Objective To explore the value of maternal serum triple markers screening,consisted of AFP (α-fetal protein),β-human chorionic gonadotropin (β-hCG) and free estriol (uE3),for Down's syndrome,in second trimester.Methods We searched published literatures from PubMed,MEDLINE,China National Knowledge Internet (CNKI) and Wanfang Database from January 1990 to August 2014 and articles met the following criteria were collected:(1) The report was of a screening test;(2) The research purpose was to study the efficiency ofAFP,hCG and uE3 (triple markers) screening for Down's syndrome;(3) The research subjects were pregnant women in second trimester;(4) All of the studied cases were confirmed by amniocentesis and chromosome karyotyping;(5) The pregnant outcomes must be available;(6) Each report should have at least one case of Down's syndrome identified;(7) The literature could be retrieved by Science Citation Index or Chinese core periodicals;(8) When assessed by QUADAS (quality assessment of studies of diagnostic accuracy included in systematic reviews) Quality Assessment Scale,the score should be ≥ 8.Information were extracted,including name of the first author,publication time,sample size,sensitivity,specificity,maternal age,gestational age,cutoff value,β-hCG type and others.MetaDiSc 1.4 software was applied for meta-analysis.I2 was used for heterogeneity,and the fixed or random effects model for calculation of the combined sensitivity,specificity,diagnostic odds ratio (DOR) and the 95％CI.The summary receiver operating characteristic (SROC) curve was drawn.Deek's test in Stata Software was used to validate publication bias.Results A total of 49 literatures were recruited in this study with a total sample size of 960 245.Deck's funnel plot analysis showed that the correlation coefficient and the standard error of bias were-1.067 and 3.64 (t=-0.290,P=0.771).The correlation coefficient and the standard error of the slope were 3.578 and 0.26 (t=13.740,P=0.000).The random effects model showed the pooled sensitivity of the 49 literatures was 0.72 (95％CI:0.70 0.74),the pooled specificity was 0.92 (95％CI:0.92-0.93),and DOR was 33.80 (95％CI:25.03-45.65).The area under the SROC was 0.900 7.DOR of younger age group (including three literatures) was 14.38 (95％CI:3.67-56.42) and 26.64 (95％CI:19.49-36.41) for the older age group (two literatures).For two literatures determining the gestational age based on ultrasonography,the DOR was 50.22 (95％CI:26.91-93.71),and DOR was 33.09 (95％CI:17.33-63.19) for those based on last menstrual period in these two literatures.For eight literatures applied the cutoff value of 1:270,12 applied 1:250 and four applied mixed cutoff value,the DOR was 10.94 (95％CI:3.04-39.38),54.34 (95％CI:42.19-70.01) and 36.37 (95％CI:31.19-42.40),respectively.DOR of total β-hCG group (12 literatures) was 22.06 (95％CI:16.46-29.58) and that of free β-hCG group (ten literatures) was 37.15 (95％CI:30.00-46.02).Conclusions Triple regimen of second trimester maternal serum screening for Down's syndrome is much more efficient.The detection rate could be further improved by determination of the gestational age with ultrasound,and application of 1:250 as the risk cutoff value and free β hCG as a screening marker.

Objective To systematically evaluate maternal perinatal complications and neonatal outcomes after in vitro fertili zation and embryo transplantation(IVF-ET).Methods The computer retrieval was performed on the databases of PubMed,Cochrane library,EMbase,CNKI,Wanfang and Chinese biomedical literature database.The articles on the comparison between IVF and natural pregnancy were included.The RevMan5.3 software was adopted to conduct the meta analysis.Results Twenty-three articles conforming to the requirements were included,including 1 312 651 cases,among them 113 044 cases were IVF and 1 199 607 cases were naturalpregnancy.IVF mother's age was larger than that of natural pregnancy,while the gestational weeks were smaller than those of natural pregnancy,the newborn birth weight was lighter than that of natural pregnancy(P＜0.05);the probability of pregnancy-induced hypertension (PIH),placenta previa,postpartum hemorrhage and gestational diabetes mellitus (GDM) occurrence in IVF mother were higher than that of natural pregnancy (P＜0.05);the rate of multiple and cesarean section in IVF mothers were higher than that of natural pregnancy (P＜0.05);the occurrence rates of small for gestational age(SGA),low birth weight infants,stillbirth and premature in IVF were higher than those of natural pregnancy (P＜0.05).Conclusion The maternal perinatal complications in IVF are higher than those of natural pregnancy,and the birth outcomes in IVF are worse than those of natural pregnancy.

Objective To explore the relationships among posttraumatic growth (PTG),social support,and coping style in women with infertility.Methods 182 women with infertility were recruited in one public hospital department of assisted reproduction technology.Measures included Posttraumatic Growth Inventory (PTGI),Perceived Social Support Scale (PSSS),and Simplified Coping Style Questionnaire (SCQ).Results ① The PTG score of women with infertility was 42.55 ± 16.83,lower than the average level.② Compared with the lower PTG group,the higher PTG group scored significantly higher in social support,positive coping,and negative coping (t =3.867,P＜ 0.01 ; t =8.452,P＜ 0.01 ; t =2.817,P＜ 0.01).③ There were significantly positive correlations among PTG,social support and positive coping (r =0.295-0.515,P ＜ 0.01).④ Positive coping served as a total mediator in the relationship between social support and PTG.Conclusion There are closely correlations among PTG,social support,and positive coping style.Positive coping style significantly mediate the relationship between social support and PTG.

Objective To study the effects of classification-partition-distribution emergency nursing management for severe trauma patients. Method A total of 60 patients from June 2014 to May 2015 were set as control group receiving common nursing and other 62 patients from June 2015 to June 2016 as observation group treated with emergency hierarchical partition and triage nursing. Result The treatment success rate in the observation group were both significantly higher than that of the control group (P<0.05). Conclusion Classification-partition-distribution emergency nursing management for severe trauma patients can increase treatment success rate .

BACKGROUND:Reversible posterior leukoencephalopathy syndrome is rarely reported, especial y concurrent during perioperative period of renal transplantation. Due to its clinical manifestations similar to uremia, transplant doctors are easy to ignore or not timely diagnosis reversible posterior leukoencephalopathy syndrome, thus impacting its treatment.
OBJECTIVE:To discuss the clinical manifestations, imaging features, treatment experience and prognosis of patients with reversible posterior leukoencephalopathy syndrome concurrent during perioperative period of renal transplantation, in order to improve the diagnostic rate and therapeutic effect.
METHODS:We reviewed clinical data of one case of concurrent reversible posterior leukoencephalopathy syndrome during perioperative period of renal transplantation admitted at the General Hospital of Shenyang Military Region.
RESULTS AND CONCLUSION:From the 3rd day postoperatively, the patient gradual y experienced abnormal blood pressure, blurred vision, headache, seizures, disturbance of consciousness and mental and behavioral abnormalities. Early head CT showed low density in the left frontal lobe and corona radiate;and further MRI re-examination showed flake-shaped T1 and long T2 signals in the bilateral frontal lobe, hippocampus, parietal occipital cortex, and brainstem, as wel as high signals on FLARI images at the corresponding parts. After active treatment, the clinical manifestations were improved. Retrospective analysis of clinical data of this case and review of relevant literature wil provide clinical data for the diagnosis and treatment of concurrent reversible posterior leukoencephalopathy syndrome during perioperative period of renal transplantation.

Objective To observe the changes of intracerebral amino acid transmitters in the periventricular leukomalacia (PVL) of newborn rats with microdialysis and so as to explore the role of excitotoxicity in PVL.Methods Replicated the model for PVL at the age of postnatal day 5 (P5) by intracerebral injection of 3-nitropropionic acid (3-NPA).Before injection of 3-NPA,and 15 min,30 min,45 min,60 min,75 min,90 min after injection of 3-NPA,collected the sample of extracellular fluid (ECF) at the corpus callosum above the left ventricle through microdialysis,respectively.After microdialysis,the experimental rats were allowed to survive to P6-P14,and then they were killed and the brains were prepared for HE stain.The amino accids of dialysate were quantified through high performance liquid chromatography(HPLC),and then the excitotoxic index (EI) was calculated.Results Fifteen min to 45 min after injection of 3-NPA,the concentrations of glumate (Glu) and aspartic acid (Asp) of ECF elevated significantly,and then returned to the normal levels.Fifteen min to 75 min and 15 min to 30 min after injection of 3-NPA,the concentrations of glycine (Gly) and GABA significantly elevated,respectively,and returned to normal levels at 90 min and 45 min after injection of 3-NPA,respectively.But the EI,which indicated the balance of excitatory amino acids(EAAs) and inhibitory amno aciols(IAAs),significantly elevated 15 min to 75 min after injection of 3-NPA,then retured to normal level after 90 min.Sub-cortical and periventricular white matter rarefaction and significant lateral ventricle enlargement were observed in HE staining.Conclusions Changes of intracerebral amino acid transmitters in the PVL of newborn rats show regularity:EAAs,IAAs of ECF and EI elavate in the early stage,and then return to the normal level quickly.It indicates that excitotoxicity play a great role in PVL,especially at the early stage.Therefore,the preventions of PVL must be executed at the early stage.

Objective To evaluate the effect of hydrogen on the postoperative cognitive function in aged mice.Methods Sixty aged male Kunming mice,aged 12-14 months,weighing 35-45 g,were assigned into 3 groups (n=20 each) using a random number table:sham operation group (group Sham),partial hepatectomy group (group PH) and partial hepatectomy plus hydrogen-enriched saline group (group PH-H).On preoperative day 3,during operation and on postoperative day 3,hydrogen-enriched saline 10 ml/kg was intraperitoneally injected once a day in group PH-H,and the equal volume of normal saline was intraperitoneally injected once a day in S and PH groups.The spatial probe test was performed on postoperative day 7 to evaluate the cognitive function.Ten mice were selected on postoperative days 3 and 7 (after the end of the spatial probe test),and blood samples were collected for determination of serum tumor necrosis factor-alpha (TNF-α),interleukin-lbeta (IL-1β) and high-mobility group box 1 protein (HMGB1) concentrations by enzyme-linked immunosorbent assay.The animals were sacrificed after blood sampling,brains were removed and hippocampi were isolated for detection of the expression of TNF-α,IL-1β and HMGB1 by Western blot.Results Compared with group S,the percentage of time of staying at the target quadrant and the number of crossing the platform within 1 min were significantly decreased,the serum concentrations of TNF-α,IL-1β and HMGB1 were increased,and the expression of hippocampal TNF-α,IL-1β and HMGB1 was up-regulated in group PH (P＜0.05),and no significant change was found in the variables mentioned above in group PH-H (P＞0.05).Compared with group PH,the percentage of time of staying at the target quadrant and the number of crossing the platform within 1 min were significantly increased,the serum concentrations of TNF-α,IL-1β and HMGB1 were decreased,and the expression of hippocampal TNF-α,IL-1β and HMGB1 was down-regulated in group PH-H (P＜0.05).Conclusion Hydrogen can improve the postoperative cognitive function in aged inice.

Objective: To evaluate the correlation between electronic cigarette (e-cigarette) use and environmental e-cigarette exposure among residents living in Guangzhou City, so as to provide the evidence for the development of the e-cigarette control policy. Methods: Permanent university students living in Guangzhou City were recruited as investigators from July to October 2021, and the permanent adult residents in communities where the university students lived were randomly selected as participants. Subjects' demographic features, e-cigarette use, passive viewing of e-cigarette use and exposure to e-cigarette advertising were collected using both online and offline questionnaire surveys, and the association of e-cigarette use with passive viewing of e-cigarette use and exposure to e-cigarette advertising were examined using a multivariable logistic regression model. Results: A total of 948 questionnaires were allocated, and 874 valid questionnaires were recovered, with an effective recovery rate of 92.19%. The respondents had a mean age of ( 34.96±13.76 ) years. There were 420 men ( 48.05% ), and 426 married residents ( 48.80% ). The prevalence of e-cigarette use was 14.99%, and the rate of e-cigarette use was 23.81% in men and 6.83% in women. In addition, 27.27% of respondents at ages of 35 to 44 years used e-cigarette, 479 respondents viewed e-cigarette advertising ( 54.81% ) and 510 respondents had at least once passive viewing of e-cigarette use ( 58.35% ). Multivariable logistic regression analysis revealed that a higher frequency of exposure to e-cigarette advertising ( OR: 3.064-5.784, 95%CI: 1.683-12.620 ) and a higher frequency of passive viewing of e-cigarette use ( OR: 2.182-2.349, 95%CI: 1.094-4.526 ) led to a higher rate of e-cigarette use. Conclusions E-cigarette use is affected by passive viewing of e-cigarette use and exposure to e-cigarette advertising among community residents in Guangzhou City. Supervision and restriction is recommended for e-cigarette advertising, marketing, and use in public places.

Objective To estimate the acceptability of nurses for division of labor pattern in China.Methods A total of 1 609 nurses in 3 provinces were investigated by self-made questionnaires.The contents of questionnaires included assignment distribution,the acceptability of current division pattern,and whether current division pattern can arouse working enthusiasm of nurses.Results The proportion of those engaged in not only life nursing but also technical nursing was more than 40％,and those only engaged in life nursing was lower than 5％ in nurses with junior college,college or bachelor education degree.The nurses' acceptability of current division pattern of nursing work was poor,most fairly reasonable and very general.The improvement of working enthusiasm for division of labor pattern at present was also poor.The higher educational background except master,the lower improvement of working enthusiasm.Conclusions The poor nurses' acceptability of division of labor pattern was low and impacted working enthusiasm.It suggested to establish a scientific and reasonable division of labor pattern for improvement of nurse working enthusiasm,and promote the overall development of clinical nursing,nursing management,nursing education and nursing scientific research.

AIM: To evaluate effects of inhaled nitric oxide(iNO) on adhesion molecule CD11b expression on lung neutrophils in experimental meconium aspiration syndrome(MAS) rabbits treated with conventional mechanical ventilation under room air or 100%O 2. METHODS: Animals were randomly allocated to 8 groups( n= 48) of 6 each: two MAS model groups(under room air or 100%O 2 without iNO treatment), 6 treatment groups were treated with continuous NO inhalation at a dose of 0.2?10 -6 mol/L,0.33?10 -6 mol/L or 0.67?10 -6 mol/L respectively for 12 hours under room air or 100%O 2. Mean systemic arterial pressure(SAP) and methemoglobin (MeHb) were performed at basement time, 0, 2, 4, 12 hours. Expression of CD11b on neutrophils in the bronchoalveolar lavage fluid(BALF) was detected with flow cytometry. RESULTS: SAP, MeHb at different time among different groups were within the normal scale. CD11b expression on the neutrophils in the BALF significantly decreased in groups of inhalation 0.33?10 -6 mol/L or 0.67?10 -6 mol/L NO, compared with the two MAS model groups. ( ?s : under 21%O 2, 0.33?10 -6 mol/L NO,121?20 vs 392?204; 0.67?10 -6 mol/L NO,112?30 vs 392?204;under 100%O 2,0.33?10 -6 mol/L NO,113?24 vs 293?65; 0.67?10 -6 mol/L 102?114 vs 293?65, P 0 05). No statistic difference was observed between groups inhaled 0.33?10 -6 mol/L NO and 0.67?10 -6 mol/L NO. CONCLUSION: 0.33?10 -6 mol/L or 0.67?10 -6 mol/L NO inhalation down-regulated the CD11b expression on the neutrophils in BALF to reduce the sequestration of neutrophils in rabbit lung.