Objective To investigate the epidemiology of drug-resistant tuberculosis (TB) in five rural counties of eastern China and analyze the biological,demographic and social risk factors.Methods Subjects of this study were all the diagnosed TB patients registered in the five study sites in Shandong Province,Jiangsu Province and Zhejiang Province during one year of 2008- 2009.Questionnaire interview was conducted in all the subjects to acquire the socio-demographic and clinical information.Sputum samples were collected for culturing and isolating of Mycobacterium tuberculosis (M.TB) strains.All the M.TB isolates were further tested for the susceptibility to first-line drugs including rifampin,isoniazid,ethambutol and strepomycin by proportion method.Mantel-Haenszel chi-square test,Fisher's exact test,ANOVA and nonconditional Logistic regression modeling were applied for data analysis.Results Among the total 380 M.TB isolates,105 were resistant to at least one of the first-line drugs.The total drug resistant TB prevalence was 27.6％.Multidrug-resistant tuberculosis (MDR-TB) was observed in 8.4％ of newly treated TB patients,whereas it was 23.3％in previously treated TB patients.After adjusted by county,gender and age of the subjects,multivariate analysis showed that previous treatment history (OR=3.900,95％CI: 1.737-8.704),tuberculosis cavity (OR - 1.987,95 ％ CI: 1.001 - 3.942) were independent factors influencing the occurrence of MDR-TB.Conclusions The prevalence of drug resistant TB in rural area of eastern China is relatively low compared with the average level in China,while it is still higher than the global average level.The present study highlights that TB patients with previous treatment history,cavitaryTB are correlated with MDR-TB,and elderly patients are at high risk of MDR-TB.

Objective To investigate dynamic change of anterior pituitary hormones (APHs), thyroid func-tion (TF) and genital hormones (GnHs) in patients with traumatic brain injury (TBI) and their clinical signifi-cance. Method APHs, TF and GnH were tested in 93 patients with TBI,who were admitted to Zhejiang Provin-cial People's Hopital from March 2006 to June 2007. Patients with primary injury in the hypothalamic and pituitary regions, as detected by CT and/or MR/examination, as well as those with tumors or immune diseases in the CNS,endocrine or urinogenital systems, were excluded. The clinical data were analyzed according to Glasgow coma scores (GCS), type and degree of injury, and whether there was any secondary cerebral injury. Twenty healthy people acted as controls. The data were analyzed by the Hotelling T2 test and t-tests using SAS 11.5. A P value of less than 0.05 indicated statistical significance. Results The levels of adrenocortieotropic hormone (ACTH),luteinizing hormone (LH) and prolactin (PRL) were markedly higher in all 93 TBI patients than controls, while those of thyroid-stimulating hormone (TSH), thyroid hormone T3,T4 and FT3 were significantly lower in TBI pa-tients in the early stage after injury than in those at follow-up and controls (P<0.05). The ACTH and PRL val-ues reached (33.33±6.86) and (31.74±5.51), respectively, and the LH value was (9.48±1.14) in the secondary cerebral injury group.The TSH value (1.26±0.17) in the brain injury group was significantly lower than those in controls (P<0.05). With the exception of TSH, PRL, testosterone (T) and E2, other APHs were markedly lower in TBI patients at following-up than in controls (P<0.05). The incidence of traumatic hypothala-mus-pituitary insufficiency (THPI) associated with low levels of more than three APHs was 3.2%, while 13.8% of THPI patients showed low levels of at least one APH. The ratio of sick euthyroid syndrome (SETS) was 14.0%. Conclusions A low level of a single APH is the prevalent pattern in THPI patients. Secondary cerebral injury, such as acute high intracranial pressure, brain edema and ischemia after TBI, may be the chief causes of THPI. Early hyperprolactinemia is an important indication for presaging THPI. The dynamic levels of neurcen-docrine hormones can serve as an important index for determining the suitability of TBI patients for treatment with hormone therapy.

Objective To investigate the impact of isoniazid (INH)-resistant Mycobacterium tuberculosis (Mtb) on the prevalence and dissemination of multi-drug resistant tuberculosis (MDR-TB).Methods A total of 251 patients diagnosed with tuberculosis in designated hospitals of Guanyun,Jiangsu and Deqing,Zhejiang from 2010 to 2011 were included in the study.The drug susceptibility tests (DST) were performed on all the Mtb isolates available from the sputum cultures.Mycobacteral interspersed repetitive units-variable number tandem repeats (MIRU-VNTR) was conducted for genotyping for all available Mtb isolates.Chi-square test,Fisher exact test,ANOVA and non-conditional Logistic regression modelling were applied for data analysis.Results Among 251 patients with Mtb isolates and DST results available,72 (28.7％) were resistant to INH,including 13 were INH mono-drug resistant.Of the remaining 59 INH-resistant Mtb,34 (13.5％) were resistant to rifampin TB and 25 were resistant to streptomycin and/or ethambutol.The clustering analysis based on MIRU-VNTR genotyping revealed 29 clustered genotypes (including 105 isolates) and 146 unique genotypes (including 119 isolates).Twentyfive clusters contained drug resistant Mtb and 16 clusters of them comprised by 37 INH-resistant isolates and 20 MDR-TB isolates,which accounted for 51.4％ of the INH-resistant isolates and 58.8％ of the MDR-TB isolates.Single factor analysis showed that sex,age,previous tuberculosis treatment history and sputum smear results were all related to INH-resistant tuberculosis and MDR-TB (all P ＜ 0.05).Multiple factors analysis showed that previous tuberculosis treatment history was risk factor of MDR-TB (OR=8.40,95 ％CI:3.342-21.105),while the risk factors of INH-resistant tuberculosis were previous tuberculosis treatment history (OR=3.52,95％CI:1.570-7.910),pulmonary caviry (OR=2.27,95％CI:1.075-4.799) and sputum smear results (OR=0.50,95％CI:0.275-0.892).Conclusions That INH-resistant strain may evolve to the MDR-TB after recent transmission is a possible trend.Patients with previous treatment history and advanced age are at high risk of INH-resistant tuberculosis and MDR-TB.

Background and purpose:Tamoxifen is the main endocrine therapy of premenopausal breast cancer with positive hormone receptors but numerous patients have developed advanced refractory breast cancer due to drug resistance.Our study investigated the role of combining oophorectomy and exemestane in the treatment of advanced refractory breast cancer.Methods:Oophorectomy was carried out in all patients.Exemestane was administered orally (25 mg/d) one week after the operation.The median time of progression (TTP),the median survival time as well as the survival rate were calculated using the Kaplan-Meier methods.Results:Seventeen patients ranging between the ages of 26 and 44 years (median:36 years) were treated resulting in an overall response rate of 64.70%,TTP was 8 months and the median survival time was 31 months.The survival rates for 1 year,3 years and 5 years were 88.24%,64.71%,29.41%,respectively.No grade Ⅲ and Ⅳ side effects appeared.Conclusion:Oophorectomy when combined with exemestane showed antitumor activity for advanced refractory premenopausal breast cancer through positive hormone receptor and it is also well-tolerated.

Objective To compare the efficacy and adverse effects of erlotinib versus vinorelbine naive patients with advanced non-small cell lung cancer (NSCLC) and epidermal growth factor receptor (EGFR) mutation.Methods Totally 46 elderly patients with histologically confirmed advanced NSCLC and EGFR mutations (exon 19 dclction or L858R point mutation) were enrolled.Patients were randomly divided into two groups:erlotinib group (43 cases,150mg per day until disease progression or unacceptable toxicities) and control group (21 cases,vinorelbine-based chemotherapy,single vinorelbine chemotherapy or vinorelbine-based double chemotherapy).Results Response rates and disease control rates were significantly improved with erlotinib compared with vinorelbine (78.6％ and 88.1％ vs.38.1％ and 61.9％,respectively,P＜ 0.05).There was a significant difference in median progression-free survival (11.6 months vs.5.6 months,P＜0.05),while no statistical difference in median overall survival with erlotinib compared with vinorelbine (19.0months vs.16.5 months,P=0.193).The most frequent adverse effects were grade Ⅰ or Ⅱ and no patients stopped treatment due to adverse effects and no drug-relatcd death.The primary adverse effects were skin rash (71.4％),diarrhea (31.0％)and liver dysfunction (23.8％) in the erlotinib group and neutropenia (66.7％),nausea or vomit (47.6％),anemia (42.9％),platelet decline (33.3％),constipation (33.3％) and peripheral neuritis (23.8％) in the vinorelbine group.Vinorelbine group versus erlotinib group have more 3-4 level adverse reactions (15/21 vs.7/42)(x2=1.69,P=0.193).Conclusions Erlotinib treatment has advances in PFS,ORR and DCR and tolerability compared with vinorelbine-based chemotherapy in elderly patients with advanced NSCLC and EGFR mutation,while overall survival is in no difference.Erlotinib may be a reasonable first-line treatment option for elderly patients with advanced NSCLC and sensitive EGFR mutation.

Background and purpose: It has been proven that gefitinib can be safely and efficiently used to treat advanced non-small cell lung cancer (NSCLC) as a molecule targeted drug. This research was aimed to investigate the efficacy and toxicity of gefitinib as the first-line therapy for advanced NSCLC. Methods: A total of 34 pathologically-confirmed NSCLC patients who were not willing to receive or tolerate traditional cytotoxic drug chemotherapy were enrolled into the study. Gefitinib was orally administered 250 mg daily until disease progression or the occurrence of intolerable toxicity. Results: The objective response rate of gefitinib was 29.4%. The disease control rate was 61.8%. The rate of symptom relief was 47.1%. The median progression-free survival was 3.0 months. The median overall survival was 10.2 months. One-year survival rate was 35.3%. The objective response rate of nun-smoker was higher than smoker (P=0.023). The disease control rate for the patients with rash toxicity after administration of the drug were higher than those without rash (P=0.005). Logistic regression showed that rash was an independent disease control factor (P=0.003). The most common drug-related adverse events were rash and diarrhea. Conclusion: Gefitinib provided another choice to patients who are unwilling or unable to be treated by chemotherapy.

Hamartoma ; complications ; surgery ; Humans ; Hydrocephalus ; etiology ; Hypothalamic Diseases ; complications ; surgery ; Infant ; Male ; Postoperative Complications ; etiology ; Puberty, Precocious ; etiology ; Subdural Effusion ; etiology

Objective To evaluate the diagnostic performances of seven estimation formulas for glomerular filtration rate (GFR) in pre-operative patients with renal cell carcinoma.Methods A total of 386 pre-operative patients with renal cell carcinoma in the first affiliated hospital of Chongqing medical university from January 2012 to October 2014 were selected.All the patients' GFRs were measured by the renal dynamic imagingwith 99mTc-DTPA as reference (rGFR) and the seven GFR estimation equations (eGFR) were compared with the rGFR respectively.Their correlations and consistencies were observed with spearman correlation analysis and Bland and Altman analysis.The diagnostic sensitivity,specificity and likelihood ratios were calculated and the eGFR accuracies were assessed with receiver operator curve (ROC) analysis.Results The correlations between the rGFR and eGFRs were significantly (P＜0.001).In addition,CKD-EPI-Asian Crea and Ruijin formula were more accurate than others in different stages with larger ROC area in diagnosing renal cell carcinoma.Conclusion There were significant correlations between the eGFRs and rGFR,but some deviations existed.CKD-EPI-Asian Crea and Ruijin formula were more suitable for assessment of eGFR of pre-operative patients with renal cell carcinoma.However,both of these equations had a few limitations.

Objective To summarize the clinical experience of T3-4 thoracic sympathectomy in the treatment of primary hyperhidrosis.Methods The clinical data of 80 patients with primary hyperhidrosis who underwent T3-4 thoracic sympathectomy were analyzed retrospectively.Results The operation was successfully performed on all patients.The symptom of palmar hyperhidrosis vanished in all patients,the operative time was (42.5 ± 15.7) min,the length of stay in hospital was (3.9 ± 0.6) d.No death and Horner syndrome occurred.All the patients were followed up for 6-24 months,compensatory hyperhidrosis was found in 26 patients,and no recurrence was found.Conclusion T3-4 thoracic sympathectomy is a safe and effective minimally invasive treatment for primary hyperhidrosis.

Objective:To explore the preventive function for sweating gustatory syndrome and esthetic effect of restoring parotid gland area defect by using platysma flap. Methods: Nine patients who underwent parotidectomy and restored parotid gland area defect with platysma flap were analyzed retrospectively in this study. Observed whether there was an incidence of subjective sweating gustatory syndrome and introcession in the operation region. Results: There was no incidence of subjective sweating gustatory syndrome. Moreover, introcession in the operation region was not obvious. Conclusion: Restoring parotid defects with platysma flap can reduce introcession in the operation region. Application of platysma flap as an interpositional barrier between the skin flap and the parotid bed after parotidectomy can reduce the incidence of sweating gustatory syndrome.