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 efficacy of ambroxol on community acquired pneumonia (CAP) in elderly patients.Methods Totally 120 patients with CAP were selected and divided into 3 groups:low-dose group (patients received ambroxol 15 mg intravenously,3 times per day,n=40),conventional-dose group (patients received ambroxol 30 mg intravenously,3 times per day,n=40)and control group (patients received routine treatment including antibiotic therapy and oxygen inhalation,n=40).All patients were treated for 7 days.The levels of white blood cell (WBC),high sensitivity C-reactive protein (hs-CRP) and procalcitonin (PCT) were determined dynamically during the treatment.Results The markedly efficient rate,efficient rate and inefficient rate were 62.5％ (25/40),15.0％ (6/40) and 22.5％ (9/40) in low-dose group,82.5％ (33/40),15.0％ (6/40) and 2.5％ (1/40) in conventional-dose group,40％ (16/40),15.0％ (6/40) and 45.0％ (18/40) in control group,respectively.The total efficient rates were 77.5％,97.5％ and 55.0％ in low dose,conventional dose and control groups,respectively.The markedly efficient rate was higher in lowdose,conventional-dose groups than in control group (x2 =15.29,P＜0.05).There was a significant difference in markedly efficient rate between low dose and conventional-dose groups (x2 =4.01,P＜ 0.05).The total efficient rate was higher in low-dose,conventional-dose groups than in control group (x2 20.22,P＜0.05).There was a significant difference in total efficient rate between low dose and conventional-dose groups (x2=7.31,P＜0.05).Compared with before treatment,the levels of WBC,hs CRP and PCT were decreased in 3 groups after treatment (all P＜0.05).The levels of WBC,hsCRP and PCT were decreased more remarkably in low dose,conventional-dose groups than in control group (all P＜0.05).There was a significant difference in the decrease of WBC,hs-CRP and PCT levels between low-dose and conventional-dose groups (all P＜0.05).Conclusions Conventional dose ambroxol treatment (30 mg,iv,3 times/d) is an efficient therapy for community acquired pneumonia in elderly patients.

BACKGROUND:The finite element model has been developed from two-dimensional model to three-dimensional model, from linear model to nonlinear model. As the advantage of this method in the analysis of mechanical characteristics of the irregular objects, the finite element model has been widely used in the research of orthopedic biomechanics, especial y in the research of hip joint. OBJECTIVE:To analyze the stress state of human femur with finite element analysis method and to investigate a method that can rapidly construct femoral finite element model and precisely analyze the biomechanics. METHODS:Normal male femur was used as specimen for CT scan to obtain cross-sectional images of femur in each slice. Three-dimensional reconstruction was performed with DICOM data and MIMICS software, then the femoral three-dimensional finite element model was established with the finite element analysis ABQUS 6.8 software, and the stress distribution of the model was analyzed under loading condition. RESULTS AND CONCLUSION:Based on DICOM data, three-dimensional finite element model of femur was constructed more quickly and precisely. The models were divided into 38 636 nodes and 201 422 units. The model included the parts of cortical and cancel ous bone. The biomechanical test results were accorded with the previous results, so the model could objectively reflect the real femur shape and biomechanical behavior with high precision. The Mimics software provided a simpler and effective method for the construction of femur model and improved the efficiency of modeling, and the three-dimensional finite element model based on DICOM data was accurate in shape and can be used for the normal research on biomechanical behavior of femur. The stress distribution analyzed with ABQUS 6.8 software is consistent with the clinical observation.

Objective To observe the role of cannabinoid receptor-2 (CB2) in acute experimental colitis in mice, and to explore its effect on the endoplasmic reticulum stress ( ERS ) in the intestinal mucosa . Methods 32 SPF mice were randomly divided into normal group,model group,CB2 agonist group and CB2 antagonist group. Disease activity index( DAI) and colon histopathological score( HS) were evaluatd. The levels of TNF-α and IL-10 in colon tissue were detected by ELISA. The expression of CB2 and ERS markers GRP78, CHOP in colon tissues were de-tected by immunohistochemical. The mRNA levels of GRP78 and CHOP were detected by RT-PCR. Results Com-pared with the normal group,the level of TNF-αwas significantly higher and the level of IL-10 was significantly low-er(P<0. 05) in the model group,the expressions of GRP78, CHOP and its mRNA were significantly higher(P<0. 05). Compared with the model group,the expression of CB2 in the CB2 agonist group was significantly higher(P<0. 05),the level of TNF-α dropped and the level of IL-10 increased(P<0. 05),and the expressions of GRP78, CHOP and its mRNA were significantly reduced(P<0. 05). The level of IL-10,TNF-α and ERS markers had no significant difference bewteen CB2 antagonist group and the model group ( P>0. 05 ) . Conclusion Severe endo-plasmic reticulum stress exists in intestinal mucosa of experimental colitis mice. The CB2 agonist activates CB2 ex-pression,reducing colitis in mice. Its mechanism may be related to inhibiting ERS in intestinal mucosa.

[Objective] To investigate the clinical effects in the treatment of gluteus muscles contracture of small incision insidious lysis and three steps rehabilitative drills.[Method]One hundred and eighteen patients were treated with small incision insidious lysis and three steps rehabilitative drills(treatment group),and fifty-six patents with gluteus maximus lysis(control group)from February 1988 to February 2006.Clinical classification of gluteal muscle contracture,mechanism of crook-lateral and spread-lateral limb cross-leg tests designed by the author,main points of small incision insidious lysis and implement of three steps rehabilitative drills were evaluated.[Result]The cases were followed up for 1~8 years,clinical outcomes were evaluated by the Huang Yao-tian's scoring system.The early clinical effect were evaluated after 45 days of operation.All the results showed statistically significant difference(

It is a difficult problem of forensic medicine to accurately estimate the post-mortem interval. Entomological approach has been regarded as an effective way to estimate the post-mortem interval. The developmental biology of carrion-breeding flies has an important position at the post-mortem inter-val estimation. Phorid flies are tiny and occur as the main or even the only insect evidence in relatively enclosed environments. This paper reviews the research progress of carrion-breeding phorid flies for esti-mating post-mortem interval in forensic medicine which includes their roles, species identification and age determination of immatures.

Objective To evaluate the effect and safety of the argon plas ma coagulation (APC)a non－ touched technique via endoscopy. Methods Various po wer setting (40 W,60 W,80 W) at increasing exposure time (1 sec,3 sec,5 sec) wer e used during application of APC to different mucosa (gastric body and autrum) o f fresh stomaches gotten from 5 pigs.Histologic appearance and measurement of de pth and diameter of tissue necrosis area were examined through light microscope. Results Under the same power,the depth and the diameter were increased with th e exposure time increasing(P

Objective To inestigate the effect of inhaled steroid hormone on the IL-16 in sputum from paitents with asthma, and to explore the mechanism of anti-inflammation of steroid. Method Budesonid inhalant were administered(400?g twice a day) persistent 4 weeks for 12 subjects with mild to moderate asthma, The percentage of eosinophils and IL-16 in induced sputum were determined in every subject .Result After the course , the concentration of IL-16 in sputum was (41 5?5 2)ng/L, significantly lower than that before the therapy which was (58 2?7 2)ng/L,P

Objective To observe the changes of disease course and the prognosis of visual acuity of Chinese patients with polypoidal choroidal vasculopathy (PCV). Methods Visual acuity and fundus photochromes of 20 eyes of 15 consecutive patients with PCV were followed up with a mean of 19.1 months (range from 2 to 64 months), in which the fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) of 14 eyes of 10 patients were followed up with a mean of 21.0 (range from 3 to 53) months. Results Among the 20 eyes, the visual acuity was more than 0.3 in 5 eyes (25.0%), between 0.1 and 0.2 in 6 (30 0%) and less than 0.1 in 9 (45.0%). During the follow-up, the visual acuity was improved in 2 (10.0%), stable in 10 (50.0%) and regressed in 8 (40.0%). Only 1 eye (5.0%) developed to macula scar. The result of ICGA revealed the polypoidal lesions that were unchanged in 4 eyes(28.6%), regressed in 2 (14.3%), grew in 6 (42.7%), repeatedly grew and spontaneously regressed in 6 (42.7%). Conclusions There is a large variation in the visual prognosis in Chinese patients with PCV. The polypoidal lesions can repeatedly grow and spontaneously regress in the natural course.

Objective To find out the clinical effect of integrative therapy for pregnant women with viral myocarditis(VMC).Methods The experimental group 60 VMC maternal cases were treated by integrative therapy,while the control group 43 patients were treated by simple western medicine,the efficacy of two treatments were compared,and left ventricular function,myocardial enzymes and other indicators were compared.Results Markedly effective rate of control group was 48.84％,and total effcctive rate was 72.09％ ; markedly effective rate of experimental group was 65.00％,and total effective rate was 91.67％.Markedly effective rate and total effective rate of experimental group were significantly higher(P ＜0.05).After treatment,stroke volume,ejection fraction and cardiac output index of experimental group were significantly higher than before treatment (P ＜ 0.05 ); After treatment,the indexes of experimental group and control group were significantly different ( P ＜ 0.05 ).After treatment,creatine kinase,creatine kinase myocardial isoenzyme,aspartate aminotransferase and lactate dehydrogenase index of experimental group were significantly lower than before treatment ( P ＜ 0.05 ) ; After treatment,the indicators of experirnental group were lower than control group( P ＜ 0.05 ).Conclusion This prescription is used to treat pregnant women with valid prescriptions of VMC,the clinical efficacy of integrative medicine is significant,the cardiac contractile function can he improved,and a strong application advantages is shown compared to conventional therapy with simple western medicine.