2016年 · 第39卷第01期

Time flies and the new year has come again. At this time, we sincerely thank our faithful readers, authors and people from all walks of life for their support and love for this magazine in the past year. Your support and attention are the driving force of our continuous progress and the source of our remarkable achievements. According to the latest journal evaluation indicators published in 2015, the impact factor of this journal is 2.026, ranking first among the series of Chinese Medical Association journals and ranking 15th among 2,383 Chinese core journals; The total citation frequency is 5306 times, ranking second in the series of Chinese Medical Association journals and 50th in the 2383 core Chinese journals; The total score of comprehensive evaluation ranks 2nd among 2383 Chinese core journals. Thank you for your support, thank you for your attention!

After decades of eagerly anticipating and anxious waiting, finally a non-foreign Chinese has won the Nobel Prize in Natural Science for the first time! No matter how much controversy there is, no matter how many people make sarcastic remarks, this move is undoubtedly a milestone in the history of Chinese science, a striking symbol of China's scientific and technological progress in the world. At the same time, it may also hint the beginning of an earth-shattering era and the arrival of an infinitely bright future. There is no reason why Chinese people, especially Chinese scientific and technological workers, should not rejoice. What is more worthy of readers' attention is that the first real Chinese person selected by the Nobel Prize jury to win the Natural Science Prize is actually the so-called "Three No Scientist", a relatively unknown scientist who has not published many SCI papers. This fact itself is very shocking, and it is enough to warn that the existing evaluation and assessment system of scientific and technological talents in China needs to be thoroughly reformed.

MTB infected people are like a huge iceberg base under the sea surface, constantly transporting new active tuberculosis patients. How to control these infected people from developing the disease has become an important issue of tuberculosis control in the world today. It is estimated that more than 500 million people are infected with MTB in China, accounting for 45% of the country's total population^[1]； About 2 billion people worldwide are infected with MTB^[2]About 5% to 10% of infected people will eventually develop active tuberculosis, and most of them occur within 5 years of the initial infection^[3]This probability can be as high as 10% if it is accompanied by human immunodeficiency virus (HIV) infection^[4]。 Epidemiological investigations showed that 85% to 90% of newly diagnosed active tuberculosis evolved from tuberculin-positive MTB infection^[5]。 At the 67th World Health Assembly, the World Health Organization proposed to carry out latent tuberculosis infection (LTBI) screening and preventive intervention, and gradually eliminate a large number of latent MTB infections among about 2 billion people. This is an important measure of the global tuberculosis control strategy goal. Therefore, the World Health Organization has specially issued "Guidelines for the Management of Latent MTB Infections"^[6]。 The above information fully illustrates the severity of MTB infection and the need to control MTB infection. Why should we discuss it again? This is because there are still some blind spots or misunderstandings in our understanding of MTB infection. For example, so far, we still lack a gold standard for diagnosing MTB infection, and the time nodes of recent infection and latent infection are not clear enough. The objects and methods of infection screening deserve our serious discussion. Preventive intervention measures need to be repeatedly weighed and weighed. The Chinese Journal of Tuberculosis and Respiratory Medicine organized the key issue of this issue in order to deepen the understanding of latent MTB infection and further clarify intervention strategies.

2015 World Health Organization "Guidelines for the Diagnosis and Treatment of latent TB infection (LTBI)"^[1]In, LTBI is defined as a state in which there is no clinical manifestation of active tuberculosis, but the body persists in an immune response to MTB antigen stimulation. Although there is a lack of direct means to detect LTBI and a "gold standard" for diagnosis, chemoprophylaxis of LTBI is an effective intervention to prevent the development of LTBI into active tuberculosis, and the conclusion is positive, especially in specific populations.

Tuberculosis is a chronic infectious disease caused by MTB infection, which seriously threatens human health. About 2 billion people worldwide are infected with MTB, and most of them live with bacteria and do not show any clinical symptoms of tuberculosis, which are called latent tuberculosis infection (LTBI). These latent infections may develop into tuberculosis when the body's immunity is reduced, especially when infected with HIV, suffering from diabetes, malnutrition and receiving immunosuppressant therapy. According to statistics, about 10% of people with latent MTB infection may develop tuberculosis. Exposure to the dangerous environment of MTB is the main cause of infection. Compared with the natural population, medical staff directly face infectious pulmonary tuberculosis patients, the exposure risk is significantly increased, and the probability of MTB infection is relatively high. Therefore, screening for MTB infection in medical staff, analyzing the risk factors of infection in medical staff and formulating corresponding prevention and control strategies are of positive significance for reducing MTB infection rate and tuberculosis incidence.

According to statistics, by the end of 2013, there were 519,000 schools at all levels and types, with about 260 million students, accounting for about 19.3 percent of the total population of the country^[1]。 In 2014, a total of 889,381 cases of tuberculosis were reported in the national infectious disease network direct reporting system, including 35,881 cases of tuberculosis in students, accounting for 4.03% of the total population. From 2010 to 2014, the epidemic of tuberculosis among students showed an overall downward trend, with the reported incidence decreasing from 20.8 per 100,000 in 2010 to 14.9 per 100,000 in 2014, a decrease of 28.3%. However, clusters of tuberculosis in schools occur from time to time. From 2008 to 2015, 31 clusters of tuberculosis in schools were reported nationwide, of which 19 occurred in high schools, mainly in rural boarding schools, especially among students in high school graduating classes.

In the coming year of 2015, great achievements have been made in the prevention and control of tuberculosis at home and abroad, but many regrets have also been left behind. It is the end of the year. Let's review the progress of tuberculosis prevention and control at home and abroad in 2015 and look forward to the new year together.

Tuberculosis is a chronic infectious disease caused by MTB, which seriously endangers human health. The World Health Organization estimates that there were 9 million new cases of tuberculosis and 1.5 million deaths worldwide in 2013^[1]。 China is one of the 22 countries with a high burden of tuberculosis, second only to India in the number of patients, and the situation of tuberculosis prevention and control is not optimistic.

sodium tanshinone ⅡA sulfonate (STS) is a water-soluble effective monomer of tanshinone ⅡA and one of the main effective components of Salvia miltiorrhiza. It is reported that STS can improve pulmonary vascular remodeling and reduce pulmonary artery pressure, thereby treating chronic pulmonary hypertension (PH) model rats^[1]Small-sample clinical trial results show that STS can improve clinical symptoms and reduce pulmonary systolic blood pressure in patients with PH, but its specific mechanism of action is not yet clear. The pathogenesis of PH is believed to be related to pulmonary vascular remodeling caused by abnormal proliferation and apoptosis of pulmonary artery smooth muscle cells (PASMCs)^[2]。 Changes in the expression and function of calcium channels and transporters on the surface of pulmonary artery smooth muscle cells are associated with the enhancement of calcium signaling pathways in patients with PH^[3]Among them, store operated calcium channel (SOCC) plays an important role in the pathogenesis of PH, STIM1 is a calcium ion receptor on the endoplasmic reticulum, which is closely related to the initiation of SOCC, and Orai1 is the main constituent protein of SOCC. This study aimed to establish a model of pulmonary artery smooth muscle cell hypoxia and give STS intervention to observe its effect on hypoxia-induced proliferation of PASMCs and the expression of STIM1 and Orai1 proteins in cells, and further explore the possible mechanism of STS in the treatment of pulmonary arterial hypertension through the change of calcium ion level.

A 56-year-old male complained of "cough and sputum for 2 weeks and fever for 1 day" and was admitted to the respiratory department of Gongli Hospital, Pudong New Area, Shanghai on June 11, 2013. The patient developed paroxysmal cough without trigger 2 weeks before admission, coughed a little white phlegm, which was difficult to cough up, coughed obviously at night, accompanied by chest tightness when cough was severe, no paroxysmal dyspnea at night, no blood in phlegm, no cough of pink foamy phlegm, no fever or chills, and was not diagnosed and treated at that time. Routine blood test in outpatient clinic 1 week ago: white blood cell count 11.18×10⁹/L, neutrophils 0.79, eosinophils 0.03, hemoglobin 136 g/L, high-sensitivity C-reactive protein 73.6 mg/L, X-ray chest radiograph showed double lower lung inflammation (Figure 1), given cefotiam (2 g, bid) to fight infection and erdostein to reduce phlegm, but the symptoms did not improve significantly. One day ago, the patient developed fever, body temperature 37.9 ℃, chest tightness and cough were worse than before, and was admitted to the respiratory ward. Past physical fitness. Smoking history for more than 40 years, smoking 60 packs per year. Drinking history 20 years, yellow wine 1 kg/d. He has no history of drug allergy and is a worker in a flour mill.

Recently, the outbreak of middle eastern respiratory syndrome (MERS) in South Korea has caused new infectious diseases to attract global attention again, which is closely related to the development of media communication speed in recent years. At the same time, the traditional way of naming emerging diseases after people, places or animals is increasingly challenged because of its possible significant impact on trade, tourism, animal protection, culture, society, profession and even religious organizations in the country or region where the disease is located. Therefore, on May 8, 2015, the World Health Organization issued the "Guidelines for the Nomenclature of New Human Infectious Diseases", emphasizing the importance of initial nomenclature of emerging infectious diseases, and the need to avoid antagonistic words and their possible misunderstandings and collateral harms^[1,2], such as Kupferschmidt^[3]The 2009 "swine flu" mentioned in the journal Science has led some countries to reject imports of pork, Arab countries are deeply unhappy with the term "Middle East Respiratory Syndrome", and the term "SARS" can mislead people into thinking that it may be related to the "Hong Kong Special Administrative Region (SAR)".

Tuberculosis, a respiratory infectious disease caused by MTB infection, is the world's single pathogen causing the highest number of deaths^[1]。 MTB can be transmitted through sputum and droplets of active TB patients, so family members or close contacts living with TB patients are high risk groups for TB. According to the estimates of the World Health Organization, about 1/3 of people in the world are infected, and 90% to 95% of them may not develop the disease for life, which is called latent tuberculosis infection (LTBI). Recently, the World Health Organization has developed a strategy to curb tuberculosis, which includes achieving the target of reducing the incidence of tuberculosis by 90 percent and the mortality rate by 95 percent between 2015 and 2035. Therefore, how to effectively reduce the incidence of tuberculosis in LTBI population becomes the key to whether this strategic goal can be achieved. In this paper, the latest progress in immunological mechanisms of LTBI host status and potential immune intervention research is reviewed as follows.

The 2012 Berlin ARDS diagnostic criteria classified ARDS into mild, moderate and severe according to oxygenation index, and selected different respiratory support strategies and modalities according to different severity of ARDS^[1]。 In addition to the cornerstone pulmonary protective ventilation strategy (low tidal volume combined with appropriate positive end-expiratory pressure), noninvasive positive pressure ventilation (NPPV), prone position ventilation (PPV), high-frequency oscillatory ventilation (HFOV), extracorporeal membrane oxygenation (ECMO), and carbon dioxide scavenging (extracorporeal CO₂removal, ECCO₂R) can be used as respiratory support for ARDS. In the face of so many supporting means, how to understand and master their respective scope of application and choose individualized ventilation strategies and methods according to different patients is particularly important.

obstructive sleep apnea syndrome (OSAS) is a common sleep breathing disorder, with a prevalence of about 5% to 14% in middle-aged people^[1]。 Its basic pathophysiological features are repeated partial/complete obstruction of the upper airway during sleep, resulting in hypopnea/apnea and intermittent hypoxia (IH) /hypercapnia, increasing breathing effort and enhancing sympathetic nerve excitability, and disrupting sleep structure; It is also closely related to cardiovascular and cerebrovascular events, metabolic disorders and neurocognitive dysfunction. Although the research on OSAS has made great progress, there is still a lot of confusion. For example, OSAS is a disease with diverse manifestations, and the clinical manifestations and comorbidities vary greatly between different individuals; The effectiveness of continuous positive airway pressure (CPAP), which is the "gold standard" of treatment, is due to low patient compliance (17% ~54% reported^[2]) and are restricted; There is no safe and effective pharmacological treatment. Although dysfunction of pharyngeal dilator muscle during sleep is believed to be the main cause of upper airway collapse, limited knowledge of the pathophysiology of OSAS is an important factor influencing the progress of OSAS treatment. Animal models have become an important method to explore the pathophysiological mechanisms, clinical features, comorbidities and new therapeutic methods of OSAS. Through animal models, not only the pathophysiological processes occurring in the human body can be replicated or studied, but also the damage caused by IH can be investigated in vitro from the molecular level. In this paper, the different modeling methods of obstructive sleep apnea animal models at home and abroad in recent years are introduced as follows.

Chronic obstructive pulmonary disease (COPD) is a respiratory disease characterized by chronic inflammation, small airway remodeling, and destruction of lung parenchyma (emphysema). At present, there are about 600 million patients with COPD in the world. According to research published by the World Health Organization, COPD will become the fifth largest economic burden of disease in the world by 2020^[1]And will become the third leading cause of death worldwide. Smoking is a major environmental risk factor for COPD, but only 10% to 20% of heavy smokers eventually develop COPD, and a few lifelong non-smokers also suffer from COPD^[2], indicating that COPD has an inherent genetic susceptibility. The onset of COPD may be the result of the interaction between individual genetic susceptibility and environmental factors^[3]。 Early identification of individuals with risk factors and getting them out of the dangerous environment is of great significance to prevent COPD and delay the course of COPD. The progress of COPD-related genomics research is summarized as follows.

The patient was a 23-year-old male. He was admitted to the hospital on August 24, 2011 because "a large amount of bilateral pleural effusion was found for more than 1 month". The patient was hospitalized in the local hospital on July 17, 2011 for inguinal hernia surgery. The preoperative examination revealed a large amount of pleural effusion on both sides. The patient had no cough, expectoration, dyspnea, chest pain, fever and night sweats. Closed drainage of left thoracic cavity was performed on July 18, 2011, and closed drainage of right thoracic cavity was performed on July 24, 2011. The drainage fluids were all "bloody milk" pleural effusion, and Li Fanta test was positive. The cell classification of pleural effusion was mainly monocytes, and the acid-resistant bacteria was negative by bacterial collection method. No tumor cells were found in exfoliated cell examination, and angiotensin converting enzyme (ACE) in pleural effusion was normal. Chest CT showed bilateral pleural effusion, pericardial effusion, peritoneal effusion, multiple low-density nodules in the spleen, bilateral multiple bone destruction of ribs and thoracic vertebrae, and retroperitoneal nodules (Figure 1，Figure 2，Figure 3)。 Intravenous cephalosporin antibiotics were treated for more than 10 days, but there was no obvious improvement. He was admitted to our hospital on August 24, 2011 for further diagnosis and treatment. Since the onset of the disease, the patient has been in good spirits, with average diet and sleep, as usual, and no weight loss. The patient is an employee of the company, has been in good health and has no bad habits, and denies a history of familial and hereditary diseases.

Bronchial asthma (asthma) is a common chronic inflammatory disease of the airway, characterized by extensive and variable reversible airflow restriction, with repeated episodes of wheezing, shortness of breath, chest tightness and cough as the main symptoms. It is estimated that the world's population of asthma reaches 300 million, and 1 in 250 patients dies from asthma^[1]。 According to statistics from the China Asthma Alliance in 2013, the number of asthma patients in China has reached nearly 30 million, accounting for 1/10 of the world's asthma population, ranking first in the world.

Italian composer Giacomo Puccini (1858-1924) was the most famous opera master in the late 19th and early 20th centuries. He composed many popular opera works, such as Turandot, Tosca and Madame Butterfly. If you are lucky enough to visit the ancient city of Lucca in Italy, you will definitely be able to see a bronze statue of Puccini in front of his former house. This bronze statue is very interesting. The master sits comfortably on a chair with his legs crossed, holding a half-burnt cigarette in his right hand. In fact, due to the maturity of camera technology at that time, Puccini left a lot of photos, and in the vast majority of photos, Puccini always had a cigarette in the picture either in his hand or in his mouth-that is how big a master's addiction to smoking is.