A study of PDCA Cycle in managing hospital medical complaints may introduce such a cycle into the medical complaints control system of a hospital, effectively handling the medical complaints process. Since 2006 when the cycle was introduced into the hospital for medical complaints control, such complaints have been cut back significantly by the end of 2009. Furthermore, such complaints are under control from the start, and prevented from growing into medical disputes, effectively improving quality of care. Such a cycle can effectively avoid medical complaints, enhance medical safety, and build a harmonious doctor-patient relationship.

0.05).The death rate of cases with pneumonia combined with ascites was higher than that of cases with ascites only(?2=4.894,P=0.027) and cases without ascites and infections(?2=9.260,P=0.002).Unfavorable prognosis was found in cases with Enterococcus faecium isolated before OLT.CONCLUSIONS Severe lung infection before OLT is one of the main reasons of death.It is important to grasp characteristics of infection,evaluate risk fully,control infections and screen cases strictly before OLT to improve survival rate.

Quality of care is key to medical safety which has a close bearing on patients’life and health,and on the branding and efficiency of the hospital.Medical safety is one of the key indicators of the overall performance appraisal of the hospital.This novel type of nurse-physician collaboration,abandoning the traditional model of health care,is a new integrated model of health care which improves the overall quality of care,enhances medical safety and patient satisfaction.This paper described in detail the implementation methods and steps of the collaboration,the progress of such a collaboration and its contribution to medical safety are also discussed.

This article sumarized a practise-based study of the hospital regarding the management of its medical activities.By means of priotizing medical safety in pre-job and on-the-job eduation,and regular trainings in this regard,a systemized medical safety education ssytem is put in place among medical staff of different types and levels.This achieved the purpose of higher awaress of medical safety in medical practice,and downsized medical complaints significantly.

Objective To explore and investigate effective solutions of some issues in the self-development of large-scale compre-hensive hospital ,such as the innovation concept of hospital management ,strengthening the organization and management agencies , improving management efficiency and promoting the establishment of systematized management .Methods Starting from concept innovation ,theory innovation and method innovation of hospital management ,comprehensive applied the advanced concept of hospi-tal management and scientific management methods into the quality of medical care .Results Continuously strengthen the hospital medical quality and safety ,and form hospital-specific quality management system .Conclusion Through innovating the concept ,the-ory and methods of hospital management ,we can effectively promote continuous improving quality of medical care in comprehensive hospital and improve continually core competitiveness of hospital .

Objective: To study the propagation and phenotypes changes of killer cell (CD3AK cell activated by CD3 mAb in vitro. Methods: Lymph nodes taken from lung cancer patient is dissociated into single cell suspension by mechanical method and cultured in culture medium added CD3 mAb and a little dose IL-2. We analyze cell immunophenotype by flow cytometry and proliferation by trypan blue exclusion test per 2 days. Results: Immunophenotypic analysis showed that CD3AK expressing CD3, CD8, CD56, CD25 increased, and reached a peak value which is 2.33 times than before culturing in the 8 th day. Conclusion: CD3 mAb added to the culture medium can obviously activate CD3AK cell and stimulate proliferation and keep its killer activity.

Objective To study the relationship between programmed death-1 (PD-1)/programmed death-1 ligand (PD-L1) expressions and serum hepatitis B virus (HBV) DNA levels in chronic hepatitis B (CHB) patients. Methods A total of 137 CHB patients and 10 healthy controls were enrolled in the study. The peripheral blood mononuclear cells (PBMCs) were isolated from fresh blood samples. HBV-specific cytotoxic T lymphocyte (CTL) was expanded in vitro in 64 human leucocyte antigen (HLA)-A2 positive patients. Flow cytometry was used to detect HLA-A2 type,expressions of PD-1/PD-L1 on PBMCs and PD-1 on HBV specific CTL. Interferon gamma (IFN-γ)was measured by commercial enzyme-linked immunosorbent assay (ELISA) kits. PD-1/PD-L1expressions on PBMCs, HBV-specific CTL and IFN-γ level in PBMC culture medium were compared among patients with different baseline HBV DNA levels. Ten hepatitis B e antigen (HBeAg) positive patients were treated with telbivudine for 24 weeks. The above mentioned parameters were determined and compared before and after the antiviral treatment. Independent-samples t test were used to compare means between two groups and one-way A NOVA were used to compare means among multigroups. We used the pearson corretation test to assess corretation significance. Results The PD-1 and PD-L1 expressions on PBMCs in patients with baseline HBV DNA＜3 lg copy/mL, 3-6 lg copy/mL and ＞6 lg copy/mL were all significant higher than those in healthy control group, but no statistical differences were found. PD-1 expressions on HBV-specific CTL in the three CHB patient groups were (69.3±11.2)%, (76.5±9. 1)% and (78.0±11.7)%, respectively. However, PD-1 expression on HBV-specific CTL was higher, while the frequency of HBV-specific CTL cells was lower in HBV DNA ＞6 lg copy/mL group compared to HBV DNA＜3 lg copy/mL group. The above parameters, including expressions of PD-1 and PD-L1, the frequency of HBV-specific CTL and its PD-1 expression were not significantly different between HBeAg-positive group and HBeAg-negative group. Compared with baseline, PD-1 and PD-L1 expression decreased obviously accompanying with increase of HBV-specific CTL cells frequency and IFN-γ level after 12 weeks and 24 weeks of telbivudine treatment. Conclusions PD-1 expression on HBV-specific CTL correlates with serum HBV DNA level, but not HBeAg status in CHB patients. Suppression of HBV replication can reduce PD-1/PD-L1 expressions and partially restore HBV specific CTL function.

Objective To evaluate the therapeutic efficacy and its related factors of entecavir treatment for patients with acute on chronic hepatitis B liver failure (ACHBLF).Methods One hundred and eight patients with ACHBLF were enrolled and divided into entecavir group (n=53) and control group (n=55).HBV DNA level, liver function and 48-week survival rate were observed, and C ox regression model was established to identify the factors which may affect the efficacy of entecavir treatment.Results Totally 70 patients died in the study and 66 died within 12 weeks.The statistical difference on cumulative survival rate between two groups was observed from the third week on (χ2=5.357, P ＜ 0.05).The 48-weekcumulative survival rate in entecavir group was 47.2% (25/53), while that in the control group was 23.6%(13/55) (χ2=7.432, P ＜ 0.01).In entecavir group, for patients aged ＜ 40 with serum bilirubin level ＜513 μnol/L and international normalized ratio (INR) ＜ 2.5, the fatality rates decreased 74.9%, 75.3%and 76.0%, respectively.Conclusions Entecavir may improve the survival rate of patients with ACHBLF.Age, serum bilirubin level and INR are major factors related to the therapeutic efficacy.

Objective To investigate the revaccination efficacy of different dosages of hepatitis B vaccine among adult non-and hyporesponders so as to improve the protection rate of hepatitis B vaccination.Methods The healthy adults who were immunized with hepatitis B vaccine at least one standard scheme in two years and negative for hepatitis B markers were enrolled in this randomized and open-label study.The hepatitis B vaccine was injected intramuscularly in the deltoid muscle on an upper arm according to routine schedule (month 0,1,6).The adults were randomly given four different dosages:73 in group A were given hepatitis B vaccine 10 μg (made in China) each time;69 in group B were given hepatitis B vaccine (made in China) 20 μg each time;70 in group C were given gene recombinant yeast hepatitis B vaccine (Engerix) 20 μg each time and 48 in group D were given gene recombinant yeast hepatitis B vaccine 40 μg each time.The serum anti-HBs was tested before and 1,2,8,12 months after the first injection.The comparison of means was done by one-factor analysis of variance and the comparison of rates was done by chi square test.Results The anti-HBs positive rates were the highest at months 8 of re-immunization in group B,C and D,which were 68.1%,70.0% and 77.1%,respectively,and were all higher than that in group A (53.4%)(χ2=21.465,P＜0.01).The anti-HBs positive rate increased in group B,C and D with increasing immunized times and over time,but there was no significant difference;it went down at 12 months after re-immunization.The anti-HBs positive rates at 1,2,8 and 12 months after re-immunization in group A were 8.2%,19.2%,53.4% and 43.8%,respectively and differences were significant (χ2=53.07,P＜0.01).The anti-HBs levels in group B,C and D were all higher than that of group A(F=7.551,P＜0.05) at month 12 of re-immunization.There were no significant differences of anti-HBs levels at different re-immunization time points in group B,C and D.Conclusion Revaecination of hepatitis B vaccine can induce immune responses and increasing dosages can improve the immune efficacy in non- and hyporesponders.

Objective To investigate the balance of Th1/Th2 cytokines and its relationship with prognosis of severe chronic hepatitis B ( CHB ). Methods Peripheral blood samples were collected from 112 severe CHB patients, 30 CHB patients and 30 healthy controls. IL-4, IFN-γ levels and HBV DNA loads were measured by ELISA and fluorescent PCR, respectively. The levels of cytokines in different stages, and their correlations with HBV DNA loads and short-term prognosis were analyzed. Results Higher levels of IL-4, IFN-γ and Th1/Th2 ratios in peripheral blood were detected in patients with severe CHB than those with CHB and the healthy controls (Z = 8.968, 10. 004 and 26. 067, P =0. 009, 0. 007 and 0. 000). IL4 levels in patients with end-stage server CHB were markedly higher than those in other stages ( Z = 3. 672 and 3. 158, P= 0.000 and 0.002), while their Thl/Th2 ratios were lower (Z=3. 161 and 2. 166, P=0.002 and 0. 030). No significant differences on levels of IL-4, IFN-γ and Th1/Th2 ratios were observed in severe CHB patients with different HBV DNA levels (Z =4.431, 2.626 and 0. 140, P =0.219, 0.403 and 0. 987). Elevated IL-4 was closely correlated with the high case-fatality rate within 12 weeks. Conclusions The balance between Th1 and Th2 cytokines is- disturbed in patients with severe CHB. Thl/Th2 ratio decreases with the aggravation of diseases, which may indicate unfavorable short-term prognosis.