Organic Reactions Enabled by Mechanical Force-Induced Single Electron Transfer.

Mechanochemical reactions, achieved through milling, grinding, or other mechanical actions, have emerged as a solvent-free alternative to traditional solution-based chemistry. Mechanochemistry not only provides the opportunity to eliminate bulk solvent use, reducing waste generation, but also unveils a new reaction strategy which enables the realization of reactions previously inaccessible in solution. While the majority of organic reactions facilitated by mechanical force traditionally follow two-electron transfer pathways similar to their solution-based counterparts, the field of mechanochemically induced single-electron transfer (SET) reactions has witnessed rapid development. This review outlines examples of mechanochemical reactions facilitated by the SET process, focusing on the reagents that initiate SET, thereby positioning mechanochemistry as a burgeoning field within the realm of single-electron chemistry.

Copper-Catalyzed 1,4-Trifluoromethylthio-Arylsulfonylation of 1,3-Enynes via the Insertion of Sulfur Dioxide.

A copper-catalyzed trifluoromethylthio-arylsulfonylation between 1,3-enynes, AgSCF3, aryldiazonium tetrafluoroborates, and SO2 (from SOgen) is presented, which could introduce sulfone, SCF3, and allene moieties into one molecule simultaneously. This strategy features mild reaction conditions, good substrate compatibility, and excellent regioselectivity. The products obtained have the potential for further conversion into other valuable compounds. Initial investigations into the reaction mechanism suggest that it may proceed via a radical pathway. Notably, SOgen was proven as a uniquely effective SO2 surrogate in this transformation.

[Establishment of a nomogram model for the early diagnosis of childhood sepsis]. / 基于列线图的儿童脓毒症早期诊断模型的建立.

OBJECTIVES: To establish a nomogram model for the early diagnosis of sepsis in children. METHODS: A total of 76 children with sepsis who were admitted to Sichuan Maternal and Child Health Hospital from January 2018 to June 2021 were retrospectively selected as the sepsis group. After matching for sex and age (±2 years) at a ratio of 1:1:1, 76 children with local infection who were hospitalized during the same period were enrolled as the local infection group, and 76 children with non-infectious diseases were enrolled as the control group. The three groups were compared in terms of laboratory markers and the results of quick Sequential Organ Failure Assessment (qSOFA) and Pediatric Critical Illness Score (PCIS). A multivariate logistic regression analysis was used to investigate the association between the above indicators and sepsis. R4.1.3 software was used to establish and validate the nomogram model for the early diagnosis of sepsis based on the results of the multivariate analysis. A receiver operating characteristic (ROC) curve analysis was used to evaluate the value of the nomogram model, and the Bootstrap method was used to perform the internal validation of the model. RESULTS: The multivariate logistic regression analysis showed that soluble triggering receptor expressed on myeloid cells-1, qSOFA score, PCIS score, C-reactive protein, interleukin-6, and interleukin-10 were independently associated with childhood sepsis (P<0.05). The above indicators were used to establish a nomogram for the early diagnosis of sepsis, with an area under the ROC curve of 0.837 (95%CI: 0.760-0.914), and the calibration curve results showed a mean absolute error of 0.024, suggesting that the performance of this model was basically consistent with that of the ideal model. CONCLUSIONS: The indicators soluble triggering receptor expressed on myeloid cells-1, qSOFA score, PCIS score, C-reactive protein, interleukin-6, and interleukin-10 are independently associated with childhood sepsis, and the nomogram model established based on these indicators has high discriminatory ability and accuracy in the early diagnosis of sepsis in children.

Effect of comprehensive nursing intervention in children with respiratory failure.

OBJECTIVE: To investigate the effect of comprehensive nursing intervention in the management of pediatric patients with respiratory failure. METHODS: A total of 60 pediatric patients were selected as research subjects, and the clinical data were collected and retrospectively investigated. The patients were divided either into a control group (n=30) or an observation group (n=30) according to the nursing care methods. Pediatric patients from the observation group underwent comprehensive nursing intervention, while those in the control group received conventional nursing care intervention. The clinical effects, negative emotions, SF-36 scores, hospital stays, clinical symptom indicators, blood gas indices, lung function indicators and the nursing satisfaction rates were compared between the two groups. RESULTS: The clinical effect in the observation group was significantly better than that in the control group. Compared with those in the control group, significantly lower scores of the Self-Rating Anxiety Scale and the Self-Rating Depression Scale were observed in the observation group. The indicators associated with blood gas and lung function in the observation group were significantly improved in contrast to those in the control group. Moreover, the disappearance time of pulmonary rales, disappearance time of cyanochroia, alleviation time of dyspnea and hospital stays in the observation group were significantly shorter than those in the control group, while the SF-36 scores and the nursing satisfaction rate in the observation group were significantly higher than those in the control group (all P<0.05). CONCLUSION: Comprehensive nursing intervention significantly improved clinical treatment effects and patient satisfaction, alleviated the clinical symptoms, increased life quality and shortened hospital stay. So, it is worth being promoted in clinical practice.

Maternal Folic Acid Supplementation, Dietary Folate Intake, and Low Birth Weight: A Birth Cohort Study.

Objectives: To investigate the independent and collective effects of maternal folic acid supplementation or dietary folate intake on the risk of low birth weight (LBW), and to further comprehensively examine the joint associations of folic acid supplementation and dietary folate intake with LBW by various clinical subtypes. Design: Participants were recruited from Gansu Provincial Maternity and Child Care Hospital. A standardized and structured questionnaire was distributed to collect demographic factors, reproductive and medical history, occupational and residential history, physical activity, and diet. Data on pregnancy-related complications and birth outcomes were extracted from medical records. Unconditional logistic regression models were used to estimate the odds ratio (OR) and 95% confidence interval (95% CI) for single and joint associations of folic acid supplementation and dietary folate intake with LBW. Setting: A birth cohort data analysis using the 2010-2012 Gansu Provincial Maternity and Child Care Hospital in Lanzhou, China. Participants: In total, 9,231 pregnant women and their children were enrolled in the study. Results: Compared with non-users, folic acid supplementation was associated with a reduced risk of LBW (OR: 0.80, 95% CI: 0.66-0.97), and the reduced risk was mainly seen for term-LBW (OR: 0.59, 95% CI: 0.41-0.85), and multiparous-LBW (OR: 0.72, 95% CI: 0.54-0.94). There were no significant associations between dietary folate intake and LBW, and there was no interaction between folic acid supplement and dietary folate intake on LBW. Conclusions: Our study results indicated that folic acid supplementation was associated with a reduced risk of LBW, and there was no interaction between folic acid supplements and dietary folate intake on LBW.

Nickel-Catalyzed Cross-Electrophile Coupling Reactions between Allylic Acetates and gem-Difluorovinyl Tosylate.

A nickel-catalyzed cross-electrophile coupling of allylic acetates and gem-difluorovinyl tosylate is presented, which first achieves allylic gem-difluoroolefins via C(sp3)-C(sp2) cross-electrophile coupling. In addition, this protocol was performed under mild reaction conditions, affording a variety of allylic gem-difluorovinyl arenes in moderate to good yields. Moreover, both linear and branched allylic acetate could produce a linear cross-coupling product exclusively. Mechanistic studies reveal that the reaction involves two different Ni(0)/Ni(II) catalytic cycles.

Acceptorless Dehydrogenative Cross-Coupling of Primary Alcohols Catalyzed by an N-Heterocyclic Carbene-Nitrogen-Phosphine Chelated Ruthenium(II) Complex.

The acceptorless dehydrogenative cross-coupling of primary alcohols to form cross-esters with the liberation of H2 gas was enabled using a [RuCl(η6-C6H6)(κ2-CNP)][PF6]Cl complex as the catalyst. This sustainable protocol is applicable to a broad range of primary alcohols, particularly for the sterically demanding ones, featuring good functional group tolerance and high selectivity. The good catalytic performance can be attributed to the nitrogen-phosphine-functionalized N-heterocyclic carbene (CNP) ligand, which adopts a facial coordination mode as well as the facile dissociation of coordinated benzene.

CXCL14 facilitates the growth and metastasis of ovarian carcinoma cells via activation of the Wnt/ß-catenin signaling pathway.

BACKGROUND: There is an urgent need to identify potential targets in anticancer therapy to improve the survival and prognosis of patients with ovarian cancer (OC). Herein, we investigated the functional significance of chemokine (C-X-C motif) ligand 14 (CXCL14) in OC cell growth and epithelial-mesenchymal transition (EMT). METHODS: qRT PCR and western blotting was used to detect CXCL14 mRNA level and protein expression, respectively. The functional mechanism of CXCL14 in OC was investigated by CCK-8, colony formation and transwell assays. The migration ability of OC cell was determined using wound healing. The protein expressions of CXCL14 and ß-catenin in OC tissues were determined by immumohistochemical staining. RESULTS: We demonstrated that high levels of CXCL14 were associated with a worse prognosis in patients with OC. CXCL14 knockdown considerably restrained the growth, migration and invasion of OC cell in vitro. In contrast, ectopic CXCL14 overexpression yielded the opposite results. Investigations to determine the underlying molecular mechanisms revealed that the Wnt/ß-catenin signaling pathway is involved in CXCL14-facilitated OC cell invasiveness. CONCLUSION: These data collectively demonstrate that CXCL14 contributes to OC cell growth and metastatic potential by regulating the Wnt/ß-catenin signaling pathway.

Association between Iron Supplementation, Dietary Iron Intake and Risk of Moderate Preterm Birth: A Birth Cohort Study in China.

BACKGROUND: To evaluate the independent and collective effects of maternal iron supplementation and dietary iron intake upon the risk of moderate preterm birth and its subtypes. METHODS: In this birth cohort study, 1019 pregnant women with moderate preterm birth and 9160 women with term birth were recruited at Gansu Provincial Maternity and Child Care Hospital from 2010-2012 in China. Unconditional logistic regression models were utilized to evaluate the association between maternal iron supplementation, dietary iron intake, and the risk of moderate preterm birth and its subtypes. RESULTS: Compared with non-users, iron supplement users exerted a protective effect upon the overall (OR=0.54, 95%CI=0.40-0.72) and spontaneous moderate preterm birth (OR=0.39, 95%CI=0.33-0.83). Compared with the 25th quartiles of dietary iron intake, either before or during pregnancy, it exerted a significantly protective effect upon those who had the highest quartiles of dietary iron intake (OR=0.87, 95%CI=0.82-0.95 for the highest quartiles of dietary iron intake before pregnancy OR=0.85, 95%CI=0.79-0.91). Positive association was observed between the additive scale and multiplicative scale for preterm birth, spontaneous preterm rather than medically indicated preterm. CONCLUSION: Iron supplements (60 mg/day) and high-iron intake (>25.86 mg/day before pregnancy, >30.46 mg/day during pregnancy) reduced the risk of moderate preterm birth. Positive correlation is found between the additive scale and multiplicative scale for preterm birth, spontaneous preterm birth.

Metal- and Base-Free C(sp2)-H Arylsulfonylation of Enamides for Synthesis of (E)-ß-Amidovinyl Sulfones via the Insertion of Sulfur Dioxide.

A metal- and base-free C(sp2)-H direct arylsulfonylation of secondary and tertiary enamides with aryldiazonium salts and ex situ generated SO2 (from SOgen) is presented. This method runs smoothly to produce ß-amidovinyl sulfones with excellent stereoselectivities in moderate to excellent yields. Moreover, this strategy features good functional group tolerance and environmentally benign reaction conditions. Mechanistic experiments indicate that this sulfonylation may proceed in a radical pathway.

Determining optimal gestational weight gain (GWG) in a northwest Chinese population: A CONSORT.

ABSTRACT: To determine optimal gestational weight gain (GWG) for the Chinese population.Live singleton deliveries at the largest maternal & childcare hospital in northwest China from 2010 to 2012 were analyzed retrospectively. Multivariable logistic regression analysis was conducted to determine the lowest aggregated risk of interested perinatal outcomes based on Chinese adult body mass index (BMI) categories.Eight thousand eight hundred seventy enrolled parturients were divided into 4 groups according to their prepregnancy BMI: underweight (21.31%, BMI < 18.5 kg/m2), normal weight (67.81%, 18.5 kg/m2 ≤ BMI < 24 kg/m2), overweight (8.99%, 24 kg/m2 ≤ BMI < 28 kg/m2 and obese (1.89%, BMI ≥ 28 kg/m2). The optimal GWG values for the above 4 groups were 16.7 kg (GWG range, 12.0-21.5), 14.5 kg (9.5-19.5), 11.5 kg (7.0-16.5), and 8.0 kg (5.0-13.0). The rates of inadequate, optimal and excessive GWG in present study were 6.14% (545), 62.34% (5529), and 31.52% (2796) respectively, which were significantly different from those of the 2009 Institute of Medicine recommendation (χ2 = 1416.05, Pinteraction < 0.0001).Wider optimal GWG ranges than those recommended by Institute of Medicine were found in our study, and our proposed criteria seems to be practical to the Chinese population.

Cooking stoves and risk of birth defects in urban China.

INTRODUCTION: Birth defects are a leading cause of infant death. Pregnant women spend a large amount of time indoors, and little research from population-based studies has investigated the association between indoor air pollution and birth defects. We aimed to examine whether using coal, biomass, or electromagnetic stoves for cooking is associated with risk of birth defects compared to using gas stoves. METHODS: A birth cohort study was conducted from 2010 to 2012 in Lanzhou, China. Cases (n = 264) were singleton births with birth defects, which were defined as abnormalities of structure or function, including metabolism, presented at birth based on the International Classification of Diseases (ICD)-10 codes. Controls (n = 9926) were defined as singleton live births without birth defects. Unconditional logistic regression models were employed to estimate the association adjusting for confounding variables. RESULTS: Compared to gas stoves for cooking, biomass (OR = 2.66, 95%CI: 1.38-5.13), and electromagnetic stove (OR = 1.90, 95%CI: 1.26-2.88) for cooking were associated with an increased risk of birth defects. The significant associations remained among non-congenital heart disease (CHD) defects but not CHDs. CONCLUSIONS: Using biomass or electromagnetic stoves for cooking during pregnancy was associated with an increased risk of birth defects. Additional studies are warranted to confirm these novel findings. Studies with larger sample size or greater statistical power are also warranted to better estimate the associations for individual birth defects.

An observational study on Ca supplementation and dietary intake during pregnancy on low birth weight and small for gestational age.

OBJECTIVE: To evaluate the effects of dietary Ca intake and Ca supplementation during pregnancy on low birth weight (LBW) and small for gestational age (SGA) infants. DESIGN: A birth cohort study was conducted in 2010-2012 at the Gansu Provincial Maternity and Child Care Hospital in Lanzhou, China. SETTING: A birth cohort study. PARTICIPANTS: Totally, 9595 pregnant women who came to the hospital for delivery at 20 weeks of gestation or more, and who were 18 years of age or older. RESULTS: Compared with non-users, Ca supplement users had a reduced risk of LBW infants (OR = 0·77, 95 % CI: 0·63, 0·95) and a reduced risk of nulliparous women giving birth to LBW infants (OR = 0·75, 95 % CI: 0·58, 0·98) (P < 0·05). More specifically, both the use of Ca supplement before conception and during pregnancy (OR = 0·44, 95 % CI: 0·19, 0·99) and during pregnancy only (OR = 0·80, 95 % CI: 0·65, 0·99) had the main effect of reducing risk of nulliparous women giving birth to LBW infants (P < 0·05). There was no association between Ca supplementation and SGA (OR = 0·87, 95 % CI: 0·75, 1·01) (P > 0·05). However, higher dietary Ca intake during pregnancy decreases the risk of both LBW (quartile 2: OR = 0·72, 95 % CI: 0·55, 0·94; quartile 3: OR = 0·68, 95 % CI: 0·50, 0·62) and SGA infants (quartile 2: OR = 0·77, 95 % CI: 0·63, 0·95; quartile 3: OR = 0·71, 95 % CI: 0·57, 0·88, quartile 4: OR = 0·71, 95 % CI: 0·57, 0·88) (P < 0·05). CONCLUSIONS: Ca supplementation and adequate dietary intake of Ca during pregnancy are associated with a decreased risk of LBW infants born to nulliparous women.

Folic acid supplementation, dietary folate intake and risk of small for gestational age in China.

OBJECTIVE: To investigate the hypothesis that folic acid supplementation and dietary folate intake before conception and during pregnancy reduce the risk of small for gestational age (SGA) and to examine the joint effect of folic acid supplementation and dietary folate intake on the risk of SGA. DESIGN: Participants were interviewed by trained study interviewers using a standardized and structured questionnaire. Information on birth outcomes and maternal complications was abstracted from medical records and dietary information was collected via a semi-quantitative FFQ before conception and during pregnancy. SETTING: A birth cohort data analysis using the 2010-2012 Gansu Provincial Maternity and Child Care Hospital. PARTICIPANTS: Women (n 8758) and their children enrolled in the study. RESULTS: Folic acid supplementation was associated with a reduced risk of SGA (OR = 0·72, 95 % CI 0·60, 0·86), with the reduced risk seen mainly for SGA at ≥37 weeks of gestational age (OR = 0·70, 95 % CI 0·58, 0·85) and nulliparous SGA (OR = 0·67, 95 % CI 0·54, 0·84). There was no significant association between dietary folate intake and SGA risk. CONCLUSIONS: Our study suggested that folic acid supplementation was associated with a reduced risk of SGA and the risk varied by preterm status and parity.

Effect of Bi2O3 content on the microstructure and electrical properties of SrBi2Nb2O9 piezoelectric ceramics.

Lead-free ceramics, SrBi2Nb2O9-xBi2O3 (SBN-xBi), with different Bi contents of which the molar ratio, n(Sr) : n(Bi) : n(Nb), is 1 : 2(1 + x/2) : 2 (x = -0.05, 0.0, 0.05, 0.10), were prepared by conventional solid-state reaction method. The effect of excess bismuth on the crystal structure, microstructure and electrical properties of the ceramics were investigated. A layered perovskite structure without any detectable secondary phase and plate-like morphologies of the grains were clearly observed in all samples. The value of the activation energy suggested that the defects in samples could be related to oxygen vacancies. Excellent electrical properties (e.g., d 33 = 18 pC N-1, 2P r = 17.8 µC cm-2, ρ rd = 96.4% and T c = 420 °C) were simultaneously obtained in the ceramic where x = 0.05. Thermal annealing studies indicated the SBN-xBi ceramics system possessed stable piezoelectric properties, demonstrating that the samples could be promising candidates for high-temperature applications.

Pre-pregnancy BMI, gestational weight gain and risk of preeclampsia: a birth cohort study in Lanzhou, China.

BACKGROUND: To evaluate the independent and joint effects of maternal pre-pregnancy BMI and gestational weight gain (GWG) on the risk of preeclampsia and its subtypes. METHODS: A birth cohort study was conducted from 2010 to 2012 in Lanzhou, China. Three hundred fourty seven pregnant women with preeclampsia and 9516 normotensive women at Gansu Provincial Maternity and Child Care Hospital were included in the present study. Unconditional logistic regression models were used to evaluate the associations between pre-pregnancy BMI, GWG, and risk of preeclampsia and its subtypes. RESULTS: Compared to women with normal pre-pregnancy BMI, those who were overweight/obese had an increased risk of preeclampsia (OR = 1.81; 95%CI: 1.37-2.39). Women with excessive GWG had an increased risk of preeclampsia (OR = 2.28; 95%CI: 1.70-3.05) compared to women with adequate GWG. The observed increased risk was similar for mild-, severe- and late-onset preeclampsia. No association was found for early-onset preeclampsia. Overweight/obese women with excessive GWG had the highest risk of developing preeclampsia compared to normal weight women with no excessive weight gain (OR = 3.78; 95%CI: 2.65-5.41). CONCLUSIONS: Our results suggested that pre-pregnancy BMI and GWG are independent risk factors for preeclampsia and that the risk might vary by preeclampsia subtypes. Our study also proposed a potential synergistic effect of pre-pregnancy BMI and GWG that warrants further investigation.

Maternal folic acid supplementation and dietary folate intake and congenital heart defects.

BACKGROUND: It has been reported that folic acid supplementation before and/or during pregnancy could reduce the risk of congenital heart defects (CHDs). However, the results from limited epidemiologic studies have been inconclusive. We investigated the associations between maternal folic acid supplementation, dietary folate intake, and the risk of CHDs. METHODS: A birth cohort study was conducted in 2010-2012 at the Gansu Provincial Maternity & Child Care Hospital in Lanzhou, China. After exclusion of stillbirths and multiple births, a total of 94 births were identified with congenital heart defects, and 9,993 births without any birth defects. Unconditional logistic regression was used to estimate the associations. RESULTS: Compared to non-users, folic acid supplement users before pregnancy had a reduced risk of overall CHDs (OR: 0.42, 95% CI: 0.21-0.86, Ptrend = 0.025) after adjusted for potential confounders. A protective effect was observed for certain subtypes of CHDs (OR: 0.37, 95% CI: 0.16-0.85 for malformation of great arteries; 0.26, 0.10-0.68 for malformation of cardiac septa; 0.34, 0.13-0.93 for Atrial septal defect). A similar protective effect was also seen for multiple CHDs (OR: 0.49, 95% CI: 0.26-0.93, Ptrend = 0.004). Compared with the middle quartiles of dietary folate intake, lower dietary folate intake (<149.88 µg/day) during pregnancy were associated with increased risk of overall CHDs (OR: 1.63, 95% CI: 1.01-2.62) and patent ductus arteriosus (OR: 1.85, 95% CI: 1.03-3.32). Women who were non-user folic acid supplement and lower dietary folate intake have almost 2-fold increased CHDs risk in their offspring. CONCLUSIONS: Our study suggested that folic acid supplementation before pregnancy was associated with a reduced risk of CHDs, lower dietary folate intake during pregnancy was associated with increased risk. The observed associations varied by CHD subtypes. A synergistic effect of dietary folate intake and folic acid supplementation was also observed.

Drug-Resistant Tuberculosis among Children, China, 2006-2015.

Microbial drug resistance has become a major public health concern worldwide. To acquire epidemiologic data on drug-resistant tuberculosis (DR TB) among children, a major cause of illness and death for this population, we conducted a retrospective study of 2006-2015 data from 36 TB prevention and control institutions in Shandong Province, China. A total of 14,223 new TB cases, among which children (<18 years of age) accounted for only 5.5%, were caused by culture-confirmed Mycobacterium tuberculosis. Among children with TB, 18.9% had DR TB and 6.9% had multidrug-resistant TB. Over the past decade, the percentage of DR TB; multidrug-resistant TB; and overall first-line drug resistance for isoniazid, rifampin, ethambutol, and streptomycin among children increased significantly (at least 12%). Understanding the long-term trends of DR TB among children can shed light on the performance of TB control programs, thereby contributing to global TB control.

Trends and characteristics of drug-resistant tuberculosis in rural Shandong, China.

OBJECTIVES: The aim of this study was to describe the secular trends in drug-resistant tuberculosis (DR-TB) and to identify unique characteristics of multidrug-resistant tuberculosis (MDR-TB) in rural China. METHODS: A retrospective study was conducted using TB data collected from 36 TB prevention and control institutions serving rural populations in Shandong Province, China, for the period 2006-2015. RESULTS: Approximately 8.3% of patients suffered from MDR-TB, among whom 70% were newly treated patients; this rate increased by 1.3% annually during the 10-year study period. An increase in the percentage of overall first-line drug resistance against isoniazid, rifampicin, ethambutol, and streptomycin was confirmed (p<0.05). The percentage of MDR-TB in new and previously treated cases increased at yearly rates of 9.9% and 11.1%, respectively. MDR-TB patients were more likely to be female (odds ratio (OR) 1.58, 95% confidence interval (CI) 1.32-1.89), smokers (OR 1.75, 95% CI 1.47-2.07), to have had recent TB contact (OR 1.58, 95% CI 1.04-2.42), or to have been retreated (OR 2.89, 95% CI 2.46-3.41). CONCLUSIONS: Increasing MDR-TB and rates of primary MDR-TB characterize DR-TB cases in rural China. Persistent efforts need to be made among MDR-TB patients in future TB control strategies.

Epidemiological trends and outcomes of extensively drug-resistant tuberculosis in Shandong, China.

BACKGROUND: Extensively Drug-Resistant (XDR) Tuberculosis (TB) has posed a great threat to global health and finance systems, especially for developing countries with high TB and Multidrug-Resistant (MDR) TB burden. METHODS: We retrospectively analyzed HIV-uninfected TB case confirmed and treated in Shandong Provincial Chest Hospital (SPCH) between January 2008 and December 2015. Unique characteristics of XDR-TB were identified; its longitudinal changes and survival were analyzed. RESULTS: Between January 2008 and December 2015, a total of 144 cases were confirmed to be XDR-TB (2.5% of 5663 culture-confirmed TB cases; 27.9% of 516 MDR-TB cases). The proportion of XDR TB cases among MDR-TB cases has increased from 26.5% in 2008 to 44.5% in 2014 (Chi-Square test for trends: P < 0.01). Among the 144 XDR-TB cases, 21 patients (14.6%) had treatment success, 123 (85.1%) had poor treatment outcomes. Mortality was higher among XDR-TB cases than among MDR TB cases (8.3% vs. 3.8%, P = 0.033) and drug-susceptible TB cases (8.3% vs. 2.1%, P < 0.01). CONCLUSIONS: XDR-TB cases comprise a substantial and increasing fraction of MDR-TB cases, causing poor treatment outcomes and high mortalities. Early drug susceptibility testing, adequate TB treatment and efficient infection control must be in place in future TB control strategies.