Objective To evaluate the efficiency and safety of esophageal stents combined with radiotherapy compared with esophageal stents alone in the treatment of advanced esophageal cancer.Methods CBM,VIP,CNKI,Cochrane Library,Pubmed and Embase etc were searched by computer begining from the establishment of these datebases to December 2012.The related references as well as communicated with other researchers were also traced to obtain certain informations.Randomized and quasi-randomized controlled trials compared esophageal stents plus radiotherapy with esophageal stents alone in the treatment of advanced esophageal cancer were included.The statistical software RevMan 5.0 was used.Results Seven published articals were included (443 patients),and all trails methodological quality were grade C.The results of Metaanalysis showed that compared with esophageal stents along,esophageal stents combined with radiotherapy improve 1-year survival rates and reduce the local recurrence rates.Gastrointestinal bleeding rates,chest pain rates,gastro-esophageal reflux rates remained similarily.Conclusion Compared with esophageal stents along,esophageal stents combined with radiotherapy can improve 1-year survival rates and reduce the local recurrence rates.

Familial adenomatous polyposis (FAP) is one of the most common hereditary colorectal cancers. Its intestinal and extra-intestinal manifestations are correlated with mutation sties of the APC gene. Potential gene modulation sites in patients who have typical clinical manifestations but with unidentified APC mutations are also discussed, which included MUTYH gene, AXIN gene and certain epigenetic changes. With the generalization of Precision Medicine, to offer individualized treatment and surveillance strategy based on the genotype-phenotype correlation will be of great value for FAP patients. This review focuses on the research advance in genotype - phenotype correlation studies of FAP patients.
Adenomatous Polyposis Coli ; genetics ; Axin Protein ; genetics ; DNA Glycosylases ; genetics ; Genes, APC ; Genetic Association Studies ; Genetic Predisposition to Disease ; Humans ; Mutation ; beta Catenin ; genetics

Objective : To understand the status of rural environmental sanitation and summer diarrhea among rural residents in Zhejiang Province,and to provide evidence for improvement of rural environmental sanitation and prevention and control of summer diarrhea. Methods : The stratified random sampling method was used. Five or six counties each were selected from the east,middle and west of Zhejiang Province;five townships（excluded Chengguan Town）were selected from each selected county;four villages were selected as field survey points from each township;five households were selected from each survey point;one family member（householder or housewife）was selected from each selected household. The information about the environmental sanitation status and prevalence of summer diarrhea were obtained by literature review,interviews,questionnaire suvey,field investigation and laboratory tests. Logistic regression model was used to analyze the influencing factors for occurrence of summer diarrhea among rural residents. Results : There were 2 000 households surveyed. In the past two weeks,108 households had families with diarrhea and the prevalence of diarrhea was 5.40%. A total of 1 828 households disposed the household waste in the garbage bins or pools,accounting for 91.40%. There were 1 926 households with organized sewage discharge,accounting for 96.30%. There were 768 households with nymphs found in the kitchen,accounting for 38.40%;404 households with live egg sheaths found,accounting for 20.20%;592 households with cockroach traces found,accounting for 29.60%;564 households with rat traces found,accounting for 28.20%;and 1 206 households with flies found,accounted for 60.30%. There were 1 314 households with disease vectors around the house,accounting for 65.70%. There were 1 944 household with sanitary toilets,accounting for 97.20%. A total of 1 915 households had habits of drinking boiled water,accounting for 96.57%. The results of multivariate logistic regression analysis showed that rat traces found in the kitchen（OR=2.026,95%CI: 1.362-3.013）were a risk factor for summer diarrhea in rural residents,while drinking boiled water（OR=0.272,95%CI: 0.091-0.811）was a protective factor. Conclusion The sanitary environment and family health habits of rural residents were related to the prevalence of diarrhea in summer. Paying attention to kitchen hygiene and drinking boiled water could prevent summer diarrhea.

Objective To compare the efficacy between left radial approach (LRA) and right radial approach (RRA) for coronary angiography (CAG).Methods The following databases were searched,including PubMed,Embase,Web of science,Cochrane Library,CBM,VIP,Wanfang databases and CNKI,from creation of database to January 2013.Two reviewers extracted data independently,according to inclusive criteria,exclusion criteria and methods of Cochrane Collaboration.Statistical analysis was performed using Review Manager Software (RevMan 5.1).Results Eleven trials with 5 442 patients were included in the systematic review.The results of meta-analysis showed that when compared with RRA,LRA did not increase the failure rate of the procedures (OR =1.04,95％ CI 0.80-1.35,P ＞ 0.05) and amount of contrast medium(mean difference =2.39,95％ CI-0.30-5.08),P ＞ 0.05).However,LRA was superior to RRA in reducing fluoroscopy time (standardized mean difference =0.15,95％ CI0.06-0.24,P ＜ 0.01).In addition,the incidence of severe tortuosity of subclavian artery was significantly lower with LRA (OR=4.65,95％CI 1.98-10.88,P＜0.01).Conclusions Based on the current evidence,LRA shares similar safety with RRA for CAG and is superior to RRA in certain respects.LRA can thus be used either as an alternative approach or routine approach for CAG.

Objective To investigate the relationship of the neutrophil/lymphocyte ratio (NLR) on admission and angiographic no-reflow phenomenon in patients with ST-segment elevation myocardial infarction (STEMI) who had undergone primary percutaneous coronary intervention (PCI).Methods 232 patients who had undergone PCI between 2010 and 2013,were included and divided into two groups based upon the thrombolysis in myocardial infarction (TIMI) flow gradings.No-reflow was defined as post-PCI TIMI Grade 0,1 and 2 flows (group Ⅰ).Normal-flow was defined as TIMI 3 flow (group Ⅱ).Receiver operating characteristic curve (ROC) analysis was used to identify the predictive effect of NLR on no-reflow phenomenon.Relationship of NLR and no-reflow was assessed by multivariate logistic regression.All statistical calculations and analyses were performed using SPSS 11.0.Results NLR was significantly higher in group Ⅰ (n=45) compared with group Ⅱ (n=187) [4.1 (2.4-6.5) vs.2.4 (1.7-3.8),P=0.001].In ROC analysis,NLR＞3.2 predicted no reflow with 80％ sensitivity and 73％ specificity.Patients with elevated NLR had a higher incidence of no-reflow phenomenon than those with non-elevated NLR (34.8％ vs.9.3％,P＜0.001).Also,NLR (＞3.2) was an independent predictor of no-reflow development [odds ratio 3.70,95％ confidence interval (1.39-9.80),P=0.009].Conclusion NLR was an independent predicator for no-reflow development in STEMI patients who had undergone PCI.This simple and low-cost parameter could provide useful information for the early risk evaluation on these patients.

Objective: To learn the disinfection effect and its influencing factors of drinking water in rural areas of Zhejiang Province,so as to provide scientific basis for the control of microbial pollution in drinking water and prevention of waterborne diseases. Methods: A total of 5 299 samples from 879 rural water plants Zhejiang Province were collected by stratified sampling method in 2017. The disinfection effect of water samples was assessed quality according to GB 5749-2006 Hygienic Standards for Drinking Water. Logistic regression models were used to analyze the influencing factors for disinfection effect of rural drinking water. Results: There were 540 rural water plants in Zhejiang Province adopting routine process for water purification,accounting for 61.43%;771 ones using surface water,accounting for 87.72%. About 4 458 samples（84.13%）were disinfected and the qualified rate was 86.05%,22.32% of which were disinfected by chlorine dioxide and the qualified rate was 100.00%. The results of multivariate logistic regression analysis showed that scale of water plant,disinfectant residue,use frequency of disinfection equipment,disinfection,season and source water turbidity were the influencing factors for the disinfection effect of rural drinking water（P<0.05）;disinfection,disinfectant residue,use frequency of disinfection equipment and source water turbidity were the influencing factors for the disinfection effect of finished water（P<0.05）;disinfection,disinfectant residue,use frequency of disinfection equipment,source water turbidity and scale of water plant were the influencing factors for the disinfection effect of tap water（P<0.05）;disinfectant residue,use frequency of disinfection equipment,source water turbidity and scale of water plant were the influencing factors forthe disinfection effect of surface water（P<0.05）;disinfectant residue,use frequency of disinfection equipment,source water turbidity and pH were the influencing factors for the disinfection effect of groundwater（P<0.05）. Conclusion The disinfection effect of drinking water in rural areas of Zhejiang Province is associated with source water quality,scale of plants,water purification technique and so on. The disinfection process should be improved,the management of water plants should be strengthened to reduce the risk of microbial contamination.

[Objective]To summarize the thought process behind Chief QIU Shengliang's decision to dispel dampness in order to fortify the spleen and tonify the spleen Yang in clinical treatment of distention and fullness.[Methods]The clinical applications of the aforementioned dampness dispelling technique were compiled for future reference through experience gained via apprenticeship,gathered medical cases,Chief QIU's verbal account on the matter and relevant references.Proven clinical cases were also attached at the end of the report for verification.[Results]Living environment,fast-paced jobs and irregular diet nowadays are making people more prone to spleen-stomach dysfunction and inhibition of Qi movement throughout the middle-Jiao,which in turn leads to distention and fullness.Chief QIU often clinically treats distention and fullness using the aforementioned dampness dispelling technique,for which remarkable efficacy has been achieved.In the medical case reported in this study,the patient was admitted due to recurrent abdominal distension and frequent loose stool.the patient was diagnosed with abdominal distension featuring spleen deficiency and dampness excess by Chief QIU.After treated by strengthening the spleen,dispelling dampness,warming the spleen Yang,promoting digestion and tranquilizing the mind,the patient showed significantly improved condition.[Conclusion]Chief QIU treats distention and fullness by dispelling dampness with the view to fortify the spleen and tonifying the spleen Yang,whose therapeutic efficacy is worth extensive share and popularization.

Gastroesophageal reflux related cough is located in the lung and stomach.The basic pathogenesis is the inversion of stomach qi and the lung loss propagating and descending.In view of the above,based on the theory of"relevance of lung and stomach",this article analyzed the modern mechanism of"relevance of lung and stomach"in gastroesophageal reflux related cough,which included"microinhalation"theory,"esophagus-bronchial reflex"theory,and"airway neurogenic inflammation"theory.This article also put forward the TCM disease name of"gastric cough",and the treatment methods of"simultaneous treatment of lung and stomach"and"treatment of cough from stomach",which would provide new ideas for the theoretical and mechanism research of TCM treatment of gastroesophageal reflux related cough.

Exogenous lipoid pneumonia is an inflammatory response to the lungs caused by inhaled lipid substances, which is prone to secondary bacterial infection, resulting in the formation of local abscesses, which can be life-threatening in severe cases. This paper reports a case of a 55-year-old patient with diesel aspiration, secondary to Klebsiella pneumoniae (ESBL positive) and Candida glabrata infection resulting in lung abscess formation. He was treated with a variety of antibacterial drugs for anti-infection, non-invasive ventilator ventilation, bronchoalveolar lavage, glucocorticoids, phlegm and other medical treatments. Finally, he underwent middle lobectomy for improvement and was discharged from the hospital, and he recovered well with regular follow-up.

Exogenous lipoid pneumonia is an inflammatory response to the lungs caused by inhaled lipid substances, which is prone to secondary bacterial infection, resulting in the formation of local abscesses, which can be life-threatening in severe cases. This paper reports a case of a 55-year-old patient with diesel aspiration, secondary to Klebsiella pneumoniae (ESBL positive) and Candida glabrata infection resulting in lung abscess formation. He was treated with a variety of antibacterial drugs for anti-infection, non-invasive ventilator ventilation, bronchoalveolar lavage, glucocorticoids, phlegm and other medical treatments. Finally, he underwent middle lobectomy for improvement and was discharged from the hospital, and he recovered well with regular follow-up.