[Suitability of Internet Medical Services of Hospitals from the Perspective of Suppliers].

Objective To investigate the suitable services of telemedicine at present and the future from the perspective of medical service supplier,clarify the challenges in the development of telemedicine services at present,and provide evidence-based suggestions for improving the quality of telemedicine services. Methods A questionnaire was developed through literature review for the survey of telemedicine services from the perspective of service providers.From January to June in 2020,electronic questionnaires were collected from volunteers.The data were collated and analyzed by Excel 2010 and SPSS 21.0. Results A total of 614 questionnaires were distributed,and 582 effective questionnaires were collected,which showed an effective rate of 94.79%.The participants of this study were mainly young healthcare workers,including doctors,nurses,technicians,and medical students.Among them,68.73% expressed concern to telemedicine services-related work,and more than 50% only had a basic understanding of the related work.The top five developable telemedicine/healthcare services were health management,online consultation,disease re-examination,disease screening,and difficult disease consultation,which were basically consistent with the services suitable for future development. Conclusions Healthcare workers have a high degree of recognition to the development of telemedicine services,while their understanding of the related technologies remains to be improved.The available telemedicine services focus on online consultation,difficult disease consultation,and disease re-examination,while the complicated medical services need to be improved.In the future,efforts should be made to continuously improve the information construction level and narrow the regional gap of medical services,so as to promote the continuous improvement and the coordinated development of medical services between regions.

[Practice and System Construction of Telemedicine for Coronavirus Disease 2019 Epidemic Prevention and Control].

Telemedicine is one of the five key components of the "Internet Plus Healthcare".Due to its high speed,real-timeness,low cost,and wide spread,telemedicine is highly feasible in the prevention and control of major infectious diseases.This article introduces the practiceof telemedicine in Peking Union Medical College Hospital during the cornavirus disease 2019(COVID-19)epidemic,during which the network resources were applied to break geographical restrictions and resolve communication barriers between hospitals and departments.This article summarizes the telemedicine application before,during and after COVID-19 control and elucidates how to build a telemedicine prevention and control system for infectious diseases,with an attempt to further improve telemedicine and is application in the public health emergency system in China.

Application of diffusion weighted imaging in rectal cancer diagnosis.

Magnetic resonance imaging has became the major method for rectal cancer diagnosis. As a novel magnetic resonance functional imaging technique, diffusion-weighted imaging has improved the lesion detection sensitivity and provided more information on changes in body functions. The past two decades have witnessed the increasing application of this technique in clinical practices. This article summarizes the application of diffusion weighted imaging in rectal cancer diagnosis.

[The diagnosis of Crohn's disease of the small bowel: comparing CT enterography, capsule endoscopy, small-bowel follow through and ileocolonoscopy].

OBJECTIVE: To investigate the diagnostic value of capsule endoscopy (CE), CT enterography (CTE), ileocolonoscopy and small bowel follow through (SBFT) for small bowel Crohn's disease (CD). METHODS: Fifty-seven consecutive patients with CD underwent ileocolonoscopy, CTE, CE, and SBFT. It included the presence of the following symptoms and signs: abdominal pain, weight loss, diarrhea, fever and positive fecal occult blood test. The location and the characteristics of intestinal and extra-intestinal lesions detected by four techniques were compared. The proportions of patients with positive findings using each examination were compared. RESULTS: Of the 57 patients, 50 underwent ileocolonoscopy, terminal ileum lesion was found in 33 patients (66.00%), the remaining 17 (34.0%) were normal; among 34 patients who had CTE, 29 of small bowel lesion were found (85.29%); CE were performed in 27 patients, due to prolonged gastric transit one time, the capsule did not reach the cecum in one patient during battery lifetime. CE showed small bowel lesion in 26 patients (96.30%); SBFT was performed in 39 patients and 26 of small bowel lesion were detected (66.67%). CE had the highest diagnostic yield for CD and ileocolonoscopy had the lowest, and there were statistically significant difference among the 4 examinations (P = 0.006). The combined positive rates of two methods were: CE + CTE 92.86% (13/14), SBFT + CTE 90.91% (20/22), CE + ileocolonoscopy 95.65% (22/23), CE + SBFT 100% (17/17), ileocolonoscopy + CTE 89.66% (26/29), ileocolonoscopy + SBFT 77.78% (28/36), but there were no significant differences between each two examinations. CONCLUSION: CE, CTE have a higher yield in depicting mild to moderate finding of CD than SBFT. CE is better for assessing early mucosal disease, whereas CTE is better for detecting transmural and extraluminal abnormalities. Most important, CE plus CTE may depict nonobstructive CD of the small bowel when conventional techniques such as ileocolonoscopy or SBFT have negative or inconclusive finding. CE provides us explanations for the symptoms of patients, decision to follow up or therapy.

[Non-Hodgkin's lymphoma with diffuse ground-glass opacity on chest CT: a report of 6 cases].

OBJECTIVE: To investigate the clinical, pathological and imaging characteristics, misdiagnosis and treatment of pulmonary non-Hodgkin's lymphoma with diffuse ground-glass opacities (GGO). METHODS: Six cases of pulmonary non-Hodgkin's lymphoma with diffuse GGO on chest CT diagnosed from January 2008 to March 2010 were retrospectively analyzed. RESULTS: There were 5 males and 1 female with average age of 52 years old (range: 30-59). The course had a range of 2-36 months. Most patients presented with dyspnea (n=5) and loss of weight (n=5). Enlargement of superficial lymph nodes (n=2) and hepatosplenomegaly (n=2) were also found. Laboratory tests showed that average hemoglobin decreased to 25 g/L and average serum LDH was 755 U/L. Chest CT showed diffuse GGO (n=2), diffuse GGO with consolidations (n=3), with wide lung septum (n=3), with multiple nodules (n=2), with enlargement of mediastinal lymph nodes (n=2). Diagnosis of the 6 cases were made by lung biopsy. Histological findings including intravascular lymphoma (n=2), diffuse large B cell lymphoma (n=2) and T cell lymphoma (n=2). The average follow-up period was 4 months (range: 2-6). Chemotherapy was administered in 4 patients with B cell lymphoma and all of them improved or remained stable. One patient with T cells lymphoma was lost to follow-up and another patient with T cell lymphoma died due to lung infection. CONCLUSIONS: Non-Hodgkin's lymphoma with diffuse GGO on chest CT scan is rare. And its misdiagnosis is common due to a lack of specific clinical manifestations. And lung biopsy is necessary for an early diagnosis.

Application of computed tomographic colonography in diagnosis of colonic polyps.

OBJECTIVE: To assess the clinical values of computed tomographic colonography (CTC) in diagnosis of colonic polyps. METHODS: Forty-two patients who were clinically suspicious of colonic polyps or underwent colonic polyps screening received examinations with both CTC and conventional colonoscopy. Sixteen- or 64-slice spiral computed tomography and professional imaging processing techniques were used for evaluation. Per-polyp and per-patient results were analyzed. Those by per-polyp were subsequently divided into > or = 10 mm group, 5-10 mm group, and < or =5 mm group. Sensitivity, positive predictive value (PPV), specificity, negative predictive value (NPV), and accuracy were calculated using statistical method for diagnostic studies, with conventional colonoscopy as a gold standard. RESULTS: Ninety and 61 polyps were found by CTC and conventional colonoscopy, respectively. The per-polyp sensitivity/PPV were 80.3%/55.6% in total, and 100%/92.9%, 93.8%/65.2%, and 68.8%/ 41.5% in the > or = 10 mm group, 5-10 mm group, and < or =5 mm group, respectively. The per-patient sensitivity, PPV, specificity, NPV, and accuracy were 97.1%, 89.5%, 42.9%, 75.0%, and 88.1%, respectively. CONCLUSION: CTC can clearly reveal the morphology of colonic polyps and be used as a routine monitoring method for the clinical diagnosis of polyps.

[Value of computed tomographic colonography in analyzing mechanism of defecation in healthy subjects].

OBJECTIVE: To establish the methodology of 3-dimensional CT reconstruction of colon and rectum in evaluating anorectum and pelvic floor function. METHODS: 19 healthy volunteers, 8 males and 11 females, aged 42.8, received both defecography and 3-dimensional CT reconstruction of colon and rectum. Relevant parameters were compared between the two methods. RESULTS: (1) CT reconstruction showed that the average value of anorectal angle (ARA) was (101 +/- 13) degrees when resting, (83 +/- 12) degrees when squeezing, and (124 +/- 13) degrees when defecating;the average values of the distance between the upper part of anal canal and the pubococcygeal line (DUAC) was (10 +/- 6) mm when resting, -2(-8 - 3) mm when squeezing, and (27 +/- 11) mm when defecating; and the average value of the anal canal length (ACL) was (29 +/- 7) mm when resting, (39 +/- 8) mm when squeezing, and (22 +/- 5) mm when defecating. The change trends of ARA, DUAC, and ACL during squeezing and defecating in CT reconstruction were the same as those in defecography. (2) No significant differences were found in ARA and ACL measured by the two methods; but the DUAC values measured by defecography when resting, squeezing, and defecating were (31 +/- 11)mm, 18(-1 - 26) mm, and (50 +/- 12) mm respectively, all significantly longer those measured by CT reconstruction (all P < 0.01). (3) During defecation, the value changes of ARA was not significantly correlated between these 2 methods (r = 0.315, 0.361, both P > 0.05). CONCLUSION: 3-dimensional CT reconstruction of colon and rectum is helpful in evaluation of anorectum and pelvic floor function.

[Diagnostic value of CT enterography in patients with Crohn's disease].

OBJECTIVE: To assess the diagnostic value of CT enterography in patients with Crohn's disease. METHODS: Multi-detector CT enterography and small bowel follow-through were performed in 30 patients with Crohn's disease. The locations and characteristics of the intestinal and extra-intestinal lesions detected by both two techniques were compared. RESULTS: Skip lesions were diagnosed in 16 patients (53.3%) by CT enterography and in 9 patients (30%) by small bowel follow-through (P = 0.039). Mucosal changes were detected in 29 patients (96.7%) by CT enterography and in 18 patients (60%) by small bowel follow-through (P = 0.001). Among 11 patients whose small bowel follow-through did not show abnormal mucosal changes, 8 patients underwent endoscopy, which showed superficial ulcer with or without mucosal congestion and edema in 5 patients, mucosal congestion and edema in 2 patients, and mucosal erosion in 1 patient. CT enterography and small bowel follow-through consistently depicted fistula in 3 patients and had no significant difference in diagnosing intestinal stenosis. CT enterography also exclusively detected abdominal abscess in one patient. CONCLUSIONS: CT enterography is superior to small bowel follow-through in diagnosing the disease location and characteristics of Crohn's disease; furthermore, it can detect more extra-intestinal lesions. CT enterography has potential to replace small bowel follow-through as the imaging examination of choice for patients with Crohn's disease.

[Diffusion weighted imaging combined with magnetic resonance conventional sequences for the diagnosis of rectal cancer].

OBJECTIVE: To evaluate the clinical value of diffusion weighted imaging (DWI) combined with conventional sequences of magnetic resonance imaging (T1 and T2-weighted imaging) for the diagnosis of rectal cancer. METHODS: DWI and conventional sequences were performed in 29 patients with endoscopically diagnosed rectal cancer and 15 patients without rectal cancer. Two doctors who were blind to the history of the patients interpreted the imaging findings. The sensitivity and specificity of conventional sequences with and without DWI were analyzed using receiver operating characteristic curve (ROC). RESULTS: The areas under ROC were 0.915 and 0.930 for conventional sequences alone, and 0.990 and 0.994 for conventional sequences with DWI, respectively, indicating that although both of them were optimal methods for the diagnosis of rectal cancer, the accuracy of conventional sequences with DWI was significantly superior to that of conventional sequence alone (P < 0.05). The Kappa value was 0.850 for conventional sequences alone and 0.858 for DWI with conventional sequences. CONCLUSION: DWI was necessary for the diagnosis of rectal cancer when performing conventional sequences.

[Computed tomography appearance of pseudomyxoma peritonei].

OBJECTIVE: To study the characteristics of computed tomography (CT) appearance in pseudomyxoma peritonei. METHODS: CT findings were retrospectively reviewed in 7 patients with surgically and pathologically confirmed pseudomyxoma peritonei. RESULTS: All patients had large-volume ascites with heterogeneous density, hepatic and splenic scallopings, and peritoneal and omental infiltration on CT. Omental cakes in 3 patients and appendiceal masses in 2 patients were found. Other findings included calcification, septa, mucinous masses, pleural effusion, and ureteral dilation. CONCLUSION: CT appearance in pseudomyxoma peritonei has certain characteristics, which should be carefully recognized by radiologists during examinations.

[Imaging features of autoimmune pancreatitis].

OBJECTIVE: To explore the clinical, pathological, and imaging features of autoimmune pancreatitis (AlP). METHODS: The clinical data of 10 patients (all men; aged 47-80 years, mean 61.3 years) with AlP in our hospital between March 2000 and August 2007 were retrospectively analyzed. gamma-globulin, immunoglobulin C (IgG), rheumatoid factors, and autoantibodies were examined for all cases. The imaging findings were reviewed, which included helical computed tomography (CT), endoscopic ultrasonography (EUS), and B-mode ultrasound in all patients, magnetic resonance cholangiopancreatography (MRCP) in 9 patients, and endoscopic retrograde cholangiopancreatography (ERCP) in 7 patients. Follow-up imaging results were available in 5 patients. RESULTS: Clinically, the most common early symptoms included obstructive jaundice (9/10) and non-specific abdominal pain (1/10), accompanied by the elevated levels of serum gamma-globulin, IgG or the presence of autoantibodies. Diabetes mellitus was detected at presentation in 2 patients. imaging findings included: CT showed diffuse (n=9) and focal (n=1) enlargement of pancreas. Minimal peripancreatic stranding was found in 7 patients, with no pancreatic pseudocyst and calcification. Six patients had enlarged peripancreatic lymph nodes. After contrast injection for 4 patients, delayed enhancement of the pancreatic parenchyma was observed, along with low-density capsule-like rim surrounding the pancreas. Magnetic resonance imaging showed diffuse enlargement of pancreas in 9 patients. MRCP showed diffuse (n=6) and segmental (n=3) irregular narrowing of the main pancreatic duct. B-mode ultrasound showed diffuse (n=9) and focal (n=1) enlargement of the pancreas. EUS showed diffuse (n=9) and focal (n=1) enlargement with hypoecho. ERCP showed stricture of distal common bile duct and irregular dilation of proximal bile ducts in 7 patients, diffuse stricture in main pancreatic duct in 4 patients, and segmental stricture in 3 patients. During the follow-up, abnormalities of imaging and serum markers were resolved after steroid therapy in 5 patients. CONCLUSION: AIP is a distinctive type of chronic pancreatitis that shows specific imaging features.

[Application of CT colonography in diagnosis of colonic polyps].

OBJECTIVE: To assess the clinical values of CT colonography (CTC) in the diagnosis of colonic polyps. METHODS: Forty-two patients who were clinically suspicious of colonic polyps or underwent colonic polyps screening received both CTC and conventional colonoscopy. Sixteen or 64-slice spiral CT and professional imaging processing techniques were used for evaluation. Per-polyp and per-patient results were analyzed. Those by per-polyp were subsequently divided into > or = 10 mm group, 5-10 mm group, and < or = 5 mm group. Sensitivity, positive predictive value (PPV), specificity, negative predictive value (NPV), and accuracy were calculated using statistical method for diagnostic studies, with conventional colonoscopy as a gold standard. RESULTS: Ninety and 61 polyps were found by CTC and conventional colonoscopy, respectively. Sensitivity and PPV were 80.3%/55.6% by per-polyp and 100%/92.9%, 93.8%/65.2%, and 68.8%/ 41.5% in the > or = 10 mm group, 5-10 mm group, and < or = 5 mm group, respectively. Sensitivity, PPV, specificity, NPV, and accuracy by per-patient were 97.1%, 89.5%, 42.9%, 75.0%, and 88.1%, respectively. CONCLUSION: CTC can clearly reveal the morphology of colonic polyps and can be used as a routine monitoring method for the clinical diagnosis of polyps.

Using of multislice helical CT colonography in patients with malignant lesions of colon.

OBJECTIVE: To investigate the techniques and clinical applications of multislice helical computed tomography (CT) colonography in colonic lesions. METHODS: Fifty-nine patients with malignant lesions of colon underwent volume scanning using multislice helical CT. Four types of reconstruction including CT virtual colonoscopy (CTVC), shaded surface display (SSD), Raysum, and multiple planar reconstruction (MPR) were used for image post-processing. The results were compared with those of colonoscopy and pathology. RESULTS: Multislice helical CT colonography detected 54 colorectal carcinomas, 4 adenomas with focal carcinoma, 1 non-Hodgkin's lymphoma (NHL). The lesions' number, size, location, morphology, stricture of intestinal cavity, infiltration, and metastasis were shown satisfactorily by multislice helical CT colonography. Whole colon could be shown in all patients. CT colonography displayed 4 synchronous colonic tumors, 1 ascending colon carcinoma combined with left renal carcinoma among 54 patients with colonic carcinomas. The accuracy of location of CT colonography was 100%. There were 9 cases that CT showed the tumor location was different from the finding of conventional colonoscopy, while all of the CT location were proven exact by operation. CT colonography also displayed the infiltration of serous layer and fatty tissue in 45 cases; 21 cases matched the pathological results in all the 24 cases of suspicious lymph node metastasis, the sensitivity was 87.5%, the specificity was 90.6%; 9 cases hepatic metastasis, 2 ovarian metastasis, and 1 double adrenal gland metastasis. CONCLUSIONS: Multislice helical CT colonography is effective in preoperative diagnosis, location, stage, and making treatment plan of colorectal carcinoma. It can display the portion not seen during colonoscopy and may have an adjunctive role.

[Clinical, pathological and radiological characters of appendiceal mucocele].

OBJECTIVE: To improve capability of appendiceal mucocele diagnosis via analyzes its clinical, pathological basis and radiological results. METHODS: Summarize 18 cases with pathological diagnosed appendiceal mucocele in PUMC Hospital since January 1985 till september 2004, including 4 males and 14 females (1:3.5), age ranged from 31 to 78 yrs old (average 59.8 years old). Eleven cases underwent barium enema, in which 9 cases received abdominal CT scanning and 1 case received CT virtual colonography. RESULTS: (1) CLINICAL RESULTS: 8 cases (44.4%) had right lower abdominal pain, 12 cases (66.7%) had palpable abdominal mass. (2) Radiological results: barium enema showed extrinsic oppressed filling defect at the end of cecum without destruction of mucosa; CT scanning showed right lower abdominal cystic mass, 75% with cystic wall calcification, massive septal mucous ascites was seen in one case with pseudomyxoma peritonei; CT virtual colonography showed clearly the extra cavity and intracavity changes at cecum. (3) Pathological results: simple mucocele (4 cases, 22.2%), mucous cystadenoma (12 cases, 66.7%) and mucous cystadenocarcinoma (2 cases, 11.1%) CONCLUSION: There are four pathological types in appendiceal mucocele. Radiological characters of appendiceal mucocele have distinct specificities while its clinical ones not. Radiological procedures are vital for correct clinical diagnosis.

[Effect of age on the precision of dual X-ray absorptiometry measurement in middle-aged and elderly women].

OBJECTIVE: To investigate whether age influence the precision of dual X-ray absorptiometry (DXA) measurement at the hip in middle-aged and elderly women. METHODS: Totally 90 women were randomly selected and divided into three age groups: 45-55 years, 56-65 years, and 66-75 years. Each age group contained 30 women. Each woman was scanned twice at the same day. Bone mineral density (BMD) values of femoral neck, ward's triangle, and trochanter were collected and grouped by calculating the root mean square (RMS). Precision errors were expressed as RMS (standard deviation, SD). RESULTS: For the femoral neck and trochanter, significant differences of SD of BMD existed among all age groups. For the ward's triangle, significant difference of BMD existed among all age groups except between the 45-55 group and 56-65 age group. CONCLUSION: Age can influence the precision of DXA measurement at the hip in middle-aged and elderly women.

[Bone mineral and body composition analysis of whole body in 292 normal subjects assessed by dual X-ray absorptiometry].

OBJECTIVE: To understand whole body bone mineral and body composition changes in normal subjects, and study the relationship between body composition and bone mineral. METHODS: 292 normal subjects aged 10-79 years old, including 140 males and 152 females, were selected to be measured bone mineral content (BMC), bone mineral density (BMD) lean and fat of whole body by dual X-ray absorptiometry (DXA). Individuals were divided into age-groups by every ten years and were analyzed by statistical methods. RESULTS: In males, peak values of BMC, BMD, lean and fat were in the 30-39, 20-39, 30-39, 70-79 age-groups. In females, they were in the 30-39, 30-39, 30-49, 50-69 age-groups respectively. Peak values of BMC, BMD and lean were higher in males than that in females, but peak value of BMD was not significantly higher in males than that in females. Peak value of fat was higher in females than that in males. Loss of BMC and BMD for females were more pronounced than that for males. Loss of lean for males was more pronounced than that for females. There are significant positive correlation between lean, weight and bone mineral in males and females. Fat has significant effect on BMC in females only. CONCLUSIONS: The normal bone mineral and body composition data of whole body for males and females, and the characteristic of changes with aging are provided for analyzing the relationship between bone mineral and body composition with ease.

[Techniques and clinical applications of 16 multislice helical CT in colonic diseases].

OBJECTIVE: To evaluate the techniques and clinical applications of 16 multislice helical CT in colonic lesions. METHODS: Eighty-one patients including 54 colorectal carcinomas, 5 adenomas, 1 non-Hodgkin's lymphoma, 6 inflammatory bowel diseases, and other 15 cases underwent volume scanning using 16 multislice helical CT. Four types of reconstruction included multiple planar reconstruction, shaded surface display, raysum, and CT virtual colonoscopy. RESULTS: Complete colon could be shown in all patients. The lesions' morphology, number, size, location, intestinal cavity, pericolonic changes, and other abdominal organs were satisfactorily shown by CT. CONCLUSIONS: Sixteen multislice helical CT colonography is a valuable imaging technique for detecting colonic diseases. It is effective in diagnosis and treatment planning. It can display the portions of colon that is inaccessible at colonoscopy.

CD4+ and CD8+ T lymphocytes in lung tissue of NSIP: correlation with T lymphocytes in BALF.

BACKGROUND: Nonspecific interstitial pneumonia (NSIP) is characterized by the interstitial infiltration T lymphocytes (TLs). Bronchoalveolar lavage fluid (BALF) has been used to analyze the inflammatory cells infiltrating in lung. The controversy about whether the BALF cellular profile reflects T lymphocytes in lung tissue still persists. Some studies found a positive correlation of cell composition between BALF and lung tissue, but others gave opposite conclusion. OBJECTIVE: To investigate CD4+ and CD8+ T lymphocytes distribution in lung tissue of NSIP and the relationship with T lymphocytes in bronchoalveolar lavage. METHODS: Thirty-seven patients diagnosed as NSIP were included. The pathological and BALF date were reviewed. The characteristics of TLs infiltration in different lung regions were investigated. RESULTS: The study included 28 women. The median age was 48 years. In lung tissue, CD4+ and CD8+ lymphocytes (counts/0.1mm2) were separately accounted in lymphoid follicle region (156.51 ± 90.70 vs 85.30 ± 43.75), small blood vessel region (66.58 ± 31.99 vs 58.43 ± 30.24), interstitial region (37.60 ± 19.40 vs 47.12 ± 33.42) and small airway region (26.59 ± 17.04 vs 40.18 ± 34.02). CD4+/CD8+ ratios in lymphoid follicle and small vessel > 1, in interstitium and small airway <1. The number of CD8+ lymphocytes in BALF was correlated with CD8+ lymphocytes around small airway (r = 0.360, p = 0.029) and in interstitial region (r = 0.451, p = 0.005). CD4+/CD8+ ratio in BALF was correlated with that in small airway region (r = 0.437, p = 0.007) and interstitial region (r = 0.468, p = 0.003). CONCLUSIONS: In NSIP, T lymphocytes were distributed in different regions of lung tissue. The CD8+ T lymphocytes and CD4+/CD8+ ratio in BALF reflect those in interstitium regions and around small airway of the lung.