Objective:To evaluate the effects and safety of adjuvant chemotherapy for adults with malignant glioma. Method:PubMed,EMBASE,Cochrane Library,CNKI,Chinese Biomedical Database and VIP were reviewed and randomized controlled trials of adjuvant chemotherapy for adults with malignant glioma were identified.The quality of the included trials was evaluated by two reviewers.A meta-analysis was conducted in homogeneous studies.Result:13 controlled trials were involved in 3639 patients.The meta-analysis results showed that compared with radiotherapy alone,the adjuvant chemotherapy might increase 1 year survival,2 years survival,2 years progression free survival,and their OR and 95%CI were 0.61(0.43,0.87),0.52(0.33,0.81),and 0.42(0.19,0.90),respectively,but 1 year progression free survival and 5 years survival had no statistical significance.Their OR and 95%CI were 0.52(0.26,1.04) and 0.75(0.54, 1.04) respectively.5 studies(2418 cases) reported that the toxicity rates increased in patients who received radiotherapy plus adjuvant chemotherapy compared with those in patients who received radiotherapy alone.Conclusion:The adjuvant chemotherapy may increase one year survival and two years survival,and have advandage impact on 2 years and 5 years progression free survival.Owing to the high possibility of attrition bias and measurement bias in the included studies,there must be a negative impact on evidence intensity of our results and therefore,some randomized controlled trials with high quality have to be expected to obtain the best evidence.

Objective:To identify the impact on asthma by the treatment of mometasone furoate monohydrate nasal spray to allergic rhinitis.Methods:This was an opened own control study.25 patients with asthma and rhinitis were given inhaled-powder salmeterol/fluticasone50 ?g/250 ?g(Seretide),one inhalation each time,twice daily via Diskhaler for 3 months.then added the use of mometasone furoate monohydrate nasal spray(Nasonex) 50 ?g,one spray each nasal side each time,twice daily.To determine the efficacy of different treatment methods.The forced expiratory volume in one second(FEV1),the forced vital capacity(FVC),asthma symptom scores,nocturnal-awakening times and the amount of use of inhaled short-acting?2-adrenoceptor agonist bronchodilators were observed respectively before the treatment,after the treatment of salmeterol/fluticasone 50 ?g/250 ?g for 3 months,and after the treatment of inhaled-powder salmeterol/fluticasone combined with Nasonex for 3 months.Results:The treatment of inhaled-powder salmeterol/fluticasone combined with mometasone furoate monohydrate nasal spray improved FEV1,FVC and clinical asthma symptoms,and decreased the amount of the use of inhaled short-acting?2-adrenoceptor agonist bronchodilators,there were significant differences(P

ObjectiveTo investigate the clinical application of transcranial Doppler (TCD) in patients with ischemic cerebrovascular diseases (ICVD). MethodsPatients complaining hemiplegia (n=38) or dizziness (n=35) after ICVD were detected with TCD and magnetic resonance angiography (MRA). ResultsThe incidence of abnormal intracranial large arteries detection was similar in patients complaining hemiplegia (χ2=1.03,P>0.05) between TCD and MRA, but different in patients complaining dizziness(χ2=10.76,P<0.05). ConclusionIn the patients with ICVD, TCD can be used in those complaining hemiplegia as a screening test before vascular interventional therapy, but be worthless in those complaining dizziness.

Objective To evaluate the effect of anisodamine on expression of Toll-like receptor 4 (TLR4) in the kidneys of exhausted rats.Methods Forty-eight male SD rats weighing 200-220 g were randomly divided into 3 groups:control group (group Ⅰ ) (.n =8) ; exhaustion group (group Ⅱ ) ( n =24) and anisodamine group (gronp Ⅲ) (n =16).In groups Ⅱ and Ⅲ exhaustion was induced by exhausting swimming and defined by (1) the animal sank to the bottom and stayed for＞ 10 s during swimming,(2) uncoordinated swimming,and (3) the animal lost escape/righting reflex when placed on the table In group Ⅲ intraperitoneal anisodamine 10 mg/kg was administered at 20 min before swimming.The animals were sacrificed immediately (T1 ),6 h (T2 ) and 24 h (T3 ) after exhaustion respectively.Their kidneys were obtained for detection of apoptosis and determination of TLR4 protein (by immuno-histochemical staining) and mRNA (by RT-PCR).Results Exhaustion significantly increased the number of apoptotic cells and up-regulated TLR4 protein and mRNA expression in group Ⅱ as compared with group Ⅰ,and anisodamine significantly attenuated the exhaustion-induced increase in the number of apoptotic cells and up-regulation of TLR4 protein and mRNA expression in group Ⅲ as compared with group Ⅱ.Conclusion Anisodamine can decrease apoptosis in renal cells in exhausted rats bydown-regulating TLR4 expression.

OBJECTIVE:To understand the status of the use of national essential medicines,and provides reference for further implementing the national essential medicine system and promoting the priority use of national essential medicines. METHODS:Ac-cording to the statistics analysis of the use of national essential medicines(for example the antihypertensives and oral hypoglycemic agents)in Beijing,Shanghai and Guangzhou areas,the related influential factors about priority use of national essential medicines were explored. RESULTS:The proportions of use amount of national essential medicines in our hospital in 2012-2013 to the total amount of medicines were 21.20% and 18.75%,respectively,with a downtrend;the proportion of antihypertension drugs to total amount was only 14.05%and 13.70%,respectively;compared with the same generic drugs with individual pricing,the GMP prod-ucts of Valsartan capsule,Bisoprilol tablet and Amlodipine tablet had no advantages in DDDs,or even lower. DDDs of individual pricing drugs of Acarbose tablet in medical institutions in Beijing area and tertiary hospitals in Shanghai and Guangzhou area in 2011-2012 were much higher than the generic GMP products with the same generic drugs. CONCLUSIONS:The clinical use of na-tional essential medicines in our hospital and parts of the country still remains to be further improved,the influential factors includ-ed reimbursement mechanism,awareness rate of related knowledge,physicians’habit to drug use and pursuing economic benefits. The propaganda and training should be strengthened,awareness rate of medical staff and publics to national essential medicines, the availability of national essential medicines and national essential medicine system and medicare reimbursement payment policy should be improved,and the priority use of national essential medicines should be promoted by more measures combination use.

BACKGROUND:Fibrin glue has been widely used in breast surgery, but due to the limitation of cases, there are some differences in clinical effects.
OBJECTIVE:To systemicaly review the clinical effect of fibrin glue in breast surgery.
METHODS: We searched China Journal Ful-text Database (CNKI), VIP database, Wanfang Database for clinical randomized controled trials related to fibrin glue used in breast surgery published from March 2002 to March 2014. A Meta-analysis was done in included studies using Rev Man 5.2 statistical software.
RESULTS AND CONCLUSION:A total of 11 studies, with 1 043 cases, were enroled for the Meta-analysis. Meta-analysis showed that the postoperative 1-day drainage amount and total drainage amount were significantly lower in the fibrin glue group than the control group [WMD=-85.62, 95%CI(-128.86,-42.39), P=0.000 1;WMD=-167.27, 95%CI (-210.05,-124.49),P < 0.000 01]. In addition, the fibrin glue group was superior to the control group in the postoperative seroma rate [OR=0.30, 95%CI (0.21, 0.44),P< 0.000 01]. Application of fibrin glue in breast cancer surgery can significantly reduce postoperative drainage and seroma rate.

For thyroid microcarcinoma(TMC),the incidence is not obvious,the lesion is small,the symptoms are not distinctive and the progression is slow. Studies suggest that patients with the age over 45 years or below 15 years old,male,lesion over 5 mm and lymph node metastasis have poor prognosis and active opera-tion treatment is needed. When in operation,the excision extension should take clinical data into consideration, and complete resection of the lesions and preservation of the normal tissue as much as possible should be done. For the patients with lymph node metastasis,lymph node dissection is feasible,and the central lymph node dis-section is applicable for the negative lymph nodes. Reduce the risk of recurrence and metastasis,increase the survival rate of patients with tumor and improve the quality of life,become the prime target of the follow up,in which the standardized treatment of TMC plays a vital role.

Exosomes are extracellular nanoparticles secreted by multiple types of cells,which are enriched for some bioactive molecules,such as proteins,messcge RNA(mRNA),micro RNA(miRNA), DNA and lipid. These molecules are documented to be involved in the process of intercellular material exchange and signal communication,thus affecting the function of cells. Also,exosomes are considered to participate in tumor angiogenesis,cancer progression and metastasis,but the mechanism remains obscure. Exosomes are of great value for the diagnosis and treatment of tumor. The correlations between exosomes and tumorigenesis and tumor metastasis as well as their clinical applications are summarized in this review.

Clinical data of 83 patients with obscure gastrointestinal bleeding (OGIB) undergoing capsule endoscopy were reviewed retrospectively.The results showed that the overall detection rate of gastrointestinal lesions for OGIB by capsule endoscopy was 81.9％ (68/83), most lesions (77. 1％, 64/83 )were located in small intestine. Of all the small intestinal lesions, arteriovenous malformation (AVM) was the most common (22 cases, 26.5％ ),followed by small intestinal space-occupying lesion (18 cases,21.7％ ) and single or multiple ulcers of small intestine ( 16 cases, 19. 3％ ). Four cases (4. 8％ ) had lesions outside of the small intestine. Small intestinal AVM was the leading cause of OGIB in patients ＞ 50 y,space-occupying lesion was the most common in patients aged 30 -50 y, while ulcer was the leading cause in patients ＜ 30 y. Bowel obstruction was not found in this group of patients. The results indicate that capsule endoscopy has great diagnostic value in detecting causes of OGIB. Small intestinal AVM is the most common cause of OGIB, followed by space-occupying lesion and ulcer.

Objective To investigate the clinical therapeutic effects of neuromuscular electric stimulation (NMES) on patients with swallowing disorders after stroke. MethodsA total of 98 patients with a swallowing disorder after stroke were randomly divided into an NMES group (38 cases),a rehabilitation group (30 cases) and a control group (30 cases).In the control group the patients were treated with medication only; the in rehabilitation group they were treated with medication and swallowing rehabilitation training; in the NMES group they were treated with medication and NMES.The treatments lasted for 3 weeks in all groups.The swallowing function of patients in each group were observed and assessed with dysphagia scoring pre-and post-treatment.Complications of the swallowing disorders,side effects of treatment and the stomach tube leaving rate were observed. ResultsAfter treatment,the dysphagia scores of patients in the NMES and rehabilitation groups both increased,but the average scores in the NMES group were significantly higher than in the rehabilitation and control groups.The difference in therapeutic effect between the three groups was statistically significant.After treatment,the incidence of aspiration pneumonia in the NMES group was significantly lower than that in the control and rehabilitation groups.The average stomach tube leaving rate in the NMES group was significantly lower than that in the control group,but there was no significant difference in stomach tube leaving rates between the rehabilitation group and the NMES group.There was no significant difference among the three groups in malnutrition.No side effect was observed in any group.Conclusions NMES could alleviate post-stroke dysphagia and decrease the incidence of aspiration.The short-term therapeutic effect of NMES was better than that of swallowing rehabilitation training,but the long-term therapeutic effects were about the same in the two groups.