Objective The study aimed to construct one severity of illness scoring system specially for children with complex congenital heart diseases and analyzed the applicability of this new score,which will be helpful to assist the medical workers in evaluating children's condition.Methods A total of 1284children patients with complex congenital heart diseases in Shanghai Children's Medical Center Affiliated to School of Medicine of Shanghai Jiaotong University.The general information and clinical data were collected.Logistic regression,method of percentiles and expert opinions were used to construct the new severity of illness scoring system.Area under ROC curve,Hosmer-Lemeshow,goodness of fit test were used to evaluate the performance and applicability of the new score.Results A total of 1284 children with complex congenital heart diseases split into construction group (1138 cases) and verification group (146 cases).The new score included seven indexes (systolic blood pressure,blood oxygen saturation,lactic acid,potassium,potential of hydrogen,glucose,positive inotropic drug score).The range of the score was 0-57 and the cut-off point was 10.The discriminatory power was sufficient (area under the curve ＞ 0.75),and the calibration capability of the score was tolerable (P ＞ 0.05).Conclusions The applicability of the new score is well and it is easy to use,which will not increase the workload for the medical workers while assisting them in the clinical environment.

Objective To compare the dosimetric difference of stereotactic body radiation therapy (SBRT) plans for spine metastasis using 6 MV X-ray flattening filter free (FFF) and flattening filter (FF) modes.Methods A total of nine previously treated patients with a total of twelve spine metastasis were retrospectively included and replanned using FFF-SBRT and FF-SBRT, respectively.The dose-volume histograms (DVH), target conformity index (CI), monitor unites (MUs) and treatment time of target volume, organs at risk and normal tissues were compared between the plans.Results Both FFF-SBRT and FF-SBRT met the clinical objectives.Dose distribution of target volume, organs at risk and normal tissues were similar.MUs of the FFF-SBRT were significantly higher than that of FF-SBRT (t =-5.20, P ＜0.0l), while the treatment time was almost half of the latter (t =17.27, P ＜ 0.01).Conclusions Two plan modes are both clinically acceptable.FFF-SBRT plans are delivered in less time and with better efficiency.Trial registration Chinese clinical trial registry, ChiCTR-TRC-14004281.

Objective To analyzed the effects of the positioning errors and weight variability of the head and neck cancer patients with intensity modulated radiation therapy (IMRT),or volumetric modulated arctherapy (VMAT) based on the kilovoltage cone-beam computed tomography (kV-CBCT).Methods CBCT images of 102 patients with head and neck cancer patients receiving IMRT or VMAT were screened by CBCT once a week for consecutively 6 weeks.The positioning errors were measured by comparing CBCT and planning CT in left-right (LR),anterior-posterior (AP) and cranio-caudal (CC) directions.Meanwhile,the weight of patients were measured every week.Results The positioning errors were (0.011 5±0.125 3) cm,(-0.017 6±0.123 3) cm and (-0.014 1±0.156 7) cm in LR,AP and CC directions,respectively.The mean systematic errors were all less than 0.02 cm in three axial directions,while the mean random errors were all within 0.2 cm.There was no statistically significant difference was observed among the setup errors in all three axial directions according to different week.Though the body weight of patients continued to drop during the radiation by with the mean weight loss of 3.5 kg and had a negative correlation with treatment course.Bivariate correlation analysis showed just the positioning errors in CC direction were significantly correlated with body weights loss.Conclusion There is no statistical relationship with in position errors of the patients with their treatment course,and the body weight loss seemed to influence the position errors in CC direction.

Objective To analyze the incidence and related factors of acute radiation pneumonitis (RP) in patients with non-small cell lung cancer (NSCLC) who underwent three-dimensional conformal ra-diotherapy with concurrent chemotherapy. Methods From January 2006 to October 2008, 90 NSCLC pa-tients treated with concurrent chemoradiotherapy were retrospectively reviewed. The clinical characteristics and treatment plan parameters from dose-volume histogram (DVH) were analyzed. Results Grade 1, 2,3, 4 and 5 RP was found in 32.2%, 30.0%, 5.6%, 0% and 1.1% of the patients. Primary tumor loca-tion was the only significant clinical factor in univariate analysis. And significant differences were found when the groups was divided by the mean lung dose (MLD) of 17 Gy, V_(5) of 47% ,V_(10) of 36% ,V_(20) of 24%,V_(30) of 23% and V_(40) of 22%, respectively. Multivariate analysis showed the MLD was the only independent predictive factor of RP. Conclusions Some factors may contribute to the RP. MLD should be set below 17 Gy in three-dimensional conformal radiation, especially when the tumor locates in the lower lobe.

OBJECTIVE:To prepare Activated carbon N-acetylcysteine microcapsule (ACNAC),and to optimize preparation technology. METHODS:ACNAC was prepared by emulsion cross-linked method using biodegradable material gelatin as capsule wall material. Using comprehensive evaluation index of drug-loading amount,entrapment rate and particle size distribution percent-age(the percentage of 80-140 μm particle)as index,drug-loading ratio,amount of gelatin,mixing speed and the amount of emul-sifier as factors,single factor test and orthogonal test were used to optimize formulation technology. The technology was validated and distribution of particle size of ACNAC was determined. RESULTS:The optimal formulation technology was as follows as drug-loading ratio 1∶1,gelatin 15%,emulsifier 2.0%,mixing speed 1 000 r/min. Average drug-loading amount of 6 batches of ACNAC was 15.9%(RSD=1.21%),average encapsulation efficiency was 78.1%(RSD=1.11%)and average particle size distri-bution percentage was 81.9%. CONCLUSIONS:ACNAC is prepared successfully,and formulation technology is reasonable and feasible.

Objective To investigate the effect of berberine on endoplasmic reticulum stress PERK apoptosis pathway in HK-2 cells by high fructose.Methods HK-2 cells were grown in DMEM/F12, containing 10% fetal bovine serum (FBS) and divided randomly into four groups: normal control group (Group C); Fructose group (Group F): it contains 25mmol/L fructose culture; Berberine group (Group B): 25mmol/L fructose + 10μmol/L berberine treatment group; TUDCA group (Group T):25mmol/L fructose +2μmol/L TUDCA culture group; Cells were collected after culturing 24h. The expression of glucose-regulated protein 78 (GRP78), CHOP protein and the phosphorylation levels of PERK, eIF2α were tested by Western blotting. The cell cycles were detected by flow cytometry and the apoptosis of cells were detected by TUNEL staining.ResultsWestern blotting showed that the expression of GRP78 and CHOP protein in group F was significantly higher than that in group C, and the levels of p-PERK and p-eIF2α in group F were significantly higher than those in group F. Compared with group F, GRP78, CHOP, p-PERK and p-eIF2α in group B and T were significantly lower (P<0.05). The expression of GRP78, CHOP, p-PERK and p-eIF2α in group B had no significant difference. Flow cytometry and TUNEL staining showed that the cell viability of fructose group was significantly lower than that of C group, and the apoptotic index was significantly higher than that of group C (P<0.05). Compared with group F, the activity of HK-2 cells in group B and T significantly increased, otherwise the apoptosis index significantly decreased, and the difference was statistically significant (P<0.05). Compared with group T, the viability index and apoptosis rate of group B had no significant difference (P>0.05).Conclusion Persistent high fructose can activate the intracellular PERK pathway in HK-2 cells, causing endoplasmic reticulum stress. Berberine can inhibit the fructose-induced PERK and eIF2α phosphorylation, down-regulated the expression of GRP78, CHOP protein, thus by regulating PERK Pathways to alleviate cell cycle arrest and reduce cell apoptosis.

A rapid and accurate determination method of lipids in microalgae plays a significant role in an efficient breeding process for high-lipid production of microalgae. Using low field nuclear magnetic resonance (LF-NMR), we developed a direct quantitative method for cellular lipids in Chlorella protothecoides cells. The LF-NMR signal had a linear relationship with the lipid content in the microalgae cells for both dry cell samples and algal broth samples (R2 > 0.99). These results indicated that we could use this method for accurate determination of microalgal lipids. Although LF-NMR is a rapid and easy lipid determination method in comparison to conventional methods, low efficiency would limit its application in high throughput screening. Therefore, we developed a novel combined high throughput screening method for high-lipid content mutants of C. protothecoides. Namely, we initially applied Nile red staining method for semi-quantification of lipid in the pre-screening process, and following with LF-NMR method for accurate lipid determination in re-screening process. Finally, we adopted this novel screening method in the breeding process of high-lipid content heterotrophic cells of C. protothecoides. From 3 098 mutated strains 108 high-lipid content strains were selected through pre-screening process, and then 9 mutants with high-lipid production were obtained in the re-screening process. In a consequence, with heterotrophical cultivation of 168 h, the lipid concentration could reach 5 g/L, and the highest lipid content exceeded 20% (W/W), which was almost two-fold to that of the wild strain. All these results demonstrated that the novel breeding process was reliable and feasible for improving the screening efficiency.
Chlorophyta ; chemistry ; Heterotrophic Processes ; High-Throughput Screening Assays ; Lipids ; analysis ; Magnetic Resonance Spectroscopy ; Microalgae ; chemistry ; Staining and Labeling

Objective:To assess the safety and efficacy of induction chemotherapy with cisplatin and docetaxel followed by radia-tion concurrent with weekly cisplatin for unresectable, locally advanced esophageal cancer. Methods: Thirty-three patients with T3N0M0 to T4N2M0 thoracic esophageal squamous cell carcinoma without celiac lymph node metastasis were included in the study. They were treated with cisplatin (75 mg/m2 d1, d22) and docetaxel (75 mg/m2 d1, d22) neoadjuvant chemotherapy followed by three-dimensional conformal radiotherapy (60Gy/30F/6w) concurrent with cisplatin (30 mg/m2 d1, 8, 15, 22, 29, 36 from the beginning of radiation). Results:Grade 4 hematological toxicities were observed in 13.33%(4/33) of the patients after the neoadjuvant chemother-apy. No grade 3 or above hepatic or renal toxicities were found. During concurrent chemoradiation, the highest grade 3 hematological toxicities were observed in the erythrocyte, granulocyte, and macrophage at 21.21%(7/33), 15.15%(5/33), and 3.01%(1/33), respec-tively. No grade 2 or above hepatic or renal toxicities were observed. Grade 3 radiation esophagitis was observed in 9.1%(3/33) of the patients, whereas grade 3 and above radiation esophagitis or grade 1 and above acute radiation pneumonitis did not occur. The evalua-tion results after treatment completion were 84.85%(28/33), 12.12%(4/33), and 3.03%(1/33) for CR+PR, SD, and PD , respectively. Two months after treatment completion, the results changed to 75.76%(25/33), 9.10%(3/33), and 15.15%(5/33), respectively. Overall, 15 patients died. The one-year survival rate was 66.4%. Local failure was approximately 46.67%(7/15), whereas the local+distant fail-ure was approximately 26.67%(4/15). Therefore, local failure is the main pattern of failure in esophageal cancer. Conclusion:The re-sults indicate that neoadjuvant chemotherapy with cisplatin and docetaxel followed by radiotherapy concurrent with weekly cisplatin for locally advanced esophageal cancer is safe. Local failure remains the main pattern of failure in esophageal cancer.

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Objective:To compare the dose distribution among CyberKnife, Tomotherapy, Edge, Triology and γ-knife in stereotactic body radiation therapy (SBRT) for pancreatic cancer.Methods:Clinical data of 10 panreatic cancer patients receiving CyberKinife treatment were retrospectively analyzed. The treatment plans were designed by five apparatuses from five centers according to the uniform requirement. All plans were transferred to MIM system for the extraction of parameters, which mainly included D min, D mean and D max of PTV, conformity index (CI), new conformity index (nCI), homogeneity index (HI), gradient index (GI), coverage, D max and dose-volume of the stomach and bowel. Results:The best CI and nCI were obtained in Triology ( P<0.001), and the worst HI was found in γ-knife ( P<0.001). The best GI was found in CyberKnife, followed by γ-knife and Tomotherapy, and Edge showed the worst GI ( P<0.001). The highest D min of PTV was found in both Edge and Triology, while lower D min of PTV was found in CyberKnife and Tomotherapy ( P<0.001). Additionally, γ-knife provided the highest D mean and D max of PTV ( P<0.001). Regarding the organs at risk, the lowest D max and D 5cm 3 of the bowel ( P<0.001), D max of the stomach ( P=0.003), D max( P=0.001), D 5cm 3 ( P<0.001) and D 10cm 3 ( P=0.005) of the duodenum, D max( P<0.001) and D 0.35cm 3 ( P<0.001) of the spinal cord were found in CyberKnife. The highest D max of the bowel was found in γ-knife. Furthermore, the highest D 5cm 3 of the duodenum was demonstrated in Edge ( P<0.001) and Tomotherapy provided the highest D max( P<0.001) and D 0.35cm 3 of the spinal cord ( P<0.001). Conclusions:All five radiotherapy apparatuses can meet the requirement of SBRT for pancreatic cancer. More rapid dose fall-off could be obtained via CyberKnife and γ-knife. Triology and Edge provide better target conformity. CyberKnife can better protect the gastrointestinal tract.