The paper analyzes the current situation of the application of the peer review system in the management of medical research funding of the army and, in view of existing shortcomings, puts forward some specific measures of improvement, including bettering methodology, enhancing efficiency, and guaranteeing openness and impartiality.

Objective To determine the toxicity, maximal dose and clinical practicality of VM26 (teniposide) plus radiotherapy for postoperative brain neurospongioma. Methods Twenty patients were alloted in phase Ⅰ trial. The total dose was 60 Gy for the field radiotherapy (30 fractions of 2 Gy over six weeks). Teniposide at three dose levels (50 mg/m2, 75 mg/m2 and 100 mg/m2) was given intravenously once a week, totally five weeks. Dose escalation was based on each level, with a minimum of five patients in cohort if severe toxicity was not observed until the maximum tolerance dose(MTD). Results The predominant form of toxicity was hematologic toxicity. Four patients developed grade 3, 4 leucopenia when a second level of MTD (75 mg/m2) was given. Conclusion Combined radiotherapy and teniposide for postoperative brain neurospongioma is well tolerated. The dose of 50 mg/m2 for phase Ⅱ clinical trial was recommended.

Objective To analyze the clinical features of unilateral oculomotor nerve palsy caused by multiple myeloma(MM).Methods A 79-year-old female diagnosed MM for 3 years was admitted due to the disease relapse.The patient presented left oculomotor nerve palsy,bone marrow biopsy showed 4.5％ of myeloma cells,the serum level of λ light chain was up to 18 g/L,and brain CT/MRI scan revealed left parasphenoidsinus lesion.A diagnosis of relapsing intramedullary and extramedullary MM,IgGλ type,stage ⅢA was made.Ten cases were retrieved from literature since 1990,the clinical features of 11 cases were analyzed as follows.Results Among 11 cases of unilateral oculomotor nerve palsy caused by MM,7 were males and 4 females with a mean age of (60 ± 12) years (40-79 years).The sub-types of MM were IgG type (7 cases),IgA type (2 cases),biclonal of IgG and IgA type (1 case),and IgD type (1 case).Oculomotor nerve palsy was presented as the initial manifestation of MM in 9 cases,as a sign of relapse of MM in 1 case,and during MM treatment in 1 case.In 7 cases,oculomotor nerve was the only cranial nerve involved,while in other 4 cases,the Ⅳ,Ⅴ,Ⅵ cranial nerves were also involved.Neuroimaging revealed parasphenoid sinus lesions in 9 cases,and myeloma meningitis in 2 cases.Most of the reviewed cases achieved significant clinical improvement after chemotherapy and/or radiotherapy,except 2 cases with myeloma meningitis.The case in our department was improved significantly and rapidly after receiving chemotherapy with bortezomib.Conclusion MM should be considered when unilateral oculomotor nerve palsy is presented with or without the history of MM,the disease is sensitive to chemotherapy in most circumstances.

ObjectiveTo analyze the transitional shifts between with different sets of cone-beam computed tomography (CBCT) and the planning CT for liver cancer patients,and calculate the margins from clinical target volume (CTV) to the planning target volume (PTV)with and without image guided radiotherapy (IGRT).MethodsFive liver cancer patients received radiotherapy after transcatheter arterial chemoembolization (TACE).The first CBCT images (CBCT1) were obtained with Elekta CBCT plus active breathing control (ABC) system before treatment.The second CBCT images (CBCT2 ) were obtained after correcting the set-up errors and the third CBCT images ( CBCT3 ) were obtained after treatment.The CBCT images were registered and matched with the planning CT images using lipiodol as a direct surrogate for target localization.The PTV margins were calculated by comparing the shift between planning CT and CBCT according to formula M =2.5 ( Σ doctor2 + Σ set-up2 + Σ transter2 )1/2.Paired t-test was used to compare the differences between the results from CBCT1,CBCT2 and CBCT3. Results The average transition shifts in the left-right ( LR),superior-inferior (SI) and anterior-posterior (AP) directions were 0.254,-0.612,0.314 cm between planning CT and CBCT1 ;were 0.020,0.014,-0.064 cm between planning CT and CBCT2 ;and they were -0.004,0.042,-0.040 cm between planning CT and CBCT3.The PTV margins were LR 0.96 cm,SI 0.96 cm and AP 0.83 cm without IGRT,and LR 0.67 cm,SI 0.68 cm and AP 0.58 cm with IGRT.ConclusionsThe PTV margins can be reduced by 3 mm with IGRT for liver cancer using lipiodol as a direct surrogate for target localization.

Objective To evaluate the precision of image guided radiotherapy (IGRT) for vertebra metastasis.Methods Cone-beam computed tomography (CBCT, ELEKTA SynergyTM) scanning was performed to 15 patients with vertebra metastasis treated with three dimensional conformal radiation therapy (3DCRT) or intensity modulated radiation therapy (IMRT).CBCT images were then compared with corresponding planning images to calculate the position errors.The isocenter was adjusted based on the errors calculated , CBCT scanning was re - performed , and the new - errors were then calculated .Results Compared to the firstly collected CBCT images, the average errors of 4 cases of cervical bone metastases in x (left-right), y (cervical-caudal), and z (anterior-posterior) directions were 1.8 mm, 0 mm and 3.6 mm respectively.After adjusting the isocenter, the new-errors were reduced to 0.1 mm, 0.4 mm and 0.3 mm.For 11 cases of thoracic and lumbar bone metastases, the average errors in x, y, and z directions were 1.9 mm, 0.1 mm, and -2.1 mm, respectively.While the new-errors were reduced to 0.9 mm, 0.5 mm and -0.3 mm.Conclusions IGRT can improve the precision of radiotherapy for vertebra metastasis to less than 2 mm, which provides a possibility of dose escalation in GTV while reduce the dose in the spinal cord.

This article was aimed to study the molecular network and bio-function ofBu-Fei-Yi-Shen (BFYS) decoction for chronic obstructive pulmonary disease (COPD) by bioinformatics analysis, in order to provide new ideas for research on pharmacological mechanism of Chinese medicine compound prescription. Components of herbs in BFYS decoction were searched in the databases. Targeted proteins of each component were found from PubChem. Comparison analyses were performed on molecular network, bio-function and canonical pathways by Ingenuity Pathway Analysis (IPA). The results showed that there were 239 target proteins of BFYS decoction. There were 9 molecular networks of BFYS decoction. The top 3 networks' functions were Cellular Development, Energy Production, and Cancer. The top 3 bio-function of BFYS decoction were Cellular Growth and Proliferation, Cell Death and Survival, and Inflammatory Response. The top 3 canonical pathways of BFYS decoction were Cell Cycle:G1/S Checkpoint Regulation, Chronic Myeloid Leukemia Signaling, and Cyclins and Cell Cycle Regulation. It was concluded that the search of target proteins for herbal compounds and bioinformatics analysis by IPA can be used to reveal the molecular network and bio-function of BFYS decoction.

Objective To investigate the clinical results of minimally invasive fixation of the sacroiliac triangle for vertically unstable pelvic posterior ring injury. Methods A retrospective study was conducted of 20 patients who had been treated for vertically unstable pelvic posterior ring from January 2014 to August 2016. They were 12 males and 8 females, aged from 20 to 58 years ( average, 35 years ) . According to Tile classification for pelvic fractures, there were 4 cases of type C1. 1, 6 cases of type C1. 2, 7 cases of type C1. 3 and 3 cases of type C2. Their posterior rings were treated by fixation through posterior paraspinal approach with S1-iliac pedicle screws plus percutaneous sacroiliac screws, and their anterior rings by closed reduction and internal fixation with cannulated screws, Infix or plate following open reduction. The incision length, operation time and intraoperative blood loss were recorded. Postoperative reduction quality was assessed by Matta radio-logical criteria and pelvic function by Majeed criteria at the final follow-ups. Results Altogether 20 fixation systems of S1-iliac pedicle screws and 37 sacroiliac joint screws were inserted in this series. The length of incision ranged from 5. 5 to 7. 6 cm ( average, 6. 2 cm ) , the operation time from 89 to 130 minutes ( average, 98 minutes) and the intraoperative blood loss from 110 to 320 mL (average, 195 mL). According to Matta ra-diological criteria, reduction was excellent in 13, good in 5 and fair in 2 cases, with an excellent and good rate of 90％. The follow-up time for the 20 patients ranged from 6 to 15 months ( average, 9 months ) . The healing time ranged from 10 to 14 weeks ( average, 12. 5 weeks ) . At the final follow-ups, X-ray and CT three-dimensional reconstruction showed fine fracture union. By the Majeed criteria, the pelvic function was excellent in 11 cases, good in 5, fair in 3, and poor in one, with an excellent and good rate of 80％. No loosening, breakage or pull-out of pedicle screws or sacroiliac screws happened. Conclusion Minimally invasive fixation of the sacroiliac triangle for vertically unstable pelvic posterior ring injury can lead to precise placement, quick recovery, small incision and good functional outcome.

Objective To investigate the feasibility and safety of the double J tube removal from ureter under fluoroscopy observation. Methods The medical records of patients in our department from April 2013 to March 2015, who performed“double J tube removal and/or replacement”were retrospectively reviewed and analyzed. These data included gender and age of the patient, position of the double J tube end in the bladder, removal method, fluoroscopy time, postoperative complications and so on. The removal methods were divided into a direct method and an indirect method. The direct method means using the ring of a gooseneck snare to hitch directly the end of double J tube in the bladder, and pulling it to the urethral orifice. For the indirect method, a guide wire and a gooseneck snare first were sent into the bladder to clip the double J tube, then, the ring of the gooseneck snare was used to hitch the end of the guide wire to withdraw the gooseneck snare and the guide wire to the urethral orifice, and the double J tube was pulled to the urethral orifice. The double J tube end position in the bladder had direct relationship with the choice of removal method. The author divided the double J tube end position in the bladder into A type, B1 type, B2 type, and C type. The bladder was divided into four quarters equally. Direct method was suitable for all types, while indirect method was only suitable for B2 and C type. Between April 2013 and September 2014, all patients were treated by the direct method;between October 2014 and March 2015, all patients with B1 and A type were treated by the direct method, and all patients with B2 and C type were treated by the indirect method. According to the success rate of operation, fluoroscopy time, the incidence of different complications, the efficacy and safety were determined. Results This study recruited a total of 49 patients, including 6 males and 43 females, who underwent 114 times of“double J tube removal”. On average, double J tube was removed 2.3 times per case. The overall success rate was 96.5% (110/114). The application of direct method was 92 times, and the success rate was 95.7%(88/92). The application of indirect method was 22 times, and the success rate was 100%(22/22). In this study, there were 4 failures to remove the double J tube, all of which happened in the direct method for the C type of patients. In the successful 110 cases, the average fluoroscopy time was (11.3+9.5) min. The application of direct method was 88 times, and the average fluoroscopy time was (12.3 ± 10.3) min; the application of indirect method was 22 times, and the average fluoroscopy time was (7.6±3.8) min. There were 10 cases with pain in urethral orifice, in which 9 cases was treated with direct method and one with indirect method. There were 5 cases with gross hematuria complicated in direct method. The overall incidence rate of the complications was 13.2% (15/114). All of postoperative complications resolved spontaneously. Conclusion The direct way and the indirect way to remove ureteral double J tube fluoroscopically are feasible and safe .

Objective To determine the effect of 6-aminocaproic acid (EACA) to reduce postoperation bleeding following in mitral valve replacement.Method 50 adult patients uddergoing mitral valve replacement was adopted a double-bisind randomized trial to be divided into two groups.Each group is 25 patients.The patients in control groups received NS,the ones in study groups received NS as same as control groups but added EACE 10 g by intravation.The bleeding amount in cavitas thoracis were recorded on the sixth,twenty-fourth postoperative hours and ACT was recorded as well.Results The bleeding amount in study groups on the sixth postoperative hours were (290.0±41.3) ml.On twenty-fourth postoperative hours were (336.3±81.3) ml.The bleeding amount in control groups on the sixth postoperative hours were (393.4±73.6) ml.On twenty-fourth postoperative hours were (450.0±79.6) ml.The bleeding amount in study groups were decreased significantly as compared with in control groups (P<0.05).Conclusion:6-aminocaproic acid can reduce postoperation bleeding following in mitral valve replacement.

Objective To study the function of early persistent vacuum suction drainage in patients with high risk of pancreatic fistula after pancreaticoduodenectomy (PD).Methods From Jul.2010 to Jun.2013,the clinical data of 286 patients undergoing PD were retrospectively evaluated.87 patients with high risk of pancreatic fistula were screened and then divided into early persistent vacuum suction drainage group (the observation group) and conventional drainage group (the control group) according to postoperative drainage manners.We statistically analyzed the two groups in terms of general information,blood loss,operative time,medical expenses,hospital stay,mortality and morbidity of complications such as pancreatic fistula.Results There were 40 patients screened into the observation group and 47 patients into the control group.No difference was found between the observation group and the control group in basic clinical data or surgical data.There was no statistical difference between the two groups in delayed gastric emptying,bile leakage,bleeding or the incidence of pancreatic fistula and intra-abdominal infection.The incidence of pancreatic fistula with grade B and C in the observation group was statistically lower than that of the control group(12.5％ vs 34.0％,P＜0.05).The incidence of intraabdominal infection in observation group was statistically lower than those in the control group (20.0％ vs 40.4％,P＜0.05).The incidence of total complications in observation group was statistically lower than that in the control group (60.0％ vs 83.0％,P＜0.05),but no difference was found between the observation group and control group in morality.Early persistent vacuum suction drainage could reduce hospital stay((21.93±7.14) days vs (28.70±12.45) days,P＜0.05) and clinical expense ((64.8±12.0) thousands vs (75.2± 14.6) thousands,P＜0.05) in patients with high risk of pancreatic fistula after PD.Conclusions Early persistent vacuum suction drainage can reduce the rate of grade B and C pancreatic fistula in patients with high risk of pancreatic fistula undergoing PD.The manner can also reduce the incidence of intra-abdominal infection,total complications and cost of hospital stay.This manner can accelerate postoperative recovery of patients undergoing PD and is worth of widely used.