10 Respiratory System

10 Respiratory System

2015075 A study on the cooperation between centers for disease control and special tuberculosis hospitals for treatment and management ofmulti-drug resistant tuberculosis.LI Renzhong（李仁忠），et al. Dept Drug-resistant Tuberc，Nat Tuber Contr&Prev Center.Beijing 102206.Chin J Tuberc Respir Dis 2014；37（10）：753-757.

ObjectiveTo improve the effectiveness of case detection and treatment ofmulti-drug resistant tuberculosis（MDR-TB）by implementing amechanism of cooperation between hospitals and centers for disease control（CDC）.MethodsSince 1 March 2010，a new mechanism of cooperation between hospitals and CDCs had been established in 5 cities including Daqing，Quzhou，Puyang，Tianjin and Wanzhou in China.Data of MDR-TB casedetection，treatmentand economic burdens before the intervention（January 1，2006-June 30，2009）and after the intervention（March 1，2010-February 29，2012）were collected.Then all data were analyzed by statistical method.ResultsAfter the intervention，samples from 68.4%（5 287/7 733）of smear-positive TB patients in the studied regions underwent TB drug-resistant testing，and the number of the detected MDR-TB caseswere 9.8times than that prior to the intervention.93.1%（108/ 116）of the patients incorporated into the treatment of MDR-TB received the standardized initial chemotherapy program，and the number was 7 times than that before the intervention.The referral rates after hospital discharge raised from 0%before the intervention to 92.8% after（90/97）the intervention；and 85.7%（83/97）of the patients received treatment and management by CDC.When the 6-month injection ended，MDR-TB patients still under treatment after the intervention were 84.5%（82/97），and those whose sputum culture became negative were 56.7%（55/97）.The proportion of patientswith self-paid and with catastrophic expenditures after the intervention were reduced to 18.0%（1 678/ 9 324）and 44.7%（17/38）respectively，as compared to 75.4%（7 659/10 158）and 76.7%（23/30）respectively before the intervention.ConclusionTo establish a well-performed Hospital-CDC cooperation mechanism could promote the performance of MDR-TB case detection and treatment.

（Authors）

2015076 Bronchial glom us tumor：report of 2 cases and review of the literature.ZHANG Xinjun（張新軍），et al.Dept Respir&Critical Care Med，Beijing Respir Med Instit，Beijing Chaoyang Hosp，Capital Med Univ，Beijing 100020.Chin JTuberc Respir Dis 2014；37（10）：756-763.

ObjectiveGlomus tumor is small，predominantly benign tumor，and typically occurs in the soft tissues，rarely in bronchus.The aim of this study was to discuss the clinical manifestation，histology，diagnosis and differential diagnosis of bronchial glomus tumor.MethodsWe studied the histopathological and immunohistochemical results of 2 cases with bronchial glomus tumor.One case was diagnosed by bronchoscopic biopsy，and another by surgery.We searched Wanfang，VIP，CNKI and PubMed database for related articles with key word“bronchial glomus tumor”both in English and in Chinese for literature review.ResultsFiberoptic bronchoscopy demonstrated a bronchial neoplasm in both cases.For Case one，the tumor was pink under fluorescence bronchoscopy，and was histologically composed of groups of nuclear-irregular round cells in interstices，with pale staining plasma and unclear boundary.Immunohistochemically，cytokeratin（CK）was negative，while vimentin and CD34vascular endothelial cell were positive，smoothmuscle actin（SMA）weakly positive，and Synaptophysin partially positive in tumor cells.These results led to the diagnosis of bronchial glomus tumor of right upper lobe bronchus.The tumor of Case two was histologically from the rightmain bronchusmesechyma，and it invaded into submucosa，but not involving the tracheal cartilage.Histological examination showed groups of mdium sized tumor cells with round nuclei，and abundance of interstitialvasculature.No cellular atypia ormitoseswere observed.Immunohistochemical staining demonstrated positive reactivity for vimentin，SMA and CD99.Pathological diagnosis was right main bronchus glomus tumor（malignant potential indeterminacy）.We identified 16 studies from databases，ofwhich 15 studies including 15 cases（12 males，3 females）were applicable.Age of onset ranged from 20 to 79 years.The lesion was in the leftmain bronchus in 8 cases，the rightmain broncus in 2，the rightmiddle lobe bronchus in 3，and the right upper lobe bronchus in 2 cases.The tumor size ranged from 0.7 to 6.5 cm.Cough，dyspnea with or without fever were observed in 7 patients.Seven cases had blood in phlegm，and 4 patients showed pulmonary atelectasis.All cases showed negative CK staining and positive SMA staining.ConclusionBronchial glomus tumor usually lacks clinical manifestations，and is often misdiagnosed as bronchial asthma.It can be classified as solid glomus tumor，ball hemangioma，ball vascular leiomyoma by histopathology.Glomus tumors showed positive immunohistochemical stainings for vimentin and smoothmuscle actin（SMA），and are usually negative for cytokeratin（CK）and epithelial mrkers.Clinical differential diagnoses such as sclerosing hemangioma，hemangiopericytoma，carcinoid tumor and epithelial tumor should be considered.

（Authors）

2015077 Pulmonary cryptococcosis：a retrospective analysis of 65 cases.WANG Lifang（王麗芳），et al. Dept Respir&Critical Care Med，Jinling Hosp，Nanjing Univ Med Sch，Nanjing 210002.Chin J Tuberc Respir Dis 2014；37（10）：764-768.

ObjectiveTo improve understanding of the clinical manifestations and imaging features of pulmonary cryptococcosis.M ethodsThe clinical features，imaging characteristics，laboratory examinations，treatment and prognosis of 65 cases of pulmonary cryptococcosiswere retrospectively analyzed.The data were collected from Nanjing General Hospital，Suqian Municipal People's Hospital and People's Liberation Army 81 Hospital from January 2001 to March 2013.ResultsThere were 65 proven cases diagnosed with pulmonary cryptococcosis，including 44 males and 21 females，aged from 12 to 73 years［average（44±13）years］.The most common clinical symptoms included cough（n=32），expectoration（n= 20），fever（n=16），and chest pain（n=14），while some patients（n=18）had no symptoms.Common chest imaging findings included single or multiple masses or nodules（n=36），patchy infiltrates（n=19），and mixed lesions（n=10）.Among the 21 cases with cryptococcal capsular polysaccharide antigen detection，14 were positive.The antigen titre（≥1∶8 for positivity）was positively correlated with disease severity and lesion extent.The diagnosis of 45 cases was proven by percutaneous lung biopsy and 3 were diagnosed by bronchoscopic biopsy，while 17 were confirmed by surgery.Among 65 patients，53 underwent Acute Physiology and Chronic Health EvaluationⅡ（APACHEⅡ）scoring，and 45 had a score of less than 10.Among them，38 cases acquired complete or partial recovery，4 were progressive and 3 died.Eight cases had a score of 10 ormore，ofwhom 3 acquired complete or partial recovery，1 was progressive and 4 died.ConclusionThemost common clinicalmanifestations of pulmonary cryptococcosis were cough and expectoration and the most common chest imaging features weremasses or nodular shadows.Percutaneous lung biopsy was a commonly usedmethod to diagnose this disease.Cryptococcal capsular polysaccharide antigen detection was helpful for the diagnosis and management with a relatively high sensitivity.Antifungal drug therapy was themajor treatmentand a few patientsmay need surgery.The prognosiswas better in patients with mild disease.

（Authors）

2015078 Clinical investigation of detecting the bron-chi responsible for pulmonary air leakage by injecting m ethylene b lue saline in 27 casesw ith intractab le pneum othorax and bronchial fistula.JIN Pule（金普樂），etal.Pulmon Dept，4th Hosp，Hebei Med Univ，Shijiazhuang 050011.Chin JTuberc Respir Dis2014；37（11）：831-834.

Ob jectiveTo establish a new method for detecting the bronchus responsible for pulmonary air leakage by injectingmethylene blue saline and to evaluate its efficacy and safety in cases with intractable pneumothorax and bronchial fistula.M ethodsFrom January 2006 to October 2013，a total of 19 cases of intractable spontaneous pneumothorax and 8 cases of bronchial fistula were recruited in the study at the Fourth Hospital affiliated to Hebei Medical University.Of all the cases，15 were diagnosed as having tension pneumothorax and 12 as having communicating pneumothorax.All the cases failed to respond to continuous pleural suction for more than 5 days and consented to the proposed treatment.Before procedure，chest suction was established to allow sustained airflow through the drainage tube while the patients breathed normally.Under direct vision through fiberoptic bronchoscope，injection catheter was inserted into the bronchoscopy channel，and methylene blue saline was slowly injected into the potentially leaking segmental or sub-segmental bronchi.When a steady decline or disappearance in the amount ofmethylene blue saline in the airways was observed，or methylthionine-tainted saline was detected within the chest drainage tube，the bronchus responsible for air leakage was indicated.Before blocking the target bronchus，the negative pressure level of pleural suction should be reduced or stopped，and then porcine fibrin glue or acyanoacrylate was used for sealing the bronchiassociated with air leakage.When the air was absent from the drainage tube，and lung recruitmentwas indicated in the chest X-ray for 5 days，and bronchial blockade of air leakage was proven successful.Resu ltsThe bronchi responsible for air leakage were successfully located in all 27 cases，among them segmental bronchi were located in 16，subsegmental bronchi in 10，and small subsegmental bronchus in only one.Multiple adjacent segmental involvement occurred in 3，and multiple adjacent subsegmental involvement in 5 cases.The average time for locating the targetbronchiwas（51±9）s，among them the average time for tension pneumothorax was（48±15）s compared with（53±16）s for communicating pneumothorax（t=0.416，P=0.699）. The average amount ofmethylene blue saline consumed for locating the targetbronchiwas（42±23）m l.During the procedure，themembrane of the bronchiwas kept intact，and the vital signswere stable.Blockade of the target bronchi was successful with fibrin glue in 20 cases and with OB glue in 7 cases.A total of61 times of bronchial blocking were performed，and the airflow of the chest drainage tube was instantly stopped in 17 times，gradually stopped in 10，steadily reduced in 22 and no change in 12 times.Adverse effects included severe cough in 4 cases，fever in 3，pleural hemorrhage in 3，and chest pain，atelectasis，and pneumonia in 2 cases，respectively.ConclusionThe bronchi responsible for pulmonary air leakage in patientswith spontaneous pneumothorax and bronchial fistula could be determined by injectingmethylene blue saline into the airways.This novelmethod does not require special instruments，and is easy to perform with safety and effectiveness.

（Authors）

2015079 Diagnostic value of serum procalcitonin in identifying the etiology of non-responding community-acquired pneumonia after initial antibiotic therapy.WANG Zheng（汪錚），et al.Dept Respir Crit Care Med，the People's Hosp Zhengzhou Univ，Zhengzhou 450003.Chin JTuberc Respir Dis 2014；37（11）：824-830.

Ob jectiveThis study was to investigate the diagnostic value of serum procalcitonin（PCT）in identifying the etiology of non-responding community-acquired pneumonia（CAP）after initial antibiotic therapy.M ethodsA retrospective analysis was performed for 232 hospitalized CAP patients admitted to the People's Hospital of Zhengzhou University during June 2013 and January 2014. Early treatment failure was defined as the presence of persistent fever（＞38℃）and/or clinical symptoms（malaise，cough，expectoration，dyspnea）or deterioration after at least 72 h of initial antimicrobial treatment，or development of respiratory failure requiringmechanical ventilation，or septic shock.Bronchoscopy or transthoracic lung biopsy was performed in case of early treatment failure when indicated.Serum level of PCTwas detected by double antibody sandwich method.The differences between 2 ormore groups were compared using 2-independent student t test，one-way ANOVA；Mann-Whitney U test，Kruskal-Wallis rank sum test，orχ2test.Risk factors and odds ratios for nonresponsiveness were analyzed by setting up a Logistic regression model. The diagnostic valuesof PCTwere determined by receiver operating characteristic curves（ROC curves）.ResultsOf the 232 CAP patients enrolled，124 were male and 108 were female，with an average age of（46±20）years.Thirty-six patients failed to respond to the initial antibiotic therapy.As shown by Logistic regression analysis，the risk factors for treatment failure included hypoalbuminemia，type 2 diabetes，previous history of splenectomy，PSI 4-5 grade，and lung infiltration≥3 lobes.The most common causes of non-responsiveness were antimicrobial insufficiency（n=23），and misdiagnosis of noninfectious mimics of pneumonia（n=11），with 2 cases ofunidentified etiology.The serum PCT level in admission was0.19（0.07-0.66）μg/L in the antimicrobial insufficiency subgroup，which was significantly higher than that in the misdiagnosis subgroup［0.06（0.05-0.08）μg/L；P＜0.01］.The antimicrobial insufficiency subgroup included 11 cases of bacterial infection（5 of G+cocciand 6 of G-bacilli）and 12 cases of nonbacterial infection；their PCT levels were 0.66（0.19 -5.80）μg/L and 0.08（0.05-0.20）μg/L，respectively（P＜0.01）.There was no statistically significant difference among PCT levels of the 4 subgroups of nonbacterial infections（4 tuberculosis，3 fungi，3 atypical pathogens，2 viruses）（F=3.025，P=0.094）.The cut-off values of PCT were＞0.13μg/L and＞0.115 μg/L for differentiating non-responsiveness originated from bacterial infection or other causes，and infection vs non-infection，which yielded a sensitivity of 100%（11/ 11）and 65%（14/23），specificity of 83%（19/23）and 91%（10/11），and AUC of 0.955 and 0.802，respectively.ConclusionAntibiotic failure to cover themicrobial pathogens，infectious complications and misdiagnosis are themost common causes of early treatment failure in patients with CAP.Serum PCT level fails to predict non-responsiveness，but is suggestive of bacterial infections in hospitalized CAP patientswith early treatmentfailure.

（Authors）

2015080 The effect ofm ild sedation on the prognosis and inflammatory markers in critical patients w ith m echanical ventilation.CAIYan（蔡燕），et al. Affil People's Hosp，Jiangsu Univ，Zhenjiang 212002. Chin JTuberc Respir Dis2014；37（11）：820-823.

ObjectiveTo compare the effect of slight and usual sedation on the prognosis and inflammatorymarker levels in patients receiving mechanical ventilation in ICU.MethodsWe enrolled 78 critically ill adult patients who were undergoingmechanical ventilation and were expected to need ventilation for more than 48 h.The patients were prospectively and randomly assigned to receive slight sedation（Richmond Agitation Sedation Score-1 to 0，n=38 patients）or usual sedation（Richmond Agitation Sedation Score-3 to-2，n=40 patients）.Sedative dosages，duration ofmechanical ventilation，length of ICU stay，complications（ventilator-associated pneumonia，tracheotomy），adverse reactions（accidental extubation，reintubation，barotrauma）and levels of inflammatorymarkers on the day of sedation time for 48 h were recorded.ResultsWhen compared with the usual sedation group，duration ofmechanical ventilation（d）（8±5 vs 13±8，P＜0.05）and length of ICU stay（d）（12± 10 vs 22±9，P＜0.05）were significantly shorter in the slight sedation group.The total doses of midazolam（mg），propofol（mg）and fentany（μg）were lower in the slight sedation group than those in the usual sedation group（275±85 vs 575±142，4 562±1 128 vs 7 434± 1 712 and 2 332±1 458 vs 4 124±2 743，P＜0.05）. Accidental extubation（5%vs3%），reintubation（5%vs 10%）and barotraumas（3%vs 8%）showed on differences between the 2 groups（P＜0.05）.In the slight sedation group，the incidences of ventilator-associated pneumonia（26%vs 53%）and tracheotomy（18%vs 48%）were significantly decreased compared with those in the usual group.The levels of IL-1（35±12 vs 47± 18，P＜0.05）ng/L，IL-6（49±21 vs 62±27，P＜0.05）ng/L，TNF-α（39±16 vs 52±25，P＜0.05）ng/L and CRP（95±41 vs 125±45，P＜0.05）mg/L were also lower in the slight sedation group than those in the conventionalgroup.Therewere no differences in ICU mortality and 28 d-survival rate between the 2 groups.ConclusionSlight sedation was shown to reduce the length ofmechanical ventilation and ICU stay.It also decreased the levels of inflammatory markers without increasing the incidence of adverse reactions.

（Authors）

2015081 Assessment of cognition and associated factors in patients with stable chronic obstructive pulm onary disease.QIAN Hongyu（錢紅玉），et al.Tianjin Chest Hosp，Tianjin 300222.Chin J Tuberc Respir Dis 2014；37（10）：769-773.

ObjectiveTo explore and analyze the cognitive function in patients with stable chronic obstructive pulmonary disease（COPD）.M ethodsThe cognition differences between patients with COPD and healthy subjects were analyzed by Montreal Cognitive Assessment（Mo-CA）.GOLD grade，PaO2，PaCO2，the education degree and the age were included as associated factors.The correlation between those factors with cognition was analyzed.ResultsThe MoCA in patients with COPD was 20.6±2.3，and that in healthy subjects was 25.3± 1.7，the difference between the 2 groups being significant（P＜0.01）.The MoCA was 22.4±0.8 in patients with GOLD gradeⅠdisease，21.7±1.0 in gradeⅡ，20.2±1.2 in gradeⅢ，and 19.1±1.20 in gradeⅣdiseases；the difference among the 4 subgroupsbeing significant（F=31.69，P＜0.05）.The MoCA in GOLD gradeⅠwas higher than that in GOLD gradeⅡ，but the difference did not reach significance（P＞0.05）.The MoCA of GOLD gradeⅢwas higher than that GOLD gradeⅣ（P＜0.05）.The MoCA in non-hypoxemia subgroup and hypoxemia subgroup was 22.2±1.1 and 19.8±1.1，respectively（P＜0.05），while the MoCA in hypercapnia subgroup and non-hypercapnia subgroup was 20.0±1.3 and 22.3±1.0 respectively（P＜0.05）.By regression analysis，the score of MoCA was correlated positively to education degree（Standard B1= 0.134，P＜0.01），GOLD grade（Standard B2=0.351，P＜0.01）and PaO2（Standard B3=0.305，P＜0.01），while the score of MoCA was correlated negatively to age（Standard B4=-0.146，P＜0.01）and PaCO2（Standard B5=-0.145，P＜0.01）.ConclusionThe MoCA score in patients with COPD was lower than that inhealthy people.Lower MoCA score was found in patients with severe COPD.The MoCA scores in both hypoxemia subgroup and hypercapnia subgroup were lower.The cognitive dysfunction in patients with stable COPD was positively correlated with education degree，GOLD grade and PaO2，but negatively with age and PaCO2.

（Authors）

2015082 Interstitial lung disease as an initial manifestation of dermatomyositis.SHEN Min（沈敏），et al. Dept Rheumatol&Clin Immunol，PUMC&CAMS，Beijing 100730.Natl Med JChin 2014；94（43）：3402-06.

ObjectiveTo explore the clinical features and prognosis of dermatomyositis patientswith interstitial lung disease（ILD）as an initialmanifestation.M ethodsMedical records of 184 dermatomyositis inpatients complicated with ILD，admitted into Peking Union Medical College Hospital from January 1999 to January 2013，were retrospectively analyzed.The clinical features，biochemical parameters，positive rates of autoantibodies，radiology，pulmonary function tests，pathology，treatments and prognosis were compared between two subgroups of ILD-initial and non-ILD-initial dermatomyositis.Resu ltsThe incidence of ILD of dermatomyositis inpatientswas17%. The average age was48±12 years and the gender ratio of male-to-female was 63∶121.Eighty eight（47.8%）dermatomyositis patients had ILD as an initialmanifestation，including（n=42，22.8%）of ILD concomitant dermatomyositis（within 1 month）and（n=46，25.0%）of ILD before dermatomyositis with an average ahead time of（11±3）months.Patients of ILD-initial dermatomyositis had a higher incidence of dyspnea on exertion，cough and lung crackles，but therewere lower incidences of heliotrope rash，chest V area rash，shawl sign and joint involvement than non-ILD-initial dermatomyositis（P＜0.05）.The positive rate of anti-Jo-1 antibodies of ILD-initial dermatomyositis group was 13.6%. The main performances of ILD-initial dermatomyositis on pulmonary function tests were diffusing and restrictive ventilation impairment.And there was a lower diffusing rate of carbonmonoxide than non-ILD-initial dermatomyositis group（P＜0.01）.Organic and non-specific interstitial pneumoniaswere themajor clinical pathology types of ILD-initial dermatomyositis.Themortality rate of ILD-initialdermatomyositis patientswas19.3%and therewas no significant difference from non-ILD-initial dermatomyositis（P＞0.05）.Themain course of ILD-initial dermatomyositis was respiratory failure due to progressive ILD（n=13，76.5%）.ConclusionILD as an initialmanifestation is a common complication and a majormortality cause of dermatomyositis inpatients.And the frequent clinical pathology types are organic and non-specific interstitial pneumonias.Symptoms of skin and muscle，creatine kinase and anti-synthetase antibodies should be closelymonitored.

（Authors）

2015083 A report of seven cases of pulm onary sequestration com p licated by aspergillosis and literature review.SUN Xuefeng（孫雪峰），etal.Dept Pulm Med，PUMC&CAMS，Beijing 100730.Chin J Intern Med 2014；53（11）：873-875.

Ob jectivePulmonary sequestration（PS）is a rare disease，and its clinical symptoms are usually related to subsequent pulmonary infections.We analyzed the clinical characteristics of PS complicated by aspergillosis，and reviewed related literature，so as to disclose the association between these two diseases.M ethodsSixtynine patientswith surgery-confirmed PS in Peking Union Medical College Hospital between January 1990 and December 2013 were retrospectively analyzed，including seven cases complicated by aspergillosis.Clinicalmanifestation，imaging and surgery of these patientswere analyzed.Literature focusing on PS complicated by aspergillosis in pubmed data base was reviewed.Resu ltsIn these seven patients，four casesweremale，and three caseswere female.Age at diagnosis ranged from 29 to 58 years old.The interval from onset to definite diagnosis ranged from two weeks to 20 years.Clinical symptoms included productive cough in seven cases，hemoptysis in three cases，chest pain in two cases，and fever in one case.All cases were intralobar PS with four in the left lower lobe and three in the right lower lobe.Consolidation in chest CT was noted in six cases.Cavitation was positive in three cases.Surgery of lung lobe resection was performed in all patients.Aberrant arteries were found during operation with the origin from aortic artery in four cases，phrenic artery in two cases，and intercostalartery in one case.Aspergillosis was diagnosed by pathology in six cases and by lung tissue culture in one case.ConclusionPS complicated by aspergillosis is extremely rare，but the trend of an increase in recent years has been noted.Strict and cautious examinations formicroorganisms and pathology will help to find relatively insidious aspergillosis.

（Authors）

2015084 Losartan m odulates T helper type 1 cells and T helper type 17 cells-m ediated responses in a mouse model of lipopolysaccharide-induced acute lung injury.LIU Jun（劉軍），et al.Dept Critical Care Med，Zhongda Hosp，Southeast Univ，Nanjing 210009. Chin J Intern Med 2014；53（10）：804-808.

ObjectiveTo assess the effectof losartan，angiotensinⅡreceptor type 1（AT1）receptor antagonist，on the pulmonary T helper（Th）cell polarization response in acute lung injury（ALI）mice.M ethodsC57BL/6 mice were randomized into control group，ALI group and ALI +losartan group，which were respectively administrated with phosphate buffed saline（PBS），2 mg/kg lipopolysaccharide（LPS）and 2 mg/kg LPS as well as15 mg/ kg losartan 30 minutes before intratracheal injection of LPS.Lung wet weight/body weight（LW/BW）was recorded to assess the severity of lung injury.The mRNA expression levels of T-box expressed in T cells（T-bet），GATA-binding protein-3（GATA-3）and retinoid-related orphan nuclear receptorγt（RORγt）were quantitatively measured by real-time polymerase chain reaction（RTPCR）.Meanwhile，interleukin 6（IL-6），interferonγ（IFNγ），IL-4 and IL-17 in lung homogenates were assessed by enzyme-linked immunosorbentassay（ELISA）.Resu lts（1）LW/BW was significantly increased in ALI group compared with ALI+losartan group.（2）Histologically，widespread interstitial thickening with edema，severe alveolar hemorrhage，and diffuse interstitial infiltration of inflammatory cells were observed in the ALI group.Whereas，losartan effectively attenuated the LPS-induced alveolar hemorrhage and leukocyte infiltration.（3）The levels of IL-6 in lung tissue were significantly enhanced in the LPS-induced ALI mice，while it markedly decreased in ALI+losartan group.（4）The mRNA expression of T-bet and ROPγt was up-regulated in ALImice at24 h and 48 h compared to control group（P＜0.05）.There was no significant difference in the expression of GATA-3.In addition，compared with ALI group，ALImice pretreated with losartan resulted in significantly reduced mRNA expression of T-betat24 h and 48 h and RORγt mRNA expression at 48 h（all P＜0.05）.（5）Meanwhile，the levels of IFNγ，IL-4，IL-17 and IL-6 in lung tissue were significantly enhanced at 24 h and 48 h in the LPS-induced ALImice.In addition，both IFNγand IL-17 in lung tissue at 24 h and 48 h decreased significantly in losartan-pretreated mice compared with the ALImice.However，the level of IL-4 in lungs was similar in ALI group and ALI+losartan group.ConclusionLosartan has a protective effect on LPS-induced ALI，which may be partly dependent on suppressions of Th1 and Th17 polarization response.

（Authors）

2015085 Antim icrobial activity of fosfom ycin combined with tigecycline againstKlebsiella pneumoniaecarbapenemase-producingKlebsiella pneumoniae.YE Rongxia（葉榮夏），et al.Dept Infect Dis，Sir Run Run Shaw Hosp，Med Coll，Zhejiang Univ，Hangzhou 310016.Chin J Infect Dis 2014；32（9）：522-527.

ObjectiveTo evaluate antimicrobial activity of fosfomycin combined with tigecycline against Klebsiella pneumoniae carbapenemase（KPC）-producing Klebsiella pneumoniae and study the mechanism of drug resistance to fosfomycin.M ethodsBroth microdilution method was used to independently determine the minimum inhibitory concentrations（MIC）of fosfomycin and tigecycline against 42 Klebsiella pneumoniae isolates（including 20 KPC-producing and 22 KPC non-producing isolates）. Checkerboard design method was applied to evaluate combined effect of different concentrations on antimicrobial susceptibility and calculate the fractional inhibitory concentration index（FICI）.FICI=MICfosfomycinjoint/ MICfosfomycin monotherapy+MICtigecycline joint/MICtigecyclinemonotherapy. Related interpretation criteria were as following：FICI≤0.5 meant synergy；0.5＜FICI≤1.0 meant additive；1＜FICI≤2 means insignificance；FICI＞2 meantantagonism.The fosfomycin resistant genes in KPC-producing Klebsiella pneumoniae isolates were screened.The data were analyzed by t test.ResultsAntimicrobial suscepti-bility testing results indicated the fosfomycin and tigecycline susceptibility rates in KPC-producing isolates were 35.0%（7/20）and 70.0%（14/20），respectively.The susceptibility rates of drug combination increased to 50.0%（10/20）and 95.0%（19/20），respectively，with both MIC decreased.MIC of tigecycline decreased significantly after combination therapy and showed a statistical significance compared with the MIC ofmonotherapy（t=-2.596，P=0.013），whereas therewas no significant differene between single and combined theapy of fosfomycin（t=-1.274，P=0.211）.FICI indicated that a total of 60.0%isolates showed synergy and additive effects between two antimicrobial agents，followed by insignificance（40.0%），but there was no antagonism effect.Among 22 KPC non-producing isolates，there were 54.5%showing insignificant effects，followed by additive（31.8%）and synergy（13.6%）effects.No antagonism effectwas found.The study also identified two isolates with fosA resistant gene which located on the same plasmid as well as the blaKPCgene.The plasmid size in the two isolateswas 138.9 kb and 104.5 kb，respectively.ConclusionKPC-producing Klebsiella pneumoniae are more susceptible to tigecycline.Combined use of two antimicrobial agentsmainly exerts synergy and additive effect rather than antagonism，which may suggest the combination therapy strategy could inhibit the activity of KPC-producing Klebsiella pneumoniae

（Authors）