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 construct and apply drug utilization evaluation （DUE） criteria for low-dose rivaroxaban in atherosclerotic cardiovascular disease （ASCVD） based on the dual pathway inhibition （DPI） antithrombotic therapy scheme， to promote clinical rational drug use. METHODS Based on the instructions and relevant guidelines of low-dose rivaroxaban （2.5 mg， bid）， the Delphi method was used to establish the DUE criteria for low-dose rivaroxaban used in ASCVD. Weighted technique for order preference by similarity to an ideal solution method was used to determine the relative weights of each evaluation index， and the rationality of the filing medical records of discharged patients using low-dose rivaroxaban for ASCVD at Anqing Municipal Hospital from February 2024 to January 2025 was evaluated. RESULTS The established DUE criteria included 3 primary indicators （medication indications， medication process， medication results） and 11 secondary indicators （such as indications， contraindications， etc.）. The higher weighted secondary indicators being contraindications （0.117 9） and indications （0.112 1）. A total of 265 medical records were included for evaluation. The evaluation results showed that 192 cases （72.45%） had reasonable medical records， 69 cases （26.04%） had basic reasonable medical records， and 4 cases （1.51%） had unreasonable medical records； unreasonable types mainly included inappropriate combination therapy， inappropriate usage and dosage， inappropriate post- medication monitoring， and inappropriate drug switching， etc. CONCLUSIONS This study establishes a DUE criteria for low-dose rivaroxaban in ASCVD based on the DPI antithrombotic treatment regimen， and the evaluation results are intuitive， reliable， and quantifiable. The use of low-dose rivaroxaban in ASCVD patients in our hospital is relatively reasonable， but further management needs to be strengthened.

Objective To evaluate the value of dynamic electrocardiography(ECG)parameters combined with CT angiography(CTA)parameters in the evaluation of major adverse cardiovascu-lar events(MACE)in elderly patients with coronary heart disease(CHD).Methods A total of 110 elderly CHD patients admitted to our Hospital from January 2021 to May 2023 were prospec-tively recruited,and then divided into a MACE group(30 cases)and a non-MACE group(80 ca-ses)according to whether MACE occurred within 1 year of follow-up.The parameters of Holter,including QT interval variability(QTV),total standard deviation of N-N interval(SDNN),per-centage of total adjacent N-N over 50 ms(PNN50),and standard deviation of the average N-N in-tervals in all 5-min segment of a 24-h recording(SDANN),and the CTA parameters,such as min-imum lumen diameter(MLD),minimum lumen area(MLA),percentage of stenosis area(AS)and percentage of stenosis diameter(DS),were compared between the two groups.A nomogram-based prediction model for MACE risk was then constructed.ROC curve and calibration curve were drawn to evaluate the prediction efficiency of the risk model.Results The MACE group had significantly advanced age,more coronary lesions,and higher AS and DS values,but obviously lower SDNN,SDANN,PNN50,QTV,MLA and MLD values than the non-MACE group(P＜0.05,P＜0.01).The risk prediction model showed that advanced age,multivessel lesions,smaller SDNN,SDANN,PNN50,QTV,MLA and MLD values,and larger AS and DS values indicated higher risk of MACE in the elderly CHD patients.ROC curve analysis revealed that the AUC val-ue of our risk prediction model was 0.872(95％CI:0.764-0.975),with a sensitivity of 93.33％(28/30),a specificity of 91.25％(73/80),and an accuracy of 91.82％(101/110).Calibration curve analysis indicated that the model had a good fit(Chi-square=2.879,P=0.410),and Bootstrap in-ternal verification suggested that the model had a good accuracy(C-index=0.834).Conclusion Dynamic ECG parameters and CT A parameters are abnormal in elderly patients with MACE.Our risk prediction model based on these parameters has high value in evaluating the occurrence of MACE in the patients.

A 13-year-old boy was admitted to the hospital due to 1 month after trauma in a traffic accident on September 29，2017. After admission，due to a large amount of pleural effusion through the chest tube，thoracoscopic exploration and fiberboard dissection were performed，and the postoperative pleural effusion was not significantly reduced. The creatinine of pleural effusion was 913 μmol/L，CT showed that left hydronephrosis and perirenal encapsulated effusion were closely related to the ureter，so ureteral injury and urinothorax were considered. Retrograde ureterography revealed a defect of left ureter，approximately 6 cm in length，and left nephrectomy + left kidney rupture repair + renal autotransplantation was performed. 7 years later，the patient recovered well and the renal blood supply was good，no left hydronephrosis was found by MRU. Early diagnosis of ureteral injury is challenging，especially when accompanied by urinothorax. When life is stable，early diagnosis and treatment can reduce the loss of renal function after combined trauma. Renal autotransplantation is safe and effective for the treatment of long segmental ureteral defects.

Objective:To investigate the efficacy of endoscopic ultrasound-guided paraesophageal varices puncture cyanoacrylate selective seal for liver cirrhosis complicated with esophageal varices.Methods:Data of 86 patients with liver cirrhosis complicated with esophageal varices undergoing endoscopic ultrasound-guided paraesophageal varices puncture cyanoacrylate selective seal (the treatment group, n=40) and conventional endoscopic tissue glue injection treatment (the control group, n=46) were retrospectively collected from Beijing Ditan Hospital from January 2023 to October 2023. The reduced percentage of severe varicose veins, the amount of tissue glue used during operation, the number of punctures and the rate of rebleeding in six months were compared. Results:There were no significant differences in the baseline data including gender, age, blood routine index, liver and kidney functions, proportion of severity varicose veins between the two groups ( P>0.05). In the treatment group, severe varicose veins accounted for 90.0% (36/40) before treatment while it was 12.5% (5/40) after the treatment, and the proportion of severe varicose veins decreased by 77.5%. In the control group, the proportion of severe varicose veins was 89.1% (41/46) before while it was 43.5% (20/46) after the treatment, and the proportion of severe varicose veins decreased by 45.6%. The proportion of severe varicose veins decreased more in the treatment group than that in the control group ( χ2=13.86, P<0.001). Compared with the control group, the median amount of tissue glue applied in the treatment group was significantly less (2.5 mL VS 3.0 mL, Z=-3.55, P<0.001), and the median number of punctures was also significantly less (2 VS 6, Z=-7.10, P<0.001). There was no significant difference in the rate of rebleeding within six months after the treatment between the two groups [12.5% (5/40) VS 10.9% (5/46), χ2=0.06, P=0.814]. Conclusion:For patients with cirrhosis complicated with esophageal varices, endoscopic ultrasound-guided paraesophageal varices puncture cyanoacrylate selective seal demonstrates superior efficacy over conventional endoscopic treatment, with less tissue glue applied, which is worth of promotion and application in clinical practice.

BACKGROUND:Mechanical alignment is the"gold standard"alignment technique in total knee arthroplasty,but regardless of advances in prosthetic materials and robotic-assisted navigation,mechanical alignment-total knee arthroplasty still has a patient dissatisfaction rate of about 20％.OBJECTIVE:To evaluate the early efficacy of navigation-assisted total knee arthroplasty using functional alignment.METHODS:A total of 44 consecutive cases(50 knees)that underwent computer navigation-assisted total knee arthroplasty with functional alignment from October 2019 to June 2023 were retrospectively analyzed,including 12 males(14 knees)and 32 females(36 knees).A total of 46 consecutive cases(50 knees)that underwent navigation-assisted total knee arthroplasty with mechanical axis alignment by the same surgical team during the same period were selected as controls,including 5 males(5 knees)and 41 females(45 knees).The tibial osteotomy angle,tibial plateau osteotomy amount,femoral osteotomy angle,distal femoral,posterior and anterior osteotomy amount,and joint line movement were observed in the two groups of patients.Preoperative and postoperative flexion and extension gap internal and external laxity,hip-knee-ankle angle,mechanical lateral distal femoral angle,mechanical medial proximal tibial angle,joint line convergence angle,sagittal femoral component angle,posterior tibial slope,arithmetic hip-knee-ankle angle,joint line obliquity,coronal plane alignment of the knee classification,Western Ontario and McMaster Universities Osteoarthritis Index,and Hospital for Special Surgery score and forgotten joint score were compared between the two groups.RESULTS AND CONCLUSION:(1)The intraoperative tibial plateau osteotomy angle in the functional alignment group was greater than that in the mechanical axis alignment group,and the proportion of gap imbalance(2％)was smaller than that in the mechanical axis alignment group(18％).The differences were all significant(P＜0.05).(2)The hip-knee-ankle angle,mechanical medial proximal tibial angle,arithmetic hip-knee-ankle angle,and joint line obliquity in the functional alignment group were smaller than those in the mechanical axis alignment group postoperatively,and the differences were significant(P＜0.05).(3)The most common coronal plane alignment of the knee classification before surgery was type Ⅰ(80％in the functional alignment group and 42％in the mechanical axis alignment group).(4)The proportion of joint line obliquity＜177°(44％)in the functional alignment group was greater than that in the mechanical axis alignment group(14％)postoperatively.(5)Hospital for Special Surgery score at 1 month,6 months,and last follow-up after surgery was higher in the functional alignment group than that in the mechanical axis alignment group;the differences were statistically significant(P＜0.05).The Western Ontario and McMaster Universities Osteoarthritis Index 1 month after surgery was lower in the functional alignment group than that in the mechanical axis alignment group;the difference was statistically significant(t=-2.85,P=0.005).There was no significant difference in postoperative range of motion and forgotten joint score between the two groups(P＞0.05).(6)It is indicated that navigation-assisted total knee arthroplasty using functional alignment optimizes early clinical efficacy.The functional alignment technique has advantages in restoration of constitutional alignment and joint line obliquity and avoids soft tissue release compared to mechanical alignment technique.

Objective To investigate the associations between unilateral or bilateral hearing loss and 12 chronic diseases as well as multimorbidity among the oldest old in China,and to identify disparities in these associations of left-and right-side hearing loss with chronic diseases.Methods Totally 7 437 people aged ≥80 years old were selected from the Chinese Longitudinal Health and Longevity Survey(CLHLS)2018 cross-sectional data.With 12 chronic diseases and multimorbidity as outcome variables,the hearing loss as explanatory variable,socio-demographic characteristics,family factors,and lifestyle as covariates,the correlations of unilateral(left-or right-side)and bilateral hearing loss with chronic diseases and multimorbidity were analyzed using multivariate logistic regression model,and the trend analyses were carried out.Results There were 205(2.76％),227(3.05％)and 3 598(48.38％)old people with left-side,right-side and bilateral hearing loss,respectively.After adjusting for confounders,the oldest old with left-sided or bilateral hearing loss had a greater risk of multimorbidity compared with those with normal hearing function,with odds ratio(95％confidence interval)of 2.14(1.58-2.90)and 1.27(1.13-1.43),respectively,while no association between right-sided hearing loss and multimorbidity was observed(P＞0.05).Trend analysis showed that the risk of multimorbidity increased with hearing loss from none to unilateral and then to bilateral(P＜0.001).Conclusion Hearing loss may be related to the increased risk of multimorbidity in the oldest old,and the risk of those with bilateral hearing loss is higher.More attention should be paid to the prevention and treatment of hearing loss in the oldest old.

Objective:To evaluate the feasibility of transjugular transcatheter tricuspid valve replacement (TTVR) using the LuX-Valve Plus system (Ningbo Jenscare Scientific, China) for the treatment of severe tricuspid regurgitation in real-world clinical settings.Methods:This prospective study enrolled 81 patients with severe ricuspid regurgitation (≥3+) who underwent TTVR with the LuX-Valve Plus system at the Department of Cardiology, West China Hospital of Sichuan University between May 2022 and March 2024. Among them, 44 patients were from a compassionate-use study, and 37 were from two premarket clinical trials. Baseline clinical data, preprocedural imaging, procedural outcomes, and postprocedural follow-up data were collected. The primary endpoint events included device success, procedural success, and 30 d composite adverse events.Results:The age of the cohort was (74.5±7.8) years, with 54 females (67%). Device success and procedural success rates were both 90% (73/81). Post-procedural tricuspid regurgitation improved, with a 6% (5/81) incidence of moderate-to-severe paravalvular leakage. The rate of permanent pacemaker implantation was 12% (10/81), of which 5% (4/81) had pre-existing indications for pacemaker implantation. Major bleeding events occurred in 10% (8/81) of patients, and the 30 d composite endpoint rate was 25% (20/81).Conclusion:TTVR using the LuX-Valve Plus system demonstrates promising feasibility for high-risk surgical patients with severe tricuspid regurgitation, effectively reducing or eliminating regurgitation with acceptable safety. However, challenges remain in reducing risks of major adverse events, including permanent pacemaker implantation and severe bleeding.

Constipation,a common functional gastrointestinal disorder,not only severely impairs patients'quality of life but is also highly comorbid with psychiatric conditions such as anxiety and depression.Emerging evidence indicates that gut microbiota dysbiosis is a critical link connecting these two disease states.On one hand,dysbiosis exacerbates constipation by affecting host metabolism and intestinal function;on the other,it plays a central role in the pathophysiology of mood disorders.This complex interaction is primarily mediated through the"microbiota-gut-brain axis."Therefore,elucidating the intrinsic relationship among anxiety,depression,gut microbiota,and constipation has become a frontier of interdisciplinary research.

BACKGROUND:Mechanical alignment is the"gold standard"alignment technique in total knee arthroplasty,but regardless of advances in prosthetic materials and robotic-assisted navigation,mechanical alignment-total knee arthroplasty still has a patient dissatisfaction rate of about 20％.OBJECTIVE:To evaluate the early efficacy of navigation-assisted total knee arthroplasty using functional alignment.METHODS:A total of 44 consecutive cases(50 knees)that underwent computer navigation-assisted total knee arthroplasty with functional alignment from October 2019 to June 2023 were retrospectively analyzed,including 12 males(14 knees)and 32 females(36 knees).A total of 46 consecutive cases(50 knees)that underwent navigation-assisted total knee arthroplasty with mechanical axis alignment by the same surgical team during the same period were selected as controls,including 5 males(5 knees)and 41 females(45 knees).The tibial osteotomy angle,tibial plateau osteotomy amount,femoral osteotomy angle,distal femoral,posterior and anterior osteotomy amount,and joint line movement were observed in the two groups of patients.Preoperative and postoperative flexion and extension gap internal and external laxity,hip-knee-ankle angle,mechanical lateral distal femoral angle,mechanical medial proximal tibial angle,joint line convergence angle,sagittal femoral component angle,posterior tibial slope,arithmetic hip-knee-ankle angle,joint line obliquity,coronal plane alignment of the knee classification,Western Ontario and McMaster Universities Osteoarthritis Index,and Hospital for Special Surgery score and forgotten joint score were compared between the two groups.RESULTS AND CONCLUSION:(1)The intraoperative tibial plateau osteotomy angle in the functional alignment group was greater than that in the mechanical axis alignment group,and the proportion of gap imbalance(2％)was smaller than that in the mechanical axis alignment group(18％).The differences were all significant(P＜0.05).(2)The hip-knee-ankle angle,mechanical medial proximal tibial angle,arithmetic hip-knee-ankle angle,and joint line obliquity in the functional alignment group were smaller than those in the mechanical axis alignment group postoperatively,and the differences were significant(P＜0.05).(3)The most common coronal plane alignment of the knee classification before surgery was type Ⅰ(80％in the functional alignment group and 42％in the mechanical axis alignment group).(4)The proportion of joint line obliquity＜177°(44％)in the functional alignment group was greater than that in the mechanical axis alignment group(14％)postoperatively.(5)Hospital for Special Surgery score at 1 month,6 months,and last follow-up after surgery was higher in the functional alignment group than that in the mechanical axis alignment group;the differences were statistically significant(P＜0.05).The Western Ontario and McMaster Universities Osteoarthritis Index 1 month after surgery was lower in the functional alignment group than that in the mechanical axis alignment group;the difference was statistically significant(t=-2.85,P=0.005).There was no significant difference in postoperative range of motion and forgotten joint score between the two groups(P＞0.05).(6)It is indicated that navigation-assisted total knee arthroplasty using functional alignment optimizes early clinical efficacy.The functional alignment technique has advantages in restoration of constitutional alignment and joint line obliquity and avoids soft tissue release compared to mechanical alignment technique.