Objective To assess the efficacy and safety of propofol sedation for gastrointestinal endoscopy,we conducted a Meta-analysis of randomized controlled trials (RCT) comparing propofol with traditional sedative agents.Methods Referring Cochrane Collaboration search strategy to develop retrieval in Medline,Web of Science,Wanfang and CNKI database to retrieve the anesthetic propofol and traditional agents in the literature for randomized controlled trials of gastrointestinal endoscopy,surgery and assess their recovery effect.Results Twenty-one original RCTs investigating a total of 1 765 patients,of whom 894 received propofol only and 871 received traditional sedative agents only,met the inclusion criteria.Research showed that compared with traditional anesthetics,no significant differences existed in anesthetic effects of propofol on gastrointestinal endoscopy surgery time.However,surgery can significantly shorten recovery time and the average discharge time; and higher recovery rates.The result of racial subgroup analysis showed:the anesthetic propofol can significantly shorten the time of gastrointestinal endoscopy surgery for Asian populations,but had little effect on the European population.Contrast method for subgroup analysis showed:anesthetic propofol could significantly shorten the ERCP angiography in gastrointestinal endoscopy surgery time,but has little effect on the UGE and colonscopy angiography.Conclusions Propofol is safe and effective for gastrointestinal endoscopy procedures and is associated with shorter endoscopy recovery and discharge time,higher post-anesthesia recovery scores.Care should be taken when extrapolating our results to specific practice settings and high-risk patient subgroups.

Objective To study the efifcacy of interferon IFN-αon chronic hepatitis B, analyze the inlfuencing factors of therapeutic effect. Methods 62 cases with hepatitis B collected in our hospital from January 2008 to December 2012 were treated with interferon IFN-αfor one year, and divided into response group and non-response group according to the efficacy, biochemical indicators, viral load, host factors of patients in both two groups were analyzed. Results After one year’s treatment, the response patients were 38 cases(61.29%), non-response patients were 24 cases(38.71%). The male to female ratio in response group was 26/12, 13/11 in non-response group. The mean disease duration in response group was (3.3 ± 1.3)years, (5.4 ± 1.4) years in non-response group. The mean age in response group was (31.9 ± 8.6) years, (32.7 ± 5.6) years in non-response group. The difference between two groups was statistically signiifcant(P<0.05) Conclusion There is good therapeutic effect for most patients. and no reply for some patients. Analysing clinical data and the results of the study, we found that the course of disease,age, male/female ratio and level of ALT and AST are inlfuencing factors in interferon IFN-αtreatment for chronic hepatitis B.They can be use to predict clinical effect of interferon IFN-αtreatment for chronic hepatitis B.

Objective To explore the relationship between poor sleep quality and stoke.Methods A total of 738 stroke patients in Xuzhou city in 2013 were selected as the case group and age-and sex-matched healthy non-stroke subjects (n =738)as control group.The writer-designed general situation questionnaire and the Pittsburgh Sleep Quality Index(PSQI)analyses were conducted for a face-to-face investigation.Results No significant difference in mean age(66.1±10.9 and 65.8 ± 10.6,t =0.60,P =0.58)and in sex (50％ vs.50 ％) was found between two groups.There were statistically significant differences between case and control groups in baseline values of BMI(t=2.40,P =0.02),histories of hypertension(x2 =174.30,P =0.00),diabetes mellitus (x2 =27.20,P =0.00),coronary heart disease(x2 =115.60,P =0.00),smoking(x2 =6.10,P =0.01),drinking (x2 =7.30,P =0.01)and living stress(x2 =11.40,P =0.01).The PSQI sub-scores and PSQI total scores were higher in case group than in control group.The rate of poor sleep quality was higher in case group(279 cases,37.8 ％) than in control group(136 cases,18.4 ％) (x2 =6.10,P =0.01).Multivariate logistic analysis showed that,after adjusting for confounding factors of BMI,histories of hypertension,diabetes,coronary heart disease.smoking,drinking and living stress,the poor sleep quality in total male plus female was independent predictor variables for stroke[odds ratio(95 ％ CI) of 2.3 (1.8-3.0)],no matter their sex,with odds ratio (95 ％ CI) in male (2.5,1.7-3.7) or in female (2.2,1.5-3.2),respectively,but there was no significance difference in the odds ratio between male and female in case group(x2 =0.04,P=0.85).The risk stroke was 2.3 folds higher in poor sleep quality versus control in male plus female,with pure male or female of 2.5 or 2.2 folds.There was no significance difference between male and female in case group versus.the control(x2 =0.04,P=0.85).Conclusions Poor sleep quality is associated with the occurrence of stroke and may be a risk factor for stroke.

Objective To understand the prevalence and influencing factors of overweight and obesity in adult residents in Xuzhou City of Jiangsu Province,so as to provide scientific basis for health policies and intervention strategies.Methods A total of 39 445 participants were recruited by multi-stage random cluster sampling method,and health data were obtained through questionnaires and physical examinations.Results The prevalence of overweight and obesity was 34.60％ and 9.40％,respectively; and the standardized prevalence was 32.97％ and 8.67％.The prevalence of overweight or obesity in males was 36.73％ and 8.62％,in females 32.61％ and 10.13％.The prevalence of overweight or obesity was increased with age,although the prevalence of overweight was decreased after 55 years of age (18-:16.31％; 25-:27.38％; 35-:37.28％; 45-:41.55％; 55-:40.71％; 65-:37.64％; 75-:32.08％) and the prevalence of obesity was decreased after 75 years of age (18-:2.49％; 25-:6.41％; 35-:9.64％; 45-:11.24％; 55-:12.07％; 65-:12.45％; 75-:8.88％).There were significant difference of the prevalence of overweight/obesity by educational level (x2=178.41,P＜0.01; x2=243.59,P＜0.01),profession (x2=191.28,P＜0.01; x2=120.38,P＜0.01) and marital status (x2=431.67,P＜0.01; x2=118.43,P＜0.01).In Logistic regression,female,vegetable over-intake every day and current cigarette smoking were protective factors of overweight/obesity,while middle and old-age,alcohol drinking and big appetite were risk factors of overweight/obesity.Conclusions A higher morbidity rate of overweight/obesity was found in Xuzhou City,and comprehensive interventions should be taken for high risk populations.

Objective To preliminarily observe the clinical efficacy of hippocampal-sparing prophylactic cranial irradiation (HS-PCI) using helical tomotherapy (HT) in patients with limited-stage small-cell lung cancer (LS-SCLC) after chemoradiotherapy,and compare HT with intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) in dose distribution.Methods From April to June,2014,six patients with LS-SCLC who had achieved a complete remission after chemoradiotherapy were assigned to HS-PCI using HT within a month after brain metastasis was ruled out using brain magnetic resonance imaging (MRI).After fusing CT images and MRI images,the hippocampus was contoured in the fusion images and hippocampal avoidance regions were created using a volumetric expansion of 3 mm around the hippocampus.A dose of 25 Gy in 10 fractions to 95％ of planning target volume (PTV) was prescribed in HT,IMRT,and VMAT.The clinical efficacy,adverse reactions,neurocognitive function,and brain metastasis were evaluated for HT.The dose distribution in PTV and hippocampus were compared between HT,IMRT,and VMAT.Results There were one patient with abdominal wall and abdominal lymph node metastases,one patient with local recurrence,and no patient with brain metastasis during the observation period.The numbers of patients with grade 1 and grade 2 headache,dizziness,and hair loss reactions were 3 and 1,3 and 1,and 4 and 2,respectively.There were no significant differences in the average score of the Mini-Mental State Examination before treatment and at 3 and 6 months after treatment (29.7,29.2,and 29.3 ; P =0.083,0.317,and 0.157).The mean dose to the hippocampus was 16.85 Gy for IMRT and 17.59 Gy for VMAT.For HT,the mean doses to the hippocampus and avoidance regions were reduced to 5.26 Gy and 6.21 Gy,respectively.The prescribed dose for HT was reduced by 79％ and 71％ compared with IMRT and VMAT,respectively.The average coverage rate of the prescribed dose was 94.48％ for HT.Conclusions HT achieves promising dose distribution and target coverage in sparing of the hippocampus.Moreover,HT dose not increase the incidence of adverse reactions.The change in neurocognitive function needs to be further studied with longterm observation and large-scale sampling.

Objective To evaluate the relation between lung dosimetric parameters and the risk of symptomatic radiation pneumonitis (RP) in patients with non-small cell lung cancer (NSCLC) who had re-ceived postoperative radiotherapy. Methods From November 2002 to March 2006, 90 patients with NSCLC who had received postoperative 3-dimentinal conformal radiotherapy (3DCRT) were retrospectively analyzed, including 53 with stage ⅢA disease, 25 with stafe ⅢB disease and 12 with stage Ⅰ-Ⅱ disease but positive margins. Seventy (78%) patients underwent lobectomy, 20 ( 22% ) underwent pneumonectomy, and 38 ( 46% ) received adjuvant chemotherapy. The median radiation dose was 60 Gy given in 30 fractions of 2 Gy using 6 MV X-ray. The percentage of the whole lung volume ( Vx ) and the ipsilateral absolute lung volume ( Vipsi-dosewhich received more than a certain dose were calculated. The endpoint was grade 2 and above RP based on CTC AE 3.0. The relation between the dosimetric factors and RP was also analyzed with receiver operating characteristic (ROC) curves. Results Nine patients ( 10% ) developed symptomatic RP ( grade 2 in 7 and grade 3 in 2), and all of them were in the lobectomy group. No RP was observed in patients who received pneumonectomy. Both V30 and V35 were higher in patients with RP than those without ( 19% vs 14% ,U= -2.16,P=0.030, and 15% vs 11%,U= -2.65,P =0.007, respectively). The area under curve in receiver operating characteristic curves based on the relation between incidence of RP and the value of Vipsi-dose was 0. 757. Using Vipsi-30 of 340 cm3 as a cut-off to predict RP, the sensitivity and specificity were 88% and 70%, respectively. The incidence of RP was 3% in patients with Vipsi-30< 340 cm3 compared with 29% in those with Vipsi-30>340cm3 ( X2 = 9.75 , P = 0.003 ) . Conclusions More than340 cm3 of the ipsilateral lung receiving 30 Gy is significantly related to the risk of RP in patients undergoing lobectomy. It is safe for patients who undergo pneumonectomy to receive postoperative 3DCRT if lung V20 is less than 10%.

Objective To explore the interaction of sleep quality and depression among patients with type 2 diabetes. Methods With multistage cluster sampling, all the participants were interviewed with self-designed questionnaire, diabetes-specific quality of life scale and self-rating depression scale, and Pittsburgh sleep quality index scale. Chi-square test was used for qualitative data. Risk factors were analyzed by means of multiple linear regression or logistic regression model. The indicator of interaction was calculated according to the delta method. Results There were 944 residents involved in the final analysis, including 365 males and 579 females. The average age was (64. 0 ± 10. 2) years. Compared with patients with type 2 diabetes mellitus( T2DM) who had good sleep quality and no depression symptoms, the risk of quality of life in those with good sleep quality but depression was 2. 75 (95% CI 1. 59-4. 77); and the risk of quality of life in those with poor sleep quality and no depression was 1. 55(95%CI 1. 03-2. 33). The risk of quality of life in those with poor sleep quality and depression was 4. 97(95% CI 2. 34-9. 63). Due to poor sleep quality and depression in patients with T2DM the combined interaction index was 2. 48 (95% CI 1. 44-4. 29), the relative excess risk was 3. 42(95% CI 2. 16-4. 67), and the attributable proportion was 0. 51(95% CI 0. 32-0. 70). Conclusion A combined interaction of poor sleep quality and depression in affecting the quality of life was found in type 2 diabetic patients. When both factors existed at the same time, the interaction effect of these 2 factors was greater than the single one.

Objective To investigate independent prognostic factors for overall survival (OS) in extensive disease small cell lung cancer (EDSCLC). Methods Between January 2003 and December 2006, 154 patients diagnosed with extensive stage small cell lung cancer were enrolled in this study.Prognostic factors such as gender, age, performance status, smoking history, weight loss, distant metastasis, the number of matastasis, brain metastasis, the cycle of chemotherapy and thoracic radiation therapy (TRT) for EDSCLC patients were evaluated by univariate and multivariate analysis. Results The median following-up time was 40. 5 months. The rate of follow-up was 92. 2%. The MST and overall survival rates at 3-year in smoking group and no-smoking group were 13 months, 11.8% and 17 months,22. 8%,respectively (χ2=3.40,P =0. 064);in ChT/TRT group and ChT group, they were 17. 2 months, 17.9%and 9.3 months,13.9%, respectively(χ2=10.47,P=0.001);and in the cycle of chemotherapy ≥4 group and ＜ 4 group, they were 16 months, 20. 1% and 9.3 months, 2. 9%, respectively (χ2=17.79,P=0. 000). By multivariate analysis, smoking history was a statistically significant unfavorable factor for OS in EDSCLC patients (versus no-smoking, hazard ratio (HR)=1.462, χ2=4.40, P=0.036). In addition, ≥4 cycles of chemotherapy and TRT were favorable prognostic factors ( ≥4 cycles vs ＜4 cycles, HR =0. 420,χ2 = 17. 17, P = 0. 000; ChT/TRT vs ChT, HR = 0. 634, χ2 = 6. 20, P = 0. 013). Conclusions Smoking is a independent unfavorable prognostic factor and ≥ 4 cycles of chemotherapy And TRT are independent favorable prognostic factors for OS in EDSCLC.

Objective To evaluate the efficacy of rescue treatment for recurrent esophageal cancer after radical esophagectomy, and to provide insights into the development of comprehensive treatment for esophageal cancer.Methods The clinical data of 218 patients who were confirmed with recurrent metastatic esophageal cancer after R0 resection and received rescue treatment in our hospital from 2004 to 2014 were retrospectively reviewed.The survival rate was determined by the Kaplan-Meier method.Univariate and multivariate prognostic analyses were performed using the log-rank test and Cox proportional hazards model, respectively.Results The median post-recurrence follow-up time was 53 months.The 1-and 3-year overall survival (OS) rates after recurrence were 57.2% and 24.4%, respectively.Among the 163 patients with local recurrence, the 1-and 3-year OS rates were 70% and 42% for patients treated with chemoradiotherapy (n=40), 55% and 24% for those with radiotherapy alone (n=106), and 23% and 8% for those with supportive therapy (n=13)(chemoradiotherapy vs.radiotherapy alone P=0.045, radiotherapy alone vs.supportive therapy P=0.004;none of the patients who were treated with chemotherapy alone survived for one year or more).Univariate analysis showed that N staging, TNM staging, and post-recurrence rescue treatment regimen were independent prognostic factors for esophageal cancer (all P=0.001).On the other hand, multivariate analysis indicated that only rescue treatment regimen was the independent prognostic factor for esophageal cancer (P=0.013).Conclusions Rescue chemoradiotherapy or radiotherapy alone can bring significant survival benefits for patients with recurrent and metastatic, especially locally recurrent, esophageal cancer following radical esophagectomy.

Objective To compare postoperative three-dimensional conformal radiotherapy (3DCRT) and conventional radiotherapy (CR) in patients with non-small-cell lung cancer (NSCLC). Methods From Nov. 2002 to Mar. 2006,162 patients with stage ⅠB～ⅢB NSCLC receiving postoperative radiotherapy in our department were restrospetcively analyzed. Among them,86 received 3DCRT and 76 re-ceived CR. The survival outcome, pattern of failure and treatment-related side effects in both groups were an-alyzed. Results The median follow-up was 29.4 months in the 3DCRT group and 24 months in the CR group. The 1-,2- and 3-year local-regional free survival was 97.5% ,83.2% and 83.2% in 3DCRT group, and 84.3% ,76.0% and 65.6% in CR group(χ2= 5.46, P = 0.019), respectively. No statistically signifi-cant difference was found in the overall survival, disease-free survival or distant metastasis-free survival be-tween the two groups. The local-regional failure rate was statistically different between the two groups (14.5% vs 33.3% ,χ2 =7.70,P =0.006). The incidence of distant metastasis in the two groups was simi-lar. Radiation pneumonitis of NCI CTC grade 2-3 occurred in 10 patients(11.6%)in 3DCRT group and 18 (23.7%) in CR group,which was statistically different(χ2 =4.10,P=0.043). Conclusions Postopera-tive 3DCRT for NSCLC provides a better local-regional control and lower incidence of radiation pneumonitis compared with CR.