Clinical evaluation of a new non-radiometric automatic system for the rapid diagnosis of tuberculosis

BACKGROUND: Tuberculosis (TB) is again a public health problem un many countries and is considered a re-emerging disease. The fastest possible diagnosis in our patients is essential for TB control programs. ESP is a non-radioactive, totally automated, continuously monitored system designed to detect mycobacteria. METHODS: Clinical evaluation of this new system for the rapid diagnosis of tuberculosis. During 1997 a total of 1,022 clinical sputum specimens were investigated. Specimens were processed in triplicate for ESP, BACTEC 460 TB and L?wenstein-Jensen systems. The validity, isolates of Mycobacterium tuberculosis and time required for detecting M. tuberculosis by the three systems were determined. RESULTS: The sensitivity, specificity, positive predictive and negative predictive values of the new systems were 98%, 99.8%, 98% and 99.8%, respectively. No significant differences were found between the recovery rates by the three systems. The mean time for detection was 10 days (range: 7-13 days) for specimens with positive bacilloscopy and 14 days (range: 10-28 days) for specimens with negative bacilloscopy. The difference was statistically significant between ESP and L?wenstein-Jensen, but not between ESP and BACTEC. CONCLUSIONS: The new system proved to have an excellent sensitivity and specificity, which along with its total automation renders it a system of great clinical interest for the rapid diagnosis of TB and an alternative method for radiometric systems.     

A novel culturing and grafting system for the treatment of leg ulcers

The purpose of this study was to develop and test an efficient culturing and grafting system for the treatment of leg ulcers. The culturing system consisted of a Petriperm culture vessel (20 cm2) aseptically placed in a larger standard Petri dish (60 cm2). Skin cultures were established and cultivated in the Petriperm dish. The cells grew on the bottom of the Petriperm dish, which was made of a gas-permeable 25-micron thick transparent Teflon film. Grafts were produced simply by cutting the film from the bottom of the Petriperm dish with a scalpel. The system was used to produce subconfluent epidermal autografts which were used to heal a 32 cm2 chronic rheumatoid arthritis leg ulcer. The cultured autografts were transferred cell side down on to the cleaned wound bed without an enzymatic digestion. The grafts consisted of autologous keratinocytes, melanocytes and fibroblasts. Caution was taken not to disturb the wound bed for 7-9 days at which time the Teflon film was removed. The wound closed 2 weeks after the last grafting and has remained closed for more than a year post-treatment. The culturing and grafting system presented here will make it possible to develop cellular-based therapies that were previously not possible.     

三电系统工程设计阶段划分及工作内容

提出了由计算机系统、电气传动系统、自动化仪表系统组成的三电系统设计阶段划分的方法及各阶段的主要任务和工作要点,以适应现代化大中型工程自动化系统设计的需要。还介绍了三电系统调试步骤及要求。     

Clinical evaluation of polymerase chain reaction DNA amplification method for the diagnosis of pulmonary tuberculosis in patients with negative acid-fast bacilli smear

The nucleotide sequences of 3 cDNA clones corresponding to entire RNA genome of bean common mosaic virus NL3 strain have been determined. The RNA is 9612 nucleotides long, excluding a 3'-terminal poly(A) tail. A putative start codon located at nucleotide positions 170-172 initiates one large open reading frame that is terminated with a UAA codon at position 9368-9370. The predicted polyprotein has 3066 amino acids and an M(r) of 340.3 kDa. The positions of putative protein cleavage sites have been determined by analogy to consensus sequences in other potyviruses. The nucleotide sequences of the non-translated regions and the predicted amino acid sequences of BCMV NL3, were compared with those of other potyviruses. Comparison of the BCMV NL3 proteins with those of other potyviruses indicated a similar genomic organization, and high percentage of amino acid sequence identity in the cylindrical inclusion protein, nuclear inclusion 'b' protein and coat protein. BCMV NL3 displays the highest amino acid sequence identity with soybean mosaic virus.     

一种新型静止无功补偿装置控制系统及其应用

提出一种基于Simadyn-D控制器的全数字静止无功补偿装置(SVC)控制系统。在该控制系统中实施了基于瞬时无功理论的瞬时功率和瞬时电流的检测算法以及一种开闭环相结合的复合控制策略。该SVC控制系统已经在首钢等多项SVC工程中得到了成功的应用。     

The pathoanatomical,diagnosis of progressive forms of pulmonary tuberculosis in relation to the new clinical classification

This communication is a letter of information that gives for postmortem diagnosis a brief account of tuberculous inflammation and major types of pulmonary tuberculosis during their progression to death and an approximate outline of pathoanatomical diagnosis. Terminal tuberculosis is shown to be now complicated by miliary and caseous pneumonias. Caseous pneumonia may appear as an independent nosological entity and as a complication of acute progression, more frequently, of fibrocavernous tuberculosis. Caseous pneumonia as a tuberculosis type is an irreversible process that calls for emergency surgical treatment. It has been found that there are primarily impairments in lung connective tissue function, acute mesenchymopathy with high blood barrier permeability in caseous pneumonia. Terminal bronchiolar lesion is a later stage in the pathogenesis of caseous pneumonia.     

Evaluation of the MB/BacT system and comparison to the BACTEC 460 system and solid media for isolation of mycobacteria from clinical specimens

The MB/BacT automated system is designed for the isolation of mycobacteria from clinical specimens. It utilizes a colorimetric sensor and reflected light to continuously monitor the CO2 concentration in the culture medium. We compared its performance to that of the BACTEC 12B media for the radiometric BACTEC 460 instrument and that of solid culture media. Respiratory specimens and urine samples were decontaminated with 4% NaOH. The vials of the two instruments were inoculated with 500 microl of sample and two solid egg-based media at 200 microl each. All vials were incubated at 37 degrees C for 6 weeks. A total of 1,078 specimens (633 respiratory specimens, 78 cerebrospinal fluid specimens, 177 other body fluid specimens, 87 urine specimens, and 103 other types of specimens) were cultured in parallel. Mycobacteria could be identified from 73 (6.8%) specimens: 67 M. tuberculosis, 3 M. kansasii, 1 M. xenopi, 1 M. terrae, and 1 mixed M. avium with M. scrofulaceum. Of these, 63 (86.3%) specimens were positive with the MB/BacT system, 67 (91.8%) were positive with the BACTEC 460 instrument, and 58 (79.5%) were positive with the two egg-based media. MB/BacT cultures were positive on average after 17.5 (+/-6.4) days, BACTEC cultures with a growth index of >20 (mean, 200) were positive after 14.3 (+/-8.2) days, and egg-based media were positive after 24.2 (+/-7.5) days. Microorganisms other than mycobacteria contaminated 46 (4.3%) MB/BacT cultures and 31 (2.9%) BACTEC cultures, which had to be discarded. The MB/BacT system is a well-automated system for the detection of M. tuberculosis in clinical specimens without using radioactive reagents. Further trials are required to determine whether it is suitable for the culture of nontuberculous mycobacteria.     

Troponin T and creatinine kinase isoenzyme MB mass in the diagnosis of myocardial infarction

The aim of this study was to compare troponin T (TnT) and creatine kinase isoenzyme MB mass (CK-MBm) with conventional enzymes, ie CK, CK-MB activity and lactate dehydrogenase isoenzyme 1, in the diagnosis of myocardial infarction (MI). 624 patients (351 men and 273 women, median age 69 years) were admitted to hospital with suspicion of an acute coronary heart disease event. TnT was elevated (> 0.10 microg/L) in 100%, CK-MBm (> 5.0 microg/L) in 99%, and both markers in 99% of the 89 patients with the diagnosis of a definite MI according to modified FINMONICA criteria. In the 60 patients with the diagnosis of a probable MI, TnT was elevated in 65%, CK-MBm in 67% and both markers in 60%. In the patients with unstable coronary artery disease (unstable angina or prolonged chest pain attack) and conventional enzymes within normal limits, TnT was elevated in 14%, CK-MBm in 17% and both markers in 9%. The use of TnT and CK-MBm did not lead to a major change in the diagnostics of definite MI. However, TnT and CK-MBm did not confirm the diagnosis of probable MI in one-third of the events. These new markers revealed a myocardial injury in about 15% of those patients who had unstable coronary artery disease and conventional enzymes within normal limits.     

A new, more invasive approach in the radiation diagnosis of breast cancer

The authors discuss the state-of-the-art techniques and the increasingly invasive approach to the diagnosis of breast diseases and also summarise their own experiences. Special attention is called to the nonpalpable, preclinical stage of breast cancers. The newest techniques like MR-mammography, stereo-taxic and ultrasound directed cytology and core biopsy are demonstrated, as well as the present place of traditional breast imaging methods: mammography and diagnostic ultrasound. The preoperative localisation of nonpalpable cancers improves the safety of surgical procedures. The authors emphasize the importance of the detection of early breast cancer, for the sake of a more favourable prognosis compared to that of the palpable, advanced cases. The results of mass screening is detailed, based on statistical data.     

Ascariasis of the alimentary tract, liver, pancreas and biliary system: its diagnosis by ultrasonography

BACKGROUND/AIMS: The purpose of this study was to describe the echographic features of Ascaris lumbricoides invasion of the alimentary tract, biliary system, liver and pancreas. METHODOLOGY: We studied 38 patients with roundworm heavy infection whose diagnosis were primarily supported by ultrasonographic examination. RESULTS: Thirty-seven patients were admitted with the following clinical complications: bowel obstruction, intra and extrahepatic dilatation, acute cholecystitis, intrahepatic abscess, acute appendicitis, subphrenic collection and acute pancreatitis. Ultrasound scanning was able to recognize in 30 cases the echogenic, nonshadowing images of the worms as single or multiple strips; in 8 cases, coiled structures and amorphous material were detected. The "inner tube" sign was considered as the most specific one. In two cases the roundworms were displayed within the stomach, a curious finding, up to now never reported in medical literature. CONCLUSIONS: Real-time sonography represents an efficient, reliable and non-invasive diagnostic approach for hepatobiliary, enteric and pancreatic ascariasis.     

A potentially powerful new tool for noninvasive diagnosis of cardiac abnormalities: the CUPID system for analysis of electrocardiograms in the frequency domain

Clinical correlation of frequency-domain characteristics of electrocardiograms with specific disease entities of thousands of patients has produced a simple, noninvasive diagnostic system capable of detecting many cardiac abnormalities with specificity and sensitivity exceeding 90%. This system, a proprietary product called CUPID, is now undergoing clinical trials in Europe, South America, and the United States. The author discusses the physiologic basis of electrocardiography and the development of the CUPID system, and reviews the results of the trials that have been completed. The system appears to hold promise for fast, inexpensive, and accurate screening of patients for cardiac disease without somatic invasion.     

The possibilities for improving the serological diagnosis of active tuberculosis by using new mycobacterial antigens and immunoblot and ELISA technics

The study concerns 264 cases among which: 119 active lung tb. eliminating and 11 cases not-eliminating M. Tuberculosis; 17 cases of extrarespiratory tb. confirmed by bacteriology and/or by anatomopathology; 18 cases of bone-joint non-tb disease; 38 cases of chronic lung disease other than tb; 61 healthy persons (controls). Sera from these cases were collected before treatment and submitted concomitantly to two different methods: (1) Mycodot test (immunoblot) with lipoarabinomannan (LAM) as antigen, on nitrocellulose discs (Dynagen, Cambridge, MA, USA); (2) ELISA test with antigen 60 (A60) (ANDA-Biologicals, Strasbourg, France) and with antigen I.C. (Cantacuzino Institute, Bucharest). The results were estimated on terms of sensitivity and specificity. As for sensitivity the results show 74-90%. the highest values were reached in ELISA with A60 IgA. The specificity of the Mycodot test was highest: 90-100% in the two successive experiments. The active tb diagnosis discrimination capacity of the studied methods allows the following classification: 1. Mycodot test with LAM antigen 2. ELISA with A60-Ig G complex 3. ELISA with I.C. antigen The Mycodot test is more advantageous being more rapid and more simple to perform.     

Slide agglutination test for the diagnosis of pulmonary and extra-pulmonary tuberculosis

Nasal polyposis can be defined as a chronic inflammatory disease of the paranasal sinus mucosa, leading to a protrusion of benign edematous polyps from the meatus into the nasal cavities. Nasal polyps are histologically characterized by massive edema and accumulation of eosinophils. IgE-mediated allergy seems to play only a minor role in eosinophil accumulation, leaving the place for a new concept of non-allergic rhinitis with eosinophilia. The central question still remains, however, why eosinophils accumulate into nasal polyposis tissue. Some initial data show that tissue structural cells, i.e. epithelial cells or fibroblasts, could produce cytokines (GM-CSF) and play a role in eosinophil accumulation (micro-environmental theory). However, further studies showed, that GM-CSF was mainly produced by eosinophils themselves (autocrine theory), leading to the hypothesis of an intrinsic eosinophilic inflammatory process. Eosinophils may contribute to nasal polyp formation and growth not only through inflammation but also by exerting their effects on extracellular matrix including stimulation of collagen synthesis. Another feature associated with nasal polyposis is aspirin sensitivity. Some preliminary data indicate that eosinophils could also be involved in aspirin-sensitivity mechanisms.     

A new bronchoscopic technique for the diagnosis of bacterial pneumonia in HIV-positive patients

The aim of the present study was to evaluate in HIV-positive patients with bacterial pneumonia, the diagnostic value of a new endoscopic technique that uses a single catheter to perform a telescopic plugged catheter (TPC) followed by a modified protected bronchoalveolar lavage (mpBAL). Fifty-eight HIV-positive patients with respiratory infection were included in the study. Samples from TPC and mpBAL were cultured quantitatively. Standard bronchoalveolar lavage was performed to rule out opportunistic infections. According to the clinical and microbiological results, patients were classified in the study group (27 with bacterial pneumonia) or the control group (31 without bacterial pneumonia). Sensitivity of TPC was 56% [95% confidence intervals (CI) 37-75%] and its specificity was 100%; these figures were 56% (CI, 37-75%) and 94% (CI, 86-100%) for mpBAL. When both techniques were assessed together, sensitivity increased to 70% (CI, 53-87%). The use of a single catheter reduced the cost of the originally described pBAL procedure by approximately 50%. The use of a single catheter to perform a TPC followed by a mpBAL can improve the diagnostic yield in HIV-positive patients with bacterial pneumonia, and reduces its cost.