2011年 · 第34卷第10期

March 18, 2011 is a day worthy of forever remembering by all the publishers and relevant persons of the Chinese Journal of Tuberculosis and Respiration. On this day, the 2nd China Publishing Government Award ceremony was held in Beijing, and the magazine won the China Publishing Government Award Journal Award. The China Publishing Government Award is the highest national award in China's publishing industry. It is selected once every three years. This year is the second time, and the journal award has been set up for the first time. There are nearly 10,000 kinds of publicly issued journals in China. This selection activity lasted for more than 4 months. Finally, 20 journals of the first China Publishing Government Award were awarded from 3,066 eligible participants, including 10 journals of natural science and social science. This journal is the only medical journal among the award-winning journals, and it is fortunate to be on the podium with famous magazines such as Seeking the Truth and Science Bulletin. Under the repeated urging and personal contact of Academician Zhong Nanshan, the former editor-in-chief and current honorary editor-in-chief, this journal held the second working meeting and award-winning celebration of the seventh editorial committee (referred to as the editorial committee) in Fuzhou on May 28th, 2011. Relevant leaders of Chinese Medical Association, surviving editors-in-chief and deputy editors-in-chief, and all editorial members of the current editorial committee were invited to attend this grand event. Professor Zhu Yuanjue, as one of the successive editors-in-chief, is certainly the key invitation target, but because of Professor Zhu's letter^[1]The reasons mentioned in, plus perhaps the more "substantive" reasons guessed by the author (Teacher Lin, who has been with Professor Zhu for decades, is inconvenient to go out due to health reasons, and Professor Zhu may not bear to leave Teacher Lin alone in Beijing) failed to make the trip, so I sent a heartfelt speech to the meeting.

On March 18th, 2011, the 2nd China Publishing Government Award ceremony was held in the conference hall of Beijing Exhibition Hall. The China Publishing Government Award is the highest national award in China's press and publishing industry. This year, the journal award was established for the first time. Among the nearly 10,000 journals in China, only 20 journals won the second China Publishing Government Award, including 10 scientific and technological journals. This journal is the only medical journal to win this honor. On May 28, 2011, this magazine held the 7th editorial committee and award-winning celebration in the beautiful Rongcheng Fuzhou. Luo Ling, Deputy Secretary-General of Chinese Medical Association, You Suning, President and Editor-in-Chief of Chinese Medical Association Magazine, Cai Lifeng, Vice President of the Magazine, Academician Zhong Nanshan, Honorary Editor-in-Chief, Professor Liu Youning, Editor-in-Chief, and Professor Luo Weici, Former Editor-in-Chief, attended the meeting and delivered speeches. It is particularly worth mentioning that Professor Zhu Yuanjue, the former editor-in-chief of this magazine, was unable to attend this celebration for some reason. However, when she heard the good news, she was very happy. She wrote a letter to express her congratulations. The full text is published below, so as to share it with fellow tuberculosis and respiratory circles!

Professor Qian Yijian, a famous expert in cardiovascular diseases and geriatrics in China, honorary president of Beijing Hospital, outstanding member of the Communist Party of China, and outstanding editor-in-chief of Chinese Medical Association series magazines, died in Beijing on July 6, 2011 at the age of 86. In the early morning of July 12th, representatives from all walks of life and editors of Chinese Medical Association series magazines went to Beijing Hospital to bid farewell to Mr. Qian. In the farewell room, wreaths sent by Chinese Medical Association, Chinese Medical Association magazines and many Chinese Medical Association series magazines were placed. On July 21st, Beijing Hospital held a grand symposium in memory of Professor Qian Yijian. Nearly 100 people, including Huang Jiefu, Vice Minister of Health, Lin Jiabin, President of Beijing Hospital, and the author attended the symposium.

influenza (influenza for short) is an acute respiratory infectious disease caused by influenza virus, which is one of the main public health problems faced by human beings. The epidemiological characteristics of influenza are sudden outbreak, rapid spread, causing varying degrees of epidemic, seasonality, high morbidity but low mortality (except human avian influenza, generally only 0.003% ~0.03%). In the past 300 years, there have been at least six influenza pandemics worldwide, including four pandemics in the 20th century, three of which originated in China.

The American College of Clinical Endocrinologists (ACCE) published the latest Guidelines for Comprehensive Treatment of Diabetes (hereinafter referred to as the Guidelines) in 2011, suggesting that clinicians should not only limit themselves to blood sugar control when diagnosing and treating diabetic patients, but should conduct multi-system and multi-organ comprehensive evaluation. The guidelines provide clinicians with the latest work plan, aiming at enabling clinicians to formulate comprehensive treatment plans for the prevention, diagnosis and treatment of diabetes and its complications, so as to improve the prognosis and quality of life of diabetic patients. For the first time, the guidelines put forward that attention should be paid to the diagnosis and treatment of sleep apnea in diabetic patients, indicating that endocrinologists have begun to pay attention to the diagnosis and treatment of sleep apnea. Obstructive sleep apnea is very common in patients with type 2 diabetes. The new guidelines recommend that adults, especially men over 50 years old with type 2 diabetes, should undergo routine screening for obstructive sleep apnea. If obstructive sleep apnea is identified by screening, it should be treated with continuous positive airway pressure (CPAP). The primary screening of obstructive sleep apnea can be performed through medical history and family simple monitoring. It is recommended that patients suspected of obstructive sleep apnea in the primary screening go to sleep-related departments. The guidelines describe the main clinical manifestations and screening, diagnosis and treatment of sleep apnea. It is pointed out that daytime sleepiness is the most obvious clinical manifestation of sleep disorders, which can increase the risk of accidents, and can lead to decline of judgment and abnormal behavior. Sleep deprivation also increases various major risk factors for heart disease. It is gradually recognized that sleep disorders can cause restless leg syndrome, and the treatment of sleep disorders can significantly reduce the symptoms of restless legs. Patients suspected of sleep apnea or restless leg syndrome should see a sleep practitioner for overnight sleep monitoring in a sleep monitoring room. There are also many sleep disorders that can be preliminarily diagnosed through detailed medical history and physical examination.

COPD is a chronic inflammatory disease of the lungs characterized by airflow restriction. Its overall population prevalence is approximately 10% and reaches 50% among smokers. COPD reportedly ranks fourth among the diseases that cause death in industrialized countries and is expected to rise to third by 2020^[1]。 Therefore, COPD has become a public health problem of wide concern worldwide, but its pathogenesis is not fully understood. At present, it is generally believed that smoking is the main cause of COPD. In addition, infection, environmental factors, protease-antiprotease imbalance and oxidation-antioxidation imbalance are all related to the pathogenesis of COPD. The results of recent studies suggest that the occurrence of COPD may be related to autoimmune response, and propose the idea that COPD may be an autoimmune disease. pattern recognition receptors (PRRs) are closely related to the mediation of immune response in COPD. PRRs can link natural immune response and adaptive immune response. By recognizing pathogens and autoantigens, PRRs activate various signaling pathways, induce the production of cytokines and inflammatory mediators, and act together with smoking to exacerbate the disease. We delve into the immune mechanisms of COPD from the perspective of PRRs, which mediate the immune response to COPD.

The prevalence and transmission of drug-resistant MTB are important factors leading to high morbidity and mortality of tuberculosis. The detection of drug-resistant MTB is also a hot and difficult issue in tuberculosis research. At present, the widely used Roche culture drug susceptibility test takes a long time and has poor accuracy. Although the rapid culture system of mycobacteria can shorten the detection time^[1]However, it still takes 4 to 6 weeks, which is far from meeting the needs of clinical diagnosis and treatment. Therefore, there is an urgent need for rapid, sensitive, simple and inexpensive new techniques for drug resistance detection. In recent years, drug resistance phenotype detection and drug resistance molecular detection technology have made great progress in MTB drug resistance detection technology, and have clinical application prospects, which are introduced below.

pulmonary lymphangioleiomyomatosis (PLAM) is a rare diffuse pulmonary disease with unknown pathogenesis. It is common in women of childbearing age and is associated with mutations in tuberous sclerosis (TSC) genes 1 and 2^[1,2,3]。 The disease is characterized by abnormal proliferation of smooth muscle cells (LAM cells) in airways, lymphatic vessels and blood vessels, which eventually leads to the formation of thin-walled sac-like structure in the lung parenchyma, lung function decrease and even respiratory failure, thus endangering the patient's life. Lung transplantation is the only possible effective treatment for medical treatment.

In recent years, the results of studies show that aldose reductase (AR) plays an important role in the inflammatory pathological process of bronchial asthma (asthma for short), and inhibiting AR activity can inhibit the release of inflammatory cytokines and reactive oxygen species (ROS) in inflammatory reaction, thus reducing airway inflammation, reducing airway hyperreactivity and massive secretion of mucus, and preventing the progression of asthma pathological process to some extent.

OSAHS is characterized by repeated complete and/or incomplete obstruction of the upper airway during sleep leading to apnea or hypopnea, and its key pathophysiological link is chronic intermittent hypoxia (CIH). Because of its damage to cardiovascular and cerebrovascular system, it has attracted gradual attention, and has become one of the hot issues in recent years. It is very difficult to establish an ideal animal model of OSAHS. Therefore, the intermittent hypoxia animal model of sleep apnea mode is mostly used in practical research to simulate the periodic hypoxia-reoxygenation process to study the multi-system damage of OSAHS. The main ways to realize CIH are intermittent inhalation of low oxygen mixed gas and intermittent ventilation blocking method. The relevant research and application progress are summarized as follows.

Bronchial asthma (asthma for short) is a very complex phenotypically heterogeneous disease, and its molecular mechanism and susceptibility genes have not been fully understood. orosomucoid 1-like 3 (ORMDL3) gene on chromosome 17 is a gene that has well-documented association with asthma^[1], has become a research hotspot at present. Therefore, in this study, the relationship between the polymorphism of ORMDL3 gene rs7216389 locus and asthma patients and their lung function was discussed in some Han nationality in China, in order to provide theoretical basis for early prevention and treatment of asthma.

The incidence and mortality of lung cancer are high. Traditional treatment methods such as surgery, radiotherapy and chemotherapy have great toxicity and adverse reactions, and the curative effect is not satisfactory. Biological immunotherapy is one of the important methods of lung cancer treatment. Exosomes derived from tumor cells contain tumor antigens and co-stimulatory molecules, which can induce anti-tumor immune response, but their anti-tumor efficacy needs to be further improved. The results show that various cytokines can regulate the secretion and function of exosomes. tumor necrosis factor (TNF) -α is a pleiotropic cytokine, which can inhibit lung cancer, kidney cancer, melanoma and other tumors^[1]However, it is not clear whether TNF-α has an effect on exosomes of lung cancer cells. We investigated the effect of TNF-α on the anti-tumor effect induced by exosomes derived from lung cancer cells, and provided a theoretical basis for the anti-tumor therapy of TNF-α combined with exosome vaccine.

idiopathic pulmonary fibrosis (IPF) is the most common interstitial lung disease, and its pathogenesis is still unclear. At present, the research on the relationship between connective tissue factor (CTGF) and pulmonary fibrosis has increased significantly at home and abroad, but most of them are animal models or in vitro studies, and few studies from human IPF lung tissue. The purpose of this study was to investigate the role of CTGF in the pathogenesis of IPF, and to provide theoretical basis for developing new IPF treatment regimens.

The occurrence of airway remodeling caused by bronchial asthma is closely related to the activation of transforming growth factor (TGF) -β signaling pathway. The biological effects of TGF-β are largely dependent on the degradation of basic signaling molecules in TGF-β/Smad pathway by ubiquitin proteasome pathway. In the above process, the E3 ubiquitin ligases Arkadia and Smurf2 were able to induce ubiquitinated degradation of Smad7, SnoN and Ski. In order to clarify the regulatory effects of Arkadia and Smurf2 on TGF-β signaling pathway in ovin-sensitized rats, a rat model of chronic airway remodeling was established by ovin-sensitized and stimulated methods. Normal human bronchial epithelial cells (NHBEC) were cultured in vitro with TGF-β₁NHBEC was stimulated and pretreated with Arkadia-siRNA, Smurf2-siRNA and protease inhibitor (lactacystin), respectively.

Pulmonary function examination has been widely used in various fields such as respiratory medicine, thoracic and abdominal surgery, orthopedics, hematology, hepatology, endocrinology, environmental medical monitoring, aviation medicine, altitude medicine and occupational disease assessment. Pulmonary ventilation function measurement is the most important and commonly used part of pulmonary function testing. The data of ventilation function measurement results have a great relationship with the cooperation between operators and subjects. The results of the subjects' improper mastery of the methods or the methods taught by the operators differ even if the same person tests^[1]。 I have referred to the schemes of ERS and ATS, and summarized some experience from the usual operation steps, which are reported below.

Refractory pneumonia refers to pneumonia that cannot achieve the therapeutic effect despite the use of appropriate antibacterial drugs^[1]。 According to statistics, 10% ~25% of community-acquired pneumonia cannot be effectively controlled within the expected time^[2]The main reason for this result is that the pathogen is unknown and effective antimicrobial treatment cannot be carried out. Therefore, some scholars^[3]And in the Guide^[4]It is recommended that specimens should be taken before using antibacterial drugs to find pathogens. The clinical situation is that most patients have used a large number of antibacterial drugs before seeing a doctor, and the pathogenic bacteria can hardly be found in the culture. Therefore, although there is no exact definition of refractory pneumonia at present, it is one of the difficult problems in clinical medicine. Therefore, we investigated the value of percutaneous lung puncture in obtaining pneumonia pathogens after the failure of empirical antimicrobial therapy by means of smear, culture and histopathological examination.

polyarteritis nodosa is a focal full-thickness necrotizing vasculitis involving small and medium arteries, which can involve multiple organs, with skin, joints, peripheral nerves, gastrointestinal tract and kidney involvement most frequently, and can lead to arterial thrombosis. The clinical symptoms of chronic thromboembolic pulmonary hypertension (CTPEH) lack specificity, often develop chronically and progressively, and right heart failure may occur in the later stage. Multiple imaging examinations show that the lesions are often in multiple sites and widely distributed, with chronic embolism signs such as adhering to the blood vessel wall in the pulmonary artery, surrounding or eccentrically distributed, and masses with calcification tendency, often combined with deep venous thrombosis of the lower limbs. Echocardiography shows that the thickness of the free wall of the right ventricle is>5 mm, which meets the diagnostic criteria of chronic pulmonary heart disease^[1]。 In order to improve the understanding of polyarteritis nodosa and CTPEH, a case of polyarteritis nodosa complicated with CTPEH improved by anticoagulation and non-invasive mechanical ventilation was reported, and its clinical characteristics were analyzed.

The patient was a 40-year-old male. Two weeks ago, there was no trigger in the left chest tingling with shortness of breath. X-ray chest radiograph showed left pneumothorax with compression of lung tissue of about 80%. X-ray chest examination 4 days after closed thoracic drainage showed pneumothorax resorption and extubation. One week ago, shortness of breath recurred. One day ago, a chest CT was performed in the outpatient clinic of Shunde First People's Hospital affiliated to Southern Medical University, which showed left pleural effusion, and he was admitted to the hospital. Since the onset of the disease, occasional chills, no fever; Occasional cough, no phlegm; Appetite and defecation were normal, and weight was not lost. The patient was born and lived in Shunde. He ate about 2.5 kg of freshwater fish every week for more than 10 years, and had a history of smoking and drinking. Physical examination: body temperature 36.5 ℃, pulse 78 beats/min, breathing 20 beats/min, blood pressure 122/90 mm Hg (1 mm Hg =0.133 kPa). Consciousness was clear, there were no subcutaneous nodules, and there was no swelling of superficial lymph nodes throughout the body. The left lower lung tactile speech tremor was weakened, percussion voices were voiced, breathing sounds were weakened, and dry and wet rales were not heard in both lungs. The heart boundary is not large, the heart rate is 78 beats/min, the rhythm is uniform, no murmur is heard, there is no tenderness in the abdomen, the liver and spleen are not palpable under the costs, and the pathological reflex is not drawn out.

A 72-year-old male suffered from middle esophageal cancer (Figure 1) In September 2009, he underwent surgical resection of esophageal cancer and underwent esophageal-gastric supraarch anastomosis. One month after the operation, the patient choked and coughed with mild dyspnea after ingesting liquid food. Chest CT scan showed that the left main bronchus was communicated with the gastric cavity, and the fistula diameter was about 0.8 cm (Figure 2，Figure 3), confirmed by bedside bronchoscopy and gastroscopy as thoracogastric-left main bronchial fistula (Figure 4)。 On the 15th day after the operation, according to the chest CT scan and measurement, the Y-shaped stent was placed under chest fluoroscopy. The postoperative fluoroscopy showed that the stent expanded well and the position was appropriate (Figure 5), oral contrast medium showed complete closure of the fistula (Figure 6)。 The preoperative American Thoracic Association criteria for evaluation of dyspnea were classified as Grade II^[1]The postoperative improvement was grade 0, and the patient's condition was stable after follow-up.

The 5th event of Beijing Young Respiratory Scholars Salon in 2011 was held on June 30, 2011. This event was hosted by Dong Xiaosong, deputy chief physician of Peking University People's Hospital, with the theme of "Application of glucocorticoids (referred to as hormones) in severe viral pneumonia".

Human understanding of sarcoidosis began in the 1880s. Sarcoidosis was first described by Jonathan Hutchinson in 1887, when one of his patients was seen with skin lesions on the face and limbs. Hutchinson called the disease Mortimer's disease using the patient's surname (Mortimer). In 1889, Besnier of Paris reported a case of a 34-year-old male patient with violet skin lesions on the nose, earlobes and central facial skin. He believed that this skin lesion was a variant type of lupus erythematosus, so he called it "lupus pernio". In 1899, Caesar Boeck first described the characteristic non-caseous granuloma in the lesion of a patient with peripheral lymph node enlargement and skin nodules. He thought that this granulomatous lesion was similar to sarcoma tissue, so he proposed the disease name "multiple benign sarcomatoid changes of the skin". Since then, sarcomatoid lesions of the eye, bone, lung and parotid tissues have been reported one after another, but sarcoidosis, as a systemic disease with the same nature, was not recognized at that time.

After experiencing the global influenza A (H1N1) epidemic in 2009, in order to further improve the understanding of clinical prevention and treatment of influenza (including seasonal influenza and human avian influenza), China urgently needs a guide that can reflect the latest research progress and guide clinical diagnosis and treatment. The "Guidelines for Diagnosis and Treatment of Influenza (2011 Edition)" published in this issue of diagnosis and treatment plan column is a diagnosis and treatment guide suitable for the majority of clinicians in China, which is formulated by the Ministry of Health organizing experts in the research fields of influenza prevention and treatment in China (including etiology, epidemiology, laboratory diagnosis, clinical treatment, traditional Chinese medicine diagnosis and treatment, disease control and prevention, etc.), with reference to the latest research results at home and abroad and the experience of influenza diagnosis and treatment in China. Its main content covers the latest comprehensive information on etiology, epidemiology, clinical manifestations, diagnosis and differential diagnosis, treatment and prevention of influenza, which must be read.