2011年 · 第34卷第07期

Professor Yang Yu is one of the famous older generation scholars in the field of respiratory diseases in China. He is now 86 years old. In the past ten years, he has rarely appeared due to diseases, but he still insists on working in Jiangsu Provincial People's Hospital (also known as the First Affiliated Hospital of Nanjing Medical University) and is a tenured professor in this hospital. Professor Yang has trained many outstanding and well-known experts in the field of respiratory diseases represented by Professor Yin Kaisheng. He is quite accomplished in the treatment of bronchial asthma and infectious diseases, and has won the National Science and Technology Progress Award. Professor Yang can't be said to be tall, but he has an upright character that is difficult for "giants" to have. He often withstands the unhealthy trend of society with his thick shoulders and solid backbone. No matter when he is smooth or in "adversity", he can speak bluntly against current disadvantages, which reflects the justice and conscience of an old intellectual. It is this old gentleman who, after reading the humble article "Opening Chapter-From Tobacco Control" published in the first issue of this magazine in 2011^[1]Later, he personally wrote a warm letter to the younger generation^[2]I was deeply moved by the enthusiastic encouragement. From between the lines of my husband's letter, I deeply realized the concern of the elderly for our generation and the current respiratory specialty...

In March 2011, the American Thoracic Society (ATS), the European Respiratory Society (ERS), the Japanese Respiratory Society (JRS), and the Latin American Thoracic Society (ALAT) inAm J Respir Crit Care MedThe journal jointly published the "Evidence-based Guidelines for the Diagnosis and Treatment of Idiopathic Pulmonary Fibrosis" (hereinafter referred to as the "Guidelines")^[1]。 The expert committee of the Guide consists of 24 respiratory specialists, 4 radiologists, 4 pathologists and 4 methodologists, 1 librarian and 2 librarians with extensive experience in literature retrieval of pulmonary diseases. Based on more than 300 papers published after 2000, this new "guide" determines the degree of recommendation for important recommendations by voting by experts participating in the meeting, which can be described as well-founded and well-recommended. Although there is no milestone progress in the understanding of idiopathic pulmonary fibrosis (IPF), a representative disease of interstitial lung disease, there are many new perspectives and ideas in this paper, which should arouse the deep thought of domestic respiratory doctors and colleagues.

When I walked out of the cinema, I saw a few young men holding cigarettes in their hands at the bus stop near the door and smoking them repeatedly. Probably, smoking was not allowed in the cinema, and the addiction to cigarettes was unbearable. I had to smoke for a while and relax.

Sarcoidosis is an unknown systemic disease characterized by non-caseous necrotizing epithelial cell granuloma^[1]。 Although the diagnosis of sarcoidosis depends on pathological examination, non-caseous necrotizing epithelial cell granuloma is not a unique pathological feature of sarcoidosis, so the diagnosis of sarcoidosis needs to be based on clinical manifestations, chest X-ray signs, serum biochemical tests, immunological indicators, BALF and⁶⁷Ga lung scan and other examination results were comprehensively judged. The clinical value and significance of commonly used examination methods for sarcoidosis are evaluated as follows.

The international evidence-based guidelines for the diagnosis and treatment of idiopathic pulmonary fibrosis (IPF) jointly published by the American Thoracic Society (ATS), the European Respiratory Society (ERS), the Japanese Respiratory Society (JRS) and the Latin American Thoracic Society (ALAT) are the latest consensus on idiopathic pulmonary fibrosis, including disease definition, epidemiological characteristics, risk factors, diagnosis, natural course, staging and prognosis, treatment and monitoring of disease progress. The purpose of this guideline is to analyze the relevant evidence accumulated since the publication of the ATS/ERS consensus in 2000, and to provide evidence-based medical recommendations for disease management, especially diagnosis and treatment of IPF.

BACKGROUND AND OBJECTIVE: Previous studies have found that certain markers of microbial exposure (e.g. endotoxin, muramic acid, etc.) are negatively associated with diseases such as bronchial asthma (asthma for short) and heterogeneous diseases. This may explain why children growing up in environments with extensive microbial exposure, such as traditional farms, are less susceptible to asthma and heterogeneity. We compared the prevalence of asthma and heterogeneity and differences in microbial exposure between children living on farms and those in a control group using different methods in 2 cross-sectional studies. METHODS: One of the studies, PARSIFAL (Prevention of Allergy – A Study of Risk Factors Associated with Sensitization in Children Related to Agricultural and Religious Lifestyles), screened mattress dust samples for bacterial DNA using single-strand configurational polymorphism analysis (SSCP) technique to detect environmental bacteria that could not be detected by culture techniques; Another study, GABRIELA (Multidisciplinary Advanced Study on the Identification of Genetic and Environmental Causes of Asthma in the European Community), used culture techniques to evaluate taxonomic units of bacteria and fungi in dust samples from children's rooms. Results: In both studies, children living on farms had lower prevalence of asthma and heterogeneity, and they were exposed to a greater variety of environmental microorganisms than control children; Conversely, microbial exposure was inversely associated with the risk of asthma [odds ratio of 0.62 in the PARSIFAL study; 95% CI (95% CI)CI) is 0.44 to 0.89; The odds ratio for the GABRIELA study was 0.86; 95%CI0.75 to 0.99]. In addition, the presence of some more limited exposure factors was also negatively associated with the risk of asthma, including exposure to certain species in the genus Aspergillus (adjusted odds ratio 0.37, 95%CI0.18 to 0.76), as well as many other bacterial species, including Listeria monocytogenes, Bacillus species, Corynebacterium species, and others (adjusted odds ratio of 0.57, 95%CI0.38-0.86). CONCLUSIONS: Children living on farms had a larger range of microbial exposure than those in the control group, and this exposure explains the nature of an inverse correlation between asthma and growing up on a farm.

Glycopeptide antimicrobial resistant enterococci are frequently present in hospitals worldwide since 1988, when they were reported. Seven genotypes of VanA, VanB, VanC, VanD, VanE, VanG and VanL have been found. This study analyzed Enterococcus faecium EFM-HS0661 isolated from a patient with abdominal infection in Shanghai in 2006. This strain is resistant to most anti-infectious drugs, including vancomycin (MIC>256 mg/L) and teicoplanin (MIC 96 mg/L), and its resistance to glycopeptides can be transferred to E. faecium BM4105RF by conjugation. The results of PCR detection of donor and transfer zygotes showed negative vancomycin resistance gene. A brand-new vancomycin resistance gene was discovered by cloning and primer sequencing, named VanM. This new gene is 1032 bp long and encodes a 343 amino acid protein that shares 79.9%, 70.8%, 66.3%, and 78.8% of the amino acids with VanA, VanB, VanD, and VanF, respectively. Although the DNA sequence of VanM is highly similar to that of VanA, its structure is most similar to that of VanD. Liquid chromatography mass spectrometry analysis of peptidoglycan precursor protein extracted from Enterococcus faecium Efm – HS0661 as a modified new precursor protein indicates that VanM leads to resistance to glycopeptide anti-infective drugs through inducible precursor protein synthesis.

The purpose of this study was to investigate the effect of chronic hypoxia on pulmonary venous smooth muscle by observing the expression of classical transient receptor potential (TRPC) and transient receptor potential vanillic acid (TRPV) channel proteins and the level of calcium pool manipulative calcium influx (SOCE) on the distal pulmonary vein, so as to investigate the role and mechanism of pulmonary venous smooth muscle in the pathogenesis of hypoxic pulmonary hypertension. Chronic hypoxia can cause pulmonary artery and pulmonary vein contraction and vascular remodeling, among which the effects of chronic hypoxia on pulmonary artery have been deeply studied, but the research on pulmonary vein has not been paid attention to at present. Our previous results show that SOCE is the main cause of intracellular calcium imbalance in pulmonary artery smooth muscle cells in hypoxic pulmonary hypertension, and can cause pulmonary artery contraction and vascular remodeling. The calcium pool manipulative calcium ion channel (SOCC) is a calcium ion channel mainly composed of transient receptor potential channel proteins.

In recent years, with the attention paid to immunoglobulin G4 (IgG4) -related sclerotic diseases, more and more research results show that IgG4-related sclerotic diseases are a group of systemic diseases, which can involve many organs and tissues besides pancreas, and related reports on IgG4-related diseases of lung gradually appear. IgG4-related diseases are characterized by elevated serum IgG4 concentrations, IgG4-positive plasma cell infiltration, and irregular fibrosis. IgG4-related sclerotic disease of pancreas has been studied earlier and reported more, and its clinical manifestations, laboratory examinations, histopathological changes and treatment have been comprehensively understood, while IgG4-related lung disease has been understood later, and its research is relatively few. IgG4-related diseases are sensitive to steroid hormone therapy and have a good prognosis. Correct diagnosis and distinction of this disease are very important for the treatment and prognosis of patients, so it is necessary to improve the understanding of IgG4-related lung diseases. At present, there are no cases of IgG4-related lung disease reported in China. The main reason is that clinicians lack awareness of it and classify it as other diseases, such as inflammatory pseudotumor and interstitial pneumonia. The clinical manifestations, imaging, histopathological changes, diagnosis and treatment of IgG4-associated lung diseases were reviewed in combination with IgG4-associated sclerotic diseases of pancreas.

Smoking is a major risk factor for COPD, and half of the elderly smokers have COPD^[1]。 Smoking cessation can slow the decline of lung function, delay disease progression and reduce the number of acute attacks in COPD patients, which is the most effective and cost-effective treatment for COPD. Although smoking cessation is essential in the treatment of COPD, COPD patients do not receive more smoking cessation advice or smoking cessation drugs than the general population^[2]。 Tobacco dependence (that is, nicotine dependence) is a chronic addictive disease. The higher the degree of nicotine dependence, the more difficult it is to quit smoking. The degree of nicotine dependence in COPD patients is higher than that of ordinary smokers, but their willingness to quit smoking is not correspondingly increased^[3]At the same time, COPD patients have an increased risk of depression, and smoking can play an antidepressant role. These characteristics increase the difficulty of COPD patients to quit smoking. Actively exploring ways to assist COPD patients to quit smoking is a hot spot in clinical research. Therefore, we review the current status of research on smoking cessation intervention methods in COPD as follows.

In the traditional renin-angiotensin system (RAS), angiotensin-converting enzyme (ACE) catalyzes the production of angiotensin Ⅱ (Ang Ⅱ), thereby promoting the occurrence of pulmonary hypertension, pulmonary fibrosis and other lung diseases. RAS system inhibitors, such as ACE inhibitor (ACEI) and Ang Ⅱ receptor blocker (ARB), have been used to treat such diseases, but their efficacy is still unclear. With the deepening of research, in 2000, scholars discovered that angiotensin-converting enzyme 2 (ACE2) of RAS system can antagonize ACE by hydrolyzing Ang Ⅱ. Current research results show that ACE2 has the effects of relieving pulmonary hypertension and anti-pulmonary fibrosis, and is closely related to many pulmonary diseases, and also plays a certain role in the occurrence of acute respiratory distress syndrome and lung cancer. These findings provide ideas for further research on the mechanisms of the above diseases and exploring new therapeutic methods. This article reviews the research progress of ACE2 and lung diseases.

eosinophilic lung diseases (ELD) refer to a heterogeneous group of clinical diseases characterized by airway and/or lung parenchymal eosinophilia, with or without peripheral blood eosinophilia^[1]。 Previously, there were many names associated with ELD, such as eosinophilic pulmonary infiltration, pulmonary eosinophilia, eosinophilic pneumonia and pulmonary eosinophilic syndrome, etc., but now they are mostly replaced by ELD^[2,3,4,5]。 In fact, the use of the term "eosinophil lung disease" is also not very appropriate, as such diseases are often characterized by alterations in mixed inflammatory cells (including alveolar macrophages, lymphocytes, neutrophils, accompanied by eosinophils). Lung injury is the result of the combined action of these cells and not just eosinophils. However, the presence of eosinophils is very significant and has important diagnostic value as a marker of the disease, so ELD is still widely used^[3,6]。 Because many clinicians lack enough understanding of ELD, and there are many confusions in their understanding of ELD, it is necessary to further elaborate on the current diagnosis and confusing problems of ELD.

In recent years, long-term home non-invasive positive pressure mechanical ventilation (HNIPPV) has been improved continuously, and has gradually become one of the important methods for the treatment of COPD. In this study, 48 patients with severe COPD with chronic type II respiratory failure in the stable phase after treatment were prospectively studied, of which 24 patients underwent long-term home noninvasive ventilator-assisted ventilation therapy and were followed up for 1 year.

neutro-philgelatinase-associated lipocalin (NGAL), a member of the apolipoprotein family, is localized on chromosome 9q34 and is highly homologous to mouse oncogene product 24p3^[1]It may be a new oncogene of human beings, which has been paid attention to in recent years. The results showed that the expression of NGAL gene was increased in tumor tissues and cell lines, and it was guessed that there was a certain relationship between NGAL gene and the occurrence, development and prognosis of tumor, but the mechanism of its action was still unclear. Nuclear factor-κ B is a class of ubiquitous transcriptional regulators, which is closely related to tumors, and the activation of NGAL gene may be related to it. Platinum-based chemotherapy has become the main chemotherapy regimen for non-small cell lung cancer (NSCLC), but the effect of chemotherapy varies greatly from individual to individual. In this study, the expression of NGAL and nuclear factor-κ B in NSCLC was detected by immunohistochemistry, and their correlation was analyzed in combination with clinicopathological factors and prognosis, which provided a theoretical basis for individualized chemotherapy regimen of NSCLC.

Pulmonary hypertension is a common complication of COPD, which can lead to progressive deterioration of the clinical course of COPD and increase the risk of hospitalization in patients with COPD^[1]。 Previous studies have shown that chronic inflammation is related to pulmonary vascular structural remodeling^[2], C-reactive protein and endothelin-1 are associated with pulmonary hypertension^[3,4]。 This study aimed to investigate the plasma levels of CRP and endothelin-1 and the relationship between CRP and endothelin-1 in patients with COPD complicated with pulmonary hypertension.

At present, it is believed that annexin-Ⅰ may be involved in intracellular signal transduction and cytoskeleton interaction in cell differentiation and proliferation. Literature reports^[1]The expression of annexin-I in normal tissues or tumor tissues is tissue-specific, and it is correlated with the occurrence, development and metastasis of tumor.

Pulmonary hypertension is a group of diseases characterized by progressive increase of pulmonary artery vascular resistance. The mechanism of occurrence is complex, and pulmonary heart disease is its terminal stage. Chemokine CX3CL1 (fractalkine, FKN) is the only member of chemokine CX3C subfamily. It has soluble form and membrane-bound form. It has the function of both chemotactic protein and cell adhesion molecule, and also has the function of growth factor to promote smooth muscle cell proliferation^[1]。 In this study, the expression changes of FKN during the development of pulmonary hypertension were observed in the rat model of pulmonary arterial hypertension induced by monocrotaline, and the role and possible mechanism of FKN in the formation of pulmonary arterial hypertension were investigated.

Patients are in extreme hypoxia due to nearly complete tracheal blockage caused by the lesion, and patients may suffer hypoxic cardiac arrest and die. This severe tracheal stenosis is clinically called asphyxial tracheal stenosis and requires urgent treatment. Whether it can quickly adjust oxygenation state and prevent hypoxic cardiac arrest is the key to the success or failure of rescue, and surgical treatment has been used in the past^[1,2]。 The diagnosis and treatment experience of 4 typical patients with asphyxial tracheal stenosis caused by tuberculosis using balloon dilatation and tracheal intubation dilatation under cardiopulmonary bypass is reported below.

The second activity of Beijing Young Respiratory Scholars Salon in 2011 was held on March 31, 2011. This activity was hosted by Dr. Huang Hui from the Department of Respiratory Medicine of Peking Union Medical College Hospital. First, Professor Xu Zuojun from the Department of Respiratory Medicine of Peking Union Medical College Hospital introduced the new guidelines for idiopathic pulmonary fibrosis (IPF) just published abroad, and then discussed related cases to deepen the understanding of diffuse pulmonary lesions.

Infectious diseases are a kind of common diseases with high incidence and great threat to human health. The prognosis of these diseases depends on three factors: pathogen, host immunity and the application of anti-infective drugs. The pathogenic composition and drug resistance characteristics of the same disease, such as community-acquired pneumonia (CAP), are quite different in different countries and regions. Therefore, the diagnosis and treatment of infectious diseases cannot copy foreign guidelines, but must formulate their own guidelines or expert consensus on the basis of evidence-based medicine, carefully refer to it, promote it, and constantly modify and improve it in the process of practice.

Idiopathic pulmonary fibrosis (IPF) is the most common type of idiopathic interstitial lung disease, with poor prognosis and obvious heterogeneity. Its complications also significantly affect the course and prognosis of the disease. Therefore, there are many problems to be solved urgently in the diagnosis and treatment of IPF. The excerpt of the "Evidence-based Guidelines for the Diagnosis and Treatment of Idiopathic Pulmonary Fibrosis" jointly published by the American Thoracic Association (ATS), the European Respiratory Society (ERS), the Japanese Respiratory Society (JRS) and the Latin American Thoracic Association (ALAT) in March 2011 is published in the Diagnosis and Treatment Plan column of this issue. Based on a large number of literatures published before May 31, 2010, the guidelines are well-founded and recommended. The contents mainly include the definition, epidemiology, risk factors, diagnosis, natural course, staging and prognosis of IPF, treatment and monitoring of disease progress, etc. The diagnostic criteria for IPF have changed significantly from those in the 2000 ATS/ERS declaration, and it is considered that there is no definite effective treatment to date. Although there is no milestone progress in the understanding of IPF in the new guidelines, there are many new views and new ideas in the paper, and I hope that domestic colleagues will pay attention to them. Professor Kang Jian wrote a review on the new "Guidelines", "Old Topics, New Perspectives: Idiopathic Pulmonary Fibrosis", and interpreted the contents of the Guidelines in detail. Professor Kang Jian introduced the view that the imaging findings of high-resolution CT proposed in the new "Guidelines" will be the most important basis for the diagnosis of IPF, and analyzed it in light of China's national conditions. He believed that although the "Guidelines" did not evaluate the role of bronchoalveolar lavage (BAL) in diseases such as infection and tumor, the role of BAL in ruling out interstitial lung disease caused by other causes should still be paid attention to, and the situation of "no drug available" caused by the new "Guidelines" re-evaluating the current situation of drug treatment of IPF was analyzed, which is worth reading carefully.