Disseminated tuberculosis remains a diagnostic challenge because the presentations are nonspecific. In the current retrospective study we describe the clinical characteristics and outcome of disseminated tuberculosis. From January 1995 to December 2004, patients with culture-confirmed tuberculosis who fulfilled the criteria for disseminated tuberculosis were selected and their medical records reviewed. Their clinical isolates were genotyped. Of the 3058 patients with culture-confirmed tuberculosis, 164 (5.4%) had disseminated disease; 14.0% of patients had acquired immunodeficiency syndrome. The most common radiographic finding was miliary lung lesions (47.0%); 31.1% of patients died at the end of the study. Poor prognostic factors included hypoalbuminemia, hyperbilirubinemia, renal insufficiency, and delayed antituberculosis treatment. Clinical findings suggestive of disseminated tuberculosis were miliary lung lesions, serum ferritin >1000 microg/L, infiltrative liver disease, and adjusted calcium >2.6 mmol/L. Simultaneously performing mycobacterial culture and histopathologic examination of bone marrow biopsy was more sensitive and faster than just performing mycobacterial blood culture in diagnosing disseminated tuberculosis. Of the 64 preserved Mycobacterium tuberculosis isolates, 47 (73.4%) were clustered and 27 (42.2%) were Beijing family. Since prognosis was worse in patients with delayed treatment, a high index of suspicion is required, especially in those with clinical findings suggestive of disseminated tuberculosis.

The overexpression of SPRR1B in bronchial epithelium is a marker for early metaplastic changes and the loss of its expression is associated with an irreversible malignant transformation. In the present study, we have used a model system consisting of normal and malignant bronchial epithelial (BE) cells to elucidate the dierential transcriptional control of SPRR1B. SPRR1B expression is either detectable or PMA (phorbol 13-myristate 12-acetate) -inducible in several malignant BE cells including squamous, adeno, small and large cell carcinomas. Loss of SPRR1B expression is correlated well with the lack of strong in vivo protein-DNA interactions at the 7152 bp promoter, which contains two functional TRE sites. Even though the basal level AP-1 protein DNA binding pattern is dierent between normal and malignant cells, PMA signi®cantly enhances Jun and Fos binding to the consensus TRE site in both cell types. Intriguingly, the composition of AP-1 protein binding to the 7152 to 786 bp SPRR1B promoter is quite dierent. In untreated cells, SPRR1B promoter is predominantly occupied by JunD and Fra2. PMA signi®cantly induced binding of JunB and Fra1 in normal cells, while JunB and Fra2 bound to TREs in the malignant cells. Overexpression of fra1 in malignant cells signi®cantly enhanced SPRR1B promoter activity. In contrast, overexpression of fra2, but not fra1, strongly reduced both basal and PMA-inducible promoter activities in normal cells. Together, these results indicate that either temporal expression and/or dierential activation of AP-1 proteins, especially Fra1 and Fra2, might contribute to the dysregulation of terminal dierentiation marker, SPRR1B, expression in various BE cells. Oncogene (2001) 20, 634 ± 644.

The aim of this study was to identify sonographic predictors of patient outcomes or need for surgical intervention of acute thoracic empyema. All patients with a clinical diagnosis of thoracic empyema underwent transthoracic ultrasonographic examination and thoracentesis at admission. According to the presence or absence of septa in sonographic images, the patients were classified into two groups: septated and nonseptated. Sonographic findings were analyzed with respect to duration of hospital stay, chest tube drainage, and treatment efficacy. A total of 163 consecutive patients were included in the study (83 patients with septated and 80 with nonseptated sonographic images). The mean duration of hospital stay (35.4 versus 27.0 days, P = 0.009) and chest tube drainage (13.1 versus 7.6 days, P < 0.001) for the patients with septa were significantly longer than for those without septa. The patients with septa were more likely to undergo intrapleural fibrinolytic therapy (63.8% versus 38.8%, odds ratio 2.79, P = 0.001) and surgical intervention (24.3% versus 7.5%, odds ratio 3.92, P = 0.004). We concluded that sonographic septation is a useful sign to predict the need for subsequent intrapleural fibrinolytic therapy and surgical intervention in cases of acute thoracic empyema. Early fibrinolytic therapy or even surgical intervention may be indicated in patients with sonographic septations.

The regression model could possibly predict the TB reinfection proportion from the local incidence. This algorithm is probably helpful in policy making for TB control programs. In areas where TB is endemic, reinfection might be responsible for >50% of TB cases, and aggressive surveillance to detect asymptomatic carriers could be an important strategy for controlling the disease.