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 gain insights into the biological characteristics of different populations of Culex tritaeniorhynchus within and around the Yellow Sea wetland from the perspective of the occurrence of resistance, we investigated the levels of resistance to deltamethrin and kdr gene mutation in the wetland and its peripheral areas. Methods Specimens were collected from Cx. tritaeniorhynchus populations at two monitoring sites in the Rare Bird National Nature Reserve and Tiaozi Ni Wetland Scenic Area, and also from two populations in Yancheng City and the Liuhe District of Nanjing, and the resistance of these mosquitoes to deltamethrin was determined using the CDC biotest bottle method. For each concentration of deltamethrin assessed, a random subset of exposed specimens was selected for amplification of the kdr gene fragment, followed by Sanger sequencing to identify and analyze resistance-associated mutations. Results The LC50 levels of deltamethrin among mosquitoes from the four populations in Luhe, Yancheng, the Rare Bird National Nature Reserve and the Tiaozi Ni Wetland Scenic Area were 2.048 5, 7.798 2, 3.473 3, and 17.695 5 mg/mL, respectively, with corresponding concentrations of deltamethrin ranging from 0.005 to 5.000,0.050 to 50.000,0.050 to 25.000 and 0.050 to 50.000 mg/mL, respectively. Furthermore, the ranges of the KT50 values were 11.76-107.43, 67.05-216.30,29.77-107.43 and 28.40-329.51 min; the 1-h knockdown rates were 34.58%-99.15%, 9.52%-43.80%, 55.09%-73.01%, and 10.09%-68.07%; and the 24-h mortality rates were 12.15%-67.52%,9.52%-79.56%,13.17%-82.21%, and 11.01%-78.99%, respectively. With respect to kdr gene mutation, we assayed a total of 63,70,59, and 57 mosquitoes for the four populations, for which we detected L1014F mutation frequencies of 14.29%, 35.00%, 20.34%, and 31.58%, respectively, with a majority of these mutations being heterozygous for resistance. In addition, five adult mosquitoes were identified has having synonymous mutations at site 1011[i. e. , AAT(asparagine)mutation to AAC(asparagine)]. Conclusions Our findings revealed the clear resistance of Cx. tritaeniorhynchus to deltamethrin in the Yancheng region of the Yellow Sea wetland, and the resistance phenotype and kdr frequency of Cx. tritaeniorhynchus in the wetland environment were comparable to those of Cx. tritaeniorhynchus in the wetland environment, thereby indicating that the resistance of different populations of Cx. tritaeniorhynchus was homogeneous under the pressure of different insecticide selection within and around the wetland. However, the underlying mechanisms need to be further studied.

ObjectiveTo investigate the effects of three-dimensional foot-ankle exercises (3DFAE) on mild-to-moderate hallux valgus in young women. MethodsFrom October to December, 2024, 45 female patients aged 18 to 26 years with hallux valgus were recruited from Capital University of Physical Education and Sports. They were randomly divided into control group (n = 15), toe-spread-out (TSO) group (n = 15) and 3DFAE group (n = 15). The control group only received foot health education, while the two intervention groups performed corresponding exercise training, for four weeks. Hallux valgus angle (HVA) was measured with photographic method, abductor hallucis activation was detected with surface electromyography, cross-sectional area of abductor hallucis was measured with Doppler ultrasound, and active ankle dorsiflexion range of motion (ROM) was assessed with a goniometer, before intervention, immediately after intervention, and four weeks after training cessation. A perceived difficulty scale was adopted to evaluate the training difficulty of TSO group and 3DFAE group at the first training session and upon completion of intervention. ResultsThe effects of time and interaction were significant for bilateral HVA, abductor hallucis activation, cross-sectional area of abductor hallucis and ankle dorsiflexion ROM (F > 2.728, P < 0.05), and the effect of group of left ankle dorsiflexion ROM was also significant (F = 4.995, P < 0.05). After intervention, bilateral HVA, abductor hallucis activation, cross-sectional area of abductor hallucis and ankle dorsiflexion ROM were all better than those before intervention (P < 0.05), and most indicators were superior to those measured at the 4-week follow-up (P < 0.05). The left ankle dorsiflexion ROM was better in 3DFAE group than in the control group and TSO group (P < 0.05). At the first intervention session, the perceived training difficulty was lower in 3DFAE group than in TSO group (t = 3.334, P = 0.002), and it decreased (t = 5.292, P < 0.001) after four weeks of training in TSO group, with no significant difference compared with 3DFAE group (P > 0.05). Conclusion3DFAE can improve ankle dorsiflexion ROM in young female patients with hallux valgus, with no more difficulty than TSO, and lower initial operation difficulty.

Methods: Thirty patients with PDVO of the lumbar or thoracic spine treated with transforaminal interbody debridement and fusion (TIDF) with AIBG between March 2014 and May 2022 were reviewed (AIBG group). For comparative analysis, 28 PDVO patients who underwent TIDF without AIBG between January 2009 and June 2011 were enrolled (non-AIBG group). The minimum follow-up duration was 2 years. Clinical characteristics and surgical indications were comparable in the two groups. C-reactive protein (CRP) levels and the postoperative antibiotics course were compared between the two groups. Results: Surgical treatment for PDVO resulted in clinical improvement and adequate infection control. Despite the shorter postoperative intravenous antibiotic duration (mean: 19.0 days vs. 39.8 days), the AIBG group had significantly lower CRP levels at postoperative 4 and 6 weeks. The mean Visual Analog Scale pain scores improved from 7.3 preoperatively to 2.2 at 6 weeks postoperatively. The average angle correction at the last follow-up was 7.9°. Conclusions TIDF with AIBG for PDVO can achieve local infection control with a faster reduction in CRP levels, leading to a shorter antibiotic duration.

Methods: Thirty patients with PDVO of the lumbar or thoracic spine treated with transforaminal interbody debridement and fusion (TIDF) with AIBG between March 2014 and May 2022 were reviewed (AIBG group). For comparative analysis, 28 PDVO patients who underwent TIDF without AIBG between January 2009 and June 2011 were enrolled (non-AIBG group). The minimum follow-up duration was 2 years. Clinical characteristics and surgical indications were comparable in the two groups. C-reactive protein (CRP) levels and the postoperative antibiotics course were compared between the two groups. Results: Surgical treatment for PDVO resulted in clinical improvement and adequate infection control. Despite the shorter postoperative intravenous antibiotic duration (mean: 19.0 days vs. 39.8 days), the AIBG group had significantly lower CRP levels at postoperative 4 and 6 weeks. The mean Visual Analog Scale pain scores improved from 7.3 preoperatively to 2.2 at 6 weeks postoperatively. The average angle correction at the last follow-up was 7.9°. Conclusions TIDF with AIBG for PDVO can achieve local infection control with a faster reduction in CRP levels, leading to a shorter antibiotic duration.

Objective:To assess the efficacy and safety of Tacrolimus（TAC）in combination with glucocorticosteroid（GC）for treating IgA vasculitis nephritis（IgAVN）in children.Methods:A retrospective analysis was conducted on pediatric patients who were diagnosed with IgAVN from January 2015 to January 2022 in Children's Hospital of Hebei Province.The patients presented with nephrotic-range proteinuria or persistent urine protein（>0.5g/24 h）despite adequate glucocorticoid and other treatments in patients who do not reach massive proteinuria levels.They were treated with TAC combined with GC. The following laboratory parameters were obtained for outcome assessment: 24-hour urinary protein excretion, serum albumin, serum creatinine levels, and fasting blood glucose measurements. The efficacy and adverse reactions of TAC were summarized.Results:A total of 97 children (55 males and 42 females) were included. The average age of diagnosis of IgA vasculitis was (8.65±2.46) years, and 95.9% of the children developed renal involvement within 30 days after diagnosis. Pathological examination of renal puncture: 5 cases of grade Ⅱa, 2 cases of grade Ⅱb, 31 cases of grade Ⅲa, 57 cases of grade Ⅲb, and 2 cases of grade Ⅳb.Remission rate at 3 months was 96.9%（94/97）.Three patients failed to achieve clinical remission who were treaed with other immunosuppressants.After 1, 3, 6 and 12 months of TAC treatment, the urine protein levels of 94 children were lower than those before treatment, and the differences were statistically significant ( P < 0.05), showing a gradual downward trend. Serum albumin levels were higher than those before treatment, and the differences were statistically significant ( P < 0.05), showing a gradual upward trend.After 3 months and 6 months of TAC treatment, the serum creatinine and fasting blood glucose of the children increased. With the remission of the disease, TAC dosage decreased, the mean values of serum creatinine and fasting blood glucose decreased after 12 months of treatment.The average treatment time of TAC was (10.8±2.6) months, the average follow-up time was (3.33±1.56) years, and the longest follow-up time was 8 years. During the follow-up period, there were no serious adverse reactions such as gastrointestinal discomfort, liver function damage and severe infection. After stopping GC and TAC treatment, 80 children got sustained remission. Conclusion:The combination of TAC and GC has been proved to be effective in treating IgAVN in children.The overall effective rate is high,and clinical remission can be achieved quickly with relatively mild adverse reactions.

Objective To investigate the changes and clinical significance of serum C1q tumor necrosis factor-related protein 12(CTRP12),adiponectin(APN),and resistin(RETN)in patients with type 2 diabetes mellitus(T2DM)combined with different grades of hypertension.Methods A total of 156 patients with T2DM were selected and divided into the following groups:isolated T2DM group(T2DM,n=38),T2DM combined with hypertension grade 1(DH1,n=39)group,T2DM combined with hypertension grade 2(DH2,n=39)group,and T2DM combined with hypertension grade 3(DH3,n=40)group.Additionally,healthy individuals who underwent physical examinations at our hospital were selected as the normal control(NC,n=40)group.Serum levels of CTRP12,APN,and RETN were measured using ELISA.Pearson correlation analysis was used to evaluate the relationship between serum CTRP12,APN,RETN,and other indicators.Multiple linear regression analysis was performed to determine the influencing factors for the three indicators.Results In NC,T2DM,DH1,DH2 and DH3 groups,DBP increased in turn(P<0.05),while CTRP12 decreased in turn(P<0.05).SBP in T2DM,DH1,DH2 and DH3 groups increased in turn(P<0.05).In DH1,DH2 and DH3 groups,RENT increased in turn(P<0.05),while APN decreased in turn(P<0.05).Pearson correlation analysis showed that serum CTRP12 was negatively correlated with WHR,BMI,HOMA-IR,FPG,HbA1c,FIns,TC,LDL-C,SBP,and DBP(P<0.05).Serum APN was negatively correlated with BMI,FPG,HbA1c,FIns,TC,SBP,and DBP(P<0.05),and positively correlated with HDL-C(P<0.05).Serum RETN was positively correlated with WHR,HOMA-IR,FPG,HbA1c,FIns,SBP,and DBP(P<0.05).Multiple linear regression analysis indicated that SBP was an influencing factor for CTRP12 and RETN,while SBP and HbA1c were influencing factors for RETN.Conclusions In patients with T2DM combined with hypertension,serum CTRP12 and APN levels decrease,while RETN levels increase,with significant changes observed as HP grades increase,suggesting that these three factors may collectively influence the occurrence and development of T2DM combined with HP.