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 investigate the clinical characteristics of Macrophage activation syndrome (MAS) in patients with rheumatoid arthritis (RA), so as to reduce misdiagnosis. The objective of this paper was to improve the comprehensive and systematic understanding of rheumatoid arthritis complicated with macrophage activation syndrome. Methods The clinical data of one patient with macrophage activation syndrome secondary to RA were analyzed retrospectively, and the related literatures were reviewed. Results The patient was a 65 year old male with ahistory of RA for 14 years. The patient presented with symmetrical multi-joint pain aggravated with stiffness for 14 years and was admitted because of aggravation for 2 weeks. He failed many drugs for the treatment of rheumatoid arthritis was ineffective accompanied with intermittent leukocytopenia. After bone marrow aspiration and biopsy, the phenomenon of phagocytosis of macrophages was clearly diagnosed. He was treatment with high dose corticosteroid +CsA+ human immunoglobulin and his condition wasimproved. Literature was searched in PubMed, Wan Fang medical network database, RA+MAS. Finally, 12 related articles was yielded, and a total of 14 patients, including 8 males, 6 females. Four patients were adults and 10 were children. The shortest duration was 0.5 months, the longest was 24 months. Fever, skin rash, arthritis, enlargement of the liver or spleen, decreased of blood cells count, elevation of liver transaminase, increase of triglyceride, and a series of symptoms and laboratory parameters were observed in the course of the disease. Conclusion When rheumatoid arthritis patients show decreased blood leukocytes and can not be explained by other causes, the differential diagnosis should be carefully performed to rule out secondary macrophage activation syndrome. Always be awake of the risks and dangers of rheumatoid arthritis complicated with macrophage activation syndrome. Early diagnosis and timely are important to improve prognosis.

Objective To investigate the function of carotid artery elasticity,radial strain (RS),and radial strain rate (RSR) in pregnancyinduced hypertension (PIH),and to conduct a comparative study with healthy pregnant women by using the arterial analysis technique.Methods Twenty-eight women with PIH were included,and 30 age-and gestational age-matched normal pregnant women were included as the control group.The arterial analysis technique was performed to trace the movement of the carotid artery and obtain RS and RSR values automatically for statistical analysis.Results In the PIH group,stiffness parameter β3 and pulse-wave velocity were significantly higher than those in the normal pregnancy group.Arterial compliance,RS,and RSR were lower,with significant differences (P ＜ 0.05).The differences in augmentation index were insignificant.Pulse-wave velocity was negatively related with RS.Conclusion These sensitive parameters could potentially be applied for early evaluation of vascular structure,and RS is more sensitive than RSR.By using the arterial analysis technique,early detection of decreased artery elasticity function is possible before blood vessel structural impairment.

OBJECTIVES: This population-based, prospective cohort study investigated the association between glaucoma and mortality in older adults. METHODS: Participants aged 45 years or older at baseline (47.9% male) were enrolled in 2011 for the China Health and Retirement Longitudinal Study (CHARLS). All-cause mortality was observed during 7 years of follow-up. The baseline data were collected in the 2011 CHARLS, and participants were followed up for 7 years (until 2018). The risk of all-cause mortality was investigated using Cox proportional-hazards regression with age as the time scale, adjusting for significant risk factors and comorbid conditions. RESULTS: Among the 14,803 participants included, the risk of all-cause death was significantly higher among people with glaucoma than among those without glaucoma, after adjustment for other confounders (hazard ratio [HR], 1.46; 95% confidence interval [CI], 1.04 to 2.03). In a subgroup analysis based on the mean age of death, among those who were 75 years and older (n=1,231), the risk of all-cause death was significantly higher in patients with glaucoma than in those without glaucoma (HR, 1.89; 95% CI, 1.24 to 1.89). CONCLUSIONS Participants with glaucoma had a higher risk of all-cause mortality, especially those aged 75 years and above. Our findings revealed potential mechanisms underlying an association between glaucoma and all-cause mortality. They also highlighted the importance of glaucoma management to prevent premature death in middle-aged and older adults.