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.

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.

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.

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.

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.

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 assess the value of multi-slice spiral CTA in the diagnosis of iliac vein compression syndrome(IVCS)and secondary thrombosis.Methods The CTA data of 80 controls and 31 patients with IVCS conformed by DSA were retrospectively studied.The inner diameters of the compressed iliac vein in two groups were measured and compression ratios were calculated.The data were compared using t test and Wilcoxon test.The findings of CTA were compared with that of DSA and the accuracy of CTA was analyzed.Results For the control group,the inner diameters of left iliac vein in female group(7.0±2.5)mm were significantly less than that in male group(8.1±2.5)mm(t=2.42,P＜0.05).For the control group,the inner diameters of left iliac vein was(7.6±2.0)mm,and the compression ratios were 0 to 65.41%(median 27.65%).The compression ratios were no statistical differences between male group(0 to 61.36%,median 26.82%)and female group(0 to 65.41%,median 28.75%)(Z=-0.59,P＞0.05).For the patients group,the inner diameters of compression iliac vein was(2.7±1.1)mm.The compression ratios were 55.18% to 100%(median 76.12%).Both inner diameters and compression ratios were statistically different between the control and patients group(t=12.78,P＜0.05;Z=-8.18,P＜0.05).Fifteen of 31 cases with IVCS were accompanied with deep vein thrombosis.The left iliac veins were compress in 28 cases,while right iliac veins were compressed in 2 cases.The left and right iliac common veins were compressed by the left and right jliac common arteries in one case.The results of CTA were consistent with that of DSA in all cases.Conclusions CTA can not only measure the inner diameters of iliae vein compression and calculate compression ratios,but also demonstrate secondary thrombosis clearly.CTA is an effective examination in diagnosis of IVCS and secondary thrombosis.

BACKGROUND: Research has been reported that serum soluble CD146 (sCD146) expression was improved on the surface of endothelial cells and activated T cells by the stimulation of inflammatory factor. Therefore, it predicts that CD146 may participate in inflammatory reaction of tissue.OBJECTIVE: To investigate the expression and clinical significance of serum sCD146 in peripheral blood from patients with ankylosing spondylitis.METHODS: A total of 62 patients with ankylosing spondylitis were selected from the Sixth People's Hospital AffiUated to Shanghai Jiao Tong University. All patients were divided into two groups: active group (n=46) and inactive group (n=16); while, 20 healthy subjects were selected as the control group. Indicators including Bath Ankylosing SpondyUtis Disease ActivityIndex (BASDAI),Bath Ankylosing Spondylitis Functional Index (BASFI), patient's global assessment (PGA), night pain, visual analogue scale (VAS),morning stiffness time, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were measured in all patients. The serum concentration of sCD146 from 62 patients with ankylosing spondlitis and 20 healthy controls was measured by enzyme-linked immunosorbent assay. Westergren method was used to measure ESR and immunoturbidimetry for CRP. Clinical data of the patients were collected as well.RESULTS AND CONCLUSION: sCD146 levels of patients with ankylosing spondlitis were significantly higher than normal control group (P ＜ 0.05). The sCD146 expression in the active group was significantly higher than inactive and normal control groups (P ＜0.05). Positive correlations were observed between sCD146 and BASDAI index of patients with ankylosing spondlitis (P ＜ 0.05).The sCD146 levels of ankylosing spondUtis patients with peripheral joint involvement were significantly higher than the patients with axial involvement alone or the normal controls (P ＜ 0.05).The expression level of sCD146 in peripheral blood was positively correlated with disease activities of patients with ankylosing spondlitis. It may play important roles in the pathogenesis in ankylosing spondlitis.