Manejo de embarazos únicos con diagnóstico antenatal de vasa previa / Management of singleton pregnancies with prenatal diagnosis of vasa previa

Introducción: vasa previa (VP) corresponde al paso de los vasos umbilicales por las membranas amnióticas, sin protección de gelatina de Wharton o placenta, antes de la presentación fetal, sobre el orificio cervical interno. Pese a su baja incidencia, el diagnóstico prenatal es relevante por las graves consecuencias que puede tener esta patología en caso de no ser diagnosticada. El objetivo de esta revisión es presentar la evidencia disponible para el manejo de embarazadas con diagnóstico antenatal de VP. Materiales y métodos: analizamos todos los estudios publicados (prospectivos, retrospectivos y reporte de casos) entre los años 1999 y 2023, con diagnóstico VP en embarazo único, reportando la edad gestacional de interrupción y el resultado neonatal. Resultados: incluimos 19 investigaciones (18 en la búsqueda primera y una adicional por relevancia). Las pacientes con manejo intrahospitalario desde las 34 semanas tuvieron mayor latencia al parto, mejores resultados neonatales y menor tasa de cesárea de urgencia que las pacientes con manejo ambulatorio. La edad gestacional de interrupción es variable entre los estudios, sin embargo, no se evidenció beneficio de interrupción a las 34 semanas comparado con manejo expectante hasta las 37 semanas de edad gestacional. Conclusión: existiría beneficio de hospitalización entre las 32-34 semanas en mujeres con diagnóstico de VP, siendo razonable la interrupción cercana a las 37 semanas por cesárea electiva.

Introduction: vasa previa (VP) corresponds to the passage of the umbilical vessels through the amniotic membranes, without the protection of Wharton's gelatin or placenta, in front of the fetal presentation, over the internal cervical os. Despite its low incidence, prenatal diagnosis is relevant due to the severe consequences of this pathology if the diagnosis is missed. This review presents the available evidence for pregnant women's management with an antenatal diagnosis of VP. Materials and methods: we analyzed all the studies published (prospective, retrospective, and case reports) between 1999 and 2023, with a diagnosis of VP in a single pregnancy, reporting gestational age at delivery and neonatal outcome. Results: We included 19 investigations (18 in the first search and another for relevance). Patients with in-hospital management from 34 weeks had a more extended latency period until delivery, better neonatal outcomes, and a lower rate of emergency cesarean section than patients with outpatient management. The gestational age at birth is variable between the studies; however, no benefit of delivery at 34 weeks was evidenced compared with expectant management until 37 weeks of gestational age. Conclusion: there would be a benefit of hospitalization between 32-34 weeks in women diagnosed with VP, being reasonable to schedule the delivery close to 37 weeks by elective cesarean section.

Status quo of current clinical drug regimens for small cell lung cancer and new progress in the potential target drug therapeutic regimens / 中国药房

Small cell lung cancer （SCLC） accounts for about 15% in lung cancer and is highly malignant， heterogeneous and invasive. Etoposide combined with platinum-based chemotherapy is the basis of standard first-line treatment for extensive-stage SCLC， but suffers from the problem of susceptibility to drug resistance and relapse. In recent years， the emergence of new immunological drugs and novel cytotoxic drugs has improved the survival of SCLC patients to a certain extent， especially bringing therapeutic hope to patients with relapsed/refractory SCLC. In this paper， we review the current clinical drug regimens and the new progress of potential target drug therapeutic regimens for the treatment of SCLC. At present， the first-， second- and third-line schemes of SCLC include etoposide+carboplatin， atezolizumab+etoposide+platinum， adebrelimab， topotecan， docetaxel， etc.； the current drug targets for the treatment of SCLC mainly focus on topoisomerase Ⅱ/Ⅰ， DNA， the immune checkpoint molecules programmed death-1/programmed death-ligand 1， tubulin， etc. The potential target drug therapeutic options include alisertib+ paclitaxel， rovalpituzumab， APG-1252， etc.， and mainly focus on DNA damage response pathways and immune pathways， which can achieve the prolongation of patient survival by exerting anti-tumor effects through aurora kinase A and other potential targets.

Eventos paroxísticos que se confunden con epilepsia / Paroxysmal events that are confused with epilepsy

Resumen Los eventos paroxísticos no epilépticos (EPNE) se definen como episodios de aparición brusca y de breve duración que imitan a una crisis epiléptica, originados por una disfunción cerebral de origen diverso y a diferencia de la epilepsia no obedecen a una descarga neuronal excesiva. Su incidencia es mucho más elevada que la epilepsia y pueden aparecer a cualquier edad, pero son más frecuentes en los primeros años de vida. La inmadurez del sistema nervioso central en la infancia favorece que en este período las manifestaciones clínicas sean muy floridas y diferentes de otras edades. Fenómenos normales y comunes en el niño pueden también confundirse con crisis epilépticas. El primer paso para un diagnóstico correcto es establecer si este primer episodio corresponde a una crisis epiléptica o puede tratarse de un primer episodio de EPNE. Es importante seguir un protocolo de diagnóstico, valorando los antecedentes personales y familiares, sin olvidar el examen físico, analizar los posibles factores desencadenantes, los pormenores de cada episodio, si es posible un registro de los episodios, aplicar el sentido común y la experiencia y solamente proceder a los exámenes complementarios básicos como el registro EEG u otras exploraciones en caso de duda o para con firmación diagnóstica. En algunos casos se ha demostrado una base genética. Las opciones terapéuticas son escasas y la mayoría de EPNE tienen una evolución favorable.

Abstract Non-epileptic paroxysmal events (NEPE) are defined as episodes of sudden onset and short duration that mimic an epileptic seizure, caused by a brain dysfunction of diverse origin and, unlike epilepsy, are not due to excessive neuronal discharge. Its incidence is much higher than epilepsy and can appear at any age, but are more frequent in the first years of life. The immaturity of the central nervous system in childhood favors that in this period the clinical manifestations are more spectacular and different from other ages. Normal and common phenomena in children can also be confused with epileptic seizures. The first step for a correct diagnosis is to establish whether this first episode corresponds to an epileptic seizure or could be a first episode of NEPE. It is important to follow a diagnostic protocol, assessing the personal and family history, without forgetting the physical examination, analyzing the possible triggering factors, the details of each episode, if it's possible a record of the episodes, applying common sense and experience and only carrying out basic complementary tests such as EEG recording or others in case of doubt or for diagnostic confirmation. In some cases, a genetic basis has been demonstrated. Therapeutic op tions are scarce and the majority of NEPE have a favorable evolution.

Diplopía binocular por paresia o parálisis oculomotoras: resultados de las opciones de tratamiento / Binocular Diplopia due to Oculomotor Paresis or Palsies: Outcomes of Treatment Options

Objetivo: Determinar resultados de las opciones de tratamiento para la diplopía binocular en pacientes con paresia o parálisis oculomotoras. Método: Se realizó un estudio descriptivo, longitudinal y prospectivo de una serie de casos que acudieron a la consulta del Servicio de Oftalmología Pediátrica del Instituto Cubano de Oftalmología Ramón Pando Ferrer. Se evaluaron las variables: edad, sexo, etiología, opciones de tratamiento, limitación de los movimientos oculares, eliminación de diplopía, fusión y estereopsis. Resultados: La etiología más frecuente fue la microvascular. El 66,7 por ciento de la muestra estudiada se resolvió solo con tratamiento médico, de ellos el 100,0 por ciento con diagnóstico de paresias o parálisis del tercer nervio craneal, seguido por el sexto y cuarto con 63,6 por ciento y 33,3 por ciento, respectivamente. Necesitaron tratamiento médico, quirúrgico y aplicación de toxina botulínica seis pacientes, el 33,3 por ciento del cuarto y el 22,7 por ciento del sexto nervio craneal. El resto de las opciones de tratamiento solo con un paciente. No se halló asociación significativa entre opciones de tratamiento y nervio craneal afectado. El 86,6 por ciento finalizó sin limitación de los movimientos oculares. El 86,7 por ciento de los casos eliminaron la diplopía en todas las posiciones diagnósticas de la mirada. El 76,7 por ciento logró fusión y el 56,7 por ciento estereopsis. Conclusiones: El tratamiento médico y el combinado de médico más inyección de toxina botulínica y cirugía de músculos extraoculares fueron las opciones más utilizadas y permitieron alineamiento ocular y eliminación de la diplopía binocular(AU)

Objective: To determine outcomes of treatment options for binocular diplopia in patients with oculomotor paresis or paralysis. Method: A descriptive, longitudinal and prospective study was carried out of a series of cases that were assisted at the consultation of the Pediatric Ophthalmology Service at Ramón Pando Ferrer Cuban Institute of Ophthalmology. The variables evaluated were age, sex, etiology, treatment options, limitation of ocular movements, elimination of diplopia, fusion and stereopsis. Results: The microvascular etiology was the most frequent. 66.7 percent of the studied sample was resolved only with medical treatment, 100.0 percent of them had a diagnosis of paresis or paralysis of the third cranial nerve, followed by the sixth and fourth with 63.6 percent and 33.3 percent, respectively. Six patients required medical and surgical treatment and application of botulinum toxin, 33.3 percent of the fourth and 22.7 percent of the sixth cranial nerve. The rest of the treatment options with only one patient. No significant association was found between treatment options and affected cranial nerve. 86.6 percent finished without limitation of eye movements. 86.7 percent of cases eliminated diplopia in all diagnostic gaze positions. 76.7 percent achieved fusion and 56.7 percent stereopsis. Conclusions: Medical treatment and combined medical treatment plus botulinum toxin injection and extraocular muscle surgery were the most used options and allowed ocular alignment and elimination of binocular diplopia(AU)

Síndromes mielodisplásicos, más allá de los hipometilantes / Myelodysplastic syndromes: beyond hypomethylating agents

Introducción: El comportamiento heterogéneo de los síndromes mielodisplásicos, así como los progresos en los últimos años en el campo de la genética y la biología molecular, han provocado la aparición de múltiples investigaciones con diferentes enfoques terapéuticos. Los agentes hipometilantes son hasta el momento el tratamiento estándar para esta entidad, pero desafortunadamente no son efectivos en el 100 % de los casos y la duración de su respuesta es variable. Objetivo: Analizar las opciones terapéuticas actuales para el tratamiento de los síndromes mielodisplásicos. Métodos: Se realizó una revisión de la literatura, en inglés y español, a través del sitio web PubMed y el motor de búsqueda Google académico de artículos publicados en los últimos 5 años. Se hizo un análisis y resumen de la bibliografía revisada. Análisis y síntesis de la información: Actualmente existen múltiples opciones de tratamiento, la mayor parte dirigidos contra los eventos epigenéticos fundamentales: la hipermetilación, la modificación de las histonas diacetilasa y la activación de la respuesta inmune citotóxica contra clones anormales. Sin embargo, como no se ha establecido una única alteración, los tratamientos en la mayoría de los protocolos se adaptan al riesgo, incluyen un número reducido de casos y los resultados son limitados. Conclusiones: Se considera que una posible solución es dirigir el tratamiento a la alteración específica con base en las alteraciones moleculares y la medicina de precisión, fundamentalmente en los pacientes refractarios o en recaída postratamiento con los actuales agentes hipometilantes(AU)

Introduction: The heterogeneous characteristics of myelodysplastic syndromes, as well as the progress in recent years in the field of genetics and molecular biology, have led to the appearance of multiple investigations with different therapeutic approaches. Hypomethylating agents are so far the standard treatment for this entity, but unfortunately they are not effective in 100% of cases and the duration of their response is variable. Objective: To analyze current therapeutic options for the treatment of myelodysplastic syndromes. Methods: A literature review was carried out, in English and Spanish, through the PubMed website and the Google Scholar search engine, for articles published in the last five years. An analysis and summary of the revised bibliography was carried out. Information analysis and synthesis: Currently, there are multiple treatment options, most of which are directed against fundamental epigenetic events: hypermethylation, modification of histone diacetylase, and activation of the cytotoxic immune response against abnormal clones. However, as long as a single alteration has not been established, treatments, in most protocols, are adapted to risk and include a small number of cases, while their outcomes are limited. Conclusions: It is considered that a possible solution is to direct treatment to specific alteration based on molecular alterations and precision medicine, fundamentally in refractory or relapsed patients after treatment with current hypomethylating agents(AU)

Estrategias de tratamiento para el edema macular diabético / Treatment strategies for diabetic macular edema

RESUMEN Se hace una revisión bibliográfica acerca del tratamiento que se utiliza en el edema macular clínicamente significativo. Esta es la primera causa de mala visión en los pacientes con diabetes mellitus. Entre las líneas de tratamiento tenemos los antiangiogénicos con sus variantes, los esteroides y la cirugía por medio de la vitrectomía pars plana con pelado de la membrana limitante interna. No existe hasta el momento el tratamiento ideal. La tomografía de coherencia óptica ayuda a predecir la visión final(AU)

ABSTRACT Treatment of clinically significant diabetic macular edema is the topic of our review. This condition is the first cause of vision loss in diabetic patients. Treatment options include anti-VEFG drugs, steroids and surgery (vitrectomy with internal limiting membrane peeling). There is no an ideal treatment at present. Optic coherence tomography is a useful tool to predict final vision in these patients(AU)

Assessing the Alternative Livelihood Options for Climate Change Vulnerable Coastal Fishing Villages in Kerala, India

Fisheries and allied sectors provide means of livelihood to millions of people around the world. In India more than 14.5 million individuals depend on fisheries for their livelihood, with Gujarat, Tamil Nadu and Kerala being the main three marine fish producing states of the country. The social and economic contribution of fisheries as a sector cannot be ignored or go unnoticed. Similarly the impact of climate change on fisheries and its resultant impact on the livelihood of fisheries dependent communities cannot be ignored. To address these pertinent issues, we first need to understand the impact of climate change on fisheries and the need of alternative livelihood options from the perspective of the direct stakeholders i.e. fishermen. This study is an endeavour to look at the need of Alternative livelihood options (ALOs) because of climate change among the coastal communities in Poonthura and Elamkunnapuzha villages of Thiruvananthapuram and Ernakulum respectively. Among the 222 marine fishing villages of Kerala, Poonthura and Elamkunnapuzha are the major fishing villages from the South West hotspot locales of India. The examination investigated different socioeconomic aspects, for example, fishing activity, basic household data, economic as well as historic and cultural dependence on fishing, employment and occupational structure, income distribution and assets, physical capital, financial capital, social capital, and exposure and awareness of the fishermen families to climate change by interviewing 1259 fishermen from Poonthura and Elamkunnapuzha. The study conducted in the most climate change vulnerable marine hotspots of Kerala (Elamkunnapuzha and Poonthura) explains the problems and prospects of the inhabitants in the sector and the importance of Alternative Livelihood Options (ALOs) in climate change adaptation.

Research status of polycythemia vera in China / 中国实用内科杂志

Polycythemia vera is a clonal malignant hematopoietic disorder that results from genetic alterations in hematopoietic stem cells, which is characterized by two or three-line blood cells increase, and mainly by erythrocytosis. This article reviews research situation of PV in China, including pathogenesis, clinical features, disease progression and therapeutic options, which helps clinical specialists to carry out precise diagnosis and treatment.

Awareness and knowledge of the general public at southern region of Saudi Arabia regarding dental implants

Aims: To assess the awareness, knowledge, and information sources regarding dental implants as anoption of treatment to replace missing teeth among patients in Jazan Province, Saudi Arabia.Materials and methods: The current study consisted of 14 questions used to assess the patients’awareness, expectations and level of knowledge of dental implants. Three categories of questionswere used, with the first one related to the patients’ knowledge and options for replacement of missingteeth, the second about dental implants and their providers, and the third on the techniques, materials,care, and durability of dental implants. The collected data was analyzed using Chi-square tests, and Pvalues less than 0.005 were considered significant. Results: A total of 380 subjects were divided intotwo groups, medical (40.3%) or non-medical (59.7%) related. We found that 85% and 71.0% of themedical and non-medical subjects, respectively know the importance of replacement of missing teeth,while 50% had known the different types of dental implants with no significance (P< .001) betweenthe two groups. Dentists were the sources of the information (43.3% and 34.8% for the medical andnon-medical groups respectively). Around 50% of the medical subjects thought that dental implantscame with a screw compared with 36.6% of non-medical subjects with value of P .025. In total, 60%-70% of respondents from both groups answered that dental implants should be provided by specialistsonly. Around 29% of all patients cited “lifetime” as the survival period of implants. Also, 52%-77%of the respondents related the implant site to the “the jaw bone,” with significant difference of P .000.Conclusions: The awareness and knowledge of the subjects were acceptable with higher percentageamong respondents in the medical group. Dentists followed by friends were the main sources ofinformation for dental implants. Dental implants are considered as the best choice for replacement ofmissing teeth with excellent durability and need of much more special care than natural teeth

Treatments of Infra-Orbital Dark Circles by Various Etiologies

Dark circles refer to visible darkness of the infra-orbital areas. Dark circles are a cosmetic concern for many individuals, although not a medical concern. Moreover, clear definitions and possible causes of dark circles have not been elucidated. This study reviews the possible causes and treatment options for dark circles based on a review of the medical literature and the authors' clinical experience. Potential factors that contribute to dark circles include excessive pigmentation, shadowing due to tear troughs and infra-orbital fat herniation, shadowing due to infraorbital laxity and wrinkles, and thin, translucent skin overlying the orbicularis oculi muscle. Given the different possible causes for dark circles, therapeutic modalities must be individualized for each patient. Because various factors cause dark circles, it is useful to identify the underlying causes in order to select the appropriate treatment.

Analysis on the distribution and treatment of malaria patients in the phase of eradication of malaria in China / 中国卫生政策研究

Objective: To understand the distribution and treatment of malaria patients, and the characteristics of sampled hospitals in thephase of eradication of malaria,and provide support for medical resources allocation in the later stages of malaria eradication phase. On this basis, this study aims at promoting the realization of the ultimate goal of total eradication of malaria in China by 2020. Methods : A multi-stage stratified cluster sampling method was used. A total number of 102 hospitals in Zhejiang, Jiangsu, Anhui, Henan, Sichuan and Yunnan Provinces were selected to collect original information on in-patient and out-patient of malaria in terms of medical records and treatment costs during the periodfrom January 1st 2014 toDecember 31th2016. In order to conduct accurate statistical analysis, Excel 2016, SPSS 20. 0 and other Software were used. Results: The survey results collected a total number of 1633 malaria patients, and these patients showed a W-shaped distribution during the months of treatment. Most of malaria patients from Henan and Sichuan Provinceswere diagnosed as having been affected by falciparum and vivax malaria, and their number sharply increased. This is paper also revealed the ratios of malaria patientsin terms of their choice of health services,namely from tertiary hospitals, municipal medical institutions and provincial medical institutions; those were77.10％,52.05％ and 23.58％,respectively. Conclusions : A new period of peak incidence of malariais detected from 2014 to 2016. With hospitals' line of malaria defending ability shrinking,it was found that malaria treatment capacitiesare relatively concentrated in the high level hospitals,which plays a greater role when it comes to the prevention and control of malaria. It is recommended that regional malaria treatment lines should be built,and severe malaria treatment knowledge trainingsshould be prepared and attended in mass in orderto improve malaria treatment capacities.

Fungal infections of the central nervous system in critically ill children / 中国小儿急救医学

Fungal infections of the central nervous system are still devastating and difficult to treat. A greater understanding of host characteristics, diagnostic criteria, and therapeutic options about the severe central nervous system fungal infection,has led to important advances in the diagnosis and management,and resulting in improved outcomes.

Introduction and analysis of FDA issuedguidance on bioequivalence recommendations for specific products related with longhalf-life drugs / 中国药学杂志

OBJECTIVE: To study and analyze FDA issued guidance on Bioequivalence Recommendations for Specific Products related with long Half-life drugs. METHODS: Bioequivalence Recommendations for Specific Products related with long Half-life drugs was analyzed from multiple aspects, including bioequivalence study designs, selection of bioequivalence subjects, dosage, selection of reference products, analytes to measure, bioequivalence waiver on multiple-strength products and implementation of the Biopharmaceutics Classification System. RESULTS: Bioequivalence Recommendations for Specific Products issued by FDA are to further facilitate generic drug product availability and to assist generic pharmaceutical industry with identifying the most appropriate methodology for developing drugs and generating evidence needed to support ANDA approval or reassessment, as an extension and implement to the guideline involved in the aspect of bioequivalence. CONCLSUTION: Bioequivalence Recommendations for Specific Products issued by FDA would provide instructive and practical assists to the equivalence assessment of quality and curative effect for generic products in China, since there is not corresponding bioequivalence guidance on specific long Half-life drugs released by CFDA yet.

Ankle Arthritis: Which to Choose – Arthrodesis or Arthroplasty

The best treatment option in ankle arthritis have always been debated. It is either ankle arthroplasty or arthrodesis. The incidence of ankle arthritishas increased over the recent decades due to the increasing life span of the population and incidence of injuries sustained during sporting events. Although arthrodesis is still largely regarded as the gold standard for it is a safe procedure but in long term, several studies have reported complications such as arthritis in adjacent joints, hip dysfunction and knee problems. Currently results have shown that ankle arthroplasty offers a better long term results than arthrodesis especially in view of patient’s satisfaction and its good functional outcome. This review article aims to analyse both options and their respective outcomes.

Surgical repair of type Ⅲpulmonary atresia with ventricular septal defect / 中华胸心血管外科杂志

Objective To evaluate the outcomes of surgical repair of typeⅢ pulmonary atresia with ventricular septal de-fect( PA/VSD) .Methods Retrospectively analyzed the clinical data of 98 patients with type Ⅲ PA/VSD who underwent sur-gical repair in the Department of Cardiovascular Surgery , Guangdong Cardiovascular Institute from September 2005 to December 2014.There were 54 males and 44 females at the mean age of(4.2 ±4.8) years and the mean weight of(13.2 ±10.0) kg. There were 67 patients in palliative repair group and 31 patients in radical repair group .There were 85 patients underwent on-pump operation including 9 beating heart cases.Results The mean bypass time was(121.2 ±49.4)min, the mean aorta cross-clamping time was(75.4 ±31.8) min.The overall postoperative mortality was 6.1%(6/98).For the survival patients, the mean ventilation time was(106.7 ±184.3) h, the mean ICU stay was(8.9 ±10.9) days and the mean hospital stay was (33.4 ±17.0)days.During follow-up period, 28 patients were underwent re-operation, the postoperative mortality was 7.1%(2/28).There were no differences in postoperative status between two groups.Conclusion The outcomes of surgical repair for type Ⅲ PA/VSD was good.Preoperative evaluation of the pulmonary development and MAPCAs were helpful for choosing surgical options.Re-operation was recommended to those appropriate patients.

Alternatives to reduce sodium in processed foods and the potential of high pressure technology

In most industrialized countries, the sodium intake exceeds the nutritional recommendations. In this sense the search for healthier foods has led the food industry to review their formulations in relation to food components such as salt, which is associated with increased risk of chronic diseases. As a result, different strategies for reducing salt levels in processed foods have been investigated. Among the technological options available, the high-pressure processing has stood out by presenting intrinsic technological advantages that can contribute to optimization of food formulations with low / reduced sodium contents. This review provides a brief overview of the key strategies and use of high pressure in the development of reduced-salt products.(AU)

Differences in attitudes to end-of-life care among patients, relatives and healthcare professionals

<p><b>INTRODUCTION</b>This study explored and compared the differences in attitudes toward end-of-life care among patients, relatives and healthcare professionals, including doctors and nurses.</p><p><b>METHODS</b>We performed a descriptive study on a cross-section of the population of a tertiary hospital in Singapore. Data was collected using a questionnaire survey involving 50 participants from each of the four groups of patients, relatives, doctors and nurses.</p><p><b>RESULTS</b>Family members were the most commonly nominated surrogate decision-makers by the patient group (76%) and the majority of the relative group (74%) felt comfortable deciding on end-of-life care for their loved ones. However, the patient and relative groups differed significantly in their preferences on end-of-life care options, including cardiopulmonary resuscitation (CPR) (p = 0.001), intubation (p = 0.003), nasogastric tube feeding (p < 0.001) and the use of antibiotics (p = 0.023). Doctors, nurses and relatives demonstrated differences in preference between end-of-life care for themselves and for their loved ones, especially with regard to the use of nasogastric tube feeding. There was also a difference between patients and doctors in their decisions on CPR (p < 0.001) and intubation (p = 0.008).</p><p><b>CONCLUSION</b>This study demonstrated the importance of early planning for end-of-life care. This must be initiated proactively by healthcare professionals to engage patients in a culturally sensitive manner to discuss their preferences, in order to facilitate open communication between the patient and family.</p>

Introduction and analysis of guidance for industry bioequivalence recommendations for specific products issued by FDA / 中国药学杂志

OBJECTIVE: To investigate Guidance for Industry Bioequivalence Recommendations for specific products issued by FDA. METHOD: Combination with FDA and CFDA issued guidance related to Bioequivalence (up to May 20th, 2016), 185 FDA issued Guidance for Bioequivalence Recommendations for Specific Products were discussed, which are involved in the CFDA announced initial list of the equivalence assessment of quality and curative effect for generic products. RESULTS: Bioequivalence Recommendations for Specific Products issued by FDA is to further facilitate generic drug product availability and to assist generic pharmaceutical industry with identifying the most appropriate methodology for developing drugs and generating evidence needed to support ANDA approval or reassessment, as an extension and implement to the guideline involved in the aspect of bioequivalence. CONCLUSION: Bioequivalence Recommendations for Specific Products issued by FDA would provide instructive and practical assists to the equivalence assessment of quality and curative effect for generic products in China, since CFDA haven't released similar guidance on specific products yet.

Advances in research and application of copy number variants in pediatric acute lymphoblastic leukemia：reports from the 57th American Society of Hematology annual meeting / 白血病·淋巴瘤

Recent studies showed that copy number variations in certain genes are closely correlated to progression and prognosis of pediatric acute lymphoblastic leukemia. Relevant reports in the 57th American Society of Hematology(ASH) annual meeting in 2015 will be reviewed together with research progress in recent years.

Surgical management in portal hypertension

Background: Portal hypertension commonly accompanies cirrhosis of liver and is a consequence of an increase in splanchnic blood flow secondary to vasodilatation and increased resistance to the passage of blood through the cirrhotic liver. Development of oesophageal varices (OV) is one of the major complications of portal hypertension. In present study we attempted to compare different surgical modalities in case of Portal Hypertension (PHT) by their indications, contraindications, complications and outcomes in a group of 50 patients. Aim and objectives: To study the indications, contraindications, complications and outcomes in different decompressive shunt procedure and devascularisation procedure, to discuss the advantages and disadvantages of different surgical procedures in case of portal hypertension, to discuss role of shunt surgery in modern era of liver transplantation. Materials and methods: During our work period from June 2008 to November 2010, all patient admitted in our institution were considered for study. Detailed history was elicited in each case. Various symptoms were noted and a detailed general, systemic and local examination was done in cases. Various operative surgery was done in the form of Distal Spleenorenal Shunt, Spleenectomy with Devascularisation, Side to Side Mesocaval Shunt, side to side lineorenal Shunt. All the patients were observed for post operative complications and managed accordingly. Regular follow up of patient was conducted till date. All the case was studied on the basis of following proforma. Results: All patients were advised surgery. Out of this only 1 (2.56%) mortality were found which was with the DSRS. All patients with Child’s Criteria B were selected for side to side portocaval Baria B, Parmar N, Kumar S, Parmar H. Surgical management in portal hypertension. IAIM, 2016; 3(9): 194-199. Page 195 shunt of which there was no mortality, in all patients with Child’s Criteria A in whom different surgical modalities were conducted have 3.12% mortality with DSRS and associated morbidity variceal bleeding, total rebleeding and shunt occlusion in both groups. Variceal bleeding was found in 2 cases of which 50% was with Grade A and 50% was with Grade B of Child’s Criteria. Total rebleeding was found in only 1 (3.12%) patient with Child’s Criteria Grade A. Shunt occlusion was found in only 1 (3.12%) patient with Child’s Criteria Grade A. Encephalopathy was found in 5 (12.82%) patients out of which 4 (57.14%) patients were with Child’s Criteria Grade B, and only 1 (3.12%) patient with Child’s Criteria Grade A. Conclusion: More studies are needed to established any conclusion as there are some shortcomings like; patients are lost in follow up, liver transplantation is yet in developmental stage and scarcity of grafts in government setup.