Objective To comprehensively evaluate the clinical effect of cryoballoon ablation (CBA) and radiofrequency ablation (RFA) in treating paroxysmal atrial fibrillation (PAF).Methods Computer retrieval of PubMed,EMbase,the Cochrane Library,Web of Knowledge,China national knowledge infrastructure (CNKI),Chinese Biomedical Medical Literature (CBM),China Wan Fang,China VIP,and other database to collect the randomized control trials (RCT) related to RFA and CBA treatment for PAF.The retrieval time was from the establishment of database to December 2015.The data extraction and methodological quality of the included studies were assessed by two reviewers independently.And meta-analysis was conducted by using RevMan 5.2 software.Results A total of 6 research papers (636 patients in total) were included.The results of meta-analysis showed that the incidence of phrenic nerve paralysis in CBA group was significantly higher than that in RFA group (RR=9.26,95％CI:2.17-39.63,P=0.003).No statistically significant differences in the operation time (MD=10.07,95％CI:-9.10-30.52,P=0.29),fluoroscopy time (MD=-0.18,95％CI:-8.14-7.77,P=0.96),12-month success rate (RR=0.91,95％CI:0.72-1.14,P=0.40) and the incidences of atrial tachycardia,atrial flutter,atrioventricular reentrant tachycardia existed between CBA group and RFA group (RR=0.47,95％CI:0.11-2.02,P=0.31).Conclusion For the treatment of PAF,no obvious differences in the operation time,fluoroscopy time,12-month success rate,and the incidences of atrial tachycardia,atrial flutter,atrioventricular reentrant tachycardia exist between CBA and conventional RFA,but CBA can increase the incidence of phrenic nerve paralysis.

Objective To study the association between neonatal asphyxia and blood glucose disorder. Methods A total of 134 cases of neonatal asphyxia born in the Maternal and Child Hospital of Hubei Province between January 2013 and January 2015 were included in this study. Blood glucose levels were determined within 30 min after birth and before glucose infusion. The infants were divided into the mild asphyxia group (Apgar score 4 to 7) and severe asphyxia group (Apgar score 0 to 3) according to the Apgar score at 5 min after birth. Statistical analyses were performed using the two-sample t-test and Chi-square test. Results The incidence of asphyxia was 3.2‰(134/41 875). Hypoglycemia was the main blood glucose disorder in the mild asphyxia group [12% (13/112)], and hyperglycemia was the main blood glucose disorder in the severe asphyxia group [32%(7/22)]. The average blood glucose level was higher in the severe asphyxia group than in the mild asphyxia group [(5.8±3.4) vs (5.0±2.3) mmol/L, t=21.979, P=0.001]. In the severe asphyxia group, the incidence of hypoglycemia was higher [18% (4/22) vs 12% (13/112), χ2=7.464, P=0.006] and the average blood glucose level was lower [(1.8±0.7) vs (2.1±0.4) mmol/L, t=5.247, P=0.042],and the incidence of hyperglycemia was also higher [32% (7/22) vs 9% (10/112), χ2=11.679, P=0.001] and the blood glucose level was higher [(11.6±3.8) vs (9.3±2.0) mmol/L, t=1.106, P=0.048]. Conclusion Neonatal asphyxia can lead to blood glucose disorders. The incidence and the severity of these disorders were higher in neonates with severe asphyxia.

Objective To investigate the site,MR signal types and morphological characteristics of ulnar nerve in cubital tunnel for healthy adults,in order to improve the awareness of ulnar nerve.Methods Unilateral elbow of forty healthy volunteers were scanned with MR,the sequences were as follows:T1-weighted-spin-echo,T2-weighted-spin-echo-fat-suppression,PD-weighted-spin-echo-fat-suppression,among 40,13 were supine,27 were prone.The site and MR signal types and morphological characteristics of ulnar nerve were observed,the long diameter and short diameter of the ulnar nerve on different axials were respectively measured.Results On axial,ulnar nerve was posterior to the medial condyle of the humerus at proximal elbow,lied between the flexor carpi ulnaris and the flexor digitorum profunds and superficialis muscles distally.The shape of the ulnar nerve was roundness or elliptic,the signal of 40 volunteers'(100％) ulnar nerve was isointensity on T1-weighted,the signal of 17 volunteers'(42.5％)ulnar nerve was isointense on T2-weighted or PD-weighted,the MRI signal of 23 volunteers' (57.5％) ulnar nerve was slight hyperintense on T2-weighted or PD-weighted,especially on the axial of medial condyle of humerus.The variation range of long diameter and short diameter of the ulnar nerve respectively were 1.4-3.8 mm,1.0-3.0 mm.Conclusion The certain location,MR signal types and morphological characteristics of normal ulnar nerve play an important role in the diagnosis of cubital tunnel syndrome.

Objective To compare patient organ doses and entrance surface dose conversion coefficients in conventional radiography using medical internal radiation dose (MIRD) phantom and voxel human phantom.Methods The voxel phantom was adapted to the Monte Carlo transport code to simulate the organ doses and entrance surface dose in five common projections, and thus the dose conversion coefficients between the entrance skin dose and organ dose were calculated.The results were compared with the reported mean values which were simulated using MIRD phantom.Results The dose conversion coefficients values of organs covered or partially covered by the X-ray field ranged from 0.149-0.650 in chest postero-anterior projection, 0.067-0.382 in chest left lateral projection, 0.023-0.374 in chest right lateral projection, 0.035-0.431 in abdominal antero-posterior projection, 0.083-0.432 in lumbar spine antero-posterior projection.In chest postero-anterior projection, significant differences were most obviously observed in lung, the dose conversion coefficients difference was 54.3％.In chest left lateral projection, the dose conversion coefficients difference of liver was greatest, which was 54.5％.In chest right lateral projection, the dose conversion coefficients differences of stomach wall was most obviously 63.8％.In abdominal antero-posterior projection, dose conversion coefficients discrepancy was most obviously observed in spleen, with the value of 65.0％;while in lumbar spine antero-posterior projection, the dose conversion coefficients differences of stomach wall was most obviously 43.7％.Conclusions Compared with the stylized MIRD phantoms, the anatomical realism in voxel phantom is evident.Therefore, the dose conversion coefficients calculated by voxel phantoms are more accurate and scientific in conventional radiology.

Objective:To investigate the effects of epidermal growth factor (EGF)on cell cycle and cell cycle-related regulatory factors of human esophageal squamous cell carcinoma (ESCC) cell line Eca109.Methods: Serum starved Eca109 cells were treated with 20 ng/ml recombinant human EGF(rhEGF)for 24 h.The cell cycle phase distribution was detected by flow cytometry.The mRNA and protein expression levels of p21CIP1/WAF1(p21) and p27KIP1(p27) were detected by real-time quantitative reverse transcription polymerase chain reaction(qRT-PCR)and Western blot,respectively.Results: The proportions of G1 phase cells in EGF group and control group were ( 54.90 ±0.82 )% and ( 65.94 ±0.74 )%.The mRNA and protein expression levels of p 21 in EGF group was significantly higher ,and p27 was significantly lower than that in control group ( P<0.01 ) .Conclusion: EGF facilitates G1-S phase transition,and promotes the proliferation of Eca 109 cells,which may be associated with the up-regulation of p21 and down-regulation of p27.

Objective To investigate the MR characteristics of ulnar nerve and muscles in cubital tunnel syndrome.Methods Twenty eight patients with cubital tunnel syndrome and 28 asymptomatic volunteers underwent MR imaging,MR neurography was performed by using an isotropic three dimensions T2 sampling perfection with application optimized contrasts using different flip angle evolutions (3D T2 SPACE)on 15 patients with cubital tunnel syndrome.To evaluate changes in T2 signal intensity of the ulnar nerve,regions of interest were placed in the center of the location of the highest apparent ulnar nerve signal intensity on the axial FS T2WI images and in normal muscle within the same image slice,and the ratio of signal intensity was calculated.The sensitivity of 3D T2 SPACE sequence in detecting cubital tunnel syndrome was determined.The standard t tests were used to assess whether ulnar nerve size and relative signal intensity in symptomatic patients were statistically different from normal volunteers.Results The cross-sectional area of ulnar nerve in 24 patients and 2 volunteers was enlarged,the signal intensity of ulnar nerve in 26 patients and 16 volunteers was increased.Increased signal and muscle atrophy adjacent to the ulnar nerve were detected in 4 patients.Cubital tunnel syndrome was detected in 14 patientson 3D T2 SPACE sequence.The mean ulnar nerve sizes in the symptomatic and normal group were (0.15±0.06)and (0.06±0.01)cm2 respectively,the mean relative signal intensities in the symptomatic and normal groups were (2.86± 1.45) and 1.57±0.39 respectively (t values were 2.220 and 4.546,P＜0.05).Conclusions Ulnar nerve size and T2 signal intensity were increased,in patients with cubital tunnel syndrome.In addition,muscles innervated by the ulnar nerve showed atrophy with increased T2 signal intensity.

Objective:To analyze the risk factors of first-episode hematogenous metastasis in patients with thoracic esophageal squamous cell carcinoma (ESCC) who received non-surgical treatment after radiotherapy and chemotherapy, and its impact on survival and prognosis.Methods:The clinical data of 230 ESCC patients who met the inclusion criteria and received radical radiotherapy in Tengzhou Central People′s Hospital and Affiliated Hospital of Xuzhou Medical University from January 2011 to October 2018 were retrospectively analyzed.Logistic regression analysis and survival were used to analyze the risk factors and prognosis of blood group metastasis after treatment.Results:In 230 patients with thoracic esophageal cancer, 70 cases (30.4%) developed hematogenous metastasis for the first time.Compared with patients without hematogenous metastasis, the median overall survival was 15 months and 20 months (χ 2=7.249, P=0.007), and the median progression free survival was 9 months and 13 months (95% CI was 7.2-10.8 months and 10.8-15.2 months, respectively χ 2=21.664, P<0.001). Logistic multivariate analysis showed that there was significant difference in the occurrence of hematogenous metastasis among different N stages (χ 2=30.764, P<0.001). N stage was an independent factor for judging hematogenous metastasis, and the increased N stage increased the risk of hematogenous metastasis (OR value were 6.000, 12.629 and 48.167, respectively; 95% CI were 1.712-21.025, 3.546-44.976 and 10.848-213.858, respectively; all P<0.05). The overall survival time of patients with concurrent chemoradiotherapy before hematogenous metastasis was longer than that of patients with sequential chemoradiotherapy and radiotherapy alone (χ 2=10.002, P=0.007). Stratified analysis showed that adjuvant chemotherapy after concurrent chemoradiotherapy could prolong the overall survival of patients with N2 and N3 (χ 2=11.025, P=0.001). Conclusion:N staging is an independent factor to judge the hematogenous metastasis.ESCC patients with hematogenous metastasis after chemoradiotherapy have poor prognosis.N2, N3 patients with concurrent chemoradiotherapy after adjuvant chemotherapy have clinical benefits.

Objective To analyze the outcomes of the subsidy mechanism reform for China's public hospitals through a financial perspective.Methods An evaluation index system was built using data from China's health (family planning) statistics yearbooks 2009-2016, for comparison of the constituent ratio and chain relative ratio growths of public hospitals in various years.Results Year 2015 found a lower growth rate of medical revenues of these hospitals;year-by-year drop of drug income ratio, yet a gradual rise of income from examinations and materials, and a drop of technical service income growth and its ratio of the total income;a year-by-year drop of drug income surplus growth, and an expanding deficit in medical services;a slower growth of medicine expense growth, with the asset-liability ratio rising to 45.3%, and salary ratio rising to 30.6%.Conclusions The reform on compensating mechanism at public hospitals is demonstrating its impacts on public hospitals, namely slower growth of medical revenue, weakened compensating role of drug income, lower surplus, and higher asset-liability ratio among other financial risk exposure.These hospitals are encouraged to take proactive measures to control costs, including tighter medical service cost control,to secure sufficient and timely government fiscal subsidy, and other funding measures to cope with debts of the hospitals.

Objective To evaluate the predictive value of neutrophil-to-lymphocyte ratio (NLR) and hemoglobinto-white blood cell ratio (HWR) prior to treatment in prognosis of non-operative esophageal squamous cell carcinoma (ESCC) patients.Methods From October 2009 to November 2014,a total of 362 non-operative ESCC patients were enrolled in this prospective study.x2 test was used to analyze the relationship between NLR,HWR and general clinical features;Univariate and multivariate Cox regression analysis was performed to evaluate the association between variables and prognosis of non-operative ESCC patients.Results The optimal cutoff level of 1.23 for NLR and 24.92 for HWR were identified by X-title software.x2 test indicated NLR was significantly associated with gender,tumor length,T stage,TNM stage and fasting blood glucose level.Moreover,univariate and multivariate analyses showed that high NLR and high HWR were all associated with a poor prognosis in non-operative ESCC.However,when patients were specifically stratified by treatment modus,subset analysis showed that NLR was only predictive of prognosis in the concurrent chemoradiotherapy group (HR =4.080,95％ CI:1.074-15.497,P =0.039),whereas the influence of HWR on prognosis was just existed in the sequential chemoradiotherapy group (HR =2.625,95％ CI:1.311-5.254,P =0.006).Conclusions In this investigation,we found that high NLR and high HWR were associated with poor prognosis in non-operative ESCC.

Objective To investigate the expression of Nek8 in esophageal squamous cell carcinoma(ESCC) tissues and cell line , and to evaluate its correlation with the clinicopathological features of ESCC and the survival rate of ESCC patients after operation . Methods The expression of Nek8 mRNA in human ESCC Eca109 cell line and two pairs of ESCC tissues and adjacent normal e‐sophageal mucosal epithelium were detected by semi‐quantitative reverse transcription polymerase chain reaction (RT‐PCR) .Immu‐nohistochemistry and tissue microarray technique were used to examine the expression of Nek 8 protein in ESCC tissues and tumor‐adjacent tissues .The correlation between Nek8 expression and clinicopathological features of ESCC and survival rate of ESCC pa‐tients was then analyzed .Results The expression of Nek8 mRNA was positive in Eca109 cells and two cases of ESCC tissue ,and it was negative in paired normal esophageal mucosal epithelium specimens .In tissue microarray ,the expression of Nek8 protein in ES‐CC tissues ,which was mainly in the cytoplasm ,was significantly higher than that in tumor‐adjacent tissues(P= 2 .16E‐13) .The high expression of Nek8 was associated with tumor size (P=0 .008) ,but not with sex ,age ,histological grade ,infiltration degree , lymph node metastasis ,and the survival rate(P>0 .05) .Conclusion The expression of Nek8 is up‐regulated in ESCC tissues and cell line ,and may be involved in tumorigenesis and development of ESCC .Nek8 could act as a potential biomarker for ESCC diag‐nose and target for therapy .