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.

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 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.

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

Objective The prosthesis used for aortic valve replacement (AVR) can be too small in relation to body size,thus causing valve prosthesis-patient mismatch (PPM).The aim of this article was to summarize the preventive strategy of PPM during AVR.Methods A total of 357 patients [203 males,154 females; mean age (54.9 ± 18.7 ) years ] underwent AVR between February.2010 and December 2011.The weight and body surface area (BSA) of the group is( 60.1 ± 11.4 )kg and (1.67 ± 0.21 )m2 respectively.The aortic valve prosthesis effective orifice area (EOA) was divided by body surface area (BSA) to obtain the EOA index (EOAI).PPM was then defined as none or mild if EOAI was ＞ 0.85 cm2/m2,as moderate for (0.65 - 0.85 ) cm2/m2 and as severe for ＜ 0.65 cm2/m2.To avoid PPM,a simple three-step algorithm was applied:Step 1,Calculate the patient's BSA from weight and height;Step 2,Calculate the minimal valve EOA required based on the BSA to ensure an EOAI ＞0.85 cm2/m2 ; Step 3,Select the type and size of prosthesis that has reference values for EOA greater or equal to the minimal EOA value obtained in step 2.For patients with a small aortic root,the following three methods was used:( 1 ) Replace aortic valve with simple interrupted suture technique ; (2) Apply new type and high-performance prosthetic valves such as St.Jude Medical Regent mechanical valve ; (3) Enlarge the narrowed aortic root when necessary.Results Of all 357 patients,272 patients received mechanical AVR and 85 bioprosthetic AVR.Among the 49 patients who received AVR with simple interrupted suture technique.St.Jude Medical Regent mechanical valve was implanted in 38 patients and the aortic root enlargement was performed in 11 patients.The total prevalence of PPM was 6.4％ and there was no severe PPM.The prevalence of PPM with mechanical AVR and bioprosthetic AVR was 1.8％ and 21.2％ respectively.There were 4 deaths during early period of operation,and the operative mortality was 1.1％.Conclusion Prosthesis-patient mismatch can be effectively prevented at the time of AVR with appropriate measurement.

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 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 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.

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.