Background and purpose:EGFR-TKI (EGFR-tyrosine kinase inhibitors), represented by geiftinib and erlotinib, have exhibited signiifcant antiproliferative effects against non-small cell lung cancer (NSCLC) with low toxicity.EGFR gene mutation was discovered to be a predictive biomarker for EGFR-TKI treatment. Although the efifcacy of EGFR-TKI is limited toEGFR wild-type patients, it is still noticeable suggesting that some other mechanisms are responsible for it. The current study is aimed at evaluating the expression of phosphorylated EGFR in advanced NSCLC, investigating its relationship withEGFR mutations and EGFR-TKI efifcacy.Methods:EGFR gene mutations were detected by denaturing high performance liquid chromatography (DHPLC) in 205 stageⅢB-ⅣNSCLC patients. The expressions of phosphorylated tyrosine 1068 (pTyr1068) and 1173 (pTyr1173) were detected by immunohistochemistry.Results:The positive expressions of pTyr1068 and pTyr1173 were 80.0% (164/205) and 57.6% (95/165) respectively. None of them were related to clinical pathological characteristics (age, gender, pathological type, smoking status, disease stage).EGFR gene mutation rate was 44.9% (92/205), which was only related to smoking status (P=0.024) compared to other clinical pathological characteristics.EGFR gene mutations were poorly related to pTyr1068 expression (P<0.001) and not related to pTyr1173 expression (P=0.297). The objective response rate (ORR),disease control rate (DCR), and progressive free survival (PFS) of EGFR-TKI treatment in patients withEGFR mutations were 48.3% (43/89), 80.9% (72/89) and 8 months (95%CI: 6.11-11.42) respectively, which were signiifcantly higher than that ofEGFR wild-type patients [ORR=16.2% (17/105,P<0.001); DCR=56.2%(59/105,P<0.001); Median PFS: 2.1 months, (95%CI: 0.89-3.24;P=0.001)]. Superior ORR: DCR and PFS appeared in patients with pTyr1068 positive expression compared to negative [ORR: 37.7% (58/154)vs 5.0% (2/40,P<0.001); DCR: 74.7% (115/154)vs 40.0% (16/40,P<0.001); Median PFS: 7.0 monthsvs 1.2 months,P<0.001)]. Inversely, the patients with pTyr1173 positive expression had lower ORR, DCR and shorter PFS [ORR: 27.8% (25/90)vs 37.9%(25/66,P=0.123); DCR: 64.4% (58/90)vs 83.3% (55/66,P=0.007); Median PFS: 4.8 monthsvs 7.7 months (P=0.016)]. In subgroup ofEGFR wild-type patients, positive expression of pTyr1068 was 69.0% (69/100).EGFR wild-type patients with pTyr1068 positive expression had a prolonged PFS and elevated ORR and DCR compared to negative [median PFS: 3.6 monthsvs 1.2 months (P<0.001); ORR: 23.2%vs 3.2% (P=0.010); DCR: 69.6%vs 35.5% (P=0.001)]. Sixteen patients with pTyr1068 positive expression who responded to EGFR-TKI treatment in this subgroup had a remarkable PFS [median PFS: 15.6 months (95%CI:7.28-23.9)]. Multiple factor analysis showed that the expression of pTyr1068 was an independence predictor factor for EGFR-TKI treatment (OR=0.24, 95%CI: 0.16~0.37,P<0.001). Conclusion:Phosphorylation at Tyr1068 of EGFR might be a potential predictive factor for clinical response and survival of EGFR-TKI treatment in patients with advanced NSCLC, especially inEGFR wild-type patients.

[Summary] To determine how endocrinologists in China access and treat patients with Graves' orbitopathy (GO) and gain insight on how to make the management of this disease more uniform and standardized in the context that management of GO continues to be challenging.Based on the questionnaire used in the European survey on GO,a questionnaire in Chinese was drafted and circulated to the members of Chinese Society of Endocrinology (CSE).There were a total of 124 valid responders.The majority (94.4％) of the responders believe that a muhidisciplinary approaches for GO management is valuable.Over 80％ of the participants advocated the evaluation of exophthalmometry,vision,visual fields by perimetry,eye movements,fundoscopy,TSH receptor antibodies,thyroid function,and ultrasound.Steroids were preferred as the first-line therapy by 92.7％ of responders,among them,59.7％ choose intravenous route.The treatment strategy for GO with intravenous glucocorticoids therapy still remains debated.Antithyroid drugs were the most common choice (72.6％) for first-line therapy of thyrotoxicosis.Treatment options for GO were very similar among Chinese,Latin-American,and European responders,though radioactive iodine and surgical treatment were more often indicated in China.The appropriate treatment of the patient with GO is controversial even amongst thyroid specialists.Further training of clinicians,easier access of patients to specialist multidisciplinary centres,and the publication of practice guidelines may help improving the management of this condition in China.

Objective: To investigate the occupation stress of orphan child care workers in Nanjing, to explore the influence of different demographic characteristics on occupational stress of orphan child care workers and propose measures. Methods: Cluster sampling method was used to investigate the occupation stress of 236 people of orphan child care workers in Nanjing by a combination of the Internet of things assessment system of occupational stress and traditional questionnaire. Results: The scores of workload, job prospects, participation decision-making, anxiety and logical in different age groups among orphan child care workers were statistically different (P<0.05) ; The scores of organizational loyalty in different education groups among orphan child care workers were statistically different (P<0.05) ; The scores of task control, resource control, workload, job prospects, job satisfaction, mental health, anxiety and ambition were statistically different among orphan child care workers with different job titles (P<0.05) ; The scores of role conflict, role ambiguity, job satisfaction, mental health, anxiety, self-esteem, colleague support, family support and task strategy were statistically different orphan child care workers in different classes (P<0.05) . Conclusion Different demographic characteristics will have certain influence on occupational stress of orphan child care workers.

Objective: To investigate the occupation stress and job burnout of orphan child care workers in Nanjing and nursing staff in Yangzhong primary hospital, to compare the differences of occupational stress and job burnout between the two social service workers. Methods: From February to May 2017, a cross- sectional survey was conducted. Cluster sampling method was used to investigate the occupation stress and job burnout of orphan child care workers in Nanjing and nursing staff in Yangzhong primary hospital, totally 403 people, by a combination of the Internet of things assessment system of occupational stress and traditional questionnaire. Results: There were statistically significant differences of occupational stress and job burnout scores of both social service workers (P<0.05). Orphan child care workers in job control, technology utilization, job routinization, work risk, role ambiguity and participation decision-making, anxiety state, body complain, life attitude, behavior characteristics, ambition, anxiety trait, social support, logic, family-work relationship and depersonalization were higher than those of Yangzhong primary nurses (P<0.05); Primary nurses in Yangzhong in quantitative load and change, workload, role conflict, job prospects, promotion, depressive symptom, daily stress, self-esteem, task strategy, time management, work input, and personal accomplishment reduction scored higher than those of Orphan child care workers (P<0.05). The logistic regression analysis of the occupational depletion positive rate of the two social service personnel showed that the protective factors of the nursing staff of the orphans and disabled children had behavioral characteristics and family support(OR=0.877, P=0.044; OR=0.691, P=0.001) . The contributing factors of the primary nursing staff in Yangzhong were task control, workload, work psychological control source (OR=1.110, P=0.019; OR=1.128, P<0.001;OR=1.066, P=0.032) . The protection factors were technical utilization, opportunities for improvement, and mental health (OR=0.775, P=0.005; OR=0.765, P=0.006; OR=0.914, P=0.002) . Conclusion The work content, the service object and the nature of the unit of primary caregivers influence the state of occupational stress and job burnout. The influencing factors of occupational stress and job burnout are not identical, Different social service personnel show occupational stress and occupational exhaustion in different aspects, and it is necessary to propose mitigation measures for two kinds of social service personnel.

The residents who had lived for at least 5 years and aged over 20 years old were sampled from urban to rural districts of Jiangsu Province with a stratified cluster sampling technique. B mode ultrasonography and thyroid function determination were carried out in 6 128 persons. The location, diameter, number, boundary, and calcification in thyroid nodules were described by using 7.5 MHz/50 mm transducer of thyroid ultrasonography. TSH was measured by chemiluminescence immunoassay. Free triiodothyronine(FT3)and free thyroxin(FT4)were measured when TSH was abnormal. The crude prevalence of thyroid nodules was 21.12% in total population, 14.55% in male, and 25.24% in female. The standardized prevalence was 15.69%, 11.20%, and 20.40%, respectively. The prevalence was lower in male than in female, and increased with age(P＜0.05). Thyroid nodules in Jiangsu Province were highly prevalent and more attention should be paid to the follow-up, early diagnosis, and treatment.

Objective To investigate the prevalence and epidemiologic characteristics of hypothyroidism among community population in Jiangsu province. Methods The residents who had lived for at least five years and aged more than 20 years old were sampled from six layers in urban and rural districts of Jiangsu province by a stratified cluster sampling technique. Serum was sampled from 7 122 subjects and sTSH was measured by chemiluminescence immunoassay, and FT3 and FT4 were determined in the subjects with abnormal sTSH level. Results (1) The crude prevalences of overt hypothyroidism and subclinical hypothyroidism were 0.66% and 7.53% respectively in total population, with the respective standardized rates of 0.43% and 6.28%. (2)The prevalences of hypothyroidism and subclinical hypothyroidism were significantly higher in females than in males (both P <0.05). (3) The prevalence of subclinical hypothyroidism was significantly increased with advancing age in both female and males (P<0.05). Conclusion Comparing with hypothyroidism, subclinical hypothyroidism shows higher prevalence in Jiangsu province, and more attention should be paid to the follow-up and diagnosis of subclinical hypothyroidism.

Thyroid nodules are very common in the clinical practice. Fine needle aspiration ( FNA) is a major method for the final diagnosis of thyroid nodules. This review tried to cover the definition, current status, clinical significance, indications, contraindications, ultrasound evaluation, as well as preparations, steps, molecular diagnosis, cytology diagnosis, and possible pitfalls of this technique. Our purpose is trying to make this procedure universalized and standardized in order to serve more patients by providing clinicians with some helpful references and advice.

OBJECTIVE: To investigate the imaging appearances and diagnostic value of axial CT scanning, spiral CT multiplanar reconstruction (MPR) and three-dimensional (3D) reconstruction in vertebral facet joints locking.
 METHODS: A total of 31 cases of vertebral facet joints locking, with injuries in different parts, were recruited to explore their CT features, and to evaluate their advantages in diagnosis against each other.
 RESULTS: Among the CT images of 31 cases with "Hamburger" sign in axial view, there were 21 cases of cervical spine and 10 cases of thoracolumbar segment; in vertical plane of MPR, "top to top" form was formed below the inferior and the superior articular process, accompanied by I° spondylolisthesis and inferior articular process tip fracture; 5 cases were unilateral locked cervical spine; none case for thoracolumbar segment. The inferior articular process was crossed with the superior articular process below and moved forward, formed "back to back" form, accompanied by II°-III° spondylolisthesis. 9 or 6 cases were bilateral or unilateral locking cervical spine, 10 cases were thoracolumbar segment, accompanied by teardrop fracture in the vertebral body below cervical spine. In coronal plane of MPR, inferior articular process showed ingression in different extent, and relied on the superior articular process below or locked in the articular fossa (21 cases for cervical spine); inferior articular process displayed upward displacement or appeared with the superior articular process at the same time, which meant joint structure disappearing thoracolumbar segment (10 cases). In 3D reconstruction, 31 cases displayed clearly in the spatial form of vertebral facet joints locking and the degree of spondylolisthesis of vertebral body.
 CONCLUSION MPR and 3D image were more clear and intuitive in vertebral facet joints locking comparing to axial CT scan image. Spiral CT MPR and 3D reconstruction contributed to the diagnosis of vertebral facet joints locking and the reduction of misdiagnoses rates.
Cervical Vertebrae ; pathology ; Fractures, Bone ; pathology ; Humans ; Imaging, Three-Dimensional ; Lumbar Vertebrae ; pathology ; Tomography, Spiral Computed ; Tomography, X-Ray Computed ; Zygapophyseal Joint ; pathology

Objective:To explore the status quo of occupational stress and its influencing factors of nursing staff for orphaned and disabled children in Nanjing, and to put forward measures for adverse reactions to occupational stress, so as to ensure the psychological health of this occupational population.Methods:From February to May 2017, 236 nursing assistants for orphans and disabled children in Nanjing social welfare home were selected by cluster sampling method. The occupational stress index(occupational stress indictor, OSI) was used to investigate occupational stress response and occupational stress factors. Partial correlation and multiple linear regression were used for statistical analysis.Results:The scores of job satisfaction, mental health and depressive symptoms in occupational stress reaction were (43. 99±6. 83) , (36. 09±4. 59) and (17. 31±2. 44) re- spectively. In terms of job satisfaction, work monotony, logic and compound change were the contributing fac- tors ( P<0. 05) , task strategy and task control were negative factors ( P<0. 05) ; on mental health, opportunities were raised and participation in decision-making Self-esteem, technology utilization, environmental control, time management, task strategy and support of colleagues as contributing factors ( P<0. 05) , ambition and role conflicts as negative factors ( P<0. 05) ; on depression, work input, participation Decision-making, promotion opportunities and behavioral characteristics were protective factors ( P<0. 05 ) . Conclusion:Occupational stress among caregivers of orphans and disabled children cannot be ignored. Occupational stress reaction is serious. Occupational stress factors should be reduced and individual stress coping ability should be enhanced.

Objective:To explore the status of job burnout of nurses for orphans and disabled children in Nanjing and its influencing factors, so as to provide reference for promoting the mental health of nurses for orphans and disabled children.Methods:From February to May, 2017, a cross-sectional survey was conducted among 236 nurses working in social welfare institutions for orphans and disabled children in Nanjing, using Occupational Stress Indicator (OSI) and Maslach Burnout Inventory (MBI) . It investigated the status of job burnout among nurses of orphans and disabled children, logistic regression analysis was used to explore the effect of occupational stress on the incidence of job burnout of nurses for orphans and disabled children.Results:The results showed that the incidence of job burnout was 67.37% (159/236) , the incidence of job burnout was negatively correlated with behavioral characteristics and family support, the incidence of emotional exhaustion was positively correlated with task control and job monotony ( P<0.05) , and negatively correlated with role ambiguity and job satisfaction ( P<0.05) . The incidence of depersonalization was negatively correlated with job monotony and peer support ( P<0.05) . Conclusion:The nurses of orphans and disabled children have serious job burnout. Occupational stress factors, personality characteristics and relieving factors have influence on the incidence of job burnout.