[Analysis of 2 cases of dyspnea happening after tracheotomy and the clinical application of Mimics 10.01]

Post-intubation tracheal stenosis was a late time complication after tracheotomy but the happening of dyspnea was unusual. Diagnosing tracheal stenosis after incubation, and figuring out the location and causes of the stenosis were important. Treatment of post-incubation tracheal stenosis relied on accurate diagnosis of the type of tracheal stenosis. Computed tomography (CT) and laryngoscope could be used for detecting the stenosis but not enough. Two patients who were already under the urgent tracheotomy over 1 year were reported. However apnea was found on these two patients for a long time after traheotomy. Obviously laryngeal obstruction appeared. CT virtual bronchoscope and laryngoscope examination showed that the cannula was obstructed and plenty of granulation tissue blocked the orificium. But the exact location of the cannula and the adjacent relationship of the tissue around the cannula was equivocal. Mimics 10.01 software was used to analyze the data of the CT scan and found that a pseudo cavity was formed by granulation tissue which partly blocked the cannula in 1 case; granulation tissue occupation and scar formation in the trachea were the reason of tracheal stenosis but not the collapse of the cartilage in case 2. The purpose of this report is to discuss the cause of dyspnea after emergency tracheotomy, its diagnostic method and their management. CT virtual bronchoscope and laryngoscope should be used as a regular examination after tracheotomy to clarify the location of cannula and avoid the failure of airway opening caused by the dislocation of cannula and the complication. Trachea tissue should be protected properly during and after the tracheotomy which might decline the rate of the tissue remodeling, tracheal stenosis and dyspnea after surgery. The clinical use of Mimics 10.01 made it possible to observe morphology more directly by invasive examination and provided a significant clue to make the operation plan so that it should be used widely. Meanwhile, the method to put the cannula into its right way under the guidance of rigid endoscope and the excision of granulation tissue by semiconductor laser should become one of the best treatments of this disease. Following the method above, laryngeal obstruction was relieved after the surgery. Postoperative follow-up lasted for 1 year and recurrence was not found.

[Investigation on the expression of microvessel pericyte coverage index and lymph vessel density in nasal polyps]

Objective: To investigate the role of lymph vessel density (LVD) and microvessel pericyte coverage index (MPI) in the pathogenesis of nasal polyps. Methods: Using immunohistochemistry and immunofluorescence double staining method, the expressions of albumin, D2-40 and CD34-α-SMA in 11 specimens of normal nasal mucosa, 26 specimens of nasal polyp and 26 specimens of inferior turbinate tissue from patients with nasal polyps were investigated. The counts of microvessel density (MVD), lymph vessel density (LVD) and microvessel pericyte coverage index (MPI) were compared. SPSS 17.0 software was used to analyze the data. Results: The nasal polyp group(0.269±0.096) had more albumin than inferior turbinate tissue group(0.159±0.078) and normal nasal mucosa group(0.138±0.045), the differences were significant (q value was 4.873, 4.446, both P<0.05). The counts of MVD in nasal polyp group (30.52±4.42) were not significantly higher than those in inferior turbinate tissue group (30.33±6.03) and normal nasal mucosa group(28.21±6.84), the differences were not significant (q value was 0.130, 1.147, both P>0.05). The MPI in nasal polyp group (0.291±0.096) was significantly lower than those in inferior turbinate tissue group(0.432±0.101) and normal nasal mucosa group(0.416±0.071), the difference was significant (q value was 5.399, 3.680, both P<0.05). The counts of LVD in the nasal polyp group(0.245±0.073) were significantly lower than those in inferior turbinate tissue group (0.431±0.054) and normal nasal mucosa group(0.470±0.078), the difference was significant (q value was 10.004, 9.328, both P<0.05). MPI expression in the nasal polyp group was negetively correlated to albumin expression(r=-0.889, P<0.05). The LVD expression in the nasal polyp group was negetively correlated to albumin expression(r=-0.901, P<0.05). Conclusion: Different LVD and MIP in nasal polyp tissues and normal nasal mucosa tissues imply that microcirculatory dysfunction plays a crucial role in the pathogenesis of nasal polyps.

[Taste dysfunction analysis in patients with allergic rhinitis]

Objective:To investigate the taste dysfuction and its features in patients with allergic rhinitis,and to study its influence on quality of life.Method:Three hundred and five consecutive cases were enrolled. Rhino conjunctivitis Quality of Life Questionnaire, visual analogue scale and Lund-Kennedy nasal endoscopy scores were used to assess the taste dysfunction. In addition, taste test with paper strips was used to evaluate the four basic tastes of the twenty patients with severity dysfuction VAS.Result:Taste dysfuction accounted for 18.03% (55/305) in all allergic rhintis, while hypogeusia and hypergeusia were 98.18% (54/55), 1.82% (1/55) respectively. There were significant differences of RQLQ scores in taste dysfuction group compared to no taste dysfunction group, there were positive correlated relationship, but no difference between taste function and nasal VAS scores nor Lund and Kennedy nasal endoscopy scores. Saline taste, bitter taste, sweet taste and sour taste were impaired in AR, thus, saline taste was more diminishes than another three (P< 0.05). Conclusion:Taste dysfunction is common symptom in allergic rhinitis, mainly including hypogeusia, especially saline taste.Taste dysfunction can impact patients'quality of life.

[Microenvironment of middle meatus involved in pathogenesis of nasal polyps-the possibility and research progress]

Chronic rhinosinusitis with nasal polyps(CRSwNP) is a complicated inflammatory disease, with increasing incidence and high recurrence rate,which the pathogenesis remains unclear. This article reviewed research progress about the relationships between middle meatus microenvironments and pathologic process of CRSwNP: including hypoxia ,microbiome imbalance, innate function of the airway epithelial barrier dysfunction. Pointing out a new direction to figure out pathogenesis of CRSwNP.

[New therapeutic strategies in allergic rhinitis]

Allergic rhinitis (AR) is a nasal inflammatory, IgE-mediated disease that occurs when some individuals inhales something he or she is allergic to, such as pollen or animal dander. It is also a refractory disease with high prevalence in the field of rhinology. The treatment of AR is really a difficult and challenging task because of the high prevalence, economic burden and the interference to the quality of life. At present, nasal corticosteroid and antihistamines were the mainly therapies, however, there is up to 40% patients not satisfactory to these therapies. So exploring new therapy or target is necessary. This article will review the results of previous studies focused on the new therapies of AR.

Final overall survival results from a randomised, phase III study of erlotinib versus chemotherapy as first-line treatment of EGFR mutation-positive advanced non-small-cell lung cancer (OPTIMAL, CTONG-0802)

BACKGROUND

The OPTIMAL study was the first study to compare efficacy and tolerability of the epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) erlotinib, versus standard chemotherapy in first-line treatment of patients with EGFR mutation-positive advanced non-small-cell lung cancer (NSCLC). Findings from final overall survival (OS) analysis and assessment of post-study treatment impact are presented.

PATIENTS AND METHODS

Of 165 randomised patients, 82 received erlotinib and 72 gemcitabine plus carboplatin. Final OS analyses were conducted when 70% of deaths had occurred in the intent-to-treat population. Subgroup OS was analysed by Cox proportional hazards model and included randomisation stratification factors and post-study treatments.

RESULTS

Median OS was similar between the erlotinib (22.8 months) and chemotherapy (27.2 months) arms with no significant between-group differences in the overall population [hazard ratio (HR), 1.19; 95% confidence interval (CI) 0.83-1.71; P = 0.2663], the exon 19 deletion subpopulation (HR, 1.52; 95% CI 0.91-2.52; P = 0.1037) or the exon 21 L858 mutation subpopulation (HR, 0.92; 95% CI 0.55-1.54; P = 0.7392). More patients in the erlotinib arm versus the chemotherapy arm did not receive any post-study treatment (36.6% versus 22.2%). Patients who received sequential combination of EGFR-TKI and chemotherapy had significantly improved OS compared with those who received EGFR-TKI or chemotherapy only (29.7 versus 20.7 or 11.2 months, respectively; P < 0.0001). OS was significantly shorter in patients who did not receive post-study treatments compared with those who received subsequent treatments in both arms.

CONCLUSION

The significant OS benefit observed in patients treated with EGFR-TKI emphasises its contribution to improving survival of EGFR mutant NSCLC patients, suggesting that erlotinib should be considered standard first-line treatment of EGFR mutant patients and EGFR-TKI treatment following first-line therapy also brings significant benefits to those patients.

CLINICALTRIALSGOV IDENTIFIER

NCT00874419.

Association between CC motif chemokine ligand 5 (CCL5) polymorphisms and asthma risk: an updated meta-analysis

BACKGROUND

Findings regarding the associations between the CC motif chemokine ligand 5 (CCL5) -403G/A and -28C/G polymorphisms and asthma risk are controversial.We performed a meta-analysis to determine whether CCL5 polymorphisms are associated with asthma risk.

METHODS

We searched the Pubmed, Embase, Chinese National Knowledge Infrastructure (CNKI), and Wanfang databases for studies published before June 2013. The strength of associations was calculated using ORs with 95% CIs.

RESULTS

Twenty case-control studies were included in this meta-analysis. We did not observe a significant association between the CCL5 -403G/A polymorphism and asthma risk (OR, 1.10; 95% CI, 0.93-1.30; P = .25). The CCL5 - 28C/G polymorphism, however, was associated with a significantly elevated asthma risk (OR, 1.17; 95% CI, 1.02-1.33; P = .02). Subgroup analyses found that the CCL5 -28C/G polymorphism was significantly associated with asthma risk in Asians (OR, 1.16; 95% CI, 1.01-1.33; P = .04) and children (OR, 1.29; 95% CI, 1.03-1.63; P = .03).

CONCLUSIONS

This meta-analysis suggests that the CCL5 -28C/G polymorphism is a risk factor for asthma.

Interferon-gamma +874A/T polymorphism is associated with asthma risk: a meta-analysis

BACKGROUND

Results regarding the association between the interferon-y (lFN-y) +874A/T polymorphism and asthma risk are controversial and ambiguous. The aim of this study was to determine with greater precision the relationship between the IFN-gamma+874A/T polymorphism and asthma using a meta-analysis.

METHODS

Published literature was retrieved from 5 databases (PubMed, EMBASE, Wanfang, China National Knowledge Infrastructure [CNKI] and Weipu). ORs with 95% Cls were used to assess the strength of association.

RESULTS

Ten case-control studies involving 697 cases and 1049 controls were identified. In the overall analysis, a significant association between the +874A/T polymorphism and asthma susceptibility was found for AA vs AT + TT (OR, 1.89; 95% CI, 1.37-2.62; P=.0001). In the subgroup analysis by ethnicity, significant associations were found among whites (OR, 1.42; 95% CI, 1.04-1.93; P=.03) and Asians (OR, 2.52; 95% CI, 1.49-4.25; P=.0006). The sensitivity analysis and cumulative meta-analysis further strengthened the validity of this association. No publication bias was observed in this study.

CONCLUSION

The results of this meta-analysis suggest that the IFN-gamma +874A/T polymorphism is a risk factor for asthma.

Effects of TNF-α polymorphisms on asthma risk: a systematic review and meta-analysis

BACKGROUND

Several studies have examined associations between TNF-α polymorphisms and asthma risk, but the results have been conflicting.

METHODS

A search was performed of the PubMed, EMBASE, and Wanfang databases. Data were extracted and pooled ORs with 95% CIs were calculated.

RESULTS

Fifty-four studies were included. A significant association between the TNFA-308A/G polymorphism and asthma susceptibility was observed for AA + AG vs GG (OR, 1.39; 95% CI, 1.23-1.58; P < .001). This polymorphism was also significantly associated with asthma risk in whites (OR, 1.47; 95% CI, 1.25-1.73; P < .001), atopic asthma risk (OR, 1.38; 95% CI, 1.16-1.65; P < .001), pediatric asthma risk (OR, 1.48; 95% CI, 1.23-1.79; P < .001), and adult asthma risk (OR, 1.35; 95% CI, 1.21-1.52; P < .001).There was also a significant association between the TNFA -857C/T polymorphism and asthma risk in the recessive model (OR, 1.25; 95% CI, 1.10-1.43; P < .001). In the subgroup analyses, asthma risk was significantly increased in Asians (OR, 1.23; 95% CI, 1.07-1.41; P = .004) and atopic individuals (OR, 1.33; 95% CI, 1.13-1.57; P < .001). No significant association was found for the TNFA-238A/G polymorphism. There were insufficient data to evaluate the associations between TNFA -1031T/C and -863C/A polymorphisms and asthma risk.

CONCLUSIONS

This meta-analysis suggests that TNFA -308A/G and -857C/T polymorphisms are risk factors for asthma.

Quality of life (QoL) analyses from OPTIMAL (CTONG-0802), a phase III, randomised, open-label study of first-line erlotinib versus chemotherapy in patients with advanced EGFR mutation-positive non-small-cell lung cancer (NSCLC)

BACKGROUND

The OPTIMAL study found that erlotinib improved progression-free survival (PFS) versus standard chemotherapy in Chinese patients with advanced EGFR mutation-positive non-small-cell lung cancer (NSCLC). This report describes the quality of life (QoL) and updated PFS analyses from this study.

PATIENTS AND METHODS

Chinese patients ≥ 18 years with histologically confirmed stage IIIB or IV NSCLC and a confirmed activating mutation of EGFR (exon 19 deletion or exon 21 L858R point mutation) received erlotinib (150 mg/day; n = 82) or gemcitabine-carboplatin (n = 72). The primary efficacy end point was PFS; QoL was assessed using the Functional Assessment of Cancer Therapy-Lung (FACT-L) questionnaire, Trial Outcome Index (TOI) and Lung Cancer Subscale (LCS).

RESULTS

Patients receiving erlotinib experienced clinically relevant improvements in QoL compared with the chemotherapy group in total FACT-L, TOI and LCS (P < 0.0001 for all scales). Erlotinib scored better than chemotherapy for all FACT-L subscales from baseline to cycles 2 and 4 (non-significant). In the updated analysis, PFS was significantly longer for erlotinib than chemotherapy (median PFS 13.7 versus 4.6 months; HR = 0.164, 95% CI = 0.105-0.256; P < 0.0001), which was similar to the previously reported primary analysis.

CONCLUSION

Erlotinib improves QoL compared with standard chemotherapy in the first-line treatment of patients with EGFR mutation-positive advanced NSCLC.

Isolated splenic metastasis from lung cancer: ringleader of continuous fever

The spleen is an infrequent metastatic organ of solid tumours, the prevalence of which ranges between 2.3% and 7.1% in populations with cancer as determined through autopsy. The most common sources of metastasis are breast, lung, colorectal and ovarian carcinoma and melanoma. Isolated metastasis of the spleen is rarely reported with only 93 cases from all sources having been reported up to 2007. Therefore, isolated splenic metastasis from primary lung cancer is exceedingly rare with only 11 cases reported to date. Herein, we report a rare case of isolated splenic metastasis in a 49-yr-old female 3 months after lobectomy for an undifferentiated large cell carcinoma in the right lung (pT(2a)N₀M₀). The only symptom the patient presented with was continuous high fever, which had never been previously reported. This patient presented diagnostic challenges due to the presentation of high fever, leukoapenia after chemotherapy and the cystic splenic mass, all of which led to the initial consideration of splenic abscess. The patient's high fever resolved rapidly after splenectomy and splenic metastasis was confirmed by pathological findings. We also reviewed all 11 reported previously cases and summarised the characteristics and appropriate management of isolated splenic metastasis from lung cancer.

YKL-40 in asthmatic patients, and its correlations with exacerbation, eosinophils and immunoglobulin E

The chitinase-like protein YKL-40, which binds chitin but lacks chitinase activity, has been found to be either the cause or a biomarker for asthma. The aim of our study was to investigate whether serum YKL-40 levels are increased in Chinese patients with asthma and identify its correlation to acute exacerbation, total serum immunoglobulin (Ig)E, the percentage of peripheral blood eosinophils and lung function. We quantified serum YKL-40 levels, total IgE levels and peripheral blood eosinophil percentages in patients with asthma, as well as in controls from the communities surrounding our hospital. The lung function of asthma subjects was also measured. Our data showed that the serum YKL-40 levels were significantly elevated in patients with asthma compared with controls and, when the asthma subjects were stratified, serum YKL-40 levels in the exacerbation group were higher than those in the stable and control groups. In addition, serum YKL-40 levels correlated positively with total serum IgE levels and the percentage of peripheral blood eosinophils, but correlated inversely with lung functions. Thus, we conclude that YKL-40 is found in increased quantities in the serum of Chinese patients with asthma, and its level correlates with exacerbation attacks, indicating that high levels of serum YKL-40 may be a biological characteristic of the exacerbation of asthma.

[Treatment of spontaneous metastatic lung cancer with tumor antigen-pulsed, interleukin-18 gene-modified dendritic cells]

OBJECTIVE

To investigate the effect of tumor antigen-pulsed, interleukin-18 (IL-18) gene-modified dendritic cells in treatment of spontaneous metastatic lung cancer.

METHODS

3LL Lewis lung cancer cells were injected into the footpads of C57BL/6 mice to establish a spontaneous metastatic lung cancer model. Ninety-six mice with lung cancer were divided into 8 groups, 12 in each. treated differently. One group was treated by subcutaneous vaccination for two times of tumor antigen peptide Mut1-pulsed, IL-18 gene-modified dendritic cells (DC-IL-18/Mut1) that were derived from normal bone marrow. The other groups were treated with other measures. After treatment, the lung weight, number of metastatic nodes on the lung surface, survival time, and NK and CTL activities were examined.

RESULTS

Compared with the mice treated with Mut1-pulsed control LacZ gene-modified DC and those treated with untreated DC, the tumor-bearing mice treated with DC-IL-18/Mut1 had the lightest lung weight (215 mg +/- 20 mg Vs 398 mg +/- 23 mg and 987 mg +/- 45 mg, t = 14.7 and 38.4, P < 0.01), the least lung metastatic nodes (0 Vs 7.8 +/- 2.7 and 49, P < 0.01), the longest survival time (chi(2) = 6.78 and 10.49 respectively, P < 0.01), the strongest cytotoxic T cell activity (53.4 +/- 3.1 Vs 41.3 +/- 2.6 and 9.8 +/- 2.1, t = 13.4 and 15, 7 respectively, P < 0.01), and increased proportions of CD4 + Tcells, CD8 + Tcells, and NK cells.

CONCLUSION

Tumor antigen-pulsed, IL-18 gene-modified dendritic cells have a significant therapeutic effect on spontaneous netastatic lung cancer through induction of anti-tumor immunological responses.

[Effect of intratracheally administered IL-12 recombinant adenovirus on ovalbumin induced bronchial hyresponsiveness in mouse model]

OBJECTIVE

To assess the effect of intratracheally administered IL-12 recombinant adenovirus (Adm IL-12) on ovalbumin (OVA) induced bronchial hyperresponsiveness in mouse model.

METHODS

C57BL/6 mice were sensitized by ovalbumin. Adm IL-12 with the dose of 10(8)pfu/mouse was administered intratracheally before OVA challenge. IL-4, IL-5 and IFN-gamma in BALF, bronchial responsiveness, eosinophil count in peripheral blood and BALF, serum total IgE and specific IgE were measured.

RESULTS

There was IL-12 gene expression in the lung tissue after Adm IL-12 administration, concentration of IL-12 in sera and BALF were (540 +/- 60) U/ml and (4 700 +/- 800) U/ml respectively, but were unable to be detected in control group (P < 0.01). Compared with the control group, there were significantly lower levels of IL-4 [(3.5 +/- 2.0) ng/ml vs (85.0 +/- 25.0) ng/ml] (t = 27.97, P < 0.01) and IL-5 [(6.5 +/- 4.5) ng/ml vs (54.0 +/- 14.0) ng/ml], (t = 7.92, P < 0.01) in BALF, accompanying with a higher level of IFN-gamma [(690.0 +/- 32.0) ng/ml vs (12.5 +/- 3.2) ng/ml] (t = 51.6, P < 0.01), lower airway resistance [(360 +/- 30) cm H(2)O vs (810 +/- 50) cm H(2)O] (t = 18.9, P < 0.01) and lower eosinophil counts in both peripheral blood [(0.7 +/- 0.1)% vs (9.2 +/- 0.5)%] (t = 47.1, P < 0.01) and in BALF [(3.5 +/- 0.7) x 10(4)/ml vs (21.6 +/- 4.7) x 10(4)/ml)] (t = 9.33, P < 0.01). However, neither serum total IgE [(65 +/- 9) microgram/ml vs (67 +/- 10) microgram/ml], nor specific IgE [(32 +/- 8) microgram/ml vs (33 +/- 8) microgram/ml] showed significant difference (all P > 0.05).

CONCLUSIONS

Intratracheally administered Adm IL-12 inhibits ovalbumin induced airway hyperresponsiveness, which may be an effective approach in the management of antigen induced bronchial asthma.

[Detection of extended-spectrum beta-lactamases and drug sensitivity test in clinical isolates of the family Enterobacteriaceae in Shanghai]

OBJECTIVE

To investigate extended-spectrum beta-lactamases (ESBLs) production in clinical isolates of the family Enterobacteriaceae in Shanghai, and compare the resistant rates of ESBLs-producing strains and non-ESBLs-producing strains to 11 antibiotics.

METHODS

Double-disk synergy test was used to detect ESBLs in 1,026 strains of the family Enterobacteriaceae; Kirby-bauer agar diffusion method was used to judge drug sensitivity.

RESULTS

34.31% of strains of the family Enterobacteriaceae were considered ESBLs producers by double-disk synergy test. The prevalences of ESBLs in isolates of Klebsiella pneumoniae, Escherichia coli and Enterobacter cloacae were 37.40%, 30.21% and 41.82% respectively. Except Imipinem and Cefmetazole, the resistant rates of ESBLs-producing strains to other 9 antibiotics were much higher than that of non-ESBLs-producing strains(P < 0.01). The resistant rates of Imipinem to ESBLs-producing strains were the lowest.

CONCLUSIONS

The prevalence of ESBLs in clinical isolates of the family Enterobacteriaceae in Shanghai was high; it is necessary for clinical laboratory to detect ESBLs in clinical isolates of the family Enterobacteriaceae routinely. The resistant rates of ESBLs-producing strains to most antibiotics were high. Imipinem and Cefmetazole were the effective antibiotics to infections caused by ESBLs-producing strains.

[Study on serotyping of Haemophilus influenzae and the positive rates of beta-lactamase]

OBJECTIVE

To investigate the serotypes of both infectious and carriage strains of Haemophilus influenzae (Hi) and to evaluate the prevalence of beta-lactamase of major serotypes in Shanghai.

METHODS

The 534 specimens of sputum and swabs from patients with acute upper or lower respiratory tract infection and 255 cases of control group were collected and incubated on improved Collumbia chocolate medium. All isolated Haemophilus influenzae strains were serotyped by slide agglutinating assay or reverse indirect blood agglutinating method. beta-lactamase were measured by iodine test and paper disc method.

RESULTS

In the patient group, of the 164 Hi strains there were 69 Hib strains (42%, 69/164) and 91 NTHi(56%, 91/164). In the control group, there were 14 strains of Hib and 49 strains of NTHi among 66 strains of Hi, which were isolated from 255 specimens(26%, 66/255). 24%(38/160) of Hi in the patient group produced beta-lactamase. In this group, the positive rate of beta-lactamase was 29%(20/69) for Hib strains and 20%(18/91) for NTHi strains. Sixteen strains resisting to ampicillin were beta-lactamase negative.

CONCLUSIONS

These results indicate that Hib and NTHi are the major serotypes of Hi in both the patient and control group. The prevalence of Hib is higher in patients than in the control. Hib strains are more likely to produce beta-lactamase than NTHi.

Effects of BRL 55 834 on allergen-induced bronchoconstriction and airway inflammation in sensitized guinea pigs

OBJECTIVE

To investigate the effects of potassium channel activator on allergen-induced bronchoconstriction and airway inflammation and to discuss which role it plays in asthma therapy.

METHODS

Airway insufflation pressure, examination of inflammatory cells in bronchial alveolar lavage fluid, analysis of airway pathology and airway Evans blue dye extravasation measurement were employed to detect airway resistance and airway inflammatory responses.

RESULTS

[(3s, 4R)-3, 4-dihydro-2, 2-dimethyl-4-(2-oxopiperidin-l-yl)-6-pentafluoroethyl-2H-1-benzopyran-3-ol] (BRL) 55 834 (8 micrograms/kg) inhibited not only ovalbumin-induced airway insufflation pressure increase but also inflammatory cell infiltration (ICI) in sensitized guinea-pigs; moreover, it did not decrease blood pressure; in contrast to BRL 55 834, single dose of BRL 38 227 (200 micrograms/kg) and verapamil (0.5 mg/kg) had a little effect on ICI; single dose of aminophylline (25 mg/kg) and dexamethasone (1 mg/kg) could not inhibit ICI, but the former could inhibit airway insufflation increase; drugs, besides aminophylline, could reduce microvascular leakage; single dose of BRL 38 227, verapamil and dexamethasone had no inhibition of airway insufflation pressure; BRL 38 227 and verapamil decreased blood pressure markedly.

CONCLUSIONS

Selective potassium channel activator BRL 55 834 not only decreases airway resistance, but also inhibit airway inflammation, and both of them are of benefit to asthma therapy.

[Laboratory and clinical investigation on lower respiratory tract infection by Haemophilus influenzae]

OBJECTIVE

To improve the positive rate of Hi isolation and to study the epidemiology, antibiotic sensitivity and clinical characteristics of the lower respiratory tract infection by Hi.

METHODS

Modified Columbia chocolate agar(ICCA) was compared with blood agar staphy stick (BASS) for the primary isolation of Hi from sputa. The sensitivities of 20 antibiotics to Hi were determined in vitro by KB method and MICs of 12 antibiotics were determined by broth microdilution method. The clinical characteristics of 92 cases with lower respiratory tract infection by Hi were analyzed.

RESULTS

The isolation rate of Hi by ICCA was 20%, which was higher than 13% of BASS(P < 0.01). The third generation cephalosporins and the quinolones were most active against Hi. The resistant rate against Hi of ampicillin was 21%, however, that of the third generation cephalosporins was 45%-49%. 67(73%) of 92 cases were bronchopneumonia.

CONCLUSIONS

The isolation rate of Hi could be improved by ICCA. The clinical characteristic of lower respiratory tract infection by Hi was not specific. There has been a steady increase of antibiotic resistance during these years.

[Isolation and drug susceptibility of Staphylococcus epidermidis from respiratory tract]

OBJECTIVE

In order to realize the significance on the isolation and drug susceptibility of S. epidermidis from patients with lower respiratory tract infections.

METHOD

(1) Qualified sputum specimens from inpatients in general wards with lower respiratory tract infections were cultured for bacteria and identification between 1990 and 1996. (2) Drug susceptibility of commonly used antibiotics against isolated S. epidermidis strains was determined by K-B methods or agar dilution method.

RESULT

(1) Two thousand and six hundred sixty strains of various kinds of bacteria were isolated from 6228 sputum specimens, 257 strains (9.66%) of which were S. epidermidis (ranking the forth). The isolating rate of S. epidermidis was 4.13%. (2) By determining the drug susceptibility of S. epidermidis to 21 commonly used antibiotics, it was found that this bacterium was resistant to all the agents except vancomycin in different levels, and the resistant rate ranged from 15.2% to 98.1%, of which many strains showed multidrug resistance. Vancomycin, imepinem, cefocefin and cefoperazone were relatively sensitive agents tested, the resistant rates being 0, 17.1%, 18.7% and 30.0%, respectively. The resistant rates of all other agents were higher than 48.5%, some of which higher than 80%. The resistant rate of penicillin G was nearly 100%.

CONCLUSION

Attention should be paid to the high isolating rate of S. epidermidis in the respiratory tract infections and the high drug resistance in some strains, and the role of this bacterium in the lower respiratory tract infections needs to be studied.

Role of leukotriene B4 in bronchial hyperresponsiveness induced by interleukin-8

Repeated intranasal administration of interleukin 8 (IL-8) induces bronchial hyperresponsiveness (BHR) accompanied by lower airway neutrophil accumulation (ANA) in guinea-pigs. Leukotriene B4 (LTB4) is a chemotactic factor for neutrophils. To elucidate whether LTB4 and neutrophil elastase are involved in the IL-8-induced BHR and ANA, the effects of a LTB4 antagonist (ONO-4057) and a neutrophil elastase inhibitor (ONO-5046) on the responses were examined. IL-8 (5 microg x kg[-1]) was administered intranasally to guinea-pigs twice weekly for 3 weeks. One day after the last administration, animals were anaesthetized and artificially ventilated through tracheal cannulae, and lateral pressure at the tracheal cannula (Pao) was measured as an overall index of airway responses to inhaled histamine. ONO-4057 (2 or 20 mg x kg[-1]) or ONO-5046 (30 or 300 mg x kg[-1]) was administered intraperitoneally 24 and 1 h before anaesthesia. ONO-4057, but not ONO-5046, significantly inhibited the IL8-induced BHR and ANA, assessed by bronchoalveolar lavage, in a dose-dependent manner. These findings suggest that interleukin 8 causes bronchial hyperresponsiveness and airway neutrophil accumulation in guinea-pigs in vivo. In part this appears to be due to release of leukotriene B4, whereas it may not be mediated by neutrophil elastase.

Cancer risks among iron and steel workers in Anshan, China, Part I: Proportional mortality ratio analysis

A standardized proportional mortality ratio (SPMR) study of 8,887 deaths during 1980-1989 among male workers in a large integrated iron-steel complex in Anshan, China, was conducted to provide clues to occupational risk factors. Accidents and cancer accounted for a higher proportion of deaths among the iron-steel workers than among the general male population (SPMR = 1.21; 95% CI = 1.12-1.31 and 1.14; 95% CI = 1.10-1.18, respectively). Among all workers, SPMRs were significantly elevated for stomach, lung, and colorectal cancers (SPMR = 1.37, 1.37, 1.38, respectively), but not other cancers. Risks of stomach cancer appeared to be highest among workers employed in jobs with exposure to iron and coal dust, whereas significant increases in colorectal cancer were seen for loading and other dusty jobs and for administrative and sedentary jobs without dust exposure. Risks of lung cancer appeared increased for a variety of jobs throughout the complex, especially those with probable high levels of exposure to polycyclic hydrocarbons and asbestos. Risk of esophageal cancer was significantly elevated for fire-resistant brick makers, and risk of nonmalignant respiratory disease was significantly elevated for those employed as furnace workers, foundry workers, and fire-resistant brick makers.

Bronchial hyperresponsiveness and airway neutrophil accumulation induced by interleukin-8 and the effect of the thromboxane A2 antagonist S-1452 in guinea-pigs

Interleukin-8 (IL-8) has been shown to be a chemotactic factor for neutrophils, T-lymphocytes and eosinophils, but it is unknown whether the IL-8-induced inflammatory cell accumulation into the airways can cause the bronchial hyperresponsiveness (BHR) characteristic of asthma. IL-8 at a dose of 0.5 or 5 micrograms/kg was administered intranasally to guinea-pigs twice a week for 3 weeks. One day after the last administration, animals were anesthetized and artificially ventilated through tracheal cannula and lateral pressure at the cannula (Pao) was measured as an overall index of airway responses to increasing concentrations of inhaled histamine (25, 50, 100, and 200 micrograms/ml). The IL-8 treatment significantly enhanced bronchial responsiveness to histamine in a dose-dependent manner (ANOVA P < 0.01). The provocative concentration of histamine causing a 100% increase in Pao (PC100) at a dose of 0.5 and 5 micrograms/kg of IL-8 was 68.1 (GSEM 1.12) and 35.6 (GSEM 1.25) micrograms/ml, respectively. The latter was significantly (P < 0.01) lower than that in control animals treated with PBS (93.3 [GSEM, 1.14] micrograms/ml). The IL-8 treatment also induced a significant influx of neutrophils, but not eosinophils, in bronchoalveolar lavage (BAL) fluid (18.3 +/- 8.8 and 30.6 +/- 8.3% in animals treated with 0.5 and 5 micrograms/kg, respectively, of IL-8 vs 3.6 +/- 0.7% in phosphate buffered saline-(PBS)-treated animals). Furthermore, we examined the effect of the thromboxane receptor antagonist S-1452 (0.01 or 0.1 mg/kg, i.p. 24 and 1 h before anesthesia) on this IL-8 induced BHR. S-1452 significantly inhibited the BHR dose-dependently (ANOVA P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)