Objective To explore the association between epidermal growth factor receptor (EGFR) mutation subtypes and the prognosis of brain metastasis in patients with lung adenocarcinoma.Methods A retrospective analysis was performed on the clinical data of 256 patients who were admitted to our hospital and confirmed with brain metastases of lung adenocarcinoma by EGFR mutation detection from 2010 to 2015.The prognostic factors for brain metastases were analyzed.The survival rate was calculated by the Kaplan-Meier method and analyzed by the log-rank test.The univariate and multivariate prognostic analyses were performed by the log-rank test and the Cox proportional hazards model.Results The median survival time was 10.13 months in all patients.The univariate analysis showed that sex,EGFR mutation status,exon 19 deletion,the Karnofsky Performance Status (KPS) score of brain metastases,and targeted therapy were prognostic predictors (P=0.006,0.001,0.010,0.000,0.003).The multivariate analysis showed that the KPS score and exon 19 deletion were prognostic factors for brain metastases (P=O.000,0.045).When grouped into the recursive partitioning analysis classes,all the patients were split into three subgroups with significantly different prognosis (P =0.000).Conclusions Exon 19 deletion is a prognostic predictor of brain metastases in patieuts with lung adenocarcinoma,which can be integrated into the prognosis scoring system for brain metastases of lung adenocarcinoma.EGFR tyrosine kinase inhibitors improve the survival in patients with brain metastases of lung adenocarcinoma and EGFR mutation,particularly,in those with exon 19 deletion.

Objective To summarize the key points for nursing children with Kasabach-Merritt syndrome (KMS) treated by transcatheter arterial scleroembolization (TASE) during perioperative period. Method The perioperative treatment and key nursing points for 39 children with KMS undergoing TASE from September 2013 to September 2015 in our hospital were summarized and analyzed retrospectively. Results About 39 children with KMS went through TASE successfully. The operational time ranged from 0.8 to 2.7 hours. The patients were discharged in 2~11 days after TASE. There was 1 case of thrush, 3 cases of respiratory infection symptoms before TASE and 2 cases of hemangioma ulcer after TASE, which were cured by treatment and nursing. Conclusion The careful care to the patients with angeioma lesions, prevention and nursing of hemorrhage, nursing during glucocorticoid treatment, strict observation on the disease condition and prevention of complications after TASE can ensure the smooth implementation of TASE, and promote their recovery from KMS.

Objective To explore the effect of prognostic nutrition index (PNI) on the overall survival time of patients with brain metastases of lung adenocarcinoma.Methods A retrospective analysis was performed on the clinic data of 274 patients who were admitted to our hospital and confirmed with brain metastases of lung adenocarcinoma from May 2013 to May 2016.The prognosic factors for brain metastases such as PNI,gender,age,smoking history,epidermal growth factor receptor (EGFR) mutation status,Karnofsky performance status (KPS) score,the number of brain lesions,treatment of brain lesions,extracranial metastases and the status of primary disease were analyzed.The receiver operating characteristic (ROC) curve was drawn to determine the optimal cut-off value of PNI,and the patients were divided into high PNI group and low PNI group.The univariate and multivariate prognostic analyses were performed by the Log-rank test and the Cox proportional hazards model.Results The patients were divided into high PNI (＞ 50.45) group (n =72) and low PNI (≤50.45) group (n =202).The median overall survival (OS) was 11.20 months in all patients with brain metastases,and the median OS of the low PNI group and high PNI group were 10.13 months and 15.17 months respectively.The univariate analysis results showed that gender (x2 =5.459,P =0.019),age (x2 =3.986,P =0.046),smoking or not (x2 =6.878,P =0.009),EGFR mutation status (x2 =20.484,P＜0.001),KPS score (x2 =126.573,P ＜ 0.001),extracranial metastases or not (x2 =4.403,P =0.036),treatment on the brain lesions (x2 =40.444,P ＜ 0.001) and PNI (x2 =7.972,P =0.005) were related to the prognosis.The Cox multivariate analysis results showed that age (HR =1.580,95％ CI:1.104-2.295,P =0.012),EGFR mutation status (HR =0.549,95％ CI:0.408-0.738,P ＜ 0.001),KPS score (HR =0.077,95％CI:0.045-0.134,P ＜ 0.001),treatment on brain metastases (HR =0.882,95％ CI:0.789-0.987,P =0.029) and PNI (HR =0.614,95％ CI:0.437-0.861,P =0.005) were related to the prognosis.Conclusion PNI is an independent prognostic predictor of brain metastases in patients with lung adenocarcinoma,and the high-PNI is correlated to the long OS of patients with brain metastases of lung adenocarcinoma,which has certain clinical practical value.