The Effect of Comprehensive Use of PDCA and FMEA Management Tools on the Work Efficiency, Teamwork, and Self-Identity of Medical Staff: A Cohort Study with Zhongda Hospital in China as an Example.

Objective: Taking Zhongda Hospital in China as an example, this study discusses the impact of comprehensive use of PDCA and FMEA management tools on the work efficiency, teamwork, and self-identity of medical staff. Methods: Two hundred medical staff in our hospital from January 2020 to December 2021 were selected as the research subjects, and the 200 medical staff were divided into a control group and a research group by the digital table method, with 100 cases in each group. The medical staff in the control group implemented conventional system management methods, while the research group comprehensively used PDCA and FMEA management tools based on implementing conventional system management. The differences in work efficiency, teamwork, and self-identity of medical staff were compared. Results: Before the study, there exhibited no significant difference in the work efficiency, teamwork, and self-identity scores of medical staff (P > 0.05). After an intervention, the work efficiency, teamwork, and self-identity scores of medical staff in the study group were higher than those in the control group (P < 0.05). After the intervention, the management quality score of the research group was higher than that of the control group (P < 0.05); after the intervention, the medical staff in the research group had lower work efficiency, insufficient professional ability, and insufficient management system cognitive behaviours than that in the control group (P < 0.05). Conclusion: The comprehensive use of PDCA and FMEA management tools in internal hospital management can remarkably enhance the work efficiency, teamwork, and self-identity of medical staff.

Diagnostic Accuracy of Prenatal Fetal Ultrasound to Detect Cleft Palate in High-Risk Fetuses: A Systematic Review and Meta-Analysis.

OBJECTIVES: This systematic review and meta-analysis investigated the accuracy of prenatal fetal ultrasound (US) to detect cleft palate during the second and third trimester (12-36 weeks) of pregnancy in high-risk fetuses. METHODS: Pubmed and Embase databases were searched for studies that performed prenatal fetal US (comparator) and postnatal examination (reference standard) in fetuses at high risk for orofacial clefts. Risk of bias among included studies was assessed using the QUADAS-2. Area under the summary receiver operating characteristic (SROC) curve and pooled sensitivity and specificity were calculated. RESULTS: This meta-analysis included 7 studies involving 663 high-risk fetuses. The individual studies showed that prenatal fetal US accurately predicted the possibility of cleft palate in these fetuses. Pooled sensitivity was 87% (95% CI 71%-95%), pooled specificity was 98% (95%CI 90%-100%), and the area under the SROC curve was 0.98 (95% CI 0.97-0.99). CONCLUSION: Second and third trimester fetal US has excellent sensitivity and specificity for the detection of cleft palate in high-risk pregnancies.

Exosomes Derived from M2 Macrophages Exert a Therapeutic Effect via Inhibition of the PI3K/AKT/mTOR Pathway in Rats with Knee Osteoarthritic.

Macrophages are commonly classified as M1 macrophages or M2 macrophages. M2 macrophages are obtained by stimulation of IL-4 with anti-inflammatory and tissue repair effects. Exosomes are 30-150 nm lipid bilayer membrane vesicles derived from most living cells and have a variety of biological functions. Previous studies have shown that macrophage exosomes can influence the course of some autoimmune diseases, but their effect on knee osteoarthritis (KOA) has not been reported. Here, we analyze the roles of exosomes derived from M2 macrophage phenotypes in KOA rats. Exosomes were isolated from the supernatant of M2 macrophages and identified via transmission electron microscopy (TEM), Western blotting, and DLS. The results showed that M2 macrophage exosomes significantly attenuated the inflammatory response and pathological damage of articular cartilage in KOA rats. In addition, a key protein associated with KOA including Aggrecan, Col-10, SOX6, and Runx2 was significantly increased, while MMP-13 was significantly suppressed following treatment with M2 macrophage exosomes. The present study indicated that M2 macrophage exosomes exerted protective effects on KOA rats mainly mediated by the PI3K/AKT/mTOR signal pathway. These findings provide a novel approach for the treatment of KOA.

The Elk1/MMP-9 axis regulates E-cadherin and occludin in ventilator-induced lung injury.

BACKGROUND: Ventilator-induced lung injury (VILI) is a common complication in the treatment of respiratory diseases with high morbidity and mortality. ETS-domain containing protein (Elk1) and Matrix metalloproteinase (MMP) 9 are involved in VILI, but the roles have not been fully elucidated. This study examined the mechanisms of the activation of MMP-9 and Elk1 regulating barrier function in VILI in vitro and in vivo. METHODS: For the in vitro study, Mouse lung epithelial cells (MLE-12) were pre-treated with Elk1 siRNA or MMP-9 siRNA for 48 h prior to cyclic stretch at 20% for 4 h. For the in vivo study, C57BL/6 mice were pre-treated with Elk1 siRNA or MMP-9 siRNA for 72 h prior to 4 h of mechanical ventilation. The expressions of Elk1, MMP-9, Tissue inhibitor of metalloproteinase 1 (TIMP-1), E-cadherin, and occludin were measured by Western blotting. The intracellular distribution of E-cadherin and occludin was shown by immunofluorescence. The degree of pulmonary edema and lung injury were evaluated by Hematoxylin-eosin (HE) staining, lung injury scores, Wet/Dry (W/D) weight ratio, total cell counts, and Evans blue dye. RESULTS: 20% cyclic stretch and high tidal volume increases the expressions of Elk1, MMP-9, and TIMP-1, increases the ratio of MMP-9/TIMP-1, decreases the E-cadherin and occludin level. Elk1 siRNA or MMP-9 siRNA reverses the degradations of E-cadherin, occludin, and the ratio of MMP-9/TIMP-1 caused by cyclic stretch. Elk1 siRNA decreases the MMP-9 level with or not 20% cyclic stretch and high tidal volume. CONCLUSIONS: The results demonstrate mechanical stretch damages the tight junctions and aggravates the permeability in VILI, Elk1 plays an important role in affecting the tight junctions and permeability by regulating the balance of MMP-9 and TIMP-1, thus indicating the therapeutic potential of Elk1 to treat VILI.

Agronomic performance of polyethylene and biodegradable plastic film mulches in a maize cropping system in a humid continental climate.

Plastic polyethylene mulch has been widely used in crop production, but also causes environmental pollution if plastic residues accumulate in soil. Biodegradable plastic mulches (BDM) are a potential solution to problems caused by polyethylene mulches, as BDMs are designed be tilled into the soil after the growing season and then biodegrade. However, the agronomic performance of BDMs still needs to be tested for comparison to polyethylene mulch. We carried out a two-year field experiment in 2018 and 2019 in a typical humid continental climate in Northeast China. Maize was planted in a ridge-furrow pattern, with mulching treatments consisting of no mulch (control), clear BDM, black BDM, clear polyethylene, and black polyethylene. Clear mulches increased soil temperature when compared to no mulch control treatments, while black mulches decreased or did not change soil temperature during the early growing season. Soil temperature and root morphology were similar between BDM and polyethylene mulches for a given type of plastic color. Maize yield did not differ across all the treatments. Maize protein, fat, N and P contents were generally higher for black BDM than other treatments, suggesting that maize quality benefited especially from black BDM. Overall, these results show that, in a humid continental climate, the agronomic performance of clear and black BDMs was equivalent to, or better than, that of polyethylene plastic mulches for maize production.

Validated MAGIC and GWAS population mapping reveals the link between vitamin E content and natural variation in chorismate metabolism in tomato.

Tocochromanols constitute the different forms of vitamin E (VTE), essential components of the human diet, and display a high membrane protectant activity. By combining interval mapping and genome-wide association studies (GWAS), we unveiled the genetic determinants of tocochromanol accumulation in tomato (Solanum lycopersicum) fruits. To enhance the nutritional value of this highly consumed vegetable, we dissected the natural intraspecific variability of tocochromanols in tomato fruits and genetically engineered their biosynthetic pathway. These analyses allowed the identification of a total of 25 quantitative trait loci interspersed across the genome pinpointing the chorismate-tyrosine pathway as a regulatory hub controlling the supply of the aromatic head group for tocochromanol biosynthesis. To validate the link between the chorismate-tyrosine pathway and VTE, we engineered tomato plants to bypass the pathway at the arogenate branch point. Transgenic tomatoes showed moderate increments in tocopherols (up to approximately 20%) and a massive accumulation of tocotrienols (up to approximately 3400%). Gene expression analyses of these plants reveal a trade-off between VTE and natural variation in chorismate metabolism explained by transcriptional reprogramming of specific structural genes of the pathway. By restoring the accumulation of alpha-tocotrienols (α-t3) in fruits, the plants produced here are of high pharmacological and nutritional interest.

Author Correction: A new coronavirus associated with human respiratory disease in China.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Investigation of a New Catheter on Relieving Pain During Male Cystoscopy - A Randomized Clinical Trial.

PURPOSE: To investigate the pain intensity and tolerability of a new catheter applied to urethral surface anesthesia during rigid cystoscopy in male patients, and explore the prospects of its application and the anesthetic method in hospitals at primary levels. MATERIALS AND METHODS: 252 adult male patients were randomly divided into the experimental group and the control group.1% lidocaine solution was irrigated into the posterior urethra of the experimental group using the new catheter before cystoscopy, while the control group was administered with lidocaine gel. Both groups were assessed by visual analogue scale(VAS) with their pain perceived during administration of lidocaine (control group) /during insertion of catheter and administration of lidocaine (experimental group) (T1),during the insertion of cystoscope (T2),at the beginning of cystoscopy (T3),The third minute of cystoscopy (T4), during the first urination after the procedure (T5), as well with the maximum pain(Pmax) perceived during the whole procedure. The fluctuations of blood pressure and heart rate in each group before, after and during the procedure were recorded, and the anesthesia costs in both groups were calculated. RESULTS: Except a slightly higher score in T1, the scores of VAS in experimental group were lower than those of control group in T2,T3 and T4. The Pmax of the control group was 4.92(SD=1.20), which was higher than in the experimental group of 3.89(SD=0.95,P<0.01).There was no significant difference on blood pressure variation in both groups. While heart rate variation in experimental group was lower than that in control group (16.3%,SD=3.4 vs. 22.6%,SD=5.0, P<0.01).No obvious complications were found in both groups. The anesthesia cost of the experimental group is about 1.53 dollars, with 1.75 dollars lower than that of the control group. CONCLUSION: It is tolerable and beneficial to apply the new catheter for male urethral anesthesia. It can significantly relieve the pain during rigid cystoscopy in male patients, and is low in cost and easy in operation. Thus this method is worth being recommended to hospitals, especially at community hospitals or primary hospitals.

Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease.

BACKGROUND: Since early December 2019, the 2019 novel coronavirus disease (COVID-19) has caused pneumonia epidemic in Wuhan, Hubei province of China. This study aimed to investigate the factors affecting the progression of pneumonia in COVID-19 patients. Associated results will be used to evaluate the prognosis and to find the optimal treatment regimens for COVID-19 pneumonia. METHODS: Patients tested positive for the COVID-19 based on nucleic acid detection were included in this study. Patients were admitted to 3 tertiary hospitals in Wuhan between December 30, 2019, and January 15, 2020. Individual data, laboratory indices, imaging characteristics, and clinical data were collected, and statistical analysis was performed. Based on clinical typing results, the patients were divided into a progression group or an improvement/stabilization group. Continuous variables were analyzed using independent samples t-test or Mann-Whitney U test. Categorical variables were analyzed using Chi-squared test or Fisher's exact test. Logistic regression analysis was performed to explore the risk factors for disease progression. RESULTS: Seventy-eight patients with COVID-19-induced pneumonia met the inclusion criteria and were included in this study. Efficacy evaluation at 2 weeks after hospitalization indicated that 11 patients (14.1%) had deteriorated, and 67 patients (85.9%) had improved/stabilized. The patients in the progression group were significantly older than those in the disease improvement/stabilization group (66 [51, 70] vs. 37 [32, 41] years, U = 4.932, P = 0.001). The progression group had a significantly higher proportion of patients with a history of smoking than the improvement/stabilization group (27.3% vs. 3.0%, χ = 9.291, P = 0.018). For all the 78 patients, fever was the most common initial symptom, and the maximum body temperature at admission was significantly higher in the progression group than in the improvement/stabilization group (38.2 [37.8, 38.6] vs. 37.5 [37.0, 38.4]°C, U = 2.057, P = 0.027). Moreover, the proportion of patients with respiratory failure (54.5% vs. 20.9%, χ = 5.611, P = 0.028) and respiratory rate (34 [18, 48] vs. 24 [16, 60] breaths/min, U = 4.030, P = 0.004) were significantly higher in the progression group than in the improvement/stabilization group. C-reactive protein was significantly elevated in the progression group compared to the improvement/stabilization group (38.9 [14.3, 64.8] vs. 10.6 [1.9, 33.1] mg/L, U = 1.315, P = 0.024). Albumin was significantly lower in the progression group than in the improvement/stabilization group (36.62 ±â€Š6.60 vs. 41.27 ±â€Š4.55 g/L, U = 2.843, P = 0.006). Patients in the progression group were more likely to receive high-level respiratory support than in the improvement/stabilization group (χ = 16.01, P = 0.001). Multivariate logistic analysis indicated that age (odds ratio [OR], 8.546; 95% confidence interval [CI]: 1.628-44.864; P = 0.011), history of smoking (OR, 14.285; 95% CI: 1.577-25.000; P = 0.018), maximum body temperature at admission (OR, 8.999; 95% CI: 1.036-78.147, P = 0.046), respiratory failure (OR, 8.772, 95% CI: 1.942-40.000; P = 0.016), albumin (OR, 7.353, 95% CI: 1.098-50.000; P = 0.003), and C-reactive protein (OR, 10.530; 95% CI: 1.224-34.701, P = 0.028) were risk factors for disease progression. CONCLUSIONS: Several factors that led to the progression of COVID-19 pneumonia were identified, including age, history of smoking, maximum body temperature at admission, respiratory failure, albumin, and C-reactive protein. These results can be used to further enhance the ability of management of COVID-19 pneumonia.

A new coronavirus associated with human respiratory disease in China.

Emerging infectious diseases, such as severe acute respiratory syndrome (SARS) and Zika virus disease, present a major threat to public health1-3. Despite intense research efforts, how, when and where new diseases appear are still a source of considerable uncertainty. A severe respiratory disease was recently reported in Wuhan, Hubei province, China. As of 25 January 2020, at least 1,975 cases had been reported since the first patient was hospitalized on 12 December 2019. Epidemiological investigations have suggested that the outbreak was associated with a seafood market in Wuhan. Here we study a single patient who was a worker at the market and who was admitted to the Central Hospital of Wuhan on 26 December 2019 while experiencing a severe respiratory syndrome that included fever, dizziness and a cough. Metagenomic RNA sequencing4 of a sample of bronchoalveolar lavage fluid from the patient identified a new RNA virus strain from the family Coronaviridae, which is designated here 'WH-Human 1' coronavirus (and has also been referred to as '2019-nCoV'). Phylogenetic analysis of the complete viral genome (29,903 nucleotides) revealed that the virus was most closely related (89.1% nucleotide similarity) to a group of SARS-like coronaviruses (genus Betacoronavirus, subgenus Sarbecovirus) that had previously been found in bats in China5. This outbreak highlights the ongoing ability of viral spill-over from animals to cause severe disease in humans.

Job Satisfaction Among Doctors from Jiangsu Province in China.

BACKGROUND Doctors' job satisfaction has an important effect on medical and health services. This study assessed the level of job satisfaction in Chinese doctors and explored how influencing factors differ between general practitioners and specialists. MATERIAL AND METHODS The Minnesota Satisfaction Questionnaire (MSQ) on job satisfaction was distributed to 1883 doctors in Jiangsu province, including 850 general practitioners and 1033 specialists. Data analysis was performed with SPSS 20.0. A one-way ANOVA was used to analyze doctors' job satisfaction and logistic regression analysis was used for multivariate analysis. Correlation analysis was done on the 5 dimensions of satisfaction. RESULTS The average MSQ score of all surveyed doctors was 3.11±0.87, with general practitioners (GPs) and specialists scores of 2.81±0.84 and 3.35±0.82, respectively. Analysis of doctor satisfaction indicated that gender, age, marital status, educational attainment, professional title, and seniority were statistically significant (P<0.05). Overall satisfaction was most closely related to the job itself (r=0.96); work, work environment, and interpersonal relationship were closely related with lead management. CONCLUSIONS The level of job satisfaction of Chinese doctors, especially general practitioners, needs to be improved. Measures such as improving education levels, work environment, and relationships should to be taken soon to improve doctors' job satisfaction in China.

Different morphologic formation patterns of dark patches in the black-spotted frog (Pelophylax nigromaculata) and the Asiatic toad (Bufo gargarizans).

The black-spotted frog (Pelophylax nigromaculata) and Asiatic toad (Bufo gargarizans), two relatively distantly related species, live in different habitats with different adaptive dark patches. To explain the formation of dark patches, the distribution patterns of melanin granules were examined with light microscopy and transmission electron microscopy. Melanin granules were produced and gathered into the "cap" structures on top of the nuclei in most epidermal cells. The "cap" structures may play a role in forming the dorsal dark patches coupled with three-layer melanophores, which can give rise to three layers of interconnected melanin networks in the dorsal dermis in P. nigromaculata. Epidermal melanocytes are rare and do not have a definitive role in forming dorsal dark patches in either P. nigromaculata or B. gargarizans. In B. gargarizans, the dermal melanophores only give rise to a single-layered melanin network, which hardly results in dark patches in the dorsal skin. However, the dermal melanophores migrate twice and form into pseudostratified networks, leading to dark patch formation in the ventral skin in B. gargarizans. The melanin granules precisely coregulate dark patches in the dermis and/or epidermis in P. nigromaculata and B. gargarizans. The dark patch formation depends on melanin granules in the epidermis or/and dermis in P. nigromaculata and B. gargarizans.

[Coumarins from root of Zanthoxylum dimorphophyllum var. spinifolium].

OBJECTIVE: To study the chemical components from dried roots of Zanthoxylum dimorphophyllum var. spinifoliun. METHOD: The chemical components were isolated by low pressure column chromatography and their structures were identified by spectroscopic methods. RESULT: Five compounds were isolated and identified as 6-(2', 3'-dihydroxy-3'-methyl-butyl)-7-hydroxy-5-methoxy-2H-1-benzopyran-2-one (I), 6-(2',3'-dihydroxy-3'-methyl-butyl)-7-methoxy-8-(3'-methyl-but-2'-enyl)-2H-1-benzopyran-2-one (II),6-(2',3'-dihydroxy-3'-methyl-butyl)-7-hydroxy-2H-1-benzopyran-2-one (III), 6-(2', 3'-oxiranyl-3'-methyl-butyl)-7-methoxy-8- (3-methyl-but-2-enyl)-2H-1-benzopyran-2-one (IV), 7-methoxy-8-(3'-methyl-but-2'-enyl)-2H-1-benzopyran-2-one (V). CONCLUSION: These compounds were isolated from the plant for the first time.

Beijing health promoting universities: practice and evaluation.

The aims of this study were to create a health promoting university within the framework of the Ottawa Charter for Health Promotion. Strategies included reforming and issuing healthy policies, creating a healthy physical and social environment, developing personal health skills, reorienting the health services, and implementing intervention activities. To evaluate the study, 180 students and 120 teaching/administrative staff were sampled for an in-depth interview with open-ended questions administered 1 year after the launch of the project. To assess health knowledge and behavior, 2500 students were sampled to answer a questionnaire, both prior to and following project implementation. With respect to policies, environment and health services, 166 students and 117 teaching and administrative staff participated in the in-depth interview. Approximately three-quarters (75.90%) of university students considered that the physical environment of the campus had improved significantly and 83.73% reported they had a good social environment. All university administration departments made commitments to health promotion. Consultations on mental health, smoking cessation and STD/AIDS prevention were provided all year round. Health education was included in a curriculum as a selective course with 1-2 credits. Almost two-thirds (60.66%) of teaching/administrative staff reported that they had had a yearly physical examination. In the final stages of the research, significantly more college students reported improved mental health (38.25% compared with 17.93% at baseline) (p < 0.01) and more were knowledgeable about transmission of STDs/AIDS (57.00/35.50% compared with 51.66/28.20% at baseline, respectively) (p < 0.01). Significantly less regular smokers were found (45% compared with 15.81% at baseline) (p < 0.01). However, there was a significant increase in high-fat food intake (44.81% compared with 49.50%) (p < 0.01) and pre-marital sex (5.11% compared with 14.00%), and a significant decrease in physical exercise participation (29.41% compared with 23.50%) (p < 0.01). As a health promotion setting, the university community can benefit greatly from implementing health promotion campaigns based on the principles of the Ottawa Charter.

[Studies on the coumarins in the root of Zanthoxylum dimorphophyllum].

OBJECTIVE: To study the chemical constituents of the dried roots of Zanthoxylum dimorphophyllumr. spinifolium and to find out the active constituents of the plant. METHOD: Modern chromatography was used to purify chemical constituents, and their structures were identified by various spectral methods. RESULT: Four compounds were isolated and identified as isopimpinellin (I), xanthoxyletin (II), 6-(2', 3'-dihydroxy-3'-methyl-butyl)-7-hydroxy-2H-1-benzopyran-2-one (III), 6-(2'-O-beta-D-glucopyranosyloxy, 3'-dihydroxy-3'-methybutyl)-7-hydroxy-2H-1-benzopyran-2-one (IV). CONCLUSION: All of the above compounds were isolated from the above mentioned plant for the first time.