Background and purpose: At present, the treatment of elderly patients with ovarian cancer, espe-cially advanced ovarian cancer, tends to be conservative, and elderly patients often can not receive standard treatment. There are few treatment experiences and research data. This study aimed to investigate the treatment outcome, survival and prognostic factors of elderly patients with advanced epithelial ovarian cancer. Methods: This study retrospectively analyzed the clinical data for women older than 65 years diagnosed with stage Ⅲ and Ⅳ epithelial ovarian cancer between Apr. 2008 to Dec. 2012 in Chongqing Cancer Hospital. Results: Of the 181 women who met study criteria, 8.8％ received no treatment, 12.7％ underwent surgery alone, 15.5％ received chemotherapy alone, 33.2％ underwent non-standard treatment, 29.8％ underwent standard treatment. Baseline comparison of different treatment methods showed that the proportion of patients with cardiovascular and cerebrovascular diseases was lower in the standard treatment group. After Correcting the effect of cardio-cerebrovascular diseases, the median survival time of standard treatment (48 months) and the median survival time of non-standard treatment (47 months) were significantly longer than that of the other treatment groups (P<0.001). The median survival time of chemotherapy alone (26 months) was significantly longer than that of the surgery alone and untreated group (P<0.001), while the median survival time of surgery alone was similar to untreated group (9 months vs 8 months, P=0.269). Multivariate analysis using Cox model showed that treatment, residual lesion size, cardio-cerebrovascular diseases significantly impacted on survival time. Conclusion: Standard treatment was still the key factor for the best survival of elderly women with advanced ovarian cancer. When this is not offered or possible, chemother-apy alone offers better survival than surgery alone. However, surgery alone does not improve prognosis.

Objective To evaluate the teaching effects of case introduced method based on picture archiving and communication system (PACS) system in medical imaging course.Methods Totally 148 students (2009 grade) majored in five-year clinical medicine from Xiangya Medical College were divided into 10 groups; the 10 groups were taken randomly as control group (n=75) and experimental group (n=73).Control group used traditional teaching methods (film teaching) while experimental group used case introduced method based on PACS system.Effects of teaching between were evaluated by questionnaire and test.x2 test was used to compare students' theoretical test scores,with α level =0.05.Results Based on results of questionnaires,more students in experimental group than in control group hold that case introduced method based on PACS system can achieve the purpose of teaching,improve interests in learning,and strengthen the mastery of knowledge.Test scores showed that the percentage of students scored 90-100 and 80-89 (respectively 14％,75％) in experimental group was significantly higher than that in control group (respectively 5％,66％) (x2 =17.932,P=0.000).Conclusions Application of case introduced method based on PACS system in medical imaging course not only improve students' motivation to learn and their clinical ability,but also allow teachers to find and correct shortcomings of students timely,therefore,it is worth promoting.

Objective To introduce the methods,complications and management of transiliaca external artery port catheter system (PCS) implantation,and to discuss its feasibility and superiority. Methods Transiliaca external artery PCS implantation were performed in 110 patients with medium or advanced malignant hepatic tumor.There were 86 male and 24 female, with average 50.8 years old, including 68 cases primary hepatic cancer, 42 cases metastatic cancer. Follow-up time was 2～53 months. Results The operation successful rate was 98.2% (108/110). Complications included: puncture local hematoma in 5 cases (4.5%), cut infection in 1 case (0.9%), slow bleeding in cut in 2 cases (1.8%), light swelling and paining of right testicle in 1 case (0.9%), target arteries occlusion or serious narrowness in 6 cases (5.5%), displacement of the tip of catheter in 3 cases (2.7%). Complications rate was 15.5% (17/110).Conclusion Transiliaca external artery PCS implantation is safe and feasible, the successful rate is higher and complications rate is lower, it can be introduced as a sort of routine method.

Objective To investigate the relationship of Vaneomycin serum concentration and drug adverse reactions (ADRs) in neonates.Methods Two hundred and thirteen neonates who were treated by Vancomycin and had their serum concentration monitored were recruited.The number of cases which had liver,kidney and hearing damage after treatment was calculated.The correlation between 3 different serum concentrations (＜5 mg/L,5-10 mg/L,＞ 10 mg/L) and ADRs were analyzed.Results The mean level of Vancomycin in serum was (4.36 ± 4.99) mg/L The total incidence of ADRs was 17.8％ (38/213 cases).The main ADRs were liver damage and hearing impairment,whose incidences were 9.9％ (21/213 cases) and 7.5％ (16/213 cases),respectively,and they were were significantly higher than kidney danage (0.5％,1/213 cases) (x2 =19.172,P =0.000;x2 =13.785,P =0.000).There was no significant difference be-tween the inidence ratio of liver damage and that of the hearing impairment (x2 =0.330,P =0.566).The ADRs ratio among 3 different serum concentrations was 17.0％ (24/141 cases),17.6％ (9/51 cases) and 23.8％ (5/21 cases).There was no significant difference between the ADRs ratios and distribution of different serum concentrations (x2 =0.576,P =0.750).Moreover,the ADRs rates didn't increase along with the serum concentrations (Z =0.648,P =0.517).Except for aspartate transaminase,the indicators of liver and kidney function varied significantly after vancomycin treatment (P ＜0.05).But there was no clinical significance because the mean value was in normal range.By Bivariate Correlation analysis,Vancomyein serum concentration had no significant influence on liver and kidney function (P ＞ 0.05).Conclusions Neonates treated by Vancomycin had reatively high ratio of the liver damage and the hearing impairment.There is no significant correlation between Vancomyein serum concentration and ADRs in neonates.

ObjectiveTo investigate the delineation of gross tumor volume (GTV) in locally advanced nasopharyngeal carcinoma (LANC) according to imageological changes before and after induction chemotherapy (IC) in order to decrease high dose area and protect normal tissue better.MethodsBetween Mar 2010 to Jan 2011,11 patients with LANC were enrolled and treated with TPF regimen followed by intensity-modulated radiotherapy (IMRT) with concurrent chemotherapy,target volumes were delineated based on fused CT imaging before and after IC following project determination.Tumor target volumes after and before IC were respectively delineated according to imaging tumor residues and were overlaid by CTVnx in order to ensure radical doses for the imaging tumor volume before IC,the resulting differences of tumor target volumes of IC before and after were measured and analyzed by paired t-test.ResultsBefore and after IC,the average volumes of GTVnx were respectively 44.72 cm3 and 28.87 ( t =3.89,P =0.003 ),the average volumes of GTVnd were respectively 32.76 cm3 and 19.82 cm3 ( t =2.47,P =0.033 ),the volumes of maximum dose area in brainstem and spinal cord as well as eyeball decreased ( t =2.93-4.59,all P ＜0.05).ConclusionsLANC treated by 3 cycle TPF regimen followed by IMRT with concurrent chemotherapy showes significant shrinkage of tumor volume.The volume of high dose region which caused by normally recovered tissues were decreased by re-delineation of target volume in brainstem and spinal cord as well as eyeball of CT images after IC.

Objective:The present study aimed to investigate the short-term efficacy and adverse effects of induction chrono-che-motherapy including docetaxe1 (TXT), cisplatin (DDP), and 5 fluorouraci1 (5-FU) followed by concomitant chemoradiotherapy in lo-co-regionally advanced nasopharyngeal carcinoma (NPC). Methods:Newly diagnosed locally advanced (Ⅲ~Ⅳb) NPC patients were enrolled in this study. All patients received three cycles of TPF regimen. The TPF chemotherapy regimen was administered as follows:TXT, 75 mg/m2, i.v. infusion, d1; DDP, 75 mg/m2, bolus infusion from 10:00 to 22:00, d1-5; and 5-FU 750 mg/m2/d bolus infusion from 22:00 to 10:00, d1-5, with 21 days each cycle, followed by concomitant IMRT and chemotherapy (paclitaxel 135 mg/m2 i.v. infu-sion, with 21 days each cycle and a total of 2 courses). Acute and late toxicities were graded according to the Common Terminology Cri-teria for Adverse Events v3.0 scoring criteria. Tumor response was evaluated using 2000 Response Evaluation Criteria in Solid Tumors criteria. Results:The CR and PR rates of induction chemotherapy were 23.8%and 68.6%, respectively;whereas the CR and PR rates of the combined modality treatment were 64.8%and 31.4%, respectively. Two-year overall survival rate was 91.4%, two-year progres-sion free survival rate was 87.0%, and two-year distant metastasis-free survival rate was 88.4%. The main side effects from induction chemotherapy include an over grade 3 granulocytopenia of 28.6%. Major toxicity from concurrent chemo-radiotherapy was oral mucosi-tis (81.0%);grade 3 to 4 oral mucositis was 16%. No treatment-related deaths occurred in this study. Conclusion:Induction chrono-che-motherapy using TPF followed by concurrent chemoradiotherapy of paclitaxel is a well-tolerated treatment with short-term efficacy and severity for locally advanced NPC. Further follow-up is required to assess the late effects and long-term efficacy.

Objective To explore the relationship between MRI findings and defecation function after laparoscopic?assisted anorectal pull?through for anorectal malformations. Methods A retrospective cohort study focused on the findings of MRI performed after laparoscopic?assisted anorectal pull?through for anorectal malformations and no spinal deformity was present in all patients who are currently older than 3 years. Forty?two patients aged from 3 to 16 years (median age was 4 years), whom accepted operation at 3 months to 13 years old(median age was 5 months), and MRI was carried out in 2 to 5 months after operation (median time was 3 months). The MRI manifestations including the relationship between the anorect and the high muscle complex(RAHMC), anorectal angle(AA); the relationship between the anorect and the low muscle complex(RALMC), the rectal maximum diameter(RMD), the fat tissue interposition(FTI) and the development of pelvic floor muscle(PFM) were reviewed and summarized. Statistically, the differences of MRI manifestations in different defecation function index, including the degree of voluntary bowel movements, soiling, constipation and Krickenbeck score were evaluated respectively with Chi?square test or rank sum test. Results statistically, There was significant differences among the groups with different degree of voluntary bowel movements, soiling and Krickenbeck score in the RAHMC (P<0.05), and AA was correlated with the degree of voluntary bowel movements, soiling, constipation and Krickenbeck score(P<0.05), but no significant differences was found among the groups with different defecation function index in the RALMC, the RMD, the FTI and the development of PFM(P>0.05). Conclusions The deviation of the anorect from the high muscle complex which showed in the postoperative MRI pictures suggested the poor prognosis, and well?developed pelvic floor muscles which indicated in the MRI was not the sufficient predictor for good outcome. Postoperative anorectal angle obtained in the MRI can be used as an objective indicator of prognosis.

The thyroid function test is universally used for the evaluation of thyroid function. However, there are factors other than endocrine diseases, such as special physiological conditions, interference in laboratory measurement, or disorders in other systems that should be taken into consideration. When encountering thyroid function test results that are not in line with clinical manifestation, a comprehensive evaluation is essential for a correct and timely diagnosis. We presented a case of a significant rise in serum total triiodothyronine(TT 3) secondary to multiple myeloma. Through case studies and literature review, we intended to provide clinicians with experience for better interpretation of abnormal thyroid function test results.

Objective To strengthen the supervision of medical equipment procurement and construct a scientific and systematic evaluation system for procuring agency supervision,providing a reference for public hospitals to implement government procurement of medical equipment.Methods The Delphi method was employed to establish the indexes and weights of the su-pervision evaluation system.Subsequently the fuzzy comprehensive evaluation method was applied to comprehensively analyze the procuring agencies X and Y.Results The evaluation results of agencies X and Y were compared and analyzed in terms of work efficiency,business capability,organization of bid evaluation,and service quality.Additionally,the results were regularly fed back and improved.Conclusion The establishment of the supervision and evaluation system for procuring agencies is conducive to promoting the standardization and efficiency of government procurement activities of medical equipment in public hospitals and safeguarding the legitimate rights and interests of procurement participants as well as the public interests.

Objective To explore the effect of cancer related anemia on the abundance of SARS-CoV-2 specific memory CD8+T cells in peripheral blood.Methods A total of 34 HLA-A*11∶01 positive patients with middle-and late-stage tumors admitted in the Rocket Force Medical Center of PLA from June to July 2023 were enrolled in this study.According to hemoglobin(HGB)level,they were divided into non anemia group(≥120 g/L,n=14),mild anemia group(90～120 g/L,n=14),and moderate to severe anemia group(＜90 g/L,n=6).After their peripheral blood mononuclear cells were isolated,memory CD8+T cells were stimulated by the epitopes of SARS-CoV-2 and then expanded.Positive epitopes were screened using enzyme-linked immunosorbent spot(ELISP OT)assay,and then MHC-peptide Tetramers were constructed.The proportion and number of Tetramer+cells and the number of ELISPOT spots were detected in the expanded cells to reflect the abundance of SARS-CoV-2 specific memory CD8+T cells.The relevance of patients'HGB level with the proportion and number of Tetramer+cells and the number of ELISPOT spots was analyzed.The differences of the proportion and number of Tetramer+cells and the number of ELISPOT spots was analyzed in different groups.Results Among the 34 patients,there were 25 males and 9 females,at an age range of 36～78(median 57)years.The proportion and number of Tetramer+cells and the number of ELISPOT spots were positively correlated with HGB level(P＜0.05).The proportion and number of Tetramer+cells and the number of ELISPOT spots were significantly decreased in patients with moderate to severe anemia than the non anemia patients(P＜0.05).Conclusion The abundance of SARS-CoV-2 specific memory CD8+T cells in peripheral blood is positively correlated with patients'HGB level,indicating that CRA may increase the susceptibility of patients to viruses by reducing the abundance of memory CD8+T cells in peripheral blood.