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 discuss the clinical application of coronary CT angiography(CCTA)-derived fractional flow reserve(CT-FFR)in evaluating the risk stratification of the coronary artery stenosis and atherosclerotic plaque quantitative parameters.Methods A total of 122 patients,who received CCTA examination at the Xuzhou Municipal Central Hospital of China,were enrolled in this study.The patients were divided into non-ischemia group(CT-FFR＞0.8,n=66)and ischemia group(CT-FFR0.8,n=56).The characteristics of atherosclerotic plaque were compared between the two groups.Logistic regression analysis was used to analyze the correlation between plaque characteristics and ischemic lesions.Results There were 218 vessels having a CT-FFR＞0.8 and 174 vessels having a CT-FFR ≤0.8.Statistically significant differences in the total plaque volume,calcified plaque volume,plaque length,and stenosis ratio＞50％existed between the two groups(all P＜0.05).Logistic regression analysis indicated that the total plaque volume,calcified plaque volume,plaque length,and stenosis ratio＞50％were the risk factors for myocardial ischemia.Conclusion CT-FFR can be used for the risk stratification of coronary stenosis and atherosclerotic plaque characteristics,which can evaluate the local myocardial blood supply condition from the anatomical stenosis and functional level so as to optimize the diagnosis and treatment measures.

Objective:To investigate the diagnosis and treatment significance of invasive and noninvasive operation for ventilator?as?sociated pneumonia ( VAP ) . Methods:A total of 80 cases of VAP suspected patients who had received mechanical ventilation at least 48 hours in ICU from Jun 2014 to Mar 2015 were enrolled. Patients were randomly divided into four groups including noninvasive operation group ( F) , invasive operation group ( Q) , mix group 1 ( H1) and mix group 2 ( H2) . VAP diagnosis rate between groups as well as living time, antibiotic use time, survival rate, calcitonin levels and APACHE II score, oxygenation index were analyzed. Results:Specimen from invasive operation had higher specimens to cultivate positive rate than that from noninvasive operation ( P<0?05), but there was no statistic significant difference in VAP diagnosis rate between two methods (P>0?05). Conclusion:Noninva?sive operation collecting samples for VAP diagnosis is also accurate as invasive one. Collecting specimens from sputum suction tube in the clinical treatment on airway suction is a low cost and simple noninvasive operation.

Objective:To explore the relationships between the endothelial microparticles (EMPs)in peripheral blood and CD4+ CD25 + Foxp3+ regulatory T cells and their cytokine levels in the patients with acute coronary syndrome (ACS),and to clarify the mechanism of EMPs in the pathogenesis of ACS by affecting the Treg cell differentiation and function.Methods:Twenty-three patients with stable angina (SAP)were allocated to SAP group,and 52 patients with ACS were allocated to ACS group.Twenty individuals with normal conventional coronary angiography results were recruited as control group.The levels of EMPs and the percents of CD4+ CD25 +Foxp3+ regulatory T cells in peripheral blood of the patients in various groups were measured by flow cytometry. The expressions of Foxp3 mRNA and the plasma levels of TGF-β1 were detected with Real-Time PCR and ELISA, respectively.Correlation analysis was performed between EMPs and regulatory T cells,Foxp3 mRNA expression level and TGF-β1 level.Results:Compared with control group and SAP group,the level of EMPs in peripheral blood of the patients in ACS group was increased significantly,but the percentage of regulatory T cells,the Foxp3 mRNA expression level and the plasma TGF-β1 level were decreased markedly (P <0.01).The correlation analysis showed that there were significantly negative correlation between EMPs and regulatory T cells,Foxp3 mRNA expression level and TGF-β1 level (r = - 0.452,P = 0.001;r = - 0.466,P = 0.001;r = - 0.555,P = 0.000 ). Conclusion:EMPs may involve in the process of occurrence and development of ACS and plaque instability by regulating the differentiation and function of CD4+ CD25 + Foxp3 + regulatory T cells.

Objective To study influence of tongxinluo on blood endothelial microparticles(EM Ps) and matrix metalloprotei‐nase‐9(MMP‐9) in patients with acute myocardial infarction after percutaneous coronary intervention(PCI) .Methods One hundred and twenty‐eight hospitalized patients with acute myocardial infarction after per‐cutaneous coronary intervention were recruited from January 2012 to December 2014 ,All patients were randomly divided into tongxinluo group (n=65) and control group (con‐ventional treatment ,n=63) .Tongxinluo group was on the basis of conventional treatment group with tongxinluo capsules 2 plus ,3 times a day .We detected the EMPs and MMP‐9 of two groups preoperatively and on the 7th postoperatively day .Results Com‐pared with the conventional treatment group ,blood EMPs and MMP‐9 in tongxinluo group were lower after 7 days treatment ,the difference was statistically significant (P<0 .05) .There was a positive correlation between the EMPs and MMP‐9(P<0 .05) .Con‐clusion For patients with acute myocardial infarction after percu‐taneous coronary intervention ,tongxinluo could further inhibit in‐flammatory reaction ,make the plaque stability and improve the function of endothelial cells on the basis of conventional treatment groups .

BACKGROUND:Fisher-Lewis rat kidney transplant models are the international common chronic renal alograft rejection models, but their application is greatly limited because of difficulty in model preparation and high costs. OBJECTIVE:To explore a new method of establishing SD-Wistar rat models of chronic renal alograft rejection. METHODS: Fifty-six pairs of SD-Wistar rats were subjected to left kidney orthotopic transplantation. The right kidneys of the recipients were intact and used as internal controls. 23 rat recipients were randomly divided into model group (n=15) and control group (n=8). The rats in the model group were injected with cyclosporine microemulsion for 10 days (2 mg/kg/day,i.p.) after kidney transplantation. The rats in the control group were not treated with immunosuppressive therapy. RESULTS AND CONCLUSION:The irreversible acute rejection occurred in al the transplanted kidneys of rats in the control group within 4 weeks, leading to the necrosis of transplanted kidney. Moderate inflammatory cel infiltration appeared in the transplanted kidneys of rats in the model group at 4, 8 and 12 weeks after transplantation. Typical histopathological changes of chronic rejection were observed within 12 weeks after transplantation. The Banff total scores were increased with time after transplantation. Al these histopathological changes were not observed in the intact right kidneys of rat recipients in both groups. The valey value of 

Objective To evaluate the effect of evidence- based nursing for patients receiving percutaneous coronary intervention and stent implantation. Methods A total of 136 patients with coronary heart disease were randomly divided into the intervention group (n = 68) and the control group (n = 68). Traditional nursing measures were employed for the patients of the control group , while evidence-based nursing intervention was adopted for the patients of the intervention group. The patient’s comfortableness, satisfaction and the occurrence of complications were determined at 24, 48 and 72 hours after the operation, and the results were compared between the two groups. Results At 24, 48 and 72 h after percutaneous coronary intervention, the each dimension score of GCQ and the total score of the intervention group were significantly higher than those of the control group (P<0.05). The occurrence of back pain, urinary retention and hypotension in the intervention group was significantly lower than those of the control group (P < 0.05). Patient’s satisfaction extent of the intervention group was significantly better than that of the control group (P < 0.05). Conclusion Evidence-based nursing intervention can effectively enhance the nursing skill and orientation, and reduce the occurrence of back pain, urinary retention and hypotension, thus improve patient’s comfortableness and satisfaction. Therefore, evidence - based nursing intervention should be recommended in clinical practice.

Objective To investigate the effects of aggressive dosing of atorvastatin on the expression of SOCS1 in CD4 + Tlymphocytes from patients with unstable angina pectoris during peri-operative period of PCI.Methods A cohort of 50 patients with unstable angina pectoris were randomized (random number) to give pretreatment with either an aggressive dose (80 mg/d,n =25) or a routine dose (20 mg/d,n =25)of atorvastatin.Circulating CD4 +T cells were subsequently obtained prior to PCI,and also 18 h to 24 hours after PCI,using a magnetic cell sorting system (MACS).Fluorescence-based quantitative real-time polymerase chain reaction (qRT-PCR) was used to measure expressions of SOCSI mRNA in the isolated CD4 + Tlymphocytes,and western blot analysis was used to detect levels of SOCS1 protein.Serum levels of IFN-γwere quantified using enzyme-linked immunosorbent assays (ELISAs).Results Compared with routine dose group,the expressions of SOCS1 mRNA and protein levels were dramatically increased and those were higher in aggressive dose group following PCI (P ＜ 0.05).In contrast,serum levels of IFN-γsignificantly increased following PCI in both groups,but it was higher in routine dose group than in aggressive dose group (P ＜ 0.05).Conclusions Treatment with aggressive dosing of atorvastatin reduced the post-PCI myocardial inflammatory response in patients with unstable angina pectoris,possibly modulating by up-regulating SOCS1 expression in CD4 + Tlymphocytes.

Objective To investigate the application value of three-dimensional surgery planning system in the preoperative evaluation of primary liver cancer (PLC) resection. Methods A total of 44 patients with PLC [32 males and 12 females, mean age of (60±12) years old] in Department of General Surgery, Lanzhou University Second Hospital from June 2012 to June 2013 were enrolled in this prospective study. The informed consents of all patients were obtained and the ethics committee approval was received. According to random number table method, the patients were randomly divided into 2 groups: computed tomography angiography (CTA) group and three-dimensional surgery planning (3D) group. Subgroups of complex PLC and non-complex PLC were further defined in each group according to tumor size, tumor invasive extent and history of surgery. In CTA group, 8 cases was assigned in complex PLC subgroup and 14 cases in non-complex PLC subgroup, and 6, 16 cases respectively in 3D group. CTA was used in the preoperative evaluation of PLC resection in CTA group. Liver three-dimensional surgery planning system was used in the preoperative evaluation of PLC resection in 3D group. The intra-operative finding was taken as a gold standard. The visualization of PLC, the adjacent relationship between PLC and peripheral tissues, the display rates of 12 abdominal vessels, variation of hepatic artery, vascular invasion of tumor, cholangiectasis by CTA and three-dimensional surgery planning system were observed. The relationship between estimated tumor volume by three-dimensional surgery planning system and actual weights of resected tumor was analyzed. Non-normal distribution data were expressed in M(Q25,Q75). The display rates by 2 methods were compared using Chi-square or Fisher's exact probability test. The relationship between estimated tumor volume by three-dimensional surgery planning system and actual weights of resected tumor was analyzed using Spearman rank correlation analysis. Results PLC lesions could be both visualized by 2 methods. The adjacent relationship between PLC and peripheral tissues could also be clearly visualized by three-dimensional surgery planning system. For patients with complex PLC, the display rate of abdominal vessels was 81%(78/96) in CTA group, and was 100%(72/72) in 3D group, where significant difference was observed (χ2=15.1, P<0.05). Cholangiectasis could not be visualized in CTA group and the display rate of cholangiectasis was 3/6 in 3D group. For patients with non-complex PLC, the display rate of abdominal vessels was 90%(151/168) in CTA group, and was 100%(192/192) in 3D group, where signiifcant difference was observed (χ2=20.39, P<0.05). Cholangiectasis could not be visualized in CTA group and the display rate of cholangiectasis was 19%(3/16) in 3D group. For patients with complex PLC, the median estimated tumor volume by three-dimensional surgery planning system was 218(129,429)ml and the actual weights of resected tumor was 194(112,429)g, where positive correlation was observed (r=0.943, P<0.05) with an average error rate of 6.5%. For patients with non-complex PLC, the estimated tumor volume by three-dimensional surgery planning system was 368(89,560)ml and the actual weights of resected tumor was 395(126,578)g, where positive correlation was observed (r =0.958, P<0.05) with an average error rate of 6.3%. Conclusions Compared with CTA, three-dimensional surgery planning system can better display the adjacent relationship between tumor and peripheral tissues, abdominal vessels, cholangiectasis and estimate the volume of resected tumor more accurately. It is especially suitable for patients with complex liver cancer.

This study examined the protective effect of ischemic postconditioning (IPoC) and minocycline postconditioning (MT) on myocardial ischemia-reperfusion (I/R) injury in atherosclerosis (AS) animals and the possible mechanism. Forty male healthy rabbits were injected with bovine serum albumin following feeding on a high fat diet for 6 weeks to establish AS model. AS rabbits were randomly divided into 3 groups: (1) I/R group, the rabbits were subjected to myocardial ischemia for 35 min and then reperfusion for 12 h; (2) IPoC group, the myocardial ischemia lasted for 35 min, and then reperfusion for 20 s and ischemia for 20 s [a total of 3 cycles (R20s/I20s×3)], and then reperfusion was sustained for 12 h; (3) MT group, minocycline was intravenously injected 10 min before reperfusion. The blood lipids, malondialdehyde (MDA), superoxide dismutase (SOD), soluble cell adhesion molecule (sICAM), myeloperoxidase (MPO), and cardiac troponin T (cTnT) were biochemically determined. The myocardial infarction size (IS) and apoptosis index (AI) were measured by pathological examination. The expression of bcl-2 and caspase-3 was detected in the myocardial tissue by using reverse transcription-polymerase chain reaction (RT-PCR). The results showed that the AS models were successfully established. The myocardial IS, the plasma levels of MDA, sICAM, MPO and cTnT, and the enzymatic activity of MPO were significantly decreased, and the plasma SOD activity was significantly increased in IPoC group and MT group as compared with I/R group (P<0.05 for all). The myocardial AI and the caspase-3 mRNA expression were lower and the bcl-2 mRNA expression was higher in IPoC and MT groups than those in I/R group (all P<0.05). It is concluded that the IPoC and MT can effectively reduce the I/R injury in the AS rabbits, and the mechanisms involved anti-oxidation, anti-inflammation, up-regulation of bcl-2 expression and down-regulation of caspase-3 expression. Minocycline can be used as an effective pharmacologic postconditioning drug to protect myocardia from I/R injury.
Animals ; Atherosclerosis ; physiopathology ; Ischemic Preconditioning, Myocardial ; methods ; Male ; Minocycline ; pharmacology ; Myocardial Reperfusion Injury ; physiopathology ; Rabbits ; Reperfusion Injury ; physiopathology