Dibutyl phthalate (DBP) has been found as a ubiquitous environmental pollutant with reproductive and developmental toxicity. The characteristics of reproductive and developmental toxicity of DBP, the mechanisms of the toxicity and effects on human health were reviewed in this paper according to the toxic effects on pregnant animals exposed to DBP, which might provide reference for the further study on toxicity of DBP and preventive measures.

Objective To investigate the exposure levels of organic pollutants in child-bearing age women body. Methods The blood and urine specimens were collected simultaneously from each of 8 health women, aged 23-32 years, the organics were extracted with hexane and determined qualitatively by gas chromatography-mass spectrometer (GC-MS) for each specimen. Results In blood, 34 kinds of organic compounds had been detected , at average of (8.63?5.01 )kinds per person. Di-n-butyl phthalate (100%) and 14-bate-H-pregna (75.0%) revealed the highest detectable rates. In urine, 39 kinds of organic compounds had been identified, at average of (10.63?1.30) kinds per person, di-n-butyl phthalate(100%), HANFETT(100%), 14-bate-H-pregna(87.5%), docosane (87.5%), di-isobutyl phthalate(75.0%) were the chemicals noticed more frequently. Some kinds of these identified organics compounds were environmental toxic pollutants. Conclusion This study suggested that toxic organic pollutants had existed in child-bearing age women body, phthalic acid esters were the chemicals checked out more frequently. Their potential adverse health effects on women and offspring should be paid highly attention to.

Objective To investigate the effect of poractant alfa injection(PS) on neonatal respiratory distress syndrome(NRDS).Methods According to the digital table,80 cases of NRDS were randomly divided into the control group (40 cases) and the treatment group (40 cases).Both two groups were treated by mechanical ventilation and conventional symptomatic,supportive treatment.The treatment group was given PS intratracheal injection,the control group was given 0.9％ sodium chloride injection intratracheal injection.The clinical symptoms,blood gas analysis and the improvement of X-ray chest film were dynamicly observed,the clinical efficacy was compared between the two groups.Results In the treatment group,PaO2 returned to ＞ 60mmHg time,PaCO2 returned to ＜ 50mmHg time,mechanical ventilation time were (2.13 ± 0.21) h,(12.56 ± 0.11) h,(18.2 ± 0.33) h,which were shorter than those in the control group [(12.41 ± 0.13) h,(89.87 ± 0.26) h,(76.13 ± 0.65) h,t =2.632,2.403,1.895,all P ＜ 0.05] ;39 cases in the treatment group were cured(97.5％),30 cases in the control group were cured(75.0％),the difference of cure rate between the two groups was statistically significant(x2 =8.53,P ＜ 0.05).The incidence rate of comnplications such as pulnonary hemorrhage,pneumothorax,intracranial hemorrhage in the treatment group was 7.5％,which was significantly lower than 32.5％ in the control group (x2 =7.81,P ＜ 0.05).Conclusion PS in the treatment of NRDS has obvious curative effect and less adverse reactions,it can be used in clinical application.

Objective To study the effect of age on the recurrence-free survival rate after hepatic resection for hepatocellular carcinoma(HCC)and the relationship between microvessel density (MVD)and recurrence of HCC in the elderly. Methods　Severty one cases of elderly patients with HCC were analyzed retrospectively with 352 cases of non-elderly HCC patients as control,and the effect of age on the recurrence-free survival rate was studied.The expressions of CD34 and endocan in HCC tissues were detected by immunohistochemistry in 30 elderly and 30 non-elderly patients.Results　The 1-,3- and 5-year recurrence free survival rates were 75.7%,43.0% and 43.0% in the elderly group respectively,which were higher than those in the non-elderly group(53.6%,38.5% and 33.4%,respectively,Log Rank value=10.25,P＜0.05).The positive rate of alpha fetoprotein (AFP)in the elderly group was 47.9%,which was lower than that in the non-elderly group(62.2%)(X2=23.68,P＜0.05).The median survival times in the high CD34-MVD group and high endocan MVD group were shorter than those in the low CD34-MVD group and low endocan-MVD group(260 d vs.850 d,360 d vs.800 d,Log Rank value was 22.18 and 20.56 respectively,both P＜0.05).Conclusions　The long-term prognosis of hepatic resection for HCC is better in elderly patients than in non-elderly patients.The recurrence of HCC in the elderly is closely related with angiogenesis.

Twelve community nursing managers were interviewed.The consensus was reached that there should be 4 main themes concerning evaluation indicators of community nursing quality:necessity,content,format and expectation.The interviewed nursing managers expressed their need for a system of community nursing quality evaluation,and those indicators should be comprehensive,concrete and practical.The format of evaluation should facilitate the development of nursing quality and the criteria should meet the requirements of Minister of Health and international standards.

The service behavior of medical staff is influenced by the organizational environment and management mode of the hospital. That is to say, the organization and management determine the standardization and sustainability of a hospital's humanistic services, and organizational driving force is also an important factor for the staff to innovate their services. Organization and management of a hospital' s humanistic services is composed of three factors: service operation management, service elements management and service performance management. These factors ensure a hospital's humanistic services to achieve whole-staff-participation, sustainability and standardization.

Objective To investigate the high risk factors for pneumonia-related bloodstream infection (BSI) caused by Acinetobacter baumannii (AB) in ventilated patients. Methods A retrospective observation was conducted. The data of invasive-ventilated patients underwent AB pneumonia admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Disease from January 2011 to December 2015 were enrolled. The patients were divided into non-AB-BSI group and AB-BSI group. The following factors were evaluated including gender, age, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score at admission of intensive care unit (ICU), clinic pulmonary infection score (CPIS), underlying disease, neutropenia or agranulocytosis, hemoptysis, treatment of steroid or immunosuppressant in recent 3 months, central venous catheter (CVC), parenteral nutrition (PN), combined antibiotic therapy after the diagnose of AB pneumonia, duration of mechanical ventilation and the resistance of AB. The risk factors were analyzed by logistic regression analysis to confirm the independent high risk factors for the pneumonia-related BSI caused by AB in ventilated patients. Results 612 patients were enrolled, 561 patients in non-BSI group, and 51 in BSI group with 5-year BSI incidence of 8.3%. There was no significant difference in gender or age between the two groups. Compared with non-BSI group, the APACHE Ⅱ score (20.8±9.2 vs. 17.3±5.5) and CPIS (7.1±3.9 vs. 5.6±1.6) in BSI group were significantly increased (both P < 0.05). The patients with CPIS > 6 [80.4% (41/51) vs. 28.0% (157/561)], chronic obstructive pulmonary diseases [COPD, 86.3% (44/51) vs. 46.7% (262/561)], diabetes mellitus [DM, 25.5% (13/51) vs. 14.8% (83/561)] in BSI group were more than patients in non-BSI group, the incidence of heart failure [HF, 5.9% (3/51) vs. 23.5% (132/561)] was significantly decreased, and the incidence of hemoptysis [27.4% (14/51) vs. 3.4% (19/561)], therapy of steroid or immunosuppressant [19.6% (10/51) vs. 7.8% (44/561)] and duration of mechanical ventilation > 14 days [80.4% (41/51) vs. 48.5% (272/561)] were significant increased (all P < 0.05); no significant difference was found in other parameters between the two groups, including gender, age, other underlying diseases, neutropenia or agranulocytosis, CVC, PN, combined antibiotic therapy, and resistance of AB. It was showed by logistic regression analysis that CPIS > 6 [odds ratio (OR) = 2.513, 95% confidence interval (95%CI) = 1.400-20.439, P = 0.011], history of COPD (OR = 1.921, 95%CI = 0.068-5.603, P = 0.030), the treatment of steroid or immunosuppressant (OR = 2.012, 95%CI = 0.556-16.313, P = 0.021) and hemoptysis (OR = 1.866, 95%CI = 1.114-6.213, P = 0.037) were the independent risk factors for the pneumonia-related BSI caused by AB in ventilated patients. Conclusion CPIS > 6, history of COPD, the therapy of steroid or immunosuppressant and hemoptysis were the independent risk factors for the pneumonia-related BSI caused by AB in ventilated patients.

Objective To investigate the effect of lower limb rehabilitation training robot combined with task-oriented training on walking ability after stroke. Methods From February 2014 to August 2015,74 consecutive patients with post-stroke who received rehabilitation therapy and met the inclusion criteria admitted to the Department of Rehabilitation Medicine,Xuanwu Hospital,Capital Medical University were collected prospectively. They were all the patients with the first-ever stroke for 1 to 12 months. They were divided into either an observation group (n = 39)or a control group (n = 35)according to whether they were treated with the lower-limb rehabilitation robot. The patients of both groups received task-oriented training,2 times a day,once for 20 min,5 days a week for 12 weeks. The observation group was also treated with the lower-limb rehabilitation training robot,1 time a day,once for 30 min,5 days a week. Berg balance scale,Fugl-Meyer assessment (FMA),timed up-and-go test (TUG)and knee flexion active range of motion (KFAROM)were used to assess the efficacy. Results (1)After treatment,the Berg scale and FMA scale scores were increased in the observation group and the control group compared with before treatment. There was significant difference (Berg scale:28 ±9 vs. 22 ±9,29 ±9 vs. 24 ±9;FMA scores:47 ± 8 vs. 36 ± 8,40 ± 6 vs. 36 ± 7;all P < 0. 01),however,there was no significant difference between the two groups (P <0. 05),and there was significant difference in FMA scores between the 2 groups (P < 0. 01 ). The differences of Berg scale scores in the observation group and the control group were 10. 75 + 0. 30 and 4. 71 + 0. 14 respectively before and after treatment. There was no significant difference between the 2 groups (t = 0. 95,P = 0. 345). The differences of FMA scores in the observation group and the control group were 5. 8 ±0. 6 and 4. 9 ±0. 8 before and after treatment (t =5. 16,P <0. 01). (2)After treatment,the tug test and KFAROM of the observation group and the control group were better than those before treatment. There were significant differences (TUG test:35 ± 13 s vs. 56 ± 18 s,53 ± 17 s vs. 58 ± 18 s;KFAROM:82 ± 24° vs. 60 ± 23°,63 ± 23° vs. 57 ± 26°;all P < 0. 01),and there were significant differences between the 2 groups (all P < 0. 01). The differences of the TUG test in the observation group and the control group before and after treatment were 21. 5 ± 5. 0 and 4. 6 ± 0. 6 s respectively. There was significant difference between the 2 groups (t = 9. 55,P < 0. 01);the differences of KFAROM in the observation group and control group before and after treatment were 5.8 ±0.6° vs. 4.9 ±0.8° respectively. There was significant differences between the 2groups (t =4.17,P <0. .01). Conclusion Lower limb rehabilitation training robot combined with task-oriented training may improve the lower extremity motor function,walking ability,knee flexion joint activity of the patients after stroke,but the improvement effect of the lower limb balance is not obvious.

Objective To investigate the influence of remote care management on the diet compliance and disease recurrence of patients with pancreatitis. Methods Seventy-four simple pancreatitis patients in our hospital from January 2013 to March 2014 were involved and numbered according to the administration order and divided into the observation group and the control group according to the random number table with 37 cases in each group. The two groups accepted conventional health education during hospitalization time. The control group was given intensive classes after discharge, while the observation group received remote care management. Twelve months later, the rate of disease recurrence and diet compliance of the two groups were observed and compared. Results After the management, the observation group was superior to the control group in diet compliance. The rate of disease recurrence was significantly lower in the observation group than that of the control group (all P<0.05). Conclusion The remote care management can effectively improve the diet compliance of pancreatic patients, lower the recurrence rate, and have positive effect on prognosis.

Objective To investigate the expressions of vascular endothelial growth factor (VEGF) , hypoxia inducible factor 1 alpha (HIF 1?) and epidermal growth factor (EGF) in hepatocellular carcinoma (HCC) and their clinical significance. Methods The expressions of VEGF, HIF 1? and EGF in 36 cases of HCC and corresponding paraneoplastic tissues and normal liver tissues (6 cases) were studied by immunohistochemistry assay. ResultsThe expression rate of VEGF, HIF 1? and EGF in HCC tissue was 89%, 67% and 75% respectively, higher than those in paraneoplastic tissues and normal liver tissues ( P