2017年 · 第40卷第11期

In January 2017, the General Office of the CPC Central Committee and the General Office of the State Council issued the "Opinions on Deepening the Reform of the Professional Title System". The most important change is to emphasize the need to overcome the tendency of only academic qualifications, qualifications and papers, and highlight the orientation of moral character, ability and performance. Professor Liu Youning, the editor-in-chief of this journal, is deeply touched by this. In the essay "Expectations for Deepening the Reform of the Professional Title System in Medical Industry", the editor-in-chief uses "love-hate" and "shocking" words to describe the existing professional title system, while he is full of expectations for the new professional title system.

In January 2017, the General Office of the Central Committee of the Communist Party of China and the General Office of the State Council issued the "Opinions on Deepening the Reform of the Professional Title System" (referred to as the Opinions). After 30 years, the professional title system has once again become the focus of the reform, and the majority of scientific and technological personnel, especially front-line medical staff, are full of eager expectations for this. The document is divided into 6 parts and 18 opinions. The most important change is to emphasize the need to overcome the tendency of only academic qualifications, qualifications and papers, highlight moral character, ability and performance orientation, so that the majority of scientific and technological cadres have more energy and time to truly do their jobs in their posts, and require the reform of multiple professional title regulations including the health system to be completed within 3 years.

severe asthma is characterized by poor asthma control, which seriously affects the quality of life of patients and increases the social and economic burden. It is the main cause of asthma disability and death^[1,2,3,4,5]。 Therefore, improving the diagnosis and treatment level of severe asthma is of great significance to improve the overall control level and prognosis of asthma and reduce the medical cost^[5]。

Although the incidence of severe asthma is not high, it is reported that it accounts for about 5.9% of asthma patients in China, but it occupies a lot of medical resources. Severe asthma is often accompanied by one or more comorbidities, such as anxiety, allergic rhinitis, sinusitis and gastroesophageal reflux, which seriously affect the quality of life of patients. Although ERS/ATS and Chinese guidelines have guiding opinions on the definition, phenotype, pathogenesis and treatment management of severe asthma, with the emergence of more new drugs and new therapies, clinicians still face confusion about how to carry out reasonable individualized treatment when they really face patients.

Bronchial asthma (asthma) can cause patients' life, labor ability and quality of life to decrease or accidental death, and public health resources are expensive. Although the vast majority of asthma patients are well-controlled after treatment with mainly inhaled glucocorticoids, 5% to 10% of patients still have severe asthma whose symptoms are not controlled by Grade 4 or Grade 5 treatment recommended by the Global Asthma Prevention Initiative (GINA) or whose symptoms are well-controlled but relapse after dose reduction^[1]。 The emergency visits and hospitalizations of severe asthma patients increased significantly, and the mortality rate increased, resulting in a heavy socio-economic burden. It is of great significance for the formulation of public health measures to attach importance to the identification and epidemiological surveillance of severe asthma, deeply understand its course and development, and assess the disease burden.

The promotion of the Global Bronchial Asthma Prevention and Treatment Initiative (GINA) has enabled most patients with bronchial asthma (asthma) to be well controlled, but 5% to 10% of asthma patients need Level 4 and 5 treatment to maintain control or remain uncontrolled. Treatment costs for these severe asthma patients even exceed 50% of global asthma costs. Asthma is a heterogeneous disease characterized by chronic airway inflammation, and the Grade 1~5 treatment regimen recommended by GINA still mainly covers allergic asthma. The heterogeneity of airway inflammation is mainly manifested in severe asthma. In addition to severe eosinophilic asthma, neutrophil asthma is also manifested as severe asthma. Oligo-inflammatory cell asthma can be seen in some asthma phenotypes, such as asthma with obesity and asthma with gastroesophageal reflux, and responds poorly to glucocorticoid (hormone) treatment. Therefore, asthma may not be a single disease, but a complex overlapping syndrome with different symptoms. In recent years, targeted anti-IgE and anti-IL-5 therapy has a good efficacy for eosinophilic asthma, but the efficacy of antagonizing other inflammatory cells or inflammatory factors is still uncertain. The mechanism of airway inflammation in severe asthma is still unclear. Sorting out the existing research directions will help to promote the deepening of scientific research and the transformation to precision treatment.

Bronchial asthma (asthma) is a chronic airway inflammatory disease with obvious heterogeneous and complex pathophysiological manifestations^[1]。 severe asthma is characterized by poor control level, which seriously affects the quality of life of patients, occupies huge medical resources, and increases the social and economic burden. It is the main cause of disability and death caused by asthma^[2,3,4,5]。 Therefore, improving the diagnosis and treatment level of severe asthma is of great significance to improve the overall control level of asthma, prognosis and reduce the medical cost^[5]。

Chronic obstructive pulmonary disease (COPD) and bronchiectasis are traditionally considered to be two distinct diseases. With the widespread use of high-resolution CT (HRCT), it has been found that both can occur alone or coexist in clinical patients. In the 2014 Global Initiative for COPD (GOLD), patients with COPD and bronchiectasis were treated as a unique phenotype, and their prognosis was noted to be poor, and it was associated with chronic infection or bacterial assignment of potential pathogenic microorganisms and frequent acute exacerbations. This study evaluated the incidence of bronchiectasis in moderate to severe COPD patients by analyzing HRCT and clinical characteristics of 200 hospitalized patients with acute exacerbation of COPD, and understood the factors related to bronchiectasis.

anaplastic large cell lymphoma (ALCL) is a special type of non-Hodgkin lymphoma (NHL), which is a highly malignant tumor.^[1]First reported in 1985. ALCL originates from T lymphocytes or null cells^[2]T-cell type accounts for about 80%, and null type accounts for 20%. Mainly occurred in lymph nodes (25%), extranodal ALCL was more common in the skin (21%), other sites including bone (17%), soft tissue (17%), lung (11%) and liver (8%), and involved gastrointestinal tract and central nervous system less^[3], bronchial invasion is more rare, accounting for about 2.5%^[4]。 Recently, a case of anaplastic large cell lymphoma diagnosed by pathology invading bronchi was diagnosed and treated in our hospital, which is now reported as follows.

Tuberculosis is a chronic infectious disease, and MTB is a typical intracellular parasite. Therefore, cellular immunity plays a major role in the process of anti-MTB infection. Macrophages, as the main cells that engulf MTB, can help the body control MTB infection^[1]。 Mature macrophages differentiate into different cell subtypes under the induction of various environmental factors, and express or secrete surface molecules and cytokines with different functions. Therefore, studying the molecular pathways of macrophage polarization in tuberculosis is helpful for people to conduct in-depth research on the occurrence, development and prognosis of tuberculosis. The research progress in this field in recent years is summarized as follows.

tracheobronchopathia osteochondroplastica (TO) is a rare benign airway lesion characterized by abnormal tracheal and bronchial submucosal ossification and cartilaginous nodular hyperplasia protruding from the lumen, generally not involving the posterior wall of the airway^[1]。 TO is also known as tracheobronchial cystic fibrous osteochondritis and osteogenic tracheopathy. 1857 Wilks^[2]TO was reported for the first time, describing it as an osseosis lesion of the larynx, trachea and bronchus. TO due TO massive deposition of calcium phosphate in the submucosa, benign bone and cartilage tissue hyperplasia, can often lead TO airway stenosis. Chronic cough and wheezing are the most common clinical symptoms of TO and are often misdiagnosed as bronchial asthma^[3]。 Although the number of TO cases reported in China has gradually increased in recent years, the understanding of this disease by domestic doctors is still insufficient. This article mainly summarizes the clinical characteristics, diagnosis and treatment of TO as follows.

Pulmonary hypertension is a malignant pulmonary vascular disease characterized by elevated pulmonary artery pressure and pulmonary vascular resistance, which ultimately leads to death from right heart failure. It is currently estimated that the global incidence of pulmonary hypertension is approximately 1%; The incidence of pulmonary hypertension is as high as 10% in people over 65 years of age^[1]。 Type 3 pulmonary hypertension, namely respiratory diseases and hypoxia-related pulmonary hypertension, has not been paid attention to by researchers for a long time, but the latest epidemiological data show that the incidence of type 3 pulmonary hypertension is increasing year by year^[2,3,4]It has become a major category of diseases that seriously endanger people's health. It is reported that 30% ~70% of patients with chronic obstructive pulmonary disease (COPD) are complicated with pulmonary arterial hypertension^[3,4,5]While the incidence of COPD among people over 40 years old in China is as high as 8.2%^[6]Tobacco smoke exposure is the most exact cause of COPD^[7]。 The relationship between tobacco smoke and the pathogenesis of pulmonary arterial hypertension has attracted much attention in recent years, and it has been proposed that tobacco smoke induced pulmonary arterial hypertension (cigarette smoke-induced pulmonary hypertension)^[8]The concept of. This article reviews this topic in order to increase the understanding of the pathogenesis of pulmonary hypertension and provide new ideas for formulating reasonable and effective prevention and treatment strategies of pulmonary hypertension.

idiopathic inflammatory myopathies (IIM) are a group of systemic autoimmune diseases characterized by chronic muscle inflammatory lesions. The most common clinical types include dermatomyositis (DM), polymyositis (PM), necrotizing autoimmune myopathy (NAM), and sporadic inclusion body myositis (sIBM)^[1]。 Most patients with IIM clinically show subacute and chronic onset, mainly manifested by characteristic rash and proximal muscle weakness; It can involve many organs such as the heart and lungs, among which lung involvement is the most common; The incidence of IIM patients with interstitial lung disease (ILD) is nearly 50%^[2]And the prognosis is often poor. Different autoantibodies can be detected in the serum of patients with IIM. These autoantibodies have important clinical significance for the diagnosis, clinical manifestation and classification, related complications, treatment and prognosis of IIM. This article mainly introduces IIM autoantibody and its related research progress in ILD, and discusses the role of IIM autoantibody detection in the diagnosis and treatment of IIM-related ILD.

When the symptoms of respiratory tract infection in the acute phase disappear, the cough still persists and lasts for 3 to 8 weeks, and there is no abnormality in chest X-ray examination, which is called post-infection cough (PIC), among which viral colds are the most common, also known as "post-cold cough"^[1]。 PIC is very common clinically and is the most common cause of subacute cough. Treatment of PIC, "Guidelines for the diagnosis and treatment of cough (draft)"^[2]Introduction: "In the case of ineffective general treatment, inhaled or oral glucocorticoid therapy can be tried for a short time"; "Guidelines for the Diagnosis and Treatment of Cough (2009 Edition)"^[3]Whether inhaled glucocorticoids (ICS) can be used is not mentioned in; However, the "Guidelines for the Diagnosis and Treatment of Cough (2015)" clearly states: "ICS is not effective in treating PIC, so it is not recommended to use it"^[1]。 In this regard, we feel doubtful and hope to get expert enlightenment.

Dr. Zhang Yaming raised questions about the fact that the new cough guidelines did not recommend inhaled glucocorticoids (ICS) for the treatment of post-infectious cough (PIC), which is also a common concern of clinicians. In the early years, the guidelines for cough diagnosis and treatment at home and abroad recommended oral hormones or ICS for the treatment of PIC based on the initial clinical case observations^[1,2]However, the results of subsequent randomized double-blind controlled studies showed that ICS was ineffective in the treatment of PIC^[3]。 A meta-analysis of 477 patients included in seven randomized double-blind controlled studies confirmed that the efficacy of various ICS for subacute cough, including PIC, was very inconsistent and mostly ineffective^[4]。 Therefore, "Guidelines for the Diagnosis and Treatment of Cough (2015)"^[5]There is evidence-based medical evidence that ICS is not recommended in the treatment of PIC.