The epidermal growth factor receptor tyrosine kinase inhibitor(EGFR-TKI)is a kind of high-efficiency and low-toxicity tumor molecular targeted drugs.It becomes a research hotspot in non-small cell lung cancer (NSCLC)treatment because of its unique curative effect and well tolerance.EGFR-TKI is mainly applied to the second and third line treatment of patients with advanced NSCLC or first line treatment of EGFR mutation patients.With the development of research,the indications of EGFR-TKI expand unceasingly.The preoperative neoadjuvant therapy is likely to become a new kind of treatment mode.

Objective High performance liquid chromatography (HPLC) and liquid chromatography-mass spectrometry (LC/MS) methods were developed for the determination of ganciclovir and its related substances. Methods A Hypersil ODS2 column (4.6mm×250mm, 5μm) was used with a mobile phase of 0.02M potassium 1.0mL/min, and UV detector set at 254nm was used for monitoring the eluents. Results The method was simple, rapid, selective and capable of separating all related substances at trace level with a detection limit of 0.04μg/mL. It has been validated with respect to accuracy, precision, linearity, and limits of detection and quantification. The linearity range was 10.2-153.0μg/mL with r=0.9998. The percentage recoveries ranged from 96.7% to 101.6%, and RSD was 1.24%-1.96% (n=5). Conclusion The method was found to be suitable not only for monitoring the reactions during the process development but also for quality control of ganciclovir. For identification of related substances, LC/MS was used. The mainly related substances of ganciclovir active pharmaceutical ingredients (API) were determined as guanine, (1, 3-dioxolan-4-yl) methyl acetate, and diacetyl guanine.

Objective To evaluate the effect of meglumine cyclic adenosine (MAC) on heart rate variability (HRV) in aged-patients with coronary heart disease (CHD).MethodsSeventy six aged-patients with CHD were randomly divided into control group (n =36) and treatment group (n =40).The patients in control group were treated with nitrate,ozagrel,calcium antagonist,aspirin enteric-coated tablets,low molecular heparin,angiotensin-converting enzyme inhibitor ( ACEI ) or angiotensin receptor antagonist ( ARB ) and lipidlowering agents according to patients' conditions.Based on this,the patients in treatment group were treated with MAC 90 mg intravenous injection once a day for two weeks.The 24 h dynamic electrocardiogram was recorded.pre-ard post-treatment,and the changes of HRV indexes were observed.Results There was no statistical significance in HRV between the two groups before treatment ( P ＞ 0.05 ).However the HRV in two groups improved significantly after treatment ( P ＜0.01 ).The improvement of HRV was more significant in MAC group than that in control group (P ＜0.01 ).Conclusion MAC can significantly improve HRV in aged-patients with CHD.

Objective:To investigate the clinical efficacy and safety of compound carraghenates suppositories in the treatment of wounds after anal fissure operation. Methods:Eighty-eight cases of patients with anal fistula post-operation wounds were diagnosed from June 2011 to June 2014 and randomly divided into the observation group (n=44) and the control group (n=44). The control group was treated with the conventional treatment and the observation group was treated with external compound carraghenates suppositories additionally. The efficacy, average healing time, growing time of granulation tissue and removal time of necrotic tissue, pain disappear-ance time and wound edema disappearance time after the operation and the area of wound surface in the two groups were observed and compared. Results:After the 14-day treatment, the time of wound healing, granulation growth and cure in the observation group was shorter than that in the control group (P<0. 05). In the observation group, the total effective rate (93. 18%) was higher than that in the control group (77. 27%, P<0. 05). After the 7-day and 14-day treatment, the pain score and wound edema score in the observa-tion group were significantly lower than those in the control group (P<0. 05), and the wound area was significantly smaller than that in the control group (P<0. 05). Conclusion:The clinical efficacy of external compound carraghenates suppositories in the treatment of wounds after anal fissure operation is significant, safe and reliable.

Objective To investigate the effects of intensive insulin therapy on the functions of vascullar endothelial cells in septic patients. Methods One hundred and twenty septic patients were randomly assigned to intensive insulin therapy 1 ,intensive insulin therapy 2 and conventional insulin therapy, serum von Willebrand factor (vWF),thrombomodulin protein(TM),endothelin-1 (ET-1) and nitric oxide(NO) of the three groups of patients were determined by enzyme-linked immunoadsorbent assay double antibody sandwich principle (ELISA) before treatment and the next 3 d,7 d after treatment. At the same time we observed the three groups of patients with 28-d mortality, the days of hospitalized in ICU, number of days for using mechanical ventilation, △ APACHE Ⅱ score and △MODS score. Results After treatment of 3 days,vWF was (142.57 ± 10.07)%, (137.32 ±9.66)% and (138. 32 ± 8. 80) % in the CIT, IIT1 and IIT2 group, respectively. After treatment of 7 days, vWF was (126.27 ±10.49) %, (116. 55 ± 9. 36) % and (120.72 ± 9. 53) % in the CIT, IIT1 and IIT2 group, respectively. After treatment of 3 days, TM was (6. 87 ± 1.62) μg/L, (5.95 ± 1.60) μg/L and (6. 17 ± 1.33) μg/L in the CIT, IIT1and IIT2 group, respectively. After treatment of 7 days, TM was (4. 55 ± 1.48) μg/L, (3.35 ± 0.94) μg/L and(3. 87 ± 1.20) μg/L in the CIT, IIT1 and IIT2 group, respectively. After treatment of 3 days, ET-1 was (61.27 ±9. 20) ng/L, (55.97 ± 9.03) ng/L and (57. 37 ± 7. 70) ng/L in the CIT, IIT1 and IIT2 group, respectively. After treatment of 7 days, TM was (43. 12 ± 6. 17) ng/L, (33.77 ± 6. 20) ng/L and (35.95 ± 5.73) ng/L in the CIT, IIT1and IIT2 group, respectively. Compared with conventional insulin therapy, vWF, TM and ET-1 were significantly decreased (P ＜ 0.05), NO were significantly higher (P ＜ 0.05) in IIT1 and IIT2, but the two sub-groups had no significant difference (P ＞ 0.05). In the CIT, IIT1 and IIT2 groups respectively, the mortality at 28 days were 20.0%, 12. 5 % and 45.0%, the days of hospitalized in ICU were (9.50 ± 3. 70) d, (7. 72 ± 3.29) d and (8.02 ±2. 90) d, number of day for using mechanical ventilation were (8. 92 ± 3.79) d, (7.23 ± 3. 32) d and (7. 37 ±3. 29) d, △ APACHE Ⅱ score were 8. 87 ± 3.46,7. 20 ± 2. 81 and 7.42 ± 3. 18, △ MODS score were 4. 15 ± 2. 15,3.20 ± 1.48 and 3.32 ± 1.74, with significant differences (P ＜ 0.05). These indices were significantly decreased (P ＜ 0.05) in IIT1 and IIT2, but the two sub-groups also had no significant differences (P ＞ 0.05). Conclusions Intensive insulin therapy on patients with sepsis has a protective effect of vascular endothelial cells, and the blood glucose controlled in the 6. 6 - 8. 3 mmol/L can significantly decrease the incidence of hypoglycemia, and intensive insulin therapy can also significantly improve the prognosis of patients with sepsis.

Esophageal cancer is a cause of cancer mortality and accounts for the sixth most common cause of cancer-related death. The focus of recent study has shifted towards testing novel agents that target specific molecular abnormalities known to occur in esophageal squamous cell carcinoma (ESCC). The preclinical studies involving various cancer models, including ESCC, epidermal growth factor receptor (EGFR) over-expression, are linked to epithelial cell proliferation, differentiation and migration, and have an inverse relationship to tumor chemotherapy curability. Nimotuzumab is a humanized anti-EGFR monoclonal antibody that binds to the extracellular domain of the EGFR and inhibits EGF binding. In many phase Ⅱ trials, nimotuzumab showed marked antiproliferative, proapoptotic and antiangiogenic effects in tumors that overexpress EGFR. Some phaseⅢtrials are ongoing.

Objective To evaluate the short-term effect of CT-guided interstitial implantation of 125I seeds for metastatic lung carcinoma. Methods A total of 82 patients with 126 metastatic lung tumors were treated with CT-guided percutaneous interstitial implantation of 125I seeds at a dose of 80 Gy. Six months after the treatment, the change of tumor volume was observed by using CT scan. The patients were followed up for 2 years. Results The mean radioactive dose was (159.3?34.5) Gy, and the median dose was (118.6?33.2) Gy. Six months after the treatment, CT scan showed a CR of 25.4% (32/126), PR 64.3% (81/126), NC 6.3% (8/126), PD 4.0% (5/126), and CR+PR 89.7% (113/126). Twelve patients showed pneumothorax and 41 had hemoptysis. During the follow-up, 11 patients (6 cases of malignant fibrous histiotoma, 3 cases of lung cancer, 1 rectal carcinoma, and 1 liver carcinoma) died within 8-12 months after the surgery. Fifteen patients (4 cases of malignant fibrous histiotoma, 4 lung cancer, 4 ovarian cancer, 2 multiple myeloma, and 1 uterine leiomyosarcoma) died within 13-24 months after the implantation. The 1-and 2-year survival rates were 86.6% (71/82) and 68.3% (56/82) respectively. Conclusion CT-guided percutaneous interstitial implantation of 125I seeds is effective for lung metastatic carcinoma.

Objective To evaluate the short-term efficacy of interstitial implantation of 125I seeds by using flexible fiberoptic bronchoscope (FFB) guided by CT for advanced non-small cell lung cancer (NSCLC). Methods A total of 185 patients with NSCLC, who were diagnosed clinically and pathologically, were enrolled into this study and divided into two groups. In 125I seeds group (n=121), the patients received interstitial implantation of 125I combined with NP regimen (NVB+DDP) chemotherapy with a prescribed dose (PD) of 80 Gy. Among the patients, the implantation was guided by CT in 89, and was performed directly under a FFB in 32. In control group (n=64), NP regimen (NVB+DDP) chemotherapy was used. Six months after the treatments, the tumor volume in the two groups was measured by using CT and FFB. The outcomes of the 2 groups were compared, and the efficacy of the treatments was evaluated according to the international standards. Results In the 125I seeds group, the mean radiation dose was 153.7 Gy, matched peripheral dose (MPD) was 89.6 Gy, and D90 was 93.5 Gy. Six months after the treatment, the effectiveness rate (CR+PR) was 95.0% (115/121), and 1-year survival rate was 0.90. In the control group, the effectiveness rate was 42.2% (27/64), and 1-year survival rate was 0.65. There existed significant difference between the two groups (log-rank test, ?2=5.12, Prob=0.04

Objective To investigate the efficacy of minimally invasive percutaneous nephrolithotomy(MPCNL) for impacted upper ureteric calculi.Methods Retro-urethral catheterization was conducted in the diseased ureter under cyctoscope.After a channel from the skin surface into the middle calyx was established under the guidance of X-ray or B ultrasonography,pneumatic lithotripsy was conducted to break up stones under ureteroscopy.Results The success rate of pneumatic lithotripsy was 100%.The rate of postoperative macroscopic hematuria was 55.1%(27/49).The symptom lasted one to three days in 26 cases,and 1 case had apparent hematuria with blood clot flowing out from nephrostomy tube,which lasted 8 days.10.2%(5/49) of cases was complicated with postoperative pyrexia.The stone-free rate in one week and one month postoperatively was 93.9%(46/49) 98.0%(48/49),respectively.Follow-up observations in 49 cases for 1-12 months(mean,5 months) showed no major complications.Conclusions MPCNL for impacted upper ureteral calculi has the advantages of simple performance,less complications and satisfactory efficacy.

Taking the Second Affiliated Hospital of Zhejiang University School of Medicine as an example,the paper discussed its practices in optimizing outpatient service process.These practices include innovating convenient outpatient service process,establishing a coordination center of hospital's beds to strengthen pre-hospital one-stop management,implementing day surgery to improve inpatient service,implementing professional and humanized hospital clinical care,introducing the concept of fast tract surgery to promote accelerated rehabilitation after surgery,and establishing a follow-up center for inpatients discharged.Such efforts have improved the medical services' efficiency and quality,and improved the patients' satisfaction.