2012年 · 第35卷第07期

The Chinese Medical Association has a long history and is widely respected and valued by peers at home and abroad. It is one of the most successful, standardized and influential academic groups in China. Given its irreplaceable academic status, colleagues in the medical profession regard it as one of the important indicators of academic success and recognition whether they can join the organization and "get a part-time job" in national or local societies, and many even regard it as a lifelong pursuit.

British scholar Strachan first reported in 1989 that the prevalence of hay fever in children was negatively correlated with family size and the number of older siblings in the family^[1]Therefore, the hypothesis is put forward that infectious diseases transmitted from older siblings in early childhood have a protective effect against allergic diseases, so that allergic diseases such as eczema, allergic rhinitis, and bronchial asthma (hereinafter referred to as asthma) are less common. This is called the "Hygiene Hypothesis".

Bronchiectasis is a pathological and permanent dilatation of the bronchial tree caused by various reasons, leading to chronic inflammation of the airway with repeated suppurative infections. The clinical manifestations are persistent or repeated cough and expectoration, sometimes accompanied by hemoptysis, which can lead to respiratory dysfunction and chronic pulmonary heart disease. Bronchiectasis in a broad sense is a pathological anatomical condition. Many diseases are also manifested by imaging as bronchiectasis, such as pulmonary interstitial fibrosis caused by traction bronchiectasis. Similar bronchiectasis with simple imaging is not discussed in this consensus.

Bronchial asthma (asthma for short) is a chronic airway inflammation involved by a variety of cells and cell components. Recent research results show that neuroendocrine-immune network (NEI) is an important inflammation regulatory system in the body, and plays an important role in the pathogenesis of asthma. The hypothalamic-pituitary-adrenal axis (HPAA) is not only the main integration center during stress response, but also the main pathway for NEI to regulate inflammatory response. It controls the release of endogenous glucocorticoids (GC) and plays an important role in regulating allergic inflammation^[1]。 HPAA dysfunction is also an important factor in the onset of asthma^[2]。 The function of HPAA, the changes of HPAA function in asthmatic patients, their mechanisms and effects, and the intervention effects of kidney-tonifying traditional Chinese medicine are summarized as follows.

non-tuberculous Mycobacteria (NTM) refers to a general term for Mycobacteria other than MTB complexes such as MTB, Mycobacterium bovis, Mycobacterium africanum and Mycobacterium voles, and Mycobacterium leprae. Up to now, 154 species and 13 subspecies of NTM have been found, most of which are rot parasites. Only a small part of NTM is pathogenic to human body, which can invade tissues and organs such as lungs, lymph nodes, bones, joints, skin and soft tissues, and can cause systemic disseminated diseases^[1,2,3]。 In recent years, the number of NTM diseases has been increasing, and the research progress in epidemiology, diagnosis and treatment of NTM diseases is reviewed^[4,5]。

The aminoglycosides streptomycin, kanamycin, amikacin and the peptide capreomycin are the anti-tuberculosis drugs for injection recommended by the World Health Organization. Kanamycin, amikacin and capreomycin are also the core second-line drugs for the treatment of multidrug-resistant tuberculosis^[1]。 All the above drugs act on MTB ribosomes, interfere with the normal synthesis of bacterial proteins, and have strong bactericidal activity in vitro. However, there is cross-resistance between the above drugs, which may lead to ineffective treatment if selected improperly. The resistance mechanism of MTB to the above drugs, especially the cross-resistance mechanism and its research progress are summarized as follows.

In recent years, the incidence and mortality rate of lung cancer have jumped to the top of common malignant tumors in many developed countries and large and medium-sized cities such as Beijing, Tianjin and Shanghai^[1]。 The histopathological types of lung cancer are divided into small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC)^[2]Under SCLC electron microscope, dense neuroendocrine granules (NEG) in different numbers can be seen in the cytoplasm of some cancer cells. The granules are 120~280 nm in diameter, and are round, oval or rod-shaped, with or without membrane surrounding the granules^[3,4]。 Attar et al.^[5]It is believed that SCLC originates from the diffuse neuroendocrine system, the so-called neuroendocrine cells. At present, most scholars prefer that SCLC may originate from stem cells in bronchial mucosal epithelium that can differentiate into neuroendocrine^[6]It is the precursor cell of various types of lung cancer. Under various carcinogenic factors, totipotent stem cells deteriorate and transform into small cell carcinoma, squamous cell carcinoma (SCC) or adenocarcinoma. SCLC has neuroendocrine properties, with a few remaining pristine^[7]。 SCLC can spread and metastasize early, and the survival rate of SCLC is not obvious in the past 20 years^[8]Therefore, we explored the expression of ASH1, growth factor independence-1 (GFI-1) or oncoprotein, which is involved in the neuroendocrine of SCLC, to explain the uncontrolled growth of SCLC^[9]It provides a reliable basis for the diagnosis, treatment and prognosis of clinical lung cancer.

Smoking is the main pathogenic factor of COPD, and airway remodeling is the main pathological basis of persistent airflow restriction in COPD patients. Nicotine accounts for more than 95% of the total tobacco alkaloids. Nicotine has an important effect on the pathogenesis of COPD, especially on airway remodeling. We studied primary cultured human airway subepithelial fibroblasts to observe the effect of nicotine on the transdifferentiation of fibroblasts to myofibroblasts, so as to explore the role of nicotine in airway remodeling in COPD.

At present, the prevalence and mortality of bronchial asthma (asthma for short) are gradually increasing at home and abroad, and it has become a major chronic disease that seriously threatens people's health. Th1/Th2 balance theory has always been the core of asthma pathogenesis. The results of recent studies have shown that in addition to Th1 and Th2 cells, there is a regulatory T cell (Tr), in which CD₈⁺Regulatory T cells (CD₈⁺Tr) is an effector cell that exerts an inhibitory effect^[1]。

In recent years, with the development of interventional techniques, many intraluminal airway lesions that require surgical treatment or cannot be treated in the past can be cured by interventional therapy^[1]。 Patients with severe tracheal obstruction and extreme hypoxia caused by different reasons can suffer from hypoxic cardiac arrest and die. This severe tracheal stenosis is clinically called asphyxial tracheal stenosis, which requires urgent unblocking of the airway, rapid correction of hypoxia and prevention of sudden death. Because of the critical condition of these patients, it is very important to choose appropriate interventional therapy tools and methods. Rigid bronchoscope (abbreviated as rigid bronchoscope) is mostly used in direct vision treatment at home and abroad^{[2,3,4,5,6,7]}Three patients with asphyxial tracheal stenosis treated with laryngeal mask ventilation under general anesthesia through flexible bronchoscope were reported to summarize the clinical experience.

A 66-year-old female was a teacher. He was admitted to hospital on August 27, 2011 due to "cough and fever for more than 6 months, aggravated for 10 days". In February 2011, the patient developed intermittent fever without obvious trigger, the attack was irregular, and the body temperature was about 38~40 ℃, which could return to normal by itself. Accompanied by paroxysmal cough, coughing a small amount of white sticky sputum; Nasal congestion, purulent discharge, sore throat, hoarseness. He has been hospitalized in other hospitals for many times and given anti-infective treatment, but the curative effect is not good. The lung CT examination was performed on June 10, 2011 and there was no obvious abnormality (Figure 1)。 Nasopharynx + sinus plain CT scan showed sinus inflammation in the whole group. Electronic nasopharyngoscopy showed laryngitis, which was likely to be fungal. Abdominal B-ultrasound showed retroperitoneal hypoechoic nodules, considering the possibility of lymph node enlargement. The diagnosis was: "Fungal laryngitis is likely; Chronic sinusitis, etc." After 1 month of antifungal and symptomatic supportive treatment with "fluconazole", the symptoms did not improve significantly. On August 17, 2011, the above symptoms of the patient were aggravated. On August 24, 2011, the lung CT examination showed small nodular blurry shadows scattered in both lungs, with clear boundaries and irregular shapes. Multiple lymph nodes were seen in the mediastinum. Since the onset of the disease, the patient has no obvious night sweats, hemoptysis, chest pain, etc. Occasionally, he has macroscopic hematuria, which is like meat washing water, and his weight has lost about 10 kg. The patient suffered from "sinusitis" in 1992, which did not recover after multiple treatments (details unknown); He had a history of "laryngitis" for 6 years, repeated sore throat attacks, and was hospitalized in the otolaryngology department of our hospital many times, and underwent "bilateral tonsillectomy" in December 2008; In 2008, due to repeated macroscopic hematuria, he was diagnosed as "IgA nephropathy" after renal histopathological examination in the Department of Nephrology of our hospital. After the diagnosis was confirmed, he was given "Tripterygium wilfordii glycosides, 20 mg, once/d" oral treatment, and was hospitalized in the Department of Nephrology of our hospital for reexamination many times. The patient has always insisted on taking medication regularly until this admission; 2 years with type 2 diabetes; Multiple thyroid cysts and hypothyroidism for 2 years. Admission physical examination: body temperature 38.5℃, unpalpable swelling of superficial lymph nodes throughout the body, saddle nose, clear nasal mucus in bilateral nostril, tenderness in both maxillary sinuses and ethmoid sinuses. The respiratory sounds of both lungs were acceptable, no obvious dry and wet rales were heard, the heart rhythm was uniform, no murmur, the abdomen was flat and soft, no tenderness and rebound pain, and the lower limbs were not swollen. Main diagnosis of admission: (1) Cause of bilateral lung lesions: vasculitis? Lung infection? (2) chronic sinusitis; (3) chronic laryngitis; (4) type 2 diabetes mellitus; (5) multiple thyroid cysts; (6) hypothyroidism; (7) IgA nephropathy.

The patient was a 32-year-old male. The main cause was "fever for 4 days, accompanied by hemoptysis and dyspnea for 2 days". He was admitted to hospital on September 26, 2009. The patient suffered from comminuted fracture of right tibia and fibula due to trauma 5 days ago, and developed fever the next day, with a maximum body temperature of 39.3℃. Hemoptysis occurred 2 days later, and more than 100 mouthfuls of bloody foamy sputum occurred every day. Accompanied by chest tightness and dyspnea. Transferred to the emergency department of our hospital 1 d ago, blood gas check showed PaO₂was 57 mm Hg (1 mm Hg =0.133 kPa without oxygen), blood D-D Dimer (D-Dimer) was elevated, and the ECG showed S_IQ_IIIT_IIIChange. Chest X-ray showed patchy high-density shadows on both lower lungs (Figure 1), CT pulmonary angiography (CTPA) showed diffuse ground glass shadows in both lungs (Figure 2，Figure 3), no filling defect was seen in the pulmonary artery. The patient was previously in good health and denied history of exposure to special substances. Physical examination: 24 breaths/min, blood pressure 110/60 mm Hg. Consciousness is clear, and scattered bleeding spots can be seen on the skin of the chest and underarms. A small amount of wet rales can be heard in both lower lungs. Heart rate 90 beats/min, rhythm, P₂>A₂No murmur was heard in the auscultation area of each valve. External fixation of the right lower limb with splint, swelling of the right lower limb and limited movement. Initial diagnosis of admission: fracture of right tibia and fibula, pulmonary embolism, ARDS, fat embolism syndrome possible. Laboratory test: peripheral blood leukocytes were 7.0×10⁹/L, 0.67 for neutrophils, 116 g/L for hemoglobin and 388×10 for platelets⁹/L; ESR was 23 mm/1 h; Anti-nuclear antibody, anti-double-stranded DNA antibody, anti-extractable nuclear antigen antibody and anti-neutrophil cytoplasmic antibody were all negative; Blood lipase and amylase were both negative; Negative urine chyle test. B-ultrasound of both lower extremities showed no thrombosis. Echocardiography: mild tricuspid regurgitation, pulmonary systolic pressure 32 mm Hg, left ventricular ejection fraction 76%. No abnormalities were found on CT of the head. Bronchoscopy showed a little old bloody secretion from the lower lobe bronchus of both lungs. BALF color is clear, total number of cells is 80×10³/ml, 0.82 for macrophages, 0.12 for lymphocytes and 0.06 for neutrophils.

Wihelm Conrad Röntgen (1845 – 1923) was a German experimental physicist who was famous for his invention of the X-ray. Born on March 27, 1845, in Leinepp, Rhine, Germany, Roentgen was brought up in a poor family. When he was three years old, he moved to Abelton, the Netherlands, and received his doctorate in Zürich in 1869.

Pulmonary function measurement has been popularized in large and medium-sized hospitals in China, and its projects have gradually increased. The application of various hospitals is uneven, the training of personnel is not in place, the clinical application of pulmonary function is not well understood, and its quality control is even more worrying. Whether pulmonary function measurement technology can give full play to its important clinical role, quality control is its key link, which includes environment, equipment, related configuration, operating requirements, and at the same time, well-qualified doctors and technicians are required, otherwise it will directly affect the accuracy of pulmonary function measurement results.

The second event of Beijing Young Respiratory Scholars Salon in 2012 was held on March 29th, 2012. This event was hosted by Dr. Bu Xiaoning of Beijing Chaoyang Hospital affiliated to Capital Medical University. The theme of the conference was "How Clinicians Do Scientific Research".

With its long history and huge academic influence, the Chinese Medical Association has a strong cohesion in the medical field of China, and has made due contributions to the development of medical cause in China. Professor Liu Youning, the editor-in-chief of this journal, recalled his "career in the Chinese Medical Association" in the column "Essays of the Editor-in-Chief", from a young scholar to the chairman of a specialist branch, from a reviewer to the editor-in-chief, from getting the "care" and "love" of the Chinese Medical Association to making great contributions to the work of the Chinese Medical Association. With his decades of growth experience, editor-in-chief Liu "randomly talked about the honor and responsibility of members of the Chinese Medical Association".