Today, the direction of litigation reformation is changing trial pattern to be trial-centered and making the trial substantialized. Under this background, the relevant provisions have been launched from the supreme people's court and other departments to make sure that the forensic expert will appear in court and accept cross-examination, and this phenomenon should be normalized and substantiated. In order to ensure the expert opinion can be fully and effectively cross-examined, the medico-legal expert should fulfill obligations, such as respect for the court, answer questions honestly and explain expert opinions. We find that some problems show up in this process: the rate of forensic expert appearing in court is low; the legal nature of expert opinion is not clear; the requirements are not clear;the conflict between forensic expert opinion and other forms of expert evidence, including auxiliary expert, is very clearly. Based on this situation, the author give some suggestions to the forensic expert: keep on learning to improve professional skill; improve the legal knowledge; pay attention to practice and strengthen the ability of expression.

Objective:To clarify the mechanism of immunoregulation of bone marrow stromal cells(BMSCs) transfected interleukin 18(IL-18) after their transplantation into glioma bearing rats.Methods:Cultured BMSCs from SD rats were transfected with rmIL-18(BMSCs/IL-18).Untransfected BMSCs were used as control.Culture supernatant medium was collected for IL-18 examination at different time point by ELISA kit.After establishment of glioma bearing rats followed by BMSCs/IL-18 transplantation,serum concentration of IFN-?,IL-2 and IL-10 were examined by means of ELISA kit.And their splenocytes were cultured with C6 cells and BMSCs/IL-18 for in vitro cytotoxicity assay,and subsets of splenocyte were detected by flow cytometry.TUNEL was used to clarify apoptosis cells inside glioma and anti-CD34 staining was performed to observe microvessel density(MVD).Results:BMSCs/IL-18 could secret IL-18 long term and stably.After being transplanted with BMSCs/IL-18,serum concentration of IL-2,IFN-? in glioma bearing rats' increased obviously and serum concentration of IL-10 decreased.Flow cytometry results showed that CD4+ and CD8+ T lymphocytes increased in the splenocytes.And rechallenge with C6 cells induced a rapid immuno-reaction.In vitro cytotoxicity assays.It was showed that BMSCs/IL-18 could stimulate splenocytes to kill C6 cells obviously.TUNEL assay showed that there were 15.74?6.23 apoptosis cells inside glioma in each view in Group 2,which was much more when compared with other groups.Microvessel density inside glioma in group 2(6.51?2.71) was lower than in group 1(13.52?3.06),group 3(12.67?2.61) and control group(14.84?1.47).Conclusion:By means of inducing Th1 cytokine and suppressing Th2 cytokine and activating cytotoxic T lymphocyte,BMSCs/IL-18 induces obviously anti-tumor activity.

Objective To evaluated the effect of first-line epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI)on advanced non-small cell lung cancer (NSCLC)patients with different EGFR mutation status (exon 1 9 deletion and exon 21 mutation).Methods Seventy-two advanced NSCLC patients with EGFR mutation confirmed by histopathology were enrolled.All of the patients received first-line EGFR-TKI.The relationships between EGFR mutation status and objective response rate (ORR),disease control rate (DCR),progression free survival (PFS ) and overall survival (OS ) were analyzed.Results Of the 72 patients,37 patients expressed exon 1 9 deletion,35 patients expressed exon 21 mutation,and all of them could be evaluated.The ORR and DCR of patients with exon 1 9 deletion were higher than those of patients with exon 21 mutation (75.7%vs.51 .4%,χ2 =4.583,P=0.032;89.2%vs.68.6%,χ2 =4.636,P=0.031 ).The modified median PFS of patients with exon 1 9 deletion was significantly higher than that of patients with exon 21 mutation (1 3.2 month vs.1 0.8 month,χ2 =4.700,P=0.030).The median OS of patients with exon 1 9 deletion was significantly higher than that of patients with exon 21 mutation (30.2 month vs.25.6 month,χ2 =4.686,P=0.030).The side effects were similar between the two groups.The most common adverse reaction was rash,and the incidence had no significant difference between the two groups (48.7% vs.48.6%,χ2 =0.000,P=0.995 ).Conclusion EGFR mutation status is a predictor for PFS,OS and ORR of first-line EGFR-TKI in patients with advanced NSCLC.NSCLC patients with EGFR exon 1 9 deletion are associated with longer survival time and better response rate compared with those with exon 21 mutation.

Objective To explore the relationship between mutation status of epidermal growth factor receptor (EGFR) and efficacy of EGFR tyrosine kinase inhibitor (EGFR-TKI) in patients with advanced nonsmall ccll lung cancer (NSCLC).Methods The data of 72 outpatients and inpatients with stage Ⅲ b/ⅣNSCLC diagnosed by histopathology and harbored EGFR-activating mutations (exon 19 and exon 21) from January 2008 to December 2013 in Xuzhou Cancer Hospital were collected.All of them received first-line EGFR-TKI.The relationships between EGFR gene status and response rate or progression-free survival (PFS)were analyzed.Results Of the 72 patients with EGFR mutation,37 patients harbored exon 19 deletion,and 35 patients harbored exon 21 L858R point mutation.The efficacies of all patients were assessable.The objective response rate (ORR) was 63.9 ％ (46/72) and disease control rate (DCR) was 79.2 ％ (57/72) in all patients,including 2 cases of complete remission (CR),44 cases of partial remission (PR),1 1 cases stable disease (SD) and 15 cases of disease progression (PD).Patients with exon 19 deletion had a higher ORR [75.7 ％ (28/37) vs 51.4 ％ (18/35),P =0.032] and a higher DCR [89.2 ％ (33/37) vs 68.6 ％ (24/35),P =0.031]than patients with exon 21 L858R mutation.The PFS of patients with exon 19 deletion was significantly longer than that of patients with exon 21 L858R mutation (12.0 months vs 9.5 months,P =0.030).Cox multivariate analysis indicated that the gender,histological type,smoking history were the major influence factors of PFS.The differences of toxicity between the two groups were not significant.Conclusion EGFR-activating mutation is a predictor for PFS and ORR of first-line EGFR-TKI in patients with advanced NSCLC.

Objective: To evaluate the efficacy and safety of apatinib combined with chemotherapy in the first-line treatment of advanced non-small cell lung cancer (NSCLC) with negative driving genes. Methods: From January 2016 to March 2018, 62 advanced NSCLC patients with negative driving genes diagnosed at Xuzhou Cancer Hospital were randomly divided into study group (30 cases) and control group (32 cases), respectively. The patients in the study group were treated with standard first-line chemotherapy combined with apatinib, while those in control group were treated with chemotherapy alone. Results: The disease control rate (DCR) and objective remission rate (ORR) in the study group were 60.0% and 16.7%, respectively, higher than 46.9% and 9.3% in the control group, but without statistical difference (P>0.05). The median progression-free survival (PFS) of study group and control group were 6.4 months and 4.9 months, respectively (P=0.004), and the median overall survival (OS) were 11.3 months and 9.2 months, respectively (P=0.006). Multivariate survival analysis indicated that treatment regimen (P=0.001) was the independent prognostic factor of PFS, and PS score (P=0.002), clinical stage (P=0.02) and treatment regimen (P<0.001) were the independent prognostic factors of OS. After treatment, the incidence of hypertension and hand-foot syndrome in the study group were 46.7% and 53.3%, respectively, significantly higher than 3.3% and 0 in the control group, respectively (P<0.05). The incidence of grade 3-4 adverse drug reactions (ADRs) in the study group was 26.7% (8/30), mainly including hypertension, hand-foot syndrome and bone marrow suppression. The incidence of grade 3-4 ADRs in the control group was 15.6% (5/32), all of which were bone marrow suppression, without significant difference (P=0.286). There was no difference in serum levels of VEGF and CEA between the two groups before treatment. After treatment, the serum level of VEGF in the study group was (169.3±10.1) pg/ml, lower than (211.8±16.7) pg/ml of the control group (P<0.05). Conclusion Apatinib combined with first-line chemotherapy for advanced NSCLC patients with negative driving genes is safe and beneficial for survival. This therapeutic strategy can significantly prolong the PFS and OS, and further improvement and application can be considered as a choice in the clinical treatment.

Objective To evaluate the efficacy and safety of apatinib combined with chemotherapy in the first?line treatment of advanced non?small cell lung cancer ( NSCLC) with negative driving genes. Methods From January 2016 to March 2018, 62 advanced NSCLC patients with negative driving genes diagnosed at Xuzhou Cancer Hospital were randomly divided into study group (30 cases) and control group (32 cases), respectively. The patients in the study group were treated with standard first?line chemotherapy combined with apatinib, while those in control group were treated with chemotherapy alone. Results The disease control rate (DCR) and objective remission rate (ORR) in the study group were 60.0% and 16.7%, respectively, higher than 46.9% and 9.3% in the control group, but without statistical difference (P＞0.05). The median progression?free survival ( PFS) of study group and control group were 6.4 months and 4.9 months, respectively (P＝0.004), and the median overall survival (OS) were 11.3 months and 9.2 months, respectively (P＝0.006).Multivariate survival analysis indicated that treatment regimen (P＝0.001) was the independent prognostic factor of PFS,and PS score (P＝0.002), clinical stage ( P＝0.02) and treatment regimen ( P＜0.001) were the independent prognostic factors of OS. After treatment, the incidence of hypertension and hand?foot syndrome in the study group were 46.7% and 53.3%, respectively, significantly higher than 3.3% and 0 in the control group, respectively ( P＜0.05). The incidence of grade 3?4 adverse drug reactions (ADRs) in the study group was 26.7%(8／30), mainly including hypertension, hand?foot syndrome and bone marrow suppression. The incidence of grade 3?4 ADRs in the control group was 15.6%(5／32), all of which were bone marrow suppression, without significant difference (P＝0.286). There was no difference in serum levels of VEGF and CEA between the two groups before treatment. After treatment, the serum level of VEGF in the study group was (169.3±10.1) pg／ml, lower than (211.8±16.7) pg／ml of the control group ( P＜0.05). Conclusion Apatinib combined with first?line chemotherapy for advanced NSCLC patients with negative driving genes is safe and beneficial for survival. This therapeutic strategy can significantly prolong the PFS and OS, and further improvement and application can be considered as a choice in the clinical treatment.

Objective To evaluate the efficacy and safety of apatinib combined with chemotherapy in the first?line treatment of advanced non?small cell lung cancer ( NSCLC) with negative driving genes. Methods From January 2016 to March 2018, 62 advanced NSCLC patients with negative driving genes diagnosed at Xuzhou Cancer Hospital were randomly divided into study group (30 cases) and control group (32 cases), respectively. The patients in the study group were treated with standard first?line chemotherapy combined with apatinib, while those in control group were treated with chemotherapy alone. Results The disease control rate (DCR) and objective remission rate (ORR) in the study group were 60.0% and 16.7%, respectively, higher than 46.9% and 9.3% in the control group, but without statistical difference (P＞0.05). The median progression?free survival ( PFS) of study group and control group were 6.4 months and 4.9 months, respectively (P＝0.004), and the median overall survival (OS) were 11.3 months and 9.2 months, respectively (P＝0.006).Multivariate survival analysis indicated that treatment regimen (P＝0.001) was the independent prognostic factor of PFS,and PS score (P＝0.002), clinical stage ( P＝0.02) and treatment regimen ( P＜0.001) were the independent prognostic factors of OS. After treatment, the incidence of hypertension and hand?foot syndrome in the study group were 46.7% and 53.3%, respectively, significantly higher than 3.3% and 0 in the control group, respectively ( P＜0.05). The incidence of grade 3?4 adverse drug reactions (ADRs) in the study group was 26.7%(8／30), mainly including hypertension, hand?foot syndrome and bone marrow suppression. The incidence of grade 3?4 ADRs in the control group was 15.6%(5／32), all of which were bone marrow suppression, without significant difference (P＝0.286). There was no difference in serum levels of VEGF and CEA between the two groups before treatment. After treatment, the serum level of VEGF in the study group was (169.3±10.1) pg／ml, lower than (211.8±16.7) pg／ml of the control group ( P＜0.05). Conclusion Apatinib combined with first?line chemotherapy for advanced NSCLC patients with negative driving genes is safe and beneficial for survival. This therapeutic strategy can significantly prolong the PFS and OS, and further improvement and application can be considered as a choice in the clinical treatment.