As a wide field of internet industry, the internet medical is sprouting prosperous with many advanta-ges still, namely promoting the medical resources integration and earlier disease prevention, providing more conven-ient health care services, etc. , but there are still many limitations. By analyzing the role of internet in the promotion of medical services, this article focused on the internet limitations. Ultimately, we put forward we should calmly oper-ate internet and make it as the auxiliary tool for medical care services instead of relying too much on it in order to pro-vide a reference and a basis for the prosperous development of internet medical.

Hydronephrosis is a common and frequent clinical disease. With the extensive application of minimally invasive techniques of Western medicine, it can quickly remove the obstruction and eliminate water. However, there may be problems of easy recurrence after surgery, causing more serious irreversible kidney damage. TCM has a unique advantage in the treatment of hydronephrosis, which can radically relieve the pain of patients, prevent recurrence, and protect the kidney function. Professor SHAO Zhao-di thinks that the cause of hydronephros is deficiency of kidney qi, which affects the function of gasification. Therefore, the treatment should be nourishing qi to invigorate spleen and reinforcing kidney for diuresis. In clinical practice, Bixie Fenqing Decoction can be used to treat hydronephrosis, which can obtain good efficacy.

Transcatheter arterial chemoembolization (TACE) has been widely applied in palliative treatment of unresectable primary and metastatic liver cancer,and its efficiency and safety also have been widely acknowledged.However,there is a wide range of related complications,such as upper gastrointestinal hemorrhage,liver failure,pulmonary embolism,embolic cholecystitis and so on.As a serious complication of TACE,bile duct injury has been reported intermittently since the introduction of hepatic arterial embolization therapy.However,the exact pathogenesis,predisposing factors and clinical implications of the injuries remain to be clarified.As we find,by far there is no literature review about the bile duct injury after TACE for liver malignant tumors both at home and abroad.Thus the purpose of our study was to discuss such current issue of bile duct injury,and 26 articles have been included and analyzed.

Objective To investigate the methods and strategies of therapeutic ERCP in patients with duodenum stricture.Methods Endoscopic procedure,success rate and complications in patients with duodenum stricture who underwent ERCP were retrospectively analyzed.Results In 7276 patients who underwent therapeutic ERCP,duodenum stricture was found in 158 (2.17％),patients with malignant tumor infiltration in 120 and benign stricture in 38.The total success rate of ERCP and biliary drainage was 84.2％,with posture change or guidewire leading method in 96 patients,stylolitic water sac dilation in 33and duodenum metal stent placement before biliary drainage in 4.The procedure was failed in 25 patients.Minor bleeding occurred in 5 patients and no major complication including massive bleeding or perforation was observed.Conclusion ERCP is safe,effective and feasible for patients with duodenum stricture,which can be performed by posture change or guidewire leading method in mild stricture,and stylolitic water sac dilation or duodenum metal stent placement in severe stricture.

Objective: To investigate the knowledge and behaviors related to hepatitis B prevention and control among carriers of hepatitis B surface antigen (HBsAg), so as to provide the basis for conducting health education and interventions for HBsAg carriers. Methods: Based on the seroepidemiological survey of hepatitis B among individuals aged 1 to 69 years in Shaanxi Province, HBsAg carriers were selected as the study subjects. Basic information, knowledge and behaviors about hepatitis B prevention and control were collected through questionnaire surveys. The awareness of hepatitis B prevention and control knowledge and related behaviors among HBsAg carriers were analyzed. Results: A total of 107 HBsAg carriers were enrolled, including 52 males (48.60%) and 55 females (51.40%), and had a median age of 47.04 (interquartile range, 19.78) years. The awareness of hepatitis B prevention and control knowledge ranged from 56.07% to 87.85% among HBsAg carriers, with the highest awareness for "hepatitis B vaccination can effectively prevent hepatitis B "(87.85%), and the lowest awareness for "sharing meals with HBsAg carriers or hepatitis B patients will not lead to infection" (56.07%) and "hepatitis B can be treated with antiviral drugs" (61.68%). The proportions of those who did not seek medical consultation, undergo regular check-ups, or receive treatment were relatively high, at 65.42%, 72.90% and 77.57%, respectively. Conclusions The awareness of hepatitis B transmission routes and treatment-related knowledge among HBsAg carriers is relatively low, and their medical-seeking behaviors are relatively passive. There is a need to enhance the dissemination of hepatitis B prevention and control knowledge, improve medical-seeking behaviors, and reduce the risk of hepatitis B virus transmission.

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 investigate the efficiency and safety of endoscopic large balloon dilation following small sphincterotomy (ESBD) for treatment of common bile duct (CBD) stones, and to prospectively compare it with traditional sphincterotomy (ES). Methods Patients with single or multiple calculi in extra-hepatic bile ducts and with the diameter of CBD larger than 13 mm, were randomized into 2 groups to receive maximal sphincterotomy (ES group), or partial sphincterotomy plus sphincteroplasty with 15mm-balloon (ESBD group), respectively, followed by conventional stones removal and/or lithotripsy. The success rate of stone clearance, operation time and related complications were observed. Results A total of 86 patients were enrolled in 2 endoscopy centers, with 2 excluded because of papillary pre-cut in 1 and non-compliance with the protocol in the other, and were randomly divided into groups ES and ESBD, with 42 patients in each. The clinical characteristics, including average diameter of CBD, size and quantity of calculi, and incidences of peri-ampullary diverticulum, of patients in both groups were all similar. Stones clearance with single session in 2 groups were 88% and 93%, respectively (P =0. 531 ). The operation time were (25.76 ± 12. 74) min and (26. 38 ± 12. 86) min ( P = 0. 825 ). The rate of mechanical lithotripsy was 36% and 25%, respectively (P=0. 363). Complications occurred in 5 cases in ES group (3 mild, 2 medium), and 2 mild complications occurred in ESBD group (no statistical difference). No death happened in any group.Conclusion ESBD is an effective method for clearance of extra-hepatic bile duct stones with the similar safety, compared with traditional sphincterotomy. It could be an optimal alternative for those with large stones or difficult sphincterotomy.

Objective To investigate the relationship between single nucleotide polymorphism in estrogen metabolizing genes CYP17、CYP19 and breast cancer susceptibility.Methods A case-control study was performed.PCR-base restriction fragment length polymorphism(PCR-RFLP)and short tandem repeat polymorphism(STRP)assay were used to detect the single nucleotide polymorphism of CYP17、CYP19 in 213 breast cancer cases and 430 matched controls.Resuits CYP17 A2/A2 genotype was found in 6.7%of breast cancer cases,which was significantly higher(P＜0.05)than that in controls(2.4%);the frequency of A2 allele of CYP17 was 16.2%in breast cancer cases,which was significantly higher(P＜0.05)than that in controls(10.6%).There Was alSO significant difference in the frequency of(TTTA)10allele of CYP19 which was 12.4%in breast cancer cases and 8.2%in controls(P=0.02).Conclusions The allele of CYP17 A2 and CYP19(TTTA)10 and CYP17 A2/A2 genotype were positively associated with the susceptibility of breast cancer.

Aim To explore micro RNAs-integrated pathogenic signaling to control endothelial-mesenchy-mal transition ( EndMT ) in pulmonary hypertension ( PH) by a network bioinformatic approach. Methods Literature-mining method was used to find PH-relat-ed genes and EndMT/EMT-related miRNAs. Bioinfor-matic prediction approach ( DIANA3 , Miranda4 , PicT-ar5 , TargetScan6 , miRDB7 and microT-CDS8 ) was used for miRNA target prediction. Hypergeometric a-nalysis was used to predict miRNAs related to EndMT in PH. The analysis of interactions between PH-rele-vant genes( PH network) was performed with the use of Biological General Repository for Interaction Datasets ( BioGRID ) . These miRNAs were ranked with the highest probability of substantial overlap among their gene targets in the PH-network, the relationship be-tween their targets and the PH functional categories which include hypoxia, inflammation, and transforming growth factor/BMP signaling. Then, the part of results was validated by animal experiment. Lastly the miR-NA-Target network was built using Cytocape 3 . Results List of 230 genes was compiled that were directly im-plicated in the development of PH and 189 miRNAs were related to EndMT in PH. Among 189 miRNAs, only 22 microRNAs(miR-let-7 family, miR-124, miR-130 family, miR-135, miR-144, miR-149, miR-155, miR-16-1, miR-17, miR-181 family, miR-182, miR-200 family, miR-204, miR-205, miR-21, miR-224, miR-27, miR-29 family, miR-301a, miR-31, miR-361 and miR-375) were related to hypoxia, inflamma-tion, and transforming growth factor/BMP signaling. Among these miRNAs, the levels of let-7g, miR-21, miR-124 and miR-130 family were significantly changed in the pulmonary artery in hypoxia-induced PH rats. Conclusions Among numerous miRNAs,22 of which may be involved in hypoxia, inflammation, and transforming growth factor/BMP signaling and re-lated to EndMT in PH by network bioinformatic ap-proach, which provides a theoretical basis for further investigation of EndMT in PH.