Fire safety is crucial for the regular operation of large public hospitals.This paper elaborates on the funda-mental guidelines for fire safety management in large hospitals.Under the framework of collaborative governance theory,it also analyzes and points out that the standardization of peoples behavior in hospitals and the integrity of fire safety facilities are the pri-mary factors influencing the efficacy of fire safety management.Subsequently,based on management practices,it suggests focu-sing on"five synergies"in enforcing primary responsibility for fire safety,namely,the implementation of fire safety main respon-sibilities in synergy,the regular inspection and rectification of fire hazards in synergy,the training and evaluation of basic fire safety skills in synergy,the lifecycle management of fire safety facilities in synergy,and the building of a fire safety management team in synergy.This approach aims to maximize overall fire safety effectiveness and comprehensively enhance the level of fire safety management in hospitals.Finally,the paper discusses and calls for further enhancements in the management of fire safety in large public hospitals.

Objective To analyze the effects of Hual qi huang granules on children with mycoplasma pneumoniae pneumonia.Methods A randomized,multicenter parallel controlled clinical trial was carried out.A total of 3 000 cases of hospitalized children with mycoplasma pneumoniae pneumonia were selected.All of them were given treatment for mycoplasma pneumoniae pneumonia with macrolide antibiotics and symptomatic treatment.They were randomly divided into 2 groups:research group and control group.The children of research group were give oral Huai qi huang granules for three months.According to the classification of pneumonia,these two groups were divided into:lobar pneumonia research group,lobar pneumonia control group,lobular pneumonia research group,lobular pneumonia control group.The hospitalization duration of fever,length of hospital stay,the absorption area of lung inflammation and pneumonia severity sores were observed.The frequency of upper respiratory infections,bronchitis,pneumonia were observed in 3 months after discharge.Results 2 378 cases were investigated.The hospitalization duration of fever,length of hospital stay of research group were significantly shorter than that of in control group (P ＜ 0.001).The children with lobar pneumonia,2 weeks after treatment,the absorption of consolidation of the lobar pneumonia research group is significantly better than lobar pneumonia control group (P ＜0.001).After two weeks treatment,the pneumonia scores of lobar pneumonia research group is lower than lobar pneumonia control group (P ＜ 0.05).Followup of 3 months after hospital discharge,frequency of upper respiratory infection and bronchitis of research group,were significantly lower than that of control.In addition,appetite increased significantly in research group than control (P ＜ 0.001).There are 21 cases with drug associated adverse reactions (mild diarrhea),including 12 cases of research group,9 cases of control group,and there was no statistical significance (P ＞0.05).Conclusion Standard treatment combined with oral Huai qi huang granules in the treatment of mycoplasma pneumoniae pneumonia,can significantly shorten hospitalization duration of fever,length of hospital stay and reduce the severity score of pneumonia.Three months oral Huai qi huang granules can significant reduce the frequency of respiratory infections and bronchitis,also can increase patients appetite,and be safe.

Objectives Toexplorethe effect of the Balint group on improving the empathy and doctorpatient communication skills among medical students in clinical practice.Methods We investigated 500 clinicalmedicalstudentsin fourth grade by JSE-HP and SEGUE framework scalein Shanghai Jiao Tong university school of medicine between July 2016 and December 2016.60 students with insufficientempathy and doctor-patient communication skills were selected randomly.These students were thanrandomly divided into the Balint group (experimental group) and the routine clinical practice group(control group).The experimental group participated inthe Balint group activitiesin addition to routine clinical practice,whilethe control group only participated in routine clinical practice.After 20 weeks of the Balintgroup intervention,the two groups were invited to assess theempathy and doctor-patient communication skills again to analyze the effect of the Balintgroup on improving the empathy and doctor-patient communication ability among intern students.The evaluation result was analyzed by SPSS 22.0 software.Data comparison was conducted using pair t test,independent sample t test and x2 testing.Results There were no statistically significant differences in age,sex,whether only child or class leader and previous year theoretical exam scoresbetween the two groups (all P＞0.05).For empathy,there was no statistically significant difference in terms of opinion,emotional care,empathy,and total scorebefore the routine clinical practicebetween the two groups (P＞0.05) and they all improvedsignificantly after the routine clinical practice (all P＜0.05).But the experimental group had higher scoresin all above scalesthan the control group (all P＜0.05).For communication skills with patients,there were no statistically significant differencesbetween the two groupsin communication initiation,information collection,understanding of patients,information giving,end questioning,and SEGUE scoresbefore the routine clinical practice (all P＞0.05),and they allimprovedsignificantly in all above 5 scales after the routine clinical practice (all P＜0.05).While except for understanding of patients,the experimental group had higher gains in other scales than the control group (all P＜0.05).Conclusion Use of the Barring group activities on the basis of routine clinical practice canimprove the empathy andthedoctor-patientcommunication skills in medical students.

Objective In order to raise the clinicians' recognition of biliary pancreatitis in children,the clinical features between children with biliary pancreatitis and those with non-biliary pancreatitis were compared.Methods In this retrospective study,a total of 88 children with acute pancreatitis(AP)were enrolled,who stayed at the Department of Pediatrics,Tianjin Nankai Hospital from January 2010 to December 2015.The clinical characteristics,biochemical index(amylase,lipase,glucose,calcium,hepatic and renal function)and imageology examination [pancreatic ultrasound,pancreatic computed tomography,magnetic resonance cholangiopancreatography(MRCP)] were analyzed and evaluated.The etiology of biliary pancreatitis was analyzed.In addition,the clinical features,laboratory examinations and imageology between the children with biliary pancreatitis and those with non-biliary pancreatitis were also compared.Then,multiple Logistic regression analysis was conducted to identify the factors which were significantly associated with biliary pancreatitis independently.Results Of the 88 cases,there were 68 cases of non-biliary pancreatitis,aged(9.5±4.2)years,and 20 cases of biliary pancreatitis,aged(6.7±4.5)years,who represented the plurality(22.7％),including 9 cases of anatomic abnormalities and 11 cases of choledocholithiasis,cholecystolithiasis and cholestasis.Compared with children of non-biliary pancreatitis,children with biliary pancreatitis had more severe condition,there was statistically significance between 2 groups(x2=23.313,P=0.000).However,there was no statistically significance between 2 groups related to the gender,course of disease,hospitalization time,body mass index(BMI)percentile and clinical symptoms(all P>0.05).Children with biliary pancreatitis showed higher levels of serum amylase,serum lipase and urine amylase than those with non-biliary pancreatitis,and there were statistically significances between 2 groups(Z=-3.535,-3.980,-2.952,P=0.000,0.000,0.003).In addition,children with biliary pancreatitis had higher levels of alanin aminotransferase(ALT),aspartate aminotransferase(AST)than those with non-biliary pancreatitis,and there were statistically significances between 2 groups(Z=-5.625,-2.341,P=0.000,0.019).However,total bilirubin did not differ significantly between 2 groups(Z=-0.453,P=0.650).There was no statistically significance between 2 groups in relation to white blood cell count,C-reactive protein(CRP),lactate dehydrogenase(LDH),blood urea nitrogen(BUN),creatinine(Cr),calcium and glucose(all P>0.05).Of the 88 cases,all children with AP were fasting,fluid and electrolyte supplementation,acid suppression of omeprazole,and octreotide by conservative treatment,which was an inhibitor of exocrine pancreatic secretion.In addition,children with AP should be given intravenous antibiotics covering gram-negative bacteria in the early stage.Children with non-biliary pancreatitis had better prognosis than those with biliary pancreatitis,and there was a statistical significance between 2 groups(P=0.000).Children with non-biliary pancreatitis had lower recurrence risk than those with biliary pancreatitis,and there was a statistical significance between 2 groups(x2=4.778,P=0.044).The positive rate was higher by abdominal ultrasound(45.0％)and computed tomography(CT)(81.2％)in biliary pancreatitis group than those with non-biliary pan-creatitis group(17.9％,35.2％),and there were statistical significances between 2 groups(x2=4.782,10.554,P=0.029,0.002).However,there was no statistical significance in relation to MRCP between the biliary pancreatitis group(83.3％)and the non-biliary pancreatitis group(85.7％)(P=1.000).In multiple Logistic regression analysis,ALT was an independent predictor of biliary pancreatitis(OR=0.896,P=0.001).Conclusions ALT is the significant risk factor for predicting biliary pancreatitis over other etiology.A biliary cause should be suspected in children with AP who are presented with high levels of ALT.These findings will spur prospective studies to determine the optimal evaluation and management of children with biliary pancreatitis.

Objective To explore the clinical characteristics and the levels of interleukin-17 (IL-17) in Mycoplasma pneumoniae (MP) pneumonia patients with atopic sensitization.Methods One hundred and sixty-two patients with MP pneumonia were hospitalized at the Department of Pediatrics,Tianjin Nankai Hospital from October 2015 to December 2016.All children with MP pneumonia were evaluated and divided into 2 groups:the atopic group (atopic MP pneumonia children,n =50) and the non-atopic group (non-atopic MP pneumonia children,n =112).Furthermore,30 healthy children were also included in this study as healthy control group at the Department of Pediatrics,Tianjin Nankai Hospital at the same time.The clinical characteristics and laboratory data of MP pneumonia patients of 2 groups were recorded and analyzed.The levels of serum IL-17 of MP pneumonia patients were measured by using enzyme-linked immunosorbent assays.Results Children with atopic MP pneumonia had more severe pneumonia.At the same time,the number of cases of oxygen therapy and glucocorticoid treatment,the duration of glucocorticoid treatment and the history of previous asthma in the atopic group were higher than those in the non-atopic group,and there was statistical difference between 2 groups(all P ＜ 0.05).The level of serum total immunoglobulin E in the atopic group [230.5 (120.8,421.5) IU/mL] was higher than that in the non-atopic group [79.9 (46.1,125.3) IU/mL],and the level of serum lactate dehydrogenase(LDH) in the atopic group [(319.3 ± 118.9) IU/L] was higher than that in the non-atopic group [(255.5 ± 66.6) IU/L],and there were statistical differences between 2 groups (all P ＜0.01).The levels of serum IL-17 in the healthy control group,atopic group and non-atopic group were (60.2 ± 15.7) ng/L,(382.2 ± 181.7) ng/L and(532.3 ± 169.1) ng/L,respectively,and there were statistical differences among the 3 groups (F =105.668,P =0.000).Whereas,the level of serum IL-17 in the atopic group was lower than that in the non-atopic group,there was statistical difference between 2 groups (t =-3.861,P ＜ 0.01).Conclusion Atopy mav cause adverse effects on the childhood MP pneumonia.It was likely to be relevant to low levels of IL-17.

Objective To investigate the clinical features of acute pancreatitis (AP) in children of differem age.Methods From January 2010 to December 2015,pediatric inpatients with AP were searched by pediatric inpatient medical records retrieval system.According to age,patients were divided into three groups:infant and toddler group (age 0 years to three years),preschool group (age ＞three years to six years) and school-aged group (age ＞ six years to 16 years).The clinical features,etiology and laboratory findings of differem age groups were retrospectively analyzed.One-way analysis of variation or rank sum test was performed for measurement data analysis.Chi-square test or Fisher exact probability test was used for the count data analysis.Results A total of 88 pediatric patients (male 38,female 50) were enrolled,and the mean age was (8.8±4.4) years.Infant and toddler group,preschool group and schoobaged group were 16,14,58 cases,respectively.The average days of hospitalization of infant and toddler group,preschool group and school-aged group were (8.4±1.9),(9.4±2.6) and (7.5± 2.5) days,respectively,and the difference was statistically significant (F=3.649,P=0.030).About 93.2％ (82/88) pediatric patients had abdominal pain.The incidence rate of epigastric distention of school-aged group (34.5％,20/58) was higher than those of infant and toddler group (2/16) and preschool-aged group (1/14).The rate of nausea/vomiting of infant and toddler group was significantly higher than those of preschool group and school-aged group (12/16,4/14 and 46.6 ％ (27/58),respectively),and the differences were both statistically significant (x2 =6.250 and 6.805,both P＜0.05).Biliary pancreatitis was the main etiology of infant and toddler group and preschool group,and the incidence was 6/16 and 6/14,respectively.Whereas,there was a variety of etiologies in school-aged group.There were 20 cases (22.7％) of severe AP.The severe cases were more in the infant and toddler group and preschool group (7/16 and 6/14,respectively),and less in school-aged group (12.1％,7/58).There was no statistically significant difference among the three age groups in blood amylase level,lipase level,white blood cells count,blood glucose level,blood calcium level and blood urea nitrogen (all P＞0.05).The percentage of obese children of school-aged group was significantly higher than those of infant and toddler group and preschool group (31.0％,18/58;1/16 and 1/14,respectively),and the difference was statistically significant (x2 =6.689,P=0.035).In addition,the level of serum total cholesterol of school aged group was higher than that of infant and toddler group and preschool group ((5.1±0.9),(3.9±0.6) and (4.8±0.8) mmol/L,respectively),and the difference was statistically significant (F =13.855,P＜ 0.01).The positive rates of abdominal ultrasound of infant and toddler group,preschool group and school-aged group were 5/16,4/14 and 21.1％ (12/57),respectively,and there was no statistically significant difference (x2 =0.889,P 0.706).The positive rates of magnetic resonance cholangiopancreatography (MRCP) of infant and toddler group and school-aged group were 4/4 and 5/6,respectively,and which were both higher than those of pancreases computed tomography (CT) examination (4/14 and 51.2％,22/43) and those of abdominal ultrasound (5/16 and 21.1％,12/57),and the differences were significant (x2 =6.655 and 15.207,both P＜0.05).Conclusions Obese children is more in school-aged children with AP.Children of this age should pay more attention to life style.Nausea or vomiting symptom is more obvious in the infant and toddler children with AP and the condition is more severe.If children of this age with unexplainable vomiting,AP should be considered.Biliary factors are more common in the infant and toddler children with AP.When children are suspected with abnormal structure of pancreatic and biliary ductal system,MRCP should be conducted.

Objective:To explore predictive value of arterial velocity-pulse index (AVI) and arterial pressure-volume index (API) for early atherosclerosis (AS) in middle-aged population.Methods:A total of 138 middle-aged patients hospitalized in our hospital from May 2016 to Nov 2016 were enrolled.According to coronary angiography (CAG) outcomes, they were divided into AS group (n=86) and non-AS group (n=52).Before CAG, AVI, API and brachial-ankle pulse wave velocity (baPWV) were collected in two groups.General data and arterial stiffness indexes were compared between two groups, and the correlation among AVI, API, baPWV and general data were analyzed.Results:Compared with non-AS group, there were significant rise in AVI [(20.4±4.2) vs.(22.8±5.3)] and baPWV [(14.0±2.5) m/s vs.(16.3±3.0) m/s] in AS group,P<0.01 both.AVI was significant positively correlated with age, SBP, DBP, mean arterial pressure (MAP), pulse pressure (PP), API and baPWV (r=0.219~0.471, P<0.05 or <0.01);API was significant positively correlated with age, BMI, SBP, DBP, MAP, PP, brain natriuretic peptide (BNP), AVI and baPWV (r=0.213~0.726, P<0.05 or <0.01);baPWV was significant positively correlated with age, BMI, SBP, DBP, MAP, PP, AVI and API (r=0.201~0.472, P<0.05 or <0.01).Multi-factor linear regression analysis indicated that SBP was influencing factor for AVI (B=0.162,P=0.001), SBP, DBP and HDL-C were influencing factors for API (B=-0.166~2.146,P<0.05 or <0.01), SBP and HDL-C were influencing factors for baPWV (B=0.116,-3.009,P<0.01 both).Conclusion:Both elevated AVI and baPWV can predict atherosclerosis in middle-aged population

Objectives Aiming at the current health management mode of chronic disease preven-tion and control as the focus of work, this paper was to evaluate the effect of chronic disease management-based education on clinical teaching and training in cardiovascular medicine. Methods Totally 54 students participating in internship training in Department of Cardiology, the Shanghai Ninth People’s Hospital be-tween July 2013 and Aug 2014 were enrolled. Twenty-eight students were taught by chronic disease man-agement-based method while twenty-six students were taught by traditional method. After the internship training in cardiology, final examination (theoretical exam, skill appraisal and case analysis) were compared between the two groups to assess the teaching efficacy. Questionnaire survey was employed to investigate student satisfaction with chronic disease management-based teaching method. Data were analyzed by SPSS 13.0 software. Quantitative data or enumeration data between two groups were compared by t-test or chi-square test respectively. Results There was no significant difference in the theoretical exam score between two groups (P=0.422). However, the scores of skill appraisal and case analysis in students taught by chronic disease management-based method were significantly higher than those in students taught by traditional method (P<0.05). Most students taught by chronic disease management-based method were satisfied with the novel teaching method. Conclusion In the course of clinical medicine education, the emphasis on the management of chronic diseases can not only significantly improve the quality of clinical teaching in car-diovascular medicine, but also lay the foundation for the implementation of the concept of chronic disease management.

Abstact:Objective To explore the clinical characteristics of biliary pancreatitis in children.Methods The clinical data from 10 children with biliary pancreatitis from January 2011 to July 2015 were retrospectively analyzed.Result In 10 children (2 males and 8 females), the average age was 6.1?±?4.9 years old, and the average hospital stay was 8.4?±?3.8 d. There were 4 cases of gallstone, 4 cases of cholestasis, 2 cases of calculus of bile duct, 2 cases of choledochocyst and 1 case of pancreatic divisum. Abdominal pain was the main clinical manifestation in these 10 children. All of them had elevated serum amylase, with the maximum value of 106-922 U/L. Six cases had elevated lipase of 22-2000 U/L. Six cases had abnormal serum alanine aminotransferase. Two cases had hypokalemia. One case had hypoglycemia. Four cases had acid-base imbalance. Abdominal ultrasonography showed pancreatitis in 4 cases. CT showed pancreatitis in all children. All of the children were treated by fasting, lfuid infusion, maintaining water and electrolyte balance, inhibiting gastric acid by omeprazole and inhibiting pancreatic secretion by octreotide. Nine cases were improved by conservative treatment and discharged, and one case was transferred to surgery. Conclusion The incidence of biliary pancreatitis in children is low. The clinical manifestation is atypical. Pancreatic duct abnormalities are more common in young children, in whom the effect of conservative treatment is relatively good.

Objective:To explore the relationship between arterial plasma levels of von Willebrand factor (vWF) and cardiovascular events in patients with stable coronary heart disease (CHD) .Methods :A total of 88 stable CHD pa‐tients from Aug 2007 to Dec 2008 , were enrolled ,their clinical ,coronary angiography (CAG) and percutaneous coronary intervention (PCI) data were collected .Enzyme linked immunosorbent assay was used to measure arterial (aortic root) plasma vWF level before PCI .Except two lost cases ,according to baseline vWF level ,other patients were divided into high vWF level group (vWF≥13.5 ng/ml ,n=43) and low vWF level group (vWF <13.5 ng/ml , n=43) .Incidence rate of major adverse cardiovascular events (MACE) ,including mortality rate ,non-fatal acute myocardial infarction (AMI) , CAG+PCI etc .after six years were followed up .Results:After a mean 74.7 months follow-up ,there were no significant difference in mortality rate (9% vs . 9% ) ,person‐time of non‐fatal AMI (12% vs .7% ) ,arrhythmia (9% vs .16% ) ,CAG+ PCI (53% vs .67% ) ,heart failure (30% vs .23% ) ,cere‐brovascular incident (14% vs .26% ) between low vWF level group and high vWF level group ,P>0.05 all .Conclu‐sion:In patients with stable coronary heart disease ,level of von Willebrand factor is not significantly related to long-term cardiovascular events .