Objective:To explore the efficacy of sequential and concurrent chemoradiotherapy in the treatment of advanced non-small cell lung cancer (NSCLC) in the elderly, and to analyze the influencing factors of prognosis and outcome.Methods:The clinical data of 195 elderly patients with advanced NSCLC admitted to Beijing Shijingshan Hospitaland and Beijing Shijitan Hospital from March 2015 to March 2018 were retrospectively analyzed. They were divided into the concurrent chemoradiotherapy (100 cases) and the sequential chemoradiotherapy (95 cases) according to different chemoradiotherapy regiments. The short-term efficacy, 3-year survival, influencing factors of prognosis and toxic and adverse effects of the two groups were compared.Results:The objective response rate in the concurrent chemoradiotherapy group was significantly higher than that in the sequential chemoradiotherapy group: 61.00%(61/100) vs. 44.21%(42/95), there was statistically difference ( χ2 = 5.51, P<0.05). The 2-year and 3-year survival rate in the concurrent chemoradiotherapy group were 52.00% and 23.00%, which were significantly higher than those in the sequential chemoradiotherapy group: 32.60%, 11.60%, there were statistically differences ( P<0.05). Multivariate analysis results showed that smoking, Karnofsky score<70, TNM stage Ⅲb, short-term efficacy and treatment methods/sequential chemoradiotherapy were independent risk factors ( P<0.05). The incidence of radiation esophagitis, bone marrow suppression and lung function damage in the concurrent chemoradiotherapy group were higher than those in the sequential chemoradiotherapy group: 45.00%(45/100) vs. 27.37% (26/95), 36.00%(36/100) vs. 22.11%(21/95), 48.00%(48/100) vs. 26.32%(25/95), there were statistically differences ( χ2 = 6.54, 4.55, 9.78; P<0.05). Conclusions:Concurrent chemoradiotherapy can improve the short-term efficacy, and improve the 2-year and 3-year survival rates in advanced NSCLC in elderly patients, but the adverse effects are significantly enhanced.

Objective:To investigate the differences between the mental clips placed intraoperatively and the tumor bed's target volume delineation of seroma based on CT scanning during radiotherapy for breast cancer patients who received breast-conserving surgery in the persuit of a better solution to determine the tumor bed position.Methods:The clinical data of 13 patients with early breast cancer who received postoperative radiotherapy after breast-conserving surgery at Beijing Shijingshan Hospital and Beijing Shijitan Hospital of Capital Medical University from December 2020 to January 2022 were retrospectively analyzed. They all had surgical clips implanted during the surgery. The following methods were used to delineate the target volume of tumor bed, including gross target volume delineation of tumor bed based on the mental clips (GTVtb-Clip), the tumor bed's gross target volume delineation of seroma based on CT scanning (GTVtb-Seroma), and the combination of both (GTVtb-C+S). The volume, diameter on three coordinate axis, neutral point displacement and conformability of these delineation methods were compared.Results:The volume of GTVtb-Clip, GTVtb-Seroma and GTVtb-C+S was (25±10) cm 3, (38±17) cm 3, (49±20) cm 3, and the differences were statistically significant (all P<0.05). The diameter on X axis was (4.7±1.2) cm, (5.3±1.4) cm, (5.7±1.6) cm, respectively in GTVtb-Clip, GTVtb-Seroma and GTVtb-C+S; the diameter on Y axis was (4.6±1.7) cm, (5.0±1.6) cm, (5.7±1.7) cm, respectively in GTVtb-Clip, GTVtb-Seroma and GTVtb-C+S; the diameter on Z axis was (4.4±1.5) cm, (5.2±1.4) cm, (5.6±1.4) cm in GTVtb-Clip, GTVtb-Seroma and GTVtb-C+S. The differences in the diameter of GTVtb-Clip and GTVtb-C+S on X,Y, Z axis were statistically significant (all P<0.05); the differences in the diameter of GTVtb-Seroma and GTVtb-C+S on X, Z axis were statistically significant (all P<0.05); the difference in the diameter of GTVtb-Clip and GTVtb-Seroma on X axis was statistically significant ( P<0.05) .Neutral point displacement was (5.8±1.6) cm, (5.5±1.9) cm, (6.0±1.7) cm, respectively of GTVtb-Clip, GTVtb-Seroma, GTVtb-C+S, and the difference was not statistically significant ( P>0.05). Conformability of GTVtb-Clip and GTVtb-Seroma, GTVtb-Clip and GTVtb-C+S, GTVtb-Seroma and GTVtb-C+S was 0.412±0.112, 0.525±0.095, 0.774±0.112,respectively, and the differences were statistically significant (all P<0.05). Conclusions:During radiotherapy after breast-conserving surgery for breast cancer, compared with the single method, the combination of GTVtb-Clip and GTVtb-Seroma can better cover the real tumor bed, thus reducing the omission of tumor bed and recurrence rate. CT position should better take place at 4 to 8 weeks for patients receiving radiotherapy after breast-conserving surgery, and target volume of tumor bed will be delineated based on the postoperative changes of both mental clips and seroma.

Objective:To propose a markless patient setup workflow based on the optical surface monitoring system (AlignRT) and open-face mask immobilization for whole-course head tumor radiotherapy, assess the setup time and repositioning frequency of the proposed workflow, and conduct a comparative analysis of the differences, correlation, and consistency of the setup errors of the AlignRT and cone beam CT (CBCT) systems.Methods:A retrospective analysis was conducted for the data on the errors of 132 fractionated setup based on open-face mask immobilization of 33 head tumor patients. AlignRT-guided markless patient setup workflow was applied throughout the radiotherapy. Meanwhile, the body structures automatically generated by the treatment planning system were used as body references. The 6-degree-of-freedom (6DoF) setup errors (lateral, vertical, longitudinal, rotation, pitch, roll, and yaw directions), setup time, and repositioning frequency of the AlignRT and CBCT systems were recorded and analyzed. The Wilcoxon and Spearman analyses were used to statistically assess the differences and correlation of the setup errors of the two systems. Moreover, the Bland-Altman analysis was employed to evaluate the consistency of the two systems.Results:The 6DoF setup errors of CBCT were within the clinical tolerance (linear motions: -0.30 to 0.30 cm; rotational motions: -2.0° to 2.0°). The setup time and repositioning frequency of CBCT were (98 ± 31) s and 1.51% (2/132), respectively. There was no significant difference in setup errors between the two systems except those in x-axis ( Z = -3.11, P= 0.002), y-axis ( Z = -7.40, P<0.001), and Pitch ( Z= -4.48, P<0.001). There was a significant positive correlation between the setup errors along lateral ( rs = 0.47, P<0.001) and vertical ( rs = 0.29, P = 0.001) directions, rotation (Rtn; rs = 0.47, P<0.001), pitch (Pitch; rs = 0.28, P = 0.001) and roll (Roll; rs = 0.45, P<0.001) of the two systems. The 95% limits of agreement (95% LoA) of 6DoF setup errors were -0.12 to 0.09 cm, -0.07 to 0.17 cm, -0.19 to 0.20 cm, -1.0° to 0.9 °, -1.0° to 1.5°, and -0.9° to 1.0°, respectively. The 95% confidence interval (95% CI) of 95% LoA was -0.14 to 0.11 cm, -0.09 to 0.19 cm, -0.23 to 0.23 cm, -1.2° to 1.1°, -1.2° to 1.7°, and-1.0° to 1.1°, respectively, all of which were within the permissible error ranges. The 6DoF setup error difference of 3.41% (27/792< 5%) was beyond the 95% LoA. The maximum absolute differences of 6DoF setup errors within the 95% LoA were 0.12, 0.16, 0.19 cm, 0.9°, 1.5°, and 1.0°, respectively. Conclusions:The proposed markless setup workflow based on AlignRT combined with open-face mask immobilization for whole-course head tumor radiotherapy exhibits reasonable agreement and consistency with the patient setup using CBCT, with acceptable clinical efficiency. It can be applied to the first radiotherapy and the real-time monitoring of therapy to improve the safety and thus is of value in clinical applications.

Objective: To explore the value of an oral squamous cell carcinoma (OSCC) diagnostic model constructed by using principal component analysis (PCA) to analyze a database of differentially expressed genes in OSCC and to provide a reference for clinical diagnosis and treatment. Methods: RNA-seq expression data of OSCC and normal control samples were obtained from The Cancer Genome Atlas (TCGA) database, and then, normalized and differentially expressed genes (DEGs) were identified by R software. DEGs were enriched by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis to identify their main biological characteristics. 70% of DEGs expression data in RNA-seq were randomly selected as the training set and 30% were selected as the test set. Then, the PCA method was applied to analyze the training set data and extract the principal components (PCs) related to the diagnosis of OSCC in order to construct a PCA model. Then, the receiver operating characteristic (ROC) curves of PCA models in the training set and the test set were respectively drawn, and the area under curve (AUC) was calculated to evaluate the accuracy of the PCA model in the diagnosis of OSCC. Results: RNA-seq expression data of OSCC and normal control samples obtained from TCGA database included 330 samples and 32 samples, respectively. Using false discovery rate (FDR) <0.001 and |log2 fold change| (|log2FC|) >4 as the thresholds, a total of 159 downregulated and 248 upregulated DEGs were identified, which were mainly enriched in cellular components such as intermediate fiber and melanosomal membrane, pigment and salivation-related biological processes and mainly involved in salivary secretion and tyrosine metabolism pathways (P.adjust<0.05 and Q<0.05). The DEGs were proposed as tumor markers for OSCC, and PCA analysis of the training set showed that the cumulative ratio of variance of PC1, PC2 and PC3: [including submaxillary gland androgen regulated protein 3B (SMR3B), proline rich 27 (PRR27), histatin 3 (HTN3), statherin (STATH), cystatin D (CST5), BPI fold containing family A member 2 (BPIFA2), proline rich protein Hae Ⅲ subfamily 2 (PRH2), keratin 35(KRT35), histatin 1 (HTN1), amylase alpha 1B (AMY1B)] were 0.873, 0.100 and 0.023, respectively, and the total weight of the three was 0.996. The PCA diagnostic model of OSCC was further constructed by combining the eigenvectors of the above three components. The ROC curves of the training set and test set showed that the AUC values of the PCA model were 0.852 and 0.844, respectively, which were higher than those of other single genes. Conclusion The OSCC diagnostic model based on the expression levels of SMR3B, PRR27, HTN3, STATH, CST5, BPIFA2, PRH2, KRT35, HTN1 and AMY1B constructed with the PCA method and DEGs has a high diagnostic advantage. This study provides a theoretical basis for the early genetic diagnosis of OSCC and the application of the PCA model in clinical diagnosis.

OBJECTIVE：To know about the current situation and trend of encouraged generic drug catalogue policy in China ， and to put forward countermeasures and suggestions for the better implementation of the policy. METHODS ：The evolution of encouraged generic drug catalogue policy in China ，the characteristics of 2 batches of included types in encouraged generic drug catalogue，the implementation effect of the first batch of encouraged generic drug catalogue ，the development trend and existing problems of encouraged generic drug catalogue policy were analyzed to put forward corresponding suggestions. RESULTS & CONCLUSIONS：The evolution of encouraged generic drug catalogue policy in China can be roughly divided into embryonic stage，policy design stage and policy implementation and adjustment stage. The first batch of included types in encouraged generic drug catalogue are mainly drugs whose patents are about to expire and the competition is insufficient ，drugs with clinical necessity ， definite curative effect and short supply ，and varieties for special clinical purposes such as the prevention and treatment of major infectious diseases and rare diseases ，and children ’s use. The second batch of included types in encouraged generic drug catalogue are mainly those with expired patents （about to expired ）and insufficient competition ，and also those with special clinical uses. Among the types of the first batch of encouraged generic drug catalogue ，the number of abbreviated new drug application （ADNA） increased by 18，involving a total of 8 varieties；only 3 ADNA were included in the priority review ，accounting for 16.67％. In 2019 and 2020，218 and 119 varieties were newly included in the medical insurance catalogue ，and 3 varieties were newly included in the encouraged generic drugs catalogue （accounting for 1.4％ and 2.5％ respectively）. At present ，encouraged generic drug catalogue policy in China has the trend and characteristics of patent oriented regression ，lack of priority review and approval system，and enhanced linkage with the medical insurance catalogue. It is suggested to adhere to the original intention of the Opinions of the State Council on Deepening the Reform of the Review and Approval System and Encouraging the Innovation of Drugs and Medical Devices in 2017，continue to adhere to the patent orientation of encouraged generic drug catalogue ，and improve the priority review system of generic drugs in the catalogue ，explore the “first imitation market monopoly period ”system in line with the characteristics of encouraged generic drug catalogue policy in China with reference to the U.S. FDA competitive imitation therapy guidelines ，and further strengthen the cooperation between government departments in the implementation of the encouraged generic drug catalogue policy.

OBJECTIVE：To investigate the inhibitory effects of total alkaloids of Gelsemium elegans （TAG） on the proliferation and angiogenesis of human colon cancer cells. METHODS ：Human colon cancer cell line HT- 29 and HUVEC were cultured in vitro . After the intervention of low- ，medium-，high-dose TAG （40，80，120 μg/mL），the morphology of the two cells was observed by fluorescence inversion microscope. The survival rate of HT- 29 cells and HUVEC was detected by CCK- 8 assay. Flow cytometry was used to detect HT- 29 cell cycle. The migration rate ，invasion rate and tube number of HUVEC were observed by scratching test ，Transwell invasion experiment and tube formation experiment. RESULTS ：Compared with blank group ，HT-29 cells and HUVEC were decreased to different extents in TAG groups ；dead cells were observed ，and the survival rate of both decreased significantly （P＜0.05 or P＜0.01）. The proportion of HT- 29 cells at G 2/M phase in TAG groups as well as those at G 0/G1 phase in medium-dose group were increased significantly ；the proportion of HT- 29 cells at S phase in TAG groups as well as those at G 0/G1 phase in high-dose group were decreased significantly （P＜0.05 or P＜0.01）. Survival rate ，migration rate and invasion rate of HUVEC were decreased significantly in TAG groups ，and tube number was also decreased significantly at each time point during 4-24 h（P＜0.01）. CONCLUSIONS ：TAG have inhibitory effect on the proliferation of human colon cancer HT- 29 cells and HUVEC，can change HT- 29 cell cycle ，inhibit the migration ，invasion and tube formation of HUVEC.

The pathogenesis of diabetic retinopathy (DR) is complex.Antisense non-coding RNA (ANRIL) in the INK4 locus in long-chain non-coding RNA (lncRNA) is closely related to cell proliferation,differentiation,and individual development.It plays an important role in the dysplasia of retinal vascular endothelial cells and is a new field in the study of the pathogenesis of DR.According to the researches at present,ANRIL may plays its role in the occurrence and development of DR through the signal pathway of nuclear factor-κB and ROS/polyadenylation diphosphate ribose polymerase,and interact with p300,miR-200b,and EZH2 to regulating the expression and function of VEGF.Specific blocking ANRIL and its related pathwaysmay become a new target in the treatment of DR.

Objective:To analyze and compare the radiation dose and image quality of kilo-voltage cone beam CT systems on different Varian accelerator platforms, providing data to support clinical decisions on selecting optimal protocols for image-guided radiotherapy based on cost-effective ratio (image quality / radiation dose).Methods:The radiation dose and image quality of various CBCT systems and scanning protocols on Varian Edge, Truebeam and ix (new and old) LINACs were obtained using a CT dose index (CTDI) phantom combined with a CT ionization chamber and a Catphan604 phantom, respectively. Figure of merit (FOM) was used to evaluate the cost-effective ratio of the image guidance schemes.Results:Considerable inter-system varieties of FOMs were observed, varying from 0.65 (Image Gently-full trajectory) to 48.46 (Image Gently-half trajectory). The inter-protocol varieties were also large, where the mean±SD was 22.14±13.47.Conclusions:Considering the explicit inter-system and inter-protocol varieties, it is clinically favorable to evaluate the image guidance schemes based on machine-specific measurement. For instance, parameters and equipment with low CTDI w can be beneficial for dose-sensitive patients. High CNR regimen favors patients with high image quality requirements. For ordinary patients, cost-effective ratio in terms of FOM can be very helpful to guide the decision-making of clinical image-guided radiotherapy.

Objective To compare the effects of bone transport versus induced membrane technique for large segmental tibial defects.Methods The clinical data were analyzed retrospectively of 89 patients with large segmental tibial defect who had been treated at Department of Orthopaedics,Wuxi No.9 People's Hospital from June 2005 to February 2017 using bone transport or induced membrane technique.They were 58males and 31 females,aged from 13 to 74 years (average,38.0 years).The bone transport group had 59cases and the induced membrane technique group 30 cases.The 2 groups were compared in terms of preoperative general data and postoperative bone nonunion,bone healing time,complications and functional recovery of the adjacent joint.Results There were no statistically significant differences between the 2groups in terms of age,gender,cause or type of defects,associated injury,course of disease,functionary scores of the adjacent joint or number of operations,showing compatibility between the 2 groups (P ＞ 0.05).All the patients were followed up for 12 to 48 months (average,20 months).The bone transport group had significandy longer clinical healing time (14.7 ± 5.4 months) and significantly higher incidences of major complications (50.8％),minor complications (57.6％) and overall complications (83.1％) than the induced membrane technique group (11.2 ± 2.8 months,16.7％,26.7％ and 30.0％,respectively) (P ＜ O.05),but significantly lower functionary scores of the adjacent joint (86.4 ± 5.0 points) than the induced membrane technique group (88.8 ± 4.9 points) (P ＜ 0.05).Conclusions Both bone transport and induced membrane technique are effective repairs for large segmental tibial defects.However,induced membrane technique may be superior to bone transport in terms of bone healing,complications and functional recovery.

Objective: To observe the hemodynamic change characteristics of left ventricle and evaluate left ventricular systolic function in patients with chronic heart failure (CHF) via vector flow mapping(VFM). Methods: Sixty-two patients with CHF(CHF group) were selected as case group and were divided into three groups (B, C, D) according to the American College of Cardiology Foundation and the American Heart Association (ACC/AHA ) recommended stages.Sixty healthy volunteers were selected as control group. The left ventricular circulation parameters (vortex quantity, vortex area, circulation) and energy loss (EL) of the apex, mid, and basal segments in different groups were compared in all the systolic phases. Left ventricular ejection fraction (LVEF) was calculated by biplane Simpson method, and the correlation was analyzed with the parameters of circulation and EL. Results: ①In the phase of isovolumetric contraction (IVC) and slow ejection (SE), compared with the control group, the levels of EL were increased in mid and basal segments (P<0.01 or P<0.05) in CHF group. The vortex area and circulation during IVC and rapid ejection (RE) were higher in CHF group than those in the control group (P<0.01 or P<0.05). As for SE, only vortex quantity was higher in CHF group than that in the control group (P<0.05). ②In CHF group, EL were increased at stage B and stage C than those in the control group (P<0.05), and EL were decreased at stage D than those in the control group ( P<0.05). Meanwhile, there was decreased tendency of EL in CHF group with the increase of ACC/AHA stages. ③The circulation during IVC of phase D was higher in CHF group than that in the control group (P<0.05), the vortex area during RE was greater in CHF group than that of the control group and stage B (P<0.05). ④EL was positively correlated with LVEF at basal segment of IVC(r=0.615, P<0.001). The vortex area during RE, circulation during IVC and RE were negtively correlated with LVEF (r=-0.598, -0.594, -0.623; all P<0.001). Conclusions VFM technology can quantify the left ventricular hemodynamic changes of patients with CHF in the systolic phase, and shows its relationship with left ventricular systolic function, to provide objective basis for grading of CHF and also provide objective quantitative indicators for clinical treatment and curative effect evaluation.