Objectives:The objective of this study is to make suggestions for the internet medical development. Methods:Based on the field survey, this paper analyzes three kinds of internet medical mode in China, and sums up the pros and cons. Results:The internet medical has the ability of technically providing healthcare by internet, and meeting the patients’ essential health care requirements. The problems mainly include health insurance, regional dis-tribution, electronic prescription audit, electronic medical record and safekeeping the record files, operation supervi-sion etc. The corresponding countermeasures include elaborating laws, gradually completing the internet medical and health insurance cooperation, the government’s regional division handling, setting up a special supervision department in the hospitals etc. Conclusion:It is important to clear the internet medical related problems and develop a model which is suitable for healthcare institutions.

Objective To investigate the computed tomography (CT) and magnetic resonance imaging (MRI) characteristics of immunoglobulin G4 associated cholangitis (IAC) and the key points for identification and diagnosis.Methods The clinical data of 11 patients with IAC who were admitted to the Peking University People's Hospital from January 2013 to January 2015 were retrospectively analyzed.Patients received plain and enhanced scan of CT,plain and enhanced scan of MRI and magnetic resonance cholangiopancreatography (MRCP) examination before hormone therapy.Patients were followed up by telephone interview and outpatient examination till January 2015,and their imaging data were evaluated.Results Of the 11 patients,7 patients received plain and enhanced scan of CT,6 patients received plain and enhanced scan of MRI and 7 patients received MRCP examination.The results of CT and MRI examinations showed bile duct segmental stricture and non-obliteration of cavity were detected in the 11 patients.Diffused thickening of intrahepatic and extrahepatic bile duct and no correlation between the thickening and the stricture of the bile duct was detected in the 8 patients.The bile duct wall of 3 patients was locally thickened,including 2 thickened common bile duct wall at the region of the head of the pancreas and 1 thickened hilar bile duct.The results of MRI showed low T2WI signal of the bile duct wall in 7 patients and equal signal in 4 patients.Enhanced signal in the bile duct wall was detected in the delayed phase in 11 patients by enhanced scan of CT and MRI,and 8 of the 11 patients had enhanced signal in the arterial,venal and delayed phase.Nine patients were complicated with autoimmune pancreatitis (3 of them were with concomitant renal disease),and 1 patient was only complicated with immune-related renal disease.Enlargement of lymph nodes was detected around the pancreas in 3 patients,while no enlargement of lymph nodes was detected in 8 patients.Among all the 11 patients undergoing hormone therapy,8 patients were followed up for a median time of 13 months (range,6-18 months),including 7 patients with good recovery and 1 patient with recurrence of IAC.Conclusion Diffused and irregular thickening and stenosis but not occlusion of biliary duct,the thickening and stenosis which are detected by CT and MRI examinations is relatively independent,and associated with autoimmune pancreatitis and other organs involved may be helpful to make a diagnosis of IAC.

Objective:To understand the current situation about pre-registered medical practitioner's ineligible practice from a legal point of view and provides references forthe Law of Medical Practitioners.Methods:The sur-vey is based on cluster sampling method which centralized the selected large clinical teaching hospitals which have launched the standardized residents training.The research is focused in Beijing and involves three kinds of people in-cluding the pre-registered medical practitioners, clinical teaching teachers and health administrators.The descriptive statistics and the Comparison rates between groups by chi-square test rates were adopted.Meanwhile, the 764 medi-cal malpractice cases from the past three years were analyzed in the Courts of the People of Haidian and the Beijing Chaoyang Districts.Results:The clinical trainees“pre-registration” made illegal situations such as independent vis-its, finding a single worker on duty, independent patient disposal, invasive technology's independent operation, inde-pendently writing the medical records, and the absence of tutors on the supervision sites.All of these mischiefs en-hanced the occurrence of medical disputes.Suggestions: Based on the current situation, it is necessary to establish the legal qualifications for the“pre-registered” trainees engaged in the accredited clinical work legislation, physician qualification examination, and in so many angles.Proposing solutions based on legal issues about “the practitioner guidance” should also be efficient.

Objective To evaluate the diagnostic value of T-cell enzyme-linked immunosorbent spot assay (T-SPOT.TB) using both pleural effusion and peripheral blood in tuberculous pleurisy.Methods One hundred and two cases of in patients with pleural effusion treated in Anhui Chest Hospital from January 2014 to October 2015 were enrolled in this study.T-SPOT.TB was performed using both serous effusion mononuclear cells (SEMC) and peripheral blood mononuclear cells (PBMC),and the diagnostic sensitivity and specificity were calculated.Chi square test was used for categorical variables and MannWhitney U test was used for continuous variables in non-normal distribution.Results Of the 102 participants,71 (69.61 ％) were microbiologically or clinically diagnosed with tuberculous pleurisy and 31 (30.39 ％) were diagnosed with other diseases.In tuberculous pleurisy group,the median spot forming cells (SFC) of T-SPOT.TB for early secretory antigenic target 6 (ESAT-6) and culture filtrate protein 10 (CFP-10) using SEMC were 159/2.5 × 105 (120/2.5 × 105-200/2.5× 105) and 160/2.5 × 105 (110/2.5 × 105-210/2.5 × 105),respectively;and the median SFC of T-SPOT.TB using PBMC were 30/2.5×105 (15/2.5×105-55/2.5×105) and 40/2.5×105(8/2.5×105-87/2.5 ×105),respectively.The SFC counts of SEMC were obviously higher than those of PBMC,and differences were statistically significant (for ESAT-6,Z=-7.818;for CFP-10,Z=-7.120,both P＜0.05).The ROC curve analysis showed that using a cut-off value of 38 SFC per 2.5 × 105 SEMC,the area under the curve is 0.969.The sensitivity and specificity of T-SPOT.TB using PBMC were 90.14％ and 77.42％,respectively;and those of T-SPOT.TB using SEMC were 95.77％ and 93.55％,respectively.When combined the T-SPOT.TB assay using both PBMC (≥6 spots) and SEMC (≥38 spots),the sensitivity and specificity were 90.14％ and 96.77％,respectively.Conclusion The joint detection of T-SPOT.TB using both PBMC and SEMC can be an effective diagnostic method for tuberculous pleurisy.

Osteoarthritis is a common articular cartilage degenerative disease and the main cause is mechanical instability. The mechanical instability can reduce the number of chondrocytes and destroy extracellular matrix through direct injury, inducing cell apoptosis, and stimulating the production of inflammatory factors, leading to decrease of matrix typeⅡ collagen and proteoglycan and degeneration of cartilage. Long-term cartilage degeneration can result in osteoarthritis. Therefore, understanding how mechanical instability leads to the incidence of osteoarthritis can better improve the course of osteoarthritis from the perspective of mechanics.

Objective To compare the diagnostic value of CT and NE for lesions of nasal cavity and paranasal sinus area.Methods 80 cases of nasal and paranasal sinus diseases which were examined by both CT and NE at same period and proved by pathology.were reviewed.Results Compare with results of pathology,the accucy rate of both CT and NE was identical in diagnosing sinusitis and tumours of paranasal sinus,NE was higher than CT in nasal and paranasal sinus polyp and nasal cavity tumour,turbinate hyperplasia CT was higher than NE in paranasal sinus cyst and anatomic variations.Conclusion Pathologic biopsy can be taken under NE guide to understand the shape,texture and colour of the illness focus CT can show the size,shape and anatomy relation between lesion and its neighbor tissue.The diagnosis may more perfectly through NE combined with CT.

Objective:To evaluate the efficacy of postoperative radiotherapy (PRT) for dermatofibrosarcoma protuberans (DFSP).Methods:A systematic review and meta-analysis of articles published before February 23, 2019 were conducted. A total of 655 studies were retrieved consisting of 195 DFSP patients. Among them, 50 cases were assigned into the PRT group and 145 cases in the surgery alone (SA) group. The recurrence rate was statistically compared between two group.Results:Meta-analysis showed that the recurrence rate in the PRT group was significantly lower than that in the SA group (8% vs. 24.1%, OR=0.28, P=0.010). The recurrence rate of patients with positive margins in the PRT group was significantly lower compared with that in the SA group (8% vs. 61.5%, P=0.002). The recurrence rate of patients with negative margins in the PRT group had a decreasing trend than that in the SA group (6% vs. 21.6%, P=0.205). Conclusions:The recurrence rate of surgery combined with PRT is lower than that of SA. The recurrence rate of patients with positive margins is higher than that of those with negative margins. For patients with positive margins, PRT can decrease the recurrence rate. The recurrence rate trends to decline in patients with negative margins after receiving PRT.

Objective To study the relationship between the spontaneous nocturnal episodes of alkalinization and the autonomic nerve system function and vagal function. Methods 24-hour intragastric pH was measured and auto nomic and vagal function was measured with the time domain analyses of heart rate variability in 20 patients with functional dyspepsia but without diseases of the cardiovascular system. Results 13 of 20 had the nocturnal episodes of alkalinization. The total 24-hour SDNN and rMSSD were normal in 20 subjects with FD. There was no significant dif ference (P ＞0. 05) in the comparison of the total SDNN and rMSSD of the 2 groups with alkalinization and without alkalinization. The 2 groups both had higher PNN50s in the nocturnal time, and there was no significant difference (P ＞0. 05). Conclusion The results suggest that the total autonomic nerve function and vagal function of patients with FD are normal, vagal activities of the 2 groups are both increased in the nocturnal period. The reason for the nocturnal episodes of alkalinization is not a decrease of vagal activity with a subsequent decrease of secretion.

Objective We evaluate if supplementary grading system can refine patient selection and accurately predict neurological outcome in BAVM. Methods We retrospectively study 221 BAVM patients who were treated micro?surgically by our hospital. The score of pre and post operation mRS and relative clinical, radiology data were collected. Two different logistic models (Spetzler-Martin, Supplementary Spetzler-Martin grading model) were constructed to com?pare the area under ROC. Results Some factors are significant different between worse outcome patients and good out?come patients:Non-hemorrhagic presentations prior surgery, AVM bigger than 3cm, diffuse shape of AVM and the elder patients. Predictive accuracy was higher for the supplementary model (ROC area, 0.91), than the Spetzler-Martin model (ROC area, 0.774). So the predictive accuracy of supplementary model was significantly better than that of the Spet?zler-Martin model (P=0.0362). Conclusions Supplementary Spetzler-Martin model can improve preoperative risk pre?diction and subgroup the patients more efficiently. When the score less than 5(including 5) in supplementary Spet?zler-Martin patients seem to have lower risk relative to surgery.

Objective To analyze the clinicopathological characteristics and prognosis of different subtypes of breast cancer patients with bone metastasis.Methods For this study, we recruited 300 primary breast cancer patients with bone metastasis treated at the Department of Oncology, the First Affiliated Hospital of Xi`an Jiaotong University, between September 1, 2007 and September 1, 2011.We also retrospectively analyzed their clinical and follow-up data.Results The percentage of Luminal A, Luminal B, human epidermal growth factor receptor-2 (HER-2) overexpression and triple negative subtypes in all the bone metastatic breast cancer patients was 59.0％, 16.0％, 13.7％ and 11.3％, respectively.Age, tumor size and histologic grade significantly differed among the four subtypes (P<0.05).However, there were no significant differences in menopausal status, lymph node metastasis, histological type or lymphovascular invasion among different subtypes (P>0.05).The median survival time of Luminal A breast cancer patients with bone metastasis was 28.6 months, longer than Luminal B (26.9 months), HER-2 overexpression (20.9 months) and triple negative breast cancer patients (12.0 months) with bone metastasis.The overall survival significantly differed among the patients with four subtypes of breast cancer.Conclusion Different subtypes of breast cancer patients with bone metastasis have different clinical characteristics and prognosis.Luminal A breast cancer patients with bone metastasis have better prognosis whereas triple negative subtype has poorer prognosis.