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To assess the application of extracorporeal membrane oxygenation (ECMO) regional treatment pattern in patients with severe cardiopulmonary diseases.A retrospective analysis was conducted. Patients with severe cardiopulmonary disease who were transferred to Henan Provincial People's Hospital after ECMO treatment in cooperative hospitals were selected. The patients who received regular ECMO treatment from June 2017 to May 2018 were enrolled as the control group, and the patients who received ECMO regional treatment from June 2018 to May 2019 were selected as the observation group. The ECMO regional treatment pattern referred to implement a referral program for critical patients in primary hospitals, which mainly included the establishment of ECMO regional cooperative treatment network and ECMO referral team, the formulation of ECMO referral management standards, and the promotion of the merging of high-quality medical resources. Time of establishment of ECMO, ECMO regional treatment satisfaction, and the incidence of adverse events were also compared.There were 27 patients enrolled in the control group and 64 patients in the observation group. There were no significant differences in gender, age, body mass index (BMI), ECMO mode, hypertension or coronary heart disease history between the two groups. Compared with the control group, the time for establishment of ECMO in the observation group was significantly shorter (minutes: 38.10±17.19 vs. 54.67±41.30, t = 2.715, P = 0.008), the ECMO treatment satisfaction of the observation group was also significantly higher than that of the control group (98.4% vs. 88.9%, χThe ECMO regional collaborative pattern in patients with severe cardiopulmonary diseases can shorten the time for establishment of ECMO, improve the satisfaction of ECMO treatment, and reduce the incidence of adverse events in ECMO referral.

To investigate the present status of intensive care unit (ICU) in the county-level general hospitals of Henan Province and provide basis for improving the construction level and rational allocation of medical resources of ICU.According to The guidelines for the construction and management of critical care medicine (trial implementation) issued by National Health Commission (NHC) (hereinafter referred as the guidelines), a cross-sectional survey was conducted on the present status of ICU in 93 county-level general hospitals in Henan Province in 2018 by using a self-designed questionnaire concerning this topic. The survey included the basic information of ICU (establishment time, organization and management mode, development of special departments in ICU, construction of key disciplines), scale and staffing allocation and training, and the equipment and technology development situation in ICU.The basic aspects of ICU situation were as follows: firstly, the establishment time: the ICU of county-level general hospitals in Henan Province started relatively late. The survey showed that all the 93 hospitals had set up ICU, of which the earliest was the ICU of Xunxian People's Hospital in 1989, only 4 county-level general hospitals established their ICUs before 2000, and 34 before 2009. Secondly, the management mode: the proportion of ICU closely managed was accounting for 68.82% (64/93), while semi-open management was 18.28% (17/93), and 12.90% (12/93) hospitals still adopted the open management mode. Thirdly, development of specialized ICU and construction of key disciplines: comprehensive ICUs were founded in 86 hospitals, and the proportions of specialized ICUs such as neonatal ICU, emergency ICU and coronary heart disease care unit (CCU) were higher than other kinds of special department; the ICUs of 8 hospitals were the key discipline of Henan Provincial Health Commission, and the ICUs of 9 hospitals were the discipline of Municipal Health Commission. Scale and staffing of ICU: a total of 2 189 ICU beds were opened in 93 county-level general hospitals. The utilization rate reaching the targets of ICU beds and the compliance rate of ICU bed area per bed were relatively high, 76.34% and 80.64%, while the compliance rates of ICU doctors/ICU beds, ICU nurses/ICU beds were low, which were 8.60% and 7.52% respectively, indicating that the clinicians and nursing facilities were insufficient. There were 1 tertiary hospital, 76 secondary-A hospitals and 16 secondary-B hospitals in this survey. Compared with secondary-B hospitals in the total number of beds (sheets: 922.22±285.99 vs. 636.75±258.84) and ICU beds (sheets: 25.28±21.15 vs. 14.63±6.89), the secondary-A hospitals were significantly higher (all P0.01), and the rate of bed use compliance of secondary-A hospitals was significantly higher than that in secondary-B hospitals [81.6% (62/76) vs. 50.0% (8/16), P0.01]. In terms of staffing, the proportion of clinicians and nurses with elementary titles was the highest, the proportion of full-time senior professional titles was relatively low, the proportion of doctors with bachelor's degree was the highest, and that of nurses with junior college degree was the highest. In personnel training, the hospitals surveyed had sent the doctors and nurses mostly to participate in the continuing education and training of critical care medicine at or above the provincial level for 745 person-times and 1 156 person-times, and there were in the mean for 8 and 12 person-times in each hospital, respectively. In terms of equipment configuration and technology development of ICU, mostly the equipment in ICU of county-level general hospitals consisted of microinjection pump, monitor, infusion pump, invasive ventilator, expectorant machine, etc. but the overall equipment was insufficient. Although an extracorporeal membrane oxygenation (ECMO) equipment was introduced in one hospital, it had not been carried out clinically. All county-level general hospitals in Henan Province had set up ICUs, but there were gaps between the compliance rates of many indicators and the requirements of the guidelines, and the medical personnel and equipment were relatively insufficient.The ICUs of county-level general hospitals in Henan Province have developed rapidly in recent years, but there is still much room for improvement.

With the development of society and economy, the disease spectrum of Chinese residents has undergone a major change, and the public health emergencies have occasionally occurred. The new situation has put forward higher requirements on the emergency capacity, professional technical level and treatment quality of critical care treatment system. Combining with the advantages of hospital aviation, ground and Internet emergency, Henan Provincial People's Hospital established a new construction path of emergency and critical care treatment system, namely "trinity" rescue system of aviation, ground and Internet emergency treatment and the "five-ring" model of critical care treatment system in hospital. The purpose of this paper is to summarize the practical experience of the construction of emergency and critical care system in Henan Provincial People's Hospital, so as to provide reference for the management of emergency and critical care in China.

BACKGROUND The coronavirus disease (COVID-19) pandemic, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in the self-quarantine of countless people due to possible infection. This situation makes telemedicine necessary as it can overcome geographical barriers, increase the number of people served, and provide online clinical support for patients. However, the outcomes of telemedicine have not yet been evaluated. OBJECTIVE The aim of our study is to describe the epidemiological features and clinical symptoms of patients receiving remote diagnosis and treatment at the online outpatient clinic of our hospital, as well as to analyze the outcomes and advantages of telemedicine, during the COVID-19 pandemic. METHODS Data from patients receiving remote diagnosis and treatment via consultation services for COVID-19 concerns at the online outpatient clinic of Henan Provincial People's Hospital from January 24 to February 17, 2020, were collected. A retrospective analysis was performed on epidemiological features, clinical symptoms, and preliminary outcomes. RESULTS Online inquiry, consultation, and suggestions were provided for patient concerns related to COVID-19. Our hospital also offered offline noncontact drug delivery services following online ordering and payment. A total of 4589 patients receiving remote diagnosis and treatment were recruited. The daily number of online outpatient visits initially increased and then decreased, reaching its peak on January 28 when the daily number of online outpatient visits totaled 612. Of 4589 patients, 1940 (42.3%) were males and 2649 (57.7%) were females (age range: 78 days to 85 years). Most patients were aged 20-39 years (n=3714, 80.9%) and came from Henan Province (n=3898, 84.9%). The number of patients from other provinces was 691 (15.1%). During the online consultations, patients discussed the following symptoms: fever (n=2383), cough (n=1740), nasal obstruction (n=794), fatigue (n=503), and diarrhea (n=276). A total of 873 orders of noncontact drug delivery following online payment was completed. The daily number of such orders gradually stabilized after the initial, steady increase. For offline drug delivery orders, the median (IQR) was 36 (58). An online satisfaction survey was filled out postconsultation by patients; of the 985 responses received, 98.1% (n=966) of respondents were satisfied with the service they received. CONCLUSIONS Remote diagnosis and treatment offered via online outpatient consultations effectively reduced the burden on hospitals, prevented overcrowding, reduced the risk of cross-infection, and relieved patients' anxiety during the COVID-19 outbreak. This plays an essential role in pandemic management.

Background The coronavirus disease (COVID-19) pandemic, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in the self-quarantine of countless people due to possible infection. This situation makes telemedicine necessary as it can overcome geographical barriers, increase the number of people served, and provide online clinical support for patients. However, the outcomes of telemedicine have not yet been evaluated. Objective The aim of our study is to describe the epidemiological features and clinical symptoms of patients receiving remote diagnosis and treatment at the online outpatient clinic of our hospital, as well as to analyze the outcomes and advantages of telemedicine, during the COVID-19 pandemic. Methods Data from patients receiving remote diagnosis and treatment via consultation services for COVID-19 concerns at the online outpatient clinic of Henan Provincial People's Hospital from January 24 to February 17, 2020, were collected. A retrospective analysis was performed on epidemiological features, clinical symptoms, and preliminary outcomes. Results Online inquiry, consultation, and suggestions were provided for patient concerns related to COVID-19. Our hospital also offered offline noncontact drug delivery services following online ordering and payment. A total of 4589 patients receiving remote diagnosis and treatment were recruited. The daily number of online outpatient visits initially increased and then decreased, reaching its peak on January 28 when the daily number of online outpatient visits totaled 612. Of 4589 patients, 1940 (42.3%) were males and 2649 (57.7%) were females (age range: 78 days to 85 years). Most patients were aged 20-39 years (n=3714, 80.9%) and came from Henan Province (n=3898, 84.9%). The number of patients from other provinces was 691 (15.1%). During the online consultations, patients discussed the following symptoms: fever (n=2383), cough (n=1740), nasal obstruction (n=794), fatigue (n=503), and diarrhea (n=276). A total of 873 orders of noncontact drug delivery following online payment was completed. The daily number of such orders gradually stabilized after the initial, steady increase. For offline drug delivery orders, the median (IQR) was 36 (58). An online satisfaction survey was filled out postconsultation by patients; of the 985 responses received, 98.1% (n=966) of respondents were satisfied with the service they received. Conclusions Remote diagnosis and treatment offered via online outpatient consultations effectively reduced the burden on hospitals, prevented overcrowding, reduced the risk of cross-infection, and relieved patients' anxiety during the COVID-19 outbreak. This plays an essential role in pandemic management.

Background: Etomidate (R-1-[1-ethylphenyl] imidazole-5-ethyl ester) is a widely used anesthetic drug that had been reported to contribute to cognitive deficits after general surgery. However, its underlying mechanisms have not been fully elucidated. In this study, we aimed to explore the neurobiological mechanisms of cognitive impairments that caused by etomidate. Methods: A total of 30 Sprague-Dawley rats were used and divided into two groups randomly to receive a single injection of etomidate or vehicle. Then, the rats' spatial memory ability and neuronal survival were evaluated using the Morris water maze test and Nissl staining, respectively. Furthermore, we analyzed levels of oxidative stress, as well as cyclic adenosine 3',5'-monophosphate response element-binding (CREB) protein phosphorylation and immediate early gene (IEG, including Arc , c-fos , and Egr1 ) expression levels using Western blot analysis. Results: Compared with vehicle-treated rats, the etomidate-treated rats displayed impaired spatial learning (day 4: 27.26 ± 5.33 s vs. 35.52 ± 3.88 s, t = 2.988, P = 0.0068; day 5: 15.84 ± 4.02 s vs. 30.67 ± 4.23 s, t = 3.013, P = 0.0057; day 6: 9.47 ± 2.35 s vs. 25.66 ± 4.16 s, t = 3.567, P = 0.0036) and memory ability (crossing times: 4.40 ± 1.18 vs. 2.06 ± 0.80, t = 2.896, P = 0.0072; duration: 34.00 ± 4.24 s vs. 18.07 ± 4.79 s, t = 3.023, P = 0.0053; total swimming distance: 40.73 ± 3.45 cm vs. 27.40 ± 6.56 cm, t = 2.798, P = 0.0086) but no neuronal death. Furthermore, etomidate did not cause oxidative stress or deficits in CREB phosphorylation. The levels of multiple IEGs (Arc: vehicle treated rats 100%, etomidate treated rats 86%, t = 2.876, P = 0.0086; c-fos: Vehicle treated rats 100%, etomidate treated rats 72%, t = 2.996, P = 0.0076; Egr1: Vehicle treated rats 100%, etomidate treated rats 58%, t = 3.011, P = 0.0057) were significantly reduced in hippocampi of etomidate-treated rats. Conclusion: Our data suggested that etomidate might induce memory impairment in rats via inhibition of IEG expression.

Brain dysfunction, especially cognitive impairment, is one of the main complications in Alzheimer's disease (AD), which threatens the health of 46.8 million people worldwide. At present, the pathogenesis of cognitive dysfunction is only partially understood, and effective therapies for memory loss in AD remain elusive. Tetramethylpyrazine (TMP) is one of the major bioactive compounds purified from Chuanxiong, a Chinese herb used for the treatment of neurovascular and cardiovascular diseases. The neuroprotective properties of TMP are evident in some neurodegenerative diseases, including Parkinson's disease. However, whether TMP plays a neuroprotective role in AD is still unknown. Here, we report that 2-week treatment with TMP rescued both short-term and long-term fear memory impairment induced by intracerebroventricular injection of streptozotocin in a well-known AD rat model. Administration of TMP also restored spatial learning and memory retention abilities in streptozotocin-injected rats. Furthermore, TMP inhibited the activity of GSK-3β, an important kinase that mediates hippocampal synaptic and memory disorders in diabetes mellitus. Finally, we found that TMP treatment restored the function of cholinergic neurons. Our data suggest that dietary uptake of TMP can provide protection against memory loss in AD, and the inhibition of GSK-3β may play an important role in this protective effect.

Edaravone is a novel free radical scavenger that exerts neuroprotective effects by inhibiting endothelial injury and by ameliorating neuronal damage in brain ischemia. Recently, it was reported that edaravone could alleviate the pathology and cognitive deficits of Alzheimer's disease patients. However, its relevance to vascular dementia (VaD) is not clear. In this study, we partially occluded the bilateral carotid arteries of rats surgically to induce chronic cerebral hypoperfusion (CCH), a well-known rat model of VaD. Water maze and step-down inhibitory test were used to evaluate the memory deficit. The activities of superoxide dismutase (SOD) and lactate dehydrogenase (LDH), the content of malondialdehyde (MDA) and total reactive oxygen species were measured to evaluate the oxidative stress level. Western blot analysis was used to evaluate the synaptic protein expression. It was found that treatment with edaravone for a 5-week period was able to reverse both spatial and fear-memory deficits in rats with CCH. Edaravone significantly reduced the level of oxidative stress in the brains of rats with CCH by increasing SOD activity and decreasing the content of MDA, LDH, and total reactive oxygen species. Furthermore, edaravone treatment also restored the levels of multiple synaptic proteins in the hippocampi of rats with CCH. Our data provide direct evidence supporting the neuroprotective effects of edaravone in VaD. We propose that the alleviation of oxidative stress and restoration of synaptic proteins play important roles in neuroprotection.

Dysfunction of learning and memory is widely found in many neurological diseases. Understanding how to preserve the normal function of learning and memory will be extremely beneficial for the treatment of these diseases. However, the possible protective effect of minocycline in memory impairment is unknown. We used the well-established D-galactose rat amnesia model and two behavioral tasks, the Morris water maze and the step-down task, for memory evaluation. Western blot and PCR were used to examine the protein and mRNA levels of Arc/Arg3.1. We report that minocycline supplementation ameliorates both the spatial and fear memory deficits caused by D-galactose. We also found that Arc/Arg3.1, c-fos, and brain-derived neurotrophic factor levels are decreased in the D-galactose animal model, and that minocycline reverses the protein and mRNA levels of Arc in the hippocampus, suggesting the potential role of Arc/Arg3.1 in minocycline's neuroprotective mechanism. Our study strongly suggests that minocycline can be used as a novel treatment for memory impairment in neurological diseases.

To establish a prognostic model for predicting extracorporeal circulation clotting in patients with continuous renal replacement therapy (CRRT).425 patients with CRRT were involved in the study. We built a predictive risk model of extracorporeal blood clotting with the 302 participants, and 103 participants were used to validate the model. The primary endpoint of CRRT was extracorporeal circulation pipe blockage.We used a score of 0-5 point evaluating system to predict the risk of 24 hours CRRT integral model of cardiopulmonary bypass clogging. The area under the CRRT predictive model of cardiopulmonary bypass clogging integral system ROC curve was 0.790 (95% CI 0.719-0.826) (P0.001). The evaluating system can determine the blockage of 24 hours CRRT extracorporeal circulation. The results showed that CRRT extracorporeal plugging prediction fitted the integral model and could predict the chance of plugging. The actual plugging rate showed no significant difference from the predicted rate (R² = 0.301, P=0.232). The cardiopulmonary pipe survival time between the 3 groups(low risk, intermediate risk, and high risk) showed a significant difference (P0.05).We established a continuity extracorporeal blood purification plugging risk score model, to predict plugging risks during CRRT treatment.