Lung cancer has become one of the most dangerous cancers to human health and the mortality rate is the highest among all the causes of cancer death. Non-small cell lung cancer (NSCLC) accounts for about 80%-85% of lung cancer. Chemotherapy is the main treatment for advanced NSCLC, but the 5-year survival rate is low. Epidermal growth factor receptor (EGFR) mutations are the most common driver mutations in lung cancer, but EGFR exon 20 insertions (EGFR ex20ins) mutation belongs to one of the rare mutations, accounting for about 4%-10% of overall EGFR mutations, thus around 1.8% of advanced NSCLC patients. In recent years, targeted therapies represented by EGFR tyrosine kinase inhibitors (TKIs) have become an important treatment option for patients with advanced NSCLC, however, NSCLC patients with EGFR ex20ins mutation are not sensitive to most of EGFR-TKIs treatments. Currently, some of the targeted drugs for EGFR ex20ins mutation have achieved significant efficacy, while some of them are still under clinical investigation. In this article, we will describe various treatment methods for EGFR ex20ins mutation and their efficacy.
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Humans ; Carcinoma, Non-Small-Cell Lung ; Lung Neoplasms ; ErbB Receptors ; Exons ; Mutation

Objective:To evaluate the feasibility of using Patient Health Questionnaire-4 (PHQ-4) to screen for depression and anxiety in inpatients in general hospitals.Methods:Using the convenient sampling method, a total of 695 inpatients from 10 ClassⅡ Grade A and above comprehensive hospitals in Nanjing from January to June 2021 were selected as the research objects. They were investigated by PHQ-4, Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder 7 (GAD-7) to compare the screening results of different measuring tools for depression and anxiety. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of PHQ-4, Kappa test was used to analyze the consistency, Cronbach's α coefficient was used to evaluate the internal consistency of the scale, and Pearson correlation analysis was used to evaluate the calibration correlation validity. A total of 695 questionnaires were sent out in this study, and 672 were effectively collected, with an effective recovery rate of 96.69% (672/695) .Results:Among 672 inpatients in general hospitals, the detection rate of depression and anxiety in patients using PHQ-4 was 38.39% (258/672), while that in patients using PHQ-9 and GAD-7 was 41.82% (281/672), and the difference showed no statistical significance (χ 2=1.64, P=0.20). Cronbachs'α coefficient of PHQ-4 was 0.913, and the half reliability coefficient was 0.888. The Kappa value of the consistency test between PHQ-4, PHQ-9, and GAD-7 for depression and anxiety screening results was 0.756 ( P<0.01). The correlation coefficients between the total scores of PHQ-4, PHQ-9 and GAD-7 in 672 inpatients from general hospitals were 0.822 and 0.802, respectively (both P<0.01). The area under the ROC curve of PHQ-4 was 0.936. With a critical score of 3, the sensitivity and specificity of PHQ-4 were 81.9% and 92.8%, respectively. Conclusions:The detection rate of PHQ-4 and PHQ-9 and GAD-7 on depression and anxiety state of inpatients in general hospital is similar, and has good reliability and validity, which is suitable for the screening of depression and anxiety of inpatients in general hospital.

Objective To analyze the clinical significance of lymph node metastasis-related indexes in evaluating the prognosis of initially treated stage N2b colorectal cancer. Methods Two hundred and six patients with initially treated stage N2b colorectal cancer in Shenzhen People′s Hospital from January 2009 to November 2013 were retrospectively analyzed. All patients underwent radical resection of colorectal cancer. The correlation between lymph node metastasis-related indexes and postoperative 5-year overall survival rate was analyzed, including number of negative lymph nodes, number of positive lymph nodes, lymph nodes ratio (LNR), log odds of positive lymph nodes (LODDS). Results The postoperative 5-year overall survival rate was 54.4% (112/206), and the postoperative 5-year recurrence-free survival rate was 48.1% (99/206). Univariate analysis result showed that angioma thrombus or nerve invasion, T stage, postoperative adjuvant therapy, number of positive lymph nodes, number of negative lymph nodes, LNR and LODDS were significantly correlated with the postoperative 5-year overall survival rate (P＜0.01 or ＜0.05). Multivariate analysis result showed that number of negative lymph nodes, number of positive lymph nodes, LNR and LODDS were independent risk factors of postoperative the 5-year overall survival rate ( RR=2.371, 2.295, 2.758 and 2.671; 95% CI 1.598 to 3.485, 1.556 to 3.360, 1.880 to 4.058 and 1.814 to 3.915; P＜0.01). The areas under curve of negative lymph nodes, number of positive lymph nodes LNR and LODDS in predicting postoperative the 5-year overall survival rate were 0.668, 0.657, 0.692 and 0.684, and there was no statistical difference (P＞0.05). Conclusions The number of negative lymph nodes, number of positive lymph nodes, LNR and LODDS in initially treated stage N2b colorectal cancer patients are independent prognostic factors.

OBJECTIVE:To establish a method for simultaneous determination of fatty acids in Isaria cicadae,Cordyceps militaris and C.sinensis,and to compare the difference of the contents of fatty acids among above medicinal herbs.METHODS:GC-MS method was adopted.Chromatographic condition:the determination was performed on TG-5MS gas phase capillary column with carrier gas of nitrogen at the flow rate of 1.2 mL/min.The inlet temperature was 290 ℃ by splitlesssampling;valve opening time was 1 min,and volume of sample was 1 μL.Mass spectrometry condition:the ion source is an electrospray ionization source.The temperatures of ion source and transmission line were 280 ℃,the initial temperature of the chromatographic column was 80 ℃ (gradient elution),ionization voltage was 70 eV.Solvent delay time was 5 min,and scan mass range was m/z 30-400.RESULTS:The linear ranges of tetradecanoic acid,pentadecanoic acid,palmitic acid,palmitoleic acid,heptadecanoic acid,heptadecenoic acid,docosahexaenoic acid,methyl oleate,linoleic acid,arachidonic acid,eicosenoic acid,diolefinic acid,eicosatrienoic acid,heneicosanoic acid,behenic acid,tricosanoic acid,lignoceric acid were 1.400-44.520 μg/mL(r=0.999 8),2.091-93.721 μg/mL(r=0.999 7),3.146-85.856 μg/mL(r=0.998 2),1.664-61.444 g/rnL(r=0.998 7),1.773-64.983 g/mL(r=0.999 5),1.781-68.421 μg/ mL (r=0.999 7),1.706-55.606 μg/mL (r=0.999 8),1.439-47.989 μg/mL (r=0.999 6),1.738-66.908 μg/mL (r=0.999 6),2.086-94.206 μg/mL(r=0.999 5),1.356-44.966 μg/mL(r=0.999 4),1.444-56.814 μg/mL(r=0.999 7),1.375-52.335 μg/mL(r =0.999 8),1.512-60.312 μg/mL(r=0.999 5),1.450-59.760 μg/mL(r=0.999 7),1.427-58.757 μg/mL(r=0.999 1),1.269-58.109 μg/ mL(r=0.999 3),respectively.The limit of quantitation was no more than 1 764.71 μg/mL,and the limit of detection was no more than 529.42 μg/mL.RSDs of precision,stability and reproducibility tests were all lower than 2.0％.The recoveries were 84.87％-108.93％ (RSD ranged 0.19％-2.23％,n=6).There were 17 fatty acids in C.militaris,16 fatty acids in Ⅰ.cicadae and 16 fatty acids in C.sinensis.The contents of unsaturated fatty acids in above medicinal herbs were higher than that of saturated fatty acids.The content of fatty acids in artificial cultivated Ⅰ.cicadae was mostly higher than other medicinal herbs.COCLUSIONS:The method is simple,accurate,stable and reproducible.It can be used for simultaneous determination of fatty acids in I.cicadae,C.militaris and C.sinensis.Above 3 kinds of medicinal materials.From the perspective of fatty acid content,the quality of artificial cultivated I.cicadae is best.

To establish a simple and sensitive LC-MS/MS method for simultaneous determination of the concentration for L-tryptophan(L-Try)and L-kynurenine(L-Kyn)in rat plasma. The changesin the process of the liver tumors formation may provide a basis for the diagnosis of liver cancer. 3-Nitro-L-tyrosine(3-NT)were added as the internal standard for the determination of two active substances and the chromatographic analysis was performed on a RRHD Eclipse Plus C18 column(3. 0 mm×100 mm, 1. 8 μm). The mobile phase was composed of water and acetonitrile(containing 0. 1%formic acid)(90 ∶10)at a flow rate of 0. 25 mL/min, and the injection volume is 5 μL. Detection and quantification were performed by mass spectrometry in multiple reaction monitoring mode with m/z 205. 12→146. 10(L-Try), m/z 209. 09 →146. 10(L-Kyn), m/z 227. 09→181. 10(3-NT), respectively. The results show that thelinear ranges were 9. 670-9 670 ng/mL for L-Try, and 9. 973-9973 ng/mL for L-Kyn(r2≥0. 9990). The limit of quantitation were 9. 670 ng/mL for L-Try, and 9. 973 ng/mL for L-Kyn, respectively. The intra- and inter-day precisions were all less than15%; the recoveries ofthe two analytes were more than 81. 17% and severe matrix effect was not observed. The ratio of L-Try/L-Kyn determined by LC-MS/MS in rat plasma showed an overall downward trend, which could used effectively for the drug metabolism studies and researches on the action mechanism of medicine on liver cancer. A rapid, simple, sensitive and specific LC-MS/MS method has been successfully developed and could also be used effectively for the drug metabolism studies and researches on the action mechanism of medicine on liver cancer.

Objective To explore the function of extended nursing combined with PDSA circle and based on positivepsychology in improving self-efficacy of patients with colostomy. Methods A total of 80 patients with colostomy match the inclusion and exclusion standard from December 2014 to December 2015, were divided into the control group and the intervention group according to the order of discharge date.Patients in the control group received conventional extended nursing, while patients in the intervention group received extended nursing combined with PDSA circle and based on positivepsychology, and interventions were conducted a week, a month, two months, three months after discharge. Patients were evaluated by stoma related self-efficacy questionnaire before the intervention, after the fourth intervention and 3 months after intervention ( T0 , T1 ,T2 ) . Results There were significant differences in the dimensions, independent items and total scores of stoma related self-efficacy between two groups at different time after intervention except the item of confidence in sexual life (P<0.05), and they also had interactive effect (P<0.05).There was significant difference in the main effect of intervention time for the single item “confidence in sexual life” (P<0.05). In the intervention group, the scores of dimensions, independent items and total scores of stoma related self-efficiency after intervention and three months after intervention were significantly higher than those before intervention. Conclusions The extended nursing combined with PDSA circle and based on positivepsychology can improve the self-efficacy of patients with colostomy.

OBJECTIVETo investigate the efficacy and adverse effect of DCF regimen with subsequent S-1 maintenance chemotherapy in patients with advanced gastric cancer (AGC).

METHODSSixty AGC patients without disease progression after 4 to 6 cycles of DCF regimen as the first-line chemotherapy were randomized into maintenance group and control group (30 patients each). The patients in the maintenance group received maintenance chemotherapy with S-1 (40 mg/m(2), twice daily for 14 days; 21 days for a treatment cycle) until disease progression or with intolerant toxicity, and those in the control group received optimal supportive care.

RESULTSThe response rate (CR+PR) was 33.3% in the maintenance group, significantly higher than that in the control group (3.33%, P<0.05), and the disease control rate (CR+PR+SD) also differed significantly between the two groups (73.3% vs 46.7%, P<0.05). The median time to progression was 7.9 months in the maintenance group and 6.8 months in the control group, with median overall survival time of 13.8 and 11.7 months, respectively (P>0.05). The most common adverse effect in the maintenance group included nausea, vomiting, leucocytopenia, and hand-foot syndrome; no death occurred in relation to the therapy.

CONCLUSIONS-1 maintenance chemotherapy, with a tolerable toxicity profile, can improve the RR, DCR and median time to progression in AGC patients who respond to DCF regimen, but its efficacy still awaits further evaluation.

Objective To investigate the efficacy and adverse effect of DCF regimen with subsequent S-1 maintenance chemotherapy in patients with advanced gastric cancer (AGC). Methods Sixty AGC patients without disease progression after 4 to 6 cycles of DCF regimen as the first-line chemotherapy were randomized into maintenance group and control group (30 patients each). The patients in the maintenance group received maintenance chemotherapy with S-1 (40 mg/m2, twice daily for 14 days; 21 days for a treatment cycle) until disease progression or with intolerant toxicity, and those in the control group received optimal supportive care. Results The response rate (CR+PR) was 33.3%in the maintenance group, significantly higher than that in the control group (3.33%, P<0.05), and the disease control rate (CR+PR+SD) also differed significantly between the two groups (73.3% vs 46.7%, P<0.05). The median time to progression was 7.9 months in the maintenance group and 6.8 months in the control group, with median overall survival time of 13.8 and 11.7 months, respectively (P>0.05). The most common adverse effect in the maintenance group included nausea, vomiting, leucocytopenia, and hand-foot syndrome; no death occurred in relation to the therapy. Conclusions S-1 maintenance chemotherapy, with a tolerable toxicity profile, can improve the RR, DCR and median time to progression in AGC patients who respond to DCF regimen, but its efficacy still awaits further evaluation.

Objective To investigate the efficacy and adverse effect of DCF regimen with subsequent S-1 maintenance chemotherapy in patients with advanced gastric cancer (AGC). Methods Sixty AGC patients without disease progression after 4 to 6 cycles of DCF regimen as the first-line chemotherapy were randomized into maintenance group and control group (30 patients each). The patients in the maintenance group received maintenance chemotherapy with S-1 (40 mg/m2, twice daily for 14 days; 21 days for a treatment cycle) until disease progression or with intolerant toxicity, and those in the control group received optimal supportive care. Results The response rate (CR+PR) was 33.3%in the maintenance group, significantly higher than that in the control group (3.33%, P<0.05), and the disease control rate (CR+PR+SD) also differed significantly between the two groups (73.3% vs 46.7%, P<0.05). The median time to progression was 7.9 months in the maintenance group and 6.8 months in the control group, with median overall survival time of 13.8 and 11.7 months, respectively (P>0.05). The most common adverse effect in the maintenance group included nausea, vomiting, leucocytopenia, and hand-foot syndrome; no death occurred in relation to the therapy. Conclusions S-1 maintenance chemotherapy, with a tolerable toxicity profile, can improve the RR, DCR and median time to progression in AGC patients who respond to DCF regimen, but its efficacy still awaits further evaluation.

Objective To evaluate the predictive effect of Braden scale for the risk of development of pressure ulcers (PU) in the department of neurology bedridden patients and to explore subgroup preventive measures. Methods 400 cases newly hospitalized bedridden patients in the department of neurology were collected with no pressure ulcers at the first evaluation and pressure ulcer risk was continuously predicted by a Braden scale skin assessment. The high-risk, middle-risk and low-risk groups were randomized into the experimental group and the control group respectively. Routine preventive measures were taken for the control group while the air fluidized bed for the high-risk group, the sponge mattress for the middle-riskgroup, and turning the body over every 4 hours for low-risk group. Other preventive procedures were undertaken simultaneously in beth the experimental and the control groups. Results The area under the ROC curve (AUC)was 0.771 and 0.828 at the first and last time Braden scale scores respectively. Such vMues as sensitiveness, specificity, positive predictive value, negative predictive value were found in higher level,when the diagnosis value was 17. There was no significant difference of incidence rate of the subgroup pressure ulcers between the high-risk, middle-risk, low-risk groups compared to the control group. Conclusions The effect of predicting pressure ulcer risk for bedridden patients in the department of neurology with Braden scale was fairly good, while the score 17 as the diagnosis value was ideal. The air fluidized bed for the high-risk group and the sponge mattress for the middle-risk group resulted in no significant decrease of incidence rate of the pressure ulcer, while taming over the patients' body every 4 hours for low-risk groups showed acceptable and therefore saving medical resources.