Adaptive design is a trial design that allows modifications to some aspects of the trial after its initiation without undermining the validity and integrity of the trial. Adaptive design makes it possible to discover and rectify inappropriate assumptions in trial designs, reduce development costs and the time to market. It has been very attractive to the pharmaceutical industries. In this paper, it is not focused on adaptive designs for clinical trials with multiple endpoints studied using computer simulations, but is to clarify our evolution, which is taken into consideration in a trial adaptive design at present, if need modifications.

The physicians and nurses in the intensive care unit often discuss about withdrawing or withholding life-support therapy of critical ill patients with them or their family members.In this article,we expatiate on the importance,approach,agendas and medical ethical issues of the communication about end-of-life care between clinicians and families.

Evaluation of regional health service system can provide guidance for regional health planning,improve the ability of the national macro-control and supervision,and optimize the medical resource allocation.China has yet to establish a set of scientific and comprehensive evaluation index system.Through the introduction of the importance,influence factors and the current methods in evaluation of regional medical service system in US,suggestions are provided for establishing and improving China's evaluation system of regional health service.

Objective To investigate the situation of mental disability in Hebei province. Methods Based on the survey of the Second National Disabled Sample in Hebei province, the data of mental disability were analysed, including the morbidity, severity, causes, and the service and demand. Results The morbidity of mental disability was higher in the countryside than that in the city (χ2=364.24, P<0.01). The severity of the disabled was more in level 3 or 4 than in level 1 and 2 (χ2=221.16, P<0.01). The genetic disease and brain disease were the major causes to the mental disability. The service did not meet the demand. Conclusion The mental disability was more in the countryside than in the city, with severity of mild to moderate.

Abstract?AlM: To investigate the relationship between carotid artery stenosis and ischemic ocular diseases.?METHODS: The clinical data of 30 cases ( 37 eyes ) of patients with ischemic eye diseases were collected from November 2010 to May 2014, and they were accepted the fundus fluorescein angiography ( FFA ) , transcranial Doppler ( TCD) ultrasonic blood vessels of the eye, neck vascular color Doppler flow imaging ( CDFl) , the neck CT angiography ( CTA ) and carotid artery digital subtraction angiography ( DSA) examination, and then the ischemic eye disease patients with ocular symptoms were analyzed. The peak systolic velocity ( PSV) and resistance index ( Rl) of ophthalmic artery and central retinal artery were compared. Correlation between the internal carotid artery intima- media thickness ( lMT ) and ophthalmic artery, central retinal artery PSV and Rl correlation risk;ipsilateral internal carotid artery plaque and ophthalmic artery PSV and Rl; PSV and Rl associated ipsilateral internal carotid artery plaque and central retinal artery were analyzed.?RESULTS:Eye symptoms:a black dim, reduced vision, the eyes flash, and around the eye pain were 75. 7%, 83. 8%, 51. 4% and 32. 4%;The eye signs:the dilatation of retinal vein, retinal hemorrhage, arterial stenosis and cotton spot and the contralateral side were regarded as main signs. Ophthalmic artery PSV and Rl value of the differences were statistically significant ( P<0. 05 ); The contralateral side of the central retinal artery PSV and Rl value of the differences were statistically significant ( P<0. 05 ); The ipsilateral internal carotid artery lMT and ophthalmic artery, central retinal artery PSV and Rl were not correlated ( P>0. 05 ); The ipsilateral internal carotid artery plaque and ophthalmic artery PSV had no correlation with Rl values (P>0. 05); PSV and Rl and the ipsilateral internal carotid artery plaque and central retinal artery had no correlation (P>0. 05).?CONCLUSlON: The incidence of ischemic eye diseases and internal carotid artery stenosis is associated with very close, the clinical can regard the degree of internal carotid artery stenosis as an important basis for diagnosis and treatment of eye diseases.

Carcinoma, Squamous Cell ; surgery ; Head and Neck Neoplasms ; surgery ; Humans ; Neoplasm Recurrence, Local ; prevention & control ; surgery ; Prognosis

Objective To determine multiple inorganic anions in drinking water with ion chromatography,such as F~-,Cl~-, NO_2~-,Br~-,HPO_4~(2-),NO_3~-,SO_4~(2-).Methods The ion chromatography was used.The optimized conditions were explored.Results Under the selected flow rate(1.5 ml/min),the optimal concentration of eluent NaHCO_3 and Na_2CO_3 was 2.0?10~(-3)and 3.0?10~(-3) mmol/L,under the concentration of eluent,the optimum pump flow rate was 1.5 ml/min,the recovery rate was 94.69%-102.20%. Conclusion This method is applicable to the determination of multiple inorganic anions in drinking water.

Objective To evaluate the feasibility and safety of transjugular liver biopsy (TJLB) by using LABS 100 liver access and biopsy set (Cook Inc, bloomington, IN, USA). Methods During the period from June 2014 to Sep. 2014, a total of twelve patients received TJLB at authors’ hospital. The clinical data were retrospectively analyzed, and the indications, number of puncturing times, technical success rate, complications, sufficient amount of specimen, etc. were summarized. Results Technical success of TJLB was achieved in all patients, and no procedure- related complications occurred. The mean number of puncturing was 2.8 times, and sufficient amount of specimen for histological examination was obtained in all cases. Conclusion This preliminary result indicates that transjugular liver biopsy with the use of LABS 100 liver access and biopsy set is clinically safe and feasible.

BACKGROUND:Intertrochanteric femoral fractures are one of the most common fractures in old patients. How to effectively fix has a great chalenge for orthopedic surgeons. No consensus on which fixation method is optimal has been obtained in the academia. OBJECTIVE: To evaluate the clinical therapeutic effects and complications of minimaly invasive percutaneous proximal femur locking compression plate for senile stable intertrochanteric fractures. METHODS:From May 2010 to May 2012, 98 patients (34 males and 64 females) with stable intertrochanteric fractures were treated with minimaly invasive percutaneous proximal femur locking compression plate fixation. The mean age was 76 years (range, 59-93 years). The mean time between fractures and operation was 3 days (range, 1-5 days). Patients were folowed up regularly after treatment. Healing time, Harris score of hip function recovery and the occurrence of complications were evaluated. RESULTS AND CONCLUSION: Al patients were folowed up for 12-24 months. Al incisions obtained healing by first intention. Al fractures reached clinical healing, and the healing time was 12-20 weeks (16 weeks on average). There was no fixation failure and loosing, rotation, crispatura deformity or screw cutting the femoral head. The function of the hip joint was assessed according to the Harris scoring: excelent in 75 cases and good in 18 cases, with the excelent and good rate of 95%. These data verify that proximal femur locking compression plate can be a feasible alternative to the treatment of stable intertrochanteric fractures. The patients obtained satisfactory outcomes, with less complication, indicating that there is a good biocompatibility between the implant and elderly host.

OBJECTIVE:To study the influencing factors for the extraction of the genomic DNA from Paeonia Suffruticosa.METHODS:Taking Paeonia Suffruticosa(root bark of Chinese medicinal herb) as material to investigate the influencing factors including concentrations of the NaCl and beta-mercaptoethanol,temperature and time of water bath,RNaseA,PCR(polymerase chain reaction) system etc in the buffer solution on the basis of modified CTAB method.RESULTS:The DNA obtained by modified CTAB method was pure,integrated,with the value of A260/A280 ranged from 1.8 to 2.0,the ampl-ified bands of PCR were clear and bright,which lay a solid foundation for the following molecular biology experiments.CONCLUSION:The modified CTAB method is economical,rapid and efficient,and it can be served as an extraction of genomic DNA from root bark Chinese medicinal herb as well as a theoretical basis for full scale production.