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.

ObjectiveTo investigate the therapeutic effect of Astragali Radix-mediated changes in gut microbiota on treating type 2 diabetes （T2DM）. MethodsA 12-week randomized， placebo-controlled clinical trial enrolled eighty patients with newly diagnosed type 2 diabetes and poor glycemic control in the Qi deficiency type. All patients received insulin therapy. The observation group （40 cases） was administered with Astragali Radix Granules， while the control group （40 cases） received a placebo. Both treamtents were taken orally twice daily. Changes in gut microbiota were assessed by 16s rDNA sequencing. Serum glucagon-like peptide-1 （GLP-1） levels were measured using enzyme-linked immunosorbent assay （ELISA）. Glucose metabolism indicators including fasting blood glucose （FPG）， 2-hour postprandial blood glucose （2 h PG），glycated albumin（GA）， and glycated hemoglobin （HbA1c） were evaluated. Pancreatic function was evaluated using fasting C-peptide （FCP）， 2-hour postprandial C-peptide （2 h CP）， and C-peptide area under the curve （AUC_cp）. Traditional Chinese medicine （TCM） syndrome scores， clinical efficacy， and safety indicators were also observed. ResultsIn terms of glucose metabolism indicators， compared with the baseline， both groups exhibited significantly lower FPG， 2 h PG， GA and HbA1C （P<0.01），while FCP， 2 h CP and AUC_cp were significantly higher （P<0.01）. Compared with the control group after the treatment， the observation group showed significantly lower FPG， 2 h PG， GA and HbA1C（P<0.05， P<0.01），and significantly higher FCP， 2 h CP and AUC_cp （P<0.05， P<0.01）， indicating that Astragali Radix can improve glucose metabolism. In terms of the diversity of gut microbiota， no significant differences were detected in the Chao1， Shannon and Simpson indexes of the two groups compared with their respective baselines. However， compared with the post-treatment control group， the observation group demonstrated significant increases in the Chao1， Shannon and Simpson indexes （P<0.05， P<0.01）. The β-diversity analysis showed significant separation in gut microbiota composition before and after treatment in both groups， indicating that Astragali Radix can significantly alter the structure and improve the diversity of gut microbiota. At the phylum level， compared with the baseline， both groups showed a significant increase in the relative abundance of Bacteroidota（P<0.01）. The relative abundance of the potentially harmful phylum Proteobacteria was significantly lower in the observation Group after treatment （P<0.01）. Compared with the post-treatment control group， the observation group had a significantly higher relative abundance of Bacteroidota（P<0.01）. No significant difference was found in Firmicutes/Bacteroidota （F/B） ratio between the two groups after treatment， and other phyla showed no significant differences. At the genus level， compared with the baseline， the observation group exhibited a significant increase in Bacteroides （P<0.01） and a significant decrease in Escherichia-Shigella （P<0.01）， whereas no significant difference was seen in the control group . Compared with the control group after treatment， the observation group after treatment had a significantly higher relative abundance of Bacteroides （P<0.01）. No significant differences were seen in other genera. Linear discriminant analysis （LDA） identified potential characteristics taxa： in the observation group， Bacteroidota at the phylum level and Bacteroides and Dubosiella at the genus level， in the control group， Proteobacteria at the phylum level as well as Barnesiella and Staphylococcus at the genus level. Correlation analysis based on a heatmap revealed that GLP-1 levels were positively correlated with Firmicutes， F/B ratio and Fusobacterium， and negatively correlated with Bacteroidota， Proteobacteria， Bacteroides and Escherichia-Shigella. In terms of clinical efficacy， compared with the control group， the total effective rate of the observation group was significantly higher （P<0.05）. Compared with the baseline， the scores for shortness of breath， fatigue， weakness， spontaneous sweating and reluctance to speak significantly decreased in both groups （P<0.01）. Compared with the control group after treatment， the score for weakness was significantly lower in the observation group （P<0.01），indicating that Astragali Radix could improve clinical symptoms and alleviate weakness symptoms. In terms of safety， compared with the baseline， alanine aminotransferase （ALT） levels significantly decreased in both groups （P<0.05，P<0.01），indicating that Astragali Radix did not induce any significant abnormalities in liver and kidney functions. ConclusionAstragali Radix demonstrates the potential to significantly improve the gut microbiota environment in patients of newly diagnosed type 2 diabetes with Qi deficiency. The therapeutic effect may contribute to glycemic control， possibly mediated by an elevation in GLP-1 level. These findings may support its further clinical investigations and potential applications.

Background Lung cancer, one of the most common malignant tumors worldwide, has long ranked first in cancer incidence and mortality, posing a severe challenge to public health systems. Objective To analyze the trends in incidence, mortality, and disability-adjusted life years (DALYs) of lung cancer among residents in Jing'an District, Shanghai, from 2002 to 2021, explore the impacts of population aging, population growth, and age-specific prevalence on disease burden, and provide a scientific basis for optimizing regional lung cancer prevention and control strategies. Methods Based on the cancer registration and cause-of-death surveillance data of registered residents in Jing'an District, Shanghai, from 2002 to 2021, Joinpoint regression models were used to analyze the annual change trends (APC) and average annual change trends (AAPC) of lung cancer incidence, mortality, DALY rate, and their age-standardized rates. Decomposition analysis was applied to quantify the contribution of population aging, population growth, and age-specific prevalence to changes in the number of new cases, deaths, and DALYs. Results From 2002 to 2021, the crude incidence rate of lung cancer in Jing'an District increased from 68.00 per 100000 to 144.36 per 100000 (AAPC=4.86%, P<0.001), and the age-standardized incidence rate rose from 43.09 per 100000 to 61.46 per 100000 (AAPC=2.89%, P<0.001). The growth rate of incidence was significantly higher in females (AAPC=6.73%) than in males (AAPC=3.62%). The crude mortality rate increased from 58.08 per 100000 to 66.11 per 100000 (AAPC=1.10%, P<0.001), while the age-standardized mortality rate decreased (AAPC=−1.54%, P<0.001). The crude DALY rate showed an upward trend (AAPC=0.94%, P=0.002), whereas the age-standardized DALY rate declined (AAPC=−1.63%, P<0.001). Significant differences were observed across genders and age groups: the mortality and DALY rates increased in males aged 60-64 years, while the fastest incidence growth occurred in females aged 45-64 years. The results of decomposition analysis indicated that the increase in new cases was primarily attributed to age-specific incidence (38.15%) and aging (37.31%); the growth in deaths and DALYs was driven by aging, while age-specific mortality and population growth showed offsetting effects. From 2002 to 2021, the probability of premature death from lung cancer among males (2.04%-2.52%) in Jing'an District showed no statistically significant trend (AAPC=−0.28%, P=0.440), while it presented a decreasing trend in the total population (1.37%-1.89%) and females (0.72%-1.26%) (AAPC=−0.80% and −2.23%, respectively; P=0.029 and <0.001, respectively). Conclusion From 2002 to 2021, the risk of lung cancer incidence in Jing’an District, Shanghai, continue to increase, with a disease burden exhibiting significant heterogeneity by gender and age: key features include a rapid increase in new cases and a trend toward younger onset among females, alongside rising mortality risk among males aged 60–64 years. Population aging and increasing age-specific incidence rates are primary drivers of the growing number of cases, while declining age-specific mortality rates mitigate the rise in mortality burden.

Objective To explore the risk factors for futile recanalization after mechanical throm-bectomy for acute large vessel occlusion(LVO)in elderly patients with atrial fibrillation(AF),and construct a prediction model.Methods A total of 146 elderly AF patients who undergoing mechanical thrombectomy due to LVO and achieved successful recanalization(modified thromb-olysis in cerebral infarction,mTICI≥2b)in our hospital from January 2018 to July 2023 were consecutively recruited in this retrospective analysis.According to the 90-day clinical outcome,they were divided into a futile recanalization group(79 cases)and an effective recanalization group(67 cases).The general clinical data were compared between the two groups.Multivariate logistic regression analysis was performed to identify the risk factors for futile recanalization,and based the factors,a nomogram for the prediction was drawn.ROC curve and calibration curve analyses were applied to evaluate the reliability of the prediction model,and decision curve analysis was conducted to assess the clinical application value.Results Multivariate logistic regression analysis identified that baseline blood glucose,NT-proBNP,internal carotid artery occlusion,and thrombec-tomy≥3 attempts were independent risk factors for futile recanalization(OR=1.395,95％CI:1.174-1.658,P=0.000;OR=1.001,95％CI:1.000-1.001,P=0.003;OR=8.024,95％CI:2.554-25.204,P=0.000;OR=5.056,95％CI:1.778-14.375,P=0.002).The AUC value of the prediction model was 0.868(95％CI:0.808-0.929).Calibration curve analysis showed that the model obtained consistent predicted probability with actual probability,and decision curve analy-sis indicated that the model had good clinical benefit.Conclusion Baseline blood glucose,NT-proBNP,internal carotid artery occlusion,and thrombectomy≥3 attempts are independent risk factors for futile recanalization after mechanical thrombectomy in elderly AF patients.Our prediction model has good predictive performance and prediction accuracy,but its application still needs prospective research and external verification.

Objective:To explore the effectiveness of staged pain nursing based on Snyder's hope theory in patients with leukemia.Methods:From January 2023 to December 2024, 124 leukemia patients admitted to Shanxi Provincial People's Hospital were selected as study subjects using convenience sampling. Using a random number table method, subjects were divided into a control group and an observation group, with 62 cases in each group. Control group received routine nursing, while observation group received staged pain nursing based on Snyder's hope theory in addition to routine nursing. Negative emotions, hope levels, and coping styles were compared between the two groups of patients before and after intervention.Results:After intervention, both groups of patients had lower scores on the Hamilton Anxiety Scale, Hamilton Depression Scale, and the avoidance and resignation dimensions of the Medical Coping Modes Questionnaire compared to before intervention, and observation group had lower scores than control group, with statistically significant differences ( P<0.05). After intervention, the Chinese version of the Herth Hope Scale scores and the confrontation dimension scores of the Medical Coping Modes Questionnaire for both groups of patients were higher than before intervention, and observation group had higher scores than control group, with statistically significant differences ( P<0.05) . Conclusions:Staged pain nursing based on Snyder's hope theory effectively improves negative emotions and coping styles of leukemia patients, and increases their levels of hope, demonstrating favorable application effects.

Objective To compare the effects of quadratus lumborum block at the lateral supra-arcuate ligament(QLB-LSAL)versus subcostal transversus abdominis plane block(STAPB)on perioperative analgesia and postoperative inflammation in patients undergoing laparoscopic radical resection of colorectal cancer.Methods In this prospective randomized study,we recruited 102 patients undergoing laparoscopic colorectal cancer surgery between October 2022 and October 2024 under general anesthesia and randomly assigned them to two groups:QLB-LSAL(Group Q,n=51)and STAPB(Group S,n=51).Mean arterial pressure(MAP)and heart rate(HR)were recorded before anesthesia induction(T0),before surgical incision(T1),start of surgery(T2),during pneumoperitoneum establishment(T3),during peritoneal lavage(T4),at the end of surgery(T5),and upon leaving the operating room(T6).Intraoperative remifentanil consumption,time to first patient-controlled analgesia demand,and frequency of effective compression and rescue analgesia were recorded.Visual Analog Scale(VAS)scores at rest and during coughing were assessed at 24,48,and 72 hours postoperatively.Interleukin-6(IL-6)and systemic immune-inflammatory index(SII)at 1 day preoperatively,1,and 3 days postoperatively were recorded.Postoperative recovery indicators and adverse events were also recorded.Results Group Q demonstrated significantly lower MAP and HR compared with Group S from T3 to T6(P<0.05).Group Q had significantly lower intraoperative remifentanil consumption,significantly longer time to first analgesic pump demand,fewer effective pump compres-sion,and lower frequency for rescue analgesia requests(all P<0.05).VAS scores at rest and during coughing in Group Q were significantly lower at 24 h and 48 h postoperatively(P<0.05).As compared with preoperative levels,both IL-6 and SII increased at 1 and 3 days postoperatively,but magnitude of increase in Group Q was smaller than in Group S(P<0.05).In comparison to Group S,Group Q demonstrated significantly earlier ambulation,shorter hospital stay,and fewer adverse events(P<0.05).Conclusion QLB-LSAL is superior to STAPB in enhancing perioperative analgesia,attenuating inflammatory response,and accelerating postoperative rehabilitation in patients undergoing laparoscopic colorectal cancer resection.

Objective:To establish a rapid and precise dose measurement method with EBT4 film and ensure its measurement accuracy to be within the required range through strict operational procedures for the purpose of addressing the two essential issues of poor measurement accuracy and timeliness of EBT film under FLASH conditions.Methods:After storing under different humidity conditions for a certain period of time, the film was exposed to radiation for analyzing the influence of air humidity on the intrinsic performance of EBT film. By means of repeated scanning operations and the film angle rotation, the influences of repeated scanning and film placement angle were analuzed. Parabolic correction method was used to reduce the spatial position influence during the scanning process. By analying the relationship between net optical density (netOD) and absorbed dose through the comparison of three fitting method, the optimal fitting curve was selected. After irradiation of the same batch of films for 5 min and 24 h, the film doses were calibrated and then compared with ionization chamber-measured result. The rapid and precise film dosimetry method was used to measure both the percentage depth dose from X-rays at ultra-high dose rate and the dose distribution at a depth of 2 cm in water.Results:Air humidity had the greatest influence on the intrinsic performance of EBT film (approximately 20%). The average deviation of repeated scans is within 0.5%. The angle at which the film is placed significantly affected the readouts of the film with the maximum influence approximately 70%. The net optical density combined with polynomial fitting can control the fitting residuals of 1-16 Gy within 3%. The change rate of light channels at 5 min already mostly met the requirements of the rapid mode (< 0.5%). Compared with the measurement result obtained using the reference ionization chamber, the deviations of the 5 min or 24 h dose calibration curves were all within 2%.Conclusions:The EBT4 film can be employed as a precise dosimeter to quickly measure the FLASH radiation dose. Rapid and precise FLASH dose measurements can meet the stringent requirements of both preclinical and clinical FLASH research.

Objective To explore the risk factors for futile recanalization after mechanical throm-bectomy for acute large vessel occlusion(LVO)in elderly patients with atrial fibrillation(AF),and construct a prediction model.Methods A total of 146 elderly AF patients who undergoing mechanical thrombectomy due to LVO and achieved successful recanalization(modified thromb-olysis in cerebral infarction,mTICI≥2b)in our hospital from January 2018 to July 2023 were consecutively recruited in this retrospective analysis.According to the 90-day clinical outcome,they were divided into a futile recanalization group(79 cases)and an effective recanalization group(67 cases).The general clinical data were compared between the two groups.Multivariate logistic regression analysis was performed to identify the risk factors for futile recanalization,and based the factors,a nomogram for the prediction was drawn.ROC curve and calibration curve analyses were applied to evaluate the reliability of the prediction model,and decision curve analysis was conducted to assess the clinical application value.Results Multivariate logistic regression analysis identified that baseline blood glucose,NT-proBNP,internal carotid artery occlusion,and thrombec-tomy≥3 attempts were independent risk factors for futile recanalization(OR=1.395,95％CI:1.174-1.658,P=0.000;OR=1.001,95％CI:1.000-1.001,P=0.003;OR=8.024,95％CI:2.554-25.204,P=0.000;OR=5.056,95％CI:1.778-14.375,P=0.002).The AUC value of the prediction model was 0.868(95％CI:0.808-0.929).Calibration curve analysis showed that the model obtained consistent predicted probability with actual probability,and decision curve analy-sis indicated that the model had good clinical benefit.Conclusion Baseline blood glucose,NT-proBNP,internal carotid artery occlusion,and thrombectomy≥3 attempts are independent risk factors for futile recanalization after mechanical thrombectomy in elderly AF patients.Our prediction model has good predictive performance and prediction accuracy,but its application still needs prospective research and external verification.

Stroke is a critical health issue in China, and carotid artery stenosis and plaque play key roles in its prevalence. Despite the acknowledged significance of this condition, detailed information regarding the prevalence of carotid artery stenosis and plaque across the Chinese population has been scarce. This study analyzed data from the China Stroke High-risk Population Screening and Intervention Program for 2020-2021, focusing on 194 878 Chinese adults aged 40 years and above. It assessed the prevalence of carotid artery stenosis and plaque and identified their associated risk factors. Results revealed a standardized prevalence of 0.40% for carotid artery stenosis and 36.27% for carotid plaque. Notably, the highest rates of stenosis were observed in north and south China at 0.61%, while southwestern China exhibited the highest plaque prevalence at 43.17%. Key risk factors included older age, male gender, hypertension, diabetes, stroke, smoking, and atrial fibrillation. This study highlights significant geographical and demographic disparities in the prevalence of these conditions, underlining the urgent need for targeted interventions and policy reforms. These measures are essential for reducing the incidence of stroke and improving patient outcomes, addressing this significant health challenge in China.
Humans ; China/epidemiology* ; Male ; Female ; Prevalence ; Middle Aged ; Carotid Stenosis/epidemiology* ; Risk Factors ; Aged ; Adult ; Plaque, Atherosclerotic/epidemiology* ; Stroke/epidemiology* ; Aged, 80 and over

Objective:To investigate the interaction of workplace noise, body mass index (BMI) and systemic inflammatory response on hypertension.Methods:In January 2019, 1124 male workers from an automobile factory in Wuhan were selected by cluster random sampling method. The study population was divided into normal body weight group (BMI<24 kg/m 2) and overweight group (BMI≥24 kg/m 2) according to BMI, and were followed up for 3 years. The occupational health examination of the workers was carried out every year, blood routine and blood biochemical indexes were collected, and the information of the workers' age, BMI, type of work and age of exposure to injury were collected through field questionnaires. The noise intensity of the workplace of the enterprise was measured for 3 consecutive years, and the equivalent sound level was calculated according to the working time. Normal and skewness measurements were described by Mean±SD and [ M ( Q1, Q3) ], respectively. t-test or Wilcoxon rank sum test was used for inter-group comparisons. Categorical variables were expressed by frequency and percentage (%), and Chi-square test was used for inter-group comparisons. Mixed effects models and generalized estimation equations were fitted to analyze the relationship between occupational noise, systemic inflammation, and their interaction terms with blood pressure and hypertension risk. Results:Univariate analysis revealed that the white blood cell counts, neutrophil counts, lymphocyte counts and eosinophil counts were positively associated with systolic blood pressure and diastolic blood pressure in overweight group ( n=467), respectively ( P<0.05). The participants with white blood cell counts≥5.94×10 9/L, neutrophil counts≥3.31×10 9/L, lymphocyte counts ≥2.03×10 9/L, and eosinophil counts ≥0.12×10 9/L had increased risk of hypertension by 52% ( RR=1.52, 95% CI: 1.11-2.05), 37% ( RR=1.37, 95% CI: 1.01-1.83), 58% ( RR=1.58, 95% CI: 1.18-2.09), and 52% ( RR=1.52, 95% CI: 1.12-2.06), respectively (all P<0.05). Multivariate analysis found a positive association between BMI and the risk of hypertension in the overweight group ( P<0.05), the participants with lymphocyte counts≥2.03×10 9/L and eosinophil counts≥0.12×10 9/L had increased risk of hypertension by 39% ( RR=1.39, 95% CI: 1.01-1.89) and 46% ( RR=1.46, 95% CI: 1.06-1.98), respectively (all P<0.05). There was no correlation between BMI and the risk of hypertension in normal weight group ( P>0.05). The multiplicative interaction of occupational noise (≥80 dB) with white blood cell counts (≥5.94×10 9/L) and lymphocyte counts (≥2.03×10 9/L) increased the risk of hypertension by 100% ( RR=2.00, 95% CI: 1.06-3.55) and 89% ( RR=1.89, 95% CI: 1.01-3.32) (all P<0.05) in overweight group, respectively. Additionally, a significant additive interaction was observed between noise exposure (≥80 dB) and basophil counts (≥0.03×10 9/L) on hypertension risk in the overweight group (RERI=0.49, 95% CI: 0.02-0.96, P<0.05) . Conclusion:The combined exposure of occupational noise and systemic inflammation may increase the risk of hypertension in overweight workers in automobile manufacturing plants, and the two have additive and multiplicative interactions.