Differential T cell responses against DosR-associated antigen Rv2028c in BCG-vaccinated populations with tuberculosis infection.

The IFN-γ release assays (IGRAs) based on region of difference 1 (RD1) antigens have improved diagnosis of Mycobacterium tuberculosis (Mtb) infection. However, IGRAs with these antigens could not distinguish latent tuberculosis infection (LTBI) from active tuberculosis (ATB). DosR regulon genes are thought to be important for Mtb dormancy, and their products have higher immunogenicity in LTBI than ATB individuals, suggesting protective immunity mediated by DosR regulon-encoded antigens and potential utility of them for differential diagnostics of Mtb-infected populations or development of therapeutic vaccines against tuberculosis (TB). Among them, Rv2028c is a dormancy-related antigen that has demonstrated potential use in TB control, but its immunological characteristics in the BCG-vaccinated Chinese population are unknown. In this study, a total of 148 individuals, including 98 patients with ATB, 20 cases with LTBI and 30 healthy controls, were tested for Rv2028c-specific T cell responses by using an IFN-γ ELISA assay. The results showed that the T-cell responses in LTBI individuals were almost always higher than those in ATB patients, regardless of the site of infection or the results of bacteriological examination in the patients. This allowed for good differentiation between these two groups of Mtb-infected individuals even in the BCG-vaccinated high TB-incidence setting that pertains in China. In addition, the diagnostic efficacy for ATB was enhanced by combining the results from Rv2028c and RD1 antigen-based IFN-γ ELISA assays. In conclusion, Rv2028c-specific T-cell responses might contribute to natural protection against dormant Mtb infection, and the determination of these responses can aid discrimination between healthy LTBI individuals and ATB patients in the Mtb-infected populations.

Evaluation of a New IFN-γ Release Assay for Rapid Diagnosis of Active Tuberculosis in a High-Incidence Setting.

Blood-based interferon-gamma (IFN-γ) release assays (IGRAs) have been proven to be useful in the diagnosis of Mycobacterium tuberculosis (Mtb) infection. However, IGRAs have not been recommended for clinical practice in most low-income settings due to cost-intensive limitations and shortage of clinical data available. The established T-SPOT. TB assay containing Mtb-specific antigens ESAT-6 and CFP10 are widely used for immunodiagonsis of Mtb infection, but the high cost is one of the restricting factors against its clinical application in the developing countries. More recently, a cost-saving IGRA assay, TS-SPOT, was approved in China. This new assay contains an additional antigen Rv3615c. Rv3615c contains broadly recognized CD4+ and CD8+ epitopes, and T-cell responses to Rv3615c are as specific for Mtb infection as the responses to ESAT-6 and CFP10 in both Mtb-infected humans and M. bovis-infected cattle. Therefore, we assessed the likely effect of inclusion of Rv3615c as stimulus besides ESAT-6 and CFP10 in an IGRA assay and evaluated the performance of TS-SPOT for diagnosis of Mtb infection and active TB compared with T-SPOT.TB. We tested 155 active TB patients, 90 non-TB lung disease patients, and 55 healthy individuals. The results presented an improved positive rate for diagnosis of active TB and Mtb infection, that could be attributable to inclusion of Rv3615c in the mixture of stimulatory antigens. The diagnostic efficiency of TS-SPOT assay for active TB was as follows: sensitivity 80.00%, specificity 83.45%, positive predictive value (PPV) 83.78%, negative predictive value (NPV) 83.45%, positive likelihood ratio (LR+) 4.83, and negative likelihood ratio (LR-) 0.24. The results were similar to those of T-SPOT.TB, with an excellent agreement (κ = 0.91, 95% CI: 0.85-0.95) being observed between these two assays. The sensitivities of the TS-SPOT assay varied for patients with different forms of active TB, with the highest sensitivity for patients with culture-positive pulmonary TB (92.16%) and the lowest for those with tuberculosis meningitis (50.00%). Taken together, the current evidence indicates that this new TS-SPOT assay is a useful adjunct to the current tests for rapid diagnosis of active TB and Mtb infection in low-income and high-incidence settings due to its characteristics of cost-effectiveness and high-quality.

[Effect of Modified Guipi Decoction on Blood Pressure and Quality of Life in Hypertension Patients Complicated Depression].

OBJECTIVE: To study the effect of Modified Guipi Decoction (MGD) on blood pressure and quality of life (QOL) in hypertension patients complicated depression. METHODS: Totally 245 hypertension patients complicated depression were randomly assigned to the treatment group (125 cases, treated with MGD) and the control group (120 cases, treated with Sertraline). Final recruited qualified patients were 117 cases in the treatment group and 111 cases in the control group. The therapeutic course for all was 4 weeks. Changes of blood pressure, scores rated by Hamilton Depression Scale-17 (HAMD-17), Hamilton Anxiety Rating Scale (HAMA), short-form 36 health survey questionnaire (SF-36), and Treatment Emergent Symptom Scale (TESS) were observed before and after treatment, thereby judging their efficacies. RESULTS: (1) Compared with before treatment in the same group, systolic and diastolic blood pressures significantly decreased in the treatment group after 2 weeks of treatment; systolic blood pressure significantly-decreased after 2 weeks of treatment and diastolic blood pressure significantly decreased after 3 weeks of treatment in the control group (all P < 0.05, P < 0.01). Decreased valley values of systolic and diastolic blood pressures at week 2, 3, and 4 after treatment were obviously higher than those at week 1 after treatment in the two groups (P < 0.05, P < 0.01). Compared with the control group at week 4 after treatment, valley value of systolic blood pressure obviously decreased in the treatment group (P <0. 01). Decreased valley values of systolic and diastolic blood pressures in the treatment group were higher than those of the control group (P <0. 01). The success rate of target blood pressure was 60. 7% (71/117 cases) in the treatment group and 42. 3% (47/111 cases) in the control group, with statistical difference (χ² = 7.6781, P < 0.01). (2) Compared with before treatment in the same group, the score of HAMD-17 at week 2, 3, and 4 after treatment all decreased in the two groups (P < 0.01). Compared with the control group, the score of HAMD-17 at week 4 after treatment decreased more obviously in the treatment group, with higher difference in decreased value (P < 0.05). The effective rate was 79.5% (93/117) in the treatment group, higher than that in the control group [66.7% (74/111); χ² = 4.7741, P < 0.05]. (3) Compared with before treatment in the same group, the score of HAMA at week 1, 2, 3, and 4 after treatment all obviously decreased in the two groups (P <0. 05, P <0. 01). Compared with the control group, the score of HAMA at week 3 and 4 after treatment decreased more obviously in the treatment group, with higher difference in decreased value (P < 0.05, P < 0.01). (4) After 4 weeks of treatment, except physical function in the control group, SF-36 total score and the score for each factor were obviously higher in the two groups (P < 0.05, P < 0.01). MGD showed superior effect in improving physical function, physical activity, overall health, emotion activity, and health changes to that of Sertraline (P < 0.05, P < 0.01). (5) The incidence of insomnia, tremor, liability to agitation, dizziness was obviously less in the treatment group than in the control group (P < 0.05). CONCLUSIONS: MGD had favorable clinical effect on hypertension patients complicated depression. Meanwhile, it also could improve their blood pressure and QOL.

[Analysis on the depression related factors in elderly patients after stroke and the effect of Chinese medicine on them].

OBJECTIVE: To study the depression related factors in elderly patients after stroke and to explore the effect of Chinese medicine anti-depression treatment for improving neurological function in patients with after-stroke depression. METHODS: Three hundred and seventy-seven after-stroke elderly patients were sorted, according to their Hamilton Depression Scale-17 (HAMD17) scores, to the non-depression group (NDG, 116 patients) and the depression group (DG, 261 patients). The depression related factors in them were analysed. Moreover, patients in DG were randomly subassigned to two groups, the 135 patients in the treated group were treated with Chinese medicine and general stroke-treatment, and the 126 patients in the control group were treated only with general stroke-treatment for 4 weeks. HAMD17 scores of neurological deficit (NDS), scores of sleep dysfunction rating scale (SDRS), Hamilton anxiety rating scale (HAMA), and treatment emergent symptom scale (TESS) in them were observed before and after treatment. RESULTS: Prevalence rate of depression in patients with cerebral hemorrhage was 79.78% (71/89), significantly higher than that in patients with cerebral infarction, 65.97% (190/288, P < 0.05). Patients of stroke with lesion occurred at cerebellum, brain stem, or cerebral hemisphere (frontal lobe) and those with moderate/severe neurological deficit were more liable to suffer from depression. The HAMD17, HAMA, SDRS, and NDS scores in the treated group after treatment were all improved more significantly than in the control group (P < 0.05). NDS score reduced in the treated group significantly from 19.1 +/- 16.3 before treatment to 31.3 +/- 14.8 after treatment, showing the evident recovery of nerve function. CONCLUSION: The occurrence of depression after stroke is closely related with the nature and position of the lesion, as well as the degree of neurological deficit in patients. Chinese medicine could improve the depressive manner effectively and thus to make for recovery of neurological function.

[Analysis on somnipathy related factors in elderly patients with stroke and comparative study on the efficacy of treatment by traditional Chinese medicine and by estazolam].

OBJECTIVE: To analyze the somnipathy related factors in elderly patients with stroke and to compare effects of traditional Chinese medicine and estazolam on sleep and the followed nervous function. METHODS: The somnipathy related factors in 336 elderly patients with stroke, 221 accompanied with somnipathy and 115 with normal sleep, were studied and analyzed. Moreover, the 221 patients with somnipathy were assigned to two groups, 112 in the treated group treated with TCM according to syndrome differentiation, and 109 in the control group treated with estazolam. Changes of scores rated by neurological deficit scale (NDS), sleep dysfunction rating scale (SDRS), Hamilton anxiety rating scale (HAMA), Hamilton depression scale (HAMD), and treatment emergent symptom scale (TESS) were observed before and after treatment. RESULTS: The occurrence of somnipathy in patients with cerebral hemorrhage was significantly higher than in those with cerebral infarction; it was higher in patients with lesion in brain stem, cerebral hemisphere (frontal lobe), or basal ganglion than in those with lesion in other sites; and patients with severe neurological deficit were more liable to having somnipathy. TCM showed a significant effect in improving the insomnia symptoms in patients, with the total effective rate reaching 81.25% (91/112), which was higher than that in the control group, 65.14% (71/109, P < 0.01). Along with the improving of sleep, marked recovery of the nervous function was shown in both groups, with NDS score reduced significantly (P < 0.05). CONCLUSION: The occurrence of somnipathy in stroke patients was closely related with the property and site of lesion, and the neurological deficit degree of patients. Better sleep is surely favorable for recovery of the nervous function, and TCM shows a favorable efficacy on somnipathy.

[Comparative study on treatment of somnipathy in patients with hypertension by traditional Chinese medicine and by estazolam].

OBJECTIVE: To study the efficacy of traditional Chinese medicine (TCM) in treating somnipathy in patients with hypertension, and to observe the change of blood pressure after sleep being improved. METHODS: Two hundred and thirty-nine patients with hypertension accompanied somnipathy were randomly assigned to two groups, 123 patients in the treated group were treated with TCM according to syndrome differentiation, and 116 in the control group treated with Estazolam. Changes of blood pressure, scores of sleep dysfunction rating scale (SDRS), Hamilton anxiety rating scale (HAMA) and treatment emergent symptom scale (TESS) before and after treatment were observed. RESULTS: TCM showed a significant effect on hypnagogic disturbance, and significantly reduced the scores of insomnia syndromes in early sleep stage, improve the quality of sleep, prolong the sleeping time to fulfill the physiological requirement, the total effective rate being 80.5% (99/123 cases), with the overall effect higher than that (66.4%, 77/116 cases) in the control group (P < 0.05). Along with the improving of sleep, blood pressure, both systolic and diastolic, reduced in both groups, but with the reduction in the treated group superior to that in the control group (P < 0.01), and the rate of reaching target BP (< 140/90 mmHg) in the former was also significantly higher than that in the latter (39.7%, 46/116 cases, P < 0.05). As compared with those in the control group, the occurence of adverse reaction, were less in the treated group (P < 0.05). CONCLUSION: TCM has better efficacy in treating somnipathy of hypertension patients than Estazolam. And the improvement of somnipathy is favorable for improving the hypertensive condition of patient.