The diagnostic values of multicolor melting curve analysis on drug resistance to 5 anti-tuberculosis drugs

Objective To explore and analyze the diagnostic value of multicolor melting curve analysis (MMCA) for the resistance of five anti-tuberculosis drugs, so as to clarify the clinical value of MMCA in detecting drug resistance of Mycobacte⁃ rium tuberculosis. Methods From April 2021 to May 2022, 200 patients with positive Mycobacterium tuberculosis admitted to the Fourth People's Hospital of Qinghai Province were selected as research objects, and sputum specimens were taken from the patients. Traditional Mycobacterium tuberculosis drug sensitivity test (modified Löwenstein-Jensen medium method) and MMCA analysis were respectively given to detect the resistance of five anti-tuberculosis drugs, including isoniazid, ethambutol, strepto⁃ mycin, rifampicin and isoniazid, respectively. Those samples with inconsistent results between the two diagnosis methods were subjected to gene sequencing verification, and the diagnosis efficiency of MMCA for the five anti-tuberculosis drugs was com⁃ pared. Results Using Mycobacterium tuberculosis drug sensitivity as the gold standard for drug resistance diagnosis, the sensi⁃ tivity of MMCA for detecting drug resistance of rifampicin, ethambutol, streptomycin, isoniazid and levofloxacin were 95.83% (46/48), 93.75% (15/16), 100.00% (15/15), 100.00% (20/20) and 70.00% (7/10), respectively, with statistical differences be⁃ tween groups (P<0.05). There were no statistically significant differences in the specificity, positive predictive value, negative predictive value and accuracy of MMCA for the five anti-tuberculosis drugs (P>0.05). For the 8 samples with inconsistent re⁃ sults between MMCA and modified Löwenstein-Jensen medium method, gene sequencing was performed and compared with the results of gene sequencing. After comparison with gene sequencing results, it was found that the coincidence rate of MMCA and gene sequencing results was 75.00% (6/8). Conclusions In the detection of drug-resistant mutations in TB patients, multi-color probe fusion curve analysis has high diagnostic efficacy for first-line anti-tuberculosis drugs, but is not sensitive to second-line anti-tuberculosis drug levofloxacin. Therefore, for the detection of first-line anti-tuberculosis drugs, MMCA has a good clinical application prospect. © 2023 China Tropical Medicine. All rights reserved.     

Short-term impact of cognition-motivation-emotional intelligence-resistance skills program on drug use prevention for school students in Wuhan,China

Drug abuse continues to be a serious public health threat worldwide.Most drug abuse prevention research has been conducted with predominantly American or European adolescent populations.Little is known about approaches that work best to prevent the initiation of Chinese adolescent drug use.For targeting risk factors of drug initiation in Chinese adolescents,a school-based health intervention program named "Cognition-Motivation-Emotional IntelligenceResistance Skills" (CMER) was developed to enhance cognition upon drug use,to decrease motivation of drug use and to improve emotional adjusting and drug resistance skills in this study.A total of 798 students from 3 senior high schools in Wuhan,a city in central China,were assigned randomly to intervention and control groups.The intervention group received the CMER program in which knowledge,development of positive attitude and motivation towards drugs and training of peer resistance skills were basic elements.The immediate impact was compared by measuring the above mentioned elements prior to and three-month after the training session.Students from both groups were asked to complete a self-administered questionnaire.The questionnaire included demographic items,self-reported drug use behavior,cognition,attitude,and motivation associated with the initiation of drug use and resistance skills.Three months after the intervention,significant effects were found on "illegal substance use at least once" (P<0.05) between the intervention and control groups.Immediate effects of the intervention were also found on knowledge,motivation and peer resistance skills (P<0.05),but there was no clear evidence for any effects on attitude towards substance use (P>0.05).It was concluded that the CMER program,which significantly increased the knowledge of drugs and peer resistance skills,was effective in the drug abuse prevention in a sample of school students in Wuhan,China.     

The Prevalence of HIV Drug Resistance among Treatment-failure Individuals and Treatment-nave Individuals in China:A Meta-analysis

Objective To understand drug resistance prevalence among treatment-failure and treatment-nave HIV-positive individuals in China.Methods We searched five electronic databases(Wanfang,CNKI,CQVIP,SinoMed,and Pubmed) for studies of HIV drug resistance.Random-effects models were carried out to estimate the prevalence of drug resistance among treatment-failure and treatment-nave individuals,respectively.Results The estimated nationwide rates of HIV drug resistance to any-class drugs among treatment-failure and treatment-nave individuals were 57%(95% CI:49%-65%) and 3.23%(95% CI:2.47%-4.07%),respectively.Among the drug classes,the prevalence of resistance to PIs was low(1.45%;95% CI:0.73%-2.33%) in treatment-failure individuals,although high rates of resistance to NNRTIs(54%;95% CI:45%-63%) and NRTIs(40%;95% CI:32%-49%) were found.Resistance to any-class drugs,NNRTIs and NRTIs manifested regional differences,but resistance to PIs did not.Positive correlations were observed between resistance to NNRTIs and NRTIs among treatment-failure and treatment-nave individuals,respectively.Conclusion The prevalence of HIV drug resistance to NNRTIs and NRTIs among treatment-failure individuals was high.In contrast,the prevalence of drug resistance among treatment-nave individuals was low.The epidemics of drug resistance matched current treatment strategies and interventions in China.Surveillance for HIV drug resistance is necessary to assess the sustainability and durability of current treatment regimens.     

Treatment of platinum-resistant recurrent ovarian cancer using a ＂predictive molecule targeted routine chemotherapy＂ system

Background Correct drug selection, the key to successful chemotherapy, is one of the most difficult clinical decisions for the treatment of platinum-resistant recurrent ovarian cancer worldwide. The exact procedures for choosing drugs are undefined, currently relying on clinical trials and personal experience, which often results in disappointing outcomes. Here, we propose a new drug selection method, the ＂predictive molecule targeted routine chemotherapy＂, to choose relatively sensitive routine drugs and avoid relatively resistant routine drugs based on the specific predictive molecule expression of the individual tumor tissue. Methods From January 2004 to June 2008, 26 cases of platinum-resistant recurrent ovarian cancer were prospectively recruited. Their routine chemotherapy drug choice was based on the expression of 6 predictive molecules （including p53） as determined by immunohistochemistry （the predictive molecule targeted routine chemotherapy group）. A further 18 cases of platinum-resistant recurrent ovarian cancer were treated by experience and formed the control group. The response rate and the overall survival were compared between the two groups. Results The response rate to second-line chemotherapy was 28% in the control group and 77% in the predictive molecule targeted routine chemotherapy group （P=-0.002）. The response rate to third-line chemotherapy was 14% in the control group and 33% in the predictive molecule targeted routine chemotherapy group （P=0.268）. The median overall survival of the predictive molecule targeted routine chemotherapy group （88 weeks） was significantly longer than the median overall survival of the control group （56 weeks） （P=-0.0315）. Conclusion The predictive molecule targeted routine chemotherapy is a new effective protocol for choosing drugs when treating platinum-resistant recurrent ovarian cancer.     

TCM Treatment for 63 Cases of Senile Dyssomnia

In order to study the therapeutic effects of the TCM drugs on senile dyssomnia, 121 such patients were randomly divided into a treatment group of 63 cases (given the TCM drugs) and a control group of 58 cases (given estazolam). The changes shown in the SDRS and HAMA scores and the other indexes were observed in both of the two groups to evaluate the therapeutic effects. The results showed that the effective rate was 76.3% in the treatment group, and it was 69.1% in the control group; and that the TCM drugs had better effects in improving such symptoms as lethargy, dry mouth, and rebound of insomnia. Therefore, it can be concluded that the effect of the TCM drugs is better for senile dyssomnia than that of the Western drug estazolam.     

Dan Zhi Xiao Yao Yin Combined With Auricular-Point-Pressing for Treatment of Optic Atrophy-A Clinical Observation of 51 Cases

To evaluate the therapeutic effect of Dan Zhi Xiao Yao Yin (丹栀消遥饮 Decoction of Moutan Bark and Capejasmine) combined with auricular-point- pressing therapy for treatment of optic atrophy. The visual acuity and visual field was observed in the 51 cases (58 eyes) from the treatment group that were treated with Dan Zhi Xiao Yao Yin combined with auricular-point-pressing therapy and the 43 cases (49 eyes)from the control group that were treated with routine western drugs at the end of the trial (60 days). The effective rates of increase in visual acuity obtained in the treatment and the control groups were 79.3% and 44.89% respectively and enlargement in visual field were 61.9% and 22.6% respectively. Statistical analysis showed that there were significant differences between two groups (P＜0.05). The therapeutic effect of Dan Zhi Xiao Yao Yin combined with auricular-point -pressing therapy in increasing the visual acuity and enlarging the visual field was superior to that of the routine western drugs.     

Treatment of inflammatory bowel disease with Chinese drugs administered by both oral intake and retention enema

Objective：To study the clinical effect of Chinese drugs administered by both oral intake and retention enema on inflammatory bowel diseases（IBD）.Methods：Adopting a randomized controlled design,78 patients were assigned to three groups：26 patients in group A treated with Chinese drugs given by both oral intake and retention enema,27 in group B with Chinese drugs given by retention enema only,and 25 in group C with given Western medicine.The changes before and after a 30-day treatment of the patients＇ symptoms （including diarrhea,abdominal pain,mucous or pus-bloody stool）,colonoscopic examination scores and histopathology of the colonic membrane were observed.Results：Group A showed the best outcomes in all the aspects of clinical comprehensive effectiveness.Improvements in the main symptoms,colonoscopic scores and histopathology of the colonic membrane were significantly different from those in groups B and C,respectively （P〈0.05）.Meanwhile comparisons between groups B and C showed insignificant differences（P〉0.05）; group B was better in ameliorating tenesmus（P〈0.05）.Conclusion：Through the use of Chinese drugs administered by both oral intake and retention enema to treat IBD,which combined external-internal therapies for both overall regulation and local managment,it was confirmed that the Chinese medicine could embody the therapeutic principle of attending to both disease-diagnosis and syndrome-differentiation.     

Observation on Treatment of Dizziness Mainly by Acupuncture

Objective: To observe the therapeutic effects of acupuncture on dizziness. Methods: 65 cases were randomly divided into a treatment group of 36 cases, and a control group of 29 cases. In the treatment group, a comprehensive treatment with both drugs and acupuncture was given, with the points Jiaji from C1- C4, Taiyang (EX-HN5) and Touwei (ST 8) mainly selected in the acupuncture treatment; while the control group was treated only with drugs. Results: The treatment group and the control group showed a total effective rate of 91.7% and 79.3% respectively, and a curative rate of 58.3% and 44.8% respectively, with significant differences.     

重庆市复治涂阳肺结核患者耐药分析

目的 通过了解重庆市复治涂阳肺结核患者对抗结核药物的耐药情况,为改进重庆市肺结核病的防治措施提供参考和建议。方法 收集重庆市39个区县2016年5月至2017年10月期间复治涂阳患者培养阳性的菌株,并采用对硝基苯甲酸培养法鉴定结核分枝杆菌复合群。共收集428例复治涂阳肺结核患者菌株,采用传统的比例法进行8种抗结核药物的药敏试验,并对复治涂阳肺结核患者菌株耐（多）药情况进行分析。8种抗结核药物包括：异烟肼（INH）、利福平（RFP）、链霉素（Sm）、乙胺丁醇（EMB）、氧氟沙星（Ofx）、卡那霉素（Km）,阿米卡星（Am）和卷曲霉素（Cm）。结果 纳入的428例复治肺结核患者总耐药率为45.09%,以青年组耐药率最高,达57.14%,显著高于老年组（36.59%,P=0.002<0.017),但与中年组比较差异无统计学意义（43.52% P=0.022(>)0.017）;复治肺结核患者耐多药率为27.10%,其中青年组耐多药率（41.96%）显著高于中年组（24.35%）和老年组（17.89%, P<0.05);复治肺结核患者广泛耐药率达3.74%,耐Ofx及耐任一种二线注射类抗结核药物（包括Km、Am和Cm）的比例分别为16.12%和6.31%;复治肺结核患者对4种一线抗结核药物的耐药率顺位为：利福平（33.18%）、异烟肼（32.94%）、链霉素（28.74%）、乙胺丁醇（9.11%）。复治涂阳肺结核患者耐一种抗结核药物的耐药率为10.28%,对8种抗结核药物全部耐药的比例为1.17%。复治涂阳肺结核患者耐药状况不同性别之间差异无统计学意义。结论 重庆市复治涂阳肺结核患者的耐药形势严峻,其中青年是耐多药结核病发生的危险人群,应根据本市情况制定科学合理的结核病防治方案,减少耐药结核病的产生和传播。     

新型冠状病毒肺炎疫情防控措施对重庆市流行性感冒传播和流行的影响

目的 分析新冠肺炎疫情的防控措施对重庆市流感传播和流行的影响,为制定有针对性的流感防控措施提供重要参考。方法 通过国家流感哨点监测系统收集重庆市2018—2020年流感监测资料,分析流感流行的季节性特征,比较2020年与2018—2019年各年同期流感样病例百分比（ILI%）和流感病毒核酸阳性率,评价新冠肺炎疫情防控对流感流行特征的影响。结果 流感监测资料和实验室检测结果显示,2018—2020年度重庆市报告ILI%依次为3.53%、2.23%和1.20%;流感病毒核酸阳性检出率分别为13.97%、23.81%和2.65%。2018—2019年ILI%分布相似,2020年2月开始,ILI%骤降并维持在较低水平。流感病毒核酸阳性率在2018—2019年每年12月至次年3月达到高峰,2020年2月后迅速下降,3月降为0。ILI%与流感病毒核酸阳性率呈正相关（r=0.404 8,P<0.05）。2020年与2018—2019年各年同期相比,ILI%增长率分别为-66.09%和-46.32%,流感病毒核酸阳性率分别下降81.03%和88.87%,其中1月降幅较小,下降率为39.87%;2...     

昌江县地中海贫血的基因型分析

目的 了解昌江县地中海贫血的基因型及分布特点.方法 收集2015年2月至2017年4月在昌江县人民医院进行地中海贫血基因检测的1328人,采用Gap-PCR法检测3种常见的缺失型α地中海贫血基因和PCR反向点杂交(PCR-RDB)法检测17个常见突变位点的β地中海贫血基因,数据采用SPSS17.0统计软件进行分析.结果 昌江县地中海贫血检出率为33.43%,其中α地中海贫血占总地中海贫血的84.01%,前四位α地中海贫血的基因型及构成比分别是-α4.2/αα(36.46%)、-α3.7/αα(36.19%)、--SEA/αα(11.8%),-α3.7/-α4.2(7.77%);β地中海贫血占总地中海贫血的9.91%,检出四种突变类型,其基因型及构成比分别是CD41-42(63.64%)、IVSⅡ-654(15.91%)、-28(11.36%)、CD17(9.09%);αβ复合型地中海贫血27例,占总地中海贫血的6.08%,主要以CD41-42合并α4.2/αα和-α3.7/αα为主.结论 昌江县地中海贫血基因的检出率较高,以α地中海贫血居多,分布具有区域性的特点.     

应用噬菌体生物扩增法对HIV/TB双重感染患者抗结核药耐药性分析研究

目的 利用噬菌体生物扩增法(PhaB)分析人类免疫缺陷病毒(HIV)合并结核病(TB)双重感染患者的结核分枝杆菌的耐药状况,优化防治对策.方法 运用PhaB法对重庆市第九人民医院收治的112例HIV/TB双重感染患者(HIV/TB组)做TB菌的药敏检测,并与208例单纯肺结核患者(单纯TB组)的药敏检测做对比分析.结果 HIV/TB组的抗TB药耐药率要比单纯TB组低,HIV/TB双重感染患者5种常见抗TB药物的耐药率分别为异烟肼(INH) 7.14％、吡嗪酰胺(PZA) 7.14％、利福平(RFP) 5.36％、链霉素(SM) 5.36％、乙胺丁醇(EMB)4.46％,与单纯TB组患者比较(RFP 17.31％、INH 13.46％、PZA11.54％、EMB 10.58％、SM 9.62％),HIV/TB组RFP的耐药率低于单纯TB组,差异有统计学意义(P＜0.05),其他4种抗TB药耐药率与单纯TB组比较差异无统计学意义(P＞0.05),与绝对浓度法结果符合率分别为INH 96.4％、RFP 98.2％、PZA 96.4％、EMB 93.8％和SM 96.4％.结论 本地区HIV/TB双重感染患者结核分枝杆菌对RFP耐药率较普通肺结核患者低,与该类患者良好的服药依从性相关.PhaB测定所需时间短,操作简便,不需特殊仪器设备,可作为结核分枝杆菌耐药性的快速筛选方法.     

抗结核药物不良反应 376例分析

  目的   探讨结核患者经抗痨治疗后出现药物不良反应（adverse reaction，ADR）的具体类型、出现时间、年龄构成，为临床合理、安全、有效用药提供一定的参考。   方法   收集昆明市第三人民医院于2015年1月至2019年12月收治的376例因服用抗结核药物而出现不良反应的患者的病历资料，并采用SPSS软件进行数据分析。   结果   患者经抗痨治疗后出现ADR的时间多集中在前10 d，且男性出现ADR的几率高于女性，但差异无统计学意义（P > 0.05）。结核患者在服用利福平（rifampicin，RFP）与异烟肼（isoniazid，INH）后出现肝毒性的几率较高（P < 0.05），结核患者服用吡嗪酰胺（pyrazinamide，PZA）后出现高尿酸血症的几率较高（P < 0.05）。患者服用乙胺丁醇（ethambutol，EMB）后出现皮肤瘙痒的发生率较高（P < 0.05）。   结论   抗结核药物可能导致的ADR多为高尿酸血症、瘙痒、皮疹、肝损伤等。患者初次用药后10d内可能因药物的刺激产生相应的ADR。因此，临床医生在其工作中需重点关注高风险人群以降低患者用药后出现ADR的风险。     

超声射频信号血管内中膜分析和高分辨率超声评价儿童颈动脉内中膜厚度的比较研究

目的比较高分辨率超声和超声射频信号血管内中膜分析(QIMT)技术测量儿童颈动脉内中膜厚度(IMT)的可靠性。方法两名超声科医师分别应用操作者徒手测量法和QIMT技术测量32名儿童的双侧颈动脉IMT。结果 QIMT技术和操作者徒手测量法测量颈动脉IMT的均差(MD),在检查者间比较,左侧为-0.00和-0.09 mm,右侧为-0.01和-0.11 mm;组内相关系数(ICC)在检查者间比较,分别为左侧0.808和0.335;右侧0.875和0.415。Bland-Altman分析显示,QIMT技术有较好的一致性,优于操作者徒手测量法。结论在规范的测量条件下,QIMT技术的检查结果具有较好的一致性,可准确测量颈动脉IMT。     

2006年重庆市残疾人抽样调查流行病学特征及康复需求分析

目的调查重庆市残疾人的流行病学特征及康复需求情况。方法以2006年全国第2次残疾人抽样调查重庆市的数据库资料为依据,调查残疾人流行病学特征及康复需求现状。结果残疾人共4990人,现患率为6.05%。其中男性2689人,现患率为6.43%;女性2301人,现患率为5.66%,男性的现患率与女性比较差异有统计学意义(P<0.01)。城镇1262人,现患率为5.27%;农村3728人,现患率为6.37%,农村的现患率与城镇比较差异有统计学意义(P<0.01)。肢体残疾现患率最高(33.99%),言语残疾现患率最低(1.96%)。60岁以上老年人所占比例最大(47.13%)。残疾人的主要康复需求为贫困残疾人救助与扶持、医疗服务与救助、康复训练与服务、辅助器具;城镇的首位康复需求是医疗服务与救助,农村的首位康复需求是贫困残疾人救助与扶持;曾接受最多的康复服务均为医疗服务与救助。康复形式的主要需要是机构康复及社区和家庭服务,康复内容主要为医疗服务和康复训练与服务。结论重庆市残疾人人数较多,其中肢体残疾现患率最高,言语残疾现患率最低;男性的残疾现患率高于女性,农村的残疾现患率高于城镇;目前提供的康复服务不能满足残疾人的康复...     

2327株结核分支杆菌耐多药情况分析

目的：了解当前结核病对一线及二线抗结核药物的耐药性及耐多药情况,为结核病防治提供依据。方法：采用WHO推荐的药敏测试法对2327株临床分离的结核分支杆菌进行药物敏感性试验。结果：总耐药率53.07%,耐多药率22.47%;近2年初始耐药占32.62%,获得性耐药占67.37%;并在102例耐多药结核病患者中发现9例严重耐多药结核病。结论：本地结核菌耐药率高于全国平均水平,耐药病例中初始耐药率较高,并已发现严重耐药结核病患者,建议积极开展耐药菌监测指导临床选择治疗方案。     

肺结核病人对抗结核FDC制剂治疗可接受性的研究

目的 评价肺结核病人对抗结核FDC制剂治疗可接受性的情况。方法对373例新发涂阳肺结核病例，随机分为FDC制剂组和广泛使用的组合药组。在治疗期间对病人的耐受性、副反应和实验室检查结果进行监测。结果与组合药组病人相比，更多的FDC组病人认为服药方式可以接受，药片大小合适，药片数适中（P〈0．05）；但药片吞咽情况、药片苦不苦、药片是否粘喉等问题上两组病人回答结果接近（P〉0．05）；FDC组病人强化治疗期流感综合症的出现率略高于组合药组（P〈0．05），其余副反应（包括消化道症状、皮肤反应、神经系统症状以及视听神经症状）的出现情况两种药物之间差异无显著性意义（P〉0．05）；实验室检查，FDC组AST异常率高于组合药组，但TBIL异常率低于组合药（P〈0．05），两组肝功能异常者ALT、AST、TBIL的分布一致（P〉0．05）。结论相对于传统组合药，病人对FDC制剂的接受性改善，但FDC组流感综合症和AST异常率高于组合药组。     

重庆市2009—2019年贫困地区肺结核登记情况分析

目的 了解2009—2019年重庆市贫困地区登记的肺结核患者流行病学特征,为制定结核病防治措施提供依据。方法 采用描述性流行病学分析法,对2009—2019年重庆市贫困地区以及其中的贫困乡镇肺结核患者登记率、地区分布、人群特征等疫情资料进行统计分析。结果 2009—2019年重庆市活动性肺结核患者年均登记率为81.62/10万,贫困地区为103.99/10万,贫困乡镇为113.17/10万,全市、贫困地区和贫困乡镇登记率年递降率分别为4.48%、3.32%、1.74%。渝东北贫困地区和贫困乡镇年均登记率分别为91.24/10万、106.44/10万;渝东南贫困地区和贫困乡镇分别为128.11/10万、131.51/10万。贫困地区男女性别比为2.28∶1,贫困乡镇为2.54∶1;贫困地区老年患者构成比为19.00%,贫困乡镇为19.60%;贫困地区和贫困乡镇农民占比分别为69.43%、80.75%。贫困地区患者发现以因症就诊（97.12%）为主。贫困地区和贫困乡镇患者就诊延迟比例分别为77.85%、80.95%。结论 重庆市贫困地区肺结核疫情下降缓慢,且分布不均,特别是渝东南地区,应通过加强贫困地区能力建设、多渠道筹资,减少贫困患者治疗负担、加强健康教育和扩大主动筛查面,有效控制疫情。