Objective:To systematically evaluate the efficacy of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) combined with radiotherapy in the treatment of lung adenocarcinoma with central nervous system (CNS) metastasis.Methods:PubMed, EMBASE, Medline, Cochrane Library, clinical trials and other databases were searched to collect the clinical control studies of EGFR-TKI combined with radiotherapy versus EGFR-TKI or radiotherapy alone in the treatment of lung adenocarcinoma with CNS metastasis published at home and abroad from January 2012 to April 2019. After evaluating the data, Revman 5.3 software was used for meta-analysis.Results:10 studies involving 1 379 participants were included. The results indicated that compared with EGFR-TKI or radiotherapy alone, EGFR-TKI plus radiotherapy had a significant benefit on overall response rate (ORR) [ OR: 3.81, 95% CI(1.73, 8.39); P<0.01], overall survival (OS) [ HR: 0.60, 95% CI(0.41, 0.89); P=0.01], neurological progression free survival (nPFS) [ HR: 0.65, 95% CI(0.46, 0.91); P=0.01] compared with EGFR-TKI or radiotherapy alone. Conclusions:EGFR-TKI plus radiotherapy had better ORR, OS, nPFS compared with TKI or radiotherapy alone.

Objective To explore the effect of chronic intermittent hypoxia(CIH)combined with high-fat diet(HFD)on gastroc-nemius muscle in mice and its possible mechanism.Methods A mouse model of obstructive sleep apnea hypopnea syndrome(OSAHS)combined with obesity was established by simulating CIH and HFD.Mice were divided into normal control group(NC),CIH group,HFD group,and CIH+HFD group.Hematoxylin-eosin(HE)staining was used to observe the structural changes of the gastrocnemius in each group of mice,and adenosine triphosphate(ATP)enzyme staining was used to analyze the changes in the types of muscle fibers in the gastrocnemius.Real-time quantitative polymerase chain reaction(RT-qPCR)was used to detect the mRNA expression level of MHC i-sotype genes(MHC1,MHC2),mitochondrial function related genes(Cs,Ant,NQO1,Hmox1,OGG1)gastrocnemius cells of mice;Western blot was used to detect the expression level of apoptosis-related proteins(cleaved-caspase-3),mitochondrial fusion proteins(Mfn1,Mfn2,OPA1)and mitochondrial division proteins(Drp1 Ser616,Fis1)in gastrocnemius cells of mice.Results Compared with the NC group,the gastrocnemius structure of the mice in the CIH+HFD group was significantly damaged.while the type Ⅰ muscle fibers in the gastrocnemius were decreased,the type Ⅱ muscle fibers in the gastrocnemius were increased.The expression level of MHC1mRNA in the gastrocnemius cells was decreased,and the expression level of MHC2mRNA was increased.In addition,the protein expressions of cleaved-caspase-3,mitochondrial division proteins(Drp1 Ser616 and Fis1)were significantly up-regulated in the CIH+HFD group.The mRNA or protein expressions of Cs,Ant,NQO1,Hmox1,OGG1,Mfn1 were down-regulated.Conclusion CIH combined with HFD can lead to structural and functional damage of gastrocnemius in mice,which may be related to mitochondrial dysfunction caused by mitochondrial dynamics disorder.

Objective To investigate the risk factors of pancreatic fistula after pancreaticoduodenectomy.Methods The retrospective case-control study was conducted.The clinicopathological data of 310 patients who underwent pancreaticoduodenectomy in the First Affiliated Hospital of Sun Yat-Sen University between January 2011 and December 2015 were collected.Observation indicators:(1) follow-up situations;(2) risk factors analysis of pancreatic fistula after pancreaticoduodenectorny.Follow-up using outpatient examination and telephone interview was performed to detect occurrence of pancreatic fistula and pancreatic fistula-induced rehospitalization or death up to June 2016.The univariate and multivariate analyses were respectively done using the chi-square test and logistic regression model.Results (1) Follow-up situations:310 patients were followed up for 6-60 months,with a median time of 31 months.During the follow-up,65 patients were complicated with pancreatic fistula,including 59 in grade B and 6 in grade C.Twenty-four patients received conservative treatment,and 41 received B ultrasound-guided catheter drainage.Of 65 patients,63 were improved and then discharged form hospital;2 in grade C of pancreatic fistula died of pancreatic fistula-related complications.(2) Risk factors analysis of pancreatic fistula after pancreaticoduodenectomy:univariate analysis showed that combined hypertension,cases with pancreaticoduodenectomy,operation time and pancreaticojejunostomy method were related factors affecting pancreatic fistula after pancreaticoduodenectomy (x2 =5.986,13.006,9.025,21.561,P＜0.05).The multivariate analysis showed that combined hypertension,operation time ＞ 6 hours and end-to-end telescopic pancreaticojejunostomy or biuding pancreaticojejunostomy were independent risk factors affecting pancreatic fistula after pancreaticoduodenectomy (Odds ratio =2.465,1.880,2.719,6.190,95％ confidence interval:1.253-4.850,1.025-3.448,1.254-5.894,2.309-16.592,P＜0.05).Conclusion The combined hypertension,operation time ＞ 6 hours and end-to-end telescopic pancreaticojejunostomy or binding pancreaticojejunostomy are independent risk factors affecting pancreatic fistula after pancreaticoduodenectomy.