The paper tells how the authors' hospital managed under the circumstances of fierce competition in the medical market to integrate the idea of a marketing chain with medical service, construct a quality and efficient marketing chain for medical service, constantly readjust each part and element of the “chain management” of technical items and service manner, and realize multi layer and multi dimensional network management. The hospital also established a “chain management” framework characterized by “compliance with market laws, customers highest and delivery of quality service”. Setting on itself such high demands as “highest speed, best quality, lowest cost and optimal service”, the hospital did its best to create a strong marketing chain for medical service products, thus providing theoretical basis and practical reform experience for the marketing of medical service products.

Objective To evaluate the factors in relation to prognosis of severe diarrhea associated with hypernatremia in children.Methods The medical records of severe diarrhea and hypernatremia admitted to pediatric intensive care unit(PICU) from January 2000 to December 2004 reviewed retrospectively.The relationship between prognosis and serum sodium peak level,severity of diseases,treatment strategies were analyzed in 63 children with severe diarrhea associated with hypernatremia.Results There were 169 severe diarrhea and 85 hypernatremia cases during the study period.In the 169 severe diarrhea children,63 were associated with hypernatremia(37.28%) and accounted for 74.12% of all 85 hypernatremia cases admitted to our PICU.The mean pediatric critical illness score(PCIS) was(75.50?6.83) score in survival group and(60.75?5.34) score in mortality group,with significant statistical difference((t=)5.86 P0.05).All the children were cured when the reduction rate of serum sodium concentration was between 0.5-1.0 mmol/(L?h).Signs of cerebral edema developed in 8 children and 5 of 8 died when the reduction rate of serum sodium concentration was between 1.2-2.4 mmol/(L?h).Conclusions Severe diarrhea associated with hypernatremia is common in children and is the major cause of hypernatremia in critically ill child.The key to determine the prognosis of severe diarrhea with hypernatremia in children is the severity of disease and the strategies of treatment.

Objective To evaluate the value of dynamic contrast-enhanced MRI (DCE-MRI)in the assessment of cervical cancer with different features.Methods A cohort study of 1 56 cervical cancer patients underwent routine MRI and DCE-MRI scanning on 3.0T MR unit.The semi-quantitative parameters from time-signal curve of DCE-MRI were divided into the following groups:1 ) squamous carcinoma and adenocarcinoma.2)different pathologic grades of cervical cancer (G1,G2,G3).3)early stage (FIGOⅠb/Ⅱa)tumor and advanced tumor (FIGOⅡb,Ⅲ and Ⅳ).4)cervical cancer with different lymph node status (no/yes).5)cervical cancer with dif-ferent tumor size (greatest diameter <2 cm,2-4 cm,>4 cm).6)cervical cancer with different age range.Statistical analysis was performed with the data analysis program SPSS and R3.1.1.Results There was a statistically significant difference between the squamous carcinoma and adenocarcinoma in the SI30s% and Slope,as well as between the tumor FIGO early and advanced stage in TTP and Slope.There was no significant difference among other groups.Conclusion The semi-quantitative parameters from time-signal curve of DCE-MRI can be used to differentiate histologic type and FIGO early/advanced stage of cervical cancer.The diagnostic accuracy may be high for Slope for histologic type differentiation,and the diagnostic accuracy is equal for TTP and Slope in differenti-ation of FIGO early and advanced stage of cervical cancer.

Objective To compare the safety of agomelatine and selective serotonin reuptake inhibitors (SSRIs) in the treatment of depression.Methods Retrieved literatures in the database at home and abroad from the built of the databases to March in 2016.The databases included Pubmed,Cochrance library,CNKI,Wanfang database and VIP database.Two researchers selected literatures,evaluated quality and extracted data independeatly.5.3.5 RevMan software was used to analyze.Result 87 literatures were retrieved,and nine English literatures and two Chinese literatures were included.Agomelatine had a lower risk than paroxetine in insomnia (RR:0.40,95％ CI:[0.17,0.92],P=0.03) and sexual dysfunction (RR:0.13,95％ CI:[0.04,0.39],P=0.0003),than fluoxetine(RR:0.68,95％ CI:[0.48,0.96],P=0.03) and paroxetine(RR:0.37,95％ CI:[0.25,0.55],P＜0.01) in nausea and vomiting,and than escitalopram in sweating(RR:0.34,95％ CI:[0.13,0.85],P=0.02) and headaches(RR:0.63,95％ CI:[0.43,0.91],P=0.01).The difference of them was statistically significant.Agomelatine had a higher risk than sertraline (RR:4.65,95％ CI:[1.02,21.16],P=0.05) in drowsiness,and than escitalopram in constipation (RR:3.46,95％ CI:[1.16,10.36],P=0.03),the difference was statistically significant too.Compared agomelatine and SSRIs,the occurrence risk of dry mouth and diarrhea were no significant difference.Conclusion Both agomelatine and selective serotonin reuptake inhibitors (SSRIs) had its pros and cons in terms of safety.Safety of agomelatine is better than paroxetine.Agomelatine and escitalopram had its own advantages and disadvantages respectively in safety.The evidence of the safety among agomelatine,fluoxetine and sertraline need further explore.

Arterio-Arterial Fistula ; complications ; Coronary Aneurysm ; complications ; Heart Ventricles ; Humans ; Male ; Middle Aged

Objective To explore the association between genetic polymorphism of a disintegrin and metalloprotease 19 (ADAM19) and chronic obstructive pulmonary disease (COPD).Methods Totally 116 patients with COPD (the COPD group) and 82 healthy volunteers (the control group) were enrolled in this study.Fasting peripheral blood was taken and whole blood corpuscle genomic DNA was extracted.The genetic polymorphism of ADAM19 (rs1422795) was determined by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP).Results The difference in genotypes frequencies (GG,AG,AA) distribution of the ADAM19 between patients (73.3％,22.4％,and 4.3％) and controls (68.3％,28.0％,and 3.7％) showed no statistically significance (x2 =0.887,P=0.634).There were also no significant differences in the distribution of the different allele gene frequencies(A,G) between patients (84.5％,15.5％) and controls(82.3％,17.7％)(x2=0.582,P=0.446).No differences were found in the distribution of the genotypes between patients of different COPD severity classified according to FEV1 (％ pred),and healthy controls(x2=3.325,P=0.787).Conclusions ADAM19 (rs1422795) genetic polymorphism is not related to the development of COPD,which may not be the COPD-related gene.

Adult ; Dimethylformamide ; poisoning ; Female ; Humans ; Occupational Exposure ; Young Adult

The aim of this study was to look for the chemical constituents from the rhizomes of Dryopteris sublaeta. The fresh plant was extracted twice with boiling water, the extract was concentrated to small volume under reduced pressure at 50 ℃. The concentrated material was partitioned with ether, ethyl acetate and n-butanol. The fraction of ethyl acetate was repeatedly chromatographied over silica gel and Sephadex LH-20 columns. Structures of pure compounds were established on the basis of their physiochemical and spectral data. Nine compounds were obtained and identified as sublaetentin A (1), sublaetentin B (2), sublaetentin C (3), sublaetentin D (4), matteuorienate A (5), matteuorienate C (6), arbutin (7), 3-methoxy-4-hydroxyphenyl-1-O-β-D-glucopyranoside (8) and 3,4-dimethoxyphenyl-1-O-β-D-glucopyranoside (9). Compounds 1-4 are new compounds, the others were isolated from this plant for the first time.