Analysis on drug resistance characteristics and risk factors for extensively drug resistant tuberculosis patients / 中华疾病控制杂志

@# Objective To analyze the drug resistance profile and risk factors for extensively drug resistant tuberculosis (XDR-TB) patients. Methods XDR-TB cases were identified by sixteen anti-TB drug susceptibility kits among inpatients with a diagnosis of laboratory-confirmed mycobacterium tuberculosis. Single-factor and Logistic analysis were used to analyze the risk factors for drug resistant of the first and second-line anti-TB drugs in XDR-TB patients. Results Resistant rate of rifampin, isoniazid and rifampicin were 100%, Resistant rate of streptomycin, rifampicin and dean, b sulfur isoniazid, levofloxacin and capreomycin were from 90% to 100%, resistant rate of kanamycin and amino salicylic acid were from 70% to 80%, resistant rate of amikacin from 60% to 70%, resistant rate of sulfur isoniazid was from 50% to 60%, resistant rate of ethambutol and moxifloxacin were from 40% to 50%, resistant rate of clarithromycin was from 10% to 20%, resistant rate of clofazimine 5.2%. 92.1% of XDR-TB patients were resistant to more than 10 anti-TB drugs, and the least of the patients were resistant to 6 anti-TB drugs.Logistic regression analysis showed the risk factors for XDR-TB first-and second-line anti-tb drugs included age ［20-40 year (OR=6.318, 95% CI:1.204-33.15, P=0.029;40-60 year (OR=4.772, 95% CI:0.973-23.392, P=0.054); 60 year (OR=41.366, 95% CI:2.909-588.265, P=0.006)］and anti-TB treatment history was retreatment(OR=28.013, 95% CI:3.357-233.766, P=0.002). Conclusions XDR-TB patients have serious drug resistance, but there were some drug treatable drug resistance types, and the risk factors mainly come from age and anti-TB treatment history.

Survival analysis of 198 patients with pancreatic cancer in Hainan, China: A multi-institution prospective study

Objective: To explore the survival status and prognostic factors of patients with pancreatic cancer in Hainan. Methods: Clinical data of patients who were diagnosed as pancreatic cancer and visited the First and Second Affiliated Hospital of Hainan Medical University and Haikou People's Hospital from 2013 to 2017 were collected based on electronic medical records. Basic information was collected by a self-designed questionnaire. Data about admission examinations including blood routine examination, blood biochemistry tests, tumour markers tests, imaging examination and other clinical tests were also collected. The date of follow-up via telephone was 30 June 2018. The survival rate was analyzed by the Kaplan-Meier method and the logrank test. Univariate and multivariate analyses were performed with COX regression model. Results: A total of 198 patients were included in the study. Kaplan-Meier results showed that the overall survival (OS) in 6 months and 1, 2, 3 and 5 years was 47.4%, 26.8%, 16.4%, 13.2%, and 8.7%, respectively. The median OS was 5.8 months. Log-rank test analysis found that there were significant differences in OS among patients with different age, surgery status, distant metastasis or absolute number of neutrophils, percentage of neutrophils, absolute number of lymphocytes, neutrophil-to-lymphocyte ratio (NLR), CA199 and carcino-embryonic antigen (P<0.1). COX multivariate analysis showed that age, surgical presence, presence or absence of distant metastasis and NLR were significantly associated OS (P<0.05). Conclusions: Older age, higher NLR and liver or lung metastasis are independent risk factors, while surgical treatment is an independent protective factor for patients with pancreatic cancer.

Evaluation of Xpert MTB/RIF for the Diagnosis of Extrapulmonary Tuberculosis in China / 生物医学与环境科学（英文）

We evaluate the performance of Xpert MTB/RIF for the diagnosis of extrapulmonary tuberculosis (EPTB) in China. The performance of Xpert was evaluated compared to the composite reference standard (CRS), drug susceptibility testing (DST), and imaging examination. The overall sensitivity and specificity of Xpert were 64.1% (195/304) and 100% (24/24), respectively, using CRS as the gold standard. The sensitivity was significantly higher than that of culture for pus (P<0.05). The proportion of EPTB-positive cases diagnosed by imaging was two times more than that diagnosed using Xpert; however, 6 out of 19 cases may have been overdiagnosed by imaging. Compared to phenotypic DST, the sensitivity and specificity of Xpert were 80% (12/15) and 100% (75/75), respectively. Considering its high sensitivity and specificity, Xpert MTB/RIF may be used as a rapid initial test for EPTB diagnosis, and may also support a quicker decision on the treatment regimen. The combination of imaging and Xpert testing could provide high efficiency and accurate diagnosis of suspected EPTB.

The Epidemiological Characteristics of Beijing Lineage Mycobacterium tuberculosis from a National Referral Center in China / 生物医学与环境科学（英文）

Our study was to investigate the epidemiological characteristics of M.tuberculosis from a national tuberculosis referral center in China. All strains isolated from TB patients, were genotyped by the RD105 deletion, 8 and 51 SNP loci and VNTR. The high differentiation SNPs of modern Beijing strains were analyzed for protein function and structure. 413 M. tuberculosis were included. Of 379 Beijing lineage M. tuberculosis, 'modern' and 'ancient' strains respectively represented 85.5% (324/379) and 14.5% (55/379). Rv2494 (V48A) and Rv0245 (S103F) were confirmed as high differentiation SNPs associated with modern strains. In a word, Modern Beijing lineage M.tuberculosis was dominant and the structural models suggested that modern sub-lineage may more easily survive in 'extreme' host condition.

Origin, phylogeny, and spread of Mycobacterium tuberculosis Beijing lineage in the five provinces of northern China / 中华流行病学杂志

Objective Using methodology of molecular genetics to explore the origin,phylogen,and gene flow of Mycobacterium tuberculosis (MTB) Beijing lineage in the five provinces from northern China,including Heilongjiang,Jilin,Liaoning,Neimenggu and Ningxia.Methods 234 MTB Beijing lineage strains were genotyped by 24 Variable Number Tandem Repeat (VNTR),and the h (the allelic diversity) value of each VNTR locus was calculated.On individual level of phylogeny,it was constructed Neighbor-Joining (N-J) tree and minimum spanning tree (MST).Phylogenetic tree was built at the population level,and the most recent common ancestor (TMRCA)was estimated through Bayesian model.Molecular variance (AMOVA) was used to understand the gene flow among strains discovered from the five provinces.Results Allelic diversities of the 24VNTR loci were low (h:0.000-0.744).234 strains of MTB Beijing lineage were dispersed in individual branch of the N-J tree,with 62.0％ (145) of them grouped to the same "colonial complexes" in MST.At the population level,the evolution relationship of 234 strains appeared the closest to Beijing lineage,which was from MIRU-VNTRplus database,and the bootstrap was 100.The TMRCA was 5308 (95％ CI:4263-6470) years.Differences of pairwise Fst values acquired by AMOVA between Jilin and Heilongjiang,Liaoning,Neimenggu and Ningxia,were not statistically significant (P＞0.05).Conclusion The genetic similarity of Beijing lineage MTB from the five provinces of northern China was high.The phylogeny branches had no characteristic dispersal in each province.It was speculated that these strains showed an evolution from a clone of MTB Beijing lineage (about 5000 years ago).The gene flow was taking place between neighboring zones.

Differences in the population of genetics of Mycobacterium tuberculosis between urban migrants and local residents in Beijing, China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Currently, migration has become one of the risk factors of high burden of tuberculosis in China. This study was to explore the influence of mass migration on the dynamics of Mycobacterium (M.) tuberculosis in Beijing, the capital and an urban area of China.</p><p><b>METHODS</b>Three hundred and thirty-six M. tuberculosis strains from the Changping district, where the problem of urban migrants was more pronounced than in other Beijing regions, were genotyped by Spoligotyping, large sequence polymorphisms (LSPs 105 and 181), and variable number tandem repeat (VNTR) typing. Based on the genotype data, the phylogeny of the isolates was studied.</p><p><b>RESULTS</b>In Changping district, the proportion of Beijing lineage M. tuberculosis isolates amounted to 89.0% (299/336), among which 86.6 % (252) belonged to the modern lineage. The frequency of modern Beijing lineage strains is so high (around 75% (252/336)) that associated risk factors affecting the tuberculosis epidemic cannot be determined. The time to the most recent common ancestor (TMRCA) of the Beijing lineage strains was estimated to be 5073 (95% CI: 4000-6200) years. There was no significant difference in the genetic variation of Beijing isolates from urban migrants and local residents.</p><p><b>CONCLUSIONS</b>The clone of modern Beijing lineage M. tuberculosis, which is dominant in the Beijing area, most likely started to expand with the five thousand-year-old Chinese civilization. In the future, with the urbanization in the whole of China, modern Beijing lineage M. tuberculosis may gain the larger geographical spread.</p>

Relationship between Beijing genotypes of Mycobacterium tuberculosis and drug-resistant phenotypes / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the distribution of the Beijing genotypes of Mycobacterium tuberculosis (M. tuberculosis) and the relationships between Beijing genotype strains and drug-resistant phenotypes in China.</p><p><b>METHODS</b>Clinical isolates were collected during a 9-month research period from April to December in 2008 in six geographic regions of China. One isolate that had been biochemically confirmed to be a member of the M. tuberculosis complex was collected from each patient. The demographic data of the patients (eg. sex, age, and history of tuberculosis) as well as the drug resistance patterns and sources of the clinical isolates were collected. Drug susceptibility testing was performed using proportion method. Beijing genotypes of M. tuberculosis were identified by spacer oligonucleotide typing or insertion of IS6110 in the genomic dnaA-dnaN locus.</p><p><b>RESULTS</b>Among the 410 M. tuberculosis clinical isolates, 67.1% (275/410) isolates were Beijing genotypes of M. tuberculosis. Significantly larger proportions of tuberculosis patients were infected with Beijing genotypes in the northeastern regions of China than that of in the central-western regions (chi2 = 20.50, P = 0.000). No significant associations were found either between Beijing genotype strains and patients' age, sex, or treatment history. Multidrug-resistant isolates and rifampin-resistant isolates were more common among Beijing genotype strains than among non-Beijing strains (P = 0.002, P = 0.005).</p><p><b>CONCLUSIONS</b>About two third of the clinical isolates of M. tuberculosis in China are Beijing genotypes. Beijing genotype strains are not correlated with patients' age, sex, treatment history. People living in the northeastern regions of China are more susceptible to Beijing genotypes than those living in the central-western of China. Beijing genotype strains tend to be rifampin-resistant or multidrug-resistant.</p>

Study of dental caries prevalence in children of Yinchuan in China / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To assess the dental caries prevalence of children in Yinchuan.</p><p><b>METHODS</b>The 3-, 5-, 12-, 15-year-old children were chosed from nursery, primary and middle schools of Yinchuan in 1990, 1996 and 2001. The survey was carried out by five senior dentists from stomatologic hospital of Yinchuan according WHO criteria. DMFT, DMFS and the ratio of tooth filled were counted.</p><p><b>RESULTS</b>From 1990 to 2001, the prevalence of dental caries of 3-, 5-, 12-year-old children was degression (P < 0.01). But the prevalence of dental caries of 15-year-old children had no obvious change. The dental caries of small proportion of children were serious. The ratio of tooth filling was low.</p><p><b>CONCLUSION</b>With the development of oral health education, the prevalence of dental caries of 3-, 5-, 12-year-old children in Yinchuan is descend. But the diagnosis, prevention and treatment should be strengthened, and the ratio of tooth filling should be increased.</p>