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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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Diabetic nephropathy （DN） is a serious complication of diabetes， a major risk factor for chronic renal failure and end-stage renal disease， a major cause of deaths of diabetic patients， and a major cause of noncommunicable disease-associated deaths in the world. Pyroptosis and inflammasome activation are closely associated with the occurrence and development of DN. They can mediate a variety of pathological changes such as the loss and fusion of podocytes， up-regulated expression of inflammatory cytokines， macrophage infiltration， glomerular mesangial matrix expansion， and increased urinary albumin-to-creatinine ratio， eventually leading to nephron loss and kidney injury. The available studies have reported that the active ingredients in Chinese medicinal herbs or classical prescriptions play a role in the treatment of DN by lowering blood glucose and lipid levels， mitigating insulin resistance， reducing inflammation， alleviating oxidative stress， and regulating immunity. Moreover， the active ingredients can inhibit the activation of inflammasomes and the pyroptosis of renal cells， repair the inflammation-induced damage， improve renal function， and slow the progression of DN， demonstrating definite therapeutic effect. Chinese medicines can treat DN in a multi-target， multi-pathway， and multi-system manner， possessing broad prospects in the prevention and treatment of DN. Despite the extensive studies about the traditional Chinese medicine （TCM） intervention of DN in vivo and in vitro， a comprehensive summary of experimental studies on the TCM intervention of DN model remains to be carried out. This paper reviews the research progress in pyroptosis， inflammasomes， roles of pyroptosis and inflammasomes in DN， and TCM intervention of DN， aiming to provide ideas and reference for the research and development of drugs for this disease.
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Smart manufacturing still remains critical challenges for pharmaceutical manufacturing. Here, an original data-driven engineering framework was proposed to tackle the challenges. Firstly, from sporadic indicators to five kinds of systematic quality characteristics, nearly 2,000,000 real-world data points were successively characterized from Ginkgo Folium tablet manufacturing. Then, from simplex to the multivariate system, the digital process capability diagnosis strategy was proposed by multivariate Cpk integrated Bootstrap-t. The Cpk of Ginkgo Folium extracts, granules, and tablets were discovered, which was 0.59, 0.42, and 0.78, respectively, indicating a relatively weak process capability, especially in granulating. Furthermore, the quality traceability was discovered from unit to end-to-end analysis, which decreased from 2.17 to 1.73. This further proved that attention should be paid to granulating to improve the quality characteristic. In conclusion, this paper provided a data-driven engineering strategy empowering industrial innovation to face the challenge of smart pharmaceutical manufacturing.
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According to its location and function, the oral mucosa can be divided into masticatory mucosa, coated mucosa and special mucosa. Oral masticatory mucosa, including hard palate and gingival mucosa, bears the chewing pressure and friction, and plays an important role in denture restoration. The study on biomechanics of oral masticatory mucosa is helpful to better understand and solve clinical problems related to oral masticatory mucosa. In this review, the progress of biomechanical researches on oral masticatory mucosa was summaried from three aspects: anatomical and physiological analysis, biomechanical characteristics (stress-strain curve, Poisson’s ratio, friction coefficient) and clinical significance, in order to provide further theoretical basis for the researches in oral prosthodontics-related areas.
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Objective:To investigate the relationship between serum leukocyte-associated immunoglobulin-like receptor 2 (LAIR2) expression and cellular immune function, prognosis in patients with non-small cell lung cancer.Methods:From April 2016 to April 2017, 90 patients with non-small cell lung cancer who were treated in Shangqiu first people’s Hospital were taken as the lung cancer group, and they were grouped into the survival group and the death group according to whether the patients died within 5 years. Another 84 patients with benign pulmonary mass were selected as the control group. The levels of CD4+[ (28.26±5.14) % vs (47.02±6.73) %], CD8+ [ (23.76±5.84) % vs (30.12±6.03) %] and CD4+/CD8+ [ (1.17±0.30) % vs (1.56±0.50) %] in peripheral blood immune cells were detected by flow cytometry; the serum LAIR2 level was detected by enzyme-linked immunosorbent assay (ELISA) , and the average serum LAIR2 level of patients with non-small cell lung cancer was applied as the boundary, and they were grouped into a low LAIR2 expression group and a LAIR2 high expression group; Pearson correlation was applied to analyze the correlation between serum LAIR2 level and immune cell level in patients with non-small cell lung cancer; Kaplan-Meier curve was applied to analyze the relationship between serum LAIR2 level and 5-year survival rate of patients with non-small cell lung cancer; and multivariate COX regression analysis was applied to analyze the factors affecting 5-year mortality in patients with non-small cell lung cancer.Results:The level of serum LAIR2 [ (69.55±13.12) ng/ml vs. (20.64±7.13) ng/ml] in the lung cancer group was significantly higher than that in the control group, and the levels of CD4 +, CD8 + and CD4+/CD8+ were significantly lower than those in the control group ( P<0.05) . The serum LAIR2 level in patients with TNM stage III+IV (77.32±13.09) ng/ml, poorly differentiated tissue (78.14±13.26) ng/ml, and lymph node metastasis (79.02±13.81) ng/ml was significantly higher than that in patients with TNM stage I+II (64.37±12.89) ng/ml, medium/well differentiated tissue (64.32±12.73) ng/ml, and no lymph node metastasis (62.92±12.85) ng/ml ( P<0.05) . The levels of CD4 +, CD8 + and CD4 +/CD8 + in the LAIR2 high expression group were significantly lower than those in the LAIR2 low expression group ( P<0.05) . Serum LAIR2 level in patients with non-small cell lung cancer was negatively correlated with CD4+, CD8+ and CD4+/CD8+ levels ( r=-0.510, -0.496, -0.494, P<0.05) . The 5-year survival rate of patients with high LAIR2 expression was lower than that of patients with low LAIR2 expression ( r=6.375, P<0.05) . LAIR2 was an independent risk factor for 5-year death in patients with non-small cell lung cancer ( P<0.05) . Conclusion:LAIR2 is highly expressed in serum of patients with non-small cell lung cancer, and its expression level is closely related to cellular immune function and prognosis.
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The purpose of this study is to dig deep into teaching materials, find ideological and political elements, and integrate ideological and political courses into pharmacology teaching on the premise of improving moral education ability of teachers. A variety of teaching methods are used in learning and teaching, and nursing professionalism is trained while imparting knowledge, so that students can establish correct outlook on world, life and values, cultivate their innovation and entrepreneurship ability, and do a better job of cultivating morality and cultivating people of nursing specialty.
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Objective:To investigate the safety and the efficacy of percutaneous and surgical approach in femoro-femoral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) cannulation.Methods:All consecutive patients implanted with femoro-femoral VA-ECMO between January 2018 and December 2020 in Beijing Anzhen Hospital, Capital Medical University. Propensity score matching was used to compare outcomes of percutaneous and surgical groups while controlling for confounders.Results:Among the 276 patients who received femoro-femoral VA-ECMO (62 surgical and 214 percutaneous), propensity-score matching selected 52 pairs of patients with similar characteristics with mean age of(59.6±13.0)years old, in which 26 patients were female. There were a lower ECMO cannulation-associated complication (28.8% vs. 48.1%, P=0.044) and a lower hospital mortality (42.3% vs. 67.3%, P=0.010) in the percutaneous group. The circuit blood flow after ECMO initiation was similar in both groups[(3.3±0.8)L·min -1·kg -1 in percutaneous group vs. (3.2±0.7)L·min -1·kg -1 in surgical group, P=0.738]. The serum lactate was declined in both group after ECMO initiation[(5.4±5.8)mmol/L vs. (9.2±6.9)mmol/L, P<0.001 in percutaneous group; (6.3±6.2)mmol/L vs. (10.5±7.0)mmol/L, P=0.003 in surgical group]. Conclusion:Percutaneous approach is a safe and efficient technique in emoro-femoral VA-ECMO cannulation. Compared with surgical cannulation, percutaneous approach is associated with lower ECMO cannulation-associated complication and lower hospital mortality.
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Objective To investigate the incidence and risk factors of acute kidney injury(AKI) requiring continuous renal replacement treatment(CRRT) in patients with acute type A aortic dissection after Sun's operation.Methods A retrospective analysis of consecutive patients with acute type A aortic dissection underwent Sun's operation in Beijing Anzhen Hospital,Capital Medical University from January 2009 to December 2015.These patients were divided into two groups according to whether had severe postoperative AKI requiring CRRT treatment:the dialysis group(AG,65 cases) and the control group(CG,618 cases),we compared the clinical outcomes of patients in two groups and analyzed the related risk factors.Results 50 patients(7.3％) died in hospital.Compared with patients in CG group,patients in AG group had higher age,more patients with preoperative coronary heart disease,pericardial tamponade,and higher rates of intraoperative coronary artery hypass surgery or valve surgery,the results were statistically different between the two groups(P ＜0.05).The patients in AG group had a higher mortality rate in hospital(26.2％ vs.5.3％),and the difference was statistically significant(P ＜0.001).The results of multiple regression analysis suggested that the age ＞ 50 years,preoperative history of pericardial tamponade,intraoperative need for combined coronary artery bypass grafting or valve surgery,and cerebral perfusion time ＞40 min were independent risk factors for CRRT treatment of postoperative severe AKI(P ＜0.05).Conclusion The incidence of severe AKI requiring CRRT treatment in patients with acute type A aortic dissection after Sun's operation was 9.5％,and the discharge survival rate in AG group was lower than that in CG group.An important way to reduce the incidence of severe AKI requiring CRRT after sun's surgery is to shorten the intraoperative cerebral perfusion time as much as possible.
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The laterodorsal tegmentum (LDT) is a brain structure involved in distinct behaviors including arousal, reward, and innate fear. How environmental stimuli and top-down control from high-order sensory and limbic cortical areas converge and coordinate in this region to modulate diverse behavioral outputs remains unclear. Using a modified rabies virus, we applied monosynaptic retrograde tracing to the whole brain to examine the LDT cell type specific upstream nuclei. The LDT received very strong midbrain and hindbrain afferents and moderate cortical and hypothalamic innervation but weak connections to the thalamus. The main projection neurons from cortical areas were restricted to the limbic lobe, including the ventral orbital cortex (VO), prelimbic, and cingulate cortices. Although different cell populations received qualitatively similar inputs, primarily via afferents from the periaqueductal gray area, superior colliculus, and the LDT itself, parvalbumin-positive (PV) GABAergic cells received preferential projections from local LDT neurons. With regard to the different subtypes of GABAergic cells, a considerable number of nuclei, including those of the ventral tegmental area, central amygdaloid nucleus, and VO, made significantly greater inputs to somatostatin-positive cells than to PV cells. Diverse inputs to the LDT on a system-wide level were revealed.
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Objective@#To introduce a combined operation for treating chronical peroneal tendon dislocation and to evalu-ate the clinical outcomes of patients.@*Methods@#Data of 12 ankles in 12 patients (male 9, female 3) with chronical peroneal ten-don dislocation who underwent the fibular groove deepening procedure with transposition of the peroneal longus muscle from June 2006 to August 2013 were retrospectively analyzed. The mean age was 24.6±4.3 years (range, 18-34 years), and there were 3 cas-es on left side, 9 on right side. The mechanism of peroneal tendon injury consisted of sports injuries in 8 and sprains in 4. There were 8 cases of flat fibula sulcus and 4 cases of convex. All patients met the inclusion criteria of a painful snapping or popping sen-sation or palpable clicking and positive provocation maneuver and without fracture and were treated with peroneal sulcus deepen-ing and peroneal longus tendon transposition. The duration of preoperative popping and pain symptoms ranged from 12 to 23 weeks, with an average of 16.9±4.0 weeks. All cases were treated conservatively 3-4 weeks before operation and were not effec-tive. The clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, visual anologue scale (VAS).@*Results@#Twelve patients were followed up with an average period of 37.3±7.0 (range, 25-50) months. The mean VAS scale score of all patients reduced from 5.6±0.9 to 0.5±0.7 at the latest follow-up. The mean AOFAS scale score improved from 61.4±5.6 to 92.6±4.2 at the latest follow-up. The difference between preoperative and postoperative was statis-tically significant. (t=16.250,-18.475; P=0.000). According to the evaluation of symptom and function scoring system, 10 cases were excellent and 2 cases were good, with an excellent rate of 100%. The mean postoperative return-sport time was 26.42±3.06 weeks (range, 23-32 weeks). All patients healed primarily and no infection, skin necrosis and residual redislocation occurred. The osteotomy healed completely without displacement, which was confirmed by imaging examination in three months postoperation. No patients had intractable pain after surgery, and they were able to perform daily activities at 3 months and physical exercise at 6 months after surgery. No slip occurred in all patients at the latest follow-up.@*Conclusion@#The fibular groove deepening procedure with transposition of the peroneal longus muscle can effectively treat chronical peroneal tendon dislocation and obtain good medi-um-term results.
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Objective To introduce a combined operation for treating chronical peroneal tendon dislocation and to evaluate the clinical outcomes of patients.Methods Data of 12 ankles in 12 patients (male 9,female 3) with chronical peroneal tendon dislocation who underwent the fibular groove deepening procedure with transposition of the peroneal longus muscle from June 2006 to August 2013 were retrospectively analyzed.The mean age was 24.6±4.3 years (range,18-34 years),and there were 3 cases on left side,9 on right side.The mechanism of peroneal tendon injury consisted of sports injuries in 8 and sprains in 4.There were 8 cases of flat fibula sulcus and 4 cases of convex.All patients met the inclusion criteria of a painful snapping or popping sensation or palpable clicking and positive provocation maneuver and without fracture and were treated with peroneal sulcus deepening and peroneal longus tendon transposition.The duration of preoperative popping and pain symptoms ranged from 12 to 23 weeks,with an average of 16.9±4.0 weeks.All cases were treated conservatively 3-4 weeks before operation and were not effective.The clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale,visual anologue scale (VAS).Results Twelve patients were followed up with an average period of 37.3± 7.0 (range,25-50)months.The mean VAS scale score of all patients reduced from 5.6±0.9 to 0.5±0.7 at the latest follow-up.The mean AOFAS scale score improved from 61.4±5.6 to 92.6±4.2 at the latest follow-up.The difference between preoperative and postoperative was statistically significant.(t=16.250,-18.475;P=0.000).According to the evaluation of symptom and function scoring system,10 cases were excellent and 2 cases were good,with an excellent rate of 100％.The mean postoperative return-sport time was 26.42±3.06 weeks (range,23-32 weeks).All patients healed primarily and no infection,skin necrosis and residual redislocation occurred.The osteotomy healed completely without displacement,which was confirmed by imaging examination in three months postoperation.No patients had intractable pain after surgery,and they were able to perform daily activities at 3 months and physical exercise at 6 months after surgery.No slip occurred in all patients at the latest follow-up.Conclusion The fibular groove deepening procedure with transposition of the peroneal longus muscle can effectively treat chronical peroneal tendon dislocation and obtain good medium-term results.
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To establish the experts consensus on the management of delirium in critically ill patients.A special committee was set up by 15 experts from the Chinese Critical Hypothermia-Sedation Therapy Study Group.Each statement was assessed based on the GRADE (Grading of Recommendations Assessment,Development,and Evaluation) principle.Then the Delphi method was adopted by 36 experts to reassess all the statements.(1) Delirium is not only a mental change,but also a clinical syndrome with multiple pathophysiological changes.(2) Delirium is a form of disturbance of consciousness and a manifestation of abnormal brain function.(3) Pain is a common cause of delirium in critically ill patients.Analgesia can reduce the occurrence and development of delirium.(4) Anxiety or depression are important factors for delirium in critically ill patients.(5) The correlation between sedative and analgesic drugs and delirium is uncertain.(6) Pay attention to the relationship between delirium and withdrawal reactions.(7) Pay attention to the relationship between delirium and drug dependence/ withdrawal reactions.(8) Sleep disruption can induce delirium.(9) We should be vigilant against potential risk factors for persistent or recurrent delirium.(10) Critically illness related delirium can affect the diagnosis and treatment of primary diseases,and can also be alleviated with the improvement of primary diseases.(11) Acute change of consciousness and attention deficit are necessary for delirium diagnosis.(12) The combined assessment of confusion assessment method for the intensive care unit and intensive care delirium screening checklist can improve the sensitivity of delirium,especially subclinical delirium.(13) Early identification and intervention of subclinical delirium can reduce its risk of clinical delirium.(14) Daily assessment is helpful for early detection of delirium.(15) Hopoactive delirium and mixed delirium are common and should be emphasized.(16) Delirium may be accompanied by changes in electroencephalogram.Bedside electroencephalogram monitoring should be used in the ICU if conditions warrant.(17) Pay attention to differential diagnosis of delirium and dementia/depression.(18) Pay attention to the role of rapid delirium screening method in delirium management.(19) Assessment of the severity of delirium is an essential part of the diagnosis of delirium.(20) The key to the management of delirium is etiological treatment.(21) Improving environmental factors and making patient comfort can help reduce delirium.(22) Early exercise can reduce the incidence of delirium and shorten the duration of delirium.(23) Communication with patients should be emphasized and strengthened.Family members participation can help reduce the incidence of delirium and promote the recovery of delirium.(24) Pay attention to the role of sleep management in the prevention and treatment of delirium.(25) Dexmedetomidine can shorten the duration of hyperactive delirium or prevent delirium.(26) When using antipsychotics to treat delirium,we should be alert to its effect on the heart rhythm.(27) Delirium management should pay attention to brain functional exercise.(28) Compared with non-critically illness related delirium,the relief of critically illness related delirium will not accomplished at one stroke.(29) Multiple management strategies such as ABCDEF,eCASH and ESCAPE are helpful to prevent and treat delirium and improve the prognosis of critically ill patients.(30) Shortening the duration of delirium can reduce the occurrence of long-term cognitive impairment.(31) Multidisciplinary cooperation and continuous quality improvement can improve delirium management.Consensus can promote delirium management in critically ill patients,optimize analgesia and sedation therapy,and even affect prognosis.
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BACKGROUND@#Epidermal growth factor receptor (EGFR) mutation non-small cell lung cancer (NSCLC) is an important subtype of lung cancer. The incidence of malignant pericardial effusion (MPCE) in EGFR-mutant NSCLC patients is high. However, there are few researches on the treatmentof this type of patients.@*METHODS@#We collected data on clinical characteristics and treatment of advanced NSCLC patients who harboring EGFR mutants and MPCE between January 2010 and December 2016. The treatments were divided into three groups: oral gefitinib combined with pericardial perfusion of hydroxycamptotheci (HCPT) group (gefitinib/HCPT); intravenous chemotherapy combined with pericardial perfusion of HCPT group (chemotherapy/HCPT) and gefitinib monotherapy group. And we retrospectively analyzed patients' outcomes in three groups.@*RESULTS@#In 273 advanced NSCLC patients with EGFR mutations, 29 cases had pericardial effusion, among which 6 patients with small amount of pericardial effusion were excluded, and 23 patients were analyzed. Median pericardium progression free survival (PFS) was 247 days. PFS for gefitinib/HCPT group (460 days) was superior to PFS for chemotherapy/HCPT group (94 days, P=0.008) and gefitinib monotherapy group (131 days, P=0.032). As for the efficacy of primary pulmonary lesions, the efficacy in gefitinib/ HCPT group was superior to chemotherapy/HCPT group [objective response rate (ORR): 33.3% vs 12.5%; disease control rate (DCR): 86.7% vs 62.5%]. There is no difference of ORR and DCR between gefitinib/HCPT group and gefitinib monotherapy group. No obvious adverse reaction was observed in all three groups.@*CONCLUSIONS@#First-line gefitinib therapy combined with pericardial perfusion of HCPT can improve pericardium PFS for advanced NSCLC patients who harboring EGFR mutants andmalignantpericardial effusion. This finding should be confirmed further through multicenter, prospective clinical trials with large sample size.
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Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Pulmonar de Células não Pequenas , Tratamento Farmacológico , Metabolismo , Patologia , Intervalo Livre de Doença , Receptores ErbB , Metabolismo , Gefitinibe , Neoplasias Pulmonares , Tratamento Farmacológico , Metabolismo , Patologia , Perfusão , Derrame Pericárdico , Pericárdio , Quinazolinas , Usos Terapêuticos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Critical ultrasonography(CUS) is different from the traditional diagnostic ultrasound,the examiner and interpreter of the image are critical care medicine physicians.The core content of CUS is to evaluate the pathophysiological changes of organs and systems and etiology changes.With the idea of critical care medicine as the soul,it can integrate the above information and clinical information,bedside real-time diagnosis and titration treatment,and evaluate the therapeutic effect so as to improve the outcome.CUS is a traditional technique which is applied as a new application method.The consensus of experts on critical ultrasonography in China released in 2016 put forward consensus suggestions on the concept,implementation and application of CUS.It should be further emphasized that the accurate and objective assessment and implementation of CUS requires the standardization of ultrasound image acquisition and the need to establish a CUS procedure.At the same time,the standardized training for CUS accepted by critical care medicine physicians requires the application of technical specifications,and the establishment of technical specifications is the basis for the quality control and continuous improvement of CUS.Chinese Critical Ultrasound Study Group and Critical Hemodynamic Therapy Collabration Group,based on the rich experience of clinical practice in critical care and research,combined with the essence of CUS,to learn the traditional ultrasonic essence,established the clinical application technical specifications of CUS,including in five parts:basic view and relevant indicators to obtain in CUS;basic norms for viscera organ assessment and special assessment;standardized processes and systematic inspection programs;examples of CUS applications;CUS training and the application of qualification certification.The establishment of applied technology standard is helpful for standardized training and clinical correct implementation.It is helpful for clinical evaluation and correct guidance treatment,and is also helpful for quality control and continuous improvement of CUS application.
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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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Objective To analyze the epidemic characteristics of tuberculosis (TB) cases in Zhejiang province from 2005 to 2014, and to identify the cluster spots.Methods TB notification data in Zhejiang province from 2005 to 2014 were analyzed at county and district level by using spatial scan statistic analysis method, which was showed on the digital map.Results In zhejiang province from 2005 to 2014, a total of 377 707 cases of patients with tuberculosis were reported.The average annual registration rates of the entire province was 72.61/100 000 (range: 28.85/100 000-182.90/100 000).Spatial analysis identified 14 clusters (RR=1.05-1.62) with statistical significance.Temporal analysis revealed that there were clusters between 2005 and 2009 in terms of the notification data on TB cases (RR=1.27,P=0.001).Spatio-temporal analysis identified 6 clusters (RR=1.19-3.55) with statistical significance.Counties and districts included in the first class cluster were similar by using the two different methods-spatial analysis and spatial-temporal analysis.Conclusions There is a descending trend of TB cases notification rates from western to eastern Zhejiang during the study period.The distribution of the TB case notified is not random at spatial, temporal and spatio-temporal levels.
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Objective To analyze the adverse drug reactions (ADR) during the standardized treatment of multidrug-resistant pulmonary tuberculosis (MDR-PTB), and to evaluate its impact on treatment outcomes.Methods A retrospective study was carried out on 305 MDR-PTB patients.Medical records of clinical treatment and laboratory examinations were collected, and the ADR data were analyzed.Chi-square test or Fisher exact test was used for discontinuous variables, and t test or non-parametric test was used for continuous variables.Results Among 305 MDR-PTB patients , 282 (92.5%) had at least one ADR.The major ADR were gastrointestinal reaction (46.9%), thyroid dysfunction (41.3%), hypokalemia (34.1%), renal injury (29.8%), hematological system impairment (21.6%), hepatotoxicity (19.0%), arthralgia or courbature (11.1%), and ototoxicity and vestibular dysfunction (8.5%).Sex, age, native place, the history of using second-line TB drugs or the history of diabetes mellitus had no significant effect on the incidence of ADR (all P>0.05).As per the Naranjo causality assessment of ADR, 34 patients had definite, 236 had probable, 12 had possible and 0 had doubtful causal relations.Among the 282 cases with ADR, 175 (62.1%) patients continued the original treatment regimen, 89 (31.6%) patients changed or stopped ADR-related drugs, only 18 (6.4%) cases stopped MDR-PTB treatment.The episodes of ADR had no significant effect on the treatment outcomes (P>0.05).Conclusions Although ADR are common in MDR-PTB patients during the treatment course, most of the ADR can be managed.Through timely monitoring and appropriate treatment of ADR, most of the patients could continue MDR-PTB treatment.
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Spatial epidemiology and molecular epidemiology have been widely used in the studies of tuberculosis (TB),but each with limitations.Integration of the two methods provides new ideas and methods in TB research.All referenced articles are from CNKI,Wan Fang database,PubMed database and Web of Science database.Method of combining spatial epidemiology and molecular epidemiology has been widely used in determining the local epidemic strains of TB genotype,the transmission mechanism,risk factors of TB,drug-resistant TB,as well as evaluating the effectiveness of TB prevention and control measures.Application of the combined methods is of important significance in the studies of TB,thus worthy to be further introduced to researchers and disease prevention and control workers in this country.
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Objective To analyze the spatial distribution characteristics ofmultidrug-resistant (MDR) tuberculosis (TB) cases in Zhejiang province in 2010-2012.Methods Data on MDR-TB cases in Zhejiang province were collected and linked to the digital map at the county and district levels.ArcGIS 10.0 software was used for spatial analysis.Results Results from the spatial autocorrelation analysis showed that spatial aggregation appeared in MDR-TB distribution during 2010-2012 while local Moran's I spatial autocorrelation analysis identified several "high incidence regions" (Wuxing,Deqing,Yuhang,Gongshu,Jianggan,Xiaoshan,Yuecheng,Shaoxing Shengzhou,Changshan,Kecheng),and "low incidence region" (Haishu).Through Getis-Ord General G spatial autocorrelation analysis,18 "positive hotspots" (Wuxing,Nanxun,Deqing,Yuhang,Shangcheng,Xiacheng,Gongshu,Jianggan,Binjiang Xiaoshan Xihu,Haining,Yuecheng,Shaoxing,Zhuji,Shengzhou,Kecheng and Suichang) and 11 "negative hotspots" (Nanhu,Haiyan,Cixi,Dinghai,Zhenhai,Jiangbei,Jiangdong,Beilun,Yinzhou,Fenghua,and Yueqing) were identified.Conclusions Spatial analysis on MDR-TB incidence implied the spatial aggregation in Zhejiang province.Data showed that the hotspots with high population density and human movement were under progressive expansion.