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 analyze the peripheral neurotoxicity of utidelone(UTD-1)in patients with human epidermal growth factor receptor 2(HER-2)negative advanced breast cancer and its related factors.Methods The patients with HER-2 negative advanced breast cancer treated by UTD-1 were collected.The patients were divided into control group(low neurotoxicity group,grade 0-1 peripheral neurotoxicity)and treatment group(high neurotoxicity group,grade 2-4 peripheral neurotoxicity)according to cohort method.The data involve age,body mass index(BMI),related indicators of metabolic syndrome(MS)before chemotherapy,hormone receptor expression status of tumor,number of treatment lines,and whether combined with capecitabine were collected.The highest level of neurotoxicity after UTD-1 was collected for each patient,and the possible related factors were analyzed.Results There were 83 cases in the treatment group and 84 cases in the control group.The BMI of treatment and control groups were(24.81±1.93)and(22.82±2.19)kg·m-2,the fasting plasma glucose(FPG)levels were(6.45±1.37)and(5.42±0.79)mmol·L-1,the C-reaction protein(CRP)levels were 11.10 and 1.60 mg·L-1,respectively,and the differences were statistically significant(allP＜0.01).Multi-factor Logistics stepwise regression analysis showed that the high neurotoxicity group was independently correlated with high BMI,high FPG and high CRP(odds ratios were 11.51,7.78 and 6.88).Conclusion BMI,CRP and FPG may be independent risk factors for high peripheral neurotoxicity iduced by UTD-1.

AIM To investigate the consistency of chemical constituents between formula granules and standard decoction of Coptidis Rhizoma.METHODS Eighteen batches of standard decoctions were prepared,after which the extraction rate and contents,transfer rates of magnolflorine,jatrorrhizine,columbamine,epiberberine,coptisine,palmatine,berberin were determined,HPLC characteristic chromatograms were established.RESULTS There were 11 common peaks in the characteristic chromatograms of 18 batches of standard decoctions and 24 batches of formula granules with the similarities of 0.861-1.000,which were clusterd into two categories.The formula granules and standard decoction demonstrated approximated extraction rate and contents,transfer rates of index constituents.CONCLUSION The chemical constituents between formula granules and standard decoction of Coptidis Rhizoma display good consistency,which can provide references for the quality control,process research and clinical application of the former.

AIM To evaluate the quality of Beidougen Formula Granules.METHODS Fifteen batches of standard decoctions and three batches of formula granules were prepared,after which paste rate and contents,transfer rates of magnoflorine,daurisoline,dauricine were determined.HPLC specific chromatograms were established,and cluster analysis was adopted in chemical pattern recognition.RESULTS For three batches of formula granules,the paste rates were 15.1%-16.6%,the contents of magnoflorine,daurisoline,dauricine were 18.93-19.39,9.42-9.60,6.79-6.85 mg/g with the transfer rates of 34.42%-35.25%,43.81%-44.65%,27.27%-27.51%from decoction pieces to formula granules,respectively,and there were seven characteristic peaks in the specific chromatograms with the similarities of more than 0.95,which demonstrated good consistence with those of standard decoctions and accorded with related limit requirements.Fifteen batches of standard decoctions were clustered into two types,and the medicinal materials produced from Jilin,Hebei,Shangdong could be used for the preparation of formula granules.CONCLUSION This reasonable and reliable method can provide references for the quality control and clinical application of Beidougen Formula Granules.

Objective To analyze the peripheral neurotoxicity of utidelone(UTD-1)in patients with human epidermal growth factor receptor 2(HER-2)negative advanced breast cancer and its related factors.Methods The patients with HER-2 negative advanced breast cancer treated by UTD-1 were collected.The patients were divided into control group(low neurotoxicity group,grade 0-1 peripheral neurotoxicity)and treatment group(high neurotoxicity group,grade 2-4 peripheral neurotoxicity)according to cohort method.The data involve age,body mass index(BMI),related indicators of metabolic syndrome(MS)before chemotherapy,hormone receptor expression status of tumor,number of treatment lines,and whether combined with capecitabine were collected.The highest level of neurotoxicity after UTD-1 was collected for each patient,and the possible related factors were analyzed.Results There were 83 cases in the treatment group and 84 cases in the control group.The BMI of treatment and control groups were(24.81±1.93)and(22.82±2.19)kg·m-2,the fasting plasma glucose(FPG)levels were(6.45±1.37)and(5.42±0.79)mmol·L-1,the C-reaction protein(CRP)levels were 11.10 and 1.60 mg·L-1,respectively,and the differences were statistically significant(allP＜0.01).Multi-factor Logistics stepwise regression analysis showed that the high neurotoxicity group was independently correlated with high BMI,high FPG and high CRP(odds ratios were 11.51,7.78 and 6.88).Conclusion BMI,CRP and FPG may be independent risk factors for high peripheral neurotoxicity iduced by UTD-1.

Humans ; Child ; Retrospective Studies ; Thrombocytosis/etiology*

OBJECTIVE: To investigate the clinical characteristics and prognosis of hematological malignancies superimposed patients with solid tumors. METHODS: The clinical data of 30 patients with more than two kinds of malignancy (the second is hematological malignancy) from October 2011 to October 2020 in Department of Hematology, Jiangning Hospital Affiliated to Nanjing Medical University were collected and analyzed retrospectively. The overall survival time was used as the prognostic evaluation standard, and the survival of patients were analyzed by KaplanMeier method. Logrank test and Cox regression model were used to carry out univariate and multivariate retrospective analysis on clinical and laboratory parameters of 30 patients. RESULTS: Among 30 cases, 20 were male, 10 were female, the median age of onset of the second tumor was 70 years old. The common types of the secondary hematological malignancies to solid tumors are myelodysplastic syndrome, acute myeloid leukemia, multiple myeloma. Univariate analysis showed that patients' gender, age, type of solid tumors, the onset of interval between two kinds of tumor, chromosome karyotype were not related to do with the patients' overall survival time. Type of hematologic disease, ECOG score were associated with patients' overall survival time, and the multivariate analysis showed that the type of hematologic disease and ECOG score were independent risk factors for patients with poor prognosis. CONCLUSION Patients superimposed with solid tumors complicated with myelodysplastic syndrome or acute leukemia and ECOG score ≥3 have poor prognosis and shorter overall survival time, which are independent risk factors influencing the prognosis. Bone marrow injury, immune dysfunction and genetic susceptibility after chemoradiotherapy may be the main causes of these diseases.
Aged ; Female ; Hematologic Neoplasms/complications* ; Humans ; Leukemia, Myeloid, Acute/complications* ; Male ; Myelodysplastic Syndromes/complications* ; Prognosis ; Retrospective Studies

Objectives: To evaluate the immunogenicity of Methods: Protein extracts from Results: Immunization with Conclusion This is the advanced study to investigate the immunogenicity of
Animals ; Antibodies, Bacterial/immunology* ; Antigens, Bacterial/immunology* ; Bacterial Proteins/immunology* ; Cross Reactions ; Cytokines/immunology* ; Female ; Genome, Bacterial ; Immunoglobulin G/immunology* ; Immunoglobulin M/immunology* ; Macrophages/immunology* ; Mice, Inbred BALB C ; Mycobacterium avium Complex/immunology* ; Mycobacterium tuberculosis/immunology* ; Tuberculosis Vaccines/administration & dosage* ; Whole Genome Sequencing

Objective:To study the resources and medicinal use of Tibetan medicine Codonopsis canescens，analyze its suitable habitat，and protect its wild resources，in order to provide an important reference basis for further rational development and utilization. Method:Combined investigation methods of literature textual research，visiting investigation and on-the-spot investigation were adopted. Result:In this paper，we investigated the resources and medicinal use of C. canescens in 27 cities and counties of Sichuan，Qinghai and Tibet. Compared with historical records of C. canescens，the results showed that there was no obvious change in the distribution range，and the distribution was uneven in different places. Ganzi Prefecture， Sichuan， boasts rich resources； in particular， Luhuo county has as high as 90-120 plants/100 m²， it is estimated that the reserves per unit area of root C. canescens in this area were 3 445.32 g·m^-2，which totaled 1 279.18 ton（1 ton=1 000 kg）. In history，the root is the main medicinal part. However， in recent years，in order to protect resources，the aboveground part is frequently used. The clinical efficacy of Tibetan medicine is mainly to tonify Qi and activate blood circulation. It can be combined with other drugs to treat rheumatism，sores，furuncle，carbuncle and other diseases. However，the plants of Codonopsis are mixed with C. canescens in each Tibetan area，and the mixed varieties are determined according to the growing varieties of the same genus in this area. Conclusion:The reserves of wild resources of C. canescens are decreasing with the increase of clinical use and market demand of Tibetan medicine. There is serious mixture of Codonopsis plants in Tibetan areas. It is suggested paying attention to resource protection，carrying out artificial planting，establishing the standard for the medicinal use of Tibetan medicine，and promote rational and sustainable utilization of resources.