Table of Content

10 December 2018, Volume 40 Issue 12

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Original Articles

Myocutaneous flap implantation for the treatment of chronic refractory tuberculous empyema(12 cases report)

QU Ji-chen,LI Jia-qi,XIE Bo-xiong,JIANG Ge-ning,DONG Jia-sheng

Chinese Journal of Antituberculosis. 2018, 40(12):  1253-1257.  doi:10.3969/j.issn.1000-6621.2018.12.002

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Objective To sum up experience in the treatment of chronic tuberculous refractory empyema with autologous myocutaneous flap implantation.Methods From January 2004 to December 2017, 12 patients with chronic tuberculous refractory empyema were treated with autologous myocutaneous flap implantation in Shanghai Pulmonary Hospital. After dressing up the wound, transplantation and filling of rectus abdominis myocutaneous flap or latissimus dorsi myocutaneous flap was performed in patients with history of ipsilateral surgical operation and the ipsilateral latissimus dorsi myocutaneous flap or pectoralis major myocutaneous flap was transfered and filled in patients without the history of ipsilateral surgical operation. The patients were treated with triplex regimen including isoniazid, rifampicin and pyrazinamide for more than 3months before operation, and continue this regimen for 12months after operation. The regimen was adjusted by the result of drug susceptibility test. All patients were males with median age 52.5 (26.0-65.0) years old. Seven cases had previous pneumonectomy including pneumonectomy in 2 cases due to pulmonary tuberculosis and bronchopleural fistula (BPF), drainage and other conservative treatment not be cured, then chest wall fenestration, and long-term dressing change in 5 cases. Chronic tuberculous refractory empyema conservative treatment (drainage, etc.) could not be cured and the lung could not be reopened for opening window to change medicine in the other 5 cases without previous operation history.Results No death cases and no respiratory complications occurred in these patients. Thoracic drainage tube was successfully removed within 5days and discharged from hospital for 3 to 6 weeks after operation. The median follow-up time was 9months. There was no recurrence of empyema and myocutaneous flap necrosis in 11 patients. Local recurrence of empyema in 1 case (removal of old occluder, application of a new type of Sheffler occluder during non-edema period, preparation for secondary musculocutaneous flap filling).Conclusion The application of auto-logous myocutaneous flap implantation combined with special materials (memory alloy scaffold), microsurgical techniques, chemotherapy and traditional operation of tuberculous empyema, in the treatment of chronic tuberculous refractory empyema has a good clinical effect.

The value of arterial embolization before pulmonary lobectomy in patients with refractory hemoptysis

ZHU Jian-kun,LIU Da-wei,JIN Feng,ZHAO Bin,WANG Cheng,ZHANG Yun-zeng,QIAO Gao-feng,YANG Xiu-zhen.

Chinese Journal of Antituberculosis. 2018, 40(12):  1258-1261.  doi:10.3969/j.issn.1000-6621.2018.12.003

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Objective To evaluate the value of superselective transcatheter arterial embolization (interventional embolization) guided by digital subtraction angiography (DSA) before pulmonary lobectomy in patients with refractory hemoptysis. Methods We analyzed retrospectively the clinical data of 45 consecutive patients admitted in Shandong Provincial Chest Hospital due to refractory hemoptysis requiring lobectomy. Twenty patients underwent interventional embolization before lobectomy as research group, and 25 patients without interventional embolization before lobectomy as control group. The distribution of blood vessels responsible for hemoptysis, the relationship between primary disease and the effect of interventional embolization were observed. The differences in operative time, bleeding volume and incidence of complications between the two groups were compared. T test was used to compare the measurement data between groups, and χ² test was used to compare the enumeration data between groups, with P<0.05 as the statistical significance. Results DSA revealed that there were 57 vessels responsible for bleeding in 20 patients in the research group, including 12 bronchial arteries (BA), 42 collateral arteries of non-bronchial body arteries (NBSA), and 3 pulmonary arteries (PA). Of 42 NBSA branches,29 branches were from intercostal artery, subclavian artery and axillary artery,in 11 cases with tuberculous destroyed lung and cavity complicated with aspergillus ball, and 13 branches were from esophageal proper artery and inferior phrenic artery in 9 cases with bronchiectasis. There were 13 (65.0%) cases of hemostasis immediately stop after interventional embolization, and 7 (35.0%) cases hemoptysis alleviating. The average intraoperative bleeding volume was (600±155)ml in the research group and that was (850±210)ml in the control group. There was significant difference between the two groups (t=23.73,P=0.000). The operative time was (150±35)min in the research group, and that was (180±40)min in the control group. The difference between the two groups was statistically significant (t=12.40,P=0.000).Conclusion NBSA is the main blood vessel responsible for refractory hemoptysis, and its distribution is related to the primary disease. Preoperative interventional embolization is helpful to control hemoptysis, and can effectively alleviate intraoperative bleeding, shorten the operation time, thereby reducing the risk of operation.

Procedure optimization for the treatment of chronic tuberculous empyema by complete video-assisted thoracoscopic surgery (Report of 59 cases)

ZHANG Ying,ZHU Wen,LIU Jun-ting,LIN Bing,LI Shu-wei,LAO Hai-jun,LIU Tao,ZHOU Ji-ming,SI Peng-fei.

Chinese Journal of Antituberculosis. 2018, 40(12):  1262-1266.  doi:10.3969/j.issn.1000-6621.2018.12.004

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Objective To explore the feasibility of procedure-optimized complete video-assisted thoracoscopic surgery in the treatment of chronic tuberculous empyema.Methods We collected 59 patients with chronic tuberculous empyema who underwent video-assisted thoracoscopic surgery in the Fourth Hospital of Chaoyang City from April 2015 to August 2017, the clinical data of chronic tuberculous empyema removal and stripping of pleural fibrous plate in this group of patients was analyzed and the clinical efficacy was evaluated, and focused on the method and effect of “ procedure optimization” surgery. The procedure optimization surgical method is a new method designed by the author to overcome the technical difficulties in the treatment of chronic tuberculous empyema by video-assisted thoracoscopic surgery through clinical practice. Procedure optimization surgical method mainly includes the following aspects: changing the order of thoracoscopic incision layout, improving the technology of thoracoscopic operation space, unifying the sequence of stripping of pleural fibrous plate, and the unique placement method of thoracic drainage tube.Results All the 59 patients underwent video-assisted thoracoscopic surgery successfully. The duration of surgery was 60-180min, average (median (quartile), M(Q₁,Q₃)) 110 (90,140)min, and intraoperative hemorrhage was 150-2000ml, average (M(Q₁,Q₃)) 700 (550,800)ml. Catheter retention time was 4 to 22d, average (M(Q₁,Q₃)) 7 (5,10)days. Post-operative hospitalization time was 6 to 24days, average (M(Q₁,Q₃)) 9 (7,12)days. The incidence of postoperative complications was 23.3% (14/60), including 5 cases of delayed wound healing, 5 cases of continuous lung leakage and 1 case of chylothorax. Chronic sinus tract was formed in 3 patients with incision re-infected and was healed after the proper treatment of incision. Postoperative follow-up lasted 3-36months,average (M(Q₁,Q₃)) 16 (8,22)months, and there was no recurrence of empyema.Conclusion The method of procedure optimization for the treatment of chronic tuberculous empyema by complete video-assisted thoracoscopic surgery is effective, safe and reliable.

The application of thoracoscope assisted small incision in treatment of chronic tuberculous encapsulated empyema

WANG Cheng,JIN Feng.

Chinese Journal of Antituberculosis. 2018, 40(12):  1267-1270.  doi:10.3969/j.issn.1000-6621.2018.12.005

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Objective To explore the experience and curative effect of thoracoscope assisted small incision in treatment of chronic tuberculous encapsulated empyema. Methods One hundred and sixty-four patients of local chronic encapsulated tuberculous empyema were treated surgically in Shandong Provincial Chest Hospital between January 2006 and December 2016. Pleurodesis were done by thoracoscope assisted small incision 103 male cases and 61 female cases were enrolled; Aged 6-65 years, the average age were (31.0±3.7)years; 3-18monthes history, the mean history were (5.0±1.7)monthes. Retrospective analysis patients’s intraoperative situation, postoperative complications, and the treatment outcome. Results All patients have no perioperative death, 164 patients were cured by surgery. 13 cases were complicated by different degree of arrhythmia and cured by symptomatic treatment. 15 cases of pulmonary leakage cured by continous chest closed drainage. 9 cases of poor healing of incision were cured by surgical dressing. Conclusion Thoracoscope assisted small incision in treatment of chronic tuberculous encapsulated empyema is a kind of reasonable choice of surgical approach which can ensure the curative effect and safety and reduce the invasiveness

Evaluation of vacuum sealing drainage in the treatment of cervical lymph node tuberculosis

YANG Lei,ZHANG Jin-gui,JIN Feng

Chinese Journal of Antituberculosis. 2018, 40(12):  1271-1274.  doi:10.3969/j.issn.1000-6621.2018.12.006

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Objective To evaluate the application of vacuum sealing drainage (VSD) in cervical lymph node tuberculosis (TB).Methods Between Jan 2013 and Jan 2017, a total of 54 patients (23 males and 31 females) who were admitted to Binzhou Central Hospital and diagnosed as cervical lymph node TB were included in the retrospective study. All enrolled patients had received standard anti-TB therapy (4-6 weeks), and then cervical lymph nodes were evaluated via CT. Surgical procedures, such as abscess drainage, lymph node resection, and second suture or flap tamponade suture, were performed. Meanwhile, all were treated with VSD therapy (-125--450mm Hg,1mm Hg=0.133 kPa) about 1-2 weeks. Finally, all patients were followed up 6-12months after 6-9months of anti-TB therapy, wound healing time and the recurrence rate were obtained for statistical analysis.Results There were no perioperative death, no serious complications and no recurrence within a follow-up period. All 54 patients were cured, the wound healing time ranged from 7 to 15days, the hospitalization time ranged from 7 to 22days, and the mean treatment time was (11.23±7.62)days.Conclusion The application of the combination of pre-surgical evaluation, abscess drainage+lymph node resection, VSD treatment and second suture was helpful to repair wound, reduce recurrence rate and hospitalization time.

Tuberculosis debridement for the treatment of peripheral localized pulmonary tuberculosis lesions in tuberculous empyema patients

WEI Lin,LIU Yu-gang,ZHU Chang-sheng,WU Li,WANG Lin-bao,LI Qian,ZHANG Hui-jun,LU Zeng-hui,DING Chao.

Chinese Journal of Antituberculosis. 2018, 40(12):  1275-1279.  doi:10.3969/j.issn.1000-6621.2018.12.007

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Objective To investigate the safety and efficacy of the debridement for peripheral localized pulmonary tuberculosis lesions in tuberculous empyema patients, via comparing the outcome of debridement and wedge resection procedure.Methods The data of 109 cases who suffered from tuberculous empyema complicated with peripheral localized pulmonary tuberculosis from January 2008 to January 2018 in Xi’an Chest Hospital were analyzed retrospectively. The patients were divided into debridement group (n=29) and wedge resection group (n=80) by different procedures. The operation time, intraoperative bleeding volume, incidence of postoperative pulmonary leak, pulmonary leak time, drainage time, incidence of residual cavity, hospital stay, and hospitalization cost were compared between the two groups. All patients were followed up for 3 years after surgery.Results Persistent pulmonary leak occurred in 17 patients in the debridement group and 63 patients in the wedge resection group. The incidence of postoperative persistent pulmonary leak in the debridement group and pulmonary wedge resection group was 58.6% (17/29) and 78.8% (63/80), respectively, and the difference was statistically significant (χ ²=4.42, P=0.036). The mean drainage time in the two groups was (7.2±2.7) and (8.2±2.3)days, respectively, and the difference was statistically significant (t=-2.01, P=0.046). The mean hospital stay was (14.2±2.1) and (15.1±1.9)days; the difference was statistically significant (t=-2.15, P=0.034). The mean hospitalization cost in the debridement group and pulmonary wedge resection group was (29016.1±2299.7) and (41617.2±4244.5) yuan, respectively; the difference was statistically significant (t=-15.17, P=0.000). Conclusion Tuberculosis debridement is safe and effective for eliminating the localized pulmonary tuberculosis lesions in tuberculous empyema patients and the hospitalization cost is less than pulmonary wedge resection.

Risk factors of residual postoperative pleural space after superior lobectomy and its effect on postoperative complications

JIANG Yu-hui,SHEN Lei,DAI Xi-yong.

Chinese Journal of Antituberculosis. 2018, 40(12):  1280-1285.  doi:10.3969/j.issn.1000-6621.2018.12.008

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Objective To analyze the risk factors of residual postoperative pleural space (RPPS) after superior lobectomy and its effect on postoperative complications.Methods A retrospective analysis was conducted on the clinical data of 80 patients who underwent superior lobectomy in Wuhan Pulmonary Hospital from October 2014 to October 2017, including 23 patients with primary pulmonary malignancies (28.75%) and 57 patients with pulmonary infectious diseases (71.25%). According to the occurrence of RPPS, they were divided into two groups: 29 cases with RPPS and 51 cases without RPPS. The differences in potential factors between the two groups were compared, and the risk factors of RPPS and its effect on early postoperative complications were analyzed.Results Of the 80 patients with superior lobectomy, 29 had RPPS, and the incidence was 36.25%. Total pleural adhesions were found in 72.41% (21/29) of patients with RPPS, significantly higher than those without RPPS (27.45% (14/51)), and the difference was statistically significant (χ ²=15.19, P=0.001). Forced expiratory volume in 1 second (FEV₁) <1.85L were found in 60.00% (12/20) of patients with RPPS, significantly higher than those without RPPS (16.67% (6/36)), and the difference was statistically significant (χ ²=11.07, P=0.001). Logistic regression analysis showed that the risk of RPPS in patients with total pleural adhesion was 7.00 (1.66-29.46) times that of patients without total pleural adhesion; the risk of RPPS in patients with FEV₁<1.85L was 10.50 (2.40-46.02) times that of patients with FEV₁≥1.85L. The postoperative 72-h drainage flow of RPPS group and non RPPS group (median (interquartile range)) (M(Q₁,Q₃)) was 1380 (1010-1635)ml and 920 (630-1150)ml, and there was statistically significant difference (U=351.00, P<0.05). The postoperative extubation time (M(Q₁,Q₃)) of the two groups was 15.0 (11.5, 25.0) and 9.0 (7.0, 10.0)days, respectively, and there was statistically significant difference (U=215.50, P<0.05). Four patients (5.00%) had serious complications in the early postoperative period. All of them occurred RPPS. RPPS infection was found in 3 patients and delayed bleeding in 1 patient. Conclusion The independent risk factors of RPPS include pleural adhesion and FEV₁<1.85L. RPPS could lead to increased drainage and prolonged extubation time in the early postoperative period, and serious complications such as infection and delayed bleeding can occur.

Surgical treatment of empyema necessitatis, the complication of tuberculous empyema (Report of 90 cases)

ZHANG Yun-zeng,ZHU Jian-kun,LIU Da-wei,QIAO Gao-feng,ZHAO Bin,WANG Cheng,JIN Feng.

Chinese Journal of Antituberculosis. 2018, 40(12):  1286-1290.  doi:10.3969/j.issn.1000-6621.2018.12.009

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Objective To explore the clinical characteristics and the outcome of surgical treatment of empyema necessitatis, the complication of tuberculous empyema.Methods The data of 192 patients with cellulosic empyema (Stage Ⅱ) and organic empyema (Stage Ⅲ) who underwent surgery in Shandong Chest Hospital between January 2008 and December 2016 were retrospectively analyzed. Among them, 90 cases who occurred empyema necessitatis were set as observation group, and 102 patients who did not occur empyema necessitatis were set as control group. The clinical features, surgical effects and complications of the two groups were compared.Results The proportion of females, previous history of tuberculous pleurisy, preoperative thoracic catheterization, preoperative thoracic biopsy, and localized empyema in the observation group were 36.67% (33/90), 23.33% (21/90), 47.78% (43/90), 15.56% (14/90), and 96.67% (87/90), respectively, which were significantly higher than those in the control group (19.61% (20/102), 11.76% (12/102), 14.71% (15/102), 4.90% (5/102), and 78.43% (80/102)); the differences were all statistically significant (χ ² values were 6.96, 4.50, 24.80, 6.09, and 14.04; P values were 0.008, 0.034, <0.001, 0.014, and <0.001, respectively). In the observation group, the median (quartile) (M(Q₁,Q₃)) of the operation time and intraoperative blood loss were 3.50 (3.00, 4.50)h and 300.00 (200.00, 500.00)ml, respectively, which were significantly lower than those in the control group (4.00 (3.50, 5.00)h and 600.00 (400.00, 675.00)ml); the differences were statistically significant (U values were 5639.00 and 6692.00; P values were 0.006 and <0.001). In the observation group, 62 cases (68.89%, 62/90) removed the ribs, M(Q₁,Q₃)) of the postoperative drainage tube time and hospital stay were 10.00 (8.00, 13.00)d and 18.00 (15.00, 18.75)d, and 11 patients (12.22%, 11/90) had complications after operation, which were significantly higher than those in the control group (17 cases (16.67%, 17/102), 8.00 (7.00, 10.00)d, 16.00 (15.00, 18.00)d, and 4cases (3.92%, 4/102); the differences were statistically significant (χ ²=53.84, U=3065.00, U=3630.00, and χ ²=4.57; P values were <0.001, <0.001, 0.012, and 0.032). Conclusion Occurrence of empye-ma necessitatis in patients with tuberculous empyema could increase surgical trauma, duration of postoperative drainage tube, length of hospital stay, and the incidence of postoperative chest wall tuberculosis.

The value of molecular biological detection of postoperative specimens in the diagnosis and treatment of tuberculosis patients

WEN Zi-lu,WANG Lin,WANG Jun,CHEN Hui,LI Hong-wei,ZHU Yi-jun,JIANG Shao-ning,ZHANG Shu-lin,SONG Yan-zheng.

Chinese Journal of Antituberculosis. 2018, 40(12):  1291-1295.  doi:10.3969/j.issn.1000-6621.2018.12.010

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Objective To preliminarily explore the value of molecular biological detection technology in the rapid diagnosis of postoperative tuberculosis patients.Methods We conducted a retrospective analysis of 170 patients with tuberculosis who underwent surgical treatment and had complete clinical data in the Shanghai Public Health Clinical Center from January 2015 to February 2018. Of the 170 patients, 100 (58.82%) were male and 70 (41.18%) were female; there were 18 cases (10.59%) in the 1 to 18 age group, 142 cases (83.53%) in the 19 to 65 age group, and 10 cases (5.88%) in the 66 to 82 age group. A total of 39 patients (22.94%) were pulmonary tuberculosis, and 131 patients (77.06%) had extrapulmonary tuberculosis. PCR membrane hybridization and second-generation sequencing techniques were applied for strain identification and drug resistance-related gene detection in postoperative specimens. All patients underwent acid-fast staining in sputum, needle biopsy before surgery, or intraoperative sampling, as well as Roche solid culture, BACTEC-MGIT 960 rapid culture, and drug susceptibility test in sputum.Results (1) The positive rate of acid-fast staining of sputum was 9.41% (16/170), and the positive rate of acid-fast staining of pulmonary tuberculosis sputum was 23.08% (9/39), while the positive rate of acid-fast staining was 51.76% (88/170) in the biopsy or intraoperative sampling. (2) The positive rate of mycobacterial culture was 27.65% (47/170); the positive rate of phenotypic susceptibility test was 14.12% (24/170). (3) The positive rate of postoperative molecular biology species identification was 51.76% (88/170). The result of PCR membrane Hybridization showed that 7 cases were identified as non-tuberculous mycobacteria; 4 cases were also identified as non-tuberculous mycobacteria by culture combined with MPB64 antigen detection, but 3 cases were not identified as non-tuberculous mycobacteria by culture method and could not be detected by MPB64 antigen detection. The seven specimens identified for strain identification by molecular biological detection were one case with co-infection of Mycobacterium phlei and Mycobacterium gordon, three cases of intracellular mycobacteria, one case of Mycobacterium marinum, one case of Mycobacterium avium, and one with Mycobacterium abscessus. (4) The drug sensitivity of the remaining 163 cases were detected by molecular biological method. The detection rate of first-line anti-tuberculosis drug resistance genes was 54.60% (89/163), while the rate was 49.69% (81/163) in the second-line anti-tuberculosis drugs. Compared with the results of drug sensitivity test after culture, 29.79% (14/47) of the samples with positive drug susceptibility test were negative in the detection of resistance gene by molecular biological technology. The consistency of molecular biological resistance gene detection and drug susceptibility test was 90.00% (27/30). The molecular biological and BACTEC-MGIT 960 rapid culture drug sensitivity test composite detection rate was 63.19% (103/163).Conclusion Molecular biological detection technology is of great value in the rapid diagnosis of postoperative specimens. It can distinguish between Mycobacterium tuberculosis and non-tuberculous mycobacteria and can identify whether the strain is drug resistant, which provides an important reference for further diagnosis and treatment of tuberculosis patients.

Analysis of the effect of surgical treatment in 487 sases with tuberculosis destroyed lung

JIANG Liang-shuang,WU Bang-gui,GONG Sheng,ZHONG Ming,JIA Shuang,LI Xiao,WAN Xun,LIU Chao,ZHOU Jun.

Chinese Journal of Antituberculosis. 2018, 40(12):  1296-1301.  doi:10.3969/j.issn.1000-6621.2018.12.011

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Objective To explore the clinical application of pulmonary surgical treatment for tuberculosis destroyed lung.Methods Clinical data of 487 patients with tuberculosis destroyed lung who were admitted to the Chengdu Public Health Clinical Medical Center from January 2007 to March 2017 were collected. All the patients underwent surgical treatment 2 weeks after standard anti-tuberculosis drugs (individualized regimens), with stable tuberculosis, improved preoperative examination, and indications for surgery. Clinical symptoms before and after surgery were compare, as well as changes in thoracic collapse, scoliosis, sputum test, lung function changes, surgical procedures, complications and follow-up. Data were analyzed by t test using SPSS 17.0 software, and P<0.05 was considered statistically significant.Results Among the 487 patients in, 93 underwent right upper lung resection, 69 underwent right pneumonectomy, 112 underwent left upper lung resection, 193 patients underwent left pneumonectomy, and 20 patients underwent double supra-pulmonary resection. Obvious cough, chest tightness, shortness of breath, and collapse of the affected chest were found in 453 patients, mediastinum were significantly biased to the affected side in 78 cases, repeated hemoptysis was found in 385 cases, 113 cases were with massive hemoptysis, repeated massive hemoptysis exsit in 32 cases; sputum test was positive in 82 cases (47 were smear positive patients and 35 were sputum positive), 57 patients were found positive for acid-fast bacilli using fiberoptic bronchoscopy; Only 23 patients had mild cough and chest tightness after operation; the thoracic collapse was improved in patients undergoing pneumonectomy; the mediastinal shift was significantly restored in patients with non-pneumonectomy; blood in the sputum after 6-months-to-2-year follow-up was found in 5 patients; 151 sputum positive patients were all negative postoperative. The vital capacity (VC) was, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), maximum call Peak gas flow rate (PEF) , maximum ventilation (MVV), were all significantly improved after surgery((85.20±10.10)% vs. (67.50±11.37)%, t=-7.56, P=0.024) ((88.00±9.80)% vs. (71.60±13.21)%, t=-8.63, P=0.01) ((84.60±7.36)% vs. (66.10±10.03)%, t=-5.37, P=0.037)((80.65±9.25)% vs. (65.90±9.54)%, t=-6.40, P=0.022) ((83.20±5.73)% vs. (61.20±13.60)%, t=-4.66, P=0.012). Complications occurred in 53 patients(53/487, 10.88%) during 3days to 6months postoperativ, including thoracic infection (n=22, bronchial-pleural fistula in 5 cases), recruitment insufficiency in residual lung (n=13), severe pulmonary infection (n=7), wound infection (n=6), and hoarseness (n=5). One patient with right pneumonectomy died ofrespiratory failure 3 hours after surgery because of tight chest adhesion, operative timeover 9 hours, and an intraoperative blood loss of more than 2000ml. Of the patients, 433 patients recovered to normal life and work 3 to 6months after surgery; 25 patients recovered at home and have resumed daily life but did not go out to work; the total effective rate was 94.05% (458/487).Conclusion Based on standard and effective anti-tuberculosis drug, surgical treatment for patients with tuberculosis destroyed lung is of efficiency, with less complications, and could significantly improves lung function in, which is essential to improve patients’ quality of life and achieve cure in clinic.

The analysis of the effect of doctor-nurse integration mode during the perioperative period after pulmonary tuberculosis surgery

LU Yong-zan,RONG Ning-ning,HAN Xing-fen,SHI Ji-yan,HAN Ying,CAO Wen-ting,ZHAO Chang-zheng,HAO Rong-mei.

Chinese Journal of Antituberculosis. 2018, 40(12):  1302-1305.  doi:10.3969/j.issn.1000-6621.2018.12.012

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Objective To explore the application effect of integrated medical care mode in perioperative nursing of tuberculosis patients.Methods The pulmonary TB patients, undergoing surgery on June 2017, were divided into two groups randomly using random number tables, according to the application of doctor-nurse integration mode:(1) control group 100 cases were treated with the routine mode, which includes: parallel line management mode, doctor’s advice, and nurses’ passive implementation without crossover. (2) experimental group 100 cases were treated with the integration mode which includes through open communication and coordination and with shared responsibility, and mutual respect and trust and have a certain degree of professional knowledge and ability between doctors and nurses to provide patients with medical care. The pulmonary function indexes (FVE₁, FVC, FVE₁%), average hospitalization time, complication rate and patient satisfaction were compared between the two groups.Results Ventilatory function was tested at seven days after surgery. Compared with the control group with routine mode, the application of the new mode improved the ventilatory function significantly (FEV₁: (1.79±0.30)L vs (2.05±0.38)L, t=5.371, P=0.016; FVC: (2.49±0.55)L vs (3.05±0.61)L, t=6.824, P=0.010; FVE₁%: (45.79±3.13)% vs (49.05±5.38)%, t=5.243, P=0.017). There was also a significant improvement in hospitalization time((14.23±2.88 vs 10.45±2.15)days, t=-10.523,P=0.004), and a significant improvement in extubation time ((4.08±1.85 vs 2.54±0.97)days,t=-7.371,P=0.008). Moreover, there was also a higher complication rate detected in the control group (19 cases vs 3 cases, χ ²=11.494, P=0.003). Patient satisfaction has been found to be higher in the experimental group: strong satisfaction (61 cases vs 82 cases, χ ²=3.891, P=0.048), weak satisfaction (27 cases vs 12 cases, χ ²=7.172, P=0.007) and dissatisfaction (12 cases vs 6 cases, χ ²=1.532, P=0.220). The average hospitalization days, extubation time and complications in the integrated medical care group were lower than those in the previous group, and patients’ satisfaction was increased. Conclusion The integrated medical care model can promote the recovery of pulmonary function, shorten hospitalization time, reduce complications, and improve patients’ medical satisfaction.

Clinical efficacy analysis of anterior approach surgery for the treatment of 310 cases of lumbar tuberculosis

HE Lei,PU Yu,HE Min,LI Hai,LI Bang-yin,CAI Yu-guo,LIU Lin,LIU Yong.

Chinese Journal of Antituberculosis. 2018, 40(12):  1306-1312.  doi:10.3969/j.issn.1000-6621.2018.12.013

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Objective To explore the clinical effect of anterior approach surgery for lumbar tuberculosis. Methods Clinical data of 310 patients with lumbar tuberculosis who underwent anterior approach debridement+bone graft fusion+internal fixation in Chengdu Public Health Clinical Medical Center from 2006 to 2016 were collected. The curative effect of anterior approach surgery in treating lumbar tuberculosis was comprehensively evalu-ated as per intraoperative blood loss, changes in lumbar kyphosis angle (Cobb angle), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) before and 3months after surgery, change in spinal nerve function (Frankel grading standard) before and after surgery, postoperative bone graft fusion (Bridwell grading standard), as well as complications and follow-up visits. Statistical analysis was performed using SPSS 20.0 software, and single-sample t-test was adopted for comparison of quantitative data, with P<0.05 suggesting difference of statistical significance. Results The operation time was 110-220min, averaging (154.46±32.11)min; the intraoperative blood loss was 220-600ml, averaging (380.64±108.35)ml. Finally, 279 patients received follow-up visits for 9 to 36months, (18.00±8.11)months in average, who all were clinically cured by the last follow-up visit. Thirty-one patients lost follow-up. Cobb angle ((15.17±6.36)°), ESR ((25.54±13.25)mm/1h), and CRP ((14.36±10.19)mg/L) 3months after surgery were all significantly lowered compared with those before surgery ( (25.26±7.34) °, (48.39±10.63)mm/1h, (31.24±13.86)mg/L, respectively) (t=16.62, 18.72, 15.08, P values <0.001). By the end of follow-up visit, out of 46 patients with preoperative neurological impairment, 34 patients (73.91%) recovered to normal (E grade) within 3 to 12months after surgery, 8 patients (17.39%) to D grade 12months after surgery, 2 patients (4.35%) to C grade 6months after surgery, and 2 patients (4.35%) never recovered. The bone graft fusion was in accordance with Bridwell class 1 standard, and the bone graft fusion rate was 100.00% (310/310), with the fusion time lasting from 4-17months, (8.10±5.31)months in average. Cerebrospinal fluid leakage occurred in 1 case 3days after operation, which was cured 10days later after receiving conservative treatment; postoperative atelectasis occurred in 5 cases, and satisfactory pulmonary resuscitation was achieved after receiving conservative treatment; 2 cases experienced loosening of internal fixation 9 and 20months after operation respectively, and after removal of the internal fixator, they were in good condition at the following follow-up visits; 3 cases formed sinus tract after operation, of whom 1 case underwent debridement again, and 2 cases recovered after adjusting antituberculosis therapy scheme and dressing change by the Internal Medicine Department of Tuberculosis of our hospital as per the results of drug sensitivity test; 2 cases had cold abscess and received paraspinal cold abscess absorption 3 to 7months after adjusting antituberculosis therapy scheme by the Internal Medicine Department of Tuberculosis of our hospital as per the results of drug sensitivity test. Conclusion On the basis of regulating effective treatment of antituberculosis drugs, anterior approach debridement+bone graft fusion+internal fixation for lumbar tuberculosis can effectively improve clinical symptoms and reduce postoperative complications, achieving satisfactory outcome in patients with lumbar tuberculosis.

Therapy of pregnancy combined with tuberculosis-69 cases clinical observation

CHEN Yan-qin,GAO Wei-wei.

Chinese Journal of Antituberculosis. 2018, 40(12):  1313-1318.  doi:10.3969/j.issn.1000-6621.2018.12.014

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Objective To investigate the effectiveness and tolerance of treatment regimen which are 2H-R-E/10H-R and 2H-Z-E/10H-R for pregnancy combined with tuberculosis patients, as well as the influence of congenital malformation for newborns.Methods Bring 79 pregnancy cases were cured in Beijing Chest Hospital from September 1998 to December 2014 combined with initial treatment pulmonary tuberculosis at first 3months’ gestation into this study, and all cases got antituberculosis therapy after 3months’ gestation. All cases were randomly divided into A group and B group through random number table method. A group was 40 cases and they got 2H-R-E/10H-R. B group was 39 cases and they got 2H-Z-E/10H-R. There were 10 cases quit. Finally, A group was 35 cases and B group was 34 cases. Evaluating treatment effect of patients in two groups at the end of second and twelfth month through CT scan. Adverse drug reaction was evaluated through therapeutic process. Meanwhile, observe the congenital malformation conditions for newborns in two groups. All data were took in statistical treatment through SPSS 14.0 software and the count data was expressed as χ ² test. Finally, P<0.05 was considered statistically significant. Results Sixty-nine cases finished treatment course. The effective rate for group A and B at the end of second and twelfth month of treatment were 97.1%(34/35) and 94.1%(32/34) respectively. And the invalid rate were 2.9%(1/35) and 5.9%(2/34) respectively. There was no statistical significance(Fisher exact propability, P=0.614). The incidence of drug-related adverse reaction at the end of twelfth month of treatment was 14.3%(5/35) and 32.4%(11/34) for group A and B respectively. There was no statistical significance(χ ²=3.16, P=0.075). There was no aggravation for 69 cases from third month of pregnancy to the end of twelfth month of antituberculosis therapy. Newborns were followed up for 5months and all newborns did not get malformation and tuberculosis infection. Conclusion The curative effect of treatment course which were 2H-R-E/10H-R and 2H-Z-E/10H-R for pregnancy patients combined with tuberculosis was obvious and no difference. Patients could tolerate this treatment course and there was no congenital malformation for newborns. Therefore, all therapeutic schedule could be applied to clinical practice.

Determination of bedaquiline plasma concentration by high performance liquid chromatography-mass spectrometry/mass spectrometry

ZHU Hui,LIU Zhong-quan,XIE Li,GUO Shao-chen,WANG Bin,FU Lei,LU Yu

Chinese Journal of Antituberculosis. 2018, 40(12):  1319-1324.  doi:10.3969/j.issn.1000-6621.2018.12.015

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Objective To establish an high performance liquid chromatography-mass spectrometry/mass spectrometry (HPLC-MS/MS) method for the determination of bedaquiline in human plasma and to evaluate the application of the method.Methods The protein of plasma samples were precipitated with acetonitrile. HPLC-MS/MS was performed using an Agilent ZORBAX SB-C18 column (2.1mm×100mm, 3.5μm) as the analytical column. The mobile phase consisted of methanol-5mmol/L ammonium formate (containing 0.1% formic acid solution) (85∶15, v/v). Electrospray ionization source (ESI) was applied and operated in the positive multiple reaction monitoring (MRM) mode. One analysis was completed within 3min.Results Chromatograms showed no endogenous interfering peaks with blank samples. The mass-to-charge ratio (m/z) of the parental ion and the quantitative ion of bedaquiline was 555.2→58.3. The linear calibration curve was obtained over the concentration on range of 0.1-5.0μg/ml. The inter- and intra-day precision (RSD) were less than 10%. The accuracy were 97.8%-107.0%. 48 plasm samples of 12 tuberculosis patients were detected using the established method. When the dosage was 400mg daily, the peak concentration of bedaquiline was (3.17±1.14)μg/ml, and the trough concentration was (1.12±0.64)μg/ml; when the dosage was 200mg per time, 3 times a week, the peak concentration of bedaquiline was (2.01±0.87)μg/ml, and the trough concentration was (0.65±0.30)μg/ml. The concentrations of bedaquiline in the 48 samples were in the range of calibration curve (0.1-5.0μg/ml).Conclusion A HPLC-MS/MS method was established for the quick analysis and determination of bedaquiline (a new anti-tuberculosis drug) in plasma samples of tuberculosis patients.

Evaluation the application of mycobacterial biphasic L-J medium in the diagnosis of tuberculosis

SONG Yuan-yuan,LIU Er-yong,TAO Bo-shan,HUANG Fei-xiang,XIAO Ya-li,LAN Ru-shu,TAN Yun-hong,LI Hui,YE Lei,CHENG Shi-ming,ZHAO Yan-lin

Chinese Journal of Antituberculosis. 2018, 40(12):  1325-1328.  doi:10.3969/j.issn.1000-6621.2018.12.016

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Objective To evaluate the value of mycobacterial biphasic L-J medium in the diagnosis of tuberculosis, and to explore its feasibility in China. Methods We conducted a multicenter trial to consecutively enroll all patients with suspected TB at 3 prefecture-level TB clinics in 3 provinces of China from October 2014 to October 2015. Of the 2320 suspicious patients enrolled, 15 cases had either one or two of the two cultures (mycobacterial modified L-J medium and mycobacterial biphasic L-J medium) with contamination or missing results, and their comparison of the culture results of the two media is not included in the analysis. 3 sputum specimens collected per patient (immediate sputum, night sputum, morning sputum) for Ziehl-Neelson stain smear microscopy (“smear”), and 2 sputum specimens with good traits were selected simultaneously for modified L-J medium and biphasic L-J medium culture. The positive detection rate of the two media was compared by paired χ² test using SPSS 24.0 software, and P<0.05 was considered statistically significant; The detection efficiency of the biphasic L-J medium was evaluated by the culture results of modified L-J medium and the clinical diagnosis as the standard; The difference between the detection time of modified L-J medium and biphasic L-J medium was statistically analyzed by Wilcoxon rank sum test. P<0.05 was considered statistically significant. Results The positive detection rates of modified L-J medium and biphasic L-J medium were 19.65% (453/2305) and 22.00% (507/2305), respectively, and the difference was statistically significant (χ²=22.091, P=0.000); Based on the culture results of modified L-J medium, the sensitivity of biphasic L-J medium was 91.39% (414/453), and the specificity was 94.98% (1759/1852), and the agreement rate was 94.27% (2173/2305);Based on clinical diagnosis, the area under the ROC curve of modified L-J medium and biphasic L-J medium were 0.694 (95%CI: 0.672-0.715), 0.707 (95%CI: 0.685-0.728), respectively; The median (quartile)(M (Q₁, Q₃)) of days when modified L-J medium reported a positive result was 28 (21, 34)d, while the M (Q₁, Q₃) of days when biphasic L-J medium reported a positive result was 18 (14, 24)d. The difference was statistically significant (Z=15.114, P=0.000). Conclusion Biphasic L-J medium has a higher positive detection rate than modified L-J medium. This method has a high diagnostic value, and the time for reporting positive results is significantly shortened. It is a reference method that can be used as a clinical diagnosis for tuberculosis, and has certain application value in grassroots laboratories in China.

Original Articles

Phenotypic pyrazinamide resistance and genotypic characteristics among multidrug-resistant Mycobacterium tuberculosis isolates in Fujian Province

LIN Shu-fang,WEI Shu-zhen,ZHAO Yong,LIN Jian,LIN Yong-ming.

Chinese Journal of Antituberculosis. 2018, 40(12):  1330-1334.  doi:10.3969/j.issn.1000-6621.2018.12.017

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Objective In order to detect the phenotypic pyrazinamide (PZA) resistance and the genotypic distribution of MDR Mycobacterium tuberculosis (MTB) isolates from Fujian Province, and analyze the correlation between PZA resistance and genotype.Methods A total of 119 MDR-MTB strains were collected from the drug resistant surveillance sites in Fujian Province among 2007-2008 and 2010-2011. The drug susceptibility test (DST) of PZA recommended by WHO was conducted. Genotyping was performed by using Spoligotyping, and the results were uploaded to SpolDB 4.0 database for cluster analysis.Results The PZA resistant rate of 119 MDR-MTB strains was 36.97% (44/119). The streptomycin (Sm) resistant rate of PZA resistant strains (70.45%, 31/44) was higher than that of PZA sensitive strains (50.67%, 38/75), and the difference was statistically significant (χ ²=4.45, P=0.035). The ethambutol (EMB) resistant rate of PZA resistant strains (81.82%, 36/44) was higher than that of PZA sensitive strains (52.00%, 39/75), and the difference was statistically significant (χ ²=1.58, P=0.001). Beijing genotype strains accounted for 67.23% (80/119). Non Beijing genotype strains (32.77%, 39/119) had 16 genotypes including 8 new genotypes, the most common genotypes of which were H family containing H and H3 and T family containing T1, T2, T3 and T5. The PZA resistant rate of Beijing genotypic strains was 38.75% (31/80), and that of non Beijing genotypic strains was 33.33% (13/39); there was no significant difference in PZA resistant rate (χ ²=0.33, P=0.566). Conclusion We should pay attention to the problem about PZA resistance of MDR-MTB strains in Fujian Province. The resistance to PZA is related to the resistance to Sm and EMB. Beijing genotype is mainly prevalent in Fujian Province, and there is no significant difference in the PZA rate between Beijing genotypic strains and non Beijng genotypic strains.

The value of Xpert MTB/RIF detection technology in diagnosis of tuberculosis

ZHOU Xi-tao,ZHANG Yue-jun,ZENG Li-yi,LONG Yun-zhu.

Chinese Journal of Antituberculosis. 2018, 40(12):  1335-1340.  doi:10.3969/j.issn.1000-6621.2018.12.018

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Objective To evaluate the value and significance of Xpert MTB/RIF in the diagnosis of tuberculosis in general hospitals.Methods From June 2016 to August 2017, 376 specimens of patients with suspected tuberculosis in Zhuzhou Central Hospital were collected, including 227 sputum specimens (60.37%), 109 alveolar lavage fluid samples (28.99%), 21 cerebrospinal fluid samples (5.59%), 15 pleural effusion samples (3.99%), and 4 other specimens (1.06%, including drainage fluid, pus, secretions, and urine, 1 case each). GeneXpert MTB/RIF test (referred to as “Xpert method”), sandwich cup liquid-based bacteria acid-fast staining smear microscopy (referred to as “sandwich cup method”) and traditional solid Roche culture method (referred to as “solid culture method”) were conducted for each specimen, and the results were compared. Statistical analysis was performed using SPSS 19.0 software. The count data were compared by χ ² test, and the difference was statistically significant at P<0.05. Results Among the 376 suspected cases, 349 were clinically diagnosed as tuberculosis and 27 were non-tuberculosis. The positive detection rate of Xpert method (37.50%, 141/376) was significantly higher than that of sandwich cup method (22.87%, 86/376) and solid culture method (17.82%, 67/376) (χ ² values were 19.09 and 36.39, respectively; P values <0.05). Taking clinical diagnosis as gold standard, the sensitivity of Xpert method (40.11%, 140/349) was significantly higher than that of sandwich cup method (23.50%, 82/349) and solid culture method (19.20%, 67/349) (χ ² values were 19.86 and 35.98, respectively; P values were <0.05). The diagnostic consistency of Xpert method (K=0.080) was higher than that of sandwich cup method (K=0.016) and solid culture method (K=0.033). Among the 140 positive specimens detected by Xpert method, proportion of resistance to rifampicin was 15.71% (22/140). Among the 63 positive specimens detected by solid culture method, the proportion of resistance to rifampicin was 14.29% (9/63). The difference in proportion of resistance to rifampicin between Xpert and solid culture method was not statistically significant (χ ²=0.07, P>0.05). For the 9 rifampicin-resistant samples detected by solid culture method, consistent results were achieved by Xpert method. Conclusion The Xpert detection method is simple and rapid and shows high sensitive. It has high clinical value for early diagnosis and treatment of tuberculosis in general hospitals.

Analysis on the capacity building and diagnosis and treatment effect of implementation of new tuberculosis prevention and management mode in Shaanxi Province

DENG Ya-li,ZHANG Hong-wei,ZHANG Tian-hua,LIU Wei-ping,MA Yu.

Chinese Journal of Antituberculosis. 2018, 40(12):  1341-1345.  doi:10.3969/j.issn.1000-6621.2018.12.019

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Objective To analyze the capacity building and diagnosis and treatment effect of implementation of the new tuberculosis prevention and management mode (new mode) in Shaanxi Province, and to provide suggestions regarding policy and measures for further prevention and control.Methods We analyzed the changes in tuberculosis system construction, capacity building, patient discovery, treatment and management index after implementing the new tuberculosis prevention and management mode in 10 prefecture-level cities and 108 counties (districts) in the province. Comparison in capacity building between 2014 and 2017 was conducted using the data derived from the “12th Five-Year Plan for Tuberculosis Prevention and Control in Shaanxi Province” and the joint inspection of tuberculosis prevention and treatment work in 2017. Comparisons in patient discovery and treatment management between the three years before implementation (2012-2014) and the three years after implementation (2015-2017) were conducted using the data derived from the “Tuberculosis Information Management System”. Statistical analysis was performed using SPSS 19.0. Chi-square test was used to compare the rate and ratio. P<0.05 was statistically significant.Results There were 20 and 107 designated tuberculosis hospitals in 2014 and 2017, respectively. The number of designated hospitals was increased by 87 in 2017 compared with 2014. In 2014, there were 923 tuberculosis control staff in the province, including 656 in the Centers for Disease Control and Prevention (CDC) and 267 in the designated hospitals. In 2017, there were 1200 tuberculosis control staff, including 403 in the CDC and 797 in the designated hospitals. Compared with 2014, staff in the CDC decreased by 38.57%, and staff in the designated hospital increased by 198.50%. In 2014, tuberculosis drug resistance molecular biology testing was carried out in 3 prefecture-level cities, molecular biology testing was carried out in 5.56% (6/108) counties (districts), and sputum culture was carried out in 12.04% (13/108) of counties (districts). In 2017, tuberculosis drug resistance molecular biology testing was carried out in 8 prefecture-level cities, molecular biology testing was carried out in 49.07% (53/108) counties (districts), and sputum culture was carried out in 55.56% (60/108) of counties (districts). In the three years before implementing the new mode, the sputum rate was 98.50% (329981/335014), 63 892 patients were reported with pulmonary tuberculosis (of whom, 4089 had tuberculous pleurisy), and 14087 patients were pathogenic positive with a positive rate of 23.56% (14087/59803). In the three years after implementing the new mode, the sputum rate was 95.00% (312503/328948), 61583 patients were reported with pulmonary tuberculosis (of whom, 5295 had tuberculous pleurisy), and 10588 patients were pathogenic positive with a positive rate of 18.81% (10588/56288). The sputum rate and pathogenic positive rate were decreased after the implementation of the new prevention and treatment mode (sputum rate: χ ²=6484.178, P=0.000; pathogenic positive rate: χ ²=390.104, P=0.000). Among all of the pulmonary tuberculosis cases, the ratio of symptomatic treatment was 29.43% (18805/63892) and 25.38% (15628/61583) before and after the implementation of the new mode, respectively. The ratio of transfer treatment of pulmonary tuberculosis was 43.90% (28047/63892) and 57.79% (35586/61583) before and after the implementation of the new mode, respectively. The ratio of patients from symptomatic treatment decreased (χ ²=259.002, P=0.000), and the ratio of patients from transfer treatment increased (χ ²=2419.762, P=0.000) after the implementation of the new mode. The overall arrival rates of reported patients or suspected patients were 93.18% (62177/66726) and 89.96% (61323/68169), respectively, which was decreased after implementation of the new mode (χ ²=453.550, P=0.000). The successful treatment rates of patients were 95.04% (60464/63619) and 94.97% (57872/60939) before and after implementing the new mode, respectively. There was no significant difference in successful treatment rate after implementing the new mode (χ ²=0.356, P=0.551). Conclusion The new tuberculosis prevention and control management model has been initially established and implementing well, and the prevention and control capacity has been strengthened in Shaanxi Province. However, some indexes of the diagnosis treatment management of patients have declined, and thus the quality of implementation needs to be improved.

Effectiveness evaluation of hierarchical diagnosis model for multidrug-resistant tuberculosis from 2015 to 2017 in Zigong City

NING Zhu,YANG Lin,SHI Wen-pei,XIE Yan,CAO Hong,ZHANG Zheng-dong,HU Yi,XU Biao

Chinese Journal of Antituberculosis. 2018, 40(12):  1346-1349.  doi:10.3969/j.issn.1000-6621.2018.12.020

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Objective To evaluate the effectiveness of hierarchical diagnosis model for multidrug-resistant tuberculosis (MDR-TB) from 2015 to 2017 in Zigong City.Methods The patients’ routine registration and report records in Ziliujing district, Daan district, Yantan district, Fushun county, Rong county and Gongjing district from 2015 to 2017 were collected. All of 4418 patients were registered in designated Centers for disease control and prevention (CDC)-hospital mixed institutions (Ziliujing district, Daan district and Yantan district). 4922 patients were registered in designated district/county hospitals (Fushun county, Rong county and Gongjing district). The detection, diagnosis, management, and economic expenses of MDR-TB patients were analyzed.Results In the model of designated CDC-hospital mixed institutions and designated district/county hospitals, the MDR-TB detection rate in tuberculosis were 9.2% (54/587) and 5.4% (37/684), the proportion of traditional drug susceptibility testing among sputum culture positive patients were 93.9% (460/490) and 84.1% (402/478), and the treatment rate of MDR-TB patients were 13.0% (7/54) and 59.5% (22/37); differences were all significant (χ ² value were 6.83, 23.72 and 21.86, respectively, all P values were <0.05). The treatment success rate were 5/7 and 77.3% (17/22), respectively, and the difference was not statistically significant (χ ²=0.10, P>0.05). The average direct economic burden per capita were (28006.90±2.83) and (26395.70±5.15) yuan, among which out-of-pocket hospitalization expenses (being reimbursed 70%) accounted for 41.8% (11696.53/28006.90) and 40.6% (10719.40/26395.70), respectively. Conclusion Despite the generally satisfactory effectiveness of hierarchical diagnosis model for MDR-TB in Zigong City, the management of referral and tracking in place, treatment rate, and healthcare payment pattern are recommended to be improved further.

A survey of family function and perceived family support in multidrug-resistant pulmonary tuberculosis patients

ZHANG Yang,SHENG Yu-chao,CHEN Cheng,ZHANG Hai-qing,ZHOU Hui,HUANG Peng,ZHU Li-mei

Chinese Journal of Antituberculosis. 2018, 40(12):  1350-1354.  doi:10.3969/j.issn.1000-6621.2018.12.021

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Objective To investigate family function and perceived family support of multidrug-resistant pulmonary tuberculosis patients in Xuzhou and Suqian regions, and evaluate the correlation between them. Methods A total of 102 multidrug-resistant pulmonary tuberculosis patients from Xuzhou between 2011 and 2016, and from Suqian between 2013 and 2016, were included in the study. A questionnaire including APGAR, PSSS (family support segment) and general situation was used to investigate family function, perceived family support and other informations of these patients; 102 questionnaires were sent out, and 96 valid questionnaires were recovered.Results In the 96 valid questionnaires, most were in high APGAR score group (score of 7-10 with median of 9 (5,10)) (n=64 (66.67%)) and PSSS score group (score of 21-28 with median of 24 (18,26)) (n=59 (61.46%)). Spearman’s rank correlation test was used to analyze the score of APGAR and the score of PSSS (r=0.875, P<0.001). The questionnaire scores of 18-40-year-group (n=47), 0-18-year group (n=1), 41-64-year-group (n=41) and ≥65 years group (n=7) were 10 (8,10), 10, 8 (5,10) and 6 (4,6). The APGAR scores in different age groups were statistically significant (H=8.741, P=0.033). The APGAR scores difference between adverse drug reactions (ADR) group (n=27, 7(5,10)) and no-ADR group (n=69, 10(6,10)) was also statistically significant ((W=1165.500, P=0.046).Conclusion In this study, most of the MDR patients were in good state of family function and perceived family support, and there was a significant correlation between family function and perceived family support.

Academic Discussion

Discussion on the evaluation methods of tuberculosis pathogens diagnosis—Comment on “Expert consensus on molecular diagnostics of tuberculosis pathogens”

YANG Lei,WANG Guo-zhi,LU Jin-biao.

Chinese Journal of Antituberculosis. 2018, 40(12):  1355-1356.  doi:10.3969/j.issn.1000-6621.2018.12.022

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The newly released “Expert consensus on molecular diagnostics of tuberculosis pathogens” contributes to improve the clinical diagnosis of tuberculosis in China. However, we have different views on the “Comparison of nucleic acid detection and traditional bacteriological detection of MTB complex”. At present the molecular diagnostic reagents are developing rapidly with certain differences in sensitivity and specificity. Therefore, the results of molecular diagnostic and bacteriological diagnostic should be interpreted carefully and it is difficult to draw the conclusion in the consensus that “If any molecular diagnostic result is positive while the bacteriological diagnostic result is negative, the final result should be subject to the molecular diagnostic method and regarded as MTB positive”.

Review Articles

Research progress of minimally invasive surgery on treatment of spinal tuberculosis

QIU Peng,LI Jing-tang,LIU Shi-wei,DING Ling-hua,XU Ke-jun,XIONG Long.

Chinese Journal of Antituberculosis. 2018, 40(12):  1357-1360.  doi:10.3969/j.issn.1000-6621.2018.12.023

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Spinal tuberculosis is the most common type of extra-pulmonary tuberculosis, which can cause bone destruction, kyphosis, spinal cord nerve compression and even paraplegia. At present, as a treatment method for spinal tuberculosis, minimally invasive surgery has been paid more and more attentions, including a series of minimally invasive surgical procedures, such as puncture and drainage under the guidance of real-time monitoring of various imaging technologies, endoscopy-assisted surgical treatment, minimally invasive approach, etc. In this article, the research progress of minimally invasive surgery on treatment of spinal tuberculosis was reviewed.

Short Articles

The value of high resolution CT in the diagnosis and treatment of nontuberculous mycobacterial pulmonary diseases

LIN Xue,JIA Hui-jun,ZHANG Hui,REN Hui-li,LIU Wen

Chinese Journal of Antituberculosis. 2018, 40(12):  1361-1365.  doi:10.3969/j.issn.1000-6621.2018.12.024

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Retrospective analysis high resolution computed tomography (HRCT)of 99 cases of patients with non-tuberculous mycobacteria (NTM) lung disease in Guangzhou Chest Hospital from March 2015 to September 2017. The location, number, shape, size,density, border and distribution of lung lesions and lymph nodes were analysed and HRCT findings before and after treatment was evaluated.The common signs of HRCT in NTM lung disease were spotty effusion and consolidation in 93 cases, bronchiectasis in 78 cases, cavitary in 60cases,59 cases of fiber shade,58 cases of nodules, tree-in-bud pattern in 55 cases,grinded glass shadow in 46 cases,45 cases of lymphadenopathy,pleural thickening in 18 cases,pleural effusion in 9 cases, multiple forms was usually observed in one patient’s HRCT. Ninety-one patients with NTM lung disease were treated with clarithromycin, rifampicin, ethambutol and amikacin for 6-18months;8 patients underwent lobectomy after precise localization by HRCT and the lesions were significantly reduced after operation but there were pleural thickening adhesions. Chest HRCT plays an important role in the diagnosis and treatment of NTM lung disease.