Due to the particularity of their disease and medical habits,cancer patients need to make regular appointments with treatment experts for follow-up visits and monitor disease progression,which can easily lead to a shortage of resources in famous experts' offline clinics.The rise of Internet diagnosis and treatment has realized the reasonable diversion of patients and improved the convenience and timeliness of medical services.In recent years,Cancer Hospital Chinese Academy of Medical Sciences has achieved good results by establishing the outpatient mode of"Internet+famous expert team",integrating the advantages of both,releasing offline space.It introduces the construction ideas,main methods,and achievements of this model,aiming to further improve the outpatient system,and provide references for improving patients experience.

Due to the particularity of their disease and medical habits,cancer patients need to make regular appointments with treatment experts for follow-up visits and monitor disease progression,which can easily lead to a shortage of resources in famous experts' offline clinics.The rise of Internet diagnosis and treatment has realized the reasonable diversion of patients and improved the convenience and timeliness of medical services.In recent years,Cancer Hospital Chinese Academy of Medical Sciences has achieved good results by establishing the outpatient mode of"Internet+famous expert team",integrating the advantages of both,releasing offline space.It introduces the construction ideas,main methods,and achievements of this model,aiming to further improve the outpatient system,and provide references for improving patients experience.

Objective To investigate the risk factors of femoral head necrosis after internal fixation of fem-oral neck fracture,and to clarify the predictive role of serological index plasminogen activator inhibitors-1(PAI-1)on femoral head necrosis.Methods A total of 95 patients undergoing internal fixation for femoral neck fracture were included in the study.Relevant clinical information of patients was obtained and the serum PAI-1 levels of the patients before surgery,1,2,and 3 days after surgery were detected.After 1-year follow-up,patients were divided into necrosis group and non-necrosis group according to the occurrence of femoral head necrosis.Visual Analog Scale(VAS),Western Ontario McMaster University Osteoarthritis Index(WOMAC),and Harris Hip Score(HHS)were conducted in all patients one year after the surgery.The differences of basic clinical information and serum PAI-1 levels before and after the surgery between necrosis group and non-necrosis group were compared,and Logistic regression analysis was performed to identify the relevant risk factors for femoral head necrosis.The relationships between the PAI-1 level after operation and the VAS,WOMAC,and HHS scores of patients were figured out.The receiver operating characteristic(ROC)curve of serum PAI-1 as a predictive indicator for femoral head necrosis was drawn to clarify its predictive val-ue.Results Garden classification and reduction quality between the necrosis group and the non-necrosis group were risk factors for femoral head necrosis(P＜0.05).The serum PAI-1 at 1 day and 2 days after surgery in the necrosis group were significantly higher than that in the non-necrosis group(P＜0.05).The level of PAI-1 at 1 day and 2 days after surgery was positively correlated with VAS and WOMAC(P＜0.05),and negative-ly correlated with HHS(P＜0.05).Logistic regression analysis showed that the increase of serum PAI-1 level at 1 day and 2 days after surgery were risk factors for femoral head necrosis(P＜0.05).The ROC curve showed that serum PAI-1 level at 2 days after surgery had higher predictive value than that at 1 day after sur-gery,and the cut-off value was 44.8 ng/L,the sensitivity was 68.49％,the specificity was 86.36％,and the ar-ea under the curve(AUC)was 0.807.Conclusion The serum PAI-1 level at 1 day and 2 days after internal fixation of femoral neck fracture could be used to predict the occurrence of femoral head necrosis,especially the serum PAI-1 levels at 2 days after surgery.

Objective: To investigate the effect of isosorbide mononitrate (ISMN) targeted nanoparticles on inflammatory factors of sinusitis by establishing a rabbit model of rhinosinusitis. Methods: Thirty healthy rabbits, male and female, weighing 2.5-3.5 kg, were randomly divided into 6 groups with 5 rabbits in each group. Group A was the control group. The model of rabbit sinusitis was established in group B to F, and CT was used to confirm the model was successful. After placing tubes into the maxillary sinus in the group C to F, saline, 45 mg/ml ISMN, 45 mg/ml ISMN nanoparticles and 45 mg/ml ISMN targeted nanoparticles were used to wash the maxillary sinus, respectively. Blood samples were collected from the ear vein of rabbits on day 7, 14, 21, 28, 35 and 42 after modeling respectively. Changes in the expression levels of inflammatory factors in rabbits during the modeling process and after drug washing were detected by ELISA. After the drug intervention, the maxillary sinus mucosa was taken for real-time quantitative PCR to detect the changes in the mRNA level of inflammatory factors. SPSS 22.0 software was used to process the data. Results: Rabbit model of sinusitis was successfully established. ELISA showed that after the action of ISMN targeted nanoparticles of 1 week (42th day after modeling), the levels of (interleukin, IL) 4, IL-8, IL-17A and interferon γ (IFN-γ) in the blood were lower compared with that of 35th day after modeling, the difference was statistically significant (5.57±1.20 vs 19.73±0.68, 66.41±11.87 vs 154.68±13.13, 17.96±1.87 vs 28.23±0.80, 53.56±5.66 vs 111.93±7.29, all P<0.05). Compared with the ISMN nanoparticles and ISMN, the ISMN targeted nanoparticles reduced the levels of IL-4, IL-8, IL-17A and IFN-γ more obviously, the differences were statistically significant (13.26±1.43 vs 8.81±1.33 vs 7.14±2.16, 89.47±17.80 vs 41.07±7.77 vs 15.84±3.72, 10.28±2.07 vs 3.06±1.62 vs 1.82±0.90, 62.16±6.18 vs 35.12±4.62 vs 27.89±10.18, all P<0.05). Real-Time PCR showed that after the flushing of ISMN targeted nanoparticles, the levels of IL-4, IL-8, IL-17A and IFN-γ mRNA were lowest compared with that of the model group, ISMN nanoparticles and ISMN group. Conclusion ISMN targeted nanoparticles can reduce the level of inflammatory factors in rabbit sinusitis model.

Objective: To make three-dimensional prototyped models of nasal cavities and paranasal sinuses for endoscopic skills training and teaching and to verify and evaluate the fidelity of the models. Methods: Imaging data of a patient with nasal septum deviation was selected for prototyping the nasal cavities model, and the imaging data of a patient with chronic rhinosinusitis who underwent the endoscopic sinus surgery 4 months ago was selected for the paranasal sinuses model. Both patients came from the Department of Rhinology, the First Affiliated Hospital of Zhengzhou University. The models were printed by the desktop-level printer based on the fused deposition modeling (FDM). The evaluations of anatomical structures and prespecified tasks on the simulators were completed by 5 residents and 5 experts of Rhinology.The models were evaluated by survey ratings based on a 5-point Likert scale. The average time to complete each task was calculated.Mann-Whitney nonparametric test was used to assess the differences between experts and residents groups. The statistical significance level was set at P<0.05. Results: All the components of the two models were prototyped in 24 h. For the nasal cavities model, the scores of each anatomical structure were more than 4.0. As to the paranasal sinuses model, except for the frontal sinus (3.6), the scores of each anatomical structure were more than 4.0. All the participants who performed the prespecified tasks evaluated the models well (>4.0). With the nasal cavity simulator, the experts completed the tasks (nasal cavity and nasopharyngeal endoscopy, removal of nasal foreign body, nasal packing, pledget insertion), and the other tasks (the nasal cavity and nasopharyngeal endoscopy, identification of ostiums of paranasal sinuses, maxillary sinus debridement with 70° nasal endoscopy) were completed with paranasal sinus model. The average time to complete each task by experts group and residents group (M (P₂₅, P₇₅)) were 10.3 (10.0, 10.7) s vs 17.1 (14.6, 20.7) s, 2.1 (2.0, 2.2) s vs 3.4 (2.6, 4.7) s, 30.1 (27.8, 32.8) s vs 59.2 (52.0, 65.4) s, 54.8 (50.1, 63.2) s vs 92.2 (79.3, 106.9) s, 9.3 (8.7, 9.9) s vs 14.5 (13.3, 14.9) s, 20.1 (19.3, 21.2) s vs 41.9 (35.5, 45.1) s, 31.1 (28.8, 35.2) s vs 52.8 (47.7, 56.3) s, respectively, and the average time to complete each task was shorter for the experts group than for the residents (U value was 0, 1.000, 0, 0, 0, 0, 0, respectively, all P<0.05). Conclusion The models of nasal cavities and paranasal sinuses made by our desktop-level FDM 3D-printer are useful for endoscopic training skills.

False and negative information has brought forth serious impacts on doctor-patient relationship in the new media era as a result of “Broken window effect”and “Butterfly effect”.The underlying reasons are herd mentality,the public’s need to vent their discontent,the subjectivity of information distribution on the Internet and lack of proper supervision and punishment mechanism.Medical Institutions should pay special attention to the new media,leveraging it to improve doctor-patient relationship by making official voice,guiding public opinion,solving problems,and providing comfortable social environment and rational public opinion environment on the Internet.

Objective To evaluate the efficacy of a new pelvic muscle gymnastic exercise in the treatment of stress urinary incontinence (SUI).Methods Prospectively,we randomly recruited 60 cases with mild and moderate SUI.We use ICI-Q-SF,pad Test and urodynamics to assess the degree of incontinence,volume of leakage,maximum urethral pressure and functional urethral length before and after intervention.Results The ICI-Q-SF score,volume of leakage,maximum urethral closure pressure and functional urethral length in study group before treatment were 11.6 ±4.2,(5.9 ±2.2) ml,(39.4 ± 12.5) cm H2O and (2.5 ±1.2) cm.The indicators in control group were 10.3 ±2.2,(5.8 ±1.3) ml,(41.3 ±8.9) cm H2O and (2.1 ± 0.5) cm respectively.There was no significant difference between the 2 groups (P ＞ 0.05).The ICI-Q-SF score,volune of leakage and maximum urethral closure pressure in study group after treatment were 7.7 ± 2.7,(1.8 ± 1.2) ml and (65.9 ± 8.9) cm H2O,which were significantly improved than the values of10.1 ±2.1,(5.7 ± 1.1) ml and (44.6 ±9.5) cm H2O in control group (P ＜0.05).Conclusions The new pelvic muscle exercise may play an important role in the treatment of mild and moderate SUI.Therefore,it could be recommended to the patients with mild and moderate SUI.