Objective To explore the value of PLR in peripheral blood in the efficacy and prognosis of targeted therapy for NSCLC with EGFR-mutated. Methods Ninety patients with EGFR-mutant of NSCLC were selected, and the PLR was calculated before targeted therapy. The PLR median was used as a cut-off point for grouping, and they were assigned to group A (low PLR group) and group B (high PLR group). All patients were treated with EGFR-TKIs. Relationship between PLR and clinicopathological features was analyzed. Objective efficacy, ORR, DCR, PFS and OS between the two groups were compared. Results Before EGFR-TKIs therapy, median PLR was 139, and there were 44 patients in group A, and 46 in group B. There were statistical differences regarding smoking, tumor location, histological differentiation, T staging, and clinical staging between group A and B (P <0.05). The rates of PR, ORR and DCR in group A were higher than those in group B, and the PD rate was lower than that in group B (P < 0.05). Log-rank test showed that median OS and median PFS in group A were longer than those in group B (P= 0.001). Conclusions PLR in peripheral blood has certain reference value for therapeutic effect and prognosis evaluation on NSCLC with EGFR-mutation. Low PLR of NSCLC patients with EGFR-mutation has higher efficacy and longer survival time after targeted therapy, and it is an independent and prognostic factor.

Objective To explore the risk factors of hepatic failure after major hepatectomy. Methods Clinical data of 293 patients receiving major hepatectomy in Sun Yat-sen Memorial Hospital of Sun Yat-sen University between January 2008 and February 2017 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. According to whether there was postoperative hepatic failure, the patients were divided into the hepatic failure group and non-hepatic failure group. There were 23 cases in the hepatic failure group, including 22 males and 1 female with the mean age of (53±12) years. There were 270 cases in non-hepatic failure group, including 224 males and 46 females with the age of (49±12) years. Single factor analysis and Logistic regression analysis were used to analyze the risk factors of postoperative hepatic failure. Results The incidence of hepatic failure after major hepatectomy was 7.8% (23/293). Multi-factor Logistic regression analysis showed that preoperative Plt, Child-Pugh classification of liver function, tumor diameter and vascular tumor thrombus were the independent influence factors of postoperative hepatic failure (OR=0.983, 0.020, 0.726, 0.225;P<0.05). Conclusion Preoperative Plt, Child-Pugh classification of liver function, tumor diameter and vascular tumor thrombus are the independent influence factors of hepatic failure after major hepatectomy.

Objective: To optimize the extraction process of total flavonoids from Oxytropis falcata bunge.Methods: With the content of total flavonoids as the index,and based on the results of single factor tests, central composite design-response surface methodology was adopted to optimize the extraction technology with the solvent amount, ethanol concentration and extraction time as the factors.Results: The optimal extraction conditions were as follows: extracted twice with 20-fold amount of 66% ethanol, and 84 minute per time.Under the above conditions, the extraction rate of total flavonoids was up to 23.21 mg·g-1.Conclusion: The central composite design-response surface methodology is convenient and highly predictive for the extraction optimization of total flavonoids from oxytropis falcata bunge.

Objective To evaluate the effect of evidence-based bundle intervention strategy on reducing the inci-dence of central line-associated bloodstream infection (CLABSI).Methods Prospective and multicenter study was adopted,patients admitted to 54 intensive care units (ICUs)of 41 hospitals and with central venous catheters (CVCs)between October 1 ,2013 and September 30,2014 were monitored .Baseline data between October 2013 and March 2014 were collected as pre-intervention data;from April to September 2014,the participated hospitals performed intervention strategy,post-intervention data were compared with pre-intervention data.Results The usage rate of CVCs before and after intervention was significantly different (44.18% vs 44.63%,χ2 =5.526,P =0.019).Incidence of CLABSI before and after intervention was not significantly different(RR ,0.82[95%CI ,0.59-1 .13],P =0.10).Constituent ratio of catheter insertion sites between pre-and post-intervention was significantly different (χ2 =76.264,P <0.001),femoral vein catheterization rate as well as proportion of two and above catheter insertion sites after intervention decreased(17.25% VS 13.72%;2.27% VS 1 .44%,respectively);hand hygiene implementation rate and accuracy rate after intervention were both higher than before intervention (79.73% vs 76.14%,P <0.001 ;91 .47% vs 74.26%,P <0.001 ,respectively);constituent ratio of skin disinfectant applica-tion before and after intervention was significantly different(χ2 =3.861 ,P <0.001 ),proportion of chlorhexidine ethanol increased (29.62% VS 50.56%);except daily assessment and record,compliance to other prevention and control measures before and after intervention were all significantly different(all P <0.001);utilization rate of max-imal sterile barrier,qualified rate of dressing of operators,and port disinfection were all significantly enhanced. Conclusion Bundle intervention in intubation and maintenance are implemented effectively,but intervention effect on CLABSI needs further study.

Objective To investigate the correlation between clinicopathological features and lymph node metastasis (LNM) in early gastric cancer (EGC).Methods From January 2006 to June 2009,the clinical data of 473 patients with EGC were collected.The data of patients including gender,age,tumor size,tumor number,general classification,differentiation degree,invasion depth,ulcer in tumor,nerve invasion,and lymphatic tumor cell embolus were analyzed.Chi-square test was performed to analyze the correlation between clinicopathological features and LNM in EGC.Logistic regression analysis was used to analyze the independent risk factor of LNM in EGC.Results Among 473 patients with EGC,77 patients had LNM and the metastasis rate was 16.3％.The metastasis rate of the female patients (24.6％,41/167) was higher than that of the male (11.8 ％,36/306).The metastasis rate of the tumors with maximum diameter over 2 cm (22.0％,39/177) was higher than that of the tumors less than 2 cm (12.8％,38/296).The metastasis rate of the elevated lesions (26.1％,6/23) was higher than that of flat and concave lesions (9.0 ％,15/167;19.8％,56/283).The metastasis rate of poorly differentiated tumors was higher than moderate differentiated and high differentiated tumors (12.7 ％,23/181; 7.1％,3/42).The metastasis rate of tumors invading into submucosa (22.9％,41/179) was higher than that of tumors invading into mucosa (12.2％,36/294).The metastasis rate of tumors with lymphatic embolus (40.7％,11/27) was higher than that of tumors without lymphatic embolus (14.8％,66/446) and the differences were statistically significant (x2 =12.960,6.873,10.704,7.382,9.277 and 12.572,all P＜0.05).The results of multifactor analyzed by Logistic regression analysis revealed that female,maximum diameter over 2 cm,poorly differentiated type and invasion to submucosa were the independent risk factors of LNM in EGC (relative risk (RR)=2.53,2.14,1.63 and 2.39,all P＜0.01).Conclusion Female,maximum diameter over 2 cm,poorly differentiated type and invasion to submucosa are the independent risk factors of LNM in EGC.

Objective To evaluate the preliminary outcome of stable vitiligo treatment with ReCell(R )technique.Methods Six patients with stable vitiligo were treated with ReCell(R ) technique.In each patient,a thin razor-thickness cutaneous biopsy was harvested from uninvolved area near the vitiligo patches.It was then processed through the ReCell(R ) system and 1 ml autologous epidermal cell suspension was obtained.The lesion area was dermabraded using a diamond fraise wheel to the dermoepidermal junction.The cell suspension was then sprayed on the wound and covered with non-adhering dressings.Results The patients were followed up for 6 months.5 patients presented with repigmentaion in the treated area.There was no significant response in one patient who was diagnosed as systematic vitiligo.Conclusions The ReCell(R ) technique is an alternative treatment for stable vitiligo patients.The clinical outcome will be satisfactory when appropriate patients are selected.

OBJECTIVETo investigate the feasibility of immediate breast and nipple-areola reconstruction after skin-sparing mastectomy.

METHODS24 patients who received skin-sparing mastectomy underwent immediate breast reconstruction with or without breast implants. The nipple-areola complex is also reconstructed with the skin paddle of the latissimus dorsi flap in one stage.

RESULTSAll the latissimus dorsi myocutaneous flaps survived completely. Partial necrosis happened in two reconstructed nipples which healed after dress changing. The follow-up period ranged from 6 to 12 months. 3 patients presented with capsular contracture (Baker I), with no necessary of surgical revision. The retraction rate of reconstructed nipples projection is 35.4% at 6 months postoperatively and 38.6% at 12 months postoperatively. 91.7% of patients were satisfied or very satisfied with the breast shape, while 83.3% were satisfied or very satisfied with the breast volume. All the patients considered the reconstructed nipple very good, while 91.6% were satisfied with the nipple projection. 91.7% considered immediate nipple reconstruction to be very important, and 8.3% considered it to be important. 66.7% considered the new breast could replace the breast they had lost, and 8.3% considered that it could not.

CONCLUSIONFor skin-sparing mastectomy, immediate breast and nipple reconstruction can achieve good aesthetic results.

Breast Neoplasms ; surgery ; Esthetics ; Female ; Humans ; Mammaplasty ; methods ; psychology ; Myocutaneous Flap ; transplantation ; Nipples ; surgery ; Superficial Back Muscles ; transplantation

The stereoselective hydrolysis of esmolol in whole blood and in its separated components from rat,rabbit and human was investigated.Blood esterase activities were variable in different species in the order of rat ＞ rabbit ＞ human.Rat plasma showed the high esterase activity and had no stereoselectivity to enantiomers.Rabbit red blood cell (RBC) membrane,RBC cytosol and plasma all hydrolyzed esmolol but with different esterase activity,whereas the hydrolysis in RBC membrane and cytosol showed significant stereoselectivity towards R-(+)-esmolol.Esterase in RBC cytosol from human blood mainly contributed to the esmolol hydrolysis,which was demonstrated with no stereoselctivity.Esterase in human plasma showed a low activity,but a remarkable stereoselectivity with R-(+)-esmolol.In addition,the protein concentration affected the hydrolysis behavior of esmolol in RBC suspension.Protein binding of esmolol enantiomers in human plasma,human serum albumin (HSA) and α1-acid glycoprotein (AGP) revealed that there was a significant difference in bound fractions between two enantiomers,especially for AGP.Our results indicated that the stereoselective protein binding might play a role in the different hydrolysis rates of esmolol enantiomers in human plasma.

The protein binding of non-steroidal anti-inflammatory drugs flurbiprofen,ketoprofen and etodolac with human serum albumin (HSA) was investigated using indirect chiral high performance liquid chromatography (HPLC) and ultrafiltration techniques.S-(-)-2-(1-naphthyl)-ethylamine (S-NEA) was utilized as chiral derivatization reagent and pre-column derivatization RP-HPLC method was established for the separation and assay of the three pairs of enantiomer.The method had good linear relationship over the investigated concentration range without interference.The average extraction efficiency was higher than 85％ in different systems,and the intra-day and inter-day precisions were less than 15％.In serum albumin,the protein binding of etodolac enantiomers showed significant stereoselectivity that the affinity of S-enantiomer was stronger than R-enantiomer,and the stereoselectivity ratio reached 6.06; Flurbiprofen had only weak stereoselectivity in HSA,and ketoprofen had no stereoselectivity at all.Scatchard curves showed that all the three chiral drugs had two types of binding sites in HSA.

The protein binding of non-steroidal anti-inflammatory drugs flurbiprofen, ketoprofen and etodolac with human serum albumin （HSA） was investigated using indirect chiral high performance liquid chromatography （HPLC） and ultrafiltration techniques. S-（-）-1-（1-naphthyl）- ethylamine （S-NEA） was utilized as chiral derivatization reagent and pre-column derivatization RP-HPLC method was established for the separation and assay of the three pairs of enantiomer. The method had good linear relationship over the investigated concentration range without interference. The average extraction efficiency was higher than 85% in different systems, and the intra-day and inter-day precisions were less than 15%. In serum albumin, the protein binding of etodolac enantiomers showed significant stereoselectivity that the affinity of S-enantiomer was stronger than R-enantiomer, and the stereoselectivity ratio reached 6.06; Flurbiprofen had only weak stereoselectivity in HSA, and ketoprofen had no stereoselectivity at all. Scatchard curves showed that all the three chiral drugs had two types of binding sites in HSA.