Objective To analyze the displacement of titanium clips for tumor bed localization after breast-conserving surgery for breast cancer and its influential factors.Methods A retrospective analysis was performed on the cone-beam computed tomography (CT) images of 14 patients with breast cancer who received radiotherapy after breast-conserving surgery from April to October,2016.The relative position of the chest wall and the errors of the titanium clips in radiotherapy were measured.A Pearson correlation analysis was used to analyze the correlation of the displacement of titanium clips with the relative position of titanium clips,the breast volume,the vertical distance between the titanium clips and the tangential line of the chest wall,and the maximum thickness of the breast.Results The system errors of the chest wall in left-right,superior-inferior,and anterior-posterior directions were 4.42,3.44,and 5.13 mm,respectively,and the random errors were 3.55,3.07,and 4.54 mm,respectively.The titanium clips had a large displacement relative to the chest wall,mainly in the left-right direction.The maximum system error was 4.39 mm and the random error was 2.42 mm.The displacement of titanium clips was not significantly correlated with the breast volume and the maximum thickness of the breast (P>0.05).However,the relative position of titanium clips in superior-inferior direction was significantly correlated with the displacement of the lowest,the most lateral,the most anterior,and the most posterior titanium clips (P<0.05).As to the uppermost clips,there was a significant difference in displacement between the clips close to the chest wall and the clips far from the chest wall (P=0.02).Conclusions Due to large setup error and displacement of titanium clips during radiotherapy,simultaneous integrated boost is not suitable for patients with breast cancer who are immobilized by vacuum cushion and received radiotherapy.The unstable immobilization may be the major influential factor for the displacement of titanium clips.

Objective To evaluate 99mTc-ciprofloxacin (Infecton) scintigraphy as a method for detecting secondary infections associated with ANP in swine,in comparison with CT.MethodsTwenty-eight healthy swine were randomly assigned to control group (n =6),non-infected ANP (n =6) and infected ANP group( n =16).ANP model was induced by retrograde injection of sodium taurocholate and pancreatic protease mixture into the biliary and pancreatic duct.Two days after ANP induction,swine in infected ANP group were injected with 3 x 108 E.coli into pancreatic tissue,while swine in non-infected ANP group were injected with inactivated E.coli.At 7 d after inoculation,at 0.5,1,2,3,4,and 6 h after intravenous administration of 370 MBq of Infecton,SPECT scan was performed.Then 64-slice spiral CT scan was performed.Then swine were sacrificed,and histopathology examination and bacterial culture of pancreatic tissue were performed.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the two methods to detect secondary infections were determined.ResultsThere were no abnormality in the normal pancreas and the bacterial culture was negative.There were pancreatic necrosis in the non-infected ANP group,but the bacterial culture was negative.There were pancreatic necrosis and infection in the infected ANP group and the bacterial culture was positive.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the Infecton method were 93.8％ ( 15/16 ),91.7％ ( 11/12 ),92.9％ ( 26/28 ),93.8 ％(15/16) and 91.7％ ( 11/12),whereas these values for CT were 12.5％ (2/16),100.0％ ( 12/12),50.0％(14/28),100.0％ (2/2) and 46.2％ (12/26),respectively.The sensitivity,accuracy,and negative predictive value of the Infecton method were significantly higher than those in CT group (P ＜0.01 ).ConclusionsInfecton scintigraphy may be a better procedure for detecting ANP secondary infections than CT.

Due to a lack of specific biomarkers, the diagnosis of drug -induced liver injury (DILI) mainly depends on the method of exclusion.The Roussel Uclaf Causality Assessment Method (RUCAM) scale is the most widely used causality assessment scale and is relatively objective, but it is still waiting for further improvement.Another method is global introspection or expert opinion , which is relatively subjective,and the simplified global introspection method is commonly used in clinical practice .The Structured Expert Opinion Procedure (SEOP) created by the US DILI network (DILIN) is very complicated and time -consuming and thus cannot be used in clinical practice .The drug rechallenge test (DRT) with a positive result is considered the gold standard for the diagnosis of DILI , but DILI cannot be excluded based on the negative result of DRT.The value of lymphocyte transformation test (LTT), modified LTT, monocyte -derived hepatocyte -like cell lactate -dehydrogenase release test, and various predictive models for drug hepatotoxicity in the diagnosis of DILI awaits further assessment .The differential diagnosis of autoimmune -mediated DILI and traditional autoimmune liver diseases usually depends on liver biopsy , the type and titer of autoantibody, and response to glucocorticoids.Reasonable timing of drug withdrawal and application of anti -inflammatory liver -protecting drugs may help most DILI patients recover .Generally, the prophylactic use of anti -inflammatory liver -protecting drugs is not recommended, except in special situations.In -depth studies are needed for the precise diagnosis and prevention /treatment of DILI.

Objective To analyze the epidemiological characteristics of severe fever cases,with thrombocytopenia syndrome (SFTS) in Zhoushan,Zhejiang,2011-2013 and to provide evidence for the development of related strategies for prevention and control of the disease.Methods Data was collected from the studies and related demography of the cases with SFTS in Zhoushan,2011-2013.Clinical and epidemiological characteristics of the cases with SFTS were analyzed descriptively.Results During 2011-2013,45 SFTS cases were reported in Zhoushan city,with fatality rate as 11.11％ (5/45),including 41 cases (91.11％) reported in Daishan county.Most cases aged 50 or over,residing in hilly regions (93.33％).The epidemic peak was seen from May to July (84.44％).Incidence rates of the disease did not show significant statistical differences between males and females.Most cases were farmers (42.22％) and housewives (31.11％).Most patients complained of fever (97.78％),anorexia (91.11％),fatigue (62.22％),chill (44.44％) and other non-specific clinical manifestations but all appeared progressive thrombocytopenia and leucopenia.Sanitation condition of the patients was generally poor.68.89％ (31/45) of cases had farmed,mowed or involved in other outdoor activities in the previous two weeks,with some of them reported having exposed to tick bites.Three events were reported,epidemiologically.Conclusion SFTS in Zhoushan was a infectious disease with natural foci and caused by SFTSV.Ticks might serve as the main vectors for SFTSV,and might cause direct transmission between humans.Improving the environment for living and carrying out essential protective measures in outdoor activities seemed to be significant in decreasing the incidence rate of the disease.

Objective To analyze the precision and stability of optical surface imaging system for patients who received radiotherapy with active breath control. Methods Eighteen radiotherapy patients with lung metastasis were managed by active breath control (ABC).The difference error detected by optical surface imaging system and CBCT were defined as the precision of optical surface imaging system. The variation among the error of optical surface imaging positioning the value of correction of treatment position and the error detected by optical surface imaging again were defined as the stability of optical surface imaging system. Intrafractional errors were analyzed by optical surface imaging system through whole treatment process (including breath hold and free breath). Results The optical surface imaging system had precision (systematic (Σ) and random errors (σ)) of 1.78/3.42 mm 2.54/6.57 mm and 2.79/3.22 mm respectively and stability of2.12/2.54 mm 3. 09/4.02 mm and 1.37/3.55 mm respectively in lateral-medial superior-inferior and anterior-posterior directions. The intrafractional errors (Σ and σ) were 0.42/0.85 mm 0.41/1.47 mm and 0.41/1.47 mm respectively for breath hold duration and 4.76/4.16 mm 6.54/7.78 mm and 3.13/5.92 mm for free breath duration in lateral-medial superior-inferior and anterior-posterior directions. Conclusions As an effective method for validate breath hold;Optical surface imaging system can improve the precision and safety of active breath control. However,the factors that affect the accuracy and stability of the optical surface imaging system in patients undergoing radiotherapy with ABC are not clear;it cannot replace the CBCT for positioning verification.