2018年 · 第41卷第07期

This journal published the "Guidelines for the Diagnosis and Treatment of Hospital-Acquired Pneumonia (HAP) and Ventilator-Associated Pneumonia (VAP) in Adults in China (2018 Edition) (referred to as the Guidelines) in Volume 41, Issue 4, 2018, which was pushed on the WeChat platform of this journal at the same time. As of June 25, 2018, the Guidelines have been clicked 43,610 times on the WeChat platform and have received wide attention. In the essay column of the editor-in-chief of this issue, Professor Liu Youning put forward his own views on the content of the Guidelines in the article" Can Mechanical Ventilation-Associated Pneumonia be Completely Separated from Hospital-Acquired Pneumonia "," Although the guidelines jointly formulated by the American Association of Infectious Diseases/Thoracic Society in 2016 emphasize that HAP and VAP in the narrow sense are completely different groups, with great differences in clinical manifestations and treatment methods, and believe that they should be treated as different diseases ", the author believes that" HAP in the broad sense corresponds to community-acquired pneumonia (CAP), emphasizing that the places of acquired pneumonia are different. In this case, there is no reason why pneumonia, including VAP, that occurs in hospitals does not fall under the category of HAP. Combined with the actual situation in China, the guideline believes that 'VAP is a special type of HAP', that is, VAP is still included in the definition of macro HAP, but it also adopts' independent definition of HAP/VAP with different meanings', which is in line with China's national conditions ".

In 2016, the guidelines jointly developed by the American Association of Infectious Diseases (IDSA) /Thoracic Society (ATS) emphasized that hospital-acquired pneumonia (HAP) and mechanical ventilation-associated pneumonia (VAP) in the narrow sense are completely different groups, and their clinical manifestations and treatment methods are quite different, and they are believed to be treated as different diseases. Countries around the world have not responded to this view according to the "leading" opinion of IDSA/ATS. Chinese Journal of Tuberculosis and Respiration published "Guidelines for the Diagnosis and Treatment of Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia in Adults in China (2018 Edition)" in Volume 41, Issue 4, 2018^[1]Combined with the actual situation in China, the guide believes that "VAP is a special type of HAP", that is, VAP is still included in the definition of macro HAP, but also adopts "HAP/VAP definition with different meanings". The author participated in the process of developing the guide, and although I have some reservations about this description, I basically agree with it.

eosinophilic granulomatosis with polyangiitis (EGPA) is a rare autoimmune disease that can involve multiple systems in the whole body. It is mainly manifested by increased eosinophilia in peripheral blood and tissues, infiltration and necrotizing granulomatous inflammation of small and medium blood vessels. It belongs to anti-neutrophil cytoplasmic antibodies (ANCA) -related systemic vasculitis. The literature reported that nearly 50% of patients tested positive for ANCA^[1]。 1951 by Churg and Strauss^[2]Discovered and reported, once known as Churg-Strauss syndrome (CSS) or allergic granulomatosis and angiitis (AGA). The 2012 Chapel Hill Conference renamed it EGPA based on its clinical and laboratory characteristics^[3]。 The overall prevalence rate reported abroad is 10.7~13.0/million, and the annual incidence rate is 0.5~6.8/million^[4]。 The incidence of EGPA in bronchial asthma population ranged from 0 to 67 per million^[5]The annual incidence rate is as high as 64.4/million, much higher than the incidence of EGPA in the total population^[6]。 There is still a lack of epidemiological data in China.

mycobacterium genus includes mycobacterium tuberculosis complex, mycobacterium leprae complex and non-tuberculosis mycobacterium. By the end of 2017, the number of mycobacterium species and subspecies reported has reached 194 (http: / /www.bacterio.net/mycobacterium.html), but only 119 mycobacteria have corresponding Chinese names. Other mycobacteria have no corresponding Chinese translations, so their Latin names can only be used in official domestic journals. Moreover, due to the lack of uniform Chinese translation principle of mycobacterial species in China, even the Chinese translation of mycobacterial species has irregular translation^[1,2]。 In order to change the current situation of mixed use of Chinese and Latin names of mycobacteria, revise the existing irregular Chinese strain translations, and provide methods for the Chinese translation of newly named mycobacteria strains in the future, the Tuberculosis Branch of Chinese Medical Association organized experts to jointly formulate the Chinese translation principles of mycobacteria strains, and formulate or revise the Chinese translation names of existing mycobacteria strains according to the above principles.

chronic thromboembolic pulmonary hypertension (CTEPH) is the fourth largest type of pulmonary hypertension caused by repeated pulmonary thromboembolism causing pulmonary artery stenosis or occlusion, pulmonary arteriolar remodeling, resulting in increased pulmonary artery resistance and increased right ventricular afterload, and finally leading to right ventricular decompensation or even death. The 3-year survival rate of untreated patients with poor prognosis of CTEPH was only 10%, and the median survival time was 2.8 years^[1]。 pulmonary endarterectomy (PEA) was generally considered the preferred treatment in the past, but PEA surgery is difficult, risky and traumatic, and some patients still have pulmonary hypertension after surgery. percutaneous transluminal pulmonary angioplasty (PTPA) is a new technique for the treatment of CTEPH in recent years. It is reported in the literature that PTPA can significantly improve the symptoms and pulmonary hemodynamics of CTEPH patients, and is expected to be an effective treatment strategy for patients who cannot accept PEA^[2,3,4,5,6]。 Although PTPA is less invasive, there are still complications, including vascular injury, rupture and postoperative reperfusion pulmonary edema. In order to reduce complications and increase the success rate, new technologies have been introduced to accurately assess lesions in real time, including intravascular imaging and pressure guide wire. A patient with CTEPH was presented to determine the scope of treatment according to the results of pulmonary perfusion examination. Intraoperative optical coherence tomography (OCT) combined with pressure guide wire was used to evaluate the morphology and function of the diseased blood vessels. Finally, PTPA was successfully implemented to improve the understanding of PTPA.

obstructive fibrinous tracheal pseudomembrane (OFTP) is one of the rare complications caused by tracheal intubation. It is characterized by the formation of thick tubular pseudomembrane on the tracheal wall. After the tracheal intubation is removed, different degrees of tracheal obstruction are formed, which leads to dyspnea, wheezing, acute respiratory failure or death from asphyxia^[1]。 If the disease is not treated in time, it can cause the patient to suffocate and die. This article retrospectively analyzed the clinical characteristics, diagnosis and treatment process of 5 patients with OFTP in our hospital, and analyzed it in combination with relevant literature, aiming to improve clinicians' understanding of this disease.

plastic bronchitis (PB), also known as fibrotic bronchitis, Hofman's bronchitis, tubular bronchitis, pseudomembranous bronchitis, or fibrinous bronchitis, is a rare and fatal lung disease characterized by the formation and adhesion of gelatinous bronchial tree-like tubes to fill the airways^[1]Respiratory dysfunction can occur due to local or extensive airway obstruction, and in severe cases, life-threatening respiratory distress can occur. The disease can occur at all ages, and it is more common in children, with varying severity, and is easily neglected. There are few clinical reports, the specific etiology and pathogenesis are unclear, and there is a lack of effective treatment. With the deepening of understanding, more and more evidence suggests that many unexplained PB may be caused by abnormal pulmonary lymphatic circulation^[2]At present, it is believed that at least part of PB may be one of the lymphatic circulatory diseases, and there have been breakthroughs in treatment methods. The incidence of PB is low, and the true incidence is unclear. Children have a higher incidence than adults and are often secondary to cardiopulmonary diseases. Clinicians don't know enough about the disease, and patients with mild symptoms are often missed or misdiagnosed.

Mechanical ventilation is the primary means of life support in critically ill patients, which can buy time for other treatments, but also has numerous potential comorbidities, even affecting distant organs^[1,2], eventually leading to the patient's death. In ARDS patients with long-term mechanical ventilation, most patients will develop lung injury and diaphragm dysfunction, leading to ventilator dependence, but some patients also develop ventilator dependence without muscle factors^[3]。 With lung-brain dialogue^[4,5]We speculate that some patients with mechanical ventilation are injured by mechanical ventilation, resulting in unstable respiratory regulation and ventilator dependence. The excitability of respiratory center is closely related to central ion channels, among which potassium ion channels play an important role, and potassium ion channels play important physiological functions in many kinds of excitable and non-excitable cells^[6]。 According to the structural basis of the channels, potassium ion channels are mainly divided into three families: voltage-gated potassium ion channels (voltage-gated K^＋channel, Kv), inward rectifying K^＋channel, Kir) and two-pore potassium ion channel (two-pore domain K^＋channel, K2P)^[7]Of which the latter two are closely related to respiratory regulation. The change of channel expression and function will affect the excitability of respiratory central nervous cells, and then change the stability of respiratory circuit. In this paper, the research progress of common modes of respiratory regulation, the relationship between respiratory dysregulation and mechanical ventilation in patients with mechanical ventilation, and the relationship between respiratory regulation and central potassium ion channels are reviewed as follows.

The pathogenesis of obstructive sleep apnea (OSA) is involved by many factors, and the PALM theory, which consists of critical closing pressure (Pcrit), low arousal threshold, high loop gain and dilator muscle function of the upper airway, has attracted widespread attention^[1]。 Among them, Pcrit was used to assess upper airway collapsibility^[2,3]It can reflect the anatomical and neurological characteristics of upper airway collapse in patients^[4,5,6,7]。 The research progress of Pcrit is summarized as follows.

The 2017 global initiative for chronic obstructive lung disease (GOLD)^[1]COPD is the fourth most fatal disease in the world and will rise to the third place in 2020. In 2006, GOLD first proposed pulmonary rehabilitation as one of the important non-drug therapies for COPD in stable phase^[2]； In 2017, GOLD emphasized the role of pulmonary rehabilitation for COPD, stating that "patients with severe symptoms and high risk of acute exacerbation (groups B, C and D) should be encouraged to participate in a complete rehabilitation program that includes setting goals for patients, designing and developing a structured treatment model, and fully taking into account the patient's COPD characteristics and related complications".^[3,4,5]。 The national institute for health and care excellence (NICE) recommends that patients with stable COPD and those with exercise limitation due to breathing difficulties should receive pulmonary rehabilitation^[6]。 Pulmonary rehabilitation has been proven to delay the decline of pulmonary function, improve dyspnea, and improve health-related quality of life (HRQL) in patients with COPD, which has attracted more and more attention from colleagues in the respiratory industry.

The vast majority of bacteria in the human digestive tract are concentrated in the colon, and the amount of bacteria carried by the colon of standard weight adult men is about 3.9×10¹³(Uncertainty 24%, variation rate 52%)^[1]These bacteria are called normal microbiota, most of which colonize the intestine, play an important role in the host's immunity, metabolism, obesity and biological clock functions, and are called "in vitro organs" with multiple regulatory functions. The intestinal flora of humans and rats is similar in classification, with four kinds of bacteria dominant: Gram-positive Firmicutes, Actinomycetes, Gram-negative Bacteroides and Proteobacteria, of which Gram-positive Firmicutes and Gram-negative Bacteroides account for more than 90%. OSAHS is a common chronic respiratory disease. The main pathophysiological features are repeated intermittent apnea during sleep, secondary to hypoxemia and hypercapnia. Patients with severe sleep breathing disorders had a 3.8-fold risk of death and a 5.2-fold risk of death from cardiovascular disease compared with those without OSAHS^[2]。 It is reported in literature that OSAHS is significantly related to cardiovascular and cerebrovascular diseases and metabolic diseases. Intestinal flora disorders are found in animal models of OSAHS sleep disorders, and there is a certain relationship between intestinal flora and OSAHS. However, there is no research report on intestinal flora in patients with OSAHS. The research progress of the relationship between OSAHS and intestinal flora in recent years is summarized as follows.

endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new examination technique in recent years. It is mainly used for the diagnosis of mediastinal and hilar lesions and staging of lung malignant lesions^[1]。 Through the real-time ultrasound probe at the front end of bronchoscope, clinicians can improve the ability to distinguish diseased tissue and surrounding blood vessels, and increase the safety and accuracy of transmural puncture examination^[1]。 Increasing evidence suggests that EBUS-TBNA has a tendency to replace mediastinoscopy as a tool for diagnosis, particularly staging, of lung malignancies^[2]。 With the widespread application of EBUS-TBNA, the reports of related complications are gradually increasing^[2]。 The complications related to EBUS-TBNA and their prevention and treatment measures are summarized as follows.

Bronchial asthma (asthma) as a chronic airway inflammatory disease^[1]At present, there are at least 300 million asthma patients in the world and at least 30 million asthma patients in mainland China^[2]。 Although the incidence of asthma appears to have entered a plateau in developed countries and regions^[3]However, the incidence rate in China is still on the rise^[4]。 In previous asthma guidelines and clinical practice, asthma can be classified into mild intermittent asthma, mild persistent asthma, moderate persistent asthma, and severe persistent asthma according to asthma symptoms and the level of treatment required^[5,6]。 Although recent global asthma prevention and treatment initiatives (the global initiative for asthma, GINA)^[7]The severity classification of mild intermittent and mild continuous asthma was gradually diluted and unified as mild asthma, but this classification still has important significance in clinical research work^[8]。

Bronchial occlusion is an effective treatment for refractory pneumothorax. Locating the bronchus leading to the pleural rupture, i.e. draining the bronchus, is a key step. Balloon exploration is the most commonly used localization method. However, when there is multi-lobar pleural fistula or obvious collateral ventilation, balloon exploration is difficult to succeed. This study attempted to establish the transbronchoscopic end-expiratory carbon dioxide (EtCO₂) Methodology for detecting and locating refractory pneumothorax drainage bronchus. Twenty-eight pneumothorax patients with persistent air leakage>7 d through intercostal drainage from July 2012 to September 2015 were included, all male, aged (65 ± 13) years. Underlying diseases include chronic obstructive pulmonary disease, silicosis, old pulmonary tuberculosis, lung cancer, segmental resection and idiopathic pneumothorax, etc.

I was fortunate to read the Chinese Journal of Tuberculosis and Respiration, Volume 40, Issue 8, 2017, and gained a lot. Among them, the article "Clinical Manifestations, Pathological Characteristics and Gene Mutations of Patients with Lung Involvement in Erdheim-Chester Disease" written by Lu Tao and others has been read carefully. With a rigorous attitude, I have the following three feelings, which are specially put forward for discussion: (1) Example 3 of the article uses "methotrexate 1.8 g intravenous continuous drip for 24 hours, 1 day of medication, and 1 course of chemotherapy". The dose of methotrexate is obviously too large. Is the dose wrong? (2) Case 3 of the article "No obvious abnormalities were found in CT pulmonary angiography in June 2016, and interferon was adjusted to 10 mU, once every other day + prednisone 30 mg, and chemotherapy once a day (days 1 to 5)". Because the patient was admitted to the hospital on May 21, 2015, spanning 1 year, the application of interferon was not explained before the article, and the dose was adjusted directly, resulting in poor connection before and after the article and difficulty in understanding; In addition, is the abnormality of pulmonary angiography necessarily related to interferon adjustment? It may be more appropriate to give an explanation if any.

At 4: 21 pm on February 10, 2018, Professor Yu Runjiang, a famous domestic respiratory scientist, finished his difficult and magnificent life and drove to the west at the age of 93.