Objective To study the efficacy and safety of recombinant human thrombopoietin (rhTPO)in the treatment of thrombocytopenia induced by chemotherapy in elder patients with acute myeloid leukemia. Methods 20 elder patients with acute myeloid leukemia who got CR received two cycles of consolidation chemotherapy. In the first cycle of chemotherapy(control cycle), they were transfused with platelet suspensions when they developed severe thrombocytopenia; In the second cycle of chemotherapy (treatment cycle), they were given subcutaneous injection of rhTPO 1.0μg·kg-2·d-1 for 14 days or until platelet count≥ 80×109/L with the treatment above all when platelet count ≤50×109/L. The efficacy and safety were evaluated. Results The duration of Plt count<100×109/L in the treatment cycle and the control cycle was (23.1±4.5)d and (25.8±5.7) d (P<0.005); the duration of Plt count≤20×109/L in the treatment cycle and in the control cycle was (6.8±2.6) d and (11.7±3.2) d (P<0.005). The minimal Plt count of the treatment cycle and the control cycle were (13.2±4.4)×109/L and (12.2±3.1)×109/L (P＝0.0967) respectively, and the maximal Plt count after its recovery were (239.3±48.7)×109/L and (163.5±32.4)×109/L (P<0.005) respectively. Platelet transfusion was (22.8±6.8) U in the treatment group, it was significantly lower than that in the control group (30.0±6.3) U (P<0.05).The changes of hemoglobin content, white blood cell count, Urine routine, the function of liver and kidney, the function of blood coagulation after chemotherapy in both groups were no obvious(P ＝0.0872). Transient adverse reaction was observed in 5 patients (25 %). No thrombotic incident had occurred. Conclusion rhTPO can significantly accelerate PLT recovery, reduce the degree and duration of thrombocytopenia induced by chemotherapy, and reduce platelet transfusion in the treatment of consolidation chemotherapy for the elder patients with acute myeloid leukemia. It is safe and can be recommended to use widely.

Objective To investigate the difference of amplitude of low-frequency fluctuation (ALFF) and fraction of amplitude of low-frequency fluctuation(fALFF) between Alzheimer's disease (AD)patients and normal aging (NA) controls by voxel-based analysis.Methods Thirty-one AD patients and 44 NA controls were enrolled in the study.Blood oxygen level dependent functional (BOLD) EPI data were obtained during resting-state by using 32-channel head coil.Data were realigned,normalized and then smoothed with 8 mm FWHM kernel.Resting-state fMRI toolkit(version 1.6) was used to generate ALFF and fALFF images.Independent two sample t-test was performed with SPM5 to compare ALFF and fALFF of AD and NA controls.Pearson correlation analysis was performed to examine the relationship between MMSE score and ALFF,fALFF parameters.The significance level was set to be uncorrected O.001 on the voxel level and 0.05 on the cluster level.Results AD patients showed increased ALFF in left temporal lobe (0.492 ±0.119) and right cingulated cortex (0.434 ± 0.093) of AD patients,which were 0.443 ± 0.068 and 0.380 ±0.081 in NA controls (t =2.658,2.227,P ＜ 0.05).Decreased fALFF was found in bilateral posterior cingulate cortices (1.167 ± 0.203) and increased fALFF was found in bilateral temporal lobes (left 1.226 ±0.127,right 1.146 ±0.214) with left side dominance,which were 1.453 ±0.269,1.134 ±0.088,1.014 ± O.132 in NA controls (t =5.001,3.695,3.285,P ＜ 0.05).Bilateral temporal ALFF and fALFF correlated with MMSE positively (r =0.768—0.909,P ＜ 0.05) with left dominance.Conclusion AD patients showed increased resting-state functional MRI changes correlated with MMSE score in the temporal lobes with left dominance,which indicated left temporal lobe may be the best location for the observation of disease progression in AD patients.

Accurate identification of intersegmental plane is one of the key steps of segmentectomy. Identification of intersegmental plane is usually based on differences in ventilation or circulation between the targeted segment and the reserved segment. In recent years, many methods of showing the intersegmental plane after blocking pulmonary circulation have emerged, and these methods have simplified segmentectomy and shortened the operation time. In this paper, we reviewed the related methods of blocking pulmonary circulation to identify the intersegmental plane.

To investigate the effect of the interval between neoadjuvant chemoradiotherapy (nCRT) and surgery on the clinical outcome of esophageal cancer. Methods    PubMed and EMbase databases from inception to March 2018 were retrieved by computer. A random-effect model was used for all meta-analyses irrespective of heterogeneity. The meta-analysis was performed by RevMan5.3 software. The primary outcomes were operative mortality, incidence of anastomotic leakage, and overall survival; secondary outcomes were pathologic complete remission rate, R0 resection rate, and positive resection margin rate. Results    A total of 17 studies with 18 173 patients were included. Among them, 13 were original studies with 2 950 patients, and 4 were database-based studies with a total of 15 223 patients. The results showed a significant positive correlation between the interval and operative mortality (Spearman coefficient=0.360, P=0.027). Dose-response meta-analysis revealed that there was a relatively better time window for  surgery after nCRT. Further analysis for primary outcomes at different time cut-offs found the following results: (1) when the time cut-off point within 30-70 days, the shorter interval was associated with a reduced operative mortality (7-8 weeks: RR=0.67, 95% CI 0.55-0.81, P<0.05; 30-46 days: RR=0.63, 95%CI 0.47-0.85, P<0.05; 60-70 days: RR=0.64, 95%CI 0.48-0.85, P<0.05); (2) when the time cut-off point within 30-46 days, the shorter interval correlated with a reduced incidence of anastomotic leakage (RR=0.39, 95%CI 0.21-0.72, P<0.05); when the time cut-off point within 7-8 weeks, the shorter interval could achieve a critical-level effect of reducing the incidence of anastomotic leakage (RR=0.73, 95%CI 0.52-1.03, P>0.05); (3) when the time cut-off point within 7-8 weeks, increased interval significantly was associated with the poor overall survival (HR=1.17, 95% CI 1.00-1.36, P<0.05). Secondary outcomes found that the shorter interval could significantly reduce the positive resection margin rate (RR=0.53, 95% CI 0.38-0.75, P<0.05) when time cut-off point within 56-60 days. Conclusion    Shortening the interval between nCRT and surgery can reduce the operative mortality, the incidence of anastomotic leakage, long-term mortality risk, and positive resection margin rate. It is recommended that surgery should be performed as soon as possible after the patient's physical recovery, preferably no more than 7-8 weeks, which supports the current study recommendation (within 3-8 weeks after nCRT).