2013年 · 第36卷第09期

With the development of science and society, some new terms and concepts must emerge constantly. History will finally prove what is appropriate will be used for a long time, which is short-lived and quickly discarded, and some of them are useless except to create conceptual confusion. Similarly, scientific and correct use of abbreviations can play a concise and concise role, which not only saves words, but also shortens the time of oral expression. However, if they are used too much and excessively, they will make readers and listeners confused, and more time will be wasted to understand them. For example, recently, words like "diaosi" and "selling cute" often appear on the Internet and paper media. Maybe young people can understand their complex meanings well, but the author can't understand them correctly so far. On the contrary, our generation knows what "one center, two basic points, three represents and four basic principles" are, but many young people do not necessarily know. There are also some new and immature concepts, ideas and many abbreviations that people can't understand in the field of medicine.

Freezing technology has been used in the treatment of airway diseases for more than 40 years. Traditional freezing requires direct contact or insertion of the cryoprobe into the diseased tissue. Because of the limited surface area of the probe, the onset of effect is usually slow and time-consuming^[1], suitable for lesions with a smaller range. In 2005, Johnston first proposed the concept of jet freezing and successfully applied it to the treatment of Barratt's esophageal patients. The cryoprobe is filled with radial jetting holes, which greatly improves the freezing efficiency, and is more suitable for lesions with wide range and uneven surface, but it is not recommended for mass-type lesions with limited range. Jet freezing technology is mostly used in digestive endoscopic treatment of Barratt's esophagus and esophageal cancer. However, due to the physiological characteristics of the respiratory tract, the difficulty and danger of endovascular treatment is much higher than that of the digestive tract. At present, it has gradually entered clinical practice abroad, but it has not been carried out in China. Our hospital has conducted animal experiments with self-developed equipment, but it has not been applied in clinical practice.

Since April 2012, a new human coronavirus infection has emerged in the Middle East. This virus was first named HCoV-EMC after the Erasmus Medical Center (EMC) in the Netherlands, where the virus was tested, and later named Middle East respiratory syndrome coronavirus (MERS-CoV) by the World Health Organization. The clinical manifestations of this viral infection are similar to those of severe acute respiratory syndrome (SARS) in 2003, with acute respiratory distress syndrome (ARDS) and multiple organ failure. Since the first laboratory-confirmed case was reported on 22 September 2012, as of 9 July 2013, the World Health Organization has received a total of 80 laboratory-confirmed cases of human infection with MERS-CoV. Due to the limited number of cases, people's understanding of MERS-CoV has great limitations, and there are many unresolved problems. In order to improve the understanding of Chinese clinicians about this new pathogen infection case and strengthen the awareness of clinical screening, its clinical characteristics, epidemiology and diagnosis are summarized as follows.

In recent years, sleep medicine has developed rapidly, and the diagnosis and treatment of sleep diseases has become increasingly standardized. Sleep disorder, as one of the most common sleep disorders, has also attracted the attention of more and more clinicians and researchers. For sleep apnea, people have long been familiar with obstructive sleep apnea (OSA), central sleep apnea (CSA), and mixed sleep apnea. However, there is a special case in clinic, that is, complex sleep apnea syndrome (CompSAS). So far, people have not known enough about it, and sleep scholars all over the world have been disputing whether CompSAS is an independent disease^[1,2]。 According to the American academy of sleep medicine (AASM), the third edition of the International Classification of sleep Disorders (ICSD-3) will be published in 2013. One of the important changes is to list complex sleep apnea independently. Therefore, this paper will introduce CompSAS based on the existing research results, aiming to give more people a deeper understanding of it.

Bronchial asthma (abbreviated as asthma) is a chronic airway inflammatory disease, with episodic wheezing, chest tightness, air tightness and cough as the main clinical manifestations. Its fundamental pathophysiological changes are airway obstruction and airflow restriction. The airflow restriction of asthma is different from chronic obstructive pulmonary disease (abbreviated as COPD), and most of it is reversible. Its pathological basis mainly includes airway smooth muscle contraction, increased gland secretion, airway wall edema and vascular congestion. After proper treatment, most asthmatic patients can return to normal lung function^[1]。 However, asthma is also a heterogeneous disease. Different asthma patients have obvious differences in severity, natural course of disease and response to treatment. Many evidences suggest that there is a specific type or phenotype of asthma, namely irreversible airflow obstruction (IAO) or fixed airway obstruction (FAO). Such patients are clinically presented with persistent airflow restriction, and pulmonary function cannot be recovered even after adequate treatment including glucocorticoids (hormones for short). In view of the fact that airflow restriction is used in recent literature instead of airway obstruction, IAO is used to represent irreversible/fixed airflow restriction in this paper.

Proton of Metabolomics (¹H) Nuclear magnetic resonance spectroscopy provides the possibility to explore the diagnosis and molecular mechanism of chronic obstructive pulmonary disease (COPD). The existing research data are from European and American countries, but no data from Asian countries have been seen. To this end, we performed serum and urine samples from stable COPD patients¹H nuclear magnetic resonance spectroscopy, by identifying its metabolite types, to explore the metabolomic changes in patients with COPD.

A 68-year-old female was admitted to the hospital on 6 June 2012 due to "intermittent fever, cough, expectoration and blood in sputum for 1 month". One month ago, the patient developed afternoon fever without obvious trigger, body temperature as high as 38.0℃, accompanied by cough, expectoration and blood in sputum, occasionally chest tightness after activity, which can be relieved by itself after a few minutes of rest, and there are no symptoms such as night sweats, chest pain and palpitations. The white blood cell count in other hospital was 12.8×10⁹/L, 0.84 for neutrophils, 100 g/L for hemoglobin and 185×10 for platelets⁹/L, C-reactive protein was 96.6 mg/L, chest enhanced CT showed left upper lung shadow, uneven density, multiple enlarged lymph nodes in the mediastinum (Figure 1，Figure 2)。 Admission to hospital for further diagnosis and treatment. Past history: Hypertension for 5 years, facial neuritis for 3 months. Deny the history of infectious diseases such as hepatitis B and tuberculosis, deny the history of trauma surgery and blood transfusion, deny the history of metallurgy. Physical examination: body temperature 38 ℃, blood pressure 115/70 mm Hg (1 mm Hg =0.133 kPa). There were no yellow stains and bleeding spots on the skin and mucosa, no abnormalities in the ear and nose, shallow frontal lines on the left side, difficulty in closing the left upper eyelid, and skewed corners of the mouth to the right. There was no deformity in the thorax, clear breathing sounds in both lungs, no dry and wet rales, uniform heart rhythm, no murmur, flat and soft abdomen without tenderness, no liver and spleen under the costs, and no abnormalities in the spine and limbs.

Tracheal glomus tumor is rare in clinic, and it is mostly reported as a case at home and abroad. Only 11 cases have been reported in China. Two cases admitted to our hospital are reported as follows.

As we all know, people in Northeast and Shandong are generous, people in Sichuan are fierce, and people in Jiangsu and Zhejiang are delicate. These are not only related to the different climate, water and soil, but also may be related to the different eating habits of various places. This is a very interesting question. Recently, People's Daily reported that Dr. Aaron Hirsch, director of the Smell and Taste Therapy and Research Foundation in the United States and author of the book "Which Food Personality Are You", conducted 25 years of research on the relationship between people's food choices and personality, and found that dietary preferences can reflect people's personality traits. (1) Love to eat salty: usually have an outgoing and easy-going personality, like to follow the crowd in life, and will not stand out easily or make things difficult for others; (2) Love to eat chocolate, cakes and other sweets: optimistic and positive, do things as you want, and rarely leave any regrets for yourself; (3) Love spicy food: Usually with a happy energy, he often does things quickly and decisively. Although he is enthusiastic, his temper is hot. He often says whatever comes to mind and insists on his own ideas; (4) Love to eat sweet and salty, sweet with bitterness and other "alternative" foods: generally introverted, like to stay alone, very careful thinking, hidden, looking a little indifferent and arrogant, difficult to contact; (5) Love to eat shabu-shabu, barbecue and other meat foods: usually active, can talk happily with different people, and always attract attention in the social circle; (6) Vegetarians: Most of them are introverted, like to be quiet but not moving, and the noisy interpersonal circle will make them feel uncomfortable. Of course, these may all be based on the results of American research. Whether the Chinese really fit perfectly needs further verification.

Obstructive airway invasive aspergillosis is a subtype of airway invasive aspergillosis, mainly caused by tracheal and bronchial infections, so it is also called aspergillous tracheal and bronchitis^[1]。 Aspergillus grows in a mass in the airway lumen, resulting in stenosis and obstruction of the lumen. Clinically, the main manifestation is progressive dyspnea, which is at risk of asphyxia at any time and has a high mortality rate. Recently, two patients with obstructive airway invasive aspergillosis and respiratory failure were urgently treated with respiratory intervention, topical application of antifungal drug irrigation and instillation, and systemic application of antifungal drugs, which achieved good results and saved the lives of patients. The report is now as follows.

A 56-year-old male was admitted to the hospital on 29 December 2010 mainly for "intermittent dry cough for 2 months, aggravated with dyspnea for 1 month". No abnormalities were found on the chest X-ray during the patient's physical examination 3 months ago (Figure 1)。 Two months ago, there was intermittent dry cough without trigger, accompanied by chest pain and headache in severe cases, and the symptoms did not relieve after symptomatic cough treatment. After 1 month, peripheral blood leukocytes were examined 8.5×10⁹/L, neutrophils 0.81, ESR 14 mm/1 h; Chest X-ray and chest CT showed slightly more texture in both lungs (Figure 2，Figure 3), diagnosed as acute bronchitis, moxifloxacin hydrochloride (0.4 mg/d) administered orally for 7 d was ineffective. Pulmonary function tests performed in other hospitals showed mild obstructive ventilatory dysfunction, FEV₁/FVC was 67.91%, FEV₁% of the projected value was 87%, and the methacholine airway challenge test was negative. After that, the patient's cough progressively aggravated and exertion dyspnea appeared. Half a month later, the X-ray chest radiograph revealed diffuse exudation in both lungs, and the lesions progressed significantly compared with before (Figure 4)。 Admitted to our hospital for further diagnosis and treatment. Since the onset of the disease, the patient has decreased appetite, greasy anorexia, easy eating, normal defecation, and weight loss of 10 kg in the past 2 months. Past physical health, no history of smoking or drinking. Physical examination after admission: body temperature 36.8 ℃, pulse 112 beats/min, respiratory rate 24 beats/min, blood pressure 120/65 mm Hg (1 mm Hg =0.133 kPa), body mass index 21.5 kg/m²。 Weak constitution, unpalpable swelling of superficial lymph nodes; The neck is soft without resistance, the trachea is in the center, the thyroid is not large, the breathing sounds of both lungs are coarse, and dry and wet rales are not heard; The heart rhythm is uniform and there is no murmur; The abdomen is depressed, soft and non-tender, and the mass is not palpable, and the liver and spleen are not palpable under the costs; Both lower limbs are not swollen.

The 2nd Beijing Young Respiratory Scholars Salon "Respiratory Department and Radiologist Face to Face" was held on May 30, 2013. The event was hosted by Dr. Bu Xiaoning of Beijing Chaoyang Hospital affiliated to Capital Medical University.

The prolongation of mechanical ventilation time is closely related to the occurrence of nosocomial pneumonia, ventilator dependence and mortality^[1]。 Therefore, early evacuation of ventilator and tracheal intubation is an important way to alleviate patients' pain and reduce complications. Tindol et al.^[2]The results of the study showed that about 50% of patients who accidentally withdrew the tracheal intubation had good spontaneous breathing and did not need to establish an artificial airway again. This result suggests that clinicians underestimated the spontaneous respiratory function of some patients and delayed the time to leave the artificial airway. However, premature pullout of the tracheal intubation is also unhelpful. Another result of the above clinical observation is that patients who accidentally pull the tracheal intubation and need respiratory support have a longer stay in ICU and an increased mortality rate in hospital. Based on the influencing factors and implementation process, this paper briefly describes the current mechanical ventilation evacuation methods.

Acute exacerbation of chronic obstructive pulmonary disease (COPD) is an important event in the natural course of COPD. Frequent attacks of acute exacerbation bring serious adverse consequences to patients, which not only leads to progressive decline of pulmonary function, but also is the main factor of increased morbidity rate, decreased quality of life and increased mortality rate. According to literature reports, the mortality rate of patients with acute exacerbation of severe COPD is about 11% in hospital, and that of patients admitted to ICU is 11% ~24%. About half of patients are readmitted to hospital at least once within 6 months after discharge^[1,2]。 The results of recent 10 years of research show that infection is the main cause of acute exacerbation of COPD. Active and effective antibacterial drug treatment for patients with acute exacerbation of COPD with antibacterial indications can quickly improve clinical symptoms, improve the cure rate of infection, reduce the mortality rate and shorten the hospital stay. However, for patients with acute exacerbation of COPD, how to recognize the pathogenesis of acute exacerbation of COPD and how to use drugs rationally according to the specific situation of patients need to be further clarified. Now, the expert opinions of the symposium on standardized antibacterial treatment of acute exacerbation of COPD are compiled into a document for the reference of clinicians.

Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory diseases. The World Health Organization estimates that in 2020, COPD will become the third leading cause of death in the world and the fifth largest burden on the world economy. The prevalence rate of COPD among people over 40 years old in China is about 8.2%, and the number of disabled people reaches 5 million to 10 million every year and the number of deaths reaches 1 million. The Global Strategy for the Diagnosis, Management and Prevention of COPD (referred to as the Global Strategy for COPD) is a strategic document based on evidence-based medical evidence. In the latest 2013 update of the Global Strategy for COPD, long-acting bronchodilators are recommended as the first-line drugs for the stable treatment of COPD.

The patient is a 56-year-old female, a company executive. The main cause was "fever with cough for 6 days" and he was admitted to the hospital on November 18, 2011. The patient developed fever after being cold on November 12, 2011, with a maximum body temperature of 38.5℃, accompanied by cough, which was dry cough without phlegm, sometimes accompanied by mild chest tightness and shortness of breath, which was aggravated during activities, and daily activities were not restricted. No nasal congestion, runny nose, chest pain, hemoptysis, etc., no fatigue, night sweats, etc. He was admitted to our hospital for further treatment after intravenous drip of "ceftriaxone" in a local hospital without a significant drop in his body temperature. Since the onset of the disease, the patient's spirit is slightly poor, his appetite and sleep are acceptable, his urine and defecation are normal, and his weight has not been significantly reduced. The patient had been diagnosed with left lower lobe pneumonia 2 years ago (Figure 1), cured after anti-infective treatment. Denial of tobacco and alcohol addiction. Physical examination: body temperature 37 ℃, pulse 84 beats/min, respiratory rate 22 beats/min, blood pressure 106/78 mm Hg (1 mm Hg =0.133 kPa), consciousness, autonomic position. The superficial lymph nodes of the whole body were not palpable and swollen, the lips were not cyanotic, the breathing sounds of both lungs were coarse, the left lung could occasionally hear dry sounds, and the two lungs could not hear wet rales. Heart rate 84 beats/min, rhythm uniform. The abdomen is soft, and the liver and spleen are not reached under the ribs. Laboratory test: Blood routine showed white blood cells 6.4×10⁹/L, neutrophils 0.66, hemoglobin 118 g/L, platelets 274×10⁹/L; Urinary routine, stool routine, coagulation routine, liver and kidney function, CD₄/CD₈No abnormalities were observed; Sputum bacteria, fungal culture, mycoplasma antibody, chlamydia antibody and virus series were all negative; PPD negative; ESR was 95 mm/1 h; Blood gas analysis showed pH 7.48, PaCO₂is 38 mm Hg, PaO₂77 mm Hg; Cardiac color ultrasound showed mild tricuspid valve insufficiency; Abdominal B-ultrasound showed hepatic cyst, but no abnormality was found. Nov 19, 2011 Chest CT showed a high-density mass shadow in the dorsal segment of the lower lobe of the left lung, considering inflammation (Figure 2), the inner walls of the trachea and the main bronchus are unevenly thickened. Pulmonary function showed FEV1 as % of the predicted value of 83.5%, and FEV₁/FVC was 74.5%, RV/TLC was 109.5%, and diffusion function was approximately normal.

In the blink of an eye, it is late summer and early autumn. In this upcoming harvest season, doctors such as Mu Xinlin in this issue have brought you a wonderful study. They raised some doubts about the literature reports of "Trichomonas pulmonalis" infection published many times at home and abroad in the past half century. Through optical and electron microscopic observation, they tried to follow the theory of "Koch hypothesis" to explore whether there is misjudgment of pulmonary infection of Trichomonas pulmonalis in current clinical work. Since 1993, many case reports of Trichomonas pulmonalis infection have been published in different journals at home and abroad in China. However, through reviewing the literature, the previous reports were all of active cells observed under light microscope, and the diagnosis was made according to their morphology, movement and flagellar characteristics. The ultrastructure of electron microscope was not observed, and the pathogen was not isolated, cultured and confirmed in vitro. Through literature review, it was found that the ultrastructure and organelle characteristics of Trichomonas cockroach under electron microscope have been reported in literature as early as 1961 and 1969. In 2011,Internal MedicineAfter two case reports in China were published, some scholars pointed out in subsequent commentary articles that the infection of Trichomonas cockroaches in the respiratory tract may be misdiagnosed. In this paper, the structure of the ciliary columnar epithelium moving under light and electron microscope is given clearly, and the schematic diagram is drawn according to the ultrastructure of Trichomonas cockroach found in cockroach (cockroach) before under electron microscope. The information is very precious, and it is recommended to read it. At the same time, due to the limitations of detection conditions and inertial thinking, we have insufficient understanding of it, resulting in misdiagnosis and mistreatment in the past 20 years, which deserves the attention and vigilance of relevant professional clinicians.