We studied and reviewed the PDCA cycle theory related literature, and summarized the research related to PDCA cycle application in the research management in hospitals in china.We also analyzed the present problems and explored future direction of development.

Objective To discuss the clinical efficacy of warm acupuncture, acupoint injection, bloodletting and electroacupuncture, and their interaction effects for acute cold type facial paralysis. Methods Totally of 48 patients with acute cold type facial paralysis were randomly divided into three groups by orthogonal experimental design, and then were assigned to 16 treatment plans. All patients received routine basic treatment, and then were given warm acupuncture, acupoint injection, bloodletting and electroacupuncture according to assigning results. 10 d were as a treatment course, with 2 d as interval, 3 treatment courses in total. The neurological function scores before and after treatment and facial nerve recovery time were recorded. Results There was statistical significance in scores of facial nerve function, warm acupuncture, acupoint injection, electroacupuncture, bloodletting had significant difference with errorterm (P<0.01). There was statistical significance in the recovery time of the facial nerve function, warm acupuncture, bloodletting compared with error term (P<0.01). Conclusion Warm acupuncture, acupoint injection, bloodletting and electroacupuncture combine with acupuncture are better for acute cold type facial paralysis. Warm acupuncture and bloodletting therapy in the acute phase of interventional therapy can shorten the recovery time of facial nerve.

Objective To investigate the effect of high glucose on the expression of transforming growth factor-?1(TGF-?1),?-SMA,E-Cadherin in renal proximal tubular epithelial cells(HKCs)and role of AG490,an antagonist of Janus kinase.Methods Cultured HKCs cells were divided into four groups:low glucose group(LG),high glucose group(HG),high mannitol group(LG+M),and HG+AG490 group(AG).Immunoprecipitation and Western blot analysis were used to measure the expressions of tryosine phosphorylated Janus kinase 2(p-JAK2),STAT1,STAT3,p-STAT1,p-STAT3 and ?-SMA,E-Cadherin.The contents of TGF-?1 and type I collagen in the supernatants of the cultured HKCs were detected by ELISA.TGF-?1 mRNA were measured by RT-PCR.ResultsCompared with low glucose control group,the expressions of JAK2,p-STAT1,p-STAT3 and TGF-?1 mRNA were significantly increased in HG group from 6 to 72 h.Meanwhile,the contents of TGF-?1 and collagen I in the supernatants and the expression of ?-SMA were increased,the expression of E-Cadherin was decreased.The expression of JAK2,p-STAT1,p-STAT3 and TGF-?1 mRNA and the level of TGF-?1,collagen I in the supernatant s in HG+AG490 group were obviously lower than those of the HG group.The expression of ?-SMA and E-Cadherinwas also decreased in HG+AG490 group.Conclusion Activation of JAK/STAT signaling pathway seems to be involved in the high glucos induced overproduction of TGF-?1 and ECM proteins in HKCs.

AIM: To investigate the effect of activation of JAK/STAT signaling pathway on the transdifferentiation induced by high concentration of glucose in renal proximal tubular epithelial cells(HKCs).METHODS: Cultured HKCs cells were divided into four groups: low glucose group(LG),high glucose group(HG),high mannitol group(LG+M),and HG+AG490 group(AG).Immunoprecipitation and Western blotting analysis were used to determine the expression of tryosine phosphorylated Janus kinase 2(p-JAK2).The protein expressions of STAT1,STAT3,p-STAT1 and p-STAT3 and expressions of ?-SMA,E-cadherin were observed by Western blotting.The contents of TGF-?1 and type I collagen in the supernatants of the cultured HKCs were detected by enzyme-linked immunoadsorbent assay(ELISA).TGF-?1 mRNA were measured by reverse transcription and polymerase chain reaction(RT-PCR).RESULTS: Compared with low glucose control group,the expression of JAK2,p-STAT1,p-STAT3 and TGF-?1 mRNA was significantly increased in HG group at different stimulated time from 6 h to 72 h.Meanwhile,the contents of TGF-?1 and collagen I in the supernatants and the expression of ?-SMA were increased,the expression of E-cadherin were decreased.The expression of JAK2,p-STAT1,p-STAT3 and TGF-?1 mRNA and the levels of TGF-?1,collagen I in the supernatants in HG+AG490 group were obviously lower than those in HG group.The expressions of ?-SMA and E-cadherin were also decreased in HG+AG490 group.CONCLUSION: Activation of JAK/STAT signaling pathway may be involved in the high glucose-induced transdifferentiation and overproduction of TGF?1 and ECM proteins in HKCs.

Objective To investigate the effect of Hongjintian decoction on the levels of serum MDA , SOD, NGF, MBP and bFGF of physical fatigue athletes.Methods 40 students of physical education college were randomly divided into experimental group and control group, 20 cases in each group.After the end of sport, the experimental group were given Hongjintian decoction, and control group were given sugar water, the levels of serum MDA, SOD, NGF, MBP and BFGF in two groups were detected.ResuIts Compared with control group, the level of MDA in experimental group was lower(P<0.05), and the level of SOD was higher (P<0.05); NGF and BFGF levels were higher in experimental group(P<0.05), MBP level was lower (P<0.05).ConcIusion Hongjintian decoction can significantly reduce serum MDA, MBP levels, increase serum SOD, NGF and BFGF levels of physical fatigue athletes.

Objective To explore the perioperative nursing method and effect of doing minimal invasive occlusion to children with congenital heart disease via subaxillary incision.Methods The data of 86 children patients with congenital heart disease underwent minimally invasive occlusion via right subaxillary incision were retrospectively analyzed and summarized nursing points including preoperative and postoperative mental nursing,postoperative postural care and sedative care,observing whether the occluder moved or detached and mechanical hemolysis,monitoring ECG and blood pressure,and preventing hemorrhage and thrombogenesis.Results One case of infracristal ventricular septal defect with frequent premature ventricular beat after occlusion was converted to thoracotomy surgery;one case of mixed atrial septal defect with heart rate increasing and dyspnea after 12 hours of occlusion was found occluder detached and immediately converted to remove the occluder and fix the atrial septal defect;The other children were successfully recovered and been discharged.Conclusions Full understanding and strengthened perioperative nursing care of complications of children with congenital heart disease after surgical minimally-invasive surgical closure is the key point to avoid the occurrence of fatal complications and ensure the children recover safely and smoothly.

Objective To explore the application value of D-dimmer(DD),hs-CRP and homocysteine(Hcy) in postoperative condition monitoring in the patients with femoral neck fracture.Methods Forty cases of femoral neck fracture treated in our hospital were selected as the observation group and 40 patients with other fractures were selected as the control group.The observation group were given the surgical treatment,while the control group adopted the corresponding measures for conducting intervention according to the fracture situation.The DD,hs-CRP and Hcy levels were detected in the two groups.Then the detection results were compared between the two groups.Results The various indexes before treatment in the observation group were slightly higher than those in the control group without statistical difference(P>0.05).The levels of various indicators at postoperative 24,48 h in the observation group were significantly elevated,moreover the increase range at postoperative 24 h in the observation group was maximal,which was significantly higher than that in the control group(P<0.05).The positive rates of hs CRP,Hcy and DD in the observation group were 75.00%,77.50% and 60.00% respectively,while which in the control group were 0.00%,2.50% and 0.00%,the observation group was significantly higher than the control group (P<0.05).Conclusion Hs CRP,Hcy and DD can be used as the important indicators of condition monitoring for femoral neck fracture.

Objective To investigate the effect of medicinal charcoal tablets combined with blood purification therapy on on renal function, inflammatory mediators, oxygenation index and intestinal barrier function in patients postoperative severe abdominal infection.Methods 65 cases with severe abdominal infection from the hospital were selected and randomly divided into control group (32 cases) and experiment group (33 cases) by random digital table method.The control group were treated by clinical routine therapy and experiment group were treated on the basis of control group with medicinal charcoal tablets combined with blood purification therapy.The renal function, inflammatory mediators, oxygenation index, intestinal barrier function and efficacy were tested.ResuIts Compared with control group after treatment, the renal function of serum creatinine (Scr), blood urea nitrogen (BUM), uric acid (UA) levels were lower (P<0.05), the inflammatory mediators of tumor necrosis factor α(TNF-α), interleukin-6 (IL-6) and interleukin-8 (IL-8) levels were lower (P<0.05), the oxygenation index (OI) was higher(P<0.05), the intestinal barrier function indicators of plasma diamine oxidase (DAO) and endotoxin of lipopolysaccharide (LPS) were lower (P<0.05), the total efficiency were higher (χ2 =3.91, P<0.05) in experimental group.ConcIusion The medicinal charcoal tablets combined with blood purification could effectively improve renal function, reduce inflammatory mediators levels, improve intestinal barrier function, and increase oxygenation index in patients with severe abdominal infection, which has a good clinical curative effect for postoperative severe abdominal infection .

Objective To explore the effects of baicalin in the treatment of a preeclampsia (PE) rat model by detecting the expression of X-linked inhibitor of apoptosis protein (XIAP) and cysteine containing aspartate-9 (Caspase-9) and observing the ultrastructure of mitochondria in trophoblast cells.Methods Forty-eight pregnant Wistar rats were randomly divided into two groups:12 in the control group and 36 in the PE model group.The PE model was established with subcutaneous injection of l-nitro arginine methyl ester with 100 mg/kg per day from the 13th day of pregnancy.Beginning from the 16th day of pregnancy,the PE rats were injected with different doses of baicalin till cesarean section,and divided into three groups:non-intervention PE model group treated with saline (NIP group),low-dose baicalin intervention group (IDB group) at 50 mg/kg per day,and high-dose baicalin intervention group (HDB group) at 100 mg/kg per day.The rat tail artery blood pressure and 24-h urine protein level were measured at pregnant day 10,16 and 20.The levels of XIAP and Caspase-9 in placenta were measured by immunohistochemistry.The ultrastructure of mitochondria of trophoblast cells of the rat placenta was observed under electron microscope.T test,F test and LSD-t test were applied for statistical analysis.Results (1) On pregnant day 10,no significant differences were observed in rat tail artery systolic blood pressure,diastolic blood pressure and 24-h urine protein level between the control group and PE model group (all P＞0.05).On pregnant day 16 and 20,the systolic blood pressure,diastolic blood pressure and 24-h urine protein level of NIP,IDB and HDB groups were significantly higher than those of control group [pregnant day 16:systolic blood pressure:(137.74±5.21),(136.15±4.86),(138.28±4.79) and (110.57±3.79) mmHg (1 mmHg=0.133 kPa),diastolic blood pressure:(89.58 ± 5.50),(88.45 ± 8.59),(89.42 ± 6.29) and (80.28 ± 7.36) mmHg,24-h urine protein:(7.78 ± 0.45),(7.53 ± 0.54),(7.86± 0.57) and (6.45 ± 0.56) mg;pregnant day 20:systolic blood pressure:(145.26 ± 4.67),(131.28 ± 4.34),(130.93 ± 5.33) and (110.40 ± 6.92) mmHg,diastolic blood pressure:(89.87±6.55),(85.34±7.33),(84.64±7.36) and (80.19±7.34) mmHg,24-h urine protein:(11.18±0.42),(9.65±0.54),(9.06±0.56) and (6.31 ±0.45) mg] (all P＜0.01).On pregnant day 20,the systolic and diastolic blood pressure and 24-h urine protein level in IDB and HDB groups were significantly lower than in NIP group (all P＜0.05),but showed no significant differences between IDB and HDB groups (allP＞0.05).(2) Compared with NIP group,the expression of XIAP in control group,IDB and HDB groups were significantly increased(210.39±0.78,180.56±0.82,195.36±0.96 and 192.84± 1.06,all P＜0.01).There was no significant difference in the expression of XIAP between IDB and HDB groups (P=0.66).The expression of Caspase-9 in control group,IDB and HDB groups were significantly decreased compared with NIP group (210.36±0.55,195.53±0.96,198.42± 1.01 and 185.25±0.64,all P＜0.01).There was no significant difference in the expression of Caspase-9 between IDB and HDB groups (P=0.65).Ultrastructure of mitochondria in NIP group showed different degrees of damage,matrix swelling,and mitochondrial cristae bresk or disappearance.In IDB group,mitochondrial matrix swelling was not obvious,and mitochondrial cristae were visible.In HDB group,mitochondrial cristae were neat and clear.Conclusions Baicalin may play an important role in the treatment of preeclampsia by reversing the trophoblast apoptosis and improving the ultrastructure of mitochondria through its regulation of XIAP expression and downregulation of Caspase-9 expression.

Objective: To explore early diagnostic and resent prognostic assessment value of serum levels of ischemia-modified albumin (IMA) and cardiac troponin I (cTnI) for acute coronary syndrome (ACS).Methods: A total of 175 ACS patients were selected, including 73 cases with unstable angina pectoris (UAP), 61 cases with non-ST elevation myocardial infarction (NSTEMI) and 41 cases with ST elevation myocardial infarction (STEMI).According to chest pain-to-visit time, ACS patients were divided into <3h group (n=112) and 3~6h group (n=63);another 40 healthy subjects were selected simultaneously as healthy control group.Serum IMA and cTnI levels were compared among above groups and between patients suffering from major adverse cardiovascular events (MACE) within 30d or not in <3h group.Risk factors for MACE in <3h patients within 30d were screened.Results: Compared with healthy control group and UAP group, there were significant rise in serum levels of IMA[(16.78±4.25) μg/L, (35.16±8.32) μg/L vs.(49.76±9.29) μg/L, (52.07±11.34) μg/L], cTnI[(0.17±0.06) ng/ml, (0.15±0.06) ng/ml vs.(7.65±1.29) ng/ml, (8.83±1.40) ng/ml]in NSTEMI group and STEMI group, and IMA level in STEMI group was significantly higher than that of NSTEMI group, that of UAP group was significantly higher than that of healthy control group (P<0.05 or <0.01);serum IMA level of <3h group was significantly higher than those of 3~6h group and healthy control group, and cTnI level of <3h group was significantly lower than that of 3~6h group (P<0.01 all);serum levels of cTnI and IMA in patients suffering from MACE in <3h group were significantly higher than those of patients without MACE (P<0.01 both);multi-factor Logistic regression analysis indicated that elevated serum IMA level was an independent risk factor for MACE within 30d in ACS patients[OR=2.757,95%CI(2.084~4.705), P=0.001].Conclusion: The levels of cTnI and IMA significantly rise in ACS patients.IMA level possesses early diagnosis and recent prognosis evaluation value.