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 propose a lung artery segmentation method that integrates shape and position prior knowledge, aiming to solve the issues of inaccurate segmentation caused by the high similarity and small size differences between the lung arteries and surrounding tissues in CT images. Methods Based on the three-dimensional U-Net network architecture and relying on the PARSE 2022 database image data, shape and position prior knowledge was introduced to design feature extraction and fusion strategies to enhance the ability of lung artery segmentation. The data of the patients were divided into three groups: a training set, a validation set, and a test set. The performance metrics for evaluating the model included Dice Similarity Coefficient (DSC), sensitivity, accuracy, and Hausdorff distance (HD95). Results The study included lung artery imaging data from 203 patients, including 100 patients in the training set, 30 patients in the validation set, and 73 patients in the test set. Through the backbone network, a rough segmentation of the lung arteries was performed to obtain a complete vascular structure; the branch network integrating shape and position information was used to extract features of small pulmonary arteries, reducing interference from the pulmonary artery trunk and left and right pulmonary arteries. Experimental results showed that the segmentation model based on shape and position prior knowledge had a higher DSC (82.81%±3.20% vs. 80.47%±3.17% vs. 80.36%±3.43%), sensitivity (85.30%±8.04% vs. 80.95%±6.89% vs. 82.82%±7.29%), and accuracy (81.63%±7.53% vs. 81.19%±8.35% vs. 79.36%±8.98%) compared to traditional three-dimensional U-Net and V-Net methods. HD95 could reach (9.52±4.29) mm, which was 6.05 mm shorter than traditional methods, showing excellent performance in segmentation boundaries. Conclusion The lung artery segmentation method based on shape and position prior knowledge can achieve precise segmentation of lung artery vessels and has potential application value in tasks such as bronchoscopy or percutaneous puncture surgery navigation.

Objective:To apply the Timed Up and Go Test(TUGT)to investigate the correlation between motor function, emotional state, cognitive function, and sleep quality among elderly individuals in the Chinese community.Methods:A cross-sectional study was conducted, involving 739 subjects aged 60 to 90 years, who were randomly recruited from December 2021 to August 2023 across Beijing, Tianjin, Zhejiang, Guangdong, and Hainan Provinces in China.Basic demographic information was collected, and the TUGT was utilized to assess motor function.Based on the TUGT time(t), the subjects were divided into three groups: normal motor function group, mild motor abnormality group, and significant motor abnormality group.Cognitive function was evaluated using the Chinese Revised Mini-Mental State Examination(MMSE), while the Patient Health Questionnaire Depression Scale(PHQ-9)was employed to measure the degree of depression.Additionally, the Epworth Sleepiness Scale(ESS)was used to assess excessive daytime sleepiness.The correlation between subjects' motor function and their cognitive abilities, mood, and sleep was subsequently analyzed.Results:Systolic blood pressure, heart rate, PHQ-9, MMSE, and ESS scores were identified as significant factors influencing TUGT time.Specifically, TUGT time was positively correlated with PHQ-9 and ESS scores, while exhibiting negative correlations with systolic blood pressure, heart rate, and MMSE scores.Additionally, TUGT time was negatively correlated with the MMSE subcomponents of orientation, immediate memory, and verbal ability.All observed differences were statistically significant(all P<0.05).Logistic regression analysis indicated that an increase in the PHQ-9 score was associated with an odds ratio( OR)of 1.099(95% CI: 1.045-1.155, P<0.001)(mild motor abnormality group)and 1.150(95% CI: 1.066-1.242, P<0.001)(Significant motor abnormality group).Additionally, a reduction in the MMSE score was observed, with an OR of 0.939(95% CI: 0.886-0.995, P<0.001)(mild motor abnormality group)and 0.793(95% CI: 0.729-0.862, P<0.001)(Significant motor abnormality group).Furthermore, an increase in the ESS score was noted, with ORs of 1.139(95% CI: 1.094-1.186, P<0.001)(mild motor abnormality group)and 1.203(95% CI: 1.132-1.279, P<0.001)(Significant motor abnormality group).These findings suggest that these variables are independently related to decreased motor function. Conclusions:Depression, cognitive impairment, and excessive daytime sleepiness are independent risk factors for motor dysfunction among elderly individuals in community settings.The Timed Up and Go Test TUGT can be utilized for the early screening of motor function decline in this population.

Objective:To analyze the influencing factors of postoperative pulmonary embolism (PE) in patients undergoing hepatectomy.Methods:Clinical data of 171 patients undergoing hepatectomy at the Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital of Kunming Medical University from January 2018 to November 2024 were retrospectively analyzed, including 95 males and 76 females, aged (52.0±12.6) years. The pathology of patients included hepatolithiasis, hepatic hemangioma, liver abscess, focal nodular hyperplasia of liver, hepatocellular carcinoma, intrahepatic cholangiocarcinoma, etc. According to whether PE occurred after hepatectomy, patients were divided into PE group ( n=64) and control group ( n=107). Univariate and multivariate logistic regression analysis were used to analyze the influencing factors of PE after hepatectomy. The receiver operating characteristic (ROC) curve was used to analyze the effect of each index on predicting PE after hepatectomy. Results:Multivariate logistic regression analysis showed that red blood cell volume distribution width ( OR=1.399, 95% CI: 1.223-1.601) and systemic inflammation response index (SIRI) on postoperative day (POD) 3 ( OR=1.317, 95% CI: 1.124-1.544) and D-dimer on POD1 ( OR=1.208, 95% CI: 1.026-1.421) were associated with a higher risk of PE after hepatectomy (all P<0.05). The area under the ROC curve of SIRI on POD3, D-dimer on POD1, and red blood cell volume distribution width on POD3 on predicting PE after hepatectomy was 0.763 (95% CI: 0.689-0.838), 0.744 (95% CI: 0.668-0.820) and 0.796 (95% CI: 0.727-0.864), respectively. Conclusion:Red blood cell volume distribution width on POD3, SIRI on POD3 and D-dimer on POD1 are the risk factors of PE after hepatectomy. These three indicators have certain predictive value for PE after hepatectomy.

Objective To explore the efficacy of DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy for management of cancer pain and provide reference for its standardized clinical application.Methods and Results Recommendations were formulated based on literature review and expert group discussion,and consensus was reached following expert consultation.The consensus recommendations are comprehensive,covering the entire treatment procedures from preoperative assessment and preparation,surgical operation process,postoperative management and traditional Chinese medicine treatment to individualized treatment planning.The study results showed that the treatment plans combining traditional Chinese with Western medicine effectively alleviated cancer pain,reduced the use of opioid drugs,and significantly improved the quality of life and enhanced immune function of the patients.Postoperative follow-up suggested good treatment tolerance among the patients without serious complications.Conclusion The formulated consensus is comprehensive and can provide reference for clinicians to use DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy.The combined treatment has a high clinical value with a good safety profile for management of cancer pain.

Objective:To apply the Timed Up and Go Test(TUGT)to investigate the correlation between motor function, emotional state, cognitive function, and sleep quality among elderly individuals in the Chinese community.Methods:A cross-sectional study was conducted, involving 739 subjects aged 60 to 90 years, who were randomly recruited from December 2021 to August 2023 across Beijing, Tianjin, Zhejiang, Guangdong, and Hainan Provinces in China.Basic demographic information was collected, and the TUGT was utilized to assess motor function.Based on the TUGT time(t), the subjects were divided into three groups: normal motor function group, mild motor abnormality group, and significant motor abnormality group.Cognitive function was evaluated using the Chinese Revised Mini-Mental State Examination(MMSE), while the Patient Health Questionnaire Depression Scale(PHQ-9)was employed to measure the degree of depression.Additionally, the Epworth Sleepiness Scale(ESS)was used to assess excessive daytime sleepiness.The correlation between subjects' motor function and their cognitive abilities, mood, and sleep was subsequently analyzed.Results:Systolic blood pressure, heart rate, PHQ-9, MMSE, and ESS scores were identified as significant factors influencing TUGT time.Specifically, TUGT time was positively correlated with PHQ-9 and ESS scores, while exhibiting negative correlations with systolic blood pressure, heart rate, and MMSE scores.Additionally, TUGT time was negatively correlated with the MMSE subcomponents of orientation, immediate memory, and verbal ability.All observed differences were statistically significant(all P<0.05).Logistic regression analysis indicated that an increase in the PHQ-9 score was associated with an odds ratio( OR)of 1.099(95% CI: 1.045-1.155, P<0.001)(mild motor abnormality group)and 1.150(95% CI: 1.066-1.242, P<0.001)(Significant motor abnormality group).Additionally, a reduction in the MMSE score was observed, with an OR of 0.939(95% CI: 0.886-0.995, P<0.001)(mild motor abnormality group)and 0.793(95% CI: 0.729-0.862, P<0.001)(Significant motor abnormality group).Furthermore, an increase in the ESS score was noted, with ORs of 1.139(95% CI: 1.094-1.186, P<0.001)(mild motor abnormality group)and 1.203(95% CI: 1.132-1.279, P<0.001)(Significant motor abnormality group).These findings suggest that these variables are independently related to decreased motor function. Conclusions:Depression, cognitive impairment, and excessive daytime sleepiness are independent risk factors for motor dysfunction among elderly individuals in community settings.The Timed Up and Go Test TUGT can be utilized for the early screening of motor function decline in this population.

Objective:To analyze the influencing factors of postoperative pulmonary embolism (PE) in patients undergoing hepatectomy.Methods:Clinical data of 171 patients undergoing hepatectomy at the Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital of Kunming Medical University from January 2018 to November 2024 were retrospectively analyzed, including 95 males and 76 females, aged (52.0±12.6) years. The pathology of patients included hepatolithiasis, hepatic hemangioma, liver abscess, focal nodular hyperplasia of liver, hepatocellular carcinoma, intrahepatic cholangiocarcinoma, etc. According to whether PE occurred after hepatectomy, patients were divided into PE group ( n=64) and control group ( n=107). Univariate and multivariate logistic regression analysis were used to analyze the influencing factors of PE after hepatectomy. The receiver operating characteristic (ROC) curve was used to analyze the effect of each index on predicting PE after hepatectomy. Results:Multivariate logistic regression analysis showed that red blood cell volume distribution width ( OR=1.399, 95% CI: 1.223-1.601) and systemic inflammation response index (SIRI) on postoperative day (POD) 3 ( OR=1.317, 95% CI: 1.124-1.544) and D-dimer on POD1 ( OR=1.208, 95% CI: 1.026-1.421) were associated with a higher risk of PE after hepatectomy (all P<0.05). The area under the ROC curve of SIRI on POD3, D-dimer on POD1, and red blood cell volume distribution width on POD3 on predicting PE after hepatectomy was 0.763 (95% CI: 0.689-0.838), 0.744 (95% CI: 0.668-0.820) and 0.796 (95% CI: 0.727-0.864), respectively. Conclusion:Red blood cell volume distribution width on POD3, SIRI on POD3 and D-dimer on POD1 are the risk factors of PE after hepatectomy. These three indicators have certain predictive value for PE after hepatectomy.

Objective To observe the difference of iron deposition in brain deep nuclei of systemic lupus erythematosus(SLE)patients with different disease activity levels using quantitative susceptibility mapping(QSM).Methods Fifty-four SLE patients were retrospectively enrolled and divided into moderate to severe activity group(score＞9,n=25)and mild activity group(score≤9,n=29)according to SLE disease activity index(SLEDAI)score.Patients' general clinical data,as well as the mean QSM of bilateral head of caudate nuclei,putamina,globi pallidi,red nuclei,substantiae nigrae,dentate nuclei and thalami were compared between groups.Pearson or Spearman coefficients were performed to analyze correlations of the mean QSM of nuclei being significant different between groups and conventional clinical indicators.Then receiver operating characteristic(ROC)curve was drawn,and the area under the curve(AUC)was calculated to evaluate the efficacy of the mean QSM for distinguishing moderate to severe and mild activity SLE.Results Compared with mild activity group,moderate to severe activity group had higher serum ferritin,erythrocyte sedimentation rate(ESR),C reactive protein(CRP),anti-double stranded DNA(anti-dsDNA)antibody levels,also higher proportion of positive anti-ribosomal P protein(anti-P)antibodies,but lower complement C3 and C4 levels(all P＜0.05).The mean QSM of bilateral putamina and thalami were significantly higher in moderate to severe activity group than in mild activity group(both P＜0.05).The mean QSM of bilateral putamina was positively correlated with SLEDAI scores,ferritin levels and positivity of anti-P antibodies in SLE patients(with r or rs of 0.447,0.526 and 0.473,respectively,and all P＜0.05).The AUC for distinguishing moderate to severe SLE and mild activity SLE based on the mean bilateral putamina QSM was 0.810.Conclusion There were significant differences of iron deposition in deep brain nuclei of SLE patients with moderate to severe and mild activity.The mean QSM of bilateral putamina could be used to distinguish SLE with moderate to severe activity and mild activity.

Objective:This study aims to investigate the expression of uridine diphosphate-glucose[]pyrophos-phorylase 2(UGP2)in breast cancer(BC)tissues and its oncogenic mechanism,assessing its potential value as a diag-nostic and prognostic biomarker for breast cancer.Methods:(1)Online database analysis was conducted to assess UGP2 mRNA and protein expression levels in breast cancer and explore their correlation with clinical characteristics.Im-munohistochemistry(IHC)was used to verify UGP2 expression in human breast cancer tumor tissues and evaluate its relationship with clinicopathological features.(2)Kaplan-Meier survival analysis and COX regression models were used to analyze the impact of UGP2 expression on breast cancer patient prognosis.(3)Bioinformatics methods were em-ployed to investigate the correlation between UGP2 and tumor immune cell infiltration,and to predict the biological func-tions and associated signaling pathways of UGP2 in breast cancer.Results:(1)The mRNA and protein expression levels of UGP2 were upregulated in breast cancer tissues(both P<0.05),and were negatively correlated with ER-positive and PR-positive status(OR<1,P<0.05),while positively correlated with Ki-67 levels and the triple-negative breast cancer(TNBC)subtype(OR>1,P<0.05).(2)Elevated expression levels of UGP2 were associated with poorer survival rates in breast cancer patients(both P<0.05)and were identified as an independent adverse prognostic factor for breast cancer(HR=1.40,P<0.05).(3)Functional analysis results suggested that UGP2 may promote tumor progression by regulating metabolism,hormone signaling,and the immune microenvironment.Additionally,UGP2 expression was negatively cor-related with NK cell activation status and positively correlated with the inhibitory state.Conclusion:UGP2 expression is elevated in breast cancer tissues and is closely associated with poor patient prognosis.It may promote cancer pro-gression through mechanisms such as metabolic reprogramming and immune suppression.UGP2 shows promise as a potential biomarker and therapeutic target in breast cancer,providing a basis for personalized treatment.

Objective To compare the differences in dosimetry and treatment efficiency of three radiotherapy plans after left-sided breast-conserving surgery,including modified intensity-modulated radiation therapy(IMRT),cross-field volume-modulated arc therapy(VMAT)or improved VMAT,so as to provide references for clinical practice.Methods Three radiotherapy plans of modified IMRT,cross-field VMAT and improved VMAT were designed for 12 patients after left-sided-breast-conserving surgery.The modified IMRT with five irradiation fields and the improved VMAT with two arcs were modified by not setting cross-fields while determining the start and end angles with the rays passing through the least lung area.The cross-field VMAT had its start and end angles set based on the cross-fields.The doses to the target areas,peripheral organs at risk,heart and its substructures were evaluated,and dose verification was carried out.The three plans were compared in terms of treatment efficiency and gamma pass rate.SPSS 22.0 was used for statistical analysis.Results All the three plans behaved well in dose distribution.In terms of planning gross tumor volume dosimetry dosimetry,the improved VMAT and modified IMRT gained advantages than others in CI and D50,respectively,with the differences being significant(all P<0.05).In terms of planning target volume dosimetry,the modified IMRT had the V107 and D50 lower than those of the others,with the differences being significant(P<0.05).In terms of the protection of peripheral organs at risk,V5 of the left lung,Dmean of the right lung and Dmean of the healthy breast were lower in the modified IMRT plan than in the other 2 plans,with statistically significant differences(P<0.05);V20,V30,V35 and V40 of the left lung were lower in the modified VMAT plan than in the other 2 plans,with statistically significant differences(P<0.05).In terms of protection of heart and its substructures,the left ventricle V20,V30 and Dmean of the improved VMAT plan behaved better than those of other 2 plans,and the difference was statistically significant(all P<0.05).In terms of treatment efficiency,the cross-field VMAT plan had the lowest MU while highest treatment efficiency;the improved VMAT plan had the MU higher while the treatment efficiency lower than the cross-field VMAT plan;the modified IMRT plan had the highest MU while the lowest gamma pass rate,and the differences in the MUs and gamma pass rates among the three plans were statistically significant(P<0.05).Conclusion Under the same standard conditions,the cross-field VMAT and improved VMAT plans show technical advantages.Though the improved VMAT plan has the treatment efficiency lower than the cross-field VMAT,it decreases the possibility of radiocardiac injury in terms of dosimetry and thus can be used for radiotherapy after left-sided breast-conserving surgery.[Chinese Medical Equipment Journal,2025,46(4):45-51]