Agreement between CBNAAT,liquid culture and line probe assay for detection of Mycobacterium tuberculosis and anti-tubercular drug resistance in extrapulmonary samples

PurposeCartridge based nucleic acid amplification test (CBNAAT) has been endorsed by the WHO as the screening test for diagnosing extrapulmonary tuberculosis (EPTB). In the present study we report the agreement between CBNAAT (Xpert MTB/RIF), liquid culture (LC) and line probe assay (LPA) for diagnosis of Mycobacterium tuberculosis and detection of drug resistance among EPTB cases.MethodsThe EP samples were subjected to CBNAAT (Xpert MTB/RIF, Cepheid, USA) and wherever possible, to LC (MGIT 960, Becton Dickinson, USA) followed sequentially by first line and second line-LPA (FL-LPA, SL-LPA, Hain Lifescience, Germany) on the isolates.ResultsTotal 566/4080 (13.9%) EP samples were detected positive for M. tuberculosis on CBNAAT. Aspirates from lymph nodes were most often positive (11/30; 36.6%), followed by pus (240/873; 27.5%) and CSF samples (166/104; 15.8%). The detection of M. tuberculosis was more in adults than children except in tissue biopsy samples. Rifampicin resistance was also higher among adults except CSF in which resistance was more in children. Total 185 of 566 (32.7%) CBNAAT positive and 770 of 3510 (21.9%) CBNAAT negative samples could be cultured of which 110/185 (59.4%) and 33/770 (4.3%) respectively turned positive. FL-LPA and SL-LPA of 143 culture isolates showed that 27 isolates had drug resistance, of which 3 (2.1%) were XDR, 11 (7.7%) were Pre-XDR (FQ) and 13 (9.1%) were MDR. Of these 27 resistant isolates, 12 were negative by CBNAAT and two were mislabeled as Rifampicin sensitive or indeterminate based on the unique RpoB gene mutation patterns on LPA. The positive and negative agreements between LC and CBNAAT for detection of M. tuberculosis were 67.1% and 92.7% respectively and between LPA and CBNAAT for rifampicin resistance detection were 98.9% and 92.9% respectively.ConclusionsFor EPTB, CBNAAT should be accompanied with LC wherever possible irrespective of the CBNAAT result.     

U波倒置40例临床分析

U波倒置40例,其中孤立性U倒16例(40％),复合性U倒24例(60％)。U波倒置常见于左心前导联V_5V_6,呈现左室肥厚及负荷加重,心电图示“左室劳损”型。U波倒置严重合并症,除心力衰竭外,还有急性心肌梗塞和室性期前收缩。笔者认为,通过本文分析,UV_5倒置对临床诊断冠心病,高血压等是有价值的。     

What we know and don't know about the development of independent ingestion in rats

Because suckling behavior differs in many ways from later ingestive behavior, the development of feeding and drinking in rats is best studied apart from the normal suckling situation. Newborn rat pups, separated from their mothers, will actively ingest diet infused into their mouths or spread on the floor beneath them. Such "independent" ingestion resembles the ingestive behavior of adult animals, but it also undergoes developmental changes in organization and control during the pre- and post-weaning periods: When young, deprived pups are fed, they show generalized, non-directed behavioral excitement; but with increasing age, this generalized responding matures into directed and focused ingestive activity. Early independent ingestion depends on a warm test environment; but with development, other familiar environmental and social cues come to influence responding. The internal controls of ingestion also change. Only gastric distension and hydrational status seem to be involved in controlling intake volume during early ingestion, with other ingestive controls emerging later in development. Thus ingestion, independent of suckling from the mother, is a system undergoing revealing developmental changes. These changes offer opportunities for studying ingestion, its controls, and its neural basis at its simplest organizational stage in the newborn, and at higher levels of complexity as maturation adds new components to the feeding system.     

Dietary fat intake and taste responses to fat in milk by under-, normal, and overweight women

Dietary fat intake, with special emphasis on dairy products, was estimated from questionnaires for 42 underweight, 80 normal weight, and 64 overweight adult women. Frequency of consumption of fresh and processed meats, frozen dairy desserts, pastries, and snacks such as potato chips was greater for the overweight than for the underweight subjects. However, preferences between verbally-described high- and low-fat versions of 14 food pairs did not differ by body size. Overweight subjects reported that they consumed more non-fat milk and less whole milk than did the other groups. Discrimination, perceived intensity, paired preference, and hedonic rating of fat in milk and in chocolate milk did not differ significantly according to body size, fat intake, or type of milk consumed. Ad libitum mixing of non-fat milk and "half and half" (12% fat) to individual levels of liking also showed no significant variation with body size. However, subjects with higher dietary fat intakes mixed to higher fat-preference levels in milk than did the low- and medium-fat intake subjects. Those reporting consumption of regular milk (3.5% fat) mixed to higher fat levels than did those who consumed low-fat (2% fat) or non-fat milk. The ad libitum procedure gave better reproducibility and appeared to be a more realistic measure of liking than the hedonic rating or paired-preference tests.     

Effects of female sterilization: one year follow-up in a prospective controlled study of psychological and psychiatric outcome

A prospective controlled study of the psychological effects of elective interval and postpartum tubal sterilization was carried out on a selected sample of women. Subjects were interviewed pre-operatively (n = 138) and one year post-operatively (n = 116; 83%), using standardized instruments and procedures, including the Present State Examination. No differences within or between sterilization and control groups were found over the follow-up year in the prevalence of psychiatric morbidity, which was no higher than would be expected in a general population sample. Beneficial effects of sterilization were reported on a number of psychosexual variables. Adverse effects such as regret or deterioration in marital relationship were rare, but were more likely to occur in postpartum subjects, among whom abdominal pain was also reported more commonly at one year follow-up than pre-operatively. The relevance of "normal" postnatal events and of the role of pre-operative counselling are considered in relation to these findings. Less favourable outcome at one year follow-up was commonly associated with higher PSE scores pre-operatively.     

Effects of different speeds of induction with sevoflurane on the EEG in Man

The effects of two kinds of induction speed of sevoflurane anesthesia on the EEG pattern were compared in the same individual using medical student volunteers: a first exposure of 4% was given, followed after full recovery, by incremental doses of 1, 2 and 4% successively, each being administered for 10min. The arterial blood level of the anesthetic was measured using gaschromatograph. The changes of EEG pattern during fast induction with 4% were not represented by the abbreviation of those observed during the slow induction with the incremental doses. The administration of 4% induced a sudden appearance of high voltage, rhythmic slow waves of 2–3Hz at 1–3min when the arterial blood anesthetic level increased maximally, which was then followed by a pattern of faster activities of 10–14Hz mixed with 5–8Hz slow waves. In contrast, the administration of incremental doses induced an increase in frequency and amplitude of EEG activities in the light plane, followed by their decreases in deeper planes. The final EEG patterns were identical for both these methods of induction. These findings confirmed our previous hypothesis that not only the arterial blood level of anesthetics but the rate of its increase are important factors determining the EEG pattern of anesthesia.(Avramov MN et al.: Effects of different speeds of induction with sevoflurane on the EEG in man. J Anesth 1: 1–7, 1987)     

Are eye movement evoked potentials different from pattern reversal evoked potentials?

The averaged lambda wave elicited by saccadic eye movements across a checkerboard pattern has been reported to differ from checkerboard reversal evoked reponses, even when the electroencephalographic responses were corrected for the artefact caused by the movement of the dipole moment of the eye itself. Because of these differences it was suggested that the recording of the lambda wave might provide extra information in pathological circumstances. We performed experiments in which the parameters of the pattern (high contrast checkerboard pattern, 20 checks, large field 72 × 72 degrees) shift across the retina were carefully adjusted. For instance, eye movements were made across an integer and odd number of checks in order to mimic the pattern reversal. Furthermore, the timing of the pattern movement in the pattern reversal condition was adjusted so as to simulate the saccadic eye movement. The results seem to suggest that the reported dissimilarities between pattern reversal and eye movement evoked responses can be accounted for by the small differences of the retinal shift in the two conditions.     

Time of day influences food acceptability

To determine whether a food's acceptability changes with time of day and degree to which a food is appropriate for a given mealtime, preferences were obtained both in the morning and the afternoon for a set of foods which included items appropriate "for breakfast", "for dinner", or for either mealtime. A second purpose of the study was to determine whether such cultural rules regarding food appropriateness had been acquired by preschool children and whether the pattern of shifting acceptability with time of day predicted for adult subjects would also appear in the preference data of the children. Participants included 25 adults and 30 three- and four-year-old children. All subjects were seen twice, once in the morning and once in the late afternoon for two identical sessions. Half of the subjects in each age group were seen first in the morning, half were seen first in the afternoon. In these sessions food preferences for the set of foods varying in mealtime appropriateness were assessed and the foods were categorized as "for breakfast" of "for dinner". The preference data of both the adults and the children showed significant preference shifts with time of day, with breakfast items more preferred in the morning than the afternoon and dinner items more preferred in the morning than the afternoon. These shifts were larger for adults than for children but not significantly so.     

松质骨中两种纵波的传播特性分析

基于松质骨的层状模型，利用Schoenberg理论分析了松质骨中两种纵波(快纵波和慢纵波)的传播特性；并在理论和实验上详细分析了骨小梁方向与传播方向间的夹角对松质骨中快纵波和慢纵波传播特性的影响。分析结果表明，当超声波平行于骨小梁入射时，松质骨中两种纵波都传播，入射角度在60度附近时，松质骨中两种纵波的相速度曲线有一个转折点，入射角度在60度以上，角度越大时，骨髓和骨小梁耦合得越紧，因此阻止了慢纵波的传播，而只有快纵波传播。