Objective To acquire setup error with X-ray volumetric images (XVI) technique during volumetric modulated arc therapy (VMAT) of pelvic tumors in order to provide guidance for the doctor to determine the interval between clinical target volume (CTV) and planning target volume (PTV).~ Totally 20 pelvic tumor patients accepting radiation oncology underwent CBCT scan before the first treatment,and auto registration was executed between CBCT images and planning CT images to determine the setup errors at X,Y and Z directions.Then the patients experienced another CBCT scan to obtain residual setup errors,VMAT was carried out after auto on-line correction by the treatment couch,and the third CBCT scan was performed after the treatment.Totally three times of CBCT scans were implemented every week hereafter.The setup errors were analyzed before and after the treatment,and the target volume margin (MPTV) was calculated accordingly.Results The setup errors at X,Y and Z directions were significantly decreased after correction.The values of MPTV at X,Y and Z directions before correction were 3.89,6.20 and 5.24 mm respectively,and the ones after correction were 1.42,2.42 and 2.40 mm respectively.The decreased values of MPTV were between 2.47 and 3.78 mm,which showed the most significant trend at Y direction.Conclusion VMAT of pelvic tumors based on XVI contributes to decreasing the setup errors and enhancing treatment quality.

Objective To investigate the expression levels of forkhead transcription factor 3 (FOXP3) and cytotoxic T lymphocyte-associated antigen-4(CTLA-4) in the peripheral blood of children with newly diagnosed type 1 diabetes mellitus(T1DM),and explore their roles in the pathogenesis of T1DM. Methods Fifty children with newly diagnosed T1DM and 30 healthy children( control group) were select-ed. FOXP3 and CTLA-4 mRNA expressions were detected using real-time PCR. Soluble FOXP3 ( sFOXP3 ) and CTLA-4(sCTLA-4) protein levels in the serum were assayed by ELISA,and the levels of diabetes anti-bodies,HbA1C and C-peptide were determined using Western blotting,high performance liquid ion-exchange chromatography,and electrochemiluminescence, respectively. Results The expressions of FOXP3 mRNA and protein in T1DM patients were lower than those in the control group[0. 95 ± 0. 48 vs. 2. 11 ± 0. 79,(6. 27 ± 1. 49) ng/ml vs. (9. 02 ± 2. 37) ng/ml,respectively,both P <0. 01],while the expressions of CTLA-4 mRNA and protein were higher than those in the control group[2. 43 ± 0. 83 vs. 1. 94 ± 0. 84,(77. 88 ± 22. 34) ng/ml vs. (65. 97 ± 12. 11) ng/ml,respectively,both P<0. 01]. In T1DM patients,the expressions of FOXP3 and CTLA-4 genes presented positive correlation with the protein expression( r=0. 758,0. 396, P<0. 05), and FOXP3 protein expression presented correlation with CTLA-4 protein expression ( r =-0. 624,P<0. 05). Conclusion There are abnormal expressions of FOXP3 and CTLA-4 genes as well as their proteins in the peripheral blood of the children with newly diagnosed T1DM,and FOXP3 regulated the expression of CTLA-4 in T regulatory cells,indicating the involvement of immune mechanisms in the devel-opment of T1DM.

Objective: To investigate the relationship between prognosis of patients with primary clear cell renal cell carcinoma (ccRCC) after radical nephrectomy and expression of tumor metastasis-associated gene CD99 and to analyze the prognostic factors of ccRCC paiients. Methods: Semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR) was used to examine the expression of CD99 in primary ccRCC tissues and their corresponding adjacent tissues. The prognosis and risk factors of survival time of patients were studied by follow-up investigation, and the main risk factors were screened by Cox hazard regression model. Results: Compared with the adjacent renal tissues, 73.5% ccRCC tissues had up-regulated CD99 expression, with significant difference found between the two groups (P=0.000). Cox hazard regression model showed that high CD99 expression in ccRCC tissues was not a survival risk factor of ccRCC patients after radical nephrectomy (HR=0.14, 95%CI[0.01, 2.15]); and age (HR=1.18, 95%CI[1.01, 1.38]), TNM stages (HR=51.91, 95%CI[4.31, 625.87]), diabetes (HR=59.94, 95%CI[2.21, 1 627]) and hypertension (HR=47.72, 95%CI[1.37, 1 670]) were the major risk factors for the survival of patients after radical nephrectomy. The 1-year and 2-year survival rates of ccRCC patients in TNM stage I were significantly higher than those in TNM stage II-IV, respectively (100.0% vs 60.0%, P=0.004; 93.8% vs 8.3%,P=0.000). Conclusion: The expression of tumor metastasis-related gene CD99 may not be associated with the prognoses of ccRCC patients. Age, TNM stage, diabetes and hypertension are the major risk factors of prognosis after resection of ccRCC.

Objective: To predict the B cell epitopes of tumor-associated protein EIF4G1 subtypes. Methods: The sequences of all the protein subtypes of EIF4G1 were retrieved from NCBI protein database. Based on single parameter evaluation, including hydrophilicity, flexility, antigenicity, the B cell epitopes of the EIF4G1 protein subtypes were predicted using NPS@ structure software and ABCpred software. Results: EIF4G1 protein had five subtypes. The variation of the five different EIF4G1 subtypes was limited within a 300aa region. We identified eight epitopes locating in or near 14-19, 21-27, 52-61, 106-112, 113-139, 183-189, 201-216, and 217-224, which can be used to identify specific B cell epitopes of different protein subtypes. Conclusion: B cell epitopes of EIF4G1 protein subtypes do exist, and they may be used for the protein subtypes evaluation and early diagnosis of tumor patients using artificially-produced matched peptides.

Objective: To evaluate the expression of metastasis-associated molecules CD99, FKBP5 and FLJ13576 in primary clear cell renal cell carcinoma (ccRCC). Methods: Semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) was used to examine the differential expression of CD99, FKBP5, and FLJ13576 in the primary ccRCC tissues and the corresponding adjacent normal renal tissues. Results: The positive rates of CD99, FKBP5, and FLJ13576 in the primary ccRCC tissues were 72%, 60% and 48%, respectively, which were significantly higher than those in the adjacent normal renal tissues(28%, 24%, and 16%, P<0.05). Conclusion: Cancer metastasis-associated molecules CD99, FKBP5 and FLJ13576 are highly expressed in the primary ccRCC tissues, which might be associated with the development and progression of renal cancer. CD99, FKBP5 and FLJ13576 may serve as potential markers for detection of ccRCC.

AIM: To evaluate the effects of different doses of valsartan alone or with concomitant benazepril on blood pressure, left ventricular hypertrophy, RAAS function and endoxin level in spontaneously hypertensive rats (SHR). METHODS: Thirty SHR (fourteen-week-old, male) were divided into five groups (six rats in each group ): SHR control group: fed with normal saline; benazepril group: fed with 1 mg?kg -1 ?d -1 benazepril); low dose valsartan group: fed with 8 mg?kg -1 ?d -1 valsartan ; high dose valsartan group: fed with 24 mg?kg -1 ?d -1 valsartan ; combination drug therapy group: fed with valsartan (8 mg?kg -1 ?d -1 ) and benazepril (1 mg?kg -1 ?d -1 ), all for 8 weeks. WKY control group (n=6):fed with normal saline for 8 weeks.RESULTS: SBP, LVM/BW,TDM of SHR were remarkably lower than those of control after drug intervene, and effect on SBP was most remarkable in high dose valsartan group and in the combination drug therapy group; effect on LVM/BW,TDM were most remarkable in combination drug therapy group. Renin activities in plasma and myocardium were remarkably increased in drug intervene groups. The levels of Ang Ⅱ in plasma and myocardium were remarkably increased in two different dose of valsartan treating group, and the larger dose of valsartan were, the higher levels of Ang Ⅱ in plasma and myocardium were; decreased in benazepril treating group and combination drug therapy group. Na +-K +-ATPase activities in myocardium were remarkably increased and the level of endoxin in myocardium were remarkably decreased as SBP decreased after drug intervene. CONCLUSION: Different dose of valsartan alone or combined with benazepril can decrease SBP of SHR, have the effect of inhibiting progression of ventricular hypertrophy. The effect of combination drug therapy group was most remarkable among five groups and can avoid the side effect of high AngⅡ in plasma and myocardium during long-term use of valsartan alone.

Objective: To investigate the clinical characteristics, diagnosis, treatment, and prognostic factors of pancreatic neuroendocrine neoplasms (PNENs). Methods: From August 2004 to August 2016, the clinical data of 63 patients with PNENs in the Sir Run Run Shaw Hospital, an affiliate of the Zhejiang University School of Medicine, were retrospectively analyzed. The data included age, gender, function, tumor location, tumor size, pathological characteristics, lymph nodes, metastasis, and treatment. Association of these factors with PNEN prognosis was proven by univariate analysis and multivariate analysis. Results: In our study, the patients' overall survival time was between 5 and 127 months; the median time was about 46.6 months. Moreover, the survival rates in three years and five years are 88.8％ and 84.1％ respectively. Univariate analysis showed that factors such as lymph node metastasis, liver metastasis, vascular invasion, TNM staging and pathological grading, and radical operation were associated with prognosis (P<0.05). We did not prove any of the factors to be an independent factor associated with poor short-term outcome by multivariate analysis. Conclusion: PNENs are rare low-grade malignant tumors with heterogeneity, which is why they can be erroneously diagnosed. AJCC TNM staging in 2017 and the WHO pathological classification in 2010 can actively guide the prognosis evaluation. The lymph node metastasis, liver metastasis,and vascular invasion affected the prognosis of PNENs. Patients with radical operation had improved prognosis.

Objective:To construct a recombinant adenoviral vector carrying the specific siRNA of Survivin gene,and to observe its effect on the expression of Survivin gene and on the radiosensitivity of cancer cells in tumor-bearing mice.Methods:The specific siRNA of Survivin gene was designed and synthesized,and a recombinant adenovirus AdEGFP-siRNA was subsequently constructed.SMMC 7721 xenograft models were established with nude mice and were divided into the following 5 groups:siRNA+radiotherapy and siRNA groups(intratumoral injection of AdEGFP-siRNA),siRNA(-)group(injected every other day with AdEGFP-siRNA[-],2?108 pfu/100 ?l per time,total 5 times),pure radiotherapy group and blank control groups(injected with the same volume of normal saline).On day 10,12,14,and 16,the mice in siRNA+radiotherapy and pure radiotherapy groups were given 5 Gy/time radiotherapy.The tumor volumes were measured regularly.The expression of Survivin in tumor tissues was determined immunohistochemically.Results:Adenovirus AdEGFP-siRNA harboring the specific siRNA of Survivin gene and enhanced green fluorescent protein gene(EGFP)was successfully recombined.The growth of SMMC 7721 xenografts in nude mice was inhibited after injecting AdEGFP-siRNA,with the inhibition rate being 56.2%.The inhibition rate in AdEGFP-siRNA therapy + radiotherapy increased to 82.6%.Immunohistochemistry study showed that the specific siRNA markedly silenced the expression of Survivin gene in hepatocarcinoma cells.Conclusion:The specific siRNA can markedly silence Survivin gene and subsequently inhibit the growth of cancer;meanwhile,it can also increase the radiosensitivity of cancer cells so as to improve the treatment effect.

Objective To determine the appropriate concentration of ropivacaine for differential sensory and motor block of brachial plexus.Methods Ninety ASA Ⅰ - Ⅲ patients aged 16-75 yr weighing 40-85 kg undergoing upper extremity operation under axillary brachial plexus block were randomly divided into 3 groups according to the concentration of ropivacaine used for the block(n = 30 each): group A 0.15% ropivacaine;group B 0.10% ropivacaine and group C 0.05% ropivacaine.Axillary brachial plexus block was performed using ultrasound guidance and electric nerve stimulation.Sensory and motor block were assessed and recorded at 10,30,60and 240 min after local anesthetic injection(T1-4).The rate of adequate sensory block,the rate of differential sensory and motor block(the areas innervated by radial,median and ulnar nerves were numb but the patients could still move their elbow,wrist and fingers)and effectiveness of the block(excellent - completely no pain;good slight pain,iv fentanyl was needed;poor -rescue brachial plexus block was needed or general anesthesia was induced).Operation time and duration of analgesia and success rate of the block were recorded.Results 0.15%ropivacaine produced excellent or good block and no failure in group A.The rate of differential sensory and motor block was significantly higher in group B(0.10% ropivacaine)than in group A.The effect of block with 0.05% ropivacaine was unsatisfactory in group C.Conclusion Axillary brachial plexus block with 0.10% ropivacaine can induce differential sensory and motor block in the majority of patients.

Objective:To study the PDT effects on culturing endothelial cell in vitro under the differens content of CPD 4. Methods: According to the existing techniques obtaining prime umbilical vein endothelial cell in 24 well culturing plate,10 5/well.Add 1640 medium mixed with different final concentration of CPD 4 individuallly and incubate for 1h. Then shine them with 630～640 nm red light. Observe the morphological changes of EC. After PDT 6 h,measure the contents of Prostaglandin F 1?(PGF 1?) and and LDH in the culturing medium and the percentage of the residual cell. Results:With the concentration of CPD 4 increasing, the damage degree of EC aggravates. There was emergence of EC contracting ,falling off , cytoplasmic swelling,floating and dying. The contents of PGF 1? and LDH were increasing and the percentage of residual cell decreases simultaneously. There was statistical significance between the five groups. Conclusion:The effect of PDT is direct.The effectiveness has two characteristic: ①CPD 4 induced PDT has direct photosensitised damage to EC. There exists CPD 4 dose dependence.②The PDT target of EC is membrane and cytoplasma organelle. The damage is lethal and irreversible.