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.

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.

To study the chemical constituents from the leaves of Celastrus gemmatus Loes., chromatographic methods were used to isolate and purify the chemical constituents, their structures were elucidated by the physiochemical characteristics and spectral data. Nine compounds were obtained and identified as (-)-massoniresinol 3a-O-β-D-glucopyranoside (1), ambrosidine (2), isolariciresinol 9-O-β-D-glucopyranoside (3), kaempferol 3-O-β-D-glucopyranoside(astragalin) (4), kaempferol 3-O-rutinoside (5), kaempferol 3-O-neohesperidoside (6), apigenin 7-O-β-D-glucuronide (7), apigenin 7-O-β-D-glucuronide methyl ester (8) and D-sorbitol (9). Compound 1 is a new compound, the others are isolated from this genus for the first time, and this is the first time to report lignan compounds from genus Celastrus.

BACKGROUND: Free radicals are produced during ischemia, which can strengthen activity of lipid peroxidation; induce lesion of cell and cellular barrier, result in necrosis or apoptosis of neurons; and aggravate edema of ischemic cerebral tissue.OBJECTIVE: To observe the effects of polydatin (PD) on free radicals, lipid peroxidation, water contents and pathological morphology of brain tissue in rats with focal cerebral ischemia so as to explore its protective mechanisms.DESIGN: A randomized controlled trial.SETTING: Intensive Care Unit, Second Affiliated Hospital, Chongqing University of Medical Sciences; Pediatric Research Institute, Children's Hospital Chongqing University of Medical Sciences.MATERIALS: The experiment was carried out at the Pediatrics Medicine Institute of Chongqing Medical University from October 2001 to July 2002.Totally 48 healthy adult male Wistar rats were divided into 3 groups randomly,with 16 in each group. Group Ⅰ was sham-operated group: rats were anaesthetized, the right common carotid arteries were separated instead of being occluded. Group Ⅱ was ischemia group: to establish the right middle cerebral artery occlusion model of rats. Group Ⅲ was PD pretreatment group: polydatin (6 g/L, 12 mg/kg) were intravenously administrated 30 minutes before the onset of ischemia. Saline substituted for PD, besides, were intravenously administrated with the same way and dosage on Group Ⅰ, Group Ⅱ and Group Ⅲ.The rats were decapitated and the brains were immediately removed after cerebral ischemia 2 hours. In each group, 8 rats were chosen to be determined water contents of brain tissue, the other 8 rats were chosen to be determined levels of lipid peroxidation and free radicals in brain tissue.METHODS: According to the formula which was: wet weight-dry weight/wet weight×100%, water content of cerebral tissue was assayed. Superior liquid was taken to assay MDA with spectrophotometer thiobarbituric acid method (TBA) method, SOD activity assayed by xanthiue oxidase enzyme method, the activities of GSH-Px, CAT and NOS determined by colorimetry,the amount of protein determined by the method of Lowry. All the procedures were carried out strictly according to the instruction.malonaldehyde (MDA) and activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), catalase (CAT) and nitric oxide synthase chemia, contents of SOD, GSH-Px and CAT in cerebral tissue of PD group were obviously higher than those of ichemia model group [(226.43±8.69),(193.37±11.14) NU/mg; (244.38±12.34), (211.71±16.50) μkat/g; (59.85±9.67),water in cerebral tissue of PD group were obviously lower than those of ichemia model group [(6.38±0.54), (8.63±0.78) μmol/g; (78.72±0.43)%,tivity in ischemic tissue but the results were similar to that in ischemia model group [(12.00±1.00), (12.84±1.17) μkat/g, P ＞ 0.05] in brain tissue.ed that PD alleviated the ischemia edema of cerebral ischemia.CONCLUSION: PD can alleviate the reaction of lipid overoxidation, improve the activities of antioxidant-enxymes, reduce ischemia brain edema,protect the function of cell member, bring down the damage to ischemia neurons. It shows that PD has significant cerebral protective role on focal ischemia brain damage.

BACKGROUND: Activated by Ca2+, phospholipase A2 will aggravate the influx of Ca2+ or the release of intracellular Ca2+, and then forms a vicious circle, which results in a continuous increase in free calcium level and leads to server injury in neural cells.OBJECTIVE: To discuss the protective effects of nimodipine on acute ischemic brain injury caused by activation of phospholipase A2.DESIGN: A completely randomized controlled trial.SETTING: Intensive Care Unit (ICU) of Children's Hospital, Chongqing Medical University.MATERIALS: From January 2001 to October 2003, it was completed at the ICU of Children' s Hospital, Chongqing Medical University. Thirty male rats were selected and divided into sham operation group, ischemia group and nimodipine treated group randomly, with 10 rats in each group.METHODS: In sham operation group, the right common carotid artery was identified by blunt dissection without ligation under anesthesia in rats. In ischemia group, at 30 minutes before cerebral ischemia, 2 mL saline was injected intraperitoneally. In nimodipine treated group, at 30 minutes before cerebral ischemia, 0.2 g/L nimodipine (2 mg/kg) was injected intraperitoneally. In all the three groups, the duration between ischemia and decollation was 120 minutes. Rats were decollated under anesthesia and their brains were taken out to assess the activity of phospholipase A2, the free calcium level in brain cells, the brain water content and the changes in mRNA levels of type Ⅱ phospholipase A2 (secretive phospholipase A2) and type Ⅳ phospholipase A2 (cytoplasmic phospholipase A2) in brain tissue.pholipase A2) and type Ⅱ phospholipase A2 (cytoplasmic phospholipase A2)in brain tissue were measured in rats in all the groups.pholipsse A2 in brain tissue: In ischemia group and nimodipine treated group, the activity of phospholipase A2 were higher than that in sham operation group [(57.8 ±7.2),(42.5±6.1), (17.1±5.3)%, P＜ 0.05-0.01], and it was a litter lower in nimodipine brain cells: It was higher in nimodipine treated group and ischemia group than that in sham operation group [(775.8±105.5), (497.2±45.9), (103.8±10.3) μmol/L,P ＜ 0.05-0.01], and it was lower in nimodipine group than in ischemia group (P ＜ 0.01).that in sham operation group [(82.9±0.5), (80.0±1.1), (72.1±0.01)%, P ＜ 0.05-0.01], and it was lower in nimodipine treated group than that in ischemia group (Ppase A2 could be detected in brain tissue. And the mRNA level of type Ⅱ phospholipase A2 in brain tissue was very low. At 120 minutes after ischemia, mRNA of type Ⅱ phospholipase A2 was detectable and the expression of type Ⅱ phospholipase A2 was increased. Compared to ischemia group, the expression of type Ⅱ phospholipase A2 was not decreased in nimodipine treated group while the expression of type Ⅱ phospholipase A2 was decreased.CONCLUSION: Nimodipine is capable of decreasing the free calcium level in brain cells, the activity of phospholipase A2 in brain tissue and the brain water content after ischemia. However, it cannot significantly inhibit the expressions of type Ⅱ phospholipase A2 and type Ⅱ phospholipase A2 after cerebral ischemia.