Based on EMR for design of telemedical regional healthcare platform / 中国医疗器械杂志

According to international medical information standard and Chinese healthcare management criterion,this paper study EMR features which focus on standard documents exchange and sharing.Tele Regional Healthcare Platform is established by EMR in order to realize medical resource sharing between big hospital in the situation of China, one solution is offered to stave difficulty and high expense of medical service in countryside.

18F-FDG uptake as a biologic factor predicting outcome in patients with resected non-small-cell lung cancer / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The outcome of surgical treatment of non-small-cell lung cancer (NSCLC) remains poor. In many patients the biological behavior of NSCLC does not follow a definite pattern, and can not be accurately predicted before treatment. (18)F-fluoro-2-deoxy-glucose ((18)F-FDG) uptake on positron-emission tomography (PET) is associated with the aggressiveness of NSCLC. The present study focused on the role of (18)F-FDG uptake in predicting the outcome of surgically treated patients with NSCLC.</p><p><b>METHODS</b>A retrospective analysis was made of 82 patients who underwent complete resection and preoperative FDG PET. The maximum standardized uptake value (SUV(max)), in addition to five clinicopathological factors and three biomolecular factors, which could possibly influence survival, was compared for possible association with patients' recurrence and survival, by the Log-rank test in univariate analysis and the Cox proportional hazards model in multivariate analysis. The association between SUV(max) and other factors was also analyzed.</p><p><b>RESULTS</b>Patients with SUV(max) more than 11 had a disease-free survival and overall survival shorter than patients with SUV(max) less than 11 in univariate analyses (P < 0.001, P = 0.002). In the multivariate analysis, SUV(max) (dichotomized by 11) was the only significant predictor for tumor recurrence. TNM stage and SUV(max) (dichotomized by 11) were independent predictors for the overall survival. Associations of SUV(max) with p53 overexpression, proliferating cell nuclear antigen (PCNA) labeling index and microvascular density of the tumor were significant in the entire group.</p><p><b>CONCLUSIONS</b>(18)F-FDG uptake on PET may be used to noninvasively assess biological aggressiveness of NSCLC in vivo, identifying the surgically-treated patients with poor prognosis who could benefit from additional therapy.</p>

Clinical therapeutic effect of esophageal carcinoma with hand video assisted surgery / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the clinical therapeutic effect of esophageal carcinoma with hand video assisted surgery.</p><p><b>METHODS</b>Forty cases which C TNM stage was T3N1M0 received hand video assisted surgery (HVATS group), 40 cases received routine operation (control group). Recurrence survival analysis of each group was analyzed with SPSS10.0 software according to the date of the stage and survival rate.</p><p><b>RESULTS</b>All group have satisfied surgical result. All patients have good quality of life. The 3 year survival rate was 52.7% in HVATS group and 51.3% in control group. The difference of survival rate was no significance.</p><p><b>CONCLUSION</b>Hand video assisted surgery for esophageal carcinoma had same result as routine thoracic operation. Short operation time, less trauma and fast recovery are the advantages of hand video assisted surgery.</p>

A prospective longitudinal study examining the impact on short term quality of life of hand video-assisted thoracoscopic surgical esophagectomy in patients with esophageal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the impact of hand video-assisted thoracoscopic surgery (HVATS) and Ivor-Lewis surgery on short term quality of life (QL) of patients with esophageal cancer.</p><p><b>METHODS</b>Thirty-nine consecutive patients with esophageal cancer were classified into HVATS group (n = 21) and Ivor-Lewis group (n = 18) randomly, all patients completed the Chinese versions of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 and QLQ-OES18 before treatment and at regular intervals until 6 months after operation. MEAN scores were calculated for every patient.</p><p><b>RESULTS</b>Baseline functional and symptom QL MEAN scores were similar in both groups. All patients reported worse functional, symptom and global QL scores (QOL) within 6 months after operation than before. HVATS group gained higher functional, global QL scores and lower symptom scores than Ivor-Lewis group, moreover, patients' QL scores of HVATS group returned to preoperative levels more quickly than those patients in Ivor-Lewis group. Significant differences were found in global health (QOL), physical functioning, fatigue and pain scales between groups. In both groups, QLQ-OES18 dysphagia scales were improved after surgery,but no significant differences were found at scales respect to esophageal cancer.</p><p><b>CONCLUSIONS</b>HVATS esophagectomy is a safe procedure which has a low disturbance to patients' short term Quality of Life compared with Ivor-Lewis esophagectomy. It might seem reasonable to choose HVATS esophagectomy for patients with early stage esophageal cancer.</p>

Resection for lung cancer invading the superior vena cava / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the feasibility and the value of resection for lung cancer invading the superior vena cava (SVC).</p><p><b>METHODS</b>Between 1988 and 2005 the data of 31 patients who underwent resection were analyzed retrospectively. The reconstruction was done using simple suture, pericardial patch or prosthetic replacement. Postoperative morbidity, long-term survival were examined using the Kaplan-Meier method (Log rank test) and the COX model for survival.</p><p><b>RESULTS</b>Seventeen squamous cell carcinomas, 8 adenocarcinomas, and 6 undifferentiated small cell carcinomas were resected. There were 13 partial SVC resection, the reconstruction was done using a simple running in 5 patients, and a pericardial patch in 8 patients. Eighteen patients underwent complete resection of SVC with prosthetic replacement. The time of clamping the SVC system was from 8 to 35 minutes for complete resection patients, while the time was from 3 to 15 minutes for partial resection patients. One patient didn't clamp the SVC. Postoperative morbidity and mortality were 48% and 0%, respectively. One, 3 and 5-year survival rates were 61%, 33% and 21%, respectively, with median survival at 31 months. Survival rate of patients with N2 disease was obviously lower than those with localized (N0/N1) nodal disease (chi2 = 14.3, P = 0.000), the median survival was 42 and 13 months respectively. There were no significant effects on overall survival with pathologic features and surgery methods. Survival rate of patients with induction chemotherapy before operation or intraoperative chemotherapy was higher than those received direct surgery (chi2 = 5.0, P = 0.025), the median survival was 39 and 14 months respectively.</p><p><b>CONCLUSIONS</b>The resection of the SVC for involvement by lung cancer can be performed in selected patients, especially for those with localized (N0/N1) nodal disease. Induction chemotherapy should be performed.</p>

Hand-assisted video-thoracoscopy for resection of esophageal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility and advantages of hand-assisted video-thoracoscopy for resection of esophageal cancer.</p><p><b>METHODS</b>Forty-five patients with esophageal cancer received hand-assisted video-thoracoscopic esophagectomy (group I). 45 patients underwent esophagectomy through routine open thoracotomy during the same period as control (group II). The data of lymph node resection, operating time and blood loss were compared.</p><p><b>RESULTS</b>There were no operative mortality in 2 groups. In group I, the number of dissected paraesophageal lymph nodes, cardiac lymph nodes and left gastric nodes were (3.6 +/- 1.0), (1.3 +/- 1.1) and (4.3 +/- 1.4), respectively. While for group II the dissected lymph nodes were (3.3 +/- 1.5), (1.6 +/- 1.1) and (4.7 +/- 2.1), respectively. There was no significant difference between two groups (P > 0.05). However, the number of dissected mediastinal nodes was (6.6 +/- 3.7) for group I and (3.8 +/- 2.5) for group II (chi(2) = 2.95, P < 0.05). The mean operating time was (29 +/- 5) minutes for group I and (60 +/- 6) minutes for group II. The mean blood loss was (93 +/- 19) ml for group I and (145 +/- 35) ml for group II. The mean chest tube drainage was (201 +/- 45) ml for group I and (295 +/- 57) ml for group II in the first postoperative day. The difference in above parameters between 2 groups was significant (chi(2) = 18.69, 6.13, 6.08, P < 0.001).</p><p><b>CONCLUSIONS</b>It is suggested that hand-assisted video-thoracoscopic esophagectomy is a safer, minimal invasive procedure in the resection of esophagus carcinoma.</p>

The clinical significance of vascular endothelial growth factor and intercellular adhesion molecule-1 expression in non-small cell lung cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the expression of vascular endothelial growth factor (VEGF) and intercellular adhesion molecule-1 (ICAM-1), and their relationship to behaviors of the non-small-cell lung cancer.</p><p><b>METHODS</b>The study included 86 patients with non-small-cell lung cancer. A rapid immunohistochemical method (streptoavidin-peroxidase, SP) was used to detect VEGF and ICAM-1 expression. All patients were treated surgically and without preoperative radio- or chemotherapy.</p><p><b>RESULTS</b>The positive expression of VEGF was significantly correlated with the lymph node metastasis, TNM stage, prognosis and hematogenous tumor metastasis positively, but ICAM-1 was negatively. For patients with positive expression of VEGF and negative expression of ICAM-1, the 5-year survival rate was the lowest in all patients.</p><p><b>CONCLUSIONS</b>The expression of VEGF and ICAM-1 correlates with the malignant behavior of non-small-cell lung cancer. Examination of VEGF and ICAM-1 in non-small-cell lung cancer may help to evaluate its intensity of lymph node metastasis, TNM stage and prognosis. VEGF and ICAM-1 may play an important role in the development and metastasis of non-small-cell lung cancer.</p>

Application of stair climbing test in preoperative evaluation for patients of lung cancer with lower pulmonary function / 中华全科医师杂志

0.05). Significant difference in diffused carbon monoxide percentage and change of heart rates before and after stair climbing test was found in LPF group (P0.05).Conclusions Patients of lung cancer intolerable for lobectomy by static pulmonary function test can be screened by stair climbing test before surgical operation,which can make some of them regain opportunity of surgical operation.