Disease spectrum and prognostic factors in patients treated for tuberculous meningitis in Shaanxi province, China.

Background: Tuberculous meningitis (TBM) is the most severe form of tuberculosis (TB) and can be difficult to diagnose and treat. We aimed to describe the clinical presentation, diagnosis, disease spectrum, outcome, and prognostic factors of patients treated for TBM in China. Methods: A multicenter retrospective study was conducted from 2009 to 2019 enrolling all presumptive TBM patients referred to Xijing tertiary Hospital from 27 referral centers in and around Shaanxi province, China. Patients with clinical features suggestive of TBM (abnormal CSF parameters) were included in the study if they had adequate baseline information to be classified as "confirmed," "probable," or "possible" TBM according to international consensus TBM criteria and remained in follow-up. Patients with a confirmed alternative diagnosis or severe immune compromise were excluded. Clinical presentation, central nervous system imaging, cerebrospinal fluid (CSF) results, TBM score, and outcome-assessed using the modified Barthel disability index-were recorded and compared. Findings: A total of 341 presumptive TBM patients met selection criteria; 63 confirmed TBM (25 culture positive, 42 Xpert-MTB/RIF positive), 66 probable TBM, 163 possible TBM, and 49 "not TBM." Death was associated with BMRC grade III (OR = 5.172; 95%CI: 2.298-11.641), TBM score ≥ 15 (OR = 3.843; 95%CI: 1.372-10.761), age > 60 years (OR = 3.566; 95%CI: 1.022-12.442), and CSF neutrophil ratio ≥ 25% (OR = 2.298; 95%CI: 1.027-5.139). Among those with confirmed TBM, nearly one-third (17/63, 27.0%) had a TBM score < 12; these patients exhibited less classic meningitis symptoms and signs and had better outcomes compared with those with a TBM score ≥ 12. In this group, signs of disseminated/miliary TB (OR = 12.427; 95%CI: 1.138-135.758) and a higher TBM score (≥15, OR = 8.437; 95%CI: 1.328-53.585) were most strongly associated with death. Conclusion: TBM patients who are older (>60 years) have higher TBM scores or CSF neutrophil ratios, have signs of disseminated/miliary TB, and are at greatest risk of death. In general, more effort needs to be done to improve early diagnosis and treatment outcome in TBM patients.

Acinar ATP8b1/LPC pathway promotes macrophage efferocytosis and clearance of inflammation during chronic pancreatitis development.

Noninflammatory clearance of dying cells by professional phagocytes, termed efferocytosis, is fundamental in both homeostasis and inflammatory fibrosis disease but has not been confirmed to occur in chronic pancreatitis (CP). Here, we investigated whether efferocytosis constitutes a novel regulatory target in CP and its mechanisms. PRSS1 transgenic (PRSS1Tg) mice were treated with caerulein to mimic CP development. Phospholipid metabolite profiling and epigenetic assays were performed with PRSS1Tg CP models. The potential functions of Atp8b1 in CP model were clarified using Atp8b1-overexpressing adeno-associated virus, immunofluorescence, enzyme-linked immunosorbent assay(ELISA), and lipid metabolomic approaches. ATAC-seq combined with RNA-seq was then used to identify transcription factors binding to the Atp8b1 promoter, and ChIP-qPCR and luciferase assays were used to confirm that the identified transcription factor bound to the Atp8b1 promoter, and to identify the specific binding site. Flow cytometry was performed to analyze the proportion of pancreatic macrophages. Decreased efferocytosis with aggravated inflammation was identified in CP. The lysophosphatidylcholine (LPC) pathway was the most obviously dysregulated phospholipid pathway, and LPC and Atp8b1 expression gradually decreased during CP development. H3K27me3 ChIP-seq showed that increased Atp8b1 promoter methylation led to transcriptional inhibition. Atp8b1 complementation substantially increased the LPC concentration and improved CP outcomes. Bhlha15 was identified as a transcription factor that binds to the Atp8b1 promoter and regulates phospholipid metabolism. Our study indicates that the acinar Atp8b1/LPC pathway acts as an important "find-me" signal for macrophages and plays a protective role in CP, with Atp8b1 transcription promoted by the acinar cell-specific transcription factor Bhlha15. Bhlha15, Atp8b1, and LPC could be clinically translated into valuable therapeutic targets to overcome the limitations of current CP therapies.

Postoperative infection of the skull base surgical site due to suppurative parotitis: A case report.

BACKGROUND: Paraganglioma occurring at the lateral skull base is a rare tumor. Surgery is the primary treatment of benign paragangliomas. Postoperative infection of the surgical site at the lateral skull base is very dangerous and hard to manage. CASE SUMMARY: A 30-year-old man with a 1-year history of left-side progressive hearing loss, tinnitus, facial palsy, and choking failed conventional treatment and is the focus of this case report. Imaging revealed a mass around the left jugular foramen that was approximately 47 mm × 38 mm × 34 mm in size and had eroded the bone of the vertebral and horizontal segments of the internal carotid artery. The tumor breached the meninges and occupied the cerebella pontine region. A two-stage surgery was designed for the resection of the mass. In the first-stage, the epidural portion of the mass was removed. The abdominal fat and the temporal muscle flap were transposed within the surgical site. The surgery was successful; however, 25 d after surgery, he developed suppurative parotitis, and the infection spread to the surgical site at the skull base. Broad-spectrum antibiotics were used, and debridement was deployed. After that, the wound was cleaned daily. Five months after the first-stage surgery, the wound was still unclosed, and there was intermittent purulent exudation within the surgical site. vacuum sealing drainage (VSD) was used, and the wound healed in a month. One year after the first surgery, the second-stage of the operation was performed to remove the intracranial portion of the tumor. Recurrence of the tumor was not detected after a 6-month follow-up. CONCLUSION: After a lateral skull base surgery, suppurative parotitis can spread into the operative cavity leading to infection of the surgical site. VSD can help to effectively heal the infected wound. A two-stage surgical approach offers a safer option for removing the lateral skull base paraganglioma that involves the meninges.

Development of a fluorescent probe for detecting Al3+ in cooked wheaten food based on phosphonic acid group functionalized polythiophene derivatives.

As an unnecessary trace element, the content of aluminium in biological systems should be strictly controlled. Therefore, it was necessary to develop a convenient method for detection of aluminium ions. In this study, a fluorescent probe based on polythiophene derivatives was developed and used to detect Al3+ in Chinese traditional pasta. The fluorescence of this probe showed a significant decrease in hexamethylenetetramine-HCl buffer solution (pH 5) when Al3+ was present. In addition, the probe exhibited good sensitivity and selectivity to Al3+ over other metal ions when EDTA was used as the masking agent. Fluorescence intensity had a good linear relationship with the Al3+ concentration in the range 0.1-10 µM and the limit of detection for Al3+ was 39 nM. Furthermore, the probe was successfully applied to detect Al3+ in food samples and the results were consistent with ICP-AES.

Validation and Precision of Mixed Reality Technology in Baha Attract Implant Surgery.

OBJECTIVE: To test the feasibility of image-guided Baha Attract implant surgery with mixed reality (MR) in the form of the HoloLens to visualize critical structures and facilitate precise Baha implant placement. METHODS: A cadaveric case study of bilateral Baha Attract implant approaches was conducted using Star Atlas MR three-dimensional (3D) medical interaction system guidance at the Otolaryngology Department of PUMCH, Beijing, China. The accuracy of visual surface registration was determined by the target registration error (TRE) between the predefined points on the preoperative 3D holographic Baha Attract implant model and the postoperatively reconstructed 3D model. RESULTS: Bilateral Baha Attract implantation was completed successfully for all four cadaveric heads using the Star Atlas MR 3D medical interaction system with the HoloLens. The preoperative 3D digital model characteristics (including bone quality and thickness and avoidance of cranial vessels, air cells, and cranial sutures) corresponded well with the 3D model of the actual implantation reconstructed postoperatively. The median TRE of our system was 2.97 mm (ranging from 1.98 to 4.58 mm) in terms of distance and 2.76 degrees (ranging from 0.59 to 6.4 degrees) in terms of angle. CONCLUSIONS: Applying MR technology in the form of the HoloLens in Baha Attract implant surgery is feasible and could improve the accuracy of the surgery. The described MR system for Baha Attract implantation has the potential to improve the surgeon's confidence, as well as the surgical safety, efficiency, and precision.

Pyoderma gangrenosum confused with congenital preauricular fistula infection: A case report.

BACKGROUND: Pyoderma gangrenosum resulting from or associated with congenital preauricular fistula is rarely reported. CASE SUMMARY: We report a rare case of pyoderma gangrenosum misdiagnosed as preauricular fistula infection. To our knowledge, this is the first report to describe pyoderma gangrenosum originating from the site of preauricular fistula. The lesion continued expanding even after combined treatment of systemic antibiotics and thorough debridement. Taking into account the possibility of pyoderma gangrenosum, we applied soft care with normal saline and Vaseline gauze dressing. Systemic corticosteroids were not used until intestinal Clostridium difficile was controlled. No local recurrence was noted at the 12-mo follow-up. CONCLUSION: This case highlights the necessity of considering rare diseases, such as pyoderma gangrenosum, when the preauricular sinus deteriorates with general management. The treatment strategy is mutually conflicting between pyoderma gangrenosum and infection of the preauricular sinus.

Properties of Rigid Polyurethane Foam Modified by Tung Oil-Based Polyol and Flame-Retardant Particles.

Although tung oil is renewable, with an abundant production and low price in China, and it is used to synthesize different polyols for rigid polyurethane foam (RPUF), it remains a challenge to improve the properties of RPUF by redesigning the formula. Therefore, we propose four novel compounds to strengthen the properties of RPUF, such as the catalyst-free synthesis of tung oil-based polyol (PTOK), aluminum phosphate micro-capsule (AM), silica micro-capsule (SiM), and grafted epoxidized monoglyceride of tung oil on the surface of SiO2 (SiE), which were designed and introduced into the RPUF. Because of the PTOK with a catalytic function, the foaming process of some RPUF samples was catalyst-free. The results show that the incorporation of AM, SiM, and SiE, respectively, endow RPUF with a better thermal stability at a high temperature, and the T5%, Tmax1, and Tmax2 of RPUF appeared to be reduced, however, the Tmax3 and residue rate at 800 °C were improved, which may have a positive effect on the extension of the rescue time in case of fire, and the limiting oxygen index (LOI) value was increased to 22.6%. The formula, containing 25% PTOK made the RPUF environment-friendly. The results were obtained by comparing the pore size and mechanical properties of the RPUF-the AM had a better dispersion in the foam, and the foam obtained a better mechanical, thermal, and flame retardancy.

Crystal and Band-Gap Engineering of One-Dimensional Antimony/Bismuth-Based Organic-Inorganic Hybrids.

Hybrid halide perovskites are emerging semiconducting materials with a diverse set of remarkable optoelectronic properties. Besides the widely studied lead halide perovskites, Pb-free metal halides such as Bi- and Sb-containing hybrid organic-inorganic materials have shown potential as semiconductors and have been deemed candidates for optoelectronic devices. Here, we report a series of 1D Sb/Bi-based organic-inorganic hybrid alloys: [4ApyH]SbxBi1-xIyBr4-y, where 4ApyH stands for the 4-aminopyridine cations. These compounds are assembled by edge-sharing octahedral [MX6] units stabilizing 1D chains with organic cations filled in between. The crystallographic data of eight selected complexes show that [4ApyH]SbxBi1-xIyBr4-y has at least five phases (space group) with the difference metal and halogen content: Pbca ([4ApyH]BiI4), Pca21 ([4ApyH]Sb0.5Bi0.5I4), P21/c ([4ApyH]SbI4 (100 K), [4ApyH]BiI2Br2, [4ApyH]BiBr4, and [4ApyH]SbBr4 (100 K)), I2/a ([4ApyH]Sb0.5Bi0.5I2Br2and [4ApyH]SbI2Br2), and C2/c ([4ApyH]SbI4 (298 K) and [4ApyH]SbBr4 (298 K)). Powder X-ray diffraction shows that the phase of the sample changes with a change of the metal and halogen ratios, and the change law accords with Vegard's law. The optical band gaps are heavily affected by the metal and halide contents, ranging from 1.94 eV for [4ApyH]BiI4 to 2.73 eV for [4ApyH]SbBr4. When Sb substitutes for Bi to form an alloy, the band gap increases from 1.94 for [4ApyH]BiI4 to 1.67 eV for [4ApyH]SbI4, from 2.13 eV for [4ApyH]BiI2Br2 to 2.41 eV for [4ApyH]SbI2Br2, and from 2.55 eV for [4ApyH]BiBr4 to 2.73 eV for [4ApyH]SbBr4. The conductivity of [4ApyH]SbxBi1-xI4 increased from ∼1.00 × 10-15 to 2.14 × 10-8 S cm-1 with an increase of the Sb content. Solution-deposited thin films of the nine complexes show the same (110) orientation, displaying a parallel growth orientation with respect to the substrate. The devices of [4ApyH]Sb0.8Bi0.2I4 and [4ApyH]SbI4 demonstrated stable open-circuit photovoltages of 0.55 and 0.44 V, steady-state short-circuit photocurrent densities of 1.52 and 1.81 mA cm-2, and light-to-electrical energy conversion efficiencies of 0.29% and 0.30%, respectively.

Tracking the dimensional conversion process of semiconducting lead bromide perovskites by mass spectroscopy, powder X-ray diffraction, microcalorimetry and crystallography.

The structural information of a material in both the solid state and solution state is essential to the in-depth understanding of the properties of inorganic-organic hybrid materials. A one-dimensional (1D) lead bromide formulated as [H][NH3(CH2)2SS(CH2)2NH3][H2O][PbBr5] (1) could be converted into a new two-dimensional (2D) complex, [NH3(CH2)2SS(CH2)2NH3][PbBr4] (2), by soaking the crystals in water. The isolated 2D compound showed single-layer lead-halide perovskite structures. Electrospray ionization mass spectrometry (ESI-MS) analyses of the reaction solution revealed that the [PbBr3]- fragments are initially formed from the rapid decomposition of the 1D [PbBr5]3- chains and subsequently reassemble into 2D [PbBr4]2- layers, which was verified by powder X-ray diffraction (PXRD) and microcalorimetry. Because of the decomposition and reassembly process, complex 1 could be used as a precursor to synthesize M2+-doped 2D lead bromide perovskites, namely, Mn@2, Ni@2 and Cd@2. In addition, preliminary tests indicated that complex 2 exhibited a lower optical band gap (3.25 eV) and higher electrical conductivity (3.2 × 10-11 S cm-1) than complex 1 (3.38 eV, 5.4 × 10-12 S cm-1).

Clinical and electrophysiological profiles in early recognition of polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes syndrome.

BACKGROUND: The detection of polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes (POEMS) syndrome at early stage is challenging for neurologists. Since polyneuropathy could be the first manifestation, it could be misdiagnosed as chronic inflammatory demyelinating polyneuropathy (CIDP). The present study aimed to determine the clinical and electrophysiological features of POEMS syndrome to distinguish from CIDP. METHODS: The data of a group of patients with POEMS (n = 17) and patients with CIDP (n = 17) in Zhongshan Hospital Fudan University from January 2015 to September 2017 were analyzed in this retrospective study. The clinical features, neurological symptoms, and electrophysiological findings were compared between the two groups. RESULTS: Clinically, patients with POEMS demonstrated significantly more neuropathic pain in the lower extremities than patients with CIDP (58.8% vs. 11.8%, P = 0.01). Multisystem features like edema, skin change, organomegaly, and thrombocytosis were also pointed towards the diagnosis of POEMS syndrome. Electrophysiologically, terminal latency index (TLI) was significantly higher in patients with POEMS than that in patients with CIDP (median nerve: 0.39 [0.17-0.52] vs. 0.30 (0.07-0.69), Z = -2.413, P = 0.016; ulnar nerve: 0.55 [0.23-0.78] vs. 0.42 [0.12-0.70], Z = -2.034, P = 0.042). Patients with POEMS demonstrated a higher frequency of absent compound muscle action potential of the tibial nerve (52.9% vs. 17.6%, P = 0.031), less conduction block (ulnar nerve: 0 vs. 35.3%, P = 0.018), and less temporal dispersion (median nerve: 17.6% vs. 58.8%, P = 0.032) than CIDP group. The combination of positive serum monoclonal protein and high TLI (if either one or both were present) discriminated POEMS from CIDP with a sensitivity of 94.1% and 47.1% and specificity of 76.5% and 100.0%, respectively. CONCLUSIONS: POEMS syndrome could be distinguished from CIDP through typical clinical and electrophysiological characteristics in practice. The combination of serum monoclonal protein and high TLI might raise the sensitivity of detecting POEMS syndrome.

Developed a novel sensor based on fluorescent graft conjugated polymer for the determination of aristolochic acid in traditional Chinese medicine.

A novel fluorescent graft conjugated polymer (poly (2, 5-bis (Polyethylene glycol oxybutyrate)-1, 4-phenylethynylene-alt-1, 4-phenyleneethynylene, PPE-OB-PEG) has been designed and synthesized for the determination of aristolochic acid (AA). The detection conditions and detection characters of PPE-OB-PEG were systematically explored in this work. The fluorescence intensity of PPE-OB-PEG changes with the different concentration of AA. PPE-OB-PEG has a good linear range towards AA from 1.00 × 10-7 to 8.00 × 10-5 mol L-1 and the limit of detection (LOD) is 3.00 × 10-8 mol L-1 (S/N = 3). PPE-OB-PEG have been applied to detect AA in traditional Chinese medicine samples and the results are satisfactory. The experimental results show that PPE-OB-PEG can be used as a fluorescence probe for rapid and sensitive detection of AA.

Monodisperse Bismuth-Halide Double Perovskite Nanocrystals Confined in Mesoporous Silica Templates.

Metal halide perovskites have fascinating electronic properties and have already been implemented in various devices. Although the behavior of the properties of lead halide perovskite nanocrystals has been studied, the properties of lead-free perovskite nanocrystals are less well-understood because synthesizing them is still very challenging. Here, a simple and popularizable method has been demonstrated to grow monodisperse bismuth-halide double perovskite nanocrystals, Cs2AgBiBr6 (1), inside three kinds of mesoporous silica templates. The size and morphology of nanocrystals depend on the structure and pore size of the template. Structural analysis shows that the nanocrystals of various sizes and morphologies retain the crystal structure of bimetallic perovskite. 1 exhibits different morphologies in the silicon channels of three templates: square nanoparticles in KIT-6, spherical and rodlike particles in SBA-15, and nanowires in MCM-41. UV-vis-NIR and photoluminescence measurements show us the variation of band gap and carrier recombination time due to quantum confinement of nanocrystals in mesoporous silicon materials. The band gaps of nanocrystals in the template exhibit an obvious blue shift compared with that of the bulk sample, and the carrier recombination time is significantly shortened. We show that mesoporous silicon templates can be used to prepare lead-free perovskite nanocrystals, and the controllable preparation of nanocrystals can be achieved by the template's own characteristics. This provides a new idea for us to find new functional materials of lead-free metal halide solid-state light-emitting diodes.

Syntheses, crystal-solution structures and magnetic properties of a series of decanuclear heterometallic [LnCoCo] (Ln = Eu, Gd, Tb, Dy) clusters.

Four unprecedented decanuclear heterometallic [Ln2CoII4CoIII4] clusters based on a diethanolamine ligand (H2dea), namely [Eu2CoII4CoIII4(dea)8(HCOO)4(OH)2(Cl)2(CH3OH)2]Cl2·4CH3OH·2H2O (1), [Gd2CoII4CoIII4(dea)8(HCOO)4(OH)2(Cl)2(CH3OH)2]Cl2·4CH3OH·2H2O (2), [Tb2CoII4CoIII4(dea)8(HCOO)4(OH)2(Cl)2(CH3OH)2]Cl2·2CH3OH·4H2O (3) and [Dy2CoII4CoIII4(dea)8(HCOO)4(OH)2(Cl)2(CH3OH)2]Cl2·2CH3OH·4H2O (4) were synthesized through a facile solution method. Single-crystal X-ray diffraction analyses reveal that complexes 1-4 consist of a [Ln2CoII4CoIII4] core, which is constructed by bridging a quasi-double cuboidal [Ln2CoII2CoIII2] core with two [CoIICoIII] units. Electrospray ionization mass spectrometry (ESI-MS) using methanol solution reveals that complexes 1-4 are stable in the solution, and the clusters undergo three different substitution reactions (Cl- replaced by OH-, OH- replaced by CH3O- and HCOO- replaced by OH-/CH3O-) at the same time in the ionization state. Magnetic susceptibilities reveal ferromagnetic couplings within complexes 3 and 4, and the magnetocaloric effect (MCE) for 2 was also evaluated and the maximum entropy change (-ΔSm) value reaches 16.3 J kg-1 K-1 at about 3 K and 5 T.

Fluorescence chemical sensor for determining trace levels of nitroaromatic explosives in water based on conjugated polymer with guanidinium side groups.

A novel fluorescent conjugated polymer (poly(2-amino-N-(2-((4-ethynylphenyl) ethynyl) phenyl)-5-guanidinopentanamide)-1,4-phenylethynylene-1,4-phenyleneethynylene, PPE-Arg) was synthesized in this paper. We found that PPE-Arg could be quenched by picric acid (PA). Photoinduced electron transfer (PET) mechanism can be used to describe the fluorescence quenching of PPE-Arg. It could be speculated that the photo-induced electrons may be transferred from PPE-Arg to nitroaromatic explosives. In this paper, the experiment conditions and detection performance of PPE-Arg were systematically studied. The experiment results demonstrate PPE-Arg as a sensor for PA has a good linear range from 5 × 10-7 to 6 × 10-5 mol L-1 with the calculated limit of detection (LOD) to be 1.0 × 10-7 mol L-1. Meanwhile, reaction time between PPE-Arg and PA is less than 1 min. This proposed sensor was applied to rapidly detect nitroaromatic explosives in environmental water samples and satisfactory results were obtained.

Spontaneous spinal epidural hematomas: One case report and rehabilitation outcome.

RATIONALE: Spontaneous spinal epidural hematoma (SSEH) is a relatively rare but potentially disabling disease, and the classical presentation of it includes an acute onset of severe, sometimes radiating back or neck pain, followed by signs and symptoms of rapidly evolving nerve root or spinal cord compression. PATIENT CONCERNS: Here, we report a 26-year-old female patient presented with weakness in bilateral lower extremities, progressing to intense paraplegia and anesthesia without recent medical history of trauma, infection, surgery, or drug use. DIAGNOSIS: A magnetic resonance imaging (MRI) scan of spinal cord was planned and a posterior epidural hematoma of the thoracic spine was observed. INTERVENTIONS: A posterior decompression and hematoma evacuation was performed after diagnosis immediately. Early rehabilitation program of the specific kind spinal cord injury was formulated and implemented. OUTCOMES: The patient finally can handle basic living activities, such as completing wheelchair locomotion, transferring from bed to wheelchair independently after 3 months of rehabilitation. LESSONS: SSEH is a rarely occurring case in emergency. Acute chest pain and paraplegia could be the initial presentation of acute spinal epidural hemorrhage, but the diagnosis of patient without classical manifestations is still a challenge for doctors. Early diagnosis, prompt decompression, and individualized rehabilitation program can improve the prognosis and outcome.

Residue analysis of tetracyclines in milk by HPLC coupled with hollow fiber membranes-based dynamic liquid-liquid micro-extraction.

A novel hollow fiber membranes-based dynamic liquid-liquid micro-extraction (HF-DLLME) coupled with HPLC-UV detection has been developed for the residue analysis of tetracyclines in milk samples without deproteinization and degreasing. The influences of experimental parameters were investigated and optimized. The method showed a good performance. The limits of detection (LOD) are in the range of 0.95-3.6µg/L. The recoveries in spiked samples range from 92.38 to 107.3%. The relative standard deviations (RSDs) are lower than 8.66%. The advantages of this method are simple operation, high efficiency, absence of sample carryover and low cost.

High rate of drug resistance among tuberculous meningitis cases in Shaanxi province, China.

The clinical and mycobacterial features of tuberculous meningitis (TBM) cases in China are not well described; especially in western provinces with poor tuberculosis control. We prospectively enrolled patients in whom TBM was considered in Shaanxi Province, northwestern China, over a 2-year period (September 2010 to December 2012). Cerebrospinal fluid specimens were cultured for Mycobacterium tuberculosis; with phenotypic and genotypic drug susceptibility testing (DST), as well as genotyping of all positive cultures. Among 350 patients included in the study, 27 (7.7%) had culture-confirmed TBM; 84 (24.0%) had probable and 239 (68.3%) had possible TBM. DST was performed on 25/27 (92.3%) culture positive specimens; 12/25 (48.0%) had "any resistance" detected and 3 (12.0%) were multi-drug resistant (MDR). Demographic and clinical features of drug resistant and drug susceptible TBM cases were similar. Beijing was the most common genotype (20/25; 80.0%) with 9/20 (45%) of the Beijing strains exhibiting drug resistance; including all 3 MDR strains. All (4/4) isoniazid resistant strains had mutations in the katG gene; 75% (3/4) of strains with phenotypic rifampicin resistance had mutations in the rpoB gene detected by Xpert MTB/RIF®. High rates of drug resistance were found among culture-confirmed TBM cases; most were Beijing strains.

Sub-optimal Specificity of Modified Ziehl-Neelsen Staining for Quick Identification of Tuberculous Meningitis.

Background: Microbiological confirmation of tuberculous meningitis (TBM) remains problematic. We assessed the diagnostic performance of a modified Ziehl-Neelsen (MZN) staining method that showed promise in earlier studies. Methods: Patients evaluated for TBM in Shaanxi province, China, were prospectively enrolled from May, 2011 to April, 2013. Cerebrospinal fluid (CSF) specimens were evaluated using the Xpert MTB/RIF® assay, MZN staining, and standard biochemical and microbiological tests, together with detailed clinical and radiological assessment. Results: Among 316 patients included in the study, 38 had definite TBM, 66 probable TBM, 163 possible TBM and 49 "no TBM," using consensus uniform research case definition criteria. Comparing "definite or probable TBM" to "no TBM" MZN staining had higher sensitivity than Xpert MTB/RIF® (88.5 vs. 36.5%), but greatly reduced specificity (71.4 vs. 100.0%); 14/49 (28.6%) cases with "no TBM" tested positive on MZN. Mycobacterium tuberculosis culture was performed in 104/179 (58.1%) of MZN positive samples; 12.5% (13/104) were positive. Using Xpert MTB/RIF® as the reference standard, MZN had a sensitivity of 92.1% (95% CI 79.2-97.3) and specificity of 71.4% (95% CI 57.6-82.2). Conclusion: Xpert MTB/RIF® offered a rapid and specific TBM diagnosis, but sensitivity was poor. MZN was mainly hampered by false positives. Strategies to enhance the sensitivity of Xpert MTB/RIF® or improve the diagnostic accuracy of MZN should be explored.

Delayed surgical management is not effective for severe Bell's palsy after two months of onset.

AIMS: To assess the effectiveness of delayed surgery and follow-up observation in managing severe Bell's palsy after two months of onset. METHODS: Forty-one Bell's palsy patients with severe facial paralysis were treated after two months of onset. Eighteen patients in group I underwent decompression operations between two and three months after onset, and eight patients in group II underwent surgery after three months of onset; 15 patients in group III were managed with follow-up observation. All patients were followed up at the end of 3rd, 6th and 12th months, and surgical outcomes were compared with follow-up observations using House-Brackmann score and Facial Clinimetric Evaluation (FaCE) scale. RESULTS: Between groups I and III, the difference in the proportion of the patients with fair or poor recoveries was statistically significant (p < 0.05) at the three-month follow-up visit. There was no significant difference in the distribution of complete, fair or poor recoveries at the 12-month follow-up visits among the three groups (p < 0.05). The total FaCE score and five individual domains were significantly improved at the end of the follow-up period in groups I and III (p < 0.05). However, in group I, the lacrimal control scores were significantly decreased at the end of the follow-up period compared to scores before surgery (p < 0.05). After surgery, four patients had sensorineural hearing loss, three patients had tinnitus and no patients had vertigo. CONCLUSION: Patients with severe Bell's palsy after two months of onset would not benefit from delayed decompression surgery.