In the context of continuously deepening medical and health system reforms and comprehensively promoting the "Healthy China" strategy, Henan Provincial People's Hospital has established a regional collaborative and vertically integrated critical care service structure and network. This initiative aims to enhance information empowerment, strengthen regional collaboration, improve the insufficient primary medical services, and ensure timely and effective treatment for critically ill patients. By establishing a comprehensive dispatch service platform for regional collaborative critical care, building a "top-down" remote medical collaboration network, and forming a cross-regional specialty alliance for critical care, the hospital has improved the efficiency of medical services and enhanced regional capabilities for treating critically ill patients. Simultaneously, for critically serious patients and those with complex diseases at primary medical institutions, a one-stop consultation and referral service has been implemented. This service adopts a "three specialists" approach and a multidisciplinary consultation mechanism within the hospital, constructs a multi-dimensional critical care transfer mode integrating air, ground, and the internet, creates a regional collaborative rescue mode, and implements full-cycle treatment for critically serious patients. The comprehensive, flexible, and efficient service pathway for regional collaborative critical care established by this system ensures timely and safe treatment for critically ill patients, promotes the distribution of high-quality medical resources, and effectively addresses issues such as uneven distribution of high-quality medical resources and varying levels of critical care capabilities. It has facilitated the formation of a new tiered diagnosis and treatment order characterized by "first diagnosis at the primary level, two-way referral, separate treatment for acute and chronic diseases, and vertical integration". This approach has enhanced the diagnostic and comprehensive service capabilities of primary medical institutions. Currently, by strengthening information empowerment and sharing, creating a full-process critical care diagnosis and treatment model, providing medical assistance and cultivating primary-level critical care talent, and promoting appropriate technologies, the hospital has gradually overcome challenges such as barriers to information exchange and sharing between hospitals, overloaded critical care teams, high pressure on patient reception and transfer, and limited critical care capabilities at primary medical institutions. This article summarizes the construction and practical application of this regionally coordinated critical care system, aiming to provide a reference for the management of critical care treatment.
Humans ; China ; Critical Care/organization & administration* ; Delivery of Health Care/organization & administration*

Objective To investigate the mechanism of Xiaotanjieyu recipe (XTJYR)in the inhibition of precancerous lesion of breast cancer through the study of its effects on the growth and apoptosis of MCF-10AT cells,as well as its effects on expressions of PTEN protein and mRNA.Methods Changes in the inhibition rate of MCF-10 AT cells growth in precancerous lesion of breast cancer after medication were closely observed at hour 24 and 48,by using CCK-8 method in the 3 groups,i.e.the herbal medicine group (or the XTJYR group),the western medicine group (or the tamoxifen group) and the control group.Western blot was used to detect changes in the expression of PTEN,and Q-PCR method was employed to detect the expression of PTEN and mRNA in the 3 groups following intervention.Results (1) OD values of the XTJYR group and the tamoxifen group were all lower than those of the control group,with statistical significance (P ＜ 0.05).The inhibition was time-dependent,furthermore,the inhibition rate of the XTJYR group was higher than that of the tamoxifen group,and statistical significance could be noted,when comparisons were made between them (P ＜ 0.05).(2) At hour 48 after drug intervention,the rates of apoptosis for the XTJYR group and the tamoxifen group were respectively (25.40 ±4.69)％ and (16.93 ± 1.29)％,which were all significantly higher,as compared with those of the control group (2.63 ±0.29％),also with statistical significance (P ＜0.05).The apoptosis rate of the XTJYR group was higher than that of the tamoxifen group and statistical significance could be seen,when comparisons were made between them (P ＜ 0.05).(3) The expression levels of PTEN were significantly increased in both the XTJYR group and the tamoxifen group 48 hours after intervention on MCF-10AT cells,and the PTEN expression level of the XTJYR group was greater than that of the tamoxifen group.PTEN mRNA expression level of the XTJYR group was (1.31 ±0.04),while that of the tamoxifen group was 0.61 ±0.11,which were all higher than that of the control group (0.13 ±0.13),and the expression level of the XTJYR group was higher than that of the tamoxifen group.Statistical significance could be found,when comparisons were made between them (P ＜ 0.05).Conclusions Xiaotanjieyu recipe proved to have the effects of inhibiting proliferation and promoting apoptosis,the mechanism of which might be related with the upregulation of PTEN protein and the elevated level of gene expression.

Objective To investigate the mechanism of Xiaotanjieyu recipe (XTJYR)in the inhibition of precancerous lesion of breast cancer through the study of its effects on the growth and apoptosis of MCF-10AT cells,as well as its effects on expressions of PTEN protein and mRNA.Methods Changes in the inhibition rate of MCF-10 AT cells growth in precancerous lesion of breast cancer after medication were closely observed at hour 24 and 48,by using CCK-8 method in the 3 groups,i.e.the herbal medicine group (or the XTJYR group),the western medicine group (or the tamoxifen group) and the control group.Western blot was used to detect changes in the expression of PTEN,and Q-PCR method was employed to detect the expression of PTEN and mRNA in the 3 groups following intervention.Results (1) OD values of the XTJYR group and the tamoxifen group were all lower than those of the control group,with statistical significance (P ＜ 0.05).The inhibition was time-dependent,furthermore,the inhibition rate of the XTJYR group was higher than that of the tamoxifen group,and statistical significance could be noted,when comparisons were made between them (P ＜ 0.05).(2) At hour 48 after drug intervention,the rates of apoptosis for the XTJYR group and the tamoxifen group were respectively (25.40 ±4.69)％ and (16.93 ± 1.29)％,which were all significantly higher,as compared with those of the control group (2.63 ±0.29％),also with statistical significance (P ＜0.05).The apoptosis rate of the XTJYR group was higher than that of the tamoxifen group and statistical significance could be seen,when comparisons were made between them (P ＜ 0.05).(3) The expression levels of PTEN were significantly increased in both the XTJYR group and the tamoxifen group 48 hours after intervention on MCF-10AT cells,and the PTEN expression level of the XTJYR group was greater than that of the tamoxifen group.PTEN mRNA expression level of the XTJYR group was (1.31 ±0.04),while that of the tamoxifen group was 0.61 ±0.11,which were all higher than that of the control group (0.13 ±0.13),and the expression level of the XTJYR group was higher than that of the tamoxifen group.Statistical significance could be found,when comparisons were made between them (P ＜ 0.05).Conclusions Xiaotanjieyu recipe proved to have the effects of inhibiting proliferation and promoting apoptosis,the mechanism of which might be related with the upregulation of PTEN protein and the elevated level of gene expression.

Objective To explore the composition and distribution law of TCM syndromes in gastric cancer. Methods Based on the multicenter and large-sample clinical epidemiological investigation, the four methods of diagnosis of and clinical materials of 767 cases of gastric cancer were collected, and the database of TCM syndromes in gastric cancer was establish. Factor analysis and clustering analysis were used to explore composition and distribution law of TCM syndromes in gastric cancer. Results Gastric cancer symptoms mainly included fatigue, weight loss, dizziness and other non-specific systemic manifestation, and epigastria discomfort, belching, fullness or eating just a little swelling, pain, acid regurgitation, loss of appetite and other local manifestations. At the same time, the red tongue, moss greasy, pulse fine or string and other traditional Chinese medicine signs were also included. Eliminating 92 cases with too little symptoms, 675 cases were under multivariate analyzed. 25 syndrome variables were selected after initial factor analysis, again through factor analysis 10 factors with eigenvalues more than 1.0 were obtained and the cumulative contribution rate was 60.5%. Through further K-means clustering analysis on 10 common factor integrals, it was found that when all the cases were clustered into 7 classes consistent with clinical practice most. The numbers of patients with the 1-7 type were 165, 82, 90, 79, 88, 95 and 76, respectively. Analysis on the main factors in the combination of professional knowledge, the 7 types were named as the syndrome of spleen and stomach qi stagnation (24.44%), the syndrome of qi and blood deficiency (12.15%), the syndrome of spleen deficiency (13.33%), the syndrome of blood stasis (11.70%), the syndrome of phlegm dampness (13.04%), the syndrome of deficiency cold of spleen and stomach (14.07%), the syndrome of incoordination between liver/gallbladder and stomach (11.41%) respectively. Conclusion The results of multivariate analysis suggests that the location of gastric cancer is in the stomach, and closely related to spleen, liver and gallbladder. The general pathogenesis is asthenia in origin and asthenia in superficiality. The deficiency lies in qi, blood and yang qi, while asthenia superficiality owes to stagnation of qi, phlegm and blood stasis.

ObjectiveTo discuss the changes in characteristics of N-glycan in gastric cancer and its relationship with TCM syndromes.Methods The blood samples of 138 gastric cancer patients and 120 healthy volunteers were collected. The changes in N-glycan were detected by DNA sequencer-assisted and fluorophore-assisted carbohydrate electrophoresis (DSA-FACE), and differences of N-glycan among different TCM syndromes were compared.Results At least 9 N-glycan peaks could be identified in all samples. Compared with the healthy volunteers, Peak1, Peak5, Peak9 and Peak2 of gastric cancer patients obviously increased (P<0.05,P<0.01), whereas Peak3, Peak6 significantly decreased (P<0.01). Peak6 of gastric cancer in stage I was obviously higher than stages II, III, and IV (P<0.01), while Peak9 in stage I was obviously lower than the other three stages (P<0.01). Peak1 was significantly lower in disharmony between liver and stomach type than stagnation of phlegm-dampness type, interior retention of toxin stagnation type, deficiency of both Qi and blood type (P<0.05,P<0.01);lower in impairment of yin due to stomach heat type, deficiency-cold in spleen and stomach type than deficiency of both Qi and blood type (P<0.01);lower in stagnation of phlegm-dampness type, interior retention of toxin stagnation type than deficiency of both Qi and blood type (P<0.05). Peak6 was higher in disharmony between liver and stomach type than impairment of yin due to stomach heat type, stagnation of phlegm-dampness type, interior retention of toxin stagnation type than deficiency of both Qi and blood type (P<0.01). Peak9 was much higher in deficiency of both Qi and blood type than disharmony between liver and stomach type (P<0.01), impairment of yin due to stomach heat type and deficiency-cold in spleen and stomach type (P<0.05, P<0.01).Conclusion The expression of N-glycan was specifically changed in gastric cancer. These variations could promote the metastasis of gastric cancer and potentially have certain correlation with TCM syndromes.

Objective To observe the effect of Xiaotan Hezhong Recipe on pancreatic fibrosis forming and the expression of related proteins in model rats of chronic pancreatitis. Methods Twenty-four Wistar rats were randomly divided into normal group, model group, pancreatin group and Chinese medicine group (n=6). Rats model were made by DDC solution intraperitoneal injection. Pancreatin group and Chinese medicine group were treated by intragastric administration with pancreatin and Xiaotan Hezhong Recipe, respectively. Body weight of rats was measured regularly. The rats were killed after 4 weeks, with pancreatic pathological detection and laminin, matrix metalloproteinase-1 detection. Results After intraperitoneal injection of DDC solution, pancreatic tissue fibrosis in different degree and inflammatory cell infiltration were found. Chinese medicine group was better than the model group in general conditions, body weight change, pancreatic pathological score and expression of laminin, matrix metalloproteinase-1, the differences were statistically significant (P<0.05). Conclusion Xiaotan Hezhong Recipe can improve chronic pancreatitis rats generally and inhibit pancreatic fibrosis, its mechanism may be related with decreasing laminin expression and increasing the expression of matrix metalloproteinase-1.

Objective: The present study is a summary of syndrome types of gastric cancer in order of priority based on clinical practical situations, routine clinical syndrome differentiation and a large-sample clinical survey in 767 patients with gastric cancer. Methods: Based on the six-type classification of gastric cancer in a previous study, a bedside syndrome differentiation diagnosis was made simultaneously by two attending doctors of traditional Chinese medicine (TCM to avoid possible diagnostic bias. A clinical differentiation survey form designed under the direction of epidemiologists was filled out by patients with gastric cancer in multiple centers, and the results were digitally valued and statistically analyzed. Results: The symptoms and signs in each syndrome type of gastric cancer were ranked in order of priority as follows: distended pain, stringy pulse, eructation, mood-related pain, susceptibility to anger, acid regurgitation, hiccup, fullness sensation or distension after eating just a little, dizziness, thin pulse, abdominal enlargement, obstruction sensation after eating, moving pain, and uneven pulse in disharmony between liver and stomach; dark red tongue with little fur or a smooth surface, burning pain, rapid pulse, associated burning heat in anus, dry mouth, fissured tongue, thin pulse, tidal fever in the afternoon, nausea and vomiting, and night sweating in impairment of yin due to stomach heat; slender tongue fur, obstruction after eating, slow pulse, moderate pulse, rapid and irregular pulse, normal mood, abdominal pain, diarrhea, cold extremities, lower-extremity edema, cold intolerance, pale complexion, dizziness, emaciation, hiccup, silence, nausea, uneven pulse, acid regurgitation, fullness sensation or distension after eating just a little, vomiting, and constipation in deficiency-cold in spleen and stomach; uneven pulse, stabbing pain, tortuous sublingual vein, blue or purplish tongue, fixed pain, tarry stool or dark red stool, vomiting of dark red fluid, pale complexion, dry mouth without desire to drink, stringy pulse, white tongue fur, nausea, thin tongue fur, colic pain, hiccup, dizziness, acid regurgitation, bitter taste in mouth, slow pulse, rapid and irregular pulse, thin pulse, and pain relief by pressing in interior retention of toxin stagnation; slippery pulse, greasy and thick tongue fur, dry mouth without desire to drink, vomiting of bilious fluid, nausea, bitter taste in mouth, fullness sensation or distension after eating just a little, colic pain, and hiccup in stagnation of phlegm-dampness; abdominal pain relief by pressing, map-like tongue, thin pulse, weakness, yellowish complexion, dizziness, spontaneous sweating, fissured tongue, epigastric discomfort, night sweating, emaciation, cold intolerance, constipation, nausea, and dry tongue in deficiency of both qi and blood. Conclusion: The summarized syndrome types of gastric cancer from this study are consistent with the clinical situations and would prove to be more referential for TCM syndrome differentiation diagnosis and treatment of gastric cancer.

Objective: To explore the relationship between expressions of estrogen (ER) and progesterone (PR) receptors and syndromes of traditional Chinese medicine (TCM) in gastric carcinoma and to establish prognostic indicators for gastric carcinoma. Methods: A total of 72 patients with gastric carcinoma were divided into six groups according to TCM syndrome differentiation. Specimens were collected after operation and ER and PR protein expressions were detected by EnVision immunohistochemical method. Results: The common syndromes in female patients with gastric carcinoma were disharmony between liver and stomach, yin impairment due to stomach heat, and insufficiency of both qi and blood; while in males, interior retention of stagnant toxin, interior retention of phlegm and dampness, and deficiency-cold in spleen and stomach were common. Different TCM syndromes were related with gender (P<0.01), pathology (P<0.01), cell differentiation (P<0.05), infiltration depth (P<0.01), lymphaden metastasis (P<0.05), distant metastasis (P<0.05), and TNM stage (P<0.01). Deficiency and excess syndromes were associated with gender (P<0.05), pathology (P<0.05), tumor location (P<0.01) and TNM stage (P<0.05). The deficiency syndromes were common in female patients. The total positive rates of ER and PR expressions were 8.33% and 37.5% respectively. There was a significant difference in PR expression among different TCM syndromes (P<0.01). PR expression was significantly higher in the syndrome of yin deficiency due to stomach heat than in the other syndromes. The PR expressions in deficiency syndromes were significantly higher than those in excess syndromes (P<0.01). No correlation was found between ER expression and different TCM syndromes. Conclusion: There is a correlation between PR expression and different TCM syndromes in gastric carcinoma.