2012年 · 第35卷第02期

As of 2011, there were more than 300,000 medical papers on AIDS and the human immunodeficiency virus (HIV), and by 2009, the number of deaths from AIDS worldwide had exceeded 30 million. By the end of September 2011, China has reported a total of 429,000 cases of HIV infection and AIDS patients. If undetected and unreported cases are added, the total number is estimated to reach 780,000 cases. The data is shocking! So, do you know who reported the first AIDS case in the world and what journal the article was published in?

I have read "A Case and Literature Review of Bronchioloalveolar Cell Carcinoma with Ten Years of Natural Growth" published in your journal, Issue 11, 2011.^[1]After the article, I was deeply puzzled. Because at the beginning of 2011, a big move in the field of international lung cancer was that the International Society for Lung Cancer Research, the American Thoracic Society and the European Respiratory Society (LASLC/ATS/ERS) jointly issued a new standard for multidisciplinary classification and diagnosis of lung adenocarcinoma. For the first time, it was proposed that the names of bronchioloalveolar cell carcinoma (BAC) and mixed adenocarcinoma should not be used, but adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) should be replaced, requiring a comprehensive and detailed histological diagnosis for MIA. The discarding of the diagnostic name BAC is due to the ongoing controversy regarding the classification of BAC, and the wide variation in tumor imaging findings, clinical management and prognosis of BAC. The new classification recommends that when the adenocarcinoma shadow is completely ground-glass nodules (GGN) or partially nodules with ground-glass components are predominant, the term BAC should no longer be used, but new terms should be used for classification, such as AIS, MIA and predominantly mural adenocarcinoma (LPA); For BACs previously classified as mucinous, it is recommended to classify them separately from non-mucinous adenocarcinomas and separately as invasive mucinous adenocarcinomas.

First of all, I would like to thank readers Ren Shaohua for their letters and guidance on this article. Because the article was initially submitted in September 2010, the main references are all documents before that time, and the new classification standard has not been promulgated at this time. In February 2011, the International Lung Cancer FieldJTONew classification criteria for lung cancer, namely the concepts of adenocarcinoma in situ and minimally invasive adenocarcinoma, are proposed in. However, these new concepts have not yet been included in the classification criteria of the World Health Organization.

Tobacco harm is an important public health problem in the world today. Medical staff is the best candidate to help smokers quit smoking. To improve the awareness of tobacco harm, we should start with every small thing^[1]。

Thank you very much to Zhu Weihua, Department of Respiratory Medicine, Guangzhou 12th People's Hospital, and Dr. Chen Rongchang, Guangzhou Institute of Respiratory Diseases, for their attention to this journal. Their suggestions are very pertinent and have played a good role in suggesting the quality of editorial work of this journal. Therefore, since 2012, all the contents involving tobacco control in this journal have been uniformly expressed by the term "tobacco smoke". At the same time, we also hope that authors will pay attention to it when submitting manuscripts.

In recent years, tyrosine kinase inhibitors (TKIs) targeting epidermal growth factor receptor (EGFR) have become a milestone in the treatment of non-small cell lung cancer (NSCLC). However, the efficacy for EGFR-negative patients is poor, and some cases have acquired drug resistance. Therefore, finding new molecular targets has become a key issue in the treatment of NSCLC. Echinoderm microtubule binding protein 4-anaplastic lymphoma kinase (anaplastic lymphoma kinase with the echinoderm microtubule-associated protein-like 4, EML4-ALK) It is a novel fusion gene found in lung cancer patients, which does not coexist with EGFR and v-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations, and lung cancer patients containing this fusion gene have specific clinical characteristics, suggesting that this gene is a molecular marker with high specificity for lung cancer. In addition, the results of phase II clinical trials show that ALK-TKI has a significant anti-tumor effect on EML4-ALK-positive NSCLC patients. Based on the above two points, EML4-ALK may become another molecular target after EGFR, and its molecular characteristics, clinical characteristics, detection methods and clinical trials have attracted widespread attention. The contents of EML4-ALK fusion gene are summarized as follows.

The ninth edition of the American College of Chest Physicians (ACCP) revised guidelines for venous thromboembolic disease (VTE) is forthcoming. Under the influence of the previous 8 editions of the guidelines, clinicians have learned more about the clinical significance of VTE^[1,2]。 Several important new developments in clinical studies of VTE are summarized below, including new ideas for the diagnosis of VTE in outpatients, the significance of superfacial venous thrombosis (SVT), the anticoagulant effect of new fixed-dose oral non-vitamin K antagonists, the study of thrombolytic treatment of pulmonary embolism (PE) with halved dose of alteplase, and the management of long-term anticoagulation and heparin-induced thrombocytopenia (HIT) after inferior vena cava filter implantation. These developments may be reflected in the revision of the new ACCP guidelines.

Respiratory viral infectious diseases are one of the most common clinical diseases, with complex etiology and large virus variability, which can easily cause outbreaks in the population. There are more than 100~200 kinds of viruses that can cause respiratory infection, including RNA virus and DNA virus. The most common pathogenic viruses include influenza virus, parainfluenza virus, respiratory syncytial virus, adenovirus, rhinovirus and coronavirus. Infections such as boca virus, measles virus, chickenpox-herpes virus, and cytomegalovirus are relatively rare. In recent years, some different kinds of new highly pathogenic viruses mainly infect the respiratory tract, such as severe acute respiratory syndrome coronavirus, H5N1 human avian influenza virus and the new H1N1 influenza virus in 2009, have appeared continuously. In addition, the aging of social population, organ transplantation, the application of immunosuppressants in immune-related diseases, the increasing incidence of human acquired immunodeficiency syndrome and the accumulation of the number of patients, etc., make the incidence of new or recurrent respiratory viral infections increasing, and the mortality rate caused by some viral infections is extremely high. Therefore, this type of disease has become a public health problem that cannot be ignored. The antiviral drugs commonly used and under study are reviewed as follows.

In 2011, the International Society for Lung Cancer Research (IASLC), ATS and ERS jointlyJ Thorac OncolThe International Multidisciplinary Classification of Lung Adenocarcinoma (New Classification) was published in^[1]。 The new classification proposes for the first time classification methods suitable for surgical resection specimens, small biopsy and cytology respectively. The name of bronchioloalveolar carcinoma (BAC) is no longer used, the name of adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) are added, and a comprehensive and detailed histological diagnosis model for invasive adenocarcinoma is advocated. The new classification is parsed below.

In April 2009, new cases of influenza A (H1N1) appeared in North America and spread widely all over the world. Severe cases and deaths continued to appear in China in the winter and spring of 2009-2010 and 2010-2011. The clinical characteristics and diagnosis and treatment process of 12 critically ill and dead patients with new influenza A (H1N1) admitted to the isolation ward and respiratory ICU of Beijing Chaoyang Hospital are reported as follows.

Gram-negative bacilli have always been the main pathogens of clinical infectious diseases. Recently, with the widespread application of broad-spectrum antibiotics, especially β-lactam drugs, the number of extended-spectrum β-lactamase (ESBL) -producing strains has increased rapidly under the pressure of selection. Plasmid-mediated cephalosporinase (AmpC) -producing strains have been found successively, indicating that their drug resistance genes can spread among different bacteria, which brings great difficulties to clinical anti-infection treatment^[1,2]。 Ceftialide is a fourth-generation new broad-spectrum antibiotic launched in Japan in 1998. Its special zwitterionic structure and high β-lactamase stability make it have strong antibacterial activity. In recent years, the dosage of ceftialide in China has gradually increased. In order to better understand its antibacterial activity, this study collected 383 common pathogenic bacteria isolated from the General Hospital of the People's Liberation Army and the First Affiliated Hospital of Henan University of Science and Technology in recent 2 years, and compared the antibacterial activity of 11 antibacterial drugs such as ceftialide in vitro, so as to provide a basis for the selection of clinical anti-infective drugs.

COPD is a common disease that seriously endangers human health. Its main pathological characteristics are incompletely reversible and progressive airflow restriction. Tobacco contains more than 4,000 chemicals and is one of the main culprits causing COPD. We found in previous studies that excessive endoplasmic reticulum stress can initiate apoptosis^[1]。 glucose regulated protein 78 (GRP78) and growth arrest-and DNA damage-inducible gene 153 (C/EBP homologous protein/growth arrest-and DNA damage-inducible gene 153, CHOP/GADD153) Significantly increased expression are two classical markers of endoplasmic reticulum stress^[2,3]。 Under endoplasmic reticulum stress, CHOP is an important signaling molecule that switches from resisting apoptosis to promoting apoptosis^[3,4]。 heme oxygenase-1 (HO-1) is a widespread antioxidant enzyme with anti-inflammatory, anti-oxidant, anti-apoptotic and anti-proliferative cytoprotective effects. When cigarette smoking extract (CSE) acts on human bronchial epithelial cells, induces endoplasmic reticulum stress and leads to apoptosis, it is still unclear whether it can exert anti-apoptotic effect by inducing the increase of HO-1 expression, and whether this anti-apoptotic effect can be achieved by downregulating CHOP. This study aimed to investigate the role of endoplasmic reticulum stress in CSE-induced apoptosis of bronchial epithelial cells.

Erlotinib is a human type I epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor. Its most common adverse reactions are rash and diarrhea (>20%), and ocular adverse reactions are rare. This paper reports a case of abnormal eyelash growth in a patient with lung cancer treated with erlotinib in Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine.

The patient was a 37-year-old male, businessman. In April 2008, episodic wheezing occurred without obvious trigger, and it was accompanied by stridor in severe cases, which occurred 4 to 5 times a day, each time lasting for about 15 minutes. The pulmonary function examination in the respiratory department of the local hospital showed a positive bronchial challenge test, and the diagnosis was "bronchial asthma". After treatment with "salmeterol fluticasone", "salbutamol" and other inhalants, the frequency of attacks was significantly reduced.

Aspergillus (aspergillus) Widely exists in nature, due to the difference of immune state, lung structural basis and spore inhalation, leading to different clinical manifestations of pulmonary aspergillosis. Clinically, pulmonary aspergillosis is usually divided into allergic bronchopulmonary aspergillosis (ABPA), invasive pulmonary aspergillosis (IPA) and aspergilloma (fungal ball).^[1]。 chronic necrotizing pulmonary aspergillosis (CNPA), also known as semi-invasive pulmonary aspergillosis, was developed by Gefter et al. in the 1980s^[2]And Binder et al.^[3]First reported. Currently considered to be a localized invasive pulmonary aspergillosis, it often occurs in patients with pre-existing underlying lung diseases, such as pneumoconiosis, COPD, lung cancer, tuberculosis, patients after lobectomy, cystic fibrosis or mild immunodeficiency, such as long-term glucocorticoid use, diabetes, alcoholism, advanced age, malnutrition and chronic granuloma^[1,3]。 Three cases of CNPA without underlying disease and immunodeficiency were reported.

pulmonary veno-occlusive disease (PVOD) is a rare occlusive disease of pulmonary retrocapillary venules and/or venules with pulmonary arterial hypertension. The estimated annual incidence rate is 0.1~0.2/100,000^[1]Theoretically, there should be more patients in China, but there are fewer domestic reports that can be retrieved at present^[2,3]。 A patient with suspicious PVOD was admitted to Drum Tower Hospital affiliated to Nanjing University School of Medicine. The clinical characteristics and outcome were consistent with those reported in the literature. The pathological results of TBLB specimens supported the diagnosis of PVOD. Now, the clinical and pathological characteristics of PVOD were reviewed in combination with the literature reports, so as to improve the clinical understanding of PVOD and avoid misdiagnosis and mistreatment.

In March 2011, the first evidence-based medicine-based guidelines for the diagnosis and treatment of idiopathic pulmonary fibrosis (IPF), jointly developed by ATS, ERS, Japan Respiratory Society (JRS) and Latin American Thoracic Society (ALAT), were officially promulgated^[1]。 A Chinese abstract translation of the guide was published in the Chinese Journal of Tuberculosis and Respiration, Issue 7, 2011^[2]。 The new guidelines introduce in detail the definition, epidemiology, risk factors, diagnosis, natural history, staging and prognosis, treatment and disease process monitoring, and future research directions of IPF, which fully reflect the new understanding of IPF today, and are of great significance for guiding the clinical diagnosis and treatment of IPF in China and promoting IPF research. Combined with the current status of clinical diagnosis and treatment of IPF in China, the author thinks that the following aspects deserve our attention and consideration.

Instruments for measuring lung function are collectively referred to as lung function tester, referred to as lung function meter for short, including spirometer, plethysmograph and pulse oscillator. According to the measurement method, the pulmonary function parameters can be divided into direct measurement parameters and indirect measurement parameters. The former can be directly measured by closed pneumometer or flowmeter. The amount of the subject's respiratory volume is the volume, including static volume parameters such as tidal volume (VT), supplementary inspiratory volume (IRV), deep inspiratory volume (IC), supplementary expiratory volume (ERV), vital capacity (VC), FVC and FEV₁Various dynamic volume parameters that reflect ventilation function; The speed at which the breath volume enters and exits is displayed as the flow rate. However, some parameters cannot be directly measured by exhalation or inspiration, such as residual gas volume (RV), functional residual gas volume (FRC) containing RV, and total lung volume (TLC), which need to be indirectly measured by gas analysis. Carbon monoxide dispersion amount (D_LCO) and the diffusion of carbon monoxide per liter of alveolar volume (D_LCO/V_A) also requires indirect assays.

In recent years, a long-term follow-up study in the field of diabetes in China has caused a huge sensation in the medical circles at home and abroad. The simple process of this matter is as follows: in the mid-1980s, Professor Pan Xiaoren and a famous American diabetes expert jointly launched an investigation in China on whether lifestyle intervention can prevent diabetes in high-risk groups. Professor Hu Yinghua's team of Daqing Oilfield General Hospital participated in the specific implementation. The study screened 110 660 people in Daqing area who were suitable for enrollment age, and performed glucose tolerance test on 3956 of them. It was found that 577 people had no diabetes but only impaired glucose tolerance. Then, they were divided into groups for 6 years of diet and/or exercise intervention. The results showed that lifestyle intervention reduced the risk of diabetes by 51%. On this basis, Professor Li Guangwei led the research group to continue the follow-up, and found that this intervention effect still existed after the intervention, which could last for more than 14 years. During the 20 years of follow-up, the risk of diabetes was reduced by 43%. The time of diabetes in the intervention group was 3.6 years later than that in the control group, while 93% of the people in the high-risk group (abnormal glucose tolerance) without intervention developed diabetes in 20 years. Two studies have been published inDiabetes CareAndLancet^[1,2]The results of this "Daqing" study are well known in the diabetology community.

The incidence and mortality of lung cancer rank first among all kinds of malignant tumors, and it is still on the rise. Global cancer statistics for 2011 show^[1]Lung cancer accounts for 13% of new cancer patients worldwide, about 1.6 million people, and lung cancer accounts for 23% of death patients, about 1.4 million people. Due to the lack of specific symptoms in the early stage of lung cancer, most patients were advanced at the time of consultation, and the overall 5-year survival rate<15%^[2]。 However, patients with early lung cancer, such as stage I non-small cell lung cancer (NSCLC), have a 5-year survival rate of 90% after receiving effective treatment^[3]Therefore, early diagnosis is of great significance to improve the prognosis of lung cancer patients. The methods and progress of early diagnosis of lung cancer in recent years are introduced as follows.

According to the latest data released by the World Health Organization in September 2011, the incidence and mortality rate of lung cancer is the highest among all types of malignant tumors worldwide, and the number of deaths caused by lung cancer exceeds the combined number of deaths from breast, prostate and colorectal cancers, which has become a serious public health problem^[1,2,3]。 In-depth understanding of the epidemiological characteristics of lung cancer is the basis for understanding its causes, realizing early diagnosis and treatment, and then reducing the incidence and mortality of lung cancer.

Lung cancer, as a malignant tumor with the highest morbidity and mortality rate in the world, has been attracting much attention. In the past decade, with the change of smoking cessation and lifestyle habits, the incidence of lung cancer in men has gradually reached a platform and even begun to show a downward trend. However, the incidence of lung cancer in women has risen rapidly, and its peak is expected to appear in 2020. This growth trend is called an "epidemic of the times", so female lung cancer has gradually gained attention.

After 4 to 6 courses of platinum-containing dual-drug combination chemotherapy in the first line of advanced non-small cell lung cancer (NSCLC), whether to "observe and wait" to get a "chemotherapy vacation" or to adopt a more active strategy (maintenance therapy) has been a controversial topic in recent years. Some scholars worry that maintenance therapy may lead to overtreatment, which will not only not benefit patients, but will increase the toxicity and adverse reactions of chemotherapy.

Taking the clinical research and application of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) as an opportunity, the treatment of advanced non-small-cell lung cancer (NSCLC) has entered the era of individualized and targeted therapy, among which crizotinib, an inhibitor of EGFR-TKI and echinoderm microtubule binding protein 4-anaplastic lymphoma kinase (EML4-ALK) fusion gene, is the most exciting. The two drugs have clear targets and definite curative effects, which can significantly improve the survival of patients with EGFR-sensitive mutations and EML4-ALK fusion.

Lung cancer is one of the malignant tumors with the highest morbidity and mortality rate in the world. In many countries (including China), lung adenocarcinoma has become the most common histological type. Lung adenocarcinoma has obvious heterogeneity in clinical, imaging, molecular biology and pathology. With the deepening of research on lung adenocarcinoma, especially the application of molecular biology and targeted therapy, the classification of lung adenocarcinoma in the past has been unable to adapt to the current development, and it is urgent to unify the classification of lung adenocarcinoma. In this context, in February 2011, the International Society for Lung Cancer Research (IASLC), ATS and ERS jointly published the International Multidisciplinary Classification of Lung Adenocarcinoma (hereinafter referred to as the New Classification)^[1]。 The new classification is jointly involved in clinical, radiological, molecular biology and pathology, changing the tradition of mainly involved pathologists in the past, and combining the latest progress in various aspects of lung adenocarcinoma in recent years, the classification of lung adenocarcinoma has been significantly improved, such as abandoning the name "bronchioloalveolar carcinoma (BAC)", and putting forward the concept of in situ adenocarcinoma and minimally invasive adenocarcinoma for the first time, as well as the treatment principles of small biopsy, cytological specimens, immunohistochemistry and molecular biology detection. The clinical application of the new classification is imperative and just around the corner. Some hospitals are already experimenting with it, and its application will be reflected in future pathology reports, and will affect the choice of treatment and the judgment of prognosis. The main changes in the new classification and their clinical significance are briefly introduced below.

According to the latest data released by the World Health Organization in September 2011, the incidence and mortality rate of lung cancer in the world rank first among all kinds of malignant tumors, and the number of deaths due to lung cancer exceeds the combined number of deaths from breast cancer, prostate cancer and colorectal cancer, which has become a serious public health problem. In order to keep respiratory doctors abreast of the latest advances in the epidemiology, early diagnosis and treatment of lung cancer, this issue focuses on lung cancer, and invites several experts to write special written talks.