Objective To investigate the predictive role of the intraoperative amylase ( IOA ) from pancreatic stump for postoperative pancreatic fistula. Methods The clinical data of 26 patients who received distal pancreatectomy ( DP) and central pancreatectomy ( CP) in the Shanghai Ruijin Hospital from June 2017 to July 2018 were retrospectively analyzed. IOA and peri-operative potential clinical factors associated with pancreatic fistula were analyzed. Receiver operating characteristics ( ROC) curve was drawn to evaluate the diagnostic efficacy of IOA from pancreatic stump in predicting postoperative pancreatic fistula, and the sensitivity and specificity were calculated. Results Of 26 patients, 19 patients underwent DP and 7 patients underwent CP. 9 patients (34.6％,9/26)had class A pancreatic fistula (biochemical leak) and 11 patients (42. 3％,11/26) had class B pancreatic fistula after surgery, and no class C pancreatic fistula occurred. Univariate analysis showed that IOA from pancreatic stump in clinically relevant pancreatic fistula group was higher than that in clinically irrelevant pancreatic fistula group(7971. 82 ± 4387. 98 vs 1589. 20 ± 1405. 00, P=0. 001). Area under the curve ( AUC) of IOA in predicting the development of clinically relevant pancreatic fistula after surgery was 0. 921 and 95％ confidential interval was 0. 807-1. 000. The optimal cut-off value was 3622 U/L , and the sensitivity and specificity were 90. 9％ and 86. 7％. Conclusions IOA from pancreatic stump could serve as a clinical indicator for predicting the occurrence of postoperative pancreatic fistula.

【Objective】 To construct an in-vitro model of erythrocyte antibody-mediated complement activation, and establish quantitative detection methods based on flow cytometry and spectrophotometry, so as to explore the correlation of anti-body titers and complement activation speed, and provide a methodological basis for studying the adverse transfusion reactions of anti-body mediated complement hemolysis. 【Methods】 Mouse monoclonal antibody that recognized human C3b and fluorescent secondary antibody were used to label C3b fragments on erythrocytes, and the deposition of C3b fragments after complement activation was detected by flow cytometry. The absorbance at 540 nm of the supernatant in the complement activation reaction system was measured by spectrophotometry as the amount of hemoglobin released was related to the absorbance. 【Results】 The complement activation system was constructed according to the ratio of 3% red blood cell suspension (mixed for 6 people) 1∶anti-Tj^a 1∶complement 2. The repeatability was good (P value>0.05) as different red blood cell mixtures had been used to repeat the detection reaction system. When using 32×, 64× and 128× dilutions of anti-Tj^a mediated complement activation, the deposition of C3b fragments has been detected by flow cytometry at 30 s, 1 min and 2 min, respectively, and MFI peaked at 5 min, 10 min and 30 min, respectively. No obvious hemolysis has been observed within 1.5 h. 【Conclusion】 In vitro model of anti-Tj^a-mediated complement activation demonstrates the speed of complement activation is related to the concentration of antibody. At a certain antibody concentration, the speed of complement activation has been slowed down, and no obvious hemolysis observed.

Objective: To develop and evaluate an automatic intensity-modulated radiation therapy (IMRT) program for cervical cancer based on a database of overlap volume histogram (OVH) and high-quality cervical IMRT plans for previously-treated patients. Methods: A database consisting of high-quality IMRT plans and OVHs from 200 cervical cancer patients was established. OVHs of another 26 cervical cancer patients were converted into gray level images to calculate the image similarity compared with those from the database. The planning optimization function of the patients from the database with the highest image similarity was selected and inherent Pinnacle³ scripts were utilized to automatically generate IMRT plan. Finally, the dosimetric parameters, plan quality and design time were statistically compared between the automatic and manual plans. Results: The target coverage, conformity index and homogeneity index did not significantly differ between two plans (all P>0.05). The V₄₀, V₄₅ and mean dose for the rectum in the automatic plans were significantly decreased by 6.1%, 1.3% and 50.7 cGy than those in the manual plans (all P<0.05). Compared with the manual plans, the mean dose for the intestine and femur in the automatic plans were significantly reduced by 31.7 cGy and 188.9 cGy (both P<0.05), whereas the mean dose for the ilium was slightly decreased by 92.3 cGy in the automatic plans (P>0.05). The plan design time was shortened by 71% in the automatic plans. Conclusions The automatic IMRT plans based on a database of OVH and high-quality IMRT plans can not only significantly shorten the plan design time, but also reduce the irradiated dose of normal tissues without compromising the target coverage and conformity index.