Objective To evaluate the setup errors for lower neck with cone beam CT (CBCT) in breast cancer patients immobilized by breast bracket,and to probe the margins from supraclavicular clinical target volume (CTV) in 3 directions.Methods A total of 14 breast cancer patients with supraclavicular lymph node radiation were enrolled.All patients were immobilized by breast bracket,and each patient would undergo CBCT at the first,tenth and twentieth treatment after positioning,respectively.Then these CBCT images were registered to the planning CT to determine setup errors in translational and rotational direction,and evaluated correlation between them.At last,CTV margins were calculated from the systenatic and random errors.Results The setup errors on x (left-ring),y (superior-inferior),z (anterior-posterior) translational directions were (2.89 ±.2.52),(3.96 ±2.97),(4.21 ±2.24) mm and on θ (pitch degree),φ (roll degree),Ψ (yaw degree) rotational direction were (2.38 ± 1.97)°,(1.60±1.63) °,(1.91 ±1.54)°,respectively.The margins from CTV were 8.08,8.13,6.30mminx,y and z direction.On y and z directions translational errors were correlated significantly with φ and Ψ degree rotational errors(Pearson =-0.515,-0.509,P ＜ 0.05).In inter-fraction only on z direction the setup changes were considered as correlative with Ψ degree (Pearson =-0.583,P ＜ 0.05).Conclusions For supraclavicular region irradiation breast cancer patients immobilized with breast bracket,the margins from CTV were recommended as not less than 8.08,8.13,6.30 mm in x,y,z directions,respectively.The position immobilized method and the positioning workflow should be further improved in order to reduce the influence of the neck rotational on setup errors.

Objective To evaluate the effect of discussion-based teaching pattern in clinical noviciate of general surgery. Methods Two hundred and ten students majoring in clinical medicine were randomly divided into the trial group and the control group during clinical noviciate of general surgery.There were 105 students in each group. The discussion-based teaching pattern and traditional teaching pattern were performed in the trial and control groups,respectively. After the clinical novici-ate of general surgery was completed,the teaching effects of both groups were evaluated by the exam-ination performance analyses and the questionnaire-based survey. Student's t-test andχ22 test were used in statistical analysis. Reults The rate of satisfaction with the teaching pattern was 88.6%in the trial group and 70.5%in control group(P<0.05). The mean scores in the trial group and control group were 80.3±9.2 and 74.5±11.3,respectively (P<0.05). The pass rate of examination in the trial group and control group were 97.1% and 88.6%,respectively (P<0.05). The excellence rate in the examination was 24.8%in the trial group and 12.4%in control group (P<0.05). The overwhelming majority of stu-dents in the trial group thought that the discussion-based teaching pattern had more advantages in im-proving students' learning initiative and enthusiasm,ability to analyze and solve problems,etc.,acord-ing to the questionnaire-based survey. Conclusions Discussion-based teaching is an effective teach-ing pattern and superior to the traditional teaching pattern.

Objective:To explore the effect of teachers-standardized patients combined with case based learning (CBL) in clinical probation of gastrointestinal surgery.Methods:A total of 140 clinical medicine undergraduates in gastrointestinal surgery were selected as the research subjects, and were randomized into the intervention group and the control group, with 70 cases in each group. Traditional teaching method is performed in the control group, and teachers-standardized patients combined with CBL is conducted in the intervention group. Student knowledge assessment and satisfaction survey were made for teaching effect evaluation. The t test and chi-square test were performed by SPSS 24.0 for comparison between the two groups. Results:The medical records writing of the students in the intervention group and the results of the theoretical assessment [(83.20±7.94) and (82.74±7.19) points] were significantly higher than those of the control group [(79.57±9.26) and (79.49±7.86) points] ( P<0.05). Students in the intervention group have a higher level of satisfaction of this teaching mode. Conclusion:Teachers-standardized patients combined with CBL can improve teaching quality and learning enthusiasm in gastrointestinal surgery, and it is worthy of promotion and application in teaching.

Objective To explore the effects of improvements on setup error ( SE ) and clinical target ( CTV ) margin of supraclavicular field ( SCF ) by using moisture-cured resin cushion and breast bracket for lower neck fixation in breast cancer patients who underwent post-mastectomy radiotherapy. Methods Totally 13 patients with breast cancer who underwent post-mastectomy radiotherapy were enrolled. All patients were immobilized by breast bracket and moisture-cured resin cushion. Firstly, each patient′s lower neck and head was fixed well by moisture-cured resin cushion, filling the gap between the neck and breast bracket. Secondly,each patient underwent the cone-beam CT ( CBCT) at the first, tenth and twentieth treatment after positioning. Then these CBCT images were registered to the planning CT to determine setup errors in translational and rotational directions, and SCF CTV margins by the systematic and random errors were evaluated. Results The setup errors in x (left-right), y (superior-inferior), z (anterior-posterior) translational directions were (2. 16 ± 1. 25), (1. 50 ± 1. 28), (1. 94 ± 1. 12) mm and (1. 76 ±1. 87)°, (1. 82 ±1. 12)°, (0. 99 ±0. 58)°, respectively in θ (pitch degree),Ф(roll degree),ψ( yaw degree) rotational directions. Non-parametric rank test ( Mann-Whitney U test) was performed with previous data, the differences of the setup error in y, z,θ directions were statistically significant ( Z =4. 152, 3. 415, 2. 053, P<0. 05). The margins from CTV were 4. 07, 4. 03 and 3. 73 mm in x, y and z directions, respectively. Compared with the previous study on SCF, CTV margin required 8, 8 and 6 mm in x, y and z axis directions, the volume of CTV to PTV were decreased by 32. 73% on average. Conclusions Compared with plastic circular pillow alone, moisture-cured resin cushion with breast bracket locating method could reduce setup errors in SCF target region. The margins from CTV to PTV weredecreased to 4. 07, 4. 03 and 3. 73 mm in x, y and z axis directions at least.

OBJECTIVE: To investigate the long-term outcome of laparoscope-assisted transanal total mesorectal excision (taTME) for rectal cancer. METHODS: Clinicopathological data of 29 patients with mid-low rectal cancer undergoing laparoscope-assisted taTME at Department of Gastrointestinal Surgery, the First Affiliated Hospital of Guangzhou Medical University from May 2010 to December 2015 were collected for the retrospective case-series study. All the operations were performed with transabdominal and transanal procedure simultaneously or sequentially. Perioperative presentations, pathological examinations, and oncologic outcomes were retrospectively analyzed. Long-term recurrence, metastasis and survival were assessed during follow-up. Outpatient clinic and telephone survey were used for follow-up. The follow-up time ended in December 2018. The overall survival (OS) rate and disease-free survival (DFS) rate were calculated by the Kaplan-Meier method. RESULTS: The average intra-operative blood loss was (75.9±9.5) ml (range,20 to 200). The average operating time was (223.6±4.1) minutes (range, 165 to 280). The average number of harvested lymph node was 22.3±2.0. The average length of pathological specimen was (13.1±0.6) cm. The average distal resection margin was (2.9±0.2) cm. 89.7% (26/29) of specimens was complete and 10.3% (3/29) near complete. Two cases (6.9%) had positive cutting circumferential margin. Median follow-up was 56 (range, 22 to 91) months. Local recurrence rate, distant metastasis rate, 3-year OS rate, 3-year DFS rate, 5-year OS rate, 5-year DFS rate were 10.3% (3/29), 20.7%(6/29), 96.6%, 83.2%, 87.6% and 79.6%, respectively. No incisional hernia or adhesive intestinal obstruction was found. CONCLUSION Long-term outcomes of mid-low rectal cancer patients undergoing laparoscope-assisted taTME are satisfactory.
Humans ; Laparoscopes ; Neoplasm Recurrence, Local ; Rectal Neoplasms ; surgery ; Rectum ; Retrospective Studies ; Transanal Endoscopic Surgery