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 explore the influencing factors of cognitive impairment in non-dialysis patients with chronic kidney disease(CKD).Methods A total of 60 hospitalized non-dialysis patients with CKD in the Department of Nephrology of Northern Jiangsu People's Hospital Affiliated to Yangzhou University from September 2022 to September 2023 were enrolled as research objects.According to the estimated glomerular filtration rate(eGFR),they were divided into stage 1 to 2 of CKD group[eGFR ≥60 mL/(min·1.73 m2)]with 23 cases,the stage 3 of CKD group[eGFR 30～＜60 mL/(min·1.73 m2)]with 20 cases,and stage 4 to 5 of CKD group[eGFR＜30 mL/(min·1.73 m2)]with 17 cases.The Montreal Cognitive Assessment Scale(MoCA)was used to evaluate the cognitive function of the patients.Basic data and common clinical laboratory in-dicators on hospital admission were collected to analyze the differences in cognitive function levels under different renal function statuses and to explore the influencing factors of cognitive impairment.Results The incidence rates of cognitive impairment in the stage 1 to 2 of CKD group,stage 3 of CKD group,and stage 4 to 5 of CKD group were 47.8％,85.0％,and 94.1％respectively,the median MoCA scored 26,24 and 20 respectively,with statistically significant between-group differ-ences(P＜0.05).Cognitive function was significantly negatively correlated with age(r=-0.634,P＜0.001),blood urea nitrogen(BUN)(r=-0.574,P＜0.001),serum creatinine(Cr)(r=-0.417,P＜0.001),cystatin C(Cys-C)(r=-0.327,P=0.011),serum β2-microglobulin(β2-MG)(r=-0.259,P=0.046),and N-terminal pro-brain natriuretic peptide(NT-proBNP)(r=-0.474,P＜0.001),and was significantly positively correlated with hemoglobin(HB)(r=0.401,P=0.001)and eGFR(r=0.485,P＜0.001).Multivariate Logistic regression analysis showed that age(P=0.006)and NT-proBNP(P=0.041)were influencing factors of cognitive im-pairment in non-dialysis patients with CKD.Receiver operating characteristic(ROC)curve analysis showed that the area under the curve(AUC),sensitivity,and specificity of age for prediction were 0.860,0.864 and 0.812 respectively,the AUC,sensitivity,and specificity of NT-proBNP for pre-diction were 0.808,0.795 and 0.875 respectively,and the combined prediction of age and NT-proBNP had an AUC,sensitivity,and specificity of 0.893,0.955,and 0.750,respectively.Conclusion As renal function deteriorates,the incidence rate and severity of cognitive impairment in non-dialysis patients with CKD tend to increase.Advanced age,renal function deterioration,high NT-proBNP level,and anemia are associated with the occurrence of cognitive impairment in non-di-alysis patients with CKD,among which age and NT-proBNP are influencing factors for cognitive im-pairment.

Critically ill patients are at high risk for hospital acquired infections, which can significantly increase the mortality rate and treatment costs for these patients. Therefore, in the process of treating the primary disease, strict prevention and control of new hospital infections is an essential component of the treatment for critically ill patients. The treatment of critically ill patients involves multiple steps and requires a concerted effort from various aspects such as theory, management, education, standards, and supervision to achieve effective prevention and control of hospital infections. However, there is currently a lack of unified understanding and standards for hospital infection prevention and control. To address this, in March 2024, a group of experts in critical care medicine, infectious diseases, and hospital infection from China discussed the current situation and issues of hospital infection control in the intensive care unit together. Based on a review of the latest evidence-based medical evidence from both domestic and international sources, 2024 Expert Consensus on Hospital Acquired Infection Control Principles in the Department of Critical Care Medicine was formed, aiming to provide a basis for the development of hospital infection prevention and control strategies in the field of critical care medicine.

Objective To explore the application value of echocardiography in the differential diagnosis of transthyretin cardiac amyloidosis(ATTR-CA)and immunoglobulin light chain cardiac amyloidosis(AL-CA).Methods We conducted a retrospective analysis of echocardiographic parameters of 50 confirmed CA patients diagnosed between November 2021 and January 2024 at The First Affiliated Hospital of Xi'an Jiaotong University,including 6 cases of ATTR and 44 cases of AL.Parameters that could potentially distinguish between the two subtypes were selected using t-tests and x2 tests,and the diagnostic capabilities of these parameters for the two subtypes were analyzed using receiver operating characteristic(ROC)curves.Results There were no statistically significant differences in general characteristics,global longitudinal strain(GLS),ratio of apical to basal strain,ejection fraction to GLS ratio(EFSR),maximum thickness of left ventricular myocardium,relative thickness of left ventricular wall,presence of thickened atrioventricular valves,or presence of enlarged atria between ATTR and AL groups(P＞0.05).The interventricular septal thickness was greater than in ATTR group than in AL group(P＜0.05),and the E/e'ratio(ratio of spectral Doppler early diastolic peak velocity to tissue Doppler early diastolic peak velocity)was greater in ATTR group than in AL group(P＜0.05).ROC curve analysis showed that the areas under the curve for distinguishing between the two subtypes based on interventricular septal thickness and E/e'ratio were 0.891(95％CI:0.792-0.991)and 0.826(95％CI:0.698-0.955),respectively,with a sensitivity of 100.00％and specificity of 95.24％for combined diagnosis.Conclusion Echocardiographic parameters,including E/e'ratio and interventricular septal thickness,may have clinical significance in distinguishing between the two main subtypes of CA in patients.

Objective:To investigate the effect of perineal single-port robot-assisted radical prostatectomy.Methods:A retrospective analysis was conducted on clinical data from 60 patients who underwent perineal single-port robot-assisted laparoscopic radical prostatectomy at our hospital between July 2019 and July 2022. The mean age of the patients was (65.9±7.6) years and the mean BMI was (24.1±2.9) kg/m 2. The median (IQR) prostate volume was 32.7 (23.8, 41.2) ml, and the median (IQR) preoperative PSA value was 8.8 (6.8, 12.6) ng/ml. Preoperative pathology revealed a Gleason score of 6 in 21 patients, Gleason score of 7 in 35 patients and Gleason score of 8 in 4 patients. There were 12 patients clinically staged as T 1 and 48 patients as T 2. A total of 18 patients underwent a total of 23 previous abdominopelvic surgeries. The patient is placed in an exaggerated lithotomy position with the head down and feet elevated approximately 15°. A 3-5 cm incision was made approximately 2 cm above on the mid-perineum between the bilateral ischial tuberosities. Next, the rectourethral muscle was divided, and the space anterior to the rectum was developed by blunt dissection. The levator ani muscles were separated to expose Denonvilliers’ fascia. Then, the disposable multi-channel laparoscopic surgical access system is inserted with a surgical wound protector. Denonvilliers’ fascia was incised transversely and the ampulla of the vas deferens, which were subsequently divided. Blunt separation is performed on both sides along the capsule of the prostate, and then, the vascular pedicles of the prostate are ligated. The membranous urethra was severed after complete urethral separation at the tip of the prostate at the urethral junction. The bladder neck was freed and dissected. The prostate and seminal vesicles were removed and a vesicourethral anastomosis is performed. A perineal drain were left in place. Preoperative and postoperative variables, complications, early urinary continence rate(Return of urinary continence status was defined as using no more than one safety pad per day) and oncological outcomes of patients were recorded. Results:All 60 surgeries were successfully completed without conversions or additional incisions. The median (IQR) total operative time was 200.0(153.8, 236.3) min, the median (IQR) console operating time was 107.5(90.0, 150.0) min and the median (IQR) estimated blood loss was 50.0(50.0, 100.0) ml. Positive surgical margins were detected in five patients (8.3%). The continence rate was 43.1%(22/51), 64.7%(33/51), 92.0%(46/50) and 98.0%(49/50), and the PSA undetectable rate was 94.6%(48/51), 98.2%(49/51), 96.6%(47/50) and 100%(50/50) at the 1, 3, 6, and 12 months after surgery. Only 1(1.7%) patient experienced biochemical recurrence 9 months after surgery. The overall complication rate was 20%, including two cases of acute respiratory distress syndrome, one case of rectal injury, one case of urinary tract injury, two cases of poor wound healing, three cases of incision infection, two cases of urinary tract infection and one case of bladder neck-urethral orifice anastomotic stricture.Conclusions:Perineal single-port robot-assisted radical prostatectomy might be safe and feasible surgical treatments for localized prostate cancer, especially for patients with a history of complex abdominal or pelvic surgery. It also showed advantages in early continence. The anatomical structure of the perineal region should be considered, and the correct incision position should be chosen. Specific incision protection measures should also be used for the incision in this particular area of the perineal region to reduce the risk of perioperative complications.

Objective To explore the effect of Yizheng Recipe on pyroptosis of alveolar epithelium in rats with recurrent respiratory tract infection(RRTI)based on HMGB1/TLR4/NF-κB signal pathway.Methods SD rats were firstly grouped into normal group and model group.In the model group,the RRTI rat model of spleen-Qi deficiency and lung- Qi deficiency was induced by fatigue combined with diet disorder and shavings and tobacco leaf smoking.Then,the rats in the model group were grouped into:RRTI model group(gavaged with normal saline 0.5 mL·100 g-1·d-1)and Yupingfeng Powder control treatment group(gavaged with Yupingfeng Powder suspension 0.5 mL·100 g-1·d-1),Yizheng Recipe high,medium and low-dose treatment groups(gavaged with Yizheng Recipe 0.75,0.5,0.25 mL·100 g-1·d-1),the normal group(gavaged with normal saline 0.5 mL·100 g-1·d-1).The general activities of the rats were observed and the pulmonary function of the rats was detected by the AniRes2005 animal pulmonary function analysis system;the expression of inflammatory factors in rat serum was detected by ELISA;HE,PAS and TUNEL staining were applied to detect the pathological changes of lung tissue;Western blot was applied to detect cell pyroptosis and the expression of HMGB1/TLR4/NF-κB signaling pathway-related proteins.Results Compared with the normal group,the lung function of the RRTI model group was weakened;the inflammatory response increased,and the lung tissue damage,edema and apoptosis were obviously increased;meantime,the pyroptosis was aggravated,and the HMGB1/TLR4/NF-κB pathway was activated(P<0.05).Compared with the RRTI model group,the Yupingfeng Powder control treatment group and the Yizheng Recipe high-dose,medium-dose and low-dose treatment groups all had different degrees of remission in lung function;inflammatory response reduced,the lung tissue damage,edema and apoptosis reduced;meantime,the pyroptosis and HMGB1/TLR4/NF-κB pathway were inhibited(P<0.05).Yizheng Recipe high-dose treatment group and Yupingfeng Powder control treatment group had similar curative effect on RRTI model rats(P>0.05);and Yizheng Recipe was dose-dependent in treating RRTI model rats(P<0.05).Conclusion Yizheng Recipe may inhibit the pyroptosis of alveolar epithelial cells in RRTI model rats by reducing the inflammatory response,and then protecting the lung tissue from damage,this process may be related to the HMGB1/TLR4/NF-κB pathway.

Objective To compare the effects of different support method on eccentric control angle and muscle strength of knee joints in 10-week Nordic hamstring exercise.Methods Twenty-eight college male football players were randomly divided into hand support group (HS group, n=14) and non-hand support group (NHS group, n=14) for 10 weeks. The eccentric control angle and eccentric muscle strength of knee joints were tested before and after the intervention.Results After 10 weeks of Nordic hamstring training, the eccentric control flexion angle of knee joint in HS group and NHS group was significantly decreased by 8° and 10°, and the knee joint angle in NHS group was 12° lower than that in HS group (P<0.05); the peak torque of hamstring and quadriceps femoris in both HS group and NHS group was significantly increased, and the peak torque of hamstring centrifugal motion at 60°/s and 120°/s in NHS group was 16 and 13 N·m higher than that in HS group, respectively (P<0.05).Conclusions NHS group is better than HS group in improving knee flexion angle and centrifugal muscle force. It is suggested that Nordic hamstring training should be taken as one of the daily training tasks for football players to prevent hamstring injury.

Isochrysis galbana is considered an ideal bait for functional foods and nutraceuticals of humans because of its high fucoxanthin(Fx)content.However,multi-omics analysis of the regula-tory networks for Fx biosynthesis in I.galbana has not been reported.In this study,we report a high-quality genome assembly of I.galbana LG007,which has a genome size of 92.73 Mb,with a contig N50 of 6.99 Mb and 14,900 protein-coding genes.Phylogenetic analysis confirmed the monophyly of Haptophyta,with I.galbana sister to Emiliania huxleyi and Chrysochromulina tobinii.Evolutionary analysis revealed an estimated divergence time between I.galbana and E.huxleyi of～133 million years ago.Gene family analysis indicated that lipid metabolism-related genes exhibited significant expansion,including IgPLMT,IgOAR1,and IgDEGS1.Metabolome analysis showed that the content of carotenoids in I.galbana cultured under green light for 7 days was higher than that under white light,and β-carotene was the main carotenoid,accounting for 79.09％of the total carotenoids.Comprehensive multi-omics analysis revealed that the content of β-carotene,antheraxanthin,zeaxanthin,and Fx was increased by green light induction,which was significantly correlated with the expression of IgMYB98,IgZDS,IgPDS,IgLHCX2,IgZEP,IgLCYb,and IgNSY.These findings contribute to the understanding of Fx biosynthesis and its regulation,pro-viding a valuable reference for food and pharmaceutical applications.

Objective To analyze plantar pressure features of patients in injured and healthy sides of the lower limbs under different walking conditions after the trimalleolar fracture surgery, and compare these characteristics with healthy subjects. Methods Twelve Trimalleolar fracture patients and twenty-three healthy subjects were recruited and their plantar pressure characteristics under different walking conditions were tested, including peak pressure, contact area and contact time percentage. Results Comparison between injured and healthy sides: during level walking, peak pressure of the 3rd-5th toe in the injured feet were smaller than those in the healthy sides; in inversion position, peak pressure and contact area of the 3rd-5th toe area in the injured feet were smaller than those in the healthy side; in eversion position, peak pressure, contact area and contact time of the 3rd-5th toe in the injured feet were smaller than those in the healthy sides, and peak pressures of the hindfoot area were larger than those in the healthy sides. Comparison between patients and healthy subjects: under three kinds of walking conditions, peak pressures of the 2nd and 3rd metatarsus bones, the 2nd toe, the 3rd-5th toe, contact area of the 1st-5th toe and contact time percentage of the 2nd toe, the 3rd-5th toe area were all smaller than those of healthy subjects, while contact time of the hindfoot and mid-foot area were all smaller than those of healthy subjects. Conclusions The plantar pressure characteristics of Trimalleolar fracture patients were asymmetrical. Compared with healthy subjects, the plantar pressure features of patients were abnormal during stance phase. Compared with healthy subjects, the motor control ability and stability of patients in eversion positions were decreased. The plantar pressure characteristics at ankle eversion can be used to evaluate ankle joint function.

Objective:The purpose of this study is to establish the trajectory of targeted grafting for facial fat compartment based on anatomical research, and then bring it to clinical practice.Methods:The boundary of fat compartment and the relationship of adjacent vessel and nerve were clarified through autopsy. The recommended injection points and trajectory for targeted fat grafting were established on the anatomical findings. Retrospective clinical data of facial rejuvenation of 46 patients through targeted fat grafting were collected from June 2017 to June 2019 in Shanghai Ninth People’s Hospital. The result of 3D scanning were analyzed to evaluate the survival rate of fat grafts.Results:There were subcutaneous superficial fat compartments in the frontal region, and there were both deep and superficial fat compartments in the temporal and middle face. According to the anatomical characteristics, a targeted fat grafting technique was established with the frontal hairline and the oral commissure corner mucosa as the entry points. In the clinical study, 46 patients were evaluated by 3D scanning 6 months after the last fat grafting. The amount of fat grafts in the temporal region was (17.84±8.47) ml and (11.2±2.44) ml was left after operation, and the survival rate was 63%. The amount of fat grafts in mid-face was (26.81±10.36) ml and (16.09±4.48) ml was left after operation, and the survival rate was 60%. Overall satisfaction rate of patients was 93% (43/46).Conclusions:Compartment-based targeted fat grafting is an accurate injection method, which meets the requirement of physiological augmentation. The trajectory of targeted fat grafting will further improve the efficacy and safety of injection.