Investigation of the cell composition and gene expression in the delayed-type hypersensitivity tuberculin skin test

Dear Editor,The tuberculin skin test(TST)reagents have continuously improved,with the ESAT6-CFP10(EC)test having recently been introduced,but are seldom based on the direction of the delayed-type hypersensitivity(DTH)mechanism.Previous studies only partially showed the infiltration and activation of immune cells and the production of cytokines of the skin induration[1,2],and lack the detailed measurements of cell proportions and gene expression in the DTH response.Therefore,in this study,we revealed the comprehensive characteristics of DTH by single-cell RNA sequencing(scRNA-seq)in the guinea pig tuberculosis(TB)model[Experimental Animal Welfare Ethics Committee,Beijing Tuberculosis and Thoracic Tumor Research Institute(2021-064)].

Performance and correlation of QuantiFERON-TB Gold, T-SPOT.TB and tuberculin skin test in young children with or exposed to tuberculosis

Objective:To evaluate the performance of interferon gamma release assays and tuberculin skin test in Bacillus Calmette-Guerin vaccinated young children.Methods:A cross-sectional study was conducted in healthy children younger than 5 years who were recently diagnosed with tuberculosis or had recent exposure to active tuberculosis.QuantiFERON-TB Gold,T-SPOT.TB and tuberculin skin test were performed in each patient.Results:Of the 60 children,median age 3.3 years,17 had tuberculosis and 43 had recent tuberculosis exposure.Overall,15(25.0%)children had tuberculin skin test reaction≥10 mm;8(13.3%)were positive by QuantiFERON-TB Gold In-Tube test,and 12(20.0%)by T-SPOT.TB.Nineteen(31.7%)children had at least one positive test.There was a moderate agreement between interferon gamma release assays and tuberculin skin test.Conclusions:The positive rates of interferon gamma release assays and tuberculin skin test were low in young children who were infected with tuberculosis,supporting the management strategy of not testing children younger than 5 years.

Performance and correlation of interferon gamma release assays and tuberculin skin test in HIV-infected children and adolescents with immune reconstitution

Objective:To evaluate the performance of interferon gamma release assays and tuberculin skin test in HIV-infected children and adolescents with immune reconstitution.Methods:A cross-sectional study was conducted in HIV-infected patients aged 5-18 years receiving antiretroviral treatment with CD4 T-lymphocytes>25%or>500 cells/mm3 for at least 6 months.QuantiF ERON-TB Gold,T-SPOT.TB,and tuberculin skin test were performed in each patient.Results:A total of 50 patients were enrolled with median age of 13.7 years,CD4 counts of 753(IQR:587-989)cells/mm3.Among 27 patients with tuberculosis(16)or tuberculosis exposure(11),8(29.6%)were positive to at least one test,2(7.4%)were positive QuantiFERON-TB Gold,3(11.1%)positive T-SPOT.TB,and 7(25.9%)had tuberculin skin test≥5 mm.Among 23 patients without history of tuberculosis or exposure,all had negative interferon gamma release assays,while 2(8.7%)had positive tuberculin skin test.Conclusions:All tests had low sensitivity despite immune reconstitution.

Relationship between Serum Specific IgE and Allergen Skin Test in Allergic Patients of Wuhan Area

Summary: In order to study the relationship between serum specific IgE (sIgE) and allergen skin test, allergen skin tests and detections of sIgE in 220 allergic patients of Wuhan area were analyzed. The coherent rate of the two methods was beyond 70 % (P<0.01). It was concluded that the in vitro and in vivo detection methods of allergens have a high coherence and can be used as the effective ways to diagnose the allergic diseases in clinical practice.

Comparison between Quanti-FERON-TB Gold In-Tube test and tuberculin skin test for diagnosis of latent tuberculosis in children: A cross-section study

Objective: To compare Quanti-FERON-TB Gold In-Tube (QFT-GIT) test and tuberculin skin test (TST) for the diagnosis of latent tuberculosis infection in children. Methods: In this cross-sectional study, 64 participants who were between 3 months and 14 years old and had close contact with smear-positive pulmonary tuberculosis were included. Both QFT-GIT test and TST were done and the results were analyzed by SPSS software and Kappa test. Results: The distribution of gender and age according to QFT-GIT and TST results were matched (P>0.05). Overall agreement between QFT-GIT and TST for diagnosis of latent tuberculosis infection in children was 75%. In addition, the contingency coefficient was 0.257, and the Kappa measure of agreement was 0.246 (P=0.034). Conclusions: Compared to TST, QFT-GIT shows no apparent advantage for diagnosis of latent tuberculosis infection in children.

Indications, Interpretation and Clinical Consequences of Tuberculin Skin Tests in Resource Limited Settings

Objective: to evaluate the policy of TST testing in Suriname. As there is no gold standard to diagnose latent tuberculosis infection (LTBI), the tuberculin skin test (TST) is used to diagnose LTBI. However, internationally, the cut-off values of the TST are not uniform and depend on local tuberculosis (TB) epidemiology and guidelines for test initiation. In Suriname, where currently several indications exist for TSTs, cut-off values are set at 5 mm or 10 mm, depending on the age and/or medical history of the patient. LTBI classification is performed by pulmonologists primarily based on the American Thoracic Society targeted TB testing guidelines. Method: retrospective analysis of outpatient TST data between 2011 and 2019 from Suriname’s sole pulmonary medicine clinic. Result: 1373 patients were evaluated. 590 patients were from the screening group of whom 253 had a positive TST result, 46 of whom were classified as LTBI. In the contact tracing group of 649 patients, 616 had a positive TST, 352 of whom were classified as LTBI. In the medical condition group of 134 patients, 96 had a positive TST, 38 of whom were classified as LTBI. Eventually, positive TST results were found for 965 tested patients: 436 patients were classified as LTBI and 529 non-LTBI patients were not prescribed chemoprophylaxis. None of the non-LTBI TST-positive patients were diagnosed with active TB, including 174 patients with a TST result of 15 mm or greater and in need of IPT, but not prescribed by judgement of the pulmonologist or because of loss to follow-up. Conclusion: the overrepresentation of positive TST results in Suriname is attributable to stringent cut-off values, especially among patients who do not disclose TB risk factors. In our opinion the TST cut-off value for such patients in Suriname and other similar settings could be set at 15 mm. We also promote that for all patients with a TST result of 15 mm or greater, offering IPT should be considered (after excluding active TB).

Inhibitory effect of Phlai capsules on skin test responses among allergic rhinitis patients:a randomized,three-way crossover study

BACKGROUND： Zingiber cassumunar Roxb., commonly known as Phlai in Thai, has been used as a traditional medicine in Thailand for the treatment of various diseases, including inflammation and chronic airway disease. OBJECTIVE： The purpose of this study was to assess the antihistaminic effect of Phlai on skin testing DESIGN, SETTING, PARTICIPANTS AND INTERVENTION： This was a randomized, open-label, three- way crossover study. Twenty allergic rhinitis （AR） patients were enrolled. In randomized sequence, patients received a single dose of Ph/ai capsules （100 or 200 mg） or Ioratadine （10 mg） with a washout period of 1 week between each treatment. MAIN OUTCOME MEASURES： Skin prick testing for histamine and common aeroallergen （house dust mite） were performed before treatment and after 1,2, 3, 4, 6, 8, 12 and 24 hours of treatment. The main treatment outcomes were the mean wheal and flare responses to the skin prick test after treatment. RESULTS： Both 100 mg and 200 mg Phlai doses suppressed wheal and flare responses to house dust mite allergen, but only 200 mg of Phlai capsules significantly suppressed wheal and flare responses to histamine. Repeated measures analysis of variance showed that Ioratadine caused more wheal and flare suppression than Phial capsules in responses to the histamine skin prick test. However, there were no significant differences among the effects of 100 mg Phlai capsules, 200 mg Phlai capsules and Ioratadine in suppression of wheal and flare induced by the mite skin prick test. Both doses of Phlai were well-tolerated with no adverse events.CONCLUSION： Both 100 mg （compound D 4 mg） when taken as a single therapeutic dose, inhibited AR patients. and 200 mg （compound D 8 mg） Phlai capsules, skin reactivity to histamine and mite skin prick tests in TRIAL REGISTRATION： Thai clinical trial registry （TCTR20160510001）

Ineffectiveness of Skin Tests in Predicting Allergic Reactions Induced by Chinese Herbal Injections

Objective:To evaluate whether skin tests are suitable to predict the allergy reactions induced by Chinese herbal injections(CHIs).Methods:The skin tests including skin prick tests(SPT),intradermal tests(IDT)and provocation tests including subcutaneous tests and intravenous tests were administered to 249 healthy subjects and 180 allergic patients for 3 CHIs,including ginkgolide injection,diterpene ginkgolide meglumine injection and Salvianolate lyophilized injection.The results of the provocation tests were used as the"gold standard"to determine the sensitivity and specificity of the skin tests.Results:The results did not show any significant differences between the healthy and allergy groups in both skin tests and provocation tests(P>0.05).The specificities of SPT and IDT were 0.976 and 0.797,respectively,and the sensitivities of both SPT and IDT were 0.Conclusion:Skin tests are insufficient to predict the likelihood of allergic reactions resulting from CHIs.(ChiCTR-CPC-15006921)

Analysis of the chemoprophylactic effect on close contacts of patients with active tuberculosis and positive tuberculin skin tests

Objective:The current study analyzed the chemoprophylactic effect of isoniazide on close contacts of patients with active tuberculosis and positive tuberculin skin tests(TSTs).Methods:A total of 1206 close contacts of patients with active tuberculosis and strongly-pos-itive TSTs were enrolled.The patients had chest X-ray examinations.Patients without tuberculosis and other diseases were divided into the following groups:90 patients in the prophylaxis group,who were given 300 mg of isoniazid qd(3-5 mg/kg for children)over a 10-month treatment course;and 89 patients in the control group without drug therapy.Both groups were followed for 10 years.Results:(1)There were 568 patients with negative results and 638 with positive results,includ-ing 445 with ordinarily-and moderately-positive results,and 193 with strongly-positive results(a positive rate of 52.9%[638/1206]and a strongly-positive rate of 16.0%[193/1206]).Fourteen tuber-culosis patients were identified(tuberculosis detection rate of 1.1%).(2)During the 3-year period of follow-up,there were 4 patients in the prophylaxis group and 12 patients in the control group who acquired tuberculosis(a morbidity rate of 4.7%[4/84]and 13.4%[12/89],respectively),and the dif-ference was statistically significant(χ^(2)=3.916,P=0.048).Six patients in the prophylaxis group,all of whom were children,discontinued medication use during the course of treatment due to adverse drug reactions,for an adverse drug reaction occurrence rate of 6.6%(6/90),a medication completion rate of 93.3%(84/90),and a 3-year protection ratio of 64.6%.(3)During the 4-6 year period,there were two patients in the prophylaxis group and three patients in the control group who acquired tubercu-losis(a morbidity rate of 2.5%[2/78]and 4.1%[3/73],respectively),two in the prophylaxis group and four in the control group who were lost to follow-up(a loss to follow-up rate of 2.5%[2/80]and 5.1%[4/77],respectively),and the difference was not statistically significant(χ^(2)=0.006,P=0.940;χ^(2)=0.215,P=0.643).(4)During the 7-10 year study,there was one patient in the prophylaxis group and two patients in the control group who acquired tuberculosis(a morbidity rate of 1.3%[1/72]and 3.1%[2/64],respectively),and four in the prophylaxis group and six in the control group who were lost to follow-up(a loss to follow-up rate of 5.2%[4/76]and 8.5%[6/70],respectively),and the dif-ference was not statistically different(χ^(2)=0.011,P=0.918;χ^(2)=0.176,P=0.675).(5)Within 10 years,there were 7 patients in the prophylaxis group and 17 patients in the control group who acquired tu-berculosis(a morbidity rate of 8.3%[7/84]and 21.5%[17/79],respectively;χ^(2)=4.770,P=0.029),and 6 in the prophylaxis group and 10 in the control group were lost to follow-up(the loss to follow-up rate was 7.1%[6/84]and 11.2%[10/89],respectively;χ^(2)=0.863,P=0.353).Conclusion:Close contacts of patients with active tuberculosis are at high-risk for acquir-ing tuberculosis.It is safe and effective for patients with strongly-positive TST results to undergo isoniazid chemoprophylaxis for 10 months.

Food intolerance and skin prick test in treated and untreated irritable bowel syndrome

瞄准：相关临床的特征对待并且有到皮肤的结果的急躁的肠症候群(IBS ) 的未经治疗的病人为食物和被吸入的东西变应原刺测试(SPT ) 。方法：我们招募了 105 个对象形成三个不同目标组：为 IBS 经历治疗的对待的组(n=44 ) ，没有治疗，为 IBS 满足罗马 II 标准的未经治疗的组(n=31 ) ，没有 IBS 症状的控制组(n=30 ) 。结果：SPT 结果在在哪个 SPT 是积极的在里面(38.6%) 17 对待病人的三个组之中是不同的，在 5 (16.1%) 未经治疗的病人并且在 1 (3.3%) 控制(P【0.01 ) 。积极 SPT 的数字比在控制组(P【0.001 ) 在 IBS 组是更大的。积极食物 SPT 的数字比在未经治疗的 IBS 组(P=0.03 ) 在对待的 IBS 组是更高的。结论：积极食物 SPT 比在控制在 IBS 病人是更高的。

Comparison and Evaluation of Several Dermatophagoides Pteronyssinus Allergen Extracts for Skin Prick Test

Objective To evaluate the significance of several Dermatophagoides pteronyssinus allergen extracts for skin prick test(SPT) in patients allergic to Dermatophagoides pteronyssinus.Methods Two hundred and nineteen patients enrolled in Peking Union Medical College Hospital underwent SPT and serum specific IgE assay to detect the Dermatophagoides pteronyssinus allergen.Three kinds of house dust mite allergen extracts were used for SPT,including the Dermatophagoides pteronyssinus extract prepared by our laboratory(group A),standardized Dermatophagoides pteronyssinus extract(group B),and mixed extracts of Dermatophagoides pteronyssinus and Dermatophagoides farinae(group C).Human serum specific IgE result was regarded as the reference standard for diagnosis of Dermatophagoides pteronyssinus allergy.The receiver operating characteristic(ROC) curve was used to evaluate the diagnostic performance of SPT with the extracts of three groups.Results SPT results showed that the median wheal diameter of group A,group B,and group C was 0.43,0.35,and 0.28 cm,respectively,with significant difference among three groups(P<0.05).The difference was significant between group A and B(P<0.01) as well as group A and C(P<0.01),but not between group B and C(P>0.05).There was no local urticaria or systemic allergic reactions following the procedure of SPT.Local reaction was observed in 5 patients and delayed reaction was in 2 patients of group A.As for group B and C,local reaction occurred in 3 cases and delayed reaction in 2 cases in each group.The area under ROC curve of SPT with extract in group A,group B,and group C was 0.765,0.801,and 0.782,respectively.Based on the detection results of serum specific IgE,the sensitivity of SPT in diagnosis of Dermato-phagoides pteronyssinus allergy with extract of group A,group B,and group C was 92.4%,87.0%,and 81.5%,and the specificity was 60.6%,73.2%,and 74.8%,respectively.Conclusion The Dermatophagoides pteronyssinus extract for SPT prepared by our laboratory offers good sensitivity and specificity comparable to commercially available allergen extracts,and it may be an appropriate candidate for clinical screening and diagnosis of Dermatophagoides pteronyssinus allergy.

Discrepancies between the responses to skin prick test to food and respiratory antigens in two subtypes of patients with irritable bowel syndrome

AIM:To compare the response to skin prick tests (SPTs) to food antigens (FAs) and inhalant allergens (IAs) in patients with two subtypes of irritable bowel syndrome (IBS) and healthy controls. METHODS:We compared the results of SPTs for IAs and FAs in 87 volunteers divided into three groups:diarrhea predominant IBS (D-IBS) GroupⅠ(n = 19), constipation predominant IBS (C-IBS) Group Ⅱ (n = 17), and normal controls Group Ⅲ (n = 51). RESULTS:Of the 285 tests (171 for FAs and 114 for IAs) performed in GroupⅠwe obtained 45 (26.3%) positive responses for FA and 23 (20.1%) for IA. Of the 153 tests for FA in Group Ⅱ, we obtained 66 (20.1%) positive responses, and of the 102 tests for IA, we obtained 20 (19.6%) positive responses. Of the 459 tests for FA performed in Group Ⅲ, we obtained 39 (84%) positive responses, and of the 306 for IA, we obtained 52 (16.9%) positive responses. The numbers of positive responses were not significantly different between the three groups, but in the D-IBS group, the number of SPTFA responses differed significantly from those for the other two groups (P < 0.01). CONCLUSION:Despite the small number of cases studied, the higher reactivity to FAs in GroupⅠcompared to Groups Ⅱ and Ⅲ adds new information, and suggests the presence of a possible alteration in intestinal epithelial function.

Effectiveness of Virtual Reality for Pediatric Pain and Anxiety Management during Skin Prick Testing

This study investigated the effectiveness of virtual reality (VR) distraction, compared to comic book distraction and no distraction, in reducing pain and anxiety during a medical procedure in a pediatric population: the skin prick test. Although this test has many advantages and is considered to be minimally invasive, it causes anxiety and painful discomfort in children. Ninety-two children aged 7 to 17 years consulting for an allergic test received VR distraction, comic book distraction, or no distraction. Outcome measures included pain score, level of anxiety, and VR measures. The results showed that there were no significant differences between the three groups regarding sex, age, and preprocedural anxiety level. In the distraction groups (VR and comic book), children reported significantly lower pain and procedural anxiety scores than children with no distraction;VR distraction had a more significant effect than comic book distraction. A decrease in anxiety before and during the skin prick test is significantly more significant in VR distraction. This study suggested the effectiveness and feasibility of VR to reduce pain and anxiety during the pediatric skin prick test.

Skin Sensitive Difference of Human Body Sections under Clothing— Smirnov Test of Skin Surface Temperatures' Dynamic Changing

Skin sensitive difference of human body sections under clothing is the theoretic foundation of thermal insulation clothing design. By a new method of researching on clothing comfort perception, the skin temperature live changing procedure of human body sections affected by the same cold stimulation is inspected. Furthermore with the Smirnov test the skin temperatures dynamic changing patterns of main human body sections are obtained.

Anaphylaxis to Skin Prick Testing in a 29-Year-Old Woman

Introduction: Skin prick testing (SPT) is a common test to diagnose IgE sensitization and the rate of adverse reactions is very low. Case Presentation: 29-year-old woman with anaphylactic reaction to routine SPT with 11 allergens (aero and food). Discussion: Allergy profile included multiple food and inhalant allergies, polysensitization, prior episode of anaphylaxis to mushrooms, active eczema and active hay fever but not active asthma. Conclusion: Anaphylaxis to SPT, although a rare event, is unpredictable necessitating availability of appropriate personnel and adequate resuscitation facilities for all testing.

Preliminary Observation and Significance of Changes on Rash of Skin Prick Test during SLIT

Objective: To observe the changes on skin wheal and erythema of skin prick test for the patients with allergic rhinitis during SLIT. Methods: Since March 2010 the 103 cases of SLIT attacked by allergic rhinitis patients, divided into four age groups, respectively measured the diameter of skin wheal and erythema before treatment, six months, one year and 2 years after SLIT. The data were analyzed by analysis of variance method;P Results: The results showed that the most changes of skin erythema diameter were statistically significant in N1, N2, N3 age group during test observation compare with the data before SLIT (p Conclusion: Although most of the skin test wheal did not change significantly during the treatment of SLIT, the erythema reaction decreased to a certain extent, indicating that the intensity of histamine release may be reduced during the treatment.

基于改进YOLOv5的人体结核菌素试验后皮下硬块检测算法研究

针对传统皮下硬块检测方法精度低、计算速度慢等问题,提出了一种基于改进YOLOv5的皮下硬块目标检测算法。首先,将YOLOv5模型的主干网络CSPDarknet53进行改进,引入Faster模块来替换其中的C3模块。其次,利用模型剪枝在保证整个模型性能的同时减轻其计算复杂度。最后,引入Wise-IoU来进一步提升网络的回归性能。实验结果表明,基于改进YOLOv5的皮下硬块目标检测算法相比于原始的YOLOv5,准确率提升了1.2%,参数量减少了77.7%,整个算法更加轻量化,有效提高了算法对于皮下硬块的检测精度,减少了计算参数量,提升了算法的运行速度。

皮肤试验预测头孢菌素过敏反应的研究进展

头孢菌素是以7-氨基头孢烷酸(7-amino-cephalosporanic acid)为母核,通过连接不同侧链而形成的一类β-内酰胺类抗菌药物。通过不断迭代研发,头孢菌素在抗菌谱、抗菌作用和药物安全性等方面得到不断优化。然而,在临床使用过程中,头孢菌素仍会出现过敏反应等药物不良反应,国内一直以来都是通过皮肤试验进行预测,但相关研究对皮肤试验的预测和应用价值是存在质疑的。为此,笔者从β-内酰胺类药物致过敏反应的分子机制和影响因素、皮肤试验的经济学价值、国内外头孢菌素的皮肤试验开展现状等方面对相关研究进行了综述,为临床评估皮肤试验对头孢菌素过敏反应的预测价值和应用前景提供参考。

心理性勃起功能障碍患者的阴茎交感皮肤反应表现分析

目的探讨心理性勃起功能障碍(ED)患者的阴茎交感皮肤反应(PSSR)的变化。方法选取因非创伤性ED收住院分别进行夜间阴茎胀大试验(NPT)及阴茎神经电生理检查的患者96例作为研究对象,将NPT结果显示有单次阴茎勃起头部硬度≥60%的时间≥10 min的有效勃起患者68例纳入心理性ED组,以至少连续两晚均未出现有效勃起患者28例纳入非创伤性器质性ED组。比较两组年龄、身高、体重、病程、检查天数、有效勃起总次数、第一天有效勃起次数、第二天有效勃起次数、第三天有效勃起次数、阴茎头部硬度≥60%的维持时间、阴茎根部硬度≥60%的维持时间、头部膨大周径、根部膨大周径、阴茎神经电生理检查结果PSSR潜伏期及波幅。结果两组身高、体重、病程、检查天数、PSSR波幅比较,差异均无统计学意义(P>0.05)。心理性ED组年龄小于非创伤性器质性ED组(P<0.01),而有效勃起总次数、第一天有效勃起次数、第二天有效勃起次数、第三天有效勃起次数、阴茎头部硬度≥60%的维持时间、阴茎根部硬度≥60%的维持时间、头部膨大周径、根部膨大周径均高于非创伤性器质性ED组(P<0.01),PSSR潜伏期短于非创伤性器质性ED组(P<0.01)。结论心理性ED患者PSSR潜伏期缩短,交感神经兴奋性可能偏高,PSSR检测可作为一种辅助方法用于心理性ED的评估。

肺结核患者家庭内学生密切接触者结核分枝杆菌感染状况调查

目的:分析肺结核患者家庭内学生密切接触者结核分枝杆菌感染状况及其影响因素。方法:以2021年1月1日至12月31日在江苏省宝应县和张家港市、湖北省宜都市、重庆市彭水苗族土家族自治县和云南省昭通市昭阳区5个县(区)登记的活动性肺结核患者家庭内学生密切接触者为研究对象,开展结核菌素皮肤试验(tuberculin skin test,TST),调查人口学特征,并通过全民健康保障信息化工程疾病预防控制信息系统收集其指示病例的基本信息和诊断信息,分析结核分枝杆菌感染的相关因素。结果:477例指示病例共有686名家庭内学生密切接触者,TST检测总体接受率为92.27%(633/686),各县(区)之间的接受率差异有统计学意义(χ^(2)=57.781,P<0.001),以宝应县为最高(100.00%,35/35)。家庭内学生密切接触者总体感染率为14.85%(94/633,95%CI:11.85%~17.85%),强阳性率为5.06%(32/633),各县(区)之间的差异均有统计学意义(χ^(2)=35.800,P<0.001;Fisher确切概率法,P=0.029)。单因素分析结果显示,≥15岁年龄组[23.47%(23/98);95%CI:13.88%~33.06%]、就读于高中及以上学校[26.09%(18/69);95%CI:14.04%~38.14%]、住在宜都市[33.33%(28/84);95%CI:20.99%~45.68%]、指示病例诊断延迟[18.37%(52/283);95%CI:13.38%~23.37%]的家庭内学生密切接触者感染率更高;多因素logistic回归分析显示,在调整混杂因素后,指示病例诊断延迟的家庭内学生密切接触者的感染风险是指示病例无诊断延迟者的1.586倍(95%CI:1.016~2.476)。结论:活动性肺结核患者家庭内学生密切接触者的结核分枝杆菌感染率较高,尤其是指示病例诊断延迟的家庭内学生密切接触者,应及时开展筛查并采取后续干预措施。