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 evaluate the practical application of the Media Fill Test(MFT)in assessing aseptic compounding competency of personnel in Pharmacy Intravenous Admixture Services(PIVAS).Methods A multicenter controlled study was conducted across six tertiary hospitals(center ①-⑥)in China.Participants were divided into an inexperienced group(Group A,n=118)and an experienced group(Group B,n=118),each performing five MFT operations.Positive controls validated medium efficacy.Contamination rates and pass rates were analyzed using chi-square and Fisher's exact tests.Results Valid samples included 584 for Group A and 588 for Group B.The sample pass rate was 66.78%(390/584)in Group A and 91.67%(539/588)in Group B,while personnel pass rates were 46.15%(54/117)and 80.51%(95/118),respectively,with significant intergroup differences(both P<0.01).All centers except Center ⑥ showed significantly higher pass rates in Group B(all P<0.05).Conclusion MFT effectively differentiates technical proficiency levels and is suitable for training evaluation of novice PIVAS staff.

Objective To evaluate the practical application of the Media Fill Test(MFT)in assessing aseptic compounding competency of personnel in Pharmacy Intravenous Admixture Services(PIVAS).Methods A multicenter controlled study was conducted across six tertiary hospitals(center ①-⑥)in China.Participants were divided into an inexperienced group(Group A,n=118)and an experienced group(Group B,n=118),each performing five MFT operations.Positive controls validated medium efficacy.Contamination rates and pass rates were analyzed using chi-square and Fisher's exact tests.Results Valid samples included 584 for Group A and 588 for Group B.The sample pass rate was 66.78%(390/584)in Group A and 91.67%(539/588)in Group B,while personnel pass rates were 46.15%(54/117)and 80.51%(95/118),respectively,with significant intergroup differences(both P<0.01).All centers except Center ⑥ showed significantly higher pass rates in Group B(all P<0.05).Conclusion MFT effectively differentiates technical proficiency levels and is suitable for training evaluation of novice PIVAS staff.

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.

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.

【Objective】 To compare the outcomes of robot-assisted laparoscopic transperitoneal and retroperitoneal operation for huge (>6 cm) adrenal tumors. 【Methods】 The clinical data of 45 patients with huge adrenal tumors who underwent robotic surgery during Jan.2017 and Dec.2021 were retrospectively analyzed, including 28 cases via the transperitoneal approach and 17 cases via the retroperitoneal approach. 【Results】 No patients were converted to open operations. There were no significant differences in postoperative drainage time (2.24±0.44 vs. 2.36±0.49) d, operation time (130.88±5.96 vs. 136.61±8.39) min, blood loss (189.41±13.91 vs. 192.5±12.36) mL and postoperative hospital stay (7.06±0.56 vs. 7.46±0.69) d between the retroperitoneal and transperitoneal approaches. Retroperitoneal approach was better than transperitoneal approach in early postoperative feeding [(38.82±6.75 vs. 74.14±6.57) h, P<0.01] . 【Conclusion】 Robotic surgery is safe and effective in the treatment of large adrenal tumors. The choice of surgical approach should be based on patients’ condition, tumor volume and location.

In recent years, it has been common for heart disease patients to undergo urological surgery.The requirements for specialized doctors to accurately assess the risk of perioperative heart disease thrombosis are also increasing. In order to conduct multi-disciplinary disease analysis and discussion in a more standardized profile and promote clinical work progress in a safer manner, this article provides a systematic review and summary of the basic characteristics of antithrombotic drugs, the bleeding risks of urological surgery, the risk identification standards for arteriovenous thrombosis, as well as the withdrawal conditions, bridging selection, and restart treatment of perioperative antithrombotic drugs, based on the constantly updated clinical researches and guideline consensuses in recent years.

Objective To evaluate the effect of erythropoietin (EPO) on the proliferation and migration of bone marrow mesenchymal stem cell (BMSC) in rats. Methods The 5th generation BMSCs were divided into the control (without EPO) and 10, 100, 500, 1 000 IU/mL EPO groups. After 24 h and 48 h of culture, the proliferation rate, migration ability and the expression levels of CXCR4 of BMSCs were detected in each group. The 5th generation BMSCs were further divided into BMSC and EPO-BMSC groups. After 48 h of culture, the effect of EPO upon surface markers, directional differentiation and cytoskeleton morphology of BMSCs were evaluated in both groups. Results After theco-culture of EPO and BMSCs for 48 h, the proliferation rate and migration ability of BMSCs were significantly enhanced, and the expression level of CXCR4 protein was significantly up-regulated in the 100 IU/mL and 500 IU/mL EPO groups compared with those in the control group (all P < 0.05). However, EPO exerted no effect upon the expression levels of surface markers and directional differentiation ability of BMSCs in the EPO-BMSC group. In the EPO-BMSC group, the fibrous skeleton of most BMSCs was arranged along the long axis in parallel. Conclusions EPO can improve the proliferation rate, migration ability and tissue repair capability of BMSCs, probably by promoting the directional homing of BMSCs to injured organs and tissues via up-regulating the expression level of CXCR4.

Objective To investigate the effect of cartilage acetabular ,glenoid labrum and acetabular tissue on closed reduction of developmental dysplasia of hip ( DDH ) by analyzing the outcomes of the ultrasound measurement on DDH before and after Pavik Harness treatment . Methods Graf method was used in ultrasound measurement before the treatment . Position of cartilaginous acetabulum and glenoid labrum and displacement direction of femoral head in 31 patients with hip dislocations ( type D ,type Ⅲ ,typeⅣ ,36 hips) were recorded . T he follow‐up testing with ultrasound measurement on the inside of the hip were performed after 1 －2 weeks of Pavik Harness treatment . M ediolateral dimension ,anteroposterior dimension and the area of maximum section of acetabular tissue were measured . Reduction effects were evaluated . Results T he success rate of reduction of dislocation hips with cartilaginous acetabulum on the head orientation was obviously higher than that on the foot orientation( P ＜0 .000 1) . T he success rate of reduction of dislocation hips with glenoid labrum on the head orientation was obviously higher than that on the foot orientation ( P ＝ 0 .001 6 ) . T here was a statistically significant difference in the success rate of different types of hip dislocation ( type D , type Ⅲ , type Ⅳ ) ( P＝ 0 .002 7 ) . T here were statistically significant differences in mediolateral dimension ,anteroposterior dimension and the area of maximum section of acetabular tissue between the reduction group and the group without dislocation ,the irreducible group and the group without dislocation ,the irreducible group and the reduction group ( P ＜ 0 .01) . Conclusions Ultrasonography is of great significance in the diagnosis and treatment of children with DDH . T he position of hip cartilaginous acetabulum and glenoid labrum ,types of hip dislocation and the volume of acetabular tissue have important effects on the success of the closed reduction .

Objective To evaluate the growth and survival of single kidney transplants with donation after citizen death (DCD) donors from infants and children (＜3 years of age) to adults.Methods We retrospectively analyzed the data of single kidney transplants with donors from infants and young children to adults in our center.All the recipients were divided into infant donor group (≤3 years of age) and children donor group (1 year＜ age ≤3 years) in terms of the donor's age.The serum creatinine (SCr) level after surgery was determined and the major diameter of the kidney was measured by Doppler B ultrasonography.DGF,vascular complications,urinary tract complications,proteinuria,acute rejection,and infection were recorded during the follow-up period.Results There were 24 cases in infant donor group and 37 in children donor group.The mean follow-up period was 28 months.The SCr level at 1 st month post-transplantation was significantly higher in infant donor group than in children donor group (350.67 ± 35.57 μmol/L versus 193.70 ± 86.76 μmol/L),and the major diameter ((X-)± s) of the kidney in children donor group was significantly greater than that in infant donor group (78.29 ± 4.68 mm versus 93.62 ± 5.57 mm),but there was no significant difference during the subsequent 3-year follow-up period.The incidence of DGF in infant donor group was significantly higher than in children donor group,but there was significant difference in the rate of vascular complications,urinary tract complications,proteinuria,acute rejection,and infection between two groups.Conclusion The single kidney transplants from infants and young children to adults can grow rapidly,and their survival rate is relatively high.