四种实验室检测技术对利福平和异烟肼耐药性检测的临床价值

目的探讨微孔板法、实时荧光PCR熔解曲线技术(简称“熔解曲线法”)、多色巢式实时荧光定量PCR技术(简称“Xpert法”)和罗氏药物敏感性试验(L-J药敏试验,简称“比例法”)用于快速筛查耐多药结核病(MDR-TB)的临床价值。方法从医院信息系统(hospital information system,HIS)连续收集2014年7月至2018年3月重庆市公共卫生医疗救治中心收治的确诊为结核病,且具有微孔板法、比例法、熔解曲线法、Xpert法检测MTB对利福平、异烟肼耐药性诊断结果的2792例患者资料;其中微孔板法、比例法采用阳性分离菌株检测,熔解曲线法和Xpert法采用患者标本直接检测。纳入同时具有微孔板法和比例法耐药性检测结果的1488例患者作为研究对象,其中341例行微孔板法+比例法+Xpert法检测利福平耐药性,87例行微孔板法+比例法+熔解曲线法检测利福平耐药性,66例行微孔板法+比例法+熔解曲线法检测异烟肼耐药性。以比例法为标准,采用SPSS13.0软件分别计算微孔板法、熔解曲线法、Xpert法检测利福平和(或)异烟肼耐药性的敏感度、特异度、符合率、Kappa值等。结果以比例法为标准,微孔板法、Xpert法、熔解曲线法检测利福平耐药性的敏感度、特异度、阳性预测值、阴性预测值、符合率、Kappa值分别为97.2%(731/752)、96.9%(713/736)、96.9%(731/754)、97.1%(713/734)、97.0%(1444/1488)、0.94,97.2%(140/144)、94.9%(187/197)、93.3%(140/150)、97.9%(187/191)、95.9%(327/341)、0.92,97.1%(33/34)、84.9%(45/53)、80.5%(33/41)、97.8%(45/46)、89.7%(78/87)、0.79;微孔板法和熔解曲线法检测异烟肼耐药性的敏感度、特异度、阳性预测值、阴性预测值、符合率、Kappa值分别为94.8%(751/792)、95.7%(667/697)、96.3%(751/780)、94.2%(667/708)、97.9%(1418/1448)、0.91,97.3%(36/37)、86.2%(25/29)、90.0%(36/40)、96.2%(25/26)、92.4%(61/66)、0.84。结论微孔板法、熔解曲线法、Xpert法检测利福平和(或)异烟肼耐药性均具有较高的敏感度和特异度,适合快速筛查耐多药结核病;微孔板法还能获得各药物最低药物浓度,为临床用药剂量的选择提供参考依据。

A Hypothesis: Excessive Fear Impairing the Kidney

The theory of seven emotions in traditional Chinese medicine(TCM)holds that excessive joy impairs the heart,excessive anger impairs the liver,excessive contemplation impairs the spleen,excessive grief impairs the lung and excessive fear impairs the kidney,etc.According to TCM,kidney is the congenital essence of life and governs the reproduction through the hypothalamus a pituitary axis to complete an ovarian function of the reproductive.Some important events reflects fear affects the reproductive health.Kidney deficiency rat model was induced successfully by the methods of using the cat to frighten the mouse and simulating the scene of cat catching rat to form panic stress.Many experimental research on excessive fear impairing the kidney were carried out.Therefore,we put forward the medical hypothesis of Excessive fear impairing the kidney.

Association between maternal gestational diabetes and allergic diseases in offspring:a birth cohort study

Background Previous studies have linked gestational diabetes(GDM)with allergies in offspring.However,the effect of specific glucose metabolism metrics was not well characterized,and the role of polyunsaturated fatty acids(PUFAs),a modifier of metabolism and the immune system,was understudied.We aimed to investigate the association between maternal GDM and allergic diseases in children and the interaction between glucose metabolism and PUFAs on allergic outcomes.Methods This prospective cohort study included 706 mother–child dyads from Guangzhou,China.Maternal GDM was diagnosed via a 75-g oral glucose tolerance test(OGTT),and dietary PUFAs were assessed using a validated food frequency questionnaire.Allergic disease diagnoses and the age of onset were obtained from medical records of children within three years old.Results Approximately 19.4%of women had GDM,and 51.3%of children had any allergic diseases.GDM was positively associated with any allergic diseases(hazard ratio[HR]1.40;95%confidence interval(CI)1.05–1.88)and eczema(HR 1.44;95%CI 1.02–1.97).A unit increase in OGTT after two hours(OGTT-2 h)glucose was associated with an 11%(95%CI 2%–21%)higher risk of any allergic diseases and a 17%(95%CI 1–36%)higher risk of food allergy.The positive associations between OGTT-2 h glucose and any allergic diseases were strengthened with decreased dietary a-linolenic acid(ALA)and increased n-6 PUFAs,linoleic acid(LA),LA/ALA ratio,and n-6/n-3 PUFA ratio.Conclusions Maternal GDM was adversely associated with early-life allergic diseases,especially eczema.We were the first to identify OGTT-2 h glucose to be more sensitive in inducing allergy risk and that dietary PUFAs might modify the associations.

Anti-oxidative Activities of Ethanol Extracts from Both Wild Plant and Suspension Cell Cultures of Rheum franzenbachii

Objective To evaluate the content of rhaponticin and anti-oxidative activities of theethanol extracts from both the wild plants and suspension cell cultures of Rheum franzenbachii.Methods Quantitative analysis of rhaponticin was performed by HPLC.The anti-oxidative activities of the ethanol extracts were evaluated using 2,2-diphenyl-1-picrylhydrazyl（DPPH）scavenging assays.Results The content of rhaponticin in the roots of the wild plant was 4.36 mg/g,while the content was only 1.59 mg/g in the leaves.The content of rhaponticin in suspension cells cultured on Murashige and Skoog（MS）medium supplemented with 1.0 mg/L 6-benzylaminopurine（6-BAP）and 2.0 mg/L 2,4-dicholorophenoxy acetic acid（2,4-D）was 17.64 mg/g,which increased by 4.05 times compared with the content in the roots of the wild plants.The roots of wild plants displayed the strongest anti-oxidative activity,followed by thesuspension cells 5 and 6,and the scavenging percent was 91.96%,91.23%,and 89.27%,respectively,at the concentration of 100μg/mL.The IC50 values were 2.477,15.644,and 31.415μg/mL,respectively.In particular,the DPPH scavenging activity of the ethanol extracts from the roots of the wild plant was generally comparable to the control of ascorbic acid（VC）,and the IC50 value of the extracts was lower than that of VC（2.502μg/mL）.Conclusion Rhaponticin production in the cell culture can be modulated and the accumulation can be increased.The roots of the wild plant display the strongest anti-oxidative activity.These results suggest that R.franzenbachii could hold a good potential source for human health.