Objective To explore the effect of Plan. Do-Check-Act on homogenization of nursing processes in ICU. Methods A total of 36 nurses were selected to implement Plan. Do-Check-Act in ICU according to evidence-based medicine. Their nursing was inspected by a senior nurse. The differences of the following items before and after Plan. Do-Check-Act were compared: nursing quality comprehensive quality control index and specialized quality control index. Results After the implementation of Plan. Do-Check-Act, comprehensive quality control index of clinical nursing quality score by (89.28 ± 2.36) points up to (97.45±1.38) points, and there was significant difference(t=-7.310, P<0.01). The specialized quality control indicators including the incidence of ventilator associated pneumonia, the incidence of catheter-related bloodstream infection, the incidence of catheter-associated urinary tract infections, the incidence of accidental extubation, the incidence of pressure sores, the incidence of glycemic out of control, the incidence of sedation out of control and retention time were 26.2%(53/202), 17.8%(36/202), 18.8%(38/202), 11.9%(24/202), 2.5%(5/202), 18.3%(37/202), 15.3%(31/202), (168.0 ± 3.3) h before the implementation and 7.1%(14/196), 3.1%(6/196), 4.1%(8/196), 0.5%(1/196), 0, 3.6%(7/196), 3.1%(6/196), (96.0±4.2) h after the implementation. There were significant differences (χ2=4.913-25.907, t=66.195, all P<0.01). Conclusions The Plan. Do-Check-Act is an effective way to improve nursing quality of ICU to make it homogeneous, reduce adverse nursing and iatrogenic complications.

Objective: To analysis the clinical characteristic and pathogenic bacterium of infective endocarditis (IE),and to compare the pathogenic microorganism and vegetation localization between the prosthetic valve endocarditis (PVE) and the native valve endocarditis (NVE).Methods: The data was collected from 266 in-patients who fulfilled Duke Criteria for IE from May 2003 to May 2008 in our hospital.The demographics and clinical data were analyzed retrospectively.Results: There were 243/266 of IE patients suffered from basic heart disease,among them,101 patients with congenital heart disease,77 patients with non-rheumatic valvular heart disease,62 with rheumatic heart disease and 3 with other heart disease.There were 218 (82%) patients with identified vegetation,and the most common vegetation localized at aortic valve,mitral valve,and aortic plus mitral valve in turn.Bacterial cultures were positive in 49.5% of patients.The proportion of Gram-Negative bacillus and Fungi infection had risen in IE.Detection rate of vegetation was lower in PVE patients than that in NVE patients (P<0.01).However,the positive bacterial culture rate was higher in PVE than in NVE (P<0.01).Streptococcus,coagulase negative staphylococcus,gram-negative bacteria showed significant difference between the two groups (P<0.05).The spectrum of microorganism was different between the early and the late PVE patients.The in-hospital mortality rate of PVE was higher than NVE.Conclusion: The spectrum and pathogenic bacterium of IE had changed obviously during the past years.Early diagnosis,bacterial culture with correct antibacterial treatment,transesophageal echocardiography,and active prevention of nosocomial infection should be essential for the disease control.

In order to accelerate the pace of teaching reform,our school explores the tutorial system of undergraduate course this year,this article emphasize the necessity and beneficial effects of this system in clinical practice.

Objective To investigate the reliability of electrocardiographic (ECG) signal for the accurate assessment of myocardial ischemia in order to evaluate the clinical value of remote real-time ECG monitoring system based on GPRS in patients with acute ST-elevation myocardial infarction (STEMI).Methods A total of 60 STEMI patients admitted between April 2008 and December 2010 were enrolled.All subjects were given the remote real-time ECG monitoring and routine 12 leads ECG monitoring at the same time.They were divided into remote ECG group and the 12 leads ECG group.The remote real-time ECG monitoring collects electrocardiosignal to imitate V1,V3,V5 lead and Ⅰ lead.P wave duration,PR interval,duration of time limit of QRS wave and T wave,QT interval,and the P wave amplitude,QRS wave amplitude,R-(Q + S),T wave amplitude were measured,and the detectability rate of arrhythmia and the definited diagnosis rate of ST segment elevation in accordance with clinical manifestion were compared in each group with different parameters.The data were analyzed by t test,rank sum test,Pearson correlation analysis,Spearman's rank correlation and the chi-square test.Results In STEMI patients,there were no statistical differences in time limits and amplitude of waves on ECG between the two groups (P ＞ 0.05),and the correlations between parameters of two groups were found to be close (P ＜ 0.01).There was no difference in the detectability rate of cardiac arrhythmia between two groups (P ＞ 0.05),and no difference in the rate of correct diagnosis of elevated ST segment between two groups (P ＞ 0.05),except V1 lead (P ＜ 0.05).Conclusions The sensitivity of the change in ST segment of the two groups is similar,and the remote real-time ECG monitoring can help determine the location of myocardial ischemia.

Objective To investigate the kindergarten weigh recipe nutrients allowance and chidren health status.Methods The dietary analysis was made in kindergartens by weighing and growth development was perfonmed in 17 947 chidren.Results The nutrients allowance was different in 15 observation projects,recipe nutrients allow-ance was sufficient for 80%,nutrients allowance was not enough for 20%.Middle serious malnutrition was 0.62%,slow gowth and development was 0.67%.simpie obesity was 5.80%.anemia was 1.40%.Conclusions The recipe nutrients allowance was difference in all kindergartens.Nutrients abundant and not enough was concurrent.Simple o-besity incidence rate was much higher than middle serious malnutrition.

This paper introduces interns shoule know the importance of interpersonal relationship in clinic practice thoroughly and good interpersonal relationship requires the teacher and medical students to make efforts together.

Objective: To isolate and purify the polysaccharide from Cordyceps sinensis, and analyze its structure. Methods:Cordyceps sinensis was cultured by a liquid fermentation method. A water-extraction and alcohol-precipitation method was applied to ex-tract polysaccharide from Cordyceps sinensis fermentation liquor (EPS) and polysaccharide from Cordyceps sinensis mycelium (IPS). Sephadex gel chromatography was applied to isolate and purify the polysaccharide. The purity and relative molecular weight of the poly-saccharide were determined by a gel filtration method. The monosaccharide composition of the polysaccharide was identified by GC. The content of uronic acid was analyzed by sulfuric acid carbazole method. Results: The analysis results showed that the molecular weight of EPS was 78kDa. The content of polysaccharide and uronic acid was 94. 8% and 6. 0%, respectively. EPS was composed of mannose,glucose and galactose with the molar ratio of 4. 5∶8. 0∶1. 0. The molecular weight of IPS was 42kDa. The content of polysac-charide and uronic acid was 92. 5% and 4. 5%, respectively. IPS was composed of mannose,glucose and galactose with the molar ratio of 2. 8∶3. 0∶1. 0. Conclusion:Both polysaccharide EPS and IPS in Cordyceps sinensis are heteropolysaccharide.

Objective To investigate the effects of atorvastatin on the improvement of cardiac function of mice with myocarditis.Methods A total of 146 Balb/c mice were divided into four groups randomly(random number).The viral myocarditis(VMC)model was made by Coxsakie virus B3(CVB)injected intra-abdominally.Four groups were normal group(n =18),VMC group(n =60),Control group (n=18)and VMCtreatment group(n =50).The mice of control group were treated with atorvastatin without VMC,and the mice of VMC treatment group were with VMC and were given atorvastatin for 2 weeks.Echocardiograms were used 3,7,10,14,21,and 30 days after virus inoculation.Blood samples were collected for cardiac troponin-Ⅰ detection at the same time.Myocardial inflammation was examined by using histochemistry staining.The changes of myocardial collagen fiber,myocardial cells and various organelles were examined by electron microscope.Results Compared with VMC group,the cumulative survival rate of VMC group treatment group was higher(87.0％ vs 59.2％)after treatment with atorvastatin for 30 days (P =0.008),and the improvement of pathological features after treatment with atorvastatin was found 10,14,21 and 30 days after the inoculation.Compared with control group,the cardiac function was decreased in the CVB infected mice 7 days after virus challenge[(69.82 ±5.12)vs(89.23 ±2.01),P ＜0.01]and compared with VMC group,the EF values of VMC treatment group were significantly higher 7,14,21and 30 days after virus inoculation.The differences in cTnI values between VMC group and CVB treatment group were statistically significant 7,10,14 and 21 days after virus challenge.Conclusions These results demonstrate that atorvastatin improves survival rates and the histological features in CVB3m-induced myocarditis.It can improve the heart function of CVB infected mice.Atorvastatin could be a treatment of choice for VMC.

Objective To explore the expression and clinical significance of constitutive androstane receptor(CAR)in placenta syntrophoblast from patients with intrahepatic cholestasis of pregnancy(ICP).Methods Placenta were collected from women with ICP who delivered from April 2009 to March 2010 in First Affiliated Hospital of Chongqing Medical University.According to the severity of ICP,patients were classified into mild ICP group(n=10)and severe ICP group(n=10).Ten healthy pregnant women who delivered in the same period were chosen as control group.The location of CAR protein in placenta was studied by immunohistochemical streptavidin-biotin complex(SABC)method.CAR mRNA level was determined by reverse transcription(RT)-PCR technique and CAR protein expression level was determined by western blot.Results(1)CAR was located in the placenta syncytiotrophoblastic cells in control group and mild ICP group,showed light tan when stained,and was mainly in the cytoplasm.In severe ICP group,CAR was also located in placenta syncytiotrophoblastic cells but mainly in the nucleolus,showed dark tan when stained.(2)The mRNA expressions of CAR in control group,mild ICP group,severe ICP group were 0.06 ±0.03,0.07 ±0.03 and 0.56±0.03.respectively.CAR in severe ICP group was significantly higher than those in control group and mild ICP group(P＜0.05).The difference of mRNA between control group and mild ICP group wag not statistically significant(P＞0.05).(3)The CAR protein levels in control group,mild ICP group,severe ICP group were 0.74±0.03,0.79±01 03 and 1.02±0.04,respectively.CAR protein expression in the severe ICP group was significantly higher than the other two groups(P＜0.05).And there was no statistical significance between mild group and control group(P＞0.05).Conclusion In ICP women.especially severe ICP patients,the CAR expression in placenta syncytiotrophoblastic cells increased appreciably,which may be involved in the maintenance of placenta barrier function and protection in ICP pathogenesis.

This study aimed to identify Belamcandae Rhizoma, Iridis tectori Rhizoma and their adulterants by ITS2 sequence. All the DNA samples of Belamcandae Rhizoma, Iridis tectori Rhizoma and their adulterants were extracted. The ITS2 sequence were succesfully amplified, and purified PCR products were sequenced. All the sequences were assembled using the CondonCode Aligner V3.7.1. The Kimura 2-Parameter (K2P) genetic distances and the Neighbor-Joining (NJ) phylogenetic tree were calculated by using MEGA5.1. Results indicated that the maximum intraspecific genetic distances of Belamcandae Rhizoma was 0, and the average GC content was 52.22%;the maximum intraspecific genetic distances of Iridis tectori Rhizoma was 0.004, and the average GC content was 67.87%. The maximum K2P intraspecific genetic distance of Belamcanda chinensis, Iris tectorum were both lower than the minimum interspecific genetic distance of adulterants. Additionally, the ITS2 sequences in each of these polytypic species were separated into pairs of divergent clusters in the NJ tree. The NJ tree based on ITS2 sequence indicated that Belamcandae Rhizoma, Iridis tectori Rhizoma and their adulterants could be distinguished clearly. It could be concluded that ITS2 barcode can be used to correctly identify Belamcandae Rhizoma, Iridis tectori Rhizoma from their adulterants, and ensure their safety in use.