Lean six sigma (LSS) emphasizes patient demand-oriented, and continuously optimizing prolesses to achieve efficiency and standardization in medical services. Starting in 2021, a specialized children′s hospital (comprising one main campus and three branch campuses) introduced the LSS management method. Through define, measure, analyze, improve, and control, the hospital utilized tools such as questionnaire surveys, SIPOC models, and fishbone diagrams to identify pain points in the building of multi-campus child-friendly hospital and develop improvement measures.To address the main issues of insufficient cross-campus collaboration, significant disparities in service quality among different campuses, unclear functional positioning of each campus, and inadequate integration with social security mechanisms, the hospital implemented a " homogeneity-differentiation-coordination" management mode. The hospital implemented unified diagnosis and treatment standards and clinical pathways, carried out remote consultations and expert rotations, completed mutual recognition of examination and testing results, optimized child friendly labeling and child friendly environment, and built a " hospital-to-hospitals, hospital to medical schools, and hospital to community health centers" linkage platform, etc., to promote the standardization of diagnosis and treatment processes, clear functional positioning of the hospital area, and efficient resource allocation. Through practice, the outpatient appointment rate and patient satisfaction rate in the main hospital had increased from 86.72% and 98.64% in January December 2021 to 91.87% and 99.72% in January December 2024, respectively; The patient waiting time had been shortened from 26.54 minutes to 21.94 minutes, and the efficiency of medical treatment and service experience had been significantly improved. As of 2024, mutual recognition of 214 inspection and testing items had been achieved cross hospital campuses, forming a collaborative pattern of " main hospital leading, campuses support, and resource complementarity", and significantly improving the level of collaboration and child friendly connotation among multi-campus. This practice explored the integration path of multi-campus collaborative governance and child-friendly services, which could provide reference and inspiration for the similar hospitals.

Lean six sigma (LSS) emphasizes patient demand-oriented, and continuously optimizing prolesses to achieve efficiency and standardization in medical services. Starting in 2021, a specialized children′s hospital (comprising one main campus and three branch campuses) introduced the LSS management method. Through define, measure, analyze, improve, and control, the hospital utilized tools such as questionnaire surveys, SIPOC models, and fishbone diagrams to identify pain points in the building of multi-campus child-friendly hospital and develop improvement measures.To address the main issues of insufficient cross-campus collaboration, significant disparities in service quality among different campuses, unclear functional positioning of each campus, and inadequate integration with social security mechanisms, the hospital implemented a " homogeneity-differentiation-coordination" management mode. The hospital implemented unified diagnosis and treatment standards and clinical pathways, carried out remote consultations and expert rotations, completed mutual recognition of examination and testing results, optimized child friendly labeling and child friendly environment, and built a " hospital-to-hospitals, hospital to medical schools, and hospital to community health centers" linkage platform, etc., to promote the standardization of diagnosis and treatment processes, clear functional positioning of the hospital area, and efficient resource allocation. Through practice, the outpatient appointment rate and patient satisfaction rate in the main hospital had increased from 86.72% and 98.64% in January December 2021 to 91.87% and 99.72% in January December 2024, respectively; The patient waiting time had been shortened from 26.54 minutes to 21.94 minutes, and the efficiency of medical treatment and service experience had been significantly improved. As of 2024, mutual recognition of 214 inspection and testing items had been achieved cross hospital campuses, forming a collaborative pattern of " main hospital leading, campuses support, and resource complementarity", and significantly improving the level of collaboration and child friendly connotation among multi-campus. This practice explored the integration path of multi-campus collaborative governance and child-friendly services, which could provide reference and inspiration for the similar hospitals.

Objective:To understand the clinical and epidemiological characteristics of gastrointestinal salmonella infection . Methods:The clinical and epidemiological characteristics of patients with gastrointestinal salmonella infection in Enteric Diseases Clinic of Jinshan Hospital affiliated to Fudan Uninversity during 1998 and 2013 ,were retrospectively analyzed .Results:During 1998 and 2013 ,235(96 .17% was recent 8 years) cases with Salmonella infection were checked out from patients with diarrhea in Enteric Diseases Clinic of Jinshan Hospital affiliated to Fudan University .Most of the cases(96 .17% ) were checked out dur‐ing 2006 and 2013 .The annual high prevalence of salmonella infection was during May and October .The onset of salmonella infection was mainly 12‐24 h after eating salmonella contaminated food .The manifestation was mainly abdominal pain ,diarrhe‐a ,and fever .Daily defecation times were from 3‐4 times to 20‐30 times .Watery stool was most often found ,while mucous stool or bloody purulent stool was accidently found .The variation of patients’ temperature was between 38℃ and 39 .4℃ .It might be accompanied by chill .Once infected with salmonella ,the symptoms of healthy adults would last for 2~5 days till re‐covery .However ,the symptoms of old and infirm ones would last for a long time .Severe vomit and diarrhea might cause se‐vere dehydration .Conclusions:To understand the clinical manifestations ,the features of onset ,and the epidemiological charac‐teristics ,is conducive to the early clinical diagnosis and therapy .

Colonoscopy has been accepted as the standard method for evaluation of colon and rectum,its success rate depends on the quality of bowel preparation. Aims:To evaluate the cleanliness and tolerance of fractionated dose versus single dose polyethylene glycol electrolyte solution( PEG-ES) bowel preparation regimens for colonoscopy. Methods:A total of 427 consecutive asymptomatic individuals undergoing colorectal cancer screening were enrolled and randomly assigned into 2 groups. Subjects in group A drank 1. 5 L PEG-ES on the eve and 4 hours before colonoscopy, respectively;subjects in group B received a single dose of 3 L PEG-ES 5 hours before colonoscopy. Score and degree of Boston bowel preparation scale(BBPS)and PEG-ES related adverse effects of the two groups were assessed and compared. Results:There were no significant differences in gender,age and cecal insertion rate between group A and group B(P ﹥ 0. 05). Score of BBPS was significantly higher in group A than in group B(P ﹤0. 01). Both regimens met the requirement of conventional colonoscopy,however,the cleanliness of colon was graded as excellent in more subjects of group A( P ﹤ 0. 01),and less subjects of group A complained PEG-ES related nausea(P ﹤0. 05). Logistic regression analysis revealed that the PEG-ES drinking pattern was associated with cleanliness of colon and occurrence of nausea( P ﹤ 0. 05). Conclusions:Fractionated dose PEG-ES regimen provides a better colonic cleansing quality and tolerance for bowel preparation of colonoscopy,which is superior to that of single dose regimen.

Objective To evaluate the feasibility of testing the high methylation of ppENK gene in stool with methylation-specific polymerase chain reaction (MSP) assay in pancreatic cancer diagnosis.Methods Twenty-four fresh stool samples of pancreatic cancer patients and six healthy control samples were collected.The methylation status of ppENK gene in all the stool samples was detected by MSP assay.The positive rate of wild-type ppENK gene in all the stool samples was determined by polymerase chain reaction (PCR).And 10 non wild-type ppENK gene negative pancreatic cancer samples were collected,and K-ras gene mutation was detected by PCR-restriction fragment length polymorphism (RFLP).The single cell suspension of pancreatic cancer PC3 cell line was added into stool sample from the same healthy individual,the positive rate of ppENK gene methylation was detected by MSP assay.The minimum number of pancreatic cancer cell was calculated when methylation was positive.Results The rate of methylation detection in 30 samples was 0 (0/30); and the rate of non-methylation detection was 10％ (3/30).The rate of wild-type ppENK detection was 6.7％ (2/30).By PCR-RFLP assay,eight were successfully amplified and seven had mutation in 12th code of K-ras gene in 10 selected wild-type ppENK gene negative pancreatic cancer samples.The minimum number of pancreatic cancer cells needed for ppENK methylation band positive detected by MSP was 50 cell/ml.Conclusion Detecting ppENK gene methylation status in stool samples of pancreatic cancer patients by MSP assay has not yet become the method of pancreatic cancer screening and diagnosis.

Objective To investigate the suppression effects of tumor suppressor gene p53 alone and apoptosis incombination with TNF-? in a hepatocellular carcinoma cell line Hep3B. Methods Hep3B cells were transfected with a wild-type p53 cDNA(wt-p53)and plain vector(pNeo) respectively. Then the cell were cultured for 12 hours, one of the transfected p53 groups was added TNF-?(20 ?g/ml). The expression of p53 was detected by immunological fluorescence assay. Determination of apoptosis was used by DNA fragmentation, TUNEL assay. Results Both a small dose TNF-? and wt-p53 can induce apoptosis more efficiently comparing with non-transfected cultures(P