The curative effect on 124 cases with multi drug resistant pulmonary tuberculosis from January 1996 to June 1999 was reported.All the cases, with an average history of 5.84 years, were recurrent ones. They included 78 cases of infultative pulmonary tuberculosis,46 cases of chronic fibrocavitative pulmonary tuberculosis. Sputum of all the cases was cultured for Mycobacterium hominis tuberculosis with Kuang`s culture medium and drug susceptibility test was done. As a result, the drug resistant rate to 2 drugs, 3 drugs,4 drugs, 5 drugs and more were 20.16%,25.0%,20.9%,33.72% respectively.The authors added 1～2 kinds of anti TB drugs never used before in each case to KOP (Kanamycin, Ofloxacin, Sodium Aminosalicylate),with a mean 3.3 months treating course. The sputum negative conversion rate was 66.9%,foci absorption rate was 72.6%, cavity close up 50.0% . There wasn′t any serious adverse effect encounted. It suggest that KOP synergetic bacteriocidal to Mycobacterium tuberculosis either inside or outside cells, with fewer side effect, is a good regimen for multi drug tuberculosis treatment.

Objective To explore the imaging appearances and the value of multi-slice CT (MSCT)with post-processing tech-niques in diagnosis and treatment of lumbar hernia (LH).Methods The imaging and clinical data of 1 6 patients with LH which were confirmed by surgery were analyzed retrospectively.Results In 1 6 patients,1 7 lesions of LH were revealed by MSCT.There were superior lumbar hernias in 13 (76.5%),inferior lumbar hernias in 3 (1 7.6%)and diffuse lumbar hernia in 1 (5.9%).Hernia ring in diameter ranged from 1.5 to 9.3 cm,and the hernia sac size ranged from 1.8 cm×2.4 cm to 1 1.3 cm× 6.2 cm.MSCT showed oval or flask shaped mass of extraperitioneal fat with or without peritoneum and visceral contents protruded through the de-fecting fascia floor into lumbar triangle.Superior lumbar hernia was bounded by the 12th rib superiorly,the erector spine muscle medially and the internal oblique muscle laterally.Inferior lumbar hernia was bounded by latissimus dorsi muscle medially,the ex-ternal oblique muscle laterally and the iliac crest inferiorly.Hernia contents included colon in 3 patients and small bowel in 2 with in-carcerated hernia with small bowel obstruction in 1,and adipose tissue and mesentery in other 12.All patients received surgery treatment,and the appropriate surgical methods were selected according to the MSCT findings.The surgical findings were consistent with MSCT results.No recurrence was found during follow-up.Conclusion LH has characteristic CT manifestations.MSCT volu-metric scanning with post-processing techniques can clearly display the type of LH,the size of abdominal wall defect,hernia contents and their complications.It is helpful for diagnosis of the LH and differentiation from other diseases,which may provide important information for clinical surgery.

ObjectiveTo evaluate the effect on postoperative urinary and sexual function of radical resection with pelvic autonomic nerve preservation for female rectal cancer patients.MethodsPostoperative sex and urination disorders were compared between groups of pelvic autonomic nerve preservation and conventional procedure in 120 female cases of middle-lower rectal carcinoma undergoing radical resection. ResultsThe venery decline、sexual climax slip、vagina wetness degree slip and the coition pain rate were 12.5%、10.5%、8.33%、4.15% in autonomic nerve preservation group and 54.1%、45.9%、41.7%、37.5% in control group, respectively(all P0.05).ConclusionPelvic autonomic nerve preservation is effective to reduce postoperative sex and urination disorders in female rectal cancer cases undergoing radical resection though it does not seem to benift cases receiving posterior pelvic exenteration.

Objective To investigate the efficacy of tamsulosin sustained release capsules combined with maximal an-drogen blockade in the treatment of advanced prostate cancer concurrent with bladder outlet obstruction. Methods Six-ty-eight patients with advanced prostate cancer concurrent with bladder outlet obstruction were randomly divided into the observation group and the control group. Both groups received maximal androgen blockade treatment, on the basis of which the observation group received oral tamsulosin sustained release capsules 0.2 mg and once a day. The treat-ment course was 4 months for two groups. Results After 4 months of treatment, QOL and Qmax of two groups elevated significantly than before treatment, and IPSS score, RU and TPSA reduced significantly than before treatment(P<0.05 or P<0.01). And the improvement degrees of IPSS, QOL, Qmax and RU of the observation group were significantly better than those of the control group (P<0.05). No obvious drug adverse reactions occurred in the control group and 1 case of mild positional dizziness occurred in the observation group. Conclusion In the treatment of patients with advanced prostate cancer, tamsulosin sustained release capsules combined with maximal androgen blockade can rapidly improve the patients' LUTS symptoms, improve the patients' quality of life, and is safe and economical.

OBJECTIVETo understand the prevalence and spatial distribution of vitamin A deficiency (VAD) in China among children at ages under six years.

METHODSAbout 8,600 children under 6 years of age in 14 cities and 28 counties of 14 provinces were selected with stratified cluster sampling for survey, including interview with questionnaire for their family information and nutritional status. Blood specimens were collected for measuring serum level of VA with fluorescent spectrophotometry in laboratory.

RESULTSTotally, 8,669 children under 6 (2,877 in urban area and 5,792 in rural area) were surveyed in 14 provinces, with 4,629 males and 4,040 females. Eight cases of night blindness and seven cases of xerophthalmia were found among the children at ages of two to five years. Sixty-one mothers of the children in this group were also found suffering from night blindness. All the cases of night blindness and xerophthalmia both in children and mothers were living in rural areas. Based on their serum levels of VA, 11.7% of the all 1 018 children were diagnosed as VAD, with serum VA concentrations below or equal to 0.70 micro mol/L. Prevalence of VAD was 15.0% and 5.8% in rural (23.3% in the poverty-stricken counties) and urban areas, respectively, and 5.8%, 11.5% and 16.8% in the coastal, inland and remote areas, respectively. The average serum level of VA was 1.20 micro mol/L and 0.99 micro mol/L for urban and rural areas, respectively, with a national average of 1.06 micro mol/L. And, babies under six months of age with an average serum levels of VA < or = 0.70 micro mol/L accounted for 33.4%, and those at ages of four to five years with the same level of VA accounted for 8%. There was significant difference in serum levels of VA between ages, but no significant difference between genders.

CONCLUSIONVAD did exist in children of China, especially in the remote and poverty-stricken rural areas and VA supplementation is urgently needed for the children in these regions.

Child ; Child, Preschool ; China ; epidemiology ; Dietary Supplements ; Female ; Health Surveys ; Humans ; Infant ; Male ; Night Blindness ; complications ; Prevalence ; Rural Health ; statistics & numerical data ; Vitamin A ; administration & dosage ; therapeutic use ; Vitamin A Deficiency ; complications ; epidemiology ; prevention & control ; Xerophthalmia ; complications

Objective To explore the changes and clinical significance of joint fluid TNF-α and TNF-β1 levels in patients with knee osteoarthritis (KOA). Methods A total of 90 patients with KOA hospitalized in our hospital were selected. They were assigned to group A with 30 patients at early stage, group B with 30 patients at medium stage,and group C with 30 patients at advanced stage according to the stage of X ray; 30 healthy volunteers were in the con-trol group. Levels of joint fluid TNF-αand TNF-β1 were tested in four groups of patients. Results Levels of joint fluid TNF-β1 at medium and advanced stages of KOA were significantly lower than those in the control group, and the dif-ferences were significant (P<0.01); Levels of joint fluid TNF-α at medium and advanced stages of KOA were signifi-cantly higher than those in the control group, and the differences were significant(P<0.01); the difference of levels of joint fluid TNF-α and TNF-β1 at early stage of KOA was not significant compared with those in the control group(P>0.05);levels of TNF-α/TNF-β1 at early,medium and advanced stage of KOA were significantly higher than those in the control group(P<0.01);TNF-αwas positively correlated with KOA stage(r=0.930,P<0.01);TNF-β1 was nega-tively correlated with KOA stage(r=-0.849,P<0.01);TNF-α/TNF-β1 was positively correlated with KOA stage(r=0.828,P<0.01). Conclusion TNF-α and TNF-β1 are involved in the formation and progression of OA, and levels of joint fluid TNF-α and TNF-β1 are able to reflect the severity of KOA lesions; joint fluid TNF-α/TNF-β1 is able to detect KOA early.

OBJECTIVEThe survey will reveal current status of subclinical vitamin A deficiency (SVAD) and explore its affecting factors in children of China.

METHODSTotally 8 669 children aged under 6 years were randomly selected from 14 provinces for clinical examination, health and dietary questionnaire and serum level of vitamin A measurement with fluorescence method. The cut-off value for SVAD was defined as

RESULTSPrevalence of SVAD was 11.7% and that of suspected SVAD 39.2% in all subjects, which decreased with the increase of gross domestic product, average annual family income, mother's schooling and children's age. Prevalence of SVAD and suspected SVAD higher in rural areas (15.0%) than in urban areas (5.2%), and higher in children with a minority mother (22.6%) than in those with a Han nationality mother (8.7%). Prevalence of SVAD and suspected SVAD was higher in children whose blood samples were collected within one week in-taking vitamin A-rich food (12.6%-22.6%) than those in-taking vitamin A daily (4.1%-10.0%), and higher in children suffering from respiratory infection, fever and diarrhea two weeks before their blood collection (15.2%-20.3%) than in those without those diseases (10.1%-11.1%). Logistic regression analysis showed that poor family economic status, living in rural areas, children with a minority mother, younger age, no-dairy milk products intake, and respiratory infection and fever all were risk factors for SVAD.

CONCLUSIONSMore than half of children under six years old in China (50.9%) had vitamin A nutrition problem. Varied factors played roles to different extent in SVAD in children.

Child ; Child, Preschool ; China ; epidemiology ; Female ; Humans ; Infant ; Male ; Prevalence ; Vitamin A ; blood ; Vitamin A Deficiency ; epidemiology ; etiology

Objective To compare the effect of laparoscopy-assisted gastrectomy (LAG) and open D2 radical gastrectomy (OG) for gastric cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 117 patients who underwent D2 radical gastrectomy at the Guangdong General Hospital from January 2014 to December 2014 were collected.Of 117 patients,60 undergoing LAG and 57 undergoing OG were respectively allocated into the LAG group and OG group.Total gastrectomy,distal subtotal gastrectomy and proximal subtotal gastrectomy were performed according to the location of the tumor.The perigastric lymph nodes dissection was performed according to the Japanese " Gastric cancer treatment protocol" (the 14th edition).Eligible patients received the adjuvant chemotherapy of XELOX regimen according to the Guideline published by National Comprehensive Cancer Network (NCCN).Observation indicators:(1) comparison of intra-and postoperative recovery between groups;(2) stratified analysis of number of lymph node dissected;(3) relationship among surgical method,number of lymph node dissected and postoperative complication;(4) follow-up and survival.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative adjuvant chemotherapy,tumor-free survival and tumor recurrence or metastasis up to December 2016.Measurement data with normal distribution were represented as (x)± s and comparison between groups was analyzed using the independent-sample t test.Count data were analyzed using the chi-square test or Fisher exact probability.The relationship between number of lymph node dissected and postoperative complication was done using the Logistic regression model.Results (1) Comparison of intra-and post-operative recovery between groups:all the patients completed the operation successfully.Volume of intraoperative blood loss,time to postoperative anal exsufflation and duration of postoperative hospital stay were (113±36) mL,(4.3±2.1) days,(9.7±2.9) days in the LAG group and (209 ± 77) mL,(5.3 ± 2.2) days,(11.2 ± 3.9) days in the OG group,respectively,with statistically significant differences between groups (t =6.850,-2.604,-2.405,P＜0.05).Number of lymph node dissected,numbers of patients with overall complication,incisional infection,intestinal obstruction,digestive tract fistula,intra-abdominal bleeding,cardiovascular accident,pulmonary infection,urinary tract infection and death within postoperative 30 days were respectively 31±7,6,1,0,4,0,0,1,0,0 in the LAG group and 34±6,12,0,1,2,2,1,4,1,1 in the OG group,with no statistically significant difference between groups (t=0.177,x2=2.743,0.126,0.563,0.837,P＞0.05).All the patients with complications received symptomatic treatment,1 patient with abdominal bleeding in the OG group died and other patients recovered smoothly.(2) Stratified analysis of number of lymph node dissected:number of lymph node dissected in patients with total gastrectomy,distal subtotal gastrectomy and proximal subtotal gastrectomy were 35±8,29±5,27±4 in the LAG group and 34± 5,34±6,29±6 in the OG group,respectively,with no statistically significant difference between groups (t =0.846,1.052,0.934,P＞0.05).Number of lymph node dissected in patients with stage Ⅰ,Ⅱ and Ⅲ of TNM staging were respectively 31±5,32±9,31±6 in the LAG group and 34±7,32±4,35±6 in the OG group,with no statistically significant difference between groups (t =0.494,1.657,0.136,P＞0.05).(3) Relationship among surgical method,number of lymph node dissected and postoperative complication:surgical method (LAG and OG) and number of lymph node dissected were used as the independent variable and postoperative complication between groups was used as the dependent variable,the Logistic regression model showed that surgical method and number of lymph node dissected were not related factors affecting the postoperative complication (OR =1.062,2.049,95％ confidence interval:0.998-1.140,0.695-6.042,P＞0.05).(4) Follow-up and survival:108 of 117 patients (54 in each group) were followed up for 2-35 months,with a median time of 28 months.During the follow-up,numbers of patients undergoing postoperative adjuvant chemotherapy,with tumor-free survival and with tumor recurrence were 45,43,10 in the LAG group and 42,42,10 in the OG group,respectively,with no statistically significant difference in the tumor-free survival and tumor recurrence between groups (x2 =0.055,0.002,P＞0.05).Conclusion Laparoscopy-assisted D2 radical gastrectomy is safe and feasible,which equivalent to clinical effect of open radical gastrectomy,meanwhile,it also can reduce volume of intraoperative blood loss and duration of postoperative hospital stay,and accelerate recovery of postoperative gastrointestinal function.

Objective: To investigate the value and feasibility of C reactive protein (CRP) in predicting postoperative anastomotic leakage in rectal cancer patients with enhanced recovery after surgery (ERAS) for safer implementation of this ERAS. Methods: A cohort study on serum CRP of 455 rectal cancer patients undergoing laparoscopic radical resection according to the ERAS procedure at Gastrointestinal Unit of General Surgery Department, Guangdong General Hospital from August 2014 to June 2017 was retrospectively carried out. The serum CRP level was measured before operation and at postoperative days 1-7, and the serum CRP level of the groups with and without anastomotic leakage was compared to analyze its prediction for anastomotic leakage. Diagnostic standard of anastomotic leakage was based on the definition of postoperative anastomotic leakage in rectal cancer from International Study Group of Rectal Cancer (ISREC) : (1) Postoperative localized or diffuse peritonitis occurred, or fecal liquid was found from the abdominal drainage tube; (2) When anastomotic leakage was uncertain, peritoneal or pelvic computed tomography scan should be used to confirm. Results: All the 455 patients underwent surgery successfully, and 41 patients (9.0%) had anastomotic leakage postoperatively. Patients with anastomotic leakage were diagnosed (4.0 ± 2.0) days postoperatively, of whom 8 cases (19.5%) were diagnosed more than 5 days postoperatively. Serum CRP levels in patients with anastomotic leakage continued to increase within 1-4 days postoperatively[ (50.04 ± 27.98) mg/L to (122.75 ± 52.98) mg/L]and decreased 5 days postoperatively[ (92.02 ± 58.26) mg/L], both were higher than those of non-anastomotic leakage group, and the difference was statistically significant (all P < 0.05, except postoperative day 2) . The serum CRP level of non-anastomotic leakage group reached the peak on the second postoperative day[ (83.10 ± 37.45) mg/L] and decreased 3 days postoperatively[ (48.01 ± 27.59) mg/L]. The ROC curve was drawn with the anastomotic leakage as the state variable, and the CRP level as the detection variable. The area under the curve (AUC) at postoperative 1, 2, 4, 5, 6 and 7 days was 0.74, 0.58, 0.83, 0.82, 0.65, and 0.70, respectively. The maximum was at postoperative day 3[0.93 (95%CI: 0.86-0.99) ]. The Youden index was 0.72, and the threshold of CRP was 80.09 mg/L, as the cut-off point to predict anastomotic leakage, with sensitivity, specificity, and positive predictive value of 79.3%, 92.3%, and 74.2%, respectively. Conclusions Monitoring the postoperative serum CRP level can help predict the occurrence of anastomotic leakage after laparoscopic surgery for rectal cancer. When the serum CRP level is > 80.09 mg/L on the third postoperative day, the CRP level has the largest value in predicting postoperative anastomotic leakage, and the safety of ERAS has a certain clinical significance as well.

Objective: To investigate the feasibility and safety of the medial approach "four-step method" in the laparoscopic mobilization of splenic flexure. Methods: A retrospective cohort study was performed. Clinical data of 157 colorectal cancer patients undergoing the medial approach "four-step method" in the laparoscopic mobilization of splenic flexure at Gastrointestinal Surgical Department of Guangdong Provincial People′s Hospital from July 2015 to June 2018 were retrospectively analyzed. Of 157 cases, 17 were transverse colon cancer, 94 were descending colon cancer, 25 were sigmoid cancer and 21 were rectal cancer; 89 were male and 68 were female; mean age was (61.8±10.3) years and mean body mass index was (23.2±3.7) kg/m². The medial approach "four-step method" in the laparoscopic mobilization of splenic flexure was performed as follows: (1) The root vessels were treated with the "provocation" technique to expand the Toldt′s gap. This expansion was extended from the lateral side to the peritoneum reflex of left colonic sulcus, from the caudal side to the posterior rectal space, and from the cephalad side to the lower edge of pancreas. (2) The left colonic sulcus was mobilized, converging with the posterior Toldt′s gap. Mobilization was carried out from cephalad side to descending colon flexure, freeing and cutting phrenicocolic ligament and splenocolic ligament, and from caudal side to peritoneal reflex. (3) Gastrocolic ligament was moblized. Whether to enter the great curvature of stomach omentum arch when the gastrocolic ligament was cut, that was, whether to clean the fourth group of lymph nodes, should be according to the tumor site and whether serosal layer was invaded. (4) Transverse mesocolon was moblized and transected at the lower edge of the pancreatic surface, merging with the posterior Toldt′s gap, and from lateral side to lower edge of the pancreatic body, merging with the lateral left paracolonic sulcus. Safety and short-term clinical efficacy of this surgical procedure was summarized. Results: All the patients completed this procedure. During operation, 3 cases were complicated with organ injury, including 1 case of colon injury, 1 case of spleen injury and 1 case of pancreas injury. No operative death and conversion to open surgery was found. The average operation time was (147.5±35.1) minutes, the average intra-operative blood loss was (40.8±32.7) ml and the average number of harvested lymph node was (16.1±5.8), including (4.0±2.3) of positive lymph nodes. The first exhaust time after surgery was (41.3±20.6) hours, the fluid intake time was (1.5±1.3) days, the postoperative hospital stay was (5.2±2.3) days. Eight (5.1%) cases developed postoperative complications, and all were improved and discharged after conservative treatments. According to the TNM classification system, postoperative pathology revealed that 31 patients were stage I, 51 were stage II, 53 were stage III, 22 were stage IV. Conclusion The medial approach "four-step method" is safe and feasible, which can effectively decrease the operation difficulty of the laparoscopic mobilization of the splenic flexure.