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.

Transfusion and Anemia Expertise Initiative-Control/Avoidance of Bleeding developed a strategy for platelet and plasma infusion management in critically ill children based on systematic reviews and consensus meetings of international multidisciplinary experts. One good practice statement and six expert consensus statements were proposed for plasma and platelet transfusions in critically ill children following severe trauma, traumatic brain injury, and/or intracranial hemorrhage. This article introduces the specific methods and basis for the formation of recommendations in this part of the guide.

Objective This study reports on the obligatory parasitism of water mites Arrenurus sp. on Anopheles messeae at the Manzhouli Port, Inner Mongolia, China. Methods Duing July 2024, a survey on the mosquito diversity was conducted at the Manzhouli Port. Captured mosquitoes and their ectoparasites were identified to species level. Results A total of 1840 adult mosquitoes were collected, representing species from three genera: Culex(Cx. modestus, Cx. pipiens pallens), Aedes(Ae. dorsalis, Ae. flavidorsalis, Ae. flavescens), and Anopheles (An. messeae). Among all the mosqutioes specimens,3 out of 150 captured An. messeae were found to carry ectoparasitic mites, with number of 2,4,27 mites separately. Morphological and molecular identification reached the same result as water mites(Hydrachnidiae, Hydracrina). COI gene sequence showed 94% similarity with the closest species Arrenurus truncatellus. Conlusions Literature review suggests water mites are host-specific parasitism of mosquito species and herein with the first record of Arrenurus sp. parasiting on An. Messeae in the most high-latitude region globally.

Objective:To observe the analgesic effect and therapeutic mechanism of the dragon-tiger fight needling method in treating lumbar disc herniation(LDH).Methods:A total of 100 patients with LDH were selected and randomly divided into an observation group and a control group,with 50 patients in each group.Both groups received the same basic treatment of Western medicine.The observation group received additional acupuncture treatment using the dragon-tiger fight needling method,administered once every other day for a consecutive month.Before and after treatment,the serum levels of bradykinin(BK),soluble tumor necrosis factor type 1 receptor(sTNF-R1),α1-acid glycoprotein(α1-AGP),phospholipase A2(PLA2),methionine enkephalin(M-ENK),β-endorphin(β-EP),and 6-keto prostaglandin E1α(6-keto-PGE1α)were measured in both groups.Additionally,the sensory conduction velocities(SCV)of the sural nerve and superficial peroneal nerve,as well as the biomechanical indicators of lumbar muscles(including the lumbar flexion-extension ratio and peak torque and average power in the lumbar extension position)were assessed.The Oswestry disability index(ODI)was evaluated,and traditional Chinese medicine(TCM)symptoms were scored for patients in both groups.After treatment,the clinical efficacy of the two groups was compared.Results:After treatment,the serum levels of α1-AGP and PLA2 in both groups decreased compared to their respective pre-treatment levels(P<0.05),and the levels in the observation group were lower than those in the control group(P<0.05).The serum levels of sTNF-R1 in both groups increased compared to their respective pre-treatment levels(P<0.05),and the levels in the observation group were higher than those in the control group(P<0.05).The serum levels of 6-keto-PGE1α and BK in both groups decreased significantly compared to their respective pre-treatment levels(P<0.05),and the levels in the observation group were lower than those in the control group(P<0.05).The serum levels of M-ENK and β-EP in both groups increased compared to their respective pre-treatment levels(P<0.05),and the levels in the observation group were higher than those in the control group(P<0.05).The lumbar flexion-extension ratio in both groups decreased compared to their respective pre-treatment level(P<0.05),and the ratio in the observation group was lower than that in the control group(P<0.05).The peak torque and average power in the lumbar extension position increased in both groups compared to their respective pre-treatment levels(P<0.05),and both values in the observation group were higher than those in the control group(P<0.05).The SCV of the superficial peroneal nerve and sural nerve in both groups increased compared to their respective pre-treatment levels(P<0.05),and the values in the observation group were higher than those in the control group(P<0.05).The ODI and TCM symptom scores in both groups decreased(P<0.05),and the scores in the observation group were lower than those in the control group(P<0.05).Conclusion:Based on Western medicine treatment,acupuncture treatment using the dragon-tiger fight needling method for LDH patients can inhibit inflammatory markers,regulate pain mediator levels,alleviate pain,improve the biomechanical and electromyographic indicators of lumbar extensor muscles,and thus enhance lumbar function and clinical efficacy.

Objective:To explore the diagnostic efficacy of monocyte chemotactic protein-1(MCP-1)and creatine kinase isoenzyme(CK-MB)for chronic heart failure(CHF)and their association with New York Heart Associa-tion(NYHA)class.Methods:A total of 300 patients suspected of CHF who underwent physical examination in the Second People's Hospital of Hefei between January 2020 and August 2021 were analyzed.After 3-month follow-up,a total of 150 patients were diagnosed with CHF.According to NYHA cardiac function classification,CHF pa-tients were divided into class Ⅱ group(n=45),class Ⅲ group(n=45)and class Ⅳ group(n=60).MCP-1 and CK-MB levels were compared among above groups.Receiver operating characteristic(ROC)curve was used to an-alyze the diagnostic efficacy of each index and their combination for CHF and their association with NYHA class were analyzed using Spearman correlation analysis.Results:Compared to those without CHF,patients with CHF had significant higher levels of MCP-1[96.01(86.21,124.28)ng/ml vs.25.38(22.79,28.72)ng/ml,P＜0.001]and CK-MB[46.26(32.74,59.72)U/L vs.19.09(18.61,19.87)U/L,P＜0.001].ROC curve showed that a combination of MCP-1 and CK-MB had a significant higher area under the ROC curve(AUC)(0.947,95％CI 0.915～0.969)than MCP-1(0.797,95％CI 0.747～0.841)or CK-MB(0.855,95％CI 0.810～0.893)alone(Z=4.543,3.170,P＜0.001 all).Compared to those in the class Ⅱ group,those in the class Ⅲgroup and class Ⅳ group had significant higher MCP-1[94.57(91.18,96.92)ng/ml vs.125.27(123.20,128.24)ng/ml vs.68.38(27.55,86.38)ng/ml]and CK-MB[48.04(45.66,51.47)U/L vs.61.01(58.81,62.96)U/L vs.31.75(25.08,33.57)U/L],and those of class Ⅳ group were significantly higher than those of class Ⅲ group(P＜0.001 all).Spearman correlation analysis indicated that the levels of MCP-1 and CK-MB were significant positively correlated with NYHA class in CHF patients(r=0.712,0.878,P＜0.001 both).Con-clusion:MCP-1 and CK-MB were abnormally elevated in CHF patients.Serum levels of MCP-1 and CK-MB are significantly correlated with NYHA class.The combination had high diagnostic efficacy for CHF.

Aim To examine the pathogenesis of disul-fide death gene in vascular dementia(VD)by bioin-formatics analysis of disulfide death differentially ex-pressed genes(DEGs)combined with experimental verification.Methods The death DEGs of disulfide were screened and their correlation was analyzed.The VD patients data in the data set were analyzed by clus-tering and typing and gene set variation.The clustering risk of DEGs was tested with a nomogram model,and the optimal learning model was predicted.After the es-tablishment of VD rat model,water maze test,HE stai-ning and RT-qPCR detection were performed to verify the results of health information.Results Four DEGs including SLC7A11 were obtained,which had antago-nistic or synergistic interaction with each other.The genetic data could be divided into two subtypes with significant differences.After typing,VD disulfide DEGs were mainly concentrated in GnRH signaling pathways.The accuracy of the nomogram prediction model was high.Generalized linear was the best ma-chine learning model.Compared with the sham opera-tion group,the escape latency of rats in the model group was prolonged,the number of crossing platforms decreased,the relative mRNA expression levels of Slc3a2 and Slc7a11 decreased,and LRPPRC in-creased.Conclusions SLC7A11 and other disulfide death DEGs and its related GnRH signaling pathway may be an important part of the pathogenesis of VD di-sulfide death.SLC3A2,LRPPRC and SLC7A11 can be used as characteristic genes in the regulation of VD by disulfide death,which may affect VD progression through the regulation of disulfide death.

Objective:To explore the diagnostic efficacy of monocyte chemotactic protein-1(MCP-1)and creatine kinase isoenzyme(CK-MB)for chronic heart failure(CHF)and their association with New York Heart Associa-tion(NYHA)class.Methods:A total of 300 patients suspected of CHF who underwent physical examination in the Second People's Hospital of Hefei between January 2020 and August 2021 were analyzed.After 3-month follow-up,a total of 150 patients were diagnosed with CHF.According to NYHA cardiac function classification,CHF pa-tients were divided into class Ⅱ group(n=45),class Ⅲ group(n=45)and class Ⅳ group(n=60).MCP-1 and CK-MB levels were compared among above groups.Receiver operating characteristic(ROC)curve was used to an-alyze the diagnostic efficacy of each index and their combination for CHF and their association with NYHA class were analyzed using Spearman correlation analysis.Results:Compared to those without CHF,patients with CHF had significant higher levels of MCP-1[96.01(86.21,124.28)ng/ml vs.25.38(22.79,28.72)ng/ml,P＜0.001]and CK-MB[46.26(32.74,59.72)U/L vs.19.09(18.61,19.87)U/L,P＜0.001].ROC curve showed that a combination of MCP-1 and CK-MB had a significant higher area under the ROC curve(AUC)(0.947,95％CI 0.915～0.969)than MCP-1(0.797,95％CI 0.747～0.841)or CK-MB(0.855,95％CI 0.810～0.893)alone(Z=4.543,3.170,P＜0.001 all).Compared to those in the class Ⅱ group,those in the class Ⅲgroup and class Ⅳ group had significant higher MCP-1[94.57(91.18,96.92)ng/ml vs.125.27(123.20,128.24)ng/ml vs.68.38(27.55,86.38)ng/ml]and CK-MB[48.04(45.66,51.47)U/L vs.61.01(58.81,62.96)U/L vs.31.75(25.08,33.57)U/L],and those of class Ⅳ group were significantly higher than those of class Ⅲ group(P＜0.001 all).Spearman correlation analysis indicated that the levels of MCP-1 and CK-MB were significant positively correlated with NYHA class in CHF patients(r=0.712,0.878,P＜0.001 both).Con-clusion:MCP-1 and CK-MB were abnormally elevated in CHF patients.Serum levels of MCP-1 and CK-MB are significantly correlated with NYHA class.The combination had high diagnostic efficacy for CHF.

The pregnant woman was 30 years old,G2P0.This singleton pregnancy at 22 weeks of gestation was screened for second-trimester ultrasound malformations,suggesting fetal aortic valve atresia,aortic stenosis with reverse blood flow,mitral valve atresia,and markedly enlarged left ventricle,which was considered for the diagnosis of hypoplastic left heart syndrome(HLHS).The pregnancy was terminated at our hospital and subsequently underwent genetic testing with results of heterozygous variants in the NOTCH1 gene,which can cause aortic valve disease type 1.The findings of the fetal autopsy were aortic valve atresia,mitral valve widening and thickening,and left ventricular enlargement with myocardial infarction.This report focuses on the ultrasound characteristics of HLHS with left ventricular enlargement and its hemodynamic changes in order to improve clinicians'understanding of the progressive changes in the disease phenotype of HLHS.

Objective To summarize the clinical and genetic characteristics of children with sodium taurocholate co-transporting polypeptide(NTCP)deficiency.Methods Clinical data of children with NTCP deficiency diagnosed and treated at the First People's Hospital of Yunnan Province from July 2022 to March 2025 were retrospectively analyzed.Results A total of 14 children were included(6 males,8 females),all with normal growth and development.Reasons for initial consultation included elevated serum bile acids in 7 cases,jaundice in 4 cases,cholestatic hepatitis in 1 case,and one case each of pneumonia and cow's milk protein allergy.At the first visit,all patients had elevated serum total bile acids beyond the normal range,with a mean of 152.5 μmol/L.Elevated alanine aminotransferase was observed in 1 case,elevated aspartate aminotransferase in 2 cases,and elevated total bilirubin in 10 cases.Genetic sequencing revealed that all children carried the homozygous SLC10A1 variant c.800C>T(p.Ser267Phe),classified as likely pathogenic.Conclusions NTCP deficiency often lacks obvious clinical symptoms and signs.Some children present with transient hyperbilirubinemia,cholestasis,or other liver function abnormalities.Persistent isolated elevation of serum bile acids warrants suspicion for this disease.Biallelic pathogenic variants in SLC10A1 constitute the basis for definitive diagnosis.There is no specific treatment for this disease,and management is mainly symptomatic.

Objective To summarize the clinical and genetic characteristics of children with sodium taurocholate co-transporting polypeptide(NTCP)deficiency.Methods Clinical data of children with NTCP deficiency diagnosed and treated at the First People's Hospital of Yunnan Province from July 2022 to March 2025 were retrospectively analyzed.Results A total of 14 children were included(6 males,8 females),all with normal growth and development.Reasons for initial consultation included elevated serum bile acids in 7 cases,jaundice in 4 cases,cholestatic hepatitis in 1 case,and one case each of pneumonia and cow's milk protein allergy.At the first visit,all patients had elevated serum total bile acids beyond the normal range,with a mean of 152.5 μmol/L.Elevated alanine aminotransferase was observed in 1 case,elevated aspartate aminotransferase in 2 cases,and elevated total bilirubin in 10 cases.Genetic sequencing revealed that all children carried the homozygous SLC10A1 variant c.800C>T(p.Ser267Phe),classified as likely pathogenic.Conclusions NTCP deficiency often lacks obvious clinical symptoms and signs.Some children present with transient hyperbilirubinemia,cholestasis,or other liver function abnormalities.Persistent isolated elevation of serum bile acids warrants suspicion for this disease.Biallelic pathogenic variants in SLC10A1 constitute the basis for definitive diagnosis.There is no specific treatment for this disease,and management is mainly symptomatic.