Objective:To study the current status of longitudinal extrauterine growth restriction (EUGR) in extremely preterm infants (EPIs) and to develop a prediction model based on clinical data from multiple NICUs.Methods:From January 2017 to December 2018, EPIs admitted to 32 NICUs in North China were retrospectively studied. Their general conditions, nutritional support, complications during hospitalization and weight changes were reviewed. Weight loss between birth and discharge > 1SD was defined as longitudinal EUGR. The EPIs were assigned into longitudinal EUGR group and non-EUGR group and their nutritional support and weight changes were compared. The EPIs were randomly assigned into the training dataset and the validation dataset with a ratio of 7∶3. Univariate Cox regression analysis and multiple regression analysis were used in the training dataset to select the independent predictive factors. The best-fitting Nomogram model predicting longitudinal EUGR was established based on Akaike Information Criterion. The model was evaluated for discrimination efficacy, calibration and clinical decision curve analysis.Results:A total of 436 EPIs were included in this study, with a mean gestational age of (26.9±0.9) weeks and a birth weight of (989±171) g. The incidence of longitudinal EUGR was 82.3%(359/436). Seven variables (birth weight Z-score, weight loss, weight growth velocity, the proportion of breast milk ≥75% within 3 d before discharge, invasive mechanical ventilation ≥7 d, maternal antenatal corticosteroids use and bronchopulmonary dysplasia) were selected to establish the prediction model. The area under the receiver operating characteristic curve of the training dataset and the validation dataset were 0.870 (95% CI 0.820-0.920) and 0.879 (95% CI 0.815-0.942), suggesting good discrimination efficacy. The calibration curve indicated a good fit of the model ( P>0.05). The decision curve analysis showed positive net benefits at all thresholds. Conclusions:Currently, EPIs have a high incidence of longitudinal EUGR. The prediction model is helpful for early identification and intervention for EPIs with higher risks of longitudinal EUGR. It is necessary to expand the sample size and conduct prospective studies to optimize and validate the prediction model in the future.

Objective:To investigate the incidence, clinical characteristics and risk factors for hip fractures in patients within two years after stroke onset.Methods:A total of 332 persons with first-onset stroke from the neurology department of our hospital between 1 June 2013 and 31 December 2014 were recruited and were divided into the hip fracture group and the non-hip fracture group.Clinical characteristics were recorded.Vision was tested as normal or impaired.Patients were accessed by the National Institutes of Health Stroke Scale(NIHSS), Behavioral Inattention Test, Baking Tray Task, Mini-Mental State Examination(MMSE), Birgitta Lindmark(BL)motor assessment scale, Berg Balance Scale(BBS), Timed Up & Go(TUG)Scale, and Stops Walking When Talking(SWWT)Scale.The clinic characteristics and risk factors for hip fractures were compared between the two groups after a 2-year follow-up.The accuracy of risk factors for fracture prediction was assessed by the sensitivity, specificity, and positive and negative predictive values.Results:Of 332 patients with stroke, 16 cases fractured their hips within two years after stroke onset, which corresponded to an incidence of 33‰/year(95% CI: 15‰/year-50‰/year). The 2-year mortality rate was 44%(95% CI: 25%-60%)and 48%(95% CI: 42%-54%)in patients with and without hip fractures respectively( χ2=0.036, P=0.724). The mean survival time for patients with and without hip fracture was 2.72 years(95% CI: 1.45-2.79)and 2.21 years(95% CI: 1.48-2.34)respectively.The proportions of patients with previous fractures history( χ2=16.780, P=0.041)and impaired vision( χ2=11.210, P=0.027), MMSE scale score( U=14.220, P=0.031), TUG ≥ 15 s( χ2=18.560, P=0.000)were higher, and SWWT( χ2=20.340, P=0.000)was lower in the hip fracture group than in the non-hip fracture group.The negative predictive values of previous fractures history, impaired vision, TUG and SWWT were higher than their positive predictive value.The specificities of previous fractures history, impaired vision, and SWWT were higher than their sensitivities.And the sensitivity of TUG was higher than its specificity. Conclusions:Hip fractures after stroke are common in elderly patients.Fractures often occur during daytime at home in daily activities.The previous fractures history, visual and cognitive dysfunction and impaired functional mobility are risk factors for hip fractures.We should take measures to prevent falls according to the relevant factors.Among the test scales, the timed up & go(TUG)scale could much more accurately identify patients at high risk for hip fractures.

Some of the recombinant protein therapeutics with short half-life requires high frequent dose or injection, which results in poor patient compliance. This challenge has prompted the development of long-acting recombinant proteins in recent years. Four strategies and methods, including chemical modification, protein engineering, fusion proteins and protein glycosylation are used to modify protein molecule and finally obtain improved pharmacokinetics (PK) properties. This article reviews the four strategies of half-life extension and presents a detailed list of long-acting therapeutics on US, EU and China markets.

Objective To examine the incidence ,clinical characteristics ,and risk factors for falls within two years after stroke in elderly patients. Methods A total of 365 elderly stroke patients from the Department of Neurology at the 8th Nanning People's Hospital were recruited from June 1 , 2013 to December 31 ,2014. They were divided into a fall group and a non-fall group and were followed up for two years. The incidence and clinic characteristics of falls were analyzed. The risk factors for falls were analyzed by multiple Logistic regression analysis. Results Of the 365 stroke patients included in this study ,falls were observed in 146(40.2％ )patients. The interval between the stroke and the first fall :72(49.3％ )patients had the first fall within 3 months;22(15.1％ )occurred between 4 and 6 months;20 (13.7％ )between 7 and 12 months ;17 (11.6％ )between 13 and 18 months ;and 15 (10.3％ )between 19 and 24 months.A hundred and five(71.9％ )patients fell during daytime and 41 (28.1％ )patients during night.Eighteen(12.3％ )patients had one fall ;65(44.5％ )patients fell 2 to 4 times ;60(41.1％ )patients fell 5 to 10 times ;and 3(2.1％ )patients fell over 10 times.A total of 709 falls were observed.Places of falls :102(69.9％ )falls happened indoors and 44(30.1％ )falls occurred outdoors.Circumstances of falls :27 (18.5％ )patients fell when turning over ;23 (15.8％ )fell when rising from a seating position ;4(2.7％ )patients fell when showering ;15(10.3％ )patients fell while standing ;9(6.8％ )fell when turning around ;56(38.3％ )fell while walking ;and 12(8.2％ )fell while climbing the stairs or running.The severity of falls :52(35.6％ )patients had no injury ;78(53.2％ ) suffered soft tissue injury ;16 (11.0％ )had fractures ;and 78 (53.2％ )had fear of falling.Multiple Logistic regression analysis showed that age(OR=2.41 ;95％ CI :1.69-3.05) ,history of falls(OR =2.85 ;95％ CI :1.46-3.81) ,history of stroke(OR=1.87 ;95％ CI :1.12-2.79) ,right hemiplegia(OR=2.37 ;95％ CI :1.62-4.59) ,left hemiplegia(OR= 2.47 ;95％ CI :1.46-4.78) ,paraplegia(OR= 2.55 ;95％ CI :1.57-4.98) ,visual impairment(OR=2.35 ;95％ CI :1.35-6.62) ,apraxia(OR=2.53 ;95％ CI :1.42-5.63) ,unilateral spatial neglect (OR=3.34 ;95％ CI :2.82-6.34) ,use of psychotropic medications (OR= 1.76 ;95％ CI :1.11-1.98) ,impaired physical mobility (OR = 1.58 ;95％ CI :1.82-2.91) ,low MMSE scale(OR = 3.42 ;95％ CI :1.38-7.41) ,low Barthel Index score(OR = 2.83 ;95％ CI :0.97-4.68) ,BBS scale<45(OR=2.48 ;95％ CI :1.27-4.18) ,TUG>15seconds(OR=3.56 ;95％ CI :1.91-5.23) ,and lack of rehabilitation therapy (OR=3.42 ;95％ CI :1.38-7.41)were independent predictors for falls(all P<0.05). Conclusions Falls are common among elderly patients within two years after stroke.Most falls happen indoors ,during daytime and while moving.Age ,history of falls ,history of stroke ,hemiplegia ,visual impairment ,apraxia ,unilateral spatial neglect ,use of psychotropic medications ,walk with a walker ,low MMSE scale ,low Barthel Index score ,BBS scale<45 ,TUG>15 seconds ,and lack of rehabilitation therapy are independent risk factors for falls after stroke.

Objective To observe the therapeutic efficacy of electroacupuncture at the acupoints on extremities or abdominal acupoints and orally taking Mosapride in treating functional dyspepsia (FD) and the different effects on life style, for guiding the points selection in acupuncture-moxibustion treatment for FD.Method Sixty FD patients were randomized into an extremity-electroacupuncture group, an abdomen-electroacupuncture group, and a Western medication group by their visiting sequence, 20 cases in each group. In theextremity-electroacupuncture group, Zusanli (ST36), Sanyinjiao (SP6), Neiguan (PC6) and Gongsun (SP4) were selected. Bilateral Zusanli and Sanyinjiao were respectively connected to G6805-2 electroacupuncture apparatus, 30 min for each session, once everyother day, 10 sessions in total. In the abdomen-electroacpuncture group, Zhongwan (CV12), Tianshu (ST25), and Qihai (CV6) were selected. Bilateral Tianshu were connected to electroacupuncture apparatus, with same treatment time, frequency and sessions. The Western medication group was intervened by oral administration of Mosapride, 1 tablet each time, 3 times a day, for 20 d in total. The three groups were evaluated by using Nepean Dyspepsia Index (NDI) prior to the treatment, after the treatment and 1 month after the treatment (follow-up study), and the therapeutic efficacies were estimated after the treatment.Result The effective rate of the extremity-electroacupuncture group was higher than that of the abdomen-electroacupuncture group and Western medication group, while there was no significant difference between the abdomen-electroacupuncture group and Western medication group in comparing the effective rate. After the treatment, the improvement of Nepean Dyspepsia Symptom Index (NDSI) in the extremity-electroacupuncture group was more significant than that in the abdomen-electroacupuncture group and Western medication group (P<0.05), while there was no significant difference between the abdomen-electroacupuncture group and Western medication group (P>0.05). The 1-month follow-up showed that the improvement of symptoms in the extremity-electroacupuncture group was more significant than that in the abdomen-electroacupuncture group (P<0.05), and the improvement in the abdomen-electroacupuncture group wasmore significant than that in the Western medication group (P<0.05). After the treatment, the improvements of Nepean Dyspepsia Life Quality Index (NDLQI) in the extremity-electroacupuncture group and abdomen-electroacupuncture group were superior to the improvement in the Western medication group (P<0.05), while there was no significant difference between the two electroacupuncture groups (P>0.05). The 1-month follow-up study showed that the quality of life in the extremity-electroacupuncture group was still significantly improved compared to that before the treatment, while the improvement in the Western medication group was insignificant.Conclusion Electroacupuncture at the acupoints on extremities and abdominal acupoints both can more effectively and consistently improve the symptoms and quality of life of FD patients compared to orally taking Mosapride. Compared to electroacupuncture at the abdominal acupoints, electroacupuncture at the extremity points works better in improving the symptoms of FD butdoesn't show advantage in improving the quality of life.

Objective:To study the diuretic effect of micronized powder of Panax notoginseng (Burk.) F.H.Chen on rats.Methods:The metabolic cage method and weighing method were used in this experiment;The indictor of urine excretion in 6 h was used to study the diuretic effect of powder ofPanax notoginseng (Burk.) F.H.Chen in the water loaded rats;the output of Na +,K +,C1-in urine were measured to elucidate the related mechanization.Results:Powder of Panax notoginseng (Burk.) F.H.Chen under high dose after administration of 2h to 5h can significantly increase the urine volume of rat compared with the blank control group (P＜0.01,P＜0.05),but no diuretic effect after administration of 6h.powder of Panax notoginseng (Burk.) F.H.Chen under high dose could increase the urine Na+,Cl-(P ＜0.01) but reduce the K+ excretion,inhibitting the Na+ reabsorption and K+ excretion of renal tubule.It could significantly increase rat urine pH value (P＜0.01),the effect ofpH value by which is similar with the effect of hydrochlorothiazide and the effect of Jinqiancao granules.Conclusion:For the first time,this study investigated the diuretic effect of powder of Panax notoginseng (Burk.) F.H.Chen,The relevant mechanism is that powder of Panax notoginseng (Burk.) F.H.Chen have an impact on inhibitting the Na+ reabsorption and K+ excretion of renal tubule.

Objective:To study the influence of Rhizoma Corydalis before and after vinegar processing on the microelement content in the eye tissues of rats to verify the vinegar processing leading the herb to liver meridian. Methods: The rats were divided into the crude Corydalis group, vinegar processing group and negative group. The content of microelement Cu, Zn and Mn in rat ocular tissues was determined and compared after the administration. Results:Corydalis could significantly increase the content of Cu and Zn in fun-dus blood and that of Zn and Mn in the eyeball vitreous, and Rhizoma Corydalis after vinegar processing showed more obvious effect. Conclusion:Rhizoma Corydalis with vinegar processing can improve the distribution of microelements in eye tissues, and because liver opens at eyes, the results provide evidence for Corydalis after vinegar processing leading to liver meridian.

Objective To analyze the genetic characteristics of the complete genome of a human echovirus 30 (Echo30) KM/A363/09 strain isolated in Yunnan, China in 2009.Methods Primers specif-ic for Echo30 were designed .The extracted RNA was amplified by using RT-PCR.Seven fragments covering the complete viral genome were sequenced and the complete sequences were aligned with other sequences of enterovirus reference strains downloaded from Genbank . By using Mega5.1, Geneious, RDP3 and SimPlot3.5.1 softwares, the phylogenetic and recombination analysis were carried out .Results The com-plete nucleotide sequence of KM/A363/09 isolate was 7425 bp in length, encoding 2194 amino acids.KM/A363/09 isolate was highly similar with Bastianni prototype strain showing the homology of 81.2%in nucle-otide and 95.8%in amino acid.The eight Echo30 isolates shared 81.2%-88.6%homologies in nucleotide sequences and 95.8%-97.8%in amino acid sequences .Phylogenetic analysis showed that the KM/A363/09 strain belonged to one clade of Echo 30 in China.The genetic recombination of KM/A363/09 isolate was detected in the non-structural region .Conclusion KM/A363/09 isolate belongs to one clade of Echo 30 in China indicating that the evolution of Echo 30 has occurred in China .

Objective To observe the efficacy and side effects of exemestane in postmenopausal breast cancer patients with bone metastasis.Methods One hundred and ten postmenopausal breast cancer patients with bone metastasis were treated with exemestane 25 mg.Results In the evaluable data from 110 patients,the complete remission(CR)was encountered in 7 cases,partial remission(PR)in 28 cases,with a total response rate of 31.8％ ;Thirty nine patients had stabled diseases for more than 24 weeks.It produced a clinical benefit (CR + PR + SD)over 24 weeks in 74 cases(67.3％).Diseases progressed in 12 of the cases(10.9％).The patients with positive ER and PR status had a higher chance to be benefited from the treatment than those with negative receptor status.The clinical efficacy was not correlated with treatment history,pathological subtypes and bone,liver,lung and lymph node metastasis(x2 =0.045,0.078,0.200,P ＞ 0.05).No severe adverse effects were observed.Conclusion Exemestane is effective to treat bone metastasis of breast cancer with minor adverse reactions and good tolerability.

Objective To evaluate the effects of different doses of dexmedetomidine on the median effective concentration (EC50) of propofol given by target-controlled infusion (TCI) at loss of consciousness (LOC).Methods Eighty ASA Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,with body mass index ≤25 kg/m2,scheduled for operations under general anesthesia,were randomly allocated to one of four groups(n=20 each): control group (group C) and dexmedetomidine 0.4 μg/kg group (group D1),dexmedetomidine 0.5 μg/kg group (group D2) and dexmedetomidine 0.6 μg/kg group (group D3).Dexmedetomidine 0.4,0.5 and 0.6 μg/kg were infused intravenously over 10 min in groups D1-3,while the equal volume of normal saline was given instead of dexmedetomidine in group C.Propofol was then given by TCI and the EC50 was determined by up-and-down sequential trial.The target plasma concentration was set at 2.0μg/ml in the first patient in each group.The ratio of the target plasma concentration between the two consecutive patients was 1.1.Loss of response to eyelash stimulation and verbal command (2 times) was considered to be signs of LOC.The EC50 and 95％ confidence interval (CI) of propofol causing LOC were calculated.Complications such as bradycardia,hypotension and respiratory depression were recorded.Results The EC50 (95％ CI) of propofol causing LOC was 2.59 (2.51-2.67),2.09 (2.02-2.16),1.82 (1.70-1.95) and 1.60 (1.49-1.72) μg/ml in groups C and D1.3 respectively.The EC50 of propofol causing LOC was significantly lower in groups D1-3 than in group C.Dexmedetomidine significantly decreased the EC50 of propofol required for causing LOC in a dose-dependent manner in groups D1-3 (P ＜ 0.05).The incidences of bradycardia and hypotension were significantly lower in groups D1.3 than in group C (P ＜ 0.05).Compared with group D1,the incidence of bradycardia was increased in groups D2,3 and the incidence of hypotension was increased in group D3 (P ＜ 0.05),There was no significant difference in the incidences of bradycardia and hypotension between groups D2 and D3 (P ＞ 0.05).No patients developed respiratory depression.Conclusion The optimum dose for dexmedetomidine infused intravenously when combined with propofol given by TCI is 0.4 μg/kg and it can decrease the EC50 of propofol administered by TCI at LOC with no adverse reactions.