2010年 · 第33卷第09期

Endoscopic ultrasound-guided transbronchial needle aspiration biopsy (EBUS-TBNA) has been recommended as an important tool for preoperative assessment of lung cancer by the National Comprehensive Cancer Network (NCCN) and the American College of Chest Physicians (ACCP) in 2007 since its development in 2002. It provides a new standard for mediastinal staging of lung cancer and may replace surgical mediastinoscopy in the trend. Among them, ultrasound bronchoscope (EBUS) is an ultrasound probe device installed at the front end of bronchoscope. Combined with a special suction biopsy needle, needle aspiration biopsy (TBNA) can be performed under the guidance of real-time ultrasound. The color energy Doppler of electronic convex array scanning can help confirm the position of blood vessels at the same time and prevent accidental penetration of blood vessels. The outer diameter of the puncture suction needle is 22 gauge, so tissue samples can be obtained in some cases. The main indications of EBUS-TBNA are: (1) lymph node staging in patients with lung cancer, (2) diagnosis of intrapulmonary tumors, (3) diagnosis of unexplained hilar and/or mediastinal lymph node enlargement, and (4) diagnosis of mediastinal tumors. EBUS-TBNA was introduced in China in 2008 and put into clinical use. This paper briefly introduces the application of EBUS-TBNA in the diagnosis and treatment of respiratory diseases.

In view of the fact that Mycoplasma pneumoniae pneumonia occupies a high proportion of community-acquired pneumonia (CAP) in China, and in recent years, it has been found that the resistance rate of Mycoplasma pneumoniae to macrolide antibiotics in vitro in China is significantly higher than that in other countries, after full discussion and solicitation of opinions from some experts outside the group, members of the infectiology group of Chinese Medical Association have reached the following consensus on the diagnosis and treatment of Mycoplasma pneumoniae pneumonia, which is specially compiled and published for clinicians' reference.

Sildenafil is a phosphodiesterase-5 inhibitor that has recently been evaluated to be defined as an effective vehicle for the treatment of pulmonary hypertension. In pulmonary artery smooth muscle cells (PASMCs), it is generally believed that the calcium pool manipulative calcium ion channel (SOCC) consists of classical transient receptor potential (TRPC), and the process of calcium ion inflow into the cell through the SOCC channel is the influence on intracellular free calcium ion concentration ([Ca^2＋]_i) and an important determinant of pulmonary vasotonicity. Some scholars have found that chronic hypoxia can cause the [Ca^2＋]_iIncreased, while the calcium pool manipulative calcium ion influx (SOCE) plays an important role in this process. Long-term exposure to hypoxia upregulated TRPC1 and TRPC6 expression in PASMCs. We investigated the possible routes of sildenafil in the treatment of hypoxic pulmonary hypertension in rats through in vivo and in vitro experiments. In this study, the normoxic control group, normoxic + sildenafil group, hypoxic control group and hypoxic + sildenafil group were established, among which the hypoxic group model applied in vitro experimentally was used by exposing cells to hypoxic conditions (4% O₂60 h) Under establishment get. The effects of sildenafil on PASMCs under long-term hypoxic exposure were experimentally determined^2＋]_iInfluence of SOCE and TRPC (TRPC1, TRPC6) expression. Compared with the hypoxic control group, the sildenafil treatment group at 300nM significantly inhibited the [Ca^2＋]_imRNA and protein expression of elevated, SOCE, TRPC. However, there was no significant difference between the results of the normoxic + sildenafil group and the normoxic control group. In vivo experiments, the applied hypoxic group animal model was performed by exposing rats to chronic hypoxia (10% O₂21 d) Get in the environment. Compared with the hypoxic control group, 50 mg · kg^-1• d^-1Sildenafil can significantly inhibit the mRNA and protein expression of TRPC1 and TRPC6 in pulmonary arteries isolated from hypoxic model rats, and is accompanied by a decrease in right ventricular pressure (RVP) and a remission of right ventricular hypertrophy (RV/LV + S and RV/body ratio decrease). Similarly, the results of the normoxic + sildenafil group were not significantly different from those of the normoxic control group. Further studies have found that in PASMCs exposed to hypoxia for a long time, the application of corresponding specific interfering RNA (siRNA) to knock out TRPC1 and TRPC6 genes can attenuate the increase of SOCE and [Ca^2＋]_iThis showed that the increased expression of TRPC1 and TRPC6 was associated with hypoxia-induced SOCE and [Ca^2＋]_iThere may be some causal link between elevations.

Respiratory central drive plays an important role in the occurrence and development of obstructive sleep apnea (OSA). The results have shown that the circuit gain of respiratory central drive is one of the important mechanisms of OSA. It is of great value to understand the mechanism of OSA accurately. For a long time, the main index to evaluate the respiratory central drive of OSA patients is esophageal pressure. Some scholars have found that esophageal pressure is affected by airflow, lung volume and abdominal muscle activity, etc. It has its limitations in evaluating the respiratory central drive of OSA patients characterized by airflow changes. The diaphragmatic myoelectricity recorded by multiple esophageal electrodes is less affected by airflow and lung volume, which is an important method to explore the respiratory central drive in patients with OSA.

extracorporeal membrane oxygenation (ECMO) refers to a cardiopulmonary assistance technology that drains part of venous blood from the body to the outside, and then pumps arterial blood into the body by a drive pump after membrane oxygenation. According to the different routes of membrane oxygenation blood transfusion, ECMO can be divided into venous-venous ECMO (V-V ECMO) and venous-arterial ECMO (V-A ECMO). V-V ECMO is mainly used for respiratory support, while V-A ECMO can be used for both respiratory support and cardiac support. Since Hill et al. first successfully used cardiopulmonary bypass to treat adult patients with hypoxic respiratory failure, ECMO has been in clinical application for more than 30 years. Although the application in adult patients with ARDS lacks the support of randomized controlled studies, many medical centers have reported that the application of ECMO to treat severe respiratory failure caused by ARDS or other causes has obtained optimistic results. In recent years, the application of ECMO in lung transplantation patients is increasing day by day, and it has become an important auxiliary tool. In 2009, the new type of influenza A (H1N1) was pandemic in the world, and some countries successfully treated a large number of critically ill patients by using ECMO technology. This article mainly reviews the application progress of ECMO in respiratory support of adult patients.

Clinically, early diagnosis of pulmonary mycosis is difficult, and its mortality rate is as high as 30% ~80%^[1]。 The diagnostic criteria of fungal infection are mainly based on the positive fungal culture of sputum specimens, but because Candida and Aspergillus contamination and colonization of upper respiratory tract are very common, early lung biopsy can improve the diagnosis rate of invasive pulmonary mycosis.

homocysteine (HCY) is an intermediate metabolite of methionine in the body, folic acid and vitamin B₁₂It is the main cofactor in the metabolism of HCY. The results of previous studies suggest that hypercysteinemia may be an independent risk factor for the development of pulmonary embolism^[1]While folic acid and vitamin B₁₂The concentration of plasma cysteine can be reduced. We use folic acid and vitamin B₁₂Intervention, to observe the effect of both on the degree and extent of embolism in homocysteine-related pulmonary embolism model^[2,3,4]。

Obstructive sleep apnea (OSA) is a sleep disorder characterized by frequent apnea caused by repeated upper airway stenosis or even occlusion during sleep. The prevalence rate is 4% ~6% in adults. The results of many clinical studies show that OSA is closely related to various cardiovascular diseases and can significantly increase the morbidity and mortality of cardiovascular diseases^[1,2]It is an independent risk factor for the development of various cardiovascular diseases.

autofluorescence bronchoscope (AFB) is a new bronchoscopic technique developed on the basis of white Light bronchoscopy (WLB). Its ability in diagnosing early cancer of airway mucosa exceeds that of WLB. The technology has been reported in Europe, America and Japan^[1,2,3]But it is still rare in China. The results of AFB examination and WLB examination for 48 patients in Peking University People's Hospital from September to November 2009 are compared and reported below.

T-bet is an important factor in the differentiation of Th1 cells, and Th17 cells are different from Th1 cells. The transcription factor solitary receptor (ROR γ T) controls its differentiation and induces the expression of interleukin (IL) -17. In order to investigate whether the expression of T-bet affects the proliferation of Th17 cells and the secretion of IL-17, small interfering RNA (siRNA) fragments were transiently transfected into mouse spleen CD₄⁺After T cells, the silencing efficiency was tested and the optimal siRNA fragment was selected. Determination of spleen CD in mice from control group, asthma group without transfection and asthma group transfected with the best siRNA fragment₄⁺The expression of T-bet, the concentration of IL-17 and the positive rate of Th17 cells in T cells were analyzed, and the correlation between them was analyzed to investigate the effect of T-bet on the Th17/IL-17 axis.

Tracheobiliary fistula is a rare complication of hepatobiliary disease. Some doctors lack understanding of this disease, which leads to patients failing to get timely diagnosis and treatment, and delaying the disease. We diagnosed and treated 2 patients with tracheobiliary fistula, which are now reported below.

A 56-year-old female was admitted to the hospital on 8 April 2008 mainly due to "shortness of breath for 2 years after activity". The patient developed progressive aggravation of shortness of breath after activity with lower limb edema 2 years ago. On November 5, 2007, he visited the local hospital. Echocardiography showed pulmonary hypertension and systolic blood pressure 101 mm Hg (1 mm Hg =0.133 kPa). On November 20, 2007, he underwent right cardiac catheterization in another hospital and was diagnosed as idiopathic pulmonary hypertension. During hospitalization, he experienced syncope and loss of consciousness once, and was treated with bosentan and vardenafil on 27 November 2007. On 21 February 2008, the patient suffered from intermittent abdominal pain and was diagnosed as gallstones, acute cholecystitis, pancreatitis and obstructive jaundice in another hospital. Because the pulmonary artery pressure was too high, it improved after conservative treatment, and no operation was performed. The patient has a history of hypertension for more than ten years, and denies a history of coronary heart disease, diabetes, hepatitis and cirrhosis, and a history of surgery.

Bronchoscopy plays an important and irreplaceable role in the diagnosis and treatment of respiratory diseases. Whether the anesthesia is satisfactory before bronchoscopy directly affects the operation effect. At present, there are three main anesthesia methods: (1) local anesthesia; (2) Local anesthesia combined with intravenous sedation and analgesia, that is, painless bronchoscopy; (3) General anesthesia.

The second event of Beijing Young Respiratory Scholars Salon in 2010 was held on April 29, 2010. The theme of this event is "Respiratory Tract Infections in Special Patients", from the Third PLA ○ Many doctors from Ninth Hospital, Air Force General Hospital, Shougang Hospital and Peking University Hospital elaborated on related issues and had heated discussions. This salon was hosted by Dr. Li Nan, Department of Respiratory Affairs, Peking University First Hospital.

The working meeting of COPD group of Respiratory Disease Branch of Chinese Medical Association was held in Guangzhou on April 10, 2010. The meeting was chaired by Professor Xu Yongjian, and attended by Academician Zhong Nanshan, Wang Chen, Bai Chunxue, Feng Yulin and Yao Wanzhen, as well as members of COPD groups from all over the country. Professor Xu Yongjian reported on the work of the COPD group. In 2010, the COPD group will continue to conduct lecture tours on COPD, strive to promote the standardized treatment of COPD, hold COPD Day activities in 2010, and prepare to hold another COPD academic conference in 2011. The conference will invite world-class respiratory experts to give lectures in China.

A 65-year-old female was admitted to the hospital on 30 March 2009 due to "dry cough for 11 years, intermittent asthma for 6 years and aggravation for 1 month". The patient developed dry cough without trigger 11 years ago, which was not treated. The patient developed asthma after cold and heavy physical activity 6 years ago, which could be relieved by rest, but was not treated. One month ago, the patient developed low fever after catching cold, with the highest body temperature of 37.8℃, accompanied by cough and cough of white sticky phlegm, and asthma and stiffness were worse than before. It could be induced after walking 2 floors upstairs and 200 m on the flat ground. X-ray chest radiograph showed bilateral pneumonia. Levofloxacin (0.4 g/d intravenous infusion for 7 days, then 0.4 g/d oral administration for 5 days) was given to fight infection for 12 days. On the second day, the body temperature dropped to normal, but asthma and cough were still present. In the past 3 to 4 days, the patient intermittently coughed pink sputum and blood in sputum. Since the onset of the disease, the patient has no night sweats, no chest pain, no muscle pain, no rash, no joint swelling and pain, no hair loss, oral ulcer, no dry mouth, dry eyes, no waking up at night, and no weight change. Past history: "Erythema nodosum" was diagnosed 47 years ago and had been treated with oral hormones (details unknown); Skull CT found "lacunar infarction" for 10 years and "depression" for half a year. Engaged in the profession of teacher, no tobacco and alcohol addiction.

In recent years, the research on infectious diseases, especially rare bacteria, mycobacterium tuberculosis and invasive fungal infections, has been paid more and more attention by scholars. With the gradual deepening of related research, the understanding of both clinical characteristics and pathological mechanisms of such diseases has been further improved.