Objective To investigate thermal degradation kinetic characteristics of Cefmenoxime Hydrochloride in infusion solutions, and predict its thermal stability. Methods The HPLC was applied to determine the contents of Cefmenoxime Hydrochloride. Classical isothermal kinetic method and multivariate linear model were used to predict the expiration date of the injection. Results It was found that the thermal degradation kinetics of Cefmenoxime Hydrochloride in two infusion solutions corresponded with the first-order kinetics. The expiration dates of Cefmenoxime Hydrochloride in 0. 9%sodium chloride injection calculated by two different methods were 2. 20 days and 1. 52 days,and in 5% glucose injection were 2. 09 days and 1. 53 days,respectively. Conclusion The thermal stability of Cefmenoxime Hydrochloride in infusion solutions is poor and its expiration dates are the same calculated by two different methods.

Objective To evaluate the effects of gestational weight gain(GWG) in different prepregnant body mass index (BMI) women on perinatal outcomes and to provide evidences for gestational weight management protocol.Methods Totally,2409 healthy singleton pregnant women accepted regular prenatal examinations in Nanjing Drum Tower Hospital from January 2009 to April 2010 were recruited in this study.They were divided into three groups according to pre-pregnant BMI,which were low BMI group (BMI＜18.5),normal BMI group (BMI 18.5-) and high BMI group (BMI≥24.0).According to GWG,the difference between pre-delivery maximal weight and prepregnant weight,the low and normal BMI women were divided into ＜10 kg,10 kg-and ≥15 kg GWG subgroups,and the high BMI women were divided into ＜5 kg,5 kg-,10 kg and ≥15 kg GWG subgroups.Data including gestational age,delivery modc,newborns' birth weight,Apgar score and incidences of gestational complications,such as hypertensive disorders complicating pregnancy (HDP),gestational diabetes mellitus (GDM),macrosomia,fetal growth restriction (FGR) and preterm birth,were recorded.Analysis of variance,Student-Newman Keuls,Chi-square test and Fisher exact test were applied for statistics.Results (1) Among the 2409 women,the percentages of low,normal and high BMI groups were 18.5％ (n=445),69.9％ (n=1685) and 11.6％ (n=279),respectively.The incidences of HDP,GDM,macrosomia and caesarean delivery in high BMI group were 12.9％ (n=36),17.9％ (n=50),13.6％ (n=38) and 52.3％ (n=146),respectively,higher than those in low BMI group [3.4％ (n=15),4.3 ％ (n=19),3.8％ (n=17) and 25.8％(n=115),x2 =23.8,37.1,23.5 and 50.2,P＜0.05] and those in normal BMI group [5.5％ (n=92),7.8％ (n=132),7.8％ (n=132)and 31.6％ (n=532),x2=21.8,29.0,10.1 and 3.4,P＜0.05].(2) In normal BMI group,the rates of FGR and preterm birth in GWG ＜10 kg subgroup were 3.5％ (4/115) and 8.7％ (10/115),higher than those in GWG 10 kg-subgroup [0.7％(4/548) and 3.3％(18/548),x2=6.0 and 6.9,P＜0.05] and GWG ≥15 kg subgroup [(0.8 ％ (8/1022) and 3.6％ (37/1022),x2=7.2 and 6.7,P＜0.05].The rates of macrosomia and cesarean delivery in GWG ≥15 kg subgroup were 10.7％ (109/1022) and 34.5％ (353/1022),higher than those in GWG＜10 kgsubgroup [3.5％ (4/115) and 32.2％ (37/115),x2=6.0 and 63.0,P＜0.05] and GWG 10 kg subgroup [3.5％ (19/548) and 25.9％ (142/548),x2=24.7 and 31.0,P＜0.05].(3) In high BMI group,the incidences of all pregnancy complications and perinatal outcomes did not show statistical significance among the four GWG subgroups (P＞0.05).Conclusions High prepregnant BMI is a high risk factor of pregnancy complications.It is suggested that normal BMI women should control GWG at 10-15 kg to lower the incidences of pregnancy complications.

Objective: To compare the treatment effect and adverse reaction of oxaliplatin and tiggio and paclitaxel or docetaxel combined with oxaliplatin or cisplatin and fluorouracil or tiggio in the treatment of advanced gastric cancer. Methods: From January 2015 to April 2018, 60 patients with advanced gastric cancer were selected from Department of Oncology of the First Affiliated Hospital of Anhui Medical University.The patients were randomly divided into two groups according to the principle of simple randomization, with 30 cases in each group.The control group was treated with oxaliplatin + tiggio.The observation group was given paclitaxel (or docetaxel) combined with oxaliplatin (or cisplatin) and fluorouracil.The incidence of adverse reactions(hematotoxicity and non-hematologic toxicity), the efficacy(CR, PR, SD, PD) of the two groups were compared. Results: The RR level of the observation group was 66.7%, which was significantly higher than 40.0% of the control group (χ²=4.286, P<0.05). There were no statistically significant differences between the two groups in incidence of adverse reactions such as thrombocytopenia, impaired liver function, anemia, oral mucositis, nausea and vomiting and neurotoxicity(all P>0.05). Conclusion Treatment of advanced gastric cancer with FLOT or DCF can improve efficacy without increasing side effects.

Objective:To investigate the predictive value of serum C-type lectin-like receptor 2 (CLEC-2) combined with insulin resistance in the outcome of patients with acute ischemic stroke (AIS) after intravenous thrombolysis.Methods:Patients with AIS received alteplase intravenous thrombolytic therapy in the Department of Neurology, the Second Affiliated Hospital of Nantong University from October 2019 to March 2021 were enrolled retrospectively. According to the modified Rankin Scale score at 90 d after onset, they were divided into good outcome group (0-2) and poor outcome group (>2). Homeostasis model assessment of insulin resistance (HOMA-IR) was used to evaluate insulin resistance. Person correlation analysis was used to determine the correlation between CLEC-2 and HOMA-IR. Multivariate logistic regression analysis was used to determine the correlation between serum CELC-2, HOMA-IR and the outcome after intravenous thrombolysis. Receiver operating characteristic (ROC) curve was used to determine the predictive value of serum CLEC-2 combined with HOMA-IR for poor outcome after intravenous thrombolysis. Results:A total of 100 patients were enrolled (56 males, 56.0%; aged 70.6±10.86 years, range 49-83 years). The baseline National Institutes of Health Stroke Scale (NIHSS) score was 10.00±6.36. Senenty-four patients (74.0%) had a good outcome and 26 (26.0%) had a poor outcome. Person correlation analysis showed that there was a significant positive correlation between serum CLEC-2 and HOMA-IR ( r=0.523; P<0.001). Multivariate logistic regression analysis showed that after adjusting for confounding factors (C-reactive protein, baseline NIHSS score, onset-to-needle time), the highest quartile of serum CLEC-2 (compared with the lowest quartile: odds ratio [ OR] 4.836, 95% confidence interval [ CI] 1.105-21.169; P=0.036) and the highest quartile of HOMA-IR (compared with the quartile 1-3: OR 15, 95% CI 2.647-30.722; P=0.002) were the independent risk factors for the poor outcome in patients with AIS after intravenous thrombolysis. ROC curve analysis showed that the area under the curve for serum CLEC-2 combined with HOMA-IR to predict poor outcome was 0.785 (95% CI 0.688-0.883; P<0.001), the optimal cut-off value was 0.72, and the sensitivity and specificity were 76.0% and 95.0%, respectively. Conclusion:CLEC-2 combined with insulin resistance has a certain predictive value for the poor outcome of patients with AIS after intravenous thrombolysis.

OBJECTIVE：To e xplore the health economic burden of hypertension patients at county-level areas and its influential factors in China. METHODS ：A questionnaire survey was conducted on hypertension patients in 7 county-level public hospitals from 6 provinces as Hebei ，Shandong，Shanxi provinces by using a convenient sampling method. Catastrophic health expenditure was defined by the standard of “medical and health expenditure exceeding 10％ of household income ”. The incidence ， average gap and relative gap of catastrophic health expenditure were analyzed. A multi-factor Logistic regression model analysis was used to analyze the influential factors that lead to catastrophi c health expenditure. RESULTS ：A total of 1 378 questionnaires were sent out ，and 925 valid questionnaires were collected with effective rate of 67.13％ . The incidence of catastrophic health expenditure，average gap and relative gap among hypertension patients were 23.03％，19.37％ and 84.12％，respectively. At different income levels ，the incidence of catastrophic health expenditure，average gap and relative gap were 72.67％ ， 96.79％ and 133.18％ in the poorest household group ，and were 1.94％ ，0.47％ and 24.23％ in the richest household group. Among different types of medical insurance ，the incidence of catastrophic health expenditure in patients covered by “New Rural Cooperative Medical Scheme （NRCMS）”the highest （31.30％）. The household income ，complications and the type of health insurance had significant impacts on the incidence of catastrophic health expenditure in hypertension patients （P＜0.05）. CONCLUSIONS：The incidence of catastrophic health expenditure in hypertension patients with different income levels is different. As the income level raised ，the incidence of catastrophic health expenditures continued to decrease. But the protection of household health expenditure by NRCMS is weak. It is suggested that a certain policy preference should be given to families with low income and patients with chronic diseases ，so as to ensure the rights and interests of patients with hypertension .

Objectives To develop a multi-stage and multi-epitope vaccine, which consists of epitopes from the early secretory and latency-associated antigens of Mycobacterium tuberculosis (MTB). Methods The B-cell, cytotoxic T-lymphocyte (CTL) and helper T-lymphocyte (HTL) epitopes of 12 proteins were predicted using an immunoinformatics. The epitopes with antigenicity, without cytotoxicity and sensitization, were further screened to construct the multi-epitope vaccine. Furthermore, the proposed vaccine underwent physicochemical properties analysis and secondary structure prediction as well as 3D structure modeling, refinement and validation. Then the refined model was docked with TLR4. Finally, an immune simulation of the vaccine was carried out. Results The proposed vaccine, which consists of 12 B-cell, 11 CTL and 12 HTL epitopes, had a flexible and stable globular conformation as well as a thermostable and hydrophilic structure. A stable interaction of the vaccine with TLR4 was confirmed by molecular docking. The efficiency of the candidate vaccine to trigger effective cellular and humoral immune responses was assessed by immune simulation. Conclusion A multi-stage multi-epitope MTB vaccine construction strategy based on immunoinformatics is proposed, which is expected to prevent both active and latent MTB infection.
Mycobacterium tuberculosis/metabolism* ; Molecular Docking Simulation ; Toll-Like Receptor 4 ; Epitopes, T-Lymphocyte/chemistry* ; Epitopes, B-Lymphocyte/chemistry* ; Vaccines, Subunit/chemistry* ; Computational Biology/methods*