Brain metastases (BM) are one of the main cause of death in patients with non small cell lung cancer ( NSCLC ).The prognosis is still poor, despite standard therapy based on surgery and radiotherapy.In recent years,with the deepening understanding of molecular mechanisms in lung cancer, epidermal growth factor receptor (EGFR) mutation might be considered as an effective therapeutic target for NSCLC with BM.Therefore,we review the current knowledge about the correlation between EGFR mutation with prevalence and prognosis in BM.

Objective To explore the necessity of EGFR?targeted therapy combined with synchronized whole brain radiotherapy ( WBRT ) for non?small?cell lung cancer ( NSCLC ) with mutated EGFR and brain metastasis by comparing the effects on prognosis between WBRT combined with tyrosine kinase inhibitor ( TKI) and TKI alone. Methods A retrospective analysis was performed in 43 patients with EGFR mutation?positive NSCLC and brain metastasis. In those patients, 24 patients received WBRT plus TKI and 19 patients TKI alone. Results The overall response rate ( RR) and 6?month intracranial disease control rate ( CR) were significantly higher in the WBRT+TKI group than in the TKI group ( 79% vs. 37%, P=0. 002;79% vs. 63%, P=0. 008). The median intracranial progression?free survival (IPFS) time was significantly longer in the WBRT+TKI group than in the TKI group ( 23. 7 vs. 8. 3 months, P=0. 025) . The multivariate analysis indicated that the control of lung cancer, WBRT+TKI, and single brain metastasis were favorable factors for substantially longer IPFS time ( P=0. 033,0. 019,0. 019) . In 23 patients with exon 19 deletion, 12 patients received WBRT+TKI and 11 patients TKI alone;compared with the TKI group, the WBRT+TKI group had significantly higher RR and 6?month CR as well as significantly longer IPFS ( 100%vs. 35%, P=0. 000;100% vs. 55%, P=0. 008;23. 7 vs. 8. 4 months, P=0. 003). In 20 patients without exon 19 deletion, however, there were no significant differences in RR or 6?month CR between the WBRT+TKI group (n=12) and the TKI group (n=8)(64% vs. 50%, P=1. 000;58% vs. 75%, P=0. 642).The median IPFS was 14. 4 and 8. 4 months ( P=0. 864) . Conclusions WBRT combined with TKI is superior to TKI alone in the treatment of NSCLC with brain metastasis. Patients with exon 19 deletion have substantially better treatment outcomes.

Objective To compare the effects of laparoscopic hepatectomy (LH) versus conventional laparotomy hepatectomy (CLH) on cellular immunity. Methods Fifteen ASA Ⅱ-Ⅲ patients aged 34-61 yrs, weighing 48-75 kg undergoing laparoscopic hepatectomy (LH) were studied. Another 15 patients aged 33-64 yrs, weighing 46-73 kg undergoing conventional laparotomy hepatectomy (CLH) served as control. The preoperative liver function was rated as Child classification A in both groups. The patients were premedicated with phenobarbital 0.1 g and atropine 0.5 mg i.m. . Anesthesia was induced with fenlanyl 4 ?g?kg-1, propofol 1.5 mg?kg-1 and succinylcholine 2 mg?kg-1. After tracheal intubation the patients were mechanically ventilated and PETCO2 was maintained at 35-45 mm Hg. Anesthesia was maintained with inhalation of isoflurane (MAC 1.0?0.31) and 60% N2O in O2 and intermittent i.v. boluses of vecuronium. The patients received after operation patient-controlled epidural analgesia (PCEA) with 0.125% ropivacaine and morphine 0.05 ?g?kg-1?min-1. Radial artery and right internal jugular vein were cannulated for BP and CVP monitoring. Peripheral venous blood samples were taken before operation and on the 1 st and 3rd postoperative day for determination of CD3+ , CD4+ , CD8+ T cells (by flow cytometry) and IL-6, TNF-?concentrations (ELBA) . Results CD3+ , CD4+ and CD8+ counts were significantly decreased while IL-6 and TNF-?levels were significantly increased on the 1st postoperative day compared with the baseline values before operation in both groups but there was no significant difference between the two groups. On the 3rd postoperative day CD3+ , CD4+ and CD8+ counts and IL-6, TNF-?levels returned to preoperative level in group LH while in group CLH CD3+ , CD4+ , CD8+ remained low and IL-6, TNF-?levels remained high.Conclusion The results suggest that LH exerts less effects on immune function than conventional laparotomy technique.

Objective To evaluate the clinical effects of Kangfuxin solution as the auxiliary treatment of chronic periodontitis.Methods 41 patients with chronic periodontal diseases were randomly divided into test group and control group.Following initial therapy,Kangfuxin solution was applied to the test group,but the control group received no drug.The bleeding on probing(BOP)was observed before treatment and 1 week after treatment.Results Before treatment.there was no significant difference in the index between the two groups.After initial therapy 1 week,both groups showed improvement in their examined index(all P＜0.01).The results of the test group were better than those of the control group,and the differences were statistically significant(P＜0.01).Conclusion Kangfuxin solution as the auxiliary treatment of periodontitis could effectively relieve the clinical symptoms and gain good clinical effect.It was worth to be used widely.

Since the first reported case of swine influenza A in Mexico,a total of 15 510 cases have been confirmed in 53 countries by May 29,2009.On April 29,2009,the World Health Organization(WHO)raised its pandemic alert from grade 4 to grade 5.The virus is described as a new subtype of A/H1N1 and is not detected in pigs or humans previously.The virus is sensitive to oseltamivir and zanamivir,but resistant to amantadine and rimantadine.The genetics of the virus are so novel that humans are unlikely to have much immunity to it.The virus can transmit from human to human;therefore it is necessary to enforce quarantine measure for close contactors because the virus transmits during latency.Precaution methods like covering noses and mouths with a tissue when coughing or sneezing can reduce the transmission opportunity.Hands should be washed frequently with soap,especially after coughing or sneezing.Public places with ventilation conditions,personal health behavior and health condition are critical for the prevention and control of this epidemic.

Several epidemic influenza viruses leading to worldwide periodical pandemics all result from the genetic reassortment of different influenza viruses.The novel 2009 A/H1N1 virus is a reassortment virus evolved from swine influenza virus A/H1N1,avian influenza virus H5N1,and human influenza virus A/H1N1.The 8 fragmente genes of the novel A/H1N1 virus had their own evolutionary characteristics.All the pandemic viruses in humans originate from avian influenza viruses and are transferred into humans after reassortment processes in pigs.Pigs as middle host and a mixing vessel of influenza A virus play an important role in the evolution of the 2009 novel A/H1N1 virus.More attention should be paid on the role of swine in the prevention and control of novel H1N1 virus epidemics in future.

Objective To detect the expression and effect of human tumor necrosis factor related apoptosis-inducing ligand (hTRAIL) in vivo,by using a novel double expressing adenoviral vector encoding hTRAIL and firefly luciferase ( luc ) gene ( ad -luc-hTRAIL),in which luc was used as reporter gene.Methods Lung cancer A549 cell xenografts in 16 nude mice models were established in subcutaneous inoculation way,the adenovirus vectors ( ad-luc-hTRAIL,ad-hTRAIL,ad-luc) and phosphate buffer saline (PBS) (n =4) as control were injected into tumor respectively.The size of the tumor was measured at different time points (4,7,10,14,21,28 d)after injection.The activity of luciferase in surface of the tumor was detected in vivo by using high-sensitivity cooled-charged coupled device(CCD) camera.The expression of hTRAIL was demonstrated by immunohistochemistry staining after sacrificing the animals at different time points,and immunohistochemical scores (IHS) were measured. The apoptosis rate of tumor cells was detected by using TUNEL and calculated. Analysis of variance,the paired t test and linear correlation analysis was used for the statistics. Results The growing speed of tumour xenografts was more slowly in ad-luc-hTRAIL and ad-hTRAIL groups than PBS group (t =2.71,2.72,P ＜ 0.05 ).The tumor volumes of ad-luc-hTRAIL,ad-hTRAIL,ad-luc and PBS groups 28 days after injection were (208.4 ± 42.3 ),( 181.5 ±23.9),( 403.1 ± 54.0 ) and ( 427.0 ± 59.3 ) mm3, respectively. There was no significant difference between ad-luc group and PBS group(t =2.07,P ＞ 0.05).The expression of luciferase in ad-luc-hTRAILgroup reached its peak at 7th day ( 1.37 ± 1.04),and then decreased quickly.The IHS and apoptosis rate in ad-luc-hTRAIL and ad-hTRAIL groups reached their peaks at 7th day,the peak values of IHS were 6.25 ±2.06 and 6.5 ± 2.89,the peak values of apoptosis rate were (60.75 ± 8.06 ) ％ and ( 61.50 ± 8.47 ) ％,respectively.The amount of luciferase expression ( absolute number of photons detected by CCD camera)was linear positive correlated with IHS and apoptosis rate ( rphotons/IHs =0.942,rph /rate =0.842,rIHs/rate =0.887,P ＜ 0.05 ).Conclusion The target gene hTRAIL can be transfected into lung cancer A549 cell xenografts nude mice models efficiently with a high level expression,and the therapeutic effect of hTRAIL can be monitored by detecting the expression of luc.

Objective:To investigate the possibility for human papillomavirus (HPV)infection to be a predictable signal for the carcinogenesis of oral mucosa by comparing the prevalences of HPV in each stage of oral mucosal carcinogenesis and to compare the sensitivity differences of the two methods in de-tecting HPV infection in oral cavity.Methods:The hybrid capture (HC-Ⅱ)was used to detect infection of HPV in 255 samples taken from 1 2 cases of healthy oral mucosa,21 1 cases of patients with pathologi-cal diagnosis and 32 cases of patients with clinical diagnosis.The diagnosed cases included 8 cases of be-nign lesions of the oral mucosa,precancerous lesions [74 cases of oral leukoplakia (OLK)with hyper-plasia and 42 cases of OLK with oral epithelial dysplasia (OED)],91 cases of precancerous condition
[oral lichen planus (OLP)]and 28 cases of oral squamous cell carcinoma (OSCC).And in situ hybri-dization (ISH)was used to detect infection of HPV in 33 cases of OSCC and 76 cases of OLK,including 30 cases of hyperplasia,1 5 cases of mild OED,1 5 cases of moderate OED and 1 6 cases of severe OED. Results:The prevalence of HPV in OLP samples was higher (1 2.1 2%,8/66 )than that of OLK (2.59%,3/1 1 6)(χ2 =4.666,P=0.031 )and OSCC(7.1 4%,2/28,χ2 =0.51 3,P=0.474).The prevalence of HPV in OSCC (7.1 4%,2/28)was higher than that of OLK (2.59%,3/1 1 6),and no significant difference was found.There was only one case of smoke spot and statistical analysis was not carried out.ISH was used to detect type 1 6/1 8 and type 31 /33 HPV DNA in 1 09 cases of oral mucosal lesions in paraffin sections and only one case of OSCC was HPV positive.Thirty-seven cases were detec-ted by HC-Ⅱ and ISH methods at the same time.The same negative results by the two methods were found in 94.6% samples (35/37).In the other two samples,one was OSCC with early infiltration and the other was OLK with hyperplasia,The HC-Ⅱ results were positive while the ISH results were nega-tive.The patients with OLP and HPV testing results were followed up and the average follow-up period was (36.2 ±1 0.5)months.It was found that three of them had a malignant transformation,and the ma-lignant transformation rate of HPV positive patients was 1 2.50% (1 /8),which was higher than that of HPV negative patients (3.45%,2/58),and the difference was not statistically significant,P=0.249. Conclusion:HC-Ⅱ assay was more sensitive in detecting HPV infection of oral mucosal lesions than ISH.The results of this study showed that there was insufficient evidence for taking HPV infection as a predictor of OLK carcinogenesis.Patients suffering from OLP were in a precancerous condition.The pre-valence of HPV in OLP patients of this study was higher than that in OLK and OSCC patients,suggesting that for some reason,OLP patients were susceptible to HPV.HPV testing can be considered as routine in patients with OLP,and HC-Ⅱassay was recommended.And patients with OLP and HPV positive should be followed up regularly.

Objective To summarize the lung HRCT findings of lung Langerhans cell histiocytosis (LCH) in children. Methods A total of 54 children with lung LCH pathologically proved in our institute from September 2006 to December 2014 were retrospectively reviewed. Patients were subdivided into two subgroups, diffuse type (n=29) and localized type (n=25). In addition, 32 children with LCH but without pulmonary infiltration were selected as control group. HRCT findings of 54 LCH with lung involvement were reviewed and analyzed for distribution pattern. The age of onset, illness duration and pulmonary function were compared between the lung LCH group and the control group. The differences of HRCT findings in LCH patients between diffuse type and localized type were compared with χ2 test. The differences on the onset age, illness duration and pulmonary function between the LCH group with lung involvement and control group were compared with non-parametric test(Mann-Whitney U Test). The differences of pulmonary function between the LCH group with lung involvement and control group were compared with Fisher exact probability test. Results The signs of pulmonary LCH on HRCT included lobular hyperinflation (n=26), interlobular septa thickening (n=11), cystic lesions (n=11), ground?glass opacity (n=10), nodules (n=9), and centrilobular nodules (n=6). The signs presented in 21, 8, 7, 9, 4 and 6 cases in diffuse type group respectively and 5, 3, 4, 1, 5, 0 in localized type group. Among them, lobular hyperinflation, ground?glass opacity and centrilobular nodules were more prevalent in the diffuse group. The difference was statistically significant (χ2=14.77,2.01,0.55,4.84,0.06 and 3.91, P<0.05). The onset age of LCH group with lung involvement was younger than the other (Z=-2.40, P<0.05). However, there was no statistically significant difference in the illness duration (Z=-1.46, P>0.05) and pulmonary function between two groups (P>0.05). Conclusions Lobular hyperinflation, ground glass opacity and centrilobular nodules are the most common manifestations in LCH patients with lung involvement and the distribution is mostly diffuse. Nodules, cystic lesions and interlobular septa thickening may exist. Several signs may coexist simultaneously. Younger children with LCH are more vulnerable to lung involvement.

Objective To investigate the correlation between prestroke comorbidity and long-term outcomes in patients with acute cerebral infarction.Methods Consecutive acute ischemic stroke patients who were hospitalized were prospectively recruited from August 2010 to November 2012.Six hundred and forty-four patients were enrolled,the baseline data including Charlson Comorbidity Index (CCI),National Institute of Health Stroke Scale (NIHSS) score,type of Oxfordshire Community Stroke Project (OCSP:total anterior circulation infarct,partial anterior circulation infarct,posterior circulation infarct and lacunar infarct) were recorded.And recovery was assessed by modified Rankin Scale (mRS) 90 days after stroke by telephone interview (mRS score ≤ 2 reflected good prognosis,and mRS score ＞ 2 reflected unfavorable prognosis).Because CCI included specific comorbidity,we considered CCI,CCI without specific comorbidity and specific comorbidity as variable respectively.After screening the risk factors affecting prognosis using univariate analysis,the relationship between comorbidity and prognosis was estimated using multinomial logistic regression model.Results CCI was an independent predictor of good prognosis and unfavorable prognosis (OR =3.446,95％ CI 1.662-7.417; P =0.001).Congestive heart failure and diabetes were each independent predictor of good prognosis and unfavorable prognosis also (diabetes:OR =2.584,95％ CI 1.709-3.906,P =0.000; congestive heart failure:OR =6.229,95％ CI 1.705-22.755,P =0.006).Conclusions After acute ischemic stroke,the patients with the higher CCI score,diabetes and congestive heart failure are more likely to achieve unfavorable outcome.CCI,diabetes and congestive heart failure can each be used as a sensitive index to evaluate the 90 d prognosis of patients.Trial registration Clinical Research Center of China (CHiCTR-OCH-14004228)