Molecular characterization of drug-resistant mycobacterium tuberculosis isolates from Sichuan Province in china.

Tuberculosis is still a severe public health issue in eastern Asia, and Sichuan is the key area for tuberculosis control in China. To determine the phenotypic and mutation patterns of drug resistance in Mycobacterium tuberculosis isolates from Sichuan, the drug susceptibility of 198 clinical isolates was examined. Among these isolates, 76 drug-resistant and 20 susceptible isolates were analyzed for the rpoB, embB, and katG and inhA regulatory regions. These are mutations believed to associate with rifampin (RIF), ethambutol (EMB), and isoniazid (INH) resistance, respectively. Of the 60 RIF-resistant isolates, 54 (90.0%) carried mutations on the amplified fragment of the rpoB gene, and the most common one (64.8%, 35/54) was at codon 531. Two new mutation patterns were recognized: one isolate harbored three mutations at codons 511, 516, and 518, and the other carried the dual mutation GAChACC at codon 516. A total of 30 INH-resistant isolates (60.0%, 30/50) had mutations at codon 315, whereas 4 (8.0%) had mutations at the inhA regulatory region. Among the 46 EMB-resistant isolates, 22 harbored the Met306 mutation. The results showed geographical variation in the mutation types of drug-resistant genes in M. tuberculosis isolates from Sichuan; this finding is valuable for the development of targeted and rapid molecular diagnostic methods suitable for specific regions.

Administrative data for quality improvement.

This article discusses the use of administrative data for quality improvement in perinatal and neonatal medicine. We review the nature of administrative data and focus on hospital discharge abstract data as the primary source of hospital- and community-based assessments. Although discharge abstract data lack the richness of primary data, these data are the most accessible comparative data source for examining all patients admitted to a hospital. When aggregated to the state level as occurs in more than 30 states, hospital discharge data reflects hospital utilization and outcomes for an entire geographic population at the state and community level. This article reviews some of the weaknesses of administrative data and then focuses how these data can be used for hospital- and community-based assessment of perinatal care citing as examples the measures of perinatal process and outcome used by the National Perinatal Information Center in its Quality/Efficiency Reports for member hospitals and a study of perinatal high-risk care in the State of Florida. The use of discharge abstract data for performance measurement at either the hospital or the system level requires a thorough understanding of how to select a patient group, its characteristics, the intervention, and the outcomes relevant to that patient group. In the perinatal arena, the National Perinatal Information Center has selected and presents those measures that rely on data items shown to be the most reliable based on validity studies and clinician opinion, delineation of the intervention, and the measurement of what occurred. As hospitals respond to the recent pressures of the Joint Commission on Accreditation of Healthcare Organizations and other quality assurance entities, the accuracy of the discharge data will improve. With accepted caution, these data sets are invaluable to researchers studying comparative populations over time or across large geographic areas.

[Alteration of plasma amino acid content in primary liver cancer patients].

Twenty-two plasma free amino acid contents from 22 primary liver cancer (PLC) patients were assayed by means of HPLC and compared with those from 16 normal subjects. The results showed that in PLC patients, plasma total amino acid (TAA), branched chain amino acid (BCAA), glycogenic amino acid, glutamine, histidine and arginine were lowered, while plasma aromatic amino acid (AAA) and methionine did not decrease significantly resulting in the BCAA/AAA ratio decline. Comparing 8/22 subclinical and 14/22 clinical liver cancers with healthy controls respectively, it was found that there was a decrease of plasma TAA, glutamine, arginine, histidine, BCAA and BCAA/AAA ratio, and an increase of tyrosine, in subclinical stage of PLC. It suggests that alteration of most amino acids occur in the early stage of PLC and become more obvious in the moderate and late stages. The changes of plasma amino acid contents in PLC were different from those in chronic liver diseases. The alteration of plasma amino acid contents in subclinical stage of PLC suggests that the disturbance of amino acid metabolism be resulted from malignancy. Correction of the amino acid metabolic disturbance in PLC patients may enhance the inhibition of tumor growth and improve the host metabolism and anti-cancer effect.