Objective:To investigate the effects of breast milk to total milk intake ratio during hospitalization on the duration of antibiotic therapy in preterm infants less than 34 weeks of gestation.Methods:Clinical data of preterm infants ( n=1 792) less than 34 gestational weeks were retrospectively collected in 16 hospitals of Jiangsu Province Neonatal-Perinatal Cooperation Network from January 1, 2019, to December 31, 2021. The days of therapy (DOT) were used to evaluate the duration of antibiotic administration. The median DOT was 15.0 d (7.0-27.0 d). The patients were divided into four groups based on the quartiles of DOT: Q 1 (DOT≤7.0 d), Q 2 (7.0 d27.0 d) groups. According to the breast milk intake ratio (breast milk intake to total milk intake during hospitalization×100%), they were also divided into four groups: very-low-ratio breastfeeding group (breast milk intake ratio≤25%), low-ratio breastfeeding group (25%75%). Univariate analysis ( Chi-square test and Kruskal-Wallis rank-sum test) was used to analyze the factors influencing DOT. Spearman correlation analysis and trend Chi-square test were used to explore the relationship between breast milk intake ratio and DOT. After using multiple imputations to address missing data, two models were constructed after adjusting for different factors, and multinomial logistic regression model was applied to evaluate the effects of the breast milk intake ratio on DOT. Finally, sensitivity analysis was conducted to assess the stability of the models. Results:(1) Of the 1 792 preterm infants, there were 507 (28.3%) in the Q 1 group, 422 (23.5%) in the Q 2 group, 438 (24.4%) in the Q 3 group and 425 (23.7%) in the Q 4 group. (2) The median values of DOT in the very-low-ratio, low-ratio, medium-ratio and high-ratio breastfeeding groups were 20.0 d (11.0-31.0 d), 20.0 d (11.0-32.0 d), 13.0 d (6.0-25.8 d) and 10.0 d (4.0-21.0 d), respectively. Compared with the very-low-ratio and low-ratio breastfeeding groups, the medium-ratio and high-ratio breastfeeding groups had shorter DOT (all P<0.05). (3) After adjusting for factors with P<0.1 (prenatal glucocorticoid exposure, antimicrobial use within 24 h before delivery, gestational age at delivery, birth weight, Apgar score≤7 at 1 min, neonatal respiratory distress syndrome, infectious pneumonia and early-onset neonatal sepsis) between the DOT quartile groups, it showed that medium-ratio and high-ratio breastfeeding were protective factors in contrast to very-low-ratio breastfeeding in the Q 2, Q 3 and Q 4 groups as compared with the Q 1 group [Q 2 group: OR=0.50 (95% CI: 0.30-0.85) and OR=0.36 (95% CI: 0.26-0.51); Q 3 group: OR=0.31 (95% CI: 0.18-0.55) and OR=0.20 (95% CI: 0.14-0.29); Q 4 group: OR=0.22 (95% CI: 0.12-0.42) and OR=0.17 (95% CI: 0.12-0.26)]. Conclusion:Breast milk intake accounting for over 50% of total milk intake has a positive impact on reducing DOT in premature infants requiring antibiotics, which suggests that breastfeeding should be actively encouraged.

Background: and Purpose Intracranial vertebrobasilar atherosclerotic stenosis (IVBAS) is a major cause of posterior circulation stroke. Some patients suffer from stroke recurrence despite receiving medical treatment. This study aimed to determine the prognostic value of a new score for the posterior communicating artery and the P1 segment of the posterior cerebral artery (PCoA-P1) for predicting stroke recurrence in IVBAS. Methods: We retrospectively enrolled patients with severe IVBAS (70%–99%). According to the number of stroke recurrences, patients were divided into no-recurrence, single-recurrence, and multiple-recurrences groups. We developed a new 5-point grading scale, with the PCoA-P1 score ranging from 0 to 4 based on magnetic resonance angiography, in which primary collaterals were dichotomized into good (2–4 points) and poor (0 or 1 point). Stroke recurrences after the index stroke were recorded. Patients who did not experience stroke recurrence were compared with those who experienced single or multiple stroke recurrences. Results: From January 2012 to December 2019, 176 patients were enrolled, of which 116 (65.9%) had no stroke recurrence, 35 (19.9%) had a single stroke recurrence, and 25 (14.2%) had multiple stroke recurrences. Patients with single stroke recurrence (odds ratio [OR]= 4.134, 95% confidence interval [CI]=1.822–9.380, p=0.001) and multiple stroke recurrences (OR=6.894, 95% CI=2.489–19.092, p<0.001) were more likely to have poor primary collaterals than those with no stroke recurrence. Conclusions The new PCoA-P1 score appears to provide improve predictions of stroke recurrence in patients with IVBAS.

OBJECTIVE：To optimi ze the optimal composition proportion of 4 ingredients （Panax ginseng ，Astragalus membranaceus，Polygonatum sibiricum ，Lycium chinensis ）in Compound ginseng immune-enhancing formula （CGIF），and to study immune activity and acute toxicity of the extracts with the optimal ratio. METHODS ：The cell activity test was used to screen the crude drug concentration range of 4 ingredients. After treated with different crude drug concentrations of each medicinal material，using the contents of NO ，IL-6 and TNF-α as indexes，uniform design was used to determine the optimal ratio of each ingredient in CGIF. Totally 240 mice were taken and randomly divided into 4 batches，with 60 mice in each batch. Each batch of mice was randomly divided into blank group （normal saline ），model group （normal saline ），positive drug group [levamisole ，4 mg/（kg·d）]，and optimal proportion extract of CGIF low-dose ，medium-dose and high-dose groups [ 0.952 8，1.905 6，3.811 2 g/（kg·d）]，with 10 mice in each group ；they were given medicine intragastrically ，qd，for consecutive 30 d. Except for blank group，mice in the other groups were intraperitoneally injected with cyclophosphamide [ 40 mg/（kg·d）] on the 24th day after first administration，qd，for consecutive 3 d to induce immunocompromised model. The immune activity of the optimal proportion extract was evaluated by determining visceral coefficients ，spleen lymphocyte transformation capacity ，serum contents of hemolysin，IL-2，IgM，IgG and IgA ，phagocytosis function of peritoneal macrophages. Another 20 mice were collected and given the optimal proportion extract 20 mL/kg intragastrically ，twice；acute toxicity of the formula was investigated with oral maximum tolerated dose （MTD）. RESULTS ：The optimal ratio of CGIF was that crude drug mass ratio of P. ginseng ， membranaceus，P. sibiricum ，L. chinensis was 1 ∶ 2 ∶ 2 ∶ 4. The immunological activity experiment showed that theoptimal proportion extract can significantly improve visceral indexes of mice ， spleen lymphocyte proliferation ability serum contents of hemolysin ，IL-2，IgM，IgG and IgA as well as macrophage phagocy tosis ability （P＜0.05 or P＜ 0.01）. The acute toxicity test indicated that oral MTD was over 15 g/kg，which was non-toxic. CONCLUSIONS ：The optimal proportion extract of CGIF can significantly enhance the immune function of mice and are non-toxic.

Objective:To investigate the compliance of statins and influencing factors in population with cardiovascular risks in the community.Methods:One hundred and eighty-six residents with cardiovascular disease risks in a community of Tianjin were recruited from June 2017 to October 2017. The Chinese revised version of the compliance Morisky scale was used to assess the compliance, and the influencing factors were analyzed.Results:Among all subjects 119 were prescribed with statins (64.0%,119/186) , of whom 7.6% (9/119) did not take the drug. According to the risk assessment of arteriosclerotic cardiovascular disease (ASCVD) in the next 10 years, among the 110 subjects taking the medicine, there were 18 subjects with intermediate risk and 92 with high risk. The subjects with good compliance accounted for 30.0% (33/110), and those with poor compliance accounted for 70.0% (77/110). Univariate analysis showed that education level, occupation, and drug types were significantly associated with statin compliance ( P<0.05). Multivariate logistic regression analysis showed that higher education level and fewer total drug users were correlated with better compliance ( OR=3.530 and 0.388, P<0.05) . The reasons for subjects not taking medicine were fearing of adverse reactions ( n=6, 6/9) , and thinking no symptoms and no need to have medication ( n=3, 3/9).The reasons of poor medication adherence were thinking no symptoms and no need to have medication ( n=31, 40.2%), thinking ineffectiveness of medication ( n=28, 36.4%), fearing of adverse reactions ( n=16, 20.8%), and economic pressure ( n=2, 2.6%). Conclusions:The proportion of residents with poor compliance of statins is high in the community. It is suggested that targeted interventions and standardized management for subjects with cardiovascular risks should be conducted based on the related factors found in the study.

Objective:To evaluate the effect of general practice service based on network platform in health management of patients with multiple chronic conditions (MCC).Methods:Based on network platform, the general practitioners provided health management service for 626 MCC patients in a petrochemical company in Panjin city of Liaoning province from June 2015 to June 2016. The individualized health management plan included health counseling, diet and exercise guidance, health information delivery, health file establishment, and rational medication guidance. After intervention the patient activeness, quality of life, clinical variables were evaluated.Results:Ninety participants dropped out of study (14.38%, 90/626), the questionnaire survey was conducted in rest 536 participants. After 1-year intervention, the scores of physical functioning, role-physical, general health, vitality, social functioning, role-emotional, mental health, and total scores in SF-36 were significantly increased ( F=12.350, 13.215, 10.515, 29.114, 42.972, 10.951, 89.783 and 33.311, respectively, all P<0.05); the values of BMI, waist, systolic and diastolic blood pressure, total cholesterol, triglycerides, low density lipoprotein cholesterol, fasting blood glucose were significantly decreased( F= 30.039, 33.849, 7.152, 27.453, 59.938, 214.270, 73.488 and 62.014, respectively, all P<0.05); the values of high density lipoprotein cholesterol were markedly increased ( F=16.491, P<0.01); the overall scores of activation were increased ( F=9.471, P<0.01), the level of activation was changed (χ 2=16.183, P<0.05); but there was no change in body pain ( F=1.486, P=0.227). There was a weak correlation between patient activation and the general health ( r=0.099, P=0.013), vitality ( r=0.101, P=0.011), mental health ( r=0.099, P=0.013). Conclusion:General practice service based on network platform is feasible and effective for patients with multiple chronic conditions, after the implementation, the activation and the health outcomes are improved significantly.

Objective:To investigate the clinical characteristics and prognosis in adult acute myeloid leukemia (AML) patients with FLT3-ITD and CEBPA double-mutated (CEBPAdm) co-mutation.Methods:Clinical data and prognostic factors were retrospectively analyzed in adult AML patients with FLT3-ITD and CEBPAdm co-mutation at The First Affiliated Hospital of Zhengzhou University from January 2016 to September 2018.Results:Among 599 non-acute promyelocytic leukemia (APL) patients, 268 received gene mutation detection, who were divided into 4 groups including 19 FLT3-ITD positive (FLT3-ITD +) and CEBPAdm positive (CEBPAdm +) cases (group A) , 84 FLT3-ITD + and CEBPAdm - cases (group B) , 95 FLT3-ITD - and CEBPAdm + cases (group C) , 70 double negative mutation cases (group D) . Gender, platelet count, FAB classification, induction treatment regimen and fusion gene mutation were comparable among four groups ( P>0.05) , while age onset, peripheral white blood cell (WBC) count, hemoglobin, percentage of blasts in peripheral blood, percentage of blasts in bone marrow, complete remission rate (CR 1 rate) after the first induction chemotherapy, the relapse rate, the median progression-free survival (PFS) time, and median overall survival (OS) time were significantly different between groups ( P<0.05) . When compared in pairs, gender, age onset, hemoglobin, platelet count, FAB classification in group A were not statistically different compared to group B, C and D ( P>0.05) , while patients in group A had higher WBC count, blasts in peripheral blood, minimal residual disease (MRD) in bone marrow. The CR 1 rates of group A, B, C, and D were 50.0%、32.4%、59.8%、39.0% respectively ( P=0.003) , and the relapse rates were 55.6%, 50.0%, 21.1%, 40.0% ( P<0.001) . As to survival, the median OS in each group was 6.25, 3.0, 15.5, 10.5 months respectively ( P<0.001) , and the median PFS was 5.0, 4.0, 10.0, 6.7 months ( P=0.032) . Conclusion:Adult AML patients with FLT3-ITD and CEBPAdm co-mutation have a higher leukemia load and low CR 1 rate, which translates into poor prognosis with high relapse rate and short survival time.

Objective To analyse the relationship between lymphatic vessels invasion and clinical pathological features of papillary thyroid carcinoma ( PTC ) .Methods The expressions of D2-40 and CK19 were examined in the 104 specimens of PTC using immunohistochemical staining with combined monoclonal antibodies and cocktail double enzyme labeled antibody( D2-40/CK19) stainings.The two methods were compared in the diagnosis of PTC metastasis, and the factors affecting lymphatic vessels formation were analyzed.Results The positive rate of lymphatic vessels invasion was 37.5%(39/104) by using immunohistochemical staining with combined monoclonal antibodies and 53.8%( 56/104 ) by cocktail double enzyme labeled antibody ( D2-40/CK19 ) staining ( P<0.05).The lymph node metastasis rate was 83.9%(47/56) in the group with lymphatic vessels invasion, significantly higher than that without invasion 22.9%(11/48, P<0.01).The age of patients, diameter of primary tumor were the influence factors of lymphatic vessels invasion in PTC patients(P<0.05 and P=0.063).Conclusion Cocktail double enzyme labeled antibody ( D2-40/CK19 ) staining is a better method to detect lymphatic vessels invasion in PTC than immunohistochemical staining with combined monoclonal antibodies.

Objective To investigate the relationship between KRAS,NRAS and BRAF gene mutations and clinicopathological parameters in patients with colorectal carcinoma (CRC).Methods By using TagMan real-time PCR method KRAS/NRAS/BRAF hotspot mutations were detected in 260 cases of CRC.The associations between KRAS/NRAS/BRAF mutation status and clinical pathological characteristics were analysed in different groups divided by gender,age,tumor size,tumor differentiation.Results (1) The KRAS hotspot mutations were G12D,G12A,G12R,G12C,G12V,G12S in codon 12 and G13 C,G13D in codon 13.They were identified in 43.1％ CRC.KRAS mutation rate was higher in females than in males (P =0.05) and the mutation rate in patients ≥ 60 years was significantly higher than that in patients ＜ 60 years(P =0.008).The incidence of metastasis and mortality were higher in KRAS mutant than in KRAS wild type (P =0.004,P =0.037).(2)The NRAS hotspot mutations were in codon1 2,13 and 61.They were identified in 4.6％ CRC.NRAS mutation rate was significantly higher in patients ≥ 60 years and well-differentiated tumors (P =0.032,P =0.042).(3) The mutation rate of BRAF V600E in CRC patients was 4.6％.BRAF V600E mutation rate was significantly higher in patients ≥60 years,with distant metastases and tumors ＞ 5 cm (P =0.032,P =0.026,P =0.038).The incidence of metastasis and rucurrence and mortality were higher in BRAF mutant (P =0.030,P =0.002,P =0.007).Conclusions In CRC patients,KRAS mutations correlate with demographic factors,metastasis and mortality,NRAS mutations correlate with age and tumor differentiation,while BRAF mutation correlate with age,tumor size,metastasis,recurrence and mortality.

Objective To study the pathologic features,differential diagnoses and pathogenesis of splenic vascular tumors.Methods The records of 7 patients with splenic vascular tumors were reviewed.Immunohistochemical studies were performed by EnVision assay.Results The histopathologic diagnoses were hemangioma (n=2),lymphangioma (n=2) and hemolymplangioma (n=3 ).Positive immunoreactivity of CD31 and CD34 was found in vascular endothelial cells,and D2-40 expression was only identified in lymphatic endothelial cells.Conclusions Immunohistochemical staining of D2-40,CD31,CD34 was very helpful in the diagnosis of splenic vascular tumors.

AIM: To investigate the protective mechanism of extract of Ginkgo biloba (EGB) on apoptosis of hippocampus neuronal cells in type 1 diabetic encephalopathic rats. METHODS: Thirty-six male Sprague-Dauley rats were divided into 3 groups: control group, diabetic group and EGB-treated group. Streptozotocin was injected intraperitoneally to the animals in later two groups to induce diabetes. The rats in EGB-treated group were injected intraperitoneally with EGB, and the same volume of normal saline was injected to the rats in other groups. At the end of the 12th week, the spatial learning and memory abilities of rats in each group were examined by Morris water maze test. Blood glucose and serum insulin concentration were measured. The neuron densities in hippocampus were measured by Image-Pro Plus 6.0 software. The expressions of Bax, Bcl-2, caspase-3 were assayed by Western blotting and immunohistochemistry. RESULTS: Compared to control group, the level of blood glucose (P<0.01), the protein expression of Bax (P<0.01) and caspase-3 (P<0.01) in hippocampus neuronal cells, and the ratio of Bax/Bcl-2 (P<0.01) and the escape latency (P<0.01) in diabetic group, were significantly increased, while the serum insulin concentration (P<0.01), the neuronal density (P<0.05) in CA1,CA2 hippocampal regions and the platform searching score (P<0.01) were significantly deceased. After treated with EGB, the serum insulin concentration (P<0.05), the neuronal density (P<0.05) in CA1,CA2 hippocampal regions and the platform searching score (P<0.01) were significantly increased, while the level of blood glucose (P<0.01), the protein expression of Bax (P<0.05), caspase-3 (P<0.05) in hippocampus neuronal cells, the ratio of Bax/Bcl-2 (P<0.01) and the escape latency (P<0.05) were significantly deceased than those in diabetic group. The protein expression of Bcl-2 in hippocampus neuronal cells did not alter in any experimental rats. CONCLUSION: EGB improves the spatial learning and memory capacity in diabetic rats by decreasing the expression of Bax, Bax/Bcl-2 ratio and down-regulating caspase-3 to reduce neurocyte apoptosis and increase the neuron density in CA1, CA2 hippocampal regions, suggesting that effective regulation of neuron apoptosis associated genes may be one of the mechanisms for EGB to treat diabetic encephalopathy.