Based on introducing the conception and developing status of the telemedicine and current administrative guidance documents of telemedicine,the paper sorts out legal relations among all parties by combining the developing status of all parties,and defines the involved civil liabilities,in order to lay a foundation for China to improve the telemedicine system standard,and vigorously promote the application of telemedicine.

OBJECTIVE To find out the main commonly encountered pathogen and antibiotic resistance in hospital infection in Department of Neurosurgery. METHODS Clinic samples from Jun 2005 to Jun 2007 were collected and drug sensitive test was taken.RESULTS The most commonly encountered pathogens of infection were Gram-negative bacillI(83.1%),including Klebsiella pneumoniae(25.0%),Escherichia coli(19.1%),andAcinetobacter baumannii(10.3%). The three kinds of pathogens had heavy resistance to at least 8 kinds of antibiotics. The resistance rates to imipenem and ofloxacin were the lowest (6.8% and 32.4%). CONCLUSIONS The pathogens isolated from Departmentof Neurosurgery are Gram-negative bacilli which have multiple antibiotic resistance. The key prevention measures of infection are to control prophylatcic usage of the third generation cephalosporins,strengthen environmental microbial monitoring,hand sterilization and cleaning among the medical staff.

Objective To research the value of bed fiber bronchial microscope technology ha neurosurgical ICU. Methods 28 cases in neurosuxgical ICU who had received bed fiber bronchial microscope operations,including blood and vomit aspiration, bronchoalveolar lavage, sputum bolt clearance were retrospectively analyzed. Results 4 cases of blood and vomit aspiration was cleaned ha time,improvement of respiratory function,31 cases was sputum as- piration by bed fiber bronchial microscope and bronchoalveolax lavage, 31 cases was sputum collected by fiber bronchial microscope and positive rate is 100% ,4 cases of atelectasis was lung recruitment by fiber bronchial micro- scope sputum aspiration. Conclusion Bed fiber bronchial microscope technology can eliminate waste effectivdy, clean dust,there axe great value in treatment of neurosurgical ICU patients with respiratory diseases.

Objective:To evaluate the precision of digital impressions taken under simulated clinical impression taking conditions with TRIOS and to compare with the precision of extraoral digitalizations . Methods:Six #14 -#17 epoxy resin dentitions with extracted #16 tooth preparations embedded were made.For each artificial dentition , ( 1 ) a silicone rubber impression was taken with individual tray , poured with type IV plaster ,and digitalized with 3Shape D700 model scanner for 10 times;(2) fastened to a dental simulator , 10 digital impressions for each were taken with 3Shape TRIOS intraoral scanner .To assess the precision , best-fit algorithm and 3 D comparison were conducted between repeated scan models pairwise by Geomagic Qualify 12.0, exported as averaged errors (AE) and color-coded diagrams.Non-parametric analysis was performed to compare the precisions of digital impressions and model images .The color-coded diagrams were used to show the deviations distributions .Results:The mean of AE for digital impressions was 7.058 281 μm, which was greater than that of 4.092 363 μm for the model images (P<0.05).However, the means and medians of AE for digital impressions were no more than 10 μm, which meant that the consistency between the digital impressions was good .The deviations distribution was uniform in the model images ,while nonuniform in the digital impressions with greater deviations lay mainly around the shoulders and interproximal surfaces .Conclusion:Digital impressions with TRIOS are of good precision and up to the clinical standard .Shoulders and interproximal surfaces scanning are more difficult.

Objective To study the feasibility of laparoscopic cholecystectomy(LC)combined with laparoscopic appendectomy(LA).Methods One hundred and thirty patients of cholecystitis with acute appendicitis or chronic appendicitis were treated by LC combined with LA at the same operation.Results One hundred and tweent-nine cases were operated successfully.1 case was converted to open operation .No complications occurred in this series.Conclusions LC combined with LA in treating patients with cholesystitis combined with acute appendicitis or chronic appendicitis is a preferable method.

Objective To evaluate the efficacy of locally administered dexamethasone for prevention of low back pain after labor epidural analgesia.Methods Two hundred nulliparous parturients who required labor epidural analgesia,of ASA physical status Ⅰ or Ⅱ,were randomly divided into 2 groups (n =100 each) using a random number table:control group (group C) and dexamethasone group (group D)).In group D,lidocaine 4 ml and dexamethasone 1 ml (5 mg) were injected around the puncture site.In group C,lidocaine 4 ml and normal saline 1 ml were injected around the puncture site.Epidural puncture was performed after local administration.According to the results of epidural puncture,each group was further divided into two subgroups:single puncture group (Cs subgroup,Ds subgroup) and repetitive puncture group (Cr subgroup,Dr subgroup).The patients were followed up for 72 h,and the development of low back pain was recorded.Results Compared to group C,the incidence of low back pain was significantly decreased,and pain was reduced in group D.The incidence of low back pain was significantly lower in Ds group than in Cs group,and in Dr group than in Cr group.Conclusion Locally administered dexamethasone 5 mg is helpful in reducing low back pain after labor epidural anesthesia.

Five groups were assigned to include intrahepatic cholangiocarcinoma ( ICC, n=30 ) , liver cirrhosis (LC,n=30),metastatic carcinoma (MCA,n=30) and 30 healthy subjects.The serum level of GPC3 was measured by a sandwich method of enzyme-linked immunosorbent assay ( ELISA ) and alpha-fetoprotein (AFP) by microparticle enzyme immunoassay (MEIA).The serum levels of GPC3 and AFP were significantly higher than those of other groups (P<0.05).At a cut-off value of 3.5μg/L,the sensitivity and specificity of GPC3 in the diagnosis of HCC was 83.3%and 76.7%respectively.The sensitivity of combined measurement of GPC3 and AFP was better than GPC3 or AFP alone.Detectable GPC3 was significantly correlated with the presence of viral hepatitis markers and tumor size.However there was no obvious difference in tumor thrombi in portal vein ( PVTT), tumor number, age, gender or hepatic function of HCC.Thus,as a sensitive serum diagnostic marker for HCC ,GPC3 may be a good supplement to AFP in differentiating HCC from non-malignant chronic liver diseases and other liver cancers.

ObjectiveTo assess the diagnostic value of ultrasonography in the diagnosis and pathological classifi cation of appendicitis with pathological results.MethodsThe study included 111 cases who confi rmed by surgery and pathology in the Six Affi liated Hospital of Sun Yat-sen University from June2012 to December 2013. The image characteristics of ultrasonic images performed before surgery were analyzed retrospectively. The cases were divided into five groups based on the pathology: 6 acute simple appendicitis, 45 acute suppurative appendicitis, 15 acute gangrenous appendicitis, 33 chronic appendicitis, and 12 acute attack of chronic appendicitis. The length, width and wall thickness of the appendicitis measured by preoperative ultrasound between various pathological type were compared with Kruskal-Wallis statistical methord, and also used the same method to compared the one which had statistically signifi cance between the fi ve groups. As in the above case, Fisher Exact Test was used to compare the characters′ of ultrasonography included gradations of the appendix, the tube cavity expansion, stercorolith, the appendiceal abscess, mergering lymph node enlargement and the appendix around effusion, if there was statistically signifi cance, the same methord was used to the further comparison between thefi ve groups.ResultsTotally 90 of 111 cases of were reminded appendicitis by preoperative ultrasound, the diagnostic accuracy rate was 81.08%, including acute suppurative appendicitis 91.11% (41/45), acute gangrenous appendicitis 93.33% (14/15), acute simple appendicitis 83.33% (5/6), chronic appendicitis 60.61% (20/33), chronic appendicitis onset acute 83.33% (10/12). There were no statistical differences of preoperative ultrasound measured between various pathological type of appendicitis in length, while the appendix width measured by preoperative ultrasound of acute gangrenous appendicitis was wider than the acute simple group and chronic group, and there were statistically signifi cance between them (P<0.05), in the aspect of wall thickness, the acute suppurative appendicitis and the acute gangrenous appendicitis groups were thicker than the chronic group, and these differences had statistically signifi cance (P<0.05). The stercorolith, lymph node enlargement and the appendiceal abscess in different types of appendicitis had no statistical difference. There were statistically differences (P<0.05) between the acute suppurative goup, acute gangrenous group and the chronic group respectively, both in gradations of the appendix and the tube cavity expansion. Also there were statistically difference (P<0.05) between the acute gangrenous appendicitis group and the chronic group in the aspect of the appendix around effusion.ConclusionsUltrasound is valuable in the diagnosis of appendicitis, especially for acute gangrenous appendicitis and acute purulent appendicitis. The measurement of appendix with wide diameter, wall thickness by ultrasond preoperatively, and the characteristics of the wall layers, lumen expansion degree and the appendix around effusion are valuable in identifying chronic appendicitis, acute suppurative appendicitis, and acute gangrene appendicitis; The ultrasonic measurement of appendix wide diameter could identify acute gangrenous appendicitis and acute simple appendicitis. Ultrasound had limited value in identifying acute suppurative, acute gangrenous appendicitis, acute simple appendicitis, chronic appendicitis, and chronic appendicitis onset acute.

Objective Hospitals are important medical scientific research institutes.The research contracts of hospitals have the characteristics of large quantity,large transaction amount,complex types and high expertise.There are many legal problems and risks arisen in the contract content,due to the medical staff's limitation of major and energy.This paper makes exploration into the general issues and questions in the medical scientific research contract with the purpose to benefit to the improvement of the contract management in the hospitals.Methods This paper collects a sample of 112 scientific research contracts that signed from 2012 through 2016 in a tertiary hospital and summarizes the general problems based on reviewing legal risk factors of these contracts.Results Statistical analysis revealed that the provision-for jurisdiction,ownership of intellectual property and contractual right is either inadequate or non-existent.Hospitals should strengthen intellectual property protection,secrecy consciousness,etc.Conclusions It is essential and urgent to regulate the article of the contract and use the standard contract.Hospitals should adjust the organization framework,control the process,consummate the regulation,control the workflow and build the culture to promote the contract administration.

Objective To evaluate the value of endorectal ultrasonography (ERUS) in assessment of mesorectal fascia (MRF) invasion in rectal cancer.Methods Data of 44 patients who accepted preoperative ERUS and total mesorectal excision surgery within a week were retrospective analyzed.There were 18 patients who accepted preoperative neoadjuvant chemotherapy and 26 patients didn't acceped.Taking the pathological diagnosis of circumferential resection margin (CRM) as the gold standard,the diagnostic efficiency of ERUS for the MRF invasion in rectal cancer was evaluated.Results The final pathological T staging was T1 in 2 cases,T2 in 17 cases and T3 in 25 cases.There were 2 cases of CRM positive results,and 42 cases of CRM negative results.With regard to the location of tumor,there were 16 cases located in low,and 28 cases in mid rectum.There were 26 cases located in anterior or antero-lateral wall of rectum,13 cases in posterior or postero-lateral wall,and 5 cases with a circle of rectum.The diagnostic accuracy were 83.33 ％ (15/18) and 92.31％ (24/26) for cases of accepting and not accepting the preoperative neoadjuvant chemotherapy;80.77％ (21/26) for cases located in anterior or antero-lateral wall,and 100％ (13/13) for cases located in posterior or postero-lateral wall;75.00％ (12/16)and 96.43 ％ (27/28) for low position and mid position tumors.The total diagnostic accuracy was 88.64％ (39/44).Conclusion ERUS can be an effective method in preoperative assessment of the MRF invasion in rectal cancer.