Arsenic is a toxic metalloid, which may enter the human body through a variety of routes, including drinking water, food, and air. Previous studies have shown that arsenic exposure during pregnancy may cause pregnancy complications and adverse pregnancy outcomes, and maternal arsenic levels correlate with neonatal neurodevelopment and adult health. However, the negative impact of arsenic exposure during pregnancy on maternal and child health has not been widely accepted because of inconsistent study conclusions and unclear mechanisms. Based on international and national studies pertaining to the effect of arsenic exposure during pregnancy on maternal and child health during the period between 2007 and 2022, this review describes the influencing factors and biomarkers of arsenic exposure during pregnancy, associations of arsenic exposure during pregnancy with pregnancy complications and adverse pregnancy outcomes and impact of arsenic exposure during pregnancy on neonatal neurodevelopment, and discusses the mechanisms underlying negative health effects caused by arsenic exposure during pregnancy, so as to provide the evidence for assessing the hazards of arsenic exposure during pregnancy and formulating the control strategy.

Objective:To investigate and analyze the current status of patient satisfaction and the influencing factors at private hospitals in Guizhou Province,and thus to provide a scientific basis for the management of medical service at private hospitals.Methods:The satisfaction scores were statistically described and analyzed by the factor analysis and multiple linear regression analysis.Results:The overall satisfaction score of patients was (3.87 ± 0.85),of which the satisfaction of medical technology,drug price,inspection fee,and medical facilities was lower.The factor analysis showed that satisfaction of patients at private hospitals could be classified into the environment,the quality of service,medical expense,and service flow.Multivariate linear regression results showed that its standardized partial regression coefficient by the parameter descending order followed as medical expense,the environment,the quality of service,and then service flow.Conclusions:Private hospitals should set up a fair medical expenditure mechanism,improve the environment and quality of medical services,and optimize service flow in order to improve patient satisfaction.

Objective To compare the effects of three artificial abortion methods, Mifepriston with Misopro-fil,Rivanol with Mifepristone and Rivanol,in mid-term pregnancy. Methods 235 women who were pregnant for 12 to 28 weeks and volunteered to abort with drugs were selected and observed. The total subjects were randomly divided into three groups,study group Ⅰ (n=80),study group Ⅱ (n=78),and control group (n=77). In study group Ⅰ, each was given Mifepristone 50 mg, po, bid, for 3 days. On the fourth day, Misoprofil 200-1000 μg was administered though vagina. In study group Ⅱ, Rivanol(70-100 mg) was injected into amniotic cavity and at the same tame, Mife-pfistone,75 mg was given bid,po,for each case for 1 day. In study group Ⅲ,each case was injected with Rivanol (70-100 nag) only into amniotic cavity. Results The complete abortion rate in study group Ⅰ, Ⅱ and Ⅲ was 88.75% (71/80), 65.38% (51/78), 38.96% (30/77) respectively. The success rate was 98.75% (79/80), 71.79% (56/78),76.62% (59/77) respectively. The mean time from the initial uterine contraction to the expulsion of the fetus and placenta was (6.85±3.68) h, (8.87±3.58) h, (14.67±3.50) h respectively. The volume of in-trapartum and postpartum vaginal hemorrhage within 2 hours was (80.86±40.28) ml, (94.70±42.35) ml, (120. 68±43.30)ml respectively. The complete abortion rate and success rate in study group Ⅰ was significantly greater than that in study group Ⅱ and study group Ⅲ. In addition, the birth process was shorter and the vaginal hemorrhage was less significantly in study group Ⅰ than those in the other two groups (P<0.01). The complete abortion rate in study group Ⅱ was significantly greater than that in study group Ⅲ (P<0.01). Conclusions Mffepristone admin-istered with Misoprpfil has many advantages usages, such as high complete abortion rate and success rate, short birth process, and less volume of vaginal hemorrhage, when used for artificial abortion in mid-term pregnancy. They are es-pecially suitable for the mid-term artificial abortion under 20-week pregnancy. Rivanol administered with Mifepristone can raise complete abortion rate,shorten labor process and decrease vaginal hemorrhage when they are used in artifi-cial abortion. They are suitable for the mid-term artificial abortion above 16-week pregnancy. The stage of labor lasts long when using only Rivanol for artificial abortion. The pain is relatively heavier and the rate of incomplete abortion is higher.

Remarkable achievements have been made for lymphocyte infusion of lymphoma and leukemia, especially of lymphoproliferative disease within twenty-first century. The donor lymphocyte infusion or mobilized donor lymphocyte infusion (DLI/DSI) offer an opportunity of second remission for relapse patients post-transplantation. Cytokine-induced killer/DC cytokine-induced killer play an anti-tumor activity beyond non-MHC restricted. Cytotoxic lymphocyte infusion activated by synthetic tumor antigen produces targeted effects of anti-tumor. Transgenic CTL of anti-tumor TCR has brought the dawn in lymphoma and leukemia patients with defective lymphocytes. Maternal lymphocyte infusion play an anti-tumor/viral activity by avoiding the immune barrier of HLA mismatch.

Objective To explore the effect of electromyogram-triggered neuromusclar stimulation (ETNS) on motor function of upper limbs of stroke patients. Methods 45 stroke patients from July, 2011 to December, 2012 in China Rehabilitation Research Center were randomly divided into control group (n=15), neuromuscular electrical stimulation (NMES) group (n=15) and ETNS group (n=15). 3 groups were given routine medication and rehabilitation treatment. They were assessed with the largest surface electromyography (sEMG), Simple Test for Evaluating Hand Function (STEF), and modified Barthel Index before and after treatment. Results After treatment, the range of sEMG of extension carpi radialis and STEF improved in three groups (P<0.05). NMES group and ETNS group were better than the control group (P<0.05), and ETNS group was better than NMES group (P<0.05). The scores of modified Barthel Index rose (P<0.05), NMES group and ETNS group were better than the control group (P<0.05). Conclusion Both NMES and ETNS can improve the motor recovery of upper limbs after stroke, and ETNS is more effective.

Objective To test the accuracy of a three-dimensional dose verification system CompassR,which reconstructing dose distribution based on measurements and independent dose calculation,and to evaluate the feasibility of its application in clinical intensity-modulated radiotherapy (IMRT) quality assure.Methods A set of square-wave chart patterns of 2 cm,1 cm and 0.5 cm gaps was designed and 11 completed IMRT lung plans were selected for the test.EDR2 film and the ionization chamber were used for test and verifying of plane dose distribution and some special points dose of CompassR.The IMRT phantom plans were verified by CompassR with three-dimension based on anatomical information.Parameters including the volume γ pass rate and the average dose deviation were tested using dose volume histograms.Results In square-wave chart patterns test,the dose distribution reconstructed and calculated by CompassR coincided with the measurement using film.The γ pass rates (3％/3 mm,2％/2 mm) exceeded 90％.When the width of field is 0.5 cm,the γ pass rate was a little lower on account of the penumbra zone.Compared to the dose distribution profile which was measured by film,the maximum deviations of the dose distribution profile which was reconstructed and calculated by CompassR were 3.21％ and 2.70％.The absolute dose deviation of specific point in the IMRT plans was less than 3％,the maximum deviation occurred in the lung.Compared to film,the averageγpass rates on the isocenter plain in IMRT plan were (94.65 + 1.93)％ (3％/3 mm) which was reconstructed by CompassR.In three-dimensional dose verification,the volume γ pass rates of targets and risk organs were not less than 90％,and the deviation of average dose was less than 1％.Conclusions Accuracy of the tested system satisfies the demand of IMRT dose verification.CompassR could provide information of volumetric dosimetry and anatomical location of dose error,which is benefit for evaluating the clinical value of verification result.

ObjectiveTo evaluate endovascular stenting for TASC TASC Ⅱ C/D femoropopliteal arterial disease.MethodsBetween January 2008 and June 2011,Endovascular treatments of 51 limbs TASC Ⅱ C/D femoropopliteal artery occlusions in 46 patients(27 male and 19 female) were retrospectively reviewed.Mean age was (70 ± 8 ) years ( range,52 years to 88 years).Severe intermittent claudication,rest pain,minor tissue defect and foot ulceration or gangrene were in 29 limbs,12 limbs,6 limbs and 4 limbs,respectively. Technical success rate,ankle brachial index (ABI),complication rate, and cumulative primary patency rate were evaluated. ResultsTechnical success rate was 90.2％.93 stents were placed in 46 limbs of the 42 patients.Postoperative ABI was increased in all patients.42 patients(46 lower limbs) were followed up for a mean period of 14.6 months.Primary,assisted-primary,and cumulative patency rates at 6 months were 81.0％,88.1％ and 90.5％.Primary,assisted-primary,and cumulative patency rates at 12 months were 66.7％,71.8％ and 79.5％ respectively. ConclusionsEndovascular treatment of TASC Ⅱ C/D femoropopliteal arterial lesions is microinvasive,safe and effective.

ObjectiveTo compare the accuracy of enhanced dynamic wedge (EDW) models of adaptive convolution algorithm (ACA) in Pinnacle3 9.0 and anisotropic analytical algorithm (AAA),and pencil beam convolution (PBC) algorithms in Eclipse7.3 treatment planning systems (TPS).MethodsTo evaluate the accuracy of the three algorithm models,we compared actual measurement values with TPS calculation values of EDW wedge factors under for different fields in which Varian-21EX 6 MV X-ray was applied,and also compared the actual dose distribution profile with that of TPS.ResultsThe deviations of EDW wedge factors of symmetry fields and asymmetric fields are within 2.8％ and 19.4％ for ACA in Pinnacle3 9.0.Meanwhile,the deviations are 1.0％ and 2.0％ for AAA,1.2％ and 3.0％ for PBC in Eclipse7.3.The deviations between measurement and calculation of all fields profile for ACA is within 3％ and within 2.7％ for AAA within 4.0％ for PBC in wedge direction.For the dose distributions,we evaluated the pass rates of three algorithms using gamma analysis.The gamma pass rates among all the three algorithms in symmetry and asymmetric fields are above 87％ and 85％ respectively.After the removal of the penumbra zone,the pass rates among all the three algorithms are above 96％ in symmetry fields,and above 95％ in asymmetric fields,respectively.Conclusions AAA and PBC algorithms in symmetric and asymmetric fields can meet the need of clinical applications.While,wedge factor of ACA should not be used in clinical due to its greater error in asymmetric fields.

Objective To investigate the application of a self-made positioning device in CT-MRI image fusion in patients with laryngeal tumor,as well as the precision of image fusion and the changes in target volume delineation after fusion.Methods A total of 10 patients with laryngeal cancer were enrolled,and a self-made positioning device was used to collect CT and MRI images in a fixed position.These images were fused by mutual information combined with manual fusion.The precision of image fusion was assessed by the positional deviation of internal and external markers and degree of gross tumor volume (GTV) overlap (PCT-MRI) between CT and MRI images.GTV was contoured based on CT images (VCr),MRI images (VMRI),and fused images (VCT+MRI).The overlapped volume of VCT and VMRI(VCT-MRI) Was calculated,and the target volume was analyzed and compared.Results The positional deviations of three external markers in the three directions were 0.996±0.222 mm,1.146±0.291 mm,and 1.368±0.298 mm (P=0.000),respectively,while those of the internal markers were 0.476±0.151 mm,0.561±0.083 mm,and 0.724± 0.125 mm (P=0.000),respectively.VCT,VMRI,VCT+MRI,and VCT-MRI were 26.355±7.876 cm3,33.556± 7.407 cm3,40.036±7.627 cm3,19.875±8.588 cm3(P=0.000),respectively.PCT-MRI was 73.7％±9.8％.Conclusions The self-made positioning device can improve the consistency of position during the collection of CT and MRI images,and fused CT-MRI images can provide more information and improve the precision of target volume delineation.

ObjectiveTo investigate whether early goal-directed therapy (EGDT) could improve the mortality rate in patients with severe sepsis or septic shock.Methods Articles were retrieved from PubMed, Cochrane Library, Embase data, Wanfang data, and CNKI from January 1980 to May 2015. Inclusion criteria included the subjects concerning patients with severe sepsis or septic shock reported as randomized controlled trial (RCT), clinical controlled trial (CCT), case-control studies, cohort studies with complete data, which endpoints were the short-term mortality [in-hospital, intensive care unit (ICU) or 28-day] and long-term mortality (60-day, 90-day or 1 year). RevMan 5.2 software was used for Meta analysis of effect of EGDT on mortality rate in patients with severe sepsis or septic shock, and funnel plot was drawn to evaluate the quality of enrolled literature.Results There were 12 studies meeting inclusive criteria including 5 528 patients, 4 RCTs, 3 case-control studies, 4 cohort studies, and 1 quasi-experimental research. It was shown by Meta analysis that EGDT was associated with significant decrease in the short-term mortality [relative risk (RR) = 0.72, 95% confidence interval (95%CI) = 0.64-0.80,P< 0.000 01], but not associated with decrease of long-term mortality (RR = 0.99, 95%CI = 0.92-1.06,P = 0.81). The funnel plot showed that there was no publication bias. EGDT was recommended as grade C.Conclusions EGDT was associated with significant improvement in short-term mortality but not with long-term mortality in patients with severe sepsis or septic shock. Grade C was recommended by our study.