Objective:To observe the effect of project-based learning (PBL) in the clinical teaching of radiation physics.Methods:Thirty-two residents specializing in radiotherapy were included in the study. In the experimental group ( n=16), PBL was adopted, while traditional clinical teaching method was employed in the control group ( n=16). After the rotation, the assessment was conducted, as well as a questionnaire survey was performed, including five aspects: overall satisfaction, understanding of radiation physics knowledge, learning motivation, learning burden, and learning efficiency. Results:The assessment score in the experimental group was 86.31±5.41, which was higher than 75.28±5.91 in the control group, and the difference was statistically significant. Residents in the experimental group were satisfied with the effect of PBL.Conclusion:Compared with the traditional teaching method, PBL can improve the learning motivation, efficiency, and performance of radiotherapy residents, which is highly recognized by the residents.

Multi-gene assays have emerged as crucial tools for risk stratification in early-stage breast cancer. This study aimed to evaluate the prognostic significance of the 21-gene recurrence score (RS) in Chinese patients with pN0-1, estrogen receptor-positive (ER
Biomarkers, Tumor/genetics* ; Breast Neoplasms/pathology* ; Female ; Humans ; Neoplasm Recurrence, Local/pathology* ; Neoplasm Staging ; Prognosis ; Receptor, ErbB-2/genetics* ; Receptors, Estrogen

Objective:To establish an automatic planning method using volumetric-modulated arc therapy (VMAT) for primary liver cancer (PLC) radiotherapy based on predicting the feasibility dose-volume histogram (DVH) and evaluate its performance.Methods:Ten patients with PLC were randomly chosen in this retrospective study. Pinnacle Auto-Planning was used to design the VMAT automatic plan, and the feasibility DVH curve was obtained through the PlanIQ dose prediction, and the initial optimization objectives of the automatic plan were set according to the displayed feasible objectives interval. The plans were accessed according to dosimetric parameters of the planning target volume and organs at risk as well as the monitor units. All patients′ automatic plans were compared with clinically accepted manual plans by using the paired t-test. Results:There was no significant difference of the planning target volume D 2%, D 98%, D mean or homogeneity index between the automatic and manual plans ((58.55±2.81) Gy vs.(57.98±4.17) Gy, (47.15±1.58) Gy vs.(47.82±1.38) Gy, (53.14±0.95) Gy vs.(53.44±1.67) Gy and 1.15±0.05 vs. 1.14±0.07, all P>0.05). The planning target volume conformity index of the manual plan was slightly higher than that of the automatic plan (0.77±0.08 vs. 0.69±0.06, P<0.05). The mean doses of normal liver, V 30Gy, V 20Gy, V 10Gy, V 5Gy and V< 5Gy of the automatic plan were significantly better than those of the manual plan ((26.68±11.13)% vs.(28.00±10.95)%, (29.96±11.50)% vs.(31.89±11.51)%, (34.88±11.51)% vs.(38.66±11.67)%, (45.38±12.40)% vs.(50.74±13.56)%, and (628.52±191.80) cm 3vs.(563.15±188.39) cm 3, all P<0.05). The mean doses of the small intestine, the duodenum, and the heart, as well as lung V 10 of the automatic plan were significantly less than those of the manual plan ((1.83±2.17) Gy vs.(2.37±2.81) Gy, (9.15±9.36) Gy vs.(11.18±10.49) Gy, and (5.44±3.10) Gy vs.(6.25±3.26) Gy, as well as (12.70±7.08)% vs.(14.47±8.11)%, all P<0.05). Monitor units did not significantly differ between two plans ((710.67±163.72) MU vs.(707.53±155.89) MU, P>0.05). Conclusions:The automatic planning method using VMAT for PLC radiotherapy based on predicting the feasibility DVH enhances the quality for PLC plans, especially in terms of normal liver sparing. Besides, it also has advantages for the protection of the intestine, whole lung and heart.

Purpose: This retrospective study aimed to evaluate the distribution pattern and prognostic value of 21-gene recurrence score (RS) in Chinese patients with mucinous breast cancer (MC) and compared with infiltrating ductal carcinoma (IDC). Materials and Methods: Patients diagnosed with MC or IDC from January 2010 to January 2017 were retrospectively recruited. Reverse transcriptase–polymerase chain reaction assay of 21 genes was conducted to calculate the RS. Univariate and multivariate analyses were performed to assess the association between RS and clinicopathological factors. Survival outcomes including disease-free survival (DFS) and overall survival (OS) were estimated by Kaplan-Meier method and compared by log-rank test. Results: The MC cohort included 128 patients and the IDC cohort included 707 patients. The proportions of patients with a low (RS < 18), intermediate (18-30), or high risk (RS > 30) were 32.0%, 48.4%, and 19.5% in MC cohort, and 26.9%, 46.8% and 26.3% in IDC cohort. The distribution of RS varied significantly according to different Ki-67 index and molecular subtype in both cohorts. Moreover, the receipt of chemotherapy was associated with RS in both cohorts. Among patients with MC, tumor stage was related to the DFS (p=0.040). No significant differences in DFS and OS were found among MC patients in different RS risk groups (OS, p=0.695; DFS, p=0.926). Conclusion RS was significantly related to Ki-67 index and molecular subtypes in MC patients, which is similar in IDC patients. However, RS was not able to predict DFS and OS in patients with MC.

Objective: To explore the correlation between microdamage in white matter and radiotherapy dose at early stage after radiotherapy (RT) in patients with nasopharyngeal carcinoma (NPC). Methods: Thirty-three patients who were initially diagnosed with NPC were recruited and received diffusion tensor imaging (DTI) scan and neuro-cognitive scale test within 1 week before RT and the first day after RT. DTI-related characteristic parameters including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (λ_‖), and radial diffusivity (λ_⊥) were calculated based on whole-brain voxel analysis method. Paired t-test was conducted to evaluate statistical significance between pre-RT and post-RT groups. In the subgroup analysis, all the subjects were divided into 3 groups according to the average dose of temporal lobe, and each group was set with an equal dose interval range. The DTI-related parameters of whole brain pre-RT and post-RT in each group were statistically compared. All the statistical results were corrected by FDR with a threshold of P<0.05 and clusters>100. Results: FA, MD, λ_‖ and λ_⊥in the post-RT group significantly differed compared with those in the pre-RT group (P<0.05). The values of FA, MD, λ_‖ and λ_⊥were 0.455±0.016, (9.893±0.403)×10^-4, (13.441±0.412)×10^-4 and (8.231±0.429)×10^-4, respectively. Subgroup analysis showed that the extent and degree of λ_‖ and λ_⊥ changes were exacerbated with the increase of the average dose of temporal lobe after RT. Particularly in high-dose group, the average dose range was 25-35 Gy and the extent of regions with significant changes was significantly larger than those in the medium-dose (15-25 Gy) and low-dose groups (5-15 Gy)(P<0.05). Conclusions DTI can be utilized to detect" normal" brain tissue microdamage in NPC patients at early stage after RT. The average radiation dose of temporal lobe may be one of the reasons for the severity of cerebral microdamage. In the future, DTI technique may be useful for guiding exposure dose of organs at risk during RT planning and to evaluate the cohort with a high risk of cerebral microdamage at early stage after RT, thereby protecting normal cerebral tissues to the maximum extent.

PURPOSE: The purpose of this study was to investigate the changes of tumor infiltrating lymphocytes (TILs) between core needle biopsy (CNB) and surgery removed sample (SRS) in early stage breast cancer patients and to identify the correlating factors and prognostic significance of TILs changes. MATERIALS AND METHODS: A retrospective study was carried out on 255 patients who received CNB and underwent surgical resection for invasive breast cancer. Stromal TILs levels of CNB and SRS were evaluated respectively. Tumors with ≥50% stromal TILs were defined as lymphocyte-predominant breast cancer (LPBC). Clinicopathological variables were analyzed to determine whether there were factors associated with TILs changes. Log-rank tests and Cox proportional hazards models were used to analyze the influences of TILs and TILs changes on survival. RESULTS: SRS-TILs (median, 10.0%) were significant higher than CNB-TILs (median, 5.0%; p<0.001). Younger age (<60 years, p=0.016) and long surgery time interval (STI, ≥4 days; p=0.003) were independent factors correlating with higher TILs changes. CNB-LPBC patients showed better breast cancer-free interval (BCFI, p=0.021) than CNB-non-LPBC (CNB-nLPBC) patients. Patients were categorized into four groups according to the LPBC change pattern from CNB to SRS: LPBC→LPBC, LPBC→nLPBC, nLPBC→LPBC, and nLPBC→nLPBC, with estimated 5-year BCFI 100%, 100%, 69.7%, and 86.0% (p=0.016). nLPBC→LPBC pattern was an independent prognostic factor of worse BCFI (hazard ratio, 2.19; 95% confidence interval, 1.06 to 4.53; p=0.035) compared with other patterns. CONCLUSION: TILs were significantly higher in SRS than in CNB. Higher TILs changes were associated with younger age and long STI. Changing from nLPBC to LPBC after CNB indicated a worse BCFI, which needs further validation.
Biopsy, Large-Core Needle ; Breast Neoplasms ; Breast ; Humans ; Lymphocytes, Tumor-Infiltrating ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Sexually Transmitted Diseases

Objective: To explore the application value of matrix assisted laser desorption time of flight mass spectrometry (MALDI-TOF-MS) inproteomics of HBV-related liver cancer. Methods: Thirty patients with HBV-related liver cancer, and 25 healthy volunteers were selected from January2018 to June 2018 in our hospital. The serum proteins of these participantswere captured by weak cation exchange (WCX) beads. MALDI-TOF-MS and related software were used to analyze the proteins, detect the marker of serum proteins in HBV-related liver cancer, establish the liver cancer diagnosis model and perform blind test. Results: Totally 81 protein peaks were screened out, and 27 protein peaks had significant difference (P<0.05), of which 17 were up-regulated, 10 were down-regulated. Three differential protein peaks (M/Z 9179.55, 7789.00, 4097.00) were screened by BPS5.0 software to establish the model. Further blind test showed that the sensitivityand specificity of the protein peaks were 90.91% and 77.78%, respectively. Conclusions MALDI-TOF-MS provided an important basis for the diagnosis and treatment of HBV-related liver cancer.

Objective To design and implement a planning backup and restore system and evaluate its clinical effectiveness.Methods The default TPS menu of data save (File-Save) and system exit (File -Exit) was replaced by user designed script (Script_Save and Script_Exit) which backup the current planning status in a special format besides performing the normal save and exit operation.The treatment plan can be rolled back to any previously saved backup status in case the data were damaged or,the plan quality was deteriorated in the try and error planning process.Results The save and exit operation was simplified by using the user designed script.An extra disk space of 59.4MB per patient was required to backup the planning process and the backup was performed with no impact to the normal planning operation.1.9％ of the plans were restored during the planning process.For all of the restoring operations,65％ were performed within 1 day,80％ were performed within 1 week,and 87.6％ were performed within 1 month.Some restoring operations were even performed 4 months after the planning.Conclusions The designed backup and restore system is clinical applicable and valuable.Clinical using of the system can improve the planning efficiency and patient data safety.

Objective To investigate the clinical effect of Xuanfei Zhike Pingchuan decoction combined with budesonide in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods84 patients with AECOPD in our hospital from June 2014 to June 2016 were selected and randomly divided into the observation group and the control group.The control group was given budesonide and the observation group on the basis of the control group was given Xuanfei Zhike Pingchuan decoction.The clinical efficacy, the levels of inflammatory cytokines and pulmonary function were compared between the two groups.ResultsThe total effective rate for clinical treatment in the observation group was significantly higher than the control group(P<0.05).The levels of IL-6 and TNF-α in the observation group after treatment were significantly lower than the control group (P<0.05),while the levels of FEV1% and FEV1/FVC were obviously higher than the control group (P<0.05).ConclusionXuanfei Zhike Pingchun decoction combined with budesonide on ARCOPD has a significantly curative effect and can effectively improve the inflammatory response and recovery of pulmonary function.

Objective To study the effect of method for activating blood circulation, removing blood stasis and resolving phlegm on hypercoagulable state and cardiopulmonary function in patients with COPD and pulmonary heart disease.Methods68 cases of patients with COPD and pulmonary heart disease treated in our hospital were enrolled in the study.According to different treatment methods, they were divided two group.Both groups were treated with routine western medicine and the study group were additionally treated by method for activating blood circulation, removing blood stasis and resolving phlegm.The curative effect was compared between the two groups.ResultsThe condition of respiratory and cardiac insufficiency in the study group was significantly better than that in the control group (P<0.05).The total effective rate of treatment in the study group was significantly higher than that in the control group (94.12% vs 76.47%) (P<0.05).The PT and APTT in the study group were significantly longer than those in the control group, and FIB was significantly lower than that in the control group (P<0.05).ConclusionThe method for activating blood circulation, removing blood stasis and resolving phlegm is effective in the treatment of patients with COPD and pulmonary heart disease.The method can effectively improve the cardiopulmonary function and relieve the hypercoagulable state in patients.