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ObjectiveAmbient air pollution is associated with ischaemic stroke incidence. However, most of the previous studies used stroke-related hospital admission rather than stroke onset itself. This study aimed to evaluate the relationship between ambient air pollutant exposures and acute ischaemic stroke based on the timing of symptom onset.MethodsA time-stratified, case-crossover analysis was performed among 520 patients who had ischaemic stroke admitted to the Second Hospital of Tianjin Medical University (Tianjin, China) between 1 April 2018 and 31 March 2019 (365 days). Daily air pollutant concentrations of particulate matter with aerodynamic diameter 2.5 µm, particulate matter with aerodynamic diameter 10 µm (PM10), sulfur dioxide, nitrogen dioxide, carbon monoxide and ozone were obtained from fixed-site monitoring stations. We used conditional logistic regression to estimate OR and 95% CI corresponding to an increase in IQR of each air pollutant after adjusting for the effects of temperature and relative humidity.ResultsOverall, a higher risk of ischaemic stroke was found between April and September. During this period PM10 was associated with an increased risk of ischaemic stroke (1-day lag: OR=1.49, 95% CI 1.09 to 2.02; 3-day mean: OR=1.58, 95% CI 1.09 to 2.29) among patients between 34 and 70 years old. Positive associations were also observed between PM10 (1-day lag: OR=1.51, 95% CI 1.10 to 2.07; 3-day mean: OR=1.57, 95% CI 1.08 to 2.29), ozone (1-day lag: OR=1.83, 95% CI 1.16 to 2.87; 3-day mean: OR=1.90, 95% CI 1.06 to 3.42) and ischaemic stroke occurrence among those with hyperlipidaemia.ConclusionOur results suggest that air pollution is associated with a higher risk of ischaemic stroke in younger people or people with hyperlipidemia. These findings still need to be further investigated.

Aim The study was conducted to assess and compare the overall diagnostic value of positron emission tomography (PET) alone and PET/computed tomography (CT) for the detection of recurrent/metastatic ovarian cancer. Methods A systematic literature search in PubMed, EMBASE and Chinese literature databases (CNKI, VIP and Wanfang) up to August 2014 was performed to identify relevant articles. The diagnostic performance of PET alone or PET/CT was assessed in terms of the following evaluation indexes: summary sensitivity, specificity, positive and negative likelihood ratio, diagnostic odds ratio and area under the curve summary receiver operating characteristics. Results Sixty-four studies with 3722 patients were included in this meta-analysis. Favorable results were obtained for both PET/CT and PET alone with similar sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio and area under the curve in diagnosing recurrent/metastatic ovarian cancer (P > 0.05). However, the sensitivity of PET/CT was significantly higher than PET alone in European patients. Conclusions Both PET and PET/CT have promising diagnostic value in recurrent/metastatic ovarian cancer. The diagnostic performance of PET/CT may be superior to PET alone in European patients.

The aim of this study is to estimate the timing impact on levothyroxine replacement among pregnant women with subclinical hypothyroidism (SCH). Ninety-eight pregnant women diagnosed as SCH in the first trimester were randomly divided into three groups: Group A, instantly initiated levothyroxine after diagnosis; Group B, administrated treatment in the second trimester, and Group C, received no prescription. Incidence of pregnancy complications and pregnancy outcomes were compared among three groups and subgroup analysis were performed stratified with TPO status in Group B. Group A exhibited lower rate of pregnancy complications (9.7%) and adverse outcome (3.2%) than Group B (41.9% and 32.3%) and Group C (64.5% and 38.7%). But the late initiation treatment group shared a comparable complication and maternal outcome with untreated women (p = .075 and .596, respectively). After stratified with TPOAb status in Group B, TPOAb+ women experienced a remarkable lower complication (14.2%) and adverse outcome rate (7.1%) compared with negative subjects (64.7% and 45%, respectively). Our data suggest that levothyroxine administrated in the first trimester was associated with decreased risk of adverse obstetric event. Additionally, pregnant women with TPOAb positive could also benefit from thyroid hormone therapy even initiated in the second trimester.

Aim We compared outcomes for traditional vaginal surgery with uterosacral ligament suspension (USLS) versus transvaginal mesh repair of pelvic organ prolapse (POP). Methods We performed a retrospective chart review of pelvic organ prolapse cases that occurred between February 2007 and December 2011. Success rates for traditional vaginal repair plus USLS and transvaginal mesh repair were determined. Results As compared with traditional surgery (n = 81), using mesh (n = 90) for stage III or IV prolapse resulted in higher rates of successful treatment. However, mesh repair also resulted in increased intraoperative blood loss and postoperative adverse events, such as pain and dyspareunia. Conclusion Traditional vaginal repair plus USLS was an improvement on traditional surgery, resulting in a higher anatomical success rate. On the other hand, both intraoperative and postoperative complications in mesh repair could be reduced by protective factors such as the surgeon's experience.

ObjectivesStroke survivors require assistance and support in their daily lives. This survey aims to investigate the needs and rights awareness in Chinese stroke survivors and caregivers in rural and urban settings.SettingThis survey was adapted from the one created by the World Stroke Organization. The questionnaire included demands for psychological support, treatment and care, social support and information. From January 2015 to January 2016, the survey was pilot tested with urban and rural-dwelling stroke survivors and caregivers from 12 hospitals. Stroke survivors were invited to participate if they were over 18 years old and had experienced a stroke. Exclusion criteria were patients who had disorders of consciousness, significant cognitive impairment, aphasia, communication difficulties or psychiatric disorders. Only caregivers who were family members of the patients were chosen. Paid caregivers were excluded.ParticipantsOne thousand, one hundred and sixty-seven stroke survivors and 1119 caregivers were enrolled.Primary outcome measuresThe needs of stroke survivors and caregivers in rural and urban areas were compared. The correlations between needs of rural and urban stroke survivors and caregivers and potential effect factors were analysed, respectively.ResultsAmong the cohort, 93.5% reported the need for psychological support, 88.6% for treatment and care, 84.8% for information and 62.7% for social support. The total needs and each aspect of needs of stroke survivors in urban settings were greater than of those in rural settings (pConclusionsNeeds and rights awareness of stroke survivors should also be recognised in both urban and rural China. According to the different needs of patients and their caregivers, regional and individualised services were needed by stroke survivors and their caregivers.