In order to improve the efficiency and quality of medical services,the authors applied the lean production and system simulation into optimizing the transfusion system of a hospital.By means of describing and analyzing the current situation and problems of a transfusion system of the hospital,the paper presented the cause-effect diagram for overlong patient waiting.5W1H and ECRS were adopted to analyze the infusion processes,while Simio was used to simulate the existing infusion system and simulation data so obtained were used to draw a value stream mapping for the system.In line with the ideas of Shojinka and one stream production,nurses deployment and conveyor speed were reconfigured.Based on these ideas,a reform plan is presented and the simulation method is used to verify the outcomes.The study proved that lean production and system simulation can effectively improve the hospital transfusion system,medical efficiency and medical service level.

Objective To evaluate the distribution and drug resistance of bacteria causing neonatal infectious pneumonia in Jiaxing,and to provide a therapy for clinical doctor to make a correct diagnosis,choose reasonable anti-biotics and avoid abuse of antibiotics.Methods Took expectoration from trachea in condition of asepsis to conduct culture and perform drug-sensitive test from 3025 cases.Results Totally 1 156 strains of aerobic bacteria were iso-lated.875 strains were gram negative bacilli(75.7%),269 strains were gram positive cocci(23.3%),and 12 strains were fungi(1.0%).Klebsiella pneumoiae,Escherichia coil,Acinetobacter baumanni,Enterobacter cloacae were com-mon in gram negative bacilli( respectively 178 cases,151 cases,87 cases,113 cases) .The proportion of the Staphylo-coccus aureus was the largest in gram positive cocci(245 cases) .The results showed that gram-negative bacilli were resistant to cefazolin, ampicillin, piperacillin and sensitive to meropenem, imipenem, piperacillin-tazuobatanna and cefoperazone-sulbactam.The drug resistance was severe of ESBL-positive.Staphylococcus aureus was resistant to penicillin, ampicillin, erythrocin, clindamycin and sensitive to linezolid, vancomycin, nitrofurantoin.Conclusion Gram-negative bacilli are the main bacteria in neonatals with infectious pneumonia.The drug resistance is severe.It is important to make a standard management and isolation.

Objective To explore and observe the clinical characteristics and laboratory testing results of children with infectious mononuclear cells syndrome (IM),in order to improve diagnostic level.Methods 152 children with IM were selected,and the clinical manifestations,laboratory testing were retrospectively analyzed.Results There were a variety of clinical symptoms,the main clinical manifestations included fever 138 cases(90.8％),swollen lymph nodes 145 cases(95.4％),angina 112 cases (73.7％),hepatosplenomegaly 28 cases(18.4％),double eyelid edema 25 cases(16.4％),rash 7 cases(4.6％).Laboratory-testing of white blood cell count ＞ 10 × 109/L in 125 cases (82.2 ％),atypicallymphocyte proportion were more than or equal to 10％ in 48 cases (31.5 ％),liver function damage in 58 cases (38.2％),myocardial damage in 38 cases (25％),abnormal urine analysis in 30 cases (19.7％),thrombocytopenia 2 cases (3.4％).Conclusion Clinical symptoms of IM children are diversity,in some cases the clinical sympotoms are not typical,to improve the understanding of this disease can reduce the rates of missed diagnosis and misdiagnosis.

This paper retrospectively analyzed nursing care of 20 critically ill patients with human infections of avian influenza A(H7N9) virus treated by oxygen therapy.According to the severity of hypoxia in patients admitted to the hospital,individualized oxygen therapy strategy was selected,such as humidified high flow nasal cannula or mechanical ventilation.Oxygen therapy strategy was adjusted in a timely manner according to patients' condition,such as prone position ventilation and extracorporeal membrane oxygenation.As a resuh,15 cases were transferred to the general ward when the virus associated test was negative,and 5 cases died.

Objective To investigate the relationship between the ultrasonography diagnosis in prenatal and the postnatal placental vascular casts of the twins reversed arterial perfusion(TRAP) sequence. Methods Six cases of TRAP sequence underwent the two-dimensional and color Doppler ultrasonography, and performed placental vascular casts after termination of pregnance. Results According to the anatomical features and ultrasonography, there were 3 cases of acardius acephalus( IV) ,2 cases of acardius anceps( II ) , and 1 case of acardius acormus( I ). In all 6 cases,there were arterio-arterial and veno-venous anastomoses at the level of the chorionic plate between the normal co-twin and the acardiac twin,these anastmosis vessels were superficial and large calibre, and the distances of the placental insertions of the umbilical cords were different,4 cases <0. 5 cm, 2 cases were 4-5 cm. In 4 cases, the vessels entered and went out of the acardiac twin were just one large umbilical artery and one large umbilical vein. In 2 cases, the umbilical artery and umbilical vein had many vascular branches in the placenta. Out of 6 cases of the pump twin, 4 cases died,and 2 cases survived. Conclusions Ultrasonography was consistent with the placental vascular casts,the contrast observing gives us new information for the further research of the special type of the vascular anastmosis and prognosis of the TRAP sequence.

Objective To observe the electroencephalogram (EEG) activity of sleep disorders and mild cognitive impairment (MCI) patients with Parkinson's disease (PD).Methods Forty-nine PD patients,admitted to our hospital from December 2012 to June 2013,were examined by Parkinson's Disease Rating Scale,Hospital Anxiety and Depression Scale,Pittsburgh Sleep Quality Scale (PSQS) and Scale Montreal Cognitive Assessment (MoCA); electroencephalogram and their clinic features were analyzed.Results As compared with the normal sleep and non-MCI patients with PD (61.8％),sleep disorder and MCI patients with PD showed higher incidence of slow wave (65.6％).Logistic regression analysis showed that sleep quality was positively correlated to the incidence of slow wave (OR=4.117,P=0.042).PD patients with slow wave had higher PSQS scores and lower MoCA scores as compared with PD patients without slow wave.Conclusion PD patients with sleep disorder and MCI show high incidence of slow wave.

Objective: To evaluate the therapeutic effect and security of Buyang Huanwu decoction in treatment of the ischemic stroke recovery. Methods: We retrieved the relevant articles of random and semi- random control trials in treating ischemic stroke recovery using Buyang Huanwu decoction, published in China National Knowledge Infrastructure (CNKI), the Wanfang Data, the Weipu Information Resources System, the Chinese Biomedical Literature Database (CBM), Cochrane Library, PUBMED and MEDLINE from the date of establishment until to March 2018. The quality of studies was evaluated according to the Cochrane Reviewers?? handbook 5.1, and the study was carried out using Cochrane system assessment methods. Statistical analysis was performed with Rev Man 5.3. Results: Altogether 39 studies and 3539 cases of ischemic stroke recovery were enrolled. In terms of clinical efficacy, the difference between Buyang Huanwu Decoction and Western Medicine conventional therapy in the treatment of ischemic stroke was significantly different from that of conventional western medicine therapy [RR =1.26, 95％CI (1.20, 1.31), Z =10.05, P ＜ 0.00001], and the difference between Buyang Huanwu Decoction and other Chinese patent medicines was statistically significant [RR =1.12, 95％CI(1.06, 1.19), Z =3.82, P =0.0001]; neurological deficit NIHSS score [MD =-2.55, 95％CI (-3.10, -2.01), Z =9.20, P ＜ 0.00001]; clinical neurological deficit score (CSS) [MD =-3.85, 95％CI (-5.21, -2.50), Z =5.56, P ＜ 0.00001]; limb motor function score (FMA) [MD =6.10, 95％CI (1.19, 11.01), Z =2.43, P =0.01]; Barthel Index of Daily Living Activity Scale [MD =9.09, 95％CI (6.95, 11.23), Z =8.33, P ＜ 0.00001]; In terms of improving blood rheology index, serum peroxide lipid (LPO), serum superoxide dismutase (SOD) and other biochemical indicators, due to the small number of studies, it may have a certain effect. Most studies did not report adverse reactions. Conclusion: Based on the existing clinical evidence, combination of Buyang Huanwu decoction and western medicine has higher clinical efficacy than western medicine alone for the ischemic stroke recovery. Due to the limited methodological quality of the included studies, more high- quality RCTs with large scale are needed to increase the strength of the above evidence.

Objective To understand the awareness and willingness of primary medical staff in Songjiang District, Shanghai towards human papillomavirus (HPV) and its vaccines, and to provide references for improving the vaccination willingness of HPV vaccine and primary prevention of cervical cancer. Methods From July to August 2023, a questionnaire survey was conducted among the in-service medical staff in 17 community health service centers in Songjiang District, Shanghai, using the random sampling method. Descriptive analysis, χ² test and logistic regression were used for statistical analysis. Results A total of 951 valid questionnaires were collected during the survey. The awareness rate of HPV among medical staff was 92.74%, and the awareness rate of HPV vaccine was 93.38%. The maximum score for HPV knowledge was 6 points, with an average score of (3.99±1.34) points. The maximum score for HPV vaccine knowledge was 10 points, with an average score of (5.63±1.61) points. 881 (92.64%) medical staff were willing to receive or recommend HPV vaccination. Multivariate analysis showed that concerns about being infected with HPV (OR=2.648, 95% CI: 1.459-4.806), qualified score on HPV vaccine knowledge (OR=1.717, 95% CI: 1.012-2.912), high price burden of HPV vaccine (OR=0.343, 95% CI: 0.157-0.746), and concerns about side effects of vaccination (OR=0.443, 95% CI: 0.243-0.805) were the influencing factors for medical staff's willingness to vaccinate. Conclusion There is insufficient knowledge of HPV and its vaccines among primary medical personnel in Songjiang District, Shanghai. It is necessary to strengthen the continuing education of medical personnel through multiple channels, supplement the HPV-related knowledge system, and eliminate their concerns about vaccines.

Objective To understand the awareness and willingness of primary medical staff in Songjiang District, Shanghai towards human papillomavirus (HPV) and its vaccines, and to provide references for improving the vaccination willingness of HPV vaccine and primary prevention of cervical cancer. Methods From July to August 2023, a questionnaire survey was conducted among the in-service medical staff in 17 community health service centers in Songjiang District, Shanghai, using the random sampling method. Descriptive analysis, χ² test and logistic regression were used for statistical analysis. Results A total of 951 valid questionnaires were collected during the survey. The awareness rate of HPV among medical staff was 92.74%, and the awareness rate of HPV vaccine was 93.38%. The maximum score for HPV knowledge was 6 points, with an average score of (3.99±1.34) points. The maximum score for HPV vaccine knowledge was 10 points, with an average score of (5.63±1.61) points. 881 (92.64%) medical staff were willing to receive or recommend HPV vaccination. Multivariate analysis showed that concerns about being infected with HPV (OR=2.648, 95% CI: 1.459-4.806), qualified score on HPV vaccine knowledge (OR=1.717, 95% CI: 1.012-2.912), high price burden of HPV vaccine (OR=0.343, 95% CI: 0.157-0.746), and concerns about side effects of vaccination (OR=0.443, 95% CI: 0.243-0.805) were the influencing factors for medical staff's willingness to vaccinate. Conclusion There is insufficient knowledge of HPV and its vaccines among primary medical personnel in Songjiang District, Shanghai. It is necessary to strengthen the continuing education of medical personnel through multiple channels, supplement the HPV-related knowledge system, and eliminate their concerns about vaccines.

Hepatocellular carcinoma (HCC) is a common malignant tumor with poor prognosis and high mortality. In this study, we demonstrated a novel vaccine targeting HCC and tumor neovascular endothelial cells by fusing recombinant MHCC97H cells expressing porcine α-1,3-galactose epitopes (αGal) and endorphin extracellular domains (END) with dendritic cells (DCs) from healthy volunteers. END⁺/Gal⁺-MHCC97H/DC fusion cells induced cytotoxic T lymphocytes (CTLs) and secretion of interferon-gamma (IFN-γ). CTLs targeted cells expressing αGal and END and tumor angiogenesis. The fused cell vaccine can effectively inhibit tumor growth and prolong the survival time of human hepatoma mice, indicating the high clinical potential of this new cell based vaccine.