The application of the Six Sigma working methods is introduced in the use and maintenance of monitor.By using Six Sigma working methods,the needs of clients are researched,and improved method are put forward.A solution to lower the failure rate of monitor is suggested,and the various causes are analyzed.By the comparison between the fore-and-aft situations,desired effect is obtained with improved work efficiency and better economic and social benefits.

Objective To observe the relationship between impaired glucose regulation(IGR)and the degree of atherosclerosis(AS)on Lacunar Infact(LI)patients.Methods A total of 83 patients with LI confirmed by CT or MRI were collected and divided into 3 groups by their fasting blood glucose,and their medical history and physical examination,the fasting blood lipid,acidum uricum and INI profile were evaluated with an automatic biochemistry machine.By employing a high resolution B-mode ultrasonography the intimae smoothness,intimae-media thickness(IMT)and plaque(s)were observed in bilateral common carotid arteries.Results The hypertension history,smoke history,waistline body mass index(BMI)and the atherosclerosis were all more marked in subjects with IGR than those in NGT(all P

Systematic pharmacological evaluation of material basis for the efficacy of Chinese herbal formula is one of the key issues in Chinese materia medica(CMM),which is in urgent need of solution.However,its scientific connotation is still controversial in academic circles.The material basis for the efficacy of Chinese herbal formula is the total non-endogenous bioactive compound(derived either directly or indirectly from this formula) exerting the therapeutic effects,which is generated by the interaction of the formula with human body and reaches certain concentration in the target organs or tissues.Systematic evaluation of material basis for the efficacy of Chinese herbal formula is the cornerstone of modernization and internationalization of CMM,while the quality control of CMM is its prerequisite.

OBJECTIVE To investigate the clinical and etiologic characteristics and treatment of central venous catheter-related(sepsis).METHODS Forty cases of patients with central venous catheter-related sepsis and their clinical manifestation,etiologic profiles and outcome of treatment were retrospectively analyzed.RESULTS Forty six strains were isolated including 23 strains of Gram-positive cocci,19 of Gram-negative bacilli and 4 of fungi.The most frequent(isolates) were Staphylococcus epidermidis.CONCLUSIONS The most common organism causing CRS is S.epidermidis;the key preventive measure is to avoid inner and outer pollution of catheter;antibiotic lock-technique can be taken for the treatment of uncertain CRS.If it is no effect after 24-48 hours,it is necessary to remove venous catheter promptly.

Tanshinones are a large class of hydrophobic natural products isolated from traditional Chinese herb Salvia miltiorrhiza Bunge and related plants. Tanshinones include tanshinone ⅡA, cryptotanshinone, tanshinone I, dihydrotanshinone, and so on. Both the tanshinones and the salvianolic acids have been identi-fied as the characteristic and main active ingredients of Salvia miltiorrhiza Bunge with cardiovascular protective activities. Ac-cumulated data in recent years have revealed that tanshinones possess remarkable anti-cancer activities both in vivo and in vitro. In this review, we summarize the latest progress of the an-ti-cancer effect and the underlying mechanisms of tanshinones, particularly with emphasis on tanshinone ⅡA, which might pro-vide reference for the further research and development of these compounds.

The proliferation of vascular smooth muscle cells is closely related to the pathogenesis of a variety of diseases, such as atherosclerosis, hypertension, diabetes, vascular restenosis, and etc. A proper model for smooth muscle cell proliferation can be served as an important tool for exploring the molecular mechanisms of smooth muscle cell proliferation and the screening of potential inhibitory agents. Various factors can induce the proliferation of smooth muscle cells with different mechanisms and pathological significance. The ox-LDL, AGEs, angiotensin II (AngⅡ), high glucose, tumor necrosis factor (TNF) and etc. have been successfully applied in the establishment of smooth muscle cell proliferation model. This article summarized the most commonly used models for smooth muscle cell proliferation. The inhibitory effects of Chinese herbal medicine, especially the isolated pure compounds were discussed. It was aimed to provide references for the screening of smooth muscle cells based medications as well as studies on related research and development of Chinese herbal medicine.

Thirty assistant general practitioners (GPs) of Jiading District Shanghai were trained for clinical skills and communication skills by using standardized patients (SP) in outpatient department from January to April 2014.The scores of clinical skills and communication skills were evaluated and compared before and two months after training.The results showed that the score of clinical skills [(72 ± 5) vs (56 ± 7), t=7.871, P＜0.05] and communication skills [(71 ±4) vs (45 ±5), t =9.573, P＜0.05] were significantly improved after training.After training, the scores of medical history taking [(36 ±5) vs (28 ± 6), t =4.352], clinical thinking [(17 ± 2) vs (14 ± 3), t =3.974], health education [(3 ± 1) vs (2 ± 1), t =3.090] and medical record v,riting [(13 ± 1) vs (8 ±2), t =5.317] were significantly higher than those before training (all P ＜ 0.05).But there was no difference in reception time management [(4 ± 0) vs (4 ± 0), t =1.025] before and after training (P ＞ 0.05).After training, the scores and the proportions of the trainees qualified for building physician-patient relationship [(20 ± 3) vs (15 ± 4), t =4.056],collecting information and providing feedback [(22 ±4) vs (13 ±3), t =4.682], understanding complaints from patients' perspective [(5 ± 2) vs (3 ± 2), t =3.107], sharing information and obtaining informed consent [(19 ± 4) vs (11 ± 5), t =4.322] and closing consultation [(6 ± 2) vs (3 ± 1), t =2.987] were higher than before training (all P ＜ 0.05).The results indicate that training by using SP can effectively improve the clinical skills and communication skills of assistant GPs.

Objective To explore the effect of suction toothbrushing in oral care of patients with dysphagia.Methods sixty patients with dysphagia from the neurology department and rehabilitation department in our hospital were equally divided into the experiment group and the control group randomly: the former used suction toothbrushing for oral care and the latter physiological saline for oral care.The two groups were compared in respect of bad breath,oral cleanliness,time for conducting oral care,stomatitis, oral ulcer and pathogenic bacteria in oral cavity.Results The time for conducting oral care in the experiment group was significantly shorter than that in the control group(P<0.001).The score on oral cleanliness of the experiment group was significantly higher than that in control group(P<0.001).The bad breath,stomatitis or oral ulcer,and mucosa damage in the experiments group were all lower than those in the control group.The number of oral bacteria on the 5th day in the experiment group was smaller than that in the control group(P<0.005).Conclusion For the patients with dysphagia,the suction toothbrushing may be effective for cleaning the mouth,reducing oral complications and improving the satisfaction degree.

Objective To observe the preventive and therapeutic effect of Baimai Ointment on stoke,and explore the principle of promoting blood circulation and removing blood stasis.Method By dermal administration,the crude drug contents of Baimai Ointment given to rats were 0.075,0.150,and 0.300 g/kg respectively.Focal cerebral ischemic model was induced by the middle cerebral artery occlusion (MCAO),and the preventive and therapeutic effect of Baimai Ointment was evaluated.The degree of hematoma absorption in rats was measured to observe the effect on promoting blood circulation and removing blood stasis of Baimai Ointmnent.The acute blood stasis model and carotid thrombosis model were established in rats to study the effects on blood viscosity and thrombosis time.Results Baimai Ointment had no significant prevent effect on stroke in rats.It effectively improved behavior coordination in stroke model rats.It also significantly decreased the area of hematoma on rats,speeded up the repairment of local demage.After administration of Baimai Ointment,blood viscosity of blood stasis model rats was obviously decreased,while thrombosis time was effectively prolonged on carotid thrombosis model.Conclusion Baimai Ointment can significantly improve the behavior coordination in stroke model rats,plays a significant role in treatment,but no significant preventive effect,a preliminary study shows that the possible therapeutic principles may be promoting blood circulation and removing blood stasis.

Objective To investigate the effect of all-trans retinoic acid (ATRA) on transforming growth factor β1 (TGF-β1)/Notch signaling pathway in injured podocytes induced by adriamycin (ADR) in vitro.Methods Podocytes cultured in vitro were randomly divided into normal group,model group,ATRA treatment control group,12-hour ATRA intervention group and 24-hour ATRA intervention group.Morphological changes were observed by using light microscope.The expressions of TGF-β1,podocin,Notch 1,Jagged 1 mRNA were evaluated through real-time polymerase chain reaction (RT-PCR) and the corresponding proteins were detected by using Western blot.Results (1) No obvious changes between normal group and ATRA treatment control group were revealed as the plump podocytes and distinct outline were found in light microscope,while podocytes in model group showed disordered arrangement,fuzzy boundary,atrophy,hypertrophy and increased cellular debris.Of note,the podocytes in 12-hour ATRA intervention group and 24-hour ATRA intervention group almost returned to normal.(2) In contrast with those in model group,the amounts of TGF-β1,Notchl,Jaggedl mRNA levels decreased in 12-hour ATRA intervention group (1.34 ±0.43 vs.4.16 ±0.31,1.67 ±0.2 vs.4.21 ±0.92,2.08 ±0.27 vs.5.14 ±0.63,q =23.83,11.45,19.67,all P ＜0.05) and 24-hour ATRA intervention group (1.22 ± 0.16 vs.4.16 ± 0.31,1.73 ± 0.53 vs.4.21 ± 0.92,2.08 ± 0.29 vs.5.14 ± 0.63,q =24.85,11.18,19.67,all P ＜ 0.05),and the differences were significant;similar trend was detected in the protein levels (1.04 ± 0.03 vs.4.31 ± 0.10,1.06 ± 0.04 vs.4.47 ± 0.24,1.07 ± 0.04 vs.4.20 ± 0.16,1.06 ±0.03 vs.4.31 ±0.10,1.07 ±0.03 vs.4.47 ±0.24,1.09 ±0.03 vs.4.20 ±0.16,q =163.50,69.61,90.36,162.50,69.40,89.78,all P ＜ 0.05),and the differences were significant;whereas the level of podocin mRNA (1.13 ±0.05 vs.0.40 ± 0.06,1.16 ± 0.03 vs.0.40 ± 0.06,q =36.50,38.00,all P ＜ 0.05) and protein (1.01 ± 0.01 vs.0.44 ±0.01,1.02 ±0.01 vs.0.44 ±0.01,q =180.25,183.41,all P ＜0.05) increased,and the differences were sig nificant.(3) The expressions of Notch1,Jagged1 mRNA were positively correlated with TGF-β1 mRNA (r =0.84,1.00,all P ＜ 0.05),but negatively correlated with podocin mRNA (r =-0.95,-0.94,all P ＜ 0.05) in model group.Conclusions ATRA might alleviate podocyte injury through cutting the expressions of TGF-β1,Notch1,Jagged1 and raising the expression of podocin in injured podocytes induced by ADR.