Objective To analyse the clinical and pathological characteristics,diagnosis,treatment and prognosis of vulvar Bowen's disease.Methods Clinical data including pathological characteristics,diagnosis,treatment methods and follow-up of 18 cases with vulvar Bowen's disease admitted to Cancer Hospital,Chinese Academy of Medical Sciences during January 1991 to June 2011 were retrospectively analyzed.Results The median age of the 18 patients was 37 years (range:23 to 64 years).Sixteen patients had symptoms of vulvar itching and two patients had no symptom.Five cases were single neoplasm focus and the other 13 cases were multiple focuses.The diagnosis of vulvar Bowen's disease was according to the pathological diagnosis.Its diagnostic characteristic was giant round or ovoid cells with mono nucleolus in the whole layer of epidermis.All the patients received operation,eleven with simple vulvectomy and other seven cases with lumpectomy.The median follow-up time was 123 months (range:5 to 197 months).Relapse was found in two cases.One patient relapsed five months postoperation and received vulvectomy.Another patient relapsed fifteen moths post-operation and received lumpectomy again.And they were follow-up for 192months and 55 months respectively after second operation without relapse.Conclusions The diagnostic characteristic of vulvar Bowen's disease is giant round or ovoid cell with mono nucleolus in the whole layer of epidermis,itsdiagnosis is according to the pathological diagnosis.Operation could get very good curative effect for patients with primary vulvar Bowen's disease and even for the recurrent patients.The prognosis of vulvar Bowen's disease is good.

Objective To discuss the clinical characteristics,treatment and prognostic factors of brain metastasis from gynecological cancers.Methods Clinical records of 25 brain metastasis patients from gynecological cancers admitted from January 1999 to January 2009 were reviewed retrospectively.The curative effects of different treatments were compared.The prognostic factors were determined using the Cox regression model.Results There were 14 cases ovarian malignant tumor,6 cases cervical carcinoma and 5 cases uterine malignant tumor.Seven cases (28％,7/25 ) had solitary metastatic lesion in the brain.Extracranial metastases were detected in 18 cases (72％,18/25 ).Five patients only received one kind of treatment,and the mean survival time was 4.0 months (0.5 to 9.5 months).Sixteen patients received combined treatment,3 of them received combined treatment including surgery,and the mean survival time was 8.4 months (4.1 to 13.4 months) ; 13 of them received chemotherapy and radiotherapy,and the mean survival time was 14.2 months (4.3 to 58.1 months).Four patients received only palliative supportive care,and the survival time was only 0.1 to 1.0 month.The Cox regression model showed that Karnofsky performance status scale,with or without extracranial metastases and the treatment method were the independent prognostic factors of brain metastasis from gynecological cancers ( P ＜ 0.05 ).Conclusion The incidence of brain metastasis from gynecological cancers is low and the prognosis is very poor.Combined treatments may get better effects.

Objective To investigate the imaging features of Budd-Chiari syndrome(BCS) on 64 slice spiral computed tomography(64SCT) and the diagnostic value of 64SCT for BCS.Methods Twenty-nine patients diagnosed as BCS by 64SCT were retrospectively included into this study and all the patients were researched by digital substraction angiography(DSA).Two abdominal radiologists analyzed the CT imaging features of BCS,paying attention to the vascular lesion,the morphology abnormality of the liver and the degree of portal hypertension,with review of DSA findings.Results ①The accuracy of 64SCT for BCS was 93.1%(27/29),and there were 2 false positive cases and no false negative case.The accuracy of 64SCT for those patients with thrombosis of inferior vena cava(IVC) and(or) hepatic vein(HV) was high as compared to those with stenosis of IVC and(or) HV.②The morphology abnormality of the liver included hepatomegaly(24 cases),low attenuation(27 cases) and inhomogeneous pattern of parenchymal contrast enhancement(5 patients in arterial phase and 19 patients in portal vein phase).③The images of all the patients showed the features of portal hypertension.Conclusion The accuracy of 64SCT for BCS is satisfactory and the false negative is seldom.The 64SCT could accurately display the morphology abnormality of the liver and the compensatory circulation in BCS patients.For those patients with stenosis of IVC and(or) HV,however,the diagnostic power of 64SCT is limited.

Objective: To explore the structural relationship of social support,loneliness and internet addiction tendency.Methods: Questionnaires were used to investigate 355 college students.Results: The internet addiction tendency of college students had significant negative correlation with social support total scores and subjective social support,and positive correlation with the total scores and every dimensions of loneliness;college students’ social support had significant negative predictive effect on internet addiction tendency;loneliness of college student played a completely mediating role between social support and internet addiction tendency.Conclusion: Loneliness of college students plays a completely mediating role between social support and internet addiction tendency.

Objective To investigate the clinical features, treatments and prognostic factors of rhabdomyosarcoma (RMS) in the female genital tract. Methods A retrospective analysis was performed on 13 cases of RMS in the female genital tract. Clinical characteristics, treatments and prognosis were compared and analyzed statistically. Results The median age was 21.0 years (range, 6 to 54 years). There were 6 cases vaginal RMS and 7 cases cervical RMS, included 11 cases of embryonal RMS (ERMS) and 2 cases of alveolar RMS (ARMS). According to the Federation International of Gynecology and Obstetrics (FIGO)staging system,there were 6 cases of stageⅠ, 3 cases of stageⅡ, 1 case of stageⅢand 3 cases of stage Ⅳ, the median survival time were respectively 112.5, 153.0, 9.0 and 3.5 months. According to the Intergroup Rhabdomyosarcom Study Group (IRSG) staging system, there were 10 cases of stageⅠ and 3 cases of the stage Ⅳ, and their median survival time were respectively 112.5 and 3.5 months. Nine patients received surgery and the median survival time was 108.0 months (range, 9 to 228 months), 6 of them received chemotherapy after surgery and the median survival time was 152.0 months (range, 9 to 228 months), the other 3 cases did not receive any therapy after surgery and the median survival time was 25.0 months (range, 9 to 108 months). Four patients did not receive surgery and the median survival time was 6.3 months (range, 1 to 117 months). There were 2 cases received combined treatment included radiotherapy and the survival time were respectively 4 and 198 months. There were 8 cases who was survival without disease and 5 cases died of cancer. The median survival time in 13 patients was 25.0 months (range, 1 to 228 months) and the 5-year overall survival rate was 58.6%. Conclusions The prognosis of early stage of RMS in the female genital tract is good. While, the prognosis of advanced stage is poor. The standard treatment strategy is combination of surgery and chemotherapy,whether radiotherapy could improve the prognosis still need further study.

Objective To investigate the safety of ovarian preservation for stage Ⅰ endometrial carcinomas in women aged 40 years and younger.Methods Seventy-five cases of stage Ⅰ endometrial cancer aged 40 years and younger from Jan 1999 to Jan 2012 were treated in Cancer Hospital , Chinese Academy of Medical Sciences.They were further divided into two groups:20 patients who underwent ovarian preservation (group A) and 55 patients who underwent oophorectomy (group B).Clinical and pathological recordings of these patients were reviewed and compared.Results In the group A , there were 13 patients preserved both ovaries , and 7 patients preserved a single ovary.While there were no significant differences in the age, body mass index, surgical staging, histology, grade, cytology of peritoneal lavage or ascites , and postoperative treatment between two groups ( all P>0.05 ).The differences in the level of CA 125 [ 25%(5/20) versus 18%(10/55)] and number of patients underwent pelvic lymphadenectomy [35% (7/20) versus 84%(46/55)] were statistically significant between two groups (all P<0.05).Of seventy-five cases, only two patients relapsed and all survived after a median follow-up time of 31.7 months ( range:0 to 160 months).Kaplan-Meier analysis revealed no difference in overall survival (100.0% versus 100.0%) and disease free survival ( 90.0% versus 95.5%) between two groups ( P =0.579 ).Conclusions Ovarian preservation has no statistically significant impact on the survival of young patients with stage Ⅰa, well differentiated endometrial cancer.Large-scale, prospective clinical studies are needed to validate the safety of ovarian preservation for those patients.

Objective To evaluate the accuracy of image registration based on bony structure (RBS) and grey-scale (RGS) in positioning correction of radiation treatment,and their reliability in clinical application.Methods Setup errors of anthropomorphic phantom (chest& abdomen,head& neck) were simulated with x-,y-,z-directions.CBCT images were acquired for each simulation and registered with planning CT.using bony structure and grey-scale registration separately.Geometry accuracy of all registration were then obtained and analyzed.Results The errors of RBS and RGS in x-,y-,z-directions were (-0.65 ±0.22) mm and (-0.70±0.17) mm (P=0.00),(1.02 ±0.27) mm and (0.90±0.20) mm (P =0.00),(1.46 ± 0.53) mm and (1.47 ± 0.47) mm (P =0.54) for head& neck positioning; with (0.82±0.33) mm and (0.79±0.18) mm (P=0.03),(2.45±1.17) mm and (1.61 ±0.84) mm (P =0.00),(1.44 ± 3.25) mm and (0.19 ± 1.11) mm (P =0.00) for chest& abdomen positioning.Conclusions RGS is more accurate and stable than RBS.The accuracy of image registration is a little better for head& neck than that for chest& abdomen.The algorithms of image registration used in clinical application needs to be tested independently and the systematic error needs to be corrected before applying in different treatment techniques according to their accuracy requirement.

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.

Objective:To analyze the prevalence of malnutrition among human immunodeficiency virus-exposed uninfected (HEU) children and to identify the associated factors in Hunan Province.Methods:All children born to human immunodeficiency virus (HIV)-infected mothers retrieved from Information System of Prevention of Mother-to-Child Transmission of human immunodeficiency virus Management (IPMTCT) in Hunan Province between July 2013 and June 2019 were included. Information including maternal demographic characteristic, maternal comorbidities/complications, anti-retroviral therapy during pregnancy, anti-retroviral prophylaxis for children, birth weight, and disease during follow-up was collected. The length and weight of children at one, three, six, nine, 12 and 18 months of follow-up time points were detected, and the prevalences of stunting, underweight, wasting and malnutrition among HEU children were evaluated. The generalized estimating equation was used to fit the logistic regression model to analyze the associated factors for malnutrition.Results:A total of 656 HEU children were finally included. The prevalences of stunting, underweight, wasting, and malnutrition among HEU children were highest at one month of age, which were 11.9%(78/656), 9.1%(60/656), 7.0%(45/656) and 21.0%(138/656), respectively. Maternal comorbidities/complications (adjusted odds ratio (a OR)=2.30, 95% confidence interval ( CI) 1.48 to 3.58), mono/dual anti-retroviral therapy during pregnancy (a OR=2.38, 95% CI 1.54 to 3.68), birth weight <2 500 g (a OR=2.66, 95% CI 1.69 to 4.21) and disease during follow-up (a OR=1.73, 95% CI 1.10 to 2.70) were the risk factors for malnutrition among HEU children (all P<0.050). Both taking zidovudine (a OR=0.60, 95% CI 0.38 to 0.94) and nevirapine (a OR=0.31, 95% CI 0.18 to 0.52) for anti-retroviral prophylaxis were the protective factors for malnutrition among HEU children (both P<0.050). Conclusions:The prevalence of malnutrition among HEU children is high. The prevalence of malnutrition is affected by maternal comorbidities/complications, anti-retroviral therapy during pregnancy, and birth weight, diseases during follow-up and anti-retroviral prophylaxis for children.

Objective To investigate the prevalence of high-risk HPV subtypes in different pathological types of cervical cancer, and analyze the attribution of carcinogenic HPV subtypes in different pathological types. Methods A total of 1 541 patients with cervical cancer were treated between February 2009 and October 2016 in Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. The median age at diagnosis was 49 years (ranged 20-82 years old). The numbers of patients with cervical cancer from North China, Northeast China, East China, Central China and other regions (including Northwest, Southwest and South China) were 961, 244, 175, 87 and 74 cases, respectively. Pathological types: 1 337 cases of squamous cell carcinoma (SCC), 87 usual adenocarcinoma (ADC), 23 adenosquamous carcinoma (ASC), 20 mucinous carcinoma (MC), 19 clear cell carcinoma (CCC), 12 endometrioid carcinoma (EC), 25 neuroendocrine carcinoma (NEC), 9 serous carcinoma (SC), 5 villous adenocarcinoma (VADC) and 4 minimal deviation adenocarcinoma (MDAC). The prevalence of high-risk HPV in different regions, age groups at diagnosis and pathological types in cervical cancer were analyzed. The attribution of 13 high-risk HPV subtypes in different pathological types of cervical cancer based on proportional attribution method, and the attribution of high-risk HPV subtypes prevented by 9-valent HPV vaccine in SCC and ADC were calculated. Results (1) The prevalence of high-risk HPV in 1 541 patients with cervical cancer was 86.6% (1 335/1 541). The multiple high-risk HPV infection rate in patients with SCC ≥60 years old (23.0%, 37/161) was significantly higher than those in patients aged 45-59 years old and≤44 years old [11.4% (85/747) vs 11.7% (50/429), P<0.01], and the high-risk HPV infection rates of patients with cervical cancer in North China, Northeast China, East China, Central China and other regions were respectively 86.8% (834/961), 87.7% (214/244), 83.4% (146/175), 83.9% (73/87) and 91.9% (68/74). SCC (86.8%, 1 337/1 541) and ADC (5.6%, 87/1 541) were the most common pathological types in cervical cancer. The high-risk HPV prevalence of SCC, ADC, ASC, MC, NEC and VADC were 90.1% (1 205/1 337), 74.7% (65/87), 87.0% (20/23), 65.0% (13/20), 72.0% (18/25) and 5/5 respectively. The high-risk HPV infection rates of SC, EC, CCC and MDAC were 4/9, 3/12, 2/19 and 0/4 respectively. (2) According to proportional attribution, HPV 16 (69.5%), HPV 18 (5.6%), HPV 58 (2.2%), HPV 31 (1.9%), HPV 52 (1.4%) and HPV 33 (1.3%) were the six common high-risk HPV subtypes in SCC. While, HPV 18 (44.1%), HPV 16 (20.5%), HPV 52 (2.3%), HPV 58 (1.2%) and HPV 51 (1.2%) were the main carcinogenic subtypes in ADC. The main carcinogenic high-risk HPV subtypes of ASC, NEC and MC were HPV 18 and HPV 16. The total attribution of HPV 16, 18, 31, 33, 45, 52 and 58 prevented by 9-valent HPV vaccine in SCC and ADC were 82.6% and 68.1% respectively; the attribution of HPV 45 in SCC and ADC were only 0.8% and 0. Conclusions SCC and ADC are the main pathological types in cervical cancer. SCC, ADC, ASC, MC, NEC and VADC are closely related to high-risk HPV infection. HPV 16 is the main carcinogenic genotypes of SCC. HPV 18 maybe play an important role in the pathogenesis of ADC.