acetylation of lysine residues in core histone H4 is directly associated with gene transcription by pro-inflammatory response mediators. The purpose of this study was to investigate the mechanism of the decrease of HDAC activity in COPD and the anti-inflammatory effect of aminophylline.

Forceps pleural biopsy trocar is a special device for pleural biopsy. We used forceps pleural biopsy trocar and blunt crochet needle (Cope needle) pleural biopsy methods to bite the posterior and inferior parietal pleura of goat thoracic cavity at the same time, and observed the effect and safety of the two methods. The methods and results are reported as follows.

A 59-year-old male was admitted to the hospital on September 4, 2008 due to "repeated cough and asthma for 1 year, fever, abdominal pain and numbness in the limbs for 1 month". Since July 2007, the patient had cough and asthma, chest tightness, shortness of breath, and cough a small amount of white phlegm without obvious trigger, and the bronchodilation test was positive in the local hospital. Blood routine: white blood cells 6.9×10⁹/L, eosinophils 0.189, neutrophils 0.604, lymphocytes 0.162; The diagnosis was "bronchial asthma (referred to as asthma)", and the symptoms were alleviated after treatment with dexamethasone hydrochloride, aminophylline, salmeterol/fluticasone propionate, etc. The symptoms worsened again in February 2008, and he was admitted to hospital several times in February, April and July 2008, respectively. Chest CT showed scattered ground glass or grid-like shadows in both lungs, and mild dilatation of small bronchus in the anterior segment of the middle and lower lobes of the right lung and the upper lobes of the left lung (Figure 1), slightly improved after treatment with methylprednisolone, budesonide/formoterol, etc. From August 2008, he had repeated fever, with a body temperature of 37.5~39.0 ℃, accompanied by numbness and fatigue in his limbs, persistent abdominal pain, poor appetite, no diarrhea and melena. Blood test routine in local hospital: white blood cells 45.5×10⁹/L, eosinophils 0.816, neutrophils 0.165, lymphocytes 0.014; Chest CT showed scattered interstitial changes in both lungs; Moxifloxacin hydrochloride, aminophylline, ambroxol hydrochloride, dexamethasone hydrochloride and methylprednisolone were given for 13 days, but the effect was not good. Admitted to our department for further diagnosis and treatment. Has a history of "allergic rhinitis" for 8 years, and had nasal polyp surgery 5 years ago; Smoking for 30 years, 15 packs per year, and has quit smoking for 1 year. Deny the history of infectious diseases such as tuberculosis and the history of exposure to epidemic water and poisons.

Tobacco harm is one of the serious public health problems nowadays, and the World Health Organization believes that its harm is even more terrible than SARS and tsunami. Tobacco can damage almost all organs in the human body, and smoking is a risk factor for many diseases. In recent years, smoking has attracted attention as an independent and serious risk factor for respiratory tract infections. The results showed that the harmful substances in tobacco directly damaged three major defense mechanisms of respiratory tract, namely mucociliary transport system, cough reflex and immunological mechanism, which increased the susceptibility of host to infection and led to the occurrence and aggravation of disease.

The 6th activity of Beijing Young Respiratory Scholars Salon in 2009 was held on September 25th, 2009. This activity was hosted by Jin Jianmin, deputy chief physician and Professor Sun Yongchang of Beijing Tongren Hospital affiliated to Capital Medical University, with the theme of "How to do a good job as attending physician in ward".

Happy New Year, dear readers and authors!