Clinical value of the MeltPro MTB assays in detection of drug-resistant tuberculosis in paraffin-embedded tissues / 中华病理学杂志

Objective: To evaluate the clinical value of the MeltPro MTB assays in the diagnosis of drug-resistant tuberculosis. Methods: A cross-sectional study design was used to retrospectively collect all 4 551 patients with confirmed tuberculosis between January 2018 and December 2019 at Beijing Chest Hospital, Capital Medical University. Phenotypic drug sensitivity test and GeneXpert MTB/RIF (hereafter referred to as "Xpert") assay were used as gold standards to analyze the accuracy of the probe melting curve method. The clinical value of this technique was also evaluated as a complementary method to conventional assays of drug resistance to increase the detective rate of drug-resistant tuberculosis. Results: By taking the phenotypic drug susceptibility test as the gold standard, the sensitivity of the MeltPro MTB assays to detect resistance to rifampicin, isoniazid, ethambutol and fluoroquinolone was 14/15, 95.7%(22/23), 2/4 and 8/9,respectively; and the specificity was 92.0%(115/125), 93.2%(109/117), 90.4%(123/136) and 93.9%(123/131),respectively; the overall concordance rate was 92.1%(95%CI:89.6%-94.1%),and the Kappa value of the consistency test was 0.63(95%CI:0.55-0.72).By taking the Xpert test results as the reference, the sensitivity of this technology to the detection of rifampicin resistance was 93.6%(44/47), the specificity was100%(310/310), the concordance rate was 99.2%(95%CI:97.6%-99.7%), and the Kappa value of the consistency test was 0.96(95%CI:0.93-0.99). The MeltPro MTB assays had been used in 4 551 confirmed patients; the proportion of patients who obtained effective drug resistance results increased from 83.3% to 87.8%(P<0.01); and detection rate of rifampicin, isoniazid, ethambutol, fluoroquinolone resistance, multidrug and pre-extensive drug resistance cases were increased by 3.2%, 14.7%, 22.2%, 13.7%, 11.2% and 12.5%, respectively. Conclusion: The MeltPro MTB assays show satisfactory accuracy in the diagnosis of drug-resistant tuberculosis. This molecular pathological test is an effective complementary method in improving test positivity of drug-resistant tuberculosis.

Treatment of osteomyelitis and soft tissue defects at distal region of leg and foot by pedicled peroneus brevis muscle flaps and reverse island flaps with sural nerve and blood supplying vessels / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the clinical effect of distally pedicled peroneus brevis muscle flaps and reverse island flaps with sural nerve and blood supplying vessels on repairing osteomyelitis and soft tissue defects at distal region of leg and foot.</p><p><b>METHODS</b>Twelve patients with osteomyelitis and soft tissue defects at distal region of leg and foot hospitalized from March 2008 to December 2010. Among them, 7 patients suffered from acute or chronic osteomyelitis and soft tissue defects at the distal end of tibia, 1 patient suffered from chronic osteomyelitis and chronic ulcer in the posterior aspect of achilles tendon, 4 patients suffered from acute or chronic osteomyelitis, soft tissue defects, and exposure of internal fixator in the lateral aspect of calcaneus. After debridement, soft tissue defect sizes ranged from 4 cm×2 cm to 13 cm×9 cm, and bone defect sizes ranged from 3.0 cm×3.0 cm×3.0 cm to 6.0 cm×3.0 cm×4.0 cm. The distally pedicled peroneus brevis muscle flaps with size ranging from 11 cm×3 cm to 16 cm×4 cm were used to fill the wound cavities of bone defects, and reverse island flaps with sural nerve and blood supplying vessels with size ranging from 5 cm×3 cm to 14 cm×10 cm were used for the repair of soft tissue defects. Flap donor sites were closed by direct suture or skin grafting.</p><p><b>RESULTS</b>Muscle flaps and flaps survived in 11 cases, and the wounds healed well. Necrosis appeared in flap and muscle flap at the distal end in one patient, which was repaired with posterior tibial artery perforator myocutaneous flap. Patients were followed up for 6 to 24 months. Osteomyelitis did not recur, and both the texture and shape of flaps were satisfactory.</p><p><b>CONCLUSIONS</b>The distally pedicled peroneus brevis muscle flaps and reverse island flaps with sural nerve and blood supplying vessels are suitable for the repair of osteomyelitis and soft tissue defects at distal region of leg and foot. The operation is simple, safe, reliable, and easy to perform.</p>

Effect of a combination of local flap and sequential compression-distraction osteogenesis in the reconstruction of post-traumatic tibial bone and soft tissue defects / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Treatment of extensive post-traumatic composite bone and soft tissue defects remains a complicated therapeutic problem and a challenge for surgeons. We investigated the application of local flaps and Ilizarov osteogenesis in the reestablishment of severe combined defects of tibial bone and soft tissue.</p><p><b>METHODS</b>Sixteen patients with bone and soft tissue defects were included. The mean age of the patients was 31.5 years. The average time from injury to initial surgery was 14.4 weeks. The average soft tissue and bone defect sizes were 92.9 cm(2) and 8.7 cm, respectively. Local flaps were created to reconstruct the soft tissue defects. The Ilizarov external fixator or the Orthofix Limb Reconstruction System was used to reconstruct bony defects using delayed distraction osteogenesis.</p><p><b>RESULTS</b>Two myocutaneous flaps and 14 reverse island flaps were applied. All transferred flaps survived. Fifteen patients healed with equal leg length, and one healed with a residual leg-length discrepancy of 1.5 cm. One patient with an Ilizarov external fixator developed ankle joint stiffening and a pin-track infection that was successfully treated with oral antibiotics. No patient developed pin loosening. All patients walked without assistance. Fifteen patients returned to their work, and one lost her job. The results were evaluated using the Paley bone and functional assessment scores. The bone assessment results were excellent in 14 and good in two patients. Functional assessment scores were excellent in 13, good in two, and fair in one patient.</p><p><b>CONCLUSION</b>The combination of local flaps and sequential distraction osteogenesis can be used for successful reconstruction of defects of incorporated bone and soft tissue.</p>

Repair of deep burn wound of neck with supraclavicular island flap / 中华烧伤杂志

<p><b>OBJECTIVE</b>To observe the therapeutic effect of supraclavicular island flap in repairing deep burn wound of neck.</p><p><b>METHODS</b>Six patients with deep burn of neck hospitalized from January 2009 to June 2011 were enrolled in the study. Their total burn area ranged from 6% to 22% TBSA, of which full-thickness area ranged from 3% to 22% TBSA. The neck wound ranged from 12 cm x 5 cm to 15 cm x 8 cm in area, and they were all full-thickness in depth. One of the neck wounds was covered with granulation tissue. Patients underwent either debridement and escharectomy or excision of granulation tissue for the neck wound, and they were covered with supraclavicular island flap designed with the size corresponding to that of wound area. Four donor sites were sutured directly. The other two donor sites were covered with free skin graft. Survival of flaps and healing of donor sites were observed. The appearance and function recovery of operative regions were followed up.</p><p><b>RESULTS</b>Supraclavicular island flaps of 6 patients survived as a whole. All the donor sites healed well. Flaps with satisfactory appearance and feeling sensation, accompanied by unlimited extension of neck were observed in the follow-up duration from 6 to 12 months. Scars observed in the flap edge and the donor sites were linear, and they did not affect the overall appearance and function of patients.</p><p><b>CONCLUSIONS</b>Supraclavicular island flap is a good choice for repairing deep burn wound of neck, and it gives a good shape and function recovery of the neck.</p>

Analysis of 59 cases of frostbite in plain region / 中华烧伤杂志

<p><b>OBJECTIVE</b>To retrospectively survey frostbite in patients living in plain regions, and to analyze the features of frostbite and the results after hospitalization.</p><p><b>METHODS</b>Fifty-nine patients with frostbite, aged from 15 to 85 years admitted in Beijing Jishuitan Hospital from 1992 to 2007, were enrolled in this study. Occupation, cause of the injury, initial visit time, position and degree of depth (assessed according to the standard of burn injury) of frostbite, and amputation rate of patients were recorded and analyzed.</p><p><b>RESULTS</b>Most patients of the 59 cases were workers or unemployed, the main reasons of injury were prolonged contact with material in a low temperature, with impaired consciousness, and having an out-door activity. The average first visit time was 11 days after the exposure. Frostbite was superficial 2(nd) to deep 2(nd) degree in 12 patients, while 47 patients were found to have 3(rd) to 4(th) degree injury. Limbs, or fingers and toes were amputated from 40 patients. The differences between patients visited within 3 days after frostbite and patients visited later than 3 days in respect of degree of depth of frostbite and amputation rate were statistically significant (P < 0.05). There was no significant difference in amputation rates in different body parts of frostbite (P > 0.05).</p><p><b>CONCLUSIONS</b>Patients in plain regions mainly suffer frostbite at the distal portions of the extremities. They should visit hospital early after injury so that the degree of frostbite can be alleviated and rate of amputation can be lowered.</p>

Staurospolin promotes the apoptosis of multidrug resistance tumor cell lines induced by adriamycin / 肿瘤研究与临床

Objective To investigate whether the protein kinase C inhibitor can promote the apopto- sis of multidrug resistance tumor cell lines which are induced by chemotherapy drugs.Methods Choose the KB/S(oral squamous cancer cell line)and KB/VCR(its multidrug resistant cell line)to compare the Adri- amycin-induced apoptosis with or without staurospolin(protein kinase C inhibitor).The apoptosis is stained with acridine orange,tested by flow cytometry,and approved by electron microscope.Results 36 hours after the treatment with 0.04 ?g/ml adriamycin,apoptotic cells of KB/S are 96.68%,and after 48 hours,the apop- totic cells of KB/VCR are 64.99%.When the concentration of adriamycin are augmented to 0.4?g/ml and 2.0?g/ml,the apoptotic cells of KB/VCR are 69.74% and 37.18% respectively.When treated with stau- rospolin together,the apoptotic cells of KB/VCR increased to 72.58%(?~2=4.5,P0.05)respectively.These results were testified by electron microscope and acridine orange-stain.Conclu- sion The resistance to apoptosis may be one of the mechanisms of multidrug resistance and the protein ki- nase C inhibitor may reverse this resistance by promoting the apoptosis of multidrug resistance tumor cells.