The association between the adverse pregnancy outcome and the exposure to air pollutants has recently become a major concern.The researches on the relationship between air pollutants and preterm delivery and low birth weight need to be further studied.This paper reviewed the epidemiological studies on the impact of air pollutants(PM10,CO,NO2,SO2 etc) on preterm delivery and low birth weight,aimed to provide some references for the control of air pollution and the occurrence of adverse pregnancy outcome and the further study on the mechanism.

ObjectiveTo evaluate results of the Lichtenstein tension-free mesh repair and summaraize the clinical experience in the treatment of the inguinal hernia. MethodsIn this retrospective study, 4011 tension-free inguinal hernia repairs were performed in 3631 patients, using a polypropylene mesh (Lichtenstein technique). Results The average hospitalization was 3.8 days, the overall complication rate was 2.4％, the recurrence rate was 0.1％. ConclusionThe Lichtenstein repair for the treatment of inguinal hernia has the advantage of less postoperative pain and low recurrence and is highly suitable for day case surgery.

To investigate the rat intestinal absorption of stearic acid-octaarginine (SA-R8) modified solid lipid nanoparticles containing paclitaxel (SA-R8-PTX-SLN), compared with the commercially available preparation of PTX (Taxol) and PTX-loaded solid lipid nanoparticles (PTX-SLN), the in situ intestinal absorption of SA-R8-PTX-SLN was investigated by means of single-pass rat intestinal perfusion technique. The absorptions of the preparations were investigated at different intestinal segments, different drug concentrations and in the presence of P-glycoprotein inhibitor (verapamil). The results showed that PTX could be absorbed at each intestinal segment and the three preparations all showed maximum absorptions at the duodenum. The cumulative absorptions of three preparations at each intestinal segment appeared SA-R8-PTX-SLN > PTX-SLN > Taxol (P < 0.05). SA-R8-PTX-SLN showed a liner absorption manner at the duodenum in the examined drug concentration range. The cumulative absorptions of Taxol and PTX-SLN were significantly promoted after the addition of P-glycoprotein inhibitor (verapamil) into the preparation (P < 0.05), but absorption of SA-R8-PTX-SLN existed no significantly difference compared with the preparation without verapamil (P > 0.05). SA-R8 and SLN might both effectively improve the oral absorption of PTX in the intestinal tract.

Objective To investigate the causes, prevention and treatment of recurrent laryngeal nerve (RLN) injury during operation in patients with thyroid cancer. Methods Clinical data of 192 patients undergone thyroidectomy operation were reviewed. Results RLN was exposed during operation in 192 patients. There were 3 cases of RLN injury, then RLN anastomosis was happened immediately during operation. It was significantiy improved in pronunciation after operation. 2 ～ 3 d after surgery, transitory hoarseness was observed in 3 patients. Unilateral RLN resection performed in 1 case with cancer involving RLN. Conclusions There were some causes of RLN injury. Exposure of RLN selectively,delicate operation and thyroid gland surgery specialist were the key point for prevention of the injury of RLN. Once RLN injury occured ,repairing should be performed as soon as possible.

Objective To design a nursing checklist for continuous renal replacement therapy in ICU patients and to apply it to clinical settings. Methods A nursing checklist for continuous renal replacement therapy was de-signed through reviewing guidelines and literatures. The checklist was used in ICU patients treated with continu-ous renal replacement therapy,and nursing situation (including operation time,operation quality,etc.) was compared before and after application of the checklist. Results After applying the nursing checklist for continuous renal re-placement therapy,the nursing procedures were standardized,the operation time was reduced,and operation quality was improved. Conclusion The application of nursing checklist in nursing management of continuous renal replace-ment therapy helped to standardize continuous renal replacement therapy operating procedures,improve efficiency and quality at work,and ensure patient safety.

Objective To explore the related prognostic factors of the patients with thyroid microcarcinoma.Methods Clinical data,including clinical,pathologic,and therapeutic factor of 203 patients with thyroid microcarcinoma admitted were analyzed retrospectively.Results The cause specific survival and locoregional failure free survival rates at 10 years were 100.0% and 91.4% , respectively.Univariate analysis showed that multifocality, cervical lymph node metastasis and radioiodine treatment was associated with prognosis.Multivariate analysis revealed that cervical lymph node metastasis was the only independent prognostic factor for locoregional failure free survival.The risk of locoregional recurrence increased 2.5 folds when lymph nodes metastasis occurred at presentation.Conclusion The ratio of thyroid microcarcinoma to thyroid carcinoma increased yearly and the overall survival rate of thyroid microcarcinoma was excellent.Of all the prognostic factors,lymph node metastasis was the most important one related to survival.

Objective To compare the clinical efficacies of polypropylene-polyglactic composite mesh, polyester mesh, polypropylene mesh in Lichtenstein repair for inguinal hernia.Methods The clinical data of 1 080 patients with primary unilateral inguinal hernia who were admitted to the Tianjin People's Hospital from February 2012 to May 2013 were prospectively analyzed.A randomized controlled study was performed based on a random numble table.All the patients were allocated into the ProGrip group (Parietex ProGripTM Self-Fixating Mesh), PET group (ParietexTM Lightweight Monofilament Polyester Mesh) and PP group (BardTM Soft Mesh).Patients received standard Lichtenstein tension-free repair under local anesthesia and were followed up by outpatient examination and telephone interview till May 2014.The indexs observed during the follow-up included occurrence of complications, post-operative pain and postoperative health-related quality of life.The following indexes were recorded : time of mesh fixation, operation time, hernia recurrence, pain degree at postoperative week 1 and month 1, 6, 12 by numerical rating scale (NRS), quality of life at postoperative month 1 by SF-36 questionnaire survey including physical function, role physical, body pain, general health, vitality, social function, role emotional,mental health.Measurement data with normal distribution were presented as x ± s.Comparisons among groups were analyzed by ANOVA and pairwise comparison by t test.Measurement data with skewed distribution were presented as M (range) and repeated measurement data were analyzed using the repeated measures ANOVA.Count data were evaluated by the chi-square test and Fisher exact probability.Postoperative moderate and severe pain rates were evaluated by the Kaplan-Meier method and analyzed by the Log-rank test.Results There were 1 022 patients screened for eligibility including 367 patients in the ProGrip group, 346 patients in the PET group and 309 patients in the PP group.The time of mesh fixation and operation time were (1.3 ± 0.5) minutes and (30 ± 5) minutes in the ProGrip group, (4.9 ± 0.9) minutes and (45 ± 7) minutes in the PET group, (5.0 ± 0.9) minutes and (44 ± 7)minutes in the PP group, respectively, showing significant differences among the 3 groups (F =6.21, 4.33,P ＜ 0.05).There were significant differences in the time of mesh fixation and operation time between the ProGrip group and the PET group (t =1.36, 4.39, P ＜ 0.05), and also between the ProGrip group and the PP group (t =2.67, 2.99, P ＜ 0.05).There was no significant difference in the time of mesh fixation and operation time between the PET group and the PP group (t =0.98, 0.63, P ＞ 0.05).Nine hundred and nine patients were followed up for a median time of 13 months (range, 12-26 months) , with a follow-up rate of 88.943％ (909/1 022).The number of recurred hernia in the ProGrip group, the PET group and the PP group was 1, 0, 0,showing no significant difference (P ＞ 0.05).The NRS scores of pain from postoperative week 1 to postoperative month 12 were ranged from 0 (0-2) to 0 (0-0) in the ProGrip group, from 2(0-5) to 0(0-0) in the PET group and from 1 (0-4) to 0 (0-0) in the PP group.The number of patients with moderate and severe pain was ranged from 52(14.17％) to 0(0) in the ProGrip group, from 87 (25.14％) to 0 (0) in the PET group and from 89 (28.80％) to 0(0) in the PP group.There were no significant differences in the changing trends of NRS scores of pain and number of patients with moderate and severe pain among the 3 groups (F =1.66, x2=1.52, P ＞ 0.05).The scores of physical function in the ProGrip group, PET group, PP group at postoperative month 1 were 52 ± 4,50 ± 6, 50 ± 6, the scores of role physical were 50 ± 6, 50 ± 6, 50 ± 5, the scores of body pain were 52 ± 7, 52 ± 7, 52 ± 7, the scores of general health were 63 ± 4, 57 ± 9, 58 ± 8, the scores of vitality were 63 ± 5, 62 ± 6,63 ± 6, the scores of social function were 58 ± 4, 58 ± 8, 57 ± 8, the scores of role emotional were 59 ± 4, 57 ± 8,58 ± 8, and the scores of mental health were 65 ± 4, 63 ± 5, 63 ± 6, respectively, showing no significant differences in above indexes among the 3 groups (F =2.36,3.65,1.98,2.41, 6.32, 2.33, 4.21, 3.52, P ＞ 0.05).Conclusion Patients undergoing Lichtenstein repair for inguinal hernia with polypropylene-polyglactic composite mesh, polyester mesh and polypropylene mesh have comparative of incidence of postoperative complications, postoperative pain, quality of life, and present postoperative long-term low recurrence, low incidence of pain and relatively high quality of life.

Objective To investigate the effects of different BIS values on postoperative cogni-tive dysfunction (POCD)and S100βprotein(S100β)in the early stage of postoperation.Methods Fifty patients who were scheduled for selective abdominal surgery under general anesthesia (male 34 cases, female 1 6 cases,aged 65 to 75 years,ASA Ⅰ or Ⅱ)were randomly divided into two groups:light anesthesia group (group L,n =25,BIS value was maintained at 50 to 59)and deep anesthesia group (group D,n =25,BIS value was maintained at 30 to 39).BP,HR,SpO 2 ,ECG,PET CO 2 ,inhaled anes-thetic concentration and BIS values were recorded on time points of 5 minutes after the patients ente-ring the operating room (T0 ),before endotracheal (T1 ),intubation (T2 ),incision (T3 ),two hours after incision (T4 ),three hours after incision (T5 )and at the end of surgery (T6 ).The procedure du-ration,anesthesia time,dosages of propofol,fentanyl,midazolam and VAS scores on 1 d after sur-gery were also recorded.Blood samples were collected on time points of 10 min before anesthesia,im-mediately after surgery and 24,48 h after operation.S100β concentration were detected.Mini-mental State Examination (MMSE)score and Trail Making Test (TMT)completion time were recorded on 1 d before surgery and 1,3,7 d after surgery.Results BIS value of group D were lower than group L on T2 ,T3 and T4 .The propofol dosage of group D was significantly greater than that in group L (P <0.05 ).The concentration of serum S100βincreased significantly immediate and 48 h after operation in both groups compared with 10 min before anesthesia(P < 0.05).It was still higher 24 hours after op-eration than before anesthesia.But there was no statistic difference.Compared with the end of surger-y,the concentration of serum S100βin two groups on 24 h after surgery were significantly decreased (P < 0.05 ).The concentration of serum S100β in group L on the end of surgery and 24 h after surgery were higher than that in group D significantly (P <0.05).Compared with 1 d before surgery, postoperative 1 d MMSE scores in two groups and postoperative 3 d MMSE score in group L de-creased significantly (P <0.01).Compared with postoperative 3 d,postoperative 7 d MMSE score in group L increased significantly (P <0.01).Postoperative 1,3 d MMSE score in group D were signifi-cantly higher than group L (P <0.05).Compared with 1 d before surgery,TMT completion time in two groups on 1 d after surgery were significantly prolonged (P <0.01 ).Compared with 1 d after surgery,TMT completion time in two groups on 3 d after surgery were significantly shortened (P <0.01).Compared with 3 d after surgery,TMT completion time in group L on 7 d after surgery was significantly shortened (P <0.01 ).TMT completion time in group D on 1,3 d postoperative were significantly shorter than group L (P <0.05).POCD incidence of group D on 1 d after surgery was lower than that in group L (P < 0.05).Conclusion Different depth of anesthesia can ensure hemo-dynamic balance in old patients during surgery and after surgery.When BIS value was maintained at 30 to 39,it had lower S100βprotein levels,lower incidence of early POCD and a lesser degree of post-operative cognitive dysfunction.

ObjectiveTo observe the status and related factors of depression symptoms in elders.MethodsRandomized multi-stage sampling method was used to select subjects.504 elders ( aged ≥65 years) in Jining were investigated and assessed by using the scales of Geriatric Depression Scale15 ( GDS-15 ),Katz-activity of daily liying (Katz-ADL) and Lawton instrumental ADL (IADL).ResultsThe GDS scores of males (2.24 ±2.12 ) were significantly lower than that of females ( 3.35 ± 3.49) ( t '=4.236,P ＜ 0.01 ).There were significant differences in GDS scores among different subgroups of age,single or not,physical activity,sleep quality,self-reported health,living condition,economic status and lonely feeling.GDS scores were significantly correlated to lonely feeling,IADL,living condition,economic status,self-reported health and age (F =27.47,P ＜ 0.001 ; R2 =0.372,R'2 =0.358 ),with the total contribution of 35.8％.ConclusionAmong elders,the main factors influencing depression symptoms are lonely feeling,IADL,female,health condition,economic condition and single,respectively.Enhancing IADL of elders can contribute to reduce the risk factors of depression.

Objective To identify anal canal structures by dual plane transrectal ultrasound. Methods One anorectal specimen was observed by ultrasonography when needles were placed in different anal muscle layers respectively. Fifty patients with no anorectal or perianal diseases were examined by transrectal ultrasound to verify the sonographic features of anal canal, meanwhile the inner and outer sphincters and longitudinal combination muscle were measured. The ultrasound images of anal canal were compared with MR images. Fifty patients were divided into three groups according to the age: 25- 40 years old, 41 -55 years old,and ＞55 years old. Results The sonographic features of anal canal structures by transrectal ultrasound were identified. Anal canal sonographic images and MR images had consistency. The thickness of inner sphincter in each group was (0.19 ± 0.03)cm, (0.22 ± 0.02)cm, (0.24 ± 0.03)cm respectively,while outer sphincter (0.44 ± 0.03)cm, (0.49 ± 0.04)cm, (0.52 ± 0.04)cm, and longitudinal combination muscle (0.10±0.02)cm,(0.11 ± 0.02)cm,(0.11 ± 0.02)cm. Conclusions Transrectal ultrasound is a simple,efficient and non-invasive method to examine anal canal which can identify anal canal structures clearly.