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Objective:To analyze the relevant factors of bacteriological diagnosis rate in pulmonary tuberculosis in Zhejiang Province, and to provide basis for the control of tuberculosis.Methods:The results of etiology detection of pulmonary tuberculosis in Zhejiang Province from 2015 to 2020 were collected from the China Tuberculosis Information Management System. Positive detection of etiology of pulmonary tuberculosis cases was analyzed. Joinpoint regression model was constructed to evaluate the annual trend of the positive rate of etiology, and linear regression model was used to analyze the influence of new diagnostic technology on the positive detection rate of etiology in smear-negative pulmonary tuberculosis cases.Results:From 2015 to 2020, the positive rate of etiology of pulmonary tuberculosis in Zhejiang Province increased from 38.66%(10 588/27 385) to 64.12%(14 275/22 262), with an average annual growth rate of 8.80%. All of the 11 prefecture cities in Zhejiang Province showed an increasing trend of the positive rate of etiology. The average annual growth rates in Wenzhou City and Lishui City were 10.27% and 11.21%, respectively, and the positive rates of etiology in Jinhua City and Lishui City were 70.13%(2 007/2 862) and 73.34%(707/964) in 2020, respectively. From 2015 to 2020, smear-negative cases accounted for 61.66%(92 935/150 733) in Zhejiang Province, and the further detection rate by culture and molecular test increased from 0.13%(22/16 650) to 84.74%(11 384/13 434). The positive rate of bacteriological tests in smear-negative pulmonary tuberculosis patients increased from 0.04%(6/16 650) to 41.28%(5 546/13 434). If the culture and molecular detection rate increased to 100.00%, the linear regression model predicted positive rate of etiology could increase to 44.20%. Thus, the positive rate of etiology of pulmonary tuberculosis in Zhejiang Province would reach 66.00%. Up to 2020, 95.56%(86/90) and 92.22%(83/90) of tuberculosis designated hospitals were equipped with molecular and liquid diagnostic equipments, respectively, and the detection positive rates of molecular and liquid diagnostics in the etiology positive pulmonary tuberculosis cases were 71.24%(10 169/14 275) and 53.44%(7 629/14 275), respectively.Conclusions:The implementation and promotion of the new diagnostic techniques for tuberculosis, especially the molecular diagnostic techniques, could significantly improve the positive rate of etiology of pulmonary tuberculosis etiology. Methods and strategies of etiological diagnosis of tuberculosis should be paid more attention in prevention and control of tuberculosis.
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Objective:To analyze the research status and discuss hot topics and development trends of studies on clinical nutrition in congenital heart disease (CHD) at home and abroad, so as to provide reference for Chinese researchers.Method:Studies on clinical nutrition in CHD were retrieved from the databases of CNKI and Web of Science, from the founding of database until 2020. CiteSpace 5.6.R5 was used for visual analysis of authors, countries, institutions, research hotspots and frontiers.Results:A total of 163 Chinese and 1,809 English publications were included. The number of literatures published at home and abroad shows an overall trend of growth. The United States has the largest number of publications, with China in seventh place. Domestic publishing institutions are mainly hospitals, led by Nanjing Children's Hospital affiliated to Nanjing Medical University. Foreign publications are mainly by university institutions, with Harvard University in the United States ranking first. Research teams led by authors including Gu Ying and Ravishankar C. are at the core in this field. The most discussed issues in China are mainly nutritional risk, nutritional support and nutrient research. The main target populations are ICU patients, premature infants, infants and children, etc. The forefront of research includes early enteral nutrition, prognosis and feeding intolerance. In foreign countries, studies mainly focus on epidemiology, nutritional support, malnutrition, risk factors, nutritional treatment, energy metabolism, obesity, clinical outcomes, etc. Main target population is special population, such as neonates with CHD, infants, children, patients after heart transplantation, etc. cohort studies and researches on overweight are at the frontier.Conclusions:The research on nutrition in CHD has attracted more and more attention. There are some differences in research content and hot topics between domestic and foreign studies. Therefore, we should strengthen the cooperation and exchanges among institutions, combine the advantages of CHD nutrition research in China, and strengthen the epidemiological study of CHD nutrition and the nutrition management of CHD key population, so as to further promote research development in this field.
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Objective Drug-resistant tuberculosis (TB) may be resistant to one or multiple anti-TB drugs.We used generalized estimation equations to analysis the risk factors of drug-resistant TB and provide information for the establishment of a warning model for these non-independent data.Methods The drug susceptibility test and questionnaire survey were performed in sputum positive TB patients from 30 anti TB drug-resistance surveillance sites in Zhejiang province.The generalized estimation model was established by the GENMOD module of SAS,with resistance to 13 kinds of anti-TB drugs as dependent variables and possible influencing factors,such as age,having insurance,HBV infection status,and history of anti-TB drug intake,as independent variables.Results In this study,the probability of drug resistance at baseline level was 20.26％.Age,insurance,whether being co-infected with HBV,and treatment history or treatment withdrawal were statistically significantly correlated with anti-TB drug resistance.The prediction equation was established according to the influence degree of the factors mentioned above on drug resistance.Conclusion The generalized estimation equations can effectively and robustly analyze the correlated binary outcomes,and thus provide more comprehensive information for drug resistance risk factor evaluation and warning model establishment.
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Objective Drug-resistant tuberculosis (TB) may be resistant to one or multiple anti-TB drugs.We used generalized estimation equations to analysis the risk factors of drug-resistant TB and provide information for the establishment of a warning model for these non-independent data.Methods The drug susceptibility test and questionnaire survey were performed in sputum positive TB patients from 30 anti TB drug-resistance surveillance sites in Zhejiang province.The generalized estimation model was established by the GENMOD module of SAS,with resistance to 13 kinds of anti-TB drugs as dependent variables and possible influencing factors,such as age,having insurance,HBV infection status,and history of anti-TB drug intake,as independent variables.Results In this study,the probability of drug resistance at baseline level was 20.26％.Age,insurance,whether being co-infected with HBV,and treatment history or treatment withdrawal were statistically significantly correlated with anti-TB drug resistance.The prediction equation was established according to the influence degree of the factors mentioned above on drug resistance.Conclusion The generalized estimation equations can effectively and robustly analyze the correlated binary outcomes,and thus provide more comprehensive information for drug resistance risk factor evaluation and warning model establishment.
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Vitreous hemorrhage in children is caused by trauma or non-traumatic factors.Long-term vitreous hemorrhage not only affects children's vision,but also can lead secondary glaucoma,traumatic retinal detachment and other serious complications.Ocular trauma,some ocular and systemic diseases are the common etiology leading to vitreous hemorrhage in children.A small amount of vitreous hemorrhage can be treated by observation and conservative treatment.However,if the vitreous hemorrhage has no obvious absorption or serious complications appeared,it needs to be treated by surgery.The choice of treatment time and methods need to be further studied.
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Objective To explore the value of MR diffusion tensor imaging ( DTI) in diagnosis of traumatic Axonal injury ( TAI) .Methods Twenty nine patients with traumatic brain injury ( TBI) and matched 22 control subjects were performed with DTI . Fractional anisotropy ( FA) was calculated from semioval center , corpus callosum , internal capsule and pons of controls and TBI pa-tients.According to Glasgow Score (GCS), TBI patients were divided into mild group (GCS≥13) and moderate-severe group (GCS≤12), each group compared with control group in FA value .The correlation between FA values in different regions and GCS score were analyzed in DTI group .Results FA value of semioval center was decreased in mild DTI group ( P <0.01 ) .FA values of semio-val center , corpus callosum , and internal capsule were decreased in moderate-severe DTI group ( P <0.05 ) .The FA values in semio-val center , corpus callosum , and internal capsule were positively correlated with GCS score in TBI group ( P <0.05 ) .Conclusions DTI is sensitive to detect the traumatic axonal injury??Changes of FA value in ROIs can access the severity of axonal injury ?? which ishelpful for diagnosis earlier and improving prognosis.
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Objective To analyze the results of sputum culture from smear-positive pulmonary tuberculosis cases after treatment for 2 months.Methods Sputum specimens from newly diagnosed 147 smear-positive pulmonary tuberculosis cases after treatment for 2 months were fast cultured by BacT/ALERT 3D.Poeitive cultures were further detected by HAIN test in Zhejiang Provincial Center for Disease Control and prevention and compared with L-J meditun.Results Mycobacteria were found in 45 specimens by Bact/ALERT 3D in contrast to 22 by Lonswtein-Jenson method.The median time was 19.3 days for the whole Bact/ALERT 3D test while the whole procedure would cost 3 months for traditional L-J test.Conclusion Results from sputum smear could not reflect tuberculosis progress properly while BacT/ALERT 3D fast culture would help to find drug resistant patients promptly and accurately.
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Objective To identify non-tuberculous Mycobacterium(NTM) rapidly with HAIN molecular assay genotype Mycobacterium kit,and investigate the advantages and disadvantages of this method.Methods Seventy-four clinical NTM isolates were collected from hospitals in Zhejiang and Anhui province.Clinical strains were identified with HAIN molecular assay genotype Mycobacterium kit.16S rRNA gene sequencing was used to estimate and compare with this method.Results The results of kit showed that there were thirty-one M.intracellulare strains,twelve M.chelonae strains,eight M.fortuitum strains,six M.kansasii strains,five M.avium strains,three M.smegmatis strains,two M.phlei strains,two M.scrofulaceum strains and one M.gordon strain.Four strains were identified as Mycobacterium without further identification.Eight M.tuberculosis strains were identified correctly too.Compared with 16S rRNA gene sequencing,except for four strains identified as Mycobacterium,others 70 strains got the same results as 16S rRNA gene sequencing,the coincidence was 94.59％,and it could further identify thirteen Mycobacterium chelonae complex and eight Mycobacterium kansasii complex to subspecies M.abscessus and M.kansasii,respectively.If only to identify strains under the identification range of this kit,the coincidence reach to 100％,Conclusion The method of HAIN molecular assay genotype Mycobacterium kit is simple and accurate,the time is shorter and should widely be applied clinically.
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Objective To evaluate three molecular methods for rapid identification of nontuberculous Mycobacterium(NTM).Methods Forty-one clinical NTM isolates were collected and 16S rRNA gene sequencing was used as the standard method for NTM identification.Meanwhile,the restriction fragment length polymorphism of hsp65 PCR-RFLP and hsp65 gene sequencing were used to identify NTM strains and compared with 16S rRNA gene sequencing.Results The results of 16S rRNA sequencing showed that there were nine Mycobacterium chelonae complex strains,seven Mycobacteriumfortuitum strains,seven Mycobacterium intracellulare strains,three Mycobacterium avium strains,three Mycobacterium kansasii complex strains, three Mycobacterium smegmatis strains, three Mycobacterium terrae strains, two Mycobacterium phlei strains,two Mycobacterium nonchromogenicum strains,one Mycobacterium scrofulaceum strain and one Mycobacterium arupense strain.Compared with 16S rRNA gene sequencing,hsp65 PCR-RFLP could identify nine Mycobacterium chelonae complexes and three Mycobacterium kansasii complexes to subspecies Mycobacterium abscessus and Mycobacterium kansasii,respectively; One Mycobacterium fortuitum strain and one Mycobacterium nonchromogenicum strain were different from 16S rRNA gene sequencing results ,but other isolates were the same.The coincidence was 95.1%.By hsp65 gene sequencing,only one identification of Mycobacterium hiberniae strain was different from 16S rRNA gene sequencing and the coincidence was 97.6%.And hsp65 gene sequencing could further identify nine Mycobacterium chelonae complexes and three Mycobacterium kansasii complexes to subspecies Mycobacterium abscessus and Mycobacterium kansasii,respectively.Conclusions All three molecular methods can identify NTM strains rapidly.Compared with 16S rRNA gene sequencing,hsp65 gene sequencing and hsp65 PCR-RFLP are easier to identify clinical common NTM strains(such as Mycobacterium kansasii and Mycobacterium abscessus),and can be widely used in clinical practice.
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Objective To investigate the anatomy of the skull base for minimally invasive keyhole approach to sellar lesions.MethodsSixty-seven samples of adult skull bone(134 sides) were collected and sawed at the levels of the supraorbital arch and anterior skull base.After inspecting the opening of the frontal sinus,we observed the appearance of the orbit roof(cerebral juga),and measured the maximum height of the two cerebral jugas.Afterwards,the operation distances and angles with regard to the anterior and posterior clinoid processes through the trans-upper orbit,trans-lateral front,trans-pterion,and trans-sub-temple keyhole approaches in 15 skull bone samples were measured.And then,we statistically analyzed the variance in these measurements among the four operative approaches.ResultsOf the 67(134 sides) adult skull bone samples,52 sides showed frontal sinus openness(38.8%,52/134).Most of the skull bases were clawed(multicuspidity or oblique ridge multicuspidity).The maximum height of the cerebral juga that was less than 2.50 mm was found in 36 sides(26.9%),and over 2.51 mm in 98 sides(73.1%).Among the four methods,the shortest distances between the keyhole and the anterior and posterior clinoid processes were found in the trans-sub-temple keyhole approach [(4.87?0.47) cm and(4.93?0.45) cm],and the longest were observed in the trans-lateral front keyhole approach[(6.45?0.30) cm and(7.83?0.54) cm],and trans-upper orbit keyhole approach[(6.47?0.28) cm and(8.31?0.34) cm].The angle between the sagittal section and the keyhole in the trans-lateral front keyhole approach [(40.83?1.11) ? and(37.86?1.37)?] was larger than that in the trans-upper orbit one [(10.23?0.90) ? and(12.29?0.86)?],while the angle between the cross section and the keyhole in the trans-sub-temple keyhole approach [(21.21?0.45) ? and(20.10?0.63)?] was larger than that in the trans-pterion one [(5.49?0.30)? and(9.84?0.58)?].ConclusionsThe size of the frontal sinus,shape and height of the cerebral juga,depth of the skull base operation,and angle between the operational and the skull base planes play important roles in the selection of minimally invasive keyhole approach for sellar lesions.