The article discusses a number of important marketing ideas which should be clarified and fully understood in strengthening the follow-up management of patients,including understanding of the meaning of customers,the formation of the concept of market and the evolution of marketing.The adoption of patient follow-up management could delivered value to customers and promote their satisfaction.In the end,the article proposes that a long-term marketing mechanism of patient follow-up services should be established in order to achieve the a better development of hospitals.

[Objective] To investigate the clinical significance of approximated molecular subtype.[Methods] Four different subtypes were defined by immunohistochemical (IHC) markers as estrogen receptor (ER),progesterone receptor (PR) and HER2.Clinical characteristics as distribution,age,menopausal status,histopathologic type and grading,tumor size,lymph node status,time to and place of first tumor recurrence were analyzed.[Results] Among all 703 cases,Luminal A was the majority (51.5%) and the least were Luminal B and HER2+.90.8% the patients were less than 59 years old with Luminal A.Different subtype has different histopathologic grading.Luminal A was more than others among grading 1 tumors and it has more T1 tumors,while T4 tumors was most among HER2+ ones.Lymph nodes metastasis has no significant difference between different groups,other than high proportion tendency of N3 stage in Luminal B and HER2+.In addition,Luminal A has the longest time to the first recurrence while HER2+ was the shortest.Moreover,HER2+ and Basal-like have high rates of lung metastasis.Different from foreign reports,the distribution of the first recurrent place and distant metastases have no significant difference.[Conclusion] The classification of breast cancer approximated molecular subtype defined by IHC markers was feasible.The distribution is similar to other countries.Luminal A has rather better clinical characteristics while HER2+ and Basal-like have high rates of lung metastasis.However,Luminal A has the highest proportion of young patients,which is different from other countries.

Objective To Analyze the imaging characteristics of intraparenchymal schwannoma and the related pathology,in order to improve the accuracy of diagnosis and be in favor of the clinics and the prognosis.Methods Four cases were confirmed to be intraparenchymal schwannoma by pathological and immunohistochemistry examination.One case was examined with precontrast and enhanced CT scanning,one with unenhanced MRI scanning,two with unenhanced and enhanced CT and MRI scanning.Their images were retrospectively analyzed.Results Of the four cases,three patients were less than 30 years old,with tumors located supratentorially.Cysts were found in all cases,with nodules on the wall in 3 cases.The nodules were enhanced markedly in two cases and moderately in one ease.In addition,calcification was detected in one case and prominent peritumoral edema existed in 1 case.The picture of the pathology demonstrated Antoni type A and Antoni type B.Immunostaining showed intense immunoreactivity for S-100 protein and Vim and negative immunoreactivity for GFAP and EMA.Conclusions Intraparenchymal schwannoma mostly occurred in juvenile,which located supratentorially in most cases.The presence of a cyst and peritumoral edema together with the tumor appears to be characteristic of intraparenchymal schwannoma.Calcification or the enhanced nodule is the helpful sign for the diagnosis.Combining the imaging findings with the pathology and immunohistochemistry results can gain the accurate diagnosis.

To study the anticancer effects of tea polyphenols on colorectal cancer with microsatellite instability (MSI) in nude mice and to explore its mechanism.

Objective To discuss the clinical features of neonatal shock retrospectively.Methods Totally 144 neonates were enrolled in this retrospective study from Sep.2006 to Sep.2012 in NICU of Beijing Children's Hospital.Clinical data were collected from our database,including the primary disease,manifestation,laboratory findings,treatment and prognosis.Results According to the severity of shock,28 cases were mild,85 were moderate,31 were severe.Regarding to the type of shock,71 cases were cardiogenic shock,22 cases were hypovolemic shock,51 cases were septic shock.About 69.4％ patients were cured,only 9 cases died.Eight of them died of septic shock.Totally 33 cases in pH ＜7.15 group,2 of them died.In pH≥7.15 group,111 cases were involved,7 of them died.There was no significant difference of mortality between two groups (P =0.959).Conclusion Neonatal shock mostly occurred within 3 days after birth,and cardiogenic shock were dominating.Septic shock increased with age,and were responsible for death.

Objective To investigate the safety and efficacy of a customized guide plate which is designed by digital medical technology and manufactured by 3D printing in clinical percutaneous needling at the hip joint.Methods Enrolled in this study were 9 patients with hip disorder who required hip joint needling during the period from April 2015 to August 2015.They were 7 males and 2 females,21 to 53 years of age (average,42 years).Laterality:5 left sides and 4 right sides.Conditions:4 cases of traumatic arthritis and 5 cases of osteoarthritis.All of them underwent lamellar CT scans whose data were imported into the software of Mimics 10.01 for 3D reconstruction.Then the software of 3-matic was used to design a customized guide plate on the reconstructed models.Finally,3D printing was used to manufacture the guide plate.The needle angle,direction and depth were adjusted in vitro and the operation was simulated before actual needling in clinic.After percutaneous hip joint needling was performed in the 9 patients separately,the accuracy of needling was checked using C-arm fluoroscopy.Results The percutaneous hip joint needling was performed successfully in the 9 patients in whom the customized guide plate was used.The results were consistent with what had been designed on the reconstructed models.The operation time in the 9 patients averaged 417.7 s (range,from 387 s to 590 s).Little intraoperative bleeding was observed at the site of needling,fluoroscopy was applied only once for check.No neurovascular injury or other operation-related complications occurred.Conclusion For patients who need repeated percutaneous needling at the hip joint,the customized guide plate designed by us can improve accuracy and ensure safety and efficacy of needling.

Objective To observe the curative effect of low molecular heparin for treating secondary high coagulation state in the patients with nephrotic syndrome(NS) .Methods Total 87 cases of NS in our hospital were divided into the conventional treat‐ment group (n=42) and the low molecular heparin treatment group (n=45) .The routine treatment group was given the prednisone treatment and the low molecular heparin treatment group was treated by low molecular heparin combined with prednisone .The re‐lated indicators of blood coagulation before and after treatment were detected and the clinical curative effects in two groups were an‐alyzed .Results The coagulation related indicators in the conventional treatment group had no statistically significant difference be‐tween before and after treatment (P>0 .05) ,the prothrombin time(PT) and activated partial thrombin time(APTT) after treat‐ment in the low molecular heparin treatment group were significantly extended compared with before treatment ,while the concen‐trations of D‐dimer and fibrinogen were significantly decreased and the concentration of antithrombin Ⅲ was markedly increased compared with before treatment ,showing statistically significant differences between the two groups (P<0 .05);the patients of the low molecular heparin group patients had no bleeding after treatment .Conclusion Low molecular heparin combined with predni‐sone can reduce the secondary high condensation state in NS without bleeding and has a significantly clinical effect .

Objective Patients with aortic dissection have a significant incidence of coronary artery disease.The purpose of this study is to evaluate the safety and feasibility of percutaneous coronary stent in patients who have undergone endovascular stent,and to assess the effect of anti-coagulant and anti-platelet treatment on patients' thrombosis process.Methods From January 2005 to July 2007,8 patients who had undergone endovascular stent-graft during the past 1 to 7 months for type B aortic dissection repair,underwent percutaneous coronary intervention (PCI) because of coexisting coronary artery disease.Anti-coagulant and anti-platelet treatments were administrated after PCI according to the standard protocol.Patients were followed up for a mean period of 23 months.Clinical and false lumen status data were collected during the follow-up.Results PCI were technically successful in all 8 patients and no severe complications such as death,paraplegia,renal failure occurred during hospitalization.Complete false lumen thrombosis was observed in 5 patients and incomplete false lumen thrombosis in the remained 3 patients at the end of follow up.There were no major complications such as death,dissection rupture or aneurysm development occurred during the follow-up period.Conclusion Our data implied that PCI can be safely performed in patients with type B aortic dissection who have undergone endovascular stent-graft,without interrupting the thrombosis process.

Background Laser in situ keratomileusis (LASIK) is frequently performed to reduce or eliminate myopic refractive error.Some patients complain of a loss of visual function after surgery even when they have 20/20 visual acuity.One of the reasons is the change of asphericity of the cornea.Objective This study attempts to investigate the short-term changes of the anterior and posterior corneal asphericity after LASIK.Methods One hundred and seven myopic eyes of 54 subjects with the equivalent spherical diopter of -1.30 to -7.50 D who have received LASIK were enrolled in this prospective study.The Q-values of the posterior corneal surface for different corneal diameters (6mm,7mm,8mm and 9mm) were measured with Pentacam preoperatively and 1 month postoperatively.The correlations between Q-value,Q change (△Q),and the mean preoperative spherical equivalent refraction (SE),central corneal thickness (CCT),central ablation depth (AD) and residual bed thickness were investigated.Written informed consents were obtained from all the subjects prior to the clinical trial.Results The Q-values of the anterior and posterior corneal surfaces gradually decreased to negative values with the increase of corneal diameter in myopic eyes.Weak correlations were found between the asphericity of the anterior and posterior corneal surfaces from diameters of 6mm,7mm,8mm and 9mm (r=0.227,0.288,0.303,0.389;P=0.019,0.003,0.002 and 0.000,respectively).No statistically significant correlation was found between Q-value and the diopter of refractive error (P＞0.05).Both the anterior and posterior corneal Q-values varied toward the positive direction except that in the 9mm area of the posterior corneal surface at postoperative 1 month(t=-1.495,P=0.138).The increase of the anterior corneal asphericity (△Q) was more obvious than that of the posterior corneal surface and showed a positive correlation with ablation depth and a negative correlation with residual bed thickness.However,no statistically significant correlation was seen between △Q and these two parameters in the posterior corneal surface (P＞0.05).Conclusion The shape of the anterior and posterior corneal surface shows more prolateness as the increase of corneal diameter in myopic eyes.Both the anterior and the posterior corneal surfaces have an oblate shift within the ablation zone 1 month after LASIK.

Objectiye To introduce the surgical technique of arthroscopy assisted anatomical posterolateral corner (PLC) reconstruction,including popliteal ligament,popliteofibular ligament and lateral collateral ligament,and evaluate the results of this technique.Methods From August 2008 to April 2010,34arthroscopic posterior cruciate ligament (PCL) and PLC reconstruction surgeries were performed.The average age of the patients was 34.1 (15-52) years.There were 32 males and 2 females.The average time period from injury to surgery was 10.7 months.All patients were chronic injuries and combined ligament injuries,including PCL and PLC injuries.Some cases had other ligament injury,including 6 patients of anterior cruciate ligament (ACL) injury (17.6%),2 of ACL combined medial cruciate ligament (MCL) injuries (5.9%),and 5 of MCL injuries (14.7%).According to Fanellis classification,for type A posterolateral rotation instability,we performed arthroscopic popliteal ligament reconstruction or popliteal ligament combined popliteofibular ligament reconstruction.For type C posterolateral instability,we performed arthroscopic PLC anatomical reconstruction.Results During the follow-up period,14 patients had undergone a second look arthroscopic examination and removal of hardware.The average follow-up time was 18.5 months (13-25 months).At the final follow-up,physical examination,stability evaluation with KT-1000 and Telos stress view,and dial test were performed.The posterior displacement of the knee had decreased from 15.56 mm preoperatively to 5.16mm postoperatively.The external rotation instability had decreased from 14.92° preoperatively to -0.22°postoperatively.The average limitation of knee flexion was 4.23° and no knee extension was limited.Conclusion With the surgical technique of arthroscopy assisted anatomical PLC reconstruction,we can restore the external rotation stability of knee.This technique can be performed combine with PCL reconstruction.