Clinical Study Therapeutic Outcome of Second Primary Malignancies in Patients with Well-Differentiated Thyroid Cancer

Background. The aims of this study were to analyze the clinical characteristics of SPM in patients with well-differentiated thyroid cancer and to determine the long-term prognosis in patients with double malignancies. Materials and Methods. We retrospectively analyzed 2,864 patients with well-differentiated thyroid cancer and a mean age of 44.0 ± 14.4 years. Of these, 200 (7.0%) were diagnosed with SPM, 115 of which were diagnosed with metachronous SPM. Results. Of 2,864 patients, 163 (5.7%) patients died of thyroid cancer and 301 (10.5%) died of any cause by the end of the follow-up period. Multivariate analysis identified age, SPM, external radiotherapy, TNM stage, and postoperative serum Tg level to be factors independently associated with decreased survival. Of 200 patients with SPM, 74 (37.0%) died. In comparison to the anachronous and synchronous groups, the metachronous SPM group had a higher mean age; more advanced tumor, node, and metastasis stage; lower remission rate; higher postoperative radioactive iodide ( 131 I) accumulated dose; a higher proportion of patients who underwent external radiotherapy; and higher thyroid cancer and total mortality rates. Conclusions. Patients with well-differentiated thyroid carcinoma and metachronous SPM had worse prognoses compared to patients without SPM

A Method of Upgrading a Hydrostatic Model to a Nonhydrostatic Model

As the sigma-p coordinate under hydrostatic approximation can be interpreted as the mass coordinate with out the hydro static approximation, we propose a method that up grades a hydro static model to a nonhydrostatic model with relatively less effort. The method adds to the primitive equations the extra terms omitted by the hydro static approximation and two prognostic equations for vertical speed w and nonhydrostatic part pres sure p'. With properly formulated governing equations, at each time step, the dynamic part of the model is first integrated as that for the original hydro static model and then nonhydrostatic contributions are added as corrections to the hydro static solutions. In applying physical parameterizations after the dynamic part integration, all physics pack ages of the original hydro static model can be directly used in the nonhydrostatic model, since the up graded nonhydrostatic model shares the same vertical coordinates with the original hydro static model. In this way, the majority codes of the nonhydrostatic model come from the original hydro static model. The extra codes are only needed for the calculation additional to the primitive equations. In order to handle sound waves, we use smaller time steps in the nonhydrostatic part dynamic time integration with a split-explicit scheme for horizontal momentum and temperature and a semi-implicit scheme for w and p'. Simulations of 2-dimensional mountain waves and density flows associated with a cold bubble have been used to test the method. The idealized case tests demonstrate that the pro posed method realistically simulates the nonhydrostatic effects on different atmospheric circulations that are revealed in the oretical solutions and simulations from other nonhydrostatic models. This method can be used in upgrading any global or mesoscale models from a hydrostatic to nonhydrostatic model

Magnetic resonance imaging for lung cancer detection: Experience in a population of more than 10,000 healthy individuals

<p>Abstract</p> <p>Background</p> <p>Recent refinements of lung MRI techniques have reduced the examination time and improved diagnostic sensitivity and specificity. We conducted a study to assess the feasibility of MRI for the detection of primary lung cancer in asymptomatic individuals.</p> <p>Methods</p> <p>A retrospective chart review was performed on images of lung parenchyma, which were extracted from whole-body MRI examinations between October 2000 and December 2007. 11,766 consecutive healthy individuals (mean age, 50.4 years; 56.8% male) were scanned using one of two 1.5-T scanners (Sonata and Sonata Maestro, Siemens Medical Solutions, Erlangen, Germany). The standard protocol included a quick whole-lung survey with T2-weighted 2-dimensional half Fourier acquisition single shot turbo spin echo (HASTE) and 3-dimensional volumetric interpolated breath-hold examination (VIBE). Total examination time was less than 10 minutes, and scanning time was only 5 minutes. Prompt referrals and follow-ups were arranged in cases of suspicious lung nodules.</p> <p>Results</p> <p>A total of 559 individuals (4.8%) had suspicious lung nodules. A total of 49 primary lung cancers were diagnosed in 46 individuals: 41 prevalence cancers and 8 incidence cancers. The overall detection rate of primary lung cancers was 0.4%. For smokers aged 51 to 70 years, the detection rate was 1.4%. TNM stage I disease accounted for 37 (75.5%). The mean size of detected lung cancers was 1.98 cm (median, 1.5 cm; range, 0.5-8.2 cm). The most histological types were adenocarcinoma in 38 (77.6%).</p> <p>Conclusion</p> <p>Rapid zero-dose MRI can be used for lung cancer detection in a healthy population.</p

[[alternative]]A Study of the System Architecture of HL7 Query Messages for Medical Record Exchanges

[[abstract]]由於電腦科技的進步，各醫療院所的病歷電腦化已經非常普遍，跨醫院交換電子病歷的需求也越來越高。在衛生署的支持下，近年來已經有多位專家學者投入電子病歷交換的研究，雖然已有部分的研究成果，但在實務應用上仍不普遍。本篇論文將探討近年來國內電子病歷交換的發展，並且提出了一個以健康第七層通訊協定（HL7）查詢訊息為主的電子病歷交換系統的架構，在系統雛形中為醫院端建立一個電子病歷交換主機，可以透過網路連結醫院的病歷資料庫系統並且交換HL7訊息；各醫院的病歷交換主機向病歷交換中心註冊，由一部索引伺服器來管理各個交換主機的網址及加解密金鑰。我們已經完成一個簡單的病歷交換系統，實際模擬HL7查詢訊息的編碼、解碼、加密、解密的功能，可以迅速安全的傳送電子病歷。[[abstract]]Because of the rapid improvements in computers and communication technologies during the last few years, electronic medical records have been used extensively in hospitals. Moreover, pressure is growing to regulate data exchange among healthcare organizations. Although the government has allocated funding for numerous projects and studies in this field for several years already, and has achieved some important goals, complete implementation of medical records exchange across all hospitals is still difficult. This study discusses existing implementations of medical record exchange in the domestic health environment and a new record-exchange architecture employing Health Level Seven (HL7) query messages. The exchange interface servers are established for hospitals to manage the information communication through the intra- and inter-hospital network linked with a medical records database. An index service center can be given responsibility for managing the exchange interface servers and publishing the addresses and public keys. The prototype machine has been implemented in this study to generate, parse and transfer the HL7 query messages. Moreover, the system can also encrypt and decrypt a message using the public key encryption algorithm and can quickly and securely transmit medical records