Objective: To investigate the rifampicin resistance status and its influencing factors among elderly patients with pulmonary tuberculosis in Changzhou City, Jiangsu Province, so as to provide the basis for improving drug-resistant pulmonary tuberculosis prevention and control strategies. Methods: Patients aged over 60 years with pulmonary tuberculosis treated in tuberculosis designated hospital was selected. Demographic information, history of previous disease, history of diagnosis and treatment and drug sensitivity test were collected. Rifampicin resistance among elderly patients with pulmonary tuberculosis and its influencing factors was analyzed. Results: Totally 249 elderly patients with pulmonary tuberculosis were included, with an average of (69.75±4.36) years. There were 147 males and 102 females, with a gender ratio of 1.44∶1. There were 183 treatment-naïve patients (73.49%) and 66 retreated patients (26.51%). Rifampicin resistance was found in 21 cases, with a drug resistance rate of 8.43%. Among them, there were 7 treatment-naïve patients (3.83%), and 14 retreated patients (21.21%). Multivariable logistic regression analysis showed that retreated elderly patients with pulmonary tuberculosis had a higher risk of rifampicin resistance (OR=10.551, 95%CI: 1.344-82.857). Conclusion The rifampicin resistance rate of 249 elderly patients with pulmonary tuberculosis was 8.43% and was associated with the type of treatment.

Objective To evaluate the usefulness of the short-segment nerve conduction studies (SSCSs,inching test) of the peroneal nerve across the fibular head in order to diagnose and localize the site of entrapment of the nerve.Methods Fifty-four patients with suspected peroneal nerve palsy and 30 controls were studied.The symptoms all occurred in unilateral leg,involving 25 left legs and 29 right legs.Both long segment motor nerve conduction studies (LSMCs) and SSCSs were performed in all patients and controls.SSCSs were obtained at 2 cm intervals,starting 6 cm proximal (P6,P4 and P2) and 4 cm distal (D2 and D4) ending to the fibular head prominence (P).Results When nerve conduction of the entire 10 cm segment across the fibular head was tested by the conventional method,only 40 showed reduction in amplitude or slowing of motor conduction velocity or both.However,with SSCSs,54 peroneal nerves were all discovered abnormal.The results of comparison of conventional methods suggested that there were significant differences in conduction velocity between the fibular head-Ankle segment and the knee-fibular head segment in the case group,the latter ((33.63 ± 9.29) m/s) being slower than the former ((47.92 ± 4.04) m/s;t =9.776,P =0.000),while there was no obvious abnormality in the control group.The results of the control group detected by SSCSs showed that there was no significant difference between the left and right sides of the mean amplitude of the stimulation points and the mean time of segmental nerve conduction.Therefore,we set the exception criteria as the segmental nerve conduction time is longer than the corresponding control group (i + 2 s),and the CMAP amplitude of proximal stimulation point decreased by more than 20％ than the adjacent distal segment.In accordance with this standard,we found that the lesions were located in P6 to P4 in 2/54 (3.7％) legs,P4 to P2 in 4/54 (7.4％) legs,P2 to P in 43/54 (79.6％) legs,P to D2 in 12/54 (22.2％) legs,D2 to D4 in 3/54 (5.6％) legs,respectively.Consequently,the P2 to P segment was most vulnerable to damage.Conclusions SSCSs are more sensitive in detecting the entrapment of the peroneal nerve across the fibular head than the LSMCs.SSCSs could precisely localize the entrapment lesions,might be a useful tool especially for the detection of mild entrapment which has normal LSMCs findings of the peroneal nerve across the fibular head.

Academic Health Systemis an effective mode to make a response to the change of medical pattern , and more and more aging population , and continued increasing of health care costs .By introducing the system to the field of general practice , using the systematic theory in three basic functions of high schools , combining medical schools with all levels of health-related institutions , building a systematic and continuity education system in general practice .it can resolve the problems such as lack of motivation , poor cooperation of the administrative department and education department , and lack of teachers and practice bases of general practice .

Guangxi Medical University had taken a lot of measures to construct systematic general medicine education system consisting of medical college education, post graduation education and continuing medical education. These measures included constructing the organization, modifying the personnel training program, training rural-order directional medical students, standardizing resi-dent training, providing on-the-job training and postgraduate degree education for general practitioners.

Objective To explore the effects of accumulated 60CD,γ-ray irradiation on small molecular metabolites in rats urine.Methods Ten healthy male SD rats were irradiated by 60Co γ-rays in 5 days and the accumulated doses were 0,0.2,0.4,0.6,0.8,1.0 Gy,respectively.The metabolites in urine of different groups were measured with 1 H-NMR combined with principal components analysis (PCA) and partial least square discriminate analysis (PLS-DA). Results The metabolites in rat urine were obviously changed after irradiation. Compared with control group,the amount of acetoacetate decreased after irradiation(t =29.7 -30.7,P ＜ 0.05 ),but its relative level was stable when the dose increased ( P ＞ 0.05 ).Meanwhile,the relative level of hippuric acid increased ( t =4.4 - 21.6,P ＜ 0.05 ) especially when the accumulated dose was higher than 1 Gy (t =21.6,P＜0.05). The relative level of proline,taurine and trimethylamine-N-oxide increased after irradiation with the same trend( t =3.5 - 13.4,4.7 - 11.5,2.9- 12.7,P＜0.05). Conclusions The acetoacetate,hippuric acid,proline,taurine,and trimethylamine-N-oxide may be applicable for biomarkers of accumulative irradiation on rat.

ObjectiveTo explore the feasibility,efficacy and cosmetic effect of three-dimensional conformal external beam partial breast irradiation (EB-PBI) after breast-conserving surgery for the selected Chinese early stage breast cancer patients.MethodsFrom June 2003 to December 2010,Forty-four early stage breast cancer patients underwent EB-PBI after breast-conserving surgery.Twenty patients had CT simulation scan in moderate deep inspiration breathing hold,and twenty-four patients in free breathing.EB-PBI was planned and delivered by three-dimensional conformal radiotherapy (3DCRT)with four noncoplanar beams.The prescribed dose was 3.40 Gy per fraction in thirty-nine patients and 3.85 Gy per fraction in five patients,twice per day at an interval of at least six hours,in five consecutive days.Results The number of patients with follow up time of 2,3 and 5 years were 39,31 and 16.Grade 1 acute radiationinduced dermatitis was observed in 17 patients (39％) at three months.Cosmesis was good or excellent in all cases at six months after radiotherapy and in 95％ cases at two years after radiotherapy.The 2-,3-and 5-year local control rates were 100％,99％ and 94％,respectively.The 2-,3-,and 5-year survival rates were all 100％ and no metastases occurred.Conclusions EB-PBI delivered by 3DCRT is feasible for selected Chinese early stage breast cancer patients after breast-conserving surgery.The cosmetic effect,local control rate and long-term survival rate are satisfactory,and acute radiation toxicity is very low.

OBJECTIVETo analyze the prognosis of rectal gastrointestinal stromal tumors (GIST).

METHODSRecords of 40 patients diagnosed as rectal GIST at the Affiliated Chinese Traditional Medical Hospital of Xinjiang Medical University and the People's Hospital of Tianjin City between June 1979 and June 2010 were reviewed. Clinical features, treatment modalities and outcomes were analyzed.

RESULTSThere were 23 males and 17 females with a median age of 54.5 years old (range, 28-81 years old). During the follow-up(median 52.5 months, range 1-300 months), 18 patients developed recurrence including 7 local recurrence, 6 metastasis and 5 local recurrence complicated with metastasis. The overall survival rates at 1, 3 and 5 years were 82.5%, 60.0%, and 42.5% respectively. On univariate analysis, tumor size(P<0.01), Fletcher classification(P<0.01), mitotic index(P<0.01), and post-operative distant metastasis were associated with survival. Multivariate analysis showed that tumor size(P<0.05), mitotic rate (P<0.01), and postoperative distant metastasis(P<0.01) were independent prognostic factors associated with survival.

CONCLUSIONSSurgery is the main treatment for rectal GIST. Tumor size, mitotic rate and metastasis are independent prognostic factors in patients with rectal GIST.

Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Gastrointestinal Stromal Tumors ; surgery ; Humans ; Male ; Middle Aged ; Prognosis ; Rectal Neoplasms ; surgery ; Retrospective Studies

Objective To study effect of bufalin on invasion and metastasis of gastric cancer cells and related mechanism.Methods AGS human gastric cancer cell line was used for in vitro experiments.Cultured cells were treated by negative control group,bufalin group and oxaliplatin group.Cell proliferation was determined by MTT.Invasion and metastasis were observed by Wound-Healing Assay and Transwell Assay.Expression levels of E-cadherin,matrix metalloproteinases (MMP)-2,MMP-9 were detected by Western blotting.Results Bufalin was found to significantly inhibit the proliferation of AGS cells in a dose and time dependent manner.Wound-Healing Assay and Transwell Assay showed that as compared with the blank control group,bufalin inhibited invasion and metastasis of AGS cells (P＜ 0.05),but there was no statistically significant difference between bufalin group and oxaliplatin group (P＞0.05).Western blotting showed the expression of E-cadherin was increased in bufalin group as compared with the blank control group while the expression levels of MMP-9 and MMP-2 were down-regulated (P＜0.05),but there was no statistically significant difference between bufalin group and oxaliplatin group (P＞ 0.05).Conclusion Bufalin has anti-cancer activity on gastric cancer cells,and it has the ability of inhibiting cancer cell invasion and metastasis,and regulating the expression of some related gene.

OBJECTIVETo summarize our experiences in the treatment of type C3 (AO/OTA) distal radius fractures fixed with AO 2.4 mm locking plates combined with percutaneous pinning after manipulative reduction.

METHODSFrom May 2009 to March 2012, 19 patients (2 cases of both sides) with type C3 (AO/OTA) distal radius fractures were treated with volar locking plates combined with percutaneous pinning for distal radius after manipulative reduction. Among the patients, the average age was (45.3 ± 17.4) years old (ranged, 31 to 66 years old). The fracture were complicated with ulnar styloid fracture in 14 wrists and 6 wrists had distal radioulnar joint instability. All the patients had closed fracture and the mean duration was (6.7 ± 3.5) days (4.5 to 9 days). The Henry approach was applied to expose the fracture site. Joint capsule and ligaments were retained for indirect reduction. After indirect reduction, the poking reduction technique was used to correct the residual compression, and congruence of distal ulnar radial joint was verified under fluorscopic guidance. Styloid process was first pinned percutaneously and then AO 2.4 mm volar locking plate was used to support rigid fixation. The fractures complicated with distal radioulnar joint instability and ulnar styloid fracture were treated with forearm plaster support in supination for 6 weeks.

RESULTSNineteen patients (21 wrists) were followed up for an average duration of 10.5 months (ranged, 7 to 17 months). Radiographic bone union of distal radius was achieved in all cases, nonunion of the ulnar styloid occurred in 3 cases, and no distal radioulnar joint instability occurred. Tendon irritation was found in 2 cases and disappeared after the internal fixation was removed. The volar tilt, radial angle, radial length, incongruence of articular surface and distal radioulnar joint were observed at the follow-up. According to Batra and Gupta scoring system, 13 wrists were assessed to have a score of more than 80, 5 wrists 70 to 90, 3 wrists less than 70. Meanwhile, the subjective and objective evaluation was executed,range of motion of wrist, residual deformity and complications were observed. According to Sarmiento's modification of the system of Gartland and Werley, 17 wrists got an excellent result, 3 good and 1 fair.

CONCLUSIONType C3 (AO/OTA) distal radius fractures could be managed with manipulative reduction. Locking plate internal fixation combined with percutaneous pinning can offer enough support for early mobilization and rehabilitation, resulting in a better clinical outcome and satisfactory prognosis.

Adult ; Aged ; Bone Plates ; Fracture Fixation, Internal ; methods ; Humans ; Manipulation, Orthopedic ; methods ; Middle Aged ; Radius Fractures ; complications ; surgery

Adult ; Humans ; Knee Injuries ; surgery ; Male ; Menisci, Tibial ; surgery ; Transplantation, Homologous ; methods