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 investigate the predictive value of quantitative parameters of contrast-enhanced ultrasound (CEUS) in evaluating kidneys from donation after brain death (DBD) for the occurrence of delayed graft function (DGF) in recipients. Methods The clinical data of 134 DBD donors and 202 corresponding kidneys and recipients were retrospective analyzed. The recipients were divided into DGF group (n=39) and non-DGF group (n=163) according to the renal function after kidney transplantation. Conventional ultrasound, CEUS parameters, and clinical data were compared between the two groups. Receiver operating characteristic (ROC) curves were used to determine the optimal cut-off values for predicting DGF using CEUS parameters, clinical parameters, and their combination, based on the highest Youden index. The predictive ability of different parameters for DGF was evaluated. Results There were statistically significant differences in cortical peak intensity (PIc), medullary peak intensity (PIm), donor albumin (ALB), serum creatinine (Scr) after admission, and the Na⁺ concentration of recipients between the two groups (all P<0.05). The area under the curve (AUC) for predicting DGF using the combination of CEUS parameters PIc and PIm was 0.711, with an optimal cut-off value of 0.193 and a Youden index of 0.382. The AUC for predicting DGF using the combination of CEUS parameters PIc, PIm and clinical parameters was 0.808, with an optimal cut-off value of 0.191 and a Youden index of 0.517. The sensitivity and specificity were 0.769 and 0.613 for the former, and 0.769 and 0.748 for the latter, respectively. The AUC for predicting DGF using CEUS parameters PIc and PIm combined with clinical parameters was significantly higher than that using CEUS parameters PIc and PIm (P<0.05). Conclusions The CEUS quantitative parameters PIc and PIm have good predictive value in assessing kidneys from DBD donors for DGF in recipients, and the diagnostic efficacy is better when combined with clinical parameters.

OBJECTIVE:The clinical efficacy and safety of preoperative intravenous glucocorticoids in patients undergoing lower limb joint arthroplasty remain controversial.Therefore,we conducted a meta-analysis based on randomized controlled trials to evaluate the efficacy and safety of preoperative intravenous glucocorticoids for clinical treatment using lower limb joint arthroplasty. METHODS:We systematically searched randomized controlled trials on the effects of preoperative intravenous glucocorticoids on the efficacy and safety of lower limb joint arthroplasty in Chinese and foreign databases up to June 2023,including PubMed,Embase,Web of Science,Cochrane Library,WanFang Data,and CNKI.The trial group was injected with intravenous glucocorticoid before operation to control pain.The control group received placebo or intravenous saline.Outcome measures included postoperative resting pain score,postoperative C-reactive protein,postoperative 5-m walking test pain score,length of hospital stay,operation time,postoperative morphine opioid supplemental dose,postoperative nausea and vomiting reaction,and postoperative periprosthesis infection complications. RESULTS:(1)A total of nine randomized controlled trials included 613 patients(n=311 in the glucocorticoid group,n=302 in the control group).(2)Compared with the control group,preoperative intravenous administration of glucocorticoids significantly reduced the resting pain scores of patients at 6 and 12 hours after surgery,as well as the pain scores of patients walking for 5 m on the first day after surgery.In addition,the need for additional morphine opioids and postoperative nausea and vomiting were reduced in the glucocorticoid group.The inflammatory C-reactive protein was lower than that of the control group within three days after surgery,and the length of hospital stay was shortened after intravenous glucocorticoid injection(P<0.05).(3)However,there were no significant differences in the incidence of infection after arthroplasty,operation time,and pain scores at 24 and 48 hours between the two groups. CONCLUSION:As an effective perioperative multi-modal analgesia protocol,intravenous injection of glucocorticoids before surgery is an effective and safe method to reduce hyperacute pain and improve joint mobility in patients with lower limb joint arthroplasty.More research is needed to determine the optimal dose and type of glucocorticoids for maximum pain control.

Objective:To explore the influencing factors of the therapeutic effect of fiberoptic bronchoscopic alveolar lavage (BAL) in children with severe pneumonia (SP), and the relationship between pulmonary ultrasound parameters and the clearance rates of procalcitonin (PCT) and C-reactive protein (CRP) after treatment.Methods:A total of 284 children with SP admitted to the Yan ′an People′s Hospital from February 2019 to October 2023 were selected as the research subjects; According to the prognosis after 30 days of treatment, they were divided into the good prognosis group ( n=213) and the poor prognosis group ( n=71). The changes of PCT clearance rate, CRP clearance rate and Lung Ultrasound Score (LUS) before and after treatment were compared between the two groups. The correlation between indexes was analyzed using the multiple linear regression (MLR) model. The odds ratio ( OR) of risk factors was calculated using the multivariate logistic regression model. The dose-response relationship was evaluated using the restricted cubic spline (RCS) model. The receiver operating characteristic (ROC) curve was used to analyze the predicting value of each index for poor prognosis after 30 days of treatment. Results:Compared with the good prognosis group, the CRP clearance rate and PCT clearance rate of children in the poor prognosis group were lower 7-14 days after treatment (all P<0.05), and the LUS was higher (all P<0.05). The MLR analysis results showed that LUS was negatively correlated with both CRP clearance rate and PCT clearance rate (all P<0.05), and there was still a significant correlation after adjusting for confounding factors (all P<0.05). The results of logistic regression analysis showed that after excluding confounding factors (Model 4), LUS, PCT clearance rate, and CRP clearance rate were independent risk factors for poor prognosis in children with SP after 30 days of treatment (all P<0.05). The results of RCS analysis showed that there was a nonlinear relationship between the continuous changes of LUS, PCT clearance rate and CRP clearance rate and the risk of poor prognosis in children with SP after 30 days of treatment (nonlinear tests all P<0.001). The combined accuracy of LUS, PCT clearance rate and CRP clearance rate in predicting the poor prognosis of children with SP after 30 days of treatment was relatively high ( P<0.05, AUC>0.75). Conclusions:The clearance rates of LUS and CRP, as well as PCT, are all associated with poor prognosis in children with SP, and the decreased clearance rates of CRP and PCT are independent factors for predicting the increase of LUS. The combined clearance rates of LUS and CRP, as well as PCT, can accurately predict the risk of poor prognosis in children.

Objective:To explore the influencing factors of the therapeutic effect of fiberoptic bronchoscopic alveolar lavage (BAL) in children with severe pneumonia (SP), and the relationship between pulmonary ultrasound parameters and the clearance rates of procalcitonin (PCT) and C-reactive protein (CRP) after treatment.Methods:A total of 284 children with SP admitted to the Yan ′an People′s Hospital from February 2019 to October 2023 were selected as the research subjects; According to the prognosis after 30 days of treatment, they were divided into the good prognosis group ( n=213) and the poor prognosis group ( n=71). The changes of PCT clearance rate, CRP clearance rate and Lung Ultrasound Score (LUS) before and after treatment were compared between the two groups. The correlation between indexes was analyzed using the multiple linear regression (MLR) model. The odds ratio ( OR) of risk factors was calculated using the multivariate logistic regression model. The dose-response relationship was evaluated using the restricted cubic spline (RCS) model. The receiver operating characteristic (ROC) curve was used to analyze the predicting value of each index for poor prognosis after 30 days of treatment. Results:Compared with the good prognosis group, the CRP clearance rate and PCT clearance rate of children in the poor prognosis group were lower 7-14 days after treatment (all P<0.05), and the LUS was higher (all P<0.05). The MLR analysis results showed that LUS was negatively correlated with both CRP clearance rate and PCT clearance rate (all P<0.05), and there was still a significant correlation after adjusting for confounding factors (all P<0.05). The results of logistic regression analysis showed that after excluding confounding factors (Model 4), LUS, PCT clearance rate, and CRP clearance rate were independent risk factors for poor prognosis in children with SP after 30 days of treatment (all P<0.05). The results of RCS analysis showed that there was a nonlinear relationship between the continuous changes of LUS, PCT clearance rate and CRP clearance rate and the risk of poor prognosis in children with SP after 30 days of treatment (nonlinear tests all P<0.001). The combined accuracy of LUS, PCT clearance rate and CRP clearance rate in predicting the poor prognosis of children with SP after 30 days of treatment was relatively high ( P<0.05, AUC>0.75). Conclusions:The clearance rates of LUS and CRP, as well as PCT, are all associated with poor prognosis in children with SP, and the decreased clearance rates of CRP and PCT are independent factors for predicting the increase of LUS. The combined clearance rates of LUS and CRP, as well as PCT, can accurately predict the risk of poor prognosis in children.

Objective To compare the clinical efficacy of ankle arthroscopy combined with closed reduction guide and conventional surgical incision in the treatment of trimalleolar fracture.Methods A total of 60 patients with ankle fracture were divided into two groups according to different surgical plans:the ankle arthroscopy combined with closed reduction guide surgery group(arthroscopy group)and the conventional incision surgery group(incision group),with 30 cases in each group.The operative time,intraoperative blood loss and complications of the two groups were observed and compared.Pain and functional recovery of patients were evaluated by the American Orthopaedic Foot&Ankle Society(AOFAS)ankle and hind foot scores and Foot and Ankle Disability Index(FADI)scores.Results All 60 patients were followed up.Compared with the arthroscopy group,patients in the incision group had a longer surgical time,a shorter incision length in the medial malleolus,a reduced number of cases of skin numbness and reduced bleeding(P＜0.05).The AOFAS score and the FADI score at 12 months after surgery were higher in the arthroscopic group than those of the incision group(P＜0.05).After 12 months of surgery,the AOFAS score in patients without cartilage injury of the arthroscopic group were higher than those of patients with cartilage injury(P＜0.05),while there were no significant differences in pain and force line scores between patients with cartilage injury and patients without cartilage injury(P＞0.05).Conclusion The application of ankle arthroscopy combined with closed reduction guide in the treatment of trimalleolar fracture can achieve better postoperative results,but it has no obvious advantages in operation time and incision infection compared with the incision surgery.

Objective:To observe the clinical efficacy of a new type of "firebreak" drainage with skin preservation in the treatment of Fournier's gangrene.Methods:This technique is suitable for patients with perianal necrotizing fasciitis who can tolerate surgery without large area of skin blackness and necrosis. Procedure and key points: (1) The dividing line between inflammatory tissue and normal tissue was determined according to imaging examination and intraoperative exploration; (2) The abscess cavity was cut along the most obvious part of the abscess fluctuation, with a long diameter of 3~4 cm and a short diameter of 1~2 cm; (3) Necrotic tissue was discreetly separated and removed from the main incision to the outer edge of the infection. A fusiform incision was made every 3 to 5 cm, with a long diameter of 2 to 3 cm and a short diameter of 1 cm, and discreetly separated until the normal tissue, and a hose was hung between the adjacent incisions for drainage. (4) Each adjacent edge cut between the stealth separation and hanging hose drainage, forming a "firebreak"; (5) Rinse the wound repeatedly; (6) If the infection invades the rectum, colostomy is performed as required. The case data of 11 patients with perianal necrotizing fasciitis admitted to the Second Affiliated Hospital of Nanjing University of Chinese Medicine from July 2019 to February 2023 were retrospectively analyzed. All patients were treated with emergency surgical debridement by "firebreak" drainage with skin preservation.Results:All 11 cases were cured with 100%. One case underwent multiple operations. The hospitalization time was 11-46 days, with an average of 22 days. The wound healing time was 28-75 days, with an average of 43 days. Except for 1 patient with trauma, all the other patients had no significant anal function injury after surgery. All the 11 patients recovered and were discharged from hospital with a median follow-up of 136 (115-413) days.Conclusions:The "firebreak" drainage based on skin preservation has the advantages of less trauma and faster recovery, and do not cause obvious anal function damage.

Objective:To observe the clinical efficacy of a new type of "firebreak" drainage with skin preservation in the treatment of Fournier's gangrene.Methods:This technique is suitable for patients with perianal necrotizing fasciitis who can tolerate surgery without large area of skin blackness and necrosis. Procedure and key points: (1) The dividing line between inflammatory tissue and normal tissue was determined according to imaging examination and intraoperative exploration; (2) The abscess cavity was cut along the most obvious part of the abscess fluctuation, with a long diameter of 3~4 cm and a short diameter of 1~2 cm; (3) Necrotic tissue was discreetly separated and removed from the main incision to the outer edge of the infection. A fusiform incision was made every 3 to 5 cm, with a long diameter of 2 to 3 cm and a short diameter of 1 cm, and discreetly separated until the normal tissue, and a hose was hung between the adjacent incisions for drainage. (4) Each adjacent edge cut between the stealth separation and hanging hose drainage, forming a "firebreak"; (5) Rinse the wound repeatedly; (6) If the infection invades the rectum, colostomy is performed as required. The case data of 11 patients with perianal necrotizing fasciitis admitted to the Second Affiliated Hospital of Nanjing University of Chinese Medicine from July 2019 to February 2023 were retrospectively analyzed. All patients were treated with emergency surgical debridement by "firebreak" drainage with skin preservation.Results:All 11 cases were cured with 100%. One case underwent multiple operations. The hospitalization time was 11-46 days, with an average of 22 days. The wound healing time was 28-75 days, with an average of 43 days. Except for 1 patient with trauma, all the other patients had no significant anal function injury after surgery. All the 11 patients recovered and were discharged from hospital with a median follow-up of 136 (115-413) days.Conclusions:The "firebreak" drainage based on skin preservation has the advantages of less trauma and faster recovery, and do not cause obvious anal function damage.

Objective To explore the major risk factors of post transplantation diabetes mellitus (PTDM) and analyze the correlation between tacrolimus and PTDM after kidney transplantation. Methods Clinical data of 123 kidney transplant recipients were collected. All recipients were divided into the PTDM group (n=19) and non-PTDM group (n=104). Clinical data of all recipients in two groups were analyzed. The risk factors of PTDM were analyzed by binary logistic regression. Twenty-four mice were evenly divided into the control group (normal saline), low-dose tacrolimus (0.1 mg/kg), medium-dose tacrolimus (0.75 mg/kg) and high-dose tacrolimus groups (1.5 mg/kg). The solutions were given twice a day. The effect of tacrolimus on blood glucose metabolism in mice was evaluated. Results The incidence of PTDM was 15.4% (19/123) within 1 year after kidney transplantation. Age≥48 years old and the trough concentration of tacrolimus≥9 ng/mL within 3 months after kidney transplantation were the risk factors for PTDM after kidney transplantation (both P < 0.05). The fasting blood glucose levels of mice after administration in the low-, medium- and high-dose tacrolimus groups were significantly lower than those before administration (all P < 0.05) in a dose-independent manner (P=0.750). In the low-, medium- and high-dose tacrolimus groups, the postprandial blood glucose levels of mice after administration were significantly higher than those before administration (all P < 0.05) in a dose-dependent manner (P=0.012). Conclusions Tacrolimus is intimately correlated with the incidence of PTDM after kidney transplantation. Age≥48 years old and the trough concentration of tacrolimus ≥9 ng/mL within 3 months after kidney transplantation are the independent risk factors of PTDM. Tacrolimus affects the postprandial blood glucose levels of mice in a dose-dependent manner.

Downstaging treatment by local therapy combined with systemic therapy before liver transplantation for patients with recurrent hepatocellular carcinoma (HCC) can control tumor progression and reduce tumor burden, which resulting in reducing the push-out rate of patients during the waiting period for liver transplantation, providing an oncological observation window, enabling patients of beyond Milan criteria downstaged with better survival benefit. The authors introduce the clinical experience of a case with recurrent HCC of beyond Milan criteria who under-went liver transplantation after receiving atezolizumab plus bevacizumab combined with local therapy. Results show the patient achieving pathological complete remission without postoperative rejection and obtaining a good prognosis with life status improved.