2012年 · 第35卷第12期

The "Editor-in-Chief Essays" column of this magazine has been established for the second anniversary. Although the writer's political consciousness, academic level and writing ability are very limited, he is constantly encouraged and encouraged by readers and relevant people. I remember that the early works of this column in 2011 and 2012 all involved public health issues that are generally concerned by the whole society and closely related to this profession, and pose a great threat to the health of Chinese people: one is tobacco control, and the other is air pollution. 2013 is coming soon, and it will also usher in the tenth anniversary of the victory of the "fight against SARS". History, especially the history forged with life, cannot be forgotten. As an ordinary medical worker who participated in this "battle" like "life and death", ten years later, I still have endless excitement and pain etched in my mind, which strongly drives me to write some commemorative words. The glory and suffering of ten years ago is one of the most memorable historical events in the medical field after the founding of New China. Today, with the sharp and complicated relationship between doctors and patients, it is of great practical significance to once again promote the spirit of "unite as one to fight SARS", which helps doctors and patients to understand each other.

People are all too familiar with mushrooms, but few people think about the difference between mushrooms and mushrooms. People usually combine the two together and think it is the same thing, but it is not. What people call mushrooms everyday is not a very scientific concept. What we usually call mushrooms actually refers to a general term for large fungi that can be directly seen by the naked eye, including caps, folds, rings, cups and holders.

ventilator-associated lower respiratory tract infections include ventilator-associated pneumonia (VAP) and ventilator-associated tracheobronchitis (VAT). VAP is the most common nosocomial infection with high morbidity and mortality. There are many reports on the pathophysiology and prevention and treatment of VAP. In recent years, VAT has also attracted extensive attention, but there are few related studies^[1,2]。 The research progress on VAP and VAT is summarized as follows.

Pyrosequencing is a new short-fragment DNA sequencing technology, which can quickly and accurately determine a short DNA fragment. Its detection accuracy is comparable to the traditional Sanger dideoxy strand termination method, and its operation is extremely simple. At present, it has been widely used in single nucleotide polymorphism (SNP) analysis, rapid identification of pathogenic microorganisms, mutation detection, methylation analysis and pharmacogenomics^[1,2,3,4,5]。 The author reviews the application of this technology in the field of tuberculosis detection.

As early as the 1960s, some respiratory experts put forward the concept of lung stress and strain, but it has not attracted the attention of scholars. In recent years, with the deepening of various researches, stress and strain have become more and more hot issues in the research related to ARDS and mechanical ventilation, which may be of great significance to the parameter setting of mechanical ventilation in critically ill patients, the monitoring of disease and curative effect, and the formulation of the best mechanical ventilation strategy.

Bronchial asthma (asthma for short) is an inflammatory disease of airway with reversible airflow restriction. However, with the prolongation of the disease course and the progression of airway inflammation, most patients will develop airway remodeling, which can lead to irreversible airflow restriction, thus making asthma symptoms difficult to control. Recent studies have shown that airway inflammation occurs simultaneously with remodeling^[1]That is, airway remodeling exists in the early stage of asthma, which highlights the importance of inhibiting airway remodeling in controlling asthma. In this paper, the drugs used in clinical treatment of asthma in recent years, including glucocorticoids (abbreviated as hormones), long-acting β₂Receptor agonist (long active β₂The effects of receptor angonist (LABA), leukotriene modulators, anti-IgE monoclonal antibodies, anti-IL-5 monoclonal antibodies and tyrosine kinase inhibitors on the process of airway remodeling were reviewed.

tracheobronchial amyloidosis (TBA) is a rare airway disease based on the abnormal deposition of amyloid fibers in the tracheobronchial submucosa^[1,2,3]From 1965 to 2010, only 75 cases of primary TBA were reported publicly with complete clinicopathological data in my country^[2]。 13 cases of TBA hospitalization in Guangzhou General Hospital and the First Affiliated Hospital of Guangzhou Medical College in 11 years are reviewed, and the summary report is as follows.

Idiopathic pulmonary fibrosis (IPF) involves the conversion of fibroblasts into myofibroblasts and excessive deposition of extracellular matrix (ECM)^[1,2]Reducing ECM deposition and promoting timely apoptosis of fibroblasts/myofibroblasts during lung injury are expected to be powerful measures for the treatment of pulmonary fibrosis. In recent years, the role of plasminogen activator inhibitor-1 (PAI-1) in the pathogenesis of pulmonary fibrosis has been discovered by experiments in transgenic mice^[3]。 In this study, we observed the effects of PAI-1 on spontaneous apoptosis and apoptosis induced by anti-Fas antibody in rat embryonic lung fibroblasts, and the signaling mechanism, further illustrating the role of PAI-1 in the pathogenesis of IPF.

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]How to effectively treat multi-drug resistant Acinetobacter baumannii has become an important clinical topic at present. Allicin is a volatile oil extracted from the spherical bulbs of garlic and is the main active ingredient of garlic. Recently, it has been reported in the literature that allicin has excellent antibacterial efficacy^[2]。 In this study, the mechanism of allicin in inhibiting pan-drug-resistant Acinetobacter baumannii was preliminarily discussed. The results are reported below.

In recent years, the incidence of tuberculosis among college students has increased, and students have become high-risk groups of tuberculosis^[1]。 In order to understand the epidemic trend and characteristics of tuberculosis among college students, provide scientific basis for formulating preventive measures, and prevent tuberculosis outbreak in university campuses, we conducted a general tuberculosis survey among college freshmen, and the results are reported as follows.

At present, the classification criteria for diffuse parenchymal lung disease/idiopathic interstitial pneumonia (DPLD/IIP) recommended by ATS/ERS in 2002 are commonly used in the respiratory community^[1]That is, DPLD is divided into four categories: (1) DPLD with established causes, such as drug-induced, occupational or environmental related substances, or related to certain diseases, such as connective tissue diseases. (2) IIP. (3) Diffuse granulomatous parenchymal lung disease, such as sarcoidosis and exogenous allergic alveolitis. (4) Other types of DPLD, such as alveolar proteinosis. On this basis, according to the findings of chest high-resolution CT (HRCT) and referring to the indexes of cell classification in BALF, lung biopsy and pathological examination when necessary, IIP was divided into 7 subtypes: idiopathic pulmonary interstitial fibrosis/common interstitial pneumonia (IPF/UIP), non-specific interstitial pneumonia (NSIP), cryptogenic organizing pneumonia/bronchiolitis obliterans with organizing pneumonia (COP/BOOP), acute interstitial pneumonia (AIP), respiratory bronchiolitis interstitial lung disease (RBLD), desquamative interstitial pneumonia (DIP) and lymphocytic interstitial pneumonia (LIP).

The first coronavirus discovered was infectious bronchitis virus (IBV) isolated from chickens in 1937^[1]。 In the 1960s, scientists observed through electron microscopy that the envelope processes of this kind of virus were regularly arranged in a crown shape, hence the name "coronavirus". Coronavirus is widespread in humans and animals, such as pigs, cows, chickens, cats, dogs, mice and bats. 229E-CoV and OC43-CoV were detected earlier, and Chinese scientists first isolated the Kunxu strain of coronavirus in 1975^[2]Generally, it only causes the common cold, etc. The SARS coronavirus (SARS-CoV), which caused the severe acute respiratory syndrome (SARS) outbreak in 2003, is highly pathogenic and infectious, and can cause death. After that, new coronaviruses such as NL63-CoV and HKU1-CoV were discovered one after another^[3,4]。 From June to September 2012, two cases of severe acute lower respiratory tract infection were detected in the Middle East, with a clinical course similar to SARS. One of them died (as of October 2, 2012). The pathogen was identified by the World Health Organization as a novel coronavirus^[5,6]。 The latest information of novel coronavirus is now provided to the majority of clinical medical staff in time. While being alert to "SARS-like cases", we can correctly understand the coronavirus, and there is no need to talk about the color change of "coronavirus".

Since June 2012, two patients with severe acute lower respiratory tract infection have been identified in Saudi Arabia and Qatar in nearly 3 months, presenting with a severe acute respiratory syndrome (SARS) -like clinical course. After pan-coronavirus polymerase chain reaction (PCR) amplification and virus isolation on respiratory tract and lung anatomical specimens, it is determined that the infectious pathogen of these two patients is the same novel coronavirus. Its nucleotide sequence will be published in GENBANK in the near future^[1]。

The advantages of bronchoscopic interventional therapy in the field of palliative care of advanced tumors have gradually become prominent and attracted clinical attention. Argon knife, also known as argon plasma coagulation (APC), is a method that uses argon plasma beam to conduct high-frequency current and achieve tissue coagulation in a non-contact way. It is a common treatment method for interventional therapy to introduce argon plasma into the airway through bronchoscope. A patient with early central lung cancer was treated with bronchoscopic argon knife combined with chemotherapy in our hospital, and good short-term and long-term results were achieved. Now, the diagnosis, treatment and follow-up were analyzed, and the relevant literature was retrospectively reviewed.

Some macrolide antibiotics can cause arrhythmias and may lead to sudden cardiac death, but azithromycin has previously been thought to be relatively less cardiotoxic. However, several recent case reports of cardiac arrhythmias suggest that azithromycin may also increase the risk of death from cardiovascular disease. To further understand the impact of short-term azithromycin use on the prognosis of patients with cardiovascular disease by analyzing the Tennessee Medicaid Cohort Study in the United States. This study included a population aged 30 to 74 years between 1992 and 2006, with a total of 347,795 patients taking azithromycin. The control group was 1 348 672 patients receiving amoxicillin, 264 626 patients receiving ciprofloxacin, 193 906 patients receiving levofloxacin and 1 391 180 patients not receiving antibiotics with matched personality propensity scores and consistent antibiotic use duration. Patients with severe non-cardiovascular disease and who had been hospitalized 30 days before enrollment were excluded, drug addicts and those with a history of care home residence were excluded. The primary endpoint of the study was fatal events, including death from cardiovascular disease and other causes. The results showed that the risk of death from cardiovascular events (hazard ratio 2.88, 95% confidence interval 1.79-4.63,P<0.001) and the risk of death from any other etiology (hazard ratio 1.85, 95% confidence interval 1.25-2.75,P=0.002) all significantly increased; However, the risk of death in the amoxicillin group was not increased compared with the non-antibiotic group. The risk of death from cardiovascular events in the azithromycin-treated group compared with the amoxicillin group (hazard ratio 2.49, 95% confidence interval 1.38-4.50,P=0.002) and the risk of death for any other cause of death (hazard ratio 2.02, 95% confidence interval 1.24-3.30,P=0.005) both increased, and a 47% increase in case mortality was expected in the azithromycin group. Compared with the ciprofloxacin group, the risk of death from cardiovascular events was significantly increased in the azithromycin group (hazard ratio 3.49, 95% confidence interval 1.32-9.26,P=0.01), but the difference between the azithromycin group and the levofloxacin group was not statistically significant. CONCLUSIONS: Treatment with azithromycin for 5 days resulted in a small increase in mortality in patients with cardiovascular disease, especially more pronounced in patients at high risk of mortality from cardiovascular disease.

COPD is characterized by incompletely reversible airflow restriction and dyspnea, with progressive exacerbations of airflow restriction associated with inhalation of harmful gases and particles. COPD has a high mortality and disability rate. As the disease progresses, most patients may develop systemic multi-system involvement, including exercise restriction, respiratory muscle and limb muscle dysfunction, pulmonary hypertension and malnutrition. There are a variety of drug and non-drug treatments for COPD. Global Strategy for Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease (global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease)^[1]Respiratory rehabilitation is regarded as the first-line non-drug treatment for COPD. In recent years, evidence-based medicine guidelines have been issued to standardize the definition and content of respiratory rehabilitation^[2]Breathing training is one of the important methods^[1]。

cycloserine has become the main drug in chemotherapy regimens for retreatment of tuberculosis long before the advent of rifampicin. In the 1950s, due to the damage to the 8th pair of cranial nerves caused by the first-line anti-tuberculosis chemotherapy regimen composed of streptomycin, isoniazid and sodium p-aminosalicylate, and the increased resistance rate of MTB to first-line anti-tuberculosis drugs, cycloserine was used clinically because of its good anti-tuberculosis effect and low resistance rate. With the deepening of clinical use and drug research, the adverse reactions of cycloserine gradually appear, and the emergence of new anti-tuberculosis drugs, especially the successful development of rifampicin, make cycloserine fade out of people's sight. In recent years, the number of multidrug-resistant tuberculosis (MDR-TB) is increasing day by day, and first-line drugs such as isoniazid and rifampicin often cannot meet the needs of clinical treatment. The low drug resistance rate of cycloserine to tuberculosis has been paid attention to^[1], the World Health Organization (WHO) recommends cycloserine for the treatment of MDR-TB^[1,2]。

High-frequency chest wall oscillation, also known as high-frequency chest wall compression or high-frequency chest compression, is a method of chest physical therapy. Its use originated in the 1960s and 1970s, and is mainly used to assist patients in eliminating airway secretions. It belongs to a kind of oscillatory airway clearing device.

cardiopulmonary exercise test (CPET) is different from the general exercise test that simply observes the changes of electrocardiogram and static lung function. It is a non-invasive detection method to objectively evaluate cardiopulmonary reserve function and exercise endurance. It comprehensively applies real-time monitoring and analysis technology of respiratory gas, electronic computer and activity tablet or power treadmill technology to detect the oxygen uptake of the body under different loads in real time (O₂) and carbon dioxide emissions (CO₂), so as to objectively, quantitatively and comprehensively evaluate the cardiopulmonary reserve function and exercise endurance. It is one of the most commonly used cardiopulmonary function examination methods in the world to measure the level of human respiratory and circulatory function. CPET emphasizes external and cellular respiratory coupling, i.e., the lung-heart-skeletal muscle group connection, with particular emphasis on the combined determination of cardiorespiratory function. With the improvement of sensor technology and the development of computer software, its application range is more and more extensive.

The characteristic lesion of COPD is chronic airflow obstruction due to a combination of small airway lesions (bronchiolitis obliterans) and pulmonary parenchymal destruction (emphysema). The average incidence rate of COPD in China is 8.2%, and the incidence and mortality rate are on the rise^[1]。 indacaterol is an ultra-long-acting beta₂-Receptor agonists, inhaled once daily, with bronchodilating effects up to 24 h^[2,3,4,5]It is currently approved for the treatment of COPD. The properties of indacaterol are now described below.

The 7th Salon of Beijing Young Respiratory Scholars 2012 was held in Chinese Medical Association on August 30, 2012, with the theme of "Dialogue between Chinese and Western Medicine: From Syndrome Differentiation to Evidence-Based". This salon activity was hosted by Professor Sun Yongchang, Department of Respiratory Affairs, Beijing Tongren Hospital affiliated to Capital Medical University.

Time flies, time flies, and in a blink of an eye, it is the end of the year, and 2013 is coming soon. As a medical worker, do you think of that memorable year of 2003 a decade ago? At that time, we risked our lives to fight in the front line of the fight against SARS, and every medical staff could fall on the battlefield without smoke at any time. However, our angels in white regarded death as home and were righteous, and saved countless fresh lives with benevolence and superb medical skills. They wrote a heroic song that touched the world with their health and even their lives. As a respiratory doctor who fought in the front line at that time, Professor Liu Youning, the editor-in-chief of this magazine, also experienced this baptism of blood and tears. Today, ten years later, he still remembers that period of history vividly. In the "Editor-in-Chief's Essay", he recalled the scenes and respectable colleagues at that time with deep affection, and missed the deceased heroes who fought SARS. The words were full of love for patients and feelings for medical staff, which was deeply moving to read. Professor Liu believes that the glory and suffering of ten years ago is one of the most memorable historical events in the medical field after the founding of New China. In today's sharp and complicated relationship between doctors and patients, it is of great practical significance to once again promote the spirit of "uniting as one to fight SARS", which will help doctors and patients to understand each other.