Objective Based on the perspective of doctors and patients,it explores the impact of Internet medicine on primary medical and health service ability.Methods A survey was conducted with 331 physicians and 675 patients,t-test and structural equation modeling was employed to analyze the relationship between Internet healthcare services and primary healthcare services capacity.Results From the perspective of physicians,Internet healthcare services were positively correlated with comprehensiveness(service accessibility),family-centered care,comprehensiveness(service provision),coordination(information systems),community orientation,and coordination,but no correlation with first treatment accessibility and continuity.From the perspective of patients,Internet healthcare services were positively correlated with family-centered care,comprehensiveness(service accessibility),coordination(information systems),comprehensiveness(service provision),community orientation,first treatment utilization,coordination,continuity,and first treatment accessibility.Conclusion Internet healthcare services is an effective strategy for enhancing primary healthcare services capacity.It is crucial to consider the similarities and differences in the demands of both physicians and patients.Strengthen equipment renewal,medication security and talent construction from the perspective of doctors,optimize and improve the first diagnosis at the grassroots level from the perspective of patients,and integrate Internet medicine into the construction of healthy families by relying on the grassroots and communities from the perspective of doctors and patients.

Objective Based on the perspective of doctors and patients,it explores the impact of Internet medicine on primary medical and health service ability.Methods A survey was conducted with 331 physicians and 675 patients,t-test and structural equation modeling was employed to analyze the relationship between Internet healthcare services and primary healthcare services capacity.Results From the perspective of physicians,Internet healthcare services were positively correlated with comprehensiveness(service accessibility),family-centered care,comprehensiveness(service provision),coordination(information systems),community orientation,and coordination,but no correlation with first treatment accessibility and continuity.From the perspective of patients,Internet healthcare services were positively correlated with family-centered care,comprehensiveness(service accessibility),coordination(information systems),comprehensiveness(service provision),community orientation,first treatment utilization,coordination,continuity,and first treatment accessibility.Conclusion Internet healthcare services is an effective strategy for enhancing primary healthcare services capacity.It is crucial to consider the similarities and differences in the demands of both physicians and patients.Strengthen equipment renewal,medication security and talent construction from the perspective of doctors,optimize and improve the first diagnosis at the grassroots level from the perspective of patients,and integrate Internet medicine into the construction of healthy families by relying on the grassroots and communities from the perspective of doctors and patients.

Objective To verify the feasibility and effectiveness of the beam hardening correction method based on Monte Carlo simulation and energy spectrum partitioning for X-ray image.Methods A beam hardening correction method based on Monte Carlo simulation and energy spectrum partitioning for X-ray image was presented.The Monte Carlo simulation results of multi-energy X-ray spectra and single-energy X-ray energy deposition were saved as a hardening correction database.The rapid calculation of the multi-energy projection data was achieved by adapting the hardening correction database based on the step size of energy spectrum partitioning and specific energy spectrum distribution of the rays.Subsequently,a polynomial fitting was performed on the multi-energy projection data and the penetration lengths of the rays through the detected object,thus realizing the fitting of hardening correction parameters for X-ray image.Results The HU value curve of the X-ray image after beam hardening correction by the proposed method was flatter.Under the condition of a tube voltage of 120 kV and a step size of 10 keV,the uniformity of the X-ray image was improved by 29.40%.Compared with the traditional Monte Carlo beam hardening correction method,the proposed method effectively improved the efficiency of the beam hardening correction parameter fitting.Conclusion The proposed beam hardening correction method based on Monte Carlo simulation and energy spectrum partitioning for X-ray image is feasible and effective.

Healthy Sanming is a new stage, a new goal and a new station of Sanming′s reform of medical and health system. Based on the rainbow model, the author summarized and analyzed the theoretical logic, content framework and practical effectiveness of the health protection system in new era, summarized the advanced experience and practices in the construction of Healthy Sanming, and systematically interpreted the Sanming practice in Healthy China. Vertically, the macro-level of institutional integration constructed a regional healthcare mechanism to improve the protection system, the meso-level of organizational integration promoted the four-tier referral mode to build a protection network, the micro-level of the professional integration carried out in-depth medical and preventive synergy and fusion to protect the key populations, and the service integration provided life-cycle health services to consolidate the health coverage. Horizontally, the instrumental level drived health performance through the innovation of the health insurance fund and payment method, and the value level standardized and balanced the layout of resources by enhancing the primary medical service capacity. Constructing the health protection system in new era is an important initiative for the construction of healthy Sanming, public hospitals have shifted their focus from treating diseases to treating diseases and health management, the service system has shifted from the program system of health care and health to the synergy and integration of medical and preventive care, and medical insurance payment has shifted from regulating the behavior of doctors′ practice to encouraging the development of health promotion. These health transformations have resulted in a series of experiences that can inform the articulation of the reform of medical and health system with the construction of Healthy China.

The reform of medical insurance payment methods is one of the important measures for Sanming City to achieve universal health. This study explored the design and implementation of DRG payment method under global budget based on the case of Sanming, in order to promote the transformation from disease treatment to health promotion. The transformation practice of Sanming City involved three aspects: concept reshaping, structural reconstruction, and functional reconstruction, which were promoted from the dimensions of goals, paths, and methods, and have achieved significant results. The author proposed three recommendations, including adhering to and improving DRG payments under global budget, attaching importance to medical quality assessment and monitoring, and designing a global budget plus composite payment method that is suitable for various health scenarios.

As a ligand-dependent transcription factor,retinoid-associated orphan receptor γt(RORyt)that controls T helper(Th)17 cell differentiation and interleukin(IL)-17 expression plays a critical role in the pro-gression of several inflammatory and autoimmune conditions.An emerging novel approach to the therapy of these diseases thus involves controlling the transcriptional capacity of RORyt to decrease Th17 cell development and IL-17 production.Several RORyt inhibitors including both antagonists and inverse agonists have been discovered to regulate the transcriptional activity of RORyt by binding to orthosteric-or allosteric-binding sites in the ligand-binding domain.Some of small-molecule inhibitors have entered clinical evaluations.Therefore,in current review,the role of RORyt in Th17 regulation and Th17-related inflammatory and autoimmune diseases was highlighted.Notably,the recently developed RORyt inhibitors were summarized,with an emphasis on their optimization from lead compounds,ef-ficacy,toxicity,mechanisms of action,and clinical trials.The limitations of current development in this area were also discussed to facilitate future research.

Rabdosia serra(R.serra),an important component of Chinese herbal tea,has traditionally been used to treat hepatitis,jaundice,cholecystitis,and colitis.However,the chemical composition of R.serra and its effect against colitis remain unclear.In this study,the chemical composition of the water extract of R.serra was analyzed using ultra performance liquid chromatography coupled with a hybrid linear ion trap quadrupole-orbitrap mass spectrometer(UPLC-LTQ-Orbitrap-MS).A total of 46 compounds,comprising ent-kaurane diterpenoids,flavonoids,phenolic acids,and steroids,were identified in the water extract of R.serra,and the extract could significantly alleviate dextran sulfate sodium salt-induced colitis by improving colon length,upregulating anti-inflammatory factors,downregulating proinflammatory fac-tors,and restoring the balance of T helper 17/T regulatory cells.R.serra also preserved intestinal barrier function by increasing the level of tight junction proteins(zonula occludens 1 and occludin)in mouse colonic tissue.In addition,R.serra modulated the gut microbiota composition by increasing bacterial richness and diversity,increasing the abundance of beneficial bacteria(Muribaculaceae,Bacteroides,Lactobacillus,and Prevotellaceae_UCG-O01),and decreasing the abundance of pathogenic bacteria(Turi-cibacter,Eubacterium_fissicatena_group,and Eubacterium_xylanophilum_group).Gut microbiota depletion by antibiotics further confirmed that R.serra alleviated colitis in a microbiota-dependent manner.Overall,our findings provide chemical and biological evidence for the potential application of R.serra in the management of colitis.

Objective:To investigate the clinical efficacy of membrane induction technique in the treatment of postoperative infection of tibial plateau fractures in adults.Methods:A retrospective case series study was conducted to analyze the clinical data of 21 adult patients with postoperative infection of tibial plateau fractures treated with membrane induction technique from April 2013 to May 2017 in Southwest Hospital of Army Medical University. There were 19 males and two females, aged 19-60 years [(44.1±5.8)years]. There was one patient with type IV fractures, 14 with type V, and 6 with type VI according to the initial fracture typing by Schatzker's classification. There were three patients with infection period of within 3 weeks, 12 of 3-10 weeks, and 6 of over 10 weeks. All patients underwent two-stage operation using membrane induction technique to place cement in the bone defect area. After removal of internal fixation and thorough debridement, antibiotic cement and internal fixation plate were placed at stage I. Bone graft and reconstruction was performed at stage II. The infection indicators were recorded. Infection indices were monitored, including white blood cell count (WBC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Clearance of infection, bony union and complications were evaluated. Range of motion (ROM) and scoring of Hospital for Special Surgery (HSS) were used to evaluate the function of knee joint.Results:All patients were followed up for 12-62 months with an average of 23.5 months. Compared with 3 months after stage II, the indicators of infection at stage I showed that WBC was decreased from (10.6±2.3)×10 9/L to (6.7±3.5)×10 9/L, ESR decreased from (26.0±5.3)mm/h to (12.1±4.3)mm/h, and CRP decreased from (10.0±1.5)mg/L to (5.8±1.0)mg/L ( P<0.05). Infection was cleared in 17 patients after stage I operation, and the other 4 patients had infection recurrence, which were given stage I debridement again to control the infection. Two patients were treated with local flap transfer to cover the wound because of skin soft tissue defect after debridement. Another two patients underwent knee arthrodesis, and none was amputated. X-ray film indicated bony union in 21 patients at 46 months (mean, 4.5 months) after operation, and clinical bone healing was acquired in all 21 patients. One patient showed donor site infection. No nonunion, recurrence of infection after stage II, deep vein thrombosis or pulmonary embolism occured after the second stage. At the latest follow-up, ROM in patients with infection periods within 3 weeks and 3-10 weeks was singnificantly improved from [(95.2±10.4)° and (85.7±11.5)°] to [(120.2±10.5)° and (98.6±12.2)°] ( P<0.01), but not in patients with infection periods of over 10 weeks ( P>0.05). The HSS score in all patients was significantly improved after operation [(65.6±8.2)points vs. (82.0±6.6)points]( P<0.01). Conclusion:For adult patients with tibial plateau fracture, membrane induction technique can effectively control the postoperative infection, achieve clinical bone healing and improve the knee function.

Objective To observe the clinical efficacy of induced membrane technique combined with locking compression plate as an external fixator for the treatment of tibia infected defects.Methods Data of 107 patients with tibia infected defects who were treated by induced membrane technique combined with locking compression plate (LCP) as an external fixator in our department from June 2013 to May 2015 were retrospectively analyzed.Among them,62 cases' LCP were replaced with intramedullary nail during second stage (internal fixation group),while 45 cases kept their LCP (external fixation group).There were 52 males and 10 females in internal fixation group,aged from 18-61 (average,39.6),and their bone defects ranged from 3-17 cm (average,6.93 cm).15 cases were type Ⅲ and 47 cases were type Ⅳ according to Cierny-Mader classification.9 cases were suffered from hematogenous osteomyelitis and 53 cases suffered from trauma.15 cases located in proximal tibia,28 cases in middle tibia and 19 cases in distal tibia.There were 45 cases in external fixation group,aged from 18-65 (average,41.3),and their bone defects ranged from 5-12 cm (average,7.12 cm).13 cases were type Ⅲ and 32 cases were type Ⅳ according to Cierny-Mader classification.6 cases were suffered from hematogenous osteomyelitis and 39 cases suffered from trauma.12 cases located in proximal tibia,19 cases in middle tibia and 14 cases in distal tibia.Results All 107 patients have been successfully followed up for 18-40 months (23.5 in average).There were 20 patients (18.7％) encountered with a second debridement before grafting because of infection recurrence and culture positive was verified in 10 cases.101 cases acquired bone union,including 58 cases in internal fixation group and 43 cases in external fixation group.Average radiographic bone union time was 6.2 and 6.9 months in internal fixation group and external fixation group respectively.Nonuinon was observed in 6 cases (internal fixation group 4 cases,external fixation group 2 cases),with nonuion rate of 6.5％ (4/62) and 4.4％ (2/45).Infection reccurrence was found 3 cases in internal fixation group and 2 cases in external fixation group,with infection reccurence rate of 4.8％ (3/62) and 4.4％ (2/45) respectively.There were 5 cases observed pin track infection and 6 cases with pin track loosening in external fixation group.Conclusion Locking compression plate combined with induced membrane technique in the treatment of tibia infected defects can achieve a good clinical efficacy despite the complication of pin-track loosening and infection,unfavorable to the reconstruction of grafting bone.In internal fixation group,both radiographic bone union and clinical bone union were shorter comparing with external fixation group.So,intramedullary nail is a better choice of induced membrane technique during the second stage.

Objective To investigate the clinical outcome of post-traumatic tibial osteomyelitis treated by induced membrane technique combined with the antibiotic cement-coated locking plate.Methods A restrospective case series analysis was made on 71 cases of post-traumatic tibial osteomyelitis treated by induced membrane technique from September 2014 to September 2014.There were 55 males and 16 females, aged 18-60 years(mean, 37.4 years).Mean length of bone defect following debridement was 4.5 cm(range, 4-11 cm).Antibiotic cement-coated locking plates were used to provide the stability of the bone defects after one-stage debridement.Bone grafting and exchanging the plates with ntramedullary nails were done during the second-stage surgery.Parameters were monitored dynamically after operation to evaluate infection recurrence and bone healing, including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), clinical features(sinus formation, redness and swelling, warmth and pain) and X-ray films of the involved limbs.Results All patients were followed up for 13-25 months (mean, 19.5 months).There was no sign of recurring infection and CRP and ESR were normal in all cases after the first stage surgery.However, four cases (6%) had recurrent infection with sinus exudates and their CRP and ESR were abnormal after the second stage surgery, and further treatments were carried out on these patients.Follow-up showed bony union in all patients within mean 5.5 months (range, 4-6 months).Conclusion Induced membrane technique with antibiotic cement-coated locking plates for treatment of post-traumatic tibial osteomyelitis can shorten bone healing time and decrease infection recurrent rate without obvious impact on osteogenic activity.