10.3969/j.issn.2095-4344.2013.23.019

Epidermal growth factor receptor tyrosine kinases inhibitor (EGFR-TKI) has impressive clinical efficacy in EGFR-mutant non-small cell lung cancer. However,there are still some patients with primary resistance to TKI.And most patients who initially respond to treatment eventually develop resistance to these drugs,which the main molecular mechanisms are T790M and MET amplification.The new targeted therapies and combination drugs to overcome drug resistance is the subject of clinical research.

Objective To study the clinical effect of expert tibial nail (ETN) in the treatment of distal tibial fractures. Methods From October 2007 to June 2008,ETN was performed in 13 patients with distal tibial fractures. There were eight males and five females, at age range of 25-47 years (33.8 on average). According to AO/ASIF classification, there were three patients with 43-A1 fractures, four with 43-B1 fractures, four with 43-B2 fractures and two with 43-C1 fractures. All the patients were with close fractures except for three patients with Gustilo-Anderson type Ⅰ fractures. Their clinical data were analyzed for assessing the clinical effect of ETN. Results All patients were followed up for a mean time of 8.4 months (range 3-13 months), which showed that all the fractures obtained stable fixation and sound healing, with no complications like breakage of ETN, wound infection, fracture nonunion or limb shortening. According to Johner-Wruhs standard, the functional results were excellent in 10 patients and good in three. Conclusion ETN has advantages of minimal invasion, shorter operation time, stronger fixation,better soft tissue protection and better functional recovery for distal tibial fractures in comparison with traditional open reduction and buttress plate fixation.

Clinical practice is an important process for the formation of the clinical skills and decent medical ethics of medical students.This paper clarifies various issues arising in the current medical ethics education,and proposes relevant countermeasures from the perspectives of medical colleges,training hospitals,guidance teachers,and so on.

56 school-aged children with epilepsy and 37 normal ones of the same gender,age and educational level were selected. All the subjects' parents completed the child adaptive behavior scale, the mutiple stepwise linear re-gression was used to explore the impact of epilepsy related factors on social adaptive function. The social adaptive function of school-aged children with epilepsy faulty is affected by seizure frequence,gender,age,epilepsy control, clinical course,and the number of antiepileptic drugs.

Objective To explore the effects of ephedrine on the hippocampal cell apoptosis and behavioral performance after hypoxia-ischemia brain injury in neonatal rats.Methods Totally 90 7-day rats were randomly divided into 3 groups,ephedrine treatment group,model group,and sham group.Hypoxia-ischemia brain injury model was established by permanently ligating right common carotid artery.Ephedrine (1.5 mg/kg,once per day) was injected intraperitoneally to the rats of ephedrine treatment group for 7 d,and the rats of model group was given normal saline at the same volume.At the following time interval of 6 and 12 h,and 1,3,and 7 d after hypoxia,the expression of bcl-2 and bax were detected in the hippocampal region by immunohistochemical staining.At 4 weeks after surgery,behavioral changes in the remaining rats were tested by Morris water maze.Results Compared with model group,the expression of bcl-2 in the ephedrine treatment group was significantly increased after hypoxic-ischemic injury,peaked at 1 d and decreased in 3 d after operation.And the expression of bax in the ephedrine treatment group was decreased in 1 d after hypoxic-ischemia.The average time of escape latency was gradually decreased in each group.However,from the 3rd to 5th day,it was much shorter in ephedrine treatment group than in model group.In addition,the frequency platform passing in the ephedrine treatment group and the percentage of swimming distance traveled in the previous target quadrant was significantly greater than those of the control group.Conclusion Ephedrine upregulates bcl-2 and downregulates bax in the hippocampus of neonatal rats after hypoxia-ischemia,and improves their ability of learning and memory.

The method of multiplex PCR was set up to identify two or three transgenes in one reaction such as uidA and bar; uidA and IDx5 or uidA, bar and 1Dx5 genes. Three sets of primer pairs which was specific to each of these three genes respectively were designed and synthesized. Recombinant plasmids pAHC25 and p1Dx5 harboring uidA + bar and 1Dx5 gene separately were used as template DNA in the process of optimizing an multiplex PCR reaction. The optimal annealing temperature for uidA and bar MPCR is range from 57. 1℃-62. 3℃ , for uidA and 1Dx5 is range from 60℃ to 60. 6℃ , and for uidA、bar and 1Dx5 range from 57. 0℃-58. 4℃. The amount of template for MPCR is twice as much as that for simplex PCR, while the concentration of primers is the same with simplex one. Less than 50bp MPCR products can be separated clearly by 10% non-denaturalized polyacrylamid gel electrophoresis. Fourteen transgenic wheat lines were tested by multiplex and simplex PCR respectively, which shows the same results and hence presents that MPCR is the reliable, rapid and high-effective approach to detect foreign genes from transgenic plant.

Objective To evaluate preliminary effect of In-Space percataneous interspinous spacer in the treatment of lumbar instability.Methods Data of 18 patients who had undergone interspinous spacer implant for lumbar instability from May 2009 to June 2011 were retrospectively analyzed.There were 10 males and 8 female,aged from 39 to 58 years.All patients suffered from varying degrees of lower back pain induced by lumbar hyperextension,as well as radiating and segmental pain of unilateral lower limb.The visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate clinical outcomes.The pre-and postoperative interspinous distance,trailing edge height of intervertebral space,foraminal width,foraminal height,segmental lordotic angle and lumbar range of motion were tested and compared.Results All patients were followed up for 18 to 36 months.The VAS score improved from preoperative 7.9±2.1 to 3.1±1.3 at 6 months postoperatively and 1.5±0.8 at final follow-up.The ODI improved from preoperative 82.1％±13.1％ to 54.7％±14.8％ at 6 months postoperatively and 10.1％±2.5％ at final follow-up.The postoperative interspinous distance,trailing edge height of intervertebral space,foraminal height,foraminal width,segmental lordotic angle and lumbar range of motion were 9.29±1.43 mm,11.28±0.85 mm,21.27±1.01 mm,10.83±0.73 mm,7.62°±0.74° and 6.34°±0.81°,respectively.Wound healed smoothly in all patients,and there were no complications such as spinous process fracture,spinal cord injury,cerebrospinal fluid leakage,device displacement and device dislocation.Conclusion It is easy and safe to use In-Space percataneousinterspinous spacer in the treatment of lumbar instability,and the preliminary effect is satisfactory.

Objective To explore the application of CARE kV technique in the adult chest CT and the value of reducing radiation dose.Methods Sixty-nine patients were divided into two groups by random number generators:group A(39 cases) and group B(30 cases).Group A was examined by using CARE kV technique and group B was examined at routine 120 kV.CT dose index(CTDIvol),dose length product (DLP) and effective dose (E) were compared between the two groups,and analyzed the correlation between tube voltage selection and patient body mass index (BMI) of group A was analyzed.Results The average CTDIvol [(11.00 ± 3.89) mGy],DLP[(294.05 ± 91.17) mGy·cm] and E[(4.12 ± 1.28) mSv] of group A were lower than those of group B (16.64 ± 1.20) mGy,[(475.99 ± 41.16) mGy · cm],[(6.66 ±0.58) mSv].With statistically significant difference (t =-7.653,-10.151,-10.150,P ＜ 0.05).Compared with routine 120 kV technique (group B),the CARE kV technique (group A) could reduce the total radiation dose about 38.14％.Compared obese patients(BMI≥28 kg/m2) with non-obese patients in group A and B,the mean E of non-obese patients was lower than that of obese patients in group A,which reduced the total E about 31.74％ (t =4.322,P ＜0.05),while E in group B was no significant different between non-obese patients and obese patients.Conclusions In adult chest CT,CARE kV technique can select optimum scanning voltage automatically according to the patients with different BMI and anatomical regions,which can reduce the overall radiation dose while maintaining image quality.

Adult ; Endocarditis ; complications ; Endocarditis, Bacterial ; complications ; Heart Defects, Congenital ; complications ; Humans ; Male ; Pulmonary Valve ; microbiology