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 explore the clinical efficacy of V-shape bichannel spinal endoscopy(VBE)in the treatment of degenerative lumbar spondylolisthesis(DLS)in elderly patients.Methods A total of 110 patients with DLS admitted to Wu'an First People's Hospital from June 2017 to April 2023 were selected as the research subjects.According to the surgical plan,these patients were divided into the minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)group and the VBE group,with 55 patients in each group.The general indicators of patients in the two groups during and after surgery,inclu-ding the length of the surgical incision,operation time,number of X-ray fluoroscopy,intraoperative blood loss,hospitalization time,and bed rest time were recorded.Before surgery and three,six months after surgery,the visual analogue scale(VAS)was used to assess the degree of pain in the back and legs,and the Oswestry disability index(ODI)was used to assess the lumbar function of the patients.The Brantigan score was used to assess bone fusion in patients at three months after surgery.X-ray films were taken before surgery and three,six months after surgery to measure the spondylolisthesis degree,intervertebral height,spondylolisthesis angle,and sagittal Cobb angle at the surgical segment.The Japanese Orthopaedic Association(JOA)score was used to assess the excellent and good rate of lumbar function in patients at six months after surgery.The incidence of postoperative complications of patients in both groups was recorded.Results The length of surgical incision,operation time,bed rest time,and hospitalization time of patients in the VBE group were significantly shorter than those in the MIS-TLIF group,and the intraoperative blood loss and X-ray fluoroscopy times were significantly less than those in the MIS-TLIF group(P＜0.05).There was no significant difference in VAS scores for low back pain and leg pain and ODI index between the two groups before surgery(P＞0.05).The VAS scores for low back pain and leg pain and the ODI index of patients in both groups at three and six months after surgery were significantly lower than those before surgery(P＜0.05).There was no significant difference in the VAS scores for low back pain and leg pain and ODI index between the VBE group and the MIS-TLIF group at three and six months after surgery(P＞0.05).There was no significant difference in the distribution of Brantigan scores of patients between the VBE group and the MIS-TLIF group(P＞0.05).There was no significant difference in the sagittal Cobb angle,intervertebral height,spondylolisthesis angle,and spondylolisthesis degree at the surgical segment of patients between the two groups before surgery(P＞0.05).The sagittal Cobb angle and intervertebral height at the surgical segment of patients in both groups at three and six months after surgery were significantly higher than those before surgery(P＜0.05),while the spondylolisthesis angle and spondylolisthesis degree were significantly lower than those before surgery(P＜0.05).There was no significant difference in the sagittal Cobb angle,intervertebral height,spondylolisthesis angle and spondylolisthesis degree at the surgical segment of patients between the two groups at three and six months after surgery(P＞0.05).At six months after surgery,the excellent and good rate of lumbar function in the VBE group and the MIS-TLIF group was 100.00％(55/55)and 98.18％(54/55),respectively.There was no significant difference in the excellent and good rate of lumbar function between the two groups(P＞0.05).No complications occurred in patients in the VBE group after surgery,while one patient in the MIS-TLIF group experienced incision exudation and delayed healing.Conclusion VBE treatment for degenerative lumbar spondylolisthesis in elderly patients shows similar efficacy with MIS-TLIF in terms of lumbar morphology,functional recovery,and safety.However,VBE can reduce tissue damage,enable earlier ambulation,and thereby accelerate the early postoperative recovery process.

OBJECTIVE: To explore the effects of veno-venous extra corporeal carbon dioxide removal (V-V ECCO₂R) on local mechanical power and gas distribution in the lungs of patients with mild to moderate acute respiratory distress syndrome (ARDS) receiving non-invasive ventilation. METHODS: Retrospective research methods were conducted. Sixty patients with mild to moderate ARDS complicated with renal insufficiency who were transferred to the respiratory intensive care unit (RICU) through the 96195 platform critical care transport green channel from January 2018 to January 2020 at the collaborative hospitals of Henan Provincial People's Hospital were enrolled. According to different treatment methods, they were divided into a conventional treatment group and an ECCO₂R group, with 30 patients in each group. Both groups received standard treatments including primary disease treatment, airway management, and non-invasive ventilation. The conventional treatment group received bedside continuous renal replacement therapy (CRRT), and the ECCO₂R group received V-V ECCO₂R treatment. General information of patient such as gender, age, cause of disease, and acute physiology and chronic health evaluation II (APACHE II) were recorded; arterial blood gas analysis was performed before treatment and at 12 hours and 24 hours during treatment, recording arterial partial pressure of oxygen (PaO₂), arterial partial pressure of carbon dioxide (PaCO₂), and oxygenation index (PaO₂/FiO₂). Respiratory mechanics parameters [tidal volume, respiratory rate, maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP)] were recorded, and the rapid shallow breathing index (RSBI) was calculated; electrical impedance tomography (EIT) was used to measure regional of interest (ROI) values in different lung areas at 12 hours and 24 hours of treatment, and the pulmonary mechanical energy was calculated. RESULTS: The arterial blood gas analysis indicators, respiratory mechanics parameters, and pulmonary mechanical energy of patients in the conventional treatment group and ECCO₂R group improved significantly after 24 hours of treatment compared to 12 hours of treatment (all P < 0.05). The levels of PaCO₂, RSBI, total mechanical power, and non-dependent zone mechanical power in the ECCO₂R group were significantly lower than those in the conventional treatment group at both 12 hours and 24 hours during the treatment [PaCO₂ (mmHg, 1 mmHg ≈ 0.133 kPa): 44.03±2.96 vs. 49.96±2.50 at 12 hours, 41.65±3.21 vs. 48.53±2.33 at 24 hours; RSBI (times×min^-1×L^-1): 88.67±4.05 vs. 92.35±4.03 at 12 hours, 77.66±4.64 vs. 90.98±4.21 at 24 hours; total mechanical power (mJ): 10.40±1.15 vs. 12.93±1.68 at 12 hours, 11.13±1.18 vs. 14.05±1.69 at 24 hours; non-dependent zone mechanical power (mJ): 7.15±0.84 vs. 7.98±0.75 at 12 hours, 7.77±0.93 vs. 9.13±1.10 at 24 hours], and MEP and MIP in the ECCO₂R group were significantly higher than those in the conventional treatment group at both 12 hours and 24 hours during the treatment [MEP (cmH₂O, 1 cmH₂O ≈ 0.098 kPa): 89.88±5.04 vs. 86.09±5.57 at 12 hours, 96.57±2.59 vs. 88.66±2.98 at 24 hours; MIP (cmH₂O): 47.64±2.82 vs. 41.93±2.44 at 12 hours, 60.11±6.53 vs. 43.63±2.80 at 24 hours], the differences were statistically significant (all P < 0.05). CONCLUSIONS V-V ECCO₂R combined with non-invasive ventilation can effectively reduce the regional tidal volume, mechanical power, and respiratory rate in the non-gravitational dependent zones of patients with mild to moderate ARDS, and improve respiratory distress and oxygenation status.
Humans ; Respiratory Distress Syndrome/physiopathology* ; Retrospective Studies ; Carbon Dioxide ; Blood Gas Analysis ; Lung/physiopathology* ; Intensive Care Units ; Male ; Female ; Noninvasive Ventilation/methods* ; Continuous Renal Replacement Therapy/methods* ; APACHE ; Middle Aged

Stroke rescue features strong time sensitivity and high complexity. Minimizing the time of consumption in pre-hospital and in-hospital stroke rescue is key to improve stroke rescue efficiency and reduce the disability rate. In December 2017, a tertiary hospital launched the construction of a one-stop stroke rescue platform. This platform was centered on " multi-mode image fusion operating room" , operating as a one-stop rescue mode integrating emergency admission, imaging examination, intravenous thrombolytic therapy, mechanical thrombolytic therapy, postoperative evaluation, and so on. The seamless convergence workflow of pre-hospital, in-hospital and post-hospital could effectively optimize the physical rescue pathway. In order to ensure the efficient and orderly operation of the platform, the hospital adopted such measures as multidisciplinary integration, pre-hospital and in-hospital integration construction, and regional stroke care network. Since its operation in September 2019, the platform has treated more than 1 000 patients by December 2021. The application of the platform had effectively improved the efficiency of stroke rescue, led the development of regional stroke rescue system, and provided the reference for raising the stroke rescue capacity and management level in China.

Ectopic thyroid gland refers to the presence of thyroid tissue outside the normal position of the neck, which is relatively rare in clinical practice, and ectopic and cancer change is rare. This article focuses on a patient with "supraclavicular mass" as the first symptom admitted to the Thyroid Surgery Department of Binzhou People’s Hospital, After the operation, the pathology confirmed ectopic thyroid cancer with lymph node metastasis, and the imaging showed lung metastasis. This article summarizes the case data.

Objective:To investigate the risk factors associated with lymph node posterior to right recurrent laryngeal nerve (LN-prRLN) metastasis in papillary thyroid carcinoma (PTC) , and analyze the clinical value of surgical dissection of LN-prRLN.Methods:Clinical data of 140 PTC patients admitted to the same treatment group from Jun. 2014 to Oct. 2015 (all patients underwent LN-prRLN area dissection, group A) were retrospectively analyzed. Univariate analysis and multivariate logistic regression analysis were used to analyze high-risk factors for LN- prRLN metastasis, and another 171 cases without LN-prRLN area dissection (group B) were collected as the control group. The total number of lymph nodes dissected in the central area on the right was compared to analyze the proportion of lymph nodes in the LN-prRLN area.Results:Of the 140 patients in group A, the right cervical lymph node metastasis rate was 64.3% (90/140) , the central zone lymph node metastasis rate was 63.6% (89/140) , and the LN-prRLN regional lymph node metastasis rate was 17.9% (25/140) . Univariate analysis showed that tumors>1 cm, multiple tumors, capsule invasion, clinical lymph node staging cN1,VI-1 and cervical lymph node metastasis were correlated with LN-prRLN metastasis ( P<0.05) . Multivariate analysis showed that capsule invasion ( OR=4.599, P=0.037) and cervical lymph node metastasis ( OR=3.505, P=0.036) were risk factors for LN-prRLN metastasis. By comparison with the control group, the total number of lymph node dissections in the right central area of group B was significantly less than that of group A ( P<0.01) . Conclusions:PTC patients have a high rate of lymph node metastasis in the right central area, and lymph nodes in the LN-prRLN area occupy a certain proportion. RN-prRLN should be routinely cleaned to ensure the completeness and thoroughness of the dissection, and to minimize the possibility of performing a second operation due to recurrence of residual lymph nodes after operation. More importance should be attached to LN-prRLN dissection when the tumor is more than 1 cm, the tumor is multiple, the capsule is invaded, in clinical lymph node stage cN1, VI-1 and with cervical lymph node metastasis.

Objective: To recombine the induced pluripotent stem cells (iPSC) derived from the urine of septic encephalopathy (SE) patients, and provided a specificity cell model to explore the mechanism of the neuronal damage and treatment for SE patients. Methods: Urine of SE patient was collected, and tubular epithelial cells were isolated and cultured from the urine. iPSC were derived from SE patient by introducing 4 transcription factors OCT4, Klf4, Sox2, c-Myc (OKSM) into patient-specific urine cells by Millipore's Human STEMCCA^TM Constitutive Polycistronic (OKSM) Lentivirus Kit. Colony morphology, alkaline phosphatase (AKP) activity, immunofluorescence staining, quantitative reverse transcription-polymerase chain reaction (RT-qPCR), and differentiation ability were used to identify the pluripetency of these iPSC lines. In addition, neurons were derived from these iPSC by inhibiting transforming growth factor-β (TGF-β) pathway. Results: The SE-iPSC exhibited morphological and growth characteristics of human embryonic stem cell (hES), showed positivity for AKP by histochemical staining, and expressed embryonic stem cell (ESC) marker genes. There was a significant statistical difference in ESC-marker mRNA expression between the SE-iPSC and the urine cells [NANOG mRNA (2^-ΔΔCt): 1.153±0.142 vs. 0.126±0.024, t = -10.688; REX1 mRNA (2^-ΔΔCt): 1.419±0.206 vs. 0.103±0.066, t = -14.245; OCT4 mRNA (2^-ΔΔCt): 1.233±0.176 vs. 0.201±0.022, t = -9.028; Sox2 mRNA (2^-ΔΔCt): 1.334±0.119 vs. 0.159±0.017, t = -12.653, all P < 0.01]. Subcutaneous injection of iPSC into NOD-SCID mice resulted in teratomas containing tissues from all the 3 germ layers. Furthermore, neurons were successfully induced from SE-iPSC. Conclusion The SE patient-specific iPSC could be generated from urine cells and differentiated into neurons, furthermore, the SE-iPSC cell line can be used as models for further elucidating the cellular pathology and developing therapeutic strategies for SE.

OBJECTIVE: To recombine the induced pluripotent stem cells (iPSC) derived from the urine of septic encephalopathy (SE) patients, and provided a specificity cell model to explore the mechanism of the neuronal damage and treatment for SE patients. METHODS: Urine of SE patient was collected, and tubular epithelial cells were isolated and cultured from the urine. iPSC were derived from SE patient by introducing 4 transcription factors OCT4, Klf4, Sox2, c-Myc (OKSM) into patient-specific urine cells by Millipore's Human STEMCCA^TM Constitutive Polycistronic (OKSM) Lentivirus Kit. Colony morphology, alkaline phosphatase (AKP) activity, immunofluorescence staining, quantitative reverse transcription-polymerase chain reaction (RT-qPCR), and differentiation ability were used to identify the pluripetency of these iPSC lines. In addition, neurons were derived from these iPSC by inhibiting transforming growth factor-β (TGF-β) pathway. RESULTS: The SE-iPSC exhibited morphological and growth characteristics of human embryonic stem cell (hES), showed positivity for AKP by histochemical staining, and expressed embryonic stem cell (ESC) marker genes. There was a significant statistical difference in ESC-marker mRNA expression between the SE-iPSC and the urine cells [NANOG mRNA (2^-ΔΔCt): 1.153±0.142 vs. 0.126±0.024, t = -10.688; REX1 mRNA (2^-ΔΔCt): 1.419±0.206 vs. 0.103±0.066, t = -14.245; OCT4 mRNA (2^-ΔΔCt): 1.233±0.176 vs. 0.201±0.022, t = -9.028; Sox2 mRNA (2^-ΔΔCt): 1.334±0.119 vs. 0.159±0.017, t = -12.653, all P < 0.01]. Subcutaneous injection of iPSC into NOD-SCID mice resulted in teratomas containing tissues from all the 3 germ layers. Furthermore, neurons were successfully induced from SE-iPSC. CONCLUSIONS The SE patient-specific iPSC could be generated from urine cells and differentiated into neurons, furthermore, the SE-iPSC cell line can be used as models for further elucidating the cellular pathology and developing therapeutic strategies for SE.
Animals ; Brain Diseases ; Cells, Cultured ; Fibroblasts ; Humans ; Kruppel-Like Factor 4 ; Mice ; Mice, Inbred NOD ; Mice, SCID ; Sepsis

OBJECTIVE:To screen the agonist active ingredients of peroxisome proliferator-activated receptor-γ (PPAR-γ) in flavonoids from Artemisia ordosica,and provide reference for finding antidiabetic agents in A.ordosica.METHODS:Using known PPAR-γagonist rosiglitazone as positive control,molecular docking technology was conducted for docking one by one for 18 flavonoids and PPAR-7 targets obtained from A.ordosica.It was compared with binding affinities and binding modes of compounds and PPAR-7 targets,and the possible PPAR-γ agonist ingredients in A.ordosica were screened.RESULTS:5 flavonoids showed good docking affinities,in which,compound 3 (5,3',4'-trihydroxy-7-methoxyflavone) showed the highest (-8.3 kcal/mol).Docking mode analysis showed that the phenol oxygen on ring A and ring B of the flavonoids with LBD active site of PPAR-γ formed one (Tyr327) or two hydrogen bonding (Tyr327,Arg288),which played an important role in the binding of flavonoids and PPAR-γ and the stability of PPAR-γ conformation.CONCLUSIONS:Results of virtual screening in molecular docking technology indicate that flavonoids (mostly containing multiple free phenolic hydroxyl groups) in can easily form good docking mode and high affinity with PPAR-γ,showing potential antidiabetic activity.The study can provide reference for further research of chemical ingredients for the treatment of type 2 diabetes.

Objective: To detect the expression of miR-133a-3p in gastric cancer (GC) tissues and plasma of GC patients, and to investigate its effect on the proliferation of GC cells as well as its correlation toprognosis of GC patients. Methods: 52 cases of cancertissues (non-necrosis part) and corresponding adjacent tissues as well as the pre-operative peripheral blood samples from GC patients, who underwent surgery at Department of General Surgery, the Forth Hospital of Hebei Medical University(Shijiazhuang, China) between May 2012 and May 2013, were collected for this study. The plasma sample (n=35) from healthy donors were obtained during their physical examination. RT-qPCR was adopted to detect the expression of miR-133a-3p in gastric cancer tissues, adjacent tissuesand plasma samples of GC patients and healthy volunteers. The relationships between miR-133a-3p expression and the median DFS as well as clinicopathological parameters were also analyzed. CCK-8 assay was adopted to detect the effect of miR-133a-3p silence or over-expression on proliferation of gastric cancer SGC7901 cells. Results: miR-133a-3p was dramatically decreased in gastric cancer tissues (P<0.01), and its expression was associated with TNM stage, tumor infiltration (T), lynphonode metastasis (N), and vascular tumor thrombus (all P<0.01); miR-133a-3p was significantly increased in the plasma of GC patients (P<0.01), and its expression was associated with TNM stage, lynphonode metastasis (N), and vascular tumor thrombus (all P<0.05). miR-133a-3p expression was positively correlated with serum CA199 level of GC patients (P<0.01). The median DFS of patients with high miR-133a-3pexpression in cancer tissues was significantly longer than that of the patients with low expression(20.8 vs 14.8 months, P<0.05); The median DFS of patients with high plasma miR-133a-3p expression was significantly shorter than that of the patients with low expression (14.4 vs 20.3 months, P<0.05). Over-expression of miR-133a-3p could significantly inhibit the proliferation of gastric cancer SGC7901 cells, while miR-133a-3p silence could significantly promote the proliferation (all P<0.05). Conclusion: miR-133a-3p could significantlyinhibit the proliferation of SGC7901 cells; miR-133a-3p aberrantlyexpressed in gastric cancer tissues and plasma, and obviously correlated with prognosis of gastric cancer patients, which may be used as a potential clinical bio-maker for early diagnosis and treatment as well as the prognosis prediction of gastric cancer.