2011年 · 第34卷第08期

Since the late 1980s, the author has participated in the review of manuscripts of this journal, and witnessed the continuous improvement of the quality of manuscripts, which reflects the improvement of clinical research level in China on the one hand, and the continuous maturity of writing skills of manuscript authors on the other hand. On the whole, compared with more than 20 years ago, the present manuscript has made a leap in both content and writing quality. But at present, some manuscripts still have some general shortcomings. The author only puts forward some common questions based on personal opinion and discusses with the authors. The main purpose is to promote enthusiastic submission, improve hit rate, shorten the publication cycle, and hope that more excellent manuscripts can be published in this journal.

BACKGROUND AND OBJECTIVE: To investigate the routine treatment and management of patients with peripheral lymph node tuberculosis in areas with high tuberculosis incidence in England and Wales, and to analyze the effect of the 6-month chemotherapy regimen recommended by the British Thoracic Society. Methods: Cases diagnosed with lymph node tuberculosis from 1995 to 2004 were selected for analysis. Results: A total of 100 cases of peripheral lymph node tuberculosis were collected, including 55 males and 45 females; 94 cases were South Asians; 92 cases were cervical and supraclavicular lymph node tuberculosis, 5 cases were axillary lymph node tuberculosis, and 3 cases were inguinal lymph node tuberculosis; Fine needle aspiration was performed in 49 cases, and pus was extracted in 38 cases and MTB culture was performed, of which 27 cases were positive; Lymph node biopsy was performed in 66 cases. Among the 100 cases in this group, 37 cases were confirmed by culture and histology simultaneously, 29 cases were confirmed by culture only, 26 cases were confirmed by histology only, and 8 cases were clinically diagnosed. Sixty-six MTB cultures were positive, of which 63 were sensitive to first-line antituberculosis drugs and 3 were resistant to first-line antituberculosis drugs (1 was resistant to isoniazid and 2 were resistant to isoniazid and streptomycin). Eighty-two patients received 6 months of standard short-course chemotherapy (2HREZ/7HR), another 7 without ethambutol (2HRZ/4HR), 5 without pyrazinamide (2HRE/4HR) due to intolerance, 4 without isoniazid (2REZ/7RE), and 2 with other regimens due to adverse drug reactions. 19 cases were treated with abscess puncture and pus aspiration, and 7 cases were treated with corticosteroids. Sinus tract was formed in 12 cases during treatment and healed after further treatment. At the end of treatment, 16 cases still had different degrees of cervical lymph node enlargement. During the follow-up period, 10 cases developed new lymph node enlargement or original lymph node enlargement. Only 3 cases were confirmed to be recurrent lymph node tuberculosis. Conclusion: Peripheral lymph node tuberculosis has different manifestations during and after treatment, and the positive rate of puncture and pus aspiration or histological culture is high, which can timely understand the drug resistance of patients. 6-month chemotherapy regimen is effective for the treatment of drug-sensitive lymph node tuberculosis patients.

BACKGROUND AND OBJECTIVE: The use of gamma-interferon release test (QFT test) in the diagnosis of latent MTB infection is more sensitive and specific than PPD test, but there are few reports that QFT test predicts the development of latent MTB infection to tuberculosis. In this study, the QFT test (Cellestic kit, Australia) and PPD test were compared in close contacts of pulmonary tuberculosis and followed up for 4 years, aiming to evaluate their predictive value for tuberculosis. Methods: The subjects were close contacts with sputum smear-positive patients in Hamburg, Germany, from May 2005 to April 2008. The contact time was within 3 months before the diagnosis of the patients, the contact time was not less than 40 h, and they coexisted indoors. All the subjects underwent QFT and PPD tests at the 9th week after exposure, and were followed up until April 2010. Results: A total of 1414 contacts were enrolled, 141 children, 1033 contacts were still residing in Hamburg, Germany at the end of the study, and 954 contacts had both QFT and PPD test results. The results showed that the positive results of QFT test were correlated with the exposure time. The longer the exposure time, the number of QFT positive patients increased significantly, while the results of PPD test had no significant correlation with the exposure time. Of the 954 contacts, 198 (20.8%) were positive for QFT, 604 (63.3%) had PPD test>5 mm, and 242 (25.4%) had PPD test>10 mm. 903 contacts refused prophylactic treatment, of which 19 contacts developed active tuberculosis and were all positive for QFT, representing 12.9% (19/147) of QFT-positive individuals. Among the 19 contacts who developed active tuberculosis, 3.1% (17/552) had PPD test results>5 mm and 4.8% (10/207) had PPD test results>10 mm. The incidence of developing active pulmonary tuberculosis was significantly higher in those who had positive QFT test results than those who had positive PPD test results. Gamma-interferon levels and age are closely related to whether or not to develop active tuberculosis. 104 child contacts refused prophylactic treatment, and 6 of 21 QFT-positive children developed active tuberculosis (28.6%), with a significantly higher incidence than adults (10.3%, 13/126). Conclusion: QFT test is more reliable than PPD test in predicting the development of latent tuberculosis infection to active tuberculosis, especially in children.

BACKGROUND AND OBJECTIVE: Fluoroquinolones play an important role in the treatment of MDR-TB and are expected to be the new first-line anti-tuberculosis drugs. Because fluoroquinolones are broad-spectrum antimicrobials and are widely used in other infectious diseases, this is undoubtedly a challenge for tuberculosis control. If patients with suspected tuberculosis receive fluoroquinolone treatment first, the number of MTB can be temporarily reduced, and the patient's sputum test result is negative, resulting in a delay in anti-tuberculosis treatment. Fluoroquinolone treatment first can also lead to selective resistance to fluoroquinolones. This study aimed to further explore the impact of empirical use of fluoroquinolones on the treatment of tuberculosis. Methods: A retrospective analysis of 440 tuberculosis patients who had used fluoroquinolones and 511 tuberculosis patients who had not used fluoroquinolones from January 2001 to March 2009 in a gold mining area in South Africa was carried out to compare the positive detection rate of sputum bacteria and the delay rate of treatment in the two types of patients. According to the use time of fluoroquinolones, they are divided into two categories: recent use (within 100 days before sputum bacteria examination) and long-term use (within 1 year before sputum bacteria examination). Patients with negative sputum culture and multi-drug resistance were excluded. At the same time, the strains of 201 patients who had used fluoroquinolones and 180 patients who had not used fluoroquinolones were tested for the presence of gyrA gene mutation, and the resistance rates of fluoroquinolones in the two groups were compared. Results: Compared with pulmonary tuberculosis patients who did not use fluoroquinolones before sputum testing, patients who had used fluoroquinolones for more than 5 days in the recent period before sputum testing were less likely to have a positive sputum smear (ORValue is 0.27, 95%CI0.11 to 0.63), and the start of antituberculosis treatment was delayed (time ratio 2.02, 95%CI1.19-3.44). Previous use of fluoroquinolones in the long term prior to sputum bacteria examination had less effect on the positive result of sputum smear (ORValue is 0.55, 95%CI0.31 to 0.98), the time of use<5 days had no effect on the detection rate of positive sputum bacteria. Among 201 patients who had used fluoroquinolones, a gyrA gene mutation was detected in one patient who had used fluoroquinolones three times. Conclusion: The use of fluoroquinolones before sputum bacteria examination in tuberculosis patients can reduce the positive rate of sputum bacteria examination and lead to the delay of anti-tuberculosis treatment. Short-term fluoroquinolone therapy in tuberculosis patients generally does not cause gyrA gene mutation. Therefore, caution with fluoroquinolones is recommended in empirical anti-infective therapy in areas with high incidence of tuberculosis.

Professor Wang Deli (1922 – 1993), a tuberculologist, was a native of Liyang County, Jiangsu Province. He was admitted to the National Shanghai Medical College in 1939 and graduated with a Bachelor of Medicine degree in 1945. Then he worked for one year in the Shanghai Aftermath Relief Administration. From 1947 to 1949, he worked as a physician and secretary of Shanghai Lung Disease Center Clinic presided over by Professor Wu Shaoqing, a famous expert on tuberculosis prevention and treatment. In 1950, in response to the call of the Party, he resolutely gave up Shanghai's superior working and living conditions in order to support the old liberated areas, and went to Shandong Province to preside over the establishment of anti-tuberculosis institutions. From site selection, personnel deployment and purchase of instruments and equipment, he personally did everything. He set up the first BCG vaccination team in Shandong Province, and extended the vaccination work from Jinan to the whole province and from cities to rural areas. In April, 1951, Professor Wang Deli became the first director of the Tuberculosis Prevention and Control Institute of Shandong Provincial Department of Health. In the early stage of hard work, there were neither professionals nor teaching materials. Under such circumstances, he presided over the compilation of books such as Lecture Notes on Tuberculosis and Tuberculosis and Common Lung Diseases, trained hundreds of professionals, and changed 11 rehabilitation hospitals and sanatoriums into local and municipal tuberculosis prevention and control centers. He put forward the model of "top-down, top-bottom combination, focusing on counties, establishing three-level tuberculosis prevention networks at counties, communities and teams", which effectively promoted the construction and development of tuberculosis prevention and control organizations in Shandong Province. In the 1960s, he assisted the provincial health department in formulating documents such as "school tuberculosis prevention work plan", "tuberculosis patient management assessment method" and "BCG vaccination routine". By summarizing the tuberculosis prevention work in rural areas, he took the lead in putting forward the comprehensive prevention and control experience of "net, check, management, treatment and card" in China, which played a guiding and promoting role in the prevention and control of tuberculosis in Shandong Province and even the whole country. Referring to the experience of intermittent chemotherapy and application of thiosemicarbazid abroad, he carried out an observational study of daily therapy with isoniazid and thiosemicarbazid and 5-day intermittent treatment of rural tuberculosis patients, so that the negative conversion rate of sputum bacteria in patients with bacterial tuberculosis treated at the beginning of 6 months reached 63.5% ~69.5%.

With the industrialization of society, the aging of population, the change of nutritional structure, the development of organ transplantation and the prevalence of some diseases, the distribution and structure of human disease spectrum are quietly changing, and the same is true of tuberculosis. Some diseases can contain, influence and coexist with tuberculosis, which increases the risk of MTB infection, increases the probability of tuberculosis, and can interfere with the treatment of tuberculosis, thus increasing the difficulty of tuberculosis prevention and control. These diseases are tuberculosis-related diseases, mainly including acquired immunodeficiency syndrome (AIDS), diabetes and pneumoconiosis^[1]The influence of this type of disease on the occurrence, diagnosis and treatment of tuberculosis is mainly manifested in the following aspects.

China is a country with a high burden of tuberculosis in the world. Therefore, when clinicians find that the patient's sputum smear is positive for acid-fast bacilli, and there are corresponding clinical manifestations and imaging changes, they are often diagnosed as smear-positive pulmonary tuberculosis and take corresponding treatment. However, the curative effect is not good for some patients, and the sputum bacteria continue to be positive. At this time, in addition to considering factors such as whether the treatment plan is reasonable, the patient's poor compliance, primary or secondary drug resistance, etc., it is also necessary to consider the possibility of non-tuberculous Mycobacterium (NTM) lung disease, which is a problem worthy of attention for tuberculosis departments and even respiratory doctors.

Silicosis (also known as silicosis, formerly known as silicosis) is a permanent lung tissue scarring caused by inhalation of silicon (quartz) dust^[1]。 Silicosis and pulmonary tuberculosis are two different lung diseases, but they are closely related. Patients with silicosis are susceptible to pulmonary tuberculosis^[2,3,4]。 After silicosis complicated with pulmonary tuberculosis, the tissue reaction caused by the synergistic action of silica dust and MTB in patients is very complicated. Its pathological changes, clinical manifestations and imaging features are different from those of simple silicosis and simple pulmonary tuberculosis. It is a special type of two diseases coexisting with each other. Clinically, it is classified as silicosis (formerly known as silicosis)^[5,6,7]。 Because silicosis tuberculosis is two diseases co-existing, mutually influencing and promoting each other, the disease progresses rapidly, the clinical manifestations are complex, the diagnosis and treatment are difficult, and the prognosis is also poor^[5,6,7]。

Invasive pulmonary aspergillosis (IPA) is a common opportunistic infection in patients with hematological malignancies or severe immunosuppression. Continuous serum galactomannan (GM) detection can be used for early diagnosis of IPA in this population. Recent research results suggest that severe COPD patients admitted to ICU are at high risk of IPA. In this population, IPA is often difficult to distinguish from common bacterial infections, difficult to diagnose and extremely high mortality rate. Early diagnosis and timely initiation of treatment are extremely important to improve the prognosis of patients with severe COPD complicated with IPA. GM detection can also be used as one of the indicators to evaluate the prognosis of patients with hematological malignancies. In this study, a single-center prospective cohort study was used to evaluate the diagnostic and prognostic value of continuous serum GM testing in patients with severe COPD complicated with IPA admitted to ICU.

Microfluidic chip system is an efficient microanalysis system developed at the end of the 20th century. It can integrate research methods such as sample preparation, liquid separation, biological and chemical reaction detection, cell culture and protein analysis. It has the characteristics of high throughput detection. In recent years, it has been gradually applied in many fields such as chemistry, drug screening and environmental detection, but it is rarely applied in medical and molecular biology research. In this study, this microfluidic chip system was used to analyze the role of intracellular glucose regulatory protein 78 (GRP78) in the chemotherapy resistance of human lung squamous cell carcinoma.

Extensively drug-resistant tuberculosis (XDR-TB) refers to the MTB infected by tuberculosis patients confirmed by in vitro tests to be resistant to at least isoniazid and rifampicin among first-line anti-tuberculosis drugs, but also to any injectable drugs of kanamycin, amikacin and capreomycin and any fluoroquinolones of ofloxacin, levofloxacin and moxifloxacin. China is one of the 22 countries with a high burden of tuberculosis in the world and one of the 27 countries with a high burden of multidrug-resistant/extensively drug-resistant tuberculosis (MDR – TB/XDR – TB). In order to understand some of the situation of XDR-TB in China, we performed a retrospective analysis of culture-confirmed multidrug-resistant tuberculosis (MDR-TB) patients in Shanghai Pulmonary Hospital from January 2008 to June 2009.

It is estimated that there are 120,000 new cases of multidrug resistant tuberculosis (MDR-TB) in my country every year, ranking second in the world^[1]。 The main cause of MDR-TB is irregular chemotherapy, which is characterized by long-term treatment, high treatment cost, high toxicity and side effects, poor chemotherapy effect, low cure rate, high recurrence rate and mortality rate. In order to prevent the spread of MDR-TB lesions and protect the normal lung tissue, the opportunity of surgery should be grasped in time^[2]。 Surgery can reduce the drug-resistant bacterial load, thereby shortening and simplifying drug treatment regimens. Since MDR-TB is mostly sputum-positive, surgery can immediately eliminate the source of infection and cut off the spread of drug-resistant MTB. The overall cure rate of MDR-TB was approximately 62% and the case fatality rate was approximately 11%^[3]Surgical intervention was positively associated with prognosis. The literature reported that 26.2% of the 252 patients with MDR-TB required surgical treatment^[4]； MDR-TB accounted for 17.6% of 199 patients undergoing pulmonary tuberculosis operation^[5]； Among the surgically treated patients, the oldest age was 78 years^[6]Minimum 2 years old^[7]Among them, men account for about 56% to 87%, and women account for about 13% to 44%^{[4,7,8,9,10,11]}。

venous thromboembolism (VTE) mainly includes deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE). It is a disease with high morbidity, mortality, disability and recurrence rate involved by genetic factors and environmental factors^[1,2,3]Therefore, constantly exploring and clarifying its risk factors is of great significance for early identification of high-risk patients and disease prevention.

At present, the diagnosis, evaluation and treatment of COPD are facing difficulties. On the one hand, COPD is defined as an incompletely reversible airflow restriction disease, and treatment is directed according to the severity of airflow restriction^[1]； On the other hand, COPD is a multisystem disease with lung and multiple extrapulmonary effects. Therefore, patients have obvious heterogeneity in clinical manifestations, physiology, imaging, response to treatment, rate of lung function decline and death. It is currently generally accepted that FEV₁itself cannot fully reflect the complexity of the disease, nor can FEV be used alone₁As a means of diagnosis, assessment and treatment of diseases^[2,3]But there is currently no alternative standard. An effective way to solve this problem is to identify and group important components of COPD syndrome into subgroups (i.e. phenotypes) that can reflect the prognosis of the disease and guide the treatment of patients^[4,5]。

exposure to tobacco smoke (ETS) can lead to a variety of tumors and cardiovascular diseases, and even death. World Health Organization (WHO) Report 2009^[1]More than 5 million people die each year from illnesses caused by smoking. 1981 Kjellman^[2]First time inLancetThe article in the magazine pointed out that tobacco smoke may cause the body's allergic state to increase. Since then, the research on the correlation between ETS and allergic diseases has gradually increased, but the relationship between the two is still unclear. At present, the research mainly focuses on the effects of smoking on allergic rhinitis, bronchial asthma (asthma) and atopic dermatitis.

In clinical work, imaging findings of mediastinal and pulmonary lymph node enlargement are more common and can be caused by a variety of diseases, so it is very important to clarify the cause of mediastinal and pulmonary lymph node enlargement.

Recently reading the book "Mao Zedong's Last Seven Years of Wind and Rain" (written by Gu Baozi, photographed by Du Xiuxian, published by People's Literature Publishing House), I found that Chairman Mao was actually the pioneer of medical informed consent in China.

With the obvious increase in the incidence of tuberculosis, the number of cases of tuberculous empyema has also increased significantly. Tuberculous empyema has a long course, difficult surgical treatment and many complications. From January 1995 to January 2008, 198 cases of tuberculous empyema were treated by different surgical methods in Beijing Chest Hospital, with good results. The results are reported below.

A 34-year-old male was admitted to the hospital on 28 September 2010 due to "systemic lymph node enlargement, low fever for 11 years and shortness of breath for 4 months after activity". In June 1999, the patient accidentally discovered swelling of submaxillary, cervical, supraclavicular, axillary and inguinal lymph nodes, without local redness, swelling, heat and pain, accompanied by low fever, body temperature 37.2~37.4 ℃, obvious in the afternoon, the local hospital examined the ESR of 130 mm/1 h, gamma globulin increased. Left supraclavicular lymph node biopsy showed "lymph node reactive hyperplasia". After 3 days of treatment with prednisone (20 mg, twice/d), the lymph node shrank and the drug was discontinued. After that, there was no obvious change in the enlarged lymph nodes of the whole body, but there was still low fever, and no further systematic diagnosis and treatment was done. In May 2010, the patient developed shortness of breath after activity, and the symptoms were more obvious after climbing 3 floors, accompanied by mild cough, no expectoration, and was competent for daily life and work. Blood examination routine in the local hospital: white blood cells 5.4×10⁹/L, hemoglobin 65 g/L, platelets 67×10⁹/L; Urine routine: occult blood (+ +), protein (+ +); Blood biochemistry: total blood protein 142.3 g/L, globulin 126.6 g/L, albumin 15.7 g/L, remaining liver and kidney function and electrolyte tests were normal; ESR was 140 mm/1 h; Anti-neutrophil cytoplasmic antibody (ANCA) positive and anti-nuclear antibody (ANA) positive (1:320). On September 13, 2010, high-resolution CT (HRCT) of the chest showed thickening of the bronchial vascular bundles and increased interstitial texture in both lungs; Multiple lobular central nodular shadows with unclear boundaries, multiple cystic bubbles and multifocal ground glass shadows, right middle lobe consolidation (Figure 1，Figure 2)。 The local diagnosis was "interstitial pneumonia complicated with infection", and the effect of anti-infection and symptomatic supportive treatment was not obvious. He came to our hospital on September 28, 2010 for further treatment. During the course of the disease, the patient had dry mouth, no dry eyes, rash, bone pain, joint pain, oral ulcer, vulvar ulcer, etc., no epistaxis, hematuria, blood in the stool, etc. Since the onset of the disease, the patient's spirit and appetite are normal, and his bowel movements are normal. In the past 10 years, he has lost 5 kg of weight. Past history, marriage and childbirth history is not special. Personal history: He had long-term close contact with his sister with "tuberculosis", had smoked for 3 years (4 cigarettes/d), and had no history of keeping pets. Family history: both parents had hypertension, father had hypothyroidism, and both uncles had hyperthyroidism.

Intimal angiosarcoma is a rare malignant mesenchymal tumor originating from the large arteries in the autologous and pulmonary circulation. In the 2002 World Health Organization classification of soft tissue tumors, classified as tumors with no definite differentiation, the incidence of pulmonary intimal sarcoma is twice that of aortic intimal sarcoma. A case of pulmonary intimal sarcoma diagnosed by interventional aspiration in Nanjing First Hospital affiliated to Nanjing Medical University in August 2010 is reported as follows.

The Fifth National Conference on Chronic Obstructive Pulmonary Disease was jointly organized by the Chronic Obstructive Pulmonary Disease Group of the Respiratory Disease Branch of the Chinese Medical Association and the Editorial Board of the Chinese Journal of Tuberculosis and Respiratory Diseases, and co-organized by the Institute of Respiratory Diseases of Zhejiang University, which was held in Hangzhou, Zhejiang Province from April 15 to 18, 2011. Professor Liu Youning, former chairman of Respiratory Disease Branch of Chinese Medical Association, and Professor Wang Chen, chairman of Respiratory Disease Branch of Chinese Medical Association, attended the meeting in person and made important speeches. The conference invited well-known experts and scholars in related majors at home and abroad to give special reports and discussions on the phenotype and clinical manifestations of COPD patients, pulmonary vascular inflammation and pulmonary hypertension in COPD, as well as COPD, OSAHS and cardiovascular complications. The conference also received nearly 100 papers, and more than 400 medical staff from all over the country who have been engaged in basic and clinical research on COPD for a long time attended the conference.

The third activity of Beijing Young Respiratory Scholars Salon in 2011 was held in Chinese Medical Association on April 28th, 2011, mainly to discuss the diagnosis and treatment of tuberculosis. This salon activity was presided over by Chen Xiaoyou, deputy chief physician of Beijing Chest Hospital affiliated to Capital Medical University.

Professor Liu Youning, the editor-in-chief, has been involved in the review of this journal for more than 20 years. During the long-term review work, he experienced the leap of quality and quantity of magazine manuscripts, and also found common problems in manuscripts. In order to encourage the authors to contribute enthusiastically and improve the publication rate, he briefly described the common problems of manuscripts in the essay of the editor-in-chief, aiming at giving some useful advice to the authors before writing and setting up the topic, which is worth reading.