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.

Substantial evidence supports the relationship between chronic inflammation and cancer development. Numerous studies suggest that chronic inflammatory disease, such as periodontitis, contributes to head and neck squamous cell carcinoma development. Oral squamous cell carcinoma (OSCC) is the most common malignant tumor in the oral and maxillofacial regions. Porphyromonas gingivalis, one of the most important pathogens in association with periodontal disease, might have a potential correlation with OSCC. Along with the development of molecular biological techniques, the association between Porphyromonas gingivalis and OSCC has been greatly emphasized in recent years. This review summarizes the association between these variables and the potential mechanisms involved in such relationship.
Carcinoma, Squamous Cell ; pathology ; Humans ; Mouth Neoplasms ; pathology ; Periodontal Diseases ; Periodontitis ; Porphyromonas gingivalis ; Research

Objective To investigate the efficacy of heart value replacement on elderly patients and summarize the experience of surgical treatment.Methods The clinical data and follow-up status of 76 elderly patients were analyzed retrospectively in our hospital from January 2008 to December 2011.The operative method,general effect,postoperative death,postoperative complications,survival rate and life quality followed-up were analyzed.Results No intraoperative death appeared and there were 4 early operative deaths with a mortality rate of 5.3％.There were 31 cases occurred postoperative complication with a complication rate of 40.8％ which including respiratory insufficiency,lung infection,arrhythmia,incision infection,pleural effusion,low cardiac output syndrome and renal insufficiency.The follow-up time was 18-52 months and the mean follow-up time was (24.7± 3.6)months.There were 5 cases lost of follow up and the follow-up rate was 93.4％.There were 6 patients died after a month postoperative with a mortality rate of 7.9％.The heart function of the survivors achieved differed degree improvements and the result at the end of follow-up were grade Ⅰ-Ⅱ 47 cases,grade Ⅲ 13 cases and grade Ⅳ 6 cases.Conclusions To correctly determine the surgery indications,do all the preoperative preparation,intraoperative rigorous operating with a good myocardial protection and to strengthen the postoperative care will be help to reduce the mortality and complications of the elderly patients with heart value replacement.

Objective: To evaluate the application of two-dimension and color Doppler ultrasound in diagnosis and differential diagnosis of fascial space infection in maxillofacial region. Methods: Retrospective analysis was conducted on 87 cases of maxillofacial space infections, among which there were 6 suspected cases of accompanying tumor.Results: In the 87 cases, 53 had abscess formation, confirmed by operative drainage or puncture biopsy. The pathological studies revealed 2 cases of Non-Hodgkin's lymphoma, and 1 case of branchial cleft cyst accompanied with infection. The 3 cases showed characteristic appearance in ultrasonic imaging. The space infection presented stronger echogenicity than that in tumors. In this study, 95% (83/87) cases showed grey or medium echogenic dots, while 4.5% (4/87) cases did not show obvious echogenic dots due to a large amount of abscess, and 2 cases of tumors, however, did not show any echogenic dots. In addition, 87% (76/87) cases had few blood flow in the lesion areas, and 22% (2/87) cases had much blood flow in the lesion areas. All cases showed that the lesion areas and the blood flow reduced obviously with enhanced echo following anti-inflammatory treatment except 2 cases accompanied with tumor without obvious changes in lesion areas and blood flow.Conclusion: The ultrasonic diagnosis with two dimension and color Doppler ultrasound has high accuracy in diagnosis of maxillofacial space infection, with accordance rate up to 96.6%, much higer than CT/MRI. It is suggested that the two dimension and color Doppler ultrasound can be used as a prior choice of diagnosis.