2010年 · 第33卷第05期

Obstructive Sleep Apnea (OSA) is a systemic disease, which is mainly characterized by snoring during Sleep accompanied by Apnea and superficial breathing, repeated hypoxemia, hypercapnia and Sleep structure disorders at night, resulting in daytime drowsiness, cardiac, cerebral and pulmonary vascular complications and even multiple organ damage, which seriously affects the quality of life and lifespan of patients.

Pregnancy is a specific stage of female life, and the fetus is the basis of human development. Any pathological changes during pregnancy will affect the health of the mother, the growth and development of the fetus, and even the physical condition in adulthood. Snoring and obstructive sleep apnea (OSA) are closely related to pregnancy, which cause serious harm to the health and even life of pregnant women and fetuses. This issue of Cai Xiaohong and other articles "The Effect of Snoring on Pregnant Women and Fetal Development"^[1], objectively reported the effects of snoring on pregnant women and fetuses, hoping to attract everyone's attention.

Positive airway pressure (PAP) in the treatment of sleep disordered breathing (SDB) began in 1981. Simple PAP works through a soft nasal mask in direct contact with the face, and an external hose is connected to the air compressor. Carbon dioxide exhaled by the patient can be exhausted through a small vent in the nasal mask. The compressed airflow delivered through the nasal mask forms an airflow support splint between the upper airways to prevent upper airway stenosis and/or closure caused by collapse of the upper airway soft tissue in the inspiratory and expiratory phases. Although PAP is simple in design and easy to operate, it has become a routine treatment for SDB, but whether PAP can finally be successfully applied to the treatment of SDB still depends on the skilled use of PAP technology by professional doctors, good patient compliance and perfect follow-up support system. This article will discuss the above three aspects in order to have a certain guiding effect on clinical work.

Obstructive sleep apnea (OSA) is common in patients with type 2 diabetes^[1], both are clinically, epidemiologically and pathogenetically relevant and independent of obesity. At present, the health harm of type 2 diabetes has been recognized by people, but the health harm of OSA and the medical burden brought by it are far from being recognized by people. Therefore, it is necessary to make people realize the relationship between OSA and type 2 diabetes through the efforts of various disciplines, and take practical actions.

This study aimed to evaluate the impact of anxiety and depression as independent risk factors on acute exacerbation and hospitalization of chronic obstructive pulmonary disease through a 1-year multicenter, prospective follow-up. The study randomly selected 491 patients with stable COPD from 10 general hospitals in Beijing, all of whom signed informed consent before entering the study. The study lasted for 1 year, and a field questionnaire was conducted at the beginning and end of the study, and the personal data of patients, the number of acute exacerbations of COPD and the number of hospitalizations 1 year ago were recorded. Anxiety-depression scale (HADS) was used to evaluate anxiety and depression; Dyspnea was evaluated by the 5-grade Medical Research Dyspnea Score (MRCQ); Respiratory symptoms such as cough, expectoration and wheezing were evaluated by ATS-DLD-78 scale; Quality of life was evaluated by applying the certified Chinese version of St. George's Questionnaire (SGRQ). All patients underwent pulmonary function tests and a 6-min walk test. Important complications and treatment related to acute exacerbations and hospitalizations of COPD were recorded, and monthly telephone follow-up was performed to record patients' acute exacerbations and hospitalizations over a 12-month period. The patients' respiratory symptoms and treatment were evaluated by a short questionnaire at each visit. Acute exacerbations associated with symptoms and acute exacerbations associated with events were recorded.

One third of a person's life is spent sleeping. Adequate sleep, a balanced diet and proper exercise are three health standards recognized by the international community. Sleep is closely related to health, but the existing survey results show that many people suffer from sleep disorders or sleep-related diseases, and about 30% of adults have sleep disorders. However, people generally lack awareness of the importance of sleep. In order to draw attention to the importance and quality of sleep, the international Foundation for Mental Health and Neuroscience launched a global sleep and health initiative in 2001 and designated 21 March each year as "international sleep day", with the aim of drawing attention to the importance and quality of sleep. In 2003, China Sleep Research Association officially introduced World Sleep Day. The reason why World Sleep Day is set on March 21st every year is that this day is the first day of spring. The periodicity of seasonal changes and the alternating law of day and night sleep all affect people's daily life.

OSAHS is a sleep disorder characterized by repeated upper airway collapse during sleep, resulting in frequent apnea or reduced ventilation. OSAHS is often associated with various metabolic dysfunctions, among which the relationship between glucose metabolism disorders and OSAHS is receiving extensive attention.

In recent years, the incidence of tuberculosis in the world has remained high. In addition to the biological factors related to tuberculosis such as MTB drug resistance and human immunodeficiency virus infection, the academic community has paid much attention to environmental factors such as smoking. Current findings have shown that smoking is associated with TB infection, occurrence, and death, but there are relatively few studies on the outcome of TB treatment. We review the literature on smoking and tuberculosis treatment outcomes in recent years in order to attract the attention of our peers.

Ventilator withdrawal refers to the process of sudden or gradual discontinuation of ventilatory support after the underlying cause of respiratory failure has improved or alleviated. Prolonged withdrawal time will increase the chance of mechanical ventilation complications and hospitalization costs, but premature withdrawal may affect the patient's treatment and prognosis. Therefore, once the patient is mechanically ventilated, attention should be paid to the related problems of withdrawal. Withdrawal includes two processes: disengagement from the ventilator and removal of the tracheal tube. For those without underlying lung diseases, under the condition of ensuring that their nervous system, cardiovascular system, mental emotion and respiratory functions are good, they can be ventilated 6~8 h after mechanical ventilation (generally<24 h) to carry out withdrawal and extubation tests. Such patients can generally be successfully withdrawn in the operating room. For patients who cannot quickly withdraw the ventilator, a system evaluation and different withdrawal test modes are required to safely and smoothly withdraw the ventilator^[1,2]。

MTB secreted protein 64 (MPT64) is an important protective antigen of MTB and one of the ideal antigens for serological diagnosis of tuberculosis^[1]。 However, it has been reported that the direct detection rate of MPT64 antigen in serum samples is low^[2]。 phage display peptide library (phage display peptide library) technology, which emerged in the 1980s, is a quick and efficient tool for analyzing protein intermolecular interactions^[3]In particular, it is suitable for screening for ligands of biologically active macromolecules. At present, this technique has successfully screened and mapped the epitope sequences of many antibodies, obtained mimic short peptides, and preliminarily applied to the diagnosis of diseases^[4]。 Shanghai Key Laboratory of Tuberculosis (Lung) has established this technology, and completed the screening of early secreted antigen of MTB with a relative molecular weight of 6000 and mimetic epitope of protein 10 fusion protein in culture filtrate^[5]。 On the basis of this work, the anti-MPT64 polyclonal antibody was used as the target molecule, and its mimetic epitope was screened and identified by this technique, which provided an effective method for the study of TB antigen-specific epitope, and provided a basis for the next step of using mimetic epitope peptide to establish a new method for detecting TB antibody.

Bronchial asthma (asthma for short) is an allergic disease with immune imbalance involved by a variety of cells and cytokines. Regulatory T cells are a kind of T lymphocytes that play an important role in the pathogenesis of asthma in recent 10 years^[1]。 In this paper, we investigated the changes of the number and function of Th3 and other helper T cells in asthma patients, aiming to investigate the role of Th3 and other helper T cells in the pathogenesis of asthma.

Tracheal and bronchial schwannomas are rare benign tumors, which are mostly removed by thoracotomy and tracheotomy in the literature. A case of tracheal schwannoma removed by high-frequency snare under bronchoscope in our hospital is reported below.

A 42-year-old male was admitted to the Department of Gastrointestinal Surgery of Liaocheng People's Hospital of Shandong Province on December 4, 2008 due to "diarrhea, bloody stool for 1 month, abdominal pain and abdominal distension for 1 day". The patient developed purulent and bloody stool 1 month ago, 5 times/d; Fever appeared 7 days ago, body temperature was about 38.5 ℃, and "cefaclor" and other drugs were taken orally in an external hospital. He is usually in good health, and there are no similar cases in his family.

With the increase of tumor incidence and the emergence of new anti-tumor drugs, lung injury is becoming more and more common. Literature reports about 10%^[1]。 However, lung injury caused by anti-tumor drugs is an important reason for the withdrawal of anti-tumor drugs. Mammalian rapamycin target protein (mTOR) inhibitors, mainly used for immunosuppressive effects after solid organ transplantation. Everolimus is a mammalian rapamycin target protein inhibitor that can be used for immunosuppressive therapy after solid organ transplantation. The drug was approved by the US FDA on March 30, 2009, and can be used for patients with renal clear cell carcinoma who have failed to be treated with sunitinib or soratinib^[2]。 Its main adverse reaction is interstitial lung injury, which is easily misdiagnosed as lung infection or tumor spread or metastasis. Everolimus, as an anti-tumor drug recently applied, has been gradually reported on its associated lung injury, but it has not been reported in China. According to foreign reports, the incidence of lung injury is about 4.3%, and there have been serious reports^[3]。 In December 2009, we admitted a case of serious associated lung injury after everolimus treatment, which is reported below.

The patient was a 64-year-old male. He was admitted to hospital on April 7, 2009 due to "cough and expectoration for 3 months, aggravated with bloody sputum for 2 weeks". The patient coughed without obvious trigger 3 months ago, coughed a small amount of white sticky sputum, and the cough worsened 2 weeks ago, coughed yellow-white sputum, accompanied by bloody sputum, the amount was small; Occasional chest tightness, no chest pain, self-conscious low fever, but no body temperature measurement. No previous history of abdominal pain, diarrhea and tuberculosis. Subtotal gastrectomy for duodenal bulb ulcer more than 20 years ago. History of hypertension 2 years. The smoking index was 80 pack years. Drinking alcohol for more than 30 years, drinking about 300 g of white wine every day. Physical examination at admission: temperature 36.8 ℃, 21 breaths/min, blood pressure 132/74 mm Hg (1 mm Hg =0.133 kPa). Slim body shape, the right thorax is slightly fuller than the left, the breathing rate is weakened, the right lower lung percussion shows turbidity, the right lower lung breathing sound is low, and a few wet rales can be heard at the bottom of both lungs; The abdomen was soft, the liver and spleen were not touched under the ribs, there was no percussion pain in the liver area, no tenderness and rebound pain in the abdomen, and no mass was touched. No pestle fingers (toes). No edema was observed in both lower limbs. CT of the chest in the outer hospital showed a massive soft tissue density shadow in the right hilar, a spherical lesion with clear margins in the right lower lung, with fluid level inside, and a small amount of pleural effusion on the right side (Figure 1，Figure 2，Figure 3，Figure 4)。 Routine blood test: white blood cells were 6.69×10⁹/L, red blood cells were 3.75×10¹²/L, 95 g/L for hemoglobin and 0.78 for neutrophils; Routine occult blood in stool was negative, and no parasite eggs, amoeba trophozoites and cysts were found; Blood aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase and alkaline phosphatase were all in the normal range, albumin was 29.9 g/L, and albumin/globulin ratio was 1.0. The sputum bacteria were cultured as respiratory normal flora, and no cancer cells were found in the sputum. The concentrated sputum was negative for acid-fast bacilli. After admission, abscess cavity puncture and catheterization under B-ultrasound positioning were performed, and about 600 ml of chocolate-colored turbid liquid was drained. The drainage liquid was brown and turbid. In Li Fanta's experiment (+ + + +), white blood cells and red blood cells were densely covered. Glucose was 1.70 mmol/L, protein was 44 g/L, bacterial culture was negative, and amoebic trophozoites were found. After ornidazole treatment for 11 days and abscess cavity irrigation for 4 days, the symptoms of cough and expectoration disappeared. Chest B-ultrasound showed consolidation of the lower lobe of the right lung. After the right lung abscess was catheterized (the abscess disappeared), the right encapsulated effusion was 16 cm ×2.6 cm in size, with a small amount of fibrous cord separation. The edge of the liver was smooth, the echo of the hepatic parenchyma was uniform, the texture of intrahepatic blood vessels was clear, and the intrahepatic and extrahepatic bile ducts and portal veins were not dilated. Bronchoscopy showed that the bronchial entrance of the basal segment of the right lower lobe was completely blocked by new organisms, the surface was covered with white coating, and the clamp tissue was prone to bleeding (Figure 5)。 Pathological examination showed squamous cell carcinoma (Figure 6)。 Clinical diagnosis: lung cancer with amoebic lung abscess.

Malignant mixed germ cell tumor of the mediastinum is rare in clinic and often occurs in young men. It is mainly manifested by cough, chest pain and shortness of breath. Chest X-ray examination shows mediastinal mass, but it lacks specificity and is difficult to diagnose early. A case of primary malignant mixed germ cell tumor of the mediastinum is reported in order to improve clinicians' understanding of this disease.

pulmonary thromboembolism (PTE) is a relatively common disease of pulmonary circulation. Because thromboembolus blocks the vascular bed of pulmonary artery, it may cause fatal acute right heart failure. However, after active treatment, acute right heart failure can be reversed after thromboembolism is opened, so acute pulmonary thromboembolism is a disease that can be treated and recovered. According to clinical presentation, acute PTE can be divided into large-area PTE and non-large-area PTE^[1]The latter included submassive PTE with right ventricular insufficiency without shock. Thrombolytic therapy has been shown to be easier to dissolve thromboembolus than heparin anticoagulation alone by catheter arterial or ultrasound, but not all patients with PTE can take thrombolytic therapy, and there is a consensus at present^[1,2,3,4]What is important is that thrombolytic therapy for acute large-area PTE can effectively open blood vessels and reduce mortality, while non-large-area PTE with stable hemodynamics only requires anticoagulation therapy. It is controversial whether thrombolytic therapy or anticoagulation therapy should be used for acute PTE patients with right ventricular insufficiency without shock.

A 57-year-old female, farmer, was admitted to the hospital on 12 September 2008 due to "cough with active chest tightness and asthma for 8 months". The patient developed paroxysmal cough without trigger 8 months ago, coughed a little white sticky phlegm, felt chest tightness and asthma during physical labor, and improved after rest, without fever or chest pain. He went to a local hospital and performed a chest CT report suggesting "left lower pneumonia with a small amount of pleural effusion (Figure 1，Figure 2，Figure 3) ", the symptoms improved slightly after nearly half a month of treatment. After that, there was still recurrent daytime active paroxysmal cough with chest tightness and asthma, which was progressively aggravated; there was no chest pain, dyspnea, hemoptysis and sitting breathing. The patient complained of night sweats, fatigue, and edema of both lower limbs at night, which was obvious during daytime labor. No systematic examination was performed in many visits. Three weeks ago, the patient was unable to do daily life, and the chest CT report in another hospital showed "nodular mass in the right lower lung and focal thickening of the left pleura (Figure 4，Figure 5，Figure 6) ", the symptomatic treatment effect was not good, and he was transferred to Drum Tower Hospital affiliated to Nanjing University School of Medicine for further diagnosis and treatment. The patient lost 8~10 kg in weight in the past 8 months. Personal history: He liked to play mahjong, and in the past 2~3 years, he often played mahjong for many hours in a row. Yu is not special.

Sleep apnea is a complex systemic disease, with a prevalence rate of about 4% among adults, mostly male patients. It is mainly manifested by snoring during sleep accompanied by apnea and superficial breathing, repeated hypoxemia, hypercapnia and sleep structure disorders at night, resulting in daytime sleepiness, cardiovascular and cerebrovascular complications and even multiple organ damage. Sleep breathing disorder special nocturnal continuous intermittent hypoxia can cause multiple system and organ damage in the whole body, seriously affecting the quality of life and lifespan of patients.