Background and purpose:Patients with lung cancer often have metastases to the mediastinal and/or hilar lymph node.Three dimensional conformal radiation therapy(3-DCRT) has been used for the treatment of lung cancer.The delineation of the lymph nodes metastasis based on CT transections may be variable from doctor to doctor.It is necessary to standardize the definition of lymph nodes regions on CT scans.Methods:Retrospective studies were performed with the enhanced CT scans and/or PET/CT imaging of patients with NSCLC before treatment from November 2004 to November 2005.A series of thoracic enhanced CT scans from a middle stature female was selected as the model.Positive mediastinal and hilar lymph nodes were marked as red points on the CT model according to its relative position.Based on standardized definition of regional lymph nodes and the actual metastasized regional nodes on the images,the boundaries were delineated by Adobe Photoshop CS software and the metastasized regional lymph nodes were delineated on the Exomio 2.0 system.Results:Forty patients with enhanced CT data were enrolled in this study.Ten cases also underwent PET/CT examination.There were 278 positive lymph nodes that were detected and marked on the CT model.We defined the boundaries of regional lymph nodes of Group 1-2R,1-2L,3A,3P,4R,4L,5,6,7,8,10-11R and 10-11L,and delineated the above regional lymph nodes on template of CT model.Conclusions:Clear definition of mediastinal and hilar lymph region boundaries on CT images provides guidelines for the clinical staging of lung cancer and the contouring nodal drainage for 3-DCRT.It is essential to make target volumes more repeatable with good conformity in contour for conformal irradiation,which would benefit the clinical diagnosis,staging and therapy of lung cancer.

Objective To survey health management cognition of residents in Shanghai city communities,and to analyze the causes,and to put forward related suggestions.Methods In October of 2013,this study was conducted in communities of Shanghai central district (Xuhui District),urban border area (Minhang District),and suburban area (Jinshan District); 800 residents from each health management cognition outpatient clinic (400 people from each of hospitals and community health service center),totally 2 400 residents were studied and investigated in the communities of Shanghai city,and 2 082 questionnaire were received (the questionnaire recovery rate was 86.75％).We used stratified random cluster sampling method,and self-designed investigation form,and did pre-experiment.The Survey included:Whether family doctors need to carry out the evaluation work about risk factors,to implement health management for school students,to implement health management for people over 60 years old,to implement the elderly health management for pension agencies,to implement special crowd health management for special people;conduct questionnaire of demand level for different population groups (type,age,gender,marital status,retirement,occupation,level of education and medical insurance form).Results The research results found that,when asked about the family doctor whether to carry out risk assessment,family doctor whether to implement special health management,whether family doctors need to teach health management to students, whether family doctor should undertake the health management work for the people over the age of 60,whether family doctors should implement special health management,whether a person thinks that it is indifference (9.3％,7.4％,3.8％,6.2％ and 5.7％) and unnecessary (3.6％,4.4％,2.5％,4.2％ and 3.9％)in the minority,the majority of people believe that they need (51.1％,52.9％,57.2％,55.6％ and 55.3％),then the general (24.5％,18.9％,12.4％,18.0％ and 16.5％) and very necessary (11.5％,16.4％,24.1％,16.0％ and 18.6％).Among them,the occupation,whether retired or not,level of education,medical insurance form and different age groups had different cognition and demand level for health management work.Conclusion To Strengthen the health management training,to take specific health management services according to different groups of people and to improve community health management services are very important.

This paper systematically analyzed the concept of patients'trust based on a study of the literatures and compared patients'trust with patients'satisfaction. The conclusion is that patients'trust plays a key role on the quality improvements of medical services.

Objective To identify the relationship between patients' trust and their health outcomes and verify the mediator role played by patients' behavioral intention in affecting the health outcomes.MethodsThe 24-item patients' trust evaluation scale customized based on QOC improvement was called into play to measure the extent of trust of 727 inpatients at two tertiary hospitals and 20community hospitals in Shanghai.The patients' behavioral intention scale,life quality scale and patients'clinical effect general scale helped reveal the patients' behavior tendency on their health.RestltsIt is found that patients' trust affects their health outcomes.Furthermore,such trust plays partial mediator role on patients' life quality,and a complete mediator role in affecting the clinical effect.Conclusion Improvement of patients' behavior can result in better health outcomes.For doctors,better trust from the patients can affect patients' behavioral intention,encourage doctor-patient communication and therapy plans for better health outcomes in the end.

ObjectiveTo analysis the current conditions of the main chronic disease,satisfaction,reactive and trust,then to make the control policy in community health management base in China.Method Using the questionnaire by oneself,which the contents include prevalence,understand rate,management rate,behavior correct rate,control rate,medicine obey and satisfaction,reactive and trust of 2009 the chronic disease in 2009.ResultsThe total investigate people was 1 189 456.The hypertension prevalence is 8.01％,the diabetes prevalence is 4.41％.To compare with Shanghai and Jilin in 6 aspects,the prevalence,understand rate,management rate,control rate,medicine obey rate is higher in Shanghai.But behavior correct rate is lower in Jilin.Survey of hypertension prevalence rate was decreased,awareness,management,rates,rates of behavior modification,medication compliance rates and control rates of growth from 2009 to 2010.Satisfaction,responsiveness and trust indicators investigated a total of 2268 people,the process of service satisfaction to 93.43％,93.78％ overall satisfaction; to have the privacy of reactivity to 94.41％ of the basic amenities and clean comfortable response of the 90.45％ ; of treatment services for the 92.59％confidence,the confidence of the cost for the 93.98％ of the overall trust in institutions is 92.76％.ConclusionsThe government must take main principle in chronic disease control.We must enhance base construct of community health management and increase management level of chronic disease.We must enhance practitioner's culture ang increase knowledge of chronic disease management.

Objective To explore the clinical efficacy of minimally invasive implantation figure-ofeight steel plate in treatment of children with lower limb angular deformity caused by a variety of reasons.Methods The clinical data of 35 lower limb angular deformity children who treated with minimally invasive implantation figure-of-eight steel plate half epiphyseal plate block method were retrospectively analyzed.During pre-operation and post-operation,the X-ray of both lower limb was shoot,the mechanical axis of lower limb and femoral tibial angle (FTA) were measured,and the clinical efficacy combining clinical results was assessed.Results All the children were completed the follow-up,the average follow-up was 15 (13-20)months.The 35 children with lower limb angular deformity achieved satisfactory correction and restored normal the mechanical axis of lower limb.All children were normal,and no complications of epiphyseal plate injury were found,except 1 child appeared incision fat liquefied and healed after secondary wound debridement and suture.Conclusions Minimally invasive implantation figure-of-eight steel plate half epiphyseal plate block method in treatment of the children with lower limb angular deformity is simple,cheap,effective,needless osteotomy,well tolerated and with less complications.It is an easily learned technique for osteology surgeons and to be worth generalization at clinical especially those hospitals without establishing special department of children' s osteology.

Humanistic quality of medical workers directly affects the quality of medical service and patient satisfaction.In view of patient′s value demand,this paper identified main setbacks in humanistic service in China in the course of medical service.The authors found out the reasons for the lack of humanities quality,and interpreted medical humanistic spirit,medical professional spirit,medical ethics and morality,and connotation of medical law culture.On such basis,the paper unveiled the importance of medical humanities accomplishment in medical practice and medical students′training,proposing to promote the concept of humanistic spirit of medicine and the doctor-patient communication skills.

Adult ; Aged ; Carcinoma, Renal Cell ; diagnosis ; surgery ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Kidney Neoplasms ; diagnosis ; surgery ; Male ; Middle Aged ; Nephrectomy ; methods ; Treatment Outcome

Objective To conduct a health check-up intention analysis to understand residents' altitude to health eheck-up. Methods A total of 3600 residents living in Shanghai completed the selfdesigned questionnaire. Results About 35.2% participants received health check-up onee per year. In 36 to 60 or > 60 age group, the figure was increased up to 62.6% or 50. 4%, respectively. Public institution employees and those with medical insurance were found to have the highest rate of health checkup. Conclusion Our investigation results suggest that government leadership,health management model and contents, and personnel training should be improve.

OBJECTIVE: To analyze the influencing factor, as well as rehabilitation method after total knee replacement.METHODS: Chinese Journal Full-text Database and PubMed database were retrieved with key words of artificial knee joint, athroplasty, and rehabilitation, from January 1999 to June 2009. The literature search was restricted to Chinese and English languages. The evaluation indexes were the knee range of movement, function, muscle strength, and joint stability. Accordingly, clinical research concerning rehabilitation treatment of total knee replacement was included, and the animal experiment was excluded.RESULTS: A total of 492 literatures were obtained by initial search with computer. On the basis of inclusion criteria, the related papers were analyzed. Rehabilitation training after total knee replacement includes pain control, joint activity training, strength training, proprioceptive training and walking training. Knee movement range was one of the important indicators in evaluating total knee replacement, which was also the most important component in the knee-rating system. Pain reduced and normal walking function was important to observe the therapeutic effects after total knee replacement. Strength training was an important part of rehabilitation training, early rehabilitation not only can regain the muscle strength, but also can promote blood circulation and prevent deep vein thrombosis of lower limbs.CONCLUSION: Rehabilitation training can restore muscle strength, joint activity and walking ability as quickly as possible, and control pain greatly, which influence therapeutic effects of replacement.