Stereotactic body radiation therapy has become more and more popular in clinical practice due to its satisfactory efficacy and relatively low incidence of side effects.Different fractionation schemes are adopted based on the characteristics,location,and size of tumor.However,the optimal fractionation scheme and dose limits for organs at risk are still not clear.Therefore,further studies and observation of long-term adverse reactions are required.

Review the history of radiation therapy service in Macau,and the evolution of radiation technology,equipment and staffs of past and now were included.We hope provide an clear understanding of cancer radiotherapy condition in Macau and looking forward to academic exchange in radiation oncology in future.

Objective To study long-term outcome and prognostic factors of nasopharyngeal carcinoma treated by intensity modulated radiotherapy.Methods A total of 299 patients with nondisseminated nasopharyngeal carcinoma who received initial radiotherapy were analyzed retrospectively.The primary lesion and the upper neck received 70 Gy (5 fraction per week in all 30 fraction) by intensitymodulated radiotherapy (IMRT).The lower neck and the supraclavicular fossa was given 54 Gy (5 fraction per week in all 30 fraction) by a single anterior tangent field with spinal cord block.A median dose of 9.2 Gy (4-20.Gy) was given to the residual primary lesion by IMRT or X-knife.The Kaplan-Meier method was used for calculating the overall survival (OS),disease progression-free survival (DPFS),distant metastasisfree survival (DMFS),Log-rank test was used for evaluating the differences between groups.Multivariate prognostic factor was analyzcd by Cox method.Results The follow-up rate was 99.7％.119 patients were followed-up more than with 5 years.The 5-year OS for stage Ⅰ + Ⅱ,stage Ⅲ and stage Ⅳ were 97.1％,82.7％ and 52.2％(x2=46.19,P=0.000),the 5 years DPFS were 100％,77.6％ and 57.7％ (x2=23.29,P =0.000),DMFS were 100％,82.3％,63.7％ (x2 =16.57,P =0.000) respectively.The 5 year OS,DPFS and DMFS of male and female were 70.7％ vs 94.1％ (x2=16.82,P=0.000),71.5％ vs 87.3％ (x2 =4.74,P =0.029) and 77.2％ vs 89.7％ (x2 =4.38,P =0.036) respectively.For patients who were younger than 45-years,the male had a significantly unfavorable 5-year OS (66.8％ vs.91.2％,x2=7.07,P=0.008),DPFS (59.9％ vs.91.2％,x2=7.72,P=0.005) and DMFS (66.4％ vs.94.0％,x2 =8.46,P =0.004) ;For patients who were old than 45-years,only OS was significantly different between male and female (72.2％ vs.96.0％,x2 =10.19,P =0.001).Multivariate analysis showed the independent prognosticfactors for OS,DPFS,DMFS,were gender (x2 =14.27,5.72,17.64,P =0.000,0.017,0.000),TNM stage (x2 =5.33,15.70,10.57,P =0.021,0.000,0.001) and lymph nodes capsular invasion (x2 =4.30,11.08,21.24,P =0.038,0.001,0.000).Intracranial invasion and supraclavicular lymph node metastasis were independent prognostic factors for OS (x2 =13.32,5.38,P =O.000,0.020).Conclusions The TNM stage,lymph nodes capsular invasion and gender are independent prognostic factors for nasopharyngeal carcinoma treated by intensity-modulated radiotherapy.The patients of younger than 45years own a worse outcome.

Objective:To explore the application effect of "blended learning + flipped classroom" in public elective courses for medical students, and provide reference for the blended construction of related courses.Methods:Totally 229 medical students were selected as research participants, who were taught by "blended learning + flipped classroom". After the courses, the curriculum evaluation questionnaires and focus group interview were used to collect students' evaluation of this course. SPSS 22.0 statistical software was used to make descriptive statistics on the questionnaire data.Results:Totally 98.5% students preferred "blended learning + flipped classroom" teaching mode, and more than 93% students thought this teaching method could improve their learning interest, empathy, understanding and application of knowledge. The results of the qualitative survey extracted two themes, namely "improving learning autonomy" and "expanding comprehensive quality".Conclusion:Perfecting the "blended learning + flipped classroom" teaching mode of the medical public elective courses plays a positive role in improving the learning autonomy and comprehensive quality of medical students and optimizing the learning effect.

Objective To observe the host response and the expression of interleukin-4 (IL-4) in different cross-linked hyaluronic acid composite gels at different time points after the implantation in vivo, and to explore the significance of biocompatibility and macrophage polarization in post-implantation inflammatory response and tissue remodeling. Methods New Zealand white rabbits were respectively injected with crosslinked hyaluronic acid-crosslinked hydroxypropyl methylcellulose gel (sample 1), crosslinked hyaluronic acid-hydroxypropyl methylcellulose gel (sample 2) and commercially available modified sodium hyaluronate gel (control) in subcutaneous tissue at both sides of the spine. Then the rabbits were dissected at 1, 4 and 12 weeks after the implantation. The tissues were fixed with 10％formaldehyde solution, embedded in paraffin and sliced. Hematoxylin-eosin (HE) staining was performed to observe the degree of inflammation and fibrosis. Masson staining was performed to observe the formation of collagen fibers. Immunohistochemical staining was performed to observe the expression of IL-4. Results The results of HE staining showed that the inflammatory reaction in the sample 1 and sample 2 groups was significantly higher than that in the control group 1 and 4 weeks after the implantation. The inflammatory cells aggregated, and the wall of capsule and microcapsule was thick. The sample 1 group was more obvious, and the result was mild stimulation. For all the groups, the results were all non-irritating at 12 weeks after the implantation. The results of Masson staining showed that the collagen fibers in the sample 1 and sample 2 groups were increased compared with the control group, mainly distributed around the implantation site, and a small amount among the gels after 1 and 4 weeks. After 12 weeks, the collagen fibers were further increased, especially among the gels, which were consistent with the control group. The results of immunohistochemical staining showed that, at the same time point, the expression of IL-4 in sample 1 and sample 2 groups was higher than that in the control group, and the expression of IL-4 increased gradually with time. The expression of IL-4 in the control and sample 1 group at 12 weeks after the implantation was higher than that at 1 and 4 weeks respectively, and the differences were statistically significant (all P<0.05). In the sample 1 group, the expression of IL-4 at 12 weeks after the implantation was higher than that at 1 week, and the difference was statistically significant (P<0.05). The expression of IL-4 in the sample 1 group was significantly higher than that in the control group at 4 weeks after the implantation, and the difference was statistically significant (P<0.05). Conclusions The two different cross-linked sodium hyaluronate composite gels have good biocompatibility. The formation of collagen fiber and the expression of IL-4 can gradually increased within 12 weeks after the subcutaneous implantation, which is beneficial to the tissue remodeling.