The rapid development of medical science and technology, which has greatly promoted the development of medicine and the improvement of diagnosis and treatment, has also brought about various negative impacts in clinical practice on the doctor-patient relationship. The paper attempts to analyze these impacts from such perspectives as medical treatment, society, ethics, and law and proposes some corresponding countermeasures in perspective of the present reality: (1)rationally controlling medical expenses; (2) effectively stepping up communication; (3)appropriately handling difficult ethical problems; (4) amplifying necessary health rules and regulations. The goal is to create a win-win situation for both progress in medical science and technology and improvement of the doctor-patient relationship.

OBLECTIVE:To promote a sustained and quick development of the high-tech medicine industry in our country.METHODS:The related literature was consulted and the current developmental status of the high-tech medicine in-dustry in our country was analyzed.RESULTS&CONCLUSIONS:The high-tech industry in our country can be pushed on only through rearrange industry mix at the right time,constructing a serial comprehensive development terrace,supporting es-pecially those medicine enterprises that with core technology and independent intellectual property rights,building a virtual strategic league together with the academy of higher learning and scientific research institutes.

Objective:To investigate the clinical manifestations and distribution characteristics of dry eye patients with ocular discomfort symptoms in Jilin Province, and to analyze the relationship between the risk factors associated with dry eye and its severity. Methods:The secondary or tertiary hospitals in Jilin Province were randomly selected and used as screening bases from July 2014 to August 2015.1 173 people initiative to the hospital for eye examinations after publicity were selected.Questionnaire was used to collect the subjective symptoms of dry eye.The breakup time(BUT) of tear film, corneal fluorescein staining, meibomian gland and tear secretion were examined and the detection rate and risk factors of dry eye of the dry eye patients with different clinical characteristics were analyzed.Results: A total of 1 122 people was actually surveyed, 896 individuals were diagnosed as dry eye, and the prevalence rate was 79.8%. The prevalence rate of the females was higher than of the males(χ2 =4.070,P<0.05).The prevalence of dry eye between different ages was statistically significant(χ2 =61.547,P<0.05).The multivariate Logistic regression analysis results showed that the age ≥40 years (40-49 years,OR =6.313,95% CI: 3.498-11.393;50-59 years,OR =6.919,95% CI: 3.876-12.351;60-69 years,OR =5.175,95% CI: 2.650-10.104;over 70 years,OR =9.508,95% CI: 3.608-25.061), moderate grade of meibomian gland dysfunction(MGD) (OR =2.123,95% CI: 1.186-3.803), and the patients with rheumatoid arthritis (OR =2.186,95% CI: 1.098-4.353) and eye surgery (OR =3.692,95% CI: 1.204-11.323) were the risk factors for dry eye. While the occupation of farmer was a protective factor for dry eye (OR =0.351, 95% CI: 0.135-0.917).Conclusion:Age, occupation, MGD grade, rheumatoid arthritis and eye surgery history affect the occurrence of dry eye to a certain extent. So enough attention and appropriate health guidance should be given to reduce the incidence of dry eye.

In order to improve the sharing of DICOM, a proposal is offered to introduce XML into DICOM on the SPIE 2005 and in this way, better readability and expansibility of DICOM files have been achieved. On this basis, the DICOM data structure is improved further by replacing the one-dimension linear data structure with multilayer tree-shaped data structure. And thus the nesting and dependence relationships between information object and data elements are much clearer and it is more convenient and easy to browse DICOM image files.
Database Management Systems ; Information Storage and Retrieval ; methods ; standards ; Medical Informatics ; methods ; Medical Records Systems, Computerized ; Programming Languages ; Radiology Information Systems ; Software ; User-Computer Interface

ObjectiveTo evaluate the feasibility and safety of endoscopic intraductal radiofrequency ablation (RFA) for unresectable malignant biliary strictures.MethodsA total of 12 patients with malignant biliary obstructions,who were unsuitable for surgical resection,were prospectively selected for this study.During ERCP,when successful biliary cannulation achieved,a bipolar radiofrequency probe was introduced into bile duct over a guidewire.RFA was given to the tumor lesion under fluoroscopy,followed by stent placement.The patients were closely observed and followed up after the procedure.ResultsSuccessful RFA was achieved in all patients before stents insertion ( plastic and metal stents in 6 respectively,additional pancreatic stents were given to 3).Mild complications of cholangitis and pancreatitis occurred in 1 patient respectively,which were cured with short-term management.Jaundice was promptly controlled in 7 patients (58.3％ ).During the mean follow-up duration of 3.4 (range 0.5-5.5) months,one patient died of cardiocerebral accident and others survived without obvious disconffort.The 1- month and 3- month stent patency was 100％ (12/12) and 80％ (8/10),respectively.ConclusionIt is technically feasible and safe to perform endoscopic intraductal RFA for the palliation of biliary malignancies.The short-term outcome is satisfying,however,long-term result and the better therapeutic schedule need further evaluation.

Objective To evaluate endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and management of biliary cast syndrome after orthotropic liver transplantation. Methods A total of 71 consecutive patients with abnormal liver function and MRCP findings after liver transplantation underwent ERCP for diagnosis and management. Their data were retrospectively reviewed. Results A total of 188 sessions of ERCP were carried out on the 71 patients, most of whom were found to have stenosis of anastomotic stoma and/or bile duct. Bile sludge was found and removed in all patients diagnosed within 3 months after liver transplantation, while pigmentoid stones were found and removed in patients diagnosed within 3-6 months and biliary casts in patients diagnosed at more than 6 months. Each patient underwent 2.6 sessions averagely. Biliary casts were formed at an average time of 22. 7 ± 15.6 months after transplantation. PostERCP complications included 2 cases of pancreatitis and 3 cholangitis, with an occurrence rate of 2. 6%(5/188), which were all controlled with conservative treatment. The follow-up data was available in 56 patients showing improvement in liver function after ERCP, among who 42 met the endoscopic criteria of cure,1 0 received second liver transplantation because of progressive sclerosing cholangitis and 4 died from diseases other than liver transplantation. Conclusion Therapeutic ERCP for the biliary cast syndrome after liver transplantation is feasible, safe and effective, and can be performed repeatedly with good short-term effect.

Objective To evaluate the safety and efficacy of a newly designed anti-reflux metallic stent (ARMS) for malignant extra-hepatic biliary obstruction. Methods A total of 23 patients with unresectable biliary malignancy in the middle or lower part of common bile duct underwent endoscopic retrograde cholangiopancreatography (ERCP) and ARMs placement. The success rate, early complications, stent patency and patients' survival were recorded. Results The ARMSs were successfully placed in all patients and no procedure-related complication was recorded. The average operation time was similar to that of self-expanding metallic stents (SEMs). In 22 patients completing the follow-up, the total serum bilirubin dropped to normal within one month in 20. ARMs dysfunction occurred in 6, including tumor in-growth in 1, overgrowth in 2, and stent dislodgement in 3. Other patients were free of biliary symptoms until death or at the end of follow-up. The average stent patency of ARMs was 14 months. Patency rates at 3, 6, and 12 months were 95%, 74% and 56%, respectively. The mean patient survival was 7. 9 months ( 1-14 months).Postoperative survival rates at 3,6 and 12 months were 91.0%, 81.3% and 17. 2%, respectively. Conclusion Endoscopic placement of novel ARMs in patients with extra-hepatic biliary tumors is feasible,safe and effective.

Objective To evaluate the effectiveness and safety of needle-knife fistulotomy (NKF)for difficult cannulation during endoscopic retrograde cholangiopancreatography (ERCP). Methods Data of patients, who received NKF on the back of major papilla when bile duct could not be accessed by conventional cannulation and/or other pre-cut methods during ERCP, were retrospectively reviewed. The success rate of deep cannulation and its complications were observed and analyzed. Results NKF was performed in 108patients due to difficult cannulation, which succeeded in 97 (91.2%) in access to the bile duct and failed in 11 patients with malignant biliary strictures. The failure rate in patients with distal malignant obstruction was higher (25. 8%, 8/31) than those with proximal lesions (5.3%, 3/57) (P = 0. 014, χ2 = 5. 983).Post-ERCP pancreatitis occurred in 5 cases (4. 6%), with the incidence significantly higher in NKF-failure group (18. 2%, 2/11) than that in NKF-suocess group (3.1% ,3/97) (P = 0. 006, χ2 = 7.418). Intestinal perforation occurred in 1 patient and cholangitis developed in 4 others, which all recovered after conservative managements. Conclusion NKF for difficult cannulations in ERCP is safe and effective, especially in hands of experienced operators, but cannulation success rate is relatively low in distal malignant biliary obstruction.

Objective To evaluate the feasibility of simultaneous endoscopic bilateral placement of self-expandable metal biliary stents. Methods A total of 9 patients with hilar malignancy of Bismuth type Ⅱ to Ⅳ were enrolled in the current study, with a mean serum bilirubin at 162. 8 ± 193. 8 μmol/L before the procedure. Two guide wires were selectively inserted into the left and right intrahepatic ducts and kept in site. After aggressive dilatation for beth sides, the metal stents were deployed one by one bilaterally. Success rate of the procedure, remission of jaundice, early complications, and short-term clinical outcome were ob-served. Results The procedure was succeeded in all patients with Y type stent in 2, plastic stent transition in 1 and parallel stenting in 6, which took an average time of 38. 1 min. The most convenient way was the parallel method with both distal ends of the stents remaining at outside of papilla. The serum bilirubin re-turned to normal level within 3 weeks in all patients except 1, and no major complications were observed. Conclusion Simultaneous endoscopic bilateral metal stent placement is technically feasible and safe, with the benefit of prompt and effective control of jaundice and infection, caused by hilar tumors. A better method is to place specially designed endoprotheses in parallel and leave the distal ends outside papilla.

Objective To investigate an effective endoscopic management of biliary anastomotic stric-tures (AS) following orthotopic liver transplantation (OLT) and to evaluate the factors which may effect the ontcome. Methods Sixty-five patients, who were diagnosed as AS 3 months after OLT, underwent ERCP. Af-ter adequate dilation of the narrowing bile ducts, plastic stents, as many as possible, were inserted across the strictures and kept in place for at least six months. Results A total of 90 consecutive endoscopic procedures were performed in 65 patients. Before stents placement, the strictures were dilated by catheter or balloon (di-ameter range: 6-10 mm), or not dilated, according to the status of the bile ducts. An average of 3 (ranging from 2 to 6) plastic stents were placed with mean total size of 22.8 F (range 14-42 F), and the stents were kept for 8. 0 months on average (range 0.2-37.8 months). Of 90 procedures of stents placement, 54 (60%) were followed by stents removal and cholangiography, which confirmed stricture resolution in 26 (48.1%). The stricture resolution rate was 81.0% (17/21) in patients who underwent balloon dilation followed by more than 3 stents (> 21 F) for at least 3 months. Stricture re-occurred in 3 patients after stents removal, in whom stents were kept less than six months. Conclusion Endoscopic sequential intervention is effective for post-OLT biliary strictures according to the stage and grade. Radical dilation with maximal stenting can lead to complete resolution of AS. To achieve better result, if possible, balloon dilatation followed by three or mere endoprothe-ses (of at least 21 F) sustaining for more than 6 months is necessary.