Objective To summarize the clinical features and treatment strategies of acute mercury poisoning caused by intramuscular injection of metallic mercury. Methods The clinical data of a patient with acute mercury poisoning following intramuscular injection of metallic mercury were collected, and a retrospective analysis of the diagnosis and treatment process was conducted. Results The patient was a 14-year-old boy who self-injected 20 g of metallic mercury into the left upper arm muscle. Clinical manifestations included fever, chest tightness, cough, and a painful mass at the injection site. Laboratory tests of the patient indicated that blood mercury level was 4.160 μmol/L, urinary mercury level was 6 545.50 μg/g creatinine, urinary retinol-binding protein was 6 556 μg/L, urinary β₂-microglobulin was 8 726.48 μg/g creatinine, and urinary α1-microglobulin was 41.60 mg/L at day 11 after injection. Thoracoabdominal imaging revealed mercury deposition in the lungs, heart, liver, kidneys, and other organs. The patient's clinical symptoms were markedly relieved after one course of treatment with sodium dimercaptopropanesulfonate for mercury chelation. Subsequent treatment included continued mercury chelation therapy, debridement of muscle tissue at the injection site, removal of retained foreign bodies, and other supportive measures. Reexamination showed a blood mercury level of 2.810 μmol/L and urinary mercury level of 5 280 μg/L at day 127 after injection. Conclusion The clinical manifestations of intramuscular injection of metallic mercury poisoning differ from those of occupational mercury poisoning. Debridement of the injection site combined with sodium dimercaptopropanesulfonate chelation therapy can alleviate systemic symptoms and reduce mercury levels in such patients.

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*

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.

Objective:To compare the efficacy of single kidney transplantation (KT) from pediatric donors between donors aged <2 and 2- 18 years.Methods:Between August 2016 and May 2023, 127 single pediatric kidney transplantations involving pediatric donors were conducted. They were assigned into two subgroups based upon age of small pediatric donors (n=22, SPD, donors aged <2 years) and normal pediatric donors (n=105, NPD, donors aged 2-18 years). A retrospective analysis was performed to compare recipient/donor baseline characteristics, postoperative complications and recipient/graft survival rates between two groups.Results:Significant inter-group differences existed in donor age[11.0 (10.0, 15.0) vs 121.0 (74.0, 166.0) month], donor weight[8.3 (8.0, 9.4) vs 30.0 (20.0, 50.0) kg]and graft-to-recipient weight ratio[0.3 (0.2, 0.5) vs 1.0 (0.6, 1.5) ] ( P<0.001). Conversely, no significant inter-group differences existed in donor gender/type, warm/cold ischemic time, human leukocyte antigen mismatch number, estimated glomerular filtration rate, recipient gender/age/weight, number of transplants, preoperative dialysis, preoperative induction therapy, panel-reactive antibody or primary disease ( P>0.05). The incidence of vascular thrombosis was 9.1% (2/22) and 0 in SPD and NPD groups with statistically significant differences ( P=0.029) ; the incidence of post-transplant hemorrhage was 13.6% (3/22) and 1.9% (2/105) with statistically significant difference ( P=0.036). However, no statistically significant inter-group differences existed in recurrent renopathy, delayed graft function or 1-year cumulative incidence of acute rejection ( P>0.05). Six recipients (27.3%) in SPD group lost allografts due to recurrent or primary nonfunction (n=1), vascular thrombosis (n=2), post-transplant hemorrhage (n=2) and thrombotic microangiopathy (n=1). In comparison, three recipients (2.9%) in NPD group lost allografts due to rejection (n=2) and infectious rupture of transplanted renal artery (n=1). Three-year recipient survival rates were 100% and 99.0% in SPD and NPD groups with no statistically significant differences ( P=0.600). And 3-year death-censored graft survival was significantly lower in SPD group than that in NPD groups (77.3% vs 91.5%) ( P<0.001, HR=8.3, 95% CI: 2.0-34.2) . Conclusions:Early postoperative vascular complications after single pediatric KT from pediatric donors aged under 2 years are frequent and predispose to graft loss.

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 provide ideas and reference for the anti-infection treatment and pharmaceutical care for severe pneumonia caused by Chlamydia psittaci. METHODS Clinical pharmacists participated in the whole process of the treatment for a patient with C. psittaci-induced severe pneumonia. According to the patient’s medical history， clinical symptoms and test results， clinical pharmacists assisted the physician to dynamically adjust the anti-infective scheme； for C. psittaci infection， the patient was treated with tigecycline combined with azithromycin successively， and other infection therapy plans were dynamically adjusted according to the results of pathogen examination. During the treatment， the patient suffered from suspicious adverse drug reactions such as prolonged QTc interval， elevated lipase and amylase； the clinical pharmacists conducted pharmaceutical care and put forward reasonable suggestions. RESULTS The physician adopted the pharmacists’ suggestion， and the patient was discharged after treatment. CONCLUSIONS For the treatment of severe pneumonia caused by C. psittaci， the characteristics of patients， drugs and pathogens should be taken into account to develop individualized anti-infective treatment. Tetracyclines and macrolides have a definite effect on C. psittaci infection， but attention should be paid to the possible ADR caused by drugs in clinical application.

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.