2012年 · 第35卷第11期

The author did not deliberately study who the sentence in the title originally came from, but this motto has fully demonstrated that Chinese traditional medicine has long recognized the importance of emphasizing the early diagnosis and treatment of diseases and even preventing them before they happen. But today, when modern medicine has been very advanced, our actual actions are still contrary to this motto.

extracorporeal membrane oxygenation (ECMO) is a continuous extracorporeal life support (ECLS) method. Its main application principle is to use a pump (similar to an artificial heart) to draw blood from the body to the outside, and then transfuse oxygenated blood back into the body after gas exchange through a membrane oxygenator (artificial lung), completely or partially replacing heart and lung functions^[1]。 According to the treatment mode and purpose, ECMO can be divided into venous-venous ECMO (VV-ECMO) and venous-arterial ECMO (VA-ECMO). The VV-ECMO is intended for patients who only need respiratory support, and the VA-ECMO provides simultaneous respiratory and circulatory support. For respiratory failure, VV mode has lower complications and mortality than VA mode, and is the most commonly used mode. While effectively improving oxygenation and ventilation, it also reduces oxygen concentration, airway pressure, tidal volume and respiratory rate, so that the lungs can fully rest, thus minimizing the risk of ventilator-related lung injury.

Bronchial asthma (asthma for short) is a chronic airway inflammatory disease. The occurrence and development of asthma are mainly caused by the joint action of environmental factors and genetic factors. Multiple genes participate together, and the interaction between genes and genes and environmental factors forms a multifactorial polygenic pattern. It is a complex polygenic genetic disease with a heritability of 36% ~79%. Its inheritance does not follow Mendel's law. Clinically, patients with asthma often have obvious family history, which confirms the important role of genetic mechanism in the pathogenesis of asthma. In the past ten years, laboratories around the world have used various methods to search for susceptibility genes or disease-causing genes of asthma-related phenotypes, and found that multiple chromosome regions are related to asthma. The newly discovered ORMDL3 gene and ADAM33 gene have become the focus of researchers at home and abroad.

The purpose of timely and accurate diagnosis of tuberculosis and complete cure of patients is not only to restore the health of patients, but also to eliminate the source of infection and control the epidemic of tuberculosis. With the widespread application of short-course chemotherapy and the increasing number of elderly, drug-resistant, diabetic and immunodeficient patients, the process of diagnosis and treatment of pulmonary tuberculosis has become increasingly complicated^[1]。 Judging the involved site of tuberculosis, whether it is active, and the patient's response to anti-tuberculosis drug treatment play an important role in guiding clinical treatment, finding drug-resistant tuberculosis patients in time and adjusting treatment plan. Fluorodeoxyglucose positron emission computed tomography (Fluorine-18 fluorodeoxyglucose positron emission tomography,¹⁸F-FDG PET) and positron emission tomography/computed tomography (PET/CT) have been widely used in tumor diagnosis, staging and efficacy evaluation, but¹⁸F-FDG is not a tumor-specific imaging agent, and inflammatory lesions such as tuberculosis are¹⁸F-FDG PET examination may also show high uptake. Currently related to¹⁸There are not many relevant literatures on the diagnosis of tuberculosis by F-FDG PET.¹⁸The value of F-FDG metabolic imaging in the involvement site of tuberculosis, judging whether it is active, evaluating its efficacy and differentiating it from malignant lesions is reviewed below.

The DJ-1 gene was developed in 1997 by Nagakubo et al.^[1]A novel mitogen-dependent oncogene was found in the H-ras gene of NIH-3T3 cells, which has a synergistic effect with ras gene. DJ-1 gene is widely present in 22 kinds of human tissues. Studies on the relationship between environmental pathogenic factors and disease genes in female lung adenocarcinoma have found that DJ-1 gene, as a molecular marker of exposure to carcinogen, can reflect the deterioration trend of epithelial cells^[2]。 There are few basic studies on the DJ-1 gene in lung cancer. The purpose of this study was to investigate the effect of this gene on lung adenocarcinoma cells and their transplanted tumors. The results are reported below.

pulmonary embolism is seriously harmful to human health, which has been widely concerned by research organizations in various countries. The rapid development of auxiliary examination has great guiding value for clinical work, especially the development of chest imaging and cardiac ultrasound plays an important role in clinical guidance. In this study, pulmonary CTA and cardiac color ultrasound were used to evaluate the correlation between embolism index and cardiovascular parameters.

angiotensin converting enzyme (ACE) 2 is a homologue of ACE and belongs to the renin-angiotensin-aldosterone system. Its function is opposite to that of ACE, and it plays an important role in balancing the function of angiotensin converting enzyme (Ang) II, which can metabolize Ang Ⅰ to Ang 1-9, and then generate Ang 1-7. Ang 1-7 can dilatate blood vessels and counter the effect of Ang Ⅱ. ACE2 plays an important role in the inflammatory response of respiratory diseases^[1]It can reduce the degree of respiratory tract damage in stress diseases such as bronchial asthma and acute lung injury. To study the role of ACE2 in the pathogenesis of COPD, we replicated the model of COPD and observed the changes of ACE2 expression in lung tissue of COPD rats.

A 56-year-old male was admitted to the hospital on 12 July 2011 due to "pain in the left lower limb for 5 months, swelling for 3 months, chest pain, dyspnea for 2 months, and hemoptysis for 3 days". Five months ago, the patient had left lower limb pain without obvious trigger, which was aggravated after walking and relieved after rest. Three months ago, the patient's left lower limb began to appear swollen, and the skin was dark purple when he got up in the morning, with aggravated pain. He went to the vascular surgery clinic of our hospital, and the D-dimer was 4.67 mg/L and the fibrinogen degradation product (FDP) was 80 mg/L. Color ultrasound of both lower extremities showed bilateral popliteal vein and left posterior tibial vein thrombosis. After warfarin sodium anticoagulation, the international standardized ratio (INR) fluctuated from 1.5 to 3.5. Two months ago, the patient began to experience dyspnea with right-sided chest pain, which worsened when coughing. 15 days ago, the patient went to a tertiary A hospital in Beijing. The peripheral blood antinuclear antibody profile, anti-neutrophil cytoplasmic antibody, anti-cardiolipin antibody and lupus anticoagulant were all negative. Protein S, protein C and antithrombin were all normal, and homocysteine (HCY) was 16.9 μ mol/L (4-12 μ mol/L), and carcinoembryonic antigen was 6.3 μ g/L (0-5 μ g/L). Warfarin sodium was discontinued and changed to low molecular weight heparin anticoagulation for 2 weeks. Subsequently, the patient had difficulty breathing and aggravated pain in the right chest and back. Six days ago, the patient discontinued low molecular weight heparin and changed to warfarin sodium 4.5 mg once a day orally. Three days ago, there was blood in the sputum, so I went to the emergency department of our hospital, and CT pulmonary angiography (CTPA) showed multiple pulmonary embolism in both lungs (Figure 1), both upper lung nodules and patchy shadows (Figure 2)； Suspected splenic infarction. The ECG was roughly normal (Figure 3)。 He was transferred to respiratory department for further diagnosis and treatment. In the past 2 months, the patient's diet, urine and stool were normal, and his weight lost 18 kg. He has been in good health and is not addicted to tobacco and alcohol. Physical examination at admission: temperature 38.3 ℃, pulse 108 beats/min, breathing 36 beats/min, blood pressure 110/80 mm Hg (1 mm Hg =0.133 kPa). The swollen lymph node can be palpable on the left clavicle, about 2 cm in diameter, mobile, hard and non-tender. No jugular distension was observed. The breathing sound of the right lower lung was low, no wet and dry rales were heard, and no pleural friction was heard. The heart boundary of percussion was not large, and the heart rate was 108 beats/min; Heart Rhythm Qi, P.₂>A₂The tricuspid region can be heard as a gallop. The abdomen was flat and soft, without tenderness and rebound pain, 2 cm under the costs of the liver, tough and without tenderness, unpalpable under the costs of the spleen, mild percussion pain in the spleen area, and mild concave edema in the left lower limb.

The clinical treatment of benign and malignant tracheal stenosis is tricky, and patients with malignant tracheal stenosis often abandon treatment. In recent years, the effect of tracheal stent placement is remarkable, and the application of metal stent in the treatment of tracheal stenosis has been reliable evidence^[1,2]。 However, with the increasing application of tracheal stent, the related complications such as restenosis and stent fracture have gradually attracted clinical attention^[3]Recently, the US FDA proposed that the indications of tracheal stents should be strictly grasped, and metal bare stents should be used carefully. We must be alert to the placement of metal stents in long-term surviving patients.^[4]。 There are many basic research and clinical reports on restenosis after tracheal stent implantation in China, but the reports of stent fracture are rare^[5]。 The clinical diagnosis and treatment of two patients with stent fracture admitted to the Affiliated Hospital of Xuzhou Medical College is reported as follows. One case was broken and disintegrated after 6 years of Z-shaped stainless steel stent placement due to tracheal stenosis caused by lung cancer; One case suffered from tracheal stenosis secondary to mediastinal metastasis of lung cancer and ruptured two months after placement of Ni-Ti memory alloy stent.

In 1963, scientists first researched the Pacific fir growing in the forests of western America (Pacific YewThe crude extract of paclitaxel was isolated from the bark and wood of), and it was found that the extract had high killing activity against tumor cells in the screening experiment. The chemical structure of the active ingredient was determined as tetracyclic diterpene compound by separation, purification and X-ray analysis, and then it was named paclitaxel (taxol). After paclitaxel contacts cells, a large number of microtubules accumulate in cells, and cell division stops in mitotic stage, which can interfere with various physiological functions of cells and block their division. Therefore, paclitaxel has been widely used in the field of anti-tumor. Previous studies have shown that paclitaxel can inhibit the formation of restenosis by inhibiting the proliferation of various cells. Its anti-cell proliferation properties have been applied in more fields, and different therapeutic purposes can be achieved by inhibiting the proliferation of various cells, especially in the treatment of benign restenosis in the airway.

Bronchial challenge test is a method that induces airway smooth muscle contraction through physical, chemical, biological and other artificial stimulation, and then judges whether and the degree of bronchial constriction by the change of lung function indexes. It is the most commonly used and accurate clinical examination to measure airway hyperresponsiveness (AHR). Currently, regardless of the Global Asthma Initiative (GINA)^[1], or "Guidelines for the Prevention and Treatment of Bronchial Asthma"^[2]And "Guidelines for the Diagnosis and Treatment of Cough"^[3]Positive bronchial challenge test is listed as one of the important diagnostic conditions for atypical bronchial asthma or cough variant asthma.

On October 19, 1936, Lu Xun, a generation of literary tycoons, died at his home in Shanghai at the age of 55. What disease did Lu Xun die of? Opinions are not consistent.

systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis and septic shock are different stages of the same pathological process. This definition was proposed by the American Association of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) Joint Congress in 1992. It has been accepted and widely used by clinicians at present, and this standard is used to guide the diagnosis and treatment of patients with severe bacterial infection. Patients with sepsis are often seriously ill, especially infants, the elderly, those with underlying diseases or low immune function, who are prone to multiple organ dysfunction and have a high mortality rate. In the past decade, the incidence of sepsis in developed countries has increased at a rate of 8% to 13% per year, mainly due to the aging of the population, the increase of high-risk interventions, the rate of cell resistance to antibiotics and the increase of multidrug-resistant (MDR) bacterial infections. There are about 30 million sepsis patients worldwide, including more than 6 million infants and more than 100,000 pregnant women^[1]。 In view of this severe situation, in order to standardize the treatment and reduce the mortality rate, the American and European Critical Care Association initiated and organized the Save Sepsis Campaign in 2004, and put forward the cluster treatment for sepsis, one of the key points is the treatment of antimicrobial drugs. How to detect and effectively treat sepsis early is a severe test faced by the global medical community at present, and it is also a difficult problem that clinical medical workers urgently hope to solve.

The 6th event of Beijing Young Respiratory Scholars Salon in 2012 was held on July 26th, 2012. This event was hosted by Dr. Bu Xiaoning, Beijing Chaoyang Hospital affiliated to Capital Medical University, with the theme of "Diagnosis and Treatment of Complex Pulmonary Embolism and Special Types of Pulmonary Hypertension". The meeting format is case sharing and discussion.

As the saying goes, the superior medicine treats the disease before it happens, and the inferior medicine treats the disease at the end. In the essay column of this editor-in-chief, Professor Liu Youning uses this motto as a quote, emphasizing the importance of early diagnosis and treatment of diseases and prevention before they happen. Although prevention is a long process for most chronic respiratory diseases, and the effect of early detection and treatment may not be so "immediate", for these patients, early prevention and control of the cause outside the hospital or in the hospital can achieve twice the result with half the effort than post-attack treatment. In the article, Professor Liu calls on respiratory doctors to think deeply, and then shoulder the heavy responsibility of clinical treatment from a more important and fundamental perspective. Its writing is simple and simple, and its content is in line with the common problems encountered in clinical practice, which is worth reading.