Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) comprise an effective therapy for advanced non-small cell lung cancer patients with EGFR-activating mutations. Unfortunately, most patients eventually develop resistance to EG-FR-TKIs, probably due to a secondary point mutation of EGFR T790M. Thus, a sensitive method for accurate detection of T790M mu-tation is essential. Peripheral blood detection has gained our attention because it is convenient, making dynamic noninvasive quantita-tive detection of T790M mutation an optimal means of monitoring the efficacy of EGFR-TKIs. To date, the clinical significance of T790M mutation and EGFR-TKI resistance remains controversial. Several EGFR-TKIs targeting EGFR mutation, which have been in-troduced in recent years, showed better response in patients with T790M mutation, indicating that T790M may be a biomarker for con-quering resistance. This review introduces the methodology of T790M detection and its role in clinical practice.

Objective To compare the ocular parameters measured by 2 biometry devices Tomey OA-2000 and IOLMaster in cataract eyes.Methods A total of 74 cataract patients (74 eyes) were included in this prospective study.Ocular parameters,including axial length (AL),keratometry (K),anterior chamber depth (ACD) and white to white (WTW),were obtained from Tomey OA-2000 and IOLMaster,respectively.Paired t-test was applied to analyze the differences of ocular parameters from Tomey OA-2000 and IOLMaster,while Bland-Altman plot was used to assess the agreement of these ocular parameters.Results The AL,flat K,steep K,mean K,central corneal thickness (CCT),ACD,lens thickness,pupil diameter and WTW values measured by Tomey OA-2000 were (24.26 ± 2.71) mm,(44.09 ± 1.76) D,(45.01 ± 1.73) D,(44.55 ± 1.72)D,(518.41 ±34.18) μm,(3.07 ±0.48)mm,(4.48 ±0.61)mm,(4.07 ±0.95)mm and (11.50 ± 0.52)mm respectively.Values of AL,flat K,steep K,mean K,ACD and WTW from IOLMaster were (24.33 ± 2.69) mm,(44.21 ± 1.74) mm,(45.15 ± 1.76) D,(44.69 ± 1.74) D,(3.04 ± 0.46)mm and (11.65 ± 0.41) mm respectively.The difference values of AL,flat K,steep K,mean K,ACD and WTW between Tomey OA-2000 and IOLMaster were (-0.07 ±0.10) mm (t =-5.99,P＜0.01),(-0.12 ± 0.21) D (t =-4.14,P＜0.01),(-0.14 ± 0.20)D (t =-5.88,P＜0.01),(-0.12 ±0.13) D (t =-7.44,P＜0.01),(0.03 ±0.14) mm (t=1.99,P=0.05) and (-0.14±0.32) mm (t=-3.73,P＜0.01) respectively.The 95％ limits of agreement (LoA) of the AL,flat K,steep K,mean K,ACD obtained from the two devices was 0.27 mm,0.50 D,0.53 D,0.38 D,0.30 mm,respectively,and the agreement was good;95％ LoA of WTW was 0.78 mm,and the consistency was poor.Conclusion The differences of AL,K values and ACD between Tomey OA-2000 and IOLMaster were small,suggesting the agreement is unified.

Objective To explore the relationship between reduction of regional cerebral blood flow in the normal appearing white matter (NAWM) and the extent of age-related white matter lesions (WML).Methods We used Fazekas scale to divide all participants into four groups (normal,mild,moderate,severe) according to the extent of the lesions showed on MRI.Regional cerebral blood flow (rCBF) in the area of WML and NAWM was measured by xenon contrast CT examination.Results A total of 56 cases were selected.The average rCBF (ml · 100 g-1 · min-1) in the lesions (WML) around ventricle,in right centrum ovale and in left centrum ovale respectively was 20.33 ± 2.52,21.27 ± 1.02,21.03 ± 1.83 for mild; 16.33 ±2.03,15.55 ±1.71,15.91 ±0.98 for moderate; 14.05 ±2.63,14.46 ±2.17,14.23 ± 1.95 for severe.The average rCBF (ml · 100 g-1 · min-1) in the NAWM around ventricle,in right centrum ovale and in left centrum ovale respectively was 20.79 ± 2.78,22.26 ± 1.9,22.15 ± 2.4 for normal; 21.12 ± 2.95,22.17 ± 1.50,22.25 ± 2.13 for mild,18.02 ± 2.41,19.45 ± 1.94,19.62 ± 1.54for moderate; 16.38 ± 3.22,18.18 ± 2.84,16.74 ± 2.97 for severe.The decrease of rCBF in the severe and moderate lesion areas was more serious than that in the mild lesion areas and reached statistic significance (P ＜ 0.05) ; The decrease of rCBF in the severe and moderate lesion areas was more serious than that in the area of NAWM in the same grade and reached statistic significance (P ＜ 0.05).The decrease of rCBF in the area of NAWM around severe and moderate lesion areas was more serious compared with that around mild lesion areas or normal areas (P ＜ 0.05) ; But the difference of rCBF in the area of NAWM around mild lesion areas and normal areas did not show any statistic significance.Conclusions Chronic ischemia was found to be existed not only in the lesions (WML) but also in the area of NAWM around the lesions,and was related to the extent of the lesions.Chronic ischemia may play a key role in the mechanism of aged-related WML.

Objective To explore the application effect of postural animation video instruction mode in elderly patients undergoing epidural anesthesia. Methods A total of 300 patients with epidural anesthesia were registered from January 2015 to February 2016. The patients were divided into trial group and control group with 150 cases each. The trial group was preoperatively interviewed by the postural anatomy video instruction mode, and the control group was only preoperatively interviewed by oral interpretation. The epidural anesthesia effect and anxiety between the two groups were compared. Results The difference of anesthesia posture and anatomical position, the average time of epidural puncture, the success rate of one puncture and the degree of anxiety before and after mission were 90.67% (136/150), (14.50 ± 10.20) s, (425.60 ± 78.30) s, 97.33% (146/150) and (21.65 ± 6.62) points respectively. The control group was 22.00%(33/150), (112.60 ± 60.80) s, (589.40 ± 90.70)s, 82.67%(124/150) and (6.65 ± 5.40) points respectively. There were significant differences between the two groups (χ2=8.79, t=13.54-19.88, all P < 0.01). Conclusions The postural anatomical video teaching mode can relieve anxiety, improve the degree of fit of epidural anesthesia and the success rate of puncture, shorten the time of posture, thus shorten the average time of epidural puncture, improve the quality of nursing in the operating room, work efficiency.

Anti neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) is a systemic disease characterized by small vessel wall inflammation and cellulose necrosis mediated by ANCA. Renal injury caused by AAV is called ANCA-associated glomerulonephritis (AAGN). The paper reported a case of AAV with renal damage combined with human immunodeficiency virus (HIV) infection. The patient was an elderly male with clinical manifestations of hematuria and uremia. Renal pathological examination showed AAV and renal injury. This case is the first report in China while reviewing the relevant literature, and it is still inconclusive whether this is an overlap of the two diseases or a specific pathological type of HIV-associated nephritis. We believe that AAV has the potential to occur in HIV-infected patients, so clinicians should not ignore the phenomenon of ANCA positivity in HIV-infected patients, and the follow-up of such patients needs to be enhanced. Clinical and renal pathological examinations are the main methods to diagnose HIV infection with AAV. At the same time, there are no clear guideline guidelines on how to administer immunosuppressive therapy for such patients who have immunodeficiency and are at higher risk of opportunistic infections, and in whom to make the best possible outcomes.