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.

This article reports a rare case of autoinflammatory disease presenting initially with skin induration and swelling after trauma as the initial manifestation, followed by progressive limb weakness. The patient was a middle-aged female who developed skin induration and swelling after trauma, which gradually progressed to limb weakness, dysarthria and bilateral facial paralysis, accompanied by livedo reticularis of the lower extremities, diffuse skin induration of the limbs, and beaded subcutaneous nodules in the right upper limb. The patient had a susceptibility to infection since childhood and a history of chronic livedo reticularis. Skin pathological examination revealed panniculitis. A comprehensive etiological screening for special infections and autoimmune diseases was completed with an unremarkable results, and whole-exome sequencing showed no abnormal findings. Following a multidisciplinary discussion combined with RNA sequencing results, the patient was diagnosed with an autoinflammatory disease, with a suspected type Ⅰ interferonopathy. Treatment with tofacitinib resulted in gradual improvement of clinical symptoms. This case highlights the importance of detailed medical history collection, systematic physical examination and multidisciplinary collaborative diagnosis and treatment, and underscores the pivotal role of molecular diagnosis in the confirmation of rare diseases. It can provide a reference for the clinical diagnosis and management of similar rare cases.

Objective To explore the independent risk factors for complicated coronary heart disease (CHD) in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and to construct a risk prediction model. Methods A retrospective study was performed to analyze the clinical data of 308 OSAHS patients who visited Jiangsu Provincial People's Hospital from January 2021 to June 2025. The patients were divided into the CHD group (n=80) and non-CHD group (n=228) according to the presence or absence of complicated CHD. Independent risk factors were identified using univariate analysis and multivariate logistic regression, and a nomogram prediction model was constructed. The model was evaluated using the calibration curve, Hosmer-Lemeshow test, Decision Curve Analysis (DCA) curve, and Receiver Operating Characteristic (ROC) curve. Results The incidence of CHD in OSAHS patients was 25.97%. Age, history of hypertension, oxygen desaturation index (ODI), severe polysomnography (PSG) grade, decreased high-density lipoprotein cholesterol, elevated homocysteine, and elevated troponin I were independent risk factors for OSAHS complicated with CHD (P<0.05). The nomogram model demonstrated good calibration (Hosmer-Lemeshow test, P=0.995), and the DCA curve showed high clinical net benefit. The area under the ROC curve was 0.940 (95% CI: 0.908~0.972), with a sensitivity of 0.842 and a specificity of 0.900. Conclusion Age, history of hypertension, ODI, PSG grade, high-density lipoprotein cholesterol, homocysteine, and troponin I are independent risk factors for CHD in OSAHS patients. The prediction model constructed based on these factors can provide a reliable tool for clinical nurses to early identify high-risk individuals and formulate targeted intervention strategies.

Background Previous studies have focused on the respiratory system and skin damage caused by refractory ceramic fibers (RCFs). However, investigations into cardiovascular health of workers exposed to RCFs are insufficient. There is limited research on the association between occupational RCFs exposure and abnormal blood pressure, as well as the potential underlying mechanisms. Objective To explore the association between occupational exposure to RCFs and abnormal blood pressure, and to analyze the role of serum 8-hydroxy-2’-deoxyguanosine (8-OHdG) in this relationship, providing a reference for comprehensive health protection strategies for RCFs-exposed workers. Methods Using a cluster sampling method, 311 workers engaged in the production and processing of RCFs at a large RCFs enterprise were selected as the study population. A questionnaire survey was conducted to collect demographic information and other relevant data. The workers’ total dust, respirable fiber, and noise exposure levels were measured. Blood pressure was measured during occupational health examinations, and blood samples were collected. Based on blood pressure levels, the participants were divided into three groups: normotension, prehypertension, and hypertension. Serum 8-OHdG concentrations were determined by enzyme-linked immunosorbent assay (ELISA). Ordinal logistic regression and multiple linear regression models were applied to evaluate the associations of exposures to noise and RCFs with abnormal blood pressure and serum 8-OHdG levels. The mediating effect of serum 8-OHdG on the relationship between occupational RCFs exposure and abnormal blood pressure was analyzed using the PROCESS 4.1 macro. Results All 311 RCFs workers had varying levels of occupational exposure to RCFs, among whom 113 were also exposed to noise. The overall prevalences of prehypertension and hypertension among the participants were 49.84% and 11.25%, respectively. In the noise-exposed group, the prevalences of normotension, prehypertension, and hypertension were 44.2%, 43.4%, and 12.4%, respectively, which showed no statistically significant difference compared to the non-noise-exposed group (35.9%, 53.5%, and 10.6%, respectively; P=0.652). Significant differences were observed in the prevalences of normotension, prehypertension, and hypertension among workers with different levels of total dust exposure (P=0.033) and respirable fiber exposure (P=0.034). The differences in serum 8-OHdG concentrations across these groups were also statistically significant (P<0.05). Multiple regression analyses showed that both total dust exposure level (OR=1.83, 95%CI: 1.34, 2.51) and respirable fiber exposure level (OR=1.85, 95%CI: 1.31, 2.62) were positively associated with the detection of abnormal blood pressure. Furthermore, total dust exposure level (β=5.85, 95%CI: 0.53, 11.17) and respirable fiber exposure level (β=6.04, 95%CI: 0.14, 11.94) were positively associated with serum 8-OHdG concentrations. Further analysis indicated that the severity of abnormal blood pressure was positively associated with serum 8-OHdG concentrations (β=10.54, 95%CI: 3.62, 17.46). Mediation analysis demonstrated that serum 8-OHdG mediated the relationship between RCFs total dust exposure levels and the risk of abnormal blood pressure (P<0.05), accounting for 8.63% of the total effect. However, no mediating effect of serum 8-OHdG was observed in the association between RCFs respirable fiber exposure levels and the risk of abnormal blood pressure (P>0.05). Conclusion Occupational exposure to RCFs is closely associated with an increased risk of abnormal blood pressure and elevated serum 8-OHdG levels. Oxidative stress may play a mediating role in the relationship between RCF exposure and abnormal blood pressure.

Heart failure （HF） is the end stage of various cardiovascular diseases， manifested as ventricular filling or impaired left ventricular ejection fraction （LVEF）. Type 2 diabetes mellitus （T2DM） is a metabolic disorder， mainly caused by insufficient insulin secretion and insulin resistance. The incidence rates of the two common clinical diseases are increasing year by year. HF and T2DM are mutually causal chronic diseases， and their mutual deterioration can form a HF-T2DM comorbidity. The comorbidity status significantly increases the mortality and readmission risk of patients， and seriously affects the quality of life of patients. At present， western medicine treatment mainly involves the use of anti HF drugs and hypoglycemic drugs， which can significantly alleviate the clinical symptoms of patients. However， these two categories of drugs are numerous in variety and differ in their mechanisms， and blind combination may produce adverse reactions. With its unique theoretical system， traditional Chinese medicine exhibits the advantages of multiple components， multiple targets， and high safety through traditional Chinese medicine monomers， Chinese patent medicine， traditional Chinese medicine compounds， and acupuncture， which significantly delays the development of HF-T2DM and shows great potential in clinical treatment. A large number of clinical studies have shown that the integrated traditional Chinese and western medicine in the treatment of HF-T2DM has a significant effect in improving cardiac function， controlling blood glucose levels， and improving the quality of life of patients. Based on relevant research at home and abroad， this paper reviewed the HF-T2DM pathogenesis， pharmacological effects， research status of traditional Chinese and western medicine， and early prevention strategies， and discussed current problems and future research directions， in order to provide new ideas and useful references for clinical prevention and treatment of HF-T2DM.

Heart failure （HF） is the end stage of various cardiovascular diseases， manifested as ventricular filling or impaired left ventricular ejection fraction （LVEF）. Type 2 diabetes mellitus （T2DM） is a metabolic disorder， mainly caused by insufficient insulin secretion and insulin resistance. The incidence rates of the two common clinical diseases are increasing year by year. HF and T2DM are mutually causal chronic diseases， and their mutual deterioration can form a HF-T2DM comorbidity. The comorbidity status significantly increases the mortality and readmission risk of patients， and seriously affects the quality of life of patients. At present， western medicine treatment mainly involves the use of anti HF drugs and hypoglycemic drugs， which can significantly alleviate the clinical symptoms of patients. However， these two categories of drugs are numerous in variety and differ in their mechanisms， and blind combination may produce adverse reactions. With its unique theoretical system， traditional Chinese medicine exhibits the advantages of multiple components， multiple targets， and high safety through traditional Chinese medicine monomers， Chinese patent medicine， traditional Chinese medicine compounds， and acupuncture， which significantly delays the development of HF-T2DM and shows great potential in clinical treatment. A large number of clinical studies have shown that the integrated traditional Chinese and western medicine in the treatment of HF-T2DM has a significant effect in improving cardiac function， controlling blood glucose levels， and improving the quality of life of patients. Based on relevant research at home and abroad， this paper reviewed the HF-T2DM pathogenesis， pharmacological effects， research status of traditional Chinese and western medicine， and early prevention strategies， and discussed current problems and future research directions， in order to provide new ideas and useful references for clinical prevention and treatment of HF-T2DM.

The pathological changes of myocardial infarction （MI） are mainly characterized by progressive myocardial ischemic necrosis， decline in cardiac diastolic function， thinning of the ventricular wall， and enlargement of the ventricles. The clinical manifestations include myocardial ischemia， heart failure， arrhythmia， shock， and even sudden cardiac death， rendering MI one of the most perilous cardiovascular diseases. Currently， the clinical treatment for MI primarily involves interventional procedures and drug therapy. However， due to their significant side effects and high complication rates associated with these treatments， they fail to ensure a satisfactory quality of life and long-term prognosis for patients. On the other hand， traditional Chinese medicine has demonstrated remarkable potential in improving patient prognosis while reducing side effects. Research has elucidated that various signaling pathways such as nuclear transcription factor-κB （NF-κB）， adenosine 5̒-monophosphate-activated protein kinase （AMPK）， transforming growth factor-β （TGF-β）/Smads， mitogen-activated protein kinase （MAPK）， Wnt/β-catenin （β-catenin）， and phosphatidylinositol 3-kinase （PI3K）/protein kinase B（Akt） play crucial roles in regulating the occurrence and development of MI. Effectively modulating these signaling pathways through its therapeutic interventions， traditional Chinese medicine can enhance MI management by inhibiting apoptosis， providing anti-inflammatory properties， alleviating oxidative stress levels， and resisting myocardial ischemia. Due to its notable efficacy and favorable safety， it has become an area of focus in clinical practice.

Objective To explore the safety of Yttrium-90 resin microsphere selective internal radiation therapy (⁹⁰Y-SIRT) on malignant liver tumors. Methods A retrospective analysis was conducted on 64 patients with malignant liver tumors who underwent ⁹⁰Y-SIRT from February 2023 to November 2024 at Weifang People’s Hospital. The clinical characteristics of the patients and the occurrence of adverse reactions after treatment were analyzed to assess the safety of ⁹⁰Y-SIRT. Results Among the 64 patients, there were 52 males (81.25%) and 12 females (18.75%); the average age was (56.29±11.08) years. Seven patients (10.94%) had tumors with maximum diameter of less than 5 cm, 38 patients (59.38%) had tumors with maximum diameter of 5-10 cm, and 19 patients (29.68%) had tumors with maximum diameter of greater than 10 cm. There were 47 cases (73.44%) of solitary lesions and 17 cases (26.56%) of multiple lesions; 53 cases (82.81%) were primary liver cancers and 11 cases (17.19%) were metastatic liver cancers. Of the 64 patients, 63 successfully completed the Technetium-99m macroaggregated albumin (^99mTc-MAA) perfusion test and received the ⁹⁰Y-SIRT; one patient received ⁹⁰Y-SIRT after the second ^99mTc-MAA perfusion test due to a work error. The most common adverse reactions included grade 1 alanine aminotransferase (ALT) elevation in 26 cases (40.62%) and grade 2 in 2 cases (9.37%), grade 1 aspartate aminotransferase (AST) elevation in 27 cases (42.18%) and grade 2 in 7 cases (10.93%); grade 1 nausea in 17 cases (26.56%) and grade 2 in 6 cases (9.37%); grade 1 abdominal pain in 12 cases (18.75%), grade 2 in 5 cases (7.81%), and grade 3 in 1 case (1.56%); grade 1 vomiting in 11 cases (17.18%), grade 2 in 5 cases (7.81%), and grade 3 in 1 case (1.56%). Conclusion The adverse reactions of ⁹⁰Y-SIRT for treating malignant liver tumors are mild, indicating good safety.

Background Under the background of global warming, research on association between ambient temperature and risk of injury is needed. Objective To examine the effect of temperature on injury in Bao'an district, Shenzhen and identify the sensitive population, thereby providing a scientific basis for formulating prevention and control strategies and measures of injury. Methods The injury reports from the Injury Surveillance System and the meteorological data of Bao'an District between 2018 to 2022 were collected. The meteorological data were sourced from the fifth generation of the European Centre for Medium-Range Weather Forecasts (ECMWF) land reanalysis data. Based on time-stratified case-crossover design, conditional logistic regression combined with distributed lag nonlinear model was used to evaluate the exposure-response association between ambient temperature and injury. The stratified analyses were further conducted by gender, age, and causes of injury. Results A total of 156205 injury cases were collected from the injury surveillance sentinel hospitals in Bao'an District of Shenzhen from 2018 to 2022, and the median of daily average temperature during the same period was 20.0 ℃. The exposure-response curve showed that the risk of injury was positively correlated with temperature. The linearized analysis revealed that each 1°C increase in temperature was associated with a 1.05% (95%CI: 0.68%, 1.42%) rise in injury risk (ER). Notably, the effect was greater in females (ER=1.31%, 95%CI: 0.67%, 1.94%) than males (ER=0.92%, 95%CI: 0.47%, 1.37%). Among age groups, adults ＞60 years faced the highest risk (ER=1.91%, 95%CI: −0.36%, 4.24%). The top three temperature-associated injury risks were sharp instrument injuries (ER=2.19%, 95%CI: 1.16%, 3.22%), animal injuries (ER=1.71%, 95%CI: 0.86%, 2.56%), and blunt injuries (ER=071%, 95%CI: −0.08%, 1.51%). The impact of temperature on unintentional injuries (ER=1.11%, 95%CI: 0.72%, 1.49%) was higher than that on intentional injuries (ER=0.43%, 95%CI: −0.85%, 1.72%). Severe injuries (ER=2.20%, 95%CI: −3.09%, 7.77%) were more affected by temperature than mild injuries (ER=1.00%, 95%CI: 0.58%, 1.43%) and moderate injuries (ER=1.15%, 95%CI: 0.42%, 1.89%). Conclusion The increase in ambient temperature associates with injury occurrence, and the impact of temperature exhibits obvious heterogeneity among different populations, indicating that targeted intervention measures should be taken for different populations and types of injuries.

The rapid development of artificial intelligence （AI） technology provides new opportunities for the modernisation of traditional Chinese medicine （TCM） diagnosis. By analysing the foundation， research progress and difficulties of the combination of AI and TCM diagnosis， it is concluded that AI has made remarkable development in intelligence-driven modernization of TCM tongue diagnosis， pulse diagnosis， listening and smelling diagnosis and text processing， and there are useful explorations in the field of constructing data-driven TCM diagnostic model and multidisciplinary integration of TCM diagnostic models. However， the current integration of AI technology in TCM diagnosis still faces many challenges， such as the scarcity and uneven quality of clinical data， the limited ability of AI algorithms to express TCM thinking model of syndrome differentiation and empirical knowledge， and the possible existence of ethical and privacy issues. By systematically sorting out the current research status and development direction of AI-empowered TCM diagnostics， it is proposed to promote the application of AI technology in TCM diagnostics in four aspects， namely， strengthening the construction of TCM big data and talent cultivation， encouraging cross-disciplinary cooperation， improving the legal and ethical framework， and promoting the popularity of the technology in primary care， so as to enhance the modernisation of TCM diagnostics.