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 evaluate the effectiveness of enhanced "Presentation-Assimilation-Discussion (PAD) class" model in electrocardiogram (ECG) internship teaching in the department of cardiovascular medicine and to improve the ECG interpretation and clinical competency of interns.Methods:A total of 200 clinical undergraduate interns enrolled from September 2022 to August 2024 were divided into a control group (traditional teaching, n=100) and an experimental group (enhanced "PAD class" model, n=100). The enhanced "PAD class" model adopted a "focused lecture, structured internalization, and case-driven discussion" approach, incorporating artificial intelligence-assisted real-time feedback and targeted task design. Post-internship evaluations compared the scores of foundational skills (ECG interpretation accuracy and standardized ECG operation), clinical competencies (clinical decision-making, critical value recognition, and diagnostic reasoning), comprehensive evaluation, and assessment of teaching effectiveness. SPSS 26.0 was used for the chi-square test and t-test. Results:The experimental group demonstrated significantly superior performance in foundational skills [e.g., ECG interpretation accuracy: (97.63±1.35) vs. (90.54±4.08)], clinical competencies [e.g., clinical decision-making: (93.45±3.18) vs. (82.17±5.62)], and comprehensive evaluation [(97.96±1.06) vs. (90.94±3.49)] (all P<0.05). In teaching effectiveness evaluation, satisfaction was significantly higher in the experimental group across all seven metrics such as stimulated learning interest and clinical thinking ( P<0.05). Conclusions:The enhanced "PAD class "model, through artificial intelligence empowerment and case-driven discussions, can significantly improve ECG teaching outcomes and clinical decision-making skills, demonstrating its potential for broader application in internship teaching in the department of cardiovascular medicine.

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 evaluate the effectiveness of enhanced "Presentation-Assimilation-Discussion (PAD) class" model in electrocardiogram (ECG) internship teaching in the department of cardiovascular medicine and to improve the ECG interpretation and clinical competency of interns.Methods:A total of 200 clinical undergraduate interns enrolled from September 2022 to August 2024 were divided into a control group (traditional teaching, n=100) and an experimental group (enhanced "PAD class" model, n=100). The enhanced "PAD class" model adopted a "focused lecture, structured internalization, and case-driven discussion" approach, incorporating artificial intelligence-assisted real-time feedback and targeted task design. Post-internship evaluations compared the scores of foundational skills (ECG interpretation accuracy and standardized ECG operation), clinical competencies (clinical decision-making, critical value recognition, and diagnostic reasoning), comprehensive evaluation, and assessment of teaching effectiveness. SPSS 26.0 was used for the chi-square test and t-test. Results:The experimental group demonstrated significantly superior performance in foundational skills [e.g., ECG interpretation accuracy: (97.63±1.35) vs. (90.54±4.08)], clinical competencies [e.g., clinical decision-making: (93.45±3.18) vs. (82.17±5.62)], and comprehensive evaluation [(97.96±1.06) vs. (90.94±3.49)] (all P<0.05). In teaching effectiveness evaluation, satisfaction was significantly higher in the experimental group across all seven metrics such as stimulated learning interest and clinical thinking ( P<0.05). Conclusions:The enhanced "PAD class "model, through artificial intelligence empowerment and case-driven discussions, can significantly improve ECG teaching outcomes and clinical decision-making skills, demonstrating its potential for broader application in internship teaching in the department of cardiovascular medicine.

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 evaluate the excitation and identification of parathyroid autofluorescence in thyroid surgery by a fluorescence laparoscopic system.Methods:The clinical data of 6 patients with papillary thyroid carcinoma who underwent Laparoscopic thyroid surgery at the Second Affiliated Hospital of Guangxi Medical University from Mar. 2022 to Apr. 2022 were collected. The autofluorescence of the parathyroid glands was detected and identified by the OptoMedic fluorescence laparoscopic system during the operation. A rapid frozen sections pathological examination of possible parathyroid tissue with autofluorescence was performed to determine whether it was parathyroid tissue.Results:Parathyroid autofluorescence with different intensities was visualized intraoperatively in all 6 patients, and it was confirmed as parathyroid tissue by rapid frozen pathological section.Conclusions:The parathyroid gland has a unique autofluorescence feature. Using this feature to identify, locate and protect the parathyroid gland during surgery can help reduce the complications of parathyroid injury.

Facial paralysis causes both physical pain and psychological distress to patients. It is difficult for a patient with facial paralysis to engage with a normal social life and at work. Progresses have been made in recent years in the treatment of facial paralysis. More attentions have been caught by masseteric to facial nerve transposition, which has advantages of adjacency in location, abundancy in nerve supply and reliability in the outcome and now has deemed an important option of facial reanimation. It has not been long since the application of the technique of masseteric to facial nerve transposition in China, therefore it still lacks a universal guidance on practice. In order to achieve the aim of better quality control and popularisation of the technique, hereby a consensus with suggestions on facial reanimation with masseteric to facial nerve transposition is proposed as the reference for surgeons specialised in facial reanimation. This consensus is proposed, discussed and drafted by experts from plastic and reconstructive surgery, oral and maxillofacial surgery, head and neck surgery and neurosurgery.

Critical ultrasonography(CUS) is different from the traditional diagnostic ultrasound,the examiner and interpreter of the image are critical care medicine physicians.The core content of CUS is to evaluate the pathophysiological changes of organs and systems and etiology changes.With the idea of critical care medicine as the soul,it can integrate the above information and clinical information,bedside real-time diagnosis and titration treatment,and evaluate the therapeutic effect so as to improve the outcome.CUS is a traditional technique which is applied as a new application method.The consensus of experts on critical ultrasonography in China released in 2016 put forward consensus suggestions on the concept,implementation and application of CUS.It should be further emphasized that the accurate and objective assessment and implementation of CUS requires the standardization of ultrasound image acquisition and the need to establish a CUS procedure.At the same time,the standardized training for CUS accepted by critical care medicine physicians requires the application of technical specifications,and the establishment of technical specifications is the basis for the quality control and continuous improvement of CUS.Chinese Critical Ultrasound Study Group and Critical Hemodynamic Therapy Collabration Group,based on the rich experience of clinical practice in critical care and research,combined with the essence of CUS,to learn the traditional ultrasonic essence,established the clinical application technical specifications of CUS,including in five parts:basic view and relevant indicators to obtain in CUS;basic norms for viscera organ assessment and special assessment;standardized processes and systematic inspection programs;examples of CUS applications;CUS training and the application of qualification certification.The establishment of applied technology standard is helpful for standardized training and clinical correct implementation.It is helpful for clinical evaluation and correct guidance treatment,and is also helpful for quality control and continuous improvement of CUS application.

We evaluated an astaxanthin overproducing Phaffia rhodozyma JMU-MVP14, and developed astaxanthin high-yielding fermentation process. We analyzed several fermentation parameters, i.e., biomass, astaxanthin and total carotenoids content to compare the characteristics of P rhodozyma JMU-MVP14 and the original strain through flask fermentation experiments. We conducted batch and fed-batch fermentation experiments in 7 L fermentor to investigate the effects of pH controlling models and feeding medium compositions on the production of astaxanthin. We further evaluated the capability and practical value of P rhodozyma JMU-MVP14 by fed-batch cultivation in the 1 m3 fermentor. Flask fermentation experiments revealed that P. rhodozyma JMU-MVP14 produced high yield of astaxanthin and carotenoids with specific productivity of astaxanthin and specific productivity of total carotenoids of 6.01 mg/g and 10.38 mg/g. Results of batch culture experiments in the 7 L fermentor showed that controlling the pH by ammonia auto-feeding was better than discontinuously adjusting pH value at 6.0 with regard to the high productivities of biomasses and astaxanthin. This P. rhodozyma strain synthesized astaxanthin partially linked to the growth with the Ks and pmax of 0.20 h ' and 21.73 g/L, respectively. Results of batch-fed fermentations in 7 L fermentor indicated that the complex feeding medium consisted of 50% glucose, 0.5% yeast extract and 0.3% corn steep syrup had lower astaxanthin productivity than the simple feeding medium containing only 50% glucose, which produced biomass, volumetric productivity of astaxanthin, volumetric productivity of total carotenoids, specific productivity of astaxanthin and total carotenoids at 32.81 g/L, 155.99 mg/L, 4.94 mg/g, 399.99 mg/L and 12.19 mg/g, respectively. As fed-batch cultured in 1 m3 fermentor, P rhodozyma JMU-MVP14 yielded 85.11 g/L of biomass, 279.96 mg/L of volumetric productivity of astaxanthin, 618.01 mg/L of volumetric productivity of total carotenoids, 3.29 mg/g of specific productivity of astaxanthin and 7.26 mg/g of specific productivity of total carotenoids. Additionally, P rhodozyma JMU-MVP14 cell contained 21.54% of protein, 41.34% of carbohydrate and 34.31% of lipid. These comprehensive results suggest that P. rhodozyma JMU-MVPl14 has great practical prosperity related to its strong ability to produce astaxanthin and good value byproducts.
Basidiomycota ; genetics ; growth & development ; metabolism ; Batch Cell Culture Techniques ; Carotenoids ; biosynthesis ; Culture Media ; Fermentation ; Hydrogen-Ion Concentration ; Industrial Microbiology ; Kinetics ; Xanthophylls ; biosynthesis

Objective To explore the psychological state after needle stick injury among nurses.Methods A questionnaire survey was conducted among 256 nurses to understand their psychological state after needle stick injury, and the results underwent analysis.Results 220 nurses suffered needle stick injury among 256 nurses.79% nurses recognized that the serious result after needle stick injury was various blood-borne diseases.91% nuuses felt feared after needle stick injury.70% nurses felt inevitable to suffer needle stick injury. 10% and 11% nurses showed avoidance and turnover idea. Conclusions The majority of nurses show negative and fearful mental status after needle stick injury, but they think it is inevitable and give no sufficient attention to it, besides, the minority of nurses show less recognition to needle stick injury.