Table of Content

10 November 2011, Volume 33 Issue 11

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Evaluation for diagnosis and treatment of endobronchial tuberculosis

DING Wei-min, FU Yu

Chinese Journal of Antituberculosis. 2011, 33(11):  697-702. 

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Study on the relationship between the efficacy of endobronchial tuberculosis and the level of interferon-γ and transforming growth factor-β

LIANG Li, YUE Jun, LIU Li-rong, SHA Wei，FANG Yong, JIANG Rui-hua, TANG Shen-jie, XIAO He-ping

Chinese Journal of Antituberculosis. 2011, 33(11):  703-706. 

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Objective  To investigate the correlation between the treatment outcome of endobronchial tuberculosis (EBTB) and the levels of interferon-γ (IFN-γ) and transforming growth factor-β (TGF-β) in the serum and bronchoalveolar lavage fluid(BALF). Methods  The levels of IFN-γand TGF-βwere measured by the ELISA method in the serum and BALF among 78 patients with EBTB before and after treatment and 50 healthy control. 78 patients with EBTB and fifty healthy controls were enrolled. The EBTB patients were divided into Group 1 in which 〖JP2〗patients who exhibited bronchial stenosis after treatment and Group 2 who had no bronchial stenosis. Results (1) IFN-γ  and TGF-β levels of the BALF in patients with EBTB were higher than those in the healthy controls. (2) Of the 78 patients with EBTB after treatment, 27 cases exhibited bronchial fibrostenosis and the other 51 cases had recovered without sequelae. The levels of IFN-γ ［（2152±1594.33）pg/ml］and TGF-β ［（1219.54±439.27 ）pg/ml］in the BALF  of the EBTB patients with bronchial fibrostenosis were higher than the patients without bronchial fibrostenosis in which IFN-γ was［(1006.3±752.57) pg/ml ］and TGF-β ［(779.24±395.91) pg/ml］(U=4.3553, 3.5315，respectively, all P＜0.01）. The level of TGF-β ［(783.21±478.67) pg/ml］in the serum from the EBTB patients with bronchial fibrostenosis was lower than that of TGF-β ［(1258.6±573.29) pg/ml］in the serum from EBTB patients without bronchial fibrostenosis (U=3.8905，P＜0.01）.  Conclusion   (1)Elevated IFN-γ and TGF-β levels in the BALF of the EBTB patients may be related to the pathogenesis of EBTB. (2) Low level of TGF-β in serum and high levels of IFN-γ and TGF-β in the BALF are correlated witn bronchial fibrostenosis in EBTB after treatment.

Analysis on re-read result of chest X-ray and diagnosis quality of initial smear-negative pulmonary tuberculosis

MA Yan, CHENG Shi-ming, ZHOU Lin, LI Liang, DU Jian,YANG Hua-lin, LIU Zhi-min, LIU Fei-ying, YAO Song

Chinese Journal of Antituberculosis. 2011, 33(11):  707-712. 

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Objective  To analyze the diagnosis quality and related factors of initial smear-negative pulmonary tuberculosis(SN-PTB) registered in county dispensaries under National Tuberculosis Control Programme (NTP) in China. Methods   Four provinces were selected according to the registration level of national initial SN-PTB registered in 2006, one prefecture and two counties were selected in each province. The X-ray films and relevant clinical data of 60 cases of SN-PTB were sampled through cluster sampling method in each county. Their chests X-ray were photographed by digital camera, which were blindly re-read by national expert individuals and national group of experts. National experts included two experts in TB prevention and control, two in clinical TB and two in radiological TB respectively; National group of experts consisted of two TB prevention and control experts, two clinical and two radiological experts. The over-diagnosis was defined as re-read results by experts or group of experts who considered the chest X-ray did not meet the radiological changes of active TB. Univariate and multivariate logistic regression analysis were made to analyze the factors affecting the over-diagnosis, and explore the quality of  SN-PTB diagnosis. Results  The overall over-diagnosis rate is 20.78%（399/1920）, the average over-diagnosis rate of eight counties ranged from 10.83%（26/240）to 32.50%（78/240）, after the re-reading by experts, the over-diagnosis rate ranged from 10.21%（49/480）to 33.13%(159/480）. Logistic regression analysis showed over-diagnosis was affected by seven factors including chest X-ray quality, gender, age, doctor, PPD examination, BCG vaccination history and source of patient. Risk factors for over-diagnosis included 40≤age≤60（OR=2.007,95%CI=1.165-3.535）and over 60 years old（OR=1.710，95%CI=1.277-2.940）, female（OR=1.941，95%CI=1.226-3.102）, clinic doctor（OR=2.243，95%CI=1.793-4.27), PPD examination history（OR=1.985，95%CI=1.106-3.564）, BCG vaccination history（OR=2.773，95%CI=1.023-7.515）, quality of chest film“C”（OR=2.402，95%CI=1.006-6.995）and quality of chest film “D”（OR=10.694，95%CI=2.348-62.596）;protective factors included diagnosis of diagnostic group（OR=0.471,95%CI=0.440-0.643）,referral(OR=0.521,95%CI=0.313-0.865）and centralized recommendation(OR=0.437,95%CI=0.206-0.927）.Conclusion  The over-diagnosis rate of smear ne-gative pulmonary tuberculosis is high in China, the occurrence of over-diagnosis is affected by a variety of factors.

Comparison of PCR sequencing and DNA microarray for rapid identification of mycobacterium species

WANG Feng, ZHU Yu-mei, GUI Jing, LAN Ya-ling

Chinese Journal of Antituberculosis. 2011, 33(11):  713-717. 

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Objective  To evaluate the value on rDNA sequencing of 16S-23S internal transcription space (ITS) and DNA microarray based on 16S rDNA for the rapid identification of mycobacterial species. Methods   21 mycobacterium reference strains and 50 clinical isolates were simultaneously identified by DNA sequencing and DNA microarray. Results  Of 21 mycobacterium reference strains, 18 were identified correctly at species level by DNA sequencing.  M.africanum and  M.tuberculosis strains were identified as M.tuberculosis complex, and M.marinum strain was identified as M.marinum/M.ulcerans. 16 strains were identified correctly by DNA microarray, but  1 M.gastri strain was identified as M.kansasii, 3 strains were absent of the specific probes in the microarray. Of 50 clinical isolates, 47 were consistent by DNA sequencing and DNA microarray, and one M.lentiflavum isolates was not identified by DNA microarray due to the absence of the specific probe. Conclusion  DNA microarray was a specific, accurate method for the rapid identification of most clinically relevant mycobacteria.

Analysis of the change of the anti-TB drug resistance spectrum in last decade in Guangdong province

YIN Jian-jun, CHEN Liang, XU Zhuo-wei, QIAN Ming, JIANG Li, ZHONG Qiu

Chinese Journal of Antituberculosis. 2011, 33(11):  718-721. 

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Objective  To explore the features of the change of the anti-TB drug resistance spectrum in last decade in order to provide reference for TB control policy development in Guangdong province. Methods  Comparative analysis were conducted on the drug resistance spectrum collected respectively from drug resistant TB (DR-TB) surveys of 1998’s and 2010’s. Both surveys adopted proportion method for drug susceptibility test (DST) and two-stage random sampling methods for choosing new smear positive cases(1482 cases in 1998; 1224 cases in 2009) and retreatment smear positive cases(166 cases in 1998; 475 cases in 2009). Results  (1) The DR-TB spectrum of 1998 were set as drug resistant units and compared with the 2009’s, dramatic decline could be found in some drug resistant units, including isoniazid (H) from 4.0% to 1.5% (χ²=12.6, P<0.01) and isoniazid+rifampicin+streptomycin (HRS) from 1.3% to 0.0%（χ²=10.9, P<0.01）in new smear positive cases, isoniazid+rifampicin (HR) from 60% to 1.7%（χ²=6.3, P<0.05）in retreatment smear positive cases. (2) According to the results of 2009’s survey, 60.0% (21/35) of DR-TB spectrum and 66.7%(8/12) of multidrug-resistant tuberculosis (MDR-TB) spectrum also included resistance to second-line drugs. Although only 2 patterns of extensively drug -resistant  tuberculosis (XDR-TB) were found, they accounted for 31.8%（14/44）of primary MDR-TB cases and 25.6%（10/39）acquired MDR-TB cases respectively.  Conclusion Over the past 10 years, although the overall situation of anti-TB drug resistance showed a downward trend, only a limited number of drug resistance units were under control. The whole province still faces the challenges of MDR and XDR-TB.

Evaluation of a line probe assay for the rapid diagnosis of multidrug-resistant tuberculosis

HUANG Yu-ping, QU Ya-hong, MA Zhen-ya, WANG Yu, MA Hua, ZHU Ning, HOU Jian-zhong

Chinese Journal of Antituberculosis. 2011, 33(11):  722-724. 

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Objective  To evaluate the feasibility of using a line probe assay to detect multidrug-resistant tuberculosis (MDR-TB) in the grass-roots work of preventing and controlling TB.  Methods  459 sputum samples from smear-positive patients with pulmonary tuberculosis were examined rifampicin- and isoniazid-resistance by a line probe assay and conventional drug susceptibility testing. Results  The rifampicin- and isoniazid-resistant rates from line probe assay (5.9%, 27/459; 8.7%, 40/459) had no significant difference with those (6.3%, 29/459; 10.0%, 46/459) from the conventional drug susceptibility testing (χ²=0.038，P＞0.05; χ²=0.231，P＞0.05). Their concordance was 98.3%（451/459）for the rifampicin resistance and 97.4%（447/459）for the isoniazid resistance. Conclusion The line probe assay is a rapid, specific and feasible method for the early diagnosis of MDR-TB in the grassroots.

The effect of CD4⁺ T lymphocytes on serum albumin in the patients with pulmonary tuberculosis

TAN Shou-yong, KUANG Hao-bin, LI Yan, LI Yan-qiong

Chinese Journal of Antituberculosis. 2011, 33(11):  725-728. 

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Objective   To study the effect of CD4⁺ T lymphocytes on serum albumin in the patients with pulmonary tuberculosis.  Methods  119 smear- and culture-positive patients with initially treated pulmonary tuberculosis were detected T lymphocyte subsets and serum albumin. According to the count for CD4⁺ T lymphocytes, they were divided into two groups: 62 patients in poor immunity group and 57 patients in normal immunity group.  We study the effect of poor cellar immunity on hypoproteinemia in the patients.  Results （1）CD4⁺ T lymphocyte count［（516.6±266.1）×10⁹/L］was positive relationship with CD3⁺［（841.6±398.8）×10⁹/L］, CD8⁺［（261.0±142.6）×10⁹/L］, and CD4⁺/CD8⁺ T lymphocyte ratio（2.33±1.40）（r=0.883，P=0.000; r=0.579，P=0.000; r=0.365，P=0.000. （2）CD4⁺ T lymphocyte count was positive relationship with the serum albumin（r=0.116，P=0.033）. （3）There were 43 patients with focus over 4 fields in the poor immunity group, which were significantly higher than those in the normal immunity group（χ²=11.335，P=0.001）. And the level of serum albumin in the poor immunity group was also significantly lower ［（33.9±5.5）g/L］than that in the normal group［（36.1±5.7）g/L］（t=2.187，P=0.031）. Conclusion   CD4⁺ T lymphocyte count is positive relationship with the level of serum albumin in the patients with pulmonary tuberculosis. The pulmonary tuberculosis patients with less CD4⁺ T lymphocytes had usually more extensive lesions, and were easy to suffer the hypoproteinemia. 

Investigation of differentially expressed miRNA in peripheral blood mononuclear cell from the patients with pulmonary tuberculosis

ZHANG Li-qun, SUN Zhao-gang, GAO Meng-qiu, MA Li-ping, WU Xiao-guang, LIU Fei

Chinese Journal of Antituberculosis. 2011, 33(11):  729-733. 

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Objective  To investigate the differentially expressed miRNAs in peripheral blood mononuclear cell from the patients with pulmonary tuberculosis.  Methods Ten patients with pulmonary tuberculosis and 10 healthy controls were selected as the participants. 5ml of venous blood was collected, and then peripheral blood mononuclear cells (PBMC) were isolated and mixed from these 2 groups, respectively. The total RNA and miRNA were extracted. The miRNA was labeled and purified, and the endogenous differentially expressed miRNAs were screened by high-throughput miRNA microarray. The result of miRNA microarray was analyzed by the corrected ratio of hybridization signal intensity in 2 group. The validation was performed by real-time quantitative PCR.   Results  Twenty-six differentially expressed miRNAs were obtained in 2 groups, including 13 overexpressed  miRNAs and 13 downexpressed miRNAs. The results of comparation between the lung tuberculosis patients and healthy controls by real-time quantitative PCR approved that hsa-miR-1(1.085±0.005，1.018±0.011)（t=4.334,  P<0.01）was overexpressed, and hsa-miR-146(0.948±0.008，1.036±0.005)（t=4.460, P<0.01）and hsa-let-7e(1.020±0.007，1.091±0.004)（t=4.149, P<0.01）were downexpressed.  Conclusion  There are many differentially expressed miRNA between the patients with pulmonary tuberculosis and healthy controls.

Analysis on the influencing factors of the mortality of  Mycobacterium tuberculosis and human immunodeficiency virus co-infection patients during the anti-tuberculosis treatment period

ZHOU Lin, CHEN Lei, WANG Ni, LIU Er-yong, HE Jin-ge, LIU Fei-ying, WANG Qiao-zhi, XUE Xiao

Chinese Journal of Antituberculosis. 2011, 33(11):  734-738. 

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Objective  To understand the influencing factors of the mortality of  Mycobacterium tuberculosis and human immunodeficiency virus (Mtb/HIV) co-infection patients during the anti-tuberculosis treatment period.  Methods  During 2007—2008, patients from 6 counties in Guangxi, Sichuan, Hunan three provinces (autonomous region) were analyzed. 330 patients were observed, 33 patients died during the anti-tuberculosis treatment period.SAS 9.2 software was used to do the analysis of the impact of patients’ weight, CD4⁺T lymphocyte level, antiretroviral therapy period, HIV infection route, HIV infection years, tuberculosis type, OIs on the mortality during the antituberculosis period. There is a significant statistical difference when  P  value is below 0.05.   Results  The mortality of Mtb/HIV co-infection patients during anti-tuberculosis treatment period was 10.0%（33/330）.Analysis on the influencing factors shows that: The logistic regression model is used to analyze the impact of CD4⁺T lymphocyte level and antiretroviral therapy on the mortality. The CD4 level has no impact on patients’ mortality（Wald χ²=0.5774, P=0.4473）.The mortality of patients who received antiretroviral therapy is 7.612 times higher than that of those who didn’t receive antiretroviral therapy. Statistical test shows P  value is below 0.001（Wald χ²=14.8539）.Whether the patient receives antiretroviral therapy is a influencing factor of the mortality;As for the HIV infection route, the mortality of sexually transmitted group was（6.7%,14/210）,drug users group was （16.1%,19/118）,drug users group have a higher risk of death.Fisher’s exact test shows P value is below 0.05, There is a significant statistical difference; As for the tuberculosis type, the mortality of smear positive pulmonary tuberculosis group was(20.9%,18/86), smear negative pulmonary tuberculosis group was(8.0%,14/174), pulmonary tuberculosis group was(11.7%,27/230), pulmonary tuberculosis with extra-pulmonary tuberculosis group was（16.7%,5/30),extra-pulmonary tuberculosis group was(1.4%,1/70),smear positive pulmonary tuberculosis and pulmonary tuberculosis with extra-pulmonary tuberculosis has a higher risk of death, χ² test shows P  value is below 0.05（χ²=17.8685, 7.9687）, There is a significant statistical difference.  Conclusion  TB/HIV co-infection patients’ pathological degree, health status are the major influencing factors of mortality.

Retrospective survey of outpatient TB service in TB institutions under Hunan case-based payment pilot project

LIU Er-yong, WANG Xue-jing, XUE Xiao, GAO Meng-qiu, ZHANG Li-qun, BAI Li-qiong, PENG Guo-qing, XU Bo, ZHOU Lin, CHENG Shi-ming

Chinese Journal of Antituberculosis. 2011, 33(11):  739-742. 

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Objective  To evaluate the quality of outpatient TB service in TB institutions under case-based payment pilot project.  Methods  Two hundreds of patients who registered from Jul.2009 to Jun.2010 in Miluo and Linxiang TB institutions and had completed full-course treatment before the survey were sampled (100 cases per county). Through going through the patients’ medical records, retrospective survey was made on the tests the patients took in the diagnosis and treatment process and treatment in dealing with adverse drug response. The data of the survey were input by Epidata, and SPSS 17.0 was used for statistical analysis.  Results  In addition to the national TB free policy covered items, for new smear positive patients, 79.12%(72/91), 61.54%(56/91), 54.95%(50/91) of patients were prescribed urine, blood, ECG test respectively; the corresponding proportions of new smear negative patients examined for these tests were 73.33%（77/105）,49.52%(52/105) and 36.19%(38/105) respectively. 90.11％（82/91）and 93.33%（98/105）of new smear positive and smear negative patients received liver function tests respectively. TB institution did not provide vision, hearing, kidney function tests. Regardless of the existence of patients with abnormal liver function tests, all patients were prescribed free liver protection drugs for preventive therapy.   Conclusion  The case-based payment methods increased the scope of free tests; especially promoted the patients’ accessibility to liver function test, improved the outpatient TB service quality in TB institutions.

Analysis on factors affecting job satisfaction of health care workers in county-level TB institutions of Hunan province

TAN Zhen, BAI Li-qiong, XU Hui-lan, TANG Yi, GONG De-hua, FAN Jiang-jing, WAN Yan-ping, XIAO Tao

Chinese Journal of Antituberculosis. 2011, 33(11):  743-747. 

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Objective  To explore the factors affecting job satisfaction of health care workers in county-level TB institutions of Hunan province.   Methods  660 health care workers (HCWs) were sampled by stratified random sampling method from 110 county level TB institutions of Hunan province, and they were given the job satisfaction questionnaire survey. The content of the survey include seven dimensions: leadership behavior, management system, working remuneration, working environment, working interpersonal relationships, willingness to work and job promotion. 629 pieces of questionnaires were collected, among which, 612 were valid for analysis. The differences of job satisfaction between different levels of each influencing factor were tested by Analysis of Variance. Multiple linear stepwise regression was used to analyze the influencing factors of job satisfaction.   Results  The overall job satisfaction was mainly affected by income and position (β=0.133、0.114，P<0.05，R²=0.412). Meanwhile, the major influencing factors of the satisfaction of leadership behavior were age and income (β=－0.153、0.148，P<0.05，R²=0.300). The satisfaction of management system was mostly affected by the posts(β=0.115，P<0.05，R²=0.373). The satisfaction of remuneration and working environment were both mainly influenced by income and position (β=0.161、0.106，P<0.05，R²=0.404；β=0.198、0.133，P<0.05，R²=0.353). The major influencing factors of the satisfaction of job promotions were age and position (β=－0.177、0.093，P<0.05，R²=0.301).   Conclusion  TB institutions in Hunan should strengthen human resources construction, improve the staffing quantity and quality, improve HCWs income and establish a rational and fair distribution system.

Analysis of the detection result of TB epidemiological random survey in Gansu in 2010

ZHANG Lan, YANG Shu-min, SI Hong-yan, WANG Wen, HE Yu-jue, LIANG Qi-jun, CHEN Wei-tao, GAO Qiao-fen, LIU fang

Chinese Journal of Antituberculosis. 2011, 33(11):  748-751. 

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Objective  To analyze the detection result of patients living with active TB in the  2010 TB epidemiological random survey in the Gansu.   Methods  The proportional stratified cluster random sampling method was employed in the fifth national TB epidemiological survey. A total of 42 613 people in 30 counties were examined.   Results  A total of 42 613 people in 30 counties were examined in this survey accounting for 96.6%（42 613/44 119）of the eligible population. The overall detection rate of active tuberculosis was 298.0/1 000 000(127/42 613). The detection rate increased slowly by age for people more than 45 years old, peaked in more than 75 years old group which was 1294.5/100 000 (12/927). The overall bacterial positive TB detection rate was 72.7/100 000（31/42 613）. Bacterial positive patient was not found in 20—, 25—, 30— age groups. Female bacteria positive detection rate reached a peak in 65— age group(419.6/100 000),male peaked in 80— age old (512.8/100 000). In rural and urban areas, TB detection rate was 339.4/100 000 (81/23 864) and 245.8/100 000 (46/18 714) respectively, the difference was statistically significant (χ ²=3.091, P=0.047) between the rural and urban areas.    Conclusion  The TB detection rate is high in Gansu, and the TB epidemic is still serious, and gradually spreading to the vulnerable elderly population. There is still a long way to go in the next 10 years.

Research on cost estimation methods of Mtb/HIV co-infection prevention and control at district level in Yunnan province

WANG Dong-mei, MA Li-ping, JIANG Yan, GAO Jin-jin, LI Tao, WANG Jia, ZHOU Lin, CHENG Shi-ming, CHENG Wei

Chinese Journal of Antituberculosis. 2011, 33(11):  752-757. 

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Objective  To explore the more rational and scientific cost estimation methods for developing the cost estimation methods system of Mtb/HIV co-infection prevention and control at the district level CDC and improve the cost management consciousness.  Methods  To select one district of Yunnan province which has general Mtb/HIV epidemic and once the groundwork of Mtb/HIV co-infection paitients integrated management has been laid, to established the method of the cost estimation of Mtb/HIV co-infection prevention and control. Meanwhile based on the existing work flow and content referred the operating time distribution coefficient, implemented the cost absorption and cost allocation for the departments of CDC, project cost allocation, the state free treatment and testing measures, and the other measures paid by the patients’ own expense. The total costs, cost structure, unit costs are estimated for Mtb/HIV co-infection response in district level CDC. All data were entered Excel 2007 for analysis and processing.   Results  To draw on the successful experience and implement use different methods to cost estimate for multiple sources. Finnally developed cost estimation methods in the Mtb/HIV prevention and control, and investigate the details of cost category and level.   Conclusion  By the Mtb/HIV co-infection response cost structure analysis and cost estimates, the cost estimation methods and system is gradually established on all kinds of prevention and control work in CDC. The cost estimation study provides a scientific and effective basis for funding configuration at all levels of government.

Cost analysis of smear microscopy using fluorescent staining and light-emitting diode fluorescence microscope

XIA Hui, OU Xi-chao, LI Qiang, ZHAO Bing, SONG Yuan-yuan, WANG Sheng-fen, ZHAO Yan-lin

Chinese Journal of Antituberculosis. 2011, 33(11):  758-761. 

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Objective  To compare laboratory cost of smear microscopy using Ziehl-Neelsen(Z-N) method and fluorescent staining and light-emitting diode fluorescence microscope (LED) method.  Methods  Laboratory direct and indirect cost related to smear microscopy examination were collected from six county laboratories, based on 3 times examination, comparison of the average cost of smear microscopy between two methods was made.  t test and F test was performed to assess the significance of the difference between the means of two samples  and multi-samples. The P <0.05 is considered statistical significance.  Results  The mean cost of a smear examination with Z-N and LED were RMB (14.98±3.94) Yuan and (13.27±4.83) Yuan respectively (t=5.084, P=0.001). The range of cost of 6 laboratories is RMB 9.44－17.82 Yuan for Z-N  and 7.80－18.93 Yuan  for LED.  Conclusion  Cost of a smear examination with LED is lower than that with Z-N, therefore worth of promotion from cost of view. 

Estimation of cost-effect on TB control and prevention in Gansu Province

YANG Shu-min, WANG Bo, CHEN Wei-tao, GAO Qiao-fen

Chinese Journal of Antituberculosis. 2011, 33(11):  762-765. 

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Objective  To estimate of cost-effect on TB control and prevention in Gansu province.  Methods  to design the questionnaire of all levels in Gansu province,TB workers in 101 TB institutions including province，city and county level  filled  the questionnaires by making use of TB information materials from 2001 to 2009,to set up material data by Epidata and to have an analyseis  and statistic by Excel and SPSS 17.0.  Results  There are 153 718 active TB cases registered by the whole province in Gansu,of whom 1056 died of TB,there are 76 801 smear positive TB cases successfully cured,and 66 720 smear negative TB cases successfully cured.It is estimated that 38 429 TB cases will die of TB without cure，smear positive TB cases successfully cured，37 373 TB cases avoided  been dead due to reagular cure, 646 802 people avoided been infectious, 64 680 cases avoided to take place, it cost about 0.18 billion RMB yuan to control and prevent TB in our province, about 44 million  RMB yuan was saved in hospital expenditures, the total of about 6.83 billion RMB Yuan social overall cost was saved.It is estimated that investment of 198.29 can save a DALY, we can output 37.86 RMB Yuan in finance if we invest the cost of one RMB Yuan from 2001 to 2009.  Conclusion  TB control and prevention has made great contritution for decreasing TB epedimic situation and improving economic development.

Research of  Mycobacterium tuberculosis dormancy mechanism

YAO Nan, ZHANG Wan-jiang

Chinese Journal of Antituberculosis. 2011, 33(11):  766-768. 

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