Predicting passing rate for VMAT validation using machine learning based on plan complexity parameters / 中华放射医学与防护杂志

Objective:To establish a prediction model using the random forest (RF) and support vector machine (SVM) algorithms to achieve the numerical and classification predictions of the gamma passing rate (GPR) for volumetric arc intensity modulation (VMAT) validation.Methods:A total of 258 patients who received VMAT radiotherapy in the 1 st Affiliated Hospital of Wenzhou Medical University from April 2019 to August 2020 were retrospectively selected for patient-specific QA measurements, including 38 patients who received VMAT radiotherapy for head and neck, and 220 patients who received VMAT radiotherapy for chest and abdomen. Thirteen complexity parameters were extracted from the patient′s VMAT plans and the GPRs for VMAT validation under the analysis criteria of 3%/3 mm and 2%/2 mm were collected. The patients were randomly divided into a training cohort (70%) and a validation cohort (30%) , and the complexity parameters for the numerical and classification predictions were screened using the RF and minimum redundancy maximum correlation (mRMR) method, respectively. Complexity models and mixed models were established using PTV volume, subfield width, and smoothness factors based on the RF and SVM algorithms individually. The prediction performance of the established models was analyzed and compared. Results:For the validation cohort, the GPR numerical prediction errors of the complexity models based on RF and SVM under the two analysis criteria are as follows. The root-mean-square errors (RMSEs) under the analysis criterion of 3%/3 mm were 1.788% and 1.753%, respectively; the RMSEs under the analysis criterion of 2%/2 mm were 5.895% and 5.444%, respectively; the mean absolute errors (MAEs) under the analysis criterion of 3%/3 mm were 1.415% and 1.334%, respectively, and the MAEs under the analysis criteria of 2%/2 mm were 4.644% and 4.255%, respectively. For the validation cohort, the GPR numerical prediction errors of the mixed models based on RF and SVM under the two analysis criteria were as follows. The RMSEs under the analysis criterion of 3%/3 mm were 1.760% and 1.815%, respectively; the RMSEs under the analysis criterion of 2%/2 mm were 5.693% and 5.590%, respectively; the MAEs under the analysis criterion of 3%/3 mm were 1.386% and 1.319%, respectively, and the MAEs under the analysis criteria of 2%/2 mm were 4.523% and 4.310, respectively. For the validation cohort, the AUC result of the GPR classification prediction of the complexity models based on RF and SVM were 0.790 and 0.793, respectively under the analysis criterion of 3%/3 mm and were 0.763 and 0.754, respectively under the analysis criterion of 2%/2 mm. For the validation cohort, the AUC result of the GPR classification prediction of the mixed models based on RF and SVM were 0.806 and 0.859, respectively under the analysis criterion of 3%/3 mm and were 0.796 and 0.796, respectively under the analysis criterion of 2%/2 mm cohort.Conclusions:Complexity models and mixed models were developed based on the RF and SVM method. Both types of models allow for the numerical and classification predictions of the GPRs of VMAT radiotherapy plans under analysis criteria of 3%/3 mm and 2%/2 mm. The mixed models have higher prediction accuracy than the complexity models.

Comparison of three fixed-field IMRT plans for nasal cavity and paranasal sinus tumors / 中华放射医学与防护杂志

Objective:To compare three fixed-field intensity-modulated radiotherapy (IMRT) plans for nasal cavity and paranasal sinus tumors, including the coplanar IMRT (C-IMRT) plan and the non-coplanar IMRT(NC-IMRT) plan which were based on a conventional C-arm LINAC (Trilogy), and the coplanar IMRT (H-IMRT) plan based on an O-ring LINAC (Halcyon).Methods:Based on the data of 10 patients in the Ningbo First Hospital from December 2018 to December 2021 with nasal cavity and paranasal sinus tumors who underwent postoperative radiotherapy, this study redesigned three IMRT plans with the same prescribed doses and optimization objectives. Then, this study compared the doses of target volumes and organ at risks(OARs), the validation pass rates, and the execution time of these plans. Friedman test was employed in this study, and multiple comparisons were further made in cases of different results.Results:The differences in the conformal index (CI) of PTV and PTV boost of the three plans were statistically significant ( χ2 = 7.51, 9.69, P < 0.05). The multiple comparisons showed that the median CI of the H-IMRT plan was higher than that of the NC-IMRT plan ( Z = 2.53, 2.68, P < 0.05). The differences in other parameters of target volumes were not statistically significant. Compared with the C-IMRT plan, the H-IMRT plan reduced the Dmax of bilateral lenses, bilateral corneas, ipsilateral optic nerve, and ipsilateral eyeball ( Z = 2.80, 2.80, 2.80, 2.80, 2.81, 2.09, P < 0.05). Compared with the C-IMRT plan, the NC-IMRT reduced the Dmax of bilateral lenses, corneas, and eyeballs and contralateral optic nerve ( Z = 2.80, 2.66, 2.80, 2.70, 2.29, 2.29, 2.65, P < 0.05) and reduced the Dmean of bilateral eyeballs ( Z = 2.80, 2.80, P < 0.05). Compared with the NC-IMRT plan, the H-IMRT plan reduced the Dmax of the ipsilateral lens and cornea ( Z = 2.50, 2.08, P < 0.05), but increased the Dmax of the contralateral optic nerve and the Dmean of bilateral eyeballs ( Z = 2.80, 2.80, 2.80, P < 0.05). The validation pass rate of the three plans met the institutional standards, and the differences were not statistically significant. Moreover, the H-IMRT plan had the shortest median execution time (172.00 s), followed by the C-IMRT plan (337.50 s), and the NC-IMRT plan (388.00 s). Conclusions:The verification pass rate of the three plans can achieve the requirements of treatment implementation. The three plans had similar dosimetric differences in target volumes. However, the H-IMRT and NC-IMRT plans can protect the normal tissues (especially optical organs) more effectively than the C-IMRT plan, which is conducive to reducing the toxicity after radiotherapy and provides space for local dose increase or the radiotherapy for the treatment of tumor recurrence. The execution efficiency of the three plans is in the order of H-IMRT > C-IMRT > NC-IMRT. It is necessary to select appropriate radiotherapy equipment and technology according to actual situations.

Dosimetric comparison between conventional IMRT and EBCRT combined with IMRT for post-mastectomy left-sided breast cancer patients / 中华放射医学与防护杂志

Objective:To investigate the dosimetric differences between conventional IMRT and electron beam conformal radiotherapy (EBCRT) combined with IMRT for post-mastectomy left-sided breast cancer patients.Methods:A total of 20 post-mastectomy left-sided breast cancer patients who were treated in the Ningbo First Hospital from June 2018 to October 2021 were retrospectively studied. The planning target volume (PTV) included the supra-and infra-clavicular regions(PTV sc)and the ipsilateral chest wall (PTV cw), and the prescribed dose was 50 Gy/25 f. All radiotherapy plans were designed using the Varian Eclipse treatment planning system (TPS). After that, the dose distribution of the target volume and the dose exposure of organs at risk (OARs) were compared and analyzed. Results:All the IMRT plans met the clinical requirements, yet 2/20 of the EBCRT combined with IMRT plans were not clinically accepted. For these two patients, the maximum chest wall thickness was 3.7 cm and 4.4 cm each, and the designed electron beam energy was 12 MeV and 15 MeV, respectively. The dose to the ipsilateral lung of these two patients exceeded the institution-specific dose limit standard. For the remaining 18 patients whose chest wall thickness was 3 cm or less, the designed electron beams were 9 MeV or less. All the EBCRT combined with IMRT plans were clinically accepted. The target dose distribution of the conventional IMRT was better than that of the EBCRT combined with IMRT (uniformity index (HI): PTV sc: t = -10.20, P<0.05; PTV cw: t = -9.24, P<0.05; conformal index (CI): PTV all: t = 10.39, P <0.05). For OARs, the V5 Gy, V20 Gy, and Dmean of the ipsilateral lung of EBCRT combined with IMRT were lower than those of IMRT ( t = 5.98, 6.30, 11.30, P <0.05). Specifically, the V25 Gy and Dmean of heart decreased by 8.3% and 4.79 Gy, respectively ( t = 15.23, 15.76, P<0.05), the Dmean of the left anterior descending coronary artery (LADCA) decreased by 44.03% ( t = 11.69, P <0.05), and the V5 Gy and Dmean of the contralateral breast decreased by 7.9% and 0.8 Gy, respectively ( t = 3.66, 4.93, P<0.05). The dosimetric differences of other OARs were not statistically significant ( P > 0.05). Conclusions:For post-mastectomy left-sided breast cancer patients with a chest wall thickness of less than 3 cm, EBCRT combined IMRT can significantly reduce the exposure dose to the heart, the ipsilateral lung, and the contralateral breast, which is beneficial to reducing the potential risk of long-term complications after radiotherapy and can further improve the long-term overall survival rate of patients. For patients with thick chest wall, IMRT plans are more technologically ideal.

Tolerance and dosimetric study of multi-leaf collimator leaf position accuracy for dynamic intensity-modulated radiotherapy / 中华放射肿瘤学杂志

Objective:To evaluate the dosimetric effect of multi-leaf collimator (MLC) position error on dynamic intensity-modulated radiotherapy (dMLC-IMRT), aiming to provide guidance for the establishment of MLC quality control accuracy and operation tolerance.Methods:In the phantom study, the virtual water phantom established in the treatment planning system (TPS), and three dynamic sliding window test fields with gap width of 5 mm, 10 mm and 20 mm were designed. Clinical treatment plans of 7 common tumor types were extracted, including nasopharyngeal carcinoma, glioma, lung cancer, esophageal cancer, cervical cancer, prostate cancer, and breast cancer, with 6 cases in each. MLC errors were introduced into the copy from original plan to generate the simulation plans. MLC errors included systematic open/close error, systematic deviation error and random error. The dosimetric differences between the original and simulation plans were compared.Results:The phantom study showed that the symbol of dose deviation was the same as that of systematic open/close error, and the value was increased with the increase of MLC error and decreased with the increase of gap width. The results of patient study showed that the systematic open/close error had a significant effect on dosimetry, the target volume dose sensitivities of different plans were 7.258-13.743%/mm, and were negatively correlated with the average field width. The dosimetric deviation caused by the systematic shift error below 2 mm was less than 2%. The dosimetric change caused by the random error below 2 mm could be neglected in clinical treatment.Conclusions:The minimal gap width should be limited in TPS, whereas the quality control of MLC should be strengthened. In addition, for the dynamic intensity-modulated treatment technology, 2 mm random error was suggested to be the operation tolerance during treatment delivery, and 0.2 mm alignment accuracy on each side (or 0.4 mm unilateral) is recommended to be the MLC quality control accuracy to ensure the dose accuracy of radiotherapy for different tumors.

Quality control of VMAT planning using artificial neural network models for nasopharyngeal carcinoma / 中华放射医学与防护杂志

Objective To train individualized three-dimensional (3D) dose prediction models for radiotherapy planning,and use the models to establish a planning quality control method.Methods A total of 99 cases diagnosed as early nasopharyngeal carcinoma (NPC) were analyzed retrospectively,who received simultaneous integrated boost (SIB) with volumetric modulated arc therapy (VMAT).Seven geometric features were extracted,including the minimum distance features from each organs at risk (OARs) to planning target volume (PTV),boost targets and outline,as well as four coordinate position characteristics.89 cases were trained and 10 cases were tested based on 3D dose distribution prediction models using artificial neural network (ANN).A planning quality control method were established based on the prediction models.The dosimetric parameters including D2％,D25％,D50％,D75％ and mean dose (MD) of each OAR were used as quality control indicators,and the passing criteria was defined as that the dosimetric difference between manual planning and the predicted dose should be less than 10％.The quality control method was tested with 10 plans ()esigned by a junior physicist.Results There was no significant discrepancy between the model predicted dose and the result of expert plan in the main dosimetric indexes of 18 OARs.The dose differences of D2％,D25％,D50％,D75％ and MD were all controlled within 1.2 Gy.All the 10 plans designed by a junior physicist reached the general clinical dose requirements,while by using our proposes quality control method,one of these plans was observed not optimal enough and some dosimetric parameters of spinal cord,spinal cord PRV,brainstem and brainstem PRV could be improved.After re-optimizing this plan according to the predicted values of the model,the D2％ of spinal cord and brainstem decreased by 8.4 Gy and 5.8 Gy,respectively.Conclusions This study proposes a simple and convenient quality control method for radiotherapy planning.This method could overcome the disadvantage of unified dose constrains without considering patient-specific conditions,and improve the quality and stability of individualized radiotherapy planning.

Quality control of VMAT planning using artificial neural network models for nasopharyngeal carcinoma / 中华放射医学与防护杂志

Objective@#To train individualized three-dimensional (3D) dose prediction models for radiotherapy planning, and use the models to establish a planning quality control method .@*Methods@#A total of 99 cases diagnosed as early nasopharyngeal carcinoma (NPC) were analyzed retrospectively, who received simultaneous integrated boost (SIB) with volumetric modulated arc therapy (VMAT). Seven geometric features were extracted, including the minimum distance features from each organs at risk (OARs) to planning target volume (PTV), boost targets and outline, as well as four coordinate position characteristics.89 cases were trained and 10 cases were tested based on 3D dose distribution prediction models using artificial neural network (ANN). A planning quality control method were established based on the prediction models. The dosimetric parameters including D2%, D25%, D50%, D75% and mean dose (MD) of each OAR were used as quality control indicators, and the passing criteria was defined as that the dosimetric difference between manual planning and the predicted dose should be less than 10%. The quality control method was tested with 10 plans designed by a junior physicist.@*Results@#There was no significant discrepancy between the model predicted dose and the result of expert plan in the main dosimetric indexes of 18 OARs. The dose differences of D2%, D25%, D50%, D75% and MD were all controlled within 1.2 Gy.All the 10 plans designed by a junior physicist reached the general clinical dose requirements, while by using our proposes quality control method, one of these plans was observed not optimal enough and some dosimetric parameters of spinal cord, spinal cord PRV, brainstem and brainstem PRV could be improved. After re-optimizing this plan according to the predicted values of the model, the D2% of spinal cord and brainstem decreased by 8.4 Gy and 5.8 Gy, respectively.@*Conclusions@#This study proposes a simple and convenient quality control method for radiotherapy planning. This method could overcome the disadvantage of unified dose constrains without considering patient-specific conditions, and improve the quality and stability of individualized radiotherapy planning.

Clinical features of patients with liver failure accompanied with non-thyroid sick syndrome / 中华传染病杂志

Objective To investigate clinical characteristics of patients with liver failure accompanied with non-thyroid sick syndrome (NTIS) and the predictive value for short-term prognosis.Methods Ninety patients with liver failure hospitalized in Tianjin Second People's Hospital from January 2013 to December 2017 were retrospectively enrolled.Among them,75 patients (liver failure group) were randomly selected to establish prognostic models and the other 15 were selected for model validation.Another 75 patients at the same time of hospitalization with chronic hepatitis were randomly selected as the control group.The serum free triiodothyronine (FT3),free thyroxine (FT4) and thyroid-stimulating hormone (TSH) were measured by chemiluminescence.The clinical characteristics and survival rates 3 months after admission of patients with liver failure accompanied with NTIS were analyzed.The predictive value of the model for end-stage liver disease (MELD) score,Child-Turcotte-Pugh (CTP) score,chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score,FT3-MELD model and FT3 for prognosis of liver failure were evaluated.Quantitative data were analyzed with Student's t-test and Mann-Whitney U test.Count data were analyzed with chi-square test.Results The liver failure group had significantly lower levels of FT3,TSH and albumin (Alb),but higher levels of total bilirubin (TBil),international normalized ration (INR),serum creatinine (Cr) and FT4 than the control group.NTIS was diagnosed in 50 patients with liver failure (50/75,66.67％).There were 32 deaths in patients with NTIS and 7 in patients with non-NTIS.The difference was statistically significant (x2 =8.654,P =0.003).INR,Cr,FT3,MELD score,CTP score and CLIF-SOFA score were significantly different between the survival and death groups (t =-3.037,t =-2,720,t =4.100,t =-4.221,t =-3.471,and t =-3.901,respectively;all P ＜ 0.01).A negative correlation was observed between FT3 and MELD score (r =-0.439,P ＜ 0.01).The area under the receiver's operating characteristic (ROC) curve of the FT3-MELD model was 0.816,with the optimal cut-off-point of 0.121 7,sensitivity of 0.769 and specificity of 0.833.The areas under the curve of the FT3,MELD score,CTP score and CLIF-SOFA score were 0.794,0.775,0.699,and 0.739,respectively.Conclusions Liver function and thyroid function are poor in patients with liver failure accompanied with NTIS.The FT3-MELD model is superior to CTP score and CLIF-SOFA score in predicting the short-term prognosis in patients with liver failure.

End-Stage Liver Disease Model in the Evaluation of Artificial Liver Treatment for Chronic Liver Failure / 天津医药

Objective To investigate the value of model for end-stage liver disease (MELD) score, MELD with in-corporation of serum sodium (MELD-Na) score and integrated MELD (iMELD) score for evaluation of prognosis of chronic liver failure. Methods A total of 159 consecutive patients with chronic liver failure were included in the study and divided into two groups (death group and survival group) according to the prognosis. The levels of total bilirubin (TBIL), serum creati-nine (Cr), prothrombin time (PT), PT international normalized ratio (INR), serum sodium (Na+), age, MELD, MELD-Na and iMELD were calculated respectively and the comparative analysis was performed. Areas under the receiver operating charac-teristic curve (AUC-ROC) of MELD, MELD-Na and iMELD were used to assess the prognosis in patients with chronic liver failure. Results The values of TBIL (μmol/L:330.9±181.9 vs 245.5±127.7),Cr (μmol/L:84.9±63.8 vs 81.2±49.3),INR (2.50±1.01 vs 2.09±0.57),MELD (26.2±6.5 vs 22.0±5.8),MELD-Na (35.9±31.5 vs 25.3±8.7) and iMELD (49.5±17.4 vs 42.4±10.9) were significantly higher in death group than those in survival group (P 0.05) for MELD score (AUC=0.691), MELD-Na score (AUC=0.690) and iMELD score (AUC= 0.674) . The cut-off scores of three systems were 25.8 (MELD), 31.0 (MELD-Na) and 53.5 (iMELD) respectively, which could discriminate higher and lower mortality accurately. Conclusion MELD, MELD-Na and iMELD scores can predict short-term clinical outcomes of liver failure patients undergoing artificial liver comprehensive medical treatment.

Combination use of diltiazem and nitroglycerin in preventing radial artery spasm in performing coronary angiography：observation of its efficacy and safety / 介入放射学杂志

Objective To investigate the efficacy and safety of combination use of diltiazem and nitroglycerin in preventing radial artery spasm in performing coronary angiography via radial artery access. Methods During the period from Dec. 2012 to June 2013 at authors’ hospital, coronary angiography via radial artery access was carried out in a total of 200 patients. The patients were randomly divided into 2 groups: nitroglycerin group (n = 100) and combination group (n = 100). After successful placement of catheter sheath 200 μg of nitroglycerin was injected through the sheath in the patients of the nitroglycerin group, while 200 μg of nitroglycerin together with 2 mg diltiazem was injected through the sheath in the patients of the combination group. The heart rate , blood pressure and electrocardiogram were recorded with an electrocardio-pressure monitor before the injection as well as at 2, 5, 15 and 30 minutes after the injection. The occurrence of radial artery spasm and patient ’s general condition were also under observation. Results Radial artery spasm occurred in 5 patients of the combination group , while it occurred in 13 patients of the nitroglycerin group, the difference between the two groups was statistically significant (P 0.05). Conclusion For the coronary intervention via radial artery access , combination use of diltiazem and nitroglycerin can more effectively prevent the occurrence of radial artery spasm. Besides , combination use of diltiazem and nitroglycerin has no obvious effect on the heart rate , the blood pressure and the electrocardiogram.

Assessment of indocyanine green clearance test combined with the model for end-stage liver disease in the prediction of short-term prognosis for liver failure / 中华传染病杂志

Objective To investigate the efficacy of the indocyanine green (ICG) clearance test (ICGR15) combined with the model for end-stage liver disease (MELD) for assessing the short-term prognosis of patients with liver failure.Methods Eighty patients with liver failure were analyzed retrospectively.ICGR15 and relevant clinical data within 24 hours of diagnosis were analyzed.Meanwhile,the MELD score and King's College Hospital (KCH) were evaluated.All findings were tested for correlation with 3-month mortality.Quantitative data were analyzed with analysis of variance and Student's t-test.Count data were analyzed with chi-square test.Correlation analysis was performed with Pearson's coefficient test.Results Among 80 patients with liver failure,39 patients survived and 41 died.The mortality rate of all patients was 51.2％.The serum total bilirubin,creainine concentrations,ICGR15,MELD scores and patient number in accordance with KCH criteria of surviving patients were (288.0±109.1) μmol/L,(63.3±24.4) μmol/L,(48.1±10.2)％,20.6±4.4,and 6 cases,respectively,which were lower than those in dead patients [(340.7 ± 108.2) μmol/L,(98.8 ± 59.1) μmol/L,(60.2 ± 10.6) ％,26.9 ± 7.1 and 19 cases,respectively] (P =0.033,P＝ 0.001,P＝ 0.000,P＝ 0.000 and P =0.003,respectively).There was no significant difference of ICGR15 among four types of liver failure.A positive correlation was observed between ICGR15 and MELD score (r=0.289,P=0.009).The ICGR15-MELD model was created by subjecting ICGR15 and MELD scores to Logistic regression analysis.The following ICGR15-MELD model,Logit (P) =0.105 × ICGR15 + 0.178 × MELD score-9.734,was constructed by Logistic regression analysis.The area under the receiver operating characteristic (ROC) curve was 0.860 and the cut offpoint of 0.3 had sensitivity of 85.40％ and specificity of 74.40％.The area under the curve of the ICGR15-MELD model was significantly higher than those of ICGR15 (0.791),MELD score (0.770) and KCH criteria (0.655).Conclusions ICGR15 and MELD scores perform better than the KCH criteria in predicting the prognosis of liver failure.The ICGR15-MELD model is superior to ICGR15,MELD score,and KCH in predicting the short term prognosis of patients with liver failure.

Effect of Puerarin on Expression of C-reactive Protein in Iliac Artery of Atherosclerotic Rabbit / 中国康复理论与实践

@#Objective To investigate the effect of Puerarin on expression of C-reactive protein(CRP)in iliac artery of atherosclerotic rabbits.Methods Twenty male New Zealand white rabbits were divided into the normal control group(n=6,fed on a normal diet),basic control group(n=8,fed on a cholesterol diet)and Puerarin group(n=8,fed on a cholesterol diet).The balloon injury of iliac arteries was performed in animals of the basic control group and Puerarin group,and the animals of the Puerarin group were injected with Puerarin(25 mg/kg/d per rabbit)after injury.Four weeks after balloon injury,untreated and balloon injury iliac arteries were harvested for immunocytochemical staining.The mRNA and protein expression of CRP were tested by RT-PCR and immunucytochemistry.Results The mRNA and expression of CRP in atheroseclerotic plaque of iliac artery in the Puerarin group was significantly lower than that in the basic control group(P<0.01).Conclusion Puerarin can make atheroseclerotic plaque stable by regulating of the expression of CRP in iliac artery of atherosclerotic rabbit.

Relationship between Serum Pregnancy-Associated Plasma Protein-A and Plaque Stability of Coronary Lesion / 中国康复理论与实践

@#Objective To study the relationship between serum pregnancy-associated plasma protein-A(PAPP-A)and plaque stability of coronary lesion.Methods Levels of serum PAPP-A were measured among 230 patients seemed as coronary heart disease(CHD)including 50 cases with acute myocardial infraction(AMI),110 cases with unstable angina pectoris(UAP),40 cases with stable angina pectoris(SAP)and 30 cases without CHD as control by enzyme-linked immunoassay(ELISA).Anginographic morphology of the coronary lesion was assessed in patients with CHD.Then,the serum PAPP-A levels were compared among different types of CHD and plaque.Results Serum PAPP-A levels were significantly higher in the AMI group(26.13±4.65)mIU/L and UAP group(20.37±5.78)mIU/L than in the SAP group(12.82±3.94)mIU/L and without CHD group(10.70±2.86)mIU/L(P<0.01,UAP group vs AMI group,P<0.05).Serum PAPP-A levels were significantly higher in the type Ⅱ lesions(24.52±4.82)mIU/L than in the other type lesions group(16.82±5.37)mIU/L and in the control group(10.70±2.86)mIU/L(P<0.01).Conclusion Serum PAPP-A level was closely associated with plaque stability of coronary lesion.

Effect of Shenmai Injection on neuroendocrine factors and cytokines in patients with chronic heart failure / 中国康复理论与实践

@#ObjectiveTo investigate the effects of Shenmai Injection(SI) on chronic systolic heart failure patients.Methods120 chronic heart failure patients were randomly divided into routine treatment and the routine treatment and SI group. The changes of angiotension Ⅱ(Ang Ⅱ), aldosterone(Ald), endothelin-1 (ET-1), interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α), plasm rennin activity (PRA), cardionatrin(ANP), brain natriuretic peptide (BNP), cardiac function were observed.ResultsAfter treatment, LVEF,stage of NYHA increased in two groups,LVDs, LVDd and the level of Ang Ⅱ,Ald, ET-1, IL-6, TNF-α,PRA, ANP and BNP decreased in both groups(P<0.05). LVEF, stage of NYHA in the routine treatment and SI group incresed more significantly than those in routine treatment group(P<0.05). LVEDs, LVEDd and the level of Ang Ⅱ,Ald, ET-1, IL-6, TNF-α,PRA, ANP and BNP in the routine treatment and SI group were decreased more significantly than those in routine treatment group (P<0.05).ConclusionSI can improve not only the disturbed endocrine function and cytokines, but also left ventricular function.