B-Raf kinase (BRAF) gene is a driver mutation,and is an effective target in the treatment of non-small cell lung cancer (NSCLC).Studies have shown that BRAF inhibitors are effective for treatment of NSCLC with BRAF mutant.It is important to understand the clinicopathologic features and the research progress of BRAF inhibitors for the individual treatment of NSCLC.

Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs)and anti-angio-genic drugs have individually demonstrated clinical benefit in the treatment of patients with advanced non-small cell lung cancer (NSCLC).Recent studies demonstrate that the combination of anti-EGFR and anti-angiogene-sis can more significantly enhance clinical benefit,and even can remit EGFR-TKIs resistance in the treatment of advanced NSCLC.According to the different kinds of anti-angiogenesis drugs,recent clinical studies mainly include the combination of anti-vascular endothelial growth factor monoclonal antibody bevacizumab plus EGFR-TKIs and multi-targeted receptor anti-angiogenic tyrosine kinase inhibitor plus EGFR-TKIs,and the for-mer results show a more significant improvement in terms of safety and efficacy in the treatment of advanced NSCLC.Therefore,the combination of bevacizumab plus EGFR-TKIs can be used as a new treatment standard in the treatment of some patients with NSCLC.

Immunotherapy is revolutionizing the treatment of non-small cell lung cancer (NSCLC).Programmed cell death protein 1 (PD-1) and programmed cell death ligand 1 (PD-L1) monoclonal antibodies have recently led to significant and durable improvements in the clinical outcome of NSCLC,and the anti-PD-1 antibody has been approved to use in first-line and second-line treatment of NSCLC.However,there are still many problems to be solved.The role of PD-L1 as a predictive biomarker remains unclear.Combination treatment models are being explored.This review summarizes the clinical efficacy,drug adverse reaction,combined treatment,and potential immune biomarkers of anti-PD-1/PD-L1 antibody research progress in the treatment of NSCLC.

Objective To evaluate the efficacy of ultrasound-guided continuous brachial plexus block for analgesia after fixation of upper extremity fractures in the pediatric patients.Methods Sixty American Society of Anesthesiologists physical status Ⅰ pediatric patients of both sexes,aged 3-10 yr,weighing 13-46 kg,with body height of 97-152 cm,scheduled for open reduction and internal fixation of distal humeral fractures,were selected and divided into 2 groups (n =30 each) using a random number table:intravenous analgesia group (group Ⅴ) and continuous brachial plexus block group (group B).Surgery was completed under brachial plexus block combined with general anesthesia in the two groups.At the end of surgery,patient-controlled intravenous analgesia was used in group Ⅴ,and continuous brachial plexus block was performed with 0.1％ ropivacaine 250 ml (background infusion 0.1 ml · kg-1 · h-1,bolus dose 0.2 ml/kg,lockout interval 30 min) in group B.Tramadol was given as rescue analgesic when necessary.Ramsay sedation scores were assessed and recorded at 2,4,8,12,24,36 and 48 h after surgery,and the development of over-sedation was recorded.The require,nent for rescue analgesics and development of respiratory depression,dizziness,nausea and vomiting,pruritus and urinary retention during analgesia were recorded.The development of adverse reactions such as vascular and nerve injury,local hematoma and pneumothorax was recorded in group B.Family's satisfaction with analgesia was assessed and scored.Results Compared with group Ⅴ,Ramsay sedation scores at 2-12 h after surgery,the incidence of oversedation,nausea and dizziness and requirement for tramadol were significantly decreased (P＜0.05),and no significant change was found in the degree of family's satisfaction with analgesia in group B (P＞ 0.05).The adverse reactions such as vascular and nerve injury,local hematoma or pneumothorax were not found in group B.Conclusion Ultrasound-guided continuous brachial plexus block can be safely and effectively used for analgesia after fixation of upper extremity fractures in the pediatric patients.

Recently, there are many prominent problems about the quality ofIndigo Naturalis. To explore the underlying reasons, both ancient and modern herbal literatures were reviewed. Through the organization of recordings onIndigo Naturalis, the traditional process method required soaking and fermentation, stiring and depositing, foaming and shade drying. The currently usedIndigo Naturalis was mostly isolated and purified from crude deposit -“Cu-Dian.” The modern process technique ofIndigo Naturalis was gradually deviated from the traditional processing method. This paper also discussed the quality standards ofIndigo Naturalis. The author considered that the current standard on descriptions ofIndigo Naturalis characteristics was deviated from the traditional morphological features ofIndigo Naturalis, which should be further researched and verified. Therefore, this study provided certain references for the quality control and market supervision ofIndigo Naturalis.

Objective To observe the influences of different anesthesia methods or adjuvant chemotherapy on hemorheological parameters in patients with cervical cancer.Methods Sixty pa-tients with cervical cancer were equally randomized into two groups.Patients in group A received three courses of chemotherapy preoperatively while those in group B did not.The patients of group A and B were divided respectively into two subgroups,combined epidural general anesthesia group (groups A1 and B1),general anesthesia group (group A2 and B2).Blood samples were taken for the hemorheological measurement at 5 min before induction of anesthesia,60 min after induction of anes-thesia and at the end of surgery.Results Red cell deformability index (EDI)was significantly lower in group A than that in group B;Erythrocyte rigidity index (ERI)and blood viscosity were higher in group A compared with those in group B (P <0.05).In groups A1 and B1,EDI,plasmic viscosity packed ERI,and ERI were all lower than those before anesthesia induction (P < 0.01 );while in groups A2 and B2 Hct decreased.Conclusion The patients of cervical cancer after chemotherapy showed some hemorheological changes characterized by a lowered EDI.Combined general and epidural anesthesia can significantly improve the above parameters.

Objective To evaluate the diagnostic value of the level of plasma D-dimer, lipoproteins and carcino-embry-onic antigen(CEA) in gastrointestinal cancer.Methods The plasma D-dimer ,lipoproteins,CEA and clinicopathological data of 139 gastrointestinal cancer patients and 155 normal controls were collected and analyzed .Lipoproteins included high-density lipoprotein(HDL),low-density lipoprotein(LDL) and lipoprotein a[LP(a)].SPSS 13.0 statistical software was used to analyze the sensitivity and specificity of each examination method and to find the appropriate combination .Results The plasma D-dimer,LDL,LP( a) and CEA levels were distinctly higher in patients than those in normal controls ( P<0.001).HDL levels were significantly lower in patients than those in normal controls (P<0.001).The cutoff of D-dimer was 0.495 μg/ml , the sensitivity of D-dimer was 62.6%,and the specificity was 86.5%.The cutoff of HDL was 1.025 mmol/L, the sensitivity was 72.7%,and the specificity was 85.2%.The cutoff of LDL was 3.375 mmol/L, the sensitivity was 54%,and the specificity was 82.6%.The cutoff of LP(a) was 27.3 mg/dl, the sensitivity was 58.3%,and the speci-ficity was 87.1%.The cutoff of CEA was 2.14 ng/ml, the sensitivity was 59.7%,and the specificity was 76.8%.The sensitivity and specificity of HDL +CEA were 77.7%and 88.4%, respectively.The sensitivity and specificity of HDL +D-dimer were 70.5% and 96.1%, respectively.The sensitivity of HDL +LP(a) was 76.3%,and the specificity was 93.5%.The sensitivity of D-dimer +HDL+LP(a) was 84.2%,and the specificity was 92.3%.The sensitivity of D-dimer +HDL+CEA was 87.1%, and the specificity was 85.8%.The sensitivity and specificity of HDL +LP(a) +CEA were 85.6%and 92.3%, respectively.The sensitivity of D-dimer +HDL+CEA +LP(a) was 89.9%while the specificity was 92.3%.Conclusions Plasma D-dimer and lipoproteins can serve as tumor markers in gastrointestinal cancer .Combined detection has higher sensitivity and specificity .

Objective To explore the influencing factors of weight gain in women with schizophrenia after treatment.Methods From January 2016 to December 2016,180 patients with schizophrenia who admitted to the Second People′s Hospital of Lishui for the first time and were treated with antipsychotics (APD) were followed up at hospital and 4 months after discharge.The height,weight and body mass index were observed.The joint general situation questionnaire,brief psychiatric scale(BPRS),negative symptoms(SANS),positive symptom scale(SAPS) and the clinical curative effect overall rating scale subscales of overall curative effect (CGI-GI) were comprehensively evaluated.The data were analyzed statistically.Results The weight gain was related to the type of antipsychotics (χ2＝37.3,P＜0.01),and the effect of aripiprazole and ziprasidone on body weight was significantly less than that in the case of weight(χ2＝31.1,P＜0.01).Single factor analysis showed that a medication time correlation (F＝4.92,P＜0.05),and each point GⅠscore had no correlation with weight gain,and weight gain was associated with BPRS,SAPS subtraction score at discharge (r＝0.079,0.092,all P＜0.01),and during follow-up weight gain was correlated with SANS score reduction (r＝-0.063,-0.086,P＜0.05 or P＜0.01).Stepwise regression analysis showed that at the alpha＝0.05 level,entered the regression equation factors in the order : APD types,maximum doses and taking the product of time,the negative symptoms,the best functional level at 1 year before disease.Conclusion It is important to control the weight gain of young women.The mediating role of diet and activity should not be underesti-mated.Appropriate APD was chosen to adjust the maintenance treatment strategy as appropriate,improve the negative symptoms and improve the level of individual social function as the main intervention measure .

OBJECTIVETo assess the value of genetic testing for Fragile X syndrome (FXS).

METHODSA domestically made diagnostic kit based Tri-primer-PCR method was used to detect mutations of the FMR1 gene among 6 pedigrees with unexplained intellectual disability. The results were verified by methylation PCR and Southern blotting.

RESULTSPedigrees 1 and 6 were positive for the screening. In pedigree 1, a full-mutation allele with methylation was identified in the proband and his mother, which was passed on to the fetus. In pedigree 6, the proband was mosaic for a full-mutation allele and a pre-mutation allele. His sister was asymptomatic with a full-mutation. His mother carried pre-mutation allele, while his father and sister's baby were normal. The number of CGG repeats of the pedigrees 2 to 5 were in the normal range.

CONCLUSIONGenetic testing can provide an effective way to prevent FXS caused by FMR1 mutations and enable prenatal diagnosis for families with a high risk for the disease.

Objective To investigate antimicrobial resistance among gram-negative bacilli in China in 2010.Methods A total of 1 259 consecutive and non-repetitive gram-negative bacilli were isolated from 13 teaching hospitals from September to December in 2010 in China.All of these isolates were sent to the central laboratory for re-identification and susceptibility testing.The MIC of meropenem and other antibacterial agents were determined by agar dilution method.Interpretive results was determined by CLSI M100-S21.Results The activity of 14 antibacterial agents against 845 Enterobacteriaceae isolates was as follows in order:meropenem ( 98.1％,829 ),amikacin ( 94.0％,794 ),imipeuem ( 90.0％,761 ),piperacillin/tazobactam ( 87.5％,739 ),cefepime ( 83.0％,701 ),ertapenem ( 82.4％,696 ),cefoperazone/sulbactam ( 80.3％,678 ),colistin (75.4％,637),ceftazidime (70.0％,591 ),ciprofloxacin (59.1％,499 ),cefoxitin ( 54.8％,463 ),ceftriaxone ( 53.5％,452 ),cefotaxime ( 52.3％,442 ) and minocycline(51.5％,435).The prevalence of ESBL was 61.3％ (106/173) in Escherichia coli,which was much higher than 41.2％ (70/170) in Klebsiella pneumoniae.The susceptibility rate of Klebsiella pneumoniae against meropenem,imipenem,amikacin and colistin were more than 90％,but were highly resistant to ceftriaxone and cefotaxime.Over 80％ of Enterobacter cloacae,Enterobacter aerogenes,Citrobacter freundii,were susceptible to meropenem,amikacin,cefepine,cefoperazone/sulbactam,imipenem,piperacillin/ tazobactam,and ertapenem.The most active antibiotics against Pseudomonas aeruginosa were Colistin (98.4％,182),Amikacin ( 85.9％,159 ),Piperacillin/Tazobactam ( 80％,148 ),Ceftazidime ( 79.5％,147),Meropenem (74.1％,137),Ciprofloxacin (74.1％,137),Cefepime (73.5％,136),Imipenem (71.9％,132) and Cefoperazone/Sulbactam (70.8％,131 ).Less than 37％ of Acinetobacter baumannii isolates were resistant to carbapenems.The susceptible rate to Minocycline was 47.8％.Colistin kept good activity against Acinetobacter baumannii (susceptible rate,97.8％,n =176),The prevalence of Pan-drug resistant P.aeruginosa and A.baumannii was 18.9％ (n =35),and 61.8％ (n =108),respectively.Conclusions Carbapenems remained very high activity against Enterobacteriaceae.Increasing resistance to the antimicrobials agents test among A.baumanni and P.aeruginosa,especially carbapenems among A.baumanni brought great concern.