ObjectiveTo investigate the relationship between the mannose-binding lectin 2 (MBL2) codon 52 A/D gene polymorphism and tuberculosis risk by meta-analysis. MethodsThe Embase, PubMed, China National Knowledg Infrastructure, Wanfang databases were searched to identify domestic and foreign case-control studies involving the association between MBL2 codon 52 A/D gene polymorphism and tuberculosis risk from establishment of these database till May 20, 2015. Two reviewers collected data according to the inclusion and exclusion criteria, and extracted data and assessed quality of the literature. Meta analysis was performed by RevMan 5.2 software and Stata 10.0 software. ResultsIn total, 1 282 cases and 1 483 controls from nine case-control studies were included in this meta-analysis. According to the test of heterogeneity, there was statistical heterogeneity among these studies (P < 0.1). Thus, we conducted the analysis by the random effect model on the basis of heterogeneity test. The results indicated that MBL2 codon 52 A/D gene polymorphism might not be associated with risk of tuberculosis [DD+AD versus AA: OR=1.46, 95% CI (0.87, 2.43), P=0.15] in total analysis by random effect model. However, when stratifying separately according to ethnicity, a significant association between MBL2 codon 52 A/D gene polymorphism and tuberculosis risk was found in Asians [OR=1.96, 95% CI (1.27, 3.03), P=0.003 for DD+AD versus AA], but not among Caucasians [OR=1.36, 95% CI (0.52, 3.56), P=0.53 for DD+AD versus AA]. Conclusions The present meta-analysis indicates that the polymorphism of MBL2 codon 52 A/D may be a risk factor for TB in Asians. But the MBL2 codon 52 A/D gene polymorphism may not contribute to the risk of tuberculosis in Caucasians.
ObjectiveTo discuss clinical characteristics and nursing countermeasure of pregnant/delivery women with tuberculosis. MethodsFrom January 2012 to December 2013, 52 cases of pregnant women complicated with tuberculosis were included. We offered specific nursing according to the psychological counseling, reasonable administration, diet nursing, fever and prevention of hospital infection on the base of their clinical features, and then analyzed the effect. ResultsIn 52 patients who had undergone the tuberculosis and obsterrics and gynecology treatment, 4 puerperal patients died of severe pneumonia and multiple organ failure; in 48 gestational patients with tuberculosis, 23 early-middle term patients accept termination of pregnancy, and in 25 middle-late term patients, 3 had full-term natural labor, 4 underwent full-term cesarean section, 5 had premature labor, and 13 continued the pregnacy. Sixteen neonatus (including 4 given at the other hospitals) had normal results of physical examination without any deformity, in whom 5 had low body weight (body weight less than 2500 g), with negative results of tuberculin test and the result of 3-moth follow-up was normal. Three months after the anti-tuberculosis treatment, the lesion was obviously absorbed in 25 patients and in 23 patients within half of a year. No patients had hospital infection. ConclusionNursing care of pregnant patients with tuberculosis should strengthen the guidance on the patients health education, improve their compliance and self-protection knowledge. Also should strengthen the basic level medical personnel training and improve the ability of early diagnosis of tuberculosis and early treatment to reduce maternal mortality.
Diabetes mellitus patients are usually at high risk of developing tuberculosis, the immune dysfunction caused by long-term high blood sugar, which can increase the susceptibility to tuberculosis. Severe tuberculosis could accelerate the course of diabetes mellitus and pose great difficulty to the clinical treatment. Therefore, early detection of potential tuberculosis patients in diabetes mellitus patients through tuberculosis screening and implementation of “three early” treatment can greatly improve the quality life of patients. This review summarizes the feasibility of tuberculosis screening in patients with diabetes mellitus, and to provide reference for the prevention and control of diabetes mellitus combined with tuberculosis.
Objective To investigate the efficacy of freeze-driedcancellous allograft in the treatment of spinal tuberculosis. Methods From January 1999 to August 2004, there were 31 cases of spinal tuberculosis who underwent surgery. The freeze-dried cancellous allograft was used as grafting material in all the cases.The cancellous allograft was packed in a titanium mesh cage or an artificial vertebrae, and then used as a strut graft anteriorly to implant into the bone defect after the redical debridement, and the instrumentation was done. Results Twenty-three cases were followed up 1.5 years to 5 years (3.7 years on average), and bonyfusion was achieved in 21 cases 6 months later. In 2 cases ceasing antituberculous therapy after 2 months of operation, the local recurrence was obvious. The loosened screw was noticed in one of these two cases, who had tuberculosis in lumbar spine. When antituberculous therapy continued, the bony fusion was observed in these two cases 12 months later. No further position change of the instrument wasnoticed in the patient carrying loosened screw, but the kyphosis of the thoracolumbar spine aggravated. Conclusion Freeze-dried cancellous allograft could be usedin the treatment of spinal tuberculosis. To achieve good results of allograft incorporation and remodeling, the rigid instrumentation should be performed, postoperative antituberculous therapy is also important.
Abstract Dual-blade plate is widely used in reconstruction of anterior stability of spine. Two hundred and ninety-eight cases were followed up since 1984. Among them, 181 cases were fractureof thoracolumbar spine; 63 cases were tuberculosis of thoracolumbar spine; 43 cases were tumor of thoracolumbar spine; 5 cases were spondylisthesis of lumbar spine; 2 cases were ankylosing spondylitis accompanied with gibbosity; 2 cases were adolescent vertebral epiphysis; I case was hemivertebra; I case was dysplasia of the first lumbar vertebra acompanied with gibbosity. Most cases were successful following operation, but in some cases, the results were unsuccessful, mainly due to the position of the dualblade plate in the vertebral body was not satisfactory. The mistakes most commonly occurred were one or two blades, or a part of the blade going into the intervertebral space, and less commonly seen was deviation of the dual -blade plate from itscorrect orientation or a little side-bent of the blade. Split of the vertebra and fall off of the dual-blade plate were happened in few cases. The causeswere analyzed and ways of prevention were provided in this article.
ObjectiveTo evaluate the effect of health economics of census versus high-risk population screening for tuberculosis in Mianyan city, in order to provide references for the selection of suitable tuberculosis screening method in western region of China. MethodsWe included active tuberculosis patients by residents health screening of 21 villages and towns in Mianyan city from June 2013 to March 2013. Relevant data was analyzed by referencing the National Assessment of Tuberculosis Control Program in 2001-2010. Results184047 residents were screened by tuberculosis census and 128 active tuberculosis patients were diagnosed while 61045 residents were screened by high-risk population screening and 76 active tuberculosis patients were diagnosed. The cost-utility ratio and benefit-cost ratio of tuberculosis census were 6174.17 and 3.84, respectively. The cost-utility ratio and benefit-cost ratio of high risk population screening were 3106.16 and 7.62, respectively. ConclusionHigh-risk population screening has higher cost-utility ratio and benefit-cost ratio than tuberculosis census with higher missed diagnosis. Benefits and harms of tuberculosis detection rate and cost should be fully balanced before tuberculosis screening method were chosen in western underdeveloped region of China.
ObjectiveTo analyze the status of systematic reviews/meta-analyses on tuberculosis. MethodsThe Web of Science was searched for systematic reviews/meta-analyses on tuberculosis up to February 4th, 2015. According to the inclusion and exclusion criteria, two reviewers screened literature and extracted data. Then SPSS 11.0 software was used to analysis data including publication year, country, institution, journal and citation situation. ResultsA total of 461 systematic reviews/meta-analyses were included. The publication numbers was increasing from 1 in 1997 to 82 in 2014. Among them, China ranked the top country (113 studies), followed by the USA and Canada. The area with the most number of countries where studies were published was Europe, followed by Asia and Africa. In terms of institution, McGill University in Canada ranked the top, followed by University of London in England and Sichuan University in China. As for the number of papers in journals, the International Journal of Tuberculosis and Lung Disease ranked the top, followed by PLOS One and European Respiratory Journal. In the terms of citation, the citation ranged from 0 to 591, and the median citation frequency was 8. ConclusionThe systematic reviews/meta-analyses on tuberculosis is gradually increasing; the developed countries are still important output areas; and China is playing more and more important role in this research field.
The application of precision medicine in the field of tuberculosis is still in its infancy. The precision medicine of tuberculosis cannot be separated from the rapid and accurate diagnosis, the effective anti-tuberculosis drugs, and the comprehensive application of new cutting-edge technologies. In recent years, the precision medicine of tuberculosis has focused on drug-resistant tuberculosis, host-directed therapy and nano-targeted therapy, which has achieved certain results, providing an important mean for the treatment of tuberculosis, especially for the drug-resistant tuberculosis. In the future, the development of new drugs and the application of emerging technologies are the focus of precision medicine of tuberculosis. It is necessary to gradually carry out relevant clinical trial research and objectively evaluate its application value and prospects.
Objective To evaluate the cl inical outcomes of primary anterior focus debridement, bone autograft, and internal fixation via transperitoneal approach in treating tuberculosis of the lumbosacral junction. Methods From February 2002 to April 2007, 16 patients with tuberculosis of the lumbosacral junction underwent anterior radical debridement, autologous il iac bone graft (two pieces of il iac bone, 5 cm × 3 cm in size), and internal fixation via transperitoneal approach, including 4 males and 12 females aged 27-63 years old (average 38 years old). The course of the disease ranged from 6 to 18 months (average 10 months). All patients experienced various degrees of pain in the lumbosacral area and toxic symptoms of thetuberculosis. Nine cases were compl icated with radicular pain in the lower extremities, and 3 cases had saddle area anaesthesia. Two cases were initially diagnosed as lumbar intervertebral disc protrusion and treated accordingly. The segments involved by the tuberculosis were L5-S1 level in all cases. The average erythrocyte sedimentation rate (ESR) was 61 mm/hour. Imaging examination confirmed the diagnosis of spinal tuberculosis. All cases received four antitubercular drugs and nutrition support for nerve before operation. Operation was performed when hepatorenal function was normal, and the toxic symptom of the tuberculosis was under control or ESR was decreased. Results Operation was performed safely in all cases without injuries of abdominal viscera, major blood vessel, cauda equina nerve and ureter. All wounds healed by first intention. No recurrence of tuberculosis and formation of sinuses occurred. All cases were followed up for 12-37 months (average 21 months). No such compl ications as tuberculous peritonitis and intestinal obstruction occurred. No postoperative erectile dysfunction and retrograde ejaculation occurred in the 4 male patients. ESR was recovered to normal 3-6 months after operation, and regular X-ray and CT exams showed no displacement of grafted bone. All patients achieved bony fusion 12 months after operation without the occurrence breakage and loosening of titanium plate and screw. The radical pain in the lower extremities and the saddlearea anaesthesia disappeared. Four patients had pain in the il iac donor site, 2 patients had mild pain in the lumbosacral area, and the pain was el iminated after symptomatic treatment. The therapeutic effect was graded as excellent in 14 cases and good in 2 cases according to the therapeutic effect evaluation criteria of Chen and co-workers. Conclusion The surgical treatment of tuberculosis of the lumbosacral junction with primary anterior focus debridement, bone autograft, and internal fixation via transperitoneal approach can achieve satisfying bony fusion and reconstruct spinal stabil ity.
Objective To assess the quality of diagnostic studies on detecting the tuberculosis antibody to diagnose tuberculosis.Methods CBM (1978 to 2006) and VIP (1994 to 2006) were searched; any author-claimed diagnostic studies which used the dot immunogold filtration assay (DIGFA) to detect the tuberculosis antibody and to diagnose tuberculosis were included. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) was used to assess the quality of included diagnostic studies by two reviewers independently.Results Thirty-eight papers were included and assessed. We found that most of the quality items were not met with QUADAS. Most papers adopted the retrospective diagnostic case-control design. Thirty-one papers did not describe the selection criteria clearly, 18 did not describe whether all the included patients were verified by using a reference standard of diagnosis, 36 did not describe whether the index test results were interpreted without knowledge of the results of the reference standard, 37 did not report the uninterpretable/intermediate test results, and 34 did not report the withdrawals from the study.Conclusion There are few high quality studies on using DIGFA to detect tuberculosis antibody to diagnose tuberculosis.