2015年 · 第38卷第07期

The eight characters in the title are the motto and true portrayal of Teacher Yu's medical practice for nearly 70 years. On February 2nd, 2015, the day of "the dragon raising his head", Mr. Yu ushered in a happy and happy 90th birthday. As the first "open door disciple" to study as a graduate student under Teacher Yu's name, the author recalls the past and the present, and is full of reverence for the generation of predecessors in respiratory discipline represented by Teacher Yu. This article is specially used to express respect and share it with readers.

venous thromboembolism (VTE) is a common complication and an important cause of death in hospitalized patients. Clinically, the prevention of VTE in surgical inpatients has been paid more attention^[1]While the prevention of VTE in internal medicine inpatients is relatively inadequate. VTE in internal medicine patients is usually occult, clinical symptoms are not obvious, and the cost of diagnosis and treatment is high. Therefore, it is particularly important to scientifically assess the risk of VTE in internal medicine patients and take preventive measures for high-risk internal medicine patients.

With the shift from "biological-medical model" to "psychological-social-biomedical model", the influence of psychological and emotional abnormalities caused by bronchial asthma (asthma) on asthma attack and control, especially the comorbidity with anxiety and depression, has been paid more and more attention, which may involve the interaction of environmental factors and genetic susceptibility, but the specific mechanism is still unclear. The results showed that Asn (asparagine) -Ile (isoleucine) mutation at position 107 of neuropeptide S receptor 1 (NPSR1) was associated with increased susceptibility to asthma^[1]。 NPSR1 and its ligand neuropeptide S (NPS) constitute a new neuropeptide system, namely NPS/NPSR1 system, which can be involved in regulating the pathophysiological processes of anxiety and depression^[2]。 It is speculated that NPSR1 may be a bridge between asthma, anxiety and depression. Therefore, by constructing a pathological model of asthmatic mice, the expression of NPSR1 in lung tissues of asthmatic mice was detected by real-time quantitative fluorescence PCR and Western blot method, which provided laboratory evidence for further research on the role of NPSR1 in the pathogenesis of asthma.

The study of gene polymorphisms associated with the pathogenesis of chronic obstructive pulmonary disease (COPD) has received extensive attention. Studies at home and abroad have shown that the gene polymorphism of nicotine receptor is closely related to the occurrence of COPD^[1,2,3]。 Nicotine receptor, CHRNA3 – CHRNA5 – CHRNB4 gene cluster polymorphisms are closely related to the development of COPD, especially α 5 D398N polymorphism in Caucasian population^[4]。 Previous studies of our research group also found that the risk gene and genotype of nicotine receptor CHRNA5rs16969968 allele in COPD patients of Han nationality in southern China are related to genetic susceptibility to COPD. The nucleotide change at position rs16969968 can cause the aspartic acid at position 398 of the α 5 encoded protein to be converted to asparagine, and its primary structure and amino acid polarity are changed; The influence of α 5 D398N polymorphism on the function of nicotine receptors related to α 5 D398N is worthy of further study.

rapid on-site evaluation (ROSE) of organs or diseased tissues by needle aspiration has been used in clinical practice for many years, especially in recent years, it has been widely used in TBNA. However, scholars' understanding of the application value of ROSE in TBNA is still inconsistent. Some studies suggest that ROSE improves the diagnostic rate of TBNA, has the advantages of reducing the number of TBNA punctures, is simple and feasible^[1,2]But the opposite opinion was also raised^[3,4]。 This paper briefly expounds the application progress and some existing problems of ROSE in TBNA.

A 44-year-old male was admitted to the hospital mainly for "intermittent abdominal pain and diarrhea for 13 years, aggravated with fever for 1 month". The patient experienced abdominal pain and diarrhea without trigger 13 years ago. Colonoscopy showed multiple longitudinal ulcers of the terminal ileum and colon, and pathology showed non-caseous epithelioid granuloma. Considering "Crohn's disease", the symptoms improved after oral administration of sulfasalazine. After that, abdominal pain and diarrhea occurred every 1 to 2 years. Five months ago, abdominal pain and diarrhea worsened again. Methylprednisolone 40 mg/d and azathioprine 75 mg/d were given orally. Abdominal pain and diarrhea improved, and then the hormone dose was gradually reduced to 16 mg. One month ago, the abdominal pain worsened again, accompanied by fever, with a maximum body temperature of 39.4 ℃, without cough and shortness of breath. Intravenous drip of levofloxacin was given, but the effect was not good, so he was admitted to hospital for further diagnosis and treatment. Previous smoking index 450 years. Physical examination: Body temperature 38 ℃, wet rales can be heard in both lower lungs. Soft abdomen, no tenderness. Chest X-ray showed patchy high-density shadows of both lower lungs (Figure 1)。 Initial diagnosis of admission: Crohn's disease, active phase; Pneumonia.

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Dear Professor Mou Xiangdong: Hello!

Pleural effusion (pleural effusion for short) refers to the accumulation of excessive fluid in the pleural cavity caused by pleural, lung and extrapulmonary diseases. Patients' medical history and physical examination findings can usually provide important clues for the differential diagnosis of pleural fluid. However, to make a definite diagnosis, thoracocentesis (referred to as thoracocentesis) must be performed to collect pleural fluid for detection, and it should first be judged whether it is exudate or leakage according to Light standard^[1]On this basis, strive to make the etiological diagnosis as soon as possible.

acute lung injury (ALI) /acute respiratory distress syndrome (ARDS) is an acute diffuse inflammatory lung injury caused by various intrapulmonary and extrapulmonary pathogenic factors, which leads to acute respiratory failure. The main pathological features are increased pulmonary vascular permeability, exudation of protein-rich fluid from the alveolar cavity, pulmonary edema and the formation of hyaline membrane. The clinical manifestations were refractory hypoxemia and respiratory distress, and the imaging manifestations were exudative lesions of both lungs. ALI and ARDS are continuous pathophysiological processes, and ARDS is its most severe stage. Since 1967 Ashbaugh et al.^[1]ARDS was first described and proposed. More than 40 years have passed. Although the treatment strategy of ARDS has been continuously improved and updated, its mortality rate remains high and has not improved significantly. A meta-analysis of 72 clinical studies of ARDS officially published internationally from 1994 to 2006 showed that the mortality rate of 11 426 patients with ALI/ARDS was 43%^[2]。 At present, the exact pathogenesis of ALI/ARDS is still unclear, and there is a lack of specific and effective treatment methods in clinic. Therefore, further exploration of the pathogenesis of ALI/ARDS is of great significance for its prevention and treatment. This article summarizes the pathogenesis of ALI/ARDS as follows.

idiopathic pulmonary fibrosis (IPF) is a chronic progressive fibrotic interstitial pneumonia of unknown cause. It is the most common idiopathic interstitial pneumonia (IIP). It occurs more than 50 years old. The lesions are confined to the lungs, and the main manifestation is progressive dyspnea. The histopathological and/or imaging manifestations are usual interstitial pneumonia (UIP), which needs to be diagnosed according to clinical manifestations, lung function, imaging and even pathology^[1]。 The incidence of IPF is high, and the annual incidence of IPF in the United States is 6.8~16.3 per 100,000^[2]The incidence rate was positively correlated with age, and the incidence of IPF in people over 65 years old was 93.7/100,000^[3]。 At present, there is still a lack of corresponding epidemiological investigation data in China, and the number of patients with IPF found in clinical practice is on the rise. IPF lacks effective treatment measures, and there are no drugs with IPF as an indication in China. The prognosis of patients with IPF is poor, and the median survival time after diagnosis is only 2 to 4 years^[4], the prognosis is worse in the elderly^[3]。 With the ageing of China's population, the incidence of IPF will increase further, which will definitely bring heavy economic and medical burden to the society. Therefore, it is of great significance to explore the pathogenesis of IPF, early detection, early diagnosis, early evaluation and early intervention.

Lung cancer is the tumor with the highest fatality rate in the world^[1]Among them, non-small cell lung cancer (NSCLC) accounts for more than 80%. Due to the lack of typical early symptoms, most patients are already in the middle and late stages of the disease at the time of diagnosis, and drug therapy has become the main treatment for lung cancer. However, in clinical application, even the best chemotherapy has an effective rate of only 20% ~40%, and is accompanied by inevitable toxicity and adverse reactions. Therefore, how to improve the efficiency of chemotherapy has become an urgent task in the treatment of lung cancer at present. At the annual meeting of the American Society of Clinical Oncology (ASCO) in 2004, the concept of "individualized treatment" was first proposed, that is, the method of treating cancer patients with specific and optimal therapeutic drug regimens according to the characteristics of pharmacogenetics and pharmacogenomics.

Lung cancer is one of the malignant tumors with the highest morbidity and mortality in the world. Lung adenocarcinoma is the most common histological type of lung cancer, accounting for about 50% of lung cancer patients^[1]Focal ground glass shadow is a common imaging manifestation of lung adenocarcinoma. In order to improve the preoperative diagnosis rate of lung adenocarcinoma, the research progress of different types of lung adenocarcinoma with focal ground glass shadows on imaging is reviewed below.

Since the introduction of bronchoscopy into clinical practice in 1970s, bronchoscopy examination and treatment technology has become rapidly popular, and it has become an indispensable means for the etiological diagnosis and local treatment of respiratory diseases. Under local anesthesia alone, patients have poor tolerance to bronchoscopy, often have painful memories after surgery, and most patients are reluctant to undergo necessary repeated examinations. There is no uniform specification for sedation protocols in the various bronchoscopy guidelines available. This article summarizes the clinical study of sedative and analgesic drugs used in bronchoscopy for alleviating patient pain and reducing operative risk.

Tuberculosis is one of the major threats to human health in the world, and the situation of tuberculosis control in China is grim. The results of two national epidemiological surveys of tuberculosis in 2000 and 2010 showed that the prevalence of active tuberculosis declined slowly, indicating that the current prevention and control strategies are not well controlled. The onset of tuberculosis is caused by recent transmission (rapid onset after infection in a short period of time) and endogenous resurgence (onset after long incubation after infection). Differentiating the roles of the two in the pathogenesis of tuberculosis has important guiding significance for formulating effective prevention and control measures. For the former, we should strengthen the discovery of infectious sources and block the transmission, and for the latter, we should strengthen the standardized treatment of patients.

Shortening the course of chemotherapy for tuberculosis will help in the management and disease control of tuberculosis patients. This Phase III clinical trial will evaluate the efficacy and safety of a 4-month regimen containing gatifloxacin in patients with rifampicin-sensitive pulmonary tuberculosis. Methods: Non-inferiority, randomized, open, controlled clinical trials were conducted in 5 sub-Saharan African countries. Criteria for inclusion: Patients aged 18 to 65 years, with positive sputum smear, rifampicin sensitivity and new onset of pulmonary tuberculosis. The control group was treated with a standard 6-month shortened regimen (2-month intensive period with isoniazid, rifampicin, ethambutol and pyrazinamide and 4-month continuation period with isoniazid and rifampicin), and the trial group was treated with a 4-month regimen consisting of 2-month intensive period with gatifloxacin 400 mg/d instead of ethambutol and 2-month continuation period with gatifloxacin, isoniazid and rifampicin. The primary efficacy endpoint event was adverse treatment outcome (including treatment failure rate, relapse rate, mortality rate, or withdrawal rate for each group at 24 months after treatment end), adjusted for country. The non-inferiority margin was set at 6%. Results: A total of 1 836 patients were included in this study, and the baseline characteristics of the two groups were balanced and comparable. At 24 months after treatment, the adjusted adverse event outcome difference between the trial and control group was 3.5% (95%CI-0.7 to 7.7), and the results of intention analysis of 1 356 patients showed that the incidence of adverse events was 21.0% in the trial group and 17.2% in the control group. Heterogeneity existed between the study countries: the difference in the outcome of adverse events between the two groups ranged from – 5.4% in Guinea to 12.3% in Senegal (P＝0.02)。 Compared with the 4-month regimen, the standard chemotherapy regimen had a higher rate of withdrawal (5.0%, 2.7%) and a higher rate of treatment failure (2.4%, 1.7%), but less recurrence (7.1%, 14.6%). There is no evidence that the 4-month regimen prolongs the Q – T interval or increases the risk of glucose metabolism disorders. CONCLUSIONS: Comparison of the primary efficacy endpoint event between the 4-month regimen and the standard chemotherapy regimen did not show non-inferiority results.