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.

With the accelerating trend of population aging, the number of elderly patients with lung cancer continues to rise, and the disease burden is becoming increasingly heavy. The clinical management of these patients faces severe challenges due to their decreased physiological reserve, complex comorbidities, and significant individual heterogeneity. Consequently, under traditional diagnosis and treatment models, doctors often struggle to identify the individualized risks of elderly patients in a timely and comprehensive manner, which can easily lead to decision biases such as undertreatment or overtreatment. In view of this, this study advocates for the establishment of an umbrella decision-making model specifically tailored for elderly lung cancer patients. Grounded in a multidisciplinary team (MDT) platform, this model deeply integrates oncological indicators with the comprehensive geriatric assessment (CGA) system. By holistically considering multidimensional variables including tumor burden, organ function, frailty index, cognitive status, and social support, the model establishes an operational mechanism characterized by "single entry, precise stratification, and targeted selection". Accordingly, patients can be scientifically triaged into distinct intervention tiers, such as active surveillance, minimally invasive surgery, drug therapy, radiotherapy, and best supportive care, thereby achieving real-time alignment between treatment intensity and patient fitness. This article elaborates on the construction logic and key operational procedures of this novel decision-making framework, aiming to guide clinical practice beyond the limitations of a tumor-centric perspective toward a holistic, dynamic, whole-course management strategy. This transition seeks to ensure optimal quality of life and clinical net benefit for elderly patients alongside survival prolongation.

Patients with lung cancer experience a heavy symptom burden during the perioperative period, which seriously affects their recovery and quality of life. Traditional symptom management models rely mainly on scheduled ward rounds during hospitalization and outpatient follow-up after discharge. However, they have limitations such as delayed symptom recognition, lack of post-discharge monitoring, and non-quantitative symptom assessment, which often lead to delayed interventions and low patient satisfaction. In recent years, the symptom management model based on electronic patient-reported outcomes (ePRO) has been increasingly valued in clinical practice. Existing high-level evidence from both domestic and international studies indicates that, through proactive monitoring, real-time alerts, and remote interventions, this model enables dynamic and continuous symptom management and helps improve patient recovery and healthcare experience. As a supplement to routine medical care, the ePRO-based symptom management model aims to enhance the quality of care rather than replace existing medical processes. To promote the standardized application of this model in perioperative lung cancer care, this consensus integrates domestic and international evidence. After multiple rounds of voting by more than 50 experts, it formulates 12 consensus statements covering the three core components, symptom monitoring, alerting, and intervention, to provide scientific and practical recommendations for clinical practice.

Collagen is a major structural protein in the matrix of animal cells and the most widely distributed and abundant functional protein in mammals. Collagen’s good biocompatibility, biodegradability and biological activity make it a very valuable biomaterial. According to the source of collagen, it can be broadly categorized into two types: one is animal collagen; the other is recombinant collagen. Animal collagen is mainly extracted and purified from animal connective tissues by chemical methods, such as acid, alkali and enzyme methods, etc. Recombinant collagen refers to collagen produced by gene splicing technology, where the amino acid sequence is first designed and improved according to one’s own needs, and the gene sequence of improved recombinant collagen is highly consistent with that of human beings, and then the designed gene sequence is cloned into the appropriate vector, and then transferred to the appropriate expression vector. The designed gene sequence is cloned into a suitable vector, and then transferred to a suitable expression system for full expression, and finally the target protein is obtained by extraction and purification technology. Recombinant collagen has excellent histocompatibility and water solubility, can be directly absorbed by the human body and participate in the construction of collagen, remodeling of the extracellular matrix, cell growth, wound healing and site filling, etc., which has demonstrated significant effects, and has become the focus of the development of modern biomedical materials. This paper firstly elaborates the structure, type, and tissue distribution of human collagen, as well as the associated genetic diseases of different types of collagen, then introduces the specific process of producing animal source collagen and recombinant collagen, explains the advantages of recombinant collagen production method, and then introduces the various systems of expressing recombinant collagen, as well as their advantages and disadvantages, and finally briefly introduces the application of animal collagen, focusing on the use of animal collagen in the development of biopharmaceutical materials. In terms of application, it focuses on the use of animal disease models exploring the application effects of recombinant collagen in wound hemostasis, wound repair, corneal therapy, female pelvic floor dysfunction (FPFD), vaginal atrophy (VA) and vaginal dryness, thin endometritis (TE), chronic endometritis (CE), bone tissue regeneration in vivo, cardiovascular diseases, breast cancer (BC) and anti-aging. The mechanism of action of recombinant collagen in the treatment of FPFD and CE was introduced, and the clinical application and curative effect of recombinant collagen in skin burn, skin wound, dermatitis, acne and menopausal urogenital syndrome (GSM) were summarized. From the exploratory studies and clinical applications, it is evident that recombinant collagen has demonstrated surprising effects in the treatment of all types of diseases, such as reducing inflammation, promoting cell proliferation, migration and adhesion, increasing collagen deposition, and remodeling the extracellular matrix. At the end of the review, the challenges faced by recombinant collagen are summarized: to develop new recombinant collagen types and dosage forms, to explore the mechanism of action of recombinant collagen, and to provide an outlook for the future development and application of recombinant collagen.

Objective:To explore the application value of the double-low technique of auto-prescription technique combined with iterative reconstruction algorithm in CT pulmonary angiography (CTPA).Methods:A total of 86 patients who were clinically suspected of having pulmonary embolism and underwent CTPA examination in the First Affiliated Hospital of Dalian Medical University were prospectively collected and randomly assigned to a control group ( n = 45) and an observation group ( n = 41) according to the random number table method. In the control group, a tube voltage of 120 kVp was used with a standard iodine contrast agent dose of 60 ml, and images were reconstructed using the 40% adaptive statistical iterative reconstruction algorithm (ASIR-V). In the observation group, the tube voltage was set by auto-prescription technique, and 0.4 ml/kg of personalized low iodine contrast agent was used. Images were reconstructed with 40%, 60%, and 80% ASIR-V, respectively, and designated as observation 1, observation 2, and observation 3 respectively. The volume CT dose index (CTDI vol), dose-length product (DLP), and effective dose ( E) were recorded and compared among the four groups. The CT values and standard deviation (SD) of the main pulmonary artery, left and right pulmonary arteries, as well as the left and right pulmonary lobe arteries were measured, and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of these arteries were calculated. Additionally, the SD value at the contrast medium concentration in the superior vena cava was measured, and the artifact index (AI) was subsequently calculated. Two observers independently assessed the visibility of the pulmonary arteries, image noise, and sclerosis artifacts in the superior vena cava using a blinded method. Results:The E in the observation group was 3.28 (2.08, 3.93) mSv, which was significantly lower than that in the control group [5.03 (4.86, 5.20)] mSv, and the difference was statistically significant ( Z = 174.00, P < 0.05). The contrast agent dosage in the observation group was 28 (25, 30) ml, which was lower than that in the control group (60 ml), and the difference was statistically significant ( Z = 0, P < 0.05). The CT values for the main pulmonary artery and the left and right pulmonary lobe arteries in the observation group were higher than those in the control group, and the differences were all statistically significant ( t = -3.65 to -3.89, P < 0.05). The SNR and CNR of the observation groups 2 and 3 were greater than those of the control group ( t = -9.20 to -2.98, P < 0.05). The consistency of subjective evaluations between the two observers was good ( Kappa = 0.729 - 0.879, P < 0.05). There was no statistically significant difference in the subjective score of pulmonary artery visibility between the control and observation group ( P > 0.05). The subjective scores for image noise in observation group 2 and group 3 were higher than those in the control group ( U =598.50, 654.00, P < 0.05). The presence of artifacts due to sclerosis in the superior vena cava was significantly lower in the observation group compared to the control group ( χ2 = 46.09, P < 0.001). Conclusions:The combination of auto-prescription technique with ASIR-V reconstruction algorithm and low contrast agent imaging protocol can reduce the radiation dose and contrast agent dose without compromising image quality, and enable personalized double low CTPA imaging.

Objective To explore the impact of ondansetron's use within 24 h before delirium assess-ment in ICU patients on the risk of delirium occurrence.Methods All data were derived from the Critical Care Medical Information Database(MIMIC)-Ⅲ,MIMIC-Ⅳ and the eICU Collaborative Research Database.The research subjects were the patients who were admitted to ICU for treatment for the first time and had re-cords of delirium assessment.The research variable was whether ondansetron was used within 24 h before de-lirium assessment.The main observation indicator was whether delirium occurred after the patient entering to ICU,and whether the patient died during hospitalization or was discharged and returned home was taken as the secondary observation indicator.The propensity score matching eliminated confounding factors,and the stepwise logistic regression and nearest neighbor matching were used to analyze the influencing factors.Results A total of 78 364 patients had the delirium assessment records,among them 22 158 patients had the positive assessment results.A total of 294 patients who used ondansetron within 24 h before delirium assess-ment were taken as the ondansetron group,and 78 070 patients who did not use ondansetron were taken as the control group.Propensity score matching corrected most of the covariates between the two groups.The results of multivariate logistic regression analysis showed that the use of ondansetron was a protective factor for the delirium occurrence(OR=0.72,95％CI:0.53-0.96),and the results of nearest neighbor matching analysis also supported this association(OR=0.48,95％CI:0.31-0.76).However,the use of ondansetron had no effect on the outcome of in-hospital death or discharge home for critically ill patients(P＞0.05).Conclusion Ondansetron may be an effective drug for the prevention or treatment of delirium in critically ill patients.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective To explore the application value of deep learning image reconstruction(DLIR)algorithm combined with a large reconstruction matrix in lung nodules screening using low-dose computed tomography(LDCT)of the chest.Methods Patients who underwent LDCT scans were prospectively enrolled.The control group(group A)used the iterative reconstruction(IR)algorithm(Karl)with a reconstruction level of Karl 5,reconstructed images of 512×512(group A1)matrix,and 1 024 × 1 024(group A2)matrix.The experimental group employed DLIR combined with 512×512(group B)matrix and 1 024 × 1 024(group C)matrix for image reconstruction at levels 1-5,which were recorded as groups B1-5 and groups C1-5.The CT values and standard deviation(SD)values of the lung parenchyma and tracheal air were measured,and the signal-to-noise ratio(SNR)was calculated.The overall lung image quality was scored on a Likert 5-point scale,and the subgroup with the best lung image quality was selected.The lung nodule detec-tion rate and clarity were compared with group A1.Results Under the same reconstruction matrix,the CT values of the tracheal air and lung parenchyma in the experimental group showed no significant difference compared to the control group,while the SD values were lower and SNR were higher(P＜0.05).Within groups B and C,as the DLIR level increased,the SD values of the tracheal air and lung paren-chyma gradually decreased,and SNR gradually improved(P＜0.05).Subjective scores for the image quality in groups B and C initially increased and then decreased,with group B3 and group C4 showed the best image quality.No difference was observed in objective eval-uation between the two groups,but the subjective image quality score of group C4 was superior to group B3(P＜0.05).Subjective eval-uation of lung nodule display in group C4 was better than in group A1(P＜0.05).Conclusion DLIR algorithm combined with a large reconstruction matrix is feasible for lung nodules screening in chest LDCT,reducing image noise while improving lung nodules clarity,demonstrating significant clinical value.

Objective To evaluate the efficacy and safety of a novel intravascular lithotripsy(IVL)balloon—Vesscrack shockwave balloon—for vascular preparation before stent implantation in patients with severe coronary artery calcification(CAC).Methods This was a prospective,single-arm,multicenter study conducted in China from June 2022 to October 2022.Patients with severe CAC were treated with the Vesscrack shockwave balloon for lesion preparation,followed by drug-eluting stent(DES)implantation.Of these,33 patients underwent optical coherence tomography(OCT).The primary endpoint was procedural success,defined as successful stent implantation with residual stenosis≤30％and the absence of in-hospital major adverse events,including cardiac death,target vessel-related myocardial infarction,or target lesion revascularization.Results A total of 170 patients[mean age:(65.9±7.9)years,116 males]were enrolled.After treatment with IVL and DES,the minimum lumen diameter increased significantly compared to baseline[(2.34±0.40)mm vs.(0.95±0.33)mm,P＜0.001],the degree of stenosis was significantly reduced[(13.24±6.60)％vs.(65.18±10.59)％,P＜0.001].Procedural success was achieved in 100％of cases,and device success was 98.8％.The 30-day patient-related cardiovascular clinical composite endpoint(POCE)rate was 0.0,with no target lesion failure,no confirmed or potential thrombotic events were observed.The shockwave energy generator demonstrated excellent stability and ease of use.Among the 33 patients assessed with OCT,after IVL intervention,the maximum calcified area of the lumen[(3.51±1.51)mm2 vs.(2.85±1.80)mm2,P＜0.001],and the minimum lumen area within the target lesion[(3.08±1.04)mm2 vs.(2.02±0.75)mm2,P＜0.001],and after DES intervention,the luminal area of the largest calcified site[(6.59±1.64)mm2 vs.(2.85±1.80)mm2,P＜0.001]and the minimum luminal area within the target lesion[(6.19±1.45)mm2 vs.(2.02±0.75)mm2,P＜0.001]were significantly increased,and the differences were statistically significant.Conclusions The Vesscrack shockwave balloon is effective and safe for vascular preparation in patients with severe CAC prior to stent implantation.It achieves significant calcified plaque modification,high procedural success rates,and minimal complications.

Objective To explore the application value of Auto-prescription combined with low-dose contrast and adaptive statisti-cal iterative reconstruction-Veo(ASIR-V)algorithm in the computed tomography angiography(CTA)of thoracodorsal artery(TDA).Methods A total of 100 patients who underwent TDA CTA examination were prospectively selected.A tube voltage of 120 kVp and contrast agent of 1.5 mL/kg were used for group A(50 cases),and images were reconstructed with 40％ post-set ASIR-V.The Auto-prescription for tube voltage and contrast agent of 1.2 mL/kg were used for group B(50 cases),while images were reconstruc-ted with 40％,60％,and 80％ post-set ASIR-V,labeled as subgroups B1 to B3.The objective and subjective evaluation results of the images were compared between and within groups.Results Group A had an effective dose(ED)of 2.98(2.65,4.03)mSv,while group B had an ED of 1.92(1.44,3.33)mSv.The iodine intake in group B was lower than that in group A,and the CT value of the axillary artery in group B was significantly higher than that in group A(P＜0.001).With the increased of ASIR-V level in group B,the signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of the images gradually increased(P＜0.05).In terms of subjec-tive scores on axial images,both subgroups B2 and B3 were superior to group A(P＜0.001);with the increased of ASIR-V level in group B,subjective scores of axial images increased first and then decreased,among which subjective score of subgroup B2 was the highest and the differences were statistically significant(P＜0.001).In terms of subjective scores on three-dimensional image quality,subgroups B1 to B3 were superior to group A(P＜0.001).Conclusion The use of Auto-prescription combined with low-dose con-trast and 60％ ASIR-V can significantly optimize the display of TDA,and reduce the radiation dose and contrast agent dose to a certain extent.