OBJECTIVE:To recommend the development strategies for small and medium-size pharmaceutical commercial enterprises. METHODS: We analyzed the development and change of the macro-policies and industrial surroundings and discussed different strategies available for small and medium-size pharmaceutical commercial enterprises. RESULTS & CONCLUSIONS: Among those suitable strategies, which include scale enlargement, service differentiation, and countryside & community market expansion etc, small and medium enterprises should choose different kinds of strategies according to their special characteristics. Meanwhile they should incessantly enhance their real strength and spare no effort to cultivate their own competitive advantage to seek survival and development.

Objective To compare the sedative efficacy and untoward effect of dexmedetomidine and midazolam in drunken patients after general anesthesia.Methods Thirty-eight drunken patients having underwent mechanical ventilation after general anesthesia were enrolled.The patients were divided into dexmedetomidine group and midazolam group with 19 cases each according to random digital table method.The sedation onset time,dysphoria,percentage of with good sleep quality,duration of mechanical ventilation,ICU length of staying and untoward effect were compared.Results The sedation onset time and duration of mechanical ventilation in dexmedetomidine group were significantly shorter than those in midazolam group:(45.6 ±8.9) s vs.(112.5 ±20.3) s and (9.4 ±2.1) h vs.(18.6 ±5.1) h,the patients of dysphoria in dexmedetomidine group was significantly less than that in midazolam group:6 cases vs.14 cases,the patients of good sleep quality in dexmedetomidine group was significantly more than that in midazolam group:12 cases vs.4 cases,and there were statistical differences (P＜ 0.05).There was no statistical difference in ICU length of staying between 2 groups (P ＞ 0.05).The patients of bradyarrhythmia in dexmedetomidine group was significantly more than that in midazolam group:9 cases vs.2 cases,but the patients of respiratory depression in dexmedetomidine group was significantly less than that in midazolam group:4 cases vs.12 cases,and there were statistical differences (P ＜ 0.05).There were no statistical differences in delirium and hypopiesis between 2 groups (P ＞ 0.05).Conclusion Compared with midazolam,dexmedetomidine is highly recommended to be used for the sedation of drunken patients after general anesthesia,but the incidence of circulatory adverse reactions should be paid attention to.

Objective: To explore the association between dietary patterns and overweight and obesity among primary and middle school students, so as to provide the guidance of diet balance and obesity prevention for students. Methods: Students from 11 primary and middle schools in Tongzhou District, Beijing Municipality, were selected using the stratified cluster sampling method. Demographic information was collected through a general questionnaire, and dietary intake types and frequencies over the past week were assessed using a food frequency questionnaire. Dietary patterns were determined using factor analysis, and the dietary pattern factor scores were divided into Q1, Q2, Q3, and Q4 groups based on quartiles. Height and weight were collected through physical examinations, and Z-scores of body mass index adjusted for gender and age were calculated to assess overweight and obesity. The association between dietary patterns and overweight and obesity was analyzed using a multivariable logistic regression model. Results: A total of 1 485 students were surveyed, including 745 males (50.17%) and 740 females (49.83%). The mean age was (12.87±2.86) years. Three dietary patterns were identified: animal and plant protein dietary pattern, high-fat and high-sugar dietary pattern, and vegetable-fruit-dairy dietary pattern. The detection rates of overweight and obesity were 42.57%, 48.42%, and 34.75%, respectively, with statistically significant differences (P<0.05). Multivariable logistic regression analysis showed that compared with the vegetable-fruit-dairy dietary pattern, the animal and plant protein dietary pattern (OR=1.406, 95%CI: 1.084-1.823) and the high-fat and high-sugar dietary pattern (OR=2.137, 95%CI: 1.643-2.779) were associated with a higher risk of overweight and obesity among primary and middle school students. Compared with the Q1 group of dietary pattern factor scores, the Q3 group (OR=1.631, 95%CI: 1.206-2.208) and Q4 group (OR=1.965, 95%CI: 1.446-2.671) of the high-fat and high-sugar dietary pattern had an increased risk of overweight and obesity, while the Q4 group of the vegetable-fruit-dairy dietary pattern (OR=0.551, 95%CI: 0.406-0.747) had a reduced risk of overweight and obesity. There was no statistical association between factor scores of animal and plant protein dietary pattern and overweight and obesity (all P>0.05). Conclusions The animal and plant protein dietary pattern and the high-fat and high-sugar dietary pattern are associated with a higher risk of overweight and obesity among primary and middle school students. Within the same dietary pattern, the more inclined students are to the high-fat and high-sugar dietary pattern, the higher their risk of overweight and obesity, while the more inclined they are to the vegetable-fruit-dairy dietary pattern, the lower their risk of overweight and obesity.

Purpose To study the clinicopathologic features, immunophenotype and differential diagnosis of solid papillary carcinoma (SPC) of breast.Methods 73 cases of breast SPC with or without invasive carcinoma were collected, and the clinical data and histopathologic features were analyzed with further investigation of transmission electron microscopy and immunohistochemical staining (EnVision method). Selected antibodies included cytokeratin (CK), myoepithelial markers, neuroendocrine markers, proliferation marker Ki-67 and ER,PR,c-erbB-2,etc.Results All the patients were females with mean age of 64.7 years.The presenting symptoms were either a palpable breast mass or nipple discharge.Metastasis was observed in 43 cases who had undergone axillary lymph node dissection. Histologically, the tumor displayed a solid-papillary growth pattern, with mucin production demonstrated in 25 cases. Intraductal papilloma was not uncommon at the peripheral area of the tumor. The tumor cells were polygonal, oval, spindled or signet ring-like and contained abundant eosinophilic to granular cytoplasm and mildly to moderately pleomorphic nuclei. More than 5 mitotic figures/10 HPF were observed in 51 cases. 43 cases contained foci of invasive carcinoma which showed similar cytologic features as those of in-situ component. Immunohistochemical study showed that the tumor cells were negative for basal cell cytokeratin; positivity for smooth muscle actin-alpha and p63 were demonstrated in the myoepithelial layers of fibrovascular cores, as well as around the expanded ductolobular units.Most cases also showed cytoplasmic positivity for chromogranin A (89.0%), synaptophysin (86.3%) and neuron-specific enolase (95.9%).The proliferatiing index, as highlighted by Ki-67 imnunostaining, was 9.2%.The tumor mainly expressed estrogen receptor and progesterone receptor. The staining for c-erbB-2 oncoprotein was negative in the most cases. Neuroendocrine granules were seen under transmission electron microscope in the cytoplasm.Conclusions SPC represents a subgroup of low-grade ductal carcinoma in situ.SPC predilection in older women is associated with mucinous and neuroendocrine components. Follow-up data suggest that SPC has a good prognosis.

OBJECTIVE To analyze the correlation between number of tissue eosinophils(Eos) and blood Eos levels in patients with chronic rhinosinusitis with nasal polyps(CRSwNP), and to investigate if tissue and blood eosinophilia predicts disease severity and prognosis in CRSwNP. METHODS A retrospective analysis of 102 patients, who diagnosed with CRSwNP was carried out in this study. Surgical specimens were evaluated for degree of tissue Eos, which was compared with blood Eos. Patients were divided into two groups according to the results of endoscopy one year after surgery: recurrent and non-recurrent group. Statistical analysis was performed to compare tissue and blood Eos and CT Lund-Mackay scores. RESULTS Blood and tissue Eos in recurrent group was significantly higher than that in non-recurrent group(P=0.032, 0.033, 0.017). There was not a statistical difference of CT scores between two groups(P =0.089). There was a significant correlation between tissue Eos and absolute number of blood Eos(r=0.637, P=0.000) as well as between tissue Eos and percentage of blood Eos(r=0.542, P=0.000). However Eos and CT scores were not correlated statistically(P>0.05). CONCLUSION Blood Eos levels can predict the degree of Eos infiltration in nasal polyps. Blood and tissue Eos correlate with prognosis.

ObjectiveTo investigate prophylaxis and treatment of bile leakage from hepatic duct anomalies after liver transplantation.MethodsWe retrospectively analyzed 3 patients with bile leakage from hepatic duct anomalies after liver transplantation in our institute.The graft procurements were combined liver-kidney harvesting.The reconstruction of the bile ducts was end-to-end anastomoses.ResultsIn the first patient with a right accessory duct joining the cystic duct,leakage of bile came from the stump of the cystic duct after anastomosis of the bile ducts.The original anastomosis was taken down,and reanastomosis was performed after plasty of the bile ducts.The patient recovered uneventfully.In the second patient with a Luschka bile duct,the biliary fistula closed spontaneously after percutaneous drainage.However,re-transplantation was performed for severe infection 7 month after the primary transplantation.In the third patient with an accessory hepatic duct from the right posterior sector joining the common bile duct,the bile duct stump which we missed leaked bile.Re-transplantation was performed because of severe complications.Conclusion Understanding the anatomy of intra- and extra-hepatic bile ducts and their common anomalies identifying the structures in the porta hepatis during preparation of the liver grafts,and looking for possible accessory hepatic ducts and aberrant bile ducts are important steps to prevent bile leakage in liver transplantation.

Objective Small-for-size syndrome (SFSS) is a common and serious problem after living donor liver transplantation (LDLT) of small grafts.To prevent SFSS by selecting large enough graft,enlarging outflow tract,and controlling the portal vein pressure and flow during LDLT.Methods 113 adult LDLT recipients were reviewed from Dec.1,2007 to Nov.30,2009.Enlarging the portal outflow tract by the incision of the anterior rim of the orifice of the right hepatic vein (RHV),modificating graft inflow,and selecting large enough graft were done to prevent SFSS.The relationship between the patients' GRWR,portal vein flow,portal vein pressure and the occurrence of SFSS was analyzed.Results All patients received the outflow orifice modification.The portal vein pressure and the portal vein flow were decreased after spleen artery ligation.No SFSS ocurred.Conclusion Selecting large enough liver graft,and enlarging portal vein inflow and outflow were safe for the LDLT recipients,and can effectively prevent SFSS.

Objective To evaluate prognostic factors and treatment of patients with advanced stage endometrial cancer. Methods One hundred and eighteen patients with advanced stage endometrial cancer were treated in our hospital between January 1996 and December 2006. The treatment and prognosis were retrospectively analyzed. The mean follow-up time was 26 months. Results During the follow-up, 33 cases (28.0%) died and 25 patients(21.2% ) had disease progression. The 3-year overall survival for patients with stage Ⅲ and stage Ⅳ was 78. 3% and 39. 4%, and for endometrioid and nonendometrioid endometrial carcinoma was 69. 3% and 42. 0%, respectively. Four patients with positive cytology only were followed closely after surgery and were free of disease up to the report time. Patients with late stages, deep myometrial invasion, nonendometrioid endometrial cancer, poor differentiation, without lymphadenectomy and without radiochemotherapy after surgery were associated with a worse prognosis by univariate analysis (P < 0. 05 ),while in a multivariate analysis only late stages and deep myometrial invasion were associated with a poor prognosis ( P < 0. 05 ). The patients who received lymphadenectomy and whose residual disease after the surgery was less than 1 cm had better prognoses than those otherwise(P <0. 05). The patients who received postoperative radiochemotherapy had better prognoses than those who did not ( P <0. 05 ). Conclusions Pathological stage and myometrial invasion are independent prognostic factors for late stage endometrial cancer. Satisfactory cytoreduction surgery and lymphadenectomy, followed by postoperative radiochemotherapy, except for stage Ⅲa patients with positive cytology only, are recommended in order to improve prognosis.

Objective To explore the effect of Angiopoietin-2(ANG-2) and Endostatin (ENS) in patho genesis and development of endometriosis. Methods Twenty-five endometriosis cases and 24 controls were enrolled. ANG-2 and ENS in endometrium were detected by Immunohistochemistry. The concentrations of ANG-2 and ENS in peri-toneal fluid were measured with enzyme linked immunoabsorbant assay. Results In the EMs group, ANG-2 positive rate in eutopic endometrium was significantly higher than that of ectopic endometrium. The ANG-2 positive rate in ectopic endometrium was significantly higher than that of control group; in EMs group, the ENS positive rate in ec-topic endometrium was significantly higher than that in eutopic endometrium. The ENS positive rate in eutopic endo-metrium was significantly higher than that in control group. There was no significant difference of ANG-2 or ENS between stage Ⅰ～Ⅱand stage Ⅲ～Ⅳ. In peritoneal fluid, ANG-2 and ENS concentration and ratio of ANG-2/ ENS in endometriosis were significantly higher than that in controls. Conclusion The effect of angiopoietin-2 and endostatin in angiogenesis of endometriosis are important play a role in pathogenesis and development of the endo-metriosis.

Objective:To compare the treatment outcomes of neoadjoint therapy combined with liver transplantation versus radical hepatectomy for patients with surgically resectable hilar cholangiocarcinoma.Methods:A retrospective study was performed on the data of 64 patients with resectable hilar cholangiocarcinoma operated from January 2009 to December 2014 at the Organ Transplantation Department of the First Central Hospital of Tianjin. There were 43 males and 21 females, with an average age of 61.2 years. There were 45 patients who underwent radical hepatectomy in the liver resection group, and 19 patients who underwent combined neoadjuvant therapy (radiotherapy combined with 5-fluorouracil intravenous drip, transcatheter lumen radiotherapy, capecitabine oral administration) and liver transplantation in the liver transplantation group. The recurrence rates and survival rate were compared between groups.Results:The 1, 3 and 5 years cumulative survival rates of the liver transplantation group were 89.5%, 73.7% and 63.2%, respectively, which were significantly better than those of the liver resection group (80.0%, 53.3% and 35.6%) ( P<0.05). The postoperative tumor recurrence rate in the liver transplantation group was 31.6% (6/19), which was significantly lower than that in the liver resection group of 60.0% (27/45) ( P<0.05). Subgroup analysis using postoperative pathological results showed the cumulative survival rates of patients without lymph node metastasis (N 0) and those with negative resection margins (R 0) were not significantly different between groups ( P>0.05). However, for patients with regional lymph node invasion (N 1) and with R 0 resection margin, the cumulative survival rates at 1, 3 and 5 years after liver transplantation were 83.3%, 66.7% and 50.0%, respectively, which were significantly superior to the 64.3%, 28.6% and 14.3% of the liver resection group ( P<0.05). Conclusion:Hepatectomy is recommended for patients with N 0 R 0 resectable hilar cholangiocarcinoma. For patients with hilar cholangiocarcinoma with marginally resectable N 1R 0, neoadjuvant therapy combined with liver transplantation resulted in significantly better long-term overall survival than resection.