基于自由场爆炸的猪鼓膜破裂规律实验研究

听觉系统各组成部分的机械损伤是爆炸后造成听力损失的主要原因,强脉冲声致听觉损害风险准则仍然存在许多争议,例如:指标选择冲量还是超压峰值,正压持续时间是否重要等。本研究基于自由场实爆条件,设计并搭建了大动物爆炸致伤平台,探究了不同爆炸参数对鼓膜破裂的影响规律,并建立了基于自由场超压峰值和正压持续时间的鼓膜创伤量效关系。通过笔形压力传感器测量自由场超压,通过Friedlander公式拟合超压时程曲线,确定冲击波超压峰值和正压持续时间,并对时域中记录的波形进行归一化能量频谱分析,以确定冲击波在频域上的信号能量分布。对爆炸后的小型猪进行解剖,记录不同爆炸参数下鼓膜创伤程度。以超压峰值和正压持续时间为自变量,对实验数据进行二元逻辑回归分析,并给出鼓膜破裂风险曲线。研究发现,当自由场超压峰值低于170 kPa时,鼓膜无明显损伤;当自由场超压峰值高于237 kPa时,部分鼓膜出现不同程度的破裂和充血。距爆心越近,超压峰值越大,但鼓膜创伤的严重程度并未随之单调增加。在8.0 kg TNT当量的爆炸实验中,鼓膜破裂的严重程度随爆心距的减小呈现先提高再降低的趋势。通过对冲击波载荷特征的分析可知,距爆心越近,正压持续时间越短,高频段能量占比相对更大,小型猪鼓膜破裂的概率可能反而降低,此时仍然出现显著的听力损失和耳蜗损伤。鼓膜作为通过振动传递声信号的黏弹性薄膜结构,其动力学响应可能与载荷频率成分密切相关。除了超压峰值,冲击波波形频谱分布对鼓膜破裂程度影响显著。

基于自由场爆炸的小型猪内耳听觉损伤模型

建立真实爆炸环境下的小型猪内耳听觉爆炸伤模型,研究不同爆炸冲击波压力对小型猪内耳听觉损伤的影响。选取14头健康小型猪,在爆炸前进行听性脑干反应(auditory brainstem response,ABR)测试。搭建自由场爆炸实验平台,使用1.9和8.0 kg TNT炸药,爆源离地面1.8 m,身体固定于防护装置中,仅暴露头部。在不同距离布放小型猪,记录冲击波峰值压力,计算即刻死亡率。爆炸后再次进行ABR测试,并取耳蜗组织进行扫描电镜观察,分析毛细胞损伤情况。在1.8~3.8 m范围内,冲击波峰值压力从96.3 kPa升至628.3 kPa,随着距离的增大,峰值压力减小。8 kg TNT爆炸在2.6 m处(峰值压力628.3 kPa)导致小型猪即刻死亡率为50%。比较爆炸前后ABR阈值发现,短声(click)和各频率短纯音(2、4和8 kHz)诱发的ABR阈值均显著升高(P<0.05),其中以4 kHz阈值变化最显著。扫描电镜显示,随着冲击波压力的升高,内毛细胞的损伤程度高于外毛细胞。爆炸冲击波可引起小型猪听觉系统的明显损伤,表现为ABR阈值升高和耳蜗毛细胞结构破坏。内毛细胞对爆炸冲击波更敏感。所建立的小型猪爆炸性听觉损伤模型可为研究爆炸伤机制和防护措施提供了重要的实验基础。

防护风镜对眼爆震伤诱导视网膜病理损伤和自噬变化的有效改善

首先基于头部动态测试系统与激波管和外场实弹实爆测试环境,验证了眼部装备(护目镜和风镜)的防护性能。研究结果表明,风镜防护性能更优,建议给执勤人员配发兼容防紫外、强光、烟雾和防破片功能的风镜产品,以提高相关人员眼部防护能力。此后,研究眼部爆震伤后组织损伤、功能改变及市售风镜动物实验版的防护作用与机制,为防治眼部爆震伤及风镜后续的设计改进提供理论依据。选用比格犬和C57小鼠进行相关动物实验,通过HE、Tunel、Nissl染色、视觉电生理检查等检测方法,发现随着冲击波强度的提高和伤后时间的延长,视网膜损伤程度和细胞凋亡程度均提高,其中神经节细胞层(ganglion cell layer,GCL)和光感受器内外节交界处(layer of photoreceptor inner/outer segments,IS/OS)受到的损伤最严重;进一步研究分子变化发现,自噬相关调节蛋白SQSTM1/p62(P<0.0001)和LC3-Ⅱ(P=0.8437)、LC3-Ⅰ(P=0.003)的表达量明显增高,说明视网膜损伤一定程度上是由爆震伤后自噬增强这一机制导致的。市售风镜的动物实验版能够有效减轻冲击波对视网膜的损伤,保护RNFL、INL/ONL、GCL和IS/OS的结构。同时,与其他组相比,3.5 MPa组防护组与损伤组视网膜损伤和细胞凋亡程度差异最显著,推测该强度下防护风镜发挥了最大的保护作用,保护机制与防护降低视网膜细胞自噬相关。

Microwave electrometry with Rydberg atoms in a vapor cell using microwave amplitude modulation

We have theoretically and experimentally studied the dispersive signal of the Rydberg atomic electromagneticallyinduced transparency(EIT)Autler–Townes(AT)splitting spectra obtained using amplitude modulation of the microwave(MW)electric field.In addition to the two zero-crossing points interval△f_(zeros),the dispersion signal has two positive maxima with an interval defined as the shoulder interval△f_(sho),which is theoretically expected to be used to measure a much weaker MW electric field.The relationship of the MW field strength E_(MW)and△f_(sho)is experimentally studied at the MW frequencies of 31.6 GHz and 9.2 GHz respectively.The results show that△f_(sho)can be used to characterize the much weaker E_(MW)than that of△f_(zeros)and the traditional EIT–AT splitting interval△f_(m);the minimum E_(MW)measured by△f_(sho)is about 30 times smaller than that by△f_(m).As an example,the minimum E_(MW)at 9.2 GHz that can be characterized by△f_(sho)is 0.056 mV/cm,which is the minimum value characterized by the frequency interval using a vapor cell without adding any auxiliary fields.The proposed method can improve the weak limit and sensitivity of E_(MW)measured by the spectral frequency interval,which is important in the direct measurement of weak E_(MW).

Building and characterizing a stylus ion-trap system

Cold trapped ions can be excellent sensors for ultra-precision detection of physical quantities,which strongly depends on the measurement situation at hand.The stylus ion trap,formed by two concentric cylinders over a ground plane,holds the promise of relatively simple structure and larger solid angle for optical access and fluorescence collection in comparison with the conventional ion traps.Here we report our fabrication and characterization of the first stylus ion trap constructed in China,aiming for studying quantum optics and sensing weak electric fields in the future.We have observed the stable confinement of the ion in the trapping potential for more than two hours and measured the heating rate of the trap to be dε/dt=7.10±0.13 meV/s by the Doppler recooling method.Our work starts a way to building practical quantum sensors with high efficiency of optical collection and with ultimate goal for contributing to future quantum information technology.

Advancing gastrointestinal stromal tumor management: The role of imagomics features in precision risk assessment

BACKGROUND Gastrointestinal stromal tumors(GISTs)vary widely in prognosis,and traditional pathological assessments often lack precision in risk stratification.Advanced imaging techniques,especially magnetic resonance imaging(MRI),offer potential improvements.This study investigates how MRI imagomics can enhance risk assessment and support personalized treatment for GIST patients.AIM To assess the effectiveness of MRI imagomics in improving GIST risk stratification,addressing the limitations of traditional pathological assessments.METHODS Analyzed clinical and MRI data from 132 GIST patients,categorizing them by tumor specifics and dividing into risk groups.Employed dimension reduction for optimal imagomics feature selection from diffusion-weighted imaging(DWI),T1-weighted imaging(T1WI),and contrast enhanced T1WI with fat saturation(CET1WI)fat suppress(fs)sequences.RESULTS Age,lesion diameter,and mitotic figures significantly correlated with GIST risk,with DWI sequence features like sphericity and regional entropy showing high predictive accuracy.The combined T1WI and CE-T1WI fs model had the best predictive efficacy.In the test group,the DWI sequence model demonstrated an area under the curve(AUC)value of 0.960 with a sensitivity of 80.0%and a specificity of 100.0%.On the other hand,the combined performance of the T1WI and CE-T1WI fs models in the test group was the most robust,exhibiting an AUC value of 0.834,a sensitivity of 70.4%,and a specificity of 85.2%.CONCLUSION MRI imagomics,particularly DWI and combined T1WI/CE-T1WI fs models,significantly enhance GIST risk stratification,supporting precise preoperative patient assessment and personalized treatment plans.The clinical implications are profound,enabling more accurate surgical strategy formulation and optimized treatment selection,thereby improving patient outcomes.Future research should focus on multicenter studies to validate these findings,integrate advanced imaging technologies like PET/MRI,and incorporate genetic factors to achieve a more comprehensive risk assessment.

Gastrointestinal dysfunction is associated with mortality in severe burn patients:a 10-year retrospective observational study from South China

Background:Data on severe and extensive burns in China are limited,as is data on the prevalence of a range of related gastrointestinal(GI)disorders[such as stress ulcers,delayed defecation,opioid-related bowel immotility,and abdominal compartment syndrome(ACS)].We present a multicentre analysis of coincident GI dysfunction and its effect on burn-related mortality.Methods:This retrospective analysis was conducted on patients with severe[≥20%total burn surface area(TBSA)]and extensive(>50%TBSA or>25%full-thickness TBSA)burns admitted to three university teaching institutions in China between January 1,2011 and December 31,2020.Both 30-and 90-day mortality were assessed by collating demographic data,burn causes,admission TBSA,%full-thickness TBSA,Baux score,Abbreviated Burn Severity Index(ABSI)score,and Sequential Organ Failure Assessment(SOFA)score,shock at admission and the presence of an inhalation injury.GI dysfunction included abdominal distension,nausea/vomiting,diarrhoea/constipation,GI ulcer/haemorrhage,paralytic ileus,feeding intolerance and ACS.Surgeries,length of intensive care unit(ICU)stay,pain control[in morphine milligram equivalents(MME)]and overall length of hospital stay(LOHS)were recorded.Results:We analyzed 328 patients[75.6%male,mean age:(41.6±13.6)years]with a median TBSA of 62.0%(41.0%–80.0%);256(78.0%)patients presented with extensive burns.The 90-day mortality was 23.2%(76/328),with 64(84.2%)of these deaths occurring within 30 d and 25(32.9%)occurring within 7 d.GI dysfunction was experienced by 45.4%of patients and had a significant effect on 90-day mortality[odds ratio(OR)=14.070,95%confidence interval(CI)5.886–38.290,P<0.001].Multivariate analysis showed that GI dysfunction was associated with admission SOFA score and%full-thickness TBSA.Overall,88.2%(67/76)of deceased patients had GI dysfunction[hazard ratio(HR)for death of GI dysfunction=5.951],with a survival advantage for functional disorders(diarrhoea,constipation,or nausea/vomiting)over GI ulcer/haemorrhage(P<0.001).Conclusion:Patients with severe burns have an unfavourable prognosis,as nearly one-fifth died within 90 d.Half of our patients had comorbidities related to GI dysfunction,among which GI ulcers and haemorrhages were independently correlated with 90-day mortality.More attention should be given to severe burn patients with GI dysfunction.

Perforation studies of concrete panel under high velocity projectile impact based on an improved dynamic constitutive model

The finite-depth concrete panels have been widely applied in the protective structures,and its impact resistance and dynamic fracture failures,especially the scabbing/perforation limits,under high velocity projectile impact,are mainly concerned by protective engineers,which are numerically studied based on an improved dynamic concrete model in this study.Firstly,based on the framework of the KCC(Karagozian&Case concrete)model,a dynamic concrete model is proposed which considers an independent tensile damage model and a continued transition between dynamic tensile and compressive properties.Secondly,the strength surface,equation of state and damage parameters of the proposed model are comprehensively calibrated by a triaxial compressive test with high confinement pressure,the rationality of which is further verified based on the single element tests,e.g.,uniaxial and triaxial compression as well as uniaxial,biaxial and triaxial tension.Thirdly,a series of projectile high velocity impact tests on thin and thick concrete panels are simulated,which indicates that the projectile residual velocity and dynamic fracture failures are reproduced satisfactorily,while the KCC model underestimates both the spalling and scabbing dimensions severely.Finally,based on the validated concrete model and finite element analyses approach,the validations of the existing five empirical formulae are evaluated,in terms of the depth of penetration(DOP)and scabbing/perforation limits of concrete panel.Both the Army corps of engineers(ACE)and modified National Defense Research Committee(NDRC)formulae are recommended in the design of the protective structure to avoid scabbing failure.

Stochastic Resonance in a Single-Ion Nonlinear Mechanical Oscillator

Stochastic resonance is a counterintuitive phenomenon amplifying the weak periodic signal by application of external noise.We demonstrate the enhancement of a weak periodic signal by stochastic resonance in a trappedion oscillator when the oscillator is excited to the nonlinear regime and subject to an appropriate noise.Under the full control of the radio-frequency drive voltage,this amplification originates from the nonlinearity due to asymmetry of the trapping potential,which can be described by a forced Duffing oscillator model.Our scheme and results provide an interesting possibility to make use of controllable nonlinearity in the trapped ion,and pave the way toward a practical atomic sensor for sensitively detecting weak periodic signals from real noisy environment.

颅脑爆炸伤致伤机制及防护研究进展

颅脑爆炸伤是现代战争中士兵面临的主要伤害之一,近年来受到广泛关注。冲击波经由颅脑传播带来的直接伤害被称为初级爆炸伤。目前,初级颅脑爆炸伤致伤机制尚不明确,可能是应力波传播、颅骨弯曲变形、颅脑空化及躯干压缩等多种因素共同作用的结果。该研究是涉及多学科交叉、多物理场耦合及短时和长时效应共存的复杂问题,需要通过建立描述冲击波和颅脑相互作用的高精度、多尺度和多物理场数值模型,发展测量颅骨应变、颅内压力、加速度等力学指标的物理测试系统,结合人体和动物病理、生理、行为学等综合因素分析,最终揭示颅脑爆炸伤致伤机制。本文中介绍了初级颅脑爆炸伤致伤机制,给出了颅脑爆炸伤的行为学、生理学相关的医学评价指标,以及颅骨应变、颅内压力等关键力学评估指标,提出了基于致伤机制和评价指标的防护结构设计方法,包括基于新型防冲击波材料的头盔系统改进、头盔缓冲系统设计、增加头部保护系统的封闭性等,最后展望了在精细化建模、原位实验及防护系统设计等诸多方面的发展趋势。

乌司他丁预处理下调NLRP3保护缺血性脑损伤的研究

目的探讨乌司他丁(UTI)通过调控核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)表达影响神经元凋亡,发挥保护受损神经元的作用和分子机制。方法培养原代神经元至成熟,随机分为空白组(Sham组)、对照组(Control组)和乌司他丁预处理组(UTI组)。先进行UTI组和对照组预处理72 h,再进行氧糖剥夺损伤3 h、6 h,最后恢复正常培养液培养2 h后取材。利用荧光免疫组化法检测NLRP3的空间表达情况;利用蛋白质印迹法(Western-blot)检测NLRP3的蛋白水平表达变化。利用细胞计数试剂盒(cell counting kit-8,CCK-8)检测试剂盒检测神经元凋亡情况。结果与对照组比较,氧糖剥夺6 h后UTI组的NLRP3蛋白表达明显降低(P<0.05),且神经元凋亡数量显著减少,各组间差异有统计学意义(P<0.05);而氧糖剥夺3 h后UTI组的NLRP3蛋白表达和神经元凋亡数量无明显变化(P>0.05)。结论 UTI预处理调控NLRP3的表达,可能是减轻神经元凋亡的重要原因之一,具有显著的保护受损神经细胞的作用。

VEGFR-3 ligand-binding and kinase activity are required for lymphangiogenesis but not for angiogenesis

Although VEGFR-3 deficiency disrupts blood vascular development during early embryogenesis, the underlying mechanism was not clear. To characterize its function in angiogenesis and lymphangiogenesis, we employed two genetically modified mouse models in this study, targeting the coding region for the ligand-binding domain （Vegfr△LBD） or the tyrosine kinase domain with an inactivation point mutation （Vegfr3^TKmat）. We show that lymphatic growth was disrupted in Vegfr3△LBD/△LBD and Vegfr3^TKmut3^TKmat mice, but blood vessels developed normally in both embryo and yolk sac. Interestingly, in Vegfr3△LBD/△LBD but not Vegfr3^TKmut3^TKmat mice, lymph sac was present but there was lack of iym- phangiogenic sprouting. We further demonstrate that both the wild-type and mutant forms of VEGFR-3 could form heterodimers with VEGFR-2, and decreased the level of phospho-VEGFR-2 and the downstream phospho-Erk1/2 in endothelial cells when they were treated with VEGF-A. These findings indicate that signaling mediated via VEGFR-3 activation by its cognate ligands （VEGF-C/-D） is not required for angiogenesis, and that VEGFR-3 may play a role in this process by modulating VEGFR-2-mediated signals.

Adipocyte-derived SFRP5 inhibits breast cancer cells migration and invasion through Wnt and epithelial-mesenchymal transition signaling pathways

Objective:Obesity is closely associated with metastasis in breast cancer patients.Secreted frizzled-related protein 5(SFRP5),one of the novel adipokines with anti-inflammatory properties,is associated with obesity.This study aims to study the role of SFRP5 in the crosstalk between obesity and breast cancer metastasis and identify the underlying mechanism.Methods:3T3-L1 pre-adipocytes were differentiated to mature adipocytes and a hypertrophic adipocyte model was induced with palmitic acid(PA).Cell motility was measured in MDA-MB-231 and MCF-7 breast cancer cells co-cultured with adipocytes conditioned medium(CM)with or without SFRP5 protein.Wnt and epithelialmesenchymal transition(EMT)signal pathways were investigated by western blot.Circulating SFRP5 level in 218 breast cancer patients and the association with clinicopathologic characteristics of breast cancer were further determined.Online databases ENCORI and PREDICT Plus were used to exam the link between SFRP5 and prognosis.Results:Reduced SFRP5 level was detected in the hypertrophic adipocyte model.Recombinant SFRP5 protein inhibited MDA-MB-231 and MCF-7 cells invasion and migration induced by PA-treated adipocyte CM,and SFRP5 inhibition by specific antibody reversed the effect of SFRP5.Furthermore,SFRP5 significantly inhibited Wnt and downstream EMT in breast cancer cells.Low circulating SFRP5 level correlated with body mass index(BMI),lymph node(LN)metastasis,TNM stage and high Ki67 expression in breast cancer patients.Increased SFRP5 level was associated with favorable predicted survival.Kaplan-Meier curves showed high SFRP5 level in tumor tissue was associated with better outcome of breast cancer patients.Conclusions:Our findings demonstrated SFRP5 is a vital adipokine that mediates the crosslink between obesity and the metastatic potential of breast cancer.Promotion of SFRP5 expression in the adipose microenvironment may represent a novel approach for preventing breast cancer metastasis.

An all-optical phase detector by amplitude modulation of the local field in a Rydberg atom-based mixer

Recently,a Rydberg atom-based mixer was developed to measure the phase of a radio frequency(RF)field.The phase of the signal RF(SIG RF)field is down-converted directly to the phase of a beat signal created by the presence of a local RF(LO RF)field.In this study,we propose that the Rydberg atom-based mixer can be converted to an all-optical phase detector by amplitude modulation(AM)of the LO RF field;that is,the phase of the SIG RF field is related to both the amplitude and phase of the beat signal.When the AM frequency of the LO RF field is the same as the frequency of the beat signal,the beat signal will further interfere with the AM of the LO RF field inside the atom,and then the amplitude of the beat signal is related to the phase of the SIG RF field.The amplitude of the beat signal and the phase of the SIG RF field show a linear relationship within the range of 0 toπ/2 when the phase of the AM is set with a differenceπ/4 from the phase of the LO RF field.The minimum phase resolution can be as small as 0.6°by optimizing the experimental conditions according to a simple theoretical model.This study will expand and contribute to the development of RF measurement devices based on Rydberg atoms.

颅脑损伤继发创伤性脑梗死的临床特点及其相关危险因素

目的观察颅脑损伤继发创伤性脑梗死的临床特点及发生的相关危险因素。方法选取2014年1月至2015年6月在我院住院的颅脑损伤患者80例进行研究,按是否继发创伤性脑梗死(TCI)将患者分为TCI组和非TCI组,观察TCI组的临床特点,对患者的年龄、性别、GCS评分、脑疝、颅骨骨折、糖尿病、蛛网膜下腔出血、低血压等因素进行统计学分析,探究颅脑损伤继发创伤性脑梗死的相关危险因素。结果 TCI的临床特点主要是偏侧肢体运动及感觉功能障碍、视功能异常、语言功能异常、反应迟钝,TCI的预后为良好11例、轻度残疾7例、重度残疾5例、死亡3例。单因素分析结果提示TCI主要与年龄、GCS评分、脑疝、低血压、蛛网膜下隙出血、颅底骨折等因素具有相关性(P <0. 05),经由Logistic回归分析表明,低血压、脑疝属于TCI的独立高危因素。结论低血压和脑疝为颅脑损伤继发TCI的独立危险因素,合理进行干预对预防TCI的发生具有重大临床意义。

Regulation of fertilization in male rats by CatSper2 knockdown

Interest in ion channels as drug targets for contraception has grown with the realization that certain ion channel subunits are located exclusively in sperm. Selective knockdown of ion channel subunits can lead to infertility without ill effects, and selective inhibitors and/ or openers of these ion channels could interfere with sperm function. In this study, in vivo electmporation （EP） and rete testis microinjection-mediated plasmid DNA were adopted to silence CatSper2 expression, which is essential in sperm hyperactivation. The results showed that high transfection efficiency and expression were achieved by plasmid DNA that was directly injected into the rete testis. As a result of the expression of CatSper2 being blocked, the treatment group showed significantly lower （P〈0.05） hyperactivation rate, fertilization rate in vitro, migration motility in viscoelastic solution and intracellular Ca2＋ peak. The low hyperactivation and fertilization rates lasted for 60 days. Meanwhile, analysis of the sperm survival rate and testis histology indicated that in vivo EP had no significant effect on the function of the testis, spermatogenesis or sperm activity. The present study demonstrated that it was feasible to achieve male contraception by silencing the expression of CatSper2, the key protein involved in sperm hvoeractivation.

1D study of the detonation phenomenon and its influence on the interior ballistics of the combustion light gas gun

One-dimensional simulations with a detailed hydrogen-oxygen reaction mechanism have been performed to investigate detonation phenomenon in a combustion light gas gun(CLGG).Convection fluxes of the Navier-Stokes equations are solved using the WAF(weighted average flux)scheme HLLC Riemann solver.A high resolution fifth-order WENO scheme for the variable extrapolation at the volume interface and a fourth-order Runge-Kutta scheme for the time advancement are used.Validation tests of the stoichiometric hydrogen-oxygen deflagration to detonation transition process shows good agreement between the computed results and the analytical and documented solutions,demonstrating the reliability on the detonation simulation of the current scheme.Simulation results of the interior ballistic process of the CLGG show that the flame propagation experiences three distinct stages.The blast detonation wave causes a high-pressure shock and hazardous oscillations in the chamber and makes the projectile accelerate with fluctuations,but has only a small improvement to the muzzle velocity.

Targeted therapies for patients with advanced NSCLC harboring wild-type EGFR:what's new and what's enough

Historically,non-small cell lung cancer(NSCLC) is divided into squamous and nonsquamous subtypes based on histologic features.With a growing number of oncogenic drivers being identified in squamous and nonsquamous NSCLC,this malignancy has been recently divided into several distinct subtypes according to the specific molecular alterations.This new paradigm has substantially highlighted the treatment of advanced NSCLC,shifting it from standard chemotherapy according to specific histologic subtypes to targeted therapy according to specific oncogenic drivers.The application of epidermal growth factor receptor(EGFR)-tyrosine kinase inhibitors(TKIs) in NSCLC patients harboring activating EGFR mutations has been a representative model of precise medicine in the treatment of NSCLC.As the role of EGFR-TKIs in routine management of patients with advanced NSCLC has been well established,this review provides an overview of alternative targeted therapy in the treatment of NSCLC,including EGFR-TKIs for patients with wild-type EGFR NSCLC,as well as other targeted agents either clinical available or in early- to late-stage development.

Advances in the management of acquired resistance to EGFR-TKI in non-small cell lung cancer

Drugs that specifically target the tyrosine kinase domain of epidermal growth factor receptor(EGFR), such as erlotinib or gefitinib, have exhibited striking efficacy in non-small cell lung cancer(NSCLC) patients harboring activating EGFR mutations. However, acquired resistance inevitably develops and remains a serious barrier for the successful management of patients with this disease. Multiple mechanisms are reportedly involved in the process of acquired resistance, which provide new insights into the management of EGFRtyrosine kinase inhibitor(EGFR-TKI) resistance. Here, we provide an overview of the emerging treatment approaches for patients with EGFR-TKI resistance.

Giant ventral hernia simultaneously containing the spleen, a portion of the pancreas and the left hepatic lobe: A case report

BACKGROUND Ventral hernia,also known as incisional hernia,is a common complication of previous surgery.The contents of ventral hernia may include omentum,preperitoneal fat,small intestine or colon.However,ventral hernia with protrusion of more than two parenchymal organs simultaneously is extremely rare,and its repair is very complex and difficult.Surgeons should make a comprehensive assessment based on their own experience and the individual characteristics of the hernia.In addition,psychological therapy should be emphasized in the whole treatment process.CASE SUMMARY We report a rare case of asymptomatic giant ventral hernia for 15 years in a 21-year-old female.The patient underwent umbilical hernia repair at the age of 1 year.Approximately 5 years later,ventral hernia recurred and repair with Mesh was performed,but the operation failed due to postoperative infection,and a huge mass appeared in the left abdominal wall.The mass increased gradually with the development and maturity of the body.Computerized tomography scan demonstrated that the patient's total spleen,part of the pancreas and left lobe of the liver were simultaneously herniated through the abdominal incisional hernia.As the patient was unable to endure the inconvenience of life and the potential risk of spleen or liver rupture,she underwent a ventral hernia repair with Mesh at our hospital.The operation was successful and the patient had a good recovery.During a 3-mo follow-up,the patient remained asymptomatic and the appearance of the surgical incision was greatly improved.CONCLUSION Ventral hernia is a common complication of abdominal surgery.Ventral hernia with protrusion of more than two parenchymal organs simultaneously is extremely rare.Surgeons should pay attention to the psychological treatment while restoring the abdominal physiological function in ventral hernia patients.