Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI) have shown great efficacy in the treatment of non-small cell lung cancer (NSCLC) patients with EGFR-mutation positive tumors.However,the response to EGFR-TKI is quite different even in EGFR-mutation positive patients.Besides that,different lesions in same patient can also show different response to EGFR-TKI.These phenomena might be associated with the heterogeneity of EGFR mutations,which involves intratumoral heterogeneity,intertumoral heterogeneity,and the heterogeneity before and after treatment.The article introduces the advance in heterogeneity of EGFR mutations from these three aspects.

ObjectiveTo observe the rabbit cardiac siz e and cardiac function change before and after bone-marrow stem transplanting(BMST) by echocardiography.MethodsThirty-four rabbits were divided into 3 groups randomly: group control, group myocardial infarction(MI) and group BMST. The left anterior coronary artery in group MI and group BMST were ligated to produce the myocardial infarction model and injected bone-marrow stem cell to the infracted area in the later group. The size and the systolic function of the heart were measured before and after infarction and transplantation. The left ventricular systolic pressure (LVSP) and the end-diastolic pressure(LVEDP) were also measured in the 3 groups at the end of experiment. ResultsThe left ventricle diameter of group BMST was smaller than that of the group MI, and the ventricular function increased, and almost reached the normal level. And more, LVSP increased and LVEDP decreased statistically in the group BMST. ConclusionsBone-marrow stem transplantation can release the enlargement of left ventricle and improve cardiac function after myocardial infarction.

Pharmacometabonomics, as an emerging branch of system biology, has been increasingly used in personalized medicine and showed broad prospects. By means of metabonomics, the complicated and detailed metabolic profile of the patient is described, thus providing more detailed description of the disease phenotype. With this understanding, response of different individuals to the drugs are predicted or evaluated through inherent genetic information of the individual combined with the environmental factors. As a result, appropriate drugs and dosage are chosen, which greatly promotes the realization of the individualized therapy goals. This article describes the emerging field of pharmacometabonomics, and the research results of personalized medicine based on the pharmacometabonomics in recent years are reviewed in detail.
Humans ; Metabolome ; Metabolomics ; Pharmacogenetics ; Precision Medicine ; methods

Objective To quantitatively assess the left ventricular systolic dyssynchrony in patients with varied degrees of chronic congestive heart failure after old myocardial infarction(OMI) by real-time three-dimensional echocardiography(RT-3DE) and investigate the clinical value of the systolic dyssynchrony index(SDI). Methods Forty patients with congestive heart failure after OMI (infarction group) were divided into the severe dysfunction group (LVEF ≤35 %) and the mild dysfunction group (35 % ＜ LVEF＜50%) ,and 30 normal subjects served as the control. RT-3DE was performed on all subjects to obtain the 17-segmental time-volumetric curves and global systolic function. SDI changes in above groups and the correlation between SDI and LVEF were analyzed. Results The SDI of the infarction group was significantly higher than that of the normal control group ( P ＜0. 01 ). The SDI of the severe dysfunction group was significantly higher than that of the mild group (P＜0.01). SDI and LVEF were negatively correlated ( r = -0.84, P ＜0. 01 ). The dyssynchrony rate in the infarction group was 85 %,in the severe dysfunction group was 100%, in the mild group was 75%. Conclusions Left ventricular systolic dyssynchrony is prevalent in patients with OMI, and it is negatively correlated with the LVEF. SDI is a sensitive indicator in assessing left ventricular systolic dyssynchrony. RT-3DE has a unique advantage in the evaluation of the left ventricular systolic dyssynchrony,especially in the patients with myocardial infarction.

Objective To evaluate the value of selecting and locating coronary artery severe stenosis by the segmental longitudinal strain imaging diastolic indexes (LSI-DI).Methods 94 subjects with left ventricular ejection function (LVEF) ≥50％ and without regional wall motion abnormalities (RWMA) were divided into A group (coronary artery sever stenosis),B group (coronary artery light or mid stenosis) and C group (normal control) using coronary angiography.Some indexes were measured such as early diastolic mitral annulus velocity of septum (e),diastolic peak flow velocity of mitral valve (E,A) and E/e ratio.Using two-dimensional speckle tracking,indexes were measured such as segmental peak systolic longitudinal strain (PSLS),segmental longitudinal strain imaging diastolic indexes (LSI-DI) and global peak systolic longitudinal strain (GPSLS),global longitudinal strain imaging diastolic indexes (GLSI-DI).Compared these indexes among the three groups,the most valuabe segments were obtained and the optimal values were found out by ROC curve.Results There were no significant differences about GPSLS among the three groups.Coronary artery severe stenosis group were significantly lower than the other two groups on GLSI-DI (P ＜0.05);GLSI-DI of B group was lower than that of normal control group but the difference was not significant(P ＞0.05).The optimal cutoff values of LSI-DI were 45.5％ in the middle anteroseptal segment for detecting left anterior descending (LAD) artery severe stenosis (sensitivity 81.8％,specificity 84.2％),44.8％ in the basal anterolateral segment for detecting left circumflex (LCX) artery stenosis (sensitivity 87.3％,specificity 85.3％),and 48.3 ％ in the basal inferior segment for detecting right coronary (RCA) artery stenosis (sensitivity 79.6％,specificity 86.9 ％).Conclusions Patients with coronary artery severe stenosis can be screened by LSI-DI among patients with LVEF ≥50％ and without RWMA through conventional echocardiography.The middle anteroseptal segment,the basal anterolateral segment and the basal inferior segment can better locate the branches of coronary artery severe stenosis and the cutoff values were separately 45.5 ％,44.8 ％ and 48.3 ％.

Objective To investigate the qualitative diagnosis of salivary gland mass with contrastenhanced ultrasound(CEUS).Methods The CEUS manifestations in 78 cases with salivary gland mass were observed after intravenous bolus injection with contrast agent SonoVue and confirmed by histology.Results Among 78 salivary gland masses,there were 29 cases with pleomorphic adenomas (37.2％),19with Warthin's tumors (24.4 ％),7 with basal cell adenomas (8.9 ％),and 11 with the other benign masses (14.1％),12 with malignant tumors (15.4％).The intensity of contrast-enhanced masses,whether the enhanced mass margin was clear,whether the peripheral enhancement rim was complete and whether the mass was enlarged were the diagnostic criteria to differentiate the benign and malignant tumors.The accuracy,the sensitivity,specificity,positive predictive value and negative predictive value were 87.2％,95.2％,56.3％,89.4％,75.0％ respectively,and the results also displayed positive likelihood ratio and negative likelihood ratio were 2.178,0.085 respectively.Although they presented with the highest incidence among benign tumors,their CEUS manifestations showed remarkable statistical differences when the pleomorphic adenoma was compared with Warthin' s tumor and basal cell adenoma respectively in enhancement intensity(P ＜0.01) while there were no statistical differences between Warthin's tumors and basal cell adenomas (P ＞0.05).Conclusions CEUS manifestations of salivary gland mass were helpful to the differential diagnosis of various salivary gland tumors.

Objective To assess the clinical diagnostic value of color Doppler ultrasogography in restrictive cardiomyopathy and constrictive pericarditis.Methods Observing mitral valvular, tricuspid valvular, pulmonary and hepatic venous flow in 16 cases of restrictive cardiomyopathy (RCM) and 20 cases of constrictive pericardities (CP), getting the spectrum results of above, analysis was made on the spectrum change accompanied with respiration. Twenty cases of normal served as control. Results Both during inspiration and expiration, the maximal peak velocity and time (E M and E T) of mitral and tricuspid valvular in group constrictive pericardities had statistical difference compared with normal group (P

Brown-Sequard Syndrome ; etiology ; Cervical Vertebrae ; Humans ; Intervertebral Disc Displacement ; complications ; surgery ; Male ; Middle Aged

ObjectiveTo evaluate left atrial function in patients with dilated cardiomyopathy (DCM)by echocardiography.MethodsThere were 31 patients with DCM and 30 controls in this study.Left atrial diameter (LAD),left ventricular diameter (LVD) were measured by M-mode in parasternal long-axis view.Mitral flow parameters including peak velocities during early diastole (E) and late diastole (A) were measured by pulsed-wave Doppler echocardiography,and the E/A ratio was calculated.Left ventricular ejection fraction (LVEF) was measured with Simpson′s method on the 2-chamber (Ap2c) and 4-chamber (Ap4c) views.Strain rate (SR) imaging was performed on all cases.Peak SR was measured at each segment (septal,lateral,posterior,anterior,and inferior walls) and mean peak systolic left atrial SR (mLASRs),mean peak early diastolic left atrial SR (mLASRe) and mean peak atrial systolic left atrial SR (mLASRa) were calculated by averaging the data in all segments.ResultsCompared with controls,LAD and LVD were significantly increased ( P ＜0.01 ),the E/A ratio had no significant changes ( P ＞0.05).LVEF and left atrial fractional shortening (LAFS) turned lower,mLASRs,mLASRe,and mLASRa of DCM decreased significantly ( P ＜ 0.05).mLASRa of DCM correlated positively with LAFS ( r =0.79,P ＜ 0.01 ).ConclusionsThe left atrial function of DCM decreased,including the reservoir,conduit and pump function.Echocardiography could evaluate the left atrial function of DCM quantitatively.

Objective To investigate the transfection efficacy and expression of Ang-1 gene and proangiogenesis in vitro and vivo by ultrasound-mediated microbubble destruction.Methods 293T cells were divided into three groups:group A was given hAng-1 plasmid and microbubbles plus ultrasonic irradiation,group B was given hAng-1 plasmid and ultrasound,group C was given hAng-1 plasmid only (without ultrasound).Forty-eight hours after transfection,the transient expression rate was observed under fluorescence microscopy and flow cytometry.RT-PCR and Western blot analysis were taken to evaluate the mRNA and protein expression of Ang-1 respectively.Twenty-seven rabbit models of ligated left circumflex branch coronary artery were divided into 3 groups randomly as follow:group Ⅰ (accepted intravenous injection of SonoVue microbubble and Ang-1 plus ultrasonic irradiation),group Ⅱ (accepted intravenous injection of Ang-1 with ultrasound),group Ⅲ (control group).Myocardial contrast echocardiography (MCE) was executed on all animals before and after the treatment.Two weeks after gene delivery,RT-PCR and Western blot analysis were taken to evaluate mRNA and protein expression of Ang-1 respectively.Microvessel density (MVD) counting of infracted myocardium,observed by Factor Ⅷ immunochemical staining,was performed to value the proangiogenesis effect of Ang-1 delivered by ultrasound mediated cavitation of microbubble.Results Green fluorescence was observed in group A and B by fluorescence microscopy,which was negative in group C.The transfection expression rate was significantly improved in group A ( P ＜ 0.01).In vivo,Microbubbles could be observed in former ischemic myocardium in MCEexamination and the Ang-1 mRNA and protein could be detected in group Ⅰ.On the other hand,the contrast agent was defected obviously and none of the animals showed Ang-1 mRNA and protein expression in other two groups.The MVD counting showed significant improvement in group Ⅰ whereas other two groups didn't.ConclusionsMicrobubble-enhanced ultrasound exposure can improve the Ang-1 gene transfection expression rate observably both in vitro and in vivo.This strategy for delivering has great proangiogenesis effect in vivo.