Objective To explore the application values of GeneXpert MTB/RIF assay (Xpert assay) for rifampicin resistance and multidrug resistant tuberculosis (MDR-TB).Discordance of Xpert and L-J proportion DST of rifampicin was analyzed.Methods Specimens of 1 300patients from January 2014to June 2016in our hospital were collected for solid culture, Xpert assay and L-J proportion drug susceptibility test (DST).Rifampicin resistance detected by Xpert assay was compared with L-J proportion method as a gold standard.Sequencing of rpoB gene and determination of minimum inhibition concentration were accomplished on the discordant MTB strains between Xpert and L-J proportion DST.Results Compared with the DST, the sensitivity, specificity, positive and negative predictive value of Xpert assay for rifampicin resistance were 99.31％, 97.82％, 92.88％and 99.80％, respectively.Among 1 300culture-positive specimens, mutations were detected from 309specimens by Xpert assay, which included 125initial treatment and 184retreatment patients.Among309specimens with rpoB gene mutations, mutations detected by probes E, D and B were common, and the rates were 65.70％, 14.56％and 10.68％, respectively.Totally 239patients were MDR-TB[77.35％ (239/309) ], of which 94initial treatment patients[75.20％ (94/125) ]and 145retreatment patients[78.80％ (145/184) ]were MDR-TB.Among 22strains which were detected rpoB gene mutations by Xpert, but sensitive by L-J proportion DST, 6strains had no mutation in rpoB gene rifampicin resistance determining region (RRDR);16strains had mutations, which were mainly located in L511Pcodon (8strains) and L533Pcodon (4strains).Among 2strains which had no rpoB gene mutation by Xpert, but were resistant by L-J proportion DST, 1strain had no mutation in rpoB gene RRDR region;1strain had mutation which was located in E546G codon outside RRDR region.Conclusion Xpert assay can be used to rapidly detect rifampicin resistance and to screen MDR-TB.Mutations in codon 511and 533are related to low-level resistance to rifampicin.

With the development of tumor molecular biology and genomics, it has been recognized that there are great heterogeneity in the biological characteristics, molecular typing and reactivity of the same tumor species among different individuals. In order to achieve true tumor individualized and precise therapy, a new concept of human tumor tissue xenograftmodel (patient derived tumor xenograft, PDTX) is proposed. The previous study has revealed that PDTX model can truly reflect the biological characteristics of tumor tissue and drug efficacy. And PDTX model could be used to select individual che-motherapy regime, evaluate drug resistance and explore efficacy and safety of new drug. PDTX model has been used in clinical practice of several type of cancer including lung cancer. In this paper, the current research progress of lung cancer PDTX is reviewed.

Objective To investigate the role of N-acetylcysteine as a protective agent in rifampicin-induced hepatic injury of mice. Methods Thirth-two Kunming mice were randomly divided into four groups(n=8 each).The mice in each group were injected intraperitoneally with 0.9% sodium chloride solution (control), N-acetylcysteine (NAC), combination of rifampicin (R), or NAC and R (NAC+R) once every day.After 14 days, the liver index (LI), alanine aminotransferase (ALT) and aspartate aminotransferase ( AST) activity in serum, and the level of malondialdehyde( MDA) ,superoxide dismutase( SOD) activity in liver tissues were measured respectively.Hepatic tissue morphology was observed under light microscope. Results Macroscopic analysis revealed that rifampicin led to severe liver tissue injury,including a wide range of hepatocellular vascular congestion,fatty change and local necrosis, whereas the administrationof NAC produced a significant reduction of rifampicin-induced hepatotoxicity .LI,ALT and AST activities in R or NAC+R group were significantly elevated as compared with the control group(P<0.01) .LI, activities of ALT and AST in serum,and MDA levels in liver tissues in NAC+R group were significantly lower than those in R group ( P<0.01) ,but the SOD activity in NAC+R group was increased significantly in comparison with R group (P<0.01). Conclusion Rifampicin was able to cause severe hepatic injury.Pre-administration of NAC reduced the side-effect induced by the treatment with the rifampicin.

Objective To Screen the carbapenem-resistant acinetobacter baumannii so as to understand the drug resistance,and to analyze the outer membrane protein expression between the carbapenem-resistant Acinetobacter baumannii and the sensitive strains.Methods The twofold agar dilution method was used to screen the carbapenem-resistant acinetobacter baumannii.PCR technique was used to detect the outer membrane protein-encoding gene carO.SDS-PAGE was used to analyze the expression of outer membrane protein.Results 32 strains were carbapenem-resistant acinetobacter baumannii separated from 1 10 strains,which were 100% sensitive to polymyxin B and were resistant to other drugs with different degrees O.They all carried carO gene.There were different protein bands between the carbapenem-resistant strains and the sensitive strains,in which two protein bands of 50× 10 3 and 22×10 3 were recognized as outer membrane proteins through the analysis of SDS-PAGE.Conclusion Drug resistance of acinetobacter baumannii is serious,and the outer membrane protein expression between the carbapenem-resistant strains and the sensitive strains presents discrepancy.

Ninety six female patients with chronic renal failure were randomly allocated into combination group (n =48) and control group (n =48).In combination group patients received both kidney transplantation and hematopoietic stem cell infusion,in control group patients underwent kidney transplantation only.The results showed that chronic rejection in the combination group was lower than that in the control group [2％(1/48)vs.17％ (8/48),P＜0.05)].The 1-,3-,5-and 10 y-survival rates of kidney in the combination group were 98％ (47/48),94％ (45/48),83％ (34/41) and 9/17,respectively,those in control group were 98％ (47/48),90％ (43/48),76％ (31/41) and 7/17,respectively.Infusion of donor hematopoietic stem cells can augment chimerism in early postoperative period and significantly reduce the rate of graft rejection,which is beneficial for the quality of life of the recipients.

Objective To summarize our experience in the modified total cystectomy and neobladder in patients with invasive bladder cancer.Methods Twenty one male patients with invasive bladder cancer were treated with modified total cystectomy and neobladder.Reconstruction of the lower urinary tract using modifiled ileal neobladder(in 17 patients)and sigmoid neobladder(in 4 patients)were performed.The median age of the patients was 62 years.The patients were followed up for 1-4 years.Clinical outcomes of these patients was evaluated,including the function of the neobladder,urinary function,renal function,serum electrolytes and QOL.Results There was no surgical mortality.The operating time was 3.5-6.5 h(mean,4.5 h).Blood transfusion was required in 4 cases.Fifteen patients(97 ％ had voluntary control of urination at daytime and 6 at night.They were functional to control urination 3-6 months after operation.Hydronephrosis to certain extent occurred in 5 patients,but was recovered after 6-8 months.There were one case of intestinal obstruction and one case of metabolic acidosis.Residual urinary volume was 30 ml in 1 cases and 40 ml in another.Conclusions Modified total cystectomy and neobladder is an ideal technique to treat invasive bladder cancer with good clinical outcomes of tumor control,high life quality,few severe complications and good urination control.

Objective To observe the effects of Roux-en-Y gastrointestinal reconstruction(RYGR) on carbohydrate and lipid metabolism in non-obese patients with type 2 diabetes and gastric carcinoma.Methods Fifty seven gastric cancer cases who underwent radical distal gastrectomy were studied and among them 35 patients had Roux-en-Y gastrointestinal reconstruction (RYGR group) and 22 had Billroth-Ⅰ gastrointestinal reconstruction (B-I GR group).Both groups were subjected to the measuring of preoperative and postoperative third,sixth months values of body mass index (BMI),glycosylated hemoglobin (GHbA1c),fasting glucose (FPG),fasting insulin (Flns) and C-peptide (FC-P),oral glucose tolerance (OGTT) including 2 hour insulin (2hIns) and C-peptide (2hC-P),plasma levels of total cholesterol (TC),triglycerides (TG),high density lipoprutein (HDL-c) and low density lipoprotein (LDL-c).Result There was no significant difference between the two groups in preoperative values (P＞0.05).There was no statistically significant difference in BMI values measured postoperatively (P ＞ 0.05).In RYGR group,preoperative FPG and that of third and sixth month postoperatively was (9.3±0.9) mmol/L vs.(7.2±2.1) mmol/L vs.(7.1±0.8) mmol/L,P=0.000,GHbAlc was (9.2±1.2)% vs.(7.3±1.2)% vs.(7.2±1.1)%,P=0.000,TG was (3.21±0.88) mmol/L vs.(2.12±0.97) mmol/L vs.(2.02±0.09) mmol/L,P =0.000,TC was (6.4±1.9) mmol/L vs.(4.3±1.0) mmol/L vs.(4.1±1.0) mmol/L,P =0.000 and LDL-c was (3.61±1.05) mmol/L vs.(2.77±0.68) mmol/L vs.(2.71±0.18)mmool/L,P=0.000,2 hour glucose after OGTT(2hPG) was (17.6±2.5) mmol/L vs.(12.1±1.9) mmol/L vs.(11.6±2.3) mmol/L,P = 0.000.Levels of FIns was (98±11) pmol/L vs.(120±9)pmol/L vs.(122±8) pmol/L,P =0.000,FC-P was (0.21±0.08) mmol/L vs.(0.30±0.01) mmol/L vs.(0.30±0.01) mmol/L,P=0.000,HDL-c was (1.08±0.10) mmol/L vs.(1.61±0.34) mmol/L vs.(1.62±0.09) mmol/L,P = 0.000,2 h Ins was (410±19) pmol/L vs.(446±19) pmol/L vs.(459±18) pmol/L,P = 0.000 and 2 h C-P was (0.87±0.17) mmol/L vs.(1.22±0.14) mmol/L vs.(1.19±0.15) mmol/L,P =0.000.In B-I GR group,preoperative and third and sixth postoperative month values of GHbA1c were (9.2±1.2)% vs.(8.4±1.6)% vs.(8.3±1.1)%,P =0.046.Conclusion Roux-en-Y gastric bypass can significantly improve the metabolism of carbohydrate and lipid in non-obese patients with type 2 diabetes and gastric carcinoma,and the effects are not related with postoperative weight loss.

BACKGROUND: Odontogenic infection factor has been given much importance in the study of the etiology of secondary trigeminal neuralgia,and the theory of jaw bone cavities is proposed. OBJECTIVE: To study the relationship of the jaw bone cavities and the etiology of trigeminal neuralgia.DESIGN: A self-controlled trial.SETTING: Department of oral and maxillofacial surgery of a university hospital.PARTICIPANTS: The patients with the trigeminal neuralgia were treated in Department of Oral and Maxillofacial Surgery, Affiliated Hospital of the Medical College of Qingdao University from February 1994 to December 2003, from whom 45 were selected for this study, including 15 males and 30 females with altogether 74 jaw bone cavities.METHODS: Curettage of the jaw bone cavities was performed in these cases, and visual analogue scale(VAS) was adopted for evaluation of the postoperative pain.MAIN OUTCOME MEASURES: ① VAS; ② Pathological examination and bacteria culture of the specimens.RESULTS: Pain relief was achieved in 33 cases(73.3% ) after the first surgery and in 10 cases(22.2% ) after a second or third surgery. In 2 cases (4.5%), the pain was alleviated but medication was still needed for pain control. Pathological examinations in most cases identified predominantly in flammatory and granulation tissues.CONCLUSION: Jaw bone cavities may be one of the major etiologic factors of trigeminal neuragia.

Objective To discuss the Clinical character of pulmonary tuberculosis combined malignant lymphoma and its Pathogenesis,and to review the literature.Methods Eighteen cases of pulmonary tuberculosis combined malignant lymphoma from 1996 to 2003 were retrospectively analyzed by its clinical manifestations,X-ray features,diagnosis and treatments.Results 18 cases were all infiltrative pulmonary tuberculosis,13 them were calcification focals,5 were active pulmonary tuberculosis;5 of all were Hodgkin’s lymphomas,13 of all were non-Hodgkin′s lymphomas.16 cases were lymphomas after tuberculosis,2 cases tuberculosis after lymphomas,none were co-existent malignant lymphoma and tuberculosis.Tuberculosis may precede or complicate a lymphomatous process during the development of both diseases,This might is linked to immune deficiency and chronic inflammation;Lymphomas might cause pulmonary tuberculosis,it might cause the immune turbulence of an individual,Pulmonary tuberculosis infection occurring during or after the radiotherapy and chemotherapy of lymphoma.Conclusions It may pulmonary tuberculosis combined malignant lymphoma in the patients in the endemic areas of tuberculosis,Appropriate invasive biopsy procedures are necessary for early diagnosis.

Objective To summarize the diagnostic and therapeutic experiences of 18 patients with chronic expanding intracerebral hematoma.Methods Clinical data of 18 patients with chronic expanding intracerebral hematoma was analyzed retrospectively.Results Most of the lesions were misdiagnosed preoperatively as cerebral neoplasms.Among 18 cases, 15 cases were cured, 2 cases had severe disability, and one case died after operation.Conclusions Chronic expanding intracerebral hematoma must be considered when encapsulated mass lesion is present in the brain. The ultimate diagnosis is confirmed at surgery and by histological analysis.