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.

ObjectiveTo investigate the effect of immunoglobulin G (IgG) extravasated from blood circulation on the expression of toll-like receptor 4 (TLR4) induced by peripheral lipopolysaccharide (LPS) in rat brain. Methods The rats were divided into four groups in random, 5 rats in each. Group one received LPS 100μg/kg by intraperitoneal administration, normal saline was given by intravenous injection 6 hours later; group two was injected with adrenalin (AD) 15μg/kg intravenously; group three was treated with LPS intraperitoneally, AD was injected 6 hours later; group four was injected normal saline intravenously as control. For all groups, the animals were sacrificed 30 min after the last injection, and the brains were taken for investigation of the TLR4 expressions by immunofluorescence staining and RT-PCR. Result Immunofluorescence staining showed that IgG immunoreactive product was patch-like, distributed in the brain parenchyma in all the animals that received AD. In the LPS+normal saline group, IgG was found merely around the blood vessels. Meanwhile, in LPS+AD animals, TLR4 immunoreactive product coexisted with microglia marker Iba-1 within the IgG extravasated area. The double-labeled cells dispersed in the brain parenchyma and near to the cerebral vessels. In the LPS+saline group, TLR4 positive cells were endothelial-like. RT-PCR results indicated that the expression level of TLR4 in the LPS+AD group were significantly higher than that in the LPS+saline group or AD group or the saline control (P<0.01). Conclusion Extravasated circulating IgG may enhance the TLR4 expression in the rat brain induced by peripheral LPS.

Objective To investigate the effects of Rhizoma Alismatis extracts on oxidative stress induced by cerebral ischemia-reperfusion injury in rats,and to explore its protective mechanism in cerebral ischemia-reperfusion injury.Methods A total of 60 male SD rats were randomly divided into sham operation group,model group,Alisma orientalis group and Nimodipine positive control group (n=15,each).Cerebral ischemia-reperfusion injury model was prepared by suture method after 14 days of intragastric administration.After 24 hours,scores of neurological dysfunction,the infarct size,the water content of the brain,the malondialdehyde (MDA),superoxide dismutase (SOD),nitric oxide (NO) levels in serum and brain tissues,and the activity of inducible NO synthase (iNOS)were detected.Results As compared with the model group,Alisma orientalis group showed that the scores of neurological dysfunction,cerebral water content,cerebral infarction size,contents of MDA and NO,and the activity of iNOS were significantly reduced,and the activity of SOD was significantly increased in respectively [(2.21 ± 0.38) vs.(2.78 ± 0.43),(81.18 ± 2.09)％ vs.(88.33±4.15)％,(0.26±0.07) ％ vs.(0.35±0.04)％,(5.92±1.64) μmol/L vs.(8.21±1.47)μmol/L,(115.48±18.65) mU/L vs.(75.52±20.78) mU/L,(28.23±4.32) μmol/L vs.(41.73±3.85) μmol/L,(15.31±1.68) mU/L vs.(23.49±3.53) mU/L,(5.41±0.68) μmol/L vs.(7.58±1.49) μmol/L,(168.57±10.65) mU/L vs.(150.11±13.62) mU/L,(14.37±0.77) μmol/L vs.(22.08±1.57) μmol/L,(9.83±0.75) mU/L vs.(13.28±1.84) mU/L,respectively,all P＜0.05]Conclusions Alisma orientalis extract has the protective effect on focal cerebral ischemia reperfusion injury,and the mechanism may be related to antioxidant and scavenging free radicals.

OBJECTIVETo explore the antibacterial activity of amoxycillin sodium and clavulanate potassium (trade name: Anqi) in vitro and the pharmacoeconomics in the therapy of acute respiratory infection.

METHODSMinimal inhibition concentration (MIC), minimal bactericidal concentration (MBC) and bactericidal curve of amoxycillin sodium and clavulanate potassium against common pathogens were determined and compared with some other same kind of antibiotics without beta-Lactamase inhibitor. Eighty cases diagnosed as respiratory infection were randomly divided into 4 groups: group 1 was treated with i.v. Anqi; group 2 was treated with i.v. Anqi and oral consecutive strategy; group 3 was treated with iv ampicillin and sulbactam; group 4 was treated with i.v. cefuroxime. The clinical therapeutic effects were observed and cost-effectiveness analyzed.

RESULTSIn terms of MIC, MBC and bactericidal curve of 135 bacterial strains, Anqi was superior to the other same-kind antibiotics without beta-lactamase inhibitor, this effect was especially obvious on Klebsiella pneumoniae and Escherichia coli which can produce extended spectrum beta-lactamases (ESBLs). The cost-effectiveness of the consecutive therapy group was the best.

CONCLUSIONAnqi has a wide antimicrobial spectrum and strong effect on the bacteria producing ESBLs, the consecutive therapy strategy should be clinically recommended.

Amoxicillin ; pharmacology ; therapeutic use ; Anti-Bacterial Agents ; pharmacology ; therapeutic use ; Bacteria ; drug effects ; Child ; Child, Preschool ; Clavulanic Acid ; pharmacology ; therapeutic use ; Dose-Response Relationship, Drug ; Drug Therapy, Combination ; therapeutic use ; Female ; Humans ; Infant ; Male ; Microbial Sensitivity Tests ; Respirovirus Infections ; drug therapy ; economics ; Treatment Outcome

OBJECTIVEMany studies have shown that tissue development is closely correlated with fluid transport. Aquaporins (AQPs) are a group of cell membrane proteins that actively and selectively transport water. This study aimed to investigate the changes of AQPs expression during lung development in rats in order to elucidate the role of AQPs in the rat lung development.

METHODSAQP1, AQP3, AQP4 and AQP5 proteins and mRNA in the lung cell membrane were measured by immunohistochemistry and reverse transcription-polymerase chain reaction (RT-PCR) respectively in the 20-day-old embryo (E20), 7-day-old newborn rat, and one-month-old young and adult rats. The correlation between AQPs expression and lung development was studied.

RESULTSWith increasing age, the lung development showed a dynamic and successive course, with the most rapid from the fetus to the newborn rat, and then a slowed down afterwards. AQPs mRNA was weakly expressed in the lung of the E20 group. Lung AQPs mRNA and protein increased rapidly after birth until adulthood. The AQPs distribution patterns in the lung were unique with no duplication. There was a positive correlation between AQPs expression and lung development (P<0.05).

CONCLUSIONSIn addition to being involved in the transepithelial transport of water in the lung, AQPs is also related to its development.

Animals ; Aquaporins ; analysis ; genetics ; physiology ; Immunohistochemistry ; Lung ; embryology ; metabolism ; RNA, Messenger ; analysis ; Rats ; Rats, Wistar

OBJECTIVETo comprehensively understand the situation of antenatal care in the last thirty years and to identify the existing problems and challenges.

METHODSPPS method was used to select those women under study and face to face interview was carried out at the house.

RESULTSThe quality and coverage rate of antenatal care as well as the rate of hospital delivery had been continuously increasing over time and the coverage rate of antenatal checkup had increased from 38.7% in 1970s to 95.9%, while the institutional delivery rose from 20.1% to 87.4% in the last three years. However, problems and challenges were found refering to the of delay first antenatal care, inadequate timing and with incomplete contents. Only 71.7% of the pregnant women had received first checkup during the first three months. 64.1% of the women received 5 times or more of the checkups while only 29.1% of the women had received all the 7 basic checkup items. Rate of hospital delivery was unsatisfactory that most (79.5%) of the women had the delivery not in the hospitals when under the assistance of midwife/village doctors. Indicators showed that the worst was in the western regions.

CONCLUSIONGreat progress had been made in the field of antenatal care in last thirty yeats in China. The coverage rate of antenatal checkup and institutional delivery had been improved. But the quality of antenatal care should be further improved, especially in the western regions.

China ; Female ; Humans ; Maternal Health Services ; Pregnancy ; Prenatal Care ; statistics & numerical data ; Quality of Health Care ; Surveys and Questionnaires

OBJECTIVETo study the activity of esterases, including butyrylcholinesterase (BchE), carboxylesterase (CarbE), paraoxonase (PonE) and acetylcholinesterase (AChE), and to explore the effect of genetic polymorphism on the activity of esterase for workers exposed to organophosphorus pesticides (OPs).

METHODSTwo hundred and forty-one long term OPs directly exposed workers and 151 indirectly exposed workers in the same factory were taken as study group. One hundred and sixty unexposed persons were taken as control group. The activity of serum enzymes was measured and the polymorphic distribution was detected using 7900 genotype detecting system and CMOS Chip technique. The effect of long-term exposure to organophosphorus pesticides was analyzed.

RESULTSThe activities of BchE, CarbE and PonE were independent on the gender or age in control group. Average values of Carb and BchE activities of directly and indirectly exposed workers were lower than those in control group respectively. PonE activity in directly exposed group was lower than that in control group. AChE activity in directly exposed group was lower than that in indirectly exposed group. All the differences were significant (P < 0.01). In the direct exposure group, the frequency of three variants of butyrylcholinesterase gene K (BCHE-K) polymorphism was 74.3%, 24.1% and 1.6% for UU, UK and KK respectively. Frequency of allele U and K was 0.863 and 0.137 respectively in the same group. Frequency of three variants of PON192 polymorphism was 15.0%, 45.5% and 39.5% for AA, AB and BB respectively in direct exposure group. Gene frequency of low activity (PON*A) and high activity (PON*B) was 0.378 and 0.622 respectively. Frequency of three variants of PON55 polymorphism was 96.2%, 3.8% and 0% for MM, LM and LL respectively in direct exposure group. Frequency of allele M and L was 0.981 and 0.019 respectively in the same group. The activity of PON was different in various genotypes of PON192 and PON55.

CONCLUSIONThe long-term exposure to OPs could inhibit the activities of CarbE, BchE, PonE and ACh E in different level. The genetic polymorphisms of PON192 and PON55 affect the activity of PonE, which is related to the detoxification of OPs and health impact.

Acetylcholinesterase ; metabolism ; Adult ; Alleles ; Aryldialkylphosphatase ; genetics ; metabolism ; Butyrylcholinesterase ; genetics ; metabolism ; Carboxylesterase ; metabolism ; Female ; Gene Frequency ; Genotype ; Humans ; Male ; Middle Aged ; Occupational Exposure ; Organophosphorus Compounds ; adverse effects ; Pesticides ; adverse effects ; Polymorphism, Single Nucleotide