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.

ObjectiveTo compare the differences in fungal community composition between lesional and non-lesional scalp areas in patients suffering from severe alopecia areata （AA）， and compare these with healthy scalp areas in control subjects. Additionally， to preliminarily explore the changes in scalp fungal communities in severe AA patients and their potential underlying immunological mechanisms. MethodsA total of 20 severe AA patients and 18 healthy controls were enrolled. Skin swab samples were collected from lesional and non-lesional scalp areas of severe AA patients， as well as from the normal scalp of healthy controls. The fungal internal transcribed spacer （ITS） region was amplified and analyzed using high-throughput sequencing. ResultsThe lesional scalp areas of severe AA patients exhibited higher α-diversity and species richness in fungal communities. Notably， the relative abundance of Ascomycota， along with genera such as Mycosphaerella， Aspergillus， Penicillium， and Wallemia， significantly increased in the bald regions. In contrast， Acremonium and Schizophyllum were more predominant in the non-lesional areas of severe AA patients. ConclusionDistinct region-specific differences in scalp fungal microbiota in severe AA patients suggests that fungal dysbiosis may play a potential role in the pathogenesis of alopecia areata. These findings provide new insights into the disease characteristics of severe AA from the perspective of scalp microecology.

ObjectiveTo analyze the effects of the progestin-primed ovarian stimulation （PPOS） protocol on embryo euploidy rate and clinical pregnancy outcomes in infertile patients. MethodsWomen who underwent Preimplantation genetic testing for aneuploidy （PGT-A） cycles were selected as study participants （a total of 656 cycles and 3 081 blastocysts）. Participants were divided into two age groups （≤35 years and >35 years） and further stratified by ovarian stimulation protocol： the Progestin-Primed Ovarian Stimulation （PPOS） group （n=48 and 60， respectively）， the Luteal Phase Long Protocol （LP） group （n=160 and 57， respectively）， and the Gonadotropin-Releasing Hormone Antagonist Protocol （AP） group （n=220 and 111， respectively）. Baseline characteristics， ovarian stimulation outcomes， and embryo development parameters were compared among the three protocols within each age group. Additionally， clinical pregnancy outcomes of the first frozen embryo transfer （FET） cycle were compared. The primary outcome measure was the embryo euploidy rate. Results① In the ≤35 years age group， baseline follicle-stimulating hormone （bFSH） levels were significantly higher in the PPOS group compared to the LP and AP groups， and the bFSH/bLH ratio was significantly higher in the PPOS group than in the AP group （P < 0.05）. In the >35 years age group， bFSH levels in both the PPOS and AP groups were significantly higher than in the LP group （P < 0.05）.② In the ≤35 years group， there were no significant differences in the rates of metaphase II （MII） oocytes， 2-pronuclei （2 PN） zygotes， cleavage， 2 PN cleavage， blastocyst formation， high-quality embryos， or embryo euploidy between the PPOS group and either the LP or AP groups. However， the PPOS group showed significantly lower values for the following parameters compared to the other two groups： total oocytes retrieved， number of MII oocytes， number of 2 PN zygotes， number of cleaved embryos， number of 2 PN cleaved embryos， number of blastocysts formed， number of high-quality embryos， number of high-grade blastocysts， number of transferable embryos， number of cryopreserved embryos， number of biopsied blastocysts， number of euploid embryos， and the rate of obtaining at least one euploid embryo. In the >35 years group， no significant differences were observed among the PPOS， LP， and AP groups in the rates of MII oocytes， 2 PN cleavage， blastocyst formation， or in the number of euploid embryos， euploidy rate， and the rate of obtaining at least one euploid embryo. However， the PPOS group had significantly lower numbers of total oocytes retrieved， MII oocytes， 2 PN zygotes， cleaved embryos， 2 PN cleaved embryos， blastocysts formed， transferable embryos， and cryopreserved embryos compared to the LP group （P<0.05）. The high-quality embryo rate was significantly lower in the PPOS group than in the AP group （P<0.05）. The numbers of high-quality embryos， high-grade blastocysts， and biopsied blastocysts were significantly lower in the PPOS group than in both the LP and AP groups （P<0.05）. Notably， the 2 PN fertilization rate was significantly higher in the PPOS group than in the AP group， and the cleavage rate was significantly higher in the PPOS group than in both the LP and AP groups （P<0.05）.③ No significant differences were found among the three groups in the biochemical pregnancy rate， clinical pregnancy rate， live birth rate， early miscarriage rate， and late miscarriage rate following the first FET cycle. ConclusionCompared to the other two protocols， the PPOS protocol does not significantly affect embryo euploidy or clinical pregnancy rates. However， in freeze-all cycles with PGT-A， the PPOS protocol does not reduce the rate of chromosomally normal embryos but may decrease the total number of available embryos. It may not be the optimal choice for younger women， but it can be considered as a viable option for women of advanced maternal age.

Objective: To investigate the effect of injectable tetra-polyethylene glycol (PEG) hydrogels loaded with sitagliptin (STG) (abbreviated as PEG-STG hydrogels) on skin wound healing in diabetic mice, providing an experimental basis for the subsequent development of local therapeutic materials for primary healing of oral and maxillofacial skin and soft tissue wounds in patients with diabetes. Methods: PEG hydrogels were fabricated via the reaction of four-arm PEG succinimidyl glutarate (PEG-SG) and four-arm PEG amine (PEG-NH2). Subsequently, PEG hydrogels loaded with STG were prepared. The microstructure, gelation, injectability, compression properties, swelling, degradation, and in vitro drug release profiles were characterized. In vitro cellular experiments were conducted using the mouse fibroblast cell line L929 and human umbilical vein endothelial cells (HUVECs), which were divided into four groups: an NC group (normal medium control), Glu group (30 mmol/L high glucose medium), PEG group (high glucose medium with PEG hydrogel extracts), and PEG-STG group (high glucose medium with PEG-STG hydrogel extracts). Biocompatibility was evaluated via CCK-8 assays, live/dead staining, and hemolysis tests. The impact of the PEG-STG hydrogels on cellular function under hyperglycemic conditions was assessed using scratch assays, Transwell migration assays, qRT-PCR, and western blotting. Furthermore, approved by the Institutional Animal Care and Use Committee of the affiliated institution, a diabetic C57BL/6J mouse skin defect model was established and divided into three groups: an NC group (normal mice control), Glu group (diabetic model control), and PEG-STG group (treated with PEG-STG hydrogel in situ). Wound healing was evaluated through gross observation, wound healing rate analysis, and histological assessment via H&E staining. Results: The PEG-STG hydrogels exhibited rapid gelation at room temperature, excellent injectability, and a uniform porous structure. Compared with the PEG hydrogels, the PEG-STG hydrogels showed a significantly increased maximum compressive strength, swelling ratio, and degradation rate (P < 0.05). In vitro release profiles indicated an initial burst release of STG followed by a sustained release phase. Biocompatibility assessments confirmed that the PEG-STG hydrogels possessed good cytocompatibility and hemocompatibility. In vitro cellular experiments demonstrated that high glucose significantly inhibited the migration of the HUVECs and L929 cells, which was not ameliorated by the PEG group but was notably improved by the PEG-STG group. Moreover, the PEG-STG hydrogels upregulated the mRNA expression levels of platelet-endothelial cell adhesion molecule-1 (PECAM-1/CD31), vascular endothelial growth factor (VEGF), and von Willebrand factor in HUVECs, along with increased protein expression of VEGF and CD31. In vivo results revealed that at 14 days post-operation, the PEG-STG group exhibited significantly enhanced wound closure compared with the Glu and NC groups. H&E staining showed improved re-epithelialization, increased granulation tissue formation, and better tissue structure restoration in the PEG-STG group. Conclusion PEG-STG hydrogels possess favorable injectability and biocompatibility. They can improve endothelial cell and fibroblast function under hyperglycemic conditions and promote diabetic skin wound healing, providing a experimental basis for developing localized therapeutic materials for oral and maxillofacial wounds in patients with diabetes.

Objective: To evaluate the clinical efficacy of preimplantation genetic testing for monogenic disorders(PGT-M) in families with hereditary epilepsy. Methods : Whole-exome sequencing(WES) and familial co-segregation analysis were performed to validate the pathogenicity of variants(PCDH19 c. 1031C > G and LGI1 c. 856T >G) in two monogenic epilepsy families. A clinical PGT-M pathway was implemented,and reproductive outcomes were tracked. Results: In Family 1(PCDH19 likely pathogenic variant),13 blastocysts were biopsied over two ovarian stimulation cycles,yielding 3 unaffected euploid embryos(23. 1%). After the third frozen embryo transfer,a healthy male infant was successfully delivered. Prenatal diagnosis confirmed that the fetus did not carry the pathogenic variant PCDH19. Family 2(LGI1 variant of uncertain significance,VUS) screened 14 blastocysts,identifying 2 unaffected euploid embryos(14. 3%),with the first transfer unsuccessful. A clinical pregnancy was currently ongoing following the second frozen-thawed embryo transfer(FET). Conclusion PGT-M can precisely block the vertical transmission of monogenic epileptic pathogenic variants,offering an effective reproductive intervention strategy for families with hereditary epilepsy.

OBJECTIVE: To assess the feasibility of first polar body transfer (PB1T) combined with preimplantation mitochondrial genetic testing for blocking the transmission of a pathogenic mitochondrial DNA 8993T>G mutation. METHODS: A Chinese family affected with Leigh syndrome which had attended the Reproductive Medicine Centre of the First Affiliated Hospital of Anhui Medical University in September 2021 was selected as the study subject. Controlled ovarian hyperstimulation was carried out for the proband after completing the detection of the mitochondrial DNA 8993T>G mutation load among the pedigree members. Mature MII oocytes were inseminated by intracytoplasmic sperm injection (ICSI), cultured in vitro for 5 to 6 days to the blastocyst stage, and trophoblastocytes were obtained by microbiopsy. Mitochondrial DNA testing (PGT-MT) and chromosomal aneuploidy (PGT-A) analyses were carried out after whole-genome amplification, and the embryos with zero mutation load were selected for transfer. Amniotic fluid and umbilical cord blood samples were collected during middle pregnancy and after birth respectively for mitochondrial DNA testing to verify the reliability of embryo screening. As an attempt, PB1 with good morphology of MII oocytes was selected for transfer into the enucleated oocytoplasm from healthy donors, followed by ICSI fertilization, blastocyst culture and PGT of embryos using the same procedure. This study has been approved by the Ethics Committee of the First Affiliated Hospital of Anhui Medical University (No. 2021zhyx-B12). RESULTS: An antagonist protocol was used for ovarian stimulation, and a total of 19 oocytes were obtained, of which 14 MII were fertilized by ICSI, and 2 had developed into blastocysts. PGT-MT was carried out on biopsied trophoblastocytes, in which the mitochondrial DNA 8993T>G mutation load was not detected in one embryo, the other was 100% mutated, and the mutation loads of the remaining unfertilized eggs and developmentally arrested embryos ranged from 0% ~ 100%, presenting a clear biased distribution. With fully informed consent, one PGT-MT zero mutation load blastocyst was transferred and clinical pregnancy was achieved. Mitochondrial DNA and chromosomal testing of amniotic fluid cells during middle pregnancy had revealed no abnormalities. The proband had delivered a healthy boy through Caesarean section at 39⁺⁵ weeks of gestation, and no mutation was detected in the cord blood sample. Five well-formed PBs from 14 eggs were selected for PB1 transfer, followed by ICSI and culture, and two of the reconstituted embryos had formed blastocysts, with none of the above mutations detected in the biopsied samples. CONCLUSION The PGT-MT technology can help families affected with mitochondrial diseases to have healthy offspring. PB1 transfer in combination with ICSI and PGT-MT holds the promise of turning waste into treasure and providing an alternative means of fertility for such families.
Humans ; Preimplantation Diagnosis/methods* ; Female ; DNA, Mitochondrial/genetics* ; Genetic Testing/methods* ; Pregnancy ; Mitochondrial Diseases/genetics* ; Polar Bodies ; Adult ; Feasibility Studies ; Sperm Injections, Intracytoplasmic/methods* ; Embryo Transfer/methods* ; Mutation ; Male ; Blastocyst/metabolism* ; Pedigree

Objective:To observe the effect of point injection at Zusanli(ST36)plus abdominal point application on gastrointestinal dysfunction after laparoscopic surgery.Methods:A total of 204 patients with gastrointestinal dysfunction after laparoscopic surgery were recruited and divided into four groups using the random number table method,with 51 cases in each group.The control group received conventional postoperative intervention.In addition to the treatment in the control group,the point injection group was given point injection at Zusanli(ST36),the application group was offered abdominal point application,and the integrated group received point injection at Zusanli(ST36)and abdominal point application.The treatment lasted 3 consecutive days in all four groups.The recovery time of gastrointestinal function indicators and the incidence rate of postoperative nausea and vomiting(PONV)were observed and recorded.Before and after treatment,the visual analog scale(VAS)was used to assess abdominal pain intensity,the venous blood type 1 helper T cells/type 2 helper T cells(Th1/Th2)was determined,the serum levels of interleukin(IL)-6 and interferon(IFN)-γ were detected using the enzyme-linked immunosorbent assay,and the plasma levels of motilin and gastrin were measured using radioimmunoassay.Results:Compared to the control group,the first exhaust time,the first defecation time,and the time of restoring fluid diet came earlier in the other three groups(P<0.05)and were earlier in the integrated group than in the point injection and application groups(P<0.05).The point injection,application,and integrated groups had a lower PONV incidence rate than the control group,and the integrated group was lower than the point injection and application groups(P<0.05).The intra-group comparisons showed that the VAS score and the levels of IL-6 and INF-γ decreased after treatment in all four groups(P<0.05);the point injection,application,and integrated groups were lower than the control group(P<0.05),and the integrated group was lower than the point injection and application groups(P<0.05).The intra-group comparisons also demonstrated that the levels of Th1/Th2,motilin,and gastrin increased after the intervention in the four groups(P<0.05);the point injection,application,and integrated groups were higher than the control group(P<0.05),and the integrated group was higher than the point injection and application groups(P<0.05).Conclusion:Point injection at Zusanli(ST36)plus abdominal point application can encourage postoperative exhaust,defecation,and the recovery of diet fluid,alleviate postoperative abdominal pain,reduce PONV,balance Th1/Th2,and regulate the secretion of motilin and gastrin in patients with gastrointestinal dysfunction after laparoscopic surgery.

Ischemic cerebrovascular disease poses a serious threat to human health.Cerebrovascular stent implantation improves the prognosis of ischemic stroke patients,but postoperative restenosis remains a major challenge that hinders its long-term efficacy.Qi deficiency and blood stasis are the primary pathological states of ischemic cerebrovascular disease,both before and after cerebral vascular stent implantation,Buyang Huanwu Decoction,as a representative formula for tonifying qi,promoting blood circulation,and resolving blood stasis,has demonstrated significant clinical efficacy in preventing and treating restenosis after stent implantation.This article will review the mechanisms of restenosis following cerebrovascular stent implantation and the clinical applications and mechanisms of Buyang Huanwu Decoction in preventing and treating post-stent restenosis.

With the rise of the digital era,various digital technologies,including three-dimensional printing,reconstruction,and visualization,have been widely applied in medicine,particularly in surgery,advancing medical development and innovation.Digital technology and preci-sion medicine have advanced with the development and application of artificial intelligence(AI),leading to diverse innovations in the field of surgery.Digital technology has also facilitated new approaches in precision medicine,enabling the precise localization of lesions before sur-gery,real-time intraoperative navigation,and the establishment of predictive models for postoperative outcomes.These advancements have thus driven the comprehensive transformation of surgical practice toward greater personalization,precision,and intelligence.This study provides a comprehensive review of the application of digital technologies in gastrointestinal tumor management,encompassing preoperat-ive planning,intraoperative navigation,and postoperative recovery.The evolution of digital technologies is described,and an in-depth sum-mary is provided of the development and clinical value of digital technology in gastrointestinal tumor surgery.Additionally,the study pro-poses future directions for digital medicine in this field.

Objective:To investigate the clinical efficiency of induced membrane technique combined with structural bone grafting for treatment of segmental defects of the metacarpus and phalanges.Methods:A retrospective study was conducted to analyze the clinical data of 26 patients with segmental defects of the metacarpus and phalanges who had been treated by induced membrane technique combined with structural bone grafting from January 2021 to January 2023 at Department of Hand Surgery, Xuzhou Renci Hospital. There were 22 males and 4 females, aged 37.5 (31.5, 54.0) years. Ten left sides and 16 right sides were affected. Acute traumatic bone defects were observed in 22 cases and bone defects after post-trauma debridement of chronic osteomyelitis in 4 cases. Metacarpal bone defects occurred in 12 cases and phalangeal bone defects in 14 cases. The sizes of the defects ranged from 0.8 cm×0.6 cm×0.6 cm to 4.2 cm×1.2 cm×1.0 cm, and the sizes of the bone grafts from 1.0 cm×0.6 cm×0.6 cm to 4.5 cm×1.2 cm×1.0 cm. All patients were treated by bone cement filling into the bone defects to induce formation of a membrane in the first stage and structural grafting with autologous iliac bone in the second stage. Regular X-ray follow-ups were conducted after surgery. Wound healing, complications, bone union time, bone union rate, and total active movement (TAM) of the finger affected at the last follow-up were observed.Results:Stage I wound healing was achieved in all the 26 patients after surgery, without such complications as infection or delayed healing. All the 4 patients with chronic post-traumatic osteomyelitis healed after a single filling treatment with bone cement containing sensitive antibiotics. All patients were followed up for 12.0 (8.7, 15.0) months. Their fracture union time averaged (8.5±1.5) weeks, ranging from 6 to 12 weeks. The bone union rate was 100% (26/26). At the last follow-up, the TAM of the finger affected was 170°± 45° in all patients, ranging from 60° to 240°, and the affected side recovered 73.0% (69.0%, 89.2%) of the hand function of the healthy side.Conclusion:In the treatment of segmental defects of the metacarpus and phalanges, induced membrane technique combined with structural bone grafting can lead to a high fracture union rate, effectively reduced infection and good recovery of the finger mobility.