2016年 · 第39卷第06期

Time passed in a flash, and half a year had passed in the blink of an eye. Issue 6 of 2016 meets you readers.

eosinophilic lung diseases (ELD) are a group of diseases with increased eosinophilia in lung tissue and/or peripheral blood, accompanied by pulmonary infiltration. In recent years, the incidence rate has increased year by year, and it is particularly important to improve the awareness of ELD.

Interstitial pneumonia is a group of non-neoplastic diseases mainly involving the lung interstitium. Its histopathological manifestations are mainly different types of inflammatory cell infiltration and fibrosis. The lesions are often diffuse or multiple in the lung, so it is also called interstitial lung disease, or generally called diffuse lung disease and diffuse parenchymal lung disease. In this group of diseases, fibrogenic interstitial pneumonia is its main component. Fibrogenic interstitial pneumonia generally refers to diffuse lung disease with interstitial or parenchymal fibrosis as the main pathological change. Pulmonary fibrosis, that is, fibrous tissue hyperplasia, includes proliferation of fibroblasts, fibroblasts, and myofibroblasts in lung tissue, and deposition of collagen fibers and elastic fibers. Such lesions lack specificity. Fibrous tissue proliferation can be seen in tissue damage, repair and accompanying lesions of various diseases caused by various reasons. It can be seen that neoplastic disease stroma, and even tumors can occur itself, lacking specificity from the cells themselves and components. Fibrogenic interstitial pneumonia has a wide spectrum of diseases, which can be idiopathic or secondary, including idiopathic pulmonary fibrosis, non-specific interstitial pneumonia, chronic exogenous allergic alveolitis, pulmonary involvement of connective tissue disease, pneumoconiosis, fibrosis and organization stage of diffuse alveolar injury, chronic drug and radiation injury, fibrotic stage of pulmonary Langhans histiocytosis, Hermansky-Pudlak syndrome and Erdheim-Chester disease, etc.

Occupational interstitial pulmonary disease (ILD) is a group of interstitial pulmonary diseases (ILD) with known etiology caused by occupational hazards^[1]。 The pathogenesis, pathophysiology, clinical manifestations and prognosis of ILD caused by occupational hazards are different due to different types, nature, duration, exposure doses and modes. With the emergence of new technologies, materials and processes, as well as the emergence of new occupations, types of work and labor methods, new occupational hazards may lead to the emergence of new diseases. Occupational hazards are not only positive pathogenic factors of ILD, but also risk factors of developing some kind of ILD.

In July 2002, the Respiratory Branch of Chinese Medical Association formulated the "Draft Guidelines for Diagnosis and Treatment of Idiopathic Pulmonary (Interstitial) Fibrosis"^[1]。 The natural course, etiology, pathogenesis and diagnostic methods of idiopathic pulmonary fibrosis (IPF) have been further understood in recent years^[2,3]In particular, the research and development of anti-pulmonary fibrosis drugs has made certain progress, bringing the treatment of IPF into a new stage^[4]。 In order to standardize the diagnosis and treatment of IPF, the Interstitial Lung Disease Group of Respiratory Disease Branch of Chinese Medical Association organized experts to formulate this expert consensus after full discussion, combined with domestic and foreign research progress, and referring to the latest international guidelines.

Some patients with idiopathic interstitial pneumonia (IIP) have the clinical characteristics of underlying autoimmune diseases, but they are not yet diagnosed with a specific connective tissue disease (CTD). For such patients, different researchers have proposed different diagnostic criteria and disease names. Due to the lack of unified diagnostic naming and classification criteria for such diseases, it is difficult to conduct relevant prospective cohort studies. The European Respiratory Society and the American Thoracic Association established the "Working Group on Interstitial Pulmonary Diseases Associated with Undifferentiated Connective Tissue Disease" in order to establish a consensus on diagnostic nomenclature and development of diagnostic criteria for such patients with IIP with autoimmune characteristics.

non-tuberculous Mycobacteria (NTM), also known as Mycobacteria other than tuberculosis (MOTT), refer to Mycobacteria other than mycobacterium tuberculosis complex (MTC) and mycobacterium leprae. With the improvement of medical workers' understanding of related diseases, the advancement of bacterial identification technology, and the increase of immunodeficiency diseases and immunosuppressant use, the clinical observation of NTM-related diseases showed a significant increase trend^[1,2]。 The increasing clinical demand for the diagnosis and treatment of NTM infectious diseases has prompted the continuous improvement of clinical laboratory testing capabilities. In order to improve the level of laboratory NTM testing and improve clinicians' correct understanding of laboratory results, the Tuberculosis Branch of Chinese Medical Association organized epidemiological, clinical and laboratory experts to discuss important issues in the field of laboratory diagnosis related to NTM, and wrote this consensus.

invasive pulmonary aspergillosis (IPA) is a fungal infectious disease caused by Aspergillus invading lung tissue, and develops into necrotizing and hemorrhagic pneumonia, forming multiple abscesses or granulomas, with small arterial embolism at the edge of the lesion, which mainly occurs in immunosuppressed people, and can also be seen in people with normal immune function after a large number of pathogenic bacteria are exposed. At present, there are more and more reports of IPA in patients with normal immune function at home and abroad, and its etiology is diverse. A patient with IPA with normal immune function was recently diagnosed and treated in our hospital. After pathological diagnosis, it is considered that it is invasive pulmonary aspergillosis caused by inhaled glucocorticoids. The report is as follows.

At present, hematopoietic stem cell transplantation (HSCT) has become an important means for the treatment of hematological malignancies, severe aplastic anemia (SAA), immunodeficiency diseases and solid tumors. These patients were severely immunodeficient due to the pretreatment of ultra-large doses of chemoradiotherapy and immunosuppressive agents after transplantation, and the incidence of MTB infection was significantly higher than that of normal population^[1,2]。 However, there are few related studies on MTB infection in patients after HSCT, and most of them are case reports. Two cases of interkinship haploid HSCT complicated with MTB infection due to the diagnosis of SAA in our hospital are reported.

obstructive sleep apnea syndrome (OSAS) is a common respiratory disease associated with sleep disorders in today's society^[1]Chronic intermittent hypoxia and sleep fragmentation during sleep can cause serious complications such as hypertension, insulin resistance, pulmonary hypertension and gastroesophageal reflux disease (GERD)^[2,3,4]。 OSAS is common in obstructive pulmonary disease such as chronic obstructive pulmonary disease (COPD^[5], called overlap syndrome; Similar to COPD, idiopathic pulmonary fibrosis (IPF) is also a chronic lung disease, which occurs in middle-aged and elderly people and leads to chronic progressive lung function impairment^[6], often concurrent SaO₂Obesity, pulmonary hypertension, GERD and other complications of IPF were significantly correlated with OSAS^[7,8]。 Since the 1980s, research results suggest that patients with IPF have sleep structure disorders, reduced sleep efficiency, often have more severe hypoxemia during sleep than during daytime and during exercise, and are prone to respiratory events such as hypopnea and apnea, resulting in a significantly higher prevalence of OSAS than the general population. There is evidence that when IPF is complicated by OSAS, it can further worsen the patient's condition and lead to an increase in patient mortality^[9]。 This article summarizes the current status and progress of sleep respiratory disturbance, nocturnal hypoxemia, treatment methods in patients with IPF as follows.

Small airway refers to the inner diameter<An airway of 2 mm and without cartilage, usually including grade 8 to 16 bronchus. Unlike the large airways, these airways lack cartilage, have a greater proportion of smooth muscle cells, and have fewer goblet cells in the epithelium^[1,2]Its main role is the conduction and transition of airflow. Because of the large number of small airways and a large amount of compensation space, symptoms or lung function will only appear after the disease is serious to a certain extent, so small airways have been called "quiet areas" in history. However, this "quiet zone" was first broken by Wagner and his colleagues, who used a 5.5 mm diameter bronchoscope to measure peripheral airway resistance and found that even in patients with bronchial asthma and healthy people, FEV₁Basically the same, but the small airway resistance is 7 times that of healthy people, and the increase of small airway resistance is related to the increase of airway reactivity^[3]。 In recent years, small airway diseases have received widespread attention. It is reported in the literature that early detection and treatment of small airway diseases may have important significance for the success or failure of treatment and prognosis of diseases.

I would like to thank reader Fang Qiuhong for her attention to this journal. In her article "Discussion on the clinical characteristics of recurrent nodular non-suppurative panniculitis with pulmonary involvement"^[1]The author recounts a short paper published in our journal in December 2010^[2]The author puts forward his own understanding and thinking, and consults the relevant literature, which is worth learning and advocating.

The patient, a 23-year-old man, was seen in the outpatient clinic of our hospital on November 11, 2012 mainly due to "intermittent expectoration, shortness of breath for 4 years and aggravation for 4 months". The patient began to have cough and shortness of breath intermittently 4 years ago, without fever, night sweats, weight loss and other symptoms. Chest CT examination in the local hospital showed exudation from the left upper lung, and was diagnosed as tuberculosis. Triple anti-tuberculosis treatment was given for 3 months, but the effect was not good, so the drug was stopped spontaneously. After that, there were still symptoms such as cough and shortness of breath, during which salmeterol/fluticasone (50 μ g/500 μ g) was ineffective for 1 month. Later, the lung shadow appeared repeatedly, sometimes good and sometimes bad, sometimes left and sometimes right; Five months ago, I went to the local chest hospital. Chest CT showed high-density shadows in the left upper lung and a few patchy exudations in the right upper lung (Figure 1), considering the recurrence of pulmonary tuberculosis, and again given anti-tuberculosis treatment for 4 months, the symptoms were further aggravated, so he came to our outpatient clinic, and the re-examination of X-ray chest radiograph showed new high-density shadow in the right upper lung and fibrous cord shadow in the left upper lung. Past health, no history of smoking or drug allergy. Physical examination: body temperature 36.5 ℃, blood pressure 120/90 mmHg (1 mmHg =0.133 kPa). There were no abnormalities in the head and neck, no deformity in the thorax, clear breathing in both lungs, a few dry rales can be heard, harmonious heart rhythm, no murmur, flat and soft abdomen without tenderness, not reaching the liver and spleen under the ribs, and no swelling in both lower limbs.

randomized controlled trial (RCT) is a commonly used clinical research method, which is mainly used to evaluate the efficacy difference between a clinical intervention and other interventions. The core idea of RCT study design is "randomization", i.e. the unpredictability of enrollment. Usually, when the RCT study protocol is formulated, it is required to make assumptions about the study purpose, and then limit the number of enrolled cases and statistical protocol according to the study hypothesis. After the study is completed, the results are statistically analyzed by using the corresponding research methods.

Oxygen is the source of human life, and hypoxia will cause many kinds of damage to the body. Therefore, oxygen therapy plays a very important role in the treatment of various diseases, especially in the rescue of critical patients. As a therapeutic means, oxygen therapy also needs to formulate a clear treatment plan when using it, including appropriate therapeutic concentration, treatment time and clear oxygen therapy goals. However, compared with the harm of hypoxia, many doctors do not realize that excessive oxygen therapy also has adverse reactions, and there has been great randomness and confusion in clinical oxygen therapy for a long time. Clinicians often have innumerable minds about the possible adverse reactions and harms of excessive oxygen therapy, insufficient understanding and attention, and lack of necessary evaluation and follow-up for the harms of excessive oxygen therapy, resulting in various chaos such as indefinite prolongation of oxygen therapy time and random or indefinite increase of inhaled oxygen concentration or oxygen flow during treatment.

The patient was a 42-year-old female, a housewoman. He was admitted to hospital on April 10, 2014 due to "cough and expectoration for more than 1 month". The patient had cough and expectoration without obvious trigger since March 2014. The cough is paroxysmal, with mostly white sticky sputum and occasionally yellow sputum. I went to the local hospital and was given "cefuroxime and levofloxacin" intravenous drip, and my cough symptoms improved slightly. After stopping the drug, the above symptoms recurred, and blood routine showed 6.6×10 white blood cells⁹/L, neutrophils 0.64. On March 26, 2014, the chest X-ray showed a large fuzzy shadow in the left upper lung, and the inflammation may be large. "Cefuroxime and levofloxacin" intravenous drip was given again, and the cough symptoms improved slightly. After stopping the drug, the above symptoms recurred again. On April 8, 2014, chest CT showed a large patchy shadow in the left upper lung. After giving "ceftriaxone and azithromycin" intravenous drip for 2 days, the symptoms of cough and expectoration were not well controlled, so he was transferred to our hospital for further diagnosis and treatment. At the time of admission, there was paroxysmal cough, occasional cough of white sticky sputum, no fever, and slight shortness of breath after activity.

Greenhouse planting is an important part of China's agricultural economy, and has become the main economic pillar industry of farmers in Northeast China. The total area of greenhouses and large, medium and small sheds in Liaoning Province is 67.8 thousand hectares, ranking first in the country. Statistics show that the number of greenhouses is increasing at a rate of 3.5% every year, and the number of farmers engaged in greenhouse operations is increasing by about 5% every year. Because greenhouse practitioners are engaged in growing vegetables, fungi, flowers and other crops and raising poultry in greenhouses, they work in greenhouses with high temperature, high humidity, poor air circulation and high colony density in soil for a long time. The incidence of respiratory diseases is high, and symptoms such as cough, dyspnea, fatigue and itchy skin can occur. If not diagnosed and treated in time, the further development of the disease can lead to allergic alveolitis, bronchial asthma, chronic obstructive pulmonary disease (COPD), arthritis and skin diseases, etc. In severe cases, lung function damage, joint deformity and chronic skin diseases can occur. Its poor prognosis and high disability rate have become important factors affecting the quality of life and social and economic burden of farmers engaged in greenhouse operations. At present, there are few reports on the epidemiology and prevention of COPD in greenhouse farmers at home and abroad. From August 2006 to June 2009, our hospital investigated the prevalence of COPD among farmers engaged in greenhouse operations such as vegetables, flowers, mushroom houses and chicken and duck houses in some areas of Liaoning Province, and analyzed the related risk factors.

On February 17, 2016, the homepage of Google, a search engine website, showed a familiar picture to doctors all over the world: the stethoscope and its inventor, Dr. René Renek (1781-1826). This is a Doodle specially created by Google to commemorate the 235th anniversary of Dr. Renek's birth.