Objective To explore the effect of fortified human milk feeding on growth,metabolism and complications of premature infants during hospital stay.Methods Totally,148 premature infants of gestational age ≤36 weeks and birth weight ≤1800 g,admitted to NICU of Peking Union Medical College Hospital between January 1st,2009 and December 31st,2012,were retrospectively enrolled and divided into two groups.Infants fed predominantly (＞50％) with human breast milk,combined with human milk fortification (HMF) formula when breast milk was insufficient during hospital stay,were named HMF group (n =73),and those fed exclusively with premature formula were called premature formula feeding group (PF group,n =75).Data of infants on growth,metabolism and incidence of various complications were compared between the two groups.Clinical data were expressed with mean± standard deviation or median and quartiles [M(P25,P75)].Statistical analysis was performed with t-test,x2 test or non-parameter test.Results Among the 148 infants included,there was no significant difference in gestational age,birth weight,head circumference,length at birth,time for regaining birth weight,SGA at birth,neonatal respiratory distress symdrome,intraventricular hemorrhage (over grade Ⅲ) and asphyxia rate between HMF and PF group(all P＞0.05).Infants of the HMF group showed shorter duration of parenteral nutrition [18 d(14 d,25 d) vs 24 d (18 d,31 d),Z=-2.950,P=0.003],smaller age to achieve 120 ml/(kg · d) through enteral feeding [16 d(12 d,23 d) vs 22 d (16 d,30 d),Z=-2.895,P=0.004],smaller age to achieve total energy intake of 120 kcal/(kg · d) [11 d(8 d,15 d) vs 14 d (10 d,18 d),Z=-2.392,P=0.017] than those of the PF group.Medical cost during hospital stay in the HMF group was significantly less than in the PF group [RMB:47 078 yuan(30 802 yuan,67 039 yuan) vs 58 400 yuan (38 166 yuan,82 737 yuan),Z=-1.970,P=0.049].The time for initial feeding,rate of feeding intolerance,daily weight gain after regaining birth weight,weekly increase of body length and head circumference,weight,body length and head circumference at discharge,proportion of small for gestational age infants at discharge,z scores of both birth weight and weight at discharge showed no significant difference (all P＞ 0.05).The level of blood alkaline phosphates before discharge in HMF group was significantly higher than that of the PF group [(347.7±149.4) U/L vs (288.6±108.8) U/L,t=2.570,P=0.011].None of the other biochemical indicator showed any statistical difference.The incidence of sepsis in the HMF group was slightly lower than that in the PF group [11.0％ (8/73) vs 20.0％ (15/75)] without significant difference (x2 =2.30,P＞ 0.05),neither the morbidity of retinopathy of premature,chronic lung disease,necrotizing enterocditis of newborns (all P＞0.05).Conclusions HMF for premature infants may ensure the same growth pattern as those fed by premature formula,and it also can accelerate the enteral feeding process,reduce the incidence of sepsis and decrease the medical cost during hospital stay.

Objective To determine the human milk insulin(HMI) concentrations of healthy,gestational diabetes mellitus (GDM) and gestational impaired glucose tolerance (GIGT) lactating mothers and their correlative factors and to explore the effect of HMI on growth and development of neonates. Methods HMI of colostrum and mature milk collected from 148 healthy lactating mothers and 46 GDM/GIGT mothers were determined by radioimmnuoassay. The intergroup HMI levels were compared by Wilcoxon test. Results (1) In the GDM/GIGT group, colostrum HMI was 28.81 μU/ml(13. 84-43.14 μU/ml), significantly lower than that of mature milk which was 57.50 μU/ml(36. 70-82. 73 μU/ml) (Z=-4. 828,P=0. 000). HMI of mature milk in the healthy group was 35.88 μU/ml(25.91-46.85 μU/ml), lower than in the GDM/GIGT group (Z=-2.874,P=0.004). ( 2 ) The colostrum HMI of the mothers underwent cesarean section was 23.64 μU/ml (14.90-38.51 μU/ml) lower than in the vaginal delivery ones which was 38.89 μU/ml(23.14-65.54 μU/ml)(Z= -4. 510, P= 0. 000). (3) HMI of mature milk in mixed feeding cases was 42.58 μU/ml (26.60-73.06 μU/ml),significantly higher than that of breast feeding ones which was 36.32 μU/ml(26.00-46.16 μU/ml)(Z=-2. 377,P=0.019). (4) Both HMI in colostrum and mature milk were positively correlated with maternal BMI (P＜0.05). Conclusions The mode of delivery significantly affects the HMI in colostrum. GDM/GIGT and the feeding patterns have some effects on HMI levels in mature breast milk. The HMI level is positively correlated with maternal BMI.

Objective To determine the clinical characteristics of neonatal asymmetric crying facies and to review the latest progress in clinical research of this condition. Methods Clinical and laboratory data of a case of neonatal asymmetric crying facies syndrome admitted to Peking Union Medical College Hospital in March, 2013 was reported. Clinical charateristics, chromosome abnormalities, treatment and prognosis of neonatal asymmetric crying facies reported in China were analyzed, and pertinent literatures in China Knowledge Resource Integrated Database and CQVIP Database were reviewed. Results Eighteen Chinese reports on this syndrome were retrieved and 48 patients, 31 males and 17 females including our patient, were analyzed. Twelve patients had neonatal asymmetric crying facies and 36 patients had neonatal asymmetric crying facies syndrome. Anomalies in these children included malformations of the heart (26 cases, 72.2%), ear (11 cases, 30.6%), gastrointestinal tract (4 cases, 11.1%), cleft palate (2 cases, 5.6%) and fingers (2 cases, 5.6%). Standard chromosome analysis in three studies was normal. In one case, chromosome 22q11.2 microdeletion was not found using flucrescence in situ hyloridization analysis. There were few studies with long-term follow-up in China. Conclusions Neonatal asymmetric crying facies are complicated with a high rate of other malformations. Identification of associated malformations and close follow-up are required, and intervention should be carried out earlier so as to ensure a good outcome.

Objective To investigate the rate of lower reproductive tract infection during pregnancy and the its impact on pregnancy outcome.Methods Five hundred and twenty pregnant women were enrolled in the study who were hospitalized for delivery from Jan.2010 to Jan.2012 at Hebei Port Group Company Limited Harbor hospital.All pregnant women were performed the bacteria detection in vagina before delivery,including candida albicans,bacterial vaginosis,trichomonas,mycoplasma,trachomatis and Neisseria gonorrhoeae,group B hemolytic streptococci GBS.The pregnant outcomes were followed.According to the results of bacteria detection,107 patients (20.58％) were with varying degrees of vaginitis and they were served as positive group.Other 403 patients were served as negative group.Results (1) Of 107 vaginitis women,48 cases (44.86％) were infected with candida albicans,and 22 cases (20.56％) were with bacterial vaginosis.The infection by mycoplasma,chlamydia,group B streptococcal infections were majority,while the trichomonas vaginalis,Neisseria gonorrhoeae infection were minority.(2) Compared with the negative group,incidence of premature rupture of membranes,preterm birth,puerperal infection and fetal distress in positive group were higher and the differences were significant(15.89％ vs.5.08％,12.15％ vs.3.15％,8.41％ vs.1.94％,5.61％ vs.1.21％ ; x2 =14.642,14.498,11.264,7.934; P ＜ 0.01).Conclusion The incidence of genital tract infection is higher during the pregnancy.Bacteria infection detection should be performed and treated as early as possible in order to reduce the occurrence of adverse pregnancy outcome.

Objective To evaluate the prognostic value of three different staging system based on positive lymph nodes,lymph node ratio and log odds of positive lymph nodes in breast carcinoma.Methods In 472 breast carcinoma patients,survival analysis was performed with Kaplan-Merier and COX regression model,the hazard ratio (HR) of the three staging system were compared.Results When more than 10 lymph nodes were dissected in the operation,there was statistical differences in survival among the staging systems based on lymph node ratio and log odds of positive lymph nodes (P ＜ 0.05),while the prognosis was highly homologous between the staging systems based on positive lymph nodes in stage N0 and N1.Univariate analysis showed age,tumor size,Her2 status,estrogen receptor status and the total lymph nodes dissected were related to overall survival (all P ＜ 0.05).COX multivariate analysis showed that the staging system based on lymph node ratio (5.495) and log odds of positive lymph nodes (4.662) had the higher HR than the N staging system (2.722).Conclusions Compared with the number of involved lymph nodes,the staging system based on lymph node ratio and log odds of positive lymph nodes were superior to the staging system based on positive lymph nodes for prognostic assessment of breast carcinoma.

Objective To investigate the group B streptococcus( GBS)colonization rate and the relationship between vaginal colonization of GBS and the pregnancy outcome. Methods Five hundred and twenty cases pregnant women were selected as our subjects. Microbiological culture was used for culture of GBS in 1 / 3 of vagina and rectus before delivery,other samples from different sites after delivery(including neonatal throat,ear and placenta). Results (1)The GBS carrier rate in 520 pregnant women was 10. 19%(53 / 520). (2)GBS carrier rate in neonatal was 8. 85%(46 / 520). The carrier rate of neonatal whose mothers also carried GBS was 22. 64%(12 / 53),higher than that of non-carrier mothers(7. 28%(34 / 467),χ2 = 8. 192,P < 0. 05) . The rate of pneumonia and the upper respiratory tract infection of neonatal with GBS-carrier-mother were 20. 75%(11 / 53)and 18. 87%(10 / 53),higher than that of non-carrier mothers(8. 57%(40 / 467)and 4. 71%(22 / 467)). The pneumonia rate and upper respiratory tract infection of GBS positive neonatal were 21. 73%(10 / 46)and 19. 56%(9 / 46),higher than GBS negative one(8. 65%(41 / 474);4. 85%(23 / 474)). and there were significant differences(χ2 = 8. 121,15. 717;P < 0. 05).(3)The incidence of intrauterine infection and fetal distress of neonatal with GBS( + )mother were 47. 17%(25 / 53),15. 09%(8 / 53),significantly higher than that of negative(7. 07%(33 / 467),4. 71%(22 / 467)),and the differences were statistically significant( χ2= 77. 248,9. 440;P < 0. 05). But there were the similar incidence in term of premature rupture of fetal membranes,premature occurrence rate between GBS positive and negative mothers( 28. 30%( 15 / 53 ) vs. 28. 48%(133 / 467;3. 77%(2 / 53)vs. 2. 36%(11 / 467);χ2 = 0. 001,0. 393;P > 0. 05). The rate of GBS positive with mycotic vaginitis,placenta previa ratio were 39. 62%(21 / 53),7. 55%(4 / 53),higher than that of GBS negative one(20. 56%(96 / 467),1. 93%(9 / 467)),and the differences were statistically significant(χ2= 9. 922,6. 168,P < 0. 05). Conclusion Maternal GBS carrier at 35 - 37 weeks of gestation can lead to adverse pregnancy outcome by increasing intrauterine infection fetal distress and neonatal infections. Screening of GBS should be performed routinely in late gestation.

Objective To evaluate the effect about medication compliance for patients with chronic heart failure in outpatients using nursing intervention model based on Omaha system.Methods 100 patients were randomly divided into observation group(50 patients)and control group(50 patients).The two groups of patients were given routine nursing intervention,the observation group also used the Omaha system to develop care programs on this basis, and was given the implementation about continuity of care.Results On the point of the two or three months after the patients were discharged,the AHFKT -V2 questionnaire scores in the observation group[(17.690 ±1.892)points, (20.900 ±2.052)points]were significantly higher than the control group[(14.080 ±2.374)points,(18.450 ± 1.781)points],the differences were statistically significant (t =-8.488,-6.442,all P <0.05).However,the same as the points after the patients were discharged,Morisky questionnaire scores in the observation group[(1.036 ± 0.780)points,(0.487 ±0.260)points]were significantly lower than the control group[(1.54 ±1.182)points, (0.920 ±0.804)points],the differences were statistically significant(t =3.420,4.965,all P <0.05).Conclusion The use of Omaha system to develop the targeted continuity of care,can improve the patients medication compliance.

Objective To evaluate the levels of ghrelin, adiponectin, leptin and true insulin in human milk from mothers with and without gestational diabetes mellitus (GDM), and to assess the effects of these parameters on infant growth. Methods Fifty-two GDM mothers and their healthy infants (GDM group) and 49 non-GDM mothers and their healthy infants (control group) were enrolled from Beijing Obstetrics and Gynecology Hospital and Peking Union Medical College Hospital from January 2010 to August 2010. The levels of ghrelin, adiponectin, leptin and true insulin in colostrum and human milk 90 days postpartum (mature milk) were determined by enzyme-linked immunosorbent assay. Infant weight, length and head circumference at birth and at 90 days old were measured. The two-sample t-test, sum-rank test and Spearman correlation analysis were used for statistical analysis. Results Compared with the control group, ghrelin was significantly lower in human milk from GDM mothers both in colostrum [136.7 (102.7-181.4) vs 175.4 (137.5-235.0) ng/L, t= -2.737] and mature milk [111.8 (77.5-184.2) vs 210.9 (147.3-381.9) ng/L, t= -3.268]. Adiponectin was also significantly lower in human milk from GDM mothers both in colostrum [21.7 (14.6-51.8) vs 57.0 (23.1-113.9)μg/L, t=-2.858] and mature milk [11.7 (8.4-14.4) vs 15.1 (11.9-18.5)μg/L, t=-2.625], however, true insulin level was higher in colostrum [22.8 (13.4-50.2) vs 20.4 (7.8-30.8) mU/L, t=-2.007] and mature milk [33.6 (22.5-54.1) vs 23.5 (13.5-31.6) mU/L, t=-2.009]. The differences were statistically significant (all P < 0.05). (2) In the colostrums of the GDM group, true insulin level was negatively associated with ghrelin (r=-0.342), but positively associated with adiponectin (r=0.305). In the control group, the level of true insulin in mature milk was positive associated with leptin in colostrums( r=0.456)and mature milk(r=0.629). The differences were statistically significant (all P < 0.05). (3) In the GDM group, adiponectin level in colostrum was negatively associated with neonatal birth weight (r= - 0.323, P=0.025); the leptin/adiponectin ratio was negatively associated with neonatal birth weight (r= -0.403, P=0.005) and head circumference (r= -0.327, P=0.039) at birth. Adiponectin level in mature milk was negatively associated with infant length 90 days postpartum (r=-0.406, P=0.040). In the control group, the leptin/adiponectin ratio in colostrum was negatively associated with neonatal head circumference at birth (r= -0.370, P=0.024). Adiponectin level in mature milk was positively associated with infant weight 90 days postpartum (r=0.432, P=0.007). Conclusion Women with GDM have different levels of ghrelin, adiponectin and true insulin in their milk from the normal controls, which may affect infant growth.

OBJECTIVE:To investigate general regularity and characteristics of adverse drug reactions/events(ADR/ADE)in-duced by Dezocine injection,and to provide reference for safe and rational drug use in clinic. METHODS:Retrieved from Jiangsu Province ADR Database during Jan. 2009-Aug. 2016,ADR/ADE induced by Dezocine injection was analyzed statistically in re-spects of patient's gender and age,usage and dosage,organs/systems involved in ADR,clinical manifestations and outcome. RE-SULTS:Among 1290 ADR/ADE induced by Dezocine injection,there were 40 cases of severe ADR/ADE(3.10％);medical insti-tutions were main reporting units (1276 cases,98.81％). In ADR/ADE cases,female was more male,with ratio of male to fe-male was 1:1.45. ADR/ADE mostly occurred in 45-65 age group(43.49％). Intravenous medication was main route of administra-tion (1137 cases,88.14％). Initial dose of 577 cases was excessive dose (50.75％). ADR/ADE mainly involved gastrointestinal system (54.99％),central and peripheral nervous system (24.72％) and systemic lesions (5.20％). Severe ADR/ADE manifested as anaphylactic shock,palpitation and dyspnea,etc. But anaphylactic shock was not mentioned in drug package inserts. 1283 ADR/ADE(99.46％)were cured or improved . CONCLUSIONS:It is necessary to strengthen drug safety reevaluation of Dezocine injec-tion after being on the market,improve drug package inserts and enhance patients education as so as to reduce and avoid the occur-rence of ADR/ADE.

The rats were assigned to blank control group, classical induction group, and drynaria total flavonoid group. Whole bone marrow culture method was applied to isolate and purify rats bone mesenchymal stem cells (BMSCs). Akaline phosphatase activity, calcium nodes, TGF-β1 and BMP-2 secretion in the process of bone mesenchymal stem cells osteogenic differentiation were detected. The results showed that compared to the blank group and classical group, drynaria total flavonoid promoted osteogenic differentiation accompanied with increased TGF-β1 and BMP-2 secretion (all P＜0. 05). Drynaria total flavonoid may promote osteogenic differentiation of BMSCs via upregulating TGF-β1 and BMP-2 expressions, and play an active role in the treatment of osteoporosis.