2018年 · 第41卷第12期

Chinese Journal of Tuberculosis and Respiration is a scientific and technological journal with a long history and a prestigious reputation at home and abroad. It was founded in July 1953 at the beginning of the founding of the People's Republic of China. By 2018, it has gone through 65 years that are both enviable and tested by ups and downs. At the beginning of its publication, today's Chinese Journal of Tuberculosis and Respiratory Medicine was a specialized journal dedicated to tuberculosis-related contents, named Chinese Journal of Tuberculosis, under the supervision of the Tuberculosis Branch of Chinese Medical Association. The editor-in-chief and deputy editor-in-chief of the first editorial board are all leading figures in tuberculosis and respiratory science in China. They are Wu Shaoqing, Zhu Guiqing, Cui Guchen and He Mu. He Changqing, Sun Zhongliang, Zhang Ben, Mu Kuijin, Cai Rusheng, Kan Guanqing and Wang Deli, whom I had the opportunity to meet or work with, were also named on the first editorial board list. In 1959, the Chinese Journal of Tuberculosis was merged with the Chinese Journal of Tuberculosis Prevention, and it was jointly organized and managed by the Chinese Medical Association and the Chinese Association of Tuberculosis Prevention. The original title of the Chinese Journal of Tuberculosis needed to be changed. In 1960, China Anti-Tuberculosis Magazine stopped publication for some reason, and resumed publication in 1963. However, in 1966, for well-known reasons, almost all scientific and technological journals, including China Anti-Tuberculosis Magazine, entered a "dormant" state.

In the 2000 international expert consensus, the expert group defined idiopathic pulmonary fibrosis (IPF) as a class of fibrotic interstitial pneumonia with unknown cause and chronic progressive exacerbation; It is more common in the elderly, and the lesions are mainly localized in the lungs. The histopathological phenotype of IPF is usual interstitial pneumonia (UIP); The main clinical manifestations are progressive aggravation of dyspnea, decreased pulmonary function, and poor prognosis. In 2011, the American thoracic society (ATS), the European respiratory society (ERS), the Japanese respiratory society (JRS), and the Association of Latin American Thorax (ALAT) jointly published the clinical diagnosis and treatment guidelines for IPF on the basis of the consensus of 2000, and proposed the diagnostic criteria for IPF based on chest imaging and histopathological manifestations. However, in the subsequent clinical application, it was found that there are still some shortcomings in the 2011 IPF diagnostic criteria (Table 1), so the 2018 version of the clinical practical guidelines for IPF diagnosis was formulated, which redefined the chest imaging and lung histopathology phenotypes of IPF and divided them into four types: "UIP type", "possible UIP type", "uncertain type" and "other diagnosis", and gave expert recommendations on issues related to IPF diagnostic measures to assist clinicians to diagnose IPF more accurately, and formulate appropriate diagnostic procedures according to the specific situation of patients.

The American Thoracic Association, together with the European Society of Respiratory Diseases, the Japanese Society of Respiratory Diseases and the Latin American Thoracic Association, jointly published the 2018 Diagnostic Guidelines for idiopathic pulmonary fibrosis (IPF)^[1]。 Guidelines The 2011 IPF Diagnostic Guidelines are updated with the results of recent studies. The guidelines indicate what is relevant to lung biopsy^[1]: (1) It is recommended to perform bronchoalveolar lavage (BAL) cytological analysis (conditional recommendation, very low evidence level), surgical lung biopsy (SLB) (conditional recommendation, very low evidence level), transbronchial lung biopsy (TBLB) and frozen lung biopsy (TBCB) for patients with first-time diagnosis of interstitial lung disease (ILD) with unknown cause and suspicion of IPF, and high-resolution CT (HRCT) with possible usual interstitial pneumoniae (UIP), uncertain UIP, and other non-UIP diagnoses. (2) For ILD with initial suspicion of IPF and HRCT with UIP, it is recommended not to perform BAL cytological analysis (conditional recommendation, very low evidence level), SLB (strong recommendation, very low evidence level), TBLB and TBCB (strong recommendation, very low evidence level). Compared with the 2011 guidelines, the 2018 guidelines recommend more relevant diagnostic methods based on the grading of HRCT, and sort out the diagnostic process, which is more detailed and convenient for clinical operation.

The 2000 ATS/ERS published an expert consensus on the diagnosis and treatment of idiopathic pulmonary fibrosis (IPF)^[1]。 In 2011, renowned experts in the fields of interstitial lung disease (ILD), idiopathic interstitial pneumonia and idiopathic pulmonary fibrosis (IPF) from ATS, ERS, Japan Respiratory Society (JRS) and Latin American Thoracic Society (ALAT) jointly developed the first evidence-based diagnosis and treatment guidelines for IPF (2011 guidelines for short), proposing the importance of imaging and pathology in the diagnosis of IPF^[2]。 After seven years, members of the expert group, mainly in respiratory department and imaging department, reviewed the clinical research on IPF diagnosis from 2011 to the present, and formulated the 2018 IPF diagnostic guidelines (referred to as the 2018 guidelines), which were officially released on September 1, 2018^[3], indicating that ILD represented by IPF has attracted more and more attention. In the 2018 guidelines, the panel mainly updated the diagnostic criteria for IPF. Compared with the 2011 guidelines, the classification criteria, biopsy methods and timing of chest high-resolution CT (HRCT) were updated, reaffirming the importance of multidisciplinary discussion in the diagnosis of IPF. This update is largely similar to the Fleischer Society's Expert Consensus on IPF Diagnosis published in early 2018^[4]。 The main updates to the 2018 Guidelines and their similarities and differences with the White Paper are briefly described.

The Japanese Society of Respiratory Diseases, the Ministry of Health, Labor and Welfare of Japan and other institutions organized experts to discuss and revise the treatment of idiopathic pulmonary fibrosis (IPF) in China, and formed an updated guideline. The English version was published online in July 2018^[1]。 Compared with previous international guidelines^[2]Or country guidelines^[3]This guide specifically discusses 17 issues, covering the treatment of acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF), as well as the treatment of drug treatment, non-drug treatment and lung cancer in the chronic phase of IPF, and puts forward specific suggestions, which have certain reference significance. According to the recommendation strength, the recommendations of the Guide are divided into strong recommendations ("recommended or not recommended") (level 1), weak recommendations ("recommended or not recommended") (level 2), and according to the level of evidence, they are divided into four levels: high (A), medium (B), low (C) and very low (D). This article introduces the main contents of the guide as follows.

malignant pleural mesothelioma (MPM) is an aggressive tumor with poor prognosis, with approximately 3,000 new cases annually in the United States. The median survival of patients with advanced MPM that cannot be surgically resected is approximately 12 months. Because MPM is relatively rare, there are few large randomized controlled studies on MPM so far, especially the clinical studies on surgical treatment are less. In conclusion, only a few MPM patients are suitable for surgical resection, and most patients are predominantly chemotherapy. Even patients who can be surgically resected should be treated with a multidisciplinary combination of chemotherapy or radiotherapy after surgery.

Bronchial asthma (asthma) is one of the most common chronic respiratory diseases. Because the pathogenesis is still unclear, current drug therapy is difficult to cure asthma, causing a heavy burden on families and society. IL-33 released by bronchial epithelial cells is the initial link of immune response during the development of bronchial asthma. At present, it is believed that under physiological conditions, IL-33 is stored in the nucleus. Once the cell is necrotic, IL-33 is immediately passively released outside the cell and acts as an alarm factor. At the same time, some studies have preliminarily found that IL-33 can also be actively released by surviving cells. However, at present, little is known about the related regulation of the active release process of IL-33.

Lung cancer is one of the malignant tumors with the highest morbidity and mortality in China and the world^[1]Of which non-small-cell lung cancer (NSCLC) accounts for about 85%. the 5-year survival rate of lung cancer patients is only 15.6%, while the prognosis of patients with different tumor TNM stages (the tumor-node-metastasis classification) is significantly different. the cure rate of carcinoma in situ is close to 100%, while the 5-year survival rates of patients with stage Ⅰ ~ Ⅳ are 43% ~73%, 25% ~46%, 7% ~24% and 2% ~13%, respectively^[2]More than 70% of patients were diagnosed in advanced stages^[3]。 Early diagnosis and early treatment are the key to improve the prognosis and reduce the mortality of lung cancer. At present, the diagnosis of lung cancer mainly relies on low-dose CT and tissue biopsy. The results of a large-scale randomized controlled study of low-dose CT screening for lung cancer published in the New England Journal of Medicine in 2011 showed that low-dose CT in high-risk groups can reduce lung cancer mortality by 20% compared with ordinary chest X-ray (P =0.004), but the false positive rate was as high as 96%^[4]。 However, lung tissue biopsy is an invasive operation, which is not suitable for some patients, such as severe emphysema, hemorrhagic disorders and severe coagulation dysfunction. Tumor heterogeneity makes the results of focal sampling deviate, which cannot reflect the complete genetic information of tumor. Therefore, finding biomarkers with high specificity and sensitivity is of great significance for early diagnosis and precise treatment of lung cancer.

The anti-tumor efficacy of tumor immunotherapy has been confirmed by a number of clinical trials. immune checkpoint inhibitors (ICIs) and chimeric antigen receptor T cells (CART) treatment are the main methods of immunotherapy for malignant tumors at this stage. ICIs have been approved by the food and drug administration (FDA) for the treatment of lung cancer, kidney cancer, melanoma, head and neck tumors, bladder cancer, lymphoma and other tumors. ICIs have shown good anti-tumor effects in the first-line treatment of patients with advanced non-small cell lung cancer (NSCLC) and the second-line treatment after failure of chemotherapy or targeted therapy. The latest NCCN guidelines for non-small cell lung cancer have also been revised^[1,2]。 In June 2018, the China food and drug administration (CFDA) also officially approved Nivolumab as the first ICIs for the treatment of Chinese patients with advanced NSCLC who have failed standard chemotherapy regimens. CART is mainly used in the treatment of refractory hematological malignancies, and it is also tried to be used in the treatment of some solid tumors^[3]。 Tumor immunotherapy has a broad prospect in the treatment of malignant tumors, but they are a "double-edged sword", and often have adverse reactions related to tumor immunotherapy, sometimes even fatal. Medical workers urgently need to improve their understanding of these drugs, grasp their clinical indications, identify their side effects in time and deal with them as soon as possible. This article mainly focuses on the related literature of lung injury caused by ICIs, in order to improve the clinical diagnosis and treatment ability of this drug adverse reaction, and improve the prognosis of these patients.

venous thromboembolism (VTE) mainly includes deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE). It is a multifactorial disease caused by the combination of genetic and environmental factors, of which genetic factors account for more than 60%^[1]。 The incidence, mortality, disability and recurrence of VTE are high^[2]In recent years, the diagnosis rate in China has increased, the missed diagnosis and misdiagnosis rate has decreased, and the research on VTE has been paid more and more attention.

Lung cancer is one of the most common cancers in the world and ranks first in cancer mortality^[1]。 The 5-year survival rate of lung cancer is directly related to tumor stage, so the screening and treatment of early lung cancer is very critical. With the popularization of low-dose CT, the detection rate of early lung cancer is significantly improved. Although the National Lung Screening Trial (NLST) found that low-dose CT Screening can reduce Lung cancer mortality, the high test cost and false positive rate still hinder the large-scale application of low-dose CT in the field of Lung cancer Screening. With the development of molecular diagnostics and genomics, the emergence of many lung cancer biomarkers has compensated for the deficiency of low-dose CT screening for lung cancer^[2]。 The markers for early screening of lung cancer are reviewed as follows.

In recent years, the rapid development of microbiomics has broadened our understanding of respiratory pathogens. Compared with traditional bacterial culture, the new generation of sequencing technology can detect thousands of different types of bacteria in the same specimen simultaneously and independently of culture^[1]。 Researchers in the respiratory field have applied these techniques to detect lung or airway specimens for normal and respiratory diseases, including chronic obstructive pulmonary disease (COPD), bronchial asthma (asthma) and cystic fibrosis^[2,3,4]。 These results have changed our understanding of respiratory pathogens. For example, microorganisms can be detected in alveolar lavage fluid and lung tissue in normal people, which may be derived from migration of oropharyngeal flora and air inhalation^[5,6]。 These findings suggest that the lower airway is not absolutely sterile, challenging conventional perceptions.

backgroundThe expected median survival of patients with acute exacerbations of idiopathic pulmonary fibrosis (AE-IPF) is 3 months, and lung transplantation may prolong their survival. There are only a few small retrospective studies analyzing the outcome of patients with AE-IPF after lung transplantation, and only analyzing the survival of 1 year after transplantation.MethodsIPF patients on the Temple University Hospital (TUH) lung transplant list from January 2012 to September 2016 were included, and their transplanted lung organ allocation score (LAS), hospitalization and survival data were collected. The primary endpoints were survival of lung transplantation during stable IPF and acute exacerbation of IPF (survival before and after transplantation, time to death, and cause of death), while the secondary endpoints were hospitalization data, time to survival before transplantation, and cause of death.resultA total of 89 patients with IPF were enrolled, 52 of whom underwent lung transplantation in stable phase and 37 of whom were patients with AE-IPF. Nine of the 37 patients with AE-IPF died before transplantation and 28 underwent lung transplantation. The mortality rate after AE-IPF lung transplantation was 50% [mean follow-up (1.6 ± 1.2) years], and the mortality rate after stable IPF lung transplantation was 12% [mean follow-up (2.6 ± 1.2) years]. The Kaplan-Meier survival curve showed that the survival rates at year 1 and year 3 after lung transplantation were 94% and 90% for patients with stable IPF and 71% and 60% for patients with AE-IPF, respectively (P=0.000 1）。 Patients with LAS>80 scores and LAS<The hazard ratio of 3-year death after lung transplantation was 5.7 (95%CI：2.3~14.0，P<0.001）。conclusionCompared with patients with stable IPF, patients with AE-IPF had significantly worse short-term and long-term survival prognosis after lung transplantation; Patients with AE-IPF with high LAS may not be able to prolong their survival by lung transplantation.

In recent years, various endoscopic examinations have been used more and more widely in clinical practice. Gastroscopy has important clinical significance for understanding various disorders of the upper gastrointestinal tract, but it is usually intolerable for patients with cardiopulmonary insufficiency^[1]。 One case of electronic gastroscopy under non-invasive ventilation was successfully completed in our hospital, which is reported below.

"Research Progress of Airway Drug Inhalation Technology" was published in the 12th issue of 2017 of Chinese Journal of Tuberculosis and Respiratory Medicine^[1]An article (hereinafter referred to as "the article"), the beginning of "the article" introduces: "Compared with other administration modes, drug airway inhalation has the advantages of high local drug concentration in the respiratory tract, rapid onset of action, exact curative effect and few systemic adverse reactions. In recent years, more and more drugs can be used for airway inhalation, including antibiotics, vaccines and antihypertensive drugs in addition to commonly used bronchodilators, mucolytics and glucocorticoids". It is suggested here that airway inhalation of drugs has a faster effect than other modes of administration, which we think is inappropriate, so we are discussing it here.

Thank you for your attention and letter to the article "Research Progress of Airway Drug Inhalation Technology". After reading it carefully, we answer the questions raised by readers as follows.

As soon as the last issue of 41 volumes of this journal is about to be published, China Institute of Science and Technology Information (ISTIC) under the Ministry of Science and Technology released the latest "Citation Report of Chinese Science and Technology Journals (Core Edition)". The results show that the comprehensive evaluation score of this journal among 2029 Chinese science and technology core journals (statistical source journals of Chinese science and technology papers) is 96.9 points, ranking first again! Comprehensive evaluation total score is based on the principle of scientometrics, systematically and comprehensively considering the relative position of each influence index (core total citation frequency, core influence factor, core other citation rate, fund paper ratio, citation rate, etc.) of the evaluated journal in its discipline, and integrating these indicators according to a certain weight coefficient. According to the design principle of comprehensive evaluation index system, the total score of comprehensive evaluation shields the differences of background values of overall indexes among various disciplines, and can be compared across disciplines. Thank you to all the experts, authors and readers in the field of tuberculosis and respiration for supporting this journal!

From August 30th to September 2nd, 2018, the Annual Meeting of Respiratory Disease Branch of Chinese Medical Association and the 19th National Respiratory Disease Academic Conference (referred to as Respiratory Annual Meeting) were held in Suzhou International Convention and Exhibition Center, Jiangsu Province. The theme of this year's annual conference on breathing is: strengthening cooperative research and promoting the development of disciplines.