The paper described development characteristics of international hospital accreditation, and challenges faced by China's hospital accreditation.The author proposed for such accreditation,as that accreditation entities are the organizational support for building a permanent mechanism of hospital accreditation,and two organizational modes:the first is societies and associations of capacity to build accreditation organizations and the government to build professional hospital accreditation bodies,and the second is to build the assessors system.

The paper described the necessity and importance of hospital accreditation,and features of this round of accreditation.The author proposed that the hospitals should take three actions to cope with this accreditation,which are understanding new concepts toCenter on Patients; learning new standards to promote continuous quality improvement; probing evidence-based methods to encourage hospital accreditation and scientific management.These points explained the key points to master for the this round of accreditation.

Objective To investigate the effects on intraocular pressure and blood pressure following anterior chamber paracentesis in acute primary angle closure glaucoma with high blood pressure.Methods 64 eyes of 64 glaucoma patients with high blood pressure were received anterior chamber paracentesis.the intraocular pressure and blood pressure were measured before and after paracentesis.Results The mean systolic blood pressure(SBP) and diastolic blood pressure(DBP) before paracentesis of 64 glaucoma were 195.10?15.24mmHg and 117.1?11.76mmHg respectively,after administration of paracentesis,the SBP and DBP were 138.82?20.86mmHg and 93.19?12.07mmHg respectively,the intraocular pressure also significantly decreased from 68.64?10.05mmHg to 10.66?4.41mmHg.There was statistical difference in SBP,DBP and intraocular pressure before and after administration of paracentesis.Conclusions Administration of paracentesis in acute primary angle closure glaucoma with high blood pressure can significantly reduce intraocular pressure and blood pressure simultaneously.

OBJECTIVE:To provide reference for reducing and avoiding medication errors of high-alert drugs in outpatient de-partment. METHODS:The medication errors of high-alert drugs in outpatient prescriptions were collected from our hospital during 2013-2014,and then analyzed retrospectively in terms of the type and degree of medication error,caused factors of medication er-rors,etc. RESULTS:670 997 prescriptions were checked in two years,and 501 medication errors were found,including 26 medi-cation errors of high-alert medication. There were 7 incorrect route of administration of insulin,1 repeated medication and 1 incor-rect dose of oral hypoglycemic agents,6 repeated administration of opioid drugs and non steroidal anti-inflammatory drugs,2 indi-cation error of paracetamol and codeine phosphate,1 specification and 1 indication error of glucose injection,2 route of administra-tion error of lidocaine,2 administration frequency errors of methotrexate,2 dose error of digoxin and 1 dose error of warfarin;18 doctors'prescribing errors were found by pharmacists'prescription audit,accounting for 69.2%;8 doctors'prescribing errors were not found by pharmacists'prescription audit,accounting for 30.8%. CONCLUSIONS:Medication errors of high-alert drugs occur mainly in the prescription segment,and the main reason is that the electronic prescription system lack of compulsory strategy and policy constraints. Improvement of safety administration of high-alert drugs need to find the error link and adopt targeted medi-cation safety practices.

Objective To analyze the relationship between plasma aldosterone level and gestational diabetes melli?tus. Methods All subjects were divided into three groups (n=20 in each group):gestational diabetes mellitus (GDM) group, pregnancy with normal glucose group,non-pregnant healthy women group. Pre-pregnant body mass index (BMI) was calcu?lated, and fasting blood glucose (FBG), blood lipid level, Fins, HOMA-IR index, RASS, PRA, ATIi and ALD were examined besides glucose intolerance test. Results The plasma ALD level was significantly higher in GDM group than that of NGT group and control group(pmol/L:1 130.15±135.45 vs 1 053.98±108.86 vs 544.31±127.97). The plasma ALD level was posi?tively correlated with FBG,1 h PBG ,2 hPBG,Fins , HOMA-IR and blood triglyceride (r=0.657, 0.757, 0.713, 0.429,P<0.05),but negatively correlated with HDL-C(r=-0.267,P=0.039). Stepwise regression analysis revealed that plasma aldo?sterone was the independent risk factor of GDM. Conclusion RASS is excessively activated in pregnancy, which contrib?utes to gestational diabetes mellitus.

Hematopoietic chimerism is a measure of the number of donor and recipient cells in the host following hematopoietic stem cell transplantation (HSCT), and it has a good correlation with GVHD and relapse. Chimerism detection after nonmyeloablative allo-HSCT is a simple essential and effective method to predict the outcome of the disease, and can significantly improve the success rate of transplants, reduce the recurrence and then improve the quanlity of life of patients.

Objective To evaluate the diagnosis value of digestive tract clinical symptoms in multiple myeloma.Methods 21 patients with multiple myeloma with digestive tract symptoms as initial clinical manifestations were analyzed.Results In 21 patients,52% below 50 years(hepatomegaly and splenomegaly was 73%),abdominalgia and diarrhea,hematocytopenia,proteinuria were 57%,90% and 67%,respectively.Conclusion Digestive tract symptoms,especially hepatomegaly and splenomegaly,occur mostly in younger patients.Hematocytopenia and proteinuria are important clue in diagnosis of multiple myeloma.Digestive tract symptoms are the common clinical manifestations,but not chief clinical features in multiple myeloma.

Objective To investigate the effect of HES 130/0.4 or sodium lactate Ringer's solution injected before operation on postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic cholecystectomy (LC). Methods Sixty patients (ASA Ⅰ-Ⅱ) undergoing LC were randomly assigned to three groups: patients in group A were injected intravenously with 2 ml/kg sodium lactate Ringer's solution before anesthesia; group B was given 10 ml/kg sodium lactate Ringer's solution; and in group C, the patients were given 10 ml/kg 6% HES 130/0.4. The following data were recorded: blood pressure and heart rate before and after operation, and 0, 5, 10, and 15 min after induction; durations of anesthesia and operation; rate of PONV on the first postoperative day; and the number of cases who were given antiemetics. Results The age, weight, and durations of anesthesia and operation were similar among the 3 groups. The MAP was decreased significantly after induction in the three groups (P0.05). In the group A, 7 patients were given antiemetics that was significantly more than that in the groups B (3/20) and C (1/20). (A vs C, ?2=3.906, P=0.048; B vs C, ?2=0.278, P=0.598) . Conclusions Compared with 2 ml/kg sodium lactate Ringer's solution, 10 ml/kg HES 130/0.4 or 10 ml/kg sodium lactate Ringer's solution injected intravenously before operation may reduce the rate of PONV in patients undergoing LC, and decrease the proportion of those who need antiemetics after operation.

Objective To explore the effect of I kappa B kinase (IKK) on liver during hepatic ischemia reperfusion (HIR) in rats.Methods Wister rats were divided randomly into HIR group in which hepatic reperfusion was given after 60 minutes of ischemia by interruption of the arterial and portal venous blood supply to the left lobes and middle lobes of the liver; HIR + PDTC treatment group in which PDTC (120 mg/kg) were injected via the dorsum vein of penis before ischemia reperfusion; and sham control group in which midline laparotomy was performed without vascular occlusion and treatment.Expression levels of IKK were measured with In situ hybridization(ISH).The NF-κB activities were determined with EMSA.Expression levels of TNF-α were measured with immunohistochemistry (IH).Serum levels of ALT were measured.Results Expression level of IKK was increased markedly from 0 to 12h and peaked 6h after reperfusion in HIR group.NF-κB was activated 0 ～ 12h after reperfusion and activities of NF-κB were maximal 6h after reperfusion in HIR group rats compared with sham control group.Expression level of TNFα was increased markedly from 0 to 12h and peaked 6h after reperfusion in HIR group.Serum levels of ALT were increased significantly after reperfusion in H1R group.Expression level of IKK was lowered markedly in HIR + PDTC group from 0 to 12h after reperfusion.NF-κB activities were significantly lower in HIR +PDTC group than in HIR group from 0 to 12h after reperfusion.Expression level of TNF-α was lowered markedly in HIR + PDTC group as compared with HIR group from 0 to 12h after reperfusion.Serum level of ALT was decreased significantly after reperfusion in HIR + PDTC group as compared with HIR group.Conclusion HIR can activate IKK-β which promotes the activation of NF-κB,then NF-κB results in upregulation transcription of TNF-α gene which gives rise to the release of other inflammatory cytokines and triggers uncontrolled inflammatory response,and induces hepatic injury.Blocking IKK-NF-κB pathway may be an effective approach to checking the generation and development of ALI,PDTC plays important prophylaxis and treatment roles in hepatic injury after HIR.

Objective To investigate Hepatitis B Virus (HBV) infection status in placentas of Hepatitis B Surface Antigen (HBsAg) positive pregnant women during middle and late period of pregnancy. Methods One hundred and sixty seven placentas from HBsAg positive pregnant women were collected, including 158 term placentas and 9 aborted second trimester placentas. HBsAg and hepatitis B core antibody (HBcAg) in placental cytotypes were detected by immunohistochemistry. Results Of the 158 term placentas, HBV infection rates in decidual cells (DC), trophoblastic cells (TC), villous mesenchymal cells (VMC) and villous capillary endothelial cells (VCEC) were 66 46% (105/158), 58 23% (92/158), 27 22% (43/158) and 12 66% (20/158), respectively. The HBV infection rates gradually decreased from maternal side to fetal side of placentas. Both HBsAg and HBcAg were mainly located in the cytoplasm of infected cells. The positive cells were mostly in focal distribution. One out of 9 aborted second trimester placentas was infected. Conclusions HBV infection was found in different cells of term placentas. The positive rates for HBsAg and HBcAg in placentas were gradually decreased from maternal side to fetal side. The positive rate was low in aborted second trimester placentas.