Distribution channel of Chinese herbal medicines has been changing. From Han to Ming Dynasty, Chinese herbal medicine were mainly trafficked to urban by dealers or farmers; From the Ming Dynasty to the foundation of new China, distribution channels are primarily intermediated with township "bazaar" and national distribution center with fixed place and regularly trading hours. In the planned economy period, the state-owned herbal medicine company was the sole medium with monopoly nature. From the mid1980s to the end of last century, planned economy and market economy have been co-existing. Stepping into 21st century, producing area highlighted in the distribution channels. Presence or absence and rise or fall of different types of distribution market went throughout the changing process of distribution channels, which became an important clue. Changes were motivated by economical consideration of channel subject, which originated from commodity characteristic and social environment changes.
Cities ; Drugs, Chinese Herbal ; economics ; supply & distribution ; Economic Development ; Marketing

Objective To explore the value of laparoscopic appendectomy (LA) in children. Methods A total of 52 children underwent laparoscopic appendectomy by using the 3-port technique from October 2002 to December 2004. Results The operations were performed smoothly in all the 52 cases. The operating time was 20~50 min (mean, 30 min). The patients were discharged from hospital at 2~4 postoperative days. Peri-port subcutaneous emphysema occurred in 2 cases. No other complications were found. Follow-up checkups for 3~29 months (mean, 14 months) in 49 cases found no intestinal obstruction or abdominal residual infection. Conclusions Laparoscopic appendectomy in children is safe, effective and minimally invasive.

Objective To provide basis for the formulation of policies and measures that will reduce the work pressure on nurses and to provide them with a better working environment. Methods An investigation was made via questionnaires into 942 nurses working in designated SARS hospitals and a comprehensive analysis was conducted by means of multivariant stepwise regression. Results The major factors affecting the pressure on nurses include: lack of support from and communications with families, arduousness of tasks to an unbearable point, extreme strictness in management, and unsoundness of treatment and living conditions. Conclusion Good communications with families are of great significance to nurses working in isolated areas. It is imperative to rationally allocate the human resources of nurses, show more concern for them, encourage them to participate in management, and strengthen scientific prevention so as to create a better working environment.

Objective To investigate the effects of electro-acupuncture on gastric emptying and Fos expression in the neuron of vagal-solitary complex (VSC) of rat bulbus after lipopolysaccharide (LPS) intraperitoneal injection (i.p.). Methods 40 male SD rats were randomly assigned to 4 groups: control group, LPS i.p. group, LPS i.p. plus electro-acupuncture at Tsusanli point group and LPS i.p. plus electro-acupuncture at non-meridian-non-acupoint group, 10 rats for each group. Immunohistochemical techniques were used to detect the Fos expression in VSC. The animal's gastric emptying was measured by phenol red method. Results The rats with gastric emptying decreased greatly to (20.7±4.5)% 2.5 hours after LPS injection, and Fos-positive neurons were significantly found in VSC (83.2±6.6) compared with control group. However, in the group of LPS i.p. plus electro-acupuncture at Tsusanli point, the gastric emptying was up-regulated to (44.1±6.2)%, and the expression of Fos -positive neurons were down-regulated to (37.9±3.8) compared with LPS i.p. group. No significant difference was found between the group of LPS i.p. plus electro-acupuncture at non-meridian-non-acupoint and the group of LPS i.p. Conclusion LPS i.p. can retard the gastric motility in rats, electro-acupuncture at Tsusanli point may well regulate the function in LPS model rats. This function may be connected with its protective effects on Fos immunoreactive neurons activity in VSC of rat bulbus.

Objective To study and evaluate islet cell adenoma of preliminary diagnosis.Method Retrospective analysis Wag done on 22 patients clinical data of preliminarily diagnosed islet cell adenoma.They were divided into two groups according to final diagnosis,group of islet cell adenoma(n=16)and group of reacfional hypoglycemia n=6).Results There were significant differences between the two groups in term of fames,cold sweat,cataphora,Whipple triad,hungry test,the ratio offasting blood insulin and fasting blood glucose exceeding 0.3 (I/G＞0.3) (P＜0.05).No statistical differences were found on blood glucose level in hypoglycemia onset,psychiatric symptom.Conclusion The clinic data is helpful for preliminary diagnosis,and Whipple triad,hungry test,I/G＞0.3 above all.

Continuous exposure to conventional glucose-containing lactate-buffered solutions will ultimately lead to irreversible changes of the structure and function of peritoneum.Therefore,the development of novel peritoneal dialysis(PD) solutions has become the focus in the PD fields in recent years.Icodextrin,which has more adventages than conventional PD solutions,is one of the most important advancements in the past decade.Icodextrin has better biocompatibility,and can reduce the absorption of carbohydrates to decrease the metabolic complications in PD patients.Apart from increasing ultrafiltration,icodextrin can also improve the fluid status and protect the residual renal function of PD patients.However,adverse consequences may result from the pseudo-hyperglycaemia caused by limited measurement of serum glucose.This article reviews the features and applications of the new PD solutions—icodextrin solutions.

Background The incidence of dry eye is growing.However,the early diagnosis of dry eye is still difficult up to now.Keratograph 5M analyzer,a novel noninvasive ocular surface analyzer for dry eye may offer important parameters.Objective This study was to evaluate the clinical value of Keratograph 5M analyzer for clinical diagnosis of dry eye.Methods An observational study was proceeded with 88 cases who accepted myopia diagnosis in Tianjin Medical University Eye Hospital from October to December 2013.A series of conventional dry eye-related examinations were performed on the patients,including tear film break-up time (TBUT),corneal fluorescein staining scoring,Schirmer Ⅰ test (S Ⅰ t),and then Keratograph 5M analyzer-related examinations were subsequently carried out,including noninvasive tear film break-up time (NITBUT) and conjunctival hyperemia scoring.The correlations between conventional dry eye-related examinations and Keratograph 5M analyzer-related examinations were assessed by using Spearman rank correlation analysis.Results A total of 88 patients were recruited with male 32 and female 56.No significant difference in age was found between different genders (P =O.34).In 88 patients,Keratograph 5M analyzer showed the non-dry eyes in 15 patients,suspicious 44 patients (50.0％) and dry eyes in 29 patients (33.0％).However,the non-dry eyes were checked out in 39 patients and dry eyes were in 49 (55.7％) based on China Dry Eye Clinical Diagnosis and Treatment Consensus.The first NITBUT (NITBUTf) was less than the average NITBUT (NITBUTav) (P =0.00),and a positive correlation was seen between them (rs =0.62,P =0.00).Dry eye grade was significantly correlated with NITBUTf or NITBUTav or conjunctival hyperemia scoring (rs =-0.60,P =0.00 ; r,=-0.89,P =0.00 ; rs =0.24,P =0.02).A negative correlation was found between the conjunctival hyperemia scoring and NITBUTav (rs =-0.24,P =0.02).However,no significant correlation was seen between conjunctival hyperemia scoring and NITBUTf,TBUT,S Ⅰ t or corneal fluorescein staining scoring (rs=-0.13,P=0.22;rs=0.16,P=0.14;rs =-0.16,P=0.13;rs=-0.08,P=0.44).No significant difference was found between TBUT and NITBUTf (P =0.71).And TBUT was correlated with NITBUTf (rs =0.23,P =0.03),but not NITBUTav (rs =0.18,P =0.09).In addition,no significant correlations were seen between S Ⅰ t and NITBUTf or NITBUTav (rs=0.20,P=0.07;rs=0.05,P=0.66).Conclusions NITBUTav has an important significance in assessing overall ocular surface conditions.The conjunctival hyperemia score is one of refrent indicators to judge ocular surface status.

OBJECTIVE To summarize the clinical features, diagnosis, treatment and prognosis of laryngeal rhabdomyosarcoma.METHODS The clinical data of 5 cases of adult laryngeal rhabdomyosarcoma treated in Beijing Tongren Hospital between 2003 and 2015 were analyzed retrospectively.RESULTS All the 5 cases firstly presented with hoarseness. 1 case was treated by combined therapy (surgery followed by radiotherapy and chemotherapy). 2 patients received surgical treatment combined with chemotherapy. 1 patient received surgical treatment only. Another patient received chemotherapy only. Pathological type: 4 patients were embryonal rhabdomyosarcoma, 1 patient was pleomorphic rhabdomyosarcoma. In the follow-up of a period from 11 months to 8 years, 2 cases were alive without tumor, 3 patients were dead.CONCLUSION Adult laryngeal rhabdomyosarcoma is rare. Surgical resection combined with chemotherapy is the main treatment method, and the prognosis is related to the pathological type and tumor stage.

Objective: To assess the implementation effects of clinical pathways, compared with usual care, among patients with stroke. Methods:Two investigators independently searched PubMed, Embase, the Cochrane Library, Web of Science, Chinese Biomedical Literature Database and Wanfang Database for studies published before December 2014. Jadad methodological approach was applied to assess the quality of included studies and RevMan software (version 5.2.7) was used for meta-analysis. Results: A total of 11 RCTs involving 913 patients were included in this meta-analysis. The overall results showed that a shorter average length of stay [MD = -2.92; 95% CI (-4.06, -1.78); P < 0.001] and a lower inpatient expenditures [SMD = -1.64; 95% CI (-1.80, -1.48); P < 0.001] in clinical pathways group comparing with the usual care group. The higher score of patient satisfaction was also seen in clinical pathways group. Conclusion: clinical pathways may reduce the average length of stay, reduce the inpatient expenditures, increase patient satisfaction and improve the quality of care in stroke management.
Stroke