Objective To analyze the drug therapeutic regimen and duration of the chemotherapy in the spinal tuberculosis in order to determine the best therapeutic regimen and duration of the spinal anti-tuberculo-sis. Methods The medication plan and duration of 890 hospitalized patients with spinal tuberculosis in our hospital from January 2001 to December 2008 were retrospectively investigated. We collected the plan of the initial treatment,retreatment,recrudescence and drug resistance. We also studied the individuation therapeutic regimen of the patients with tuberculosis at other parts or complications. On the basis of these data,we analyzed the interferential appearance that the antituberculosis drug acted on different onsets,manifestations and operations. Results In 890 patients of spinal tuberculosis,596 cases ( 67% ) were initial treatment,294 ( 33% ) were retreatment,recur cases were 110 ( 12. 3% ) ,drug resistance cases were 74( 8. 3% ) ,and those compli-cated with tuberculosis in other parts were 273 ( 30. 7% ) . The main chemotherapeutic regimen was the usual tetragenous protocol ( H12 /R12 /E9 /Z5 /S3) . The retreatment cases were given second-line drugs such as levo-floxacin. The drug resistance cases were also given second-line drugs and intravenous infusion. According to the anti-tubercle bacillus spectrum,individuation treatments were adopted,and the plan was changed in time. The medication duration continued for 9-36 months. All the 890 patients were cured. Conclusion For the treatment of spinal tuberculosis,it is significance to make a efficient and standardized anti-tuberculosis chemotherapy.

Objective To investigate the causes and treatment strategies of spinal multidrug-resistance tuberculosis.Methods Data of 16 patients with spinal multidrug-resistance tuberculosis from Jane 2007 to September 2012 were retrospectively analyzed.There were 12 males and 4 females,with an average age of 26.6 years (range,10-49 years).The 16 patients involved 44 vertebrae,with an average of 2.75 vertebrae.The involved segments included:9 thoracic segments,1 thoracic-lumbar segment,2 lumbar segments and 3 lumbar-sacral segments.1 patient involved jumping segments including T8.9,T12L1.Among them,5 suffered from pulmonary tuberculosis,4 tuberculous pleurisy,3 tuberculous empyema,1 tuberculosis of cervical lymph nodes,1 tuberculosis of sternum,1 tuberculosis of chest wall and 1 nephrotic syndrome.We analyzed the reasons of multidrug-resistance.All patients received individualized chemotherapy based on drug sensitivity test.The operation process and time were also collected.The treatment effects were determined by long-term follow-up.Results Among all the 16 patients,6 received 1 operation; 7 received 2 operations; 2 received 3 operations and the last operation was one-stage posterior instrumentation and anterior debridement,bone grafting which conducted in our hospital; 1 received 4 operations and the last of which was excision of sinus in our hospital.All patients were followed up for 10 to 60 months (average,28.4 months).The time of chemotherapy which accorded to the drug sensitivity test was 24 months.2 cases recurred after 22 months and 46 months of the 1st surgery and received operation again.At the last follow-up,all patients were in a stable state of tuberculosis.In 16 patients,2 were initial drug resistance and 14 were acquired drug resistance.The causes of acquired drug resistance were multiple organs tuberculosis caused by failure chemotherapy,times of failed surgeries without adjusted schedules,suspension of the anti-tuberculosis chemotherapy due to serious adverse drug reactions and so on.Conclusion It is very important to carry through the culture of tubercle bacillus and acquire the results of drug sensitive test earlier.The key to prevent and cure multidrug-resistant tuberculosis of spine are formulating individualized anti-tuberculosis chemotherapy program,monitoring closely the adverse drug reactions and selecting the appropriate time for surgery.

Objective To investigate treatment effects of levonorgestrel-releasing intrauterine system (LNG-IUS) for adenomyosis with menorrhea in a prospective study. Methods From December 2006 to December 2014, patients of symptomatic adenomyosis diagnosed by transvaginal ultrasound in outpatient or inpatient clinics of Peking Union Medical College Hospital were given the treatment of LNG-IUS. Before and after placement of LNG-IUS, all the patients′parameters were recorded prospectively, including scores of menstruation blood loss, carrying status of IUS, symptoms and scores of dysmenorrhea, biochemical indicators, physical parameters, menstruation patterns and adverse effects. Changes of pictorial chart scores of menstruation and distribution of anemia during follow-up were analyzed. Results Totally 1 100 women meets inclusion criteria, among which 618 cases (56.18%, 618/1 100) had severe menorrhea, with median follow-up period of 28 months (range 1-60 months), and accumulative carrying rate of 66% at 60 months follow-up. After placement of LNG-IUS, compared with baselines, pictorial chart scores and ratio of menorrhea had decreased significantly (all P<0.01), the scroes of menstruation were 157±34, 94±35, 70±33,67 ± 18, 67 ± 20, 65 ± 19, 66 ± 19, 65 ± 21 at 0, 3, 6, 12, 24, 36, 48 and 60 months respectively. During 24 months after placement of LNG-IUS, pictorial chart scores and distribution of anemia had improved significantly compared with preceding period (all P<0.01). We found no dependent factors predicting improvement of pictorial chart scores of menorrhea, which was neither relevant with simultaneous changes of menstruation patterns nor adverse effects (all P>0.05). Conclusions LNG-IUS is effective for adenomyosis of menorrhea. Improvement of menstruation blood loss is independent on patients characters, menstruation patterns or adverse effects.

Objective To investigate treatment effects of levonorgestrel-releasing intrauterine system (LNG-IUS) for adenomyosis with severe dysmenorrhea in a prospective cohort study. Methods From December 2006 to December 2014, patients of symptomatic adenomyosis diagnosed by transvaginal ultrasound in outpatient or inpatient clinics of Peking Union Medical College Hospital were given the treatment of LNG-IUS. Before and after placement of LNG-IUS, all the patients′parameters were recorded prospectively, including symptoms and scores of dysmenorrhea, menstruation scores, biochemical indicators, physical parameters, carrying status of LNG-IUS, menstruation patterns and adverse effects. Changes of scores and patterns of pain during follow-up were analyzed. Results Totally 1 100 women meets inclusion criteria, among which 640 cases (58.18%, 640/1 100) had severe dysmeorrhea, with median follow-up period of 35 months (range 1-60 months), and accumulative carrying rate of 65% at 60 months follow-up. After placement of LNG-IUS, scores of pain and ratio of severe dysmenorrhea had decreased significantly compared with baselines (all P<0.01), the scroes of visual analog scale (VAS) were 8.1 ± 0.9, 5.5 ± 2.4, 4.6 ± 2.4, 3.3 ± 2.2, 2.2 ± 2.1, 2.2 ± 1.8, 1.4 ± 1.6 and 1.3 ± 1.3 at 0, 3, 6, 12, 24, 36, 48 and 60 months respectively. During 36 months after placement of LNG-IUS, scores of pain had improved significantly compared with preceding period (all P<0.01). We found no universal dependent factors predicting improvement of pain, which was neither relevant with simultaneous changes of menstruation patterns nor adverse effects (all P>0.05). Conclusion LNG-IUS is effective for adenomyosis of severe dysmenorrhea. Improvement of pain is independent on patients characters, menstruation patterns or adverse effects.

Objective To investigate the changes of mestruation patterns and adverse effects during the treatment of levonorgestrel-releasing intrauterine system (LNG-IUS) for symptomatic adenomyosis in a prospective cohort study. Methods From December, 2006 to December, 2014, patients of symptomatic adenomyosis diagnosed by transvaginal ultrasound in Peking Union Medical College Hospital were given LNG-IUS. Before and after placement of IUS, all patients′ parameters were recorded, including carrying status of IUS, symptoms and scores of dysmenorrhea, menstruation scores, biochemical indicators, physical parameters, menstruation patterns and adverse effects. Risk factors for changes of menstruation patterns and adverse effects, and their impact on treatment effects were analyzed. Results Totally 1 100 cases met inclusion criteria, with median age 36 years (range 20-44 years), median follow-up 35 months (range 1-108 months). During follow-up changes of menstruation patterns increased significantly with amenorrhea and shortened-menstruation being the most common manifestations. On 3, 6, 12, 24, 36, 48 and 60 months after the placement of LNG-IUS, 0, 5.8%(43/744), 6.9%(47/682), 10.1%(60/595), 17.3%(87/502), 27.2%(104/383) and 29.6%(82/277) patients achieved amenorrhea respectively (P<0.01). Total and subclassification of adverse effects decreased significantly (P<0.01). Within 12 months and >12 months after placement, abdominal pain and body weight increasing ≥5 kg/year were the most common adverse effects. Changes of menstruation patterns, total and subclassifications of adverse effects were neither dependent on patient parameters, treatment modes and treatment effects, nor could predict future LNG-IUS carrying status (all P>0.05). After taking out of LNG-IUS, most changes of menstruation and adverse effects disappeared. Conclusions During the treatment of LNG-IUS for symptomatic adenomyosis, changes of menstruation patterns increase gradually with amenorrhea and shortened-menstruation being the most common manifestations, while adverse effects decrease significantly. Changes of menstruation patterns or adverse effects neither have any risk factor nor have impact on treatment effects.