2012年 · 第35卷第06期

Not long ago, on the afternoon of March 23rd, 2012, another martyr of the doctor-patient contradiction, an intern doctor in the Department of Rheumatology and Immunology, the First Affiliated Hospital of Harbin Medical University, was about to go to the University of Hong Kong to study for a doctorate at the age of 28. Wang Hao, who was full of hope and longing for the future, suddenly suffered from misfortune and passed away in a hurry before he even had time to say goodbye to his relatives and friends. And the only "fault" of Wang Hao's brutal murder was that he sat closer to the door, making it easier for the murderer to attack... Similar incidents have been unfolding in the past few years, and there is no sign of ending or decreasing in the foreseeable future. What are Chinese medical workers doing wrong? Why is it not thanks and praise that "saving lives and healing the wounded" gets, but repaying kindness with hatred? The incident of Harbin Medical University and the media's reaction to this incident shocked the author again. Although I was also worried, I finally chose such a topic to show my condolences to the deceased, sympathy for Wang Hao's relatives, and complain about the unfair treatment of medical workers for a long time...

If anyone doesn't know what Simmons bed is, people will curl their lips, which means that anyone doesn't know yet, but seriously, if you want everyone to explain the origin of Simmons and why it's called Simmons, some people may not dare to say anything.

At the 12th Annual Meeting of Respiratory Disease of Chinese Medical Association in 2011, the Interventional Respiratory Disease Group of Respiratory Disease Branch of Chinese Medical Association was formally established, which is undoubtedly a milestone in the development of interventional respiratory disease in China. The establishment of the group embodies the ardent expectations of the older generation of experts in respiratory science, and also carries the care and love of the leaders of the Chinese Medical Association.

Bronchial fistula refers to the pathological state of abnormal passages (fistula or fistula) between trachea, bronchus and thoracic cavity, thoracic cavity, stomach, esophagus and even biliary tract. bronchopleural fistulas (BPF) are the most common. Broadly speaking, pneumothorax is also a kind of bronchopleural fistula. The occurrence of bronchial fistula can prolong the hospital stay, increase the medical expenses and the mortality rate of patients. The results show that the mortality rate of bronchial fistula in patients with non-small cell lung cancer after operation is 27.2%^[1]。 In recent years, with the extensive development of medical technology such as surgery and radiotherapy, the incidence of bronchial fistula after surgery or radiotherapy has increased significantly. In the past, bronchial fistula was mainly treated by conservative treatment or surgery. In recent years, with the rapid development of bronchoscopic interventional technology and related instruments, bronchoscopic interventional treatment has become one of the effective methods for the treatment of bronchial fistula.

Current research results show that long-term low-dose application of macrolides (erythromycin, roxithromycin, clarithromycin) has achieved good results in some chronic pulmonary inflammatory diseases (such as diffuse panbronchiolitis and cystic pulmonary fibrosis). The main mechanism of its action is to inhibit the activation of inflammatory cells and the release of inflammatory mediators and have certain immune regulatory effects. The main pathological feature of COPD is chronic inflammation involving the airway, pulmonary parenchyma and pulmonary vessels, which is clinically manifested as repeated acute exacerbation. In this study, the effect of 6-month erythromycin on airway inflammatory cells and the number of acute exacerbations in patients with COPD was investigated by randomized double-blind control method.

Lower respiratory tract infection is a common infectious disease, which seriously endangers human health. According to the statistics of the World Health Organization, the death rate of lower respiratory tract infections in the world was 6.1% in 2008, ranking third among the ten leading causes of death in humans^[1]。 Common pathogens of lower respiratory tract infections include bacteria, viruses, mycoplasma, chlamydia and parasites. The results show that accurate and reliable diagnosis of pathogens is an important guarantee to effectively control lower respiratory tract infections, improve the cure rate and reduce bacterial drug resistance. However, the pathogenic detection technologies such as bacterial culture and virus isolation that are routinely used in clinical practice generally have shortcomings such as long time consumption and poor sensitivity, which greatly reduces the detection efficiency and is difficult to play an effective guiding role in clinical anti-infection treatment.

microRNA (microRNA) is a kind of highly conserved, endogenous non-coding small RNA, about 20-25 nucleotides in length, widely found in plant, nematode and human cells. It has many kinds, its expression has certain tissue specificity, and it participates in the regulation of gene post-transcription level. In recent years, with the gradual deepening of microRNA research, it has been found that some microRNAs are involved in the occurrence, development and regulation of fibrosis in myocardium, liver, kidney and lung. The production and mechanism of microRNA, its role and potential therapeutic value in the development of idiopathic pulmonary fibrosis (IPF) are reviewed below.

Massive hemoptysis is a common severe respiratory emergency in clinic. Although there are many new hemostatic drugs and intensive care has been widely used, the effect of conservative medical treatment is still very poor, and the mortality rate of patients with asphyxia is 50% ~100%^[1]Although surgery can completely stop bleeding, the mortality rate is still 7.1% ~18.2%, and the mortality rate of emergency surgery is as high as 40%^[2]。 The efficacy of bronchial artery embolization (BAE) in the treatment of massive hemoptysis is positive, and the immediate hemostasis rate is 73% ~98%^[3]。 There are many causes of hemoptysis, bronchiectasis and pulmonary tuberculosis are the two main causes of hemoptysis, and bronchial artery is the main hemorrhagic artery in both of them. However, due to the different causes, there are obvious differences in pathophysiological characteristics and efficacy after BAE. This study retrospectively analyzed 83 patients with bronchiectasis and pulmonary tuberculosis treated with BAE to explore the differences in pathophysiology and prognosis of hemoptysis caused by the two patients.

Acinetobacter baumannii is a common conditional pathogen in clinical practice, and its drug resistance, especially to carbapenem antibiotics, has increased rapidly in recent years^[1]Even strains that are only sensitive to colistin and resistant to all other antibiotics appear^[2]How to effectively treat multi-drug resistant Acinetobacter baumannii has become an important clinical topic at present. allicin, also known as allicin and chemically known as diallyl trisulfide, is a volatile oil extracted from the spherical bulbs of garlic and is the main active ingredient of garlic. In recent years, scholars at home and abroad have conducted many studies on the chemical properties, pharmacological effects and clinical efficacy of allicin, which proved that allicin has strong bactericidal power and wide antibacterial spectrum^[3]。 In this study, the effect of allicin on inhibiting multi-drug resistant Acinetobacter baumannii was preliminarily discussed. The results are reported as follows.

The incidence and mortality of COPD continue to rise, and smoking is the most important environmental risk factor for COPD. However, only 20% of long-term smokers eventually develop COPD patients, suggesting that this may be related to genetic factors. It has been reported in the literature that glutathione S-transferase (GST) variation is one of the main genetic risk factors for COPD^[1]。 We conducted this study to investigate the relationship between GST gene polymorphism and susceptibility to COPD in Kazakh patients in Xinjiang Uygur Autonomous Region.

As COPD progresses, it is inevitable that patients experience reduced exercise endurance^[1]。 Clinical evaluation and pulmonary function tests determined that patients with similar disease severity may have different levels of physical activity, reflecting the complexity of the causes of decreased exercise endurance in COPD patients, with restricted airflow, abnormal metabolic function, respiratory and peripheral skeletal muscle function, nutritional status, and body weight all affecting their exercise endurance^[2]。 Malnutrition and weight loss are one of the characteristics of disease progression in patients with COPD. Patients with moderate to severe COPD are more likely to develop low body weight^[3]。 Body mass index is one of the commonly used measures of human nutritional status, and it is also an independent factor to predict the prognosis of patients with COPD^[4]。 The purpose of this study was to investigate the effect of body mass index on exercise endurance in patients with COPD and its potential mechanism, so as to provide theoretical basis for nutritional support therapy in patients with COPD.

Tuberculous meningitis may have serious consequences^[1], early diagnosis is a key factor affecting patient prognosis^[2]However, there is still a lack of effective methods^[3]。 After MTB infection, autophagocytosis of pathogens by immune cells is an important mechanism of host innate immunity to MTB infection, and it is also an important link in the process of acquired immune antigen presentation, and has potential therapeutic significance^[4]。 To investigate the autophagy process of MTB infection in the central nervous system, we determined the expression of microtubule-associated protein 1 light chain 3 (LC-3) in cerebrospinal fluid of patients with tuberculous meningitis and other types of infection.

A 45-year-old female was seen in July 2011 for "dry cough for 6 months". The patient developed a cough after a "cold" 6 months ago, which was intermittent dry cough without obvious expectoration, without symptoms such as wheezing, chest tightness, chest pain and hemoptysis, and did not receive formal diagnosis and treatment. Recently, I had fever, and my body temperature was as high as 39℃. After out-of-hospital anti-infective treatment (medication unknown), my body temperature dropped to normal, and my cough was slightly relieved. X-ray chest X-ray and chest CT found large patches of high-density shadows of the lungs, so I went to our hospital. Recently, the patient lost about 4 kg of weight. Physical examination: normal growth and development, no deformity in thoracic appearance, no tenderness in chest wall, clear breathing sounds in both lungs, and no dry and wet rales; A 4 cm ×3 cm bone mass can be palpable in the upper part of the right humerus, with a smooth surface, hard texture, no tenderness, and slightly movable. The bone nodule in the lower part of the left femur is about 2 cm ×2 cm in size, and the lower part of the right fibula is enlarged. After asking about the medical history, the patient found a bone nodule the size of a mung bean in the right foot at the age of 2, which grew painlessly and slowly to the size of a peanut. After that, bone masses or nodules appeared in many parts of the whole body (middle right tibia, middle right fibula, upper left tibia, lower left femur, etc.), which was considered as "benign osteoma" by the external hospital. In 1982, the above-mentioned bone neoplasm was removed by surgery, and the pathological examination was "bone tissue". The masses of the lower right fibula, the lateral left lower femur and the upper right humerus were not operated, and there were no signs of growth. Multiple family members in the patient's family have this disease (Figure 1)。 X-ray chest radiograph of the outer hospital showed an elliptical shadow of increased density in the left middle lung field, a diffuse patchy shadow of increased density in the left lower lung field, with unclear boundary, and unclear left heart margin, left diaphragmatic surface and costophragmatic angle (Figure 2)。 Chest CT showed irregular calcification (coral-shaped) in the lower lobe of the left lung, with clear boundary, closely related to the ribs, and the corresponding ribs were abnormal in shape (Figure 3，Figure 4), a "mushroom-shaped" bone neoplasm was seen in the left shoulder blade (Figure 5)。 Based on the medical history, clinical manifestations, imaging features and past history, it was considered as multiple osteophytic warts.

pleural hyalinizing granuloma (pleural hyalinizing granuloma) is rarely reported. The earliest report of this disease was found in 1977 by Engleman et al^[1]Description of an independent and rare patient with pleural disease, with nearly 70 cases currently reported worldwide^[2], 2007 Na et al.^[3]A case of hyaline granuloma presented as a solitary subpleural nodule was reported. At present, no simple hyaline granuloma was reported. The clinical data of a patient with pleural hyaline granuloma found by thoracoscopic pathological biopsy in the respiratory department of Nanfang Hospital of Southern Medical University in September 2010 were analyzed, and the related literature of pulmonary hyaline granuloma was consulted to improve the understanding of this disease.

The patient was a 65-year-old male. He was admitted to hospital on June 23, 2011 due to "chest tightness and shortness of breath with cough for 1 month". The patient developed chest tightness and shortness of breath without obvious inducement 1 month ago, which worsened after activity. At the same time, it is accompanied by a small amount of cough and expectoration. Small amount of phlegm, white color, sticky, difficult to cough up. With fatigue and weight loss. There were no symptoms such as fever, night sweats, chest pain, phlegm and blood, palpitations, paroxysmal dyspnea at night, and edema of both lower limbs. The chest X-ray of the outer hospital showed patchy shadows on both lungs. Chest CT showed diffuse patchy cord-like lesions in both lungs. After anti-infective treatment, the condition was not significantly relieved. The reexamination of X-ray chest radiograph showed no obvious absorption in both lung lesions. High-resolution CT of the chest after admission showed diffuse lesions in both lungs. Since the onset of the disease, the patient has poor appetite, acceptable sleep, and normal urine and defecation. Previous health is average, has a history of hypertension for 3 years, and regularly takes antihypertensive drugs. Has a history of smoking for more than 20 years, and quit smoking in 1998. Had arrhythmia for more than 2 years and took amiodarone for 1.5 years. Deny history of infectious disease, allergy, trauma, surgery and blood transfusion, and no history of special occupational exposure.

A 70-year-old male was admitted to the hospital on 24 April 2011 due to "recurrent, intractable cough for 4 years, aggravated for 2 weeks". The patient mainly had dry cough, without chills, fever, nasal congestion, sneezing, chest tightness, asthma, acid reflux, belching and other symptoms. There was no obvious correlation between cough and season, environment, body position and eating. When cough was severe, it seriously affected life and sleep. There were no abnormalities in X-ray chest X-ray examinations in local hospitals for many times. Every visit was diagnosed as "pharyngitis, acute tracheitis, chronic bronchitis or bronchial asthma, etc.", and various antibiotics and cough-relieving and phlegm-reducing treatment were given, but there was no obvious effect. Has a history of hypertension for 15 years, and has not regularly taken angiotensin converting enzyme inhibitors and other antihypertensive drugs. No history of long-term dust exposure and pet keeping. After admission, there were no positive signs in the systemic physical examination, and the otolaryngology specialist examination was normal. Auxiliary examinations: Blood routine, ESR, liver and kidney function, C-reactive protein and carcinoembryonic antigen were all normal. X-ray chest radiograph showed slightly widened right upper mediastinum shadow, no obvious parenchymal lesions in both lungs, electrocardiogram and cardiac color Doppler ultrasound were normal, pulmonary function examination showed normal pulmonary ventilation function and diffusion function, and electronic gastroscopy showed chronic superficial gastritis. The initial diagnosis was "chronic cough". Albuterol (2.4 mg, 3 times/d) and Mimin pseudoanesthetic solution (10 ml, 3 times/d) were administered orally, dexamethasone was infused intravenously (10 mg, 1 time/d), and omeprazole (10 mg, 2 times/d) and domperidone (10 mg, 3 times/d) were administered orally for possible gastroesophageal reflux. Although the cough symptoms improved slightly, they could not be completely relieved. One week after admission, a chest CT examination was performed. It was found that there was a circular soft tissue mass of about 4.0 cm ×3.0 cm next to the trachea of the right upper middle mediastinum, with clear boundary and smooth capsule. After enhancement, there was uneven enhancement in the lesion (Figure 1，Figure 2)。 Bronchoscopy showed that the trachea was patent, the mucosa was smooth, and there was no obvious compression deformation in the bronchial lumen of the right upper lobe. In order to clarify the nature of the mass, mediastinal mass puncture was performed under CT positioning, and a tissue block about 2 cm long was obtained for pathological examination. Under the microscope, the tumor cells were spindle-shaped, densely arranged in a palisade or vortex shape, and the nucleus was rod-shaped and partially twisted (Figure 3)。 Immunohistochemistry: acidic callink protein (S-100) was (+ + +), neuron-specific enolase (NSE) was (+), synaptophysin (Syn) was (±), c-kit oncogene protein (CD117) was (–), smooth muscle actin (–), primitive hematopoietic stem cell antigen (CD34) was (–), Desmin (Desmin) was (–), and cell proliferation marker (Ki-67) was (<5% +), pathological report: schwannoma. On May 6, 2011, he was transferred to thoracic surgery. During the operation, the tumor was located behind the superior vena cava and in front of the right main bronchus. The envelope was smooth, with a size of 4.0 cm ×3.0 cm ×3.0 cm. The right vagus nerve passed through its edge. The lesion was completely resected, and the final pathological diagnosis was vagus schwannoma (benign). The patient recovered well after surgery and was followed up for half a year without recurrence of cough.

10% ~22% of patients after tracheal intubation and/or tracheotomy can be complicated with tracheal stenosis, which is the most common cause of benign tracheal stenosis reported abroad at present. Patients have no obvious self-conscious symptoms in the early stage, and only 1% ~2% of patients with severe tracheal stenosis have corresponding symptoms such as dyspnea and wheezing after activity, which are unspecific. If the medical history is not combined at the time of consultation, it is easy to be misdiagnosed as "bronchial asthma" and other diseases, and it is easy to be complicated with life-threatening respiratory failure without effective treatment. The treatment and follow-up of a patient with severe tracheal stenosis after intubation admitted to the Department of Respiratory Medicine of Shanghai Changhai Hospital were analyzed, and retrospectively reviewed with relevant literatures.

The patient was a 24-year-old male, unemployed. Three months ago, I had a cough after catching a cold, coughed a small amount of white sticky sputum, accompanied by fever, the highest body temperature was 38.5℃, the fever type was unknown, there was no fear of cold, night sweats, hemoptysis and chest pain, and a painless soft mass appeared on the right lower chest wall. I was treated with anti-infective treatment such as penicillin in the local hospital. One week later, my body temperature was normal, but I still had intermittent cough, coughed a small amount of yellow sticky sputum, and the chest wall mass gradually increased. In a cancer hospital in Guangzhou, the chest CT showed multiple cystic lesions of the pleura, and the puncture smear of the right chest wall mass showed necrotic and inflammatory cells, but no cancer cells. The patient attended the Institute of Respiratory Diseases of the First Affiliated Hospital of Guangzhou Medical College on October 11, 2007, and was admitted with multiple cystic lesions of pleura to be examined. The patient had been engaged in lathe processing for more than 1 year, had a history of smoking for 4 years, about 5 cigarettes a day, had a history of eating raw coriander, no other medical history, and lost about 2 kg of weight since the onset of the disease. Physical examination: body temperature 36.7 ℃, 22 breaths/min, blood pressure 108/66 mm Hg (1 mm Hg =0.133 kPa), no abnormalities in skin and mucosa; Multiple lymph nodes can be palpable under both axillaries, about 1.5 cm in diameter, smooth, no tenderness, and good mobility; An oval-like mass with a diameter of about 3.5 cm was seen in the right anterior and inferior chest wall, with no obvious change in size with respiratory movement, no tenderness and no sliding sensation under the skin; A mass with a diameter of about 1.5 cm was seen in the right abdominal wall at the xiphoid process, and its character was similar to the aforementioned mass; The breathing sound of the right lung was slightly weakened, and no dry or wet rales were heard in both lungs. No abnormalities were observed in other systems. Routine blood test: white blood cell count is 14.4×10⁹/L, 0.85 for neutrophils, 0.08 for lymphocytes, 0.01 for eosinophils, 116 g/L for hemoglobin and 5.3×10 for platelets⁹/L; There were no abnormalities in urine and fecal routine, ESR was not examined, serum MTB antibody was positive, sparganosis antibody was weak positive, antibodies against parasites such as hydatid, cysticercosis, paragonimiasis, liver fluke and schistosoma were negative, hepatitis B surface antibody was positive, hepatitis C antibody, human immunodeficiency virus antibody and syphilis serological test were negative, tumor markers: neuron specific enolase was 18.9 mg/L, non-small cell lung cancer associated antigen, carcinoembryonic antigen, CA125 antigen and CA153 antigen were not abnormal, anti-streptococcal hemolysin O test was 613 U, C-reactive protein was 4.4 mg/L, rheumatoid factor was 10 kU/L, IgA was 19.8 g/L, IgG was 7.4 g/L, IgM and complement C3, C4 and CH50 were all in the normal range, anti-neutrophil cytoplasmic antibody (cytoplasmic and perinuclear) and antinuclear antibody were negative, and angiotensin converting enzyme was 17.3 μ mol·min^–1• L^–145.4 μ g/L for eosinophil cationic protein and 495 mg for D-dimer; X-ray chest radiograph showed patchy exudation in the posterior segment of the right upper lung, the right pleura showed diffuse coherent wavy thickening with smooth edges and uniform density, the right diaphragmatic surface was elevated, and the right costophragmatic angle became blunt (Figure 1，Figure 2)。 Exudative tuberculosis of the right upper lung, proliferative tuberculosis of the left upper lung, and extensive pleural tuberculosis of the right side were considered.

A 67-year-old male was admitted to the hospital on 10 January 2007 mainly due to "fever and cough for 1 month". No abnormalities were found on the chest X-ray during the patient's physical examination 3 months ago (Figure 1)。 One month ago, he had fever, cough, expectoration and a small amount of hemoptysis without trigger, and his body temperature was 38.5℃; After 7 days, peripheral blood leukocytes (WBC) were examined in outside hospital: 10.9×10⁹/L, neutrophils 83.8%, ESR 45 mm/1 h; X-ray chest radiograph showed a large exudation of the right upper lung with cavities (Figure 2), diagnosed as lobar pneumonia, treated with cefuroxime and clindamycin for 4 days but ineffective, switched to cefoperazone/sulbactam and levofloxacin to fight infection for 7 days, the fever did not relieve, and the body temperature rose to 39.5 ℃. The bacterial and fungal culture of sputum were all negative, the acid-resistant staining of sputum was negative multiple times, and the PPD test was negative. Chest CT showed consolidation in the upper lobe of the right lung, multiple cavities, bronchial gas phase and CT angiography signs, and bilateral pleural effusion (Figure 3，Figure 4，Figure 5)。 Severe community-acquired pneumonia (CAP) was diagnosed in other hospitals, with a high possibility of Staphylococcus aureus infection, and bronchioloalveolar carcinoma was not excluded. Anti-infective treatment with vancomycin and moxifloxacin for 10 d did not improve, and dyspnea occurred. Bronchoscopy was performed in other hospitals, and the samples of bronchial brush, bronchial secretion and bronchial mucosa biopsy were all negative by acid-resistant staining and pathological examination. Re-examination of chest X-ray showed obvious progression of right upper lung lesions (Figure 6), transferred to our hospital for further diagnosis and treatment. Loss of appetite and weight loss of 10 kg in the last 3 months. Past history: Hypertension for 20 years, cerebral thrombosis for 10 years, repair for perforated duodenal ulcer 3 months ago. Smoking index 90 pack years. Physical examination: body temperature 39.1 ℃, pulse 98 beats/min, respiratory rate 25 beats/min, blood pressure 110/60 mm Hg (1 mm Hg =0.133 kPa), body mass index 17.5 kg/m²。 Acute disease, weak constitution, unpalpable swelling of superficial lymph nodes; The neck is soft without resistance, the trachea is in the center, the right thorax is slightly collapsed, the right upper lung knocks with a voiced sound, and tubular breathing sounds can be heard; The heart rhythm is uniform and there is no murmur; The abdomen is depressed, soft and untender, and the liver and spleen are untouched under the costs; Mild concave edema of both lower limbs.

The 1st Beijing Young Respiratory Scholars Salon in 2012 was held on February 23rd, 2012. The theme of this salon was "Imaging in Respiratory Intensive Care Unit (RICU)", which was presided over by Dr. Shen Ning, Department of Respiratory Care, Peking University Third Hospital.

The patient was a 77-year-old male, a retired worker. He was admitted to the hospital on 22 Apr 2010 due to "chest and back pain for 20 d". Twenty days ago, the patient developed pain at the third intercostal area on the left margin of the sternum, which was paroxysmal tingling pain, and it was aggravated when taking deep breathing. At that time, the patient did not pay attention to it. Two weeks later, the patient's symptoms did not improve significantly, and he developed paroxysmal dull pain at the subscapular corner of the left back. No fear of cold and fever, occasional cough and expectoration, no hemoptysis, no chest tightness and shortness of breath, no weight loss and night sweats, no hissing. Outpatient chest CT showed that the upper lobe of the left lung occupied space, so he was admitted to the hospital. In the past, I occasionally coughed up yellow purulent sputum, and intermittently had blood in the sputum. Foreign hospitals had diagnosed it as "bronchiectasis". Usually, I basically did not use medication, and denied that I had used inhaled glucocorticoids. The patient did not provide relevant imaging data. History of lacunar infarction. Deny a history of smoking, deny a history of unclean sexual intercourse.

Pulmonary function testing is an important method to assess patient's surgical tolerance, anesthesia risk, choice of surgical mode, and predict whether postoperative complications (PPC) occur. At present, many operations (such as thoracotomy, important organ transplantation, etc.) have included lung function test as a necessary condition for surgical admission. This article mainly summarizes the influence of thoracic surgery on lung function and the value of common lung function indexes in surgical risk assessment.

pneumocystis pneumonia (PCP) is mainly seen in patients with acquired immunodeficiency syndrome (AIDS)^[1]However, with the widespread application of glucocorticoids (hormones for short) and cytotoxic drugs, the rapid development of tumor radiotherapy and chemotherapy, various organ transplantation and the improvement of PCP diagnosis, more and more non-AIDS patients with PCP^[2,3]Compared with AIDS patients, the latter has acute onset, rapid progress, easy misdiagnosis and high mortality rate^[4]。

In the middle of summer, the heat is gradually growing. At the turn of spring and summer, the season of irritation and fever, the contradiction between doctors and patients has become the focus of social attention with a series of attacks on doctors. In the essay column of the editor-in-chief of this issue, Professor Liu Youning chose this heavy topic with many concerns to express his condolences to the deceased, sympathy for the relatives of the victims, and complain about the unfair treatment of medical workers for a long time. At present, the topic of doctor-patient relationship is sensitive and deeply taboo. Although this article is called an essay, it is actually a block in the author's chest-what are the victims of doctor-patient conflict, and the responsibility of social trust and public opinion lies! Scholars or powerless, spirit has not lacked, wish to have common harmony, and encourage you.