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*

Natural products (NPs) have long held a significant position in various fields such as medicine, food, agriculture, and materials. The chemical space covered by NPs is extensive but often underexplored. Therefore, high-throughput and efficient methodologies for the annotation and discovery of NPs are desired to address the complexity and diversity of NP-based systems. Mass spectrometry (MS) has emerged as a powerful platform for the annotation and discovery of NPs. MS databases provide vital support for the structural characterization of NPs by integrating extensive mass spectral data and sample information. Additionally, the released annotation methodologies, based on a variety of informatics tools, continuously improve the ability to annotate the structure and properties of compounds. This review examines the current mainstream databases and annotation methodologies, focusing on their advantages and limitations. Prospects for future technological advancements are then discussed in terms of novel applications and research objectives. Through a systematic overview, this review aims to provide valuable insights and a reference for MS-based NPs annotation, thereby promoting the discovery of novel natural entities.
Biological Products/chemistry* ; Mass Spectrometry/methods* ; Databases, Factual ; Drug Discovery/methods* ; Humans

Objective:To explore the mechanism of Huangqi Jiedu Decoction (HQJD) in the treatment of breast cancer with the syndrome of Zheng deficiency and toxic incandescence by network pharmacology and molecular docking technology.Methods:The main active ingredients and targets of HQJD were screened through the traditional Chinese medicine (TCM) systematic pharmacology database and analysis platform. The relevant targets of breast cancer with the syndrome of Zheng-deficiency, toxic-incandescence were obtained using OMIM, GeneGards and Drugbank databases, and the relevant targets of HQJD for the treatment of breast cancer with the syndrome of Zheng-deficiency and toxic incandescence were obtained by intersection; The Cytoscape 3.9.1 software was used to build the protein protein interaction (PPI) network and the " drug active component target disease" network on the basis of String 11.0 database, and the core active components and core targets of HQJD in treating breast cancer with the syndrome of Zheng-deficiency and toxic-incandescence were inferred according to the topological parameters. gene ontology (GO) enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis were performed on core targets using R language; and molecular docking verification on the main active ingredients and core targets were conducted.Results:230 effective targets of active ingredients of HQJD were screened, and 15 467 active ingredients of breast cancer with syndrome of Zheng-deficiency/toxic-incandescence were obtained; 217 intersection targets; GO function enrichment analysis showed that the treatment of HQJD for breast cancer with the syndrome of Zheng-deficiency and toxic-incandescence mainly involved oxidative stress and cytochemical stress; The enrichment analysis of KEGG pathway showed that HQJD treatment of breast cancer with the syndrome of Zheng-deficiency and toxic-incandescence was mainly related to phosphatidylinositol 3-protein kinase B (PI3K-Akt), interleukin-17 (IL-17) and other signal pathways. The molecular docking results showed that the main active ingredients such as β-sitosterol, stigmasterol, luteolin had good binding ability with core targets.Conclusions:HQJD has the characteristics of multi-component, multi target and multi pathway in the treatment of breast cancer with syndrome of Zheng-deficiency and toxic-incandescence, and its main mechanism may be related to PI3K-Akt, IL-17, P53 and other signal pathways.

Objective:To preliminarily investigate the applicability of a poliovirus pseudovirus-based neutralization assay in evaluating the immunogenicity of recombinant poliovirus vaccines and their in vivo potency in rats. Methods:Serum samples from rats immunized with recombinant poliovirus vaccines were tested using both the pseudovirus neutralization assay and the live-virus neutralization assay with Sabin strain. The consistency and correlation of the two methods were analyzed using the Kappa test and Spearman′s rank correlation.Results:For the neutralizing antibodies against typeⅠ, Ⅱ, and Ⅲ polioviruses, the Kappa values for consistency analysis of the two methods were 0.914, 1.000, and 0.751, respectively ( P<0.001), and the correlation coefficients ( R values) were 0.833, 0.927, and 0.859, respectively ( P<0.001). Conclusions:The test results of the two methods are consistent and show a good correlation, indicating that the pseudovirus neutralization assay can be applied to evaluating the immunogenicity of poliovirus vaccines and also can be used in rat potency tests.

Objective:To investigate the clinical significance of gene mutations in epidermal growth factor receptor (EGFR), tumor suppressor gene P53 (TP53), phosphatidylinositol-4, 5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA), or SMAD family member 4 (SMAD4) in patients with advanced non-small cell lung cancer (NSCLC) based on circulating tumor DNA (ctDNA) analysis.Methods:A single-center, retrospective study was conducted among patients with NSCLC who visited Shanghai Chest Hospital from June 2022 to January 2024. Peripheral blood was collected from patients prior to targeted therapy, and cell-free DNA (cfDNA) and leukocyte DNA were isolated for next-generation sequencing. ctDNA data was obtained through comparative analysis. Patient gene mutations were analyzed according to the guidelines for the interpretation of somatic variants jointly established by the Association for Molecular Pathology/College of American Pathologists/American Society of Clinical Oncology. Analysis of variance and Kaplan-Meier survival curves were applied to assess the partial response (PR) rate among patients with EGFR gene mutations and those with concurrent mutations in other genes.Results:Among 126 patients, the rate of carrying only EGFR mutations was 46.0% (58/126), with a PR rate of 74.1% (43/58). The rate of double mutations in EGFR and TP53 was 37.3% (47/126), with a PR rate of 53.2% (25/47). The rate of triple mutations in EGFR, TP53, and concurrent mutations in PIK3CA or SMAD4 was 16.7% (21/126), with a PR rate of 28.6% (6/21). The comparison of progression-free survival curves among the three groups showed a statistically significant difference (χ 2=23.81, P<0.01). Conclusions:next-generation sequencing detection technology based on ctDNA can detect concurrent mutations in TP53, PIK3CA, or SMAD4 along with EGFR mutations. Multiple gene mutations are significant factors for poor PR rates and progression-free survival curves in patients.

Objective:To evaluate the immunogenicity and immune persistence of purified Vero cells rabies vaccine (PVRV) with Zagreb and Essen regimen.Methods:Prospective study: Patients with first Class II exposure to rabies were recruited from the Dog Injury Cinic of Guangxi Center for Disease Control and Prevention (Guangxi CDC) and randomly divided into the Zagreb (2-1-1) and Essen (1-1-1-1-1) regimen group. All patients were inoculated with the vaccines from the same manufacturer and batch, and 3 ml serum was collected at the 45th day and in 1-year, 2-year and 3-year after immunization. Rapid fluorescent inhibition test (RFFIT) was used to detect rabies virus neutralizing antibody (RVNA). The attenuation of RVNA positive rate and geometric mean titer (GMT) with time was analyzed. Retrospective study: The informed consents for rabies vaccine in the Dog Injury Clinic of Guangxi CDC were checked out. The patients who were injected with PVRV (same manufacturer but unlimited batch) but without passive immune agents for the first time within 3 years were selected and divided into 1-year, 2-year and 3-year group. Each group was further divided into Zagreb and Essen regimen group. The serum (3 ml) was collected at 1 year, 2 years and 3 years after immunization and detected the RVNA by RFFIT.Results:Prospective study: The RVNA positive rates on the 45th day and in 1-year, 2-year and 3-year after immunizationin in the Zagreb and Essen regimen group were 100%, 95%, 85%, 80% and 98.25%, 89.47%, 89.47%, 85.96%, respectively. There was no statistically significant difference in the RVNA positive rates at the same time point between the two regimen groups ( P>0.05). The RVNA GMT on the 45th day and in 1-year, 2-year, and 3-year in the Zagreb and Essen regimen group were 11.32 IU/ml, 1.69 IU/ml, 1.30 IU/ml, 1.30 IU/m and 13.18 IU/ml, 2.13 IU/ml, 1.87 IU/ml, 1.84 IU/m, respectively. There was no significant difference in the RVNA GMT levels at the same time point between the two regimen groups ( F=1.971, P=0.164). The RVNA GMT levels in the two regimen groups had the same trend of attenuation over time (time*group F=0.702, P=0.435). Retrospective study: The RVNA positive rates in 1-year, 2-year and 3-year after immunization in the Zagreb and Essen regimen group were 100%, 95%, 91.43%和94.73%, 86.21%, 87.5%, respectively. There was no statistically significant difference in the RVNA positive rates at the same time point between the two regimen groups ( P>0.05). The RVNA GMT in 1-year, 2-year, and 3-year groups after immunization in the Zagreb and Essen regimen group were 2.65 IU/ml, 2.03 IU/ml, 1.57 IU/ml和3.2 IU/ml, 2.58 IU/ml, 2.45 IU/ml, respectively. There was no significant difference in the RVNA GMT levels at the same time point between the two regimen groups ( P>0.05). Conclusions:The PVRV showed the same excellent immunogenicity and immune persistence after the vaccination with the Zagreb and Essen regimens.

New biodegradable intravascular stent can reduce risk of foreign bodies retained, thus, it is widely concerned and some of the products have been introduced into the clinic. However, the characteristic of biodegradable may lead to more safety concerns associated with thrombosis. To ensure the safety, the thrombus formation experiment needs to be carefully designed and evaluated based on GB/T 16886.4 standard, but current standard do not provide explicit testing and evaluating methods. Establishing animal model with experimental pigs, the study compares biodegradable coronary stents and metal stents by simulating clinical implantation on the thrombus formation in the implanting process, and after the short-term and long-term implantation. The evaluation methods include gross observation, digital subtraction angiography intraoperative analysis, optical coherence tomography analysis, scanning electron microscopy and so on. The results show that combining these methods could comprehensively evaluate the whole process of the thrombus formation from the beginning of implantation to the end of preclinical animal experiments, so that, it may better predict the clinical thrombosis risk, and the selection of the control was very important. The study tries to use the comparison examples of thrombosis on the new medical instrument to provide the clue for thrombosis evaluation on similar instruments and show the methodology on the preclinical evaluation.
Absorbable Implants ; adverse effects ; Animals ; Drug-Eluting Stents ; adverse effects ; Polymers ; Swine ; Thrombosis ; etiology ; Tomography, Optical Coherence ; Treatment Outcome

Objective To explore the effect of scenario simulation teaching method in the training of cardiopulmonary resuscitation (CPR) for junior surgical residents. Methods 133 junior residents (working life<3 years) in the author's hospital rotating Cardiac Surgery department were selected and divided into control group (n=65) and observation group (n=68), in which the control group adopted traditional classroom teaching: teacher explanation-demonstration-student practice-teacher counseling; the observation group adopted scenario simulation teaching: teacher explanation-demonstration-student practice-teacher counseling scenario simulation. Before and after training, two groups both received the CPR theory and double operation assessment , comparing the difference of assessment scores between groups before and after training . Results There was no statistically significant difference in the demographic characteristics between the two groups. The assessment scores of CPR theory and operation were improved in both groups after training, and there were significant differences (P=0.000). There were no statistically significant differences in the CPR theory and operation assessment scores between the two groups before training (P>0.05);compared with the scores of CPR operation between the two groups after training, the observation group [(84.62±3.94)] was significantly higher than that of the control group [(79.68±5.45)] and there were significant statistical differences (P=0.000), while there was no statistically significant difference in CPR theory assessment scores between the two groups (P>0.05). Conclusions Both traditional classroom teaching and scenario simulation teaching methods could improve the CPR theory and skill level of the surgical junior resident, but situa tional simulation teaching method is better than traditional classroom teaching method in improving students' CPR performance.

Objective To explore the correlation factors and clinical significance of lymph node metastasis in right recurrent laryngeal nerve of thyroid papillary carcinoma (PTC).Methods Ninty-eight consecutive patients with PTC who were underwent total thyroidectomy with routine central lymph node dissection in the Second People's Hospital of Hefei from January 2015 to August 2017 were analyzed.The right paratracheal lymph nodes in the central compartment lymph nodes were divided into the level Ⅵ-A (anterior) and level Ⅵ-B (posterior,that was lymph node posterior to recurrent laryngeal nerve) compartments by recurrent laryngeal nerve.The lymph node metastasis of Ⅵ-B area during central compartment lymph node dissection was analyzed.We drew the receiver-operating characteristic curve (ROC) for right neck Ⅵ-A number of lymph node metastasis,and calculated the area under the curve (AUC) and Youden index.Results Among 98 cases,16 cases occurred Ⅵ-B district lymph node metastasis (16.33％).Single factor analysis results showed that lymph node metastasis in Ⅵ-B area of PTC patients were related to the tumor size (x2 =12.864,P ＜0.001),tumor capsular invasion (x2 =16.354,P ＜ 0.001),the right neck Ⅵ-A area lymph node metastasis (x2 =16.065,P ＜ 0.001),tumor number (x2 =15.593,P ＜ 0.001) and neck lymph node metastasis (x2 =21.098,P ＜0.001),but they were not related to the patients' gender,age and lesion location (all P ＞ 0.05).Lymph node metastasis in Ⅵ-B area of PTC patients were related to the number of right neck Ⅵ-A area lymph node metastasis.When the number of right neck Ⅵ-A metastatic lymph nodes was 2.5,the sensitivity and specificity were 70.60％ and 70.00％ respectively,AUC was 0.754,and Youden index was 0.406.Conclusion For patients with PTC,primary tumor diameter ＞ 1 cm,tumor extracapsular invasion,Ⅵ-A area lymph node metastasis,multiple tumor and lateral cervical lymph node metastasis were the predictive factors for the lymph node metastasis in Ⅵ-B area.When the number of right neck Ⅵ-A area metastatic lymph nodes was greater than 3,we should dissect Ⅵ-B area.

Objective To investigate the levels of serum macrophage inflammatory protein-1α (MIP-1α),inflammatory factors and pulnonary function in patients with asthma,and the correlation between thenm.Methods Eighty patients with asthma were selected who were treated in our hospital from March 2015 to August 2016,and the data of 80 healthy adults were selected as control.The differences of serum MIP-1α,inflammatory factors,imnmunoglobulin and lung function were observed in two groups.The correlation between MIP-1α and inflammatory factors,lung function and immunoglobulin were analyzed.Results The levels of MIP-1α,interleukin (IL)-6,and tumor necrosis factor-α (TNF-α) in patients with asthma were significantly higher than those in control group (t =-207.04,-33.209,-55.132,P ＜ 0.01);The levels of forced vital capacity (FVC),the forced expiratory volume in one second (FEV1),FEV1/FVC,maximal mid expiratory flow (MMEF),and peak expiratory flow (PEF) in the asthma group were significantly lower than those in the control group (t =17.100,39.154,22.791,25.391,19.356,P ＜ 0.01).The IgG and IgM of asthma group were significantly lower than those of the control group (t =9.564,7.528,P ＜ 0.01).The IgE level was significantly higher than that of the control group (t =-82.683,P ＜0.01).The level of MIP-1α was positively correlated with the levels of IL-6,TNF-0 and IgE,and negatively correlated with FVC,FEV1,FEV1/FVC,MMEF,PEF,IgG and IgM in patients with asthma.Conclusions The level of serum MIP-1 α in asthmatic patients is high,and is closely related to the inflammatory cytokines and lung function in patients with asthma.