2010年 · 第33卷第11期

acute lung injury (ALI) is a common critical disease in clinical practice. At present, there is no effective treatment, and the mortality rate is as high as 40%^[1]。 The damage and activation of endothelial cells play an extremely important role in the pathogenesis of ALI^[2]。 Abnormal endothelial cells can increase capillary permeability, expand inflammatory response, further aggravate tissue damage, and at the same time, vasomotor dysfunction caused by it can cause pulmonary hypertension; Excessive proliferation of extracellular matrix can also lead to pulmonary fibrosis. Therefore, preventing endothelial cell damage and reversing the established damage has become a new trend in the development of ALI treatment, which has received wide attention. Recent research results show that endothelial progenitor cells (EPC) can participate in the repair of damaged vascular endothelial cells and maintain the function and integrity of blood vessels, which has gradually become a hot spot in targeted therapy of ALI^[3]。

Changes in tumor volume measured by chest CT or other anatomical imaging modalities cannot objectively evaluate the efficacy because tumor tissue is composed of different malignant cells, interstitial cells, and inflammatory cells, and the repair of various components is not synchronized and incomplete, and even after cure of non-small cell lung cancer (NSCLC), fibrotic masses remain. In addition, atelectasis, radiation pneumonia and later fibrosis all affect the definition of primary lesions before and after treatment, which leads to the uncertainty of the optimal time of imaging follow-up and can lead to some new lesions not being detected in time, so that patients lose the opportunity of treatment. Conversely, the slow shrinking of the mass after treatment may lead to an unnecessary prolongation of the treatment period, or may be mistaken for a more aggressive treatment for poor efficacy of the initial treatment. Because the metabolic changes of tumor cells after radiotherapy and chemotherapy are obviously earlier than the morphological changes, which are manifested as functional dysfunction, inhibition of physiological activity and metabolic decrease,¹⁸F-deoxyglucose positron emission tomography (¹⁸F-fluorodeoxyglucose positron emission tomography,¹⁸F-FDG (PET) can reflect this phenomenon well, but the anatomical changes of inhibited tumor cells are slow, and it is difficult to be detected by imaging examination reflecting the morphological structure. Since most lung cancer tissues have a great impact on¹⁸F-deoxyglucose is high uptake, and effective treatment can reduce uptake, thus¹⁸The clinical application of F-FDG PET in monitoring the therapeutic response of NSCLC is increasing.

At present, there is still a lack of understanding of different causes of acute lung injury (ALI) in clinic. We replicated the animal models of acute lung injury (ALI) induced by intrapulmonary infection and systemic endotoxemia, and compared the differences in pathological morphology, inflammatory response and intervention effect of glucocorticoid (abbreviated as hormone).

The main pathophysiological process of obstructive sleep apnea syndrome (OSAS) is intermittent hypoxia, that is, repeated transient hypoxia followed by reoxygenation, which is associated with many cardiovascular diseases. Among them, vascular endothelial growth factor (VEGF) plays an important role. In this study, a model of intermittent hypoxia was established to determine the changes of VEGF content in endothelial cells under intermittent hypoxia, and to explore the pathogenesis of OSAS-related cardiovascular diseases.

In recent years, the clinical research on the diagnosis and treatment of cough has made some progress in China, and in 2005, the "Guidelines for the Diagnosis and Treatment of Cough (Draft)" was formulated in China^[1]。 In order to further clarify the etiological composition of chronic cough, this study followed the etiological diagnosis process of chronic cough in China, and compared the etiological composition of chronic cough patients in the outpatient department of the First Affiliated Hospital of China Medical University and the etiological composition of chronic cough in several hospitals in China, so as to provide a basis for empirical diagnosis and treatment of chronic cough in Shenyang and surrounding areas.

The child is a girl, 11 years old. He was admitted to hospital due to "fever for 5 days, hematemesis, melena and abdominal pain for 1 day". The child had fever 5 days ago, with a maximum body temperature of 40 ℃ and occasional cough; One day before admission, there was sudden hematemesis, which was bright red, not much, melena 3 times, moderate amount, and periumbilical abdominal pain. The child developed hematemesis when he was 2 years old. After 9 years, he was treated in a local hospital due to repeated fever and cough. Multiple chest X-ray examinations showed right lower pneumonia. Admission physical examination: body temperature 38.1 ℃, heart rate 94 beats/min, breathing 24 beats/min, blood pressure 90/52 mm Hg (1 mm Hg =0.133 kPa); The breathing sound of the right lower lung was slightly low, no dry or wet rales were heard, the abdomen was flat and soft, and the tenderness under the xiphoid process and around the umbilical cord was painful. White blood cells 5.7×10⁹/L, neutrophils 0.49, lymphocytes 0.37, hemoglobin 63 g/L, platelets 221×10⁹/L, C-reactive protein 13 mg/L; Stools were tarry with occult blood (+ + + +). The first gastroscopy (day 2 of admission) revealed chronic superficial gastritis; The second time (on the 6th day of admission) showed a large amount of old blood accumulation in the gastric cavity. After irrigation of the gastric antrum, gastric angle and duodenal bulb cavity, the mucosa was smooth and no obvious bleeding focus was seen. No bleeding focus was found in the cardia after retraction of the microscope. A rest room was visible directly to the right 25 cm away from the incisors, with an opening of about 1 cm, no bottom was visible, and fresh blood scab was seen inside. Bleeding was still seen after irrigation. Esophageal diverticulum with bleeding was considered (Figure 1)。 On the right side of the middle and lower segment of the esophagus, a stripe channel communicated with the right lower lung, suggesting esophageal airway fistula (Figure 2，Figure 3)。 After esophagography, plain CT scan of the chest showed that the right thorax was slightly smaller than the contralateral, and the right middle and lower lung fields were consolidated with uneven density, with stripes and small vesicles of transparent gas shadows. After oral administration of the positive contrast medium, the positive contrast medium can be seen in the air cavity of the esophagus and the consolidated tissue of the right middle and lower lung. The right pulmonary artery is slimmer than the contralateral. It suggests abnormal bronchial opening in the middle and lower lobes of the right lung (opening in the esophagus,Figure 4)。 Magnetic resonance imaging of the thoracic aorta showed that the thoracic aorta ran naturally and the signal was uniform. Diagnosis: Congenital esophago-right lower bronchial fistula with pulmonary hemorrhage, right middle and lower lung dysplasia, right pulmonary artery stenosis. Transfer to thoracic surgery for surgical treatment. The 7th intercostal incision of the right axillary midline was used to enter the chest, and a mass of about 10 cm ×6 cm ×5 cm in the right lower chest was seen, which was hard in texture and densely adhered to the right lower lung, diaphragm and chest wall. After the adhesion was separated, the esophagus at the diverticulum was free, and the diverticulum was sinus-shaped, with a diameter of 0.7 cm and an entry tube of 0.5 cm. The mass and diverticulum were completely removed, the esophageal fistula was repaired, and the esophageal end of the fistula was closed with bio-glue. The results of pathological examination of the right lower chest mass showed focal hemorrhage, chronic inflammation and interstitial fibrosis. After 8 months follow-up, the children did not have any symptoms again.

menstrual pneumothorax (MPT) is rare in clinic, and its onset is closely related to the menstrual cycle, often recurring. First by Maurer et al.^[1]Report, 1972 Lillington et al.^[2]Officially named menstrual pneumothorax. It is more common in women over 30 years old, often within 48 hours before and after menstruation, and mostly occurs on the right side. A case of menstrual pneumothorax with poor drug treatment in Shanghai Pulmonary Hospital is reported as follows.

A 57-year-old male was fitted with a pacemaker in October 2009 due to "coronary atherosclerotic heart disease, paroxysmal atrial fibrillation with sinus arrest". Postoperative X-ray chest radiograph revealed a shadow of the right lower lung, and enhanced CT scan revealed eccentric cavity with basically clear boundaries and multiple light-transmitting areas in the center. Cavitary pulmonary tuberculosis was considered, and cavitary peripheral lung cancer was not excluded. At the same time, the right hilar and mediastinal lymph nodes were slightly enlarged (Figure 1,Figure 2,Figure 3)。 B-ultrasound examination detected left supraclavicular lymph node and right cervical lymph node enlargement. The patient had no respiratory discomfort such as chest pain or cough, and was transferred to the surgical department for exploratory thoracotomy of right lower lung mass. During the operation, the mass was located in the lower lobe of the right lung, soft in texture, with clear boundary. The parabronchial and parahilar lymph nodes were not enlarged, there was no pleural effusion, and the pleura and diaphragm were smooth. Intraoperative freezing pathology showed that it was benign lesion. Wedge lobectomy was performed, and the resected tissue was sent to histopathological examination.

idiopathic pulmonary fibrosis (IPF), whose cause is unknown, is a chronic progressive fibrotic interstitial lung disease characterized by usual interstitial pneumonia (UIP). At present, there are no effective therapeutic drugs to prolong the survival of patients^[1]。 In recent years, the molecular and cellular biological mechanisms of pulmonary fibrosis have made great progress. Previous research results show that different molecular mechanisms, such as abnormal alveolar epithelial damage and repair, immune imbalance of helper T cell subsets (Th1/Th2), fibroblast proliferation, imbalance of extracellular matrix regulation, oxidative stress, abnormal neovascularization and apoptosis, are involved in the occurrence and development of pulmonary fibrosis^[2,3]For each specific link of the above pathogenesis^[3]At present, a number of double-blind, randomized and placebo-controlled IPF clinical trials have been carried out. Judging from the results of a number of clinical trials published one after another^{[4,5,6,7,8,9,10,11]}The high-quality experimental results of many in vitro cellular and animal disease models have not been successful in the translation to clinical trials of human IPF, and the results are regrettable.

The 4th event of Beijing Young Respiratory Salon in 2010 was held on June 24th, 2010. This event was hosted by Cui Junchang of PLA General Hospital, with the theme of "Diagnosis and Treatment of Nosocomial Infection of Multi-drug-resistant Acinetobacter baumannii".

Sleep apnea can be classified into central (CSA) and obstructive sleep apnea (OSA). Because of the different pathogenesis and treatment methods of CSA and OSA, it is very important to distinguish them accurately in both clinical and scientific research. The classical way to distinguish CSA from OSA is to rely on sleep multi-mapping, particularly airflow and thoracic belt signals. When the airflow stops, this event is defined as CSA if there is no fluctuation in the thoracoabdominal belt signal; Conversely, if the thoracoabdominal band signal fluctuation persists when the airflow signal stops, the event is defined as OSA. Because the thoracoabdominal belt may be displaced or loosened, it cannot accurately reflect the respiratory effort and respiratory central drive. Previous research results show that some CSA events judged by the thoracoabdominal belt signals are actually OSA events, and the thoracoabdominal belt signals cannot quantify the respiratory central drive, and cannot distinguish between obstructive and central sleep apnea and hypopnea events. In order to find a better way to differentiate OSA from CSA, we explored the value of esophageal diaphragm myoelectricity in differentiating between obstructive and central sleep apnea and hypopnea.

The 19th ETS Annual Conference was held in Vienna, Austria, known as the music capital, from September 12 to 16, 2009. 18,000 delegates from more than 120 countries and regions attended the conference. The focus of the conference was on COPD, bronchial asthma (asthma for short), lung cancer, lung infection, tuberculosis, pulmonary hypertension and influenza. Due to the many contents of the annual meeting, the author only briefly introduces one or two of them here, which shows one of the annual meetings.

1. General requirements This section should answer the questions raised in the preface. Use words, figures and tables to give the specific data in the chart, explain the results of comparison with the control group, and also inform the unexpected results. The percentage of avoidance when less than 100 subjects were studied, and the score was applied when less than 10 subjects were studied. The sample number, range, mean and standard deviation or confidence interval should be given when the results are involved; If variation is involved, its degrees of freedom andFValue. Configure the chart appropriately for the length of the section. Present the results in a logical order in the text and in the charts, describe the important findings, only emphasize or summarize the main findings of this study, and do not use abbreviated sentences such as "Results are shown in Tables 1-5 and Figures 1-4". In this part, the function of words, graphs and tables is to describe the results with words, give the essence of the results with tables, and deepen the impression of readers with graphs.

The contents worth paying attention to in this issue are first of three basic research papers funded by fund projects, followed by two meta-analytical articles and several clinical research papers. Finally, Professor Cai Hourong's "Confusion and Reflection in Clinical Research on Treatment Drugs for Idiopathic Pulmonary Fibrosis" and several other column manuscripts are also worth reading.