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.

Mastitis is one of the common and prevalent diseases in dairy cows,and the natural prod-uct daidzein is a kind of natural flavonoids with a wide range of pharmacological and anti-inflam-matory effects.However,the effect of daidzein on mastitis in dairy cows has not been reported.Therefore,in this study,we explored the effects of daidzein on LPS-induced inflammatory response and tight junction damage in dairy mammary epithelial cells Firstly,we pretreated the MAC-T cell line using different concentrations of daidzein,and it was clarified that daidzein below 200 μmol/L had no effect on the cell activity.Next,we examined the production of pro-inflammatory mediators in LPS-stimulated MAC-T cell lines using qRT-PCR,and clarified that daidzein could reduce the production of pro-inflammatory mediators in a concentration-dependent manner.Subsequently,af-ter the expression of Occludin,Claudin3 and ZO-1 was detected by immunofluorescence and West-ern Blot,it was clear that daidzein could alleviate MAC-T cell intercellular tight junction injury.Fi-nally,it was demonstrated that daidzein significantly inhibited LPS-induced activation of the NF-κB signaling pathway within MAC-T using network pharmacological analysis and Western Blot.The above results suggest that daidzein can inhibit LPS-induced inflammatory response and tight junc-tion damage in mammary epithelial cells of cows by suppressing the activation of NF-κB signaling pathway.The present study provides a theoretical basis for the alleviation of mastitis by natural products and further expands the pharmacological effects of daidzein.

OBJECTIVE: To observe the clinical efficacy and safety of acupuncture combined with blade needle therapy for knee osteoarthritis (KOA). METHODS: A total of 60 patients with KOA were randomly divided into an observation group and a control group, 30 cases each group. The control group received acupuncture at Neixiyan (EX-LE4)，Dubi (ST35), Yinlingquan (SP9), Liangqiu (ST34), Xuehai (SP10), Yanglingquan (GB34) and Zusanli (ST36) on the affected side, once every other day, 3 times a week. The observation group received blade needle therapy on the basis of the treatment in the control group, once every 3 days, 2 times a week. Both groups were treated for 4 weeks. Before treatment, after 2, 4 weeks of treatment, and after 1 month of treatment completion (in follow-up), the scores of pain visual analogue scale (VAS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and Lequesne index were observed in the two groups, and the clinical efficacy and safety were evaluated. RESULTS: After 2, 4 weeks of treatment and in follow-up, the pain VAS scores, Lequesne index scores, and pain, stiffness, function scores of WOMAC in both groups were decreased compared with those before treatment (P<0.05), and the VAS scores, Lequesne index scores and pain, function scores of WOMAC in the observation group were lower than those in the control group (P<0.05). The effective response rate in the observation group was 76.7% (23/30), while that in the control group was 70.0% (21/30), there was no statistically significant difference in the effective response rates between the two groups (P>0.05). No adverse reactions were observed in either group. CONCLUSION Acupuncture combined with blade needle therapy could alleviate pain and promote functional recovery in KOA patients, and achieve long-lasting improvements.
Humans ; Osteoarthritis, Knee/physiopathology* ; Acupuncture Therapy/instrumentation* ; Male ; Female ; Middle Aged ; Aged ; Acupuncture Points ; Treatment Outcome ; Adult ; Needles ; Combined Modality Therapy

Time perspective therapy can reshape the time perspective of chronic disease patients,improve their psychological state,optimize behavioral patterns,and enhance self-management awareness.This article reviews the concept and theoretical basis of time perspective therapy,assessment methods of time perspective,and influencing factors of time perspective in chronic disease patients,as well as methods and effects of applying time perspective therapy in self-management.Additionally,it analyzes challenges in implementation and proposes practical recommendations,aiming to provide psychological guidance for self-management interventions in chronic disease patients.

Objective To investigate the impact of body mass index(BMI)on the perioperative outcomes and prognosis in patients with clear cell renal cell carcinoma(ccRCC)undergoing robot-assisted partial nephrectomy(RAPN),so as to provide reference for optimizing clinical management strategies.Methods The clinical data of 745 ccRCC patients undergoing RAPN at our hospital during 2014 and 2023 were retrospectively analyzed.Patients were categorized into three groups according to preoperative BMI:normal weight(18＜BMI＜24,n=202),overweight(24＜BMI＜28,n=428),and obese(BMI≥28,n=115).Baseline characteristics,surgical parameters,postoperative complications,pre-and post-operative estimated glomerular filtration rate(eGFR),and overall survival(OS)were compared among the groups.Multivariate regression analyses were performed to adjust potential confounders.Results Among baseline characteristics,only the gender distribution differed significantly among the three groups(P=0.009).Multivariate analysis showed that gender had no significant effects on reoperation,transfusion,operation time,intraoperative blood loss,or postoperative renal function.The median follow-up was 32(12,55)months.Compared with the normal-weight group,the obese group had longer operation time[140.0(115.0,170.0)min vs.160.0(125.0,190.0)min,P=0.009]and greater intraoperative blood loss[50.0(50.0,100.0)mL vs.100.0(50.0,150.0)mL,P=0.003].No statistically significant differences were observed among the three groups in pre-and post-operative eGFR,overall complication rate,long-term follow-up eGFR,or OS(P＞0.05).Conclusion RAPN provides comparable surgical benefits across BMI categories in patients with ccRCC;however,obese patients may experience increased operation time and blood loss.

Objective:To explore the effects of Yiqi Yangyin Tongluo Decoction combined with TCM syndrome differentiation diet on renal function, inflammatory factors, and nutritional status of DN patients with qi-yin deficiency and blood stasis syndrome based on propensity score matching method.Methods:Retrospective clinical studies were carried out. A total of 152 DN patients with qi-yin deficiency and blood stasis syndrome in Dongfang Hospital, Beijing University of Chinese Medicine from January 2022 to January 2024 were selected and divided into an observation group of 83 cases and a control group of 69 cases according to the treatment method. Propensity score matching (PSM) was further adopted to balance the confounding factors before treatment at a ratio of 1:1. Finally, 46 patients in each group were successfully matched. The control group received conventional Western medicine therapy intervention, while the observation group received a combination of Yiqi Yangyin Tongluo Decoction and TCM syndrome differentiation diet treatment on the basis of the control group. Both groups were treated for 3 months. TCM syndrome scores were performed before and after treatment, and t-test was used to detect the levels of SCr, BUN, and β2-MG. ELISA was used to detect the levels of IL-1β, TGF-β1, and TNF-α. Body composition analyzer was used to measure the triceps circumference (AMC) and triceps skinfold thickness (TSF) of the upper arm; the Mini Nutritional Assessment (MNA) was used to assess the risk or status of malnutrition. Adverse reactions were recorded and clinical efficacy was evaluated.Results:The total effective rate of the observation group was 91.3% (42/46), while that of the control group was 69.7% (32/46). There was a statistical significance in the total effective rate between the two groups ( χ2=4.84, P=0.028). After treatment, the observation group had lower scores of soreness and weakness in the waist and knees, fatigue and weakness, restlessness and heat in the five hearts, and a decrease in the depth of the tongue and dark veins compared to the control group ( t values of 4.23, 3.86, 3.68, 4.62, respectively, P<0.001); serum SCr [(221.53±23.40) mmol/L vs. (261.92±25.48) mmol/L, t=7.92], BUN [(21.74 ± 4.13) mmol/L vs. (25.12 ± 4.50) mmol/L, t=3.75], β2-MG [(2.88 ± 0.71) mg/L vs. (4.54 ± 0.93) mg/L, t=9.62] levels, as well as IL-1β [(47.21 ± 5.48) μg/L vs. (51.92 ± 5.63) μg/L, t=4.07], TGF-β [(67.84 ± 8.03) μg/L vs. (73.29 ± 8.88) μg/L, t=4.75], TNF-α [(29.74 ± 4.13) μg/L vs. (33.12 ± 4.98) μg/L, t=3.54] were lower than those in the control group ( P<0.001); the MNA score (24.89 ± 4.48 vs. 21.02 ± 4.16, t=4.29), AMC [(24.34±2.83) mm vs. (22.19 ± 2.88) mm, t=3.61], TSF [(8.34 ± 2.13) mm vs. (7.12 ± 1.98) mm, t=2.85] were higher than those in the control group ( P<0.001 or P<0.05). During the treatment period, the incidence of adverse reactions in the observation group was 13.0% (6/46), while in the control group it was 8.7% (4/46). There was no statistical significance between the two groups ( χ2=0.45, P=0.503). Conclusion:The combination of Yiqi Yangyin Tongluo Decoction and TCM syndrome differentiation diet can effectively alleviate the clinical symptoms of DN patients, improve their kidney function, enhance their nutritional and health status, and inhibit inflammatory response levels, with good treatment safety.

Objective:To investigate the promoting effect of individualized instruction combined with a blended learning model (IIBLM) in continuing training of neurology.Methods:A total of 93 trainees who received continuing training in Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, from August 2022 to December 2024 were enrolled as subjects. The 50 trainees registered since January 2024 were enrolled as observation group and received IIBLM teaching, including sub-specialty modular training, a cycle-adaptive cultivation system, a "mutual-selection" mentorship program, an on/off-line dual-track curriculum system, a dynamic course allocation mechanism based on "mutual selection", and a competency growth evaluation system, while the 43 trainees registered before January 2024 were enrolled as control group and received traditional teaching. A questionnaire survey and comprehensive competency assessments were performed to evaluate the effect of teaching, and the t-test, the chi-square test, and the qualitative analysis were used for statistical analysis. Results:Compared with the control group, the experimental group showed systematic improvements in clinical contents, theoretical curriculum, faculty competency, and workflow arrangement during continuing training, with a significant difference in the score of workflow arrangement between the two groups [(9.58±0.67) vs. (9.07±1.44), t=-2.13, P=0.037]. The observation group had a score of (97.70±1.30) for dynamic course allocation, an overall satisfaction rate of 97.15%, and a course benefit rate of 97.55%. The qualitative analysis showed that the trainees in the control group mainly complained of course monotony, while those in the observation group expected to enhance interdisciplinary integration and the cultivation of scientific research abilities. In addition, the results of competency assessment showed a continuous improvement in teaching effect after reform, with no significant difference. Conclusions:IIBLM teaching effectively enhances professional qualities, clinical competency, and the degree of satisfaction with courses among the trainees receiving continuing training, and it also revealed the necessity of interdisciplinary collaborative teaching and the integration of research and clinical practice.

Mastitis is one of the common and prevalent diseases in dairy cows,and the natural prod-uct daidzein is a kind of natural flavonoids with a wide range of pharmacological and anti-inflam-matory effects.However,the effect of daidzein on mastitis in dairy cows has not been reported.Therefore,in this study,we explored the effects of daidzein on LPS-induced inflammatory response and tight junction damage in dairy mammary epithelial cells Firstly,we pretreated the MAC-T cell line using different concentrations of daidzein,and it was clarified that daidzein below 200 μmol/L had no effect on the cell activity.Next,we examined the production of pro-inflammatory mediators in LPS-stimulated MAC-T cell lines using qRT-PCR,and clarified that daidzein could reduce the production of pro-inflammatory mediators in a concentration-dependent manner.Subsequently,af-ter the expression of Occludin,Claudin3 and ZO-1 was detected by immunofluorescence and West-ern Blot,it was clear that daidzein could alleviate MAC-T cell intercellular tight junction injury.Fi-nally,it was demonstrated that daidzein significantly inhibited LPS-induced activation of the NF-κB signaling pathway within MAC-T using network pharmacological analysis and Western Blot.The above results suggest that daidzein can inhibit LPS-induced inflammatory response and tight junc-tion damage in mammary epithelial cells of cows by suppressing the activation of NF-κB signaling pathway.The present study provides a theoretical basis for the alleviation of mastitis by natural products and further expands the pharmacological effects of daidzein.

Objective To investigate the impact of body mass index(BMI)on the perioperative outcomes and prognosis in patients with clear cell renal cell carcinoma(ccRCC)undergoing robot-assisted partial nephrectomy(RAPN),so as to provide reference for optimizing clinical management strategies.Methods The clinical data of 745 ccRCC patients undergoing RAPN at our hospital during 2014 and 2023 were retrospectively analyzed.Patients were categorized into three groups according to preoperative BMI:normal weight(18＜BMI＜24,n=202),overweight(24＜BMI＜28,n=428),and obese(BMI≥28,n=115).Baseline characteristics,surgical parameters,postoperative complications,pre-and post-operative estimated glomerular filtration rate(eGFR),and overall survival(OS)were compared among the groups.Multivariate regression analyses were performed to adjust potential confounders.Results Among baseline characteristics,only the gender distribution differed significantly among the three groups(P=0.009).Multivariate analysis showed that gender had no significant effects on reoperation,transfusion,operation time,intraoperative blood loss,or postoperative renal function.The median follow-up was 32(12,55)months.Compared with the normal-weight group,the obese group had longer operation time[140.0(115.0,170.0)min vs.160.0(125.0,190.0)min,P=0.009]and greater intraoperative blood loss[50.0(50.0,100.0)mL vs.100.0(50.0,150.0)mL,P=0.003].No statistically significant differences were observed among the three groups in pre-and post-operative eGFR,overall complication rate,long-term follow-up eGFR,or OS(P＞0.05).Conclusion RAPN provides comparable surgical benefits across BMI categories in patients with ccRCC;however,obese patients may experience increased operation time and blood loss.

Objective:To investigate the promoting effect of individualized instruction combined with a blended learning model (IIBLM) in continuing training of neurology.Methods:A total of 93 trainees who received continuing training in Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, from August 2022 to December 2024 were enrolled as subjects. The 50 trainees registered since January 2024 were enrolled as observation group and received IIBLM teaching, including sub-specialty modular training, a cycle-adaptive cultivation system, a "mutual-selection" mentorship program, an on/off-line dual-track curriculum system, a dynamic course allocation mechanism based on "mutual selection", and a competency growth evaluation system, while the 43 trainees registered before January 2024 were enrolled as control group and received traditional teaching. A questionnaire survey and comprehensive competency assessments were performed to evaluate the effect of teaching, and the t-test, the chi-square test, and the qualitative analysis were used for statistical analysis. Results:Compared with the control group, the experimental group showed systematic improvements in clinical contents, theoretical curriculum, faculty competency, and workflow arrangement during continuing training, with a significant difference in the score of workflow arrangement between the two groups [(9.58±0.67) vs. (9.07±1.44), t=-2.13, P=0.037]. The observation group had a score of (97.70±1.30) for dynamic course allocation, an overall satisfaction rate of 97.15%, and a course benefit rate of 97.55%. The qualitative analysis showed that the trainees in the control group mainly complained of course monotony, while those in the observation group expected to enhance interdisciplinary integration and the cultivation of scientific research abilities. In addition, the results of competency assessment showed a continuous improvement in teaching effect after reform, with no significant difference. Conclusions:IIBLM teaching effectively enhances professional qualities, clinical competency, and the degree of satisfaction with courses among the trainees receiving continuing training, and it also revealed the necessity of interdisciplinary collaborative teaching and the integration of research and clinical practice.