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 To study the etiology of comumunity acquired pneumonia (CAP) in children of Jiaxing city and provide the basis for the clinical diagnosis and treatment.Methods An etiological study was performed on 800 young children with CAP in Jinxing First Hospital from Jan 2008 to Dec 2010.Sputum samples were collected for isolating bacteria and checking the antigen of respiratory syncytial virus ( RSV),adenovirus ( ADV),influenza virus (IV) and parainfluenza virus ( PIV ).IgM antibodies of mycoplasma pneumoniae (MP),ADV,W and PIV paired serum samples were detected.The 202 cases with positive etiology were divided into three groups:bacteria group ( 109 cases),virus group (54 cases) and MP group (39 cases).The leukocyte,C-reactive protein (CRP) and procalcitonin (PCT) were detected.Results The etiology of CAP was identified in 202 (25.25％) children of all the 800 cases,the distribution of causal agents was as follows:Streptococcus pneumoniae in 46 cases (22.77％,46/202 ),Haemophilus influenzae in 32 cases (15.84％,32/202),Staphylococcus in 5 cases (2.48％,5/202),Klebsiella pneumoniae in 8 cases (3.96％,8/202),Escherichia coli in 12 cases (5.94％,12/202),MP in 39 cases ( 19.31％,39/202),RSV in 48 cases (23.76％,48/202),ADV in 1 case (0.50％,1/202),IV in 3 cases ( 1.49％,3/202),and PIV in 2 cases ( 0.99％,2/202 ),Streptococcus pneumoniae and RSV mixed infection in 3 cases ( 1.49％,.3/202),Streptococcus pneumoniae and MP mixed infection in 3 cases ( 1.49％,3/202).RSV infection occured mainly in infants less than 1-year-old,Streptococcus pneumoniae oceured in all ages but was mostly in 1 ～ 3years,Haemophilus influenzae infection occured mainly in infants less than 3-year-old,MP infection occured mainly in infants more than six years.The PCT levels of the three groups were (7.78 ±6.14) ng/ml,(0.39 ±0.56) ng/ml,and (0.20 ±0.34) ng/ml,respectively.There were significant differences among the three groups ( P ＜ 0.05 ).Conclusion RSV infection occurs mainly in infants of age less than 1 year,Streptococcus pneumoniae and Haemophilus influenzae infection occur mainly in infants of age 1 ～3 years,while MP is the leading cause of pneumonia in children of age more than 6 years in Jiaxing city.We can decide pathogen on ages,clinical manifestation and PCT level to guide the rational use of drugs.

OBJECTIVE:To understand the drug use of sample hospitals,and to provide reference for drug production,man-agement and service department. METHODS:Statistical analysis was conducted in the data of drug use in national 1 248 sample hos-pitals during 4th quarter of 2012-3rd quarter of 2013. RESULTS&CONCLUSIONS:Anti-infection medicine,Chinese patent medi-cine,nervous system drugs has being ranked the top 3 in the list of consumption sum,and that of various drugs is in an upward trend. Top 20 drugs in the list of consumption sum mainly are biological products,drugs for the nervous system,digestive system drugs;that of human albumin and deproteinized calf serum have increased greatly. Top 10 imported pharmaceutical enterprises or joint ventures in the list of consumption sum mainly are multinational enterprises,and they are stable in ranking. The development of pharmaceutical enterprises should focus on brand,quality,price and service,etc.,so that their competitiveness can be improved.

Objective To study the effect of the serum levels of 25-hydroxyvitamin D3 [25-(OH)D3] and total IgE (TIgE) in pathogenesis of the children bronchial asthma.Methods Twenty-two children with bronchial asthma (bronchial asthma group) and 20 healthy children (control group) were selected.The serum levels of 25-(OH)D3 and TIgE in the children of 2 groups were detected.Results The level of serum 25-(OH)D3 in bronchial asthma group was significantly lower than that in control group [(23.64 ± 3.89)μ g/L vs.(35.82 ± 4.37) μ g/L],there was statistical difference (P ＜ 0.05).The level of serum TIgE in bronchial asthma group was significantly higher than that in control group [(208.62 ± 32.59) kU/L vs.(73.84 ± 18.86) kU/L],there was statistical difference (P ＜ 0.05).There was negative correlation between the level of serum 25-(OH)D3 and TIgE in bronchial asthma group (r =-0.832,P ＜ 0.01),but there was no correlation between the level of serum 25-(OH)D3 and TIgE in control group (r =-0.038,P ＞0.05).Conclusions The lack of 25-(OH)D3 may be associated with allergy and childhood bronchial asthma.By monitor the levels of 25-(OH)D3 and TIgE may assess condition of childhood bronchial asthma.

Objective To investigate the change of T-lymphocyte subgroup in children with infectious mononucleosis (IM).Methods Sixty young children with IM caused by Epstein-Barr virus (EBV) were recruited for this study in Jiaxing First Hospital from Jan 2005 to Dec 2010.Thirty-six normal children were chosen as control group.Both of the two groups were detected blood test,blood smear,T-lymphocyte subgroup ( including CD3,CD4,CD8,CD4/CD8 ),liver and kidney function test,IgM antibodies of EBV,cytomegalovirus,adenovirus,and hepatitis virus.Results Compared with the control group (53.58％ ± 5.97％,31.22％±8.72％ ),the ratio of CD3 (81.55％ ±9.04％ ) and CD8(58.13％ ± 13.35％ ) were significantly higher in IM group( P ＜0.05 ).And the ratio of CD4 ( 18.19％ ± 7.61％ ) and CD4/CD8 (0.37 ± 0.33) were significantly lower in IM group,compared with the control group (36.98％ ± 5.32％,1.98 ± 0.41 )(P ＜ 0.05 ).While the leukocyte count,the ratio of abnormal leukomonocyte,and alanine transaminase had no correlation with the decrease of CD4/CD8 ( P ＞ 0.05 ).Conclusion Children with IM caused by EBV have bad immunocompetence,and we can treat them with immunotherapy early.

Objective To systematically review the efficacy of hypotensive resuscitation for traumatic-hemorrhagic shock.Methods Randomized controlled trails (RCTs) or quasi-Randomized controlled trails (qRCTs) were searched in Pubmed,Embase and the Corchrane Library from inception to August 2015.Two reviewers respectively picked out the useful data and performed quality evaluation.Metaanalysis was carried out with RevMan 5.3 software,risk ratio (RR) and its 95％ confidence interval (CI) were pooled to estimate the enumeration data,and GRADE 3.6.1 software was used to rate the level of evidence.Results The results of meta-analysis and GRADE rating system which included 4 studies showed that:compared with conventional resuscitation,hypotensive resuscitation was associated with lower total mortality [RR =0.77,95％ CI:0.62-0.95,P =0.01;n =984,GRADE rating:moderate],and 24-hour mortality [RR =0.47,95％ CI:0.24-0.91,P =0.03;n =281,GRADE rating:moderate],but the subgroup analysis of total mortality showed that there were no significant differences in mortality between the subgroup of blunt or penetrating trauma and the subgroup of penetrating trauma.Conclusions Hypotensive resuscitation reduced total mortality and 24-hour mortality,and the quality of the evidence was moderate.The future studies should do further research to explore the efficacy of hypotensive resuscitation for different types of trauma.

Objective To understand the pathogenic distribution and drug resistance in the patients with blood infections in our hospital to provide reference for the empirical medication of blood infections .Methods The cases of blood infections in our hospital during the period 2012-2014 were performed the retrospective investigation .The BD Bactec blood culture system was adopted to conduct the blood culture .The bacterial strain identification and susceptibility test was conducted by using the Microscan Walkaway 40 and the data were analyzed by adopting the WHONET5 .6 software .Results The top four of department distribution in blood infections were the digestive system department ,lung diseases department ,orthopedic department and surgery department ,account‐ing for 25 .20% ,19 .60% ,14 .70% and 10 .50% respectively .The pathogens were mainly Gram negative bacteria ,and the top three were Escherichia coli ,Klebsiella pneumoniae and non fermenting bacteria ,accounting for 44 .10% ,13 .30% and 7 .69% respective‐ly .The top three of Gram positive bacteria were coagulase negative staphylococci ,Staphylococcus aureus and Enterococcus ,account‐ing for 12 .58% ,9 .09% and 7 .69% respectively .The positive rates of ESBL in Escherichia coli and Klebsiella pneumoniae were 45 .5% and 60 .8% respectively .The detection rate of methicillin resistant coagulase negative staphylococci (MRCNS) was 55 .5% , which of methicillin-resistant staphylococcus aureus (MRSA) was 58 .0% .Conclusion The cases of blood infections in our hospi‐tal come from different wards areas ,and the digestive system department is in the majority mostly .The pathogenic bacteria are dom‐inated by Gram negative bacteria ,and the treatment should rationally use the antibacterial drugs according to the bacteria drug re‐sistance situation .

Objective To investigate the efficacy of C225(cetuximab),a chimeric human-mouse anti-epithelial growth factor receptor monoclonal antibody.combined with 60Co gamma irradiation against humall non-small cell lung cancer cell line H-520. Methods H-520 cells were treated either with different dose of 60Co irradiation(1,2,4,6,8 and 10 Gy)alone or together with C225(100 nmol/L).Colony forming capacity was determined to create the survival curve 10 days after the treatment.Cells in different groups were harvested 72 hours after irradiation for apoptosis analysis or 48 hours after irradiation for cell cycle analysis by flow cytometry assay. Results The clone number in combinational treatment group was less than that in irradiation only group,which suggested that the cell survival rate in the combinational treatment group was significantly decreased comparing with irradiation only group(F=6.36,P＜0.05).The sensitizing enhance rate(SER)was 1.35.The percentage of apoptotic H-520 cells was 5.56%±0.62%,13.86%±0.80%,25.36%±1.02%and 29.89%±2.09%,respectively in 0,2,4 and 8 Gy irradiation alone groups,which were significantly lower than 13.75%±0.83%.25.12%±1.60%.46.12%±2.60%and 50.5l%±4.06%.respectively in irradiation combined with C225 treatment groups(F=4.72,P＜0.05).The cellcycle analysis showed that cells arrested in G0+G1 phases for C225 treatment,in G2+M phases for 60Co irradiation,and in both G0+G1 and G2+M phases for C225 in combination with 60Co irradiation. Conclusions C225 has radiosensitizing effects on H-520 cells.which may through the enhancement of 60Co irradiation-induced cell death and cell cycle arrest.This study provides a supportive evidence for clinical treatment in non-small cell lung cancer.

Objective To study complement receptor typeⅠ(CR1)activity of erythrocytes in pa-tients with SLE.Methods Using polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP),CR1rosette(RBC-CR1R)and immuno-complex rosette(RBC-ICR)on red cell,the ery-throcyte complement receptor I type(ECR1)genomic density polymorphism(HH type,HL type,LL type)and erythrocyte CR1immune activity were determined in32patients with SLE and in48normal individuals.Results It was found that HH type rate of ECR1density polymorphism in patients with active SLE was significantly lower(10/16,62.5%)than that(13/16,81.3%)in patients with stable SLE.The level of CR1immune activity in HH type was significantly higher than that in HL,LL type of SLE,and significantly dif-ferent from that in48normal individuals(P

Objective To investigate antibiotic resistance of Pseudomonas aeruginosa isolated from the patients'specimens in the hospital ,the carrying rate of integronⅠ and insertion sequences common area(ISCR)and provide reference for clinical treatment . Methods 106 isolates of Pseudomonas aeruginosa were collected and their bacterial antibiotic resistance and clinical distribution were analyzed by using WHONET5 .6 software .PCR and electrophoresis were used to screen integronⅠ and ISCR carried by the target strains .Results Clinical isolates of Pseudomonas aeruginosa mainly collected from department of pulmonary disease which accounted for 48 .11% ,and sputum specimens were the major source of the 106 isolates ,which accounted for 73 .58% .The sensitiv‐ities of Pseudomonas aeruginosa to tobramycin ,amikacin ,gentamicin were about 85% ,while to imipenem only 65 .09% .The carry‐ing rate of integronⅠ and ISCR in Pseudomonas aeruginosa was 84 .91% and 76 .42% ,respectively .Conclusion Pseudomonas aeruginosa distribution of hospital departments mainly concentrate in pulmonary department and the major type of specimen is spu‐tum .The sensitivity of Pseudomonas aeruginosa to aminoglycoside antibiotic is relatively good .IntegronⅠand ISCR in Pseudomonas aeruginosa could be associated with antibiotic resistance .