OBJECTIVE:To evaluate the role of PDCA cycle management on standardizing clinical use of atomization inhala-tion drug. METHODS:Using a retrospective method,300 medical records of atomization inhalation drug use were collected from our hospital during Jan.-Dec. in 2013(non-intervention group),200 medical records collected during Apr.-Jun. in 2014(one cycle intervention group),and 180 medical records collected during Oct.-Dec. in 2014(two rounds of cycle intervention group). The use of atomization inhalation drugs was compared before and after the application of PDCA cycle management. Before and after two cy-cle intervention,4 types of medical staff were investigated on cognition of the related knowledge of atomization inhalation drugs, as physicians,pharmacists,nurses and mechanic. RESULTS:After two rounds of PDCA cycle management and intervention,the proportion of unsuitable route of administration of antibiotics,long acting glucocorticoid,non-atomization inhalation dosage form of resolving phlegm drugs,protease decreased from 54.0%,62.0%,59.7%,44.7% before intervention to 0.6%,1.1%,15.0%, 1.1% after intervention;those phenomena had not been found,such as unsuitable route of administration of TCM injection and non-atomization dosage form of theophyllines,unsuitable atomization frequence,unsuitable indication,drug mixture for preventing and controlling symptom,etc. The proportion of medical staffs being familiar with medical device,drug classification,drug selec-tion for prerention and treatment and the proportion of hospital drug stock to 93.4%,86.7%,92.4%,96.2% after intervention from 38.0%,79.0%,49.0%,39.5%before intervention. CONCLUSIONS:The application of PDCA cycle management can effec-tively regulate the use of atomization inhalation drugs in our hospital;the method can be promoted and applied.

Objective The research aimed to identify symptom clusters of head and neck cancer (HNC) patients.Methods The M.D.Anderson Symptom Inventory-Head & Neck (MDASI-H&N) was applied to measure symptoms of 247 HNC inpatients.Factor analysis was applied to identify symptom clusters.The Spearman correlation analysis was used to find the relationship of symptoms within symptom clusters.Results Five clusters were identified and the Cronbach's α coefficients of symptom clusters were 0.904,0.928,0.898,0.815 and 0.662 respectively.Symptoms within clusters were all significantly interrelated to each other (r=0.393-0.856,P＜0.01).Conclusions Symptoms of HNC patients tend to occur not in isolation,but in symptom clusters.Effective management can not only eliminate or alleviate the symptom burden of HNC patients,but also be cost-effective.

Objective To evaluate immunogenicity of the recombinant protein GST-p55/570 of Pneumocystis carinii.Methods The fusion protein GST-p55/570 was expressed from the prokaryotic expression plasmid pGEX-570,and purified by using glutathione-agarose.The expressed product was analyzed by SDS-PAGE.Thirty-three mice were randomly divided into three groups,immunized with GST-p55/570,GST and PBS,respectively.Each group was immunized for four times at 2 week intervals.At the 7th day after final immunization,spleen was removed to obtain single cell suspension.Proliferation ability of lymphocytes was determined by MTT.Serum samples were collected at pre-immunizaton and two weeks after each immunization.Antibody level in sera of mice was determined by ELISA.The immune response to the recombinant GST-p55/570 recognized by sera of immunized mice was examined by Western blotting.Results The expressed fusion protein GST-p55/570 showed a Mr 47 000.Compared with GST group(1.134 5?0.073 5) or PBS group(1.124 8?0.041 6),a higher stimulation index(2.063 0?0.160 2) was revealed in GST-p55/570-immunized mice(P

Purpose The mean pulmonary artery (MPAP) has been widely used as an important parameter to diagnose and evaluate pulmonary hypertension (PH).The purpose of this paper is to compare the efficacy of two methods in evaluating PH,including estimating pulmonary artery systolic pressure (PASP) using Doppler ultrasonography to measure tricuspid regurgitation (TR) velocity,and directly using the peak velocity of TR.Materiasl and Methods From January 2012 to June 2013,eighty patients with left-to-right shunt congenital heart diseases (CHD) planned for closure procedure in Tangdu Hospital of the Fourth Military Medical University and the General Hospital of Shenyang Military region were included in this prospective study,who underwent right heart catheterization to measure pulmonary artery pressure,and underwent Doppler ultrasonography to measure the peak velocity ofTR.Results Using catheter-measured MPAP of≥ 25 mmHg as diagnostic reference,the false positive rate was 62.96％,and the false negative rate 0％ when the estimated PASP of ＞30 mmHg determined by TR method was used to diagnose PH.There was high diagnostic agreement when peak velocity of TR was used to diagnose PH.When 320 cm/s and 340 crn/s were used as diagnostic cutoff values,false positive rates were 14.81％ and 7.41％,and false negative rates were 15.91％ and 20.45％,respectively.Conclusion In patients with left-to-right shunt CHD,peak velocity of TR measured on echocardiography can be used to diagnose PH which overcomes the high false positive rate in estimation method.It is more suitable to diagnose PH when the MPAP is used as the diagnostic criterion.

Objective To explore the characteristics of the flow velocity waveform of superior vena cana (SVC) in a rat model with chronic monocrotaline-induced pulmonary hypertension by echocardiography.Methods The chronic pulmonary hypertension model was developed by monocrotaline solution (60 mg/kg) injection into the abdominal cavity in 32 SD rats.Eight rats with the placebo injected served as controls.An examination of the flow velocity waveform of SVC was performed by Doppler echocardiography via supraclavicular fossa before and 28-day after the injection.The pulmonary arterial systolic pressure was measured by pressure-guided micro-catheter 28-day after the injection both in the control and the pulmonary hypertension model group.Results Chronic monocrotaline-induced pulmonary hypertension was successfully developed in 29 rats.The flow velocity waveform of SVC showed that the ratio of the maximum reverse peak flow velocity due to atrial contraction (VAR) to the maximum systolic peak flow velocity (Vs) and VAR increased dramatically 28-day after the monocrotaline solution injection in both sides of SVC (P ＜0.01), while only the Vs of the right SVC significantly decreased (P ＜0.05).Conclusions The changes of VAR/Vs ratio and VAR in rat model with chronic monocrotaline-induced pulmonary hypertension suggested that the changes of flow velocity waveform of SVC have indicating features in reflecting pulmonary hypertension.

Objective To establish a canine model with acute thrombo-embolic pulmonary hypertension monitored by echocardiography. Methods Simulated the pathophysiologic process of acute thrombo-embolic pulmonary hypertension in human, the canine model was developed. The femoral vein puncture and the right heart catheterization to monitor pulmonary artery pressure were operated guided by echocardiography, while the autologous blood clot was injected to the contralateral femoral vein. The criteria of model was the pulmonary artery systolic pressure was higher than 30 mmHg. Results Echocardiography can accurately guide the placement of right heart catheterization and ancillarily observe the pressure testing of pulmonary artery. Of twenty seven healthy experiment dogs, twenty four models with acute thromboembolic pulmonary hypertension were successfully developed. The successful rate was 88.9 %. Conclusions This canine model with acute thrombo-embolic pulmonary hypertension guided by echocardiography is easy to operate and its repeatability is good.

Objective To evaluate the influence of narrow-band ultraviolet B on lesional microvessel density (MVD),vascular endothelial growth factor (VEGF),matrix metalloproteinases 2 (MMP-2)as well as on serum VEGF in patients with psoriasis vulgaris(PV).Methods Fifteen patients with PV were recruited into this study with 10 normal human controls.All patients received NB-UVB phototherapy thrice a week for 4-5 weeks.Prior and after the treatment,psoriasis area and severity index (PASI)was calculated,tissue specimens were taken from non-photoexposed lesions,and sera samples were obtained from these patients.Then,MvD and the expression level of VEGF and MMP-2 were measured by immunohistochemical labeled dextran polymer(LDP)method in the tissue specimens.Also,the serum level of VEGF was tested by enzyme-linked immunosorbent assay(ELISA).Results PASI score remarkably decreased in patients after the photothempy(t=13.35,P＜0.01).The MVDs were 20.52±5.02,7.33±1.24 and 4.26±0.79 capillaries per high power field(400 × amplification),in psoriatic lesions before treatment,after treatment,and normal control tissues,respectively,with a significant difference among the three groups (F=97.57,P＜0.05),and a significant increase was observed in the lesions before treatment compared with those after treatment and normal controls.The serum level of VEGF was 307.55±121.65 ng/L in psoriatic lesions before treatment,significantly higher than that after treatment(163.92±95.57 ng/L),and in normal control skin (139.78±79.06 ng/L),whereas there was no significant difference between the latter two groups(P＞0.05).The positivity rate of MMP-2 was similar among the three groups without statistical difference(P＞0.05).In psoriatic patients,a positive correlation was observed among PASI score,MVD,lesional and serum VEGF levels(P＜0.05),also among the MVD,VEGF and MMP-2 levels in lesions(P＜0.05).but lesional MMP-2 was unrelated to PASI score or sgrum VEGF(both P＞0.05).Conclusions NB-UVB may regulate superficial dermal microvascular proliferation by acting on the expression of VEGF in sera and lesions of psoriatic patients.VEGF and MMP-2 may bOth participate in the proliferation process of microvessels,while MMP-2 is unlikely to be involved in the therapeutic mechanism of NB-UVB.

To construct the eukaryotic expression plasmid containing the p55 gene fragment of Pneumocystis and to investigate the efficient expression in COS-7 cells, the gene fragment conaining the whole length of p55 gene was used as template to amplify this fragment with PCR and the amplified fragment was then cloned to vector pGEM-T. After enzyme digestion, p55 gene was cloned to the eukaryotic expression vector pcDNA3.1(+) to construct the plasmid pcDNA3.1(+)-582. This plasmid was then transfected to the eukaryotic expression cells COS-7 and PCR and SDS-PAGE assays were used to confirm the presence of target protein in these cells. In these ways, the eukaryotic expression vector for the p55 gene of Pneumocystis of rats was successfully constructed and expressed in COS-7 cells, thus providing the basis for further studies on the nucleic acid vaccine.

Objective To explore the bioeffect of different parameters on 4 cell lines by ultrasoundmediated microbubble destruction.Methods The orthogonal experimental design was used to investigate the effect of three factors on the bioeffects of four cell lines under three levels.Three factors included microbubble concentration,sound intensity,irradiation time.Human breast tumor (MCF-7) cells,ovarian tumor (A2780) cells,liver tumor (Bel7402) cells and thyroid tumor (ARO) cells were exposed to ultrasound in the presence of SonoVue.The cell survival rate was determined by MTT methods and the cell luminosity factor was detected by flow cytometry.Results The optimum parameters for Bel7402 and ARO cell were the same (A2B3C2),and they were different from those from MCF-7 (A3B1C1) and A2780 (A1B3C3) cell.The cell survival rates for 4 cell lines were above 75％,and the cell luminosity factors were different among 4 cell lines.Conclusions The optimum parameters by ultrasound-mediated microbubble destruction for different cell lines are different,and under the optimum parameters the bioeffects of different cell lines are different.

Objective To analyze the changes of superior vena cava SVC spectra in patients with pulmonary hypertension PH and screen the proper parameters of SVC to predict PH Methods Eighty patients with congenital heart disease who underwent right heart catheterization for the measurement of pulmonary artery pressure were included SVC Doppler ultrasound was performed before the catheterization The cut-off point of SVC parameters in the prediction of PH was analyzed using receiver operator characteristic curve ROC curve Results Eighty subjects were included and there were 61 patients in PH group and 10 patients in the control group whose spectra pattern had four waves The data of the 9 subjects whose SVC spectrum were not four waves were excluded from the analysis Diagnostic criteria for PH was pulmonary artery systolic pressure PASP more than 30 mmHg measured by right heart catheterization The analysis of the peak velocity of SVC waves showed that ventricular systolic wave S reduced ventricular reversal wave VR reduced and the ratio of atrial reversal wave and ventricular systolic wave AR S increased in the PH group Compared with the control group their differences were statistically significant t =2 244 2 063 -2 896 P =0 028 0 043 0 005 The ROC curve showed that the ratio of AR S had better diagnostic effect than other parameters On the ROC curve of AR S when the ratio of AR S was 0 45 the sensitivity was 73 77% and specificity was 80 00% respectively for predicting PH When AR S was used to distinguish the control group from patients with moderate and severe PH group the sensitivity was 82 86% and specificity was 80 00% respectively Conclusions Using the ratio of AR S 0 45 as a cut-off for prediction of PH shows a good sensitivity and specificity which might be an alternative method for assessing PH
alternative method for assessing PH.