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.

Sophorae Flavescentis Radix is one of the commonly used traditional Chinese medicine in China, and a large amount of pharmaceutical residue generated during its processing and production is discarded as waste, which not only wastes resources but also pollutes the environment. Therefore, elucidating the chemical composition of the residue of Sophorae Flavescentis Radix and the differences between the residue and Sophorae Flavescentis Radix itself is of great significance for the comprehensive utilization of the residue. This study, based on ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry(UPLC-Q-TOF-MS) technology combined with multivariate statistical methods, provides a thorough characterization, identification, and differential analysis of the overall components of Sophorae Flavescentis Radix and its residue. Firstly, 61 compounds in Sophorae Flavescentis Radix were rapidly identified based on their precise molecular weight, fragment ions, and compound abundance, using a self-constructed compound database. Among them, 41 compounds were found in the residue, mainly alkaloids and flavonoids. Secondly, through principal component analysis(PCA) and orthogonal partial least squares discriminant analysis(OPLS-DA), 15 key compounds differentiating Sophorae Flavescentis Radix from its residue were identified. These included highly polar alkaloids, such as oxymatrine and oxysophocarpine, which showed significantly reduced content in the residue, and less polar flavonoids, such as kurarinone and kuraridin, which were more abundant in the residue. In summary, this paper clarifies the overall composition, structure, and content differences between Sophorae Flavescentis Radix and its residue, suggesting that the residue of Sophorae Flavescentis Radix can be used as a raw material for the extraction of its high-activity components, with promising potential for development and application in cosmetics and daily care. This research provides a scientific basis for the future comprehensive utilization of Sophorae Flavescentis Radix and its residue.
Drugs, Chinese Herbal/chemistry* ; Chromatography, High Pressure Liquid/methods* ; Mass Spectrometry/methods* ; Sophora/chemistry* ; Flavonoids/chemistry* ; Alkaloids/chemistry*

Objective To propose an in vitro cytotoxicity evaluation method for novel iron-based biodegradable mateirals focusing on their degrading characteristics.Methods Half-finished scaffolds of nitrided iron tubes with a higher iron content of over 99％and a nitrogen content of 0.03％to 0.20％were selected as test samples,and based on the treatment mode were divided into an anaerobic treatment group,a non-anaerobic treatment group,a non-anaerobic treatment with removed iron particle group and a non-anaerobic treatment with plate-washing group.The anaerobic treatment group was processed in an anaerobic workstation;the conventional treatment group underwent standard handling in a biosafety cabinet;the conventional treatment with removed iron particle group was subjected to iron particle elimination using a Midimacs Starting Kit manual sorter after conventional treatment;and the conventional treatment with plate-washing group was rinsed with 0.9％sodium chloride injection before tetrazolium salt reagent treatment.Different extraction media(simulated body fluid,cell culture medium,phosphate buffer and 0.9％sodium chloride injection)were used for the immersion treatment of the test samples in each group to compare the effects of the degradation products on the survival rate of L929 cells.Results The anaerobic treatment group and the conventional treatment with removed iron particle group exhibited no detectable cytotoxicity.Trypan blue staining revealed significant cytotoxicity in the conventional treatment group,while false-negative results emerged due to interactions between the tetrazolium salt reagent and degradation products.In the non-anaerobic treatment with washing plate group,the false negative from iron particles was eliminated while potential cytotoxicity was showen,and the result accuracy was affected because some cells were washed out.Conclusion The proposed method can be used for the in vitro cytotoxicity evaluation,and facilitates the safety evaluation of the application of such materials.[Chinese Medical Equipment Journal,2025,46(3):35-41]

Objective To investigate the value of MRI of the sternal end of clavicle in bone age assessment in Chinese population,especially its applicability in the determination of criminal responsible age.Methods A total of 431 patients aged from 10.00 to 29.99 years with neck or chest MRI were retrospectively collected.According to the Schmeling grading method,the epiphyseal development of the clavicle MRI was divided into five grades.The consistency of methods was evaluated.The correlation and general descriptive analysis between MRI grades and age was analyzed.The sex difference was analyzed.Curve fitting was used to establish a nonlinear model between age and grades.Results The grades of clavicle MRI showed a significant age-related trend(Figure 2),and the correlation was 0.861(0.887 in males and 0.840 in females).Except for grade 1,there was no significant difference between males and females in other grades.The minimum age of male grade 3 was greater than 14 years old,and the minimum age of female grade 3 was greater than 16 years old.The minimum age in grade 4 and grade 5 was over 18 years old in both sexes.The best curve fitting model was cubic model for both sexes(R2=0.805 for men and 0.722 for women).Conclusion Clavicle MRI can be used for the assessment of bone age in Chinese population.Complete epiphyseal plate closure can be used as a reliable indicator for the determination of age at 18 years old,and it is expected to achieve radiation-free forensic bone age assessment.

Objective To develop a multivariate predictive nomogram to identify high-risk cohorts for sentinel lymph node(SLN)metastasis among cT 1-2N0 breast cancer patients with preoperatively normal axillary ultrasound(AUS),thereby providing a reference for personalized axillary management.Methods A retrospective analysis was conducted on the clinicopathological and ultrasonographic data of 427 patients diagnosed with invasive breast cancer who received treatment at Ward 4(Breast Unit),Department of General Surgery,Liuzhou Workers' Hospital,between January 2018 and December 2023.Univariate correlation analysis and multivariate logistic regression analysis were employed to identify independent risk factors associated with SLN metastasis.The accuracy and predictive performance of the nomogram were assessed using receiver operating characteristic(ROC)curve analysis.Results Our study enrolled 427 women diagnosed with clinical T1-2N0 breast cancer who underwent preoperative AUS with normal findings.Among these patients,47 cases(11.0％)exhibited sonographically normal axillary lymph nodes,whereas 380 cases(89.0％)showed non-visualized lymph nodes.SLN metastasis,confirmed by postoperative pathological examination,was identified in 78 patients(18.3％).Univariate analysis revealed that estrogen receptor(ER)status,maximal tumor diameter,tumor location,lymphovascular invasion(LVI),and perineural invasion(PNI)were significantly associated with the presence of SLN metastasis(P＜0.05).Multivariate logistic regression analysis further identified the following independent high-risk factors for SLN metastasis:tumor location in the upper outer quadrant(OR=4.118,95％CI=1.349～12.571),tumor size greater than 2 cm(OR=2.246,95％CI=1.252～4.029),presence of LVI(OR=4.477,95％CI=2.207～9.081),and presence of PNI(OR=3.013,95％CI=1.573～5.771)(all P＜0.05).Ultrasonographic features of axillary lymph nodes—including their positivity status,short-axis diameter,and numerical count—did not show a statistically significant association with the SLN metastatic burden(P ≥ 0.05).However,these features demonstrated a statistically sig-nificant correlation with the pathological nodal stage(pN-stage)classification(P＜0.05).In patients with 1～2 positive sentinel lymph nodes,sonographic characteristics of axillary lymph nodes(including status,maximum diameter,minimum diameter,and numerical count)did not exhibit a significant association with either axillary lymph node metastatic burden or pN-stage classification(all P ≥ 0.05).The area under the receiver operating characteristic curve(AUC)for the predictive nomogram was 0.702(95％CI:0.651～0.749,P＜0.0001),with a sensitivity of 78.21％and specificity of 59.12％.Conclusions Tumor location in the upper outer quadrant,tumor size greater than 2 cm,LVI,and PNI were identified as significant independent risk factors for SLN metastasis among patients with clinical T1-2N0 breast cancer who underwent preoperative AUS with normal findings.Further-more,from the perspective of pN-stage stratification,omission of axillary lymph node dissection(ALND)appears to be clinically feasible for the majority of cT1-2N0 patients with 1～2 metastatic SLNs.However,preoperative ultrasonographic characteristics of lymph nodes demonstrate limited predictive value for axillary lymph node(ALN)metastatic burden or pN-stage progression.

OBJECTIVE To explore the expression levels of microribonucleic acid(miR)-29b and soluble Klotho protein in peripheral blood of the chronic obstructive pulmonary disease(COPD)patients complicated with pulmo-nary infection and analyze the clinical significance.METHODS The clinical data were retrospectively collected from 139 patients with COPD who were treated in Ningxia Medical University General Hospital from Feb.2022 to Feb.2024.The patients were divided into the infection group with 41 cases and the no infection group with 98 cases ac-cording to the status of pulmonary infection.The distribution of pathogens isolated from the patients of the infec-tion group was observed.The levels of serum miR-29b and Klotho were compared between the infection group and the no infection group or of the infection group before and after the anti-infection treatment.The efficiencies of ser-um miR-29b and Klotho in prediction of pulmonary infection were analyzed by means of receiver operating charac-teristic(ROC)curves.RESULTS Totally 46 strains of pathogens were isolated from the infection group,67.39％of which were gram-negative bacteria,26.09％were gram-positive bacteria,and 6.52％were fungi.There were significant differences in the levels of serum miR-29b and Klotho between the infection group and the no infection group(P＜0.05);the expression level of serum miR-29b of the patients in the infection group who were effective for the anti-infection treatment was lower after the treatment than before the treatment,while the expression level of Klotho was higher after the treatment than before the treatment(P＜0.05);the expression level of miR-29b of the patients effective for the treatment was lower than that of the patients ineffective for the treatment,while the expression level of Klotho of the patients effective for the treatment was higher than that of the patients ineffective for the treatment(P＜0.05).ROC curve analysis showed that the area under the curve(AUC)of the joint detec-tion of serum miR-29b and Klotho was 0.927 in prediction of pulmonary infection in the COPD patients,higher than 0.837 and 0.852 of the single detection.CONCLUSIONS The COPD patients complicated with pulmonary in-fection show the high expression level of serum miR-29b and low expression level of Klotho.The joint detection of the two indexes has high efficiency in prediction of pulmonary infection in the COPD patients,which can be used as reliable indexes for assessment of the curative effect after the anti-infection treatment.

Objective:To explore the value of using computed tomography(CT)values to distinguish fresh and old fractures vertebral bodies in osteoporotic vertebral compression fractures(OVCF).Methods:Retrospective analysis of clinical data of 101 OVCF patients in our hospital from September 2022 to September 2023.Kappa test for consistency between magnetic resonance imaging(MRI)and vertebral CT values in distinguished fresh or old OVCF.The difference of CT values between fresh,old fractures and adjacent normal vertebral bodies were compared.The diagnostic efficiency was analyed by receiver operating characteristic(ROC)curve.Results:There was a high consistency between vertebral CT values and MRI in the diagnosis of OVCF in fresh and old fractures(Kappa value=0.934).There was a difference in difference of CT values between adjacent normal vertebral bodies and fresh fractures vertebral bodies(P＜0.05).There was a difference in difference of CT values of fresh fractures vertebral bodies and old fractures vertebral bodies(P＜0.05).The ROC curve analysis results showed that,the combined measurement of CT values of fresh and old fractured vertebral bodies has an area under the curve(AUC)of 0.723,which was higher than alone measurement of the CT values of fresh fractured vertebral bodies and old fractured vertebral bodies of 0.536 and 0.610(Z=2.548,2.605,2.841,P＜0.05).Conclusion:CT values of vertebral bodies show high consistency in distinguish fresh and old fractures of OVCF compared to MRI findings,and the diagnostic efficiency of combine detection is relatively high.

Objective:To explore the diagnostic value of conventional computed tomography(CT)combined with enhanced CT scan in bone metastases.Methods:This study was a retrospective observational study,84 suspected bone metastases patients admitted to our hospital from January 2022 to August 2024 were selected,All patients underwent conventional CT and enhanced CT scan and pathological examination,Using pathological examination results as the"gold standard"for diagnosis.The imaging manifestations of bone metastases using conventional CT combined with enhanced CT scan examination were observed;The detection rate and bone metastases types of conventional CT and enhanced CT scan were analyzed;The bone metastases location in different types of malignant tumors were analyzed;The detection results of bone metastases between conventional CT and enhanced CT scan were compared;the diagnostic efficacy of conventional CT and enhanced CT scan alone and in combination for bone metastases were analyzed by Receiver operating characteristic(ROC)curve.Results:The detection rate of osteogenic,osteolytic,cystic and mixed bone metastases by conventional CT combined with enhanced CT scan was supered to that of conventional CT and enhanced CT scan alone(P＜0.05).Bone metastases from lung cancer,breast cancer and other tumors mainly occur in the spine,limbs and ribs,while esophageal cancer,gastric cancer,liver cancer,prostate cancer,thyroid cancer,renal cancer,and nasopharyngeal cancer had relatively fewer bone metastases.The positive detection cases of bone metastases used conventional CT combined with enhanced CT scan were supered to those used conventional CT and enhanced CT scan alone.The sensitivity,specificity and accuracy of conventional CT combined with enhanced CT scan for the diagnosis of bone metastases were 94.00％,94.11％and 94.04％,respectively,and the positive/negative predictive values were 95.91％and 91.42％,respectively.The sensitivity,specificity and accuracy of conventional CT scan were 84.00％,78.78％and 80.95％,respectively,and the positive/negative predictive values were 85.71％and 74.28％,respectively.The sensitivity,specificity and accuracy of enhanced CT were 89.79％,85.71％and 88.09％,respectively.and the positive and negative predictive values were 89.79％and 85.71％,respectively.The diagnostic efficacy of conventional CT combined with enhanced CT scan for bone metastases was significantly better than that of conventional CT and enhanced CT scan alone.Conclusions:Conventional CT combined with enhanced CT scan can significantly improve the diagnostic efficiency of bone metastases,and provide an important basis for clinical treatment.

Objective To propose an in vitro cytotoxicity evaluation method for novel iron-based biodegradable mateirals focusing on their degrading characteristics.Methods Half-finished scaffolds of nitrided iron tubes with a higher iron content of over 99％and a nitrogen content of 0.03％to 0.20％were selected as test samples,and based on the treatment mode were divided into an anaerobic treatment group,a non-anaerobic treatment group,a non-anaerobic treatment with removed iron particle group and a non-anaerobic treatment with plate-washing group.The anaerobic treatment group was processed in an anaerobic workstation;the conventional treatment group underwent standard handling in a biosafety cabinet;the conventional treatment with removed iron particle group was subjected to iron particle elimination using a Midimacs Starting Kit manual sorter after conventional treatment;and the conventional treatment with plate-washing group was rinsed with 0.9％sodium chloride injection before tetrazolium salt reagent treatment.Different extraction media(simulated body fluid,cell culture medium,phosphate buffer and 0.9％sodium chloride injection)were used for the immersion treatment of the test samples in each group to compare the effects of the degradation products on the survival rate of L929 cells.Results The anaerobic treatment group and the conventional treatment with removed iron particle group exhibited no detectable cytotoxicity.Trypan blue staining revealed significant cytotoxicity in the conventional treatment group,while false-negative results emerged due to interactions between the tetrazolium salt reagent and degradation products.In the non-anaerobic treatment with washing plate group,the false negative from iron particles was eliminated while potential cytotoxicity was showen,and the result accuracy was affected because some cells were washed out.Conclusion The proposed method can be used for the in vitro cytotoxicity evaluation,and facilitates the safety evaluation of the application of such materials.[Chinese Medical Equipment Journal,2025,46(3):35-41]

Objective To develop a multivariate predictive nomogram to identify high-risk cohorts for sentinel lymph node(SLN)metastasis among cT 1-2N0 breast cancer patients with preoperatively normal axillary ultrasound(AUS),thereby providing a reference for personalized axillary management.Methods A retrospective analysis was conducted on the clinicopathological and ultrasonographic data of 427 patients diagnosed with invasive breast cancer who received treatment at Ward 4(Breast Unit),Department of General Surgery,Liuzhou Workers' Hospital,between January 2018 and December 2023.Univariate correlation analysis and multivariate logistic regression analysis were employed to identify independent risk factors associated with SLN metastasis.The accuracy and predictive performance of the nomogram were assessed using receiver operating characteristic(ROC)curve analysis.Results Our study enrolled 427 women diagnosed with clinical T1-2N0 breast cancer who underwent preoperative AUS with normal findings.Among these patients,47 cases(11.0％)exhibited sonographically normal axillary lymph nodes,whereas 380 cases(89.0％)showed non-visualized lymph nodes.SLN metastasis,confirmed by postoperative pathological examination,was identified in 78 patients(18.3％).Univariate analysis revealed that estrogen receptor(ER)status,maximal tumor diameter,tumor location,lymphovascular invasion(LVI),and perineural invasion(PNI)were significantly associated with the presence of SLN metastasis(P＜0.05).Multivariate logistic regression analysis further identified the following independent high-risk factors for SLN metastasis:tumor location in the upper outer quadrant(OR=4.118,95％CI=1.349～12.571),tumor size greater than 2 cm(OR=2.246,95％CI=1.252～4.029),presence of LVI(OR=4.477,95％CI=2.207～9.081),and presence of PNI(OR=3.013,95％CI=1.573～5.771)(all P＜0.05).Ultrasonographic features of axillary lymph nodes—including their positivity status,short-axis diameter,and numerical count—did not show a statistically significant association with the SLN metastatic burden(P ≥ 0.05).However,these features demonstrated a statistically sig-nificant correlation with the pathological nodal stage(pN-stage)classification(P＜0.05).In patients with 1～2 positive sentinel lymph nodes,sonographic characteristics of axillary lymph nodes(including status,maximum diameter,minimum diameter,and numerical count)did not exhibit a significant association with either axillary lymph node metastatic burden or pN-stage classification(all P ≥ 0.05).The area under the receiver operating characteristic curve(AUC)for the predictive nomogram was 0.702(95％CI:0.651～0.749,P＜0.0001),with a sensitivity of 78.21％and specificity of 59.12％.Conclusions Tumor location in the upper outer quadrant,tumor size greater than 2 cm,LVI,and PNI were identified as significant independent risk factors for SLN metastasis among patients with clinical T1-2N0 breast cancer who underwent preoperative AUS with normal findings.Further-more,from the perspective of pN-stage stratification,omission of axillary lymph node dissection(ALND)appears to be clinically feasible for the majority of cT1-2N0 patients with 1～2 metastatic SLNs.However,preoperative ultrasonographic characteristics of lymph nodes demonstrate limited predictive value for axillary lymph node(ALN)metastatic burden or pN-stage progression.