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.

In order to investigate the related pathogens and reveal the etiological characteristics of gout in goslings,191 typical clinical cases from partial regions of China were examined by RT-PCR/PCR detection of viral nucleic acids in domestic poultry and pathological analysis.The autop-sy results show that the clinical cases could be classified into three types based on the severity of urate deposition:severe,moderate,and mild,namely systemic urate deposition,local urate deposi-tion mainly in the liver and kidneys,and only a small amount of fine-grained urate deposition in the liver,gallbladder,or glandular stomach.The results of RT-PCR/PCR detection showed that the to-tal positive rates were as follows:GAstV Group2 63.9％,GAstV Group1 50.3％,AAstV-2 38.7％,novel Muscovy duck parvovirus(NPV)17.8％,GPV 16.2％,GoCV 12.6％,MDPV 7.9％,MDRV 8.4％,DPV 0.5％,GPMV and NDV 0.5％,the AstV-1、ARV、TMUV、NDV、FAdV、GHPyV were zero.Among all the postive samples,the rates of single positive,double positive,and multiple posi-tive were 18.3％,27.2％,and 44.0％,respectively.The rate of single positive samples containing AAstV was only 12.0％,the double or multiple positive samples containing GAstV Group 1/2 was 60.7％,and the rate of samples without GAstV Group 1/2 was 10.5％.The results also showed that 20(10.5％)samples were negative for 16 types of viruses.The AAstV particles isolated from single positive samples appear spherical shape,non-enveloped and 20-80 nm minsize.Two types of virus particles which with spherical shape and diameters of 40-100 and 20-40 nm can be isolated from the negative samples.The virus inoculation results show that the goose embryos can be led to death by clinical GAstV isolates,which with classic histopathological characteristics.Although the GAstV isolates cannot led to death and obvious typical histopathological change in goslings,the vi-ral nucleic acids can be detected in heart,liver,spleen,kidney,intestine and cloacal anal swabs.The above results indicated that there were multiple pathogens co-infection dominated by AAstv in Gosling gout in China,including cross species infections of multiple AAstVs,parvovirus,ARV and suspec-ted novel viruses.Moreover,the GAstV maybe not the only pathogen causing gout in goslings.

Goose astrovirus(GAstV)has become one of the most important pathogens endangering the goose farming industry in China.To discover the genomic information of prevalent strains in China in 2022 and reveal their biological characteristics,the whole genomes of 9 strains of GAstV-1 and 12 strains of GAstV-2 isolated from parts of China in 2022 were sequenced by the Chromo-some Walking and analyzed by bioinformatics software and websites.The analysis results of gene structure showed that the sizes of the coding genes ranged from 6 977 to 7 215 bp.The open read-ing frame 1(ORF1)of all strains contained the characteristic motifs of serine protease,nuclear lo-calization signal(NLS)and RNA-dependent RNA polymerase(RdRp).The ribosomal frameshift signals(RFS)were all in the form of stem-loop structures.However,the numbers of stem and loop nucleotides in GAstV-1 were"14+11"configuration,while those in GAstV-2 were"12+14"configuration,and the loop of GAstV-2 was in the"8+6"double-loop configuration.The results of homological analysis for ORF1b showed that the homology of the GAstV-1 isolats compared with the representative strains of avian astrovirus types 1,2,and 3(AAstV-1,AAstV-2,AAstV-3)ranged from 7％to 64％,and the homology of the GAstV-2 isolates ranged from 8％to 68％.The average genetic distances of ORF2 were 0.9,1.2,and 0.9 respectively compared with the represent-ative strains of AAstV-1,AAstV-2 and AAstV-3.While for the GAstV-2 isolates,the highest ho-mologies were 68％and 56％,the lowest homologies were 8％and 36％respectively.And the aver-age genetic distances of ORF2 were 1.0,1.2,and 0.5 respectively.B-cell-conformational epitopes screening results of ORF2 showed that,there were four common epitopes in the GAstV Group 1 i-solates,namely PRE,LALQSQSVNTFA,AAG and YQQVTSDQSI except for N-145,N-287 and N-314 in the two strains G1FJ267 and G1JS277.And there were seven common conformational epitopes in the GAstV-2 isolates,namely NQE,RAN,GPE,PRQ,TRAQ,SNS,and AVPPNTPL except for N-83,N-136,N-331 and N-351 in the strain G2FJ283-3B.The above results indicated that GAstV maybe belong to a new type of AAstV because of the difference between the clinical i-solates and the known strains of AAstV.And there was pathogenic diversity among the isolates.All the isolates of GAstV-1 and GAstV-2 belong to two different serotypes,and the possible serologi-cal subtypes among the isolates of GAstV-1 or GAstV-2 are remained to be further identified by serological tests.

Alcohol abuse is a global public health problem.Excessive drinking not only damages digestive tract,cardiovascu-lar and endocrine systems,but also damages central nervous system(CNS).Recent studies have shown that alcohol interacts with neu-roimmune system to alter neuroimmune signaling and molecular expression,thereby leading to neuroinflammation and regulating a wide range of brain functions.Microglia is main cell of CNS involved in neuroimmune responses.Microglia is activated by alcohol and acts on neurons,leading to neuropsychiatric diseases,such as neuronal loss,abnormal synaptic connections,cognitive decline and motor dysfunction.Alcohol chronically stimulates digestive tract and also affects microglia along gut-brain axis.Neural properties of microglia and related immune factors and their important roles in neuroinflammation provide a new insight into neuroimmune mecha-nisms underlying alcohol-induced changes in brain function and behavior.This review discusses progress of role of microglia and their immune signaling in alcohol-induced neuroinflammation,and provides theoretical basis for further research on neurobiological mecha-nism and treatment of alcohol abuse.

Goose astrovirus(GAstV)has become one of the most important pathogens endangering the goose farming industry in China.To discover the genomic information of prevalent strains in China in 2022 and reveal their biological characteristics,the whole genomes of 9 strains of GAstV-1 and 12 strains of GAstV-2 isolated from parts of China in 2022 were sequenced by the Chromo-some Walking and analyzed by bioinformatics software and websites.The analysis results of gene structure showed that the sizes of the coding genes ranged from 6 977 to 7 215 bp.The open read-ing frame 1(ORF1)of all strains contained the characteristic motifs of serine protease,nuclear lo-calization signal(NLS)and RNA-dependent RNA polymerase(RdRp).The ribosomal frameshift signals(RFS)were all in the form of stem-loop structures.However,the numbers of stem and loop nucleotides in GAstV-1 were"14+11"configuration,while those in GAstV-2 were"12+14"configuration,and the loop of GAstV-2 was in the"8+6"double-loop configuration.The results of homological analysis for ORF1b showed that the homology of the GAstV-1 isolats compared with the representative strains of avian astrovirus types 1,2,and 3(AAstV-1,AAstV-2,AAstV-3)ranged from 7％to 64％,and the homology of the GAstV-2 isolates ranged from 8％to 68％.The average genetic distances of ORF2 were 0.9,1.2,and 0.9 respectively compared with the represent-ative strains of AAstV-1,AAstV-2 and AAstV-3.While for the GAstV-2 isolates,the highest ho-mologies were 68％and 56％,the lowest homologies were 8％and 36％respectively.And the aver-age genetic distances of ORF2 were 1.0,1.2,and 0.5 respectively.B-cell-conformational epitopes screening results of ORF2 showed that,there were four common epitopes in the GAstV Group 1 i-solates,namely PRE,LALQSQSVNTFA,AAG and YQQVTSDQSI except for N-145,N-287 and N-314 in the two strains G1FJ267 and G1JS277.And there were seven common conformational epitopes in the GAstV-2 isolates,namely NQE,RAN,GPE,PRQ,TRAQ,SNS,and AVPPNTPL except for N-83,N-136,N-331 and N-351 in the strain G2FJ283-3B.The above results indicated that GAstV maybe belong to a new type of AAstV because of the difference between the clinical i-solates and the known strains of AAstV.And there was pathogenic diversity among the isolates.All the isolates of GAstV-1 and GAstV-2 belong to two different serotypes,and the possible serologi-cal subtypes among the isolates of GAstV-1 or GAstV-2 are remained to be further identified by serological tests.

In order to investigate the related pathogens and reveal the etiological characteristics of gout in goslings,191 typical clinical cases from partial regions of China were examined by RT-PCR/PCR detection of viral nucleic acids in domestic poultry and pathological analysis.The autop-sy results show that the clinical cases could be classified into three types based on the severity of urate deposition:severe,moderate,and mild,namely systemic urate deposition,local urate deposi-tion mainly in the liver and kidneys,and only a small amount of fine-grained urate deposition in the liver,gallbladder,or glandular stomach.The results of RT-PCR/PCR detection showed that the to-tal positive rates were as follows:GAstV Group2 63.9％,GAstV Group1 50.3％,AAstV-2 38.7％,novel Muscovy duck parvovirus(NPV)17.8％,GPV 16.2％,GoCV 12.6％,MDPV 7.9％,MDRV 8.4％,DPV 0.5％,GPMV and NDV 0.5％,the AstV-1、ARV、TMUV、NDV、FAdV、GHPyV were zero.Among all the postive samples,the rates of single positive,double positive,and multiple posi-tive were 18.3％,27.2％,and 44.0％,respectively.The rate of single positive samples containing AAstV was only 12.0％,the double or multiple positive samples containing GAstV Group 1/2 was 60.7％,and the rate of samples without GAstV Group 1/2 was 10.5％.The results also showed that 20(10.5％)samples were negative for 16 types of viruses.The AAstV particles isolated from single positive samples appear spherical shape,non-enveloped and 20-80 nm minsize.Two types of virus particles which with spherical shape and diameters of 40-100 and 20-40 nm can be isolated from the negative samples.The virus inoculation results show that the goose embryos can be led to death by clinical GAstV isolates,which with classic histopathological characteristics.Although the GAstV isolates cannot led to death and obvious typical histopathological change in goslings,the vi-ral nucleic acids can be detected in heart,liver,spleen,kidney,intestine and cloacal anal swabs.The above results indicated that there were multiple pathogens co-infection dominated by AAstv in Gosling gout in China,including cross species infections of multiple AAstVs,parvovirus,ARV and suspec-ted novel viruses.Moreover,the GAstV maybe not the only pathogen causing gout in goslings.

Alcohol abuse is a global public health problem.Excessive drinking not only damages digestive tract,cardiovascu-lar and endocrine systems,but also damages central nervous system(CNS).Recent studies have shown that alcohol interacts with neu-roimmune system to alter neuroimmune signaling and molecular expression,thereby leading to neuroinflammation and regulating a wide range of brain functions.Microglia is main cell of CNS involved in neuroimmune responses.Microglia is activated by alcohol and acts on neurons,leading to neuropsychiatric diseases,such as neuronal loss,abnormal synaptic connections,cognitive decline and motor dysfunction.Alcohol chronically stimulates digestive tract and also affects microglia along gut-brain axis.Neural properties of microglia and related immune factors and their important roles in neuroinflammation provide a new insight into neuroimmune mecha-nisms underlying alcohol-induced changes in brain function and behavior.This review discusses progress of role of microglia and their immune signaling in alcohol-induced neuroinflammation,and provides theoretical basis for further research on neurobiological mecha-nism and treatment of alcohol abuse.

Objective:To analyze the allocation of general practitioners per 10 000 population in China and its influencing factors, so as to provide reference for optimizing the allocation of general practitioners resources in China.Methods:The number of general practitioners per 10 000 population and other relevant data of 31 provinces (except Hong Kong, Macao and Taiwan) in China from 2012 to 2021 were collected from China Statistical Yearbook, China Health Statistics Yearbook, China Health and Family Planning Statistical Yearbook. The geographical area data of 31 provinces (except Hong Kong, Macao and Taiwan) from 2012 to 2021 were retrieved from the website of the Central People ′s Government. The influencing factors of the number of general practitioners per 10 000 population were preset by literature analysis and unstructured interview. Taking the number of general practitioners per 10 000 population as the dependent variable, the correlation between it and the preset influencing factors was analyzed by panel data regression. Results:From 2012 to 2021, the average annual growth rate of the number of general practitioners per 10 000 population in each province of China was greater than 0. The factors affecting the number of general practitioners per 10 000 population included the number of people per square kilometer ( r=3.818, P<0.01), the number of beds in medical and health institutions per capita ( r=2.135, P<0.01), the proportion of the elderly population aged 65 and above ( r=0.180, P<0.01), and the proportion of total expenditure in medical and health institutions to gross domestic product ( r=0.080, P<0.01). Conclusions:The development trend of general practitioners resources allocation in China is good, but the government needs to integrate the population agglomeration and aging trend, the allocation of medical and health resources, the investment support for the development of general practitioners and other influencing factors, optimize the allocation of general practitioners resources according to local conditions, and strengthen policy support for areas and links where the allocation of general practitioners resources is relatively weak.

Objective:To analyze the allocation of general practitioners per 10 000 population in China and its influencing factors, so as to provide reference for optimizing the allocation of general practitioners resources in China.Methods:The number of general practitioners per 10 000 population and other relevant data of 31 provinces (except Hong Kong, Macao and Taiwan) in China from 2012 to 2021 were collected from China Statistical Yearbook, China Health Statistics Yearbook, China Health and Family Planning Statistical Yearbook. The geographical area data of 31 provinces (except Hong Kong, Macao and Taiwan) from 2012 to 2021 were retrieved from the website of the Central People ′s Government. The influencing factors of the number of general practitioners per 10 000 population were preset by literature analysis and unstructured interview. Taking the number of general practitioners per 10 000 population as the dependent variable, the correlation between it and the preset influencing factors was analyzed by panel data regression. Results:From 2012 to 2021, the average annual growth rate of the number of general practitioners per 10 000 population in each province of China was greater than 0. The factors affecting the number of general practitioners per 10 000 population included the number of people per square kilometer ( r=3.818, P<0.01), the number of beds in medical and health institutions per capita ( r=2.135, P<0.01), the proportion of the elderly population aged 65 and above ( r=0.180, P<0.01), and the proportion of total expenditure in medical and health institutions to gross domestic product ( r=0.080, P<0.01). Conclusions:The development trend of general practitioners resources allocation in China is good, but the government needs to integrate the population agglomeration and aging trend, the allocation of medical and health resources, the investment support for the development of general practitioners and other influencing factors, optimize the allocation of general practitioners resources according to local conditions, and strengthen policy support for areas and links where the allocation of general practitioners resources is relatively weak.

Objective:To explore the application effect of new whole-course closed sputum specimen collection technology in intensive care unit patients.Methods:From April 2020 to January 2022, the convenient sampling was used to select 442 ICU mechanical ventilation patients admitted to 6 hospitals in Jiaxing City as the research objects. According to the order of admission time, the patients were divided into the control group ( n=221) and the experimental group ( n=221) . The control group adopted the traditional open sputum specimen collection technology, while the experimental group adopted the new whole-course closed sputum specimen collection technology. The heart rate, the incidence of hypooxygen saturation and the incidence of sputum spatter were compared between the two groups after sputum sample sampling. Results:The incidences of hypooxygen saturation and sputum spatter in the experimental group were lower than those in the control group, and the differences were statistically significant ( P<0.01) . Conclusions:The new whole-course closed sputum specimen collection technology can effectively stabilize the oxygen saturation of ICU patients in the process of sputum specimen collection, reduce the incidence of sputum spatter and promote the safety of both patients and medical staff, which is worthy of clinical promotion and application.