Objective To collect and store all interactions relating to medical information between our center and allied specialized hospitals by constructing a database system for thoracic surgery and pulmonary tuberculosis. Methods We collected all related medical records of patients who had been clinically diagnosed with pulmonary tuberculosis and tuberculous empyema using the CouchBase Database, including outpatient and inpatient system of the Department of Thoracic Surgery at the Public Health Clinical Center of Chengdu between January 2017 to June 2023. Then, we integrated all medical records derived from the radiology information system, hospital information system, image archiving and communication systems, and the laboratory information management system. Finally, we used artificial intelligence to generate a database system for the application of thoracic surgery on pulmonary tuberculosis, which stored structured medical data from different hospitals along with data collected from patients via WeChat users. The new database could share medical data between our center and allied hospitals by using a front-end processor. ResultsWe finally included 124 patients with 86 males and 38 females aged 43 (26, 56) years. A structured database for the application of thoracic surgery on patients with pulmonary tuberculosis was successfully constructed. A follow-up list created by the database can help outpatient doctors to complete follow-up tasks on time. All structured data can be downloaded in the form of Microsoft Excel files to meet the needs of different clinical researchers. Conclusion Our new database allows medical data to be structured, stored and shared between our center and allied hospitals. The database represents a powerful platform for interactions relating to regional information concerning pulmonary tuberculosis.
ObjectiveTo understand the drug resistance of Mycobacterium tuberculosis complex in West China Hospital, Sichuan University, analyze its drug resistance characteristics, and provide reference for the monitoring of drug-resistant tuberculosis.MethodsFrom January 2016 to March 2018, Mycobacterium tuberculosis drug susceptibility testing kit was used to detect the drug susceptibility of Mycobacterium tuberculosis culture-positive strains in Department of Laboratory Medicine, West China Hospital, Sichuan University. The tested drugs included four of the first-line anti-tuberculosis drugs: rifampicin, isoniazid, ethambutol, and streptomycin, and ten of the second-line anti-tuberculosis drugs: capreomycin, ofloxacin, ethionamide, p-aminosalicylic acid, levofloxacin, moxifloxacin, rifabutin, amikacin, kanamycin, and chlorine phenazine.ResultsA total of 130 patients (130 strains) were enrolled, including 82 newly diagnosed patients (82 strains) and 48 re-treated patients (42 strains). The drug resistance rate of the 130 patients was 37.69%. The drug resistance rate of the newly diagnosed patients (28.05%) was significantly lower than that of the re-treated patients (54.17%), and there was a statistical difference (χ2=8.794, P=0.003). The multi-drug resistance rate of the newly diagnosed patients (6.10%) was significantly lower than that of the re-treated patients (25.00%), and the difference was statistically significant (χ2=9.517, P=0.002). The resistance rate of isoniazid, rifampicin, and streptomycin in newly diagnosed patients (23.17%, 8.54%, and 7.32%, respectively) were significantly lower than those in the re-treated patients (45.83%, 41.67%, and 29.17%, respectively), and the differences were statistically significant (P<0.05). The resistance rate of ofloxacin, moxifloxacin, rifabutin and ethionamide in the newly diagnosed patients (9.76%, 8.54%, 7.31%, and 4.88%, respectively) were significantly lower than those in the re-treated patients (39.58%, 27.08%, 25.00%, and 22.92%, respectively), and the differences were statistically significant (P<0.05).ConclusionIt is necessary to strengthen the standardized treatment of patients with newly diagnosed tuberculosis, increase the treatment and management of re-treated tuberculosis patients, and prevent the generation and spread of drug-resistant patients, especially multidrug-resistant patients.
ObjectiveTo investigate the effectiveness of debridement and single-incision vertebral screw-rod fixation combined with pedicle screw-rod fixation and autograft bone fusion in treatment of thoracolumbar tuberculosis. MethodsBetween January 2008 and October 2010, 22 patients with thoracolumbar tuberculosis were treated by debridement and single-incision vertebral screw-rod fixation combined with pedicle screw-rod fixation and autograft bone fusion, and were given anti-tuberculosis therapy after operation. Of 22 patients, 14 were male and 8 were female with an average age of 42 years (range, 18-66 years). The disease duration was 2-16 months (mean, 6 months). Sixteen double-segment lesions included T7, 8 in 3 cases, T8, 9 in 1 case, T9, 10 in 3 cases, T11, 12 in 2 cases, L1, 2 in 4 cases, and L3, 4 in 3 cases; 6 three-segment lesions included T7-9 in 2 cases, T11-L1 in 1 case, and L2-4 in 3 cases. Preoperative visual analogue scale (VAS) score was 7.50 ± 0.63. According to Frankel classification of America Spinal Injury Association (ASIA), 2 cases were rated as grade B, 4 cases as grade C, 9 cases as grade D, and 7 cases as grade E. ResultsTwenty-two patients were followed up 15-36 months (mean, 25.2 months). Wound infection occurred in 1 case and was cured after corresponding treatment; incision healed by first intention in other patients. No loosening or breakage of internal fixator was found; the patients had no deteriorations in spinal cord injury or cerebrospinal fluid leakage. X-ray films and CT showed obvious bone fusion in the intervertebral space. The time of bone fusion was 3-6 months (mean, 5.2 months). The erythrocyte sedimentation rate after operation was significantly lower than that before operation (P lt; 0.05). The VAS scores were significantly improved to 2.90 ± 1.00 at 2 weeks after operation and 2.60 ± 0.81 at last follow-up (P lt; 0.05). At last follow-up, nerve function was significantly improved. According to Frankel classification, 2 cases were rated as grade C, 5 cases as grade D, and 15 cases as grade E. ConclusionSingle-incision vertebral screw-rod fixation combined with pedicle screw-rod fixation for thoracolumbar tuberculosis is a stable and minimally invasive method. However, the long-term effectiveness need further follow-up.
ObjectiveTo explore the influencing factors of medication compliance in drug-resistant pulmonary tuberculosis patients.MethodsUsing phenomenological research methods, a semi-structured in-depth interview was conducted on 19 inpatients with drug-resistant pulmonary tuberculosis admitted to the Drug-resistant Tuberculosis Department of Changsha Central Hospital between April and August 2019, and the data were coded, analyzed, sorted out, summarized, and extracted.ResultsThe influencing factors of medication compliance in patients with drug-resistant pulmonary tuberculosis could be divided into two categories: promoting factors and hindering factors. The promoting factors included the patient’s own factors (emphasis on medication therapy, desire for medication knowledge, and efforts to solve medication difficulties) and social factors (family support). The hindering factors included the patient’s own factors (lack of knowledge about tuberculosis, and severe negative emotions), drug treatment factors (fear of adverse drug reactions, and complicated medication plans), and social factors (increased financial burden).ConclusionsDrug compliance of patients with drug-resistant pulmonary tuberculosis is affected by patients, family members, medical staff and social environment. Nursing staff should develop personalized drug plan to improve the patients’ drug compliance.
Objective To assess the value of fluorine-18 fluorodeoxyglucose （18 F-FDG） positron emission tomography （PET） in patients with pulmonary tuberculosis. Methods Fifty-three patients with pulmonary tuberculosis were imaged with 18SF-FDG-PET. 18F-FDG-PET data were analyzed retrospectively with visual method and semiquantitative method. When pulmonary tuberculosis with abnormal 18F-FDG uptake appeared in PET scans confirmed by visual method, their maximum standard uptake value （SUVmax）, mean standard uptake value （SUVmean） and standard uptake value of normal lung （SUVlung） were measured using semiquantitative method. Results Thirty-six pulmonary tuberculous nodules could be detected by 18SF- FDG-PET, and were diagnosed active tuberculosis with visual method. SUVmax（2. 77±1. 20） and SUV mean（2.15±0.86） were higher than SUVlung（0.41± 0.09, Z=-5. 232, P〈0.01 ; Z=- 5. 232, P〈0.01）. Correlations were not found between SUVmax ,SUVmax and nodule size （Dmax, Dmin）, SUVlung, age, blood glucose level in these 36 patients （P〉0.05）. Seventeen fibrosis and calcification cases without caseous necrosis were not found abnormal in 18F-FDG-PET. Conclusion 18F- FDG- PET is useful in diagnosing active tuberculosis , extent of tuberculosis and guiding therapeutic regimen.
Objective To access the effectiveness and safety of levofloxacin in controlling multidrug resistant tuberculosis (MDR-TB). Methods The electronic searches in databases of PubMed, EMbase, The Cochrane Library, CNKI, CBM and VIP, handsearches and other searches were conducted from the date of their establishment to April 2011 for collecting randomized controlled trials (RCTs) on levofloxacin treating MDR-TB. Two researchers independently screened the literature according to the inclusive and exclusive criteria, extracted the data, assessed the quality of the included studies by adopting the Jadad scale, and performed Meta-analysis by using RevMan 5.0 software. Results A total of 31 RCTs involving 2836 cases were included. The results of meta-analysis showed: a) Compared with the placebo group, levofloxacin could increase the sputum negative conversion rate after 3-month taking and at the end of the treatment period; b) Compared with the ofloxacin group, levofloxacin could increase the sputum negative conversion rate after 3 months and at the end of the treatment period; c) levofloxacin replacing either ethambutol or streptomycin could increase the sputum negative conversion rate after 3 months and at the end of the treatment period; d) Compared with the levofloxacin group, gatifloxacin and moxifloxacin could increase the sputum negative conversion rate after 3 months and at the end of the treatment period; e) There was no significant difference in the adverse reaction rate between each of the medication regimens (P=0.19). Conclusion Levofloxacin is more effective for MDR-TB than ofloxacin, ethambutol and streptomycin, but it is inferior to gatifloxacin or moxifloxacin. Its adverse reaction rate is equivalent to other medicines’.
Objective To study the effect of comprehensive nursing on the treatment compliance and depression of patients with pulmonary tuberculosis complicated with depression. Methods Fifty-seven patients with pulmonary tuberculosis complicated with depression treated between May 2012 and June 2014 were randomly divided into study group (n=30) which was given comprehensive nursing, and control group (n=27) which accepted routine nursing. The scores of depression, treatment compliance and clinical treatment outcome were compared between the two groups. Results The scores of Hamilton Depression Scale were respectively 19.18±2.36, 18.65±2.61, 17.43±1.78 and 16.57±2.05 at the time of 3, 4, 5 and 6 months after nursing intervention, while the same scores of the control group were 22.05±3.03, 21.88±2.85, 20.96±2.06 and 20.04±1.39. The sputum negative conversion rates in the study group at those time periods were respectively 66.7%, 76.7%, 80.0% and 86.7%, while the rates in the control group were 37.0%, 44.4%, 51.6% and 63.0%. The CT lung lesions absorption rates in the study group were 43.3%, 56.7%, 63.3% and 76.7%, while the rates in the control group were 18.5%, 25.9%, 35.3% and 40.7%. The above indicators between the two groups were all statistically significant (P<0.05). The compliance of treatment in the study group was 90.0%, which was significantly higher than that in the control group (63.0%) (P<0.05). Conclusion Comprehensive nursing can help to improve negative emotion, enhance treatment compliance and clinical treatment effect, and promote the early recovery of patients with pulmonary tuberculosis combined with depression.
Basing on development of medical model, new national diagnostic standard is interpreted according to three aspects: classification, diagnostic standard, and diagnostic contents. Tracheobronchial tuberculosis and tuberculous pleurisy are added into the classification. The value of molecular and pathological techniques for diagnosis of the pulmonary tuberculosis is emphasized. The status of drug-resistance is included in the diagnostic content. Two opinions are suggested: some practical methods such as diagnostic chemotherapy are indicated in some grassroots areas, while new molecular techniques for detection of DNA/RNA of mycobacteria and resistant mutation are encouraged in some suitable institutions.
Objective To investigate the effectiveness of extreme lateral channel debridement and fusion combined with posterior fixation for lumbar spinal tuberculosis. Methods A retrospective analysis was made on the clinical data of 17 patients with lumbar spinal tuberculosis undergoing extreme lateral channel debridement and fusion combined with posterior fixation between December 2008 and December 2014. There were 10 males and 7 females, aged 20-69 years (mean, 42.6 years). The disease duration was 1-6 months (mean, 3.4 months). The involved segments included L1, 2 in 5 patients, L2, 3 in 6 patients, L3, 4 in 3 patients, and L4, 5 in 3 patients. Based on American Spinal Injury Association (ASIA) classification, there were 2 cases of grade C, 13 cases of grade D, and 2 cases of grade E. The visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, and Barthel index were used to evaluate the effectiveness, and the improvement rate of JOA score and Barthel index was calculated at the same time. Lumbar X-ray film and CT were taken regularly to evaluate lumbar kyphotic Cobb angle correction and bony fusion. Results The operation was successfully performed in 17 patients, and pathological examination showed tuberculosis. All cases were followed up 24-48 months (mean, 35.3 months). Lumbar X-ray film and CT showed that necrotic bone and abscess were cleared completely, and lumbar kyphosis correction was satisfactorily in all cases. Bony fusion was achieved within 6 months, and clinical cure was obtained within 18 months in all cases; no recurrence was found during follow-up period. No loosening or breakage of internal fixation was observed. At last follow-up, ASIA classification was recovered to grade D and grade E from grade C in 2 cases, to grade E from grade D in 11 cases and had no change in 2 cases (grade D). Two cases of ASIA grade E showed no neurological deficit. The VAS score, JOA score, Barthel index, and lumbar kyphotic Cobb angle were significantly improved at 2 weeks after operation and at last follow-up when compared with preoperative ones (P<0.05). At last follow-up, the improvement rate of JOA score was 75.2%±6.2% and the improvement rate of Barthel index was 75.7%±10.8%. Conclusion To use extreme lateral channel debridement and fusion combined with posterior fixation is an effective treatment for lumbar spinal tuberculosis.
ObjectiveTo explore the value of the single-direction lobectomy in the treatment of complicated pulmonary tuberculosis.MethodsA retrospective analysis was performed on 88 patients with complicated pulmonary tuberculosis who received lobectomy in our hospital from 2017 to 2019. There were 64 males and 24 females, with an average age of 21-70 (47.67±13.39) years. According to the surgical procedure, patients who received single-direction lobectomy were divided into a single-direction group (n=32), and those who received traditional lobectomy were divided into a control group (n=56).ResultsThe two groups had no statistical differences in gender, age, primary disease and complications, lesion morphology, clinical symptoms, operative site, interlobitis adhesion or hilar mediastinal lymph node calcification (P>0.05). Operation time [210.0 (180.0, 315.0) min vs. 300.0 (240.0, 320.0) min], intraoperative blood loss [200.0 (100.0, 337.5) mL vs. 325.0 (200.0, 600.0) mL], postoperative lung air leak time [3.0 (2.0, 5.0) d vs. 9.0 (6.8, 12.0) d] and the postoperative hospital stay [11.5 (8.0, 14.8) d vs. 18.0 (14.0, 22.0) d] of the single-direction group were less or shorter than those of the control group (P<0.05). There was no statistical difference between the single-direction group and the control group in the incidence of surgical complications [1 patient (3.12%) vs. 10 patients (17.86%)] or the cure rate [32 patients (100.00%) vs. 54 patients (96.43%)].ConclusionThe single-direction lobectomy can reduce lung injury and bleeding, shorten the duration of operation and accelerate the postoperative recovery in patients with complicated pulmonary tuberculosis, which has certain advantages compared with traditional lobectomy.