With reference to the research report of American Medical Association on the healthcare system,the paper analyzed the existing medical service,and probed into the causes of poor quality of care The author staged the six countermeasures highlighting patient-focus,safe,effective,timely,efficient and fair medical service models,in the hope of improving quality of care and ensuring patient safety.

Objective To discuss the protective effect of Tongsaimai pellets(TSMP) and butylphthalide(NBP) on PC12 cell in the hypoxia/hypoglycemia model.Methods Two ischemia models including hypoxia,hypoglycemia models were used to assay the anti-ischemic roles of TSMP and NBP in cultured PC12.Results TSMP and NBP possessed obvious protective effects on PC12 cells from two injured models.Both of them could increase the number of living cells and decrease LDH activity significantly,particularly in hypoglycemia injured model.Conclusion TSM and NBP have protective effect on PC12 cells from two injured models effectively in vitro.

Objective To explore clinical practice value of Disease Severity Evaluation Scale (DSAS), and divide patient's nursing level according to the results of DSAS. Methods The assessment group was set up for evaluation of the scale, DSAS was used to determine the nursing level of 3 713 hospitalized patients (age > 18 years old) from 17 clinical departments, from April to May 2014. Results Nursing level determined by DSAS was compared with the standard nursing level, kappa coefficient was 0.72, P < 0.05, suggesting that the consistency was better. According to the kappa coefficient, 17 clinical departments could be divided into three categories, namely the applicability of DSAS were different in different departments. Conclusions DSAS can be used as a objective basis for division of nursing level and has a certain clinical significance. But in order to make it guide clinical work better, scoring system with department characteristic should be developed on the basis of DSAS.

Objective To study the effectiveness of intravenous Lidocaine on subjective tinnitus in the elderly, and analyze its correlation with the effectiveness of subsequently oral Carbamazepine.Methods A prospective case-control study was conducted in 120 elderly patients with subjective tinnitus, who were divided into two groups.The control group (n=60) was treated with oral Carbamazepine 0.1 g Bid for one month, and the treatment group (n=60) was treated with 2％ lidocaine by intravenous injection.Patients in the treatment group were observed on responses in tinnitus during the period with Lidocaine injections.The treatment group was further divided into the improvement subgroup and the no-improvement subgroup, according to responses to intravenous lidocaine.All the patients in the treatment group received oral carbamazepine 0.1 g Bid for one month following the intravenous lidocaine injection phase.Results In the control group, 5 patients showed marked improvement, 20 patients showed partial improvement, 33 patients showed no improvement, and 2 patients showed symptom deterioration, with an effectiveness rate of 41.7％ (25/60).In the treatment group, 6 patients showed marked improvement, 26 patients showed partial improvement, 24 patients showed no improvement, and 4 patients showed symptom deterioration, with an effectiveness rate of 53.3％ (32/60).Of the 32 patients in the improvement subgroup, 6 cases showed marked improvement, 16 cases showed partial improvement, 8 cases showed no improvement, and 2 cases showed symptom deterioration after subsequent oral Carbamazepine treatment, and the effectiveness rate was 68.8％ (22/32).Of the 28 patients in the no-improvement subgroup, 1 case showed marked improvement, 9 cases showed partial improvement, 16 cases showed no improvement, and 2 cases showed symptom deterioration, and the effectiveness rate was 35.7％ (10/28).The effectiveness rate in the improvement subgroup was higher than in the no-improvement subgroup (68.8％ vs.35.7％, x2 =6.55, P＜0.05).The effectiveness of lidocaine followed by carbamazepine was better than that of carbamazepine alone (68.8％ vs.53.3％, x2 =6.13, P＜0.05).Conclusions Oral Carbamazepine treatment following intravenous Lidocaine injection in elderly patients with subjective tinnitus has better therapeutic outcomes than treatment with oral Carbamazepine alone, but is not as effective in patients with negative responses to Lidocaine as in patients with positive responses.

OBJECTIVE:To provide reference for better improving the risk perception of Omeprazole sodium for injection in nurses in a third-grade class-A hospital,strengthening risk management of ward drugs and ensuring safety of patients. METHODS:Nurses in the clinical departments in a third-grade class-A hospital where usage frequency of Omeprazole sodium for injection was relatively more were adopted as study subjects and a self-designed questionnaire was used to investigate on related knowledge on medication risk in nurses in emergency department,gastroenterology department,ICU and CCU in 2012 and 2014. RESULTS:51 and 81 questionnaires were distributed in 2012 and 2014,and 51 and 81 were effectively received with effective recovery of 100%and 100%,respectively. In both surveys,100% surveyed nurses could correctly choose one solvent at least,1.96% and 3.70%nurses could correctly choose 2 solvents;correct answering rates of intravenous administration time were 94.12% and 96.30%,re-spectively;correct answering rates of stable duration after preparation were both lower than 9%;correct answering rates of adverse reaction of this drug were 3.92% and 1.23%,respectively;correct answering rates of interaction of this drug were 1.96% and 6.17%,respectively;correct answering rates of stable formulation of this drug were 17.65%and 22.22%,respectively;the propor-tion of nurses observing ADRs were 25.49% and 13.58%,respectively;the proportion of nurses finding inappropriate compatibility were 15.69% and 22.22%,respectively,Ornidazole and sodium chloride injection was the most used incompatible drug;45% or more nurses hoping to strengthen the continuing education of nursing personnel. CONCLUSIONS:Nurses in this third-grade class-A hospital lack certain knowledge on the medication risk of Omeprazole sodium for injection,the drug risk management is not sufficient,and awareness prevention of drug risk is relative weak. It is suggested that the hospital should strengthen drug risk management system,nurses should strengthen the learning about drug risk and play the role of clinical pharmacists in the drug risk management to reduce the related drug risk and incidence of adverse reactions.

AIM To establish a quantitative analysis of multi-components by single-marker (QAMS) method for the simultaneous content determination of four saikosaponins in Xiaozheng Pellets (Bupleuri Radix,Cyperi Rhi-zoma,Rhei Radix et Rhizoma,etc.).METHODS The analysis of 5％ ammonia-methanol extract of this drug was performed on a Waters Xbridge C18column (250 mm ×4.6 mm,5 μm),with the mobile phase comprising of acetonitrile-water flowing at 1.0 mL/min in a gradient elution manner,and the detection wavelengths were set at 210 nm and 254 nm.With saikosaponin a as a internal standard,the relative correction factors of saikosaponins b1,b2 and c were calculated,followed by the determination of their contents.RESULTS Four saikosaponins showed good linear relationships within their own ranges (r ≥ 0.999 5),whose average recoveries were 98.08％-102.94％ with the RSDs of 0.85％-1.82％.The results obtained by QAMS approximated those obtained by external standard method.CONCLUSION This simple,precise and feasible method can be used for the quality control of Xiaozheng Pellets.

ObjectiveTo screen mimetic HIV-1 neutralizing epitopes from plasma with high level neutralizing antibody,and to provide useful information for further study of the interaction between antigen and antibody.MethodsIn order to gain neutralizing antibody recognized mimotopes, we detected neutralizing antibodieslevelsof 11HIV-1infectedslowprogressorsbyPBMC-basedneutralization assays.High-titer HIV-neutralizing antibodies from plasma of SPs was used as the ligand for biopanning by phage-displayed random peptide library.Positive phage clones was evaluated by ELISA,sequenced,and analyzed for homology to HIV-1 env by local BLAST to deduce the neutralizing peptide.ResultsTwenty-two clones were obtained consistent with requirement through three rounds biopanning.After comparison analysis,twelve clones include C8 were obtained as mimotopes of neutralizing antibody,C40 located in gp41Ⅱ cluster with the highest titer by inhibition ratio may be as neutralizing epitope.Conclusion By the use of IgG antibodies from SPs to screen the phage random polypeptide library,one can acquire multiple phage mimetic peptides of HIV related antigen epitope.(Chin J Lab Med,2012,35:838-842 )

Objective To evaluate the value of contrast-enhanced uhrasound(CEUS)for liver fibrosis.Methods Ninty-two chronic hepatitis B patients with histology diagnosis and fifteen health control were detected by CEUS,dynamic images and the time-intensity curve were analyed.Results Hepatic veinartery transit(HV-ATT)became shorter in the early hepatic cirrhosis patients [(7.5±2.1)s]compared to the control[(11.8±2.7)s].However,there was no difference between the fibrosis patients [(13.0±2.2)s]and the control.Furthermore,HV-ATT of the fibrosis patients with S1 to S3 stage were(11.7±2.7)s(S1),(11.8±3.0)S(S2),(11.8±2.3)s(S3)without significant difference.Conclusions CEUS is valuable in diagnosing earlier hepatic cirrhosis,but not fibrosis.

Objective To explore the polymorphism of nef gene and conservation level of functionally important domains of nef as well as their influences on HIV-1 disease progression of HIV-1 B'infected individuals in northern China.Methods 30 long term nonprogressors(LTNPs)and 42 typical progressors (TPs)were selected.Provirus DNA was extracted from whole blood sample.The full nef gene was amplified by nested-PCR.PCR product was sequenced directly after purification.Phylogenetic analysis and amino acid sequence mutation was applied on nef sequences to explore the differences between LTNPs and TPs.Results At position 15,the S15R/K/N substitution was detected.The frequency of TPs(64.29%)wsa higher than LTNPs(33.33%,P<0.01,0R=3.60);R21K/E/H/I.Q,TPs and LTNPs mutation frequency was 59.52%and 93.33%(P<0.005,OR=0.11);At position 39,K39R/E/N was only detected in TPs(23.81%,P<0.005).Conclusion No significant deletion or defect associated with disease progression wsa detected in nef gene of HIV-1 B'.But it suggested that K/E/H/I/Q mutation at 21 st amino acid of nef associated the disease nonprogression.R/K/N at 15 th amino acid of nef and R/E/N mutation at 39th amino acid of nef associated the disease progression in.HIV-1 B'.All domaias of nef amino acids sequences were comparatively conservative.