Practice of multi-campus hospital management based on integrated interconnected and digital intelligence-based service system / 中华医院管理杂志

Medical homogenization in multi-campus hospital plays an essential role in leveraging the advantages of public hospitals, promoting the expansion of high-quality medical resources and balancing regional layout. The Second Affiliated Hospital Zhejiang University School of Medicine deeply used digital intelligence technology to build a new integrated mobile health service system consisting of internet hospital and 5G intelligent applications, which empowered medical efficiency in multi-campus hospital. This system broke the limitations of inconsistent medical resources, unbalanced discipline layout, and insufficient information connectivity in the construction of multi-campus hospitals, and achieved remarkable results in practice. It could provide reference for the multi-campus construction of other large public hospitals.

Conversion therapy for liver metastases of colorectal cancer / 中华肝胆外科杂志

Colorectal cancer patients with potential resectable liver metastases may benefit from hepatectomy or other local treatment to achieve R 0 resection or no evidence disease after conversion treatment by chemotherapy with or without target therapy. FOLFOX or FOLFIRI combined with cetuximab is appropriate for RAS and BRAF wide type and primary tumor at left-side colon cancer and rectal cancer. It is complex for RAS and BRAF wide type and primary tumor at right-side colon cancer or RAS or BRAF mutated patients. FOLFOXIRI combined with bevacizumab may be the first choice for those patients with young age and good performance score to achieve best conversion chance, while FOLFOX/CapeOx/FOLFIRI combined with bevacizumab could be the second choice. A surgical re-evaluation should be planned every 2 months after initiation of conversion treatment in multi-disciplinary treatment assessment. Once it is demonstrated conversion treatment is successful, surgery should be performed as soon as possible.

Applying telemedicine to electronic ICU: a new paradigm in critical care / 中华医院管理杂志

The remote monitoring of patients at intensive care units(ICU), known as tele-ICU technology, is as yet a new concept in China. The authors introduced the efforts made by the Second Affiliated Hospital in working with a hospital in Xinjiang to provide the tele-ICU model. In this model, telemedicine medical workers cooperate with bedside healthcare providers of the hospital in Xinjiang in co-care of the patients. Such a practice can elevate the critical care medicine of the latter hospital, worthy of further promotion.

Applying telemedicine to electronic ICU:a new paradigm in critical care / 中华医院管理杂志

The remote monitoring of patients at intensive care units (ICU),known as tele-ICU technology,is as yet a new concept in China.The authors introduced the efforts made by the Second Affiliated Hospital in working with a hospital in Xinjiang to provide the tele-ICU model.In this model,telemedicine medical workers cooperate with bedside healthcare providers of the hospital in Xinjiang in cocare of the patients.Such a practice can elevate the critical care medicine of the latter hospital,worthy of further promotion.

Practice and insight in the post setup of telemedicine assistants at a hospital / 中华医院管理杂志

The paper presented the concept of telemedicine assistants, and analyzed their professional attributes, training modality and job description. Such scenarios as emergency telemedicine consultation, electronic ICU building, and international remote pathology consultation were taken as an example, to further elaborate the role of such assistants, for the purpose of providing patients with telemedicine services of higher quality, efficiency and convenience.

Associated vessel heteromorphosis in laparoscopic complete mesocolic excision and solutions to intraoperative hemorrhage / 中华胃肠外科杂志

Vessel identification and dissection are the key processes of laparoscopic complete mesocolic excision (CME). Vascular injury will lead to complications such as prolonged operative time, intraoperative hemorrhage and ischemia of anastomotic stoma. Superior mesenteric artery (SMA), superior mesenteric vein(SMV), gastrointestinal trunk, left colic artery(LCA), sigmoid artery and marginal vessels in the mesentery have been found with possibility of heteromorphosis, which requires better operative techniques. Surgeons should recognize those vessel heteromorphosis carefully during operations and adjust strategies to avoid intraoperative hemorrhage. Preoperative abdominal computed tomography angiography(CTA) with three-dimensional reconstruction can find vessel heteromorphosis within surgical area before operation. Adequate dissection of veins instead of violent separation will decrease intraoperative bleeding and be helpful for dealing with the potential hemorrhage. When intraoperative hemorrhage occurs, surgeons need to control the bleeding by simple compression or vascular clips depending on the different situations. When the bleeding can not be stopped by laparoscopic operation, surgeons should turn to open surgery without hesitation.

Endoscopic ultrasonography (EUS) in diagnosis of colorectal submucosal lesions / 中国内镜杂志

Objective To investigate the role of endoscopic ultrasonography (EUS) in diagnosis and treatment of colorectal submucosal lesions. Methods EUS were applied in 74 patients with suspected colorectal submucosal lesions. According to the origin of submucosal lesion, the patients had received biopsy, endoscopic ultrasonography-fine needle aspiration (EUS-FNA) and endoscopic treatment or surgery. The correlation between EUS and clinical pathology is analyzed retrospectively. Results In the diagnosis based on EUS, there were 28 cases of neuroendocrine tumors (occurred in the rectum), 15 lipomas (4 cases occurred in ileocecal, 1 in transverse colon, 8 in ascending colon, 2 in sigmoid colon), 2 rectal gastrointestinal stromal tumor (1 in muscularis propria and the other in muscularis mucosa), 14 external pressure changes (9 ovarian tumor, 2 lymph nodes, 3 pelvic tumor), 5 cyst (4 in transverse colon, 1 in ascending colon), 1 gas cyst, 3 sigmoid colon endometriosis, 4 rectum malignant tumor invasion, 2 intestinal lymphoma. All the patients had received biopsy, EUS-FNA, endoscopic treatment or surgery. Compared with pathology, a total coincidence rate of 91.9% (68/74) was achieved by EUS, and 2 cases were pathologically diagnosed as leiomyoma, which is considered as rectal carcinoma by EUS at first, 1 case of intestinal lymphoma instead of lipoma, 2 inflammatory mass instead of malignant tumor around the rectum, and 1 rectal carcinoma instead of endometriosis. Conclusion The digestive tract structure could be showed clearly with EUS, and the size of the colon and rectal submucosal lesions, the layer of origin and the structural relationship of adjacent tissues could also be detected. Then, the appropriate treatment against the colon and rectal submucosal lesions would be adopted after the accurate judgment of lesions with EUS.

Key points and difficulties in implementing enhanced recovery after surgery of colorectal cancer / 中华胃肠外科杂志

Enhanced recovery after surgery (ERAS), a hotspot of modern surgery, aims to make patients get early recovery of physical and psychological condition from surgical injury through reducing interference of inner-equilibrium. Our center has carried out fast track multi-disciplinary treatment (FTMDT) trail of colorectal cancer since 2009. This paper discusses the key points and difficulties in implementing ERAS for colorectal cancer from the association between ERAS and shortening of hospital stay, the idea renewal of medical staff and comprehensive therapy mode based on our experience and current situations in China.

Integrative management of operation, perioperative rehabilitation and postoperative adjuvant chemotherapy in elderly patients with colorectal carcinoma / 中华胃肠外科杂志

With the aging of the Chinese population, it seems obvious that the number of elderly patients with the disease of colorectal carcinoma grows significantly. Meanwhile, no evidence-based practical guideline for the treatment of colorectal carcinoma are available in this particular age group. Therefore, the concept of integrative management has been brought up by the Colorectal Cancer Center of the Second Affiliated Hospital of Zhejiang University, which combines the processes of surgery, perioperative rehabilitation and adjuvant chemotherapy together. In this way, the cooperation and complementarity between different clinical departments could cooperate and complete tasks together to integrate the treatment processes into a cohesive one. To achieve the goal of integrative management, the project is divided into horizontal and vertical aspects. The horizontal integration means the cooperation between different clinical departments, which is also known as multi-discipline treatment (MDT). The vertical integration reflects the completeness of the entire treatment under the goal of consistency, strictness and job separation, which could also be explained as the clinical pathway. Furthermore, this review stresses on the integrative strategy of both clinical and biochemical indexes rehabilitation, as well as the operation and postoperative adjuvant chemotherapy which has been put in execution several years by the Colorectal Cancer Center of the Second Affiliated Hospital of Zhejiang University.

Development and challenge in the fast-track surgery for colorectal cancer / 中国癌症杂志

Since the concept of fast-track was raised in 2001, it has been widely used in the surgical treatment for colorectal cancer. Several studies showed that patients receiving fast-track surgery gained enhanced recovery,shorter hospital stays and less cost. The British NICE guideline also strongly recommends the use of fast-track surgery in colorectal cancer patients. The present review would discuss the concept, development, advantage, impact on the recovery of elderly patients and the cost effectiveness of fast-track surgery over the past 10 years.

Quality control of laparoscopic colorectal surgery / 中华胃肠外科杂志

Total mesorectal excision(TME) has become the standardized modality in rectal cancer surgery. The strict quality control of surgery has been introduced. The improvement of surgery quality resulted in the decrease of local recurrence rate and the increase of survival rate. TME becomes the model that quality control of surgery improved outcomes. In view of this, in recent years, complete mesocolic excision (CME) and extralevator abdominoperineal excision (ELAPE) have been established as the corresponding standardized procedures, which shows the preliminary clinical effects. Utilization of laparoscopic surgery for management of colorectal cancer has been widely accepted. Laparoscopic TME and CME will further improve the overall outcomes of colorectal cancer.

Study of CCL28 expression in breast cancer / 中国癌症杂志

Background and purpose:Chemokines play an important role in breast cancer occurrence and development. However, little about the function of CCL28 in breast cancer is reported. This study was designed to observe and study the expression of chemokine CCL28 in breast cancer, and analyze their association with pathological features of breast cancer.Methods:Expressions of chemokine CCL28 in 150 breast cancer patients were determined by IHC(immunohistochemistry) technique. The corresponding normal breast tissues in paraneoplastic were also detected. The level of CCL28 expression in 150 breast cancer was analyzed whether it was associated with age, cTNM stage, tumor diameter, axillary lymph node status, ER status, PR status and HER-2 status. Results:①CCL28 was highly expressed in both breast cancer and normal breast tissues in paraneoplastic. The positive expression rate of CCL28 in breast cancer was 54.6%and the positive expression rate of CCL28 in normal paraneoplastic breast tissues was 9.3%. Expression of CCL28 in breast cancer was signiifcantly higher than that in normal paraneoplastic breast tissues, there was statistically significance between the two groups(P0.05). Conclusion:The level of CCL28 expression showed signiifcantly difference between breast cancer and paraneoplastic normal breast tissues. In conclusion, CCL28 may be correlated with breast cancer carcinogenesis and evolvement. The level of CCL28 expression was not signiifcantly correlated with lymph node metastasis. If CCL28 may be a factor to predict lymph node metastasis in breast cancer is worth further studying.

Aspirin in the prevention of colorectal cancer / 国际肿瘤学杂志

A large nunber of studies show that aspirin and other non-steroid anti-inflammatory drugs (NSAID) have chemopreventive effects on several cancer type s,and more specifically in colorectal cancer.Aspirin can help prevent colon cancer,which has a specific advantage of drug prophylaxis.Studies found that aspirin play different roles on high-risk,moderate-risk and low-risk populations in time and dose.There is limited evidence about the influence on incidence of adenoma among the general risk populations.

Effect of a recombinant lentiviral vector carrying hepatocyte nuclear factor 6 gene on migration and invasion abilities of SW620 cells / 南方医科大学学报

<p><b>OBJECTIVE</b>To construct a recombinant lentiviral vector that stably express hepatocyte nuclear factor 6 (HNF6) in colorectal cancer cell line and examine its effects on the invasive ability of SW620 cells.</p><p><b>METHODS</b>The lentiviral vector pLeno-DCE-HA-HNF6 was constructed and transfected into 293T cells. The supernatant containing the lentivirus particles was harvested to determine the virus titer. A stable cell line was established by infecting SW620 cells with the lentivirus particles, and the transfection efficiency was examined by fluorescence microscopy and flow cytometry. The invasion ability of the transfected SW620-HNF6 cells was assessed by wound healing and transwell assays.</p><p><b>RESULTS</b>The recombinant lentiviral vector was correctly constructed and verified by sequencing. SW620-HNF6 cell line with stable HNF6 expression was established successfully, and the transfection efficiency reached 82.3%. Western blotting and quantitative PCR demonstrated significantly upregulated HNF6 expression in SW620-HNF6 cells, which showed obviously suppressed invasive ability in wound healing and transwell assays.</p><p><b>CONCLUSION</b>We have successfully established a colorectal cancer cell line SW620-HNF6 stably expressing HNF6, which shows a lowered migration activity in vitro.</p>

Development of sunitinib in the treatment of imatinib-resistant gastrointestinal stromal tumors / 国际外科学杂志

Sunitinib malate (SU11248 ,Sutent) is an orally available small-molecule multitargeted tyrosine kinase inhibitor that has potent anti-angiogenic and antitumour activities.In 2006 sunitinib was approved by FDA for imatinib intolerant gastrointestinal stromal tumors (GIST) patients or imatinib resistant GIST patients.This article review the molecular-based mechanism,the mechanism of resistance,the biomarker,the clinical trials and the adverse effects of sunitinib in the treatment of imatinib-resistant GIST.

Progress of primary angiosarcoma of breast / 国际外科学杂志

Primary angiosarcoma of breast is a rare malignant tumor,about 0.05%of all the malignant tumor of breast.The heteromorphism,such as endothelioeyte,blood vessel even caryocinesia,distinguishes this disease from other carcinoma of breast.Positive ratio of endothelial cell makers(Anti-FⅧR,CD3 1,CD34,UEA-1,et al)and VEGF is relatively high.Besides fine needle aspiration and biopsy,ultrasound,X-ray and MRI maybe helpful to di agnosis.Surgery is certainly the first choice to care this disease.The effect of chemotherapy,radiotherapy and tar geted therapy is still in research.

Resistance mechanism of imatinib therapy in gastrointestinal stromal tumors / 国际外科学杂志

Imatinib,a small-molecule kinase inhibitor,has proven useful in the treatment of recurrent or metastatic gastrointestinal stromal tumors ,However,resistance to imatinib is a more and more serious problem.This review summarizes the existing knowledge of the imatinib resistance mechanism in gastrointestinal stromal tumors and describes the treatment directions in further.

Progress on colon cancer stem cell / 国际外科学杂志

With advancements in the field of cancer stem cells,the hypothesis that colon cancer originates from stem cells has not only been introduced but also receives substantial supports by separating a subpopulation of colon cancer cells through primitive cells markers.Unlike most non-tumourigenasis colon cancer cells,these tumor-initiating cells have many specific characters both in vitro and in vivo.An improved understanding of drug resistance based on cancer stem cells and molecular pathways that regulate proliferation and differentiation of gastrointestinal cancer stem cells could doubtless translate into new therapeutic strategies.

Prognostic prediction of PTEN and Her-2 expression in breast cancer / 中国病理生理杂志

AIM: To study the prognositic value of PTEN and Her-2 expression in primary breast cancer.METHODS: 81 breast cancer specimens with 15 years follow-up were obtained from 1989 to 2004.Immunohistochemical methods were used to detect the expression of PTEN and Her-2 in 81 paraffin-embedded specimens.The correlation between expression of PTEN and clinipathological factors was discussed with the Chi-square test.The survival rate analysis results were calculated with Kaplan-meier method.Long-rank test and Cox model by SPSS 10.0 software.RESULTS:(1) PTEN expression significantly affects 5-year and 10-year survival rate of breast cancer(P

A study on the diagnosis and a clinicopathologic characteristics of gastrointestinal stromal tumors / 中国普通外科杂志

Objective To study the diagnosis, pathomorphological and immunohistochemical features of gastrointestinal stromal tumor (GIST) and to explore the reference parameters for malignancy. Methods Light microscopy was used to study the morphologic characteristics in 54 cases of gastrointestinal mesenchymal tumors, and the expression of CD117,CD34 and S 100 was detected by EnVision immunohistochemical method. ResultsMost borderline and malignant tumors were found in male. CD117 showed diffuse strong expression, CD34 mostly showed diffuse strong expression, S 100 incidentally showed focal expression, and the positive rates were 100%, 59% and 16% respectively. Conclusions CD117 is a sensitive and specific marker for the diagnosis of GIST. Tumor necrosis, high tumor cellularity and intestinal tumor mitotic activity over 1/50HPF were helpful parameters for judgement of malignancy, tumors are most often seen in male.