Objective:To introduce the reform and practice of diagnosis and treatment mode in a hospital, analyze the output results, and put forward the characteristics, advantages and disadvantages of online medical care.Methods:The hospital launched the " online consultation" service for the first time in July 2019, and continuously accelerated the function construction of the Internet hospital, gradually transforming the traditional offline diagnosis and treatment mode into a new full-cycle diagnosis and treatment mode integrating online inquiry, billing, self payment, drug mailing, inspection appointment, self admission and chronic disease follow-up. The operation data of hospital online outpatient service from January to June in 2020 were analyzed.Results:From January 1st to June 21st, 2020, the Internet hospital has received over 318 000 patients. Most of the online outpatients suffered from chronic diseases, while the diseases that needed further treatment were mainly in the offline outpatient department, such as the first diagnosis and acute diseases. Among the online outpatient expenses, the drug cost accounted for the highest proportion(80.52%), and the registration cost accounted for the least(4.04%).Conclusions:The change of medical treatment mode will force the continuous reform of public hospitals, but the current policy environment for Internet hospital development needs to be in place. In the future, we should further clarify the functional orientation of Internet hospitals and promote the rapid integration of online and offline services.

Objective:To investigate the dosimetric effects of prone immobilization devices combined with a belly board (PIDBBs) in the intensity-modulated radiotherapy (IMRT) for gynecologic cancers.Methods:A total of 20 patients with cervical or endometrial cancer treated with radiotherapy in the Third Affiliated Hospital of Sun Yat-sen University from August 2020 to June 2021 were retrospectively analyzed. Two sets of body contours were outlined for each patient. One set of body contours did not contain the immobilization devices, and the other contour set included the immobilization devices. For each patient, doses were calculated for the two sets of contours using the same 7-field IMRT plan and were recorded as Plan without and Plan with. The dosimetric difference caused by the immobilization devices was assessed by comparing the parameter values in the dose-volume histograms (DVHs) and by plan subtraction. The Gafchromic EBT3 film and anthropomorphic phantom were used to verify the calculated doses. Results:The target coverage and average dose of Plan with were lower than those of Plan without. Specifically, the V50 Gy, V49 Gy, and Dmean of planning target volume (PTV) decreased by 19.75%, 7.99%, and 2.54% ( t = 8.96, 10.49, 22.09, P < 0.01), respectively. The V40 Gy, V30 Gy, V20 Gy, V15 Gy, and Dmean of skins increased by 51.79%, 51.05%, 45.72%, 33.63% and 10.80% ( t = -2.54, -5.63, -15.57, -24.06, -13.88, P < 0.01), respectively. Doses to other organs at risk (OARs) showed no significant differences. As indicated by the EBT3 measurements, the doses to skins of the abdomen and pelvis on the anthropomorphic phantom increased by approximately 37.24% ( t = 10.86, P<0.01). Conclusions:Although PIDBBs can effectively reduce the low dose to the small intestine, the radiation attenuation caused by them can reduce the PTV coverage of radiotherapy plans and increase the doses to abdominal and pelvic skins sharply, especially for patients requiring irradiation of the groin and perineum.

Objective:To evaluate the development of children 2-4 years old with autism spectrum disorders (ASDs) using the Chinese version of the Griffiths Development Scales (GDS-C).Methods:Eighty-eight children with ASD, 80 children with developmental language disorder (DLD) and 82 healthy children aged 2-4 were evaluated using the GDS-C. They were compared and their development in sports, personal and social relationships, language, hand-eye coordination and other performance were analyzed. The personal-social and language results of the ASD and DLD children were compared.Results:No significant differences were found between the ASD and DLD children in their language development. The development quotient of the ASD children was significantly lower, on average, than those of the DLD and healthy children in all fields except language. However, the ASD children′s development was not balanced. Their average developmental quotients in the language and the personal-social fields were significantly lower than in the sports, performance and hand-eye coordination fields. In the field of language, the entry loss rates of the two structural modes of receptive language and non-verbal expression of the ASD children were significantly higher than the DLD children′s averages. In the personal-social field the entry loss rates of communication and housework skills and of self-care skill were significantly higher than the DLD children′s averages. The command structure model of the ASD children was also superior, on average.Conclusions:The GDS-C can effectively assess the development of ASD children aged 2-4, especially in terms of language and personal and social skills. It can provide clinical evidence useful for early diagnosis and intervention for children with ASD.

【Objective】 To analyze the influence of different Inc parameters in the Monaco planning system on the left breast cancer volumetric modulated arc therapy (VMAT) planning, in the hope of providing some reference for plan design. 【Methods】 Seventeen left-breast cancer patients who were receiving radical radiotherapy were selected. The plans were enrolled in the design of VMAT with the same optimization conditions but different Inc parameters in the Monaco planning system. All plans used different Inc parameters like 10°, 20°, 30°, and 40°. The results of the plan were compared. The dosimetric parameters of the PTV and the organs at risk inquired by the plan were analyzed. The SPSS software was used for calculating the differences between the VMAT plans and evaluating the quality of the plans. 【Results】 The different Inc parameters affected the dosimetric parameters D98%, D2%, D50%, V55 Gy of PTV and CI, HI (F=10.528, F=15.154, F=15.513, F=16.979, F=4.632, F=14.277, all P<0.05). The MU of the four groups significantly differed (F=4.632, P<0.05), and the difference of V10 on the ipsilateral lung was significant (F= 3.324, P<0.05), the remaining parameters in the four groups had no statistically significant difference. 【Conclusion】 For the left-breast cancer volumetric modulated arc therapy, the smaller of Inc parameter on the plan had better dose distribution and conformity index while the monitor units increased. 40° was not suitable for the breast cancer VMAT plan, and the high amount beyond the range would increase the toxic and side effects on the skin.