Up to present,the research of the early-warning system for the risk of the medical quality has been carried out both at home and abroad.The majority of these researches aimed at providing theoretical guidance for the scientific decision-making of local health departments.In order to construct quality of medical care evaluation indicators system.On the bases of intelligence research,drawing on a series of internationally recognized quality of medical care evaluation system.The majority of these researches aimed at providing theoretical guidance for the scientific decision-making of local health departments.However,the hospital-related research is very limited.Therefore,hospitals were selected as objects in this study.33 experts from 6 three"A" hospitals were selected.And by using a series of internationally recognized quality health care system as a source of reference and focusing on process control and standardizing of management,the early-warning system for the risk of the medical quality has been constructed based on the combination of theory and practice.At the same time,Delphi method was used to verify the results repeatedly to form a set of early-warning system for the risk of the medical quality which is objective,scientific and approved by experts.

Objective To understand the molecular mechanism by which protein kinase C? mediates multidrug resistance of human glioma cell line SHG-44.Methods SHG-44/ADM was constructed by stepwise concentration increasing method and intermittent administration method.SHG-44/WT and SHG-44/ADM were treated by PKC? reactivator PMA and PKC? inhibitor staurosporine,then the expressions of PKC? and MDR-1 were detected by Western blotting,the PKC? activity was assayed by kinase,and ADM accumulation was determined by fluorescence spectrometry.Results PMA increased PKC? activity and MDR-1 protein expression and activity.Staurosporine was able to block PKC? activity and decrease MDR-1 expression and activity.Conclusion Multidrug resistance in human glioma cells is mediated by PKC? via MDR-1 pathway.

Objective To investigate the effects of different culture media and pretreatment methods on the results of matrix-assisted laser desorption ionization time-of-flight mass spectrometry(MALDI-TOF MS) for the identification of Vibrio parahaemolyticus,and then provide the optimal conditions.Methods Forty strains of Vibrio parahaemolyticus were collected,and subcultured with the blood agar plate,thiosulfate citrate bile salts sucrose(TCBS) agar plate and double wash agar plate,respectively.The pretreatment methods before mass spectrometry included the smear method,extension method and extraction method.The effects of different culture media and pretreatment methods on the results of MALDI-TOF MS for the identification of Vibrio parahaemolyticus were analyzed by the logistics regression model and Chi-square test of SAS software.Results The detection rate of Vibrio parahaemolyticus was the highest in the combination of blood agar plate with the extraction method(genus level:100％;species level:67.5％),followed by the combination of double wash agar plate with the extraction method(genus level:70％;species level:37.5％).For the genus identification level of Vibrio parahaemolyticus,when the pretreatment method was the same,different culture media produced significantly different detection rates(P ＜ 0.01).However,when the culture medium was the same,there was no significant difference in detection rates for different pretreatment methods (P ＞ 0.05).The odd ratios (OR) of the smear method and extention method relative to the extraction method were 0.66 and 0.95,respectively,and there was no significant difference in detection rates for them(P ＞ 0.05),while the ORs of the TCBS agar plate and double wash agar plate relative to blood agar plate were 0.06 and 0.10,respectively,and there was significant difference in detection rates for them(P ＜0.05).The logistic regression equation was Y=2.95-0.41a-0.05b-2.83c-2.83d(a:smear method;b:extension method;c:TCBS agar plate;d:double wash agar plate).For the species identification level of Vibrio parahaemolyticus,when the extension method or the extraction method was used,different culture media produced significantly different detection rates(P ＜ 0.05).When the blood agar plate was used,different pretreatment methods also produced significantly different detection rates(P ＜ 0.01).The ORs of the smear method and extention method relative to the extraction method were 0.32 and 0.55,respectively,and there was significant difference in detection rates for them (P ＜ 0.05),while the ORs of the TCBS agar plate and double wash agar plate relative to blood agar plate were 0.18 and 0.49,respectively,and there was significant difference in detection rates for them(P ＜0.05).The logistic regression equation was Y =0.20-1.15a-0.61b-1.72c-1.72d(a:smear method;b:extension method;c:TCBS agar plate;d:double wash agar plate).Conclusion For improving the detection rate of Vibrio parahaemolyticus by MALDI-TOF MS,the selection of appropriate culture medium is more important than that of the pretreatment method.It is recommended that the extraction method may be as a conventional pretreatment method,and that the optimal medium is the blood agar plate,followed by the double wash agar plate and TCBS agar plate.

Objective:To investigate the effect of standardized nutritional therapy for gastric cancer during perioperation.Methods:Seventy-six patients with gastric cancer who underwent nutritional therapy were randomly divided into observation group (38 patients) and control group (38 patients),between May 2015 and May 2016.In the observation group,the nutritional therapy was made by medical workers who had received the training of Total Nutritional Therapy (TNT) and Goal Nutrition Therapy (GNT) for Cancer Patient.In the control group,the nutritional therapy was given by doctors according to their conventional experience.Nutritional conditions,gastrointestinal function recovery conditions,complications and hospital stays were compared between the two groups.Results:First,the weight,triceps skinfold thickness and arm muscle circumference of preoperative 1 day and postoperative 7 day in the observation patients were significantly higher than those in the control patients (P ＜ 0.05).Second,the level of serum prealbumin of preoperative 1 day,postoperative 1 and 7 day in the observation patients was significantly higher than that in the control patients (P ＜ 0.05).Third,the time of anus exhaust and defecate in observation group was significantly shorter than that in the control group (P ＜ 0.01).Fourth,each group had one patient who suffered bleeding after operation,and 2 patients in control group had anastomotic leakage.Fifth,the time of hospital stays in the observation group was significantly shorter than that in the control group (P ＜ 0.01).Conclusion:The standardized nutritional therapy for gastric cancer can improve the patient's nutrition status,promote the recovery of gastrointestinal function,and then decrease the time of hospital stays during perioperation.

Objective To compare the effects of remifentanil infused at different rates on median effective target plasma concentration (EC50) of propofol inhibiting responses to laryngeal mask airway (LMA) insertion and determine the optimum infusion rate of remifentanil when used for fiberoptic bronchoscopy in pediatric patients.Methods Eighty-four ASA Ⅰ or Ⅱ pediatric patients,aged 7 months-3 years,scheduled for elective fiberoptic bronchoscopy,were randomly assigned into 3 groups (n =28 each):normal saline group (group C),remifentanil infused at 3 ng· kg-1 ·min-1 group (group R1) and remifentanil infused at 5 ng· kg-1 · min-1 group (group R2).Responses to LMA insertion were defined as body movement and/or bucking during insertion.The initial target plasma concentrations of propofol were 5.2,4.8 and 4.4 μg/ml in groups C,R1 and R2,respectively.The target plasma concentration of propofol was determined by up-and-down sequential allocation.Each time the target plasma concentration increased/decreased by 0.2μg/ml.EC50 and 95 ％ confidence interval of propofol blunting responses to LMA insertion were determined by probit method.Results EC50 (95 ％ confidence interval) of propofol was 5.03 (4.92-5.12) μg/ml,4.71 (4.58-4.84) μg/rnl and 4.46 (4.20-4.94) μg/ml in groups C,R1 and R2,respectively.There was no significant difference in EC50 of propofol between groups R1 and C (P ＞ 0.05).EC50 of propofol was significantly lower in group R2 than in groups C and R1 (P ＜ 0.05).Conclusion The infusion rate of remifentanil should not be lower than 5 ng· kg-1· min-1 when combined with propofol in pediatric patients undergoing fiberoptic bronchoscopy.

Objective To analyze the antimicrobial resistance profile of clinical isolates in Shanghai Xinhua Hospital Chongming Branch affiliated to Shanghai Jiaotong University School of Medicine , a member of China Antimicrobial Resistance Surveillance System, during 2015, for the purpose to facilitate rational antimicrobial therapy. Methods Strain identification?and?susceptibility?testing?were?carried?out?for?the?clinical?isolates?using?MicroScan?WalkAway?96?Automated?Systems and Kirby-Bauer method. Results In 2015, a total of 1815 isolates were collected, including gram-negative bacteria (73.2 %) and gram-positive bacteria (26.8 %). The top three frequently isolated species were Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. ESBL-producing strains were found in 36.3 % of the Escherichia coli isolates, 12.6 % of the Klebsiella (K. pneumoniae and K. oxytoca) isolates, and 28.0 % of the Proteus mirabilis isolates. The prevalence of carbapenem-resistant strains was 0.69 % in Enterobacteriaceae isolates. The prevalence of methicillin-resistant strain was 29.1 % in S. aureus, and 61.4 % in coagulase-negative Staphylococcus isolates. No more than 15 % of the Enterobacteriaceae isolates and no more than 20 % of the P. aeruginosa and Acinetobacter isolates were resistant to carbapenems. No vancomycin-or linezolid-resistant strains were found in Enterococcus or Staphylococcus. Conclusions Antibiotic-resistant clinical isolates are a serious threat for clinical antimicrobial treatment. We should pay more attention to such urgent situation and rational use of antibiotics.

ObjectiveDiabetes is an independent risk factor for coronary artery bypasss grafting(CABG). Off pump coronary artery bypasss (OPCAB) experience in 251 cases was reviewed to determine whether diabetes wou ld be applicable in OPCAB procedures.MethodsConsecutive 251 patients underwent OPCAB over 12 month period. This study included 71 diebetic patients (DM group) and 180 nondiabetic patients (NDM group). Preoperative v ariables were compared between the two groups by univariate analysis.R esultsNo differences were found regarding the length of stay in cardio intensive care unit [DM group(2.4?0.3)d; NDM group (2.4?0.3) d;P=0. 386], and sternal complication (DM group: 5.7%;NDM group: 3.9%;P=0.511) . In hospital complications were as follows: death rate(DM group: 2.8%; NDM gr oup: 1.1%; P=0.680); stroke (DM group: 2 8%; NDM group: 1 7%; P=0 623 ); hemofiltratioin renal failure (DM group: 2.8%; NDM group: 0.5%; P=0.194); myocardial infarction(DM group: 0%; NDM group: 0.5%;P=1.000); blood using were more frequent in DM group comparied with NDM group (P=0.111). ConclusionOPCAB in diabetic patients is as safe as in non diabetic patients.

This study is performed to analyze the anti-liver fibrosis effect of the fusion protein of human serum albumin and extracellular domain of transforming growth factor beta type II receptor(eTGFBR2)in vivo to looking for the more stable anti-liver fibrosis drug. The mice model of liver fibrosis was constructed by CCl4 induction and the following groups are included in the study: the control group, CCl4 model group, the positive control group, eTGFBR2 treatment group, HSA-eTGFBR2 treatment group, and HSA group. Hematoxylin eosin staining, serum liver function index detection, and western blot are used to identify the anti-liver fibrosis activities. The results showed that: (1)CCl4 caused liver structure disorder, hepatocellular necrosis, collagen fibers proliferation, and induced liver fibrosis at last; (2)HSA-eTGFBR2 and its monomer drug improved the symptoms of liver fibrosis significantly, as well as reduced the damage of liver cells and collagen deposition, and recovered the liver basic structure to normal. Both of HSA-eTGFBR2 and its monomer drug improved liver function and reduced the expression level of liver fibrosis marker α-SMA and COL I. Moreover, the anti-liver fibrosis effect of the fusion protein is comparable to the monomer drug. In contrast, the albumin had no effect on therapeutic effect; (3)Reducing the injection frequency of HSA-eTGFBR2 achieved the comparable effects to the monomer drug with the normal injection frequency. In summary, the fusion protein HSA-eTGFBR2 has good anti-liver fibrosis effect. In addition, reducing the injection frequency of the fusion protein could also achieve the comparable treatment with the monomer drug, indicating that the fusion protein is stable and has longer half-lives and then a relatively positive application prospect in future.

The current study to separate and identify constituents from Millettia nitida var. hirsutissima. The compounds from Millettia nitida var. hirsutissima were isolated by means of various chromatographic techniques such as column chromatography over ODS and Sephadex LH-20, preparative HPLC, and the structures of these isolated compounds were identified through spectroscopic analyses. Nine isoflavonoids and two flavans were isolated and identified as 5-O-methy genistein (1), 7-hydroxy-3',4'-dimethoxyisoflavone (2), ononin (3), catechin (4), formononetin (5), genistein (6), calycosin (7), (-)-gallocatechin (8), sissotrin (9), wistin (10), daidzin (11). Compounds 1, 2, 9 are obtained from the genus Millettia for the first time,and compounds 4, 8 are isolated from this plant for the first time.
Drugs, Chinese Herbal ; chemistry ; isolation & purification ; Flavones ; chemistry ; isolation & purification ; Isoflavones ; chemistry ; isolation & purification ; Mass Spectrometry ; Millettia ; chemistry ; Molecular Structure

Background:Resistance of Helicobacter pylori(Hp)to antibiotics is the primary reason for failure of Hp eradication therapies. It has been reported that there are regional differences in the resistance rate of Hp to commonly used antibiotics. Monitoring the regional Hp resistance status is helpful for improving the eradication rate in local area. Aims:To investigate the resistant spectrum of clinical Hp strains to commonly used antibiotics in Jiaxing Area,Zhejiang Province. Methods:A total of 17 402 patients who underwent gastroscopy from Jan. 2009 to Dec. 2013 at Jiaxing First Hospital were recruited for Hp culturing by using gastric antral biopsies. Then a drug sensitive test was performed for the Hp strains obtained from the culturing. Sensitivity of these Hp strains to metronidazole,amoxicillin,gentamicin,furazolidone,clarithromycin and levofloxacin was determined. Results:Among the 17 402 cases of gastric antral biopsies,5 898(33. 9% )were positive for Hp culturing. Drug sensitive test revealed that the resistance rate of metronidazole was extremely high in all year and age groups;the resistance rates of clarithromycin and levofloxacin were increasing by years;and the resistance rates of furazolidone,amoxicillin and gentamicin were considerably low in all year and age groups. When two antibiotics were combined,amoxicillin and gentamicin accounted for the lowest resistance rate,and the next were amoxicillin and furazolidone,and gentamicin and furazolidone,respectively. Conclusions:The clinical Hp strains isolated from all age groups in Jiaxing Area,Zhejiang Province are highly resistant to metronidazole,therefore it is not recommended to be used in first line eradication regimen. Amoxicillin combined with gentamicin/ furazolidone is an ideal antibiotic combination for patients with Hp infection in all age groups;and combination of gentamicin and furazolidone is recommended to patients who are allergic to penicillin.