The core of hospital management is to strengthen and upgrade medical quality and secure satisfactory medical service through the mobilization of manpower,fund and materiel.The Lanzhou Aumy Hospital has gradually perfected the medical quality control system of a general hospital in combi- nation with the hospital's management system and in consideration of the development of modern hospi- tal administration in recent years.The operational law of the system is also studied and formulated.

Objective]Summary of the role of adipokineson insulin resistance and the effective components and mechanisms of traditional Chinese medicine and its extract in recent years to improve insulin resistance.[ Methods]Consulting CNKI, VIP database, PubMed database about adipokines to improve insulin resistance and effective components of traditional Chinese medicine research literature, summarize the main adipokines and traditional Chinese medicine for improving IR by interfering with the adipokines.[Result]Leptin, adiponectin and resistin and other factors play a key role in the formation of insulin resistance and diabetes.The research on the effect of Chinese herbal medicine extract and its active components on the improvement of insulin resistance by the intervention of the adipokines is also increasing.[Conclusion]The inflammatory reaction mediated by the adipokines is one of the important factors that lead to insulin resistance, traditional Chinese medicine can effectively improve the type 2 diabetes insulin resistance caused by adipokines.

Objective:To investigate esomeprazole combined with early enteral nutrition on the immune function and intestinal flo-ra in the elderly by patients with severe acute pancreatitis. Methods:Totally 78 elderly by patients with severe acute pancreatitis were selected and randomly divided into the observation group (39 cases) and the control group (39 cases). The control group was treated with early enteral nutrition therapy, and the observation group was treated with esomeprazole additionally. The treatment course was 14 days. Results:The total effective rate of the observation group was higher that of the control group (P<0. 05). The abdominal pain relief time, recovery time of bowel sounds, abdominal distension relief time, and the time of serum amylase returning to normal and u-rine amylase returning to normal in the observation group were all better than those in the control group (P<0. 05). The incidence of intestinal flora disorders in the observation group was lower than that in the control group (P<0. 05). After the treatment, CD3+, CD4+ and CD4+/CD8+ increased in both groups (P<0. 05), and those in the observation group were higher than those in the con-trol group (P<0. 05). Serum amylase and urine amylase decreased in both groups after the treatment (P<0. 05), and the decrease in the observation group was more significant than that in the control group (P<0. 05). No serious adverse drug reactions appeared in both groups. Conclusion:Esomeprazole combined with early enteral nutrition in the elderly by patients with severe acute pancreatitis shows significant effect, and the effect may be related with improving the immune function and intestinal flora.

ObjectiveTo observe the curative effect of alprostadil combined with cilostazol in treatment of patients with lower limb atherosclerosis.MethodsSixty-two patients with lower limb atherosclerosis were divided into cilostazol group (cilostazol 100 mg,2 times a day,oral) and therapeutic alliance group (cilostazol 100 mg,2 times a day,oral; alprostadil 10 μ g dissolved in 100 ml intravenous infusion of 0.9％ sodium chloride,once a day) by random number table with 31 cases each.The changes of ankle-brachial index (ABI),distance of 6-minute walk test(6-MWT) and the dorsal blood flow were compared before and after treatment.Results | After treatment,the distance of 6-MWT,ABI and the level of dorsal blood flow were significantly improved in two groups (P ＜ 0.05 or ＜ 0.01 ).Distance of 6-MWT and the level of dorsal blood flow in therapeutic alliance group was significantly higher than that in cilostazol group after treatment [(425.4±138.5) m vs.(379.5±124.6) m,(0.77±0.18) ml/ (s·cm2) vs.(0.66±0.14) ml/( s· cm2)] ( P＜0.05 ).The total effective rate in the treatment of cold feel in therapeutic alliance group was significantly higher than that in cilostazol group [ 87.5％(21/24) vs.61.9％( 13/21 ) ](P＜ 0.05).Conclusion Alprostadil combined with cilostazol is safe and effective in treating lower limb atherosclerosis.

TiO2 coated hollow fiber ( HF) was prepared by sol-gel method and characterized by X-ray powder diffraction and scanning electron microscope. The adsorption performances of the self-prepared TiO2 coated HF for interest metal ions were explored. The sample solution was extracted for 30 min at pH 8. 0 under stirring at speed of 700 r/min, then desorpted with 100μL of 1 mol/L HNO3 . On the basis of this, a method combining TiO2 coated HF micro-solid phase extraction with electrothermal vaporization-inductively coupled plasma mass spectrometry ( ICP-MS ) was developed for the determination of trace metal ions in environmental water samples. Under the optimized conditions, the limits of detection obtained by the proposed method were 0. 039, 0 . 021 , 0 . 009 and 0 . 018 ng/mL for CrⅢ, CuⅡ, CdⅡ and PbⅡ with enrichment factors of 12 . 5 , 11 . 7 , 10. 3 and 18. 6, respectively. The preparation reproducibility of self-prepared TiO2 coated HF ranged from 4. 5% to 6. 8% (n=9) in one batch, and from 7. 7% to 9. 6% (n=7) in batch-to-batch. The developed method has been validated by analyzing a certified reference material ( GSBZ50009-88 200925 ) and also applied to the analysis of CrⅢ, CuⅡ, CdⅡ and PbⅡ in East Lake water and snow water successfully. Meanwhile, TiO2 coated HF stir bar was prepared for a comparison and it was demonstrated that TiO2 coated HF displayed higher extraction efficiency and adsorption capacity for target ions.

Objective To investigate the changes of platelet aggregation rate and platelet surface CD 41+CD62P+ expression af-ter clopidogrel discontinuation in the patients with percutaneous coronary interventions (PCI)) .Methods The platelet aggregation rates and platelet surface CD41+CD62P+ in 52 PCI patients with oral clopidogrel for near 12 months and discontinuation soon were measured before clopidogrel therapy(T0 ) ,in 1 week after clopidogrel therapy(T1 ) ,1 week before clopidogrel discontinuation(T2 ) , 1 week(T3 ) and 1 month after clopidogrel discontinuation (T4 ) .Results Compared with T0 ,the platelet aggregation rate and the expression of platelet CD41+CD62P+ at T1 were significantly decreased ,the difference showing statistical significance (P<0 .05) , which at T2 maintained the lower levels ;which at T3 were increased ,which at T4 were recovered to those at T0 .The platelet aggre-gation rates at various time points were (44 .20 ± 18 .36)% ,(25 .38 ± 12 .10)% ,(23 .74 ± 8 .15)% ,(51 .79 ± 10 .55)% and(45 .97 ± 16 .42)% respectively ,and the positive rates of CD41+ CD62P+ were(12 .96 ± 11 .48)% ,(3 .93 ± 3 .33)% ,(4 .72 ± 3 .14)% , (13 .90 ± 10 .38)% and(10 .84 ± 8 .13)% ,respectively .Conclusion In the patients treated with 12-month clopidogrel after PCI ,the platelet aggregation rate and the CD41+CD62P+ positive rate are mildly increased at 1 week after clopidogrel discontinuation and gradually returned to the level before discontinuation at 1 month after clopidogrel discontinuation .

Objective To observe the recent clinical efficacy of the sequential therapy hormone in the treatment of active rheumatoid arthritis.Methods In accordance with the principle of digital sheet,160 patients with active rheumatoid arthritis were randomly divided into the observation group and the control group,80 cases in each group.On the basis of methotrexate and leflunomide in both groups,the hormone sequential therapy was given in the observation group,but prednisone was given in the control group.The clinical efficacy of treatment after 1 week and 3 months were compared in two groups.Results In the observation group,the indicators in 7 d after treatment were significantly reduced,compared with untreated(t =19.90,7.63,14.73,7.58,6.84,14.09,all P ＜0.01),In the control group,three indicators of the duration of morning stiffness,joint tenderness index and joint swelling index in 7d after treatment were significantly reduced,compared with untreated (t =13.42,3.34,7.24,all P ＜ 0.01),Compared the indicators in the two groups in 7 d after treatment,there were statistically significant differences (t =13.07,4.92,10.51,5.23,5.74,15.03,all P ＜ 0.01).The indicators in the 3 months after treatment in both groups were signifi cantly decreased,buttherewasnosignificantdifferencebetweenthetwogroups (t =1.80,1.73,1.59,1.22,1.21,1.35,all P ＞ 0.05).The total effective rate was 80% in the observation group; but the rate was 75 % in the control group;there was no statistically significant difference in the two groups(x2 =0.57,P ＞ 0.05).Conclusion The sequential hormone therapy is an effective means for the treatment of active rheumatoid arthritis,by controlled the symptoms of rheumatoid arthritis effectively and alleviated the patient's condition.

OBJECTIVE:To evaluate the effect of psychological intervention based on pharmaceutical care on the communi-ty patients with essential hypertension. METHODS:172 patients with essential hypertension in a community health service certer in Nanjing Gulou area in 2013 were divided into control group(n=87)and intervention group(n=85)by simple random meth-od. Control group received conventional antihypertensive drugs and management,intervention group additionally received pharma-ceutical care and psychological intervention,it lasted 6 months. Blood pressure controlling,drug compliance,mastery of drug knowledge and health status in 2 groups before and after treatment were compared. RESULTS:Before treatment,there were no significant differences in the systolic blood pressure(SBP)and diastolic blood pressure(DBP)between 2 groups(P>0.05);af-ter treatment, SBP and DBP in 2 groups were lower than before,SBP and DBP in intervention group were lower than control group,the decrease degree of SBP and DBP was bigger than control group,the differences were statistically significant (P<0.01). 1 month after the beginning of intervention,there was no significant difference in the proportion of drug compliance be-tween 2 groups (P>0.05);1 month after the end of the intervention,the proportion of drug compliance in intervention group was higher than 1 month after the beginning of intervention and control group,the differences were statistically significant(P<0.05). Before treatment,there was no significant difference in mastery of drug knowledge between 2 groups (P>0.05);after treatment,the proportion of patients showed good and excellent mastery of drug knowledge was higher than before and control group,the differences were statistically significant (P<0.05). Before treatment,there were no significant differences in scores of physical,mental,social health subscale and SRHMS between 2 groups(P>0.05);after treatment,scores of physical health subscale and SRHMS in control group,each subscale and to-tal scale scores in intervention group were higher than be-fore, and scores of mental, social health subscale and SRHMS in intervention group were higher than control group, the differences were statistically significant (P<0.05). CONCLUSIONS: The psychological intervention based on pharmaceutical care can effectively promote the con-trol of blood pressure,improve drug compliance,mastery of drug knowledge,health status and mental situation,which is worth of popularizing and applying in community health services.

OBJECTIVE:To study the pharmacokinetic characteristics of Recombinant hirudin enteric-coated capsule by single and multiple administration in Beagle dogs. METHODS:12 Beagle dogs were divided into single ig group and single iv group by random control method,6 in each group. Recombinant hirudin 0.2 mg/kg was intragastrically administrated or intravenously inject-ed,blood sample was collected;after 2 weeks of cleaning,12 dogs were intragastrically administrated recombinant hirudin 0.2 mg/kg,for 7 d. Sample blood was collected,referred to multiple ig group. Recombinant hirudin concentration in plasma was deter-mined by enzyme-linked immunosorbent assay,and pharmacokinetic parameters were calculated by DAS 2.0 software. RESULTS:The results showed that pharmacokinetics by ig and iv recombinant hirudin in Beagle dogs fitted to two-compartment model,abso-lute bioavailability of ig Recombinant hirudin enteric-coated capsule was(14.908±1.868)%;the pharmacokinetic parameters in sin-gle ig group and multiple ig group were tpeak of(2.105±0.243),(3.000±0.000)h,t1/2β of(8.660±2.965),(14.870±2.710)h, cmax of(10.700±0.872),(12.05±1.587)ng/mL,AUC0-1440 min of(55.250±4.386),(58.978±6.002)ng·h/mL,without statistical significances in two groups(P>0.05). CONCLUSIONS:The ig Recombinant hirudin enteric-coated capsule can be absorbed into the blood to a certain extent. There is no accumulation for ig Recombinant hirudin enteric-coated capsule for several days,and it dose not change the pharmacokinetic characteristics.

Objective To master the current status of iodine nutrition of people in Nanjing after the adjustment of iodized salt standard,and to provide scientific basis for reasonable iodine supplementation and strategies for iodine nutrition control.Methods The probability proportional to size (PPS) sampling method was employed in the investigation.We firstly selected 30 streets in the whole city,and then chosen 50 children aged 8-10 years from each of 30 primary schools respectively,which was selected from 30 different streets to examine the size of thyroid gland by palpation and B-type ultrasound.We also collected urine and edible salt samples from 12 children aged 8-10 years from each primary school,to detect their urinary and salt iodine content.Moreover,20 pregnant women and 10 lactating women were picked out from each of 30 schools nearby to detect their urinary and salt iodine content.We also conducted a unique questionnaire survey in 30 fifth-grade students selected from each of 30 schools,and 5 housewives selected from these schools nearby to understand their knowledge of iodine deficiency disorders.Results The thyroid palpate swelling rate was 0.33％(5/1 500) in 1 500 children aged 8-10.The medians of urinary iodine level were 220.5 μg/L in 362 school-age children,196.7 μg/L in 600 pregnant women and 152.0 μg/L in 300 lactating women.A total of 1 260 samples of edible salt were tested.The coverage rate of iodized salt and the consumption rate of eligible iodized salt were 99.7％ (1 256/1 260) and 96.9％ (1 221/1 260),respectively.The mean iodine content of edible salt was (24.5 ± 4.5) mg/kg.A total of 900 fifth-grade students and 150 housewives were surveyed for health knowledge of iodine,and the eligible rate was 83.2％ (2 246/2 700) and 91.6％ (412/450),respectively.Conclusions After the adjustment of iodized salt content,iodine nutrition level of people in Nanjing has maintained appropriately.However,health education should be further strengthened.Improving the awareness rate of iodine deficiency knowledge,and guiding scientific iodine consciousness are our serious task in the future.