Hepatocellular carcinoma with concomitant hepatic angiomyolipoma and cavernous hemangioma in one patient.

The risk of developing hepatocellular carcinoma (HCC) is strongly associated with hepatitis B virus infection. Hepatic angiomyolipoma (AML), a rare benign tumor, is composed of a heterogeneous mixture of adipose cells, smooth muscle cells and blood vessels. Here, we report the case of a 44-year-old man who developed HCC with a concomitant hepatic AML and a cavernous hemangioma, in the absence of cirrhosis. To our knowledge, based on an extensive literature search using the www.pubmed.gov website, this is the first report of an HCC case with both concomitant AML and cavernous hemangioma at the same position in the liver. The presence of the hepatitis B surface antigen was detected, but the liver function was normal. Clinical and pathological data were collected before and during the treatment. Hepatic AML was diagnosed based on the typical histological characteristics and immunohistochemical staining, which revealed, a positive staining with a melanocytic cell-specific monoclonal antibody. There was no evidence of tuberous sclerosis complex in this patient. Although the HCC was poor- to moderately-differentiated, the characteristics of the AML and the cavernous hemangioma in this patient did not match any criteria for malignancy. Hepatectomy followed by transarterial chemoembolization treatment were effective therapeutic methods for the adjacent lesions in this patient. This case is an interesting coincidence.

Different behaviors in the transformation of PATP adsorbed on Ag or Au nanoparticles investigated by surface-enhanced Raman spectroscopy - a study of the effects from laser energy and annealing.

In order to explore the key role of surface plasmon resonance (SPR) and active (3)O2 for the chemical transformation to 4,4-dimercaptoazobenzene (DMAB) from p-aminothiophenol (PATP) adsorbed on Ag or Au NPs, we systematically investigated the laser wavelength and temperature dependent surface-enhanced Raman spectra of PATP capped Ag and Au NPs. DMAB can be easily observed at the 514.5nm laser for Ag NPs but at the 632.8nm laser for Au NPs, indicating that a suitable energy level is necessary for the formation of DMAB. The tendency is consistent with the wavelength dependent SPR properties of Ag or Au NPs accordingly. With the energy provided by annealing, the transformation of PATP to DMAB is much easier on Ag NPs at a lower temperature, and more DMAB can be observed at the same temperature, compared to the case of Au NPs under the same condition. It is mainly due to the active (3)O2 on Ag surfaces could be more easily formed than that on Au surfaces.

Laser-induced chemical transformation of PATP adsorbed on Ag nanoparticles by surface-enhanced Raman spectroscopy-a study of the effects from surface morphology of substrate and surface coverage of PATP.

The laser induced transformation of p-aminothiophenol (PATP) to p,p'-dimercaptoazobenzene (DMAB) has attracted intensive interest recently, in which localized surface plasmon resonance (LSPR) assisted photocatalysis has been demonstrated to play an important role. In this paper, we systematically investigate the factors that influence the reaction for further understanding the mechanism using surface-enhanced Raman spectroscopy. The laser-induced formation of DMAB was found to depend on the surface coverage of PATP, the aggregation state of NPs, and the laser power. The disappearance of DMAB Raman signal at very low concentration of Ag NPs reveals that DMAB may only be formed between the neighboring NPs that can provide a suitable distance for the interaction between adsorbed PATP molecules.

Effects of hypoxic exercise training on microRNA expression and lipid metabolism in obese rat livers.

To investigate the effects of hypoxic exercise training on microRNA (miRNA) expression and the role of miRNA expression in regulating lipid metabolism, 20 dietary-induced obese SD rats were divided into a normoxic sedentary group (N, n=10) and a hypoxic exercise training group (H, n=10). After four weeks, measurements were taken of body weight, body length, fat mass, serum lipid concentration, miRNAs differentially expressed in rat liver, and gene and protein expression levels of peroxisome proliferator activated receptor α (PPARα), fatty acid synthetase (FAS), and carnitine palmitoyl transferase 1A (CPT1A) in rat liver. Body weight, Lee's index, fat mass, fat/weight ratio, and serum levels of total cholesterol (TC) and high density lipoprotein cholesterol (HDL-C) were all significantly lower in the H group than in the N group (P<0.01). Six miRNAs expressed significantly differently in the liver (P<0.05). Specifically, expression levels of miR-378b were significantly lower in the H group than in the N group (P<0.05). Compared with the normoxic sedentary group, hypoxic exercise training resulted in a lower ratio of FAS mRNA to CPT1A mRNA (P<0.05), as well as lower CPT1A protein levels (P<0.01), while a higher ratio of FAS to CPT1A protein levels (P<0.01) was observed. In conclusion, hypoxic training may elevate the resistance of high fat diet induced obesity in rats by reducing the expression of miR-378b, and decrease the fatty acid mitochondrial oxidation in obese rat livers by decreasing the protein expression of CPT1A and increasing the protein expression ratio of FAS/CPT1A.

Long non-coding RNA CARLo-5 is a negative prognostic factor and exhibits tumor pro-oncogenic activity in non-small cell lung cancer.

Despite recent advances in the management of non-small cell lung cancer (NSCLC), the prognosis of NSCLC is still relatively poor. Thus, it is of great importance to identify novel effective diagnostic and prognostic biomarker of NSCLC. A growing volume of literature has demonstrated the vital roles of long non-coding RNAs (lncRNAs) in cancer biology. Cancer-associated region long non-coding RNA (CARLo-5), a recently identified lncRNA, was initially characterized in colon cancer. However, little is known about its role in NSCLC. In the present study, a great upregulation of CARLo-5 was observed in cancer tissues compared to their adjacent normal tissues. Meanwhile, patients with high CARLo-5 expression have significantly poorer prognosis than those with low expression. Inhibition of CARLo-5 by siRNA suppressed the proliferation, migration, and invasion in NSCLC cell lines in vitro. In addition, silencing of CARLo-5 reversed the epithelial-mesenchymal transition in NSCLC cell line. Our study suggests that CARLo-5 may represent a prognostic marker and a potential therapeutic target of NSCLC.

Etoposide-cisplatin alternating with vinorelbine-cisplatin versus etoposide-cisplatin alone in patients with extensive disease combined with small cell lung cancer.

BACKGROUND: The aim of this study was to evaluate the efficacy of alternating etoposide-cisplatin and vinorelbine-cisplatin (EP-NP) compared with an etoposide-cisplatin (EP) regimen for advanced combined small cell carcinomas. MATERIALS AND METHODS: Histologically confirmed combined small cell carcinoma patients who met the inclusion criteria were randomly assigned (1:1) into either the EP-NP setting (group A) or the EP setting (group B). The primary endpoint was progression-free survival in patients who received at least one dose of treatment. RESULTS: Eighty-two patients entered into this trial, 42 in group A and 40 in group B. The objective response rates in group A and group B were 42.9% and 32.5%, respectively (p=0.334). Survival analysis showed that median progression-free survival was 6.1 months in group A, which was significantly longer than the 4.1 months in group B (p=0.041). However, as to overall survival, no significant difference was found between the two groups (11.0 vs 10.1 months in groups A and B, respectively, p=0.545). No unexpected side effects were observed in either group. CONCLUSIONS: The EP-NP regimen for combined small cell carcinomas prolonged progression- free survival compared with the EP regimen. Further clinical investigations are warranted.

[A cross-sectional survey on the prevalence of Brucellosis among workers in Jiangsu province, 2012].

OBJECTIVE: To study the status of infection and risk factors on Brucellosis among workers in Jiangsu province so as to provide related preventive and control measures. METHODS: A cross-sectional survey was conducted on 238 workers at three butcheries, one trading market and one stockyard. Related risk factors on the different exposures to the disease were also analyzed. RESULTS: 50 workers were identified to have had the infection, with a infection rate as 21% (50/238). No significant differences in gender, age, working length and occupations were found. Jobs as slaughtering (RR = 1.80, 95%CI:1.1-3.1), particular on bleeding (RR = 1.90, 95%CI:1.1-3.3) were risk factors. Habit as hand-washing before eating was a protective factor (RR = 0.25, 95% CI: 0.14-0.44). CONCLUSION: Workers from butcheries, trading markets and stockyards were seriously infected with Brucellosis in Jiangsu province and related. Control measures and education should be implemented to the workers in that trade.

Electrochemical behavior of N-methyl-N'-carboxydecyl-4,4'-bipyridinium probed by surface-enhanced Raman spectroscopy.

Interfacial structure determines the activity and selectivity of a sensor and plays important roles in interfacial electrochemistry, electroanalysis, biosensing, etc. In situ electrochemical Raman spectroscopy appears to be a powerful tool to probe the electrochemical interface and surface process by providing the molecular fingerprint information. Herein, the electrochemical behaviors of N-methyl-N'-carboxydecyl-4,4'-bipyridinium (derivatives of methyl viologens, MV(2+)) with different alkyl chain lengths (n=2 and 10) on roughened Au electrodes were systematically investigated by the electrochemical surface-enhanced Raman spectroscopy (SERS). Three systems with different interfacial structures were constructed. One is to anchor the MV(2+) molecules via esterification with the 2-mercaptoethanol molecule pre-assembled on the Au surface. The second system is similar to the first one but without esterification. The third system is the direct adsorption of MV(2+) molecules on the bare roughened Au surfaces. The three systems gave different spectral response upon the change of the electrode potential. A drastically increased relative Raman intensity of 19a/8a modes of the MV(2+) molecules was observed at negative potentials. The phenomenon is attributed to the formation of the reduced form of MV(2+) molecules, which produces resonant Raman effect to enhanced the signal of 19a mode. The third system showed the highest electrochemical reduction activity towards the reduction of MV(2+) molecules, followed by the first and second systems. The result indicates that the interfacial structure can sensitively influence electrochemical activity of the electrode.

[Clinical characteristics and diagnosis of pulmonary mucosa-associated lymphoid tissue-derived (MALT) lymphoma: a retrospective analysis of 29 cases].

OBJECTIVE: To study the clinical manifestations and radiological characteristics, diagnostic methods and outcomes of pulmonary mucosa-associated lymphoid tissue-derived(MALT) lymphoma. METHODS: A retrospective review of clinical, radiological and follow-up data of 29 pulmonary MALT lymphoma cases at Shanghai Pulmonary Hospital affiliated to Tong Ji University from January 2002 to June 2010 was performed. RESULTS: Among these patients, there were 19(65.5%) males and 10 (34.5%) females aged from 27 to 73 (median 53) years old. Common clinical manifestations were cough (51.7%), fever (20.7%), apnea (17.2%), chest pain (17.2%), fatigue (13.8%) and weight loss (13.8%), while 9(31.0%) cases had no symptoms at diagnosis. The characteristics of the chest CT showed that 22 (75.9%) of the cases had patch infiltration or consolidation of the lung, 7(24.1%) of the cases had mass, and 15 (51.7%) unilateral and 14(48.3%) bilateral lesions. Their diagnosis duration varied between 0.5 and 96 months. 18(62.1%) cases were confirmed by surgery (15 open lung and 7 video-assisted thoracic surgery, VAST), 4 (13.8%) by percutaneous lung biopsy, 5 (17.2%) by bronchoscopic biopsy, and 2 (6.9%) by peripheral lymph node biopsy. The treatment methods included surgery, combined chemotherapy, radiotherapy and Chinese herbal medicine. The 1- and 3-year-survival rates were 92.3% and 87.4%, respectively. CONCLUSIONS: Pulmonary MALT lymphoma is atypical in clinical manifestations and radiological characteristics, and easy to be misdiagnosed. Local diseases are mainly treated by operation while extensive diseases receive combined chemotherapy. A proper diagnosis is mainly based on pathological biopsy. Patients with MALT lymphoma have a favorable outcome. Poor prognosis may be connected with poor performance status and long diagnosis duration.

[Detection of KRAS gene mutation and its clinical significance in colorectal adenocarcinoma].

OBJECTIVE: To explore the clinical significance of KRAS mutation detection in colorectal adenocarcinoma. METHODS: Paraffin-embedded tissue specimens were obtained from 440 patients with colorectal adenocarcinoma. The genomic DNA was extracted. Mutations of exon 2 of KRAS gene were examined by PCR and direct sequencing. RESULTS: Somatic mutations of KRAS gene were identified in 146 cases, with the mutation rate of 33.2% (146/440). Among these 146 patients, KRAS mutation involved codon 12 in 118 patients, including 35G > A (Gly12Asp, 62 cases), 35G > T (Gly12Val, 35 cases), 34G > T (Gly12Cys, 9 cases), 34G > A (Gly12Ser, 6 cases), 35G > C (Gly12Ala, 5 cases), and 34G > C (Gly12Arg, 1 case); in 27 patients the mutation involved codon 13, including 38G > A (Gly13Asp, 25 cases), 38G > C (Gly13 Val, 1 case) and 37G > T (Gly13 Cys, 1 case); and in one patient, the mutation involved codon 14 with 40G > A (Val14Ile). The status of KRAS or codon 12 mutations in colorectal adenocarcinoma was related to patients' gender (P = 0.021 and P = 0.030, respectively), and this significant correlation to females was conserved in clinical stage III (P = 0.007 and P = 0.003, respectively), but not in stages I, II, and IV. The status of KRAS or codon 12 mutations was also related to tumor stage. Between stage II and stage IV, the mutation rate of KRAS and codon 12 showed significant difference (P = 0.028 and 0.034, respectively). Between stage III and stage IV, only the codon 12 mutation rate showed significant difference (P = 0.011). Codon 13 mutation was not related to tumor stage. CONCLUSION: About one third of patients with colorectal adenocarcinoma have KRAS gene mutation, which might be related to patients' gender; and could be consistently detected by PCR and direct sequencing.

Individualized Chemotherapy in Advanced NSCLC Patients Based on mRNA Levels of BRCA1 and RRM1.

OBJECTIVE: Experimental evidence suggests that the overexpression of breast cancer-specific tumor suppressor protein 1 (BRCA1) gene enhances sensitivity to docetaxel and resistance to cisplatin and ribonucleotide reductase M1 (RRM1) gene overexpression enhances resistance to gemcitabine. To further examine the effect of BRCA1 and RRM1 mRNA levels on outcome in advanced non-small cell lung cancer (NSCLC), we performed this non-randomized phase II clinical trial which tested the hypothesis that customized therapy would confer improved outcome over non-customized therapy. METHODS: RNA was isolated from fresh tumor tissue. Patients received chemotherapy regimen based on their BRCA1 and RRM1 mRNA levels: both low-cisplatin plus gemcitabine (GP); both high-vinorelbine plus cisplatin (NP); BRCA1 low and RRM1 high-cisplatin plus docetaxel (TP); BRCA1 high and RRM1 low-vinorelbine plus gemcitabine (GN). RESULTS: From Dec 2005 to Nov 2008, 94 metastatic and locally advanced NSCLC patients from our institute were enrolled in this study. The median age was 58 years old. Among them, 21 patients received GP, 30 patients received TP and 43 patients received NP chemotherapy. GP group had a higher response rate, and longer median time to progression (TTP) and median overall survival (OS) time than the other 2 groups. The response rates in the GP, TP and NP groups were 42.9%, 36.7% and 27.9%, respectively (P=0.568). The median TTP was 5.6, 5.0, 4.8 months (P=0.975), respectively, and the median OS time was 12.5, 11.0, 9.7 months (P=0.808), respectively. CONCLUSION: Chemotherapy customized according to BRCA1 and RRM1 expression levels is associated with higher response rate and longer TTP and OS time in the GP group. This suggests that BRCA1 and RRM1 mRNA levels could be used as biomarkers in individual therapy in NSCLC.

[Focal nodular hyperplasia of liver: a clinicopathologic study of 238 patients].

OBJECTIVE: To study the clinicopathologic features of focal nodular hyperplasia (FNH) of liver. METHODS: The clinical, radiologic, pathologic findings and follow-up data of 238 cases of FNH were retrospectively analyzed. RESULTS: The patients included 93 females and 145 males. The age of the patients ranged from 11 to 77 years (median = 39.1 years). Amongst the 233 patients who had clinical information available, 188 were asymptomatic, 216 had no history of hepatitis B and/or C infection and 232 had negative serum alpha-fetoprotein level. Amongst the 185 patients who had undergone radiologic examination, 123 (66.5%) were accurately diagnosed as such. Macroscopically, of the 284 lesions from 238 patients, the average diameter was 3.7 cm. Two hundred and fifteen cases (90.3%) were solitary, 172 cases were located in the right lobe and 115(40.5%) had central stellate fibrotic scars or lobulated cut surface. Histologically, 229 lesions belonged to classic type and 9 lesions were of non-classic type. The latter was further classified as the telangiectatic form (6 lesions) and the mixed hyperplastic and adenomatous form (3 lesions). There was no evidence of significant cytologic atypia. Follow-up data were available in 173 patients (72.7%). None of them died of the disease and 2 patients suffered from relapses after 2 and 4 years, respectively. CONCLUSIONS: FNH is a hyperplastic response of normal liver cells to local blood flow anomalies. It has no obvious sex predilection and more than 66% can be diagnosed accurately with radiologic examination. The lesions in the current study show no cytologic atypia.

Clinical and pathological studies of borderline gastrointestinal stromal tumors.

BACKGROUND: Borderline gastrointestinal stromal tumors (GISTs) are intermediate tumors between benign and malignant variants; however, the clinical and pathological features of borderline GISTs remain poorly defined. This study aimed to characterize GISTs and to identify a set of borderline criteria for practical use. METHODS: Medical records and specimens of 840 patients from 12 hospitals were retrospectively examined. Totally 485 and 76 patients with any of the parameters predictive of either malignant or benign tumors were excluded. The Kaplan-Meier method was used to calculate disease-free survival and overall survival rates. RESULTS: Among the remaining 279 borderline GIST patients, 223 were followed up for 1 to 31.48 years. Two patients developed local recurrence, and both were cured by subsequent operations alone. The 5-year disease-free survival and overall survival rates were 99% and 100%, respectively. Morphologically, borderline GISTs typically exhibited moderate cellularity, and subsets of them also showed moderate atypia, low mitotic activities, or large tumor size. According to the National Institutes of Health (NIH) consensus criteria, the risk levels of the 279 GISTs were classified to be very low to high. However, the disease-free survival rates were not significantly different among these risk groups (P = 0.681). CONCLUSIONS: The proposed borderline GIST criteria in the current study may complement the existing NIH criteria, based primarily on tumor size and mitotic count, in the evaluation of the biological behaviors of GISTs. Since a subset of borderline GISTs with high risk level showed favorable outcome, the introduction of the borderline GIST system may avoid overdiagnosis and over therapy.

[Melanotic epithelioid clear cell tumor of kidney: report of three cases].

OBJECTIVE: To study the pathologic features and immunophenotype of 3 cases of melanotic epithelioid clear cell tumor of kidney. METHODS: More than 2000 cases of renal tumors were retrospectively reviewed. Three cases of melanotic epithelioid clear cell tumor were identified. Immunohistochemical study was carried out using the paraffin-embedded tissue samples. Electron microscopy was also performed in 1 case. RESULTS: Amongst the 3 cases studied, the male-to-female ratio is 1:2. Histologically, 2 cases showed a clear cell carcinoma-like pattern. Papillary structures covered by clear cells and eosinophilic cells were observed in 1 case. Immunohistochemical study showed that the tumor cells in all cases expressed HMB 45. Two of them were also positive for Melan A. The staining for epithelial markers and S-100 protein was negative. Melanosomes were not identified by ultrastructural examination. CONCLUSIONS: Melanotic epithelioid clear cell tumor is a rarely seen neoplasm of kidney. There are some histologic overlaps with renal cell carcinoma, epithelioid angiomyolipoma and melanoma. Immunohistochemical study is useful in confirming the diagnosis. The tumor represents a morphologic variant of epithelioid angiomyolipoma.

Clinical and histopathological alterations of lymphangioleiomyomatosis in 14 Chinese patients.

BACKGROUND: Lymphangioleiomyomatosis (LAM) is a rare disease that predominantly affects young females. It is considered as an "orphan" life-threatening disease of unknown etiology, with uncertain clinical prognosis, and no effective treatment. LAM can arise sporadically or in association with tuberous sclerosis complex (TSC), an autosomal inherited syndrome characterized by hamartoma-like tumor growth and pathologic features that are distinct from manifestations of pulmonary LAM. The clinical course of LAM is characterized by progressive dyspnea on exertion, recurrent pneumothorax, and chylous fluid collections. METHODS: Fourteen cases of LAM from Zhongshan Hospital, Fudan University are reviewed, twelve were confirmed by lung biopsy, one by retroperitoneal lymphangioleiomyoma resection, and one by autopsy. RESULTS: All 14 patients were women, aged 18 to 69 years (mean 43.3 years, median 46.5 years). Haemoptysis (57.1%) and chylothorax (35.7%) were more frequent than those described in previous case series. Extrapulmonary findings such as renal angiomyolipoma (AML), enlarged abdominal lymph nodes, liver AML and retroperitoneal lymphangioleiomyoma were seen in 21.4%, 14.3%, 7.14% and 7.14% in 14 cases respectively, which is remarkably lower than in the previously reported. Abnormal smooth muscle cells (LAM cells) were found to line the airways, bronchioles, lymphatics and blood vessels leading to airflow obstruction and replacement of the lung parenchyma by cysts. There were some surprises in the autopsy case as several LAM cell emboli were found in the veins of mediastinum lymph nodes; LAM cells were found to be disseminated in soft tissues adjacent to the ilium. CONCLUSIONS: Women with unexplained recurrent pneumothorax, tuberous sclerosis, or a diagnosis of primary spontaneous pneumothorax or emphysema in the setting of limited or absent tobacco use should undergo high-resolution computed tomography (HRCT) scan screening for LAM. Routine abdominal and pelvic imaging examinations should be performed to detect extrapulmonary involvement. The autopsy studies histologically suggested that LAM could be a multisystemic disease and LAM cells might possess metastatic potential.

[Clinicopathologic analysis of pulmonary lymphangioleiomyomatosis].

OBJECTIVE: To improve the understanding and diagnosis of pulmonary lymphangioleiomyomatosis (LAM). METHODS: Fifteen cases of LAM of our hospital were presented and 73 cases reported in domestic literature from 1993 to 2008 were reviewed. By means of histological and immunohistochemical(IHC)studies, the clinical and pathological features of LAM were analyzed. RESULTS: All the 88 cases were female, with an average age of onset at (37 +/- 9) years. The main clinical manifestations included dyspnea (83/88, 94%), hemoptysis (48/88, 54%), pneumothorax (41/88, 47%), and chylothorax (28/88, 32%). High resolution computerized tomography (HRCT) showed thin-walled air-filled cysts throughout both lungs. Pathological features showed cystic changes in the lung, and abnormal smooth muscle cells (LAM cells) lined the airways, bronchioles, lymphatics and blood vessels leading to airflow obstruction and replacement of the lung parenchyma by cysts. In the autopsy case, extrapulmonary organs (eg, kidney, lymph nodes and soft tissues) were also involved. Abnormal manifestations in abdomen, including renal mass, retroperitoneal mass and retroperitoneal lymphadenopathy, were detected in 23 cases. CONCLUSIONS: LAM is a multisystem disease. Chest HRCT had confirmative value for diagnosis of LAM. In practice, chest HRCT, as well as other routine abdominal and pelvic imaging examinations, should be performed for child-bearing-age women with progressive dyspnea, hemoptysis, or spontaneous pneumothorax.

[Gefitinib in the treatment of refractory non-small cell lung cancer].

OBJECTIVE: To observe the efficacy, median survival time, time to progression, quality of life and adverse effect of gefitinib (IRESSA) in the treatment for refractory advanced non-small cell lung cancer (NSCLC). METHODS: Forty-one patients with stage III b to IV NSCLC who had previously treated with 2-7 cycles of platinum-based chemotherapy were enrolled into the study, 85.4% of the patients had received second line chemotherapy. The regimen was oral intake of gefitinib 250 mg once daily until the disease progression or intolerable toxic reaction occurred. The patients were required to receive tumor assessment before the treatment, one month, two months and every three months after IRESSA administration. RESULTS: All 41 patients were evaluable for therapeutic effect. Partial response rate (PR), stable disease (SD) and progression of disease (PD) was 43.9% (18/41), 34.1% (14/41) and 22.0% (9/41), respectively. No complete regression was observed. The overall response rate was 43.9% (18/41) with a rate of 42.1% in the male and 45.5% in the female (P > 0.05). The disease control rate (PR + SD) was 78.0% (32/41). Twenty-two of the 41 patients (53.7%, 22/41) were still alive with MST of 10.1 months when the follow-up ended in Nov. 2006. TP and MST of dead patients was 2.7 and 5.0 months, respectively. The rate of symptom improvement was 78% for all patients with MST of 13.3 months for PR patients. The performance status (Karnofsky) was improved (20 +/- 5) after 28-day treatment. III-IV degree toxicity was not observed. CONCLUSION: IRESSA is effective and safe for the advanced NSCLC patients with poor performance status who previously failed in the second or third line chemotherapy.