Objective To analyze the characteristics of the rpoB, KatG and inhA genes mutations in rifampin and isoniazid resistant Mycobacterium tuberculosis (MTB) clinical isolates in Baise district, Guangxi autonomous region. Methods 128 MTB clinical strains were collected and isolated for drug susceptibility testing, and drug resistant strain DNA was subtracted for rpoB, KatG and inhA genes mutation analysis. Results 75%(27/36)isolates carried mutations in the rpoB gene,and 59.3%(16/27)isolates carried mutations in 531 sites. 44.1%(15/34) isolates carried mutations in KatG or inhA, and 66.7%(10/15) isolates appeared in KatG 315 site, with two new mutations found in KatG 279 and 427 site. In these mutation isolates, 13.3%(2/15) mutations appeared in inhA 5, 6.7%(1/15) in inhA 16, and 20%(3/15) in both katG and inhA. Conclusions The mutation of rpoB, katG and inhA genes in TB is highly correlated with its resistance to rifampin and isoniazid in Baise district, Guangxi autonomous region. The study will provide a basis for further understanding the anti-bacterium mechanism and quick diagnostic methods for drug-resistant tuberculosis.

Objective:To investigate the effect of nurse-led multiple disciplinary team-based intervention in the prevention of venous thromboembolism in paitents undergoing general surgery.Methods:A total of 118 patients who underwent general surgery in the Tianjin First Central Hospital from May 2017 to October 2018 were divided into study group and control group by random digits table method, with 59 cases in each group. The control group received routine thrombosis prevention nursing, the study group carried out nurse-led multiple disciplinary team-based intervention. The condition of lower limbs deep venous hemodynamic was detected by color Doppler ultrasonography at 3 days after surgery, the levels of D-dimer, thrombelastograph coagulation analyzer (TEG) coagulation parameters were also measured at after 24 hours of admission and postoperative day 3, respectively.Results:The vein blood stasis rate was 94.9% (3/59) in the study group, 79.7% (12/59) in the control group, the venous blood flow of the lower 1imbs in the study group was better than that in the control group ( Z value was 2.477, P<0.05). At 3 days after surgery, the levels of D-dimer were (5.26±1.42) mg/L in the study group, (6.36±1.58) mg/L in the control group, D-dimer was decreased in study group compared to the control group, the difference was statistically significant ( t value was 3.991, P<0.05). Coagulation reaction time(R) value and solidification angle(Angel), maximum thrombus intensity(MA), composite coagulation index(CI) levels were (5.30±0.91) min, (69.64±21.93) deg, (65.40±13.76) mm and (1.23±0.20) in the study group, those index were (4.41±0.75) min, (76.64±16.02) deg, (70.98±13.39) mm, (2.09±0.36) in the control group, R value were increased and Angel, MA, CI levels were decreased in the study group compared to the control group ( t value was 2.001-15.997, P<0.05). Conclusions:Nurse-led multiple disciplinary team-based intervention improves the lower limbs deep venous hemodynamic and coagulation function, as well as reduce the incidence of venous thromboembolism.

Objective To discuss the safety and the application of the self-designed multifunctional inflatable pelvis and hip-joint fixator (MIPHF) in damage control in pelvic fracture patients.Methods The MIPHF was subjected to pressure test and quality inspection.From September 2016 to June 2017,61 pelvic-fracture patients were treated with our self-designed MIPHF as pre-hospital first-aid care according to the concept of damage control orthopedics (DCO) (MIPHF group).The control group consisted of 69 pelvic-fracture patients who had not received pre-hospital first-aid care with the self-designed MIPHF from December 2015 to August 2016.There were no statistically significant differences between the two groups in gender,age,types of pelvic fracture,and preoperative injure severity score (ISS).The study compared the two groups for the case fatality rate,volume of blood transfused during surgeries,early complication rates,fracture reduction (Matta standards),and long-term efficacy (Cole scores).Results The pressure test showed that the MIPHF had a good fixation effect on the pelvis.And the quality inspection showed that the material used for the MIPHF was in line with national standards and the safety was guaranteed.The MIPHF group had 1 death (1.6％) and the control group had 8 deaths (11.6％),which was a significant difference (x2=4.979,P=0.026).All survival patients in both groups were followed up.The MIPHF group (61 cases) received 3.0 to 18.0 months follow-up,with an average of 9.0 months.And the control group (69 cases) had 18.0 to 30.0 months follow-up,with an average of 21.9 months.In the MIPHF group,23 cases were treated conservatively,and 37 cases were treated with surgery.Among them,3 cases were fixed with external fixator,20 cases with anterior open reduction and internal fixation,9 cases with posterior open reduction and internal fixation,and 5 cases with combined anterior and posterior fixation.The timing of surgery was 1 to 20 days after injury,with an average of 4.1 days.The volume of blood transfused in the MIPHF group during surgery was 200 to 1500 ml,with an average of 628.6 ml.In the control group,27 patients were treated conservatively,and 42 patients were treated with surgery.Among them,2 cases were fixed with external fixator,24 cases with anterior open reduction and internal fixation,10 cases with posterior open reduction and internal fixation,and 6 cases with combined anterior and posterior fixation.The timing of surgery was 1 to 15 days after injury,with an average of 3.l days.The volume of blood transfused in the control group during surgery was 200 to 4000 ml,with an average of 1 707.1 ml.There was a significant difference between the two groups in intraoperative blood transfusion(Z=-2.330,P=0.020).The MIPHF group had 10 (16.4％) cases of early serious complications and the control group had 22 (31.9％) cases,which had a significant difference (x2=4.187,P=0.041).According to the criteria proposed by Matta et al.,the good rate of results for treating fractures was 82.0％ in the MIPHF group and 60.9％ in the control group,which got a significant difference (x2=6.967,P=0.008).The MIPHF group and the control group also differed significantly in their mean long-term Cole scores (27.2±4.0 versus 25.1 ±5.6,t=2.457,P=0.015).Conclusion MIPHF,which reflects the DCO concept,may be recommended as pre-hospital first-aid care for patients with pelvic fracture because it can lessen bleeding and prevent secondary pelvic injury,thus reduce case fatality rate and the incidence of complications.It can also improve the success rate of treating pelvic fracture,which will positively affect long-term outcomes.

Objective To investigate the correlations of serum Apelin-13 and fatty acid binding protein 4(FABP4)levels with metabolic and bone metabolic indicators in postmenopausal women with different bone mass.Methods A total of 145 postmenopausal women were selected as subjects and divided into three groups based on bone mineral density(BMD)test results:normal bone mass group(49 cases),osteopenia(ON)group(51 cases),and osteoporosis(OP)group(45 cases).Se-rum Apelin-13,FABP4 levels,bone metabolic indicators,and biochemical indicators were measured and compared among the three groups.Spearman correlation analysis was used to analyze the correla-tions of Apelin-13,FABP4,and other indicators with BMD.Multivariate Logistic regression analysis was performed to analyze the risk factors for OP,and the receiver operating characteristic(ROC)curve was plotted to analyze the predictive value of serum Apelin-13 for postmenopausal osteoporosis(PMOP).Results The serum Apelin-13 level in the OP group was lower than that in the ON group and the normal bone mass group(P＜0.05).No significant difference in serum FABP4 levels was found among the three groups(P＞0.05).The levels of serum parathyroid hormone(PTH),alkaline phosphatase(ALP),type Ⅰ procollagen amino-terminal propeptide(PⅠNP),type Ⅰ collagen cross-linked C-terminal peptide(CTX Ⅰ),and bone-specific alkaline phosphatase(BALP)in the OP group were higher than those in the ON group and the normal bone mass group(P＜0.05).Lumbar post-menopause BMD was positively correlated with serum Apelin-13 levels(P＜0.05),but had no cor-relation with serum FABP4 levels(P＞0.05).Lumbar BMD was negatively correlated with serum PTH,ALP,P Ⅰ NP,CTX Ⅰ,BALP,and age(P＜0.05),but positively correlated with body weight,body mass index,T-score,fasting insulin,and insulin resistance index(P＜0.05).Multi-variate Logistic regression analysis showed that serum Apelin-13,PTH,ALP,P Ⅰ NP,CTX Ⅰ,and BALP levels were independent factors influencing the occurrence of OP in postmenopausal women(P＜0.05).ROC curve results showed that the optimal cut-off value of serum Apelin-13 for predic-ting PMOP was 18.51 pg/mL,with an area under the curve of 0.716,a sensitivity of 70.0％,and a specificity of 64.4％.Conclusion Apelin-13 is lowly expressed in the serum of PMOP patients,and its expression level is closely related to lumbar BMD,which may serve as an early screening in-dicator and potential therapeutic target for PMOP.

Objective To investigate the correlations of serum Apelin-13 and fatty acid binding protein 4(FABP4)levels with metabolic and bone metabolic indicators in postmenopausal women with different bone mass.Methods A total of 145 postmenopausal women were selected as subjects and divided into three groups based on bone mineral density(BMD)test results:normal bone mass group(49 cases),osteopenia(ON)group(51 cases),and osteoporosis(OP)group(45 cases).Se-rum Apelin-13,FABP4 levels,bone metabolic indicators,and biochemical indicators were measured and compared among the three groups.Spearman correlation analysis was used to analyze the correla-tions of Apelin-13,FABP4,and other indicators with BMD.Multivariate Logistic regression analysis was performed to analyze the risk factors for OP,and the receiver operating characteristic(ROC)curve was plotted to analyze the predictive value of serum Apelin-13 for postmenopausal osteoporosis(PMOP).Results The serum Apelin-13 level in the OP group was lower than that in the ON group and the normal bone mass group(P＜0.05).No significant difference in serum FABP4 levels was found among the three groups(P＞0.05).The levels of serum parathyroid hormone(PTH),alkaline phosphatase(ALP),type Ⅰ procollagen amino-terminal propeptide(PⅠNP),type Ⅰ collagen cross-linked C-terminal peptide(CTX Ⅰ),and bone-specific alkaline phosphatase(BALP)in the OP group were higher than those in the ON group and the normal bone mass group(P＜0.05).Lumbar post-menopause BMD was positively correlated with serum Apelin-13 levels(P＜0.05),but had no cor-relation with serum FABP4 levels(P＞0.05).Lumbar BMD was negatively correlated with serum PTH,ALP,P Ⅰ NP,CTX Ⅰ,BALP,and age(P＜0.05),but positively correlated with body weight,body mass index,T-score,fasting insulin,and insulin resistance index(P＜0.05).Multi-variate Logistic regression analysis showed that serum Apelin-13,PTH,ALP,P Ⅰ NP,CTX Ⅰ,and BALP levels were independent factors influencing the occurrence of OP in postmenopausal women(P＜0.05).ROC curve results showed that the optimal cut-off value of serum Apelin-13 for predic-ting PMOP was 18.51 pg/mL,with an area under the curve of 0.716,a sensitivity of 70.0％,and a specificity of 64.4％.Conclusion Apelin-13 is lowly expressed in the serum of PMOP patients,and its expression level is closely related to lumbar BMD,which may serve as an early screening in-dicator and potential therapeutic target for PMOP.

Objective To explore the safety and feasibility of the application of day surgery management model under enhanced recovery after surgery(ERAS)concept in patients undergoing gynecologic laparoscopic surgery.Methods A non-randomized concurrent control trial was conducted on the patients who underwent laparoscopic surgery in our department from January to August 2021.A total of 92 patients admitted on odd date were assigned into Ward B of our department and served as the control group,and another 96 patients hospitalized on even date were subjected into Ward A and served as the observation group.The control group was given the routine treatment schedule,including the relevant examinations after admission and general operation procedure during hospitalization.The observation group was under a day surgery management model based on the concept of ERAS,with aid of a day surgery team and optimized perioperative management measures,including pre-hospital rehabilitation,shortening water fasting before surgery,multi-mode analgesia,preventive antiemesis,intraoperative warmth,prevention of deep vein thrombosis,immediate postoperative eating and activity,and follow-up after discharge.Postoperative subjective comfort,intestinal function recovery,social and economic benefits,postoperative complications and inflammatory indicators were compared between the 2 groups.Results In 0～6,7～12 and 13～24 h after operation,the scores of thirst,hunger,nausea,pain,abdominal distension and pharyngeal discomfort were significantly lower in the observation group than the control group(P＜0.01).The observation group had obviously shorter length of hospital stay and ealier bowel sound recovery and first anal exhaust than the control group(P＜0.01).No postoperative complication,such as fall,unplanned secondary operation or wound infection was observed in both groups.The postoperative inflammatory indicators,including procalcitonin(PCT),neutrophil percentage(Neu％)and white blood cell count(WBC)were all in the normal ranges in the 2 groups at 24 h and 3 and 7 d after surgery.Statistical differences were found in firstly postoperative mobilization,length of hospital stay,hospitalization cost and patient satisfaction between the 2 groups(P＜0.01).Conclusion ERAS-based day surgery management model has the advantages of shortening hospital stay,reducing medical costs,promoting postoperative rehabilitation,and improving the comfort and satisfaction in patients undergoing gynecologic laparoscopic surgery.