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*

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 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.

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 investigate the role of bone marrow mesenchymal stem cells (BMSCs) pretreated with erythropoietin (EPO) in the prevention of acute rejection after renal transplantation in rats. Methods BMSCs were divided into five groups: control group (without EPO), group A (pretreated with EPO at a final concentration of 10 IU/mL), group B (pretreated with EPO at a final concentration of 100 IU/mL), group C (pretreated with EPO at a final concentration of 500 IU/mL) and group D (pretreated with EPO at a final concentration of 1 000 IU/mL). In each group, the BMSCs were cultured for 24 h and 48 h. The proliferation rate of the BMSCs was determined by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT) assay. The BMSCs were divided into two groups: BMSC group (without EPO) and EPO-BMSC group (pretreated with EPO at a final concentration of 500 IU/mL). After 48 h culture, Western blot was adopted to measure the expression level of CXC chemokine receptor (CXCR) 4 protein in BMSCs. Wistar rats were used as the donors, and SD rats were utilized as the recipients to establish the rat models with acute rejection after renal transplantation. The recipient rats were randomly divided into four groups (n=6 in each group) including the control group (without any intervention), EPO group (injection of 1 mL of solution containing 500 IU EPO via tail vein immediately after surgery), BMSC group (injection of 1 mL of solution containing 1×106/mL BMSCs via tail vein immediately after surgery) and EPO-BMSC group (injection of 1 mL of solution containing 1×106/mL BMSCs cultured in vitro with 500 IU/mL EPO via tail vein). The level of serum creatinine (Scr) level was determined by Scr detection kit. Western blot was used to detect the expression levels of interferon (IFN)-γ and interleukin (IL)-4 proteins. Results After 24 h culture, the proliferation rate of BMSCs did not significantly differ among all groups (all P>0.05). After 48 h culture, the proliferation rate of BMSCs in group C (pretreated with EPO at a final concentration of 500 IU/mL) was significantly higher than that in the control group (P<0.05). Compared with the BMSC group, the expression level of CXCR4 protein on the surface of BMSCs was higher in the EPO-BMSC group (P<0.05). At 1 d after renal transplantation, the levels of Scr did not significantly differ among all groups (all P>0.05). At 5 d after operation, the levels of Scr in the EPO, BMSC and EPO-BMSC groups were significantly lower than that in the control group (all P<0.05). The level of Scr in the EPO-BMSC group was markedly lower than those in the EPO and BMSC groups (both P<0.05). At postoperative 1 d and 5 d, the expression levels of IL-4 protein in the kidney tissues did not significantly differ among all groups (all P>0.05). At 1 d after surgery, compared with control group, the expression levels of IFN-γ protein and IFN-γ/IL-4 ratio in the renal tissues in the EPO, BMSC and EPO-BMSC groups were significantly decreased to varying extents (all P<0.05), and similar results were obtained at 5 d after surgery (all P<0.05). The expression levels of IFN-γ protein and IFN-γ/IL-4 ratio in the EPO-BMSC group were significantly lower than those in the EPO group and BMSC group (both P<0.05). Conclusions BMSCs pretreated with EPO can prevent the incidence of acute rejection after renal transplantation and protect the renal graft function.

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.

Components and compounding of parenteral nutrition solutions were different in different hospitals and different parts of China.In order to raise awareness,reduce improper compounding and improve patient safety,Pharmacy Cooperative Group of Chinese Society for Parenteral and Enteral Nutrition composed the Consensus for Parenteral Nutrition Solutions Compounding,providing evidence for standardization in this field.

Objective To summarize the puncture indications and the pathological type features of renal allografts biopsies in our center for evaluating its safety and diagnostic value .Methods The data of 773 percutaneous renal allograft biopsies in 629 kid‐ney transplants in the Pearl River Hospital of Southern Medical University from January 2005 to June 2014 were retrospectively an‐alyzed .Results The success rate of renal biopsy was 100% ,9 cases(1 .2% ) were complicated postoperative perirenal small hemato‐ma ,33 cases(4 .3% ) with gross hematuria and 1 case(0 .13% )with abdominal pain .Among the indications of 773 biopsies ,protein urine occured 205 cases(26 .5% ) of patient ,blood Cr increased in 187 cases(24 .2% )of patients ,protein urine simultaneously com‐plicating blood Cr increased ,in 313 cases of patients ,53 cases(6 .9% )had postoperative oliguria urinary ,and 15 cases(1 .9% )were get procedural biopsy .In the pathological types ,21 cases(2 .7% ) were normal ,179 cases (23 .2% ) were acute T cell‐mediated rejec‐tion after transplantation ,51 cases (6 .6% )were acute antibody‐mediated rejection ,205 cases (26 .5% ) were chronic T cell‐mediated rejection and 43 cases(5 .6% ) were chronic antibody‐mediated rejection;41 cases(5 .3% ) were drug toxicity ,29 cases(3 .7% ) were acute tubular necrosis(ATN) ,11 cases(1 .4% ) were relapsed or new nephropathy ;9 cases(1 .2% )were HBV related renal disease;39 cases (5 .0% ) were critical lesion and 145 cases(18 .8% )were others .Conclusion Rrenal allograft biopsy is safe ,it is important to the etiological diagnosis of renal disease after renal transplant ,which can guide the clinical treatment and improve the long term survival of renal graft and should be routinely carried out in clinic .

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