Evaluation of the direct nitrate reductase assay for rapid detection of extensively drug-resistant tuberculosis.

SETTING: Jiangxi, China. OBJECTIVE: To evaluate the performance of the direct nitrate reductase assay (D-NRA) for rapid, low-cost detection of multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB) in high-burden, resource-limited settings. METHODS: A total of 225 smear-positive sputum samples were collected from consecutive drug-resistant TB subjects. Samples were processed at the Province TB Reference Laboratory and tested for susceptibility to rifampicin (RMP), isoniazid (INH), ofloxacin (OFX), kanamycin (KM) and capreomycin (CPM) by D-NRA, using the indirect Löwenstein-Jensen proportion method (LJ-PM) as reference. RESULTS: Of the 225 smear-positive sputum samples, 214 isolates were identified as Mycobacterium tuberculosis and analysed for further comparison. The sensitivity of the D-NRA in the detection of resistance to RMP, INH, OFX, KM and CPM was respectively 95.1% (97/102), 93.1% (135/145), 97.4% (76/78), 88.9% (40/45) and 90.6% (29/32); specificity was respectively 100% (112/112), 97.1% (67/69), 100% (136/136), 98.8% (167/169) and 96.7% (176/182). The median time to culture positivity was significantly shorter for NRA than for the indirect LJ-PM (14 days vs. 70 days, P < 0.001). CONCLUSION: D-NRA showed high sensitivity and specificity in the rapid diagnosis of MDR- and XDR-TB in a high-burden, resource-limited setting.

Time-dependent variations of the skin barrier function in humans: transepidermal water loss, stratum corneum hydration, skin surface pH, and skin temperature.

Although circadian rhythms have been described for many human functions, there are minimal data on circadian rhythms related to skin physiology. This study investigated the circadian rhythmicity of skin variables related to skin barrier function in humans. We measured transepidermal water loss, stratum corneum moisture, skin surface pH, and skin temperature in 16 healthy volunteers (nine men and seven women, aged 23-53 y). Subjects were sampled every 2 h in two sessions over a 24 h span. Twelve samples were obtained for each variable in the following sites: forehead, forearm, upper back, and shin. We used cosinor analysis and ANOVA to validate observed differences. Time-dependent rhythms were detected in most skin variables except in stratum corneum hydration. We found a statistically significant circadian rhythmicity characterized by cosinor analysis in transepidermal water loss, skin surface pH, and skin temperature on the forearm, forehead, and shin. Peak-trough differences occurred in all locations. The values of the same variables measured at different sites correlated positively, whereas the values of the different variables did not. These results suggest that skin permeability is higher in the evening and night than in the morning. These data may be clinically relevant in several aspects applied to skin physiology and topical drug application.

[Preliminary experimental and clinical study of the treatment of chronic renal insufficiency by granule of yi-qi bu-shen].

The effects of the granule of Yi-Qi Bu-Shen on the chronic renal insufficiency (CRI) was studied. 30 cases of CRI patients using the granule was compared with other 23 CRI patients by using Aldehyde-coating Oxidated Starch in same conditions. The effective rate of these 2 groups were 53, 3% and 42.9% respectively (P > 0.05). According to laboratory observation, the granule had the ability to reduce BUN, Scr, Ch, TG and increase Ccr, Hb. The granule also could relieve symptom of Kidney-deficiency. Animal experimental research suggested the granule had the function of reducing BUN, Scr and could improve pathological changes in rat kidneys. The conclusion were that the granule was effective on treating CRI and could postpone the progress of CRI.

Evaluation of indirect drug susceptibility testing using the MODS assay for the detection of XDR-TB in China.

SETTING: The First Affiliated Hospital of Nanchang University and the Chest Hospital of Jiangxi Province, Jiangxi, China. OBJECTIVE: To assess the performance and feasibility of the microscopic observation drug susceptibility (MODS) assay for the simultaneous detection of multidrug-resistant (MDR) and extensively drug-resistant tuberculosis (XDR-TB) in a high-burden, resource-limited setting. METHODS: A total of 208 archived clinical isolates of Mycobacterium tuberculosis were used to compare MODS with the conventional proportion method for the rapid detection of resistance to rifampicin (RMP) and isoniazid (INH), as well as to the second-line drugs ofloxacin (OFX) and kanamycin (KM). RESULTS: Sensitivity was respectively 94.5%, 91%, 96.2% and 91.5% for RMP, INH, OFX and KM, and specificity was respectively 97.5%, 96%, 100% and 98.7%. Results for MODS were obtained in a median time of 7 days (range 5-17). CONCLUSION: The MODS assay offers a simple, rapid, economical and feasible method for the detection of M. tuberculosis resistance to first- and second-line drugs in resource-limited settings.

Clinical impact of selective serotonin reuptake inhibitors therapy with bleeding risks.

The selective serotonin reuptake inhibitors (SSRIs) are extensively used for the treatment of multiple psychiatric conditions. In vitro and ex vivo data with these agents indicate they may have varying degrees of antiplatelet activity via multiple receptors. Reports of bleeding in patients receiving SSRIs appeared soon after their introduction. A review of the literature suggests SSRI therapy may increase the risk of bleeding especially with concomitant aspirin or nonsteroidal anti-inflammatory agents. Clinicians should exercise caution when prescribing these agents in high risk patients and maintain awareness of the potential contribution of SSRIs to unexplained bleeding episodes.

[A further research on physiopathological basis of "Liver Yang Forming Wind Syndrome"].

The multiple experimental parameters of different aspects in this study were determined in the patients with "Liver Yang Forming Wind Syndrome (LYFWS)", "Qi Deficiency Blood Stagnation Syndrome (QDBSS)" and "Yin Deficiency Forming Wind Syndrome (YDFWS)". The results showed that cerebral hemorrhage was similar to cerebral infarction in almost all parameters and the two diseases were with LYFWS. It was found that there were several characteristics in LYFWS, i.e. 1. Hyperfunction of sympathetic adrenal medullary system. 2. Hypotriiodothyroidoglobulin syndrome. 3. The marked changes of the active substance regulating vessel smooth muscle function. 4. The increased inflammatory medicators. The pathophysiological parameters in patients with QDBSS were the same as those with YDFWS, but the changes of QDBSS and YDFWS weRe milder than those of LYFWS.