OBJECTIVE: To explore the way to develop online pharmacy in China. METHODS: The online pharmacy was compared between China and the USA in respect of authentication, qualification of enterprises, distribution of medicines, management scope, payment, and protection of consumers' interest; and the implication of the development of the USA online pharmacy for China was analyzed. RESULTS & CONCLUSIONS: In the development of online pharmacy, China should draw experiences from the USA to introduce multiform management model, carry out multi- level online drug quality control, and to establish measures such as the compensation system for the drug induced sufferings.

Objective To evaluate the characteristics and the value of dual-source CT single-energy high pitch scanning technology in postoperative follow-up of endovascular graft exclusion to DeBakey Ⅲ aortic dissection.Methods All of 58 patients with endovas-cular graft exclusion to Debakey Ⅲ aortic dissection underwent dual-source CT checkup.30 patients (group A)were scanned with single-energy high pitch technology,voltage 120 kV,pitch 3.2;28 patients (group B)were scanned with dual-energy standard pitch technology,voltage 100 kV and 140 kV,pitch 1.0;both groups were used CareDose4D technology to automatically track the cur-rent.Image post-processing was completed at the workstation.The stent condition,endoleak and residual dissection were observed and analyzed.The differences of image quality and radiation dose between two scanning modes were compared.Results All of 58 cases,postoperative conditions to 9 cases were perfect,the proportion was 1 5.52%;43 cases were with distal residual dissection,the proportion is 74.14%;and 12 cases were accompanied with endoleaks,the proportion was 20.69%.The endoleaks manifestation in-cluded punctuate,band-like,and patchy high density around the stent in enhanced images.The difference of scan length between group A and group B was not statistically significant,the image quality of both groups met excellent standard .The acquisition time and effective radiation dose to group A were 1/4 and 56% of group B respectively.the differences of both groups were statistically significant.Conclusion Dual-source CT with single-energy high pitch scanning technology can ensure image quality and significantly reduce the effective radiation dose,it is a more advantageous scanning mode.

To improve the medical students'comprehensive quality and clinical practice ability,we summarize personal and the department's experiences,enhance the students'education on their entering into clinic,accentuate basic skills of medical paperwork and endeavor to foster students'surgically logic thinking ability.

Objective To investigate the difference of surgical efficacy between extended lymph node dissection and standard lymph node dissection in laparoscopic radical cystectomy.Methods We retrospectively analyzed 62 bladder cancer cases,icluding 52 males and 10 females patients in our hospital from January 2011 to October 2016,who underwent laparoscopic radical cystectomy and pelvic lymph node dissection.Their mean age was (62.5 ± 9.6) years,ranged from 42 to 83 years.27 cases were underwent extended lymph node dissection and 35 cases were underwent standard lymph node dissection respectively.The basic characters,operative time,intraoperative blood loss,intraoperative and postoperative complications,postoperative eating time,postoperative activity time,postoperative hospital stay,lymph nodes positive rate,lymph node density,and cancer-free survival were evaluated.Results All patients were underwent successful operation.There was no significant difference in operation time [(326.2 ± 77.5) min vs.(345.5 ± 66.8) min,P =0.297],blood loss [(198.2 ± 77.5) ml vs.(213.7 ± 160.0) ml,P =0.590],intraoperative complications (0/27 vs.5/35,F =0.063),postoperative complications (8/27 and 9/35,P =0.732),postoperative eating time[(4.8 ±2.2)d vs.(4.6 ± 1.9)d,P =0.817],postoperative activity time[(1.9 ± 0.8) d vs.(1.9 ± 0.9) d,P =0.838] and postoperative hospital stay[(15.6 ± 7.5) d vs.(16.0 ± 5.9)d,P =0.483].In this study,994 lymph nodes and 100 positive lymph nodes were dissected.There were significant differences in the number of lymph nodes dissected in the two groups (23.2 ±6.6 vs.10.5 ±3.6,P ＜0.01).40.74％ (11/27) of cases in ePLND were lymph node positive and the lymph node density was 11.7％ (73/626),which was higher than that of the sPLND group (28.57％ vs.7.34％,respectively).In regard to prognosis,the cancer-free survival rate (DFS) of ePLND group was 96％,91％,80％ and 71％ at 3,6,12 and 24 months follow-up respectively.The other group was 97％ 94％,84％,80％ correspondingly.And no significant difference was detected (P =0.546).Although there was no significant difference (P ＞ 0.05),DFS of ePLND group tended to be higher than that of sPLND group in lymph node positive subgroups.Conclusions Extended lymph node dissection and standard lymph node dissection have similar surgical safety and prognosis,and appropriate surgical procedures should be selected according to the patient's condition.

The periods of the medical students' clinical practice is an important transition from medical theory to medical practice.According to the medical interns' expectations,such as the clinical tutor' level,hardware of the department,daily medical process and our department' s experiences,we grope for much better teaching methods that can meet medical interns' expectations and evaluate the new teaching methods.The basic clinical skills of medical students and the teaching level of gastrointestinal surgery department have been effectively improved.

With the development of computer technique, Excel office software is widely applied in the management of clinical teaching. According to the problems existing in the clinical teaching management of our college, Excel electronic software is accepted to reform the present management measures. Its designation, essential archives establishment, method, result, analysis and discussion are introduced definitely in this paper.

The intra-tumor MTX concentration was measured in 12 patients with cerebral gliomas and 31 patients of malignant gliomas were treated with intracarotid infusion of papaverine and bis-chloroaitrosourea (BCNU). After intracarotid infusion of papaverine to open up the blood-brain-barrier (BBB), the MTX concentration within tumor tissues was 1854? 512ng/gram, which higher than that without papaverine infusion, which was 1020? 512ng/gram. The diagnosis was glioblastoma in 21 patients and anaplastic astrocytoma in 10. They received the infusion for a mean of 2.1 times with 250mg BCNU each. The mean survival time was 101.6? 32.7 weeks, with 104 weeks of median survival time. Fourteen were still living, including 11 glioblastoma and 3 anaplastic astrocytoma. Of those, four have lived over three years. We considered combination of papaverine and BCNU infusion for chemotherapy of malignant cerebral glioma is simple, safe and effective, so long as tumors were susceptible to the chemotherapeutic drugs.

Objective To assess the diagnostic value of magnetization transfer contrast (MTC) gradient echo (GRE) T2WI sequence in bone injury of knee joint. Methods MRI data of 56 patients with knee injury were analyzed retrospectively. All patients underwent SE sequence (sagittal T1WI, T2WI) and sagittal MTC-GRE T2WI sequence. The size, signal intensity and margin of bone contusion with different MRI sequence were analyzed and compared. Results Among 56 patients, 43 and 45 cases were demonstrated on SE T1WI and T2WI, respectively; 50 cases were displayed on MTC-GRE T2WI sequence. The size, border of bone contusions and sensitivity displayed on MTC-GRE T2WI sequence were statistically higher than those on SE sequence (P<0.05). Conclusion MTC-GRE T2WI sequence has great diagnostic value in contusion of knee joint, which is superior to FSE sequence.

Objective:To determine the status of glucose intolerance in breast cancer patients without DM history after combined treatment with surgery and/or chemotherapy through an oral glucose tolerance test (OGTT). Methods:All 121 breast cancer patients more than 3 months after combined treatments with surgery and/or chemotherapy and without the diagnosis of diabetes underwent OGTT and fasting. Then, 2 h glucose levels were measured to identify glucose tolerance and diabetes. Meanwhile, six patients with a history of diagnosed diabetes did not undergo OGTT. Results:The median ages of all breast cancer patients and the mean duration after combined treatments with surgery and/or chemotherapy were 50.4 years and 19 months, respectively. Among the 121 breast cancer pa-tients without the history of diabetes, the incidences of diabetes, prediabetes, and normal glucose intolerance were 19.8%(24 cases), 45.5%(55 cases) and 34.7%(42 cases), respectively. Among all breast cancer patients, the incidences of previously diagnosed diabetes, undiagnosed diabetes, and prediabetes were 4.72%, 18.9%, and 43.3%, respectively. The ratio of previously undiagnosed diabetes was about 80%. About 80.0% of undiagnosed diabetes and 74.5% of prediabetes met the criteria for elevated 2 h plasma glucose levels through OGTT instead of elevated fasting glucose levels. Conclusion: Breast cancer patients during follow-up after combined treat-ments with surgery and/or chemotherapy highly suffer from glucose intolerance, with high incidences of undiagnosed diabetes and pre-diabetes. OGTT should be made for breast cancer patients after combined treatments for early diagnosis, prevention, and treatment of di-abetes.

Objective To observe the effect of pioglitazone on peroxisome proliferators activated receptors (PPARγ) mRNA expression in rats with acute necrotizing pancreatitis (ANP). Methods 54 rats were randomly divided into sham group, ANP group, and pioglitazone group. ANP was induced by the retrograde injection of sodium taurocholate into pancreatic duct. The levels of serum amylase at 3 h, 6 h, and 12 h after ANP induction were determined and pancreatic pathological scores were measured, and the expression of pancreatic PPARγ mRNA was determined by RT-PCR. Results The levels of serum amylase and pancreatic pathological scores at 6 h in ANP group were (7171 ± 1636) U/L and 13.00 ±2.36; which were significantly higher than those in sham group [ (523 ± 166)U/L and 1.67 ± 234, P < 0. 01 ]. While the expressions of PPARγ mRNA were weakly expressed in ANP gyoup and sharm group(0. 18 ± 0.05 vs 0. 22 ±0. 03, P > 0. 05). The levels of serum amylase and pancreatic pathological scores at 6 h in pioglitazone group were (4504 ± 1901 )U/L and 9.00 ±0.89, which were significantly lower than those in ANP group (P <0. 05).While the expressions of PPARγ mRNA was higher than that in ANP group (0.56 ±0.05 vs 0. 18 ±0.05, P <0.05). Conclusions The protective role of pioglitazone on ANP rats was closely correlated with up-regulation of PPARγgene expression.