2016年 · 第39卷第02期

Peach talisman bid farewell to the old year, flying snow to welcome the new year, on the occasion of the new year, to all readers New Year greetings!

Language and writing are indispensable and important tools in communication between people, including science and technology. Without language and writing, human beings may degenerate into animals. Even animals, some animals have preliminary "language" communication ability. Different nationalities often have their own unique language and writing, and some nationalities have only language but no writing. Assuming that the whole world can use the same language and the same language, it will bring great convenience to the communication between different countries and nationalities. For this reason, there have been attempts to create the so-called "Esperanto" and "Universal Writing", but because of various reasons, such as the need to preserve the world language, cultural diversity and political factors, "Esperanto" has not been popularized at all, and has even been "stillborn". Countries and nations in the world, no matter how big or small, no matter whether they have a long history or not, all hope that their national language can become the lingua franca of the world. China, with a population of more than one billion people and a history of more than five thousand years, will certainly never allow the Chinese language to disappear from the world. Because of this, our country has begun to strengthen Chinese language and Chinese studies education in schools at all levels.

Tuberculous lung damage refers to extensive caseous lesions, cavities, fibrosis and bronchial stenosis or dilatation in the lobe or one side of the whole lung, basically losing lung function, difficult drug treatment, and becoming the source of infection, repeated bacterial or fungal infection, repeated hemoptysis, and difficult clinical treatment. From January 2008 to November 2014, 45 cases of tuberculous pneumonectomy with video-assisted mini-thoracoscopy (VAMT) were performed in our hospital and Shaoxing People's Hospital. Compared with 38 cases of tuberculous pneumonectomy with traditional thoracotomy in the same period, VAMT has the advantages of less trauma, less bleeding and fast recovery. The results are reported below.

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease whose mechanism is related to the abnormal inflammatory response of the airways, pulmonary parenchyma and pulmonary blood vessels to inhalation of harmful particulate matter or harmful gas components. Alveolar macrophages are the first line of cellular defense in the lung, and play an important role in phagocytosis and clearance of inhaled particulate matter or pathogens. The decrease of phagocytosis will lead to the decrease of particulate matter clearance, which will easily induce infection and lead to acute exacerbation of COPD. Valdes et al.^[1]It was found that every 10 μ g/m increase in PM2.5 concentration in the air³The incidence of acute exacerbation of COPD increased by 0.36% on the same day and by 1.94% 2 days later. It has been reported in the literature that PM2.5 can impair macrophage phagocytic capacity and increase the risk of acute exacerbation of COPD patients^[2,3]。 Astragalus polysaccharide is the main component of perennial legume Astragalus membranaceus. It is a mixed polysaccharide composed of hexuronic acid, glucose, fructose, rhamnose and arabinose. It has been reported that astragalus polysaccharide has the effects of regulating immunity, antioxidant and antitumor in many lung diseases such as COPD, lung hypoplasia and small cell lung cancer^[4,5,6], can also activate macrophages via Toll-like receptor (TLR) -4-mediated signal transduction pathway^[7]。 This study attempted to observe whether astragalus polysaccharide can improve the phagocytic dysfunction of macrophages induced by PM2.5 and explore its possible mechanism.

An 18-year-old female was admitted to the hospital on 26 November 2014 due to "4 years of discovery of lung shadow". Four years ago, the patient underwent chest X-ray examination and found bilateral diffuse nodules. Chest CT reexamination in the local hospital showed diffuse nodules in both lungs. He felt no discomfort and did not undergo relevant treatment. In the past 2 years, he occasionally had chest tightness and choking, which was not related to activities. He had no symptoms such as cough, expectoration, fever, palpitations, fatigue and weight loss. Chest CT reexamination in the local hospital still showed diffuse nodules in both lungs. High-resolution chest CT in our outpatient clinic showed diffuse nodules in both lungs and widened interlobular septum, so he was admitted to the hospital for further diagnosis and treatment. The patient was in good health in the past, denying the history of tuberculosis, hypertension, heart disease, diabetes, cerebrovascular and mental diseases, denying the history of contact with epidemic water and epidemic sources, denying the history of smelting, denying the history of smoking and drinking, denying the history of food and drug allergies, denying the family genetic history, and no patients with similar diseases in the family. First admission physical examination: body temperature 36.4 ℃, heart rate 76 beats/min, 19 breaths/min, blood pressure 100/70 mmHg (1 mmHg =0.133 kPa). The patient was conscious and in good spirits, with no cyanosis of the lips, no palpable swelling of the superficial lymph nodes, clear breathing sounds in both lungs, no dry and wet rales, and no other abnormalities were found on physical examination. Laboratory tests: Blood gas analysis (without oxygen): pH 7.43, PaO₂94 mmHg, PaCO₂35.0 mmHg, HCO₃^－22.2 mmol/L, SaO₂In 99.1%, there were no obvious abnormalities in blood routine, C-reactive protein, coagulation, liver and kidney function, blood electrolyte, urine and stool routine. PPD test, sputum culture, sputum smear acid-fast bacilli and serum tuberculosis antibody were all negative. Biochemical examination of ESR, lymphocyte subsets, immunoglobulin, autoimmune-related antinuclear antibody and titer, anti-neutrophil cytoplasmic antibody and titer, and anti-cardiolipin antibody were all normal or negative. Pulmonary function was normal, electrocardiogram showed no abnormality, thyroid B-ultrasound (including both cervical lymph nodes) showed no abnormality. High-resolution CT of the chest showed diffuse interlobular septum thickening in both lungs, some interlobular septa accompanied by multiple tiny nodules, a small number of patches in the upper lobe of the left lung, the size of mediastinal lymph nodes in the normal range, diffuse calcification of the bilateral pleura, and the thickening was not obvious. The diagnosis of admission was "unknown nature of shadows in both lungs", and the possibility of sarcoidosis was considered. Two days later, TBLB examination was performed to confirm the diagnosis. Lung biopsies of the right upper and lower lobes were blindly taken under bronchoscopy. Pathological examination results showed a large number of round or irregular calcifications in the alveolar cavity. No malignant tumor cells were found in the lavage fluid smear of the right upper lobe, but a small number of calcifications were seen. Special staining PAS (+), iron staining (-) and Congo red (-) was performed. Combined with imaging and pathological examination results, the patient was clinically diagnosed as alveolar microlithiasis. No special treatment was given. The patient was discharged from hospital and continued follow-up.

A 60-year-old male was admitted to the hospital on May 5, 2015 due to "cough for more than 3 months and chest pain for 5 days". The patient developed a cough without obvious trigger 3 months ago, which was irritating dry cough. The symptoms improved after anti-infective treatment, and developed right chest pain 5 days ago, which was persistent. Chest CT was performed in the outpatient clinic (Figure 1，Figure 2，Figure 3，Figure 4) showed a space-occupying lesion of the right upper lung (35 mm ×40 mm) and mediastinal lymph node enlargement, which was admitted for further diagnosis and treatment. There were no abnormalities in routine physical examination, laboratory blood routine and biochemical examination. Tumor markers: CA199: 69.94 U/ml, cytokeratin 19 fragment antigen (CYFRA21-1): 6.42 mg/ml, CA125: 31.3 U/ml, and no abnormalities were found in the rest. There were no abnormal manifestations on electrocardiogram, cardiac ultrasound showed mild pulmonary hypertension (35 mmHg, 1 mmHg =0.133 kPa), abdominal B-ultrasound showed no abnormalities, whole body bone scan showed no abnormalities, and skull MRI plain scan and enhancement showed no abnormalities. Bronchoscopy was performed, and the bronchial opening of the right upper lobe was obviously narrowed under the microscope, and the mucosa was uneven. Biopsy, brushing and lavage were performed, and abnormal hypoechoic signals were found in the precarina lymph node area and the lesion of the right upper lobe by EBUS. Then, TBNA was guided by EBUS. An abnormal echo signal in the main trunk of the right pulmonary artery was unexpectedly detected during EBUS (Figure 5，Figure 6), consider the possibility of pulmonary embolism. Postoperative CT pulmonary angiography (CTPA) showed that the right upper lung occupied space with mediastinal lymphadenopathy, right pulmonary artery embolism and superior vena cava embolism (Figure 7，Figure 8)。 The pathological diagnosis of biopsy results was squamous cell carcinoma, stage IIIB (T4N2M0). Intravenous chemotherapy with "docetaxel 120 mg once a day, 1 d + cisplatin 60 mg once a day, 1 d" was administered, together with anticoagulation and stent placement in the superior vena cava to prevent fatal pulmonary embolism caused by intravenous embolus detachment. At present, the patient has completed 2 cycles of intravenous chemotherapy and is generally in good condition.

With the increasing number of multidrug resistance (MDR) pathogens in nosocomial infections, the treatment of pulmonary infections has become extremely difficult, especially in severe patients with mechanical ventilation, cystic fibrosis and bronchiectasis. The traditional treatment plan is mainly to administer sensitive antibacterial drugs intravenously, but drugs such as polymyxin and aminoglycosides often have poor curative effect due to narrow therapeutic window and poor lung penetration ability, which is difficult to achieve effective lung tissue concentration. In recent years, inhalation administration methods can not only increase the lung tissue concentration of antimicrobial drugs, but also reduce the systemic exposure level of antimicrobial drugs^[1]So as to increase the efficacy while reducing the occurrence of systemic adverse reactions. However, most of the current studies mainly focus on the evaluation of the efficacy of inhaled antimicrobial drugs, and the research on their mechanism is still insufficient. Therefore, at present, the inhalation dosing regimen of antimicrobial drugs in clinic is mostly based on experience, and there is still a lack of pharmacokinetic data. This paper summarizes the in vivo process after inhalation administration of antimicrobial drugs by sorting out the relevant literature at home and abroad in recent years, and analyzes its pharmacokinetic characteristics, so as to provide a reference for making a reasonable dosing regimen in clinic.

Dieulafoy's disease, also known as constant-diameter arterial malformation, is due to vascular malformations of gastrointestinal, biliary or bronchial walls. After the blood supply artery enters the submucosa, it does not gradually thin to form capillaries, but keeps the diameter unchanged and protrudes from the lumen. Acute luminal hemorrhage caused by rupture or spontaneous rupture under the action of external factors. Since 1897, French physicians Dieulafoy and Simplex^[1]Since the disease was described as "simple ulcer", it has been named today after more than 100 years of re-recognition.

Chronic obstructive pulmonary disease (COPD) has a high incidence, with approximately 3 million patients dying every year, ranking the fourth leading cause of disease death in the world, and is expected to rise to the third place in 2020, second only to ischemic heart disease and stroke^[1,2]It has become a major global social burden problem. The incidence rate of COPD in people over 40 years old in China is 8.2%^[3]。 Acute exacerbation of COPD can lead to rapid deterioration of respiratory function. The deaths associated with COPD mostly occur in the acute exacerbation stage, of which 50% ~70% are infectious factors, 10% are due to environmental pollution, and about 30% are of unknown causes^[4]。 COPD is an independent risk factor for pulmonary embolism, but the rate of timely diagnosis is low^[5]Symptoms such as dyspnea caused by pulmonary embolism are often masked by COPD, which may also be the neglected cause of acute exacerbation, and the prognosis of patients is worse due to the lack of timely anticoagulant treatment^[6,7,8]。

neuromuscular disease (NMD) usually involves peripheral nerves, neuromuscular junctions, and muscle tissue. As the disease progresses, respiratory muscle drive and muscle tone decrease, and inevitable sleep-related diseases, especially sleep disordered breathing (SDB), appear. However, such patients are usually associated with significant respiratory muscle dysfunction, disease of the respiratory center of the brain, sedation or weight gain due to metabolic reduction^[1]There is some interference in the diagnosis of NMD-related SDB. Therefore, it is important to understand the characteristics of neuromuscular diseases combined with sleep respiratory events, especially the characteristics of polysomnography (PSG), to improve clinical diagnosis and give appropriate intervention as soon as possible. The clinical characteristics of sleep breathing event points related to neuromuscular diseases are summarized as follows.

idiopathic pulmonary fibrosis (IPF) is a fatal and progressive pulmonary disease, which lacks effective treatment. The average survival time after diagnosis is only 2~3 years^[1]。 At present, it is believed that abnormal tissue repair caused by persistent alveolar epithelial cell damage is the main pathogenesis of IPF. However, the cause of alveolar epithelial injury is unknown, which is an important reason for the difficulty of IPF treatment. Recent studies have found that gastroesophageal reflux disease (GERD) may be the potential cause of IPF. GERD has been listed as one of the main risk factors of IPF in the new guidelines of evidence-based medicine for IPF in 2011^[2]The related research progress of GERD and IPF is summarized as follows.

Chronic obstructive pulmonary disease (COPD) is a major public health problem and ranks fourth in the global mortality rate^[1], repeated acute exacerbation of chronic obstructive pulmonary disease (AECOPD) not only aggravates the decline of pulmonary function in patients, but also brings a heavy economic burden^[2]。 There are many causes of AECOPD. Some scholars believe that 70% ~80% may be related to respiratory virus and bacterial infection^[3,4]Viruses are more difficult to detect than bacteria. With the advance of reverse transcription-on-polymerase chain reaction (RT-PCR) and other technologies, it has been found that viral infection plays an important role in the acute exacerbation of COPD^[5]Especially human rhinovirus (HRV)^[6]。 Literature reports^[7,8]30.2% ~53.3% of COPD patients can detect HRV in the exacerbation phase, and its detection rate and viral load are much higher than those in the stable phase. In order to understand the transmission route and pathogenic mechanism of HRV and reduce the frequency of acute exacerbation in patients with COPD by prevention and treatment of rhinovirus infection, the following review is summarized.

A 27-year-old female was admitted to the hospital on June 6, 2012 mainly due to "fever and cough for 4 days". The patient developed fever and cough after catching cold 4 days ago, with the highest body temperature of 38.4℃, coughing a small amount of white phlegm, accompanied by fatigue. Blood routine showed leukocytes 13.5×10⁹/L, hemoglobin 136 g/L, platelets 233×10⁹/L, the neutrophils were 0.64, and the chest X-ray showed a large patch of high density shadow in the left lower lung (Figure 1), chest CT showed a 4.4 cm ×5.6 cm round mass in the basal segment of the lower lobe of the left lung, and a huge halo sign was seen around it (Figure 2，Figure 3，Figure 4)。 Past physical health, doctoral student living on campus, denying history of exposure to special substances. Physical examination: clear consciousness, no rash on the skin and mucous membranes, unpalpable swelling of superficial lymph nodes, a little wet rales can be heard in the left lower lung, and no abnormalities in the heart and abdomen. Preliminary diagnosis of admission: pneumonia.

Nasal congestion, nasal tube, mask, etc. are commonly used oxygen therapy methods for adults with hypoxia and respiratory failure, but the traditional oxygen therapy methods have certain limitations: (1) the flow rate is much lower than the peak inspiratory flow rate of adults spontaneously inspiring; (2) insufficient humidification and warming; (3) poor patient tolerance of mask-type oxygen inhalation devices; (4) there is a difference between the oxygen flow inhaled by the actual patient and the oxygen flow transmitted, and the difference is uncertain; (5) The content of inhaled oxygen is not constant and inaccurate.

The 6th activity of Beijing Young Respiratory Scholars Salon in 2015 was held in Chinese Medical Association on November 26th, 2015. The value of bronchoscopy in the diagnosis of peripheral lung lesions and the rapid on-site evaluation technology were mainly discussed. This salon activity was presided over by Shen Ning, chief physician of Peking University Third Hospital.

Frédéric François Chopin (1 March 1810 – 17 October 1849, Polish composer and pianist) was one of the most influential and popular piano composers in history, a representative figure of European Romantic music, whose main career was in France (1831 – 1849). He composed more than 230 works, almost all of which were piano works, and made extremely important contributions to piano composition and performance techniques. Although the technique of many works is rather difficult, but he never shows off his skills as the ultimate goal. Chopin paid more attention to poetry and delicate emotion in his works, and was known as the "piano poet".