Neurocritical care involves complex pathophysiological mechanisms, and its incidence is higher, injuries are more severe, and treatment is more challenging in high-altitude environments. This consensus, based on the latest domestic and international evidence-based medical data, establishes a standardized, goal-oriented framework for neurocritical care management applicable in high-altitude regions and nationwide. The consensus was developed following international standards for evidence quality assessment and underwent two rounds of Delphi expert consultation, resulting in 32 recommendation statements covering three parts: management systems, monitoring and assessment, and core strategies. Key updates include: advocating for the establishment of independent neurocritical care units and implementing precise tiered diagnosis and treatment based on the "Five Differences in Critical Care" concept; constructing a "trinity" multimodal brain monitoring system centered on cerebral blood flow, cerebral oxygenation, and brain function, emphasizing routine bedside transcranial Doppler ultrasound, cerebral oximetry, and continuous electroencephalography monitoring; shifting management strategies from mild hypothermia therapy to targeted temperature management, and defining the "446" target management pathway for the supercritical stage; emphasizing the assessment of static and dynamic cerebrovascular autoregulation functions through multimodal methods to achieve individualized optimal mean arterial pressure management; elevating cerebrospinal fluid management goals to the level of "glymphatic system" function maintenance; implementing a multidisciplinary collaborative, whole-process management model focusing on patients' long-term neurological functional outcomes; de-escalation criteria include multidimensional indicators such as recovery of brain structure, restoration of cerebrovascular autoregulation, improvement in cerebrospinal fluid dynamics, and reduction in biomarker levels; and integrating cutting-edge technologies like artificial intelligence into post-critical care management and rehabilitation planning. This consensus systematically integrates the entire process of neurocritical care management, reflecting the modern connotation of goal-oriented, dynamic, and multimodal integration in neurocritical care medicine. It aims to adapt to new trends such as deepening understanding of pathophysiological mechanisms, the integration of medicine and engineering, and the empowerment of artificial intelligence, thereby further advancing the discipline of critical care medicine.

Objective:This study aimed to explore the status of radiological Kashin-Beck disease (KBD) among school-aged children in Chamdo City, Tibet, through a 3-year monitoring survey, providing epidemiological evidence for prevention and control strategies.Methods:The target areas for this study were Luolong, Bianba, and Basu counties in Chamdo City, Tibet Autonomous Region, identified as having the most severe historical cases of KBD. Children aged 7-12 years attending school were enrolled as study subjects. Anteroposterior X-ray films of the right-hand were taken, and radiological diagnoses were made based on the "Diagnosis of Kashin-Beck Disease" criteria (WS/T 207-2010). Two experienced researchers independently reviewed the X-rays, and intra- and inter-group consistency were assessed using weighted Kappa values and percentage agreement. Cross-sectional surveys were conducted in 2017 and 2020 to describe the X-ray detection rates of KBD, and logistic regression analysis was employed to construct a predictive model of risk factors for radiological KBD cases.Results:In 2017, a total of 5,711 children aged 7-12 years in Chamdo City, Tibet, participated in the baseline cross-sectional survey (average age 9.2 years, 48.0% female), with 28 cases of radiological KBD. The age- and gender-standardized prevalence rate was 0.527%. In 2020, 6,771 participants (average age 9.3 years, 49.5% female) underwent a second cross-sectional survey, with 9 cases of radiological KBD and a standardized prevalence rate of 0.134%. Logistic regression analysis indicated that older age [ OR=2.439, 95% CI(1.299, 4.580), P=0.006] and female gender [ OR=8.157, 95% CI(1.016, 65.528), P=0.048] were independent risk factors for radiological KBD cases. Conversely, higher residential altitude, under the premise of Tibet's high altitude, was a protective factor [ OR=0.995, 95% CI(0.990, 0.999), P=0.032). Conclusion:The radiographically positive detection rate of KBD among school-aged children in Chamdo City, Tibet Autonomous Region, is at an extremely low level and showing a declining trend, reaching the historical standard in 2020. Considering the absence of positive signs in affected children, it suggests that local KBD has been effectively eliminated.

Objective To observe the clinical efficacy of the integrative Chinese and western medicine therapy with the utilization of Niujiao Dihuang Jiedu Decoction(derived from the modified Xijiao Dihuang Decoction)in the treatment of acute-on-chronic liver failure(ACLF).Methods Sixty patients with ACLF of toxic-heat-stasis stagnation type were randomly divided into the trial group and the control group,with 30 patients in each group.The control group was given western medicine comprehensive treatment(including etiologic treatment,liver-protecting treatment and symptomatic and supportive treatment),while the trial group was treated with Niujiao Dihuang Jiedu Decoction on the basis of treatment for the control group,and the courses of treatment covered four weeks.The changes of liver function indicators and coagulation function indicators of the patients in the two groups before and after treatment were observed,and the clinical efficacy of the patients in the two groups after treatment was evaluated.Results(1)During the trial,there were two cases in the trial group and three cases in the control group dropped off,and the falling-off cases in the two groups were counted as invalid cases.(2)After four weeks of treatment,the total effective rate of the trial group was 80.00%(24/30)and that of the control group was 53.33%(16/30),and the intergroup comparison(by chi-square test)showed that the therapeutic efficacy of the trial group was significantly superior to that of the control group(P＜0.05).(3)After treatment,liver function indicators such as alanine transaminase(ALT),aspartate transaminase(AST),total bilirubin(TBIL),and direct bilirubin(DBIL)in the two groups were significantly improved compared with those before treatment(P＜0.05),and the improvement of liver function indicators in the trial group was significantly superior to that in the control group(P＜0.05).(4)After treatment,the prothrombin time(PT)of patients in the two groups was significantly improved when compared with that before treatment(P＜0.05),and the improvement of PT in the trial group was significantly superior to that in the control group(P＜0.05).Conclusion The integrative Chinese and western medicine therapy with the utilization of Niujiao Dihuang Jiedu Decoction is effective in treating ACLF patients with toxic-heat-stasis stagnation type,which can significantly improve the liver function and coagulation function of the patients.The therapeutic efficacy of the integrative therapy is significantly superior to that of the western medicine comprehensive treatment alone,which has high clinical value.

Enterotoxigenic Escherichia coli（ETEC）infection can induce watery diarrhea，leading to dehydration，electrolyte disturbance，and even death in severe cases. Recombinant B subunit/inactivated whole-cell cholera（rBS/WC）vaccine is effective in preventing ETEC infectious diarrhea. On the basis of the latest evidence on etiology and epidemiology of ETEC，as well as the effectiveness，safety，and health economics of rBS/WC vaccine，National Clinical Research Center for Child Health（The Children’s Hospital，Zhejiang University School of Medicine）and Zhejiang Provincial Center for Disease Control and Prevention invited experts to develop expert consensus on rBS/WC vaccine in prevention of ETEC infectious diarrhea. It aims to provide the clinicians and vaccination professionals with guidelines on using rBS/WC vaccine to reduce the incidence of ETEC infectious diarrhea.

Objective: To explore the association between the cognition of Nutrition Facts Panel and prepackaged food purchase behavior among residents in six provinces in China. Methods: Using a multi-stage sampling method, 3 002 adults aged 18-70 were selected from the western region (Sichuan), eastern region (Guangdong, Jiangsu, Beijing), central region (Henan), and northeastern region (Heilongjiang) of China from July 2020 to March 2021. Socio-demographic characteristics of participants and their cognition of Nutrition Facts Panel and prepackaged food purchase behavior were collected through questionnaire. A multivariate binary logistic regression model was used to analyze the association between cognition of Nutrition Facts Panel and prepackaged food purchase behavior. Results: The age of 3 002 subjects was (42.3±13.4) years, among which 63.8% (1 914) were female, 66.7% knew the Nutrition Facts Panel, 49.8% would read it when purchasing, 30.7% could understand it, and 56.6% (1 699) bought prepackaged food more than once a week. The results of multivariate analysis showed that after adjusting for relevant confounding factors, compared with the participants knowing but not reading the Nutrition Facts Panel, the group knowing and reading was more likely to buy 11 types of prepackaged food at least once a week (all P<0.05). Compared with the participants reading but not understanding the Nutrition Facts Panel, the group reading and understanding was less likely to buy 11 types of prepackaged food at least once a week (all P<0.05). Conclusion: There was a correlation between cognition of Nutrition Facts Panel and prepackaged food purchase behavior among residents.
Adult ; Female ; Humans ; Male ; Food Labeling/methods* ; Food ; Nutritional Status ; Surveys and Questionnaires ; China ; Health Knowledge, Attitudes, Practice

OBJECTIVE: To investigate the ameliorate effect and underlying mechanism of Xueshuantong for Injection (Lyophilized, , XST) in streptozocin (STZ)-induced diabetic retinopathy (DR) rats. METHODS: Diabetes mellitus (DM) model was induced by intraperitoneal (i.p.) injection of STZ (60 mg/kg) in Sprague-Dawley rats. Diabetic rats were randomized into 3 groups (n=10) according to a random number table, including DM, XST50 and XST100 groups. XST treatment groups were daily i.p. injected with 50 or 100 mg/kg XST for 60 days, respectively. The control and DM groups were given i.p. injection with saline. Blood glucose level and body weight were recorded every week. Histological changes in the retina tissues were observed with hematoxylin-eosin staining. Apoptosis and inflammation related factors, including cleaved caspase-3, glial fifibrillary acidic protein (GFAP), tumor necrosis factor-α (TNF-α) and intercellular cell adhesion molecule-1 (ICAM-1) were detected by Western blot or real-time polymerase chain reaction. Then, the levels of advanced glycation end product (AGE) and its receptor (RAGE) were investigated. Tight junctions proteins (Zonula occludens-1 (ZO-1), Occludin and Claudin-5) of blood-retinal barrier were detected by Western blot. The levels of retinal fifibrosis, transforming growth factor-β1 (TGF-β1)-Smad2/3 signaling pathway were evaluated at last. RESULTS: There was no signifificant difference in the body weight and blood glucose level between XST and DM groups (P>0.05). Compared with the DM group, XST treatment signifificantly increased the retinal thickness of rats (P<0.05 or P<0.01), and suppressed cleaved caspase-3 expression (P<0.01). XST increased the protein expressions of ZO-1, Occludin and Claudin-5 and decreased the mRNA expressions of matrix metalloproteinase 2 (MMP-2) and MMP-9 (P<0.05 or P<0.01). Moreover, XST signifificantly reduced the productions of AGE and RAGE proteins in the retina of rats (P<0.05 or P<0.01), suppressed the over-expression of TNF-α, and decreased the elevated level of ICAM-1 in retina of rats (P<0.05 or P<0.01). XST signifificantly reduced the levels of α-smooth muscle actin (α-SMA), connective tissue growth factor (CTGF), TGF-β1 and phosphorylation of Smad2/3 protein in rats (P<0.05 or P<0.01). CONCLUSIONS XST had protective effects on DR with possible mechanisms of inhibiting the inflammation and apoptosis, up-regulating the expression of tight junction proteins, suppressing the productions of AGE and RAGE proteins, and blocking the TGF-β/Smad2/3 signaling pathway. XST treatment might play a role for the future therapeutic strategy against DR.

To establish the UPLC fingerprint of Zhongyi Angong Niuhuang Pills, in order to evaluate its quality by chemical pattern recognition. The method was developed on a column of Poroshell 120 EC-C_(18), with methanol-0.1% formic acid solution as the mobile phase for gradient elution at a flow rate of 0.4 mL·min~(-1). The column temperature was 30 ℃,and the detective wavelength was 254 nm. The similarity of 24 batches of Angong Niuhuang Pills was compared by using Traditional Chinese Medicine Chromatographic Fingerprint Similarity Evaluation System(2004 A). Hydrophobic cluster analysis,principal components analysis and partial least squares discriminant analysis were conducted by using SIMCA 13.0 software to investigate different components among these products. The UPLC characteristic fingerprint was established in this study. And 17 common peaks were identified by standard reference and UPLC-MS. The similarity of 24 batches samples were above 0.980,which can be classified into three categories for pattern recognition. Baicalin,berberine,jatrorrhizine,wogonin and wogonoside were identified as the main markers that cause differences of various batches. The method is simple,rapid,accurate and reproducible,and can provide scientific basis for improving the quality standard of Zhongyi Angong Niuhuang Pills.
Chromatography, High Pressure Liquid ; Drugs, Chinese Herbal/chemistry* ; Tandem Mass Spectrometry

In recent years,the role of pericytes in brain tissue has received increasing attention.Pericytes as a member of microcirculation vascular wall cells,are involved in a variety of regulatory functions.Pericytes,astrocytes and endothehal cells constitute Bloodbrain barrier together,maintaining the stability of the brain tissue environment.For cerebrovascular diseases,such as stroke,dementia and other neurodegenerative diseases,pericytes play an important role.The following is a brief introduction to the role of pericytes and simple drug therapy.

BACKGROUNDInvasive fungal infections such as candidiasis and mold infections cause significant morbidity and mortality in seriously ill patients. Micafungin is an echinocandin antifungal agent with potent activity against most species of Candida and Aspergillus. We did this meta-analysis to clarify whether micafungin offers superior efficacy and safety compared with other antifungal agent for treating infections associated with invasive candidiasis.

METHODSWe did a meta-analysis of randomized controlled trials to examine whether micafungin has superior efficacy and safety compared with other antifungal agents recommended by the treatment guidelines for fungal infection. Seven trials involving 2913 patients were included in this analysis. Odds ratios (OR) and 95% confidence intervals (CI) were calculated.

RESULTSMicafungin was associated with significantly better treatment success compared with the comparator antifungal agents (modified intention to treat, 2851 patients; random-effects model, OR 1.20, 95%CI 1.00 - 1.45, P = 0.0487). In addition, micafungin was more effective than the comparators for antifungal prophylaxis of neutropenic patients undergoing hematopoietic stem cell transplantation (OR 1.47, 95%CI 1.08 - 2.00, P = 0.01). Although there was no significant difference between the compared regimens in terms of the incidence of adverse drug effects (OR 0.94, 95%CI 0.77 - 1.11), fewer patients treated with micafungin withdrew from the studies because of adverse events (OR 0.64, 95%CI 0.44 - 0.94).

CONCLUSIONSMicafungin has a good safety and tolerability profile, with an efficacy at least comparable to the other antifungal agents. Micafungin offers advantages over other agents for antifungal prophylaxis. Micafungin offers an appropriate alternative for antifungal prophylaxis rather than the treatment of invasive candida infections.

Antifungal Agents ; adverse effects ; therapeutic use ; Candidiasis, Invasive ; drug therapy ; Echinocandins ; adverse effects ; therapeutic use ; Humans ; Lipopeptides ; adverse effects ; therapeutic use ; Randomized Controlled Trials as Topic ; Treatment Outcome

ObjectiveTo study tumor necrosis factor-related apoptosis-inducing ligand(TRAIL) 1525 locus polymorphism in patients with nodular thyroid disease and investigate the relation between individual gene polymorphism and thyroid diseases.Methods A total of 125 patients were diagnosed with nodular thyroid disease at the Department of Endocrinology,the First Affiliated Hospital of Inner Mongolia Medical College.Among these patients,67 cases were nodular thyroid goiter and 58 cases were nodular thyroid adenoma,54 males,71 females,and average age was 41.05 ± 14.42. Patients with nodular thyroid goiter were grouped into toxic and non-toxic and thyroid adenoma were grouped into high-functioning or non-high-functioning.A total of 100 healthy subjects.47 males,53 females,average age 42.35 ± 16.52 were as control group.According to the principle of informed consent,venous blood was collected,polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method for TRAIL gene 1525 locus polymorphism determination was performed to calculate genotype of the TRAIL gene (homozygous GG,heterozygous GA,mutationhomozygous AA) and the gene frequency (G,A),and relative degree of risk(odd ratio,OR) was compared.ResultsNodular goiter group TRAIL gene 1525 locus genotype frequencies(GG:40.3％,AG:44.8％,AA:14.9％),allele frequencies(G:62.7％,A:37.3％) were compared with that of the control group(GG:17.0％,AG:65.0％,AA:18.0％; G:49.5％,A:50.5％),the differences were statistically significant(x2 =11.376,5.633,P ＜ 0.01 or ＜ 0.05 ).Adenomas group 1525 locus genotype frequencies of the TRAIL gene(GG:44.8％,AG:38.0％,AA:17.2％),allele frequencies(G:63.8％,A:36.2％) were compared with that of the control group,the differences were statistically significant(x2 =15.342,6.054,P ＜ 0.01 or ＜ 0.05).Allele frequencies of thyroid goiter group and denoma group were compared with that of the control group,OR values were 1.714 and 1.797(all P ＜ 0.05) and 95％ confidence intervals were 1.097 - 2.679 and 1.124 - 2.874.The difference of 1525 locus genotype or allele frequency distribution in toxic and non-toxic nodular group,high functioning and non-high-functioning adenomas group were not statistically significant (x2 =3.714,2.792; 1.103,2.020; all P ＞ 0.05).ConclusionTRAIL gene 1525 locus polymorphism is significantly associated with nodular thyroid disease.