Evaluation of Xpert MTB/RIF for the Diagnosis of Extrapulmonary Tuberculosis in China.

We evaluate the performance of Xpert MTB/RIF for the diagnosis of extrapulmonary tuberculosis (EPTB) in China. The performance of Xpert was evaluated compared to the composite reference standard (CRS), drug susceptibility testing (DST), and imaging examination. The overall sensitivity and specificity of Xpert were 64.1% (195/304) and 100% (24/24), respectively, using CRS as the gold standard. The sensitivity was significantly higher than that of culture for pus (P<0.05). The proportion of EPTB-positive cases diagnosed by imaging was two times more than that diagnosed using Xpert; however, 6 out of 19 cases may have been overdiagnosed by imaging. Compared to phenotypic DST, the sensitivity and specificity of Xpert were 80% (12/15) and 100% (75/75), respectively. Considering its high sensitivity and specificity, Xpert MTB/RIF may be used as a rapid initial test for EPTB diagnosis, and may also support a quicker decision on the treatment regimen. The combination of imaging and Xpert testing could provide high efficiency and accurate diagnosis of suspected EPTB.

Bilateral traumatic hemorrhage of the basal ganglia.

Hemorrhage of the basal ganglia is common in hypertensive patients, and most of the cases are spon- taneous unilateral hemorrhage. Traumatic basal ganglia hemorrhage is uncommon, while bilateral hemorrhage of the basal ganglia after trauma is an extremely rare entity. This report described a rare case of bilateral hemorrhage of the basal ganglia after head trauma. We also analyzed the mechanisms and reviewed relative literatures.

[Analysis on influential factors in China's exports of primary and semi-finished products of traditional Chinese medicine to ASEAN].

Two regression models, based on panel data over the period of 2000-2011, are built and used to analyze what factors determine China's exports of primary and semi-finished products of traditional Chinese medicine to ASEAN. The results indicate that, China GDP, the ratio of ASEAN to China GDP per capita, average export price, the ratio of state-owned assets to total assets, have a significant positive influence on the export volumes of primary products of Chinese medicine. At the same time, RMB appreciation, the ratio of three kinds of foreign-invested assets to total assets, China-ASEAN Early Harvest Program, ASEAN-China Free Trade Area have a significant negative influence. In respect of the export volumes of semi-finished products of Chinese medicine, the significant influential factors are ASEAN GDP and the ratio of ASEAN to China GDP per capita. The former is positive and the latter is negative. In order to optimize the commodity composition of experts, it is needed to increase export volumes of both primary and semi-finished products of Chinese medicine. According to the analysis above, some proposals are put forward, such as, improving the performance of foreign capital, playing an exemplary and leading role in technological innovation by state-owned enterprises, taking advantage of bargaining power of suppliers, increasing outward foreign direct investment.

Safety and effectiveness assessment of endovascular recanalization for non-acute middle cerebral artery occlusion.

BACKGROUND: Endovascular treatment for patients with symptomatic nonacute middle cerebral artery occlusion remains clinically challenging, and proof of a beneficial effect on functional outcome is lacking. We aim to evaluate the effectiveness and safety of endovascular recanalization for patients with symptomatic nonacute middle cerebral artery occlusion. METHODS: Ninety-eight patients with symptomatic atherosclerotic nonacute middle cerebral artery occlusion were divided into drug treatment groups (42) and endovascular treatment groups (56). The rate of recanalization, peri-procedural complications, and follow-up results were evaluated. RESULTS: Among the 56 patients who received endovascular treatment, 53 (94.6%) achieved successful recanalization. The rate of peri-procedural complications was 7.1% (4/56), and the death rate was 1.8% (1/56). Any stroke within 90 days was 7.1% (4/56). Among the 42 patients in drug treatment group, any stroke within 90 days was 19.0% (8/42), death rate was 0. CONCLUSION: Among patients with symptomatic nonacute middle cerebral artery occlusion with a short length of occlusion and a moderate-to-good collateral circulation, endovascular treatment seems to be safe. And endovascular treatment could reduce the recurrence rate of stroke.

A case report of diffuse pneumocephalus induced by sneezing after brain trauma.

Pneumocephalus is the presence of air in the cranial vault. The common etiologies of pneumocephalus are brain trauma and cranial surgery. We report a case of a 26-year-old man with brain trauma who developed diffuse pneumocephalus after sneezing. CT scan was performed on arrival, and the image showed subarachnoid hemorrhage without pneumocephalus. On the seventh day after a big sneeze brain CT scan was re-performed, which showed pneumocephalus. After another ten days of treatment, the patient was discharged without any symptoms.

[Spiropyran-based fluorescent sensor for Hg2+, Cr3+, Ag+ and their interaction spectra].

A 6',8'-di-tert-butyl-1-hydroxyethyl-3,3-dimethyl-indoline benzospiropyran L1 and its derivative L2 were synthesized and characterized. Chelation-enhanced appearswhen L1 with electron donating groups of 6', 8'-di-tert-butyl touch on benzospiropyran and affect the stability of cyanine structure. L1 exhibited high selectivity to Hg2+, Cr3+, Ag+ over other metal ions. While, there was no obvious interferences of coexist metal ions on Hg2+, Cr3+, Ag+ detection. The Hg2+, Cr+, Ag+ recognition of L1 not only could be achieved by means of fluorescense and absorption "turn-on" spectra but also an obvious color change from colorless to yellowish by naked-eyes. The binding of L1 to Ag+, Cr3+, Hg2+ are in 1 : 1 stoichometry and the detection limits are 7.435 8 x 10(-6), 6.126 8 x 10(-6), 3.452 4 x 10(-6) mol x L(-1). The sensing mechanism was also investigated from L2.

[Analysis on influential factors of Chinese medicinal herb growers' willingness to use green pesticides: evidence on Panax notoginseng production areas in Wenshan, Yunnan province].

The purpose of the article is to apply a binary logistic model to analyze the major factors, which influence Chinese medicinal herb growers' willingness to use green pesticides by using survey data collected in Wenshan, Yunnan Province. The results indicate that, output per capita, average pesticide cost per mu, cognition of pesticide residues, expectations on Panax notoginseng prices, cognition of pesticides' effect of pests control, cognition of P. notoginseng prices of low pesticide residues have a significant influence on growers' willingness to use green pesticides. According to the analysis above, some proposals for enhancing Chinese medicinal herb growers' willingness to use green pesticides are put forward, such as, moving toward the intensive planting systems, fetching down the pieces of green pesticides, emphasizing and propagating the advantages of green pesticides, keeping the prices of Chinese medicinal herb running at steady rates.

Does the AVNeo valve reduce wall stress on the aortic wall? A cardiac magnetic resonance analysis with 4D-flow for the evaluation of aortic valve replacement with the Ozaki technique.

OBJECTIVES: Aortic valve neocuspidalization aims to replace the 3 aortic cusps with autologous pericardium pre-treated with glutaraldehyde, and it is a surgical alternative to the classical aortic valve replacement (AVR). Image-based patient-specific computational fluid dynamics allows the derivation of shear stress on the aortic wall [wall shear stress (WSS)]. Previous studies support a potential link between increased WSS and histological alterations of the aortic wall. The aim of this study is to compare the WSS of the ascending aorta in patients undergoing aortic valve neocuspidalization versus AVR with biological prostheses. METHODS: This is a prospective nonrandomized clinical trial. Each patient underwent a 4D-flow cardiac magnetic resonance scan after surgery, which informed patient-specific computational fluid dynamics models to evaluate WSS at the ascending aortic wall. The adjusted variables were calculated by summing the residuals obtained from a multivariate linear model (with ejection fraction and left ventricle outflow tract-aorta angle as covariates) to the mean of the variables. RESULTS: Ten patients treated with aortic valve neocuspidalization were enrolled and compared with 10 AVR patients. The aortic valve neocuspidalization group showed a significantly lower WSS in the outer curvature segments of the proximal and distal ascending aorta as compared to AVR patients (P = 0.0179 and 0.0412, respectively). WSS levels remained significantly lower along the outer curvature of the proximal aorta in the aortic valve neocuspidalization population, even after adjusting the WSS for the ejection fraction and the left ventricle outflow tract-aorta angle [2.44 Pa (2.17-3.01) vs 1.94 Pa (1.72-2.01), P = 0.02]. CONCLUSIONS: Aortic valve neocuspidalization hemodynamical features are potentially associated with a lower WSS in the ascending aorta as compared to commercially available bioprosthetic valves.

Mongoliicoccus roseus gen. nov., sp. nov., an alkaliphilic bacterium isolated from a haloalkaline lake.

Two pink, non-motile, aerobic, alkaliphilic, halotolerant, Gram-negative cocci, designated MIM28(T) and MIM29, were isolated from the surface water of a haloalkaline lake on the Mongolia Plateau. The isolates grew optimally at 30-33 °C, at pH 8-9 and with 3-4 % (w/v) NaCl. The isolates were chemoheterotrophic and could assimilate carbohydrates, organic acids and amino acids. The major respiratory quinone was menaquinone MK-7. The major polar lipids were phosphatidylcholine and phosphatidylethanolamine. The predominant cellular fatty acids were iso-C(15 : 0) (13.8-17.5 %), anteiso-C(15 : 0) (10.5-11.2 %), iso-C(16 : 0) (9.9-13.0 %), C(16 : 0) (4.3-4.6 %), iso-C(17 : 0) (3.8-5.3 %), anteiso-C(17 : 0) (3.7-7.1 %), C(17 : 1)ω6c (4.6-6.4 %), iso-C(17 : 0) 3-OH (4.6-5.8 %), summed feature 3 (C(16 : 1)ω7c and/or C(16 : 1)ω6c; 4.0-6.4 %) and summed feature 9 (iso-C(17 : 1)ω9c and/or C(16 : 0) 10-methyl; 10.4-12.5 %). Phylogenetic analysis based on 16S rRNA gene sequences showed that the isolates were most closely related to Litoribacter ruber YIM CH208(T) (93.6 % 16S rRNA gene sequence similarity), the genus Echinicola (90.4-92 %) and other members of the family Cyclobacteriaceae (87.8-90 %). The DNA G+C contents of strains MIM28(T) and MIM29 were 62.8 and 62.2 mol%. On the basis of morphology, physiology, fatty acid composition, phylogeny and 16S rRNA gene sequence analysis, the isolates are assigned to a novel species of a new genus, for which we propose the name Mongoliicoccus roseus gen. nov., sp. nov.; the type strain of the type species is MIM28(T) (= ACCC 05511(T) = KCTC 19808(T)).

Low-dose intravenous tirofiban infusion after endovascular recanalization for non-acute middle cerebral artery occlusion.

Background and purpose: Endovascular recanalization for patients with symptomatic non-acute middle cerebral artery occlusion still remines challenging. Postoperative treatment is still controversial. This study aims to investigate the safety and effectiveness of tirofiban after elective angioplasty in patients with non-acute middle cerebral artery occlusion related ischemic stroke. Methods: Our study is a retrospective case series study of 48 stroke patients who received elective endovascular recanalization for middle cerebral artery occlusion. Patients who received EVT without hemorrhage were divided into 2 groups: those who did not receive intravenous tirofiban treatment (control group, n = 25); those who received continuous intravenous infusion of 0.2-0.3 mg/h tirofiban for 48 h after endovascular recanalization (intravenous tirofiban group, n = 23). Early reocclusion of treated arteries, symptomatic hemorrhage, and 90-day functional outcome of the 2 groups were compared. Results: The 90-day mRS score and NIHSS score after endovascular recanalization showed no significantly different between the two groups. However, the rate of mRS score reverse (≥1) was significantly higher in the intravenous tirofiban group than the control (73.9% versus 24.0%, P = 0.001), and the rate of NIHSS score reverse (≥3) in the intravenous tirofiban group was also higher (43.5% verse 16.0%, P = 0.037). The rate of early reocclusion, symptomatic hemorrhage (4.3% versw 4%, P = 0.734), showed no difference between the two groups. Conclusions: Low-dose intravenous tirofiban infusion (0.2-0.3 mg/h for 48 h) after endovascular treatment seems to be safe and potentially effective for non-acute middle cerebral artery occlusion patients.

The influence of tumour vasculature on fluid flow in solid tumours: a mathematical modelling study.

Tumour vasculature is known to be aberrant, tortuous and erratic which can have significant implications for fluid flow. Fluid dynamics in tumour tissue plays an important part in tumour growth, metastasis and the delivery of therapeutics. Mathematical models are increasingly employed to elucidate the complex interplay between various aspects of the tumour vasculature and fluid flow. Previous models usually assume a uniformly distributed vasculature without explicitly describing its architecture or incorporate the distribution of vasculature without accounting for real geometric features of the network. In this study, an integrated computational model is developed by resolving fluid flow at the single capillary level across the whole tumour vascular network. It consists of an angiogenesis model and a fluid flow model which resolves flow as a function of the explicit vasculature by coupling intravascular flow and interstitial flow in tumour tissue. The integrated model has been used to examine the influence of microvascular distribution, necrosis and vessel pruning on fluid flow, as well as the effect of heterogeneous vessel permeability. Our results reveal the level of nonuniformity in tumour interstitial fluid pressure (IFP), with large variations in IFP profile between necrotic and non-necrotic tumours. Changes in microscopic features of the vascular network can significantly influence fluid flow in the tumour where removal of vessel blind ends has been found to reduce IFP and promote interstitial fluid flow. Our results demonstrate the importance of incorporating microscopic properties of the tumour vasculature and intravascular flow when predicting fluid flow in tumour tissue.

Influence of wind energy utilization potential in urban suburbs: a case study of Hohhot.

Given the increasing trend of using wind energy in cities, the utilization of distributed wind energy in cities has been widely concerned by researchers. The related research on the micro-site selection of wind turbines, a sub-project of the Task27 project of the International energy agency, was continued in this paper. The wind speed data of an observation station near Hohhot, Inner Mongolia, with a range of 10-19 m were collected. The evaluation included wind direction, Weibull parameter characteristics, and turbulence intensity. The potential energy output in 10 different heights was estimated using commercial horizontal and vertical axis wind turbines of the same power. Results showed that the following: the three-parameter Weibull distribution model can well describe the statistical properties of the wind speed in this site. The wind speed distribution model constructed from extrapolation parameters reflects the wind speed statistical properties out of detection positions to a certain extent. The wind energy density of the vertical axis wind turbine is slightly lower than that of the horizontal axis wind turbine. Furthermore, more power can be generated from March to May.

Average capacity optimization in free-space optical communication system over atmospheric turbulence channels with pointing errors.

A model is proposed to study the average capacity optimization in free-space optical (FSO) channels, accounting for effects of atmospheric turbulence and pointing errors. For a given transmitter laser power, it is shown that both transmitter beam divergence angle and beam waist can be tuned to maximize the average capacity. Meanwhile, their optimum values strongly depend on the jitter and operation wavelength. These results can be helpful for designing FSO communication systems.

[Clinical application of prospective electrocardiogram-gated 320-detector computed tomography coronary angiography].

OBJECTIVE: to compare the success rate, radiation dose, image quality and diagnosis of prospective electrocardiogram(ECG)-gated 320-detector computed tomography coronary angiography (CTCA) versus retrospective ECG-gated CTCA. METHODS: patients suspected coronary artery disease were divided into two groups which underwent 320-detector CTCA with prospective ECG-gated and retrospective ECG-gated scanning (n = 240 each, HR < 65 bpm). Curved-planar reconstruction (CPR), maximum intensity projection (MIP) and volume rendering (VR) were performed to demonstrate the coronary arteries. The image quality was defined as excellent, good and poor by motion and stair-step artifacts. Effective radiation exposure dose was estimated from the dose-length product. Effective radiation dose, image quality and diagnosis were evaluated. RESULTS: the success rate of examination was 100% in prospective ECG-gated group and retrospective ECG-gated group. The mean effective radiation dose of prospective ECG-gated CTCA [(3.3 ± 1.3) mSv] was significantly lower than that of retrospective ECG-gated CTCA [(13.0 ± 1.6) mSv, P < 0.01]. Segments of diagnostic image quality (95.42%, 3435/3600) and non-diagnostic coronary segments (4.58%, 165/3600) in prospective ECG-gated group were similar as those of retrospective ECG-gated group (95.81%, 3449/3600 and 4.19%, 151/3600, all P > 0.05). Compared with CAG, the sensitivity, specificity, false positive and false negative value in prospective ECG-gated group (93.22%, 99.21%, 91.64%, 99.05%) and retrospective ECG-gated group (94.55%, 98.80%, 95.86%, 98.54%) were not significantly different. CONCLUSION: though the effective radiation dose is significantly lower, the success rate, image quality and diagnosis of prospective ECG-gated 320-detector CTCA is comparable with that of retrospective ECG-gated 320-detector CTCA on patients with stable heart rates less than 65 bpm.

[Antioxidant activity and spectroscopic behavior study with DNA of several Salen Mn(II), Eu(III) complexes].

Five kinds of Salen Mn(II) and two kinds of Eu(III) complexes were synthesized. Under the system of NBT/L-methionine, which creates and detects O2*-, the complexes of antioxidant activity were studied, and the conclusion revealed that all Mn(II) complexes have obvious antioxidant activity. The fluorescence study indicated that all the Salen metal complexes could bind with DNA, which shows their potential anticancer activity.

[Distribution characteristics of syndrome types in essential hypertension].

OBJECTIVE: To investigate the distribution characteristics of syndrome types of traditional Chinese medicine (TCM) in essential hypertension and to explore the distribution rule of TCM syndromes. METHODS: A multicenter, large-sample survey method of clinical epidemiology was applied to choose the patients with essential hypertension from North, Middle, and South China. A questionnaire was designed and filled in, then 477 untreated patients with first-diagnosed essential hypertension were selected and the information was recorded into FileMaker database. A cluster analysis method was utilized to study the TCM syndrome distribution rule of essential hypertension. RESULTS: Two-step cluster analysis was done from 3 to 7 clusters. Seven clusters were appropriate, which included deficiency of heart and kidney qi, hyperactivity of liver-yang, deficiency of yin and yang, stagnation of phlegm-dampness, phlegm-heat (subtype of stagnation of phlegm-dampness), blood stasis obstructing collaterals, and other syndromes. The symptoms presenting high percentage in each cluster were more significant in TCM theory. The syndromes of hyperactivity of liver-yang (24.1%) and stagnation of phlegm-dampness (27.1%) presented the high percentages, and deficiency of heart and kidney qi (10.1%), deficiency of yin and yang (8.4%), and blood stasis obstructing collaterals (9.0%) presented the low percentages. CONCLUSION: As compared with the current syndrome differentiation criteria, two-step cluster analysis results not only include the syndromes of deficiency of yin and yang, hyperactivity of liver-yang, stagnation of phlegm-dampness, but also cover qi deficiency and blood stasis.

Research progress on the regulation of cognitive decline by microglia in aging / 临床神经病学杂志

The incidence of dementia increased significantly in the context of an aging population,imposing a significant burden on the economy and society.Therefore,finding the specific mechanism underlying cognitive decline in aging is of paramount significance.Recently,the role of microglia in the initiation and progression of cognitive decline in aging has become a research hotspot.Microglia,the resident immune cells of CNS,play important roles in immunosurveillance,synaptic pruning,damage repair and maintaining immune homeostasis.However,microglia undergo a variety of changes in cell morphology,gene expression and functional status with aging.This article review the impact of normal aging on microglia and the role of microglia in the pathogenesis of cognitive decline in aging,to provide a novel strategy for slowing or preventing the onset of dementia.

Determination of the Critical Concentration of Rifabutin for Susceptibility Testing Using the Proportion Method with Löwenstein-Jensen Medium against Mycobacterium Tuberculosis Isolates.

OBJECTIVE: To determine the critical concentration of rifabutin (RFB) for susceptibility testing against Mycobacterium tuberculosis (Mtb) on Löwenstein-Jensen (L-J) medium using the proportion method. METHODS: We used 47 strains were used to determine the critical concentration of RFB. The microplate antimicrobial assay (MABA) was used as a reference method. We used 160 strains to evaluate its correlation with the classification results derived from the MABA method. We performed antimicrobial susceptibility testing (AST) against RFB and rifampin (RIF) for 2748 other strains using the proportion method on L-J medium. RESULTS: The determined critical concentration for RFB was 20 µg per mL. Identical classification as susceptible or resistant was observed in 93.8% and 92.5% strains for RFB and RIF, respectively, using the 2 different methods. The cross-resistance ratio between RFB and RIF was 72.7% in the 2748 Mtb strains. CONCLUSIONS: We determined that a critical concentration of 20 µg per mL RFB was reliable for AST of Mtb.

Evaluation of guidelines on the screening and diagnosis of gestational diabetes mellitus: systematic review.

OBJECTIVE: Guidelines for screening and diagnosis of gestational diabetes mellitus (GDM) have been updated in the past several years, and various inconsistencies exist across these guidelines. Moreover, the quality of these updated guidelines has not been clarified. We thus conducted this systematic review to evaluate the relationship between the quality and detailed recommendations of these guidelines. DATA SOURCES: The Guidelines International Network Library, the National Institute for Health and Clinical Excellence (NICE) database, the Medline database, the Embase and the National Guidelines Clearinghouse were searched for guidelines containing recommendations on screening and diagnosis strategies for GDM between 2009 and November 2018. METHODS: Guidelines included a target group of women with GDM, and contained recommendations for screening and diagnostic strategies for GDM were included in the present systematic review. Reviewers summarised recommendations on screening and diagnosis strategies from each guideline and rated the quality of guidelines by using the Appraisal of Guidelines Research and Evaluation (AGREE) criteria. RESULTS: A total of 459 citations were collected by the preliminary literature selection, and 16 guidelines that met the inclusion criteria were assessed. The inconsistencies of the guidelines mainly focus on the screening process (one step vs two step) and criteria of oral glucose tolerance test (OGTT) (International Association of Diabetes and Pregnancy Study Groups [IADPSG] vs CarpenterandCoustan). Guidelines with higher AGREE scores usually recommend a one-step OGTT strategy with IADPSG criteria between 24 and 28 gestational weeks, and the majority of these guidelines likely to select evidence by Grading of Recommendations Assessment, Development and Evaluation criteria. CONCLUSIONS: The guidelines of WHO-2013, NICE-2015, American Diabetes Association-2018, Endocrine Society-2013, Society of Obstetricians and Gynaecologists of Canada-2016, International Federation of Gynecology and Obstetrics-2015, American College of Obstetricians and Gynecologists-2018, United States Preventive Services Task Force-2014 and IADPSG-2015 are strongly recommended in the present evaluation, according to the AGREE II criteria. Guidelines with higher quality tend to recommend a one-step 75 g OGTT strategy with IADPSG criteria between 24 and 28 gestational weeks.

Correlations of brain network functional connectivity alterations with cerebrospinal fluid pathological markers in patients with Alzheimer's disease / 中华神经医学杂志

Objective:To explore the correlations of brain network functional connectivity (FC) alterations with cerebrospinal fluid (CSF) pathological biomarkers in patients with Alzheimer's disease (AD).Methods:A total of 39 patients with cognitive impairment, admitted to Department of Neurology, Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University from January 2020 to December 2022 were recruited; 23 patients were with AD and 16 with non-AD. Clinical data were compared between the 2 groups. Resting-state functional MRI (rs-fMRI) data were collected, and FC differences between brain networks and FC differences within brain networks were compared by independent component analysis. Correlations of FC differences between brain networks and FC differences within brain networks with concentrations of β-amyloid protein 1-42 (Aβ 1-42) and Tau protein in CSF were analyzed. Results:Compared with the non-AD group, AD group had significantly lower Aβ 1-42 in CSF ( P<0.05). Compared with those in the non-AD group, FC alterations between the left frontoparietal network (lFPN) and anterior default mode network (aDMN) and between the visual network (VN) and posterior cingulate cortex (PCC), as well as FC alterations in lFPN, were significantly increased in AD group ( P<0.05). Compared with those in the non-AD group, FC alterations between lFPN and cerebellar network (CEN), and FC alterations in aDMN, sensorimotor network (SMN) and VN were significantly decreased in AD group ( P<0.05). In AD group, FC in SMN was positively correlated with total Tau and phosphorylated-Tau181 in CSF ( P<0.05); FC between VN and PCC was positively correlated with total Tau in CSF ( P<0.05). CSF Aβ 1-42 was positively correlated with FC alterations in aDMN and VN, but negatively correlated with FC in FPN ( P<0.05). Conclusion:In AD patients, characteristic changes in FC within and between multiple brain networks are noted, which are related to changes of Tau protein and Aβ 1-42 in CSF.