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.

While pooled CRISPR screens have revolutionized functional genomics by enabling genome-scale interrogation, they have long faced a fundamental compatibility challenge with high-resolution microscopy-based phenotypes. The core issue lies in the technical disconnect between pooled screening formats, where cells are typically analyzed in bulk populations, and microscopy approaches that require spatial resolution and single-cell visualization. This limitation has created a significant blind spot in functional genomics, preventing researchers from systematically linking genetic perturbations to detailed subcellular architectural changes. To bridge this critical technological gap, a recent landmark study published in Developmental Cell has unveiled an integrated microscopy-based CRISPR screening platform that represents a paradigm shift in the field. The most innovative breakthrough of the platform involves extending photoactivation-based labeling techniques to fixed, immunostained cells, thereby overcoming a key limitation of prior approaches that were restricted exclusively to live-cell reporter systems. This methodological advancement allows researchers to capture transient cellular states and preserve delicate subcellular structures that would otherwise be lost in live-cell imaging scenarios. By seamlessly integrating this enhanced labeling approach with sophisticated automated imaging workflows and high-content analysis pipelines, the system enables unprecedented high-throughput, organelle-level phenotypic profiling at true single-cell resolution. The platform’s capabilities were demonstrated through its application to a comprehensive genome-wide screen for regulators of cilium assembly, a complex cellular process involving intricate cytoskeletal dynamics and membrane remodeling events. The screening results validated the platform’s robustness by successfully recapitulating known ciliary machinery components while simultaneously uncovering novel regulatory factors. Most notably, the study identified SMIM27/TZMP1, a conserved transition zone microprotein, as a previously unrecognized regulator of ciliary function. This discovery provides crucial insights into the molecular mechanisms governing ciliary transition zone barrier formation and selectivity. This accessible and versatile framework effectively overcomes longstanding bottlenecks in microscopy-based screening technologies, offering a generalizable strategy for dissecting organelle biology and cellular architecture at scale. The platform’s ability to combine genome-wide screening power with detailed morphological analysis opens new avenues for investigating cellular responses to genetic perturbations across diverse biological contexts.

Purpose: This study assessed the performance of the ultrasound-guided attenuation parameter (UGAP) in diagnosing and grading hepatic steatosis in patients with metabolic dysfunctionassociated steatotic liver disease (MASLD). Magnetic resonance imaging proton density fat fraction (MRI-PDFF) served as the reference standard. Methods: Patients with hepatic steatosis were enrolled in this prospective study and underwent UGAP measurements. MRI-PDFF values of ≥5%, ≥15%, and ≥25% were used as references for the diagnosis of steatosis grades ≥S1, ≥S2, and S3, respectively. Spearman correlation coefficients and area under the receiver operating characteristic curves (AUCs) were calculated. Results: Between July 2023 and June 2024, the study included 88 patients (median age, 40 years; interquartile range [IQR], 36 to 46 years), of whom 54.5% (48/88) were men and 45.5% (40/88) were women. Steatosis grades exhibited the following distribution: 22.7% (20/88) had S0, 50.0% (44/88) had S1, 21.6% (19/88) had S2, and 5.7% (5/88) had S3. The success rate for UGAP measurements was 100%. The median UGAP value was 0.74 dB/cm/MHz (IQR, 0.65 to 0.82 dB/ cm/MHz), and UGAP values were positively correlated with MRI-PDFF (r=0.77, P<0.001). The AUCs of UGAP for the diagnoses of ≥S1, ≥S2, and S3 steatosis were 0.91, 0.90, and 0.88, respectively. In the subgroup analysis, 98.4% (60/61) of patients had valid controlled attenuation parameter (CAP) values. UGAP measurements were positively correlated with CAP values (r=0.65, P<0.001). Conclusion Using MRI-PDFF as the reference standard, UGAP demonstrates good diagnostic performance in the detection and grading of hepatic steatosis in patients with MASLD.

Objective:To investigate the relationship between sagittal position parameters and screw loosening after unilateral biportal endoscopic (UBE) combined with percutaneous pedicle screw fixation for single-segment lumbar spinal stenosis.Methods:A total of 180 patients with single-level lumbar spinal stenosis who received UBE combined with percutaneous pedicle screw internal fixation in our hospital from June 2020 to June 2023 were enrolled. According to the postoperative follow-up, they were divided into the non-loosening group (112 cases) and the loosening group (68 cases). The demographics, operative parameters and sagittal position [pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), sagittal vertical axis (SVA)] before and after operation were compared between the two groups. The indicators with significant differences between the two groups were included in the multivariate logistic regression analysis to analyze the influencing factors of screw loosening. The dose-response relationship between sagittal position parameters and screw loosening was analyzed by restricted cubic spline model.Results:At 6 months and 1 year postoperatively, the fusion rates in the loosening group were 47.1% and 55.9%, respectively, which were significantly lower than the rates (85.7% and 100.0%) in the non-loosening group, respectively ( P<0.05). Postoperatively, the SS in the non-loosening group (36.16°±5.35°) and the loosening group (32.02°±5.54°) and the LL in the loosening group (51.26°±6.35°) were all significantly lower than preoperative values (40.51°±6.11°, 40.49°±6.08°, and 54.08°±6.21°) ( P<0.05). Meanwhile, the PT in the non-loosening group (15.24°±2.69°), TK in the non-loosening group (32.46°±7.29°), PI in the loosening group (56.82°±5.23°), PT in the loosening group (17.01°±3.64°), and TK in the loosening group (34.87°±7.21°) were all significantly higher than preoperative values (13.12°±3.19°, 30.25°±5.17°, 52.84°±5.12°, 13.15°±3.21°, and 30.26°±5.12°) ( P<0.05). Postoperatively, the loosening group had significantly lower SS (32.02°±5.54°), LL (51.26°±6.35°), and SVA (-0.87±1.06 cm) than the non-loosening group (36.16°±5.35°, 53.73°±6.27°, and -0.51±1.04 cm), respectively ( P<0.05). Conversely, the PI (56.82°±5.23°), PT (17.01°±3.64°), and TK (34.87°±7.21°) in the loosening group were significantly higher than those in the non-loosening group (53.48°±5.20°, 15.24°±2.69°, and 32.46°±7.29°), respectively ( P<0.05). Binary logistic regression analysis indicated that PT, SS, LL, and SVA were independent risk factors for screw loosening ( P<0.05). The restricted cubic spline model revealed a nonlinear dose-response relationship between sagittal parameters (PT, SS, LL, and SVA) and screw loosening ( P<0.05). With increasing PT, the odds ratio (OR) for screw loosening increased, whereas increasing SS, LL, and SVA reduced the OR for screw loosening. Conclusion:After UBE combined with percutaneous pedicle screw fixation in single-level lumbar spinal stenosis patients, sagittal position parameters PT were positively correlated with screw loosening, while SS, LL and SVA were negatively correlated with screw loosening.

To explore the value of general information and rapid laboratory tests obtained from the emergency department in the early diagnosis and prevention of young patients with acute myocardial infarction and acute myocarditis, in order to prevent the disease from progressing to a critical stage. This study employs a retrospective observational study, compiling clinical data from young patients diagnosed with acute myocardial infarction or acute myocarditis who were admitted to the Department of Cardiology or Emergency Department of the Second Affiliated Hospital of Soochow University from January 2015 to September 2024. Demographic information and laboratory test results from both the outpatient and emergency departments were retrieved. The acute myocardial infarction group comprised 267 patients (257 males, 10 females) aged 23-44 ys, while the acute myocarditis group included 134 patients (93 males, 41 females) aged 18-44 ys. A comparative analysis of the clinical data between the two groups was conducted, encompassing variables such as age, gender, comorbidities, high-risk factors, emergency blood routine tests, high-sensitivity C-reactive protein levels, coagulation profiles, renal function tests, NT-proBNP levels, myocardial injury markers, electrocardiogram readings, blood pressure, and heart rate. The results showed that:Compared with the young myocarditis group, the myocardial infarction group was older (ys)[38(35, 42) vs 30(25, 37), U=7 893, P<0.001], more male [257(96.3%) vs 93(69.4%), χ2=57.95, P<0.001], more smoking [211(79.0%) vs 38(28.4%), χ2=97.32, P<0.001], drinking history [125(46.8%) vs 22(16.4%), χ2=35.51, P<0.001], family history of coronary heart disease [45(16.9%) vs 3(2.2%), χ2=18.09, P<0.001], hypertension [100(37.5%) vs 12(9.0%), χ2=36, P<0.001] and diabetes [42(15.7%) vs 4(3.0%), χ2=14.27, P<0.001]. Systolic blood pressure (mmHg)[126(114, 144) vs 119(101, 126), U=11 389.50, P<0.001], diastolic blood pressure (mmHg)[80(70, 93) vs 72(62, 81), U=12 220.50, P<0.001], total white blood cell count (10 9/L)[11.3(9.2, 14.1) vs 8.5(6.6, 11.2), U=10 825.50, P<0.001], hemoglobin (g/L)[157(147, 166) vs 143(129, 154), U=9 404.50, P<0.001], platelet count (10 9/L)[244(206, 297) vs 207(173, 253), U=11 680, P<0.001], uric acid (μmol/L)[380(315, 446) vs 347(265, 412), U=14 805.50, P=0.005], ST segment elevation [204(76.4%) vs 57(42.5%), χ2=73.03, P<0.001] and Q wave formation [76(28.5%) vs 17(12.7%), χ2=12.47, P<0.001] in ECG were higher than those in myocarditis group. The duration of onset (hs) [6(3, 25) vs 48(24, 73), U=27911, P<0.001], heart rate (beats/min)[82(74, 92) vs 92(78, 103), U=22 347, P<0.001], D-dimer (μg/ml)[0.23(0.17, 0.51) vs 0.61(0.30, 1.38), U=25 806, P<0.001], High-sensitivity troponin T/99th percentile upper reference limit [5(1, 36) vs 16(8, 39), U=22 577, P<0.001], NT-proBNP (pg/ml) [204(64, 644) vs 824(189, 4 043), U=25 134, P<0.001], C-reactive protein (mg/L)[6(3, 9) vs 24(6, 55), U=26 349.50, P<0.001] and body temperature (℃) [36.50(36.30, 36.60) vs 37.35(36.50, 38.50), U=26 961, P<0.001] were significantly lower than those in myocarditis group, the symptoms of chest pain in myocardial infarction group was significantly higher than those in myocarditis group [262(98.1%) vs 83(61.9%), χ2=97.24, P<0.001], and the history of prodromal infection [12(4.5%) vs 112(83.6%), χ2=261.26, P<0.001], syncope [11(4.1%) vs 18(13.4%), χ2=11.53, P<0.001] and shock [6(2.2%) vs 22(16.4%), χ2=27.59, P<0.001] in myocardial infarction group were significantly lower than those in myocarditis group. With acute myocardial infarction as the target outcome, 8 influencing factors selected by LASSO regression, and 5 independent influencing factors were found after multiple Logistic regression, those were age ( OR=1.21, 95% CI: 1.12-1.31; P<0.001), pre-infection ( OR=0.02, 95% CI: 0.01-0.06; P<0.001), body temperature ( OR=0.37, 95% CI: 0.18-0.77; P=0.008), chest pain ( OR=26.75, 95% CI: 5.87-121.81; P<0.001) and white blood cell count ( OR=1.27, 95% CI: 1.12-1.44; P<0.001). Younger age, high body temperature and pre-infection are independent predictors for acute myocarditis, while chest pain and elevated white blood cell count are independent predictors for acute myocardial infarction. The five influencing factors selected by multivariate logistic regression and their combined diagnostic model were subjected to ROC analysis. The AUC reached 0.969, sensitivity reached 0.940 and specificity reached 0.925. Calibration curve and decision curve analysis(DCA) demonstrate that the model possesses excellent clinical application value. In conclusion, age, chest pain, pre-infection, body temperature and white blood cell count were independent factors in distinguishing acute myocardial infarction and acute myocarditis in young people. The clinical differential diagnosis model based on 5 independent factors may has high efficiency and good clinical practicability.

AIM To investigate the tumor-suppressive mechanism of Guiqi Yiyuan Extract combined with cisplatin in Lewis lung cancer mice.METHODS Ten intact C57BL/6J mice were assigned to the blank group.Sixty additional mice were developed into Lewis lung cancer models bearing transplanted tumor and subsequently allocated into the model group,the cisplatin group(5 mg/kg),the high-dose Guiqi Yiyuan Extract group(6.6 g/kg),and the low-dose,medium-dose and high-dose Guiqi Yiyuan Extract combined with cisplatin group(1.6,3.3,6.6 g/kg+5 mg/kg),with 10 mice in each group.Mice in the blank and model groups received saline via daily gavage,while treatment groups were administered Guiqi Yiyuan Extract orally(once daily),and cisplatin injection intraperitoneally(once every other day).After 14 days of drug administration,mice were euthanized for endpoint analysis.The following assessments were conducted:general health status and body weight changes monitored throughout the study period;tumor excision and weighing for inhibition rate calculation;histopathological examination of tumors via hematoxylin-eosin(HE)staining;serum quantification of IL-1 β,IL-18 and HMGB1 by ELISA;ultrastructural analysis of tumor cell death using transmission electron microscopy(TEM);spatial localization of TXNIP and GSDMD-N in tumor sections via immunofluorescence(IF);and Western blot detection of TXNIP,NLRP3,Caspase-1,cleaved Caspase-1,GSDMD,GSDMD-N protein expressions in tumor tissues.RESULTS Compared to the model group,the cisplatin group and all combination therapy groups exhibited significant reduction in tumor weight(P＜0.05)and increased tumor suppression rate;enhanced tumor tissue necrosis with characteristic pyroptotic morphology;elevated serum levels of IL-1β,IL-18 and HMGB1(P＜0.05);and upregulated expressions of pyroptosis-associated proteins TXNIP,NLRP3,Caspase-1,cleaved Caspase-1,GSDMD and GSDMD-N(P＜0.05).The high dose combination group demonstrated optimal therapeutic efficacy(P＜0.05).CONCLUSION Guiqi Yiyuan Extract enhances cisplatin sensitivity,demonstrating synergistic anti-tumor effects in Lewis lung carcinoma-bearing mice.This combinatorial therapeutic effect likely involves modulation of the TXNIP/NLRP3/Caspase-1/GSDMD pathway.

Objective:To investigate the relationship between the changes in extracellular vesicles (EVs) size distribution before and after cardiopulmonary bypass (CPB) cardiac surgery and postoperative coagulation function.Methods:A total of 103 patients undergoing cardiac surgery with CPB were enrolled. Venous blood samples were collected at preoperation, postoperative 12 h and 3 days. Additionally, 50 age- and gender-matched healthy volunteers served as a control group. EVs were isolated using gradient centrifugation, and their size distribution was assessed by dynamic light scattering (DLS). The relationship between EV size characteristics, including peak diameter, peak height, and interquartile range( IQR), and postoperative coagulation function was analyzed. Results:Compared to patients with normal postoperative coagulation function, those with postoperative coagulation dysfunction had lower size at peak and IQR, and significantly higher peak intensity. Logistic regression analysis indicated that elevated peak intensity and lower size at peak and IQR were risk factors for coagulation dysfunction. The area under the curve ( AUC) for diagnosing coagulation dysfunction with 12 h postoperative EVs peak intensity was 0.76, with a positive predictive value of 85% at the optimal cutoff of 8.2; the AUC for IQR was 0.84, with a sensitivity of 83%, specificity of 82%, and negative predictive value of 86% at the optimal cutoff of 125.05 nm. Conclusion:The size distribution of circulating EVs show a correlation with coagulation function after cardiac surgery with CPB and may serve as a novel biomarker to predict postoperative coagulation dysfunction.

Objective To design a night vision simulation training system to provide pilots with practical training on ground night vision goggles.Methods The system had its hardware composed of a control stick,a throttle lever,rudder pedals,a head-up display(HUD),a control box,a computer,a projector and a screen.The HUD and control box were designed using night vision-compatible lighting technology to simulate the ambient light conditions pilots experienced when flying with night vision goggles.The software of the system consisted of five ones developed with C++programming languge for visual scene simulation,instrument simulation,flight performance simulation,integrated management control and cockpit manage-ment.Night vision images and computer-rendered images of typical scenes with varying brightness levels were collected.Objective image evaluation metrics such as contrast and brightness were used as inputs,while subjective evaluation data served as outputs to construct and train a support vector machine(SVM)model.Totally 30 typical night vision training scenarios were selected based on model validation and optimization to evaluate the system's optical fidelity.Results The average fidelity score for the 30 typical night vision training scenarios was 8.05,indicating that the system could realistically simulate terrain and landscapes under various lighting and weather conditions during night flights and static and dynamic targets in the air,on the ground and at sea.Conclusion The system meets the desired requirements and effectively facilitates night vision training for pilots.[Chinese Medical Equipment Journal,2025,46(3):21-26]

Objective To explore the clinical value of energy-spectrum CT single-energy imaging in enhancing the image quality and stent display of stent placement CT angiography(CTA)in lower extremity atherosclerotic occlusive disease.Methods Twenty patients[mean(65.61±9.65)years;male/female,16/4]who underwent stenting for chronic occlusive disease of the lower extremity arteries by lower extremity arterial energetic spectral CTA were retrospectively recruited at our hospital.The original images were reconstructed into seven sets of single energy(40-100 keV),120 kVp,virtual unenhanced images(VUE)and metal artifact reduction(MAR)technique images.Images were debossed and then scaffolded for display with volumetric reconstruction(VR),maximum density projection(MIP)and curve planar reconstruction(CPR),and were objectively and subjectively assessed and compared using one-way analysis of variance(ANOVA).Results The 80 keV and MAR images had the highest scores compared to the other reconstruction group images(P＜0.01).Conclusion 80 keV single-energy imaging and de-metallization artifacts MAR improve the image quality of lower extremity arterial stent lumen and structure display;therefore,they have higher diagnostic value for clinicians.

Objective To validate the diagnostic performance and risk stratification ability of an AI-based recognition system(PE-AI)for pulmonary embolism(PE)using computed tomography pulmonary angiography(CTPA)so as to analyze its diagnostic value in clinical practice.Methods A total of 416 patients with suspected PE who underwent CTPA from January 1,2023 to December 10,2023 at our hospital were included in this study.Two junior radiologists and PE-AI separately detected and diagnosed emboli in the collected cases by double-blind method,and recorded the diagnosis time respectively.Three senior radiologists reviewing with clinical follow-up results were used as the gold standard in this study.Diagnostic performance was evaluated by using the receiver operating characteristic(ROC)curve analysis and Delong-t test.For positive cases,the pulmonary artery obstruction index(PAOI)calculated by AI and manually were collected respectively and consistency analysis was performed.Results The area under the curve(AUC)of PE-AI,manual and combined diagnosis was 85.6％,90.8％and 95.1％,respectively,which differed significantly(P＜0.05).The reading time of PE-AI[(0.16±0.07)min]was significantly lower than the time of manual[(4.42±1.85)min,P＜0.001]and combined diagnosis[(4.58±1.84)min,P＜0.001].The PAOI measured by PE-AI and manually had high consistency(intraclass correlation efficient,ICC=0.80)in the subgroup analysis of confirmed cases.Conclusion AI can quickly identify pulmonary artery emboli in a short time and assist radiologists to improve diagnostic efficiency.At the same time,through the intelligent detection of PAOI,it is helpful for the risk stratification of patients with PE and optimizing the diagnosis and treatment pathway for pulmonary embolism.