The JCI-based PDCA cycle makes continued quality improvement its comerstone.Its use in ICU human resource management consists of assurance of HR quantity,assurance of HR quality,and scientific use of human resources.Its application in ICU nursing care consists of creating excellent environment and providing high quality nursing items,with emphasis on quality nursing service in detail.Conversion of working mode,rationalized HR deployment,high quality nursing care,all contribute to raising the quality and social reputation of the hospital and the department,to standardized management,enhanced teamwork,better nursing care quality,and to higher satisfaction of the patients in the end.

ObjectiveTo investigate the effects of early stage Alzheimer's disease(AD)on white matter(WM)integrity using diffusion tensor imaging(DTI)and its relationship with cognitive function decline.MethodsDTI was performed in 32 subjects,including 14 early AD patients and 18 elder controls(ON)with a 1.5 T MR scanner. Fractional anisotropy(FA)and mean diffusivity(-D)values were computed and compared for 9 regions of interest(ROI).Eight standard neuropsychological tests were performed and compared between AD and ON to evaluate basic cognitive capacities of AD.Correlation analysis was applied between FA,(-D) values and scores of neuropsychological tests for all subjects.ResultsFA significantly decreased in splenium of the corpus callosum and the posterior parietal-temporal region(S2),and D significantly increased in the splenium in AD patients(P＜0.05).AD patients showed lower scores compared with ON in all neuropsychological tests(P＜0.05).FA of the splenium and S2 positively correlated with several tests scores,while (-D) of multiple ROIs negatively correlated with several tests scores (P＜0.05).ConclusionsIn the early stage of AD,neuropathology has effect not only on cognitive function,but also on white matter structure,and they have strong relationship.AD patients show white matter changes in specific regions,which reflect loss in cortico-cortical connections.

Objective To evaluate the association between cytomegalovirus (HCMV) infection and atherosclerosis (AS) and explore the possible role of endothelin (ET) and serum tumor necrosis factor(TNF ?) in the pathogenesis of AS in diabetic patients and the relationship between HCMV infection and concentrations of ET and TNF ?. Methods Blood samples were collected from 21 patients with AS of type 2 DM, 47 patients with non AS of type 2 DM and 20 controls. Special antibodies to HCMV (IgM,IgG) were measured by enzyme linked immunosorbent assay (ELISA) . The concentrations of serum TNF ? and plasma ET were determined by RIA. Results (1) Type 2 diabetic patients, especially those with established AS, had a higher prevalence of active infection of HCMV. (2) The levels of plasma ET and serum TNF ? in type 2 diabetic patients were higher than those in normal people. In the pathogenesis of AS in diabetic patients, the ET played more important role than the TNF ?.(3) There was a significantly positive correlation between anti IgM to HCMV and the level of plasma ET in type 2 DM patients. It suggested that the injury of endothelium cell was related to the active infection of HCMV. Conclusion The study suggests that HCMV infection may be important in the pathogenesis of AS in type 2 diabetic patients and ET possibly plays an important role on the pathological course of AS.

Objective To explore the clinical value of the disposable uterine cavity tissue suction tube in diagnosing abnormal u‐terine bleeding .Methods Seventy‐five patients ,who needed an endometrial biopsy because of abnormal uterine bleeding ,were se‐lected for this study .An endometrial biopsy was performed by a disposable uterine cavity tissue suction tube before the conventional suction dilatation and curettage (D&C) .The sample satisfactory rate and the diagnose accordance rate of the two methods were compared .Results The sample satisfactory rate of the disposable uterine cavity tissue suction tube and of the D&C was 85 .3%(64/75) and 94 .7% (71/75) respectively .The difference was not statistically significant(P>0 .05) .The diagnose accordance rate of the disposable uterine cavity tissue suction tube and the D&C was 90 .3% (56/62) and 93 .5% (58/62) respectively .The differ‐ence was not statistically significant(P>0 .05) .Conclusion To a certain extent ,endometrial biopsy performed by disposable uter‐ine cavity tissue suction tube can be a substitute for D&C as the initial inspection to assess abnormal uterine bleeding ,for its econo‐my ,efficiency and safety .

AIM: To study the protective effect of hepatic stimulator substance(HSS) on chemotherapeutic liver damage induced by cyclophosphamide and its possible mechanism.METHODS: The serum biochemical parameters,oxidative parameters and anti-oxidative parameters of liver tissue of male Kunming mice inoculated with S_(180) cells were measured.The pathology of the liver was observed with microscope.The weight of S_(180) sarcom was weighted.RESULTS: The elevation of MDA content of liver tissue and the less of GSH content and CAT,GSH-PX,GST,and SOD activities induced by CP were restored remarkably by HSS.The ALT and LDH activities of serum in HSS group which was compared with control group and CP group were not statistically distinctive.In the pathologic examination,spotty and focal necroses of hepatocytes in the liver of CP group were found with a great deal of inflammatory cells infiltration in the necrotic and portal areas,while the damage in the liver of HSS group was ameliorated obviously;The weight of S_(180) sarcom in CP group and HSS group was not statistically distinctive.CONCLUSION: The effect of HSS on CP-induced chemotherapeutic liver damage maybe due to anti-oxidative activity.

The gene and the amino acid sequence of the structural and regulatory region of the Pseudomonas aeruginosa with different resistance patterns were analyzed. Six strains with different resistance patterns were selected and the AmpC beta-lactamase was identified. The objective gene fragment was amplified by colonies PCR. The sequences of the PCR-products were analyzed. The DNA sequence of the structural gene ampC and the regulatory genes ampR, ampD and ampE was detected. The 6 strains and the wild-type Pseudomonas aeruginosa are highly homogeneous in structural and regulatory region. Some new mutant points were found.
Bacterial Proteins/*genetics ; DNA, Bacterial/genetics ; Point Mutation/*genetics ; Pseudomonas aeruginosa/enzymology ; Pseudomonas aeruginosa/*genetics ; Sequence Analysis, DNA ; beta-Lactam Resistance/*genetics ; beta-Lactamases/*genetics

Objective To survey the knowledge of chronic stable coronary artery disease management among general practitioners (GPs) in Shanghai Pudong New Area.Methods The survey was conducted among 363 GPs with at least 2-year work experiences from community health service centers in Shanghai Pudong New Area from July to September in 2014.A self-designed questionnaire based on the guidelines/consensus of chronic stable coronary artery disease management were used in the survey.The questionnaire consisted of 4 parts:diagnosis,drug therapy,revascularization and treatment of special types.Results Among 363 participants 362 questionnaires were completed.History taking,physical examination and electrocardiogram were applied for diagnosis in all participants,49.2％ (178/362) also used coronary computed tomography angiography,26.5％ (96/362)used exercise testing for assistant examination.More than 95.0％ of participants recognized that smoking,obesity,hyperlipidemia,hypertension,diabetes were risk factors.75.7％ (274/362) of participants used aspirin,91.4％ (331/362) knew the dose of aspirin as 75-150 mg;for aspirin intolerance 14.6％ (53/362)would use clopidogrel alternatively.50.6％ (183/ 362) of participants sometimes used statins;and 39.2％ (142/362) did not use stain because of not knowing the contraindication.Facing increases of alanine aminotransferase or aspartate aminotransferase levels 95.3％ (345/362) of participants would immediately discontinue stain;80.4％ (291/362) discontinued statins as creatine kinase increased.32.0％ (116/362) of participants gave enough drug-free period avoiding nitrates resistance.79.6％ (288/362) seldom used β-blockers and 42.5％ (154/362) failed to use β-blockers because not knowing the contraindication.78.7％ (285/362) knew percutaneous coronary intervention but did not know its indications;83.1％ (301/362)knew coronary artery bypass but did not know its indications.27.6％ (100/362) knew calcium antagonists were first-line drugs for variant angina and 93.6％ (339/362) never heard of microvascular angina.Conclusion The survey shows that GPs from community health service centers in Shanghai Pudong are not well familiar with examination of coronary heart disease and lack of sufficient knowledge of drugs recommended by the guideline,not well understand the indications for revascularization and the diagnosis and treatment of special types of coronary heart disease.

Objective: To study the effect of Maitork (a sodium chloride injection containing Ginkgo bioba extract and ligustrazine phosphate) on plasma levels of fibrinogen (Fg), platelet granule membrane protein 140 (GMP-140), tissue plasminogen activator (tPA) after focal cerebral ischemia-reperfusion in rats. Methods: Eighty male SD rats were randomly allocated into groups 3-day (n=40) and 7-day (n=40) after operation. Then each group was divided into 4 subgroups: sham-operation, ischemia control, Ginaton and Maitork. The focal cerebral ischemia model was established in rats. The activities of GMP-140 and tPA were measured by chromogenic substrate assay, and the level of Fg was measured by gel plaque assay. Results: The level of Fg in the Ginaton group was significantly higher than that in the ischemia control group, and the 7-day group was also significantly higher than that in the Maitork group (P

Objective: To study the prevalence and pathogenesis of TT virus (TTV) in hemodialysis patients. Methods: Serum TTV DNA was tested in 69 hemodialysis patients from our hospital by nested-PCR using primers from a conservative region of TTV genenome, genetic analysis and detection of hepatitis C virus antibody (anti-HCV) and the levels of alanine aminotransferase (ALT) were also carried out simultaneously. Results: The overall prevalence of TTV viremia was 27.5%. The PCR-amplified gene fragment from one patient was sequenced, and its gene sequence homologies with GH1,TA278, TTVCHN1 and TTVCHN2 ranged from 89% to 100%, its deduced amino acid sequence ranged from 87% to 100%. There was no significant difference of TTV prevalence between anti-HCV positive and negative patients. No significant elevation of ALT was found in all patients. Conclusion: High prevalence of TTV infection is found among hemodialysis patients, and TTV infection has no significant association with HCV infection or elevation of ALT.

Objective To explore neurobehavioral changes in rats with recurrent seizures and the prevention effect of melatonin.Methods 6-day-old (P6) SD rats were randomly divided into four groups of 24 (n =6):the control group (CONT),melatonin per se group (MEL),recurrent neonatal seizure group (RS) and melatonin administration prior to RS group (RS + MEL).Rats in RS group were subjected to 5 seizures with flurothyl during the first 14 days of life.In RS + MEL group,melatonin was injected at 8:00 before seizures were induced.Neurobehavioral tests including Plane righting experiment,Cliff avoidance test,the grip-strength test and negative geotaxis test were implemented on P24,while open field test on P35.Results (1) Plane righting experiment:the time of plane righting in RS group ((0.33 ± 0.51)s) was significantly shorter than that in the CONT group ((1.17 ± 0.40) s) and RS + MEL group ((0.50 ± 0.54) s) (P ＜ 0.05).(2) Cliff avoidance test:the time of cliff avoidance in RS group ((16.00 ± 6.32) s) was significantly longer than that in CONT group ((4.00 ± 2.60) s)(P ＜ 0.01),while the time of cliff avoidance in RS + MEL group ((7.67 ± 3.26) s) was shorter than that in the RS group (P ＜ 0.05).(3) The grip-strength test:compared with CONT group ((49.50 ± 28.96) s),the time needed to hold on wire in RS group((11.67 ± 7.58)s)was significantly shorter (P ＜ 0.05) and longer in RS+ MEL group ((24.83 ± 6.61) s) (P ＜ 0.05).(4) Negative geotaxis test:the time for rats to turn 180° upward in RS group((7.67 ± 1.36) s) was longer than that in the CONT group ((4.50 ± 2.66) s) and RS + MEL group ((6.17 ± 0.75) s) (P ＜ 0.05).(5) Open field test:the time for rats to begin to run in the RS group ((8.17 ± 3.86) s) was longer than that in the CONT group ((3.00 ± 1.41) s) (P ＜ 0.05).Conclusion The neurobehaviors are damaged following flurothyl-induced recurrent neonatal seizures,and melatonin can reduce the neurobehavioral injury.