Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) comprise an effective therapy for advanced non-small cell lung cancer patients with EGFR-activating mutations. Unfortunately, most patients eventually develop resistance to EG-FR-TKIs, probably due to a secondary point mutation of EGFR T790M. Thus, a sensitive method for accurate detection of T790M mu-tation is essential. Peripheral blood detection has gained our attention because it is convenient, making dynamic noninvasive quantita-tive detection of T790M mutation an optimal means of monitoring the efficacy of EGFR-TKIs. To date, the clinical significance of T790M mutation and EGFR-TKI resistance remains controversial. Several EGFR-TKIs targeting EGFR mutation, which have been in-troduced in recent years, showed better response in patients with T790M mutation, indicating that T790M may be a biomarker for con-quering resistance. This review introduces the methodology of T790M detection and its role in clinical practice.

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.

Objective To investigate the correlations between ambulatory arterial stiffness index and intracranial/extracranial arterial stenosis.Methods One hundred and twenty-eight cases of ischemic cerebrovascular disease were collected in our hospital from January 2010 to March 2012.Joint diagnosis of cranial computer tomography(TCD) and magnetic resonance angiography (MRA) and,or CT angiography (CTA) were used to detect the degree and number of intracranial arteries,and in accordance with the lesions level,patients were divided into stenosis group,the mild stenosis group,the moderate stenosis group and severe stenosis group.24 h ambulatory blood pressure was monitored and ambulatory arterial stiffness index (AASI) was calculated and statistically analyzed.Results (1) Age,sex,hypertension proportion of diabetes,body mass index(BMI) of different Intracranial arterial stenosis in four groups did not have significant differences (P ＞0.05),but in AASI the without stenosis group is 0.48 ± 0.15 ; the mild stenosis group 0.62 ± 0.16,the moderate stenosis group 0.61 ± 0.17,severe stenosis group 0.64 ± 0.15,and there was significant difference (F =3.955,P =0.001).(2) Age,sex,hypertension proportion of diabetes,BMI of different extracranial arterial stenosis in four groups did not have significant differences (P ＞ 0.05),but in AASI the without stenosis group was 0.48 ± 0.01 ; the mild stenosis group 0.57 ± 0.11,the moderate stenosis 0.59 ± 0.12,and severe group 0.60 ±0.15,and there was significant difference (F =3.643,P =0.002).In comparison between any two group:light,moderate and severe stenosis AASI were significantly higher than those without stenosis,and there was significant difference (P ＜ 0.05).And there was significant different in AASI among different intracranial and extracranial arterial lesions (F =7.395,P ＜ 0.001).Compared to 0 branch pathological changes,1 branch,2 branch,3 branch and above,there was was significant difference(P ＜ 0.05).Conclusion Based on a 24-hour ambulatory blood pressure monitoring indicators,AASI was mainly reflecting the impact of atherosclerosis on blood pressure,associated with intracranial and extracranial artery stenosis.AASI would play a major role in clinical diagnosis and treatment of ischemic cerebrovascular and forecast.

OBJECTIVE To review and analyze the change in the MICs of vancomycin,teicoplanin and linezolid in meticillin-resistant Staphylococcus aureus(MRSA) strains isolated in our hospital from 2003 to 2007. METHODS The MICs of vancomycin,teicoplanin and linezolid were tested by Etest method on a sample of randomly selected MRSA strains. RESULTS The incidences of MRSA increased from 52.2% in 2003 to 74.5% in 2007.MIC of vancomycin increased from 1.85 ?g/ml in 2003 to 2.15 ?g/ml in 2007,and teicoplanin MIC geometric mean increased even more markedly from 1.28 ?g/ml in 2003 to 2.07 ?g/ml in 2007.The linezolid MIC remained almost unchanged. CONCLUSIONS The incidences of MRSA were increasing from 2003 to 2007.There is a upward trend in MIC of glycopeptide over the years,in which the increase for teicoplanin is higher than others two.

BACKGROUND: Neurological complications after coronary artery bypass grafting still have a high incidence rate, and the etiology is multiple.OBJECTIVE: To retrospectively investigate the occurrence and relevant factors of severe neurological complications after coronary artery bypass grafting (CABG).METHODS: A total of 761 consecutive patients with undergoing CABG were included in this study from September 2002 to August 2009 at the Nanjing Drumtower Hospital, including 443 males and 318 females, aged from 32-89 years. All patients were grouped according to age(more than or less than 70-year-old) and on pump or off pump coronary surgery. Disclose the relationship between the risk factors and the neurological complications by statistics analysis.RESULTS AND CONCLUSION: Totally 41 patients had serious neurological complications in this study. There was a higher complication incidence in 570-year-old group patients (n=22) than < 70-year-old group (n=19)(14.9% vs. 3.1%, P< 0.001). The neurological complications incidence was similar in on-Pump CABG group (n =7) and off-Pump CABG group (n = 34) (5.3% vs.5.4%, P=0.39). The incidence rate of severe neurological complications was high in carotid artery stenosis > 50% patients. A total of 8 cases died, 2 for massive hemorrhage of gastrointestinal tract; 1 for severe sepsis; 4 for multiple organ dysfunction syndrome;1 for epilepsia gravior postoperatively. Finally, 33 cases survived. The average time of follow up was 3 years, 3 cases died, 3 cases recovery from limitation of limb or hand movement partly, and 1 case had severe mental retardation. Results displayed that elderly patients(= 70 years) undergoing CABG are at higher risk of neurological dysfunction. Carotid artery stenosis is the most risk factor. There are no significant effects on postoperative complications between on-pump CABG and off-pump CABG.

Objective To explore the effect of coronary artery bypass grafting(CABG) on left atrial (LA) function by strain rate imaging(SRI). Methods Twenty-three patients with coronary heart disease who underwent coronary artery bypass grafting were involved. SRI was performed on those patients to evaluate LA function quantitatively at baseline (before CABG),and at 1 week, 1 month and 3 months after CABG. Peak strain rate(SR) was measured at each segment (septal, lateral, posterior, anterior, and inferior walls) and mean peak systolic SR (SRs),peak early diastolic SR (SRe) and peak atrial systolic SR (SRa) were calculated by averaging data in each segment. Results Compared with the baseline,LV pre-systolic volume(LAVp), maximal volume (LAVmax), minimal volume (LAVmin), LV active emptying fraction (LAAEF) and passive empting fraction(LAPEF) had on significant differences at 1 week (P >0.05). LAVp,LAVmin,LAVmax and LAAEF decreased gradually after CABG, LAPEF increased gradually after CABG (P <0.05). Compared with the baseline, the peaks of SR curve showed no significant differences at 1 week (P >0.05). Nevertheless,the peaks of SR were increased at systole and early diastole,decreased at atrial contraction at 1 month (P <0.05). Those changes were turned more significantly at 3 months (P 0.01). Left ventricular ejection fraction (LVEF) both increased at 1 month and 3 months,and its changing rate correlated inversely with the changing rate of SRa respectively (r = -0.751, -0.783,all P<0.01).Conclusions LA function is affected by CABG, presented as reservoir and pump functions decreased and conduit function increased. SRI can evaluate the atrial function quantitatively and monitor the changing of LA function dynamically after CABG.

Objective To explore the value of echocardiography in detecting left atrial systolic function in patients with hypertrophic cardiomyopathy(HCM) or hypertensive left ventricular hypertrophy (HLVH). Methods There were 3 groups in this study,the group of HCM, HLVH and control,each group had 30 cases. Left atrial diameter,interventricular septal thickness, posterior left ventricular thickness, peak E and A of mitralis were measured by conventional echocardiography. Left atrial fractional shortening (LAFS) was calculated. Tissue velocity imaging of all patients and controls were accepted in apical two, four and long axis chamber views. Strain rate(SR) imaging was performed on all cases, peak atrial systolic left atrial SR(LASRa) were measured at each segment (septal,lateral, posterior,anterior, and inferior walls of left atrium), mean LASRa was calculated by averaging data in all segments. Results Compared with controls, LAFS and mLASRs of HCM and HLVH were significantly higher ( P ＜0.05). Moreover, LAFS and mLASRs of HCM were significantly higher than HLVH (P ＜ 0.05). mLASRa correlated positively with LAFS of HCM and HLVH respectively ( r =0.81,0.88,all P ＜0.01). Conclusions The change of left atrial function of HCM and HLVH presented as pump function increased.

Objective To detect cardiac function in rabbits models with isehemic reperfusion and to evaluate the short-term protective effects of ischemic postconditioning on regional systolic function of left ventricle by echocardiography. Methods Twenty-eight rabbits were divided into 2 groups:control group and ischemic postconditioning(IP) group. Echocardiography were performed before tests and 2 weeks after tests. The conventional echocardiography indices included left ventricular end-diastolic diameter(LVDd) ,left ventricular anterior wall end-diastolic thickness (AW) and left ventricular ejection fraction (LVEF). Quantitative tissue velocity imaging and strain rate imaging indices included the peak velocity in systole(Vs) and radial peak strain rate in systole(SRs). Results Before tests, there were no difference in conventional echocardiography indices between the two groups; compared with before test, the two groups had significantly larger LVDd,thiner AW and lower LVEF(P <0.05) ; compared with the controls, the group IP had significantly smaller LVDd, thicker AW and higher LVEF 2 weeks after tests(P<0.05) ; compared with controls, the number of segments with abnormal wall motion in group IP significantly decreased. Before tests,there were no differences in Vs and radial SRs between the two groups; compared with before test,the two groups had significantly lower Vs and radial SRs(P<0.05) ; compared with the controls,Vs and radial SRs in group IP significantly increased 2 weeks after tests (P<0.05). Conclusions Ischemic postconditioning can protect regional systolic function of rabbits models with ischemic reperfusionin in short-term,which can be effectively evaluated by strain rate imaging.

Aged ; Female ; Humans ; Male ; Middle Aged ; Silicosis

Objective To evaluate the anti-tumor activity and toxicity of FOLFIRI regimen in the treatment of patients with advanced colorectal cancer. Methods 22 patients with advanced colorectal cancer used Irinotecan combined with 5-Fu/CF regimen to chemotherapy. Regimen: CPT-11 150 mg/m2 iv drip d1, CF 200 mg/m2 iv drip 2 h d1, 2; 5-Fu 400 mg/m2 iv drip d1, 2; 5-Fu 600 mg/m2 iv drip 22 h d1, 2. It is repeated every 2 weeks, two times a course. Efficiency and toxicity was evaluated after 4-6 cycles. Results Forty four patients were evaluated the efficiency. Two patients achieved CR, 16 PR, response rate was 40.9 %; MST was 11.3 months. TTP was 6.5 months. The main toxicity was cholinergic syndrome and delayed diarrhea,myelosuppression. There were no deaths during treatment. Conclusion The effectiveness of FOLFIRI regimen was higher and side effects was minor in advanced colorectal cancer. It should be further used and studied.