Table of Content

10 November 2013, Volume 35 Issue 11

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Risk factors related to anti-tuberculosis drug-induced liver injury and countermeasures of clinical treatment

LEI Jian-ping, WU Xue-qiong, ZHANG Wen-hong

Chinese Journal of Antituberculosis. 2013, 35(11):  858-864. 

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The anti-tuberculosis drug-induced liver injury is common. It has complex and diverse reason. Its risk factors should be known, the laboratory examination methods should be improved. Explore the reasonable adjustment of anti-tuberculosis treatment, therapy for the liver protects and the measure of stop anti-tuberculosis medicine. Make the measure of tuberculosis treatment and management to keep pace with the times.

The progress and the existing problems and countermeasures of TB drug resistance testing technology

HU Zhong-yi

Chinese Journal of Antituberculosis. 2013, 35(11):  865-867. 

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TB drug resistance testing technology research has made significant progress, but still cannot meet the needs of clinical diagnosis and treatment, and prevention and control. Some new drug susceptibility testing technology including molecular biology and bacteriology is more rapid and sensitive than the traditional detection method, but all kinds of new tools have some problems in clinical application. In this review, the advantages and disadvantages of these new technologies are presented and the potential countermeasures and the advancements are put forward, so as to improve the promotion and application of the new technologies.

Focus on tuberculosis control and prevention among vulnerable populations

YANG Ying-zhou

Chinese Journal of Antituberculosis. 2013, 35(11):  868-870. 

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Epidemic features of pulmonary tuberculosis in students in China: data mining based on national disease surveillance system

XIA Yin-yin, MA Yan, CHEN Wei, CHENG Shi-ming

Chinese Journal of Antituberculosis. 2013, 35(11):  871-875. 

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Objective   To explore the reported incidence and epidemic features of pulmonary tuberculosis (PTB) in students in China. Methods  We got numbers of reported PTB patients (students and whole population) data from Chinese Infectious Disease Report Information System and abstracted total numbers of students in school using data from China Statistical yearbook, then used them to calculated incidence of reported PTB patients (students and whole population). Besides, we got data of demographic, incidence and prognosis features of registered PTB patients (students and whole population) from Chinese Tuberculosis Information Management System, and PTB emergencies reports from Chinese Public Health Emergencies Information Management System. Together we used data mining methods to analyze the epidemic features of PTB patients among school students in 2011. Results  The reported PTB incidence in students was 20.16/100 000 (41 608/206 339 584) in 2011, while in whole population the incidence was 71.09/100 000 (953 275/1 340 909 996). The highest and lowest reported PTB incidences at provincial level in 2011 were 66.24/100 000 (Tibet, 350/528 389) and 10.54/100 000 (Shandong, 1508/14 300 995). In 2011, 30.59%（12 193/39 853） registered PTB patients in student were smear positive, the proportion was higher than that in all PTB patients (46.82%, 423 830/905 344) (χ²=3542.85, P<0.01).The primary smear-positive patients in students got higher sputum negative conversion rate after 2 months treatment (97.37%, 11 310/11 616) and cure rate (95.56%,11 278/11 802) than all PTB patients (93.83%, 353 729/377 005; 93.98%, 353 238/375 859)(χ²=247.70/50.79, All P<0.01).   Conclusion  In China, the reported incidence of PTB in students is approximately 1/3 of all PTB patients, and the proportion of smear positive cases is lower than whole TB cases, while the cure rate is higher than whole TB cases. However, some provinces and prefectures still need to enhance TB control in students, detect and report public health emergencies induced by TB in school more timely.

Analysis on knowledge of tuberculosis prevention and control in middle school students in 3 provinces of western China

XIE Yan, ZHAO Qi, JIANG Shi-wen, ZHAO Fei, XU Biao

Chinese Journal of Antituberculosis. 2013, 35(11):  876-880. 

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Objective  To analyze status quo of tuberculosis (TB) related knowledge, attitude and practice in middle school students and provide evidences for TB health education intervention.  Methods  Three epidemiological survey sites where lots of active TB cases were found and two adjacent counties were selected in Sichuan, Guizhou and Yunnan province. One senior high school was purposively sampled in each county, and two classes in grade 2 of each school were randomly sampled. A self-designed questionnaire investigation concerning TB core information, TB related attitude, practice and health education was conducted among all students in the 10 classes selected. 443 questionnaires were sent out while 437(98.6%) recovered. General awareness rate, awareness rate of each message, attitude distribution and score were calculated.  Results  General awareness rate of the 10 TB related messages was 54.3% (2375/4370). Awareness rates of TB healthcare strategy and hazard were low, in which was 23.9% (209/874) and 23.8% (104/437) respectively. The median score was 6 (P₂₅=4, P₇₅=7). 7.0% (30/430) of the students would conceal the facts if getting TB, 21.2% (91/430) would keep away from TB patients, and 0.5% (2/430) would not contact with TB patients. 65.7% (287/437) of the students were never proactive in knowing TB knowledge, whereas 96.3% (420/436) thought it necessary to carry out TB health education in school.  Conclusion  Students in the western region of China had poor TB knowledge and negative attitudes. Collaboration of health and education departments and comprehensive methods of information spread were needed to improve the situation.

Survey on knowledge of tuberculosis prevention and control among part of college students in Guangzhou

LAO Wei-min，CHEN Liang

Chinese Journal of Antituberculosis. 2013, 35(11):  881-886. 

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Objective  To explore college students’ awareness rate of tuberculosis, attitudes towards tuberculosis patients and their ways for obtaining tuberculosis knowledge in Guangzhou city, in order to provide references for carrying out more effective health education on TB control.   Methods  Forty-seven classes from 10 universities were selected by stratified cluster random sampling, and a questionnaire of TB knowledge was made by ourselves. 1534 questionnaires were eligible in all 1588 subjects. Chi-square test and logistic regression analysis were used to analyze statistically. Results  1534 eligible questionnaires were finally included into the research. The ge-neral awareness rate of key information on TB control is 62.9%（4824/7670） in college students. However, awareness rate about free policy was only 27.1%（416/1534）, and about all key information was only 13.4%（206/1534）. Faced to tuberculosis patients, about 22.9%（351/1534）college students had a estranged attitude. The awareness rate was closely related to gender（male 59.3%，2321/3915; female 66.3%,2490/3755；χ²=38.73，P<0.001）, source place（urban 63.8%，2544/3985; rural 61.5%,2265/3685；χ²=5.95，P=0.015）, parents’ vocation（agrarian or unemployed 59.8%，1648/2755; non-agrarian 63.8%,3138/4915；χ²=9.02，P=0.003） and friends’ history of TB（yes 69.9%，619/885; no 61.7%, 4189/6785；χ²=20.16，P<0.001） in the college students. Meanwhile, grade（low grade 21.4%，294/1373；high grade 35.4%,57/161；Waldχ²=15.83，P<0.001）, source place（urban 26.9%，214/797; rural 18.6%,137/737；Waldχ²=17.96，P<0.001） and friends’ history of TB（yes 37.3%，66/177; no 21.0%,285/1357;Waldχ²=19.74，P<0.001） were significantly associated with attitudes towards tuberculosis patients. Their OR values（95%CI values）are 2.07（1.45-2.96）,0.58（0.46-0.75）and 0.46（0.33-0.65）respectively.  Conclusion  The awareness rate of TB knowledge in college students is still low. To strengthen college students’ knowledge on preventing and controlling tuberculosis, the school should carry out the pertinent propaganda and education, cooperating with sectors of the community. Only in this way, it will be conducive to the prevention and treatment on tuberculosis in the whole society.

Analysis on results of purified-protein derivative test among freshmen in Central University of Finance and Economics

CHEN Xi, WANG Li

Chinese Journal of Antituberculosis. 2013, 35(11):  887-890. 

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Objective  To understand the results of purified-protein derivative (PPD) test of new students in Central University of Finance and Economics, and to provide scientific evidence for tuberculosis (TB) control and prevention in school. Methods  The PPD test results of 9702 college students enrolled from 2009 to 2012 were collected and analyzed with descriptive statistical method. Chi-square test was used for comparison between groups, and P<0.05 was set as the criteria of statistical difference. Results  The positive rate of college students investigated was 6.02% (584/9702), and the intensely positive rate in male (4.04%,145/3587) was significantly lower than that in female(7.18%,439/6115) (χ²=39.32, P<0.05). From 2009 to 2012, the intensively positive rate was 5.43% (136/2505), 10.44% (233/2231), 3.92% (99/2524) and 4.75% (116/2442) respectively. There were 4 pulmonary TB cases detected during the four years, and the detection rate was 0.14% (14/9702). Conclusion  PPD screening in college students is an necessary additional method for TB diagnosis, and can effectively control the spread of TB in colleges.

Analysis on tuberculosis epidemic in college students in Shapingba district of Chongqing

LUO Xing-neng, LIU Xiong-e, LI Ting-rong

Chinese Journal of Antituberculosis. 2013, 35(11):  891-895. 

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Objective  To analyze tuberculosis (TB) epidemic of college students in Shapingba district, and to provide the evidence for improvement of TB control in college in Chongqing. Methods  Descriptive epidemiological analysis was conducted on the data of 820 TB patients of college students in Shapingba district from 2005 to 2012. Excel 2007 was used to set up the database, and SPSS 13.0 was used for data analysis. Chi-square test was used to analyze the impact of different ages, gender and detection methods to diagnosis delay and patient delay. P<0.05 was considered statistically significant. Results  The notification rate of TB among college students had decreased from 144.00/100 000 (121/84 028) in 2005 to 29.47/100 000 (76/257 889) in 2012, but more than 10% TB patients were college students in the past 8 years. In those 820 TB patients, 66.34% (544/820) had no suspected pulmonary tuberculosis symptoms, 77.32% (634/820) patients were detected by referral, 33.09% (271/819) had patient delay and 25.12% (206/820) had diagnostic delay. 71.43% (30/42) patients detected by tracing had diagnosis delay. Conclusion  The TB epidemic in college has been controlled in recent years in Shapingba district, but the TB epidemic prevention and control in college is still grim. Comprehensive prevention and control measures, such as improving TB control system in college, strengthening TB health promotion and optimizing the surveillance of TB epidemic should be taken.

Analysis of the network direct reporting quality for infectious disease cards of TB in Guangdong province

LIAN Yong-e, JIANG Li, LI Jian-wei, WU Hui-zhong, GAO Yan-bo, ZHONG Qiu, ZHOU Lin

Chinese Journal of Antituberculosis. 2013, 35(11):  896-899. 

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Objective  To evaluate the network direct reporting quality for infectious diseases of TB at all medical institutions and find out the existing problems for the further improvement of reporting quality. Methods  The data of network direct reporting for infectious diseases of TB were collected and analyzed. The report area and entry time as the qualification download before the day of the TB reporting cards. All the TB reporting cards were collected from February 1, 2012 to January 31, 2013. We used the timely reporting rate, information missing rate and lack of information rate to analysis of 200 015 pulmonary TB reporting cards in Guangdong province. Results  The timely reporting rate, information missing rate and lack of information rate at all medical institutions were 98.59%（197 189/200 015）, 77.01%（154 040/200 015）and 1.07%（2144/200 015）respectively. The timely reporting rate, information missing rate and lack of information rate in TB institutions（99.49%，24 669/24 795） were higher than the medical institutions（98.46%，172 520/175 220） and the difference is statistically significant（χ²=166.32，P<0.001）. The lack of information for TB report cards included ID card number［63.01%（126 027/200 015）］, address of TB cases［13.64%（27 283/200 015）］, parents name of TB cases［11.93%（131/1098）］, work address［32.73%（15 968/48 792）］ and telephone numbers［25.51%（51 023/200 015）］. The missing information rate is lower in the TB institutions（0.71%，175/24 795）than non-TB institutions（1.12%，1969/175 220） and the difference is statistically significance（χ²=35.78，P<0.001）. Conclusion  The quality of TB reporting card is higher in TB institutions. We should improve the reporting quality in other medical institutions.

Analysis of risk factors associated with treatment failure in smear positive pulmonary tuberculosis patients among floating population in Bao’an district, Shenzhen

ZHAO Mei-gui, WANG Yun-xia, ZHAO An-gui, ZHENG Juan-juan, LIU Zhen-yang

Chinese Journal of Antituberculosis. 2013, 35(11):  900-904. 

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Objective  To explore the risk factors associated with treatment failure in smear positive pulmo-nary tuberculosis (PTB) patients among floating population, and to provide a theoretical evidence for intervention measures development. Methods  4398 smear positive PTB patients among floating population that completed the treatment course with an outcome of failure or cure from January 2008 to December 2012 in Bao’an district, Shen-zhen city were enrolled in this study, among whom 4007 were cured and 391 were failed. The demographic, clinical, bacteriological information and management methods were compared by Chi-square test, Kruskal-Wallis test or Fisher’s test, and non-conditional logistic regression analysis was used to explore the influencing factors for treatment failure. Results  There were more males in treatment failure group (72.63%, 284/391) than cure group (62.27%, 2495/4007), and the difference was statistically significant（χ²=16.4636，P<0.0001）. Compared to cure group (56.66%,2271/4007), less cases were younger than 30 years in failure group (40.66%,159/391), and there was significant difference between the 2 groups (χ²=36.9359, P<0.0001). More patients in failure group had positive sputum at the end of 2 months’ treatment (48.69%, 186/382) than cure group (14.08%, 562/3992), and the difference was statistically significant (χ²=294.6323, P<0.0001). The proportion of patients treated with systematic management was 94.37% (369/391) in failure group, which was significantly lower than cure group (98.65%, 3953/4007) (χ²=38.4086, P<0.0001). Cavity presented more in failure group (48.59%, 190/391) than cure group (36.41%, 1459/4007), and the difference was statistically significant (χ²=22.5579, P<0.0001). The result of unconditional logistic regression analysis showed that female, aged 30 years and above, smear-positive at the end of 2 months’ treatment, the implementation of the systematic management and presence of cavity were significantly associated with treatment failure, and the OR (95%CI) values were 0.76 (0.60-0.97), 1.59 (1.27-1.99), 5.13 (4.10-6.43), 0.37 (0.19-0.72) and 1.36 (1.09-1.70), respectively. Conclusion  Female and the implementation of the systematic management are protective factors for treatment failure, and aged 30 years or above, smear-positive at the end of 2 months’ treatment and presence of cavity are risk factors for treatment failure. Paying close attention to risk factors associated with treatment failure and exploring effective management methods for PTB patients among floating population may help to reduce the incidence of treatment failure.

Analysis on results of HIV screening among TB patients in national key counties (districts) for Mtb/HIV co-infection control and prevention

LI Tao, CHENG Shi-ming, DU Xin, WANG Dong-mei, LAI Yu-ji, LIU Er-yong, ZHOU Lin

Chinese Journal of Antituberculosis. 2013, 35(11):  905-909. 

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Objective  To analyze the results of HIV screening among tuberculosis (TB) patients in national key counties (districts) for Mtb/HIV co-infection control and prevention, and to provide evidence for improving HIV screening strategy among TB patients. Methods  The results of 48 848/98 739 screened patients of 294 national Mtb/HIV co-infection key counties (districts) in 2010/2012 were analyzed, and the positive rate was compared with that of National HIV Infection Survey among TB patients and of 2540 non-priority counties. Results  In 2010, the average HIV screening rate in 294 key counties (districts) was 43.32% (48 848/112 757), the overall HIV detection rate in key counties and non-priority counties were 2.71% (1324/48 848) and 0.41% (185/45 274) respectively, and the corresponding rates were 86.63% (98 739/113 978), 1.63% (1605/98 739) and 0.39% (628/159 586) in 2012. The HIV detection rates of key counties were 2.71% (1324/48 848) and 1.63% (1605/98 739) respectively in 2010 and 2012, while those of non-priority counties were 0.41% (185/45 274) and 0.39% (628/159 586). The differences of HIV detecting rate were significant between key counties and non-priority counties in 2010 and 2012 (χ²=789.17/1080.37, P<0.0001). The numbers of Mtb/HIV co-infection cases detected in 294 key counties in 2010 and 2012 were 1324 and 1605 respectively, which accounted for 50.40% (1324/2627) and 63.64% (1605/2522) of the estimated number of national Mtb/HIV patients. Conclusion  The number of screened cases and Mtb/HIV patients detected in key counties in 2012 has increased significantly than in 2010, and the implementation effect of the strategy of HIV screening among TB patients in Mtb/HIV co-infection key counties is good.

Analysis on baseline investigation for the establishment of early warning models of tuberculosis  in Minhang district，Shanghai

CHENG Yu-ping，SHEN Mei，SHEN Xin，YAN Hui-qin

Chinese Journal of Antituberculosis. 2013, 35(11):  910-913. 

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Objective  To understand the epidemic status and characteristics of tuberculosis (TB) in Minhang district, Shanghai, to build the observed cohort and provide scientific basis for the development and validation of the early warning model of TB.  Methods  According to the requirement of the project “Study on the early warning models of tuberculosis”, one of the 11th five-year major projects for infectious disease. Xinzhuang town was selec-ted. Prospective epidemiological method was used to investigate the residents selected through cluster sampling. 121 898 residents were selected as research subject to analyze their epidemic characteristics of people with suspicious TB symptoms and TB patients. Chi-square test was used to analyze the prevalence rates of different groups and 0.05 was set as the criteria of statistical significance.  Results  120 637 residents were investigated (61 055 males and 59 582 females), and the survey rate was 98.97% (120 637/121 898). 551 TB suspects, including 194 people with at least one suspicious symptom and 357 people with a history of TB, and 16 TB cases were detected. After further examination, 1 TB suspect was diagnosed as TB. The prevalence rate of TB in Xinzhuang town was 14.09/100 000 (17/120 637). The proportion of smear positive cases was 11/17, and that of new smear positive cases was 6/17. The majority of patients were male 13/17 and the prevalence in male was 21.29/100 000 (13/61 055), which was significantly higher than that in female (6.71/100 000, 4/59 582) (χ²=4.549, P=0.049). The highest prevalence rate appeared in the 55-65 age group (38.68/100 000, 8/20 681) and the prevalence rate of people aged 55 years and above was 29.64/100 000 (11/37 113), which was greater than that aged under 55 years (7.18/100 000, 6/83 524), and there was significant difference between 2 groups (χ²=9.196, P=0.004).  Conclusion  Baseline survey indicated that, the epidemic situation of TB is relatively mild in Minhang district compared with other districts. The majority of patients are male and the higher prevalence rate appears in elderly.

Supply management survey of anti-TB drugs

MA Yan, HUANG Guo-fang, LI Liang, DU Jian, WAN Li-ya, ZHOU Lin, WANG Ni, CHENG Shi-ming

Chinese Journal of Antituberculosis. 2013, 35(11):  914-918. 

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Objective  To analyze the anti-TB drug stock and expiration damage situation in order to understand the anti-TB drug supply management status. Methods  Six provinces (include 4 cities and 10 counties,20 TB dispensaries as study sites in all) were selected according to different anti-TB drugs procurement and supply models to investigate drug inventory and out of stock status. The inventory, breakage and out of stock rate and consistency with account book was analyzed.  Results  Nationally, the average usage time of free anti-TB drug was 2.7 to 5.8 months at quarter-end with the average out of stock rate between 12.9% and 15.8%. The average usage time in these 6 provinces was 1.4 to 18.1 months. The inventory rate of 4 kinds of free drug in 20 investigated institutions was 33.3% to 100.0%，the average out of stock rate between 1.0% and 20.5%; 7 institutions existed the phenomenon of drugs expired or damaged with expired and breakage rate of 0.1% to 2.4%; 5 institutions existed discrepancies between actual drug and account book, the consistency rate was 50.0% to 66.7%. Conclusion  We should strengthen the monitoring and evaluation of drug supply management, provide scientific evidence to improve the anti-TB drugs supply and management system.

Study on the value of diagnosis for active pulmonary tuberculosis with the blood ELISA stimulated by three antigens

YANG Xin-ting, LIANG Qing-tao, YANG Yang, LI Qi, CHEN Xiao-you

Chinese Journal of Antituberculosis. 2013, 35(11):  919-922. 

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Objective  To evaluate the value of diagnosis for active pulmonary tuberculosis with blood interferon gamma release assay stimulated by three antigens of PPD, ESAT-6/CFP-10 fusion protein(E/C) and ESAT-6.  Methods  187 participants including patients with active pulmonary tuberculosis and control were enrolled. 5 ml morning fasting venous heparinazed blood were taken from all participants and stimulated by purified protein derivative(PPD), early secretory antigenic target 6(ESAT-6) and E/C. The production of IFN-γ was measured by ELISA after incubated for 16-22 hours. Results  The production of IFN-γ stimulated by ESAT-6, E/C and PPD in active pulmonary tuberculosis was 96(41-379), 3180(1192-7231) and 4348(1230-9026) pg/ml, respectively. It was much higher than that in control （ESAT-6：10（4-52）、E/C： 210（49-523）、PPD： 1800（70-3021），U=1190.5、2405和1309.5，P<0.01）. The sensitivity and specificity of ESAT-6, E/C and PPD were 78.1%(75/96) vs 76.9%(70/91)、87.5%(84/96) vs 83.5%(76/91) and 85.4%(82/96) vs 65.9%(60/91), respectively. Conclusion  The ESAT-6/CFP-10 fusion protein could be a very useful supplementary tool for the diagnosis of active pulmonary tuberculosis.

The study of procalcitonin clinical value in 134 cases of pulmonary tuberculosis patients complicated with other bacterial infection

LU Jia-ze, KUANG Hao-bin, LI De-xian, LIANG Guo-tian

Chinese Journal of Antituberculosis. 2013, 35(11):  923-926. 

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Objective  To explore the clinical value of procalcitonin detection in pulmonary tuberculosis patients complicated with other bacterial infection. Methods  Selected 134 cases of pulmonary tuberculosis patients in the Severe Tuberculosis Department in Guangzhou Chest Hospital from May to September in 2012. Based on their APACHE-Ⅱand acute physiology and chronic health evaluation, they were divided into severe group (51 cases, admitted to the intensive care room, APACHE-Ⅱ score of 19 to 34, with an average of 23.71 points) and mild group (83 cases, admitted into the general ward). Based on the infection situation among these patients, which were divi-ded into pulmonary tuberculosis complicated with pulmonary infection group (61 cases) and pulmonary tuberculosis only group (73 cases). Detected the concentration of procalcitonin (PCT) in their serum.  Results  Severe patients median value of PCT was 2.75 μg/L，P₂₅＝0.52 μg/L， P₇₅＝10.45 μg/L，and that in mild group was 0.11 μg/L,P₂₅＝0.05 μg/L,P₇₅＝0.43 μg/L, of which was significant difference (Mann-Whitney, U=690,P=0). The median value of PCT of patients combined with lung infection was 3.13 μg/L，P₂₅=1.08 μg/L，P₇₅=10.21 μg/L, and that in pulmonary tuberculosis only patients was median 0.07 μg/L，P₂₅=0.05 μg/L， P₇₅=0.23 μg/L, of which was statistically significant difference (Mann-Whitney, U=265,P=0). The PCT concentration of 90.4%(66/73) pulmonary tuberculosis patients was within the range of <0.5 μg/L.Their sensitivity and specificity were 85.2%(52/61),and 96.3%(52/54) respectively，based on an amount of more than 0.675 μg per liter as a critical clinical reference of a patient to be diagnosed with pulmonary infection of pulmonary tuberculosis.  Conclusion  The mea-surement of procalcitonin was benefit for identifying pulmonary tuberculosis patient complicated with lung infection and prognosis, thus guiding the use of antibiotics.

Clinical analysis on 33 elder patients with acute hematogenous disseminated pulmonary tuberculosis

HUANG Mai-ling，WU Xiao-guang，MA Li-ping，GAO Meng-qiu，CHEN Hong-mei，LIU Rong-mei，XIE Li，ZHANG Li-qun

Chinese Journal of Antituberculosis. 2013, 35(11):  927-929. 

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Objective  To evaluate clinical characteristics of elder patients with acute hematogenous disseminated pulmonary tuberculosis. Methods  We analyzed retrospectively the clinical data from 33 elder patients with acute hemotogenous pulmonary tuberculosis hospitalized in Beijing Chest Hospital Affiliated Capital Medical University in recent 6 years. Results  In 33 patients, the mainly clinical symptoms presented were fever, cough, fatigue and anorexia. Seven cases with positive smear，while 4 cases with positive sputum culture. The chest X-ray or computed tomography (CT) showed miliary nodules in whole lung field of double lungs in 32 cases. Nutritional risk assessment score were more than 3 scores in 32 cases, 30 cases were complicated with hypoalbuminemia, 29 cases with total lymphocyte counts below 1.2×109/L. Thirty-two patients with high-risk or chronic diseases, 8 patients with tuberculous meningitis, 6 cases with bone joint tuberculose and 16 cases were misdiagnosed with other diseases. Thirty cases were treated with individual anti-tuberculosis therapy regimens and 25 patients were improved. Conclusion  Acute hematogenous disseminated pulmonary tuberculosis in elder patients is serious, with many complications, untypical clinical manifestations, high rate of misdiagnosis and malnutrition. However most patients can get better when they are treated individually.

Analysis of 33 cases of atypical pulmonary tuberculosis ball by CT images

XU Shu-ming，CHENG Lin-xian，YANG Xuan-qin，XIN Lei，FAN Shang-fei

Chinese Journal of Antituberculosis. 2013, 35(11):  930-933. 

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Objective  To raise the CT differential diagnosis level, comparative study CT imaging and clinic pathologic features in patients with atypical tuberculosis which were easily misdiagnosised as lung cancer. Methods  Retrospective studies 33 cases of atypical pulmonary tuberculosis patients (confirmed by pathology) were misdiagnosised as lung cancer by CT in Shanxi Tumor Hospital. Results  All the 33 focuses in 33 cases showed nodule or mass shadows，the diameter was around 0.9－5.7 cm， average value was（3.04±0.15）cm. Focuses of 25 cases were occurred at double upper lobe of lung and double lung dorsal segment of lower lobe. There were 7 cases with cavity in focuses interior(21.2%,7/33)，10 cases with calcification(30.3%,10/33). There were marginal spiculated sign in 8 cases(24.2%,8/33) and long streaks in 10 cases(30.3%,10/33). Eight cases were with the same lung field with satellite nodules(24.2%,8/33)，4 cases were with calcification and granular in other lung field(12.1%,4/33).One case was pleural effusion. CT appearance with enhancement scan: 28 cases with enhancement，there were inhomogeneous enhancement 35.7%(10/28)，honeycomb enhancement 32.1%(9/28). Seventeen cases with CT plain and enhancement scan，the results showed CT value of enhancement part can be increase 7-58HU, ave-rage（24.1±1.8）HU. Conclusion  The CT appearance and clinical characteristics of atypical pulmonary tuberculosis were multiform，such as honeycomb enhancement， long streaks and satellite nodules， which can help distinguish atypical pulmonary tuberculosis from lung cancer.

Analysis on efficacy of surgical lobar fissure free in patients with chronic empyema by using stripped pleural fibreboard

CHENG Lü-huan，MA Yong，HU Xin-chun，WANG Wu-ming，ZHENG Ren-shan，HU Chen

Chinese Journal of Antituberculosis. 2013, 35(11):  934-938. 

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Objective  To analyze the efficacy of surgical lobar fissure free in the chronic empyema by using stripped pleural fibreboard. Methods  Ninety-two patients with chronic empyma, who admitted in Jiangxi Chest Hospital, were randomly divided into experimental group and control group by 46 cases each. Each group was treated with stripped pleural fibreboard, meanwhile in the experimental group additional using surgical lobar fissure free. We analyzed the two groups’ operative duration, blood loss, drainage quantity after 24 h postoperatively, intubation time, postoperative length of stay and pulmonary function. Results  The experimental group and control group’s operative time were (148.52±45.38) min and (142.97±47.61)min, blood loss were (372.41±241.89)ml and (333.35±301.19)ml,drainage quantity after 24 h postoperatively were (252.10±120.18)ml and (260.58±111.48)ml, intubation time were (4.51±4.01) d and (4.34±7.53) d, postoperative length of stay were (14.58±3.90) d and (15.28±6.35) d, respectively. There was no statistically difference between the two groups. And the experimental group’s lung function improved significantly, including vital capacity and maximal voluntary ventilation both increased remarkably compared with the control group (P<0.05). Conclusion  Surgical lobar fissure free for the chronic empyema by using stripped pleural has no effect on the operative duration, blood loss,drainage guantity after 24 h postoperatively, intubation time, postoperative length of stay, and it could improved the patients’ lung function remarkably, it’s worth to be recommended widely.