Objective    To explore the relation of preoperative red blood cell distribution width (RDW) with prognosis in esophageal cancer. Methods    The PubMed, EMbase, Web of Science, Cochrane Library, VIP, Wanfang, CNKI and SinoMed databases were searched to identify potential studies assessing the correlation between preoperative RDW and prognosis of esophageal cancer patients from establishment of databases to February 2019. The endpoint events included the overall survival (OS), cancer-specific survival (CSS) and disease-free survival (DFS). The Stata 12.0 software was applied for the meta-analysis and the hazard ratio (HR) and 95% confidence interval (CI) were calculated. Results    A total of 10 retrospective studies involving 4 260 esophageal cancer patients from China or Japan were included. The score of Newcastle-Ottawa scale (NOS) of the included studies was more than 6 points. The results demonstrated that elevated preoperative RDW was significantly associated with poor CSS (HR=1.50, 95% CI 1.14 to 1.99, P=0.004) and DFS (HR=1.45, 95% CI 1.14 to 1.85, P=0.002), while no significant association between preoperative RDW and OS in esophageal cancer was observed (HR=1.17, 95% CI 0.95 to 1.45, P=0.143). Subgroup analysis based on the pathology revealed that preoperative RDW had high prognostic value in esophageal squamous carcinoma (ESCC) (HR=1.37, 95% CI 1.05 to 1.77, P=0.018). Conclusion    Preoperative RDW may be an independent prognostic factor for Chinese and  Japanese esophageal cancer patients, especially for ESCC patients. However, more prospective studies with bigger sample sizes from other countries are still needed to verify our findings.

Objective: To evaluate the epidemiologic characteristics of hand, foot and mouth disease in Zhejiang province between 2009 and 2017, so that scientific evidence could be provided for prevention and control of hand, foot and mouth disease. Methods: Spatial, temporal and population distribution of HFMD was analyzed. Real-time reverse transcription polymerase cain reaction was used to test Enterovirus A71 and Coxsackievirus A16 in samples. Results: Between 2009 and 2017, 1 108 093 HFMD cases were reported in Zhejiang with the prevalence of 226.24/100000; 2010, 2012, 2014 and 2016 had a higher prevalence than other years. Prevalence of HFMD peaked in April-July and September-October. Wenzhou, Taizhou and Ningbo had a higher prevalence than other cities. In total, 69.27% cases were children who were not enrolled in nursery school, and 65.67% were 1-3 years old. Pathogen surveillance showed that EV-A71 decreased in mild cases, whereas other enterovirus increased. However EV-A71 was still predominant in severe and fatal cases (56.0%). Conclusions Temporal and spatial distribution of HFMD is characteristic in Zhejiang province. EV-A71 predominated in severe cases and fatal cases, while other enterovirus (non-EV-A71, non CV-A16) were the main pathogen for mild cases.

Objective To analyze the clinical manifestation caused by local injections of botulinum toxin type A for cosmetic reason and the effect of antitoxin for adverse reaction.Methods Diagnosis and treatment process of 40 patients were retrospectively analyzed for adverse reactions due to botulinum toxin injections for beauty.Severe adverse reaction was assessed according to the patients clinical manifestation and the nervous system of physical assessment.The patients were given symptomatic treatment,observation or antitoxin therapy.Results Adverse reactions developed in 40 patients were mainly the nervous system abnormalities.Dyspnea developed in four cases.34 cases (85 ％) were given symptomatic treatment.4 cases (10 ％) were given botox treatment,and the patients were followed up for 1-3 months.The patients fully recovered to normal and did not leave any neurological sequelae.Conclusions The management of type A botulinum toxin injections should be strengthened.In case of poisoning,antitoxin therapy should be given as early as possible.

Objective To improve the understanding of the vertebrobasilar dolichoectasia (VBD) by analyzing the MRA imaging features of VBD.Methods The data of 438 patients underwent MRA were analyzed in the study.The length and transverse deviation of the basilar arteries (BA) were measured for the diagnosis and classification of VBD.Of 438 patients, 342 patients were diagnosed as brain infarction (BI) by head MRI.All of the BI patients were divided into 2 groups (VBD and non-VBD) and the classifications of BI were compared between the two groups.Results Of 438 patients, 16 were diagnosed with VBD by MRA.According to the modality of VBD on MRA, VBD were classified into 4 types: S type, U type, L type and spiral type.Among the 16 patients, there were 7 patients with S type, 5 patients with U type, 3 patients with L type and 1 patient with spiral type.S type had the highest incidence and the mildest symptom.The incidence of VBD in BI patients was 3.98%, and the incidence of BI in VBD patients was 2.1 times greater than that of patients without VBD (P<0.05).Conclusion VBD can be classified into 4 types according to the MRA results.The clinical symptoms are varied with different imaging features, and VBD is closely related to the posterior circulation ischemia, especially brainstem infarction.

Objective    To clearly define and describe the difference of analgesic actions and side effects between dezocine and parecoxib sodium in video-assisted thoracic surgery (VATS) lobectomy. Methods    Ninety patients underwent thoracotomy (lobectomy) and were hospitalized in the Department of Thoracic Surgery, West China Hospital, Sichuan University between August 2015 and January 2016. Patients were randomly divided into two groups including a parecoxib sodium group (a PG group, 43 patients) and a dezocine group (a DG group, 47 patients). We analyzed the occurrence of side effects in the two groups, as well as other outcomes including visual analogous scores and location of the pain et al. Results    The occurrences of nausea, vomit and abdominal distention in the PG group (9.30%, 2.33%, 13.95%) were significantly lower than those of the DG group (25.53%, 17.02%, 40.43% , P=0.046, P=0.032, P=0.009) in the early period after operation. Pain scores at the postoperative 12 h, 24 h, 48 h and 72 h in the PG group (2.56±0.96, 2.47±0.96, 1.93±0.99, 0.98±1.24) were better than those of the DG group (4.00±1.60, 3.62±1.48, 3.36±1.55, 2.47±1.78, P=0.000, P=0.000, P=0.000, P=0.002). And the same results were found in the postoperative coughing VAS assessment. The mostly reported pain location was the chest drainage, incision site and chest wall in turn. Postoperative pain properties, in turn, were swelling, stabbing pain and numbness. Conclusion    Postoperative pain after VATS lobectomy may be adequately controlled using parecoxib sodium. The low pain scores and decreased adverse effects are achieved.

Objective: To analyze the effect of NCCN (2015) risk stratification on prognosis of patients with acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: Retrospective analysis of 258 patients with AML in CR (186 cases in CR₁, 72 cases in CR₂) who underwent allogeneic HSCT in our hospital between April 2012 and March 2015 according to NCCN (2015) risk stratification. Of them, 63 cases were classified as low risk, 112 cases intermediate risk and 83 cases high risk. Results: ①With the median follow up of 18 (5-41) months, two-year disease free surviva (DFS) in 258 patients was 78.0% (95% CI 60.4%-96.6%) . Two-year DFS in AML after transplantation was 78.6% (95% CI 61.0%-96.2%) in low risk, 76.0% (95% CI 84.0%-93.6%) in intermediate risk and 80.3% (95% CI 62.7%-97.9%) (P=0.886) in high risk groups respectively. ②Univariate analysis showed that DFS has no significant difference in patient age, the median disease course before HSCT, the WBC number at the beginning of the disease, blood routine and chromosomes examination before transplantation, extramedullary disease before transplantation, disease status before transplantation, conditioning regimen, donor type, donor and recipient sex, recipient blood type, transfused MNC number, transfused CD34⁺ cell number and transfused CD3⁺ cell number. DFS was significant lower in primary AML than that in secondary AML (P=0.006) and also lower in MRD positive than that in MRD negative (P=0.003) . The accumulative relapse was significant higher in CR₂ compared to that in CR₁ (P=0.046) . Accumulative non-relapse mortality (NRM) was significanlyt higher in secondary AML compared to that in primary AML (P=0.004) and also higher in MRD positive compared to that in MRD negative (P=0.010) . ③Multivariate analysis showed that MRD positive was the only significant factor in DFS and NRM. Conclusion Allo-HSCT treatment of AML CR patients could achieve a high efficacy, which is similar between CR₁ and CR₂ patients. There is no significant correlation between NCCN (2015) risk stratification and the prognosis of AML patients with allo-HSCT treatment. Pre-conditioning MRD status monitored by multiparameter flow cytometry was the only impact factor on DFS and NRM in allo-HSCT for CR-AML patients.

This study was to investigate the inhibitory effects of single-chain variable fragment of alpha fetopro-tein (scFv-AFP)in combination with doxorubicin on the proliferation of human hepatocellular carcinoma cell lines Huh7.Huh7 cells were treated with different concentration of scFv-AFP or doxorubcin alone or their combi-nation.The inhibitory effects were detected by MTT assay,and cycle arrest and apoptosis of Huh7 cells were ana-lyzed by flow cytometry in different groups using PI and Annexin V /PI-staining respectively.Results showed that scFv-AFP,doxorubicin alone or in combinations dose-dependently inhibited the proliferation of Huh7,and a syn-ergistic effect was observed in their combined action.The combination treatment resulted in significantly higher apoptosis than those in other groups (P <0.05).scFv-AFP (40 μg/mL)markedly blocked the Huh7 cell pro-gression by arresting the cells in the G0 /G1 phase,and the percentage of cells in S phase decreased dramatically (P <0.05);and scFv-AFP combined with doxorubicin blocked the Huh7 cell progression by arresting the cells in G2 /Mphase (P <0.01).

Objective To compare the clinical effects of intravascular ultrasound (IVUS) and blood flow reserve fraction (FFR) in guiding the treatment of critical disease of coronary artery.Methods Forty nine patients with coronary artery disease who underwent coronary angiography were divided into IVUS group (n=43) and FFR group (n=51).In IVUS group,such as MLA ＜4 mm2 or coronary artery stenosis was insufficient,but IVUS showed unstable plaque,and we went the PCI treatment;in the FFR group,FFR＜0.75 was regarded as coronary stenting sign.The patients were followed up for 6 months.The incidence of cardiovascular adverse events was compared between the two groups.Results (1)There was no significant difference in general information and coronary angiography between the two groups (P＞ 0.05).(2)The proportion of interventional therapy in IVUS group was higher than that in FFR group (P＜0.01).(3)The incidence of adverse events between the two groups was not statistically significant (P＞0.05).Conclusion IVUS and FFR examination can be used to guide the interventional treatment of critical disease of coronary artery.However,the accuracy of IVUS can not replace the status of blood flow reserve.

Objective To investigate the risk factors and the influence of intravenous thrombolysis of acute cerebral infarction with cerebral microbleeds(CMBs)by SWI.Methods 1 64 patients with acute cerebral infarction were enrolled in this study.All pa-tients were scanned with routine MRI and SWI.According to the presence of CMBs on SWI,the patients were classified into two groups:CMBs group(73 cases)and non-CMBs group(91 cases).Past history was recorded and risk factors of CMBs were explored. 76 cases patients(including 35 cases of CMBs group and 41 cases of non-CMBs group)were treated by intravenous thrombolysis and rescanned with routine MRI and SWI to compare the changes in the number of CMBs and hemorrhage transformation 24 hours after thrombolysis.Results The difference age,hypertension,lacunar infarction and leukoaraiosis between the two groups were significant (P <0.05).The difference of CMBs and hemorrhagic transformation between the two groups treated by thrombolysis were not sig-nificant(P >0.05).Conclusion Acute cerebral infarction with CMBs are influenced by age,hypertension,lacunar infarction and leu-koaraiosis.Thrombolysis in acute cerebral infarction with CMBs can not augment the incidence of hemorrhagic transformation.

Objective To investigate the potential effect of depression on overweight and obesity in Tangshan city .Methods A total of 2 180 subjects were enrolled into this cross‐sectional survey conducted in Kailuan community .Anthropometric measurement and structured questionnaire survey were administered to each subject .Status of depression was assessed by Patient Health Ques‐tionaire‐9(PHQ‐9) .The potential effect of depression on overweight and obesity was analyzed with Logistic regression .Results The average score of PHQ‐9 as well as the prevalence of moderate or major status of depression in people with overweight and obe‐sity was significantly higher than those with normal weight .The multivariate logistic regression showed that the score of PHQ‐9 was a risk factor for prevalence of overweight and obesity (OR=1 .43 ,95% CI:1 .05-1 .95 ,P<0 .05;OR=1 .07 ,95% CI:1 .04-1 .10 ,P<0 .05) .In comparison to the none/mild depression ,moderate and major depression could significantly increase the risk for overweight (OR=2 .28 ,95% CI:1 .49-3 .49 ,P<0 .05 ;OR=3 .47 ,95% CI:2 .06-5 .84 ,P<0 .05) and obesity (OR=1 .22 ,95%CI:1 .03-1 .45 ,P<0 .05 ;OR=1 .81 ,95% CI:1 .44-2 .29 ,P<0 .05) .Conclusion The depression status could contribute to the development of overweight and obesity and the role of psychological elements should be taken into consideration in overweight and obesity management .