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: To investigate the characteristics and trends of malaria cases in Lishui City, Zhejiang Province from 2012 to 2023, so as to provide a basis for improving malaria prevention and control measures. Methods: Case data of malaria in Lishui City from 2012 to 2023 were collected from the Parasitic Disease Control Information Management System of the National Information System for Disease Control and Prevention in China. The parasite species, source of infection, temporal distribution, population distribution, geographical distribution, and clinical diagnosis and treatment of the cases were descriptively analyzed. Results: A total of 169 malaria cases were reported in Lishui City from 2012 to 2023, and P. falciparum malaria was the main type, accounting for 79.88% (135 cases). The positive rate of Plasmodium detection was 3.30‰(169/51 212), the highest was 5.41‰ (18/3 327) in 2017, and the lowest was 0.38‰ (1/2 632) in 2021. Malaria cases were reported in every month from 2012 to 2023, with 91 cases (53.85%) reported from May to October. There were 168 imported cases, of which 163 (96.45%) originated from Africa. There were 127 male cases (75.15%), and the majority of cases were aged 20 to 49 years, with 138 cases accounting for 81.65%. The majority of the occupation was overseas labor export workers, with 164 cases accounting for 97.04%. A total of 161 cases (95.27%) were registered residents of Lishui City, and cases were reported from all nine counties (cities, districts), with Qingtian County and Liandu District having the higher numbers of 98 and 41 cases, respectively. The median interval from onset to hospital visit for malaria cases was 2.00 (interquartile range, 4.00) days, and the median interval from hospital visit to diagnosis was 0 (interquartile range, 1.00) day. The diagnostic rate of first-diagnosed malaria cases in municipal and county medical institutions was 95.90% (117/122) and 91.49% (43/47), respectively, with no statistical significance (P>0.05). Conclusions The P. falciparum malaria was the predominant type in Lishui City from 2012 to 2023, with the majority of cases being imported. Male overseas labor export personnel aged 20 to <50 were the key demographic.

Objective:To survey the knowledge levels about diagnosis and management of asthma among general practitioners in community health centers in Shanghai and to analyze influencing factors.Methods:A questionnaire survey was conducted from May to June 2022 among general practitioners from 80 community health care centers in Shanghai. The questionnaire contained the basic information of the responders; knowledge about the diagnosis of asthma (symptoms, diagnostic methods, interpretation of bronchodilation and fractional exhaled nitric oxide, FeNO tests); and treatment of asthma (choosing and usage of therapeutic drugs). Logistic regression was used to analyze.Results:A total 324 general practitioners completed the questionnaire survey. Among them 221 (68.21%) had bachelor degree; 200 (61.73%) were attending doctors; the median working duration was 11 years; 174 (53.70%) had training on asthma knowledge in last 3 years. The survey results showed that 55 (16.98%) responders misinterpreted results of bronchodilation test, and 90(5.86%)misinterpreted results of FeNO test for diagnosis of asthma; 244 responders (75.31%) suspected implication of long-term cough for diagnosis of asthma; 277(85.49%)would order bronchodilation text to suspected patients; 273(84.26%)prescribed inhaled corticosteroid plus long-acting beta-2 agonist to asthma patients. For mild asthma patients, 144 responders(44.44%)suggested to use budesonide formoterol as needed; for moderate to severe asthma, 174(53.70%)suggested to use budesonide formoterol regularly and as needed, 100(30.86%)suggested to use salmeterol fluticasone regularly and salbutamol as needed. Logistic analysis showed that longer working duration was correlated with higher misinterpretation rate of bronchodilation and FeNO tests( OR=0.798,95% CI:0.694-0.918, P=0.002; OR=0.859,95% CI:0.739-0.998, P=0.047). The accuracy rate of all the questions was significantly higher in general practitioners who had training on asthma knowledge than those who didn′t receive training in last 3 years(all P<0.05). Conclusions:Most general practitioners in community health service centers in Shanghai have relatively high levels of knowledge about diagnosis and treatment of asthma. Years of work experience and training experience can affect the levels of asthma knowledge among community general practitioners.

Objective:To investigate the impact of the deep learning reconstruction algorithm TrueFidelity TM for Gemstone Spectral Imaging (TF-GSI) and the adaptive statistical iterative reconstruction algorithm (ASiR-V, hereinafter referred to as ASiR-V) based on phantom and animal models on the image quality of dual-energy CT images. Methods:GE Revolution Apex CT was used to scan the ACR 464 phantom and a mouse model of gastric cancer with lymph node metastasis ( n=16). TF-GSI and ASiR-V were separately used to reconstruct middle and high-grade images (TF-GSI-M, TF-GSI-H, ASiR-V-50%, and ASiR-V-100%) on the phantom and mouse based on virtual monoenergetic images at 70 keV. The task transfer function (TTF) of bone and acrylic, image noise power spectrum (NPS), and detectability index (d′) of the phantom images were evaluated. One-way ANOVA analysis was used to compare the image noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) for brain and liver on images of mice. The consistency of the two reconstruction-algorithm images (TF-GSI-H and ASiR-V100%) in the detection of small lesions by two radiologists (A and B) was evaluated using kappa test. Results:In terms of the phantom, the TF-GSI-H group had the best performance in TTF, NPS, and d′. Compared to ASiR-V-100%, the TTF50% of bone and acrylic in the TF-GSI-H group increased by 2.4% and 8.9%, respectively; the NPS peak decreased by 54.1%, compared to ASiR-V-100%; the d′ of bone and acrylic in the TF-GSI-H group relative to ASiR-V-100% increased by 52.7% and 59.5%, respectively. The TF-GSI group had reduced image noise compared to the ASiR-V group, and both SNR and CNR of the two tissues increased, but the differences between the groups were not statistically significant (all P>0.05). The two reconstruction-algorithm images showed good consistency in image evaluation by the two radiologists (A, Kappa=0.875, P<0.001; B, Kappa=0.625, P=0.012). In terms of the detection of micro-metastases in mice, the TF-GSI group outperformed the ASiR-V group (average accuracy: 83.5% vs 71.9%; average sensitivity: 77.8% vs 61.2%; average specificity: 85.7% vs 85.7%). Conclusion:Compared with iterative reconstruction algorithm, the DLIR algorithm showed improved spatial resolution, reduced image noise, and enabled detectability of micro-lesion for images from dual-energy CT.

Background Neonicotinoid insecticides (NEOs) are emerging synthetic insecticides that have been used in various pest management regimens worldwide as alternatives to conventional insecticides. Recently, several studies have indicated that humans are widely exposed to NEOs, but limited is known about the levels and associated health risks of NEOs exposure among children. Objective To estimate exposure levels of four kinds of NEOs in urine samples among 5-year-old children from Laizhou Wan, Shandong Province, and to evaluate health risks of single and cumulative exposure to NEOs among children in this area. Methods A total of 205 children who participated in the 5-year-old follow-up in Laizhou Wan Birth Cohort (LWBC) were included. Urinary concentrations of four NEOs [imidacloprid (IMI), acetamiprid (ACE), clothianidin (CLO), and thiamethoxam (THM)] were measured by high-performance liquid chromatography coupled with triple quadrupole mass spectrometry. Based on the detected NEOs concentrations, estimated daily intake (EDI) was calculated, and the health risk of exposure to single NEO was assessed using hazard quotient (HQ, risk threshold=1). A relative potency factor (RPF) approach was used to standardize the concentrations of the four NEOs by IMI to calculate their cumulative concentrations. Then, the health risk of cumulative exposure to the four NEOs was further evaluated based on the HQ method. Results The detection rates of the four NEOs in the 5-year-old children were all above 90%, and their median creatinine-adjusted urinary concentrations were in the order from high to low as follows: CLO (1.373 μg·g⁻¹) > THM (0.628 μg·g⁻¹) > IMI (0.310 μg·g⁻¹) > ACE (0.073 μg·g⁻¹). Of the four NEOs, the median EDI of IMI was 0.035 µg·kg⁻¹·d⁻¹, higher than those of CLO (0.032 µg·kg⁻¹·d⁻¹), THM (0.012 µg·kg⁻¹·d⁻¹), and ACE (0.002 µg·kg⁻¹·d⁻¹). The maximum HQ values of IMI, CLO, THM, and ACE were 0.168, 0.152, 0.055, and 0.022, respectively, which were all far lower than the risk threshold of 1. The median concentration of cumulative exposure to the four NEOs standardized by IMI was 21.241 μg·g⁻¹, and its median EDI was 2.370 µg·kg⁻¹·d⁻¹. The maximum HQ of cumulative exposure to the four NEOs was only 0.694, which also did not exceed the risk threshold of 1. Conclusion NEOs exposure is common among the 5-year-old children in Laizhou Wan, Shandong. Although there is no obvious health risk associated with single and cumulative exposure to NEOs in the children in this area, their exposure levels of NEOs are higher than those in some foreign areas. The adverse health effects of long-term exposure to low dose of NEOs deserve our extensive attention.

The laterodorsal tegmentum (LDT) is a brain structure involved in distinct behaviors including arousal, reward, and innate fear. How environmental stimuli and top-down control from high-order sensory and limbic cortical areas converge and coordinate in this region to modulate diverse behavioral outputs remains unclear. Using a modified rabies virus, we applied monosynaptic retrograde tracing to the whole brain to examine the LDT cell type specific upstream nuclei. The LDT received very strong midbrain and hindbrain afferents and moderate cortical and hypothalamic innervation but weak connections to the thalamus. The main projection neurons from cortical areas were restricted to the limbic lobe, including the ventral orbital cortex (VO), prelimbic, and cingulate cortices. Although different cell populations received qualitatively similar inputs, primarily via afferents from the periaqueductal gray area, superior colliculus, and the LDT itself, parvalbumin-positive (PV) GABAergic cells received preferential projections from local LDT neurons. With regard to the different subtypes of GABAergic cells, a considerable number of nuclei, including those of the ventral tegmental area, central amygdaloid nucleus, and VO, made significantly greater inputs to somatostatin-positive cells than to PV cells. Diverse inputs to the LDT on a system-wide level were revealed.

Objective To investigate the pollution caused by the aerosols and variations of polycyclic aromatic hydrocarbons (PAHs) in a certain submarine cabins,and analyze the pollution source of PAHs,then to evaluate the toxicology of the contaminated submarine air.Methods Andersen cascade sampler was used to collect atmospheric particulate matter samples,during 6 days of continuous submergence of the submarine.The composition and variation of PAHs were analyzed by gas chromatography-mass spectrometry (GC-MS).Research on the main pollution sources of PAHs was made by using principal component analysis.Results Aerosol pollution in various cabins of the submarine was quite serious,furthermore it displayed the feature of pollution by different particle sizes.Particle size distribution analysis revealed that the 8-man cabin,meeting room,command room,torpedo room and engine room were of a unimodal size distribution,and the galley and hot air engine room displayed 3 relatively high peaks.Total PAHs were detected,with the concentration scope from 33.1 ng/m3 to 90.8 ng/m3 and with the 3-ring and 4-ring as the primary components.Total TEQ concentration ranged from 0.077 ng/m3 to 0.251 ng/m3.Conclusions Aerosol pollution in the cabins of the submarine was serious,with the cooking mist and volatile components of fuel as the main sources of PAHs and electrical appliances and laundry detergents as secondary source of pollution.

Objective To investigate the pollution caused by the aerosols and variations of polycyclic aromatic hydrocarbons (PAHs) in a certain submarine cabins,and analyze the pollution source of PAHs,then to evaluate the toxicology of the contaminated submarine air.Methods Andersen cascade sampler was used to collect atmospheric particulate matter samples,during 6 days of continuous submergence of the submarine.The composition and variation of PAHs were analyzed by gas chromatography-mass spectrometry (GC-MS).Research on the main pollution sources of PAHs was made by using principal component analysis.Results Aerosol pollution in various cabins of the submarine was quite serious,furthermore it displayed the feature of pollution by different particle sizes.Particle size distribution analysis revealed that the 8-man cabin,meeting room,command room,torpedo room and engine room were of a unimodal size distribution,and the galley and hot air engine room displayed 3 relatively high peaks.Total PAHs were detected,with the concentration scope from 33.1 ng/m3 to 90.8 ng/m3 and with the 3-ring and 4-ring as the primary components.Total TEQ concentration ranged from 0.077 ng/m3 to 0.251 ng/m3.Conclusions Aerosol pollution in the cabins of the submarine was serious,with the cooking mist and volatile components of fuel as the main sources of PAHs and electrical appliances and laundry detergents as secondary source of pollution.

Objective To investigate and analyze the pollution of aerosol PM 2.5,PM 10 and TSP in the cabins of a certain AIP-submarine during 8 days of continuous submerged operation.Methods The aerosol concentrations of the said substances in the submarine cabins were detected by using TSI8533 aerosol detector.Results In normal submerged operation,the aerosol concentrations in the cabins were all relatively lower,with the galley as an exception,however,they did not exceed the specified national standards.The PM 2.5 concentration in the galley exceeded the allowable limit specified in GB3095-2012.The highest concentrations of PM 2.5,PM 10 and TSP all occurred in the air compressor compartment when the compressor system was under operation.The next highest concentrations of these substances occurred in the main engine room,when damage control operation was under way.TSP concentration was relatively higher in the living cabins of the crew.Conclusions The main sources of aerosol pollution were air compressors and cooking oil fume.The crew and their activities also had some effects on the TSP concentration in the cabins of the submarine.

Objective To investigate and analyze the pollution of aerosol PM 2.5,PM 10 and TSP in the cabins of a certain AIP-submarine during 8 days of continuous submerged operation.Methods The aerosol concentrations of the said substances in the submarine cabins were detected by using TSI8533 aerosol detector.Results In normal submerged operation,the aerosol concentrations in the cabins were all relatively lower,with the galley as an exception,however,they did not exceed the specified national standards.The PM 2.5 concentration in the galley exceeded the allowable limit specified in GB3095-2012.The highest concentrations of PM 2.5,PM 10 and TSP all occurred in the air compressor compartment when the compressor system was under operation.The next highest concentrations of these substances occurred in the main engine room,when damage control operation was under way.TSP concentration was relatively higher in the living cabins of the crew.Conclusions The main sources of aerosol pollution were air compressors and cooking oil fume.The crew and their activities also had some effects on the TSP concentration in the cabins of the submarine.