Objective To commission a Mobetron intra-operative mobile accelerator and analyze the characteristics of its electron beams. Methods The dosimetrie characteristics of the electron beams genera-ted by Mobetron accelerator were measured and compared with those generated by conventional accelerator (Primus, Siemens). M oberton accelerator can generate electron beams of nominal energies of 4,6,9 and 12 MeV. The measurement items were as followings : percentage depth dose perpendicular to water phantom sur-face and beam profiles parallel to water phantom surface, output factors, applicator leakage, electron beam at-tenuation made by lead blocks,and machine output calibration. The measurement devices included a three-dimensional ( 3 D) water scanning phantom, an electrometer, a 0.6 cm3 Farmer ionization chamber, a parallel-plate ionization chamber and solid water slabs. During measurement, all applicators of different tilt angles and diameters were attached to the machine head,and their ends were adjusted to be tangent to the phantom surface. Results Except for the 12 MeV,skin dose for all energies was no more than 90%. The skin dose was higher for Mobetron accelerator electron beams than for regular electron beams. The Dmax depth in water for a 10 cm flat applicator were 0.7,1.3,2.0 and 2.2 cm for the 4 energies,respectively. The depths of 90% dose were 1.0,1.8,2.7 and 3.6 cm, respectively. The selected flat applicator was just 1 cm larger than the tumor bed. But for the beveled applicators,the field flatness and symmetry became worse,and con-sequently,the applicator size had to be selected based on the isodose distribution. The leakage dose at 1 cm outside the applicator was 1.2% ,5.1%, 10.0% and 9.1%, respectively. The lead thickness for full block was 1.5,3.0,4.5 and 6.0 mm,respectively. Conclusions Through the commissioning of Mobetron accel-erator, the machine characteristics are understood, and the data for clinical implementation and routine quality assurance are acquired.

Objective To compare changes in indexes and analyze their values in prognosis of severe burn patients with sepsis.Methods A retrospective analysis was conducted. The patients with severe burn sepsis admitted to the Third Affiliated Hospital of Soochow University from August 2014 to December 2016 were enrolled. The blood culture was positive in the clinical diagnosis of sepsis. According to the prognosis, the patients were divided into death group and survival group. Their general information, vital signs, blood routine examination, serum sodium (Na+), serum glucose (Glu), C-reactive protein (CRP) and arterial partial pressure of carbon dioxide (PaCO2) at the time of admission and diagnosis of sepsis as well as the level of serum procalcitonin (PCT) at admission, diagnosis of sepsis and 1-8 days of post diagnosis were also compared. Receiver operating characteristic curve (ROC) was used to analyze the prognostic value of each index, and multivariate Cox regression analysis was used to analyze the influence of each index on the survival time, and the survival curve of Kaplan-Meier was analyzed for dead patients.Results There were 25 cases of severe burn patients with sepsis, which were admitted to hospital within 12 hours after injury; the time of diagnosis of burn sepsis was (14±6) days; 8 cases of survival; 17 cases died, the mortality rate was 68.0%, the time from diagnosis of sepsis to death was (28±14) days. The age of the death group was significantly higher than that of the survival group (years: 41±12 vs. 29±9,t = 2.598,P = 0.016), but there was no significant difference in the gender, total burn area,Ⅲ degree area, and the time of diagnosis of sepsis between the two groups. The platelet count (PLT) at the diagnosis of sepsis in death group was significantly lower than that of the survival group (×109/L: 69±43 vs. 180±108,t = -2.773, P = 0.023), and the PCT at 1-8 days of post-diagnosis in the death group was significantly higher than that of survival group [μg/L: 4.4 (2.2, 9.0) vs. 1.6 (0.7, 2.3),Z = -2.521,P = 0.012], but there was no significant difference in body temperature, heart rate, white blood cell count (WBC), percentage of neutrophils (Neu), Na+, Glu, CRP, PCT, PaCO2 at the time of admission and diagnosis of sepsis and PLT at the time of admission between the two groups. ROC curve analysis showed that the area under ROC curve (AUC) of age, PLT at the time of diagnosis and PCT at 1-8 days of post-diagnosis of sepsis was 0.808, 0.779, 0.825, respectively, for predicting the prognosis of patients with severe burn sepsis (allP < 0.05). At the cut-off age of 32, the sensitivity was 73.3% and the specificity was 75.0%. As the cut-off of PLT was 138×109/L at the time of diagnosis, the sensitivity was 92.3% and the specificity was 75.0%. As the cut-off of PCT was 2.39μg/L at 1-8 days of post-diagnosis of sepsis, the sensitivity was 73.3% and the specificity was 87.5%. Multivariate Cox regression analysis showed that age and PLT at the time of diagnosis were the favorable factors for the survival time of patients with severe burn sepsis (β value were -1.834, -0.029, respectively, bothP < 0.05). Kaplan-Meier survival analysis for patients in the death group showed that the median survival time of patients ≥32 years old was longer than that of patients < 32 years old (days: 32 vs. 9); 18-day cumulative survival rate was significantly higher than that of patients < 32 years old [83.3% (10/12) vs. 25.0% (1/4),χ2 = 9.705,P = 0.003].Conclusion Age, PLT at diagnosis of sepsis and PCT at 1-8 days after diagnosis of sepsis could be used as prognostic indexes for severe burn patients with sepsis.

OBJECTIVE:To discuss the application of biomedical fibrin glue in laparoscopic hepatectomy(LH).METHO-DS:40 patients undergoing LH were randomly divided into biomedical fibrin glue group(trial group) and control group:the patients in trial group underwent LH,transection of liver by ultrasound knife,with the transected liver surface sprayed with biomedical fibrin glue guided by laparoscope;the control group underwent routine LH only.The postoperative blood loss and bile leakage were observed by T-tube drainage.RESULTS:In the biomedical fibrin glue group,the operations for all the patients were successful,the postoperative recovery was smooth,the postoperative drainage volume,RBC in the drained fluid,level of hemoglobin and length of hospital stay were all significantly lower than in the control group(P

OBJECTIVE:To observe the clinical effects of interstitial implantation of 125 I particles together with5-FU slow-release particles for advanced pancreatic cancer.METHODS:A total of12patients with advanced pancreatic cancer whose tumors were unsuitable to be resected were implanted with5-FU slow-releasing particles and then 125 I particles.The intensity of radioactive 125 I particles was0.4mCi～0.5mCi,the matched peripheral dose was60Gy～100Gy,and an average of16 125 I particles and1000mg5-FU were used for each patient.RESULTS:Relief of pain was achieved in all the subjects,with the effective rates of odynolysis at91.7%.The tumor size in all the subjects was diminished to some degree,with local control rate at83.3%.1y survival rate was25%.CONCLUSION:Interstitial implantation of 125 I particles and5-FU slow-release particles for advanced pancreatic cancer is simple,safe and effective.

Objective To study the effect of Numb gene overexpression on invasion and migration in human renal cell carcinoma cells and its related mechanism. Methods The Numb-ORF plasmid was transfected into renal cell carcinoma cells 786-O, set the negative control and blank control. The expression of Numb and matrix metalloproteinase-9 (MMP-9) was detected by real-time PCR and western blot. Then abilities of cells invasion and migration were measured respectively by transwell assay and scratch-wound-healing assay. Results Compared to negative control (2.51±0.27) and blank control (2.87±0.21), Numb expression in Numb-ORF group (36.13 ±8.33) was significantly higher (P= 0.00). Meanwhile, MMP-9 level in Numb-ORF group was decreased: Numb-ORF group was 2.36±0.29, negative control was 8.73±0.91, blank control was 8.99±0.78 (P=0.00). In scratch-wound-healing assay,the repair ratio of 12 h was as follow: Numb-ORF group was 0.53 ±0.06, negative control was 0.73 ±0.09, blank control was 0.75 ±0.08 (P= 0.02). In transwell assay, the number of invasion cells in Numb-ORF group was 31.40±5.96, less than negative control (126.93±13.61) and blank control (131.87 ±15.42) (P= 0.00). Conclusion Overexpression of Numb significantly decreases abilities of invasion and migration in 786-O cells, and the suppressive effect may be due to the down-regulation of MMP-9 expression in human renal cell carcinoma.

OBJECTIVETo investigate the effects of direct intratumor injection of the packaged cells with retroviral vector carrying human endostatin (hEN) on the growth inhibition of B16 melanoma in C57/BL6 mice.

METHODSRetroviral vector, pLNC-hEN, was constructed with modified and identified hEN gene. The cell line, PA317, was used to establish ecotropic virus producing cells by transfecting and packing with pLNC-hEN. Then the cells were injected directly into the tumor in C57/BL6 mice bearing B16 melanoma, established by intra-cutaneous injection of B16 cell suspension. The tumor size was measured at different intervals to observe the antitumor effect. Micro-vessel density (MVD) in the tumor tissue was evaluated by immunohistological examination to count the apoptotic cells by TUMEL staining.

RESULTSTumor with diameter of 2 - 3 mm was observed in all mice after 7 - 9 days. The average tumor volume on D3, D5, D7 and D9 after gene transfection was 4.67 +/- 1.1, 22.25 +/- 13.06, 84.17 +/- 43.5 and 155.08 +/- 81.1 mm(3) in the gene therapy group but 136.17 +/- 30.61, 390.17 +/- 220.47, 1 021.67 +/- 537.4 and 2 920.2 +/- 220.01 mm(3) in the control group, the difference of which was statistically significant. The average MVD in the gene therapy and control groups were 8 +/- 2.28 and 28.17 +/- 5.31 while the average apoptotic cell number in the two groups were 23.33 +/- 3.83 and 2.33 +/- 1.21, both of which were statistically significant.

CONCLUSIONThe direct injection of packaged cells carrying hEN gene is able to inhibit the growth of micro-blood vessels and promote tumor cell apoptosis, which ultimately inhibits the growth of B16 melanoma.

Angiogenesis Inhibitors ; therapeutic use ; Animals ; Apoptosis ; Collagen ; genetics ; therapeutic use ; Disease Models, Animal ; Endostatins ; Gene Transfer Techniques ; Genetic Therapy ; Genetic Vectors ; genetics ; Humans ; Melanoma, Experimental ; pathology ; therapy ; Mice ; Mice, Inbred C57BL ; Neoplasm Transplantation ; Peptide Fragments ; genetics ; therapeutic use ; Transfection ; Tumor Cells, Cultured

Objective To investigate the safety and acute toxicities of intraoperative electron radiotherapy for patients with abdominal tumors.Methods From May 2008 to August 2009, 52 patients with abdominal tumors were treated with intraoperative electron radiotherapy,including 14 patients with breast cancer,19 with pancreatic cancer,3 with cervical cancer, 4 with ovarian cancer, 6 with sarcoma, and 6 with other tumors.Fifteen patients were with recurrent tumors.The intraoperative radiotherapy was performed using Mobetron mobile electron accelerator, with total dose of 9 - 18 Gy.In all, 29, 4 and 19 patients received complete resection, palliative resection and surgical exploration, respectively.The complications during the operations and within 6 months after operations were graded according to Common Terminology Criteria for Adverse Events v3.0 (CTC 3.0).Results The median duration of surgery was 190 minutes.Intraoperative complications were observed in 5 patients, including 3 with hemorrhage, 1 with hypotension,and 1 with hypoxemia, all of which were treated conservatively.The median hospitalization time and time to take out stitches was 12 and 13 days, respectively.And the in-hospital mortality was 4% (2/52).Twentyfour patients suffered post-operative adverse events, including 3 postoperative infections.With a median follow-up time of 183 days, 20% of patients sufferred from grade 3 to 5 adverse events, with hematological toxicities being the most common complication, followed by bellyache.Grade 1 and 2 toxicities which were definitely associated with intraoperative radiotherapy was 28% and 4%, respectively.None of grade 3 to 5 complications were proved to be caused by intraoperative radiotherapy.Conclusions Intraoperative electron radiotherapy is well tolerable and could be widely used for patients with abdominal tumors, with a little longer time to take out stitches but without more morbidities and toxicities compared surgery alone.

Purpose: The aim of the study was to evaluate the status of psychological resilience among women in their second pregnancy and to investigate the possible influencing factors. Methods: A total of 275 women in their second pregnancy and who met the criteria were surveyed from two public hospitals in China from July 2018 to January 2019. The instruments included the General Self-designed Questionnaire, Connor–Davidson Resilience Scale, Social Support Rate Scale, and 36-item Pregnancy Stress Rating Scale. Results: The total psychological resilience score of second-pregnancy women was relatively low. Multivariate regression analysis identified five factors associated with psychological resilience: intimacy with husbands, social support utilization, gender of the first child, high-risk pregnancy of the first child, and the stress caused by worrying about the health and safety of the mother and fetus. Conclusion Women in their second pregnancy represent a unique population, and their low psychological resilience score deserves attention. Identification of factors contributing to decreased psychological resilience may enable us to design prevention and intervention strategies and to deliver specific psychological supports to pregnant women at high risk of developing negative psychology.

Purpose: The aim of the study was to evaluate the status of psychological resilience among women in their second pregnancy and to investigate the possible influencing factors. Methods: A total of 275 women in their second pregnancy and who met the criteria were surveyed from two public hospitals in China from July 2018 to January 2019. The instruments included the General Self-designed Questionnaire, Connor–Davidson Resilience Scale, Social Support Rate Scale, and 36-item Pregnancy Stress Rating Scale. Results: The total psychological resilience score of second-pregnancy women was relatively low. Multivariate regression analysis identified five factors associated with psychological resilience: intimacy with husbands, social support utilization, gender of the first child, high-risk pregnancy of the first child, and the stress caused by worrying about the health and safety of the mother and fetus. Conclusion Women in their second pregnancy represent a unique population, and their low psychological resilience score deserves attention. Identification of factors contributing to decreased psychological resilience may enable us to design prevention and intervention strategies and to deliver specific psychological supports to pregnant women at high risk of developing negative psychology.

Objective:To investigate a time series deep learning model for respiratory motion prediction.Methods:Eighty pieces of respiratory motion data from lung cancer patients were used in this study. They were divided into a training set and a test set at a ratio of 8∶2. The Informer deep learning network was employed to predict the respiratory motions with a latency of about 600 ms. The model performance was evaluated based on normalized root mean square errors (nRMSEs) and relative root mean square errors (rRMSEs).Results:The Informer model outperformed the conventional multilayer perceptron (MLP) and long short-term memory (LSTM) models. The Informer model yielded an average nRMSE and rRMSE of 0.270 and 0.365, respectively, at a prediction time of 423 ms, and 0.380 and 0.379, respectively, at a prediction time of 615 ms.Conclusions:The Informer model performs well in the case of a longer prediction time and has potential application value for improving the effects of the real-time tracking technology.