Journal of Tuberculosis and Lung Disease

Current status and prospects of applying imaging examination in the diagnosis and treatment of pulmonary tuberculosis

Hong-peng ZHAO,Xi-wei. LU

Journal of Tuberculosis and Lung Health. 2019, 8(1): 5-8. doi:10.3969/j.issn.2095-3755.2019.01.003

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Imaging examination plays an important role in tuberculosis control and prevention. Due to the influence of traditional mindset, the value of imaging hasn’t been fully utilized in clinical observation, chronic complication detection and pathogenesis exploration in tuberculosis. We sorted the current status and prospects of the application of imagining examination in classifying tuberculosis, determining the activity status of tuberculosis, identifying complications and exploring new pathogenesis, as well as tuberculosis prevention and control, and put forward suggestions for the application of imaging in tuberculosis control and prevention in the future.

Development and prospect of the construction of tuberculosis prevention and treatment system in Guangdong Province

Wei WANG,Yu DUAN,Wen-pei. WEN

Journal of Tuberculosis and Lung Health. 2019, 8(1): 9-14. doi:10.3969/j.issn.2095-3755.2019.01.004

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Tuberculosis is a major infectious disease that seriously endangers the health of people. The epidemic situation of tuberculosis in China is relatively serious, and China is one of the countries with high burden of tuberculosis in the world. After the founding of China, with the continuous development and evolution of national tuberculosis prevention and control system, local tuberculosis prevention and control models that are suitable for different provinces are exploring. This article reviews the historical evolution of tuberculosis prevention and control system in China and Guangdong Province and discusses the achievements and advantages and disadvantages of various models, providing a basis for formulating tuberculosis prevention and control model in Guangdong Province.

The application of WeChat technology in school tuberculosis prevention and control work

Lan-jun FANG,Wen-pei WEN,Fang-jing. ZHOU

Journal of Tuberculosis and Lung Health. 2019, 8(1): 15-18. doi:10.3969/j.issn.2095-3755.2019.01.005

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The advent of the network era and the popularization of mobile terminals provide a good hardware foundation for mobile medical services. Previous studies have shown that the use of WeChat technology to carry out health education in tuberculosis in schools can make full use of medical resources and improve the awareness rate of core knowledge of tuberculosis prevention and treatment for teachers and students in schools. By using WeChat to manage the treatment of tuberculosis patients in school, we can accurately obtain direct evidence of patient compliance, improve patient compliance and overall quality of care, reduce management costs and improve management effectiveness. It is worth promoting the WeChat technology application in school tuberculosis prevention and control work.

Analysis on the effectiveness of different tuberculosis prevention and control system models in Guangdong Province

Bao-jiang WEN,Xiao-dong DENG,Guang-yong FENG,Wen-pei. WEN

Journal of Tuberculosis and Lung Health. 2019, 8(1): 19-23. doi:10.3969/j.issn.2095-3755.2019.01.006

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Objective To explore and analyze the effectiveness of different tuberculosis prevention and control system models in Guangdong Province.Methods The 2017 indicator data in the Guangdong Provincial Tuberculosis Monitoring Report, the gross domestic product of the cities and towns reported by the Guangdong Provincial Bureau Statistics in 2017, and the work summary of the cities in Guangdong Province, the report of the provincial supervision city and the research report on the models of tuberculosis prevention and control system model in Guangdong Province in 2017, as well as historical record were comprehensively analyzed. The effectiveness of same model under different local government inputs (combination of prevention and control at hospital level) and different models under the same government input (combination of prevention and control at hospital versus outpatient level, and combination versus separation of prevention and control) were evaluated.Results In 2017, the local governments of Guangdong Province invested 1316800 to 36149000 yuan, and the total benefit of the government investment was between 58113900 and 2777636500 yuan. (1) Comparison in effectiveness of same model under different local governments inputs (combination of prevention and control at hospital level) between Shenzhen and Shantou City: the per capita government investment was 3.04 yuan in Shenzhen and 1.41 yuan in Shantou, respectively; the total benefit of government investment in Shenzhen (1347208900 yuan) was higher than that in Shantou (278276100 yuan); the reported incidence rate in Shenzhen (55.3/100000) was lower than that in Shantou (117.8/100000); the registration rate (45.9/100000) was close to the reported incidence rate in Shenzhen, whereas the registration rate (47.6/100000) was far from the reported incidence rate in Shantou. (2) Comparison in different models under the same governments inputs: ① combination of prevention and control at hospital level (Foshan City) versus combination of prevention and control at outpatient level (Zhuhai City): the per capita government investment was 1.89 yuan in Foshan and 1.83 yuan in Zhuhai; the total benefit of the government investment in Foshan (989780600 yuan) was higher than that in Zhuhai (368948100 yuan); the referral rate and successful treatment rate were 93.4% and 94.8% in Foshan, which were close to those in Zhuhai (both were 95.8%); the incidence rate (48.9/100000) and the registration rate (49.0/100000) in Foshan was similar; the reported incidence rate in Zhuhai was 71.3/100000, and the registration rate was 74.6/100000, and the difference between the two indicators was larger. ② Separation of prevention and control (Chaozhou City) versus combination of prevention and control (Maoming City): the per capita government investment was 0.50 yuan in Chaozhou and 0.48 yuan in Maoming; total benefit invested by the Maoming Municipal Government (337232600 yuan) was higher than that of Chaozhou Municipal Government (58113900 yuan); the reported incidence rate in Chaozhou (68.5/100000) was higher than that in Maoming (61.5/100000); the registration rate in Chaozhou (27.7/100000) was lower than that on Maoming (53.8/100000).Conclusion The level of government input has a great impact on the effectiveness of the tuberculosis prevention and control system. Under the same government input, the combination of prevention and control model is better than the separation model (“Trinity” model), and combination at the hospital level is better than that at the outpatient level.

Analysis on the effectiveness of different tuberculosis prevention and control service system models in Shanghai and Shenzhen

Jing-wen. LAI

Journal of Tuberculosis and Lung Health. 2019, 8(1): 24-28. doi:10.3969/j.issn.2095-3755.2019.01.007

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Objective To analyze effectiveness of different models of tuberculosis prevention and control service system in Shanghai and Shenzhen, and to provide reference for improving the construction of tuberculosis service system in China.Methods Shanghai (the representative city of the “Trinity” prevention and control model in 2017) and Shenzhen (the representative city of the “integration of prevention, treatment and management” under the chronic disease prevention and control system in 2017) were selected as the study subjects. The population composition, funding for tuberculosis control, and incidence and registration rate of tuberculosis were collected from “Disease Reporting Information System” and “Tuberculosis Information Management System”, the sub-category of “China Information System for Disease Control and Prevention”. The effectiveness of the two models in patient discovery were evaluated by the four comparable core indexes of “13th Five-Year” tuberculosis prevention and control in national tuberculosis surveillance information, e.g. Overall arrival rate of pulmonary tuberculosis, pathogenic positive rate of pulmonary tuberculosis, screening rate of close contacts of smear-positive pulmonary tuberculosis patients, and drug resistance screening rate in high-risk population.Results In 2017, the floating population of Shanghai and Shenzhen accounted for 40.22% (972.69/2418.33) and 65.30% (818.11/1252.83) of the resident population. The per capita funding for tuberculosis prevention and control was 1.30 yuan (3134.80/2418.33) in Shanghai and 2.89 yuan (3614.90/1252.83) in Shenzhen. The reported incidence of tuberculosis was 26.56/100000 (6424/24183300) in Shanghai and 52.58/100000 (6587/12528300) in Shenzhen. The registration rate of tuberculosis was 27.93/100000 (6754/24183300) in Shanghai and 43.64/100000 (5467/12528300) in Shenzhen. The drug resistance screening rate in high-risk population (68.60%, 319/465), pathogenic positive rate (50.94%, 3269/6417), and close contact screening rate (99.85%, 5403/5411) in Shanghai were lower than those in Shenzhen (82.16% (221/269), 53.70% (2936/5467) and 100.00% (5455/5455)) (χ ²=16.101, P=0.000; χ ²=9.021, P=0.003; χ ²=8.071, P=0.004). Despite differences between the two cities, both cities achieved the task of the “13th Five-Year National Tuberculosis Prevention and Control Plan” with the overall arrival rate of 95%, close contact screening rate of 95%, pathogen positive rate of 50% and drug resistance screening rate in high-risk population of 95%.Conclusion Although the two different tuberculosis prevention and control service system models showed different effectiveness, both achieved the national tuberculosis prevention and control task, indicating that gradually developing and improving the tuberculosis service system according to local conditions is the key of tuberculosis prevention and control.

Analysis on registration and outcome of diabetes mellitus complicated with pulmonary tuberculosis patients in Xuhui District of Shanghai from 2013 to 2017

Juan WANG,Xiang XU,Jing JIANG,Mei-xia. YANG

Journal of Tuberculosis and Lung Health. 2019, 8(1): 29-32. doi:10.3969/j.issn.2095-3755.2019.01.008

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Objective To analyze the registration and outcome of diabetes mellitus complicated with pulmonary tuberculosis patients in Xuhui District of Shanghai from 2013 to 2017.Methods The data from the Xuhui District Tuberculosis Management Information System, Disease Control Information Management Platform and electronic medical records of tuberculosis designated hospitals from 2013 to 2017 were collected. The data of diabetes management population were collected from the diabetes subsystem of Disease Control Information Management Platform. From 2013 to 2017, 1383 active tuberculosis patients were registered in Xuhui District of Shanghai, including 903 males and 480 females. Among them, there were 147 cases of diabetes complicated with pulmonary tuberculosis and 1236 cases of pulmonary tuberculosis only. The demographic data was derived from the statistical yearbook of Xuhui District. The clinical data of the two groups were compared and analyzed.Results From 2013 to 2017, 147 cases of diabetes mellitus complicated with pulmonary tuberculosis were registered in Xuhui District of Shanghai, accounting for 10.63% (147/1383) of all registered pulmonary tuberculosis cases. The registered incidence of pulmonary tuberculosis in diabetic patients (54.20/100000-117.18/100000) was about 2.18-4.72 times that of the general population (22.86/100000-28.62/100000). In the group of diabetes mellitus complicated with pulmonary tuberculosis patients, the average age was 64.26±1.06 years, the proportion of male patients was 81.0% (119/147), the proportion of smear positive patients was 57.1% (84/147), the median patient delay time (quartile) (M(Q₁,Q₃)) was 14.0 (5.0,32.0)days, and the average treatment course was 10.90±2.68 months. In the group of pulmonary tuberculosis only patients, the average age was 43.75±0.59 years, the proportion of male patients was 63.4% (784/1236), the proportion of smear positive patients was 37.1% (458/1236), the median patient delay time (quartile) (M(Q₁,Q₃)) was 11.5 (2.0,27.0)days, and the average treatment course was 10.09±3.14 months. There were significant differences in these indicators (t=11.73, χ ²=17.80, χ ²=22.25, Z=-2.22, t=3.16, all Ps<0.05). Conclusion The registration incidence rate of pulmonary tuberculosis in diabetes mellitus patients is higher than that in the general population. The average age, male ratio, smear positive ratio, patient delay time and treatment course of diabetes mellitus complicated with pulmonary tuberculosis patients are higher than those of pulmonary tuberculosis only patients.

Survey on awareness and use of ultraviolet germicidal air disinfection among tuberculosis nurses

Wen-wen SHI,Zhen-lan DUAN,Dong-xia LI,Fei-fei NIE,Ya-hong WANG,Xiu-hua. WANG

Journal of Tuberculosis and Lung Health. 2019, 8(1): 33-37. doi:10.3969/j.issn.2095-3755.2019.01.009

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Objective To understand awareness and use status of ultraviolet germicidal air disinfection among tuberculosis (TB) nurses.Methods A total of 396 TB nurses from 26 hospitals in 20 provinces (autonomous regions and municipality) were selected by stratified sampling. Self-designed Knowledge of Ultraviolet Germicidal Air Disinfection Questionnaire (9 items, scores range from 0 to 100 points) and Use of Ultraviolet Germicidal Air Disinfection Questionnaire (11 items) were used to investigate the influential factors for knowledge of ultraviolet germicidal air disinfection among TB nurses.Results Regarding the awareness of ultraviolet germicidal air disinfection, awareness of usage time, installation quantity, radiation intensity and installation height was low and the accuracy rate was 19.9% (79/396),35.4% (140/396),55.1% (218/396) and 64.4% (255/396). The total score of awareness of ultraviolet germicidal air disinfection was 64.52±14.03. The scores of group aged 41-57 years (69.13±11.3) was higher than that of group aged 26-30 years (61.98±14.07). The score of 21-38 working years group (69.49±11.26) was higher than that of 0.5-5 years working years group (61.51±15.07). The score of 11-38 working years in TB group (67.32±13.54) was higher than that of 0.5-5 years working years in TB group (63.07±14.05). The score of deputy chief nurses and above (69.93 ±10.54) were higher than that of ordinary nurses (61.67±15.07). The score of head nurses (69.43±13.81) was higher than that of director of nursing department (62.96±11.69). The differences were statistically significant (F=5.16, 6.95, 3.67, 6.50 and 5.23; P=0.002, 0.000, 0.026, 0.000 and 0.006).Conclusion The overall awareness of ultraviolet air disinfection in TB nurses is weak. The older the age, the longer the working years, the higher the nurses’ awareness level. Medical institutions should strengthen the training and education work especially focusing on the younger new nurses, in order to improve the awareness of ultraviolet air disinfection.

Application of light-emitting diode fluorescence microscopy in detection of Mycobacterium in county level laboratories

Xue-zhi ZHANG,Bai-feng LIN,Xin-fa PEI,Li CHEN,Ying PENG,Lu. TANG

Journal of Tuberculosis and Lung Health. 2019, 8(1): 38-41. doi:10.3969/j.issn.2095-3755.2019.01.010

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Objective To study the practicability of light-emitting diode (LED) fluorescence microscope in laboratory staff to examine Mycobacterium.Methods A total of 3770 newly diagnosed TB suspected patients were continuously included from eight county-level TB dispensaries of Heilongjiang from July 2017 to October 2018. Each patient provided 2-3 sputum specimens, and 9079 examples were analyzed and cultured. The laboratory staff prepared two sputum smears for each sample. Ziel-Nelson (Z-N) and fluorescence staining for the smear were conducted, respectively. Then traditional light microscopes and LED fluorescence microscopes were used for microscopic examination. At the same time, reading time and smear preservation were recorded and analyzed.Results The positive rates of traditional light microscopy and LED fluorescence microscopy were 11.41% (430/3770) and 12.79% (482/3770); the positive detection rate of simple method of solid culture was 17.14% (646/3770), the difference was statistically significant (χ ²=5602.10, P<0.01). Using culture test as the standard, the sensitivity of microscopy by traditional light microscope and LED fluorescence microscope was 61.46% (397/646) and 66.72% (431/646), and the specificity was 98.94% (3091/3124) and 98.37% (3073/3124), respectively. Youden index of traditional light microscope and LED fluorescence microscope was 0.604 and 0.651. The reading time of LED fluorescence microscope ((184.33±52.22)s) was obviously lower than that of traditional light microscope ((291.21±95.40)s), and the difference was statistically significant (F=5670.80, P<0.01). 1179 positive fluorescent staining smears with different positive grades detected by LED fluorescence microscopy were putted in the opaque glass box at room temperature (22-25℃), and avoided direct sunlight. Five qualitative errors and 10 quantitative errors were found after 4 months of storage.Conclusion The efficiency of LED fluorescence microscopy in detecting acid-fast bacilli is better than that of ordinary optical microscopy. It shortened the film reading time of the staff. The stained glass slides can be stored in the glass box that avoids direct sunlight at room temperature, which is suitable for promotion and application in the basic laboratory.

Diagnostic accuracy of Xpert MTB/RIF Ultra for tuberculous meningitis

Pei-ze ZHANG,Jun-feng ZHENG,Liang FU,Tian-pin LI,Xing-liao YUAN,Hou-ming LIU,Guo-fang. DENG

Journal of Tuberculosis and Lung Health. 2019, 8(1): 42-47. doi:10.3969/j.issn.2095-3755.2019.01.011

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Objective To investigate the diagnostic performance of Xpert MTB/RIF Ultra assay (Xpert Ultra) in the initial diagnosis of tuberculous meningitis among HIV-negative patients.Methods A total of 21 HIV-negative patients with suspected tuberculous meningitis from February to December 2018 were enrolled. Cerebrospinal fluid of all patients was examined for Mycobacterium tuberculosis with Xpert Ultra, Xpert MTB/RIF and liquid culture. According to the international diagnostic criteria for tuberculous meningitis, clinical score ≥6 points was used as the reference standard, and all patients were divided into tuberculous meningitis group (15 cases) and non-tuberculous meningitis group (6 cases). The sensitivity, specificity, positive predictive value, and negative predictive value of different diagnostic methods were compared.Results The cerebrospinal fluid of all 6 non-tuberculous meningitis patients was negative for Xpert Ultra, Xpert, and mycobacterial liquid cultures. Of the 15 patients with tuberculous meningitis, 10 (10/15, 66.7%) were positive for Xpert Ultra, 4 (4/15, 26.7%) were positive for Xpert, and 4 (4/15, 26.7%) were positive for liquid culture; Xpert Ultra was used for diagnosis of tuberculous meningitis with sensitivity of 66.7% (10/15), specificity of 100.0% (6/6), positive predictive value of 100.0% (10/10), and negative predictive value of 54.5% (6/11). Xpert was consistent with liquid culture for diagnosis of tuberculous meningitis, the sensitivity was 26.7% (4/15), specificity was 100.0% (6/6), positive predictive value was 100.0% (4/4), and negative predictive value was 35.3% (6/17). The difference of sensitivity among the three testing methods is statistically significant (χ ²=4.821,P=0.028). In the 10 Xpert Ultra positive patients, rifampicin resistance could not be determined in 3 patients (one test result was “very low” and another two were “trace call”), rifampicin resistance was not detected in the other 7 patients.Conclusion Xpert Ultra is the most sensitive method for diagnosing tuberculous meningitis and is recommended for initial diagnosis of tuberculous meningitis. When Xpert Ultra detects result is very low or trace call, there is a problem that rifampicin resistance cannot be determined, and further verification of drug resistance is needed.

Psychological characteristics of patients with newly diagnosed smear positive pulmonary tuberculosis and effect analysis after supportive psychotherapy intervention

Ying WU,Gui-chun DU,Bing-li BAO,Xue YANG,Yu CHEN,Ying. SUN

Journal of Tuberculosis and Lung Health. 2019, 8(1): 48-53. doi:10.3969/j.issn.2095-3755.2019.01.012

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Objective To investigate the psychological characteristics of newly diagnosed smear positive pulmonary tuberculosis (PTB) patients and analyze the related influencing factors, and to explore the effect of supportive psychotherapy on newly diagnosed smear positive PTB patients.Methods Symptom checklist 90 (SCL-90) was used to evaluate 263 initial treatment smear-positive PTB patients, who visited Shenyang Chest Hospital in April to October 2018, and then compared the evaluation results of the patients with that of normal Chinese people (norm). The related influencing factors were analyzed. Then two weeks supportive psychotherapy was given to those patients and the clinical effects were analyzed after intervention.Results The scores of somatization symptoms, compulsion, anxiety, depression and hostility was 1.52±0.31, 1.81±0.42, 1.45±0.23, 1.62±0.28 and 1.59±0.58 respectively in the patients before they received intervention, which were significantly higher than those in the norm (1.37±0.48, 1.62±0.58, 1.39±0.43, 1.50±0.59 and 1.46±0.55) (t value was 6.161, 5.759, 3.331, 5.456, 2.862 respectively, P<0.01). The scores of somatization symptoms, depression, anxiety and interpersonal sensitivity in the female patients (1.61±0.48, 1.67±0.49, 1.51±0.26 and 1.72±0.38) were significantly higher than those in the male patients (1.45±0.25, 1.58±0.52, 1.39±0.63 and 1.59±0.46) (t value was 2.571,2.137,2.532,1.985 respectively, P<0.05). The scores of depression, anxiety and paranoia in the patients with college education level or above (1.73±0.36, 1.52±0.27 and 1.53±0.39) were significantly higher than those in the patients with senior high school education level or below (1.59±0.47, 1.39±0.59 and 1.41±0.46) (t value was 2.026, 2.123 and 1.987 respectively, P<0.05). There were significant differences of scores on depression (1.60±0.36-1.68±0.43), anxiety (1.42±0.53-1.51±0.18) and interpersonal sensitivity (1.63±0.47-1.72±0.35) in different age groups of the patients (F value was 2.378, 2.356 and 2.427 respectively, P<0.05). After supportive psychotherapy, the scores of somatization symptoms (1.39±0.42), compulsion (1.65±0.51), anxiety (1.35±0.29), depression (1.54±0.47), hostility (1.51±0.35) and psychiatric factors (1.29±0.35) were significantly lower than those before treatment (1.52±0.31, 1.81±0.42, 1.45±0.23, 1.62±0.28, 1.59±0.58 and 1.30±0.13) (t value was 10.153, 8.252, 3.584, 2.218, 3.235 and 2.165 respectively, P<0.05).Conclusion Psychological health level of the newly diagnosed smear-positive pulmonary tuberculosis patients is worse than that of the norm. Their mental health level can be effectively improved by giving supportive psychotherapy.

Analysis of referrals and tracking of tuberculosis patients reported by non-tuberculosis control institution in Heilongjiang Province from 2009 to 2017

Bi-bo ZHANG,Hong-hai. LI

Journal of Tuberculosis and Lung Health. 2019, 8(1): 54-59. doi:10.3969/j.issn.2095-3755.2019.01.013

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Objective To analyze the referral and tracking of tuberculosis and suspected patients in Heilongjiang Province’s non-tuberculosis control institutions (referred to as “non-TB institutions”) from 2009 to 2017, and provide evidence for the government to formulate relevant prevention and control policies.Methods A total of 230913 cases of tuberculosis and suspected patients were reported by the non-TB institutions in the Heilongjiang Provincial Tuberculosis Management Information System from 2009 to 2017. The χ ² test was performed on referral and location data of all patients, and P<0.05 was considered statistically significant.Results From 2009 to 2017, the rate of referral of tuberculosis and suspected patients reported by Heilongjiang Province’s non-TB institutions was 46.61% (107640/230913), and the fluctuation in 9 years was 42.98% (8698/20239) to 48.53% (13020/26828) (χ ²=240.631, P=0.000); the tracking rate was 91.34% (109947/120376), showing an increasing trend year by year (89.37% (12109/13550) to 93.45% (11463/12267)) (χ ²=289.624, P=0.000); the overall occupancy rate was 95.48% (220484/230913), showing an upward trend (94.34% (28069/29752) to 96.69% (23520/24324)) (χ ²=296.607, P=0.000), and stable at around 95%; the total number of tuberculosis and suspected patients in the province reached 95.48% (220484/230913), of which patients diagnosed with active tuberculosis accounted for 60.92% (134310/220484), the diagnosis rate of patients in the 9-year period increased year by year (56.60% (15888/28069) to 67.50% (15877/23520)) (χ ²=1433.560, P=0.000); 18.15% (40026/220484) patients were diagnosed with smear-positive tuberculosis, and showed a downward trend year by year (11.14% (2145/19263) to 24.68% (6493/26305)) (χ ²=2713.209, P=0.000); the overall contribution rate of tuberculosis patients to active pulmonary tuberculosis patients in the province was 45.47% (134310/295367); the overall contribution rate to smear-positive pulmonary tuberculosis patients was 39.73% (40026/100752).Conclusion The non-TB institutions of Heilongjiang Province reported that the overall rate of tuberculosis patients reached the target of more than 95%. The reported diagnosis rate of patients increased year by year and became the main source of patient discovery. However, there are still some problems, such as low referral rate, and the proportion of reported smear positive patients decreased year by year.

Diagnosis and differentiation of female pelvic tuberculosis and ovarian cancer

Yan LI,Hui-ling ZHANG,Ling. OU-YANG

Journal of Tuberculosis and Lung Health. 2019, 8(1): 60-64. doi:10.3969/j.issn.2095-3755.2019.01.014

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Objective To analyze the differences in clinical characteristics, imaging feature and laboratory data between patients with pelvic tuberculosis and ovarian cancer in order to improve the accuracy of pelvic tuberculosis diagnosis.Methods A total of 25 patients with pathologically confirmed pelvic tuberculosis in Shengjing Hospital of China Medical University from September 2013 to September 2018 were included as tuberculosis group. During the same period, 25 cases of age-matched ovarian epithelial carcinoma who were hospitalized in the same hospital were included as ovarian cancer group. The clinical symptoms and signs, imaging data and laboratory examination results between the two groups were compared and analyzed.Results The incidence of abdominal pain, abdominal distension and infertility were 40.0% (10/25), 36.0% (9/25) and 20.0% (5/25) in the pelvic tuberculosis group and 48.0% (12/25), 32.0% (8/25) and 0.0% in the ovarian cancer group; there were no significant differences between the two groups (χ ²=0.33, 0.09 and 3.56; P=0.569, 0.765 and 0.059, respectively). Pelvic ultrasound examination of patients indicated that the maximum diameter of mass in the pelvic tuberculosis group (median (quartile), M(Q₁,Q₃): 6.45 (4.70, 9.55)cm) was shorter than that in the ovarian cancer group (10.60 (7.40, 15.10)cm); the difference was statistically significant (Z=3.08, P=0.002). The positron emission tomography-computed tomography (PET-CT) showed that standard uptake value (SUV) of mass in the pelvic tuberculosis group (M(Q₁,Q₃): 8.00 (7.72, 8.28)) was lower than that of the ovarian cancer group (14.01 (12.53, 15.17)); the difference was statistically significant (Z=1.85, P=0.045). Laboratory examination results showed that human epididymis protein 4 (HE4) (M(Q₁,Q₃): 92.84 (75.20, 102.95)pmol/L) and carbohydrate antigen 724 values ( $M (Q 1, Q 3$ ): 1.24 (1.10, 2.83)kU/L) of the pelvic tuberculosis group were lower than those of the ovarian cancer group (267.38 (168.88, 489.70)pmol/L and 19.43 (2.31, 50.39)kU/L); the differences were statistically significant (Z=2.06 and 3.28, P=0.042 and 0.001, respectively).Conclusion The main clinical manifestations of pelvic tuberculosis and ovarian cancer were abdominal pain, abdominal distension and infertility. Pelvic mass in the pelvic tuberculosis patients was smaller compared with ovarian cancer patients. The SUV of mass indicated by PET-CT in the pelvic tuberculosis patients was lower compared with ovarian cancer patients. The increased HE4 value in the pelvic tuberculosis patients was not as significant as the ovarian cancer patients. It is difficult to diffe-rentiate pelvic tuberculosis and ovarian cancer in clinic. Pathological examination is required when necessary.

Investigation of an outbreak of tuberculosis in an adult education centre in Tianjin

Yan-ming YU,Xue-wen PANG,Yan-yong. FU

Journal of Tuberculosis and Lung Health. 2019, 8(1): 65-68. doi:10.3969/j.issn.2095-3755.2019.01.015

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Objective To analyze an outbreak of tuberculosis (TB) in an adult education centre in Tianjin, and to provide evidences for formulating disposition measures of school TB.Methods The information of an epidemiological investigation and screening on the outbreak of TB in the adult education center in Tianjin from October 2017 to April 2018 were collected, and the epidemiological characteristics, causes and disposition measures of the epidemic were analyzed.Results The center had organized three rounds of screening for close contacts by tuberculin skin test and chest X-ray examination since the first case was found. Seventeen students were diagnosed as TB in succession. The first two cases were detected by passive identification, and the remaining 15 cases were detected by screening. The 17 confirmed cases were distributed in five classes, mainly in the class of the first case (12 cases (52.2%) were detected among the 23 students in the class). Two cases (1.3%) were diagnosed as TB among 159 students in other classes on the same floor. The risk of TB infection in the class of first case was 86.73 times higher than other classes (95%CI: 17.22-436.87; χ ²=67.19, P<0.01). Among the ten students in the dormitories of the first and second smear-positive cases, eight were diagnosed as TB. Four of the 129 students in the dormitories on the same floor were diagnosed as TB. The risk of TB infection in the dormitories of the first two cases was 125.00 times higher than other classes (95%CI: 19.82-788.44; χ ²=60.17, P<0.01). In the outbreak, the diagnosis rates of abnormal chest X-ray and strong positive TB skin test were 66.7% (10/15) and 11.0% (16/145), respectively.Conclusion Poor ventilation is easy to cause the spread of Mycobacterium tuberculosis. The students with TB cannot be detected and put in quarantine as soon as possible, which is likely to cause infection and morbidity of contacts in the same classes and dormitories. During the outbreaks, the positive predictive value of screening measures is high so that the students with abnormal test results should be given special attention.

Effect of nursing intervention with peer support on respiratory function and life quality of patients with COPD

Qi LIU,Bing. LI

Journal of Tuberculosis and Lung Health. 2019, 8(1): 69-72. doi:10.3969/j.issn.2095-3755.2019.01.016

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Objective To explore the effect of nursing interventions with peer support on respiratory function and life quality of patients with chronic obstructive pulmonary disease (COPD). Methods A total of 79 COPD patients, who visited No. 7 Department of Internal Medicine of Wangkai Infectious Disease Hospital from January to October 2018, were recruited in this study. Among them, 39 patients, who received routine nursing intervention from January to May 2018, were in the control group; while 40 patients, who received nursing intervention with on peer support from June to October 2018, were in the observation group. In the control group, the routine nursing interventions were provided to the patients while the nursing interventions with peer support based on routine nur-sing were given to the patients in the observation group. The difference of respiratory function, life quality and 6 min walking distance (6-MWD) of the patients in the two groups were compared after three-month interventions.Results After the interventions, FEV₁ of the patients in the observation group was (1.9±0.4)L while that was (1.5±0.3)L in the control group. There was significant difference between two groups (t=-4.16, P=0.000). FEV₁% of the patients in the observation group was (65.2±6.6)% while that was (56.5±8.7)% in the control group. There was significant difference between two groups (t=-5.20, P=0.000). The value of FEV₁/FVC of the patients in the observation group was 76.2±6.3 while that was 68.5±5.3 in the control group. There was significant difference between two groups (t=-5.88, P=0.000). After interventions, the QOL scores of the patients in the two groups were compared and the results showed that the scores of physiological domain, psychological domain, independent domain, social relationship domain, environmental domain and spiritual/religious domain in the patients of observation group were 83.8±4.0, 81.3±2.1, 82.3±2.5, 80.5±2.5, 87.3±2.4 and 84.5±2.6 respectively; while those were 70.8±4.2, 57.9±1.5, 70.5±2.3, 69.9±2.3, 72.9±2.4 and 70.5±2.8 respectively in the patients of control group. There were significant difference in all six domains between the two groups (t=2.58, 2.69, 2.71, 1.79, 2.83, 2.76 respectively; P=0.023, 0.021, 0.018, 0.029, 0.014, 0.016 respectively). The 6-MWD test result of the patients in the observation group was (409.1±83.0)m while this value was (363.9±81.8)m in the patients of control group. There was significant difference between two groups (t=-2.45, P=0.016).Conclusion Nursing interventions with peer support can effectively improve the respiratory function and life quality of COPD patients.

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