Objective To perform a preclinical test of a delineation software based on atlas-based auto-segmentation (ABAS),to evaluate its accuracy in the delineation of organs at risk (OARs) in radiotherapy planning for nasopharyngeal carcinoma (NPC),and to provide a basis for its clinical application.Methods Using OARs manually contoured by physicians on planning-CT images of 22 patients with NPC as the standard,the automatic delineation using two different algorithms (general and head/neck) of the ABAS software were applied to the following tests:(1) to evaluate the restoration of the atlas by the software,automatic delineation was performed on copied images from each patient using the contours of OARs manually delineated on the original images as atlases;(2) to evaluate the accuracy of automatic delineation on images from various patients using a single atlas,the contours manually delineated on images from one patients were used as atlases for automatic delineation of OARs on images from other patients.Dice similarity coefficient (DSC),volume difference (Vdiff),correlation between the DSC and the volume of OARs,and efficiency difference between manual delineation and automatic delineation plus manual modification were used as indices for evaluation.Wilcoxon signed rank test and Spearman correlation analysis were used.Results The head/neck algorithm had superior restoration of the atlas over the general algorithm.The DSC was positively correlated with the volume of OARs and was higher than 0.8 for OARs larger than 1 cc in volume in the restoration test.For automatic delineation with the head/neck algorithm using a single atlas,the mean DSC and Vdiff were 0.81-0.90 and 2.73％-16.02％,respectively,for the brain stem,temporal lobes,parotids,and mandible,while the mean DSC was 0.45-0.49 for the temporomandibular joint and optic chiasm.Compared with manual delineation,automatic delineation plus manual modification saved 68％ of the time.Conclusions A preclinical test is able to determine the accuracy and conditions of the ABAS software in specific clinical application.The tested software can help to improve the efficiency of OAR delineation in radiotherapy planning for NPC.However,it is not suitable for delineation of OAR with a relatively small volume.

Objective To evaluate the impacts of slice thickness and registration frame range on the accuracy of cone-beam computed tomography ( CBCT) image-guided head and neck ( HN) radiotherapy, and to provide a basis for positioning correction in image-guided radiotherapy.Methods A planned CT scan was performed for an anthropomorphic HN phantom with slice thickness of 1 mm and 3 mm and simulated positioning errors in x, y, and z directions on the accelerator.CBCT scan and reconstruction were performed with slice thickness of 1 mm and 3 mm.Two different registration frame ranges were used ( range 1:from C7 to superior orbit;range 2:from C7 to calvaria ) .Automatic bony registration was performed for CBCT and planned CT images with slice thickness of 1 mm and 3 mm.The registration accuracy was evaluated.Results For range 1, the registration errors in x, y, and z directions with a slice thickness of 1 mm were significantly lower than those with a slice thickness of 3 mm (0.5±0.2 mm vs.-0.7±0.2 mm, P=0.00;0.5±0.3 mm vs. 1.0±0.3 mm, P=0.00;-0.1±0.5 mm vs.1.5±0.5 mm, P=0.00).For range 2, the registration errors in x, y, and z directions with a slice thickness of 3 mm were-0.4±0.2 mm, 0.5±0.2 mm, and 0.7±0.4 mm, respectively.Conclusions Engagement of calvaria in registration range can substantially enhance the registration accuracy in CBCT or CT images for HN.The registration error with slice thickness of 1 mm can be controlled within 1 mm.

Objectiye To evaluate the therapeutic efficacy and safety of (endoscopic sphincterotomy, EST) plus balloon dilation for difficult bile duct stones. Methods Patients with difficult common bile duct stones on endoscopic retrograde cholangiopancreatography (ERCP) from March 2008 to December 2009 were randomly divided into 2 groups to receive EST or EST plus balloon dilation ( EST + EPBD), respectively. The success rate of complete stone removal, number of endoscopic sessions, the rate of using mechanical lithotripsy and the complication rate related to the procedure were compared between the 2 groups. Results Compared with EST alone, EST plus balloon dilation resulted in similar outcomes in terms of overall successful stone removal rate (2/62 vs. 2/61 ) and early complication rate (4/62 vs. 6/61, P ＞0. 05). However,EST group needed more sessions ( EST 15/46 vs. EST + EPBD 5/57, P ＜0. 05) and use of mechanical lithotripsy to achieve complete removal of stones ( EST 12/61 vs. EST + EPBD 4/61, P ＜0. 05 ). Conclusion EST plus balloon dilation is as safe and effective as, but more convenient than EST, for endoscopic removal of common bile duct stones.

Objective To evaluate the efficacy and safety of fluoroscopy guided frequency-doubled double-pulsed laser lithotripsy for removing difficult bile duct stones. Methods From March 2008 to December 2009, patients with difficult bile duct stones were divided into cholangioscopy guided group ( n = 21 )and fluoroscopy guided group ( n = 19) to receive corresponding treatments. The success rate of complete stone removal and the complication rate related to the procedure were compared between the two groups.Results There are no significant differences between 2 groups in regarding of either success rate of complete stone removal ( 19/21, 90. 5% in cholangioscopy guided group vs. 17/19, 89. 5% in fluoroscopy guided group, P ＞0. 05 ) or rate of procedure related complication (4/21, 19. 0% in cholangioscopy guided group vs. 3/19, 15. 8% in fluoroscopic guided group, P = 0. 559 ). Conclusion Frequency-doubled doublepulsed laser lithotripsy guided by cholangioscopy or fluoroscopy are both safe and effective.

Objective To explore the value of computer-animal-clinic sequential training model in colonoscopy training.Methods Sixty-five gastroenterologists without any experience in colonoscopy were randomly assigned to 2 groups to accept a two-week′endoscopy training with computer simulator or with com-puter-animal-clinic sequential training.Both groups underwent at least 10 hours of training with a computer-based simulator,and sequential training group also underwent animal simulator training for 2 days in first week,then both groups underwent clinical endoscopy training in the second week.Performance parameters including cecal intubation,procedure duration and degree of comfort were evaluated.Results The training group had higher cecal intubation rate (46.28% VS 35.79%;P <0.01 )and shorter procedure duration (9.05 ±2.12 min VS 11.15 ±3.12 min;P <0.05)and less degree of comfort (5.18 ±1.41 VS 6.78 ± 2.15;P <0.05).The sequential training group was much better in performance than the other group in colonoscopy training.Conclusion Computer-animal-clinic sequential training model is effective in providing trainees with colonoscopy skills in improving the success rate,shortening the teaching times and lessening the uncomfortable of patients.

Background/Aims: We aimed to study the effects of sedation on endoscopic ultrasound–guided tissue acquisition. Methods: We conducted a retrospective study evaluating the role of sedation in endoscopic ultrasound–guided tissue acquisition by comparing two groups: anesthesia care provider (ACP) sedation and endoscopist-directed conscious sedation (CS). Results: Technical success was achieved in 219/233 (94.0%) in the ACP group and 114/136 (83.8%) in the CS group (p=0.0086). In multivariate analysis, the difference in technical success between the two groups was not significant (adjusted odds ratio [aOR], 0.5; 95% confidence interval [CI], 0.234–1.069; p=0.0738). A successful diagnostic yield was present in 146/196 (74.5%) in the ACP group and 66/106 (62.3%) in the CS group, respectively (p=0.0274). In multivariate analysis, the difference in diagnostic yield between the two groups was not significant (aOR, 0.643; 95% CI, 0.356–1.159; p=0.142). A total of 33 adverse events (AEs) were observed. The incidence of AEs was significantly lower in the CS group (5/33 CS vs. 28/33 ACP; OR, 0.281; 95% CI, 0.095–0.833; p=0.022). Conclusions CS provided equivalent technical success and diagnostic yield for malignancy in endoscopic ultrasound–guided tissue acquisition. Increased AEs were associated with anesthesia for the endoscopic ultrasound–guided tissue acquisition.

Objective To investigate the effect of SABP, a water-soluble component of Salvia miltiorrhiza, on the growth of orthotopic transplantation of H22 liver cancer and the immune microenvironment of liver cancer. Methods We established a mouse model of orthotopic transplantation of H22 cell liver cancer in BALB/c mice. ELISA was used to detect the expression of PD-L1, TGF-β, IL-1β, IL-10, IL-4, IFN-γ, IL-18, IL-7, IL-2, CCL-2 and CCL-21 in the liver. We counted the organ indexes of liver, spleen and kidney. Results SABP inhibited the growth of orthotopic transplantation tumors of H22 cell liver cancer, and increased the expression levels of PD-L1, TGF-β, IL-1β and IL-10 in the microenvironment of liver cancer, as well as the liver, spleen and kidney coefficients. Conclusion SABP could inhibit the growth of orthotopic transplantation tumors of H22 cell liver cancer and promote the expression of PD-L1, TGF-β, IL-1β and IL-10 in the microenvironment of liver cancer.

Objective:To analyze the impacts of different registration ranges on the accuracy of multiple metastases treated with helical tomotherapy.Methods:According to the locations of target volumes, 28 patients with multiple metastases were divided into the head/chest group ( n= 15) and the chest/pelvis group ( n= 13). The CT and MVCT images acquired in first fraction were studied and compared in two groups, which were captured and matched with different registration ranges (all targets/the targets in proximity to the head/ the targets in proximity to the foot). The CTV MVCT volume coverage rate (CR) under the matched target volumes, the dice similarity coefficient (DSC) between the CTV CT and CTV MVCT, and the position deviation of the CTV geometric center were compared. Results:We observed similar results in the head/chest group and chest/pelvis group. Specifically, there was no significant difference in the CR, DSC and geometric center deviation between the two target regions when registered with all targets ( P>0.05). Regarding single target region registration, the DSC and geometric center deviation of this target were significantly superior to the other non-registered target ( P< 0.05). To a single target, the CR, DSC, and geometric center deviation obtained with registration presented the best performance, which was significantly greater than these parameters obtained with all targets registration, while the other side target area obtained the worst results ( P< 0.05). Conclusions:Registration of one target region may reduce the accuracy of other non-registered targets. We recommend that the image guidance ranges for multiple metastases treated with tomotherapy should include all target regions or independent registrations for different targets.

Objective:To investigate the effect of flipped classroom model in the theory teaching of psychiatry for medical undergraduates.Methods:A total of 121 students from grade 2014 were randomly divided into observation group and control group. The observation group was given flipped classroom teaching and the control group was given traditional teaching. In order to evaluate the teaching effect of flipped classroom, the students in the observation group were evaluated by comparing the test scores of the two groups in class and using the self-made questionnaire. SPSS 18.0 was used to conduct t-test. Results:The results showed that the average score of the observation group was significantly higher than that of the control group ( P < 0.05). The results of teaching effect showed that there were 60 students in the observation group, among which 96.7% (58 students) believed that flipped classroom teaching was beneficial to promoting pre-class preview, improving teamwork ability, autonomous learning ability and teacher-student communication; 95.0% (57 students) thought they were satisfied with flipped classroom teaching, which was conducive to linking theory with practice; 93.3% (56 students) thought that they could arouse their interest in learning, improve their attention, and improve their ability to analyze and solve problems; 90.0% (54 students) thought flipped classroom was superior to traditional classroom and helpful to their future study; 86.7% (52 students) did not think their study burden was increased. Conclusion:The flipped classroom model can stimulate students' interest and attention, and promote the combination of independent learning and interactive learning, which has a better effect than the traditional teaching model in the theory teaching of psychiatry and is easily accepted by students. Therefore, it holds promise for application.

Objective:To evaluate the differences in the cumulative doses for cervical cancer between two different methods, and analyze the correlation between the severity of radiation proctitis and the cumulative dose of the rectum.Methods.:Clinical data of 278 patients with cervical cancer treated with radiotherapy were retrospectively analyzed. The total dose of radiotherapy was calculated by simple dose volume histogram parameter accumulation method (S-DVH group) and dose accumulation by deformation image registration (DIR group) in 49 patients with radiation proctitis. The rectal cumulative dose of the 278 patients with S-DVH was counted(D 2.0cm 3/D 1.0cm 3/D 0.1cm 3). The correlation analysis was performed by Spearman’s correlation analysis. Results:The average cumulative dose(D 90%) difference of high-risk clinical target volume (HRCTV) between the S-DVH and DIR groups was 2 Gy (EQD 2Gy)[(88.66±5.75) vs. (86.66±5.54) Gy, P<0.05], and the average cumulative dose difference(D 2.0cm 3 and D 1.0cm 3) of bladder was 2.13 Gy[(82.46±6.91) vs.(80.33±6.86) Gy, P<0.05] and 2.35 Gy[(88.46±4.37) vs.(86.11±3.93) Gy, P<0.05], and the average cumulative dose difference(D 2.0cm 3 and D 1.0cm 3) of rectum was 1.99 Gy[(72.49±5.17) vs.(70.50±5.03) Gy, P<0.05] and 2.71 Gy[(78.87±4.50) vs.(76.16±4.14) Gy, P<0.05]. The rectal cumulative dose(D 2.0cm 3/D 1.0cm 3/D 0.1cm 3) was positively associated with the grade of radiation proctitis. Conclusions:The cumulative doses differ between two groups, and are equally in an acceptable range. S-DVH method is a relatively simple method to evaluate the cumulative exposure dose. The cumulative doses of the rectum(D 2.0cm 3/D 1.0cm 3/D 0.1cm 3) can be used to predict the incidence of radiation proctitis.