Objective To learn the present hospital medical quality management,to explore and improve the quality of care management system.Methods Literature review analysis theory of medical quality management system,questionnaires analysis the present medical quality management,case and influencing factors.Results The literature review showed that the trend of quality management study increased year by year in recent 20 years,and is gradually becoming a hot topic in China.The management practices survey found the quality of care management systems mostly established,yet with rooms of improvement for the management content and details.Thanks to the three-stage introduction,operation and indepth study of international standards,hospitals have effectively promoted their quality management.Conclusions Key influencing factors for hospital quality management are the design of such quality management system itself,and lack of quality tools and resources.To build a better quality of care management system,efforts should be paid from both internal and external aspects,thus elevating such quality to a new level.

Objective To study antidepressant effect and mechanism of different polar fraction of Acorus tatarinowii Schott.on depression mouse model and explore the mechanism. Methods Different polar fractions were prepared by systematic solvent method. The adult dose recommended by Chinese Pharmacopeia ( 10 g?d-1 ) was converted to the dose of mouse. Intragastric administration was performed.A total of 80 male mice was randomly divided into normal control group,model control group and different polar fraction groups of Acorus tatarinowii Schott.. Depression mouse model was established by chronic unpredictable mild stimulation ( CUMS) with solitary feeding,and external performance of mice of different groups was observed. After 21-day feeding,blood was harvested from eyes of the mice.Concentrations of triiodothyronine (T3),tetraiodothyronine (T4), thyroid-stimulating hormone ( TSH) ,adrenocorticotrophic hormone ( ACTH) in mouse plasma and 5-hydroxy tryptamine ( 5-HT) , ACTH in brain were measured by ELISA method. Results Concentrations of T3 , T4 and ACTH in model control group [(1.203±0.042),(44.80±2.21),(11.27±0.50) ng?mL-1] were significantly increased as compared with the normal control group [(0.794±0.028),(24.87±1.25),(7.04±0.24) ng?mL-1] (P<0.05).Concentration of 5-HT in brain (146.87±10.96) was significantly decreased as compared with that of normal group ( 237. 11 ± 21. 87 ) ng?L-1 , and concentration of ACTH (58.94±4.46) ng?L-1 was significantly increased as compared with that of normal group [(38.89±2.26) ng?L-1,P<0.05)]. Concentrations of T3[(0.824±0.067),(0.812±0.051),(0.943±0.049) ng?mL-1],T4[(25.97±1.96),(27.53±1.88), (31.26±1.97) ng?mL-1] and ACTH [(7.21±0.40),(7.58±0.39),(8.69±0.42) ng?mL-1] in extraction group,cyclohexane group and chloroform group were significantly decreased as compared with model control group. At the recommendation dose of Chinese Pharmacopeia,concentrations of 5-HT in brain [(219.59±10.48),(202.19±11.95),(186.96±10.29) ng?L-1] were significantly increased,and concentrations of ACTH [(41.65±2.65),(44.87±2.95),(47.75±3.06) ng?L-1] were decreased ( P<0.05) . Conclusion Mouse model of CUMS shows typical depression symptom,and the symptom has relationship with the concentrations of endocrine hormones of T3 , T4 , ACTH, 5-HT, etc. Extraction and low polar fractions ( cyclohexane, and chloroform) of Acorus tatarinowii Schott. can partly correct incretion disorder of depression model, which may be parts of the reasons why Acorus tatarinowii Schott.exerts anti-depressant effect.

Objective; To study the chromatic distribution of the chromatic value of Vitapan 3D- Master shade guide in color space. Methods: The color space of.Vitapan 3D-Master shade guide was measured and analyzed with CIE-1976-L* a* b. system and MINOLTA chromatic instrument (CR-321 ) under D65 standard source. Results: 26 shades of Vitapan 3D-Master could be divided into 5 groups according to the 3-dimensional layers. Inside the 2nd, 3th and 4th group, 6 shades distributed as equidistant ring circling M2 shade because their hue and chroma were different. The hue of L1. 5 and L2. 5 deflected to yellow, R1.5 and R2. 5 to red,that of M1-3 was intervenient. Conclusion: Vitapan 3D-Master shade guide is equidistant in color space and can be used more effeciently than Vitapan classical. Its chromatic value distribution perfectly and evenly covered color region of nature tooth.

Using cDNA from Rehmannia glutinosa leaf as template, a 972 bp fragment of expansin gene which containing a 762 bp ORF that encoded 253 amino acids, was cloned, named RgEXPA10, which GenBank accession number for this gene is KF011918. A 1 207 bp genomic sequence of RgEXPA10 was amplified by PCR with leaf DNA as template, sequencing analysis revealed that three exons and two introns in RgEXPA10 genomic sequence, and which GenBank accession number is KF011919. Molecular and bioinformatic analyses indicated that RgEXPA10 protein have DPBB_1 and Pollen_allerg_1 domain, also including a 26 aa nuclear localization signal and a 19 aa transmembrane region. Phylogenetic analysis revealed that RgEXPA10 showed the highest homology with AtEXPA8 among the 26 α-expansins in Arabidopsis thaliana. However, the RgEXPA10 indicated the highest homology with the expansin from Solanum lycopersicum among 22 plant species. Expression patterns using qRT-PCR analysis showed that RgEXPA10 mainly expressed in unfolded leaf, followed by the tuberous root at stage of expanding period, and rarely expressed in senescing leaf. And RgEXPA10 showed higher expression level in tuberous root at 60 and 90 days after emergence. The transcription level of RgEXPA10 significantly reduced under all the three stresses including continuous cropping conditions, salinity and waterlogging. This study will lay foundations for molecular function in development and regulation of different stresses for R. glutinosa.

The analysis of stable nitrogen isotopic composition (δ15 N) of individual amino acid was recognized as an effective method for estimating the trophic level of organisms and detecting the nitrogen flow in food webs. In this study, we evaluated a two-stage procedure of esterification followed by acylation, in which biological samples underwent hydrolysis in acid and the released individual amino acids were derivative into the corresponding N-pivaloyl-iso-propyl ( NPP ) esters for gas chromatography-combustion-isotope ratio mass spectrometric ( GC-C-IRMS) analysis. A total of 13 kinds of individual amino acid derivatives were baseline separated on a nonpolar gas chromatography column (DB-5ms). The amount of sample for each test was not less than 20 ng N on column. High correlations were observed between the δ15 N values respectively obtained by GC-C-IRMS and element analysis-isotope ration mass spectrometry (EA-IRMS). Furthermore, the mean precision of this method was better than 1‰. Cation-exchange chromatograph was used to purify the samples, and the difference of the detection δ15 N values before and after purification by the resin was within 1‰. This method was applied to estimate the trophic level of various natural freshwater organisms from Aha Lake. The present study provided a new idea for the application of stable nitrogen isotope (δ15 N ) in the trophic level estimation of organisms and metabolism analysis of amino acid.

Objective Pulmonary dysfunction is common in the obese patients after laparoscopic surgery. To reduce or avoid this complication caused by improper combination of mechanical ventilatory parameters,we conducted the following trial of 3 factors with 3 levels of mechanical ventilation in order to explore the optimal combination with low airway pressure. Methods Patients were randomly allocated into 9 groups (k=3,n=27) according to the "30≤BMI<40" obesity index (ASAⅠ-Ⅱ). Anesthesia machine parameters were set as follows: respiratory frequency (f), tidal volume (VT), respiratory ratio (I:E) as the three factors of A, B, C, with 3 levels of f=15, 12, 9 (bpm), VT=8, 10, 12 (mL/kg), I:E=1:2.5, 1:2.0, 1:1.5. By using L9(3~4)K=3 repeat orthogonal experimental design and analysis table, the variable factors that affect the respiratory index such as the end tidal carbon dioxide pressure (P_(ET)CO_2), peak airway pressure (PIP), mean airway pressure (P_(mean)), and the end of endogenous airway pressure (PEEPi) were analyzed. Results In this study, 27 cases undergoing laparoscopic surgery under general anesthesia were allocated into 9 experimental groups. The hemodynamics of these patients was stable, SPO_2 was kept at 100 percent during the operation. The results of different combinations were described as follows: ①P_(ET)CO_2: f and VT with different level had great impact on P_(ET)CO_2 (P<0.01), I:E had no significant difference in three levels (P>0.05);② PIP: f had great effect on PIP (P<0.05);VT and I:E in three levels also had significant effect on PIP(P<0.01);③ P_(mean): all the ventilation parameters with different combination had significant effect on P_(mean)(P<0.01). Conclusions The best combination of respiratory parameters is A3B1C2, i.e., f=9 bpm, VT=8 mL/kg, and I:E=1:2.0, which indicates that neither small tidal volume and faster frequency, nor slow frequency large tidal volume is a good choice. In order to let obese patients under general anesthesia obtain the best lung protective effect by low airway pressure with good ventilation, it is worth noting that: ①I:E has a great effect on airway pressure (PIP, P_(mean)), which is important for lung protection;②I:E has the opposite effect on PIP and P_(mean).

Objective To learn the present hospital management conditions in Shanghai for upgrading quality of care.Methods The stratified sampling method was used for a questionnaire survey of the quality of care at 20 hospitals in Shanghai (10 tertiary hospitals and 10 secondary hospitals).The survey covered such six dimensions as organizational framework,management functions,management tools,professional training,regulations and norms,and supervision over operations.Results Medical quality management system is established at such hospitals and all of them have established medical quality management committees.Rooms of improvement remain in such details as departmental quality management,regulations standardization,IT support,and management tools popularity.Conclusion Management regulations and standards of medical quality management should be improved and implemented from both external and internal aspects,to improve medical quality and patient safety.

Objective To study the resistance and molecular profiles of Staphylococcus aureus strains isolated from the clinical specimens.Methods Antimicrobial susceptibility was tested with 56 strains of Staphylococcus aureus isolated from a hospital from May to November 2011.The mecA and pvl genes were detected.The spa genetic types were analyzed.Results A total of 21 (37.5%)Staphylococcus aureus strains were resistant to methicillin (MRSA)and 35 (62.5%)were sensitive to methicillin (MSSA).Nineteen of the 21 (90.5%)MRSA strains carried mecA gene.Compared with MSSA,MRSA were much less sen-sitive to rifampin,fluoroqunolones,tetracycline and gentamicin (P <0.05).All the MRSA isolates were susceptible to vanco-mycin,linezolid,tigecycline,quinupristin-dalfopristin and nitrofurantoin.Six spa types were identified among the MRSA strains.Type t030 was the most prevalent,accounting for 66.7% (14/21)of all the MRSA strains.MRSA-t030 and MRSA-t002 were resistant to multiple antibiotics.Eighteen spa types were identified among the MSSA strains.Type t189,t377 and t034 were the top three spa types of MSSA,accounting for 14.3%,14.3% and 11.4%,respectively.A new MSSA spa typ-ing strain new1 was isolated from pus.There were five Panton-Valentine leukocidin (PVL)-positive isolates,3 of which was MSSA-t189 type. Conclusions Type t030 is the most prevalent spa type among clinical MRSA strains,which is resistant to many kinds of antibiotics and widely spreads in the hospital setting.There are many different spa types a-mong the MSSA strains.Type t389,t377 and t034 are the top three spa types of MSSA.

Objective To evaluate efficacy and safety of locally-produced pazufloxacin mesilate sodium chloride injection in the treatment of bacterial infections of respiratory and urinary tract.Methods A multi-center double-blind randomized controlled clinical trial was carried out to evaluate efficacy and safety of pazufloxacin mesilate sodium chloride in treatment for acute bacterial infection, as compared to those of levofloxacin hydrochloride and glucose injection as control treatment.A total of 244 patients with acute bacterial infection of respiratory and urinary tract were enrolled in the studies.120 in trial group and 120 in control group, with four withdrawals.Pazufloxacin mesilate and levofloxacin were administered intravenously by drip at a dose of 300 mg and 200 mg, every 12 hours for 7 to 14 days for trial and control groups, respectively.Resuits Overall efficacy of pazufloxacin mesilate was 77.0 percent and 93.5 percent in treatment for acute bacterial infections of respiratory and urinary tract.respectively, and that of levofloxacin was 80.6 percent and 89.6 percent, respectively.Overall bacterial clearance rate WaS 91.5 percent for pazufloxacin mesilate, 89.6 percent for respiratory tract infection and 94.1 percent for urinary tract infection, respectively.and 93.4 percent for levofloxacin, 97.3 percent for respiratory tract infection and 89.7 percent for urinary tract infection, respectively.No significant difference in adverse drug reactions between the two groups(P＞0.05)was found, with 4.88 percent and 7.44 percent for trial and control groups, respectively.Conclusions Pazufloxacin mesilate sodium chloride injection produced locally is a safe and effective antibiotic in treatment for acute infections of respiratory and urinary tract.