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.

This study was aimed at investigating the effects of demethylase fat mass and obesity-associated protein(FTO)and methyltransferase methyltransferase like protein 3(METTL3),key molecules in N6-methyladenosine(m6A)modification,on the replication and proliferation of Japanese encephalitis virus(JEV).Recombinant lentiviruses were generated by packaging the FTO and green fluorescent protein into lentiviral vectors.Neuro2a cells,a mouse neuroblastoma cell line,were infected with the lentivirus,and stable FTO-expressing cell lines were obtained through puromycin selection.Successful overexpression of FTO was confirmed through fluorescence microscopy,real-time quantitative PCR,and western blot analysis.When Neuro2a cells overexpressing FTO were infected with JEV,the overexpression of FTO decreased JEV replication in the cells,and increased the expression of interferon(IFN)and related molecules.Additionally,treatment of JEV-infected Neuro2a cells with the METTL3-specific inhibitor STM2457 resulted in a dose-dependent decrease in JEV replication and viral protein expression.These findings suggested that lowering m6A methylation levels inhibits JEV replication,thus shedding light on the regulatory role of methylation modification in JEV replication.

Objective To analyze the predictive value of microRNA-34a-5p(miR-34a-5p)expression in pancreatic cancer tissue on postoperative poor prognosis.Methods The surgically resected pancreatic cancer tissues and normal tissues adjacent to cancer from 123 patients with pancreatic cancer were collected to detect the expression of miR-34a-5p.The expression of miR-34a-5p in pancreatic cancer tissues for patients with different clinicopathological characteristics were compared.The patients were divided into the poor prognosis group and the good prognosis group according to their prognosis,and the clinical data of patients between the two groups was compared.The risk factors of poor prognosis for patients with pancreatic cancer were analyzed by Cox regression model,and the predictive value of miR-34a-5p expression in pancreatic cancer tissues on poor prognosis of patients was analyzed by receiver operating characteristic(ROC)curve.Results The expression of miR-34a-5p in pancreatic cancer tissues was lower than that in normal tissues adjacent to cancer(P<0.05).There were statistically significant differences in the expression of miR-34a-5p in pancreatic cancer tissues of patients with different differentiation degrees,TNM stages,and lymph node metastasis(P<0.05).The proportions of low differentiation,TNM stage for stage Ⅲ,lymph node metastasis and incisal margin of R1,and levels of carbohydrate antigen 199(CA199),neutrophils/lymphocytes ratio(NLR)and platelet/lymphocyte ratio(PLR)for patients in the poor prognosis group were higher than those in the good prognosis group(P<0.05),while miR-34a-5p expression was lower than that in the good prognosis group(P<0.05).Cox regression analysis showed that low differentiation,TNM stage for stage Ⅲ,lymph node metastasis,incisal margin of R1,decreased expression of miR-34a-5p and increased levels of CA199,NLR and PLR were risk factors of poor prognosis for patients with pancreatic cancer(P<0.05).ROC curve analysis showed that the optimal cut-off value of miR-34a-5p expression in pancreatic cancer tissue for predicting poor prognosis of patients was 0.48,the sensitivity was 78.82%,the specificity was 89.47%and the area under the curve was 0.855,with good predictive value.Conclusion The expression of miR-34a-5p in pancreatic cancer tissue is lower than that in normal tissue adjacent to cancer,and its expression is related to the differentiation degree,TNM stage and lymph node metastasis,which is also a risk factor and predictor of poor prognosis for patients with pancreatic cancer.

The medicinal materials of Bawei Chenxiang Pills(BCPs) were extracted via three methods: reflux extraction by water, reflux extraction by 70% ethanol, and extraction by pure water following reflux extraction by 70% ethanol, yielding three extracts of ST, CT, and CST. The efficacy of ST(760 mg·kg~(-1)), CT(620 mg·kg~(-1)), and CST(1 040 mg·kg~(-1)) were evaluated by acute myocardial ischemia(AMI) and p-chlorophenylalanine(PCPA)-induced insomnia in mice, respectively. Western blot was further utilized to investigate their hypnosis mechanisms. The main chemical components of different extracts were identified by the UPLC-Q-Exactive-MS technique. The results showed that CT and CST significantly increased the ejection fraction(EF) and fractional shortening(FS) of myocardial infarction mice, reduced left ventricular internal dimension at end-diastole(LVIDd) and left ventricular internal dimension at end-systole(LVIDs). In contrast, ST did not exhibit significant effects on these parameters. In the insomnia model, CT significantly reduced sleep latency and prolonged sleep duration, whereas ST only prolonged sleep duration without shortening sleep latency. CST showed no significant effects on either sleep latency or sleep duration. Additionally, both CT and ST upregulated glutamic acid decarboxylase 67(GAD67) protein expression in brain tissue. A total of 15 main chemical components were identified from CT, including 2-(2-phenylethyl) chromone and 6-methoxy-2-(2-phenylethyl) chromone. Six chemical components including chebulidic acid were identified from ST. The results suggested that chromones and terpenes were potential anti-myocardial ischemia drugs of BCPs, and tannin and phenolic acids were potential hypnosis drugs. This study enriches the pharmacological and chemical research of BCPs, providing a basis and reference for their secondary development, quality standard improvement, and clinical application.
Animals ; Drugs, Chinese Herbal/isolation & purification* ; Mice ; Male ; Sleep Initiation and Maintenance Disorders/physiopathology* ; Humans ; Myocardial Infarction/drug therapy* ; Myocardial Ischemia/drug therapy*

Objective To explore the feasibility,safety and effectiveness of ultrasound-guided biopsy of pancreatic lesions with exophytic and backward growth morphology.Methods Fifty-three patients with pancreatic lesions with exophytic and backward growth morphology who underwent ultrasound-guided biopsy were retrospectively collected.Conventional ultrasonic manifestations of lesions were observed,and the technical success rate,complication rate,repeat puncture rate,as well as the sensitivity,specificity and accuracy of biopsy were recorded.Results Totally 61 lesions were detected,with the maximum diameter of 1.4-7.3 cm and the median maximum diameter of 2.7 cm,located in pancreatic uncinate process(26/61,42.62％),head(12/61,19.67％),neck(13/61,21.31％)and body(10/61,42.62％),respectively,mainly presented as hypoechogenic(61/61,100％)and borderless(60/61,98.36％)masses tending to invade blood vessels(51/61,83.61％)and pancreatic ducts(40/61,65.57％).The technical success rate,complication rate and repeat puncture rate of ultrasound-guided biopsy was 100％(61/61),1.89％(1/53)and 21.31％(13/61),respectively,and the sensitivity,specificity and accuracy of biopsy diagnosis was 75.00％(45/60),100％(1/1)and 75.41％(46/61),respectively.Conclusion Ultrasound-guided biopsy was safe and feasible for pancreatic lesions with exophytic and backward growth morphology,but its diagnostic efficacy should be improved.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Objective:To investigate the relationship among iron content, volume and drainage venous oxygen saturation (SvO 2) in deep gray matter nuclei of healthy people using quantitative susceptibility mapping (QSM). Methods:The study was a cross-sectional study. A total of 126 healthy volunteers were prospectively enrolled in the community in Tianjin from June 2019 to December 2023, and 57 males and 69 females, aged 48±15 years. All healthy volunteers underwent MRI examinations to get STrategically Acquired Gradient Echo images, then it was post-processed to obtain T 1 weighted enhanced images, QSM maps and the maximum intensity projection images. In QSM maps, caudate nucleus (CN), putamen (PUT), globus pallidus (GP), thalamus (THU), subthalamic nucleus (STN), substantia nigra (SN) and red nucleus (RN) were semi-automatically segmented to calculate the iron content and volume using SPIN software. Four bilateral deep cerebral veins regions of interest, including septum pellucidum veins, thalamostriate veins, internal cerebral veins and basilar veins, were manually delineated on the maximum intensity projection images of QSM to obtain venous magnetic sensitivity. The venous magnetic sensitivity was calculated as SvO 2. To observe the age-related trend of SvO 2, iron content and volume, the partial correlation analysis was conducted. The relationships between iron content, volume and SvO 2 were explored using the partial correlation analysis. To explore the potential effects of SvO 2 between iron content and volume in deep gray matter, the mediation analysis was utilized. Results:The relationships between the SvO 2 of thalamostriate veins ( r=0.23, P=0.018), basilar veins ( r=0.27, P=0.004) and age were positive. The relationships between the SvO 2 of internal cerebral veins and the iron contents of CN ( r=?0.25, P=0.042) and PUT ( r=?0.33, P<0.001) were negative. The relationships between the SvO 2 of basilar veins and the iron contents of STN ( r=?0.25, P=0.042) and SN ( r=?0.24, P=0.045) were negative. The relationships between iron content and volume including CN ( r=0.46, P<0.001), PUT ( r=0.20, P=0.027), GP ( r=0.76, P<0.001), STN ( r=0.87, P<0.001), SN ( r=0.90, P<0.001), RN ( r=0.79, P<0.001) were positive. The mediation analysis showed that the SvO 2 of internal cerebral veins indirectly mediated the relationship between iron content and volume of CN, PUT, GP and THU. Conclusions:The process of iron deposition required the participation of oxygen in deep gray matter nuclei. Volume shows positive correlation with iron content in deep gray matter nuclei, with individual variations. The SvO 2 of internal cerebral veins mediate the relationship between iron content and volume of deep gray matter nuclei.

This study was aimed at investigating the effects of demethylase fat mass and obesity-associated protein(FTO)and methyltransferase methyltransferase like protein 3(METTL3),key molecules in N6-methyladenosine(m6A)modification,on the replication and proliferation of Japanese encephalitis virus(JEV).Recombinant lentiviruses were generated by packaging the FTO and green fluorescent protein into lentiviral vectors.Neuro2a cells,a mouse neuroblastoma cell line,were infected with the lentivirus,and stable FTO-expressing cell lines were obtained through puromycin selection.Successful overexpression of FTO was confirmed through fluorescence microscopy,real-time quantitative PCR,and western blot analysis.When Neuro2a cells overexpressing FTO were infected with JEV,the overexpression of FTO decreased JEV replication in the cells,and increased the expression of interferon(IFN)and related molecules.Additionally,treatment of JEV-infected Neuro2a cells with the METTL3-specific inhibitor STM2457 resulted in a dose-dependent decrease in JEV replication and viral protein expression.These findings suggested that lowering m6A methylation levels inhibits JEV replication,thus shedding light on the regulatory role of methylation modification in JEV replication.

Objective To analyze the predictive value of microRNA-34a-5p(miR-34a-5p)expression in pancreatic cancer tissue on postoperative poor prognosis.Methods The surgically resected pancreatic cancer tissues and normal tissues adjacent to cancer from 123 patients with pancreatic cancer were collected to detect the expression of miR-34a-5p.The expression of miR-34a-5p in pancreatic cancer tissues for patients with different clinicopathological characteristics were compared.The patients were divided into the poor prognosis group and the good prognosis group according to their prognosis,and the clinical data of patients between the two groups was compared.The risk factors of poor prognosis for patients with pancreatic cancer were analyzed by Cox regression model,and the predictive value of miR-34a-5p expression in pancreatic cancer tissues on poor prognosis of patients was analyzed by receiver operating characteristic(ROC)curve.Results The expression of miR-34a-5p in pancreatic cancer tissues was lower than that in normal tissues adjacent to cancer(P<0.05).There were statistically significant differences in the expression of miR-34a-5p in pancreatic cancer tissues of patients with different differentiation degrees,TNM stages,and lymph node metastasis(P<0.05).The proportions of low differentiation,TNM stage for stage Ⅲ,lymph node metastasis and incisal margin of R1,and levels of carbohydrate antigen 199(CA199),neutrophils/lymphocytes ratio(NLR)and platelet/lymphocyte ratio(PLR)for patients in the poor prognosis group were higher than those in the good prognosis group(P<0.05),while miR-34a-5p expression was lower than that in the good prognosis group(P<0.05).Cox regression analysis showed that low differentiation,TNM stage for stage Ⅲ,lymph node metastasis,incisal margin of R1,decreased expression of miR-34a-5p and increased levels of CA199,NLR and PLR were risk factors of poor prognosis for patients with pancreatic cancer(P<0.05).ROC curve analysis showed that the optimal cut-off value of miR-34a-5p expression in pancreatic cancer tissue for predicting poor prognosis of patients was 0.48,the sensitivity was 78.82%,the specificity was 89.47%and the area under the curve was 0.855,with good predictive value.Conclusion The expression of miR-34a-5p in pancreatic cancer tissue is lower than that in normal tissue adjacent to cancer,and its expression is related to the differentiation degree,TNM stage and lymph node metastasis,which is also a risk factor and predictor of poor prognosis for patients with pancreatic cancer.

Objective:To investigate the relationship among iron content, volume and drainage venous oxygen saturation (SvO 2) in deep gray matter nuclei of healthy people using quantitative susceptibility mapping (QSM). Methods:The study was a cross-sectional study. A total of 126 healthy volunteers were prospectively enrolled in the community in Tianjin from June 2019 to December 2023, and 57 males and 69 females, aged 48±15 years. All healthy volunteers underwent MRI examinations to get STrategically Acquired Gradient Echo images, then it was post-processed to obtain T 1 weighted enhanced images, QSM maps and the maximum intensity projection images. In QSM maps, caudate nucleus (CN), putamen (PUT), globus pallidus (GP), thalamus (THU), subthalamic nucleus (STN), substantia nigra (SN) and red nucleus (RN) were semi-automatically segmented to calculate the iron content and volume using SPIN software. Four bilateral deep cerebral veins regions of interest, including septum pellucidum veins, thalamostriate veins, internal cerebral veins and basilar veins, were manually delineated on the maximum intensity projection images of QSM to obtain venous magnetic sensitivity. The venous magnetic sensitivity was calculated as SvO 2. To observe the age-related trend of SvO 2, iron content and volume, the partial correlation analysis was conducted. The relationships between iron content, volume and SvO 2 were explored using the partial correlation analysis. To explore the potential effects of SvO 2 between iron content and volume in deep gray matter, the mediation analysis was utilized. Results:The relationships between the SvO 2 of thalamostriate veins ( r=0.23, P=0.018), basilar veins ( r=0.27, P=0.004) and age were positive. The relationships between the SvO 2 of internal cerebral veins and the iron contents of CN ( r=?0.25, P=0.042) and PUT ( r=?0.33, P<0.001) were negative. The relationships between the SvO 2 of basilar veins and the iron contents of STN ( r=?0.25, P=0.042) and SN ( r=?0.24, P=0.045) were negative. The relationships between iron content and volume including CN ( r=0.46, P<0.001), PUT ( r=0.20, P=0.027), GP ( r=0.76, P<0.001), STN ( r=0.87, P<0.001), SN ( r=0.90, P<0.001), RN ( r=0.79, P<0.001) were positive. The mediation analysis showed that the SvO 2 of internal cerebral veins indirectly mediated the relationship between iron content and volume of CN, PUT, GP and THU. Conclusions:The process of iron deposition required the participation of oxygen in deep gray matter nuclei. Volume shows positive correlation with iron content in deep gray matter nuclei, with individual variations. The SvO 2 of internal cerebral veins mediate the relationship between iron content and volume of deep gray matter nuclei.