2013年 · 第36卷第06期

Not long ago, with the participation of the National Committee for Approval of Scientific and Technological Terms and relevant leaders of the Chinese Medical Association, a review meeting of the respiratory volume of medical terms was held. While feeling the importance of this work and the hardship of completing this work, I also have some special feelings. I specially disclose these immature views to readers. Please correct me.

Fluid resuscitation generally means that the volume of infusion and blood transfusion within 6 hours is greater than that of conventional treatment, so as to correct hypovolemia and ensure effective cardiac output and organ blood perfusion; 6-72 h was less than conventional treatment, and the curative effect was maintained. In the case of ineffective fluid rehydration, vasoactive drugs mainly based on norepinephrine should be applied^[1]。 The concept of fluid resuscitation has played a positive role in the treatment of sepsis, but there are also many problems. First of all, this measure is applied indiscriminately to a variety of critical diseases, neglecting many links to improve tissue oxygen supply, and also neglecting the individual differences of different patients. For example, in the elderly, patients with cardiorenal impairment and anesthesia surgery, a large amount of fluid rehydration can easily lead to left heart failure and pulmonary edema, and a large amount of crystal or colloidal fluid rehydration in patients with acute respiratory distress syndrome (ARDS) can easily aggravate pulmonary edema.

Cinchona cream, whose chemical name is quinine, is an organic compound with a complex structure. Pure quinine is in the form of a white powder and has a bitter taste. It is used to treat malaria. Because it can bind to the DNA of the malaria parasite to prevent its reproduction, thus inhibiting the malaria parasite.

Sarcoidosis is a systemic disease of unknown etiology and characterized by non-caseous necrotizing epithelial cell granuloma. Its diagnosis depends on histological evidence, clinical and imaging findings, and granulomatous lesions of other causes need to be excluded^[1]。 After diagnosis, it is also necessary to judge the extent, stage and activity of organs involved in sarcoidosis. 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 the diagnosis, staging and efficacy evaluation of tumors, but¹⁸F-FDG can not only be accumulated by tumor cells, but also be taken up by inflammatory cells such as lymphocytes, macrophages and fibroblasts^[2]。 In recent years, some scholars have tried to¹⁸F-FDG PET is used in activity evaluation and efficacy evaluation of sarcoidosis. Now will¹⁸The value of F-FDG PET in the diagnosis, activity judgment, efficacy and prognostic evaluation of sarcoidosis is reviewed below.

Bronchial asthma (asthma for short) is a chronic airway allergic disease with genetic susceptibility involving multiple genes. Its pathogenesis involves a variety of inflammatory cells, inflammatory mediators and complex cytokine networks. Allergic asthma is an airway inflammatory disease characterized by increased serum allergen-specific IgE, eosinophil infiltration in lung tissue and airway hyperresponsiveness^[1]。 Allergen (also called allergen) refers to an antigen that can induce the body to produce IgE antibodies and cause allergic reactions (allergies). The best management strategies for asthma include correct etiological diagnosis, sound treatment, and patient education and management protocols. The primary measures for asthma are avoidance of exposure to allergens and appropriate medication. allergen-specific immunotherapy (ASIT) may be considered when the patient's symptoms are not under desired control, which is so far the only effective therapy for the etiological treatment of asthma and allergic rhinitis. ASIT targets allergens and alters the natural course of asthma through immunomodulatory mechanisms^[2]。 At present, there are two kinds of ASIT commonly used in clinical practice, including subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT). The patient's tolerance to the allergen is gradually increased by subcutaneous injection or sublingual administration of an allergen preparation aimed at reducing or eliminating asthma symptoms. In addition, ASIT can maintain long-term efficacy and prevent cross-reactivity of new allergens after discontinuation of treatment, and can prevent allergic rhinitis from developing into asthma^[3]。 In this paper, the research progress of ASIT preparation and its mechanism, application status, safety and new methods in the treatment of asthma are reviewed as follows.

Smoking is a major risk factor for chronic obstructive pulmonary disease (COPD). Oxidative substances in tobacco smoke can cause endoplasmic reticulum stress in lung structural cells, and excessive endoplasmic reticulum stress can cause apoptosis in lung structural cells, thus promoting the occurrence and development of COPD^[1]。 Derlin-1 is a transmembrane protein located in the endoplasmic reticulum, which is closely related to endoplasmic reticulum-related degradation^[2]。 In this study, immunohistochemistry, Western blot and polymerase chain reaction were used to detect the expression of derlin-1 in tobacco smoke-exposed rats, which provided experimental data for the study of the pathogenesis of COPD.

Bronchial asthma (abbreviated as asthma) is a chronic inflammatory disease of airway involved in various inflammatory cells such as eosinophils and inflammatory mediators and cellular components. It is characterized by increased or abnormal expression of various inflammatory genes^[1]。 With the rapid development of immunology and molecular biology, more and more theories show that the network imbalance of cytokines plays an important role in the pathogenesis of asthma. IL-37 is a new member of the IL-1 family discovered in 2000 and plays a protective role in many diseases^[2,3,4,5]Different from the pro-inflammatory effects of most IL family members, IL-37 is gradually gaining attention as an anti-inflammatory cytokine. IL-37 is expressed in macrophages or epithelial cells, which can effectively inhibit the release of pro-inflammatory factors induced by TLR and the activity of dendritic cells^[6,7,8]。 Decreased expression of endogenous IL-37 can lead to a large increase in pro-inflammatory factors^[9]。 In this paper, by observing the changes of IL-37 in peripheral serum of patients with acute asthma attack, the role of IL-37 in acute asthma attack was evaluated preliminarily.

Oxidative and antioxidant imbalance play an important role in the pathogenesis of chronic obstructive pulmonary disease (COPD). glutathione S-transferase P1 (GSTP1) is an important antioxidant enzyme in lung, and the single nucleotide polymorphism of exon 5 of GSTP1 gene can affect the antioxidant activity of the enzyme. The relationship between exon 5 polymorphism of GSTP1 gene and COPD is still controversial^[1,2]。 Therefore, we studied the relationship between exon 5 polymorphism of GSTP1 gene and susceptibility of Kazakh patients with COPD in Xinjiang Uygur Autonomous Region.

Bronchial asthma (asthma for short) is a common respiratory immune disease. The results showed that rock salt aerosol therapy alone or in combination was effective in patients with asthma, chronic obstructive pulmonary disease and allergic rhinitis in adults and children^[1,2,3,4]However, there is no study on the immune mechanism of the therapeutic effectiveness of rock salt aerosol therapy in asthma patients. In this study, we compared the changes of serum IL-4, γ-interferon (IFN-γ) and immunoglobulin (IgE) in different stages of asthma patients by three therapeutic methods, and investigated the effect of rock salt aerosol therapy on the curative effect and related immunological indexes of asthma patients.

Pleural nodules are localized lesions originating from visceral or parietal pleura, which can be displayed by modern imaging techniques and have certain imaging features. In practical clinical work, if the patient's chest CT examination reveals multiple pleural nodules, but there is no obvious or small lung lesion, and there is little or no pleural effusion, it is difficult for the patient to make a definite diagnosis at this time.

ICUs are rapidly becoming the core of modern hospital operations. In the United States, although ICU beds only account for about 5% of hospital beds, the hospitalization cost of ICU patients accounts for more than 30% of the total medical consumption of hospitals, and the average fatality rate of ICU is 30%, which is 10 times that of all hospitalized patients^[1]。 With the aging of the population and the increasing bias of the inpatient structure towards those with more serious conditions, the demand for ICU beds is bound to further increase in the future. Therefore, the construction and management of ICU is very important from the perspective of medical treatment and management. At present, the organizational management mode of ICU varies greatly around the world^[2,3]This paper systematically introduces the American ICU system from many aspects, hoping to provide reference for domestic counterparts to carry out ICU work.

Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease that seriously endangers people's health. The prevalence of COPD in China is 8.2% in people over 40 years old and 16.3% in the elderly. There are as many as 50 million patients with COPD in China, and 10 million people are disabled due to illness, and about 90% of patients have not been reasonably diagnosed and treated, which makes the burden of COPD in China increasing day by day. GlaxoSmithKline China (GSK) COPD College provides a platform for respiratory doctors across the country to learn and communicate. On January 12th, 2013, the college held the first meeting of the general hospital in Shenzhen, ushering in the sixth academic year.

For many years, the severity of chronic obstructive pulmonary disease (COPD) has been assessed by pulmonary function classification. However, in the clinical process, we often find that patients' lung function and symptoms are not parallel. The results of several studies have shown that there is only a weak correlation between the severity of airflow restriction, symptoms and quality of life in patients with COPD^[1]Therefore, measuring pulmonary function alone does not fully reflect the severity and prognosis of the disease. In the 2011 edition of the Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease, a new comprehensive assessment method was proposed^[2]。

extracorporeal membrane oxygenation (ECMO) is one of the extracorporeal lung assist (ECLA) technologies, which is mainly used to partially or completely replace the cardiopulmonary function of patients, so that the heart and lung can fully rest, so as to buy time for the treatment of the primary disease. Although ECMO has become a bedside-accessible life support technology in developed countries, it started late in China. In the early stage, it was mainly used in the field of heart disease, and its application in the field of respiratory failure began with the pandemic of new type A (H1N1) in China in 2009. At present, many hospitals have begun to apply ECMO to the treatment of severe respiratory failure. So far, we have carried out ECMO to treat nearly 40 cases of respiratory failure. The author believes that in order to successfully carry out ECMO, after accumulating a certain number of cases and mastering its operation and management, the most important thing is still to grasp the indications of ECMO, which requires special clarification of the treatment goals of ECMO and comprehensive consideration of the effects of ECMO. Various factors.

The standardization of medical nouns and units of measurement is very important, but the unification of nouns and units of measurement should be as consistent as possible to bring convenience to users. Unrealistic pursuit of internationalization can only do more harm than good and bring trouble to Chinese people. Professor Liu Youning listed an example of the dispute between the names of SARS and SARS in the essay column of the editor-in-chief. He believed that it was understandable to temporarily name SARS as SARS when the pathogen was unclear at the beginning of the epidemic, but it was obviously inappropriate to insist on the original name after the pathogen of SARS was very clear and the degree of harm was shown. The ideal and correct naming of an infectious disease should reflect the nature of the disease and its severity, and preferably be helpful in the selection of treatment options. At present, the official and mass media still call it "SARS", and Chinese academic journals mark SARS after "SARS", while internationally only SARS is named. Professor Liu suggested that the official name of "SARS" should be called "SARS" according to the traditional custom of China, with brackets indicating that it was once called "SARS" and "infectious SARS" in China. For example, the problem of influenza A (H1N1) is inappropriate to simply call it "influenza A (H1N1)" because the source of the virus and the clinical manifestations of patients are significantly different from those of common seasonal influenza. This journal has corrected its name to "new influenza A (H1N1)" in a relevant paper published in 2009. Finally, Professor Liu also talks about the problems posed by certain "standardized" units of measurement, such as mm Hg, cm H₂O After changing to Pa and kPa, it brings a lot of inconvenience to clinicians. For example, blood pressure, PaO₂, PaCO₂As well as the test indicators in the field of lung function and mechanical ventilation, if mm Hg and cm H are used₂O, its normal value is easy to remember and convenient to use, while converting into a non-integer kPa value is difficult to remember and extremely inconvenient to use. There are also many pressure-related derivative units in respiratory department, such as compliance, resistance and gas diffusion capacity, which will be miserable for doctors if they are changed to Pa or kPa values.