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 compare the differences in repair of rabbit bone defects between allogeneic platelet rich plasma (PRP) gel and autologous PRP gel.Methods:Thirty-six healthy New Zealand white rabbits were selected and randomly divided into an autologous group, an allogeneic group, and a control group ( n=12). A model of bilateral forelimb bone defects was established in each group. The autologous group was repaired with self-made deproteinized bone scaffold materials + autologous bone marrow mesenchymal stem cells (BMSCs) + autologous PRP gel, the allogeneic group with self-made deproteinized bone scaffold materials + autologous BMSCs + allogeneic PRP gel, and the control group with only self-made deproteinized bone scaffold materials + autologous BMSCs. At postoperative 1, 2, and 3 months, 4 animals were euthanized in each group, respectively, for gross observation, X-ray examination, Micro-CT examination, biomechanical testing and histological analysis (HE staining for tissue morphology) to compare the differences in repair of bone defects. Results:The formation of trabecular bone, cortical reconstruction, and medullary recanalization occurred earlier in the autologous and allogeneic groups than in the control group. Micro-CT analysis at postoperative 2 months showed that bone mineral density [(281.51±33.69) mg/mL and (266.13±37.13) mg/mL], bone volume fraction (23.52%±2.81% and 21.91%±1.94%), and trabecular number [(1.68±0.29) mm -1 and (1.63±0.22) mm -1] in the autologous and allogeneic groups were significantly higher than those in the control group [(197.47±18.61) mg/mL, 16.54%±3.06%, and (1.06±0.11) mm -1] ( P<0.05). No significant differences were found among the 3 groups in trabecular thickness [(0.33±0.09) mm, (0.42±0.16) mm, and (0.28±0.13) mm] or in the maximum compressive load ( P>0.05). HE staining revealed a significantly greater number and earlier formation of chondrocytes and osteoblasts in the autologous and allogeneic groups than in the control group. Conclusion:Since allogeneic PRP exhibits similar efficacy in promoting new bone formation compared with autologous PRP in a rabbit bone defect model, it may serve as a viable substitute for autologous PRP.

Objective:To investigate the clinical effects of the anterolateral thigh perforator flaps transplantation in repairing the wounds after radical resection of skin malignant tumors in the head, face, and neck.Methods:This study was a retrospective observational study. From May 2020 to December 2023, 27 patients with skin malignant tumors in the head, face, and neck were admitted to the Department of Burns and Plastic Surgery of the First People's Hospital of Kashi Prefecture, including 19 males and 8 females, aged 53 to 89 years. There were 21 cases with squamous cell carcinoma and 6 cases with basal cell carcinoma. The wound area after radical resection of tumors was 9.0 cm×7.0 cm to 27.0 cm×21.5 cm. The wounds were repaired with the lobulated, combined, or various forms of combination of the anterolateral thigh perforator flaps, and the harvesting flap area in single donor site was 10.0 cm×8.0 cm to 27.0 cm×11.0 cm. The wounds in the flap donor sites were closed by suturing in 26 patients, while the wound in the flap donor site in 1 patient was repaired with medium-thickness skin graft in the lower leg. The survival of the flap, and the occurrence of vascular crisis and infection were observed after surgery. During follow-up after surgery, the tumor recurrence, shape and texture of the flaps, and the function and scar formation of the limbs where the donor site was located were observed.Results:Only one patient developed venous crisis of the flap 27 hours after surgery, and the flap survived after vascular exploration and reanastomosis of the vein; the flaps in the other patients survived after surgery. One patient had an infected effusion under the flap after surgery, which healed after dressing change. After 6-36 months of postoperative follow-up, no tumor recurrence was observed; the flap had good appearance, texture, and elasticity; the limb where the donor site was located functioned normally, with only linear scars left.Conclusions:For complex wounds after radical resection of skin malignant tumors in the head, face, and neck, different forms of anterolateral thigh perforator flaps can be used to repair the wounds according to the condition of the wounds, and the wounds in the recipient sites heal well after surgery, with minimal damage to the donor site.

Objective To explore the difference in clinical efficacy of sacubitril valsartan(SV)and enalapril in the treatment of elderly patients with chronic heart failure with reduced ejection frac-tion(HFrEF).Methods A total of 126 elderly patients with chronic HFrEF admitted in our de-partment between January 2020 and January 2023 were prospectively recruited and randomly di-vided into control group(enalapril treatment,63 cases)and observation group(SV treatment,63 cases).After 3 months of treatment,the improvement rate of NYHA cardiac function grade,and changes in cardiac function indicators[6-minute walking distance(6MWD),NT-proBNP,LVEDD,LVEF],and echocardiographic indicators[left ventricular myocardial work(Tei)index,stroke volume,cardiac output(CO)]before and after treatment,adverse reactions during treat-ment and prognosis were compared between the two groups.Results The improvement rate of NYHA grade was significantly higher in the observation group than the control group(80.95％vs 65.08％,P＜0.05).The results of 6MWD,LVEF,stroke volume and CO were obviously higher in both groups after treatment than before treatment(P＜0.05).The results of 6MWD,LVEF,stroke volume and CO were notably higher in the observation group than the control group(P＜0.01).The SBP,DBP,NT-proBNP,heart rate,LVEDD and LV Tei index were decreased after treatment in both groups,and those in the observation group were even lower than those in the control group(P＜0.05,P＜0.01).As of April 2024,the readmission rates due to HF was re-markably lower in the observation group than the control group(7.94％vs 20.63％,P＜0.05),but no statistical difference was seen in the mortality or the incidence of adverse reactions be-tween them(P＞0.05).Conclusion SV is superior to enalapril in improving the efficacy,cardiac function and cardiac load of elderly HFrEF patients,with advantages of reducing the incidence of readmission but not increasing adverse reactions.

Cervical spinal cord injury without fracture-dislocation (CSCIWFD) is referred to as a special type of cervical spinal cord injury characterized by traumatic spinal cord dysfunction and no significant bony structural abnormalities on imagines. Duo to the high risk of missed diagnosis during the initial consultation, CSCIWFD may lead to progressive neurological deterioration or even complete paralysis, severely impacting patients′ prognosis. Currently, there are no established consensuses over the diagnosis and treatment of CSCIWFD, such as the lack of evidence-based standards for indications of non-surgical treatment and risk of secondary neurological injury, as well as debates over the optimal timing for surgical intervention and indications for different surgical approaches. To address these issues, the Spine Trauma Group of the Orthopedic Branch of the Chinese Medical Doctor Association organized experts in the relevant fields to formulate Diagnosis and treatment guideline for acute cervical spinal cord injury without fracture- dislocation in adults ( version 2025) . Based on evidence-based medicine and the principles of scientific rigor and clinical applicability, the guidelines proposed 11 recommendations covering terminology, diagnosis, evaluation treatment, and rehabilitation, etc., aiming to standardize the management of CSCIWFD.

Medication reconciliation plays a key role in improving patient medication safety,reducing inappropriate polypharmacy,and promoting the high-quality development of pharmaceutical services.Compared to advanced international guidelines,China's medication reconciliation service standards have deficiencies in areas such as definition and process design,and multidisciplinary team building.There is a need to establish a comprehensive medication reconciliation effect evaluation index system,develop pharmacist-led multidisciplinary teams,promote the advancement of artificial intelligence and big data technologies,and strengthen outpatient and community medication reconciliation coverage,thereby contributing to the high-quality development of pharmaceutical services in China.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

Objective:To develop a treatment-related quality of life scale for Chinese patients with multiple myeloma (MM) and to test its reliability and validity.Methods:The initial scale was constructed through a literature search, Delphi expert correspondence, and cognitive testing. This study conducted a preliminary survey of 379 patients with MM and a formal survey of 865 patients from the hematology departments of 155 hospitals nationwide from February 2024 to March 2024. The final scale was obtained after conducting item analysis and reliability and validity tests on the initial scale.Results:The constructed scale contains 36 items covering six domains: physiological, psychological, social, treatment side effects, general health, and others. In the preliminary survey, the Cronbach’s alpha coefficient of each item ranged from 0.597 to 0.939, and the test-retest reliability was 0.747 ( P<0.001). Exploratory factor analysis extracted eight common factors with a cumulative variance contribution of 60.058%. In the formal survey, the Cronbach’s alpha coefficient of each item ranged from 0.484 to 0.930, and the test-retest reliability was 0.835 ( P<0.001). Confirmatory factor analysis revealed a comparative fit index of 0.750, a root-mean-square error of approximation of 0.090, and a root-mean-square residual of 0.067. Conclusion:The treatment-related quality of life scale for Chinese patients with MM designed in this study exhibited good reliability and validity, reflecting the impact of treatment on the quality of life of patients. This scale can provide a reference to clinicians for assessing the disease status of patients.

Objective:To investigate the expression and methylation status of the SALL4 gene in placental tissues of fetal growth restriction (FGR) and its effects on trophoblast cell proliferation, migration, and invasion. Methods:Placental tissues were collected from 20 full-term FGR patients and 20 healthy term controls who underwent regular prenatal examination and cesarean section at the Third Affiliated Hospital, Zhengzhou University between July 2023 and February 2024. SALL4 mRNA and protein expression were analyzed by quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot. Methylation specific polymerase china reaction (MSP) assessed promoter methylation levels. HTR8/SVneo cells were transfected with SALL4-targeting small interfering RNA (si-SALL4) or negative control small interfering RNA (si-NC). HTR8/SVneo cells were treated with the demethylating agent 5-aza-2′-deoxycytidine (5-Aza-dC) to inhibit gene methylation (5-Aza-dC group) or with 10% RPMI-1640 medium as a vehicle control. Transfection efficiency (for siRNA) and the efficacy of 5-Aza-dC-induced demethylation were assessed by qRT-PCR and Western blot. The functional effects of SALL4 knockdown and methylation inhibition on trophoblast cells were evaluated using proliferation assays, scratch wound healing assays, and Transwell invasion assays. Statistical analyses included independent t-tests and Chi-square test. Results:(1) Human tissues: FGR placentas showed lower SALL4 mRNA (0.802±0.194 vs. 1.015±0.186, t=3.55) and protein expression (0.445±0.114 vs. 0.701±0.113, t=3.19), alongside higher methylation rates of SALL4 [80% (16/20) vs. 15% (3/20), χ2=14.44] compared to controls (all P<0.05). (2) In vitro: si-SALL4 transfection reduced HTR8/SVneo proliferation (OD450 at 48 h: 0.653±0.021 vs. 0.827±0.040, t=6.60), migration [healing rate at 48 h: (24.317±2.637)% vs. (49.327±1.961)%, t=13.18], and invasion [counted invaded cells: (133.000±6.557) vs. (272.667±18.009) cells, t=12.62] versus si-NC (all P<0.05). Conversely, 5-Aza-dC treatment increased HTR8/SVneo proliferation (0.917±0.042 vs. 0.783±0.031, t=－4.47), migration [(71.097±3.354)% vs. (51.632±2.877)%, t=－7.63], and invasion [(384.000±12.166) vs. (202.833±7.095) cells, t=－13.69] versus vehicle control (all P<0.05). Conclusions:Hypermethylation of the SALL4 promoter in FGR placentas suppresses its expression, impairing trophoblast cell function. Demethylation restores SALL4 expression and enhances cellular proliferation, migration, and invasion, involving in the occurrence and development of FGR disease.