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.

Despite breakthroughs in immunotherapy for solid tumors, significant variations in treatment efficacy persist. Up to 80% of cancer patients suffer from malnutrition, which leads to: lymphoid atrophy and reduced T-cell reserves; deficiency of substrates required for T-cell activation and expansion; concurrent inflammation hindering T-cell infiltration into tumors; and cachexia accelerating PD-1 antibody clearance. Clinical studies confirm that severe malnutrition significantly impairs immune responses and increases the risk of treatment toxicity. Therefore, implementing standardized nutritional therapy is crucial for optimizing the reserve, activation, expansion, and infiltration capacity of immune cells, thereby providing a sound immune system foundation for immunotherapy. Immunonutrition therapy, by enhancing immunonutrients such as arginine, omega-3 polyunsaturated fatty acids, and nucleotides, reduces the secretion of pro-inflammatory mediators and promotes T-cell activation and proliferation. This enhances anti-tumor immune responses, prolongs survival, and advances cancer treatment towards multimodal combination and precision approaches.

This paper presents an automatic acquisition and analytic procedure of acupuncture manipulation based on optical navigation, aiming at solving the shortcomings of existing acquisition methods of acupuncture manipulation. An acquisition holder installed at the handle tail of filiform needle was designed to display the movement trajectory of the needle during acupuncture delivery by collecting the movement trajectory of holder. The 3-month old male Bama miniature pig was selected as the experimental subject, and 6 points, "Bojian" "Qiangfeng" "Housanli" "Xiaokua" "Huiyang" (BL35) and "Baihui" (GV20), were selected during acupuncture manipulation. The optical navigation system was used to collect the real-time data, and these data were per-processed and analyzed using mean filtering and Fourier transform. The acupuncture procedure was divided into 3 stages, inserting, lifting-thrusting, and twisting. The results showed that the accuracy was 96.3% at lifting-thrusting stage, and that was 100.0% at twisting stage. The decomposition effect of the entire procedure was satisfactory. This study provides a new approach to the quantitative analysis of acupuncture manipulation. In the future, it needs to further optimize the algorithm and expand the sample size so as to improve the accuracy of this analytic technique.
Acupuncture Therapy/methods* ; Male ; Animals ; Swine ; Acupuncture Points ; Humans ; Swine, Miniature ; Needles

Objective To observe the clinical efficacy of Shuxin Jieyu Decoction(composed of Chuangxiong Rhizoma,Angelicae Sinensis Radix,Bupleuri Radix,Paeoniae Radix Alba,Paeoniae Radix Rubra,Curcumae Radix,Ziziphi Spinosae Semen,Glycyrrhizae Radix et Rhizoma Praeparata cum Melle,Platycladi Semen,Polygoni Multiflori Caulis,Polygalae Radix,Toosendan Fructus,Corydalis Rhizoma,and Albiziae Cortex)in treating coronary heart disease(CHD)with angina pectoris complicated by anxiety disorder in patients with qi stagnation and blood stasis syndrome.Methods Sixty patients diagnosed with qi stagnation and blood stasis syndrome type of CHD with angina pectoris and anxiety disorder were enrolled from the outpatient and inpatient departments of Taihe Hospital of Traditional Chinese Medicine Affiliated to Anhui University of Chinese Medicine between January 2024 and January 2025.Patients were randomly divided into an observation group(n=30)and a control group(n=30)using a random number table method.The control group received conventional CHD treatment and anxiolytic therapy(Flupentixol and Melitracen Tablets),while the observation group additionally received Shuxin Jieyu Decoction.Both groups were treated for 4 weeks.Changes in traditional Chinese medicine(TCM)syndrome scores and Hamilton Anxiety Rating Scale(HAMA)scores were evaluated before and after treatment.The therapeutic effects of angina pectoris,nitroglycerin reduction/cessation rates,and total adverse event rates were compared between the two groups.Results(1)After 4 weeks of treatment,the total effective rate in the observation group was 93.33％(28/30),compared to 73.33％(22/30)in the control group.The intergroup comparison(by Fisher's precision probability test)showed that the observation group's efficacy was significantly superior to that of the control group(P＜0.05).(2)After treatment,both groups showed significant reductions in TCM syndrome scores(P＜0.05)for symptoms including chest tightness and pain,costal distension,anxiety,palpitations,excessive sighing,irritability,and insomnia.The observation group's reduction was significantly greater than that of the control group(P＜0.05).(3)After 4 weeks,the total reduction/discontinuation rate of nitroglycerin was 90.00％(27/30)in the observation group versus 66.67％(20/30)in the control group.The intergroup comparison(by Fisher's precision probability test)showed that the observation group's reduction rate was significantly higher than that of the control group(P＜0.05,Fisher's precision probability test).(4)After treatment,both groups exhibited reduced Hamilton Anxiety Rating Scale(HAMA)scores(P＜0.05),with the observation group showing a significantly greater improvement(P＜0.05).(5)The total incidence of adverse reactions was 20.00％(6/30)in the observation group and 23.33％(7/30)in the control group,with no statistically significant difference between groups(P＞0.05).Conclusion The combination of Shuxin Jieyu Decoction with conventional western medicine treatment demonstrates superior clinical efficacy compared to conventional western medicine alone in patients with qi stagnation and blood stasis syndrome type of CHD with angina pectoris and anxiety disorder.It effectively alleviates angina symptoms and anxiety disorder,reduces nitroglycerin usage,without increasing adverse effects.

Objective To establish models for real-time dynamic monitoring of intracellular cytoplasmic adenosine triphosphate(ATP)and mitochondrial ATP levels in cells in order to study the changes in metabolic processes.Methods The lentiviral plasmids of the cytoplasmic chemogenetic green fluorescent protein(GFP)ATP probe(Chemo-G)and those of the mitochondrial-localized chemogenetic GFP ATP probe(mito-Chemo-G)were constructed before being transfected into HEK293T together with the helper plasmids,respectively.Chemo-G and mito-Chemo-G lentiviruses were obtained.HeLa cells were infected with the lentivirus.Puromycin resistance selection and flow cytometry cell sorting were employed to identify and isolate the infected HeLa cells.The growth and GFP expressions of HeLa cells were observed.A live-cell imaging system was used for continuous imaging of the cells,with stimuli added at specific time points to alter intracellular ATP levels to observe changes in the fluorescence intensity of the ATP probe.Results Lentiviral plasmids containing Chemo-G and mito-Chemo-G sequences were constructed.Two cell lines which could stably express Chemo-G and mito-Chemo-G were established that exhibited strong growth and accurate intracellular fluorescence localization.Live-cell imaging revealed that after the addition of 2-deoxy-D-glucose(2-DG)into HeLa-Chemo-G,the fluorescence resonance energy transfer(FRET)/GFP ratio showed a decrease that was partially reversed by the addition of glucose.The FRET/GFP ratio increased after histamine stimulation,but rapidly decreased after the addition of oligomycin.Conclusion The Chemo-G and mito-Chemo-G lentiviral vectors and stably transfected cell lines HeLa-Chemo-G and HeLa-mito-Chemo-G are constructed,which provides reliable experimental models for studying cellular metabolism and changes in intracellular ATP levels.

Mitochondria not only serve as the central hub for cellular energy metabolism,but also participate in crucial physiological processes such as signal transduction and activity regulation.Abnormal mitochondrial quantity,imbalance in mtDNA copy number,accumulation of genetic mutations,and aberrant activation of autophagic pathways can lead to mitochondrial dysfunction or even organelle disorders,while activating mechanisms of cellular damage and death,consequently contributing to the pathogenesis of various diseases.As a highly selective form of autophagy,mitophagy plays a pivotal regulatory role in organelle quality control and homeostasis maintenance.This article focuses on the classic PINK1/Parkin pathway-mediated mitophagy as an entry point,summarizing recent research advances regarding the role of mitophagy in neurodegenerative diseases,aiming to provide novel insights for developing targeted mitophagy regulation strategies to improve prevention and treatment approaches for neurodegenerative disorders.

Objective To investigate the correlation between baseline data,early treatment response and prognosis in children with acute lymphoblastic leukemia(ALL).Methods Ninety-two children with ALL were divided into the endpoint event group(19 cases)and the event-free survival group(73 cases)according to whether there was an endpoint event(recurrence or death).The age and gender at initial diagnosis were recorded.Initial white blood cell count(WBC),platelet count(PLT),immunophenotype,chromosome karyotype,fusion gene,prednisone test,bone marrow remission status on the 15th day of induction chemotherapy and minimal residual disease(MRD)on the 15th,33rd and 55th day of induction chemotherapy were detected.The correlation between the above baseline data and early treatment response and the occurrence of endpoint event in children with ALL was analyzed.Logistic regression was used to analyze influencing factors of endpoint events in children with ALL.Receiver operating characteristic(ROC)curve was plotted to evaluate the predictive value of baseline data and early treatment response to endpoint events in children with ALL.Results The proportion of WBC≥100×109/L at first diagnosis,prednisone poor reaction and positive MRD on the 33rd day of induction chemotherapy were higher in the endpoint event group than those in the event-free survival group(P<0.05),and there were no significance differences in remaining indicators(P>0.05).Logistic regression analysis showed that prednisone poor reaction and positive MRD on the 33rd day of induction chemotherapy were risk factors for endpoint event in children with ALL(P<0.05),and the combined value of the two indicators was better than that of a single indicator in predicting endpoint events in children with ALL.Conclusion Prednisone poor reaction and positive MRD on the 33rd day of induction chemotherapy are associated with recurrence and death in children with ALL.

Objective To investigate the relationship between occupational noise exposure and glycated hemoglobin (HbA1c) levels, as well as prediabetes diagnosed by HbA1c. Methods A total of 1 181 workers from a cigarette factory were selected as the research subjects using a judgment sampling method. Workers were divided into control, low-level noise exposure and high-level noise exposure groups, consisting of 236, 359, and 586 individuals, respectively. The blood sample was collected for HbA1c test and occupation noise exposure intensity in workplace was detected by an area-sampling method. Results There were no statistical significant differences in HbA1c levels and prediabetes prevalence among the three groups of workers (all P>0.05). After adjusting for potential confounding factors such as years of service, gender, smoking, pack-years of smoking, alcohol consumption, and body mass index, multiple linear regression analysis showed that the high-level noise exposure group had higher HbA1c level than the control group (P<0.05). Multivariable logistic regression analysis results showed that the high-level noise exposure group had higher risk of prediabetes compared with the control group (P<0.05). Conclusion Occupational noise exposure could be a risk factor for the increased HbA1c levels and prediabetes incidence among the occupational population. More attention should be paid to the effects of occupational noise exposure on the HbA1c level in occupational health surveillance.

Objective : To investigate the effects of glycated low density lipoprotein (Gly⁃LDL) on the growth of human umbilical vein endothelial cells (HUVECs) and the expression of toll like receptor 4 (TLR4) and hypoxia inducible factor⁃1α (HIF⁃1α), and to explore its possible mechanism . Methods : HUVECs were cultured in vitro and divided into control group, positive control group[50 mg/L normal low density lipoprotein(n⁃LDL)], low concentration, medium concentration and high concentration Gly⁃LDL(50, 75, 100 mg/L) groups . Respectively, the effects of different concentrations of Gly⁃LDL on survival rate of HUVECs were detected by CCK⁃8; The motility of HUVECs under different treatments were detected by wound healing assays; The level of inflammatory cytokine, such as tumor inducing factor⁃α(TNF⁃α), interleukin⁃6(IL⁃6), intercellular adhesion molecule⁃1(ICAM⁃1) and vascular cell adhesion molecule⁃1(VCAM⁃1) were detected by ELISA; The mRNA levels of TLR4, HIF⁃1α, TNF⁃α and IL⁃6 were detected by qRT⁃PCR; Protein expressions of TLR4, HIF⁃1α, TNF⁃α and IL⁃6 were detected by Western blot; Respectively, si⁃RNA of TLR4 and HIF⁃1α was used to intervene the effects of Gly⁃LDL on HUVECs . The experiment was divided into control group, model group (Gly⁃LDL 100 mg/L), si⁃TLR4 group (Gly⁃LDL 100 mg/L + si⁃TLR4), TLR4 unloading group( Gly⁃LDL 100 mg/L + si⁃NC1), si⁃HIF⁃1α group ( Gly⁃LDL 100 mg/L + si⁃HIF⁃1α) and HIF⁃1α unloading group ( Gly⁃LDL 100 mg/L + si⁃NC2) . Protein expressions of TLR4 and HIF⁃1α were detected by Western blot to verify the interaction between TLR4 and HIF⁃1α . Results: The survival rate and migration rate of HUVECs were inhibited in Gly⁃LDL(50 mg/L, 75 mg/L, 100 mg/L) group (P < 0. 01), the inflammatory cytokines, such as TNF⁃α, IL⁃6, ICAM⁃1,VCAM⁃1 increased by Gly⁃LDL function on HUVECs(P < 0. 001), and the mRNA and protein levels of TLR4, HIF⁃1α, TNF⁃α and IL⁃6 increased by Gly⁃LDL in a dose dependent manner. After TLR4 was knocked out, the proteins expression of TLR4 and HIF⁃1α were down⁃regulated compared with model group(P < 0. 05),but after HIF⁃1α was knockout, only the protein expression of HIF⁃1α was down⁃regulated compared with model group( P < 0. 01),while the protein expression of TLR4 was up⁃regulated under the influence of Gly⁃LDL. Conclusion Gly⁃LDL may inhibit the proliferation and migration of HUVECs by up⁃regulating TLR4/HIF⁃1α inflammatory signaling pathway, and promote the expression of inflamma⁃tory cytokines, leading to vascular endothelial injury .

【Objective】 To analyze the root causes of adverse events to insufficient plasma transfusion, so as to explore improvement measures, optimize the transfusion strategy and avoid such adverse events. 【Methods】 The root causes of insufficient plasma transfusion were analyzed by health care failure mode and effect analysis, the targeted improvement measures were formulated and the effect was evaluated. 【Results】 After the improvement, the incidence of adverse events to insufficient plasma transfusion decreased significantly.The risk priority value affecting the safety of blood transfusion decreased from 70 to 8, and the proportion of coagulation function test after blood transfusion increased from 44.61%(1 309/2 934)in 2012 to 80.55% (2 187/2 715)in 2019, and plasma transfusion volume per capital increased from 300 mL to 528 mL. PT and APTT values after plasma transfusion in 2019 significantly increased compared with those in 2012. Meanwhile, the proportion of plasma transfusion in hospitalized patients decreased from 3.16% (2 934/92 838)to 2.12%(2 715/128 352). 【Conclusion】 Risk management of quality and safety of blood transfusion by combing healthcare failure mode, effect analysis and root cause analysis(RCA) can improve the risk awareness of clinical blood transfusion, optimize the proportion of plasma transfusion, and is essential to ensure the safety and effectiveness of blood transfusion and improve the prognosis of transfused patients.