Anatomic structures and their relative position of the target and organs at risk surrounded will change more or less during fractional radiotherapy.These uncertainties will affect the practice of treatment planning correctly.The degree of these uncertainties can be investigated by imaging verification system during clinical practice.The possible reasons of these uncertainties may be tumor volume variations,organ motions orshape changes,patients weight or form changes and set-up errors.The development and practice of imageguided radiotherapy,dose guided radiotherapy and adaptive radiotherapy can offer rational approaches to over-come the uncertainties of the target and organ at risk surrounded during radiotherapy.

Objective To investigate the effect of rivaroxaban on HIF-α, P-selectin and TNF-αin patients with lower extremity venous thrombosis.Methods 41 cases from May 2014 to February 2015 were selected and randomly divided into two groups, 21 cases in the control group were treated by routine treatment, 20 cases in the experiment group were treated on the base of the control group with ivaroxaban.Serum HIF-α, P-selectin and TNF-αwere detected before and after the treatment.ResuIts Compared with the control group, the clinical effect were higher ( P<0.05 ) , the adverse reactions occur rate was no difference (P>0.05).HIF-α, P-selectin and TNF-αwere lower(P<0.05),HIF-αwas positively correlated with TNF-α(r =-0.468,P<0.05), and was not correlated with P-selectin, P-selectin was not associated with TNF-α.ConcIusion Rivaroxaban can effectively improve the lower limb venous thrombosis in patients with clinical symptoms, reduce serum HIF-α, P-selectin and TNF-αexpression, has better clinical curative effect, for clinical treatment of lower limb venous thrombosis has important significance.

Objective To investigate the efficacy of preoperative concurrent radiotherapy and chemotherapy in middle and low rectal cancer.Methods From October 2012 to September 2016,64 patients with middle and low rectal cancer underwent surgical treatment,were randomly divided into two groups,the treatment group 32 cases,the application of simultaneous preoperative radiotherapy and chemotherapy and surgery,control group of 46 patients,only the application of surgical treatment.After treatment,the efficacy,tumor decline,adverse reactions,serum CEA levels,the lower edge of the tumor to the anal distance,the longest diameter of the tumor and quality of life improvement were compared between two groups,and compared the local recurrence and survival of 2 groups in 3 and 5 years.Results The total effective rate of the treatment group was 78.13％,the rate of tumor decline was 87.5％,the improvement rate of quality of life 84.38％,the survival rate of 3 years and 5 years were 90.63％and 75％(19.14±8.52)ng/mL,the distance from the lower edge of the tumor to the anal margin was(7.88±2.07)cm,and the longest diameter of the tumor was(2.24±1.15)cm(P<0.05).The local recurrence rates were 6.25％and 15.63％in 3 years and 5 years,which were all lower than those in the control group(P<0.05).The side effects after radiotherapy and chemotherapy in the treatment group were(31.8％),nausea and vomiting(46.88％),radioactive pancreatitis(71.88％),neurotoxicity(3.13％),liver function abnormality(31.25％),leukopenia(25.00％),hemoglobin reduction),Diarrhea(87.5％),the vast majority of Ⅰ～Ⅱ degrees,the corresponding treatment were relieved.Conclusion The clinical curative effect of preoperative concurrent chemoradiation and radiotherapy of middle and low rectal cancer is significant,which has clinical value.

Objective To investigate the effects of pramipexole on serum cystatin C, antioxidant indexes and brain derived neurotrophic factor ( BDNF) in the treatment of patients with Parkinson’s disease.Methods Retrospective a total of 96 patients with Parkinson’s disease were collected and randomly divided into experimental group and control group with 48 cases in each group.Patients in the control group were treated by levodopa,patients in the experimental group were treated on the basis of the control group with pramipexole, movement and non-movement symptoms were assessed by unified Parkinson’ s disease rating scale ( UPDRS), the serum cystatin C, antioxidant indexes and brain derived neurotrophic factor levels were measured, and the clinical efficacy and adverse reactions were compared.Results The effective rate of the control group (68.75%) was lower than the experimental group (87.50%), with statistical significance (P<0.05); compared with the control group, the movement and non-movement symptoms of the experimental group reduced after treatment, after treatment the serum CRP, serum cystatin C decreased, serum BDNF increased, after treatment the glutathione (GSH), catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidate (GPX) levels increased, with statistical significance (P<0.05).Conclusion Pramipexole in the treatment of patients with Parkinson’s disease could reduce serum cystatin C, improve the levels of BDNF and antioxidant capacity, the effect is remarkable.

Objective To assess the analytical performance of three sensitive cardiac troponin Ⅰ assays and compare the clinical application to provide help in choosing the detection method for clinical laboratory. Methods A total of 474 serum samples were collected from apparently healthy subjects and a total of 112 serum samples were collected from patients presenting with symptoms suggestive of acute myocardial infarction. The functional sensitivities of three assays from Abbott, Beckman-Coulter and Ortho were determined ( CV = 10% ). The reference ranges have been established. The analytic performance was compared according to the assessment mode described by Apple. The relationship was compared among the different assays. The preliminary clinical application value for different detection methods has been evaluated and validated with self-established reference ranges. Results The functional sensitivities ( CV = 10% ) of the cTnI assays for Abbott, Beckman-Coulter and Ortho were 0. 030, 0. 04 and 0. 013 μg/L, respectively.The 99th percentiles of cTnI in healthy volunteers were 0. 021, 0. 02 and 0. 026 μg/L respectively. The analytical data of ROC curve showed that the area under curve (AUC) of the cTnI assays for Abbott,Beckman-Coulter and Ortho for diagnosis of AMI was 0. 852,0. 909 and 0. 910,respectively. There was no statistical difference between any two methods(Z1 = 1.18 ,Z2 = 1.21 ,Z3 =0. 026,all P ＞0. 05). There were good consistency between the 99th percentile obtained from our laboratory and suggested by manufacturers (Kappa value were 1. 000, 0. 730 and 0. 893 respectively, all P ＜ 0. 01 ). Conclusions The analytical performance of two cTnl assays is "clinical accepted" ,the other one is accepted according to guideline. All of them could detect cTnI in apparently healthy subjects. There exist differences among three assays, but their diagnostic characteristics for AMI are not significantly different.

Objective To assess the analytical performance of hs-cTnT and biological variations in healthy population as well as establish hs-cTnT reference intervals. Methods The serum samples from 100 acute myocardial infraction patients and 474 apparently healthy subjects were collected. The functional sensitivity,within- and between-run imprecision were determined. The hs-cTnT assay and con-cTnT assay were evaluated. The serum hs-cTnT levels were detected in apparently healthy subjects to establish reference intervals. Moreover,the long-term and short-term biological variations for hs-cTnT in healthy volunteers were assessed. Results The functional sensitivity of hs-cTnT was 0. 005 μg/L. The within- and between-run precision for lower level control(0. 014 μg/L) and higher level control(2. 500 μg/L) was 2. 97% vs 3. 64%and 0. 66% vs 1.01% ,respectively. The correlation between hs-cTnT assay and con-cTnT assay was good ( R2 =0. 972 ,P ＜0. 01 ). The 99th percentile in apparently healthy subjects was 0. 003 μg/L for women less than60 years, 0.008 μg/L for men less than 60 years, 0.015 μg/L for women above 60 years and 0. 021 μg/L for men above 60 years. The CVa, CVi, CVg and CVt of short-term biological variations in detecting hs-cTnT from 22 apparently healthy subjects were 3.8%, 4. 8%, 49.9% and 58.5%,respectively. The CVa,CVi ,CVg and CVt of long-term biological variations were 5. 3% ,6. 4% ,56. 6% and 68. 3% respectively. Conclusions The analytical performance of the hs-cTnT is better than con-cTnT assay,achieving acceptable level according to guideline. Our experimental result could provide the basis for the new high sensitivity cTnT assay in the diagnosis of acute myocardial infarction.

Objective To investigate the changes and significances of peripheral blood CD34,KDR/CD34,CD133/CD34,and CD117/CD34 positive cell levels in patients with hemorrhagic stroke at the acute phase. Methods Thirty patients with acute hemorrhagic stroke admitted to the Department of Neurosurgery, Jiangsu Haimen People’s Hospital from September 2013 to April 2014 were enrolled retrospectively. At the same time,20 healthy subjects were selected as a control group. CD34 +,KDR+ /CD34 +,CD133 + /CD34 +, and CD117 + /CD34 +cell levels in peripheral blood were detected in patients with hemorrhagic stroke at day 1 to day 7 after cerebral hemorrhage and the day of physical examination of the control group using FACSCalibur flow cytometry. The data were obtained and analyzed using CELLQuest software. Results Peripheral blood CD34 + cells and KDR+ /CD34 +, CD133 + /CD34 +, CD117 + /CD34 + cells at day 1 to day 7 after ischemic stroke were all lower than control group (all P<0. 05). CD34 + and CD117 + /CD34 + cells decreased firstly at day 1 and 2, then increased gradually;KDR+ /CD34 + and CD133 + /CD34 + cells increased gradually at day 1 to day 5,they were all reached the peak at day 5,which were (14. 8±3. 5) í105 and (16. 7±3. 3) í105 respectively. Compared with that at day 1,CD34 + cells at day 5 and 6 were (27. 4 ±6. 3) í105 and (25. 4 ±5. 7) í105 respectively;KDR+ /CD34 + and CD133 + /CD34 + cells at day 4,5,and 6 were (10. 2±3. 1) í105,(14. 8±3. 5) í105,(12. 1±3. 4) í105 and (14. 3±3. 6) í105,(16. 7±3. 3) í105,and (13. 1±4. 0) í105,respectively;CD117 + /CD34 + cells at day 5 was (21. 3 ±4. 2) í105,which were all higher than the first day after cerebral hemorrhage (P<0.05). In the CD34 + cells,the proportion of KDR+ /CD34 + cells at day 1 to day 7 all decreased compared with the control group (all P<0. 05);the proportion of CD133 + /CD34 + cells at day 4 was (65±4)%,it was higher than the control group (P<0. 05);the proportion of KDR+ /CD34 + cells at day 5 was (55±6)% compared with day 1;the proportion of CD133 + /CD34 + at day 4 was (65 ±4)%;the proportions of CD117 + /CD34 + cells at day 4 and day 5 were (69 ±6)% and (72 ±6)% respectively,and they all increased (all P <0. 05). Conclusion Peripheral blood CD34 + cells and their cell subsets are change in patients with hemorrhagic stroke in acute phase. Speculating the different cell subsets may have different functions and potential. KDR+ /CD34 + and CD133 + /CD34 + may be the early sensitive indicators of acute hemorrhagic stroke,and CD117 + /CD34 + is largely mobilized in early stage.

Objective To analyze differences of serum proteins measurements by different methods in different systems and investigate whether the assigned serum valued by ERM-DA470k/IFCC can replace ERM-DA470k/IFCC in clinical measurements to promote the harmonization of serum proteins measurements.Methods Serum specimen was collected from 100 medical examination persons in Zhongshan Hospital (Jun 2012; age:27-73; 47 male and 53 female).Serum IgA,IgG,IgM,C3c,C4,TRF and PA of health persons,ERM-DA470k/IFCC and the assigned valued by ERM-DA470k/IFCC were measured by Hitachi 7600 (Roche and DiaSys reagents),Siemens BN Ⅱ (Siemens reagent) and Beckman IMMAGE (Beckman reagent),respectively.ERM-DA470k/IFCC was used as a calibrator to value the mixed serum.Serum proteins results obtained from the same methods were compared by T test and Wilcoxon test,and analysis of variance and Firendman test were used to compare results from different methods.The correlation of two groups was analyzed by linear regression.Results The differences of serum proteins results measured by two immunonephelometries,two immunoturbidimetries and all assays were statistically significant (P ＜0.05),respectively.The serum proteins results measured by two immunoturbidimetries showed good correlation (R2 were all above 0.97 except for C3c).In contrast,the serum proteins results measured by two immunonephelometries show poor correlation (R2 were all ranged from 0.90 to 0.94) except for IgM (above 0.96).The serum IgA,IgG and IgM results measured by different methods show good correlation (R2 were all above 0.95) Based on certified values of ERM-DA470k/IFCC,serum protein results measured by different methods could be harmonized,and got similar results from the assigned serum (P ＞ 0.05).Conclusions There is significant difference of serum proteins results detected by different methods.The ERM-DA470k/IFCC and certified serum can make serum protein results obtained from different methods harmonized.

A sensitive and selective method was developed for the separation and characterization of related substances (RSs) in EVT-401 by hyphenated LC–MS techniques. Complete separation of the RSs was achieved with an Inertsil ODS-SP column (250 mm×4.6 mm, 5 μm) by linear gradient elution using a mobile phase consisting of 0.2% formic acid solution, methanol and acetonitrile. EVT-401 was found to be susceptible to acid, alkaline and oxidative stresses, while relatively stable under photolytic and thermal dry stress conditions. Fourteen RSs including six process-related substances and eight degradation products were detected and identified in EVT-401 with positive ESI high-resolution TOF-MS analysis of their parent ions and the corresponding product mass spectra elucidation, and some of them were further verified by chemical synthesis and NMR spectroscopy. The specific LC–MS method developed for separation, identification and characterization of RSs is valuable for EVT-401 manufacturing process optimization and quality control.

Objective To investigate the changes of target during fractionated radiotherapy for e-sophageal cancer, and to assess their impact on the implementation of radiotherapy. Methods Fourteen pa-tients with unresectable esophageal cancer were enrolled to receive full course conformal radiotherapy. CT scans were performed after every ten fractions. New targets (GTV) were delineated on repeated CT scans. Then the pretreatment radiotherapy plans were copied to the new targets to investigate the conformity between the new GTV and the plans. Results The majority of the GTVs decreased with the increasing fractions dur-ing radiotherapy. However, GTVs of 35.7% (5/14) patients increased by 2.0%-37.7% at the tenth frac-tion. The PTVs covered by 95% isodose curve at the time of pretreatment,tenth fraction,twentieth fraction and thirtieth fraction were 97.81%±1.53%, 91.95%±5.25%, 94.27%±4.23% and 94.03%±6.45%, respectively. Moreover, at tenth, twentieth and thirtieth fraction, there were 6,5, and 4 patients whose PTVs covered by 95% isodose curve were below 95%, respectively. Conclusions There are signifi-cant target changes during fractionated radiotherapy for esophageal cancer, which may result in uncertainties of radiotherapy implementation.