ObjectiveTo evaluate the accuracy and practicability of matrix assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF MS) in clinical isolates of mycobacteria.MethodsWe collected all tested strains, which were positive for Mycobacterium tuberculosis culture and positive for acid-fast staining, from West China Hospital of Sichuan University from 2014 to 2017, eliminating duplicate strains sent by the same patient at the same time. The traditional method was used with the P-nitrobenzoic acid (PNB)/ 2-Thiophenecarboxylic acid hydrazide (TCH) indicator to initially identify acid-resistant positive strains. Mycobacteria was identified by MALDI-TOF MS; the specificity and sensitivity of the MALDI-TOF MS was analyzed by duplex primer-polymerase chain reaction (Duplex-PCR) method and DNA sequencing method as the "gold standard" for the identification.ResultsA total of 237 anti-acid positive strains were collected; Mycobacterium tuberculosis complex (MTC) and non-tuberculous mycobacteria (NTM) were identified by mycobacterium double primer PCR, and NTM was identified by 16S rRNA gene sequencing. There were 218 cases of MTC and 19 cases of NTM. The results of preliminary identification using the traditional identification method of PNB/TCH indicator showed that there were 209 cases of MTC (with the sensitivity of 95.9%, specificity of 100.0%, positive predictive value of 100.0%, and negative predictive value of 67.9%) and 28 cases of NTM (with the sensitivity of 100.0%, specificity of 95.9%, positive predictive value of 67.9%, and negative predictive value of 100.0%). The results of MALDI-TOF MS method indicated that there were 199 cases of MTC (with the sensitivity of 91.3%, specificity of 100.0%, positive predictive value of 100.0%, and negative predictive value of 50.0%), 32 cases of NTM (with the sensitivity of 68.4%. specificity of 94.0%, positive predictive value of 40.6%, and negative predictive value of 97.1%), and 6 cases of others. There were 168 strains (84.4%) with the identification score>1.9 obtained by MALDI-TOF MS method.ConclusionsMALDI-TOF MS is a better method for identifying mycobacteria, which has the same identification results as the traditional methods, and has low cost and is suitable for routine use in clinical microbiology laboratories.
ObjectiveTo explore the effectiveness of intertransverse bone graft after debridement and fusion combined with posterior instrumentation in patients with single segmental thoracic tuberculosis.
MethodsBetween March 2014 and May 2015, 17 cases of thoracic tuberculosis were treated by the surgery of intertransverse bone graft after debridement and fusion combined with posterior instrumentation. There were 10 males and 7 females with an average age of 48.5 years (range, 18-70 years), and with a mean disease duration of 4 months (range, 1-9 months). The affected segments included T4, 5 in 2 cases, T6, 7 in 5 cases, T7, 8 in 3 cases, T9, 10 in 2 cases, T10, 11 in 4 cases, and T11, 12 in 1 case. The operation time, intraoperative blood loss, and hospitalization time were recorded. Postoperative plain radiography was taken to assess the decompression and internal fixation, and the fusion effect was evaluated by X-ray or CT examination. The erythrocyte sedimentation rate (ESR), C reactive protein (CRP), visual analogue scale (VAS), Oswestry disability index (ODI), and Kyphosis angle were recorded and compared; the nerve function was evaluated by American Spinal Injury Association (ASIA).
ResultsThe mean operation time, intraoperative blood loss, and hospitalization time were 184 minutes (range, 165-220 minutes), 231 mL (range, 150-800 mL), and 18 days (range, 12-26 days) respectively. No complication of hematoma or wound dehiscence was found. All patients were followed up 17.9 months on average (range, 9-22 months). No bone graft failure, internal fixation broken, pleural effusion, cerebrospinal fluid leakage, wound infection, fistula formation, and other complications occurred. Satisfactory intervertebral fusion was obtained in all patients at 3-8 months (mean, 5.3 months) after surgery. The ESR, CRP, VAS score, ODI score, and Kyphosis angle were significantly improved at immediate after operation and last follow-up when compared with preoperative ones (P < 0.05), and the ESR, CRP, VAS score and ODI score at last follow-up were significantly better than those at immediate after operation (P < 0.05). At last follow-up, the nerve function was recovered to ASIA grade E from grade C (1 case) and grade D (6 cases).
ConclusionIntertransverse bone graft is a reliable, safe, and effective way of bone graft applied to the single segmental thoracic spinal tuberculosis.
ObjectiveTo observe the impact of perioperative nursing intervention on pulmonary tuberculosis patients undergoing lung resection.
MethodThirty-six pulmonary tuberculosis patients going to undergo lung resection hospitalized between January and December 2013 were randomly divided into intervention group and control group with 18 in each. Patients in the intervention group received routine perioperative care plus nursing intervention including preoperative, environmental, dieting and pain intervention. Then, complications, hospitalization time and costs, as well as patients' satisfaction with the nursing work were compared between the two groups.
ResultsAfter nursing intervention, complications, hospitalization time, hospital costs of patients in the intervention group were significantly less than the control group (P<0.05), and patients' satisfaction was significantly higher (P<0.05).
ConclusionsPerioperative nursing intervention on lung resection treatment and rehabilitation of patients play an active and effective role, which can reduce complications, shorten hospitalization time, reduce hospital costs and improve patients' satisfaction.
ObjectiveTo investigate the effectiveness of debridement and single-incision vertebral screw-rod fixation combined with pedicle screw-rod fixation and autograft bone fusion in treatment of thoracolumbar tuberculosis. MethodsBetween January 2008 and October 2010, 22 patients with thoracolumbar tuberculosis were treated by debridement and single-incision vertebral screw-rod fixation combined with pedicle screw-rod fixation and autograft bone fusion, and were given anti-tuberculosis therapy after operation. Of 22 patients, 14 were male and 8 were female with an average age of 42 years (range, 18-66 years). The disease duration was 2-16 months (mean, 6 months). Sixteen double-segment lesions included T7, 8 in 3 cases, T8, 9 in 1 case, T9, 10 in 3 cases, T11, 12 in 2 cases, L1, 2 in 4 cases, and L3, 4 in 3 cases; 6 three-segment lesions included T7-9 in 2 cases, T11-L1 in 1 case, and L2-4 in 3 cases. Preoperative visual analogue scale (VAS) score was 7.50 ± 0.63. According to Frankel classification of America Spinal Injury Association (ASIA), 2 cases were rated as grade B, 4 cases as grade C, 9 cases as grade D, and 7 cases as grade E. ResultsTwenty-two patients were followed up 15-36 months (mean, 25.2 months). Wound infection occurred in 1 case and was cured after corresponding treatment; incision healed by first intention in other patients. No loosening or breakage of internal fixator was found; the patients had no deteriorations in spinal cord injury or cerebrospinal fluid leakage. X-ray films and CT showed obvious bone fusion in the intervertebral space. The time of bone fusion was 3-6 months (mean, 5.2 months). The erythrocyte sedimentation rate after operation was significantly lower than that before operation (P lt; 0.05). The VAS scores were significantly improved to 2.90 ± 1.00 at 2 weeks after operation and 2.60 ± 0.81 at last follow-up (P lt; 0.05). At last follow-up, nerve function was significantly improved. According to Frankel classification, 2 cases were rated as grade C, 5 cases as grade D, and 15 cases as grade E. ConclusionSingle-incision vertebral screw-rod fixation combined with pedicle screw-rod fixation for thoracolumbar tuberculosis is a stable and minimally invasive method. However, the long-term effectiveness need further follow-up.
Objective To investigate the clinical and imaging manifestations, laboratory examination, diagnosis, treatment and prognosis of hepatic tuberculosis, and improve the understanding of hepatic tuberculosis. Methods One case of hepatic tuberculosis that treated by author was reported, at the same time, the domestic literatures were retrieved from 2000 to 2015, 158 cases of hepatic tuberculosis were collected, and the clinical manifestations, imaging examination, diagnosis and prognosis of 159 cases were analyzed. Results ①In 159 cases, male patients were in the majority, male and female ratio was about 2:1. Symptom with fever (68.55%), liver discomfort (43.40%), loss of appetite and fatigue (40.88%) were the main performance. ②Results of laboratory examination: erythrocyte sedimentation rate increased (71.76%), abnormal liver function (58.49%), and lower hemoglobin (52.83%). ③The comparation of imaging diagnosis: the positive rates of CT and B-ultrasound were no significant difference (P＞0.05), there existed significantly difference between MRI, B-ultrasound and CT, MRI had a higher positive rate (P＜0.05). ④The preoperative diagnosis rate of hepatic tuberculosis about 13.84%, was low. The misdiagnosis rate was high, during which liver cancer were the most common misdiagnosed. Diagnosis mainly depends on pathological examination. ⑤Medical treatment was the main treatment, and it’s effect was good. Conclusions Hepatic tuberculosis lacked specific clinical manifestations, and the imaging features of various, the diagnostic rate of hepatic tuberculosis was low, and the misdiagnosis rate was high. In order to definite it, histopathological examination is necessary. The first choice of treatment is drug therapy, which is good.
ObjectiveTo overview the systematic reviews on the timing of different surgical interventions for severe multidrug-resistant pulmonary tuberculosis patients.MethodsPubMed, EMbase, The Cochrane Library, CBM, WanFang Data and CNKI databases were searched for systematic reviews about the timing of different surgical interventions for severe multidrug-resistant pulmonary tuberculosis patients from inception to December, 2018. Two reviewers independently screened literature, extracted data, evaluated the reporting and methodological qualities using the PRISMA checklist and the AMSTAR tool. After re-extraction of individual RCT data from included systematic reviews, meta-analysis was performed by Stata10.0 software.ResultsA total of 11 systematic reviews were included. The average methodological quality score was 8.13 in AMSTAR , the reporting quality score was from 19.5 to 25 in PRISMA. Re-performed meta-analysis showed that, the total success rate of operation was 93.3% (95%CI 92.9 to 93.8), the failure rate was 3.7% (95%CI 3.3 to 4.0), the mortality rate was 2.0% (95%CI 1.8 to 2.2), and the loss rate was 1.0% (95%CI 0.8 to 1.2). The cure rates of different surgical methods were all over 80%, among which single lobectomy (98.47%) and compound lobectomy (98.94%) had the higher cure rates than others. For the time of different surgical interventions, cure rate could be improved obviously in patients receiving surgery treatment after 1 months (OR=1.58, 95%CI 1.29 to 1.94, P=0.000 12), 1-8months (OR=1.66, 95%CI 1.30 to 2.12, P=0.000 05) and 9-24 months (OR=1.48, 95%CI 1.15 to 1.90, P=0.002) of anti-tuberculosis therapy compared with 0 month.There were significant differences between two groups.ConclusionCurrent evidence shows that operation is an effective way for severe multidrug-resistant pulmonary tuberculosis. Operative opportunity should be selected after 1-24 months of anti-tuberculosis drug treatment when the operation time depending on whether the tuberculosis has turned negative or not. Operative mode should be decided by the location and the scope of the lesion, which ensures the maximum excision of lesions and retention of lung function.
ObjectiveTo explore the influencing factors of medication compliance in drug-resistant pulmonary tuberculosis patients.MethodsUsing phenomenological research methods, a semi-structured in-depth interview was conducted on 19 inpatients with drug-resistant pulmonary tuberculosis admitted to the Drug-resistant Tuberculosis Department of Changsha Central Hospital between April and August 2019, and the data were coded, analyzed, sorted out, summarized, and extracted.ResultsThe influencing factors of medication compliance in patients with drug-resistant pulmonary tuberculosis could be divided into two categories: promoting factors and hindering factors. The promoting factors included the patient’s own factors (emphasis on medication therapy, desire for medication knowledge, and efforts to solve medication difficulties) and social factors (family support). The hindering factors included the patient’s own factors (lack of knowledge about tuberculosis, and severe negative emotions), drug treatment factors (fear of adverse drug reactions, and complicated medication plans), and social factors (increased financial burden).ConclusionsDrug compliance of patients with drug-resistant pulmonary tuberculosis is affected by patients, family members, medical staff and social environment. Nursing staff should develop personalized drug plan to improve the patients’ drug compliance.
ObjectiveTo investigate the short-term effectiveness of one-stage radical debridement and total hip arthroplasty (THA) in the treatment of active tuberculosis of the hip.
MethodsBetween January 2006 and June 2011,one-stage radical debridement and THA were performed on 12 cases (12 hips) of active tuberculosis of the hip.There were 7 males and 5 females,aged 18-60 years (mean,46.3 years).The disease duration ranged from 6 to 24 months (mean,10.5 months).According to Babhulkar and Pande staging criteria,5 cases were at stage Ⅲ and 7 cases were at stage IV.One case had sinus,and 2 cases had previous pulmonary tuberculosis.Preoperative hip range of motion was (35.83±9.25)°; hip Harris score was 36.83±6.44.Erythrocyte sedimentation rate (ESR) was 45-90 mm/1 h (mean,62.4 mm/1h); C-reactive protein (CRP) was 19-50 mg/L (mean,33.6 mg/L).Perioperatively all the patients accepted the regular anti-tuberculous medication.
ResultsThe results of histopathological examination and PCR detection were positive for tuberculosis bacillus.Postoperatively the incisions healed primarily.All the patients were followed up 25-60 months (mean,40.8 months).The ESR and CRP returned to normal level with no liver injury.Tuberculosis recurrence occurred in 1 patient at 4 months after operation,which was cured after revision.X-ray film showed no prosthesis shift,prosthesis loosening,or sinus tract.At 18-24 months after operation,the bilateral sides had the same bone density,which was similar to that at the final follow-up.Hip range of motion was significantly improved to (107.08±13.56)° (t=14.571,P=0.000).Hip Harris score was significantly increased to 88.00±10.78 (t=16.750,P=0.000).
ConclusionA combination of one-stage radical debridement and THA is a safe method to treat active tuberculosis of the hip,which can relief symptoms and improve hip function,with low recurrence and satisfactory short-term effectiveness.
Objective
To systematically review the safety of rifapentine vs. rifampicin for pulmonary tuberculosis.
Methods
PubMed, EMbase, The Cochrane Library, CBM, VIP, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) of rifapentine vs. rifampicin for pulmonary tuberculosis up to September 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.
Results
A total of 26 RCTs involving 3 624 cases were included. The results of meta-analysis showed that the rifapentine group was superior to the rifampicin group on the incidence of abnormal liver function (RR=0.31, 95%CI 0.32 to 0.47, P<0.000 01), skin rash occurrence rate (RR=0.24, 95%CI 0.16 to 0.37,P<0.000 01), the incidence of leukopenia (RR=0.41, 95%CI 0.31 to 0.54,P<0.000 01), and the incidence of gastrointestinal reaction (RR=0.46, 95%CI 0.37 to 0.57,P<0.000 01) with statistical significance.
Conclusions
Current evidence shows that compared with rifampicin, rifapentine can effectively reduce the adverse reactions of patients. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To study the cl inical effects of modified Galveston technology in the treatment of lumbosacral tuberculosis. Methods From January 2001 to May 2008, 19 patients with lumbosacral tuberculosis were treated, including13 males and 6 females aged 21-58 years old (average 38 years old). The course of disease was 8-22 months. The tuberculosis was at the L4-S1 level in 3 cases, the L5, S1 level in 10 cases, the L5-S2 level in 5 cases, and the S1, 2 level in 1 case. Seven cases were compl icated with neural symptom of the lower l imbs, 3 cases of them were grade C and 4 cases were grade D according to the Frankel scale of nerve function. The preoperative JOA score of lower back pain was 5-22 (average 19). Six cases were compl icated with il iac abscess, 3 cases with psoas abscess, 3 cases with sacroil iac joint tuberculosis, and 2 cases with pulmonary tuberculosis. For 12 patients, the operation of modified Galveston internal fixation via the posterior approach, focus debridement via vertebral canal, and interbody fusion with autogeneous il iac bone fragment grafting was performed; for 7 cases, the operation of modified Galveston internal fixation via the posterior approach, vertebral lamina fusion with autogeneous il iac bone fragment grafting, and anterior focus debridement was performed. Results The incision of 18 cases was healed by first intention, and 1 case had sinus 3 weeks after operation and healed 3 months after operation. Nineteen patients were followed up for 12-82 months (average 21 months). There was no recurrence of the local tuberculosis, and the common toxic symptom of tuberculosis disappeared 6-12 months after operation. All the patients achieved bony fusion 4-6 months postoperatively, and 3 patients with sacroil iac joint tuberculosis achieved sacroil iac joint fusion. For those 7 patients with combinations of the neural symptomof the lower l imbs, the symptoms disappeared and their Frankel scales were improved to grade E. The JOA score of low back pain at the final follow-up was 22-29 (average 26). There was a significant difference between preoperation and postoperation (P lt; 0.05). Conclusion The modified Galveston technology is helpful to reconstruct the stabil ity of lumbosacral vertebrae, improve bony fusion rate, reduce the postoperative in-bed time.
