Objective To understand the characteristics and related factors of adverse reactions (ADR) of anti-tuberculosis drugs among Zhuang nationality patients with smear-positive pulmonary tuberculosis (TB) and to provide basis to ADR control.Methods During Dec 2007 to May 2008,408smear-positive pulmonary TB cases of Zhuang nationality in 14 counties were selected by simple random sampling,and followed up for 6-8 months.Questionnaires were performed and liver/renal functions were tested during the research.Data were analyzed by chi square test and Logistic regression model.Results The incidence of ADR of Zhuang nationality people was 17.2％,which was higher than national level ( 12.62 ％ ).The incidence of allergic reaction was highest of all ADR ( 5.9 ％ ) and the incidences among different types of ADR were significantly different ( x2 =36.9,P=0.000).Serious ADR types were allergic reaction,gastrointestinal reaction,liver damage,nerve damage and kidney damage.And 24.3 ％ of the cases had two or three kinds of ADR.ADR occurred at the median of 21.5th day of anti-TB treatment,and the gastrointestinal reaction occurred the earliest (6th day).81.4 ％ of the ADR occurred in the first 2 months of anti-TB treatment.The rates of drug withdrawal and interruption were 11.5 ％ and 9.2 ％,respectively.Liver damage and nerve damage were the main causes of treatment withdrawal and interruption.Multiple factor non-conditional Logistic regression analysis showed that the ADR was correlated with age and the risk of ADR in ≥60years old patients was 3.3 times of that in 14-34 years old patients (OR=3.275,P=0.006).Thus,ADR incidence was increased with aging.Conclusions The incidence of ADR is higher in Zhuang nationality patients than that in general patient population.ADR monitoring and intervention must be strengthened in high-risk groups during high-risk period to reduce the adverse effect of anti-TBtreatment.

Objective To study the anxiety and depression in patients with amyotrophic lateral sclerosis(ALS).Method One hundred and seventy-four ALS patients were evaluated by self-rating anxiety scale(SAS)and self-rating depression scale(SDS) to study the anxiety and depression in them.Results In 174 ALS patients,21 had anxiety(12.07%)and 65 the depression(37.36%). The scores of SAS and SDS in the ALS patients were significantly higher than the national norm(P<0.05).The depression incidence in the female patients was significantly higher than the male(P<0.05).Conclusions Anxiety and depression are more severe than those in ALS patients than those in normal people.Psychological support is important for these patients,especially for those female patients.

Objective To establish a method to simultaneously determine syringing and isofraxidin by HPLC;To investigate the features of percutaneous absorption in vitro of Jiegugao blended and pasted by white vinegar, honey and vaseline; To discuss the mechanism of commonly used ointment matrices in Tujia Minority. Methods Rat abdomen skin in vitro was as transdermal barrier;the modified Franz diffusion pool was used to simulate human skin medication; the content of syringin and isoprofen was determined by HPLC; the percutaneous absorption equation was established and the related parameters, such as cumulative permeation rate and permeation rate, were calculated. Results When using Syncronis C18 (250 mm × 4.6 mm, 5 μm) as chromatographic column, acetonitrile-0.1%phosphoric acid as mobile phase, 1.0 mL/min as perfusion speed and 265 nm as determine wavelength, regression equation of syringingwas A=10 686.454 6C+1565.778 8 (r=1.000 0), regression equation of isofraxidin was A=12 297.305 4C-5913.729 9 (r=0.999 9). Cumulative permeation quantity of syringing in Jiegugao blended and pasted by white vinegar, honey, vaseline and blank were 7.549 2, 4.580 3, 3.890 8 and 5.378 4 μg?cm-2?h-1 respectively and permeation rate were 25.66%, 16.11%, 13.73% and 18.78%. Meanwhile, cumulative permeation quantity of isofraxidin were 2.536 9, 1.941 8, 1.178 2 and 2.293 6 μg?cm-2?h-1 respectively and permeation rate were 47.04%, 35.06%, 22.11%and 41.11%. Conclusion Using white vinegar as the ointment matrix can promote the percutaneous absorption of effective composition in Jiegugao blended. However, it will retard the percutaneous absorption of effective composition in Jiegugao when using honey and vaseline as the ointment matrices, but honey and vaseline can be used as a slow-release matrix.

Objective To examine the reliability and validity of compensative neurosis assessing scale (CNAS) and in order to develop the quantitative assessing method for distinguishing the compensation neurosis from malingering and typical neurosis. Methods The reliability and validity of the scale was tested based on the subjects including the cases involved forensic problems, the patients with typical neurosis in general psychiatric 0.944. The test-retest reliability was more than 0.820. The scorer reliability was more than 0. 812. The total accu-racy rate of CNAS for evaluating three groups of subjects based on the experts diagnosis, and with 91.2% of speci-ficity and 79.3% of sensitivity for evaluating compensation neurosis. Condusion The CNAS has acceptable psy-chometrics properties on reliability and validity. It will provide method to distinguish the compensation neurosis from malingering and typical neuroses.

AIM: To investigate the effect of ulinastatin plus thymosin - a, therapy on improving immune function in septic patients. METHODS: 70 patients were divided into two groups. One group was classical treatment group ( CT) with regular therapy and another group was classical treatment plus immunotherapy group ( CIT) with ulinastatin plus thymosin -a, for a week. The immune index before and after treatment on day 0,1,3 and 7 was observed, including the clinical and survival data. RESULTS: The most common pathogen of sepsis was bacteria, and infection by fungi was in rare. The common locations of bacteria observed were sputum and abdominal drainage. The level of TNF - α was significant lower in CIT group than that in CT group (P <0.05). IL - 10 level was significantly higher in CIT group than that in CT group (P < 0.05 ). IgG level was significant lower in CIT group than that in CT group (P < 0.05 ). No significant difference in the levels of IgA, IgM, C_3 and C_4 between two groups was observed (P > 0.05 ). CD4~+ T lymphocytes were significant higher in CIT group than those in CT group (P < 0.05 ). From day 7 to day 28, the lymphocytes and level of HLA -DR in CD14~+ monocytes were significant higher in CIT group than those in CT group (P < 0.05). The time of mechanical ventilation and vasopressors used in CIT group was shorter than those in CT group ( P < 0.05 ). But the length of stay and the cost in ICU showed no significant increase between these two groups (P >0.05). During hospitalization, 20 patients died in the CT group and 13 patients died in CIT group ( P < 0.05 ). The long - term survival time in CIT group was longer than that in CT group ( P < 0.05 ). CONCLUSION: Immunotherapy in septic patients can decrease TNF - α level and increase IL - 10 level. Immunotherapy in septic patients can increase IgC level slightly, CD4~+ T lymphocyte, and HLA - DR in CD14~+ monocytes, which improve the immune paralysis in septic patients. Immunotherapy can shorten the time of mechanical ventilation and vasopressors used, but it doesn't increase the length of stay and the cost.

Objective:To explore the association between HLA-DR,DQ allele polymorphisms and onset of epidemic hemorrhagic fever(EHF)among Han Nationality in Zunyi area.Methods:Using group study,HLA-DR and DQ genotyping was conducted in 100 EHF cases and 100 controls among Han Nationality in Zunyi area with polymerase chain reaction-sequence specific primer(PCR-SSP),GF(gene frequency)and RR(relative risk)were calculated and compared.Results:The frequency of HLA-DRB1 16 in patients with EHF was higher than in the control group(RR=3.58,?2=4.916,P=0.0266

Objective To study the effect of immunomodulation on improvement of immune function and prognosis in sepsis in rats,and its mechanism.Methods Experimental part: cecal ligation-perforation(CLP) models were divided into three groups including sham group(n=20),control group(n=20) and experimental group(n=20).Control group only used antibiotic and experimental group used antibiotic plus immunomodulation.Blood collections were made after CLP model at 3,12,48 and 72hr.Lymphocyte counting,CD4+,CD8+ T lymphocyte and CD4/CD8 ratio were checked.The apoptosis of lymphocyte in thymus and spleen and survival rate were checked.Clinical part: Prospective analysis of seventy patients who conformed to the sepsis standard.They were divided into two groups randomly.One was control group with regular therapy,and the therapy group with ulinastatin plus thymosin-?1 for 7days.The immune index before and after therapy at 0,1d,3d,and 7d was observed,including the clinical changes and survival data.Results Experimental part: Lymphocytes,CD4+ T lymphocytes and CD4/CD8 ratio in experimental group increased more significantly than in control group(P

ObjectiveTo assess the value of passive leg raising (PLR) test in predicting fluid responsiveness in patients with sepsis-induced cardiac dysfunction.Methods A prospective observational cohort study was conducted. Thirty-eight patients under mechanical ventilation suffering from sepsis-induced cardiac dysfunction admitted to Department of Surgical Intensive Care Unit of First Affiliated Hospital of Sun Yat-Sen University from September 2013 to July 2014 were enrolled. The patients were studied in four phases: before PLR (semi-recumbent position with the trunk in 45°), PLR (the lower limbs were raised to a 45° angle while the trunk was in a supine position), before volume expansion (VE, return to the semi-recumbent position), and VE with infusing of 250 mL 5% albumin within 30 minutes. Hemodynamic parameters were recorded in every phase. The patients were classified into two groups according to their response to VE: responders (at least a 15% increase in stroke volume,ΔSVVE≥15%), and non-responders. The correlations among all changes in hemodynamic parameters were analyzed by linear correlation analysis, and the receiver operating characteristic curve (ROC) was plotted to assess the value of hemodynamic parameters before and after PLR in predicting fluid responsiveness.Results Of 38 patients, 25 patients were responders, and 13 non-responders. There was no significant difference in the baseline and hemodynamic parameters at semi-recumbent position between the two groups. The changes in SV and cardiac output (CO) after PLR (ΔSVPLR andΔCOPLR) were significantly higher in responders than those of non-responders [ΔSVPLR: (14.7±5.7)%vs. (6.4±5.3)%,t = 4.304,P = 0.000;ΔCOPLR: (11.2±7.5)% vs. (3.4±2.3)%,t = 3.454,P = 0.001], but there was no significant difference in the changes in systolic blood pressure, mean arterial pressure, pulse pressure, and heart rate after PLR (ΔSBPPLR,ΔMAPPLR,ΔPPPLR andΔHRPLR) between two groups.ΔSVVE in responders was significantly higher than that of the non-responders [(20.8±5.5) % vs. (5.0±3.7) %,t = 8.347,P = 0.000]. It was shown by correlation analysis thatΔSVPLR was positively correlated withΔSVVE (r = 0.593,P = 0.000),ΔCOPLR was positively correlated withΔSVVE (r = 0.494,P = 0.002). The area under ROC curve (AUC) ofΔSVPLR≥8.1% for predicting fluid responsiveness was 0.860±0.062 (P = 0.000), with sensitivity of 92.0% and specificity of 70.0%; the AUC ofΔCOPLR≥5.6% for predicting fluid responsiveness was 0.840±0.070 (P = 0.000), with sensitivity of 84.0%and specificity of 76.9%; the AUC ofΔMAPPLR≥6.9% for predicting fluid responsiveness was 0.662±0.089, with sensitivity of 68.0% and specificity of 76.9%; the AUC ofΔSBPPLR≥6.4% for predicting fluid responsiveness was 0.628±0.098, with sensitivity of 76.0% and specificity of 61.5%; the AUC ofΔPPPLR≥6.2% for predicting fluid responsiveness was 0.502±0.094, with sensitivity of 56.0% and specificity of 53.8%; the AUC ofΔHRPLR≥-1.7%for predicting fluid responsiveness was 0.457±0.100, with sensitivity of 56.0% and specificity of 46.2%.Conclusion In patients with sepsis-induced cardiac dysfunction, changes in SV and CO induced by PLR are accurate indices for predicting fluid responsiveness, but the changes in HR, MAP, SBP and PP cannot predict the fluid responsiveness.

Objective To understand the effect of antiretroviral therapy (ART) in reducing deaths among patients co-infected with Mycobacterium tuberculosis and human immunodeficiency virus (TB/HIV),and provide data-based evidence for improving ART in TB/HIV patients.Methods The information about TB patients who were HIV positive confirmed previously or recently in Guangxi were collected,and the TB/HIV patients were confirmed by using the related data from national AIDS prevention and treatment information system.Then a retrospective case control study was conducted to understand the survivals and deaths in the patients receiving ART or receiving no ART by using Kaplan-Meier method and estimate the ART protective rate within 1 year after TB treatment initiation.Results Among 519 TB/HIV patients,100 received ART (19.3％) ; Among 84 TB/HIV patients who died within 1 year after TB treatment,8 (9.5％) received ART,while 76 (90.5％) received no ART.Compared with the 18.7％ mortality rate in non-ART group,TB/HIV patients mortality rate in ART group was only 8.08％,the difference was statistical significant (P＜0.05).Kaplan-Meier survival curve showed that the survival rate in patients receiving ART was higher than that in patients receiving no ART within 1 year after TB treatment,the difference was statistical significant (Log-rank=4.96,P=0.02).Compared with patients receiving ART,the OR value was 2.31 times higher than that in patients receiving no ART; ART could protect 56.7％ of TB/HIV patients against death during the first year of anti-TB therapy.Conclusion In the first year of anti-TB therapy,the risk of death in TB/HIV patients receiving no ART was much higher than that in TB/HIV patients receiving ART,and the survival time was longer in the patients receiving ART.The ART coverage should be expanded in TB/HIV patients.

Objective:To discuss the clinical features of a family with Welander distal myopathy and analyze the genetic characteristics of the T-cell intracellular antigen 1 (TIA1) gene mutation in this family.Methods:The clinical data, electrophysiological and pathological examination results of some family members were collected, and the proband was tested by next generation sequencing techniques to detect possible pathogenic mutations. Sanger sequencing was performed in some family members for the gene mutations closely related to the clinical phenotype.Results:The proband, a 30-year-old man, manifested progressive weakness and muscle atrophy in distal limbs, followed by the involvement of muscles in proximal limbs. A gene mutation of c.91G>A was detected by genetic testing in the TIA1 gene, which was associated with Welander distal myopathy. The further Sanger sequencing revealed the same mutation site in the proband′s mother, one younger brother and his youngest uncle, who showed similar symptoms as the proband including muscle weakness and atrophy. The youngest brother of the proband was a mutation carrier without obvious symptoms, and his electromyography test showed myogenic injuries.Conclusions:Welander′s distal myopathy is a slowly progressing autosomal dominant disorder, characterized by weakness and muscle atrophy mainly in the extremities. In this family, the patients showed the onset in the extremities of the lower limbs and presented weakness and atrophy in distal and proximal limbs, with disease heterogeneity among patients. Genetic testing and the analysis of the family members confirmed the diagnosis of Welander′s distal myopathy and the pathogenic mutation c.91G>A in the TIA1 gene.