Objective:To explore diagnostic value of the parameters of transvaginal color Doppler flow imaging(CDFI)on ovarian cancer of elderly,and the correlation between that and pathological characteristics.Methods:The data of 120 elderly patients with ovarian cancer admitted to General Hospital of Northern Theater Command of the Chinese PLA from February 2023 to May 2024 were retrospectively collected,and they were included in the observation group.The data of 120 elderly patients with benign ovarian lesions admitted at the same period were collected,and they were included in the control group.Both groups underwent transvaginal CDFI,and the peak systolic blood flow velocity(PSV),end diastolic blood flow velocity(EDV),resistance index(RI),and pulsatility index(PI)of transvaginal CDFI parameters were compared between the two groups.The receiver operating characteristic(ROC)curve was drawn,and the diagnostic values of transvaginal CDFI parameters alone and the combined examination of various parameters for ovarian cancer of elderly were analyzed.And then,the correlation factors between transvaginal CDFI parameters and pathological characteristics of elderly patients with ovarian cancer were analyzed.Results:The PSV and EDV of the observation group were respectively(21.55±2.50)cm/s and(12.84±2.10)cm/s,which were higher than those(15.41±1.95)cm/s,(8.11±1.20)cm/s of the control group.The RI and PI of the observation group were respectively(0.51±0.12)and(0.95±0.14),which were lower than those(0.79±0.20)and(1.50±0.25)of the control group.The differences of the above 4 indicators between two groups were statistically significant(t=21.214,21.423,13.151,21.027,P<0.05).The area under curve(AUC)values of the ROC curves of PSV,EDV,RI and PI were respectively 0.882,0.876,0.800 and 0.882 in diagnosing ovarian cancer of elderly,all of which had diagnostic value.The value of combined examination of these indicators was higher,which AUC was 0.976.The PSV and EDV of elderly patients with ovarian cancer at tumor stages III-IV were higher than those of elderly patients at tumor stages I-II,while RI and PI were lower than those of elderly patients at tumor stages I-II,and the differences were statistically significant(F=16.232,13.743,6.671,11.846,P<0.05).The PSV and EDV of elderly patients with ovarian cancer who occurred lymph node metastasis were higher than those who did not occur lymph node metastasis,and the RI and PI were lower than those who did not occur lymph node metastasis.The differences of the above 4 indicators between two kinds of patients were statistically significant(t=15.185,15.168,5.598,9.796,P<0.05).Logistic regression analysis showed that increased PSV and EDV were risk factors for tumor staging and lymph node metastasis in elderly patients with ovarian cancer(OR=6.168,5.044,5.302,8.417,P<0.05).The increased RI and PI were protective factors for tumor staging and lymph node metastasis in elderly patients with ovarian cancer(OR=0.005,0.010,0.001,0.002,P<0.05).Conclusion:Transvaginal CDFI parameters have higher diagnostic value for ovarian cancer of elderly,and they correlate with tumor staging and lymph node metastasis,which can be used as important indicators in diagnosing ovarian cancer of elderly,and assessing pathological characteristics.

Objective To analyze the application value of 3D Slicer software in endoscopic transsphenoidal surgery for pituitary adenoma resection.Methods A retrospective analysis was made on the clinical data of 36 patients with pituitary adenomas treated with 3D Slicer-assisted endoscopic transsphenoidal surgery(3D Slicer group)in the Department of Neurosurgery,The Second Affiliated Hospital of Xi'an Jiaotong University,from January 2024 to December 2024.Preoperatively,multimodal images were fused and reconstructed using 3D Slicer software to systematically evaluate bony anatomical structures such as sphenoid sinus ostia,intrasphenoidal septa,and sellar floor structures,design the size of pedicled nasoseptal flaps,and clarify the positional relationships between pituitary adenomas and surrounding vital structures including the internal carotid artery,pituitary gland,and optic chiasm,so as to provide real-time guidance for intraoperative procedures.Meanwhile,45 patients with pituitary adenomas treated with neuronavigation-assisted endoscopic transsphenoidal surgery from January 2023 to December 2023 were included as the control group(neuronavigation group).The surgical outcomes and postoperative complications were compared between the two groups.Results Compared with the neuronavigation group,the 3D Slicer group demonstrated higher identification rates of the optic nerve groove and carotid artery impression(94.4％vs.77.8％),shorter operative time[(2.9±0.6)h vs.(3.5±0.9)h],less intraoperative bleeding[(159.7±70.5)mL vs.(237.8±96.0)mL],and a lower incidence of postoperative olfactory dysfunction(8.3％vs.26.7％),with statistically significant differences(P＜0.05).However,there were no statistically significant differences between the two groups in the identification rate of the sphenoid sinus ostium(100.0％vs.97.8％),gross total resection rate(75.0％vs.64.4％),and the incidence of other postoperative complications,including cerebrospinal fluid leakage(0.0％vs.6.7％),intracranial infection(2.8％vs.11.1％),transient diabetes insipidus(30.6％vs.22.2％),and hypopituitarism(38.9％vs.37.8％,P＞0.05).Conclusion 3D Slicer software helps improve the mastery of anatomical basics in endoscopic transsphenoidal approach among junior and primary physicians,enhancing the clinical efficacy and safety of pituitary adenoma resection,and thus is worthy of clinical promotion.

Objective:To explore diagnostic value of the parameters of transvaginal color Doppler flow imaging(CDFI)on ovarian cancer of elderly,and the correlation between that and pathological characteristics.Methods:The data of 120 elderly patients with ovarian cancer admitted to General Hospital of Northern Theater Command of the Chinese PLA from February 2023 to May 2024 were retrospectively collected,and they were included in the observation group.The data of 120 elderly patients with benign ovarian lesions admitted at the same period were collected,and they were included in the control group.Both groups underwent transvaginal CDFI,and the peak systolic blood flow velocity(PSV),end diastolic blood flow velocity(EDV),resistance index(RI),and pulsatility index(PI)of transvaginal CDFI parameters were compared between the two groups.The receiver operating characteristic(ROC)curve was drawn,and the diagnostic values of transvaginal CDFI parameters alone and the combined examination of various parameters for ovarian cancer of elderly were analyzed.And then,the correlation factors between transvaginal CDFI parameters and pathological characteristics of elderly patients with ovarian cancer were analyzed.Results:The PSV and EDV of the observation group were respectively(21.55±2.50)cm/s and(12.84±2.10)cm/s,which were higher than those(15.41±1.95)cm/s,(8.11±1.20)cm/s of the control group.The RI and PI of the observation group were respectively(0.51±0.12)and(0.95±0.14),which were lower than those(0.79±0.20)and(1.50±0.25)of the control group.The differences of the above 4 indicators between two groups were statistically significant(t=21.214,21.423,13.151,21.027,P<0.05).The area under curve(AUC)values of the ROC curves of PSV,EDV,RI and PI were respectively 0.882,0.876,0.800 and 0.882 in diagnosing ovarian cancer of elderly,all of which had diagnostic value.The value of combined examination of these indicators was higher,which AUC was 0.976.The PSV and EDV of elderly patients with ovarian cancer at tumor stages III-IV were higher than those of elderly patients at tumor stages I-II,while RI and PI were lower than those of elderly patients at tumor stages I-II,and the differences were statistically significant(F=16.232,13.743,6.671,11.846,P<0.05).The PSV and EDV of elderly patients with ovarian cancer who occurred lymph node metastasis were higher than those who did not occur lymph node metastasis,and the RI and PI were lower than those who did not occur lymph node metastasis.The differences of the above 4 indicators between two kinds of patients were statistically significant(t=15.185,15.168,5.598,9.796,P<0.05).Logistic regression analysis showed that increased PSV and EDV were risk factors for tumor staging and lymph node metastasis in elderly patients with ovarian cancer(OR=6.168,5.044,5.302,8.417,P<0.05).The increased RI and PI were protective factors for tumor staging and lymph node metastasis in elderly patients with ovarian cancer(OR=0.005,0.010,0.001,0.002,P<0.05).Conclusion:Transvaginal CDFI parameters have higher diagnostic value for ovarian cancer of elderly,and they correlate with tumor staging and lymph node metastasis,which can be used as important indicators in diagnosing ovarian cancer of elderly,and assessing pathological characteristics.

Objective To analyze the application value of 3D Slicer software in endoscopic transsphenoidal surgery for pituitary adenoma resection.Methods A retrospective analysis was made on the clinical data of 36 patients with pituitary adenomas treated with 3D Slicer-assisted endoscopic transsphenoidal surgery(3D Slicer group)in the Department of Neurosurgery,The Second Affiliated Hospital of Xi'an Jiaotong University,from January 2024 to December 2024.Preoperatively,multimodal images were fused and reconstructed using 3D Slicer software to systematically evaluate bony anatomical structures such as sphenoid sinus ostia,intrasphenoidal septa,and sellar floor structures,design the size of pedicled nasoseptal flaps,and clarify the positional relationships between pituitary adenomas and surrounding vital structures including the internal carotid artery,pituitary gland,and optic chiasm,so as to provide real-time guidance for intraoperative procedures.Meanwhile,45 patients with pituitary adenomas treated with neuronavigation-assisted endoscopic transsphenoidal surgery from January 2023 to December 2023 were included as the control group(neuronavigation group).The surgical outcomes and postoperative complications were compared between the two groups.Results Compared with the neuronavigation group,the 3D Slicer group demonstrated higher identification rates of the optic nerve groove and carotid artery impression(94.4％vs.77.8％),shorter operative time[(2.9±0.6)h vs.(3.5±0.9)h],less intraoperative bleeding[(159.7±70.5)mL vs.(237.8±96.0)mL],and a lower incidence of postoperative olfactory dysfunction(8.3％vs.26.7％),with statistically significant differences(P＜0.05).However,there were no statistically significant differences between the two groups in the identification rate of the sphenoid sinus ostium(100.0％vs.97.8％),gross total resection rate(75.0％vs.64.4％),and the incidence of other postoperative complications,including cerebrospinal fluid leakage(0.0％vs.6.7％),intracranial infection(2.8％vs.11.1％),transient diabetes insipidus(30.6％vs.22.2％),and hypopituitarism(38.9％vs.37.8％,P＞0.05).Conclusion 3D Slicer software helps improve the mastery of anatomical basics in endoscopic transsphenoidal approach among junior and primary physicians,enhancing the clinical efficacy and safety of pituitary adenoma resection,and thus is worthy of clinical promotion.

In recent years, traditional Chinese medicine (TCM) has made great progress in the prevention and treatment of cancer. It has gradually revealed its characteristics and advantages in clinical practice, including alleviating clinical symptoms, prolonging survival time, decreasing the adverse effects of chemotherapy, and improving living quality. However, clinical TCM treatment of cancer lacks systematic theoretical guidance, because ancient TCM has not formed a recognized theoretical system of cognitive cancer, and there still are different opinions on the pathogenesis of cancer. Due to the complexity of cancer, the essence of cancer pathogenesis has not been described accurately by using common pathogenic factors, such as pathogenic wind, cold, dampness, summer heat, dryness, and fire. Ancient and modern TCM physicians have a similar understanding that the occurrence of cancer is related to toxin. In the 1990s, the thought of cancerous toxin was first proposed by Prof Zhou Zhongying, a TCM master based on more than 60 years of clinical practice, who used “pandemic Qi (Li-Qi) is a specific pathogenic factor of epidemic disease” in Wenyi Lun (Treatise on Pestilence) for references. The pathogenesis theory of cancerous toxin was gradually established under the guidance of the thought of cancerous toxin. It holds that the cancerous toxin, a special pathogenic factor of cancer, is the key pathogenesis of the occurrence of malignant tumors. According to the pathogenesis theory of cancerous toxin, the basic pathogenesis of malignant tumors is the accumulation of pathogenic factors and cancerous toxin, and the deficiency of the vital Qi (Zheng-Qi). Therefore, the treatment principle involves eliminating pathogenic factors, resolving cancerous toxin, and supporting the vital Qi. The anticancer detoxification methods and the classification of Chinese medicinal herbs with anticancer detoxification effects were put forward. System theory has much in common with the concepts in the theory system of TCM, such as the universal relation theory, asking for a concrete analysis of concrete conditions, the humanism thought, and so on. This article aims to describe, review, and analyze the pathogenesis theory of cancerous toxin based on system theory for clinical practices.

Background::A phase II trial on recombinant human tenecteplase tissue-type plasminogen activator (rhTNK-tPA) has previously shown its preliminary efficacy in ST elevation myocardial infarction (STEMI) patients. This study was designed as a pivotal postmarketing trial to compare its efficacy and safety with rrecombinant human tissue-type plasminogen activator alteplase (rt-PA) in Chinese patients with STEMI.Methods::In this multicenter, randomized, open-label, non-inferiority trial, patients with acute STEMI were randomly assigned (1:1) to receive an intravenous bolus of 16 mg rhTNK-tPA or an intravenous bolus of 8 mg rt-PA followed by an infusion of 42 mg in 90 min. The primary endpoint was recanalization defined by thrombolysis in myocardial infarction (TIMI) flow grade 2 or 3. The secondary endpoint was clinically justified recanalization. Other endpoints included 30-day major adverse cardiovascular and cerebrovascular events (MACCEs) and safety endpoints.Results::From July 2016 to September 2019, 767 eligible patients were randomly assigned to receive rhTNK-tPA ( n = 384) or rt-PA ( n = 383). Among them, 369 patients had coronary angiography data on TIMI flow, and 711 patients had data on clinically justified recanalization. Both used a –15% difference as the non-inferiority efficacy margin. In comparison to rt-PA, both the proportion of patients with TIMI grade 2 or 3 flow (78.3% [148/189] vs. 81.7% [147/180]; differences: –3.4%; 95% confidence interval [CI]: –11.5%, 4.8%) and clinically justified recanalization (85.4% [305/357] vs. 85.9% [304/354]; difference: –0.5%; 95% CI: –5.6%, 4.7%) in the rhTNK-tPA group were non-inferior. The occurrence of 30-day MACCEs (10.2% [39/384] vs. 11.0% [42/383]; hazard ratio: 0.96; 95% CI: 0.61, 1.50) did not differ significantly between groups. No safety outcomes significantly differed between groups. Conclusion::rhTNK-tPA was non-inferior to rt-PA in the effect of improving recanalization of the infarct-related artery, a validated surrogate of clinical outcomes, among Chinese patients with acute STEMI.Trial registration::www.ClinicalTrials.gov (No. NCT02835534).

OBJECTIVE To systematically evaluate the therapeutic effect of acupuncture on geriatric insomnia.METHODS Randomized controlled trials(RCTs)on acupuncture in the treatment of senile insomnia were searched in CNKI,VIP,Wanfang,China Biomedical Database,PubMed,Web of science,Embase and Cochrane Library databases from inception dates to June 24,2024.Litera-ture was screened and data were extracted based on the inclusion and exclusion criteria.The literature quality was evaluated according to the risk of bias table recommended by the Cochrane Collaboration Handbook 5.1.0,and the outcome indicators were graded using the GRADE system for the quality of evidence.RevMan5.4 software was used to evaluate the quality of the included literature,and Sta-ta18.0 software was used to conduct Meta-analysis on the included literature.RESULTS A total of 18 studies involving 1399 pa-tients were included.Meta-analysis showed that:compared with the simple western medicine treatment,acupuncture in the treatment of senile insomnia patients could improve the clinical effective rate[RR=1.18,95%CI(1.13,1.24),P<0.001],reduce the total PSQI score[MD=-1.10,95%CI(-1.25,-0.96),P<0.001],daytime dysfunction[MD=-1.38,95%CI(-1.59,-1.16),P<0.001],sleep latency[MD=-0.66,95%CI(-0.86,-0.47),P<0.001],sleep duration[MD=-0.45,95%CI(-0.64,-0.25),P<0.001],sleep efficiency[MD=-0.69,95%CI(-0.89,-0.49),P<0.001],sleep disorder[MD=-1.24,95%CI(-1.47,-1.01),P<0.001],sleep quality[MD=-0.84,95%CI(-1.05,-0.64),P<0.001].GRADE classification showed that the clinical efficacy was advanced evidence;the adverse reactions were intermediate evidence;the total score of PSQI,daytime dysfunction,sleep latency,sleep efficien-cy,sleep quality and sleep disorder were low evidence;sleep time was extremely low evidence.CONCLUSION Acupuncture inter-vention in senile insomnia patients is superior to the control group in clinical efficiency and various PSQI scores.Acupuncture interven-tion is worthy of further promotion and use in clinical practice as the complementary and alternative therapy for the conventional western medication treatment of senile insomnia.However,the evidence levels of some outcome indicators are relatively low,and more high-quality RCTs with large sample sizes are still needed to increase the strength of evidence.

In the past, the use of neoadjuvant androgen deprivation therapy (ADT) for prostate cancer did not exhibit survival benefits and was not recommended by the practicing guidelines. In recent years, with the emergence of novel hormonal therapeutics such as Abiraterone, Enzalutamide, Apalutamide and Darolutamide, the interest for neoadjuvant therapy has been reignited. Here, we summarize the four categories of neoadjuvant therapy with new hormonal agents, and discuss how to evaluate the efficacy and explore the molecular mechanism after neoadjuvant therapy.

Objective:To analyze the correlation between the Naples prognostic score (NPS) after preoperative neoadjuvant chemoradiotherapy in locally advanced rectal cancer (LARC) and evaluate the prognostic value of NPS in LARC.Methods:136 patients with LARC meeting the recruitment criteria from 2015 to 2020 were selected. Serum albumin, total cholesterol (TC) were collected and neutrophil-lymphocyte ratio and lymphocyte-monocyte ratio were calculated. All patients were scored and graded according to the NPS rule. The survival rate was calculated with Kaplan- Meier method. Multivariate prognostic analysis was performed by Cox models. Results:There was no significant correlation between NPS score and tumor regression or pathological complete response (pCR) of LARC patients after neoadjuvant therapy ( P=0.192, P=0.163). However, Cox multivariate analysis showed that NPS was an independent risk factor for overall survival (OS) and disease-free survival (DFS) of LARC ( P=0.009, P=0.003), and hierarchical analysis suggested that LARC patients with lower NPS score obtained better prognosis. Besides NPS, tumor size was also an independent risk factor for OS, and tumor size and N stage were the independent risk factors for DFS. Conclusion:NPS has no correlation with tumor regression or pCR for LARC after neoadjuvant chemoradiotherapy, whereas it could serve as an effective predictor for long-term prognosis of LARC.

To review the literatures on the treatment of COPD combined with anxiety and depression treated by TCM in recent years, which conclude that to treat this kind of disease is usually by taking drugs, as well as non-drug therapy such as traditional Chinese exercises, acupuncture and massage, and music, etc, which could improve patients unhealthy emotions and quality of life. The recent clinical researches on TCM treatment has been increased, but the overall number of the research of this kind is limited, with problems such as small sample size, singular observing indicator, and requiring multi-center research. There still lacks related basic research and needs more attention.