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.

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 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.

Humans ; Hypertension ; complications ; Metabolic Syndrome ; complications ; physiopathology

OBJECTIVEThis study aimed to evaluate the influence of loading in different healing periods on implant stability and to establish an animal model of anchorage implant screws.

METHODSAnchorage implant screws were implanted in sheep alveolar bone to establish the implant screw animal model. The animals were randomly divided into four groups: group A, sheep without loading; group B, sheep loaded immediately after implant; group C, sheep loaded after two weeks; and group D, sheep loaded after four weeks. The maxillary and mandibular tissue specimens with implants were dissected. The maxillary tissue specimens were used to make undecalcified bone grinding slices, and the healing mode of the implant-bone interface was observed by light microscope. The maximum shear strength of loose mandibular specimens was measured by a material testing machine. The differences in group data were statistically analyzed. RESULTS 1) A general difference in shear strength exists among the four groups. The shear strengths in groups A and B were lower than those in groups C and D. 2) No significant difference in healing mode was found between the pressure side and the tension side of the longitudinal-grinded bone slices with implants. Both fiber combination and osseointegration of transverse-grinded slices could be found in the interface in all four groups. The major integration mode of the implant-bone interface of groups A and D was osseointegration, whereas that of the implant-bone interface of groups B and C was fibrous tissue transformation. The surrounding bone tissue regenerated toward the implants of group C.

CONCLUSIONResults show that loading time influences the stability of implant anchorage.

Objective To detect the clinical characters and the classification of the congenital retinal vascular anomalies. Methods Nine cases (12 eyes) of congenital retinal vascular anomalies were exa- mined by ocular examination and fundus fluorescein angiography (FFA), in which 3 cases (4 eyes) were examined by indocyanine green angiography (ICGA) simultaneously. Results The congenital retinal vascular anomalies were located at the posterior pole in 8 cases (10 eyes), and extended to peripheral retina in 1 case (2 eyes). Congenital retinal vascular anomalies were classified as follows: congenital retinal macrovessel (1 case, 1 eye); congenital retinal arteriolar tortuosity (2 cases, 3 eyes); inherited retinal venous beading (1 case, 2 eyes); and congenital prepapillary vascular loops (5 cases, 6 eyes). Four cases (5 eyes) were associated with spontaneous hemorrhage induced by physical exertion (Valsalva maneuver). Conclusion Most of the congenital retinal anomalies are located at the posterior pole, involving arteries and veins, and can be associated with spontaneous hemorrhage induced by Valsalva maneuver.

Objective To investigate the characteristics of the ocular fundus of Chinese patients with polypoidal choroidal vasculopathy (PCV). Methods The photographs of ocular fundus of 42 Chinese patients (48 eyes) with PCV diagnosed by fundus photography, fundus fluorescein angiography (FFA), and indocyanine green angiography (ICGA) were analyzed. Results In 48 eyes with PCV, 35 (72.9%) had subretinal hemorrhage, 13 (27.1%) had yellow-white exudation, 7 (14.6%) had subretinal tuberculum-like focus in tangerine peel at the posterior pole, and 26 (54.2%) had hemorrhagic or serous pigment epithelium detachment (PED). Thirty-six eyes (75.0%) had polypoidal dilations with branching vascular network, and the other 12 (25.0%) had scattered polypoidal dilations without identifiable continuous branching vascular network. The location for these lesions were at the macular region in 30 eyes (62 5%), arcade region in 6 (12.5%), peripapillary region in 3 (6.3%), and combination region in 9 (18.8%). Conclusions Most of the lesions in Chinese patients with PCV locate at the macular region and temporal vascular arcade. Most eyes are characterized by branching choroidal vessels with polyplike terminal aneurysmal dilations in ICGA.

Objective To evaluate the efficacy and safety of high-dose ambroxol in treating acute exacerbations in chronic obstructive pulmonary disease (AECOPD).Methods The trial design was random,open,and parallel control.126 patients with AECOPD were involved.High-dose group received ambroxol 150 mg 3 times per day for 7 days (n=46),while conventional-dose group given ambroxol 30 mg 3 times per day for 7 days (n=40) and control group was given a routine treatment (antibiotic therapy,oxygen inhalation and bronchodilators) (n=40).Results The effective rates of high-dose group and conventional-dose group (95.6 ％,77.5 ％) were significantly higher compared with control group (55.0％) (x2 =19.81,4.53,both P＜0.05).The average duration of hospitalization was significantly lower in high-dose group (10.78 ±0.95)d and conventional-dose group (11.75±0.84)d comparing with control group (13.15±0.89)d (q=11.88,7.24,both P＜0.05).The clinical efficacy in high dose group was much better.Conclusions High-dose ambroxol is a safe and efficient therapy in the treatment of acute exacerbations in chronic obstructive pulmonary disease.

[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(

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.