Clinical features of psittacosis in 46 Chinese patients / Características clínicas de 46 pacientes con psittacitis China

Background: Psittacosis is a relatively uncommon cause of community-acquired pneumonia, often leading to diagnostic difficulty.Methods: A retrospective study was conducted on the clinical features of psittacosis patients in China. Forty-six cases of Chlamydophila psittaci infection with atypical pneumonia of varying severity in the last two years were described retrospectively.Results: Fever, relative bradycardia, and other systemic upsets were the main clinical presentation. The most common radiographic abnormality was segmental or lobar shadowing or consolidation. The total white cell counts were usually normal or slightly increased. The concentration of creatine kinase, C reactive protein, and lactic dehydrogenase increased, while albumin decreased remarkably. These cases exhibited good recovery after being treated with tetracycline or quinolone antibiotics.Conclusion: These features may help differentiate psittacosis from other traditional bacterial pneumonia. However, they do not provide a definitive diagnosis. Psittacosis diagnosis must perform the whole-genome sequencing for Chlamydophila psittaci in respiratory, blood, or sputum specimens. Increased awareness of psittacosis can shorten diagnostic delays and improve patient outcomes.(AU)

Antecedentes: La psitacosis es una causa relativamente poco común de neumonía adquirida en la comunidad, y a menudo conduce a dificultades diagnósticas.Métodos: Se realizó un estudio retrospectivo sobre las características clínicas de los pacientes con psitacosis en China, en el que se describen retrospectivamente 46 casos de infección por Chlamydia psittaci con neumonía atípica de gravedad variable en los últimos dos años.Resultados: La fiebre, la bradicardia relativa y otros trastornos sistémicos fueron la presentación clínica principal. La anomalía radiográfica más común fue el sombreado o consolidación segmentaria o lobular. Los recuentos totales de glóbulos blancos fueron generalmente normales o ligeramente aumentados. Las concentraciones de creatina quinasa, proteína C reactiva y deshidrogenasa láctica aumentaron, mientras que la albúmina disminuyó notablemente. Estos casos mostraron una buena recuperación después de ser tratados con antibióticos de tetraciclina o quinolona.Conclusión: Estas características pueden ayudar a diferenciar la psitacosis de otras neumonías bacterianas tradicionales. Sin embargo, no proporcionan un diagnóstico definitivo. El diagnóstico de psitacosis debe realizar la secuenciación del genoma completo de Chlamydia psittaci en muestras respiratorias, sanguíneas o de esputo. Una mayor conciencia de la psitacosis puede acortar los retrasos en el diagnóstico y mejorar los resultados de los pacientes.(AU)

Clinical features of psittacosis in 46 Chinese patients.

BACKGROUND: Psittacosis is a relatively uncommon cause of community-acquired pneumonia, often leading to diagnostic difficulty. METHODS: A retrospective study was conducted on the clinical features of psittacosis patients in China. Forty-six cases of Chlamydophila psittaci infection with atypical pneumonia of varying severity in the last two years were described retrospectively. RESULTS: Fever, relative bradycardia, and other systemic upsets were the main clinical presentation. The most common radiographic abnormality was segmental or lobar shadowing or consolidation. The total white cell counts were usually normal or slightly increased. The concentration of creatine kinase, C reactive protein, and lactic dehydrogenase increased, while albumin decreased remarkably. These cases exhibited good recovery after being treated with tetracycline or quinolone antibiotics. CONCLUSION: These features may help differentiate psittacosis from other traditional bacterial pneumonia. However, they do not provide a definitive diagnosis. Psittacosis diagnosis must perform the whole-genome sequencing for Chlamydophila psittaci in respiratory, blood, or sputum specimens. Increased awareness of psittacosis can shorten diagnostic delays and improve patient outcomes.

Icariin Improves Glucocorticoid Resistance in a Murine Model of Asthma with Depression Associated with Enhancement of GR Expression and Function.

Icariin, a flavonoid glycoside isolated from Epimedium brevicornum, exerts a variety of biological activities. However, its effects on depression-induced glucocorticoid resistance in asthma and the underlying mechanisms have not been elucidated. In this study, a murine model of asthma with depression was established by exposure to ovalbumin combined with chronic unpredictable mild stress, and icariin was given orally during ovalbumin challenge and chronic unpredictable mild stress exposure. Depression-like behaviors were assessed by the open field test, forced swim test, and tail suspension test. The characteristic features of allergic asthma, including airway hyperreactivity, histopathology, inflammatory cytokine levels in bronchoalveolar lavage fluid, and immunoglobulin E and corticosterone levels in serum, were examined. Following splenocyte isolation in vitro, the inhibitory effects of corticosterone on the proliferation and cytokine secretion of splenocytes, glucocorticoid receptor DNA-binding activity, and expression of p-glucocorticoid receptor s226, glucocorticoid receptor α, and p-p38 mitogen-activated protein kinase in splenocytes were determined. We found that icariin had limited effects on depression-like behaviors, however, it markedly suppressed airway hyperresponsiveness, inflammatory infiltration in lung tissues, levels of interleukin-4, interleukin-5, and interleukin-6 in bronchoalveolar lavage fluid, and immunoglobulin E in serum. Furthermore, icariin improved the inhibitory effects of corticosterone on lipopolysaccharide-stimulated splenocytes, increased the glucocorticoid receptor expression and glucocorticoid receptor DNA-binding activity, and inhibited the phosphorylation of glucocorticoid receptors S226 and p38 mitogen-activated protein kinase. Taken together, icariin improved glucocorticoid resistance in a murine model of asthma with depression associated with enhancement of glucocorticoid receptor function and glucocorticoid receptor expression, and its effects on the glucocorticoid receptor function were related to decreased phosphorylation of glucocorticoid receptors S226 and p38 mitogen-activated protein kinase.

Blood exosome PD-L1 is associated with PD-L1 expression measured by immunohistochemistry, and lymph node metastasis in lung cancer.

BACKGROUND: Previous observations illustrated that programmed cell death ligand 1 in exosomes (Exo-PD-L1) may lead to immunosuppression. This study proposed to investigate the significance of Exo-PD-L1 and the results of PD-L1 immunohistochemistry (IHC) assay in the clinical diagnosis and treatment of lung cancer. METHODS: 29 lung cancer patients were enrolled. Exosomes were extracted from the blood of patients and purified, and the extracts were identified by Western blot and transmission electron microscope. Next, the levels of Exo-PD-L1 and PD-L1 in tumor tissue were evaluated by enzyme-linked immunosorbent assay (ELISA) and IHC, respectively. The correlation between Exo-PD-L1, IHC PD-L1 status and pathological features of patients was analyzed by applying Chi-square test. After immune checkpoint inhibitor (ICI) treatment, the objective response rate (ORR) was calculated, and drug response prediction in lung cancer patients by using Exo-PD-L1 alone, IHC PD-L1 alone, and their combined detection were analyzed. RESULTS: This study confirmed that lung cancer patients had much expression of PD-L1 in blood exosomes and that Exo-PD-L1 level was associated with IHC PD-L1 status. The expression level of Exo-PD-L1 was evidently related to the positive lymph node metastasis of lung cancer patients, while IHC PD-L1 status was not correlated with clinicopathological features of patients. Moreover, Exo-PD-L1 and IHC PD-L1 alone or their combined detection could be utilized to predict the efficacy of ICI therapy in lung cancer patients. CONCLUSION: The correlation between Exo-PD-L1 and IHC PD-L1 status was indicated, and Exo-PD-L1 could assist in determining the suitable lung cancer patients suitable for ICI therapy using IHC PD-L1. This study provides references for the application of Exo-PD-L1 as an effective predictor of ICI therapy.

Cost-Effectiveness of Posaconazole vs. First-Generation Triazoles for the Prevention of Invasive Fungal Infections Among High-Risk Patients With Hematological Malignancies in China.

Background: Posaconazole is confirmed to be more effective for preventing invasive fungal infections (IFIs) than first-generation triazoles (fluconazole and itraconazole), but its economic value has not been comprehensively evaluated in China. This study compared the cost-effectiveness of these two antifungal prophylaxis regimens in hematological-malignancy patients at high risk for IFIs from the Chinese healthcare perspective. Methods: A hybrid decision tree and Markov model were built using published data to estimate the total costs and quality-adjusted life-years (QALYs) of antifungal prophylaxis with posaconazole oral suspension and first-generation triazoles. Regimens with an incremental cost-effectiveness ratio (ICER) lower than the threshold of willingness to pay (WTP) were considered cost-effective. One-way and probabilistic sensitivity analyses were performed to assess model robustness. The regional imbalance of economic development and the tablet formulation of posaconazole were considered in the scenario analyses. Results: In the base-case analysis, posaconazole oral suspension provided an additional 0.109 QALYs at an incremental cost of $954.7, yielding an ICER of $8,784.4/QALY, below the national WTP threshold of $31,315/QALY. One-way and probabilistic sensitivity analyses showed that the results were robust. Scenario analyses showed that the base-case ICER was consistently below the WTP thresholds of all 31 Chinese provinces, with the likelihood of posaconazole being cost-effectiveness ranging from 78.1 to 99.0%. When the posaconazole oral suspension was replaced by the tablet formulation, the ICER increased to $29,214.1/QALY, still below the national WTP threshold and WTP thresholds of 12 provinces. Conclusions: Posaconazole oral suspension is a highly cost-effective regimen for preventing IFI in high-risk hematological-malignancy patients from the Chinese healthcare perspective. Posaconazole tablets may also be considered in some high-income regions of China.

Effect of renal function on the risk of thrombocytopaenia in patients receiving linezolid therapy: A systematic review and meta-analysis.

AIMS: The association of renal function and linezolid-induced thrombocytopaenia (LIT) remains controversial. We performed a meta-analysis to determine whether impaired renal function is associated with an increased LIT risk. METHODS: We conducted a systematic search of PubMed, EMBASE and the Cochrane Library from inception to February 2021 for eligible studies evaluating the relationship between renal function and LIT. Indicators of renal function included renal impairment (RI), severe RI, haemodialysis status, creatinine clearance rate (Ccr) and estimated glomerular filtration rate (eGFR). Unadjusted and adjusted estimates and 95% confidence intervals (CIs) were calculated separately using a random-effect model. RESULTS: A total of 24 studies with 3580 patients were included in the meta-analysis. RI patients had an increased LIT risk compared to non-RI patients in both the unadjusted (OR 3.54; 95% CI 2.27, 5.54; I2 = 77.7%) and adjusted analyses (OR 2.51; 95% CI 1.82, 3.45; I2 = 17.9%). This association persisted in the subset of studies involving only patients receiving a fixed conventional dose (600 mg every 12 h) and other subgroup analyses by ethnicity, sample size and study quality. Moreover, the LIT risk was significantly higher in patients with severe RI and haemodialysis than in patients without severe RI and haemodialysis. The eGFR and Ccr were significantly lower in LIT patients than in non-LIT patients. CONCLUSIONS: Impaired renal function is associated with an increased risk of LIT. A reduced linezolid dose may be considered in RI patients at a low risk of treatment failure, ideally guided by therapeutic drug monitoring.

Coinfection by Talaromyces marneffei and Mycobacterium abscessus in a human immunodeficiency virus-negative patient with anti-interferon-γ autoantibody: a case report.

Patients with anti-interferon (IFN)-γ autoantibodies have weakened immune defenses against intracellular pathogens. Because of its low incidence and non-specific symptoms, diagnosis of anti-IFN-γ autoantibody syndrome is difficult to establish during the early stages of infection. Here, we report a patient with high titers of serum anti-IFN-γ autoantibodies suffering from opportunistic infections. The patient presented with intermittent fever for 2 weeks. During his first hospitalization, he was diagnosed with Talaromyces marneffei pulmonary infection and successfully treated with antifungal therapy. However, multiple cervical lymph nodes subsequently became progressively enlarged. Mycobacterium abscessus infection was confirmed by positive cervical lymph node tissue cultures. High-titer serum anti-IFN-γ antibodies were also detected. Following anti-M. abscessus therapy, both his symptoms and lymph node lymphadenitis gradually improved. Anti-IFN-γ autoantibody syndrome should be considered in adult patients with severe opportunistic coinfections in the absence of other known risk factors.

Effect of the vancomycin minimum inhibitory concentration on clinical outcomes in patients with methicillin-susceptible Staphylococcus aureus bacteraemia: a systematic review and meta-analysis.

OBJECTIVE: The use of the vancomycin minimum inhibitory concentration (MIC) as a prognostic predictor in patients with methicillin-susceptible Staphylococcus aureus (MSSA) has been debated in the last decade. We performed a systematic review and meta-analysis to investigate whether an elevated vancomycin MIC is associated with a worse prognosis for patients with MSSA bacteraemia. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, Embase and the Cochrane Library were searched from inception to December 2019. ELIGIBILITY CRITERIA: Randomised controlled trials or observational studies were considered eligible if they provided clinical outcomes of patients with MSSA bacteraemia, stratified by vancomycin MIC. DATA SYNTHESIS: Primary outcome was mortality. Secondary outcomes included septic thrombophlebitis, persistent bacteraemia and complicated bacteraemia. Pooled ORs and 95% CIs were calculated. Subgroup analyses included the susceptibility testing method. RESULTS: Fifteen observational studies were included. Bacteraemia due to MSSA isolates with high vancomycin MICs was associated with higher mortality than isolates with low MICs (OR 1.44; 95% CI 1.12 to 1.84; I2=40.3%). Additionally, significantly greater septic thrombophlebitis (OR 3.16; 95% CI 1.11 to 9.00; I2=58.6%) and a trend towards more persistent bacteraemia (OR 1.79; 95% CI 0.97 to 3.31; I2=0%) were observed in patients with high vancomycin MICs than in patients with low MICs. Differences in complicated bacteraemia were not significant. Similar findings were obtained in subgroup analyses using Etest. However, significant differences in outcomes were not observed between the high and low vancomycin MICs detected using broth microdilution. CONCLUSION: The available data suggest an association between elevated vancomycin MICs detected using Etest and adverse clinical outcomes for patients with MSSA bacteraemia. Future studies should validate these findings and explore the potential mechanisms. PROSPERO REGISTRATION NUMBER: CRD42018090547.

Rapid and precise diagnosis of T. marneffei pulmonary infection in a HIV-negative patient with autosomal-dominant STAT3 mutation: a case report.

BACKGROUND: Talaromyces marneffei, also named Penicillium marneffei, is an opportunistic pathogen that can cause systemic or limited infection in human beings. This infection is especially common in human immunodeficiency virus (HIV)-infected hosts; however, it has also been recently reported in HIV-negative hosts. Here, we report a very rarely seen case of T. marneffei pulmonary infection in a non-HIV-infected patient with signal transducer and activator of transcription 3 (STAT3) mutation. CASE PRESENTATION: A 34-year-old woman was admitted to our hospital for uncontrollable nonproductive cough and dyspnea with exercise. She had been immunocompromised since infancy. Computerized tomography scan showed multiple ground glass opacities with multiple bullae in both lungs. Next generation sequencing (NGS) of the bronchoalveolar lavage fluid identified T. marneffei nucleotide sequences. Culture of bronchoscopy specimens further verified the results. The patient was HIV negative, and blood gene detection indicated STAT3 mutation. To date, following the application of itraconazole, the patient has recovered satisfactorily. CONCLUSION: In clinical practice, T. marneffei infection among HIV-negative individuals is relatively rare, and we found that patients who are congenitally immunocompromised due to STAT3 mutation may be potential hosts. Early diagnosis and timely treatment are expected to improve the prognosis of T. marneffei infection. NGS is a powerful technique that may play an important role in this progress. The reviews of this paper are available via the supplemental material section.

Effects of Pre-Hospital Antiplatelet Therapy on the Incidence of ARDS.

BACKGROUND: Clinical observations on the potential of pre-hospital antiplatelet therapy in preventing ARDS have been inconsistent. To further the correlation between antiplatelet therapy and ARDS, we conducted a meta-analysis to evaluate the effects of pre-hospital antiplatelet therapy on subjects with ARDS. METHODS: A literature search in major data banks was performed. We included prospective and retrospective cohorts, case-control trials, and randomized controlled trials that compared the ARDS incidence in subjects with or without pre-hospital antiplatelet agents. RESULTS: Meta-analysis of 7 studies (a total of 30,291 subjects) showed significantly lower odds of ARDS in the pre-hospital antiplatelet therapy group compared with subjects with no pre-hospital antiplatelet therapy (odds ratio 0.68, 95% CI 0.56-0.83; P < .001). However, ARDS mortalities in the hospital and ICUs were not affected. CONCLUSIONS: These findings indicated that pre-hospital antiplatelet therapy was associated with a reduced rate of ARDS but had no effect on the mortality in the subjects at high risk.

Efficacy and safety of daptomycin versus linezolid treatment in patients with vancomycin-resistant enterococcal bacteraemia: An updated systematic review and meta-analysis.

OBJECTIVES: A systematic review and meta-analysis were conducted to re-assess the efficacy and safety of daptomycin compared with linezolid treatment for vancomycin-resistant enterococcal (VRE) bacteraemia and to explore whether high-dose daptomycin is beneficial. METHODS: PubMed, EMBASE, the Cochrane Library, and meeting abstracts were searched from inception to February 2019. Studies evaluating daptomycin and linezolid treatment for VRE bacteraemia were included. RESULTS: Twenty-two observational studies were identified. A non-significant higher mortality (OR 1.27; 95% CI 0.99-1.63) and significantly lower risk of thrombocytopenia (OR 0.78; 95% CI 0.61-0.99) were found with daptomycin compared with linezolid treatment. Clinical response (OR 0.88; 95% CI 0.59-1.33), microbiological cure (OR 0.82; 95% CI 0.53-1.28), recurrence of bacteraemia (OR 0.96; 95% CI 0.70-1.32), and risk of creatine kinase elevation (OR 0.82; 95% CI 0.46-1.47) were similar for the two agents. In the subgroup analysis of studies focusing on high-dose daptomycin treatment, similar mortality was observed (OR 0.92; 95% CI 0.46-1.84). Moreover, patients receiving daptomycin tended to show a higher clinical response (OR 1.61; 95% CI 0.37-7.09) and microbiological cure (OR 2.09; 95% CI 0.43-10.1) and a lower risk of bacteraemia relapse (OR 0.47; 95% CI 0.15-1.45), although the difference was not significant. CONCLUSIONS: Compared with linezolid treatment, daptomycin treatment showed comparable clinical and microbiological outcomes but a lower incidence of thrombocytopenia. Because of the dose-dependent effect that was observed, high-dose daptomycin should be considered for patients with VRE bacteraemia.

Modified Si-Jun-Zi-Tang Attenuates Airway Inflammation in a Murine Model of Chronic Asthma by Inhibiting Teff Cells via the mTORC1 Pathway.

Background: Modified Si-Jun-Zi-Tang (MSJZT), a multi-herb formulation, is frequently used in traditional Chinese medicine for patients during the remission stage of asthma. However, the pharmacological basis underlying the effects of MSJZT on asthma has yet to be elucidated. This study aims at evaluating the anti-asthmatic effects of MSJZT and investigating its possible mechanism. Methods: A chronic murine model of asthma was established by sensitization and repeated challenge with ovalbumin (OVA) in female BALB/c mice, followed with oral administration of MSJZT during remission, and then mouse were re-challenged by OVA. The chemical profile of MSJZT was analyzed by high-performance liquid chromatography. The characteristic features of allergic asthma, including airway hyperreactivity, histopathology, cytokine levels (IL-4, -5, -13, -17, and INF-γ), T regulatory (Treg) lymphocytes (Foxp3+CD4+CD25+), and T effector (Teff) lymphocytes (Foxp3-CD25+CD4+) in bronchoalveolar lavage fluid (BALF), and downstream proteins of mTORC1/2 signaling pathway were examined. Results: MSJZT markedly suppressed airway hyper-responsiveness to aerosolized methacholine, and reduced levels of IL-4, IL-5, and IL-13 in the BALF. Histological studies showed that MSJZT significantly reduced inflammatory infiltration in lung tissues. The percentage and absolute number of Teff cells were suppressed to a remarkable level by MSJZT without affecting Treg cells. Furthermore, MSJZT effectively inhibited the mTORC1 activity, but exerted limited effects on mTORC2, as assessed by the phosphorylation of the mTORC1 and mTORC2 substrates, S6 ribosomal protein, p70 S6 kinase, mTOR S2481, and Akt, respectively. Conclusion: MSJZT attenuated chronic airway inflammation in a mouse model of asthma by inhibiting Teff cells, which occurred, at least in part, via modulation of the mTORC1 signaling pathway.

Activation of SIRT1 ameliorates LPS-induced lung injury in mice via decreasing endothelial tight junction permeability.

The integrity of the endothelial barrier is a determinant of the prognosis of lipopolysaccharide (LPS)-induced acute lung injury (ALI). In this study, we investigated whether and how Sirtuin 1 (SIRT1) maintained the vascular integrity during ALI. An experimental model of ALI was established in mice through intratracheal administration of LPS (10 mg/kg). LPS stimulation significantly increased the pulmonary permeability and decreased the expression of SIRT1 and tight junction proteins (TJs), including occludin, claudin-5, tight junction protein 1 and tight junction protein 2. Morphological studies showed that LPS induced obvious lung injury with inflammatory cell infiltration in the interstitial and alveolar space, hemorrhage, edema, and the thickened alveolar wall compared to the control mice. Intratracheal administration of the selective SIRT1 activator SRT1720 (6.25 mg/kg) significantly attenuated LPS-induced lung injury, lung hyper-permeability and increased TJs expression, whereas intratracheal administration of the selective SIRT1 inhibitor EX527 (6.25 mg/kg) aggravated LPS-induced ALI. Similar protective effects of SIRT1 on pulmonary cellular permeability were observed in primary human pulmonary microvascular endothelial cells treated with LPS (2 mg/mL) in vitro. We further demonstrated that the RhoA/ROCK signaling pathway was activated in SIRT1 regulation of tight junction permeability. The RhoA/ROCK inhibitor Y-27632 (10 µM) increased the expression of TJs and reversed LPS- or EX527-induced hyper-permeability. In conclusion, SIRT1 ameliorates LPS-induced lung injury via decreasing endothelial tight junction permeability, possibly via RhoA/ROCK signaling pathway. This finding may contribute to the development of new therapeutic approaches for lung injury.

Endobronchial ultrasound plus fluoroscopy-guided biopsy compared to fluoroscopy-guided transbronchial biopsy for obtaining samples of peripheral pulmonary lesions: A systematic review and meta-analysis.

BACKGROUND: We report a meta-analysis of recent studies comparing the diagnostic yields of endobronchial ultrasonography plus fluoroscopically-guided transbronchial biopsy (EBUS + TBB) with that of conventional fluoroscopically-guided TBB for peripheral pulmonary lesions (PPLs). METHODS: We searched Medline, the Cochrane Library, PubMed, and Google Scholar through 31 March 2013 using the keywords: lung neoplasm, pulmonary lesions, diagnosis, endobronchial ultrasound, fluoroscopy, and fluoroscopic. RESULTS: Four studies were included in the study with a total of 461 patients, 222 in the EBUS + TBB group and 239 in the TBB only group. The meta-analysis revealed that the group with EBUS + TBB was more favored in terms of positive diagnostic yield than the group diagnosed with only conventional TBB (odds ratio [OR] = 2.211, 95% confidence interval [CI] = 1.422-3.438, P < 0.001). Subgroup analysis based on lesion size found that smaller PPLs had higher accuracy (OR = 4.502, 95% CI = 2.002-10.126, P < 0.001) than PPLs of large size (OR = 1.849, 95% CI = 1.033-3.311, P = 0.039). CONCLUSION: Obtaining TBB samples for histopathological diagnosis is enhanced by the addition of EBUS to conventional fluoroscopic guidance; this is, especially important for patients with small peripheral lung lesions who benefit greatly from early diagnosis.

Risk Characteristics of Venous Thromboembolism in Chinese Patients.

BACKGROUND AND OBJECTIVE: There is little report concerning risk characteristics of Chinese patients with venous thromboembolism (VTE). The present study was designed to investigate the risk characteristics in Chinese patients with VTE through a retrospective study. METHODS: A total of 1048 registry patients with VTE in the recent 10 years were analyzed retrospectively with respect to underlying diseases or predisposing factors. RESULTS: The incidence of VTE in both male and female has been increasing in the recent 10 years. A total of 885 patients were aged more than 50 years, and the mean age of the patients at diagnosis was 58.8 ± 15.7 years. Main risk factors were a prolonged immobilization and malignant tumors, which were different from Western patients. CONCLUSIONS: This registry demonstrated the different risk characteristics in Chinese patients compared to Western patients. Our results will be available for establishing the prevention of VTE in China.

Three cases of avian-origin influenza A (H7N9) virus infection in Zhejiang Province, China: case report and literature review.

This report provides information on the clinical characteristics and treatment of three patients with avian influenza A (H7N9) virus treated in Zhejiang Province, China. The infection was characterized by respiratory symptoms, fever, rapid progression, and significant hypoxemia. Laboratory tests showed a low level or decrease in leukocytes. It is recommended that neuraminidase inhibitors be administered at early stage of the disease.

Effects of electroacupuncture at Zusanli (ST36) on inflammatory cytokines in a rat model of smoke-induced chronic obstructive pulmonary disease.

OBJECTIVE: Improvement in lung function was reported after acupuncture treatment of chronic obstructive pulmonary disease (COPD), but little is known about the underlying mechanisms. Because an immune response imbalance could be seen in COPD, we hypothesize that electroacupuncture (EA) may play a role in regulating inflammatory cytokines and contribute to lung protection in a rat model of smoke-induced COPD. METHODS: A COPD model using male Sprague-Dawley rats exposed to cigarette smoke was established. The rats were randomly divided into four groups (control, sham, COPD, and COPD plus EA), and COPD model was evaluated by measuring pulmonary pathological changes and lung function. EA was applied to the acupuncture point Zusanli (ST36) for 30 min/d for 14 d in sham and COPD rats. Bronchoalveolar lavage fluid (BALF) was used to measure levels of tumor necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß), and malonaldehyde (MDA). RESULTS: Compared with the control rats, COPD rats had significant changes in lung resistance (RL) and lung compliance (CL) (both P<0.01), bronchi and bronchiole airway obstruction (P<0.01), and levels of MDA, TNF-α, and IL-1ß (P<0.01). There were no significant differences between the control and the sham groups. Compared with the COPD rats, the COPD plus EA rats had decreased RL and increased CL (both P<0.05), and reduced bronchi and bronchiole airway obstruction (P<0.05, P<0.01, respectively), while levels of TNF-α, IL-1ß, and MDA in BALF were lowered (P<0.05 and P<0.01, respectively). However, TNF-α and IL-1ß levels of the EA group rats remained higher than those of the control group (P<0.05). CONCLUSION: EA at ST36 can reduce lung injury in a COPD rat model, and beneficial effects may be related to down-regulation of inflammatory cytokines. The anti-inflammatory and antioxidant effects may prolong the clinical benefit of EA.

Novel role for cystic fibrosis transmembrane conductance regulator in alveolar fluid clearance in lipopolysaccharide-induced acute lung injury in mice.

BACKGROUND AND OBJECTIVE: Alveolar fluid clearance (AFC) is important for the resolution of acute lung injury (ALI). The role of cystic fibrosis transmembrane conductance regulator (CFTR) in AFC has not been entirely elucidated in animal models of ALI. The aim of this study was to investigate the role of CFTR and its mechanisms in AFC in normal and ALI mice. METHODS: Seventy mice were randomly divided into 14 groups and ALI was established by intratracheal instillation of lipopolysaccharide (LPS). After 48 h, CFTR activator CFTRact-16 or inhibitor CFinh-172 with or without ß-agonist was instillated intratracheally and AFC was measured with radioisotopic tracer. RESULTS: Although there was no effects of CFTRact-16 on AFC in mice with or without isoproterenol, CFinh-172 markedly decreased isoproterenol-stimulated AFC in both normal (P < 0.01) and LPS-induced ALI mice (P < 0.01) and there was significantly decreased basal AFC in ALI mice (P < 0.05). CONCLUSIONS: These results provide direct functional evidence for CFTR in cAMP-mediated AFC in both normal and ALI mice.

Acid sensing ion channel 1 in lateral hypothalamus contributes to breathing control.

Acid-sensing ion channels (ASICs) are present in neurons and may contribute to chemoreception. Among six subunits of ASICs, ASIC1 is mainly expressed in the central nervous system. Recently, multiple sites in the brain including the lateral hypothalamus (LH) have been found to be sensitive to extracellular acidification. Since LH contains orexin neurons and innervates the medulla respiratory center, we hypothesize that ASIC1 is expressed on the orexin neuron and contributes to acid-induced increase in respiratory drive. To test this hypothesis, we used double immunofluorescence to determine whether ASIC1 is expressed on orexin neurons in the LH, and assessed integrated phrenic nerve discharge (iPND) in intact rats in response to acidification of the LH. We found that ASIC1 was co-localized with orexinA in the LH. Microinjection of acidified artificial cerebrospinal fluid increased the amplitude of iPND by 70% (pH 7.4 v.s. pH 6.5:1.05±0.12 v.s. 1.70±0.10, n = 6, P<0.001) and increased the respiratory drive (peak amplitude of iPND/inspiratory time, PA/Ti) by 40% (1.10±0.23 v.s. 1.50±0.38, P<0.05). This stimulatory effect was abolished by blocking ASIC1 with a nonselective inhibitor (amiloride 10 mM), a selective inhibitor (PcTX1, 10 nM) or by damaging orexin neurons in the LH. Current results support our hypothesis that the orexin neuron in the LH can exert an excitation on respiration via ASIC1 during local acidosis. Since central acidification is involved in breathing dysfunction in a variety of pulmonary diseases, understanding its underlying mechanism may improve patient management.

Real-time monitoring of blood carbon dioxide tension by fluorosensor.

A new intravascular fluorosensor was developed and validated for inline P(CO)2monitoring. The P(CO)2sensor was based on the fluorescent indicator 1-hydroxypyrene-3,6,8-trisulfonate. The P(CO)2sensor was then immersed in various solutions in vitro and carotid artery bypass of rabbits in vivo for testing. Changes of P(CO)2in solutions and blood were created by bubbling CO2/N2 and hyperventilation/hypoventilation, respectively. The changes of fluorescent intensity over P(CO)2 range of 14-150 mmHg was linear. The resolution of the whole sensor system was 1 mmHg, with a bias ± SD of -0.1 ± 2.9 mmHg and precision ± SD of 2.1 ± 1.9 mmHg. The sensor signal has been stable during measurement for at least 25h and was insensitive to fluctuations of ions concentration and osmosis at pathophysiological limits. The performance of the sensor is in agreement with blood gas analyzer in a wide range of P(CO)2and it is qualified for continuous intravascular measurement of blood P(CO)2at various conditions.