Objective To validate the association between genetic polymorphisms of nucleotide binding oligomerization domain 2 (NOD2) gene and the risk of tuberculosis in Chinese population.Methods A validation case-control study was performed with a total of 1043 pulmonary tuberculosis patients and 808 healthy controls.All controls had no history of tuberculosis or malignancy,and were matched with cases by sex and age.Genomic DNA from the peripheral blood samples of participant was extracted.Single nucleoside polymorphisms (SNP) of rs3135499,rs7194886,rs8057341,and rs9302752 in the NOD2 gene were genotyped using a TaqMan-based allelic discrimination system.The chi-square test was used to analyze categorical data and Logistic regression model was used to calculate the odds ratio (OR) and 95％ confidence interval (CI).Results When all patients as the cases were included in the analysis,no significant association was found between the four SNP of NOD2 gene and the risk of pulmonary tuberculosis.In a subgroup analysis by restricting cases to sputum culture positive patients,the variant genotypes of rs7194886 were significantly associated with an altered risk of tuberculosis.Compared with the CC genotype,individuals carrying the CT/TT genotype of rs7194886 had an increased risk (OR =1.35,95％ CI:1.05-1.72) for sputum culture positive tuberculosis.After adjusted for potential confounders,the increased risk of CT/TT genotype was still observed (OR=1.35,95％CI:1.05-1.73).Stratification analysis revealed that the effect of the SNP rs7194886 (CT/TT vs TT) was significant among men (OR=1.44,95％CI:1.08-1.92),individuals with age ＜55 years (OR=1.51,95％CI:1.05-2.16),smokers (OR=1.53,95％CI:1.07-2.18),and alcohol drinkers (OR=1.84,95％CI:1.01-3.33).But the heterogeneity test was not significant.Haplotype analysis showed that the rs9302752C-rs7194886T haplotype was associated with an increased risk of sputum culture positive tuberculosis (x2 =4.27,P=0.039).Conclusion In summary,genetic polymorphisms of rs7194886 in the NOD2 gene may be associated with the risk of pulmonary tuberculosis in the Chinese population.

Objective To explore the effect of early phase rehabilitation training on the urination function recovery of the patients with paraplegia caused by spinal cord injury (SCI).Methods Sixty-six patients with paraplegia caused by SCI were selected and divided into the rehabilitation and the control group.The rehabilitation group of patients received early phase rehabilitation training on the urination function,the control group received routine training on the urination training and urinary catheter nursing care.The urination function recovery effect was compared between two groups.Results The urination function recovery effect of the rehabilitation group was significantly better than the control group.Conclusions The usage of early phases of urination training measures on the SCI paraplegia patients can help them cast off the catheter,build up regular urination,and reduce complications.

The drug resistant mutations in human immunodefieiency virus type 1 (HIV-1) are a major impediment to successful highly active antiretrovirai therapy (HAART) and new drug design. In order to understand the drug resistance mechanism of HIV-1 integrase (IN) mutually existed for multiple drug-resistant strains to the most potent IN inhibitors diketo acids (DKAs), three S-1360-resistant HIV-1 strains were selected and molecular docking and molecular dynamics (MD) simulations were performed to obtain the inhibitor binding modes. Based on the binding modes, compelling differences between the wild-type and the 3 mutants for IN have been observed. The results showed that: 1) In the mutants, the inhibitor is close to the funetional loop 3 region but far away from the DNA binding site. Different binding sites lead to the decrease in susceptibility to S-1360 in mutants compared to the wild-type IN. 2) The fluctuations in the region of residues 138～166 are important to the biological function of IN. 2 hydrogen-bonds between S-1360 with residues N155 and K159 restrict the flexibility of the region. Drug resistant mutations result in a lack of the interaction, consequently, the less susceptible to S-1360. 3) In the 3 mutant IN complexes, the benzyl ring of S-1360 is far from the viral DNA binding site, thus, S-1360 can not prevent the end of the viral DNA from exposure to human DNA. 4) After T66I mutation, the long side chain of I occupied the active pocket in the 3 mutants, consequently, the inhibitor could not move into the same binding site or have the same orientation. All the above contribute to drug resistance. These results will be useful for the rational inhibitor modify and design.

Objective To investigate the clinical value of hand-sewn ileal pouch anal anastomosis (HIPAA) for the treatment of ulcerative colitis.Methods The clinical data of 191 patients with ulcerative colitis who were admitted to the General Hospital of Tianjin Medical University from January 1989 to December 2013 were retrospectively analyzed.All the patients received proctocolectomy and open or laparoscopic HIPAA.Patients were followed up by questionnaire at postoperative month 3 and 12.The function of pouch was evaluated according to the defecation frequency per 24 hours and per night,Bristol scale stool form and Kirwan classification.The quality of life was assessed according to the Cleveland global quality of life (CGQL).Patients were followed up till April 2014.The independent samples were compared by t test,and data from multiple groups were compared by analysis of variance,pairwise comparison was done by LSD-t test,and the count data were analyzed using the chi-square test.Results Of the 191 patients,180 received open surgery and 11 received laparoscopic surgery.Nine patients were treated by one-stage surgery,175 by two-stage surgery and 7 by three-stage surgery.The pouches of 181 patients were J shape,9 were H shape and 1 was W shape.No patient died perioperatively.Eight patients had abdominal infection and 7 had incisional infection at early period after the operation,and they were cured by antibiotics.Four patients had pouch anastomotic bleeding and 4 had anastomotic leakage at postoperative week 1-2,and they were cured by local hemostasis or titanium clipping.Six patients had high intestinal obstruction,and they were alleviated by symptomatic treatment.Eight patients had inflammation of pouch,and they were alleviated by diet adjustment or antibiotics treatment.Two patients had sexual dysfunction.All the patients were followed up for 1-25 years.The function of the pouch was improved gradually.At postoperative month 12,the defecation frequencies were (3.7 ± 1.4)/24 hours and (1.3 ±0.5)/night,and the number of patients with type Ⅳ (Bristol classification),type Ⅴ,type Ⅵ and in grade Ⅰ (Kirwan classification),grade Ⅱ,grade Ⅲ were 107,76,8 and 177,8,6,respectively,which were significantly improved when compared with (6.5 ±2.8)/24 hours,(2.9 ± 1.5)/night,86,89,16 and 160,19,12 at postoperative month 3 (t =12.36,3.98,x2=7.76,29.27,P＜ 0.05).The CGQL indexes before operation and at postoperative month 3 and 12 were 0.37 ±0.19,0.67 ±0.16 and 0.82 ±0.13,respectively,with significant differences (F =6.011,P ＜0.05).There were significant differences between the CGQL indexes before operation and at postoperative 12 and 3 months (t =16.69,10.06,P ＜ 0.05).A significant difference was also observed between the CGQL indexes before operation and at postoperative 12 months (t =27.01,P ＜ 0.05).Conclusions HIPAA is suitable for the surgical treatment of ulcerative colitis.The function of the pouch is good and the quality of life is improved.

OBJECTIVE To investigate the status of the management of nosocomial infection in Anhui Province so as to help to improve it.METHODS Twenty-four hospitals were on-the-spot investigated in a way of questioning and sampling using uniform questionnaire by trained investigators.RESULTS 95.83% Of all involved hospitals have built independent department of nosocomial infection management.These departments from 70.83% hospitals play an important role in infection management and 45.83% of them have suitable structure of staff.There are some problems in the key regions of nosocomial infection control such as operating room,blood dialyzing center and sterilization supply department: small work area,old equipment,irrational arrangement,sterilizing inadequately and so on.CONCLUSIONS The work of administration of nosocomial infections needs to be strengthened.

Objective To determine the expression of human protection of telomeres 1 (hPOT1) and its relationship with Helicobacter pylori (HP) infection in gastric carcinoma.Methods The expressions of hPOT1 protein and hPOT mRNA were detected in 53 gastric carcinoma specimens (observed group) and 20 normal gastric mucosa tissues (control group) by SP immunohistochemical method and in situ hybridization (ISH), respectively.HP infection was examined by Warthin-Starry method in observed group.Results The positive expression rate of hPOT1 protein was 84.91％ (45/53) in observed group, higher than that in control group [30.00 ％ (6/20)] (P ＜ 0.01).The positive expression rate of hPOT1 mRNA was 58.49 ％ (31/53) in observed group, higher than that in control group [10.00 ％ (2/20)] (P ＜ 0.05).The positive co-expression rate of hPOT1 protein and mRNA was 56.60 ％ (30/53), both had positive relationship in gastric carcinoma (r =0.394, P ＜ 0.05).The rate of HP infection in 53 cases of gastric carcinoma was 52.83 ％ (28/53).The positive expression rates of hPOTI protein and mRNA in observed group with HP infection were significantly higher than those in observed group without HP infection[protein: 96.43 ％ (27/28) vs 72.00 ％ (18/25), P ＜0.05;mRNA: 85.75 ％ (24/28) vs 28.00 ％ (7/25), P ＜ 0.01].Conclusions hPOT1 may be associated with occurrence of gastric carcinoma.Combined detection of hPOT1 protein and mRNA can be used for the diagnosis of gastric carcinoma.HP infection may be associated with abnormal expression of hPOT1 in occurrence of gastric carcinoma.

Objective To explore the effect of comprehensive intervention on postoperative pain of patients with rectal disease. Methods A total of 200 patients with postoperative pain after the treatment of anorectal perianal disease from May 2015 to May 2016 were randomly divided into two groups with 100 cases each. The control group was treated with drugs and usual nursing, the observation group were adopted drugs and comprehensive nursing intervention. The improvement of pain, psychological states and the quality of sleep were compared between two groups. Results The VAS pain scores at 4, 6, 12, 24, 48 h after treatment was (2.1 ± 0.6), (3.3 ± 0.4), (3.5 ± 0.3), (2.3 ± 0.5), (1.9 ± 0.5) points in the observation group, and (3.0 ± 0.5), (5.1 ± 0.6), (6.2 ± 0.6), (5.7 ± 0.8), (5.8 ± 0.5) points in the control group, and the difference was statistically significant (t=8.539-38.806, P < 0.05). The Self-rating Anxiety Scale was (20.32 ± 6.16) points in the observation group, and (35.58 ± 7.43) points in the control group, and the difference was statistically significant (t=41.188, P<0.05). The sleep quality, the amount of sleep , sleep time, sleep efficiency of Pittsburgh Sleep Quality Index Questionnaire scores was (0.91±0.28), (0.86±0.2), (0.83±0.27), (0.59±0.31), (0.62±0.27), (0.58±0.41), (4.39±1.79) points in the observation group, and (1.61± 0.88), (1.32 ± 0.75), (1.59 ± 0.89), (1.34 ± 0.58), (1.36 ± 0.45), (1.29 ± 0.86), (8.51 ± 3.55) points in the control group, and the difference was statistically significant (t=4.557-17.740, all P<0.05). Conclusions The comprehensive intervention on postoperative pain relief in patients with anal disease is significant, it is beneficial to relieve the pain response, improve sleep quality, and achieve physical and psychological comfort, and has a positive effect to clinical.

Objective To determine the relationship between osteosarcopenia and distal radius fracture in postmenopausal women.Methods Fifty-five cases who diagnosed as distal radius fracture by X-ray in the Affiliated Hospital of Shenyang Medical College from January 2018 to January 2019 was as study group,and 55 cases matched by age for postmenopausal women without distal radius fracture was as control group.Grip strength and gait speed were measured with the recommendation of Asian Sarcopenia Working Group,hip and lumbar bone mineral density(BMD),body mass index (BMI),relative skeletal muscle index (RSMI) and resting metabolic rate (RMR) were measured and compared by dual energy X-ray (DXA),and compared between two groups.Results In study group,32 cases of osteoporosis,21 cases of sarcopenia,15 cases of osteosarcopenia;while 26 cases of osteoporosis,12 cases of sarcopenia and 9 cases of osteosarcopenia in control group.The rate of sarcopenia and osteosarcopenia in study group were significantly higher than those in control group:38.2％ (22/55) vs.21.8％(12/55),27.3 ％(15/55) vs.16.4％(9/55),P＜0.01.Compared with the control group,grip strength of study group was decreased significantly:(17.4 ± 4.7) kg vs.(19.2 ± 6.1) kg,P＜0.01.However,there was no significant difference in gait speed between the two groups (P＞0.05).The RMR,RSMI,BMD of femoral and total hip in study group were significantly lower than those in control group:(1.02 ± 0.45)kcal/d vs.(1.38 ± 0.39) kcal/d,(5.21 ± 1.10) kg/m2 vs.(6.12 ± 1.20) kg/m2,(0.85 ± 0.25) g/cm2 vs.(1.12 ± 0.32) g/cm2,(0.87 ± 0.16) g/cm2 vs.(1.08 ± 0.43) g/cm2,P＜0.01.However,there was no significant difference in lumbar BMD between the two groups (P＞0.05).Conclusions Fracture prevention and post-fracture management should include evaluation and treatment of muscles and bones.The clinical significance is that increasing the muscle mass above the critical value of the elderly may help to reduce the risk of distal radius fracture.

Objective Abnormalities of lipid profile were considered as risk factors of hemorrhage after ischemic stroke. We aimed to determine the relationship between lipid levels and bleeding in minor stroke or transient ischemic attack (TIA) patients receiving antiplatelet therapy. Methods Serum total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglyceride were tested in a subgroup of 3044 consecutive patients from Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial. Patients were randomized to clopidogrel plus aspirin group or single aspirin group. The primary endpoint was any bleeding within 90 days. The secondary endpoint was severe bleeding according to the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO) definition. Cox proportional hazards models were used to assess the associations of lipid levels and outcomes. Results A total of 59 (1.9％) bleeding events occurred at 90 days. High-density lipoprotein cholesterol (adjusted HR=2.16; 95％CI 1.17-4.00, P=0.014) and age (adjusted HR=1.04;95％CI 1.01-1.06, P=0.006) were significantly associated with any bleeding. High-density lipoprotein cholesterol was also associated with severe bleeding (adjusted HR=3.05;95％CI 1.39-6.68, per 1 mmol/L increase). No correlations between outcomes and levels of total cholesterol, low-density lipoprotein cholesterol and triglyceride were found. There was no interaction of any lipid component level with randomized antiplatelet therapy. Conclusions Elevated high-density lipoprotein cholesterol is independently associated with any bleeding and severe bleeding in the patients with acute minor stroke or high-risk TIA on antiplatelet therapy.

Humans ; Survival Analysis