2018年 · 第41卷第01期

Dear readers, the first issue of this magazine in 2018 met with you as scheduled. In the foreword, the editorial department of this magazine, while wishing you a happy new year, also reported to you the achievements of this magazine in 2017. I sincerely thank you for your continuous support and attention to this magazine!

At the beginning of the new year, all members of this magazine thank you for your strong support and selfless help to this magazine. I sincerely wish you a happy new year and good health!

How to handle the relationship between clinical, scientific research and foreign language is always the inevitable focus of debate for doctors in different hospitals. The author's point of view is that for the vast majority of clinical doctors in primary hospitals in China, striving for excellence and doing a good job in clinical work is the first priority, and it is also the needs of the people of the whole country and the expectation of the whole society for us. For those clinicians working in non-teaching hospitals, there is no need to demand foreign language proficiency, scientific research and thesis results.

Since the end of the 20th century, drug-resistant tuberculosis (DR-TB) has been a difficult problem in global tuberculosis control. The World Health Organization (WHO) has issued a series of guidelines on DR-TB, which cover the clinical classification and definition of DR-TB, drug grouping and principles for formulating protocols^[1]Standardizes the diagnosis and treatment of DR-TB worldwide. After repeatedly understanding the contents of the guidelines, combined with the research results and clinical experience in China, and facing the challenge of DR-TB epidemic in China, some thoughts are put forward.

Drug-induced liver injury (DILI) caused by anti-tuberculosis drugs is a common adverse reaction of anti-tuberculosis drugs in clinic at present. In 2013, Chinese Journal of Tuberculosis and Respiratory Medicine published "Expert Suggestions on Diagnosis and Management of Drug-induced liver injury Caused by Anti-tuberculosis Drugs"^[1]It will bring great help to the majority of clinicians to further understand and correctly handle DILI caused by anti-tuberculosis drugs. However, the mechanism of DILI caused by anti-tuberculosis drugs, especially the molecular genetic mechanism, is not well understood. It has been reported in the literature that old age, female, malnutrition, hepatitis B virus infection, human immunodeficiency virus infection and chronic alcoholism are the risk factors of DILI caused by anti-tuberculosis drugs^[2,3]But that only explains some of the external factors. With the rapid development of molecular biology, more and more evidences show that genetic factors are the intrinsic factors that cause significant differences between individuals and groups of adverse drug reactions^[2,4]。 The latest research results and experience at home and abroad are introduced below for discussion.

nontuberculous mycobacterium (NTM) is a conditional pathogenic bacterium, which exists widely in nature and water sources, and more than 170 species have been found. The most common clinical manifestation of NTM infection is pulmonary disease, but about 10% are still manifested as extrapulmonary disease, often through respiratory tract, gastrointestinal tract, trauma infection or invasive surgical infection. Outbreaks of NTM infection due to contamination of surgical equipment, injectable solutions or drugs have also been reported.

The treatment of drug-resistant tuberculosis, especially multi-drug resistant tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-TB), is still plaguing the majority of tuberculosis prevention and treatment workers. linezolid isZolidinone antibacterial drugs are another brand-new synthetic antibacterial drugs on the market after sulfonamides and quinolones. The drugs have attracted much attention for their unique mechanism of action and good antibacterial activity. Recent research results have shown that linezolid has good anti-Mycobacterium tuberculosis (MTB) effect, and also shows strong antibacterial activity against drug-resistant strains. Linezolid has also achieved satisfactory clinical efficacy in the treatment of MDR-TB and XDR-TB. The World Health Organization listed linezolid as an anti-tuberculosis drug in the guidelines related to drug-resistant tuberculosis. In 2016, the World Health Organization classified it as a core treatment for MDR-TB in the "Guidelines for the Treatment of Drug-resistant Tuberculosis"^[1,2,3]。 At present, linezolid has to be used to treat refractory MDR-TB and XDR-TB when drug-resistant TB treatment drugs are scarce. At present, there are no norms or guidelines for the clinical application of linezolid in China for reference, and clinicians have many problems or confusions to be solved in practical work. Therefore, the Tuberculosis Branch of Chinese Medical Association organized experts in relevant fields across the country to discuss the issues related to linezolid anti-tuberculosis treatment, and formulated the "Expert Consensus on Linezolid Anti-tuberculosis Treatment" for reference by domestic colleagues.

tuberculosis is a respiratory infectious disease caused by mycobacterium tuberculosis (MTB), which is widely prevalent worldwide and is one of the major public health problems worldwide. The World Health Organization reported in 2016 that 10.4 million new cases of tuberculosis occurred worldwide in 2015, and 1.4 million people died of the disease. The situation of prevention and treatment remains grim^[1]。 In recent years, although the diagnosis and treatment technology of tuberculosis has developed rapidly, 1% to 3% of patients still progress to severe tuberculosis, among which respiratory failure and multiple organ dysfunction syndrome are the main reasons for severe tuberculosis patients to be admitted to tuberculosis intensive care unit (TBICU). The mortality rate of the former is as high as 69%^[2,3,4,5,6]The incidence of the latter reaches 19% ~80%^[5,7,8]。

More and more studies have shown that the soluble advanced glycation end product receptor (sRAGE) is associated with a variety of respiratory diseases. The purpose of this study was to examine the changes of plasma expression of sRAGE in adult patients with bronchial asthma (asthma) and its correlation with IL-8, FEV₁In order to explore its potential clinical value, the correlation of exhaled nitric oxide (FeNO) and asthma control test (ACT) scores was studied.

Warfarin is currently the most widely used oral anticoagulant for the prevention and treatment of thromboembolic diseases, and bleeding is the most common adverse reaction. In recent years, foreign literature has reported that tracheobronchial calcification in children after heart valve disease surgery is related to long-term warfarin use^[1,2,3,4], long-term warfarin administration after deep vein thrombosis, atrial fibrillation, and heart valve replacement in adults can also cause tracheobronchial calcification^[5,6]However, no relevant reports have been seen in China. A case of diffuse tracheobronchial calcification caused by long-term warfarin administration admitted to the Third Hospital of Peking University is reported as follows.

Bronchoscopy can directly observe the diseases of the respiratory tract, and at the same time, it can obtain the diseased tissue to diagnose respiratory diseases. It is a common method to diagnose respiratory diseases at present^[1]。 Painless bronchoscopy has been gradually carried out in clinic. At present, modified laryngeal mask is mainly used to control the airway of patients^[2,3,4]。 But Chen Lu and Zhang Chuanhan^[5]It is believed that the advantages of laryngeal mask should not be seen unilaterally and the possibility of complications should be ignored. This study was intended to compare the effects of supraglottic jet ventilation and a modified ordinary laryngeal mask in outpatient painless bronchoscopy.

tuberculosis is a global public health problem that seriously endangers public health. The concept of "multidrug resistance tuberculosis (MDR-TB)" was formally proposed in an article on drug resistance tuberculosis published by the Centers for Disease Control and Prevention (CDC) in June 1992. In October 2006, the World Health Organization revised the definition of extensively drug-resistant tuberculosis (XDR-TB): MDR-TB is resistant to at least one of any one of fluoroquinolones, three second-line injectable drugs, capreomycin, kanamycin and amikacin^[1]。 China is one of the endemic countries of drug-resistant tuberculosis^[2]According to the latest baseline survey data of tuberculosis drug resistance in China, MDR-TB is 8.32% and XDR-TB is 0.68% in pulmonary tuberculosis patients in China. Based on this, it is estimated that there are 120,000 new MDR-TB patients and 9,000 XDR-TB patients in China every year^[3]。

Exosomes are extracellular vesicles secreted by a variety of cells, such as reticulocytes, dendritic cells, lymphocytes, macrophages and adipocytes. In 1983, exosomes were first discovered in the study of the loss of transferrin receptor during the maturation of reticulocytes to red blood cells. In 1987, small vesicles formed in endosomes and released into the extracellular region were officially named as exosomes^[1]。 By negative staining, exosomes showed a cup-like structure under transmission electron microscope^[2]About 50-150 nm in diameter^[3]。 Exosomes can encapsulate bioactive substances such as proteins, lipids and nucleic acids, which play an important role in the process of intercellular communication. Exosomes can bind to recipient cells by means such as direct contact, membrane fusion, and endocytosis^[4]Change the functional state of recipient cells, such as inhibiting autophagy of recipient cells, promoting differentiation of recipient cells, and increasing the expression and release of cytokines of recipient cells.

OSAHS is a chronic sleep respiratory disease, characterized by repeated complete and/or incomplete obstruction of the upper airway during sleep, accompanied by intermittent hypoxemia or combined with hypercapnia and sleep structural disorders^[1]。 It is reported in the literature that 3% to 7% of surgical patients are complicated with OSAHS^[2,3,4,5]About 90% of these patients did not have a preoperative diagnosis of moderate to severe OSAHS^[6]。 Compared with other surgical patients, patients with OSAHS have a higher risk of postoperative complications^[7]。 Currently, the standard method for diagnosing OSAHS is polysomnography (PSG), but this examination is time-consuming and relatively expensive. Recent studies have shown that routine preoperative screening for OSAHS in patients undergoing elective surgery improves the effectiveness of perioperative management, reduces the incidence of postoperative complications, and minimizes the financial burden on patients^[8]。 The research progress of preoperative screening tools for OSAHS in recent years is reviewed below.

Non-invasive ventilation refers to mechanical ventilation methods that do not need to establish artificial airways (such as tracheal intubation, etc.), including positive intra-airway pressure ventilation and negative chest pressure ventilation. noninvasive positive pressure ventilation (NPPV or NIPPV) includes bi-1evel positive airway pressure (BiPAP) and continuous positive airway pressure (CPAP), among which BiPAP is a commonly used ventilation mode in clinical practice and is also the focus of most clinical studies. The clinical application of non-invasive positive pressure ventilation technology is increasingly widespread, its application indications are constantly expanding, and its clinical application efficacy is also supported by more and more evidence-based clinical practices^[1]。 In recent ten years, NPPV has been applied in pulmonary rehabilitation (PR) treatment of patients with chronic obstructive pulmonary disease (COPD), and has achieved good curative effect. The new ATS/ERS definition of pulmonary rehabilitation is as follows: "Pulmonary rehabilitation is an evidence-based, multidisciplinary and integrated intervention for patients with symptomatic and reduced daily activity chronic lung disease. In combination with individualized treatment of patients, symptoms are reduced, participation is increased, and health care costs are reduced by stabilizing the disease and reversing the systemic manifestations of the disease"^[2]。 The 2013 British Thoracic Society (BTS) guidelines for adult pulmonary rehabilitation recommend that the purpose of pulmonary rehabilitation combined with long-term home noninvasive ventilation in patients with COPD should not be limited to improving prognosis, as long as patients with pulmonary rehabilitation conditions can attempt pulmonary rehabilitation combined with long-term home noninvasive ventilation, and the grade is D^[3]。 At present, there are few studies on the combined application of pulmonary rehabilitation and noninvasive ventilation, and there are obvious differences in methodology^[4]In this paper, the application indications, application strategies and clinical effects of NPPV in pulmonary rehabilitation treatment (NPPV + PR) of patients with COPD at home and abroad in recent years are reviewed as follows.

Aquaporin 1 (AQP1) is a product of Smith and Agre^[1]A class of transmembrane proteins with a molecular mass of about 28 000 was first discovered in 1988. Shortly thereafter, other family members of aquaporins were identified from animals, yeasts, bacteria, and plants, with at least 13 aquaporins (AQPs) present in humans, AQP0-AQP12^[2]。 1992, Preston et al.^[3]Aquatic channel function of AQPs was confirmed in Xenopus laevis oocytes. In recent years, with the deepening of research, it has been gradually found that AQPs are not only the main pathway for water to pass through the epithelial and endothelial barriers in airways, alveoli and pleura, but also play an important role in the occurrence and development of pulmonary edema, pulmonary inflammation, pulmonary hypertension, pulmonary tumors, bronchial asthma, chronic obstructive pulmonary disease (COPD) and other diseases^[4,5,6,7,8]。 This article summarizes the relationship between AQPs and lung diseases as follows.