2014年 · 第127卷第13期

Abstract：Background This multicenter prospective study aimed to assess the utility of dynamic enhanced magnetic resonance imaging (MRI) prior to breast-conserving surgery for breast cancer.Methods The research subjects were drawn from patients with primary early resectable breast cancer treated in the breast disease centers of six three-level hospitals in Beijing from 1 January 2010 to 31 December 2012.The participants were allocated to a breast-conserving surgery group (breast-conserving group) or a total mastectomy group (total mastectomy group).Enhanced MRI was used to measure breast volume,longest diameter of tumor and tumor volume.The correlations between these measurements and those derived from histopathologic findings were assessed.The relationships between the success rate of breast-conserving surgery and MRI-and pathology-based measurement results were statistically analyzed in the breast-conserving group.Results The study included 461 cases in the total mastectomy group and 195 in the breast-conserving group.Allocation to these groups was based on clinical indications and patient preferences.The cut-off for concurrence between MRI-and pathology-based measurements of the longest diameter of tumor was set at 0.3 cm.In the total mastectomy group,the confidence interval for 95％ concurrence of these measurements was 35.41％-44.63％.Correlation coefficients for MRI and histopathology-based measurements of breast volume,tumor volume and tumor volume/breast volume ratio were r=0.861,0.569,and 0.600,respectively (all P ＜0.001).In the breast-conserving group,with 0.30 cm taken as the cut-off for concurrence,the 95％ confidence interval for MRI and pathology-based measurements of the longest diameter of tumor was 29.98％-44.01％.The subjective and objective success rates for breast-conserving surgery were 100％ and 88.54％,respectively.Conclusions There were significant correlations between dynamic enhanced MRI-and histopathology-based measurements of the longest diameter of breast lesions,breast and tumor volumes,and breast volume/tumor volume ratios.Preoperative MRI examination improves the success rate of breast-conserving surgery。

Abstract：Background Dry eye is a multifactorial disease of the tears and the ocular surface.This study aimed to investigate the clinical efficacy of a non-steroidal anti-inflammatory drug,pranoprofen,in the treatment of dry eye.Methods It is a prospective,multi-center,randomized,controlled,parallel group study.One hundred and fifteen patients with mild to moderate dry eye disease (55-60 in each treatment group) participated in this multi-center study.Patients were randomly administered with eyedrops containing 0.1％ pranoprofen (PRA) plus 0.1％ sodium hyaluronate (SH) or SH only,three times daily for 28 days,followed by a 1-week after treatment observation.Dry eye symptom score (DESS),fluorescein corneal staining (FLCS),tear break-up time (TBUT),and Shirmer 1 tear test (ST1,without anesthesia) were evaluated or conducted before treatment and at each study visit.Conjunctival impression cytology was taken from the patients treated with PRA plus SH before and after treatment and real-time polymerase chain reaction (RT-PCR) was performed to detect the changes of human leukocyte antigen DR (HLA-DR) and intercellular adhesion molecule 1 (ICAM-1).Results Patients treated with PRA plus SH showed gradual improvements of DESS,FLCS,and TBUT.Between-group comparisons of FLCS and TBUT have statistically significant differences from day 14.Good tolerance with no severe adverse events was found in both groups.Patients treated with PRA plus SH had a reduced expression level of HLA-DR and were statistically different after 28 days of therapy.Conclusions The application of PRA at a dose of 0.1％ was well tolerated and benefited to the patients with mild to moderate dry eye disease.The underlying mechanism of its efficacy may be associated with the reduction of inflammatory factors of conjunctival epithelial cells。

Abstract：Background The value of gamma probes in the surgical treatment of secondary hyperparathyroidism (sHPT) was determined.The aim of this study was to enhance the rate of successful total parathyroidectomy in patients with sHPT using intraoperative gamma probe investigations.Methods We retrospectively analyzed the clinical data of 48 sHPT patients between May 2007 and September 2011.Preoperative 99Tcm-methoxyisobutyl isonitrile (MIBI) scintigraphy and high-frequency ultrasonography were used for parathyroid localization.Thirty-five patients (group Ⅰ) underwent conventional neck exploration and open parathyroidectomy.Thirteen patients (group Ⅱ) underwent gamma probe-guided total parathyroidectomy and parathyroid transplantation.The two groups were compared in terms of the number of parathyroid resections,operative time,and postoperative changes in the blood levels of parathyroid hormone (PTH),calcium,and phosphate.Results The clinical manifestations,PTH and calcium levels,age distribution,and clinical characteristics did not differ between the two groups.The accuracy of preoperative 99Tcm-MIBI scintigraphy (89.74％) for the diagnosis of hyperparathyroidism did not differ from that of ultrasonography (81.25％).However,the accuracy of 99TcmMIBI scintigraphy (66.67％) for localizing hyperfunctioning parathyroids was significantly lower than that of ultrasonography (76.86％).The operation time was significantly longer in group Ⅰ ((120±25) minutes) than in group Ⅱ ((90±30) minutes).The accuracy of parathyroid identification was significantly higher in group Ⅱ (92.59％) than in group Ⅰ (80.39％).On average,significantly fewer parathyroid specimens were obtained in group Ⅰ (2.5±0.5) than in group Ⅱ (3.5±0.5).Compared with group Ⅰ,group Ⅱ showed a significant increase (15.4％) in the number of parathyroid resections.The PTH,calcium,and phosphate levels significantly decreased postoperatively in all patients.Conclusions Intraoperative gamma probe examination confirmed that the excised specimen was parathyroid tissue and improved the accuracy of parathyroid resection.The parathyroidectomy rate was increased by 15.4％ due to the use of these probes.However,the probes did not detect all ectopic parathyroids,and further research is required to clarify the underlying reasons。

Abstract：Background Gastric neuroendocrine carcinomas (g-NECs) are rare tumors that have aggressive biological behaviors and poor prognosis,but the prognostic factors of postoperative patients with g-NEC are still unclear.Our aim was to study and explore the clinical characteristics and prognostic factors of patients with g-NEC treated with radical surgery.Methods The clinical data of 43 g-NEC patients who underwent surgery from January 2002 to January 2011 at the Zhongshan Hospital of Fudan University were analyzed.Follow-up was conducted by telephone,mail,or returning visit survey.Results The sizes of the 43 neuroendocrine carcinomas (G3) were 1.5 cm × 1.5 cm × 0.5 cm to 7 cm × 8 cm × 1.5 cm.Eight NECs were localized,and 35 had lymph node involvement,of which 1 also had hepatic metastasis.At the end of the follow-up,the follow-up rate was 97.7％ (42/43),and the median follow-up time was 22.2 months.The median overall survival of g-NEC patients was 36.5 months,and the 1-,3-,and 5-year overall survival rates were 86.0％,51.6％,and 36.7％,respectively.Sex (P ＜0.05) and lymph node involvement (P ＜0.05) were prognostic factors of postoperative g-NEC patients,among which sex was an independent prognostic factor (P ＜0.05),as a survival advantage of female patients over male was observed.Conclusions Most of the g-NECs were diagnosed at an advanced stage.The prognosis of g-NECs was related with sex and lymph node involvement,of which sex was an independent prognostic factor,with female patients having a survival advantage。

Abstract：Background Bariatric surgery offers a productive resolution of type 2 diabetes mellitus (T2DM).The development of T2DM vasculopathy is due to chronic inflammation,which increases matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) expression.This study sought to examine MMP-9 and TIMP-1 expression in the thoracic aorta after duodenal-jejunal bypass (DJB) surgery on a T2DM rat model induced by a high-fat diet and low dose streptozotocin (STZ).Methods Twenty-one T2DM Wistar rats induced by high-fat diet and low dose STZ were randomly divided into DJB and sham duodenal-jejunal bypass (S-DJB) groups.Ten Wistar rats were fed a normal diet as a control.Recovery of gastrointestinal function post-operation and resumption of a normal diet completed the experiment.Body weight,blood glucose,blood lipid levels,and MMP-9 and TIMP-1 expression levels in aortic endothelial cells were measured throughout.Results DJB rats showed significant weight loss 2 weeks post-operation compared with S-DJB rats.After surgery,DJB rats showed significant improvement and steady glycemic control with improved insulin sensitivity and glucose tolerance.They also exhibited improved lipid metabolism with a decrease in fasting free fatty acids (FFAs) and triglycerides (all P ＜0.05).Immunohistochemistry showed decreased MMP-9 and TIMP-1 expression 12 weeks after surgery (P ＜ 0.01).Conclusions DJB surgery on an induced T2DM rat model improves blood glucose levels and lipids,following a high-fat diet and low dose STZ treatment.In addition,DJB decreased MMP-9 and TIMP-1 expression in vascular endothelial cells,which may play an important role in delaying the development of T2DM vascular disease。

Abstract：Background The Study for Monitoring Antimicrobial Resistance Trends program monitors the activity of antibiotics against aerobic and facultative Gram-negative bacilli (GNBs) from intra-abdominal infections (IAIs) in patients worldwide.Methods In 2011,1 929 aerobic and facultative GNBs from 21 hospitals in 16 cities in China were collected.All isolates were tested using a panel of 12 antimicrobial agents,and susceptibility was determined following the Clinical Laboratory Standards Institute guidelines.Results Among the Gram-negative pathogens causing IAIs,Escherichia coli (47.3％) was the most commonly isolated,followed by Klebsiella pneumoniae (17.2％),Pseudomonas aeruginosa (10.1％),and Acinetobacter baumannii (8.3％).Enterobacteriaceae comprised 78.8％ (1521/1929) of the total isolates.Among the antimicrobial agents tested,ertapenem and imipenem were the most active agents against Enterobacteriaceae,with susceptibility rates of 95.1％ and 94.4％,followed by amikacin (93.9％) and piperacillin/tazobactam (87.7％).Susceptibility rates of ceftriaxone,cefotaxime,ceftazidime,and cefepime against Enterobacteriaceae were 38.3％,38.3％,61.1％,and 50.8％,respectively.The leastactive agent against Enterobacteriaceae was ampicillin/sulbactam (25.9％).The extended-spectrum β-lactamase (ESBL) rates among E.coli,K.pneumoniae,Klebsiella oxytoca,and Proteus mirabilis were 68.8％,38.1％,41.2％,and 57.7％,respectively.Conclusions Enterobacteriaceae were the major pathogens causing IAIs,and the most active agents against the study isolates (including those producing ESBLs) were ertapenem,imipenem,and amikacin.Including the carbapenems,most agents exhibited reduced susceptibility against ESBL-positive and multidrug-resistant isolates。

Abstract：Background Cochlear implant surgery is widely practiced.Minimal incision cochlear implant surgery has been developed with the aims of reducing the impact of surgery on the patient and improving cosmesis while maintaining the low morbidity of conventional wider access approaches.This study aimed to assess the surgical technique and complication rate of minimal incision cochlear implantation (MICI) for children and adults.Methods Data for this study were obtained via a retrospective analysis.Totally 378 patients were included in the study.All patients received minimal incision cochlear implantation,using the skin protector during the process of the operation.The surgical complications of MICI were recorded in a spreadsheet format.The incidence of major and minor complication were analyzed,and appropriate treatment was provided.Results A total of 40 (10.5％) complications were noted in the study.There were 0 life-threatening,9 major,and 31 minor complications.Of the nine major complications,five were device failures,one developed infection and extrusion,and three required receiver-stimulator repositioning.Conclusions MICI is as safe as standard cochlear implantation (SCI) and affords with it other benefits.Eliminating the scalp flap avoids devascularization and minimizes the opportunity of flap infection or necrosis.Complications not related to the flap are similar to SCI。

Abstract：Background Prediabetes is an early stage of β-cell dysfunction presenting as insulin resistance.Evidences suggest that endoplasmic reticulum (ER) stress is involved in the pathogenesis of type 2 diabetes mellitus and prediabetes.In a Chinese population with prediabetes,we investigated single nucleotide polymorphisms (SNPs) in the genes of PERK,JNK,XBP1,BIP and CHOP which encode molecular proteins involved in ER stress pathways.Methods Nine SNPs at the PERK,JNK,XBP1,BIP and CHOP loci were genotyped by mass spectrometry in 1 448 unrelated individuals.By using a 75 g oral glucose tolerance test (OGTT),828 subjects were diagnosed as prediabetes and 620 subjects aged 55 years and over as normal controls based on WHO diagnostic criteria (1999) for diabetes mellitus.Results The allele C of SNP rs867529 at PERK locus was a risk factor for prediabetes,with the carriers of C allele genotype at a higher risk of prediabetes compared to non-carriers (OR=1.279,95％ CI:1.013-1.614,P=0.039,after adjustment for age,sex and body mass index (BMI).The SNPs rs6750998 at PERK locus was associated with homeostasis model assessments of insulin resistance (HOMA-IR) (P=0.019),and rs17037621 with BMI (P=0.044).The allele G of SNP rs10986663 in BIP gene was associated with a decreased risk of prediabetes (OR=0.699,95％ CI:0.539-0.907,P=0.007).The SNP rs2076431 in JNK gene was associated with fasting plasma glucose levels (P=0.006) and waist-hip ratios (P=0.019).The SNP rs2239815 in XBP1 gene was associated with 2-hour plasma glucose levels after 75 g oral glucose load (P=0.048) in the observed population.Conclusion Common variants at PERK and BIP loci contributed to the risk of prediabetes,and the genetic variations in JNK and XBP1 genes are associated with diabetes-related clinical parameters in this Chinese population。

Abstract：Background Extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae (K.pneumoniae) is one of the most popular pathogens that cause refractory respiratory tract infection.The genetic environment,including insertion sequences and the types of promoter,plays a key role in exploration of the mechanism of prevalence and dismission of the ESBL-producing K.pneumoniae isolates.The aim of the investigation was to target analysis the genetic environment and promoter sequences of blaCTX-M,blaSHV and blaTEM,the most popular β-lactamase genes harbored by ESBL-producing K.pneumoniae isolates.Methods From February 2010 to July 2011,158 of 416 K.pneumoniae isolates producing ESBL from patients with lower respiratory tract infection were collected from seven tertiary hospitals from Beijing,Anhui,Fujian,Liaoning,Hebei and Inner Mongolia Autonomous Region in China.The genetic environment including promoters of 10 types of blaCTX-M,18 types of blaSHVand 2 types of blaTEM were analyzed by amplification and direct sequencing with various sets of PCR primers.Results ISEcp1 was located upstream of the 5' end of the blaCTX-M gene in 130 (97.0％) out of 134 K.pneumoniae isolates harboring blaCTX-M and provided a conserved promoter to blaCTX-M.A non-coding sequence preceded by kdpC and recF was identified in all of the blaSHV genes except blaSHV-12 and blaSHV-2a.IS26 was also found upstream of 1 blaCTX-M-15,10 blaSHV-1 strains,4 blaTEM-1 and all of the blaSHV-2,blaSHV-2a,blaSHV-5 and blaSHV-12.Eighty-seven of 91 strains harboring blaTEM-1 carried a copy of Tn2 and IS26-blaTEM-1 fragments were also detected in 4 strains.With respect to K.pneumoniae,the genetic environment of blaCTX-M-38,blaSHV-142 and blaTEM-135 were firstly elaborated,and four kinds of novel genetic environment of blaCTX-M-3,blaCTX-M-15 and blaTEM-1 have been detected as well.Conclusions Perfective implementation of the genetic environment information of β-lactamase gene needs to be further explored and supplemented.ISEcp1 and IS26 elements are widespread upstream of the blaCTX-M,blaSHV and blaTEM genes and contribute to horizontal transmission and genetic expression。

Abstract：Background Recent studies on bone have shown an endocrine role of the skeleton,which could be impaired in various human diseases,including osteoporosis,obesity,and diabetes-associated bone diseases.As a sensor and regulator of energy metabolism,AMP-activated protein kinase (AMPK) may also play an important role in the regulation of bone metabolism.The current study aimed to establish the expression profiles and phosphorylation patterns of AMPK subunits in several mesenchymal cell types.Methods Reverse transcription-polymerase chain reaction (PCR) for relative quantification,real-time PCR for absolute quantification,and Western blotting were used to investigate the gene expression profiles and phosphorylation patterns of AMPK subunits in several mesenchymal cell types,including primary human mesenchymal stem cells (hMSCs) and hFOB,Saos-2,C3H/10T1/2,MC3T3-E1,3T3-L1,and C2C12 cells.Results AMPKα1 and AMPKβ1 mRNAs were abundantly expressed in all cell types.AMPKY1 mRNA was abundantly expressed in C3H/10T1/2,MC3T3-E1,3T3-L1,and C2C12 but not detected in human-derived cell types.AMPKY2 mRNA was mildly expressed in all cell types.AMPKα1 protein was highly expressed in all cell types and AMPKα2 protein was highly expressed only in hFOB and Saos-2 cells.AMPKβ1 protein was abundantly expressed in all cell types except for Saos-2,in which AMPKβ2 protein overwhelmed AMPKβ1 expression.AMPKy1 and AMPKY2 proteins were expressed in C3H/10T1/2,MC3T3-E1,3T3-L1,and C2C12 cells and only AMPKY2 protein was expressed in hMSCs,hFOB and Saos2 cells.AMPKα was phosphorylated at Thr172 and Ser485 and AMPKβ1 was phosphorylated at Ser108 and Ser182 in all cell types with a specific pattern in each cell type.Conclusion The combination of AMPK α,β,and Y subunits and phosphorylation of AMPKα (Thr172 and Ser485) and AMPKβ1 (Ser108 and Ser182) showed a specific pattern in each cell type。

Abstract：Background Osteoarthritis (OA) is the most common form of human polyarthritis.Many genetic factors have been implicated in OA.It was reported that a polymorphism in the gene of interleukin-6 (IL-6) was associated with OA of knee.The aim of this study was to determine whether functional IL-6 promoter-174G/C (rs1800795) polymorphisms confer susceptibility to knee OA.Methods A meta-analysis was conducted on the association between the IL-6 polymorphism and knee OA.Electronic search at PubMed,EMBASE,Weipu database,and Wanfang database was conducted to select studies.Case-control studies containing available genotype frequencies of IL-6-174G/C were chosen,and odds ratio (OR) with 95％ confidence interval (C/) was used to assess the strength of this association.Results A total of seven studies involving 6 464 subjects (knee OA 3 331 and controls 3 133) were considered in this study.The results suggested that the variant genotypes were not associated with knee OA risk in all genetic models (additive model:OR=1.144,95％ CI 0.934-1.402,P=0.194; recessive model:OR=1.113,95％ CI 0.799-1.550,P=0.526;dominant model:OR=1.186,95％ CI 0.918-1.531,P=0.191).A symmetric funnel plot,the Begg's test (P ＞0.05),suggested that the data lacked publication bias.Conclusions This meta-analysis does not support the idea that rs1800795 genotype is associated with increased risk of knee OA.However,to draw comprehensive and more reliable conclusions,further prospective studies with larger numbers of participants worldwide are needed to examine the association between rs1800795 polymorphism and knee OA。

Abstract：Background Over the past two decades,the clinical presentation of renal masses has evolved,where the rising incidence of small renal masses (SRMs) and concomitant minimal invasive treatments have led to noteworthy changes in paradigm of kidney cancer.This study was to perform a proportional meta-analysis of observational studies on perioperative complications and oncological outcomes of partial nephrectomy (PN) and radiofrequency ablation (RFA).Methods The US National Library of Medicine's life science database (Medline) and the Web of Science were exhaustly searched before August 1,2013.Clinical stage 1 SRMs that were treated with PN or RFA were included,and perioperative complications and oncological outcomes of a total of 9 565 patients were analyzed.Results Patients who underwent RFA were significantly older (P ＜0.001).In the subanalysis of stage T1 tumors,the major complication rate of PN was greater than that of RFA (laparoscopic partial nephrectomy (LPN)/robotic partial nephrectomy (RPN):7.2％,open partial nephrectomy (OPN):7.9％,RFA:3.1％,both P ＜0.001).Minor complications occurred more frequently after RFA (RFA:13.8％,LPN/RPN:7.5％,OPN:9.5％,both P ＜0.001).By multivariate analysis,the relative risks for minor complications of RFA,compared with LPN and OPN,were 1.7-fold and 1.5-fold greater (both P ＜0.01),respectively.Patients treated with RFA had a greater local progression rate than those treated by PN (RFA:4.6％,LPN/RPN:1.2％,OPN:1.9％,both P ＜0.001).By multivariate analysis,the local tumor progression for RFA versus LPN/RPN and OPN were 4.5-fold and 3.1-fold greater,respectively (both P ＜0.001).Conclusions The current data illustrate that both PN and RFA are viable strategies for the treatment of SRMs.Compared with PN,RFA showed a greater risk of local tumor progression but a lower major complication rate,which is considered better for poor candidates.PN is with no doubt the golden treatment for SRMs,and LPN has been widely accepted as the first option for nephron-sparing surgery by experienced urologists.RFA may be the best option for select patients with significant comorbidity。

Abstract：Background Surgical treatment has become the standard treatment for nontreumatic diseases of the spleen.This metaanalysis compared the relative merits of laparoscopic splenectomy (LS) with open splenectomy (OS) for nontraumatic splenic diseases.Methods A literature search was performed to identify studies comparing perioperative outcomes in patients who underwent LS or OS for nontraumatic diseases.Pooled odds ratios (ORs) and weighted mean differences (WMD) with 95％ confidence intervals (C/s) were calculated using a fixed-or random-effects model.Results Thirty-five studies matched the selection criteria.Of the 7 269 patients included 3 981 underwent LS and 3 288 underwent OS for nontraumatic diseases.OS was associated with shorter operation time (WMD=42.65,95％ CI:25.58-59.73),whereas LS was associated with reduced operative blood loss (WMD=-133.95,95％ CI:-229.02 to-38.88),need for blood transfusion requirement (OR=0.53,95％ CI:0.39-0.72),overall postoperative morbidity rate (OR=0.44,95％ CI:0.38-0.51),postoperative mortality rate (OR=0.38,95％ CI:0.24-0.59),and length of hospital stay (WMD =-2.73,95％CI:-3.34 to-2.12).Conclusions LS is superior to OS for nontraumatic diseases,with reduced operative blood loss,need for blood transfusion,postoperative morbidity and mortality rates,and length of hospital stay,although OS is associated with reduced operation time.LS may be a good alternative to OS for patients with nontraumatic splenic diseases。

Abstract：Background The pathogenesis of gastric cancer (GC) involves environmental and genetic factors.Recently,two genome-wide association studies found that phospholipase C epsilon 1 (PLCE1) polymorphisms might be related to GC risk,and several studies further validated this finding.However,these studies yielded inconsistent results.Methods A comprehensive database search was performed to identify eligible studies.Odds ratios with 95％ confidence intervals were calculated to assess the strength of the association between PLCE1 rs2274223,rs753724,and rs11187842 and risk of GC.Subgroup analyses,publication bias,and sensitivity analyses were also conducted.Results Eleven studies (12 cohorts) were included in the meta-analysis.Based on 13 676 cases and 23 569 controls,a significant association between PLCE1 rs2274223 and GC risk was detected under various genotypic models.In the subgroup analyses,the association was significant for cardia GC,but weak for non-cardia GC.The association under the heterozygote model was detected for PLCE1 rs753724 and rs11187842 based on three studies involving 2768 cases and 3890 controls.Conclusions Our findings demonstrate that the presence of the G allele at rs2274223 of the PLCE1 gene may contribute to susceptibility to GC,especially cardia GC.PLCE1 rs753724 and rs11187842 are associated with GC risk under the heterozygote model.Further well-designed large studies are warranted to validate these findings。

Abstract：Background The objective of this study was to analyze the trend in the publication of systematic reviews on hip fractures through a bibliometric approach.Methods Literature including systematic reviews or meta-analyses on hip fractures was searched from the ISI Web of Science citation database.The search results were analyzed in terms of geographical authorship and frequency of citation by country,institution,author,and periodical distribution.Results A total of 654 published systematic reviews from 1995 to 2013 in 48 countries or regions were retrieved.The United States (171) was the predominant country in terms of the number of total publications,followed by the United Kingdom (149),Canada (120),Australia (76),and China (54).The number of systematic reviews significantly increased during the last 6 years,especially in China.The production ranking changed in 2012,at which time the United States and China were the leaders in the yearly production of systematic reviews on hip fractures.The amount of literature (27 publications) from China contributed almost one-quarter of the total literature (109 publications) in 2012.However,the average number of citations of each article from China was still low (6.70),while the highest number of citations of each article was from Sweden (193.36).The references were published in 239 different journals,with 15 journals contributing to 41.3％ of the systematic reviews on hip fractures.The two journals that contributed the most were Osteoporosis International (10.6％) and the Cochrane Database of Systematic Reviews (7.6％).The predominant institution in terms of the number of publications was McMaster University (36) in Canada.Conclusions The best evidence in the field of hip fractures has attracted increasing attention.Systematic reviews on hip fractures from China have been increasingly more frequent during the past 6 years,particularly in 2012。

Abstract：Objective To review the research methods of mass casualty incident (MCI) systematically and introduce the concept and characteristics of complexity science and artificial system,computational experiments and parallel execution (ACP) method.Data sources We searched PubMed,Web of Knowledge,China Wanfang and China Biology Medicine (CBM) databases for relevant studies.Searches were performed without year or language restrictions and used the combinations of the following key words:“mass casualty incident”,“MCI”,“research method”,“complexity science”,“ACP”,“approach”,“science”,“model”,“system” and “response”.Study selection Articles were searched using the above keywords and only those involving the research methods of mass casualty incident (MCI) were enrolled.Results Research methods of MCI have increased markedly over the past few decades.For now,dominating research methods of MCI are theory-based approach,empirical approach,evidence-based science,mathematical modeling and computer simulation,simulation experiment,experimental methods,scenario approach and complexity science.Conclusions This article provides an overview of the development of research methodology for MCI.The progresses of routine research approaches and complexity science are briefly presented in this paper.Furthermore,the authors conclude that the reductionism underlying the exact science is not suitable for MCI complex systems.And the only feasible alternative is complexity science.Finally,this summary is followed by a review that ACP method combining artificial systems,computational experiments and parallel execution provides a new idea to address researches for complex MCI。

Abstract：Objective To briefly review the literature regarding the impact of statins on the prevention and treatment of stroke,especially on intracerebral hemorrhage (ICH).We described statins' effects,mechanism of ICH,serum total cholesterol and ICH,and the relationship between statins and ICH.Data sources All articles used in this review were mainly searched from the PubMed database with no limitations of language and year of publication.Study selection Randomized controlled studies,prospective cohort studies,animal experiments,and meta-analysis articles related to this topic in the past decade were selected.Results Statins play an important role in the primary and secondary prevention of cardiovascular diseases and also have an impact on the treatment of vascular diseases.There still exist controversies about the relationship between statins and ICH.More clinical and experimental trials indicate that statins do not increase the risk of ICH.Conclusion A low or a regular dose of statins would not increase the risk of ICH。