2012年 · 第35卷第01期

The New Year's bell is about to ring, and the wheel of time has left another deep mark. Basked in the warm winter sun, 2012 arrived as promised. Time passes, the world is changing, people and things in the world are changing, but the only thing that remains unchanged is our gratitude and gratitude to the authors, readers and people from all walks of life who have accompanied this journal for 58 years. It is your strong support that this journal has achieved today's achievements and academic status. In this beautiful moment of farewell to the old and welcoming the new, all members of the editorial department of this magazine sincerely wish everyone a happy new year and good health!

OSAHS is a common and frequently-occurring disease, and it is also one of the hot spots of respiratory disease research in recent years. The prevalence rate of adults is as high as 4%, and the prevalence rate of people over 60 years old is as high as 20% ~40%. Its pathophysiological characteristics are that during sleep, due to the increase of airway collapse, the upper airway is partially or completely obstructed and the airflow is limited, resulting in repeated intermittent hypoxia, carbon dioxide retention and sleep fragments, which in turn leads to neuromodulation imbalance, endocrine dysfunction, hemodynamic changes and microcirculation abnormalities, and finally leads to multi-system organ function damage, which causes great harm to health and life, and seriously affects the quality of life and lifespan of patients. It has been confirmed that OSAHS is one of the independent risk factors of many systemic diseases, so actively treating OSAHS is particularly important.

In the past 20 years, sleep respiratory diseases in China have developed rapidly. Because of the wide spectrum and large proportion of sleep respiratory diseases among various sleep diseases, sleep respiratory laboratories have been established in various places. However, sleep respiratory diseases are special and harmful, with high risks in the diagnosis and treatment process, and higher requirements for the professional quality of monitoring personnel. Therefore, it is necessary to formulate corresponding sleep respiratory experiment establishment and personnel training norms.

The "Guidelines for Diagnosis and Treatment of Obstructive Sleep Apnea Hypopnea Syndrome" (hereinafter referred to as the Draft Guidelines) formulated in 2002 has effectively standardized and promoted the clinical and scientific research of sleep apnea diseases in China^[1]。 In recent years, with the deepening of the pathophysiology, clinical research and epidemiological investigation of OSAHS^{[2,3,4,5,6,7,8,9]}The emergence of new diagnosis and treatment technologies and the formulation of new international standards, and the revision of the imperfect parts of the original diagnostic standards^[3]It is imperative to formulate new guidelines for the diagnosis and treatment of OSAHS that can be in line with international standards and in line with China's national conditions. On the basis of repeated discussions and extensive consultations with experts from all over the country, the draft guidelines developed in 2002 are being modified as necessary to accommodate the new situation^[10]To further standardize the clinical diagnosis and treatment of OSAHS.

Current research results show that patients with bronchial asthma (asthma for short) may have adrenaline release dysfunction, resulting in low adrenaline levels in the body, which makes it difficult to effectively relieve bronchospasm caused by asthma. The appearance of this pathophysiological phenomenon may be closely related to the following mechanisms: the expression of nerve growth factor (NGF) in asthmatic patients is too high, which induces the tendency of neuronal transformation in adrenal medullary chromaffin cells, thus damaging the endocrine function of chromaffin cells and reducing adrenaline secretion. In this study, a rat model of asthma in pregnancy was established by ovalbumin (OVA) sensitization and challenge, and the model was intervened with NGF and its antibody to observe the phenotypic transformation of adrenal medulla chromaffin cells in offspring rats.

With the concern and support of the leaders and readers of Chinese Medical Association Magazine, 12 articles have been successfully published in the "Editor-in-Chief Essays" column of this journal in the past year. Because of the limitation of my knowledge and consciousness level, there will inevitably be inappropriate points in the article. Please criticize and forgive the readers.

The diagnosis and treatment of obstructive sleep apnea syndrome (OSAS) has been carried out in China for more than 30 years, and it has been rapidly developed and popularized in the past decade. According to incomplete statistics, there are more than 900 hospitals with OSAS diagnosis and treatment conditions in China, which can provide timely diagnosis and treatment for hundreds of thousands of patients. China has the largest OSAS patient population in the world. Even according to relatively strict diagnostic criteria, the number of patients is estimated to reach about 30 million. In fact, the high-risk population of OSAS far exceeds this number. How to ensure that such a large group of patients can get scientific, reasonable and standardized diagnosis and treatment is a major event to ensure that patients are protected from OSAS harm and improve the quality of life of patients. Therefore, in 2002, the Sleep Apnea Group of Respiratory Disease Branch of Chinese Medical Association organized and formulated the first "Guidelines for Diagnosis and Treatment of Obstructive Sleep Apnea Syndrome" in China^[1]This guideline has played a very good role in guiding and regulating the past clinical and research work, and its citation frequency has reached 810 times, ranking first among the domestic respiratory disease guidelines, reflecting the demand of clinical and research work for "guidelines" and the willingness of colleagues to follow the guidelines well.

There is a Chinese idiom called "Wu Niu panting for the moon", which comes from the fourth quotation of "Customs Tong" in "Taiping Yulan": "Wu Niu panting when he looks at the moon, and he suffers from the sun, and he is terrified and panting when he sees the moon". Li Bai once said in a poem: "When Wu Niu gasps for the moon, why do you bother with a tugboat?" Wu Niu refers to the buffalo in the Jianghuai area at that time. The weather in Wu was hot. During the day, the buffalo braved the scorching heat to plow in the water, and was often tired and panting. There was no hot sun at night, but when the buffalo saw the bright moon in the sky, he thought the sun was out again, and lay on the ground looking at the moon and panting. This idiom is a metaphor for fear because of suspicion, which is an abnormal psychological phenomenon. Some patients with bronchial asthma (asthma for short) used to smell dichlorovinyl dimethyl phosphate (DDV), which induced asthma, and later wheezed when they saw people holding empty nebulizers without DDV liquid. Some asthma patients hear that pollen can induce asthma, and they are so nervous that they breathe when they see paper flowers. Therefore, doctors should pay attention to the psychological state of patients and pay attention to psychological factors when treating various diseases.

Prof. Jorgen Vestbo, Chairman of the Scientific Committee of the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD), and Prof. Roberto Rodriguez – Roisin, Chairman of the Executive Committee, presented the main modifications to the 2011 edition of GOLD at the 16th Annual Meeting of the Asian and Pacific Respiratory Society in Shanghai on 6 November 2011. The new edition of GOLD provides a clearer picture of the evaluation and disease management of COPD.

Since the new influenza A (H1N1) virus with partial swine influenza genes was first discovered in Mexico in April 2009, the virus quickly caused a worldwide pandemic and became the main epidemic virus in the 2009-2010 influenza epidemic season. According to information released by the World Health Organization (WHO), the new influenza A (H1N1) has circulated in about 213 countries and regions around the world since its outbreak in April 2009 to March 2010, causing at least 17,000 deaths^[1]。

cough variant asthma (CVA) is a special type of bronchial asthma (asthma for short). cough is its only or main clinical manifestation. There are no obvious symptoms or signs such as wheezing and shortness of breath, but there is airway hyperresponsiveness. 1972 Glauser^[1]The CVA was first described and it was considered that there was a group of asthmatic patients whose main manifestation was cough. It is reported that CVA accounts for 24% ~29% of the etiology of chronic cough in Europe and America^[2]The leading cause of chronic cough in Japan (44%)^[3]Domestic studies have reported that CVA can account for 14% to 33% of the causes of chronic cough^[4,5]。 The Respiratory Branch of Chinese Medical Association has formulated guidelines for the diagnosis and treatment of cough^[6]It has played an important role in promoting the standardized diagnosis and treatment of chronic cough. The following is an overview of the new knowledge in the diagnosis and treatment of CVA in recent years.

In the past, the pathogenesis of COPD was mainly based on inflammation theory, protease imbalance theory and oxidative stress. Recent research results show that in addition to the above mechanisms, endoplasmic reticulum stress causes apoptosis of alveolar epithelial cells is also one of the important mechanisms in the pathogenesis of COPD^[1]。 Salubrinal is a useful tool to study endoplasmic reticulum stress. It is a small molecule substance screened from more than 19 000 compounds that can protect mice pheochromocytoma from apoptosis caused by endoplasmic reticulum stress. It can selectively induce eukaryotic translation initiation factor 2 subunit α (eIF2 α) phosphorylation and inhibit its dephosphorylation to protect cells from apoptosis caused by endoplasmic reticulum stress. Salubrinal has been used in the study of many diseases, such as diabetes, leukemia and neurodegenerative diseases^[2,3,4]and will serve as a therapeutic target for the disease. Alveolar epithelial cells of COPD rats induced by lipopolysaccharide and cigarette smoke were studied to observe the protective effect of Salubrinal on apoptosis of alveolar epithelial cells and its possible mechanism.

Bronchial asthma (asthma for short) is a chronic inflammatory disease of the airway involved in a variety of cells, including airway inflammatory cells, structural cells and cellular components^[1]。 Eosinophils (Eos) are key effector cells of airway inflammation in asthma. Insufficient or delayed apoptosis of airway Eos in asthma is one of the causes of massive infiltration of airway Eos. Blocking the IL-13 signaling pathway can significantly improve airway inflammation and reduce airway hyperresponsiveness (AHR). In this study, recombinant IL-13 soluble receptor α 2 (sIL-13R α 2) was used to treat asthma mouse model, and the effects of Eos apoptosis rate and Eotaxin expression in BALF were observed, so as to explore the therapeutic effect and related mechanism of sIL-13R α 2 on asthma.

With the advancement of electronic endoscope and television camera technology, medical thoracoscopy technology has been developing continuously, and has been widely used in clinical practice^[1]。 There have been reports of using medical thoracoscopy to diagnose and treat pleural effusion of unknown origin at home and abroad, but there are few reports of pleural diseases without pleural effusion. The main reason is that the establishment of artificial pneumothorax is still difficult, due to the limitations of instruments, equipment, operation skills and expenses. We used modified pneumothorax to establish artificial pneumothorax in 21 patients who were found to have abnormal pleural thickening or a small amount of pleural effusion by chest CT examination in the respiratory department of Nanfang Hospital of Southern Medical University from November 2009 to November 2010. The pathological diagnosis was obtained by medical thoracoscopy and pleural biopsy. To observe the success rate of artificial pneumothorax and the changes of vital signs during the operation, the purpose is to evaluate its effectiveness, safety and feasibility, and to discuss its application value.

In 2002, the Sleep Respiratory Group of Respiratory Disease Branch of Chinese Medical Association formulated the "Guidelines for Diagnosis and Treatment of Obstructive Sleep Apnea Hypopnea Syndrome", which was published in the Chinese Journal of Tuberculosis and Respiratory Disease^[1]。 The guidance includes the following 12 aspects: (1) OSAHS related terms and their definitions; (2) Main risk factors; (3) Clinical characteristics; (4) Physical examination and routine examination items; (5) main laboratory testing methods; (6) general diagnostic process; (7) diagnosis; (8) simple diagnostic methods and criteria; (9) differential diagnosis; (10) a primary treatment method; (11) follow-up after treatment; (12) Health education. This is the first programmatic document on the diagnosis and treatment of OSAHS in China, which is comprehensive and concise in content. After its publication, it has played a huge role in the comprehensive promotion of the standardized diagnosis and treatment of OSAHS in China. The citation results show that from its official publication to August 2011, it was cited 810 times. Since then, the clinical and scientific research development of sleep respiratory disease at home and abroad has changed with each passing day. In practice, it has gradually been found that many contents in the guidelines need to be revised urgently, including the definition of OSAHS, clinical characteristics, diagnostic methods, disease grading standards, differential diagnosis, strict control of surgical treatment indicators, establishment of efficacy evaluation standards and strengthening health education, etc. It is planned to be further revised when the conditions are ripe^[2]。 In 2009, the American Academy of Sleep Medicine published "Clinical Guidelines for the Assessment, Management, and Long-Term Care of Obstructive Sleep Apnea in Adults."^[3]This guideline fully reflects the latest achievements of clinical scientific research in sleep respiratory diseases abroad in recent years, and provides a good reference for our revision work. Therefore, in February 2011, the Sleep Respiratory Disease Group organized relevant experts to revise the 2002 edition of the Guide on the basis of consulting the relevant literature in Chinese and foreign languages. After drafting and revising the first draft, it was distributed to the relevant experts of the group for extensive opinions, and on this basis, it was initially finalized, and then again to solicit opinions and make additional revisions. Finally, the group discussed and finalized the draft, which is now publicly published^[4]。 In conjunction with the revision of the 2002 edition of the guidelines, two additional related documents were developed, namely, "Expert Consensus on the Clinical Application of Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea Hypopnea Syndrome (Draft)"^[5]And "Recommendations for the Establishment and Management of Sleep Respiratory Disease Laboratories and Personnel Training"^[6]。

Primary benign tracheobronchial tumors are rare in clinical practice. In the past, most patients were treated by thoracotomy due to technical limitations. In recent years, with the advance of bronchoscopic interventional therapy, laser, high-frequency electrical, argon plasma coagulation, freezing, microwave and photodynamic techniques can be used to treat benign endotracheal tumors. Among them, argon plasma coagulation (APC) and cryotherapy have good efficacy and safety, and their clinical applications are increasing day by day. From January 2009 to January 2011, the data of 5 cases diagnosed with benign tracheal and/or bronchial tumors, who received APC combined with cryotherapy and were followed up for more than 1 year in Sir Run Run Shaw Hospital affiliated to Zhejiang University were retrospectively analyzed, and the diagnosis and treatment process were analyzed, so as to explore the application value of APC combined with cryotherapy in benign tracheal tumors.

COPD has become a difficult problem in the global medical community. Its mortality rate is rising faster than any other major cause of death, and it is the only disease among all causes of death whose incidence continues to rise. At present, COPD has surpassed cerebrovascular disease to become the third leading cause of death in the United States^[1]。 It is estimated that the cumulative number of deaths from COPD in China will exceed 65 million from 2003 to 2033^[2]。 As the burden of disease caused by COPD grows, so does our awareness of the extent of its impact and effective management^[3]。 In order to optimize the management of COPD comprehensively, it is necessary to discuss the problems that need attention in COPD. Therefore, we briefly discussed important clinical problems such as intractable dyspnea, pulmonary hypertension and the management of lung cancer in COPD patients.

Routine pulmonary function in adults, including lung volume, ventilation function and carbon monoxide diffusion, can perfectly reflect the existence, nature and severity of airway obstruction, thoracic and lung tissue lesions and other related tissue lesions. Because environmental conditions, region and individual factors can affect the measurement results, standardized correction and predicted value calculation are required. Routine pulmonary function measurements were corrected to physiological conditions (body temperature and pressure, saturated, BTPS), that is, normal body temperature, standard atmospheric pressure and saturated water vapor state. Breathing includes two phases: inspiration and expiration. Unless otherwise specified, it generally refers to the change of expiration phase.

The Keystone Symposium Tuberculosis International Symposium 2011 was held in Vancouver, Canada, from 15 to 20 January 2011. The author summarizes the main contents of the conference as follows.

Time flies, it's another new year, dear readers and authors, Happy New Year!