Using Response Surface Methodology (RSM), an optimizing model of concurrent parameter and tolerance design is proposed where response mean equals its target in the target being best. The optimizing function of the model is the sum of quality loss and tolerance cost subjecting to the variance confidence region of which six sigma capability can be assured. An example is illustrated in order to compare the differences between the developed model and the parameter design with minimum variance. The results show that the proposed method not only achieves robustness, but also greatly reduces cast. The objectives of high quality and low cost of product and process can be achieved simultaneously by the application of six sigma concurrent parameter and tolerance design.

Objective To investigate the influencing factors for late-preterm birth of twins. Methods We retrospectively analyzed the clinical data of 301 twins delivered in Beijing Haidian Maternity and Child Health Hospital between August 1, 2011 and August 31, 2013. Twins with late-preterm births were classified as the observation group(n=138) and those delivered at term were classified as the control group (n=163). Comparison between the two groups was conducted on both maternal and neonatal complications. Two independent sample Student's t test, Chi-square test and logistic regression analysis were performed for statistical analysis. Results (1) The ratio of two male fetuses, dichorionic diamniotic twins, and iatrogenic preterm birth were 41.3% (57/138), 76.1% (105/138) and 65.2% (90/138), respectively, in the observation group, while 23.9% (39/163), 89.6% (146/163) and 96.9% (158/163), respectively, in the control group (χ2=10.40, 9.81 and 53.59, respectively, all P<0.05). Mean birth weight of twins in the observation group was less than that in the control group [(2 450±349) vs (2 640±304) g, t=7.12, P<0.05]. Maternal age, gravidity, parity, history of abortion, mode of conception and 1 min Apgar score of the neonates between the two groups were not significantly different (all P>0.05). (2) The risk factors for late-preterm birth of twins included hypertension diseases complicated pregnancy, gestational diabetes mellitus, premature rupture of membranes, fetal distress, anemia and umbilical cord abnormality [OR=0.190(95%CI: 0.094-0.387), 1.980 (95%CI: 1.009-3.883), 0.030(95%CI: 0.007-0.131), 0.062(95%CI: 0.006-0.642), 0.470(95%CI:0.243-0.908) and 2.779(95%CI:1.093-20.736), respectively, all P<0.01 or 0.05]. (3) The incidences of hyperbilirubinemia, respiratory diseases, hypoglycemia, anemia, and neonatal infection were 27.9%(77/276), 4.4%(12/276), 4.7%(13/276), 4.4%(12/276) and 3.6%(10/276), respectively, in the observation group, which were all higher than those in the control group [9.5%(31/326), 0.6%(2/326), 1.2%(4/326), 0.6%(2/326) and 0.3%(1/326), respectively,χ2=34.33, 9.18, 6.61, 9.18 and 9.16, respectively, all P<0.05]. The incidence of small for gestational age in the observation group was lower than that in the control group [3.6%(10/276) vs 12.3%(40/326),χ2=3.86, P<0.05]. Other complications in the two groups (intracranial hemorrhage, acidosis, and hemolysis) were not significantly different (all P>0.05). Conclusions Late-premature births in twin pregnancies are related to many maternal and fetal risk factors. Therefore, clear understanding of these risk factors might improve the pregnancy outcomes.

Objective To investigate the effectiveness of intensive sit-to-stand training in improving the balance and walking of hemiplegic stroke patients. Methods Sixty hemiplegic stroke patients were randomly divided into an observation group and a control group with 30 cases in each.Both groups were treated with routine rehabilitation.The observation group also underwent extensive sit-to-stand training.The training lasted for 15 min/time,6 times/week for 4 weeks.All of the patients were assessed with respect to their body weight distribution,Berg balance scale (BBS) scores,timed up & go test (TUGT) times and using footprint gait analysis,before the treatment and 4 weeks post treatment. Results After 4 weeks of treatment body weight distribution,BBS scores,TUGT times and gait improved significantly in both groups.The BBS,TUGT and gait improvements were significantly greater in the observation than in the control group.There was no significant difference between the two groups in terms of body weight distribution. Conclusions Extensive sit-to-stand training combined with routine rehabilitation can distinctly improve the balance and walking of hemiplegic stroke survivors.

Objective To investigate the biological effect of GM-CSF on splenic dentritic cells (DCs)when used to treat severe sepsis and the influence on the prognosis.Methods All 160 male Kunming mice were randomly(random number)divided into four groups:control group(n =50),the mice didnt receive special treatment; CLP group(n =42),the mice underwent cecal ligation and puncture;conventional treatment group(n =34),the mice received intraperitoneal injection of 5 mg/kg ceftriaxone at 12,24,36,48,60,72 and 84 h after surgery; GM-CSF treatment group(n =34),the mice received hypodermic injection of 20 μg/kg GM-CSF besides ceftriaxone at 12,36,60,and 84 h after surgery.The mice were sacrificed at 0,12,24,48 and 72 h after CLP by cervical dislocation.The amount of splenic DCs and apoptosis rate were measured by flow cytometry,and the serum concentrations of IL-12 were detected by ELISA in each group.Meanwhile the survival prognosis was observed at 96 h.Results At every time point,the apoptosis of splenic DCs increased and the amount markedly reduced in severe sepsis(P ＜0.05),the serum concentration of IL-12 increased on an one-way curve type(P ＜0.05).The treatment of cephalosporin exacerbated the loss of DCs(P ＜ 0.05),while hadnt any effect on IL-12(P ＞ 0.05).GMCSF treatment increased the amount of DCs(P ＜ 0.05),and decreased IL-12 concentrations(P ＜ 0.05).The OR of GM-CSF was 0.079 computed by Logist regression analysis.Conclusions GM-CSF treatment severe sepsis can increase the amount of splenic DCs,decrease serum levels of IL-12,and improve prognosis.

Fecal microbiota transplantation (FMT) has become a key treatment for Clostridium difficile infection (CDI).The Chinese fecal microbiota bank rescue plan is a non-profit central platform for the treatment of refractory CDI using FMT.This article reviewed and analyzed the principle,protocol and risk management of the Chinese fecal microbiota bank rescue plan.

Objective To systematically assess the values of B-ultrasound(US),computed tomography(CT),magnetic resonance cholangiopancreatography(MRCP)and endoscopic retrograde cholangiopancreatography(ERCP)in diagnosing cholangiocarcinoma(CCA).Methods All published literatures on bile duct cancer were collected from the literature databases of PubMed,Medline,Embase,CNKI and Wanfang.Then the patients with bile duct cancer suspected by US,CT,MRCP and ERCP were performed the systematic review.The evaluation indicators included sensitivity and specificity.The summary receiver operating characteristic(SROC)curve was adopted to obtain the area under the curve(AUC)and Q values.The diagnostic values of 4 kinds of method were analyzed.Results Forty-four articles were included,involving 4 364 patients.The pooled sensitivities of US,CT and MRCP were 0.75,0.82 and 0.85 respectively,the specificities were 0.72,0.80 and 0.87 respectively(sensitivity and specificity of ERCP cytology and image were 0.62,0.98;0.88,0.84),the Q values were 0.690 8,0.787 8 and 0.841 7(0.846 1,0.833 2 in ERCP cytology and image).Conclusion The accuracy of CT,MRCP and ERCP for diagnosing bile duct cancer is similar and higher than that of US,which is an effective assisted examination method when compared with US.The pooled specificity of ERCP cytology is obviously higher than that of other examination method and has high clinical diagnostic value in the patients with highly suspected bile duct malignant tumor.

Objective To determine the minimum alveolar concentration(MAC)of sevoflurane for blunting the responses to removal of the laryngeal mask airway(LMA)in 50%anesthetized children.Methods Twenty-five ASA Ⅰ or Ⅱ children aged 3-8 yr undergoing elective surgery under general anesthesia weTe enrolled in this stuay.Anesthesia was induced with inhalation of 8%Sevoflurane.LMA was inserted when the children lost eyelash reflex and the lower jaw was relaxed.Anesthesia was maintained with 3%sevoflurane.All the children kept spontaneous breathing during operation.Assisted ventilation waw performed when necessary to maintain PET CO2 at 35-45 mm Hg.After the surgery the target end-tidal sevoflurane concentration was maintained for 10 min before LMA was removed.Up-and-down sequential allocation was used to determine山e MAC.The initial end-tidal concentration was 1%and was increased/decreased by 20%in the next patient if the extubation response was positive or negative.Limb movement,breath-holding,laryngosposm and hypoxemia(SpO2<95%)were considered to be the signs of positive response.The midpoint from positive response to negative response was made the balance point.and the mean value ofthe concentrations of sevoflurane at all the balance points were calculated as MAC.Results The end-tidal sevoflurane concentration for blunting the responses to removal of LMA was 0.98%.Conclusion The MAC of sevoflilrane for blunting the responses to removal of LMA in 50%anesthetized children(aged 3-8 yr)is 0.98%.

Objective To explore the effect of Jin's three-needle therapy, as an assistant treatment, in improving the intelligence of children with mental retardation (MR).Method Seventy-six MR patients were divided into a control group and an observationgroup, 38 cases in each group.The control group was treated with rehabilitation, while the observation group with JIN's three needle therapy plus the rehabilitation training.Prof. JIN Rui's 10-item observation index was adopted to evaluate the memory ofthe patients before and after the treatment; Gesell Developmental Schedule (GDS) was used to measure the intelligence before and after the treatment. The clinical efficacies in the two groups were statistically analyzed.Result After the treatment, Prof.JIN Rui's 10-item index scores dropped obviously and the GDS scores increased significantly in both groups, while the decrease and increase of scores in the observation group were more significant than those in the control group (P<0.05). The total effective rate was 94.7% in the observation group, significantly higher than 71.1% in the control group (P<0.05).Conclusion As an assistant treatment, JIN's three-needle therapy can help rehabilitation training to improve the intelligence of MR patients.

Background FIZZ1 is a newly found protein associated with pulmonary inflammation. It has been shown to involve in proliferation of pulmonary arterial vascular smooth cells, contriction of vascular vessels, and stimulation of fibroblasts. Objective This study was designed to investigate the expression of FIZZ1 in atherosclerotic plaque of C57BL/6J ApoE-/-mice and the role of FIZZ1 on the proliferation of vascular smooth muscle cells obtained from aorta. Methods Nine C57BL/6J ApoE-/-mice were fed with high fat diet and nine C57BL/6J wild type mice with normal chow for 24 weeks. All mice were euthanized and the aortas were collected. HE stain histological examination and FIZZ1 immunohistochemistry were used in vivo study. In vitro, smooth muscle cells were treated with normal saline (control groups) or recombinate FIZZ1 at different concentrations (final concentration 3?10-6, 9?10-6, 2.7?10-5 mmol/L) respectively. The proliferation of smooth muscle cells were detected by MTT. Results After 24 weeks of high fat diet treatment, large atherosclerotic plaques were found in aortic root of ApoE-/-mice. FIZZ1 was found in atherosclerotic plaques of C57BL/6J ApoE-/-mice, however, no FIZZ1 was expressed in the arteries of C57BL/6J wild type mice. Cell culture study showed FIZZ1 promoted the proliferation of smooth muscle cells in a dose dependent manner(P

Background Found in Inflammatory Zone 1(FIZZ1)is a newly found protein associated with pulmonary inflammation.We previously had reported its role in the development of atherosclerosis,but its detailed mechanism has not been explored.Objective This study was designed to delineate the effect of FIZZ1 on the expression of scavenger receptor(SR-A)in vascular smooth muscle cells(VSMC)scavenger receptor(SR-A)induced by ox-LDL.Methods Smooth muscle cells were treated with ox-LDL(20 mg/L)or cocultured with recombinate FIZZ1 at different concentration(final concentration 3?10-6,9?10-6,2.7?10-5 mmol/L).The expression of SR-A of smooth muscle cell was detected by flow cytometry and laser confocal microscopy.Results SR-A positive expression was found in VSMCs treated with ox-LDL after 24 hours,which were located mainly in cell membrane by laser confocal microscopy.FIZZ1 significantly accentuate the LDL induced increases in SR-A positive rate in VSMC in a dose dependent manner(P