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.

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.

Objective To investigate the prevalence of Schistosoma japonicum infections in wild rodents in schistosomiasis-endemic areas of China, so as to provide insights into formulation of technical guidelines for monitoring of and the precise control strategy for S. japonicum infections in wild rodents during the elimination phase. Methods Two administrative villages where schistosomiasis was historically highly prevalent were selected each from Dongzhi County, Anhui Province, and Duchang County, Jiangxi Province as study villages. Wild rodents were captured from study villages with baited traps or cages at night in June and September, 2021. The number of rodents captured was recorded, and the rodent species was characterized based on morphologi-cal characteristics. Liver tissues were sampled from captured rodents for macroscopical observation of the presence of egg granu- lomas, and S. japonicum infection was detected simultaneously using liver tissue homogenate microscopy, examinations of mesenteric tissues for parasites, and modified Kato-Katz thick smear technique (Kato-Katz technique). A positive S. japonicum infection was defined as detection of S. japonicum eggs or adult worms by any of these methods. The rate of wild rodent capture and prevalence of S. japonicum infections in wild rodents were compared in different study villages and at different time periods, and the detection of S. japonicum infections in wild rodents was compared by different assays. Results The overall rate of wild ro- dent capture was 8.28% (237/2 861) in Dongzhi County, and the wild rodent capture rates were 9.24% (133/1 439) and 7.31% (104/1 422) in two study villages (χ² = 3.503, P = 0.061), and were 8.59% (121/1 409) and 7.99% (116/1 452) in June and September, 2021, respectively (χ² = 0.337, P = 0.561). The overall rate of wild rodent capture was 3.72% (77/2 072) in Duchang County, and the wild rodent capture rates were 6.91% (67/970) and 0.91% (10/1 102) in two study villages (χ² = 51.901, P < 0.001), and were 4.13% (39/945) and 3.37% (38/1 127) in June and September, 2021, respectively (χ² = 0.815, P = 0.365). Rattus norvegicus was the predominant rodent species captured in both counties, accounting for 70.04% (166/237) of all captured wild rodents in Dongzhi County and 88.31% (68/77) in Duchang County. No S. japonicum infection was detected in wild rodents captured in Duchang County. Nevertheless, the overall prevalence of S. japonicum infections was 51.05% (121/237) in wild rodents captured in Dongzhi County, with prevalence rates of 50.38% (67/133) and 51.92% (54/104) in two study villages (χ² = 0.098, P = 0.755), and 54.31% (63/116) and 47.93% (58/121) in September and June, 2021, respectively (χ² = 0.964, P = 0.326). Of 237 wild rodents captured in Dongzhi County, there were 140 (59.07%) rodents with visible hepatic egg granulomas, 117 (49.47%) tested positive for S. japonicum eggs by liver tissue homogenate microscopy, 34 (14.35%) tested positive for S. japonicum eggs with Kato-Katz technique; however, no adult S. japonicum worms were detected in mesenteric tissues. In addition, hepatic egg granulomas were found in all wild rodents tested positive for S. japonicum eggs with liver tissue homogenate microscopy. Conclusions The rate of wild rodent capture and prevalence of S. japonicum infection in wild rodents vary greatly in schistosomiasis-endemic areas of China, and the prevalence of S. japonicum infection is slightly higher in wild rodents captured in autumn than in summer. Liver tissue is recommended as the preferred sample for surveillance of S. japonicum infection in wild rodents, and a combination of macroscopical observation of hepatic egg granulomas and liver tissue homogenate microscopy may be a standard method for surveillance of S. japonicum infection in wild rodents.

Objective To explore the perioperative trend of heart rate variability(HRV)in patients undergoing aortic valve replacement(AVR)under cardiopulmonary bypass and investigate the influence of age and/or postoperative atrial fibrillation(POAF)on this trend.Methods Baseline and clinical data of 134 patients undergoing AVR due to aortic valve disease in Department of Car-diovascular Surgery of Northern Theater General Hospital of PLA from January 2021 to January 2023 were collected and retrospectively studied.According to the age and/or POAF,they were divided into group A(aged＜60 years,no POAF,49 cases),group B(aged＜60 years,complicated with POAF,21 cases),group C(aged≥60 years,no POAF,30 cases)and group D(aged≥60 years,with POAF,34 cases).The dynamic electrocardiogram indicators were collected in 7 d be-fore and 7 d after operation.The changes in perioperative HRV were also observed.Results After operation,the standard deviation of sinus heart beat RR intervals,average of the standard devia-tions of NN intervals for each 5 min segment of a 24 h HRV recording(SDNNidx),root mean square of successive RR interval differences,and percentage of successive RR intervals that differ by more than 50 ms were significantly lower than those in 7 d before operation[61.172±17.449 ms vs 804.567±230.518 ms,20.284±9.432 ms vs 42.933±12.876 ms,1.307±0.196 ms vs 1.412±0.148 ms,3.00(1.30,7.23)ms vs 5.30(3.00,10.40)ms,P＜0.01].The group D had obvi-ously lower SDNNidx than the group A in 7 d after surgery(42.568±14.749 ms vs 46.467±11.754 ms,P＜0.05).Conclusion Autonomic dysfunction is observed in the early stage after AVR.For the patients aged≥60 years with POAF,the HRV indicators are significantly decreased,the dys-function of the vagus nerve is aggravated,and the disorder is exacerbated because of their syner-gistic effect.

BACKGROUND:Currently,the main purpose of surgical treatment for lumbar compression fractures is to improve symptoms,reduce pain,improve quality of life,minimize surgical risks,and reduce surgical exposure time.OBJECTIVE:To explore the safety and clinical efficacy of percutaneous vertebroplasty via Kambin's triangle in the treatment of senile spinal deformity accompanied by osteoporotic vertebral compression fractures.METHODS:A retrospective analysis was conducted on 31 patients with spinal deformity and osteoporotic vertebral compression fractures who were admitted to Tianjin Union Medical Center from January 2019 to December 2022.There were 21 males and 10 females,aged between 60 and 84(70.0±10.3)years old.The duration of illness ranged from 1 to 6(3.5±1.7)weeks.A total of 35 vertebral segments were affected.The distribution of vertebral compression fractures included:10 cases of L1 fracture,12 cases of L2 fracture,2 cases of L1+L2 fracture,5 cases of L3 fracture,and 2 cases of L1+L3 fracture.Based on the surgical approach,patients were divided into two groups:group A(via Kambin's triangle approach)with 15 cases,and group B(via traditional pedicle puncture)with 16 cases.Unilateral approach vertebroplasty was performed on both groups.The surgical duration,number of radiation exposures,presence of bone cement leakage,occurrence of complications such as nerve and vascular injuries were recorded in both groups.Postoperative CT scans were used to observe the dispersion and hardening of bone cement.RESULTS AND CONCLUSION:(1)In the group A,the surgical duration was 21-30 minutes per vertebra,with an average of(25.0±5.7)minutes.In the group B,the surgical duration was 25-43 minutes per vertebra,with an average of(33.0±7.2)minutes.The surgical duration for puncturing a single vertebra was significantly longer in the group B compared to the group A,with a statistically significant difference(P＜0.05).(2)The average number of radiation exposures per vertebra during surgery was(6.2±1.6)in the group A and(9.3±1.8)in the group B,with a statistically significant difference between the two groups(P＜0.05).(3)In the group A,no bone cement leakage was found.In group B,2 cases had bone cement leakage,and 1 case had bone cement entering the spinal canal,but no obvious neurological symptoms were observed.The leakage rate was 13％.Both groups had 1 case of subcutaneous hematoma.(4)Postoperative CT scans for observing the distribution of bone cement in the vertebral body showed that the rates of uniform dispersion of bone cement within the vertebrae were 71％and 33％in the groups A and B,respectively,with a statistically significant difference between the two groups(P＜0.05).(5)It is suggested that percutaneous vertebroplasty via Kambin's triangle approach offers advantages such as shorter surgical duration,better dispersion and filling of bone cement within the vertebrae,lower risk of complications,reduced radiation exposure,and satisfactory results with unilateral puncture.

Idiopathic pulmonary fibrosis(IPF)is a fatal interstitial lung disease characterized by progressive scarring of the lung parenchyma,often result ing in death from respiratory failure in its terminal stages,with a median survival of only 3 to 5 years.Experimental models are essential tools for investigating the pathogenesis of IPF,screening potential drugs,and evaluating therapeutic efficacy.In addition to animal and cell models,the recent development of precision medicine and multi-omics technologies has increased attention on the need to establish models that integrate traditional Chinese medicine(TCM)syndromes with disease patterns,as well as emerging organoid models.IPF experimental models have evolved from simulating a single pathological aspect to multidimensional models that integrate genetic heterogeneity,microenvironment interactions,and the TCM pathophysiological mechanisms of"phlegm,stasis,deficiency,and collateral damage".This systematic review considers the strategies used to construct IPF experimental models,the detection indicators,TCM syndrome research,and evaluation systems,with the aim of providing a reference for IPF-related research.

Plant-derived bioactive peptides have become a research hotspot in the fields of food and medicine due to their high source safety,easy absorption and utilization by the human body,and potential edible and medicinal value.Bioactive peptides can be classified into antihypertensive,hypoglycemic,hypolipidemic,anticancer,antioxidant,antimicrobial,and anti-inflammatory peptides according to their functions.Among these,antihypertensive,hypoglycemic,and hypolipidemic peptides are collectively referred to as cardiovascular active peptides,which can be used for the treatment and prevention of cardiovascular diseases and have an important role in the development of modem biomedicine.This review focused on the preparation methods,separation,purification,and identification techniques of bioactive peptides,as well as their mechanisms of action and applications in regulating cardiovascular diseases,aiming to provide a reference for further development and application of plant-derived cardiovascular peptides.

Objective:To assess the association between temperature and risk of animal injury, and identifying vulnerable populations.Methods:Based on a time-stratified case-crossover design, the number of animal injuries monitored in hospitals of Guangdong Provincial Injury Surveillance System in 2011 and 2015-2016 was included, and the daily meteorological data were derived from the fifth generation of European ReAnalysis-Land, which was produced by the European Centre for Medium-Range Weather Forecasts. Conditional logistic regression combined with a distributed lagged nonlinear model was applied to analyze the association of temperature and animal-specific injuries. We also conducted stratified analysis by region, sex, age, occupation, and location of injury occurrence.Results:There was an almost linear relationship between temperature and the occurrence of animal injury. The excess risk ( ER) of animal injury was 2.65% (95% CI: 2.27%-3.04%) for a 1 ℃ rise in temperature with much higher risk of occurrence ( ER=9.34%, 95% CI: 7.57%-11.13%) for non-mammalian injury than that for mammalian injuries ( ER=2.30%, 95% CI: 1.90%-2.70%). Stratified analysis revealed that the occurrence of animal injury was more susceptible to temperature influences in urban ( ER=2.78%, 95% CI: 2.35%-3.21%), female ( ER=2.71%, 95% CI: 2.16%-3.27%), the elderly aged 60 years and above ( ER=3.05%, 95% CI: 1.65%- 4.47%), farmer ( ER=4.66%, 95% CI: 3.03%-6.32%) and agricultural area ( ER=10.63%, 95% CI: 7.57%-13.79%) than their correspondents. In terms of mammalian injury, dog bites showed the highest risk ( ER=2.71%, 95% CI: 2.12%-3.30%). In terms of non-mammalian,snake injuries were highly influenced by temperature ( ER=16.74%, 95% CI: 11.33%-22.40%). Conclusions:The ambient temperature rises could increase the risk of animal injury with much higher risk for non-mammalian than that for mammalian injuries. Our findings suggest that global warming may increase the risk and disease burden from animal injuries.

Objective:To explore the associations of temperature, relative humidity, and their interaction effect with fall risk.Methods:Data on fall cases were collected using the national injury surveillance system from May to September, in 2006-2022 in Hubei Province. Combined with the meteorological and air pollution data, we conducted a time-stratified case-crossover design and used conditional logistic regression models and distributed lag nonlinear models to examine the exposure-response relationships between temperature, humidity, and fall risk. We further divided the low and the high temperature groups and the low and the high relative humidity groups and analyzed the excess risk ( ER) of falls attributed to dry-hot or wet-hot events. Finally, we calculated the additive interactions of temperature and humidity on fall risk. Results:A total of 55 401 fall cases were included. With the increase in temperature and relative humidity decrease, the exposure-response curves of fall showed nonlinear upward trends among all populations. Gender and age differences were found in temperature-fall and relative humidity-fall risk relationships. Compared with wet-non-hot (normal temperature and high relative humidity) events, the ER of fall in dry-hot (high temperature and low relative humidity) events was 14.80% (95% CI: 9.69%- 20.15%), and the ER of wet-hot (high temperature and high relative humidity) events was 9.59% (95% CI: 2.52%-17.13%). However, there was no statistically significant difference between dry-hot and wet-hot events in the fall, and no statistically significant difference between different genders, ages, occupations, and fall occurred place (all P>0.05). No significant synergistic additive interaction was found between temperature and relative humidity on fall risk (relative excess risk due to interaction=-0.08, 95% CI: -0.19-0.02). Conclusions:Higher temperatures and lower relative humidity were associated with increased fall risk. Both dry-hot and wet-hot events had a higher risk of fall, while high temperature and low humidity have no synergistic effect on fall risk.

Objective:To test the difficulty, discrimination, and reliability of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire.Methods:Two researchers independently translated the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire and cross-checked it to form a Chinese version of the questionnaire. The Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire consists of 24 items, with correct answers scoring one point and incorrect answers scoring zero points, with a total score of 24 points. Convenience sampling was used to select ICU nurses from 14 GradeⅢ Class A hospitals in five provinces/autonomous regions and two municipalities in China for the survey between April and July 2023. The difficulty index, discrimination index, and Cronbach's α coefficient of the questionnaire were analyzed.Results:A total of 1 121 questionnaires were distributed, with 1 020 valid responses, yielding a valid response rate of 90.99%. The mean score of the 1 020 ICU nurses on the Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire was (16.10±5.58) , with a minimum score of 4.00 and a maximum score of 24.00. The Cronbach's α coefficient of the Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire was 0.91. The questionnaire's overall difficulty and discrimination indexes were 0.67 and 0.59, respectively.Conclusions:The Chinese version of the ICU Nurse Pressure Injury Prevention and Care Knowledge Questionnaire has appropriate difficulty, moderate discrimination, and strong reliability, making it a valuable tool for assessing ICU nurses' knowledge of pressure injury-related topics.