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*

Oral submucous fibrosis(OSF)is a chronic and inflammatory mucosal disease caused by betel quid chewing,which belongs to oral potentially malignant disorders.Abnormal fibroblast differentiation leading to disordered collagen metabolism is the core process underlying OSF development.The epithelium,which is the first line of defense against the external environment,can convert external signals into pathological signals and participate in the remodeling of the fibrotic microenvironment.However,the specific mechanisms by which the epithelium drives fibroblast differentiation remain unclear.In this study,we found that Arecoline-exposed epithelium communicated with the fibrotic microenvironment by secreting exosomes.MiR-17-5p was encapsulated in epithelial cell-derived exosomes and absorbed by fibroblasts,where it promoted cell secretion,contraction,migration and fibrogenic marker(α-SMA and collagen type I)expression.The underlying molecular mechanism involved miR-17-5p targeting Smad7 and suppressing the degradation of TGF-β receptor 1(TGFBR1)through the E3 ubiquitination ligase WWP1,thus facilitating downstream TGF-β pathway signaling.Treatment of fibroblasts with an inhibitor of miR-17-5p reversed the contraction and migration phenotypes induced by epithelial-derived exosomes.Exosomal miR-17-5p was confirmed to function as a key regulator of the phenotypic transformation of fibroblasts.In conclusion,we demonstrated that Arecoline triggers aberrant epithelium-fibroblast crosstalk and identified that epithelial cell-derived miR-17-5p mediates fibroblast differentiation through the classical TGF-β fibrotic pathway,which provided a new perspective and strategy for the diagnosis and treatment of OSF.

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.

The implementation and implementation of DIP medical insurance payment system reform has a far-reaching impact on hospital operation and management mode,which resulted in an urgent need to adapt and optimise the way hospitals operate and manage their content.It analyzes in-depth DIP health insurance payment for the impact of hospital operations and management,from the perspective of the implementation of disease classification policy,medical insurance cost accounting control,medical service quality improvement,medical insurance after-the-fact analysis,disease category management,etc.In order to better promote the healthy and sustainable development of the hospital.

The implementation and implementation of DIP medical insurance payment system reform has a far-reaching impact on hospital operation and management mode,which resulted in an urgent need to adapt and optimise the way hospitals operate and manage their content.It analyzes in-depth DIP health insurance payment for the impact of hospital operations and management,from the perspective of the implementation of disease classification policy,medical insurance cost accounting control,medical service quality improvement,medical insurance after-the-fact analysis,disease category management,etc.In order to better promote the healthy and sustainable development of the hospital.

The implementation and implementation of DIP medical insurance payment system reform has a far-reaching impact on hospital operation and management mode,which resulted in an urgent need to adapt and optimise the way hospitals operate and manage their content.It analyzes in-depth DIP health insurance payment for the impact of hospital operations and management,from the perspective of the implementation of disease classification policy,medical insurance cost accounting control,medical service quality improvement,medical insurance after-the-fact analysis,disease category management,etc.In order to better promote the healthy and sustainable development of the hospital.

The implementation and implementation of DIP medical insurance payment system reform has a far-reaching impact on hospital operation and management mode,which resulted in an urgent need to adapt and optimise the way hospitals operate and manage their content.It analyzes in-depth DIP health insurance payment for the impact of hospital operations and management,from the perspective of the implementation of disease classification policy,medical insurance cost accounting control,medical service quality improvement,medical insurance after-the-fact analysis,disease category management,etc.In order to better promote the healthy and sustainable development of the hospital.

The implementation and implementation of DIP medical insurance payment system reform has a far-reaching impact on hospital operation and management mode,which resulted in an urgent need to adapt and optimise the way hospitals operate and manage their content.It analyzes in-depth DIP health insurance payment for the impact of hospital operations and management,from the perspective of the implementation of disease classification policy,medical insurance cost accounting control,medical service quality improvement,medical insurance after-the-fact analysis,disease category management,etc.In order to better promote the healthy and sustainable development of the hospital.

The implementation and implementation of DIP medical insurance payment system reform has a far-reaching impact on hospital operation and management mode,which resulted in an urgent need to adapt and optimise the way hospitals operate and manage their content.It analyzes in-depth DIP health insurance payment for the impact of hospital operations and management,from the perspective of the implementation of disease classification policy,medical insurance cost accounting control,medical service quality improvement,medical insurance after-the-fact analysis,disease category management,etc.In order to better promote the healthy and sustainable development of the hospital.

The implementation and implementation of DIP medical insurance payment system reform has a far-reaching impact on hospital operation and management mode,which resulted in an urgent need to adapt and optimise the way hospitals operate and manage their content.It analyzes in-depth DIP health insurance payment for the impact of hospital operations and management,from the perspective of the implementation of disease classification policy,medical insurance cost accounting control,medical service quality improvement,medical insurance after-the-fact analysis,disease category management,etc.In order to better promote the healthy and sustainable development of the hospital.