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 explore the protective effect of L-carnitine on myocardial systolic dysfunction in sepsis and its underlying mechanism.Methods A mouse sepsis model was established by cecal ligation and puncture(CLP).Ten-week-old male SPF-grade C57BL/6 mice(body weight 20～30 g)were randomly divided into 5 groups via random number table:Sham group,Sepsis group,L-carnitine group,L-carnitine+Etomoxir(Eto)group,and Eto group.Echocardiography assessed cardiac function,ELISA measured serum creatine kinase isoenzyme MB(CK-MB)levels,and 72-hour survival rates were recorded to evaluate L-carnitine's effects on cardiac function.Cardiomyocytes were isolated,and a cell microtensiometer was used to detect cardiomyocyte contractile function and calcium transients.Myocardial tissues were collected from each group,and ELISA was used to determine the contents of triglyceride(TG),free fatty acid(FFA),and adenosine triphosphate(ATP).An in vitro sepsis model was constructed by stimulating HL-1 cardiomyocytes with lipopolysaccharide(LPS)for 12 hours,which was divided into 5 groups:control(CTRL)group,LPS group,L-carnitine group,L-carnitine+Eto group,and Eto group.ELISA was used to detect the contents of TG,FFA,and ATP as well as the activity of carnitine palmitoyltransferase 1A(CPT1A)in cardiomyocytes.A cellular energy metabolism analysis system was employed to measure fatty acid oxidation capacity,and Western blot was used to detect the protein expression of CPT1A in cardiomyocytes.BODIPY-FL-C16(green fluorescently labeled palmitic acid)was utilized to detect the distribution of fatty acids in the cytoplasm and mitochondria via immunofluorescence technology,thereby observing the ability of cells to transport fatty acids into mitochondria.Results Compared with the Sham group,cardiac function was significantly impaired in the Sepsis group,as evidenced by decreased ejection fraction and mean arterial pressure(P<0.05),along with elevated levels of the cardiac injury marker CK-MB(P<0.05).Treatment with L-carnitine significantly improved myocardial function,restored blood pressure in septic mice,and increased their survival rate from 12.50%to 81.25%(P<0.05).Compared with the Sham group,the contractile function and calcium transients of acutely isolated single cardiomyocytes were significantly reduced in the Sepsis group(P<0.05),while L-carnitine treatment remarkably restored the contractile function and calcium release capacity of septic cardiomyocytes(P<0.05).Both in vivo and in vitro experiments showed that TG and FFA levels were significantly increased(P<0.05),and ATP levels was significantly decreased(P<0.05)in the Sepsis and LPS groups—effects significantly reversed by L-carnitine treatment.Compared with the CTRL group,the basal oxidation rate and maximum oxidation capacity of fatty acids in cardiomyocytes of the LPS group were significantly reduced(P<0.05),and L-carnitine treatment notably improved these indicators.Compared with the CTRL group,the expression and activity of CPT1A in cardiomyocytes of the LPS group were significantly decreased(P<0.05),while L-carnitine treatment significantly increased the expression and activity of CPT1A(P<0.05).In LPS group cardiomyocytes,green fluorescently labeled palmitic acid primarily formed numerous granular/clumpy aggregates in the cytoplasm with minimal mitochondrial colocalization.In the L-carnitine group,the green fluorescent granules in the cytoplasm of cardiomyocytes were smaller,and colocalization with mitochondria was increased.However,the L-carnitine+Eto group exhibited similar phenomena to the LPS group.In addition,both in vivo and in vitro experiments demonstrated that treatment with the CPT1A inhibitor Eto reversed the effect of L-carnitine.Compared with the L-carnitine group,the ATP content in the L-carnitine+Eto group was significantly decreased(P<0.05),while the FFA content was significantly increased(P<0.05).Conclusion L-carnitine facilitates fatty acid entry into mitochondria for β-oxidation via a CPT1A-dependent mechanism,thereby ameliorating fatty acid oxidation dysfunction in septic cardiomyocytes and improving myocardial contractile function.

Since the enrollment in 2002, the cultivation model of "4+4" program of clinical medicine in Shanghai Jiao Tong University School of Medicine has been continuously explored and practiced. With the goal of cultivating high-level compound outstanding medical innovative talents with multi-disciplinary cross-capacity, through strengthening the heuristic teaching, establishing the medical-engineering cross-course, emphasizing the training of scientific research ability, and taking teaching reform in the basic clinical single-circulation organ system integration course, we have established a talent training system with the characteristics of Shanghai Jiao Tong University School of Medicine, which is characterized by "thick foundation, strong practice, re-transformation, shaping norms, and international integration", and intend to make further exploration in the field of post-graduation education convergence.

Objective:To investigate the clinical effect of posterior fossa decompression combined with dural reconstruction in the treatment of Chiari malformation-Ⅰ(CM-Ⅰ) complicated with syringomyelia (SM).Methods:The clinical data of 50 patients with CM-Ⅰ complicated with SM who were treated in Yan′an University Xianyang Hospital from June 2019 to January 2021 were analyzed. They were divided into the study group (27 cases) and the control group (23 cases) according to the surgical methods. The former received posterior fossa decompression combined with dural reconstruction, while the latter received posterior fossa decompression alone. The clinical symptom improvement, neurological function, cerebrospinal fluid dynamics and syringomyelia changes were compared between the two groups before and after the surgery, and postoperative complications were compared.Results:The overall clinical symptom improvement rate between the two groups had no significant difference ( P> 0.05). After the surgery, the scores of pain, sensory disturbance, dyskinesia and ataxia in the study group were higher than those in the control group: (4.56 ± 0.35) points vs. (4.28 ± 0.43) points, (3.61 ± 0.82) points vs. (3.15 ± 0.73) points, (3.81 ± 0.44) points vs. (3.59 ± 0.50) points, (4.43 ± 0.41) points vs. (4.09 ± 0.53) points, there were statistical significant ( P<0.05). After the surgery, the cerebrospinal fluid stroke volume (SV) and mean flow (MF) in the study group were higher than those in the control group: (0.05 ± 0.02) ml vs. (0.04 ± 0.01) ml, (0.05 ± 0.01) ml/s vs. (0.04 ± 0.01) ml/s; the maximum peak flow velocity (V max) of the head and tail in the study group were lower than those in the control group: (3.14 ± 1.05) mm/s vs. (3.87 ± 1.13) mm/s, (5.56 ± 1.38) mm/s vs. (6.43 ± 1.22) mm/s, there were statistical significant ( P<0.05). There were no significant differences in the rate of reduction or disappearance of syringomyelia, the rate of no change and the rate of increase of syringomyelia after the surgery between the two groups ( P>0.05). There was no significant difference in the incidence of postoperative complications between the two groups ( P>0.05). Conclusions:Posterior fossa decompression combined with dural reconstruction in CM-Ⅰ complicated with SM can better improve cerebrospinal fluid dynamics, and promote the reduction of syringomyelia without increasing postoperative complications.

Objective:To investigate the risk factors of postoperative acute respiratory distress syndrome (ARDS) in patients with esophageal cancer.Methods:The clinical data of patients with esophageal cancer who underwent surgery in the Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University from January 2020 to April 2021 were retrospectively analyzed, 223 patients were enrolled. The patients were divided into ARDS group (28 cases) and non-ARDS group (195 cases) according to whether ARDS occurred after surgery. The clinicopathological features of the two groups were compared, and the risk factors of postoperative ARDS were analyzed by univariate and multivariate logistic regression.Results:The age of patients in the ARDS group was higher than that in the non-ARDS group [(70±4) years old vs. (66±7) years old, P = 0.024]. The proportion of patients with history of chronic obstructive pulmonary disease (COPD) in the ARDS group was higher than that in the non-ARDS group [25.0% (7/28) vs. 4.6% (9/195), P < 0.001]. There were no statistical differences in gender, systolic pressure, body mass index, left ventricular ejection fraction, laboratory related examinations, history of smoking, history of diabetes, history of hypertension, history of cardiovascular disease, history of cerebrovascular disease, pathological type, tumor location, tumor stage and postoperative complications between the two groups (all P > 0.05). After further adjusting for gender, multivariate logistic regression analysis showed that the old age (≥65 years old) ( OR = 4.581, 95% CI 1.299-16.154, P = 0.018) and the history of COPD ( OR= 5.493, 95% CI 1.644-18.358, P = 0.006) were independent risk factors for postoperative ARDS in patients with esophageal cancer. Conclusions:Esophageal cancer patients with an age of ≥65 years old or history of COPD have a high risk of postoperative ARDS. Age and history of COPD may have certain significances in judging the occurrence of postoperative ARDS in patients with esophageal cancer.

Objective : To investigate the clinical effect of polidocanol sclerotherapy in the treatment of giant venular malformations of the lips and cheeks in adults. Methods: From September 2019 to September 2020, 5 patients with huge venular malformations of the lips and cheeks (4 males, 1 female) admitted to Xuzhou Central Hospital were included in the study. All the patients were treated with local injection of polidocanol foam scleroagent, and all patients were followed up with a 3-week treatment course. If the clinical symptoms were not alleviated and the MRI examination showed that > 25% of the lesion remained, or it relapsed again after symptoms are stable, the patient needed to be treated again. The endpoints of treatment were: ①subsidence of clinical symptoms and MRI showing residual lesions < 25% in size; ②continuous treatment for 4 times without relief or aggravation of symptoms; ③a discontinuation of treatment. Results: All 5 patients successfully completed the treatment and were injected 2 to 4 times during treatment. The curative effect was evaluated according to the Achauer standard, including grade Ⅰcurative effects in 1 patient, grade Ⅱ in 2 patients, grade Ⅲ in 2 patients. Among them, one patient suffered from erosion and bleeding in the lesion before the operation, and the symptoms were significantly improved postoperatively. No serious side effects were found except skin pigmentation in 1 case. Conclusion Local injection of polidocanol foam scleroagent is a safe and effective treatment method for adult giant venular malformations of the lips and cheeks, and it has a hemostatic effect on spontaneous bleeding invenular malformations.

Objective To investigate the recovery of affected side kidney function after upper urinary tract obstruction was relieved Methods 78 patients who had been diagnosed with upper urinary tract obstruction were enrolled from January to December of 2015 in our hospital.All patients received the surgery to relieve the obstruction.GFR of the affected side kidney was done after one months of the surgery.The average age was(51.3 ± 12.8)years old.The reason of obstruction was upper urinary tract calculi (72 cases) and upper urinary tract stenosis (6 cases) respectively.All the patients received CT and ECT before and after operation.All the patients was divided into 3 groups by the decreased degree of affected side kidney function,including moderately decreased group [15 rnl/min ≤ GFR ＜ 30 ml/min,n =43,mean value =(23.1 ±5.0) mL/min],severely decreased group [7.5 rnL/min≤ GFR ＜ 15 ml/min,n =23,mean value =(11.2 ± 2.3) ml/min],and extreme severely decreased group [GFR ＜ 7.5 ml/min,n =12,mean value =(4.3 ± 2.9)ml/min].Linear correlation analysis was used to analysis the relationship analysis between the GFR value (pre-operation,post-operation) and the renal cortical thickness.The follow up time of extreme severely decreased group extended to 8-12 months.Results The GFR of moderate decreased group recovered to(30.6 ± 8.5) ml/min,regained averagely (7.56 ± 7.62) ml/min;the severely decreased group recovered to (13.1 ± 4.5) ml/min,regain (1.94 ± 3.38) ml/min.Extreme severely decreased group recovered to (11.1 ± 3.4) ml/min,regained averagely (6.75 ± 4.76) rnl/min,the GFR mean value after operation 8-12 months recovered to (12.7 ± 3.6) ml/min.All groups got significant recovery of kidney function of the affected side.The correlation coefficient between GFR value and the renal cortical thickness was 0.59 (before the surgery) and 0.70 (after the surgery) respectively (P ＜ 0.05).Conclusions Most of affected side kidneys got different degree of recovery.Obstruction influenced the accuracy of ECT at the time of evaluating the actual renal function before operation.The kidneys which had been supposed should be resected in presurgical evaluation could recover to the level of kidney reserve after the surgery.

Objective To compare the clinical effects of proximal femoral nail antirotation (PFNA) and proximal femoral nail antirotation-Ⅱ (PFNA-Ⅱ) in the internal fixation of femoral intertrochanteric fracture.Methods A retrospective study was conducted of the 54 patients with femoral intertrochanteric fracture who had been treated at our department from May 2009 through July 2014.During May 2009 and November 2011,27 of them were treated with PFNA;during December 2011 and July 2014,the other 27 of them were treated with PFNA-Ⅱ.The 2 groups were compared in terms of operation time,intraoperative blood loss volume,hidden blood loss volume,intraoperative and postoperative complications,fracture healing time and Harris hip score at the last follow-up.Results In the PFNA group,27 patients were followed up for an average time of 22.6 ± 4.8 months.In the PFNA-Ⅱ group,27 patients were followed up for an average time of 19.5 ± 4.6 months.The PFNA group had significantly more intraoperative blood loss volume (130.1 ± 74.3 mL),and significantly higher rates of intraoperative lateral wall fracture of the proximal femur (18.5％,5/27),postoperative lateral thigh soft tissue irritation (22.2％,6/27) and postoperative thigh pain (22.2％,6/27) than the PFNA-Ⅱ group [46.3 ± 23.1 mL,0,3.7％ (1/27),3.7％ (1/27),respectively] (P ＜ 0.05).There were no significant differences between the 2 groups in operation time,hidden blood loss,postoperative complications of internal diseases,fracture healing time,or Harris hip score of last follow-up (P ＞ 0.05).Conclusion Compared with PFNA,PFNA-Ⅱ may lead to a smaller volume of intraoperative blood loss and a lower incidence of complications related to internal fixation.