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.

BACKGROUND:Living microecological hydrogels are a hot topic in the field of wound dressing and have received widespread attention.OBJECTIVE:To summarize the basic features and advantages of living microecological hydrogels,review the progress in the application of hydrogels loaded with different living organisms in skin wound repair in recent years.METHODS:The articles published from database inception to 2024 were retrieved from Web of Science,PubMed,CNKI,and WanFang databases with"cell,probiotics,phage,chlorella,algae,living microecological,hydrogel,skin,wound healing,wound repair"as search terms in English and Chinese.The articles for inclusion were screened according to the inclusion and exclusion criteria.Finally,108 articles were included for review.RESULTS AND CONCLUSION:The living microecological hydrogels have good biocompatibility,and the hydrogel can provide a suitable living environment for the loaded organisms,and play a barrier role between the living organisms and the wound to avoid potential threats.Compared with traditional wound dressings,the effect of living microecological hydrogels is sustainable and renewable.Biological regulation can keep the microenvironment at the wound site relatively stable,which can provide suitable conditions for wound healing for a long time and reduce the additional trauma caused by frequent dressing changes.Compared with the direct use of living organisms to promote wound healing,living microecological hydrogels can improve the survival rate of organisms and ensure their biological regulation.Living microecological hydrogels promote wound healing mainly by regulating the"inflammation"and"proliferation"stages in the wound healing process.The existing living microecological hydrogels mainly load organisms such as cells,probiotics,algae,and phages,which give hydrogels with different biological properties,so that they can promote wound healing by releasing substances required for wound healing or improving the wound environment,and have great application potential.To further expand the actual clinical application of living microecological hydrogels,it is necessary to further control the biosafety risks of active organisms in hydrogels in the future,avoid potential biological threats,and research the hydrogel matrix that can better adapt to the complex changes of human skin wounds and can support living organisms.

BACKGROUND:Living microecological hydrogels are a hot topic in the field of wound dressing and have received widespread attention.OBJECTIVE:To summarize the basic features and advantages of living microecological hydrogels,review the progress in the application of hydrogels loaded with different living organisms in skin wound repair in recent years.METHODS:The articles published from database inception to 2024 were retrieved from Web of Science,PubMed,CNKI,and WanFang databases with"cell,probiotics,phage,chlorella,algae,living microecological,hydrogel,skin,wound healing,wound repair"as search terms in English and Chinese.The articles for inclusion were screened according to the inclusion and exclusion criteria.Finally,108 articles were included for review.RESULTS AND CONCLUSION:The living microecological hydrogels have good biocompatibility,and the hydrogel can provide a suitable living environment for the loaded organisms,and play a barrier role between the living organisms and the wound to avoid potential threats.Compared with traditional wound dressings,the effect of living microecological hydrogels is sustainable and renewable.Biological regulation can keep the microenvironment at the wound site relatively stable,which can provide suitable conditions for wound healing for a long time and reduce the additional trauma caused by frequent dressing changes.Compared with the direct use of living organisms to promote wound healing,living microecological hydrogels can improve the survival rate of organisms and ensure their biological regulation.Living microecological hydrogels promote wound healing mainly by regulating the"inflammation"and"proliferation"stages in the wound healing process.The existing living microecological hydrogels mainly load organisms such as cells,probiotics,algae,and phages,which give hydrogels with different biological properties,so that they can promote wound healing by releasing substances required for wound healing or improving the wound environment,and have great application potential.To further expand the actual clinical application of living microecological hydrogels,it is necessary to further control the biosafety risks of active organisms in hydrogels in the future,avoid potential biological threats,and research the hydrogel matrix that can better adapt to the complex changes of human skin wounds and can support living organisms.

Objective To develop a personalized recommendation strategy for tranexamic acid administration during the perioperative period of orthopedic surgery based on machine learning,aiming to reduce perioperative bleeding and related complications and improving clinical outcomes.Methods A total of 11 727 patients undergoing orthopedic surgery from the INSPIRE database were subjected in this study.Missing data were handled using multiple imputation methods,and relevant feature variables were screened using Boruta analysis.We constructed various machine learning models,including Gradient Boosting Machine(GBM),Generalized Linear Model(GLM),eXtreme Gradient Boosting(XGBoost),K-Nearest Neighbors(KNN),Neural Network(NNET),Naive Bayes(NB),and Random Forest(RF),to evaluate their performance in predicting intraoperative bleeding and prolonged postoperative length of hospital stay.The optimal model was then selected and further integrated using a weighted ensemble,aiming to achieve the best prognosis by recommending usage strategies for tranexamic acid.The predictive performance of the constructed model was then verified against the testing set,and compared with the physician decision-making to complete the evaluation.Results In predicting intraoperative bleeding,the RF model achieved an area under the receiver operating characteristic curve(AUC)of 0.73,which was significantly better than other models.In predicting the prolonged postoperative length of hospital stay,the XGBoost model performed the best,with an AUC value of 0.84.Based on the above best-performing models,an ensemble strategy was implemented.The patients who followed the recommended strategy had reduced intraoperative bleeding and shorter postoperative length of hospital stay.Conclusion The use of tranexamic acid is associated with intraoperative bleeding and postoperative length of hospital stay.Personalized decision-making recommendation based on our constructed model can effectively improve the outcomes of the patients undergoing orthopedic surgery.

As a cheap and effective antibiotic,sulfonamides are often used in animal husbandry.However,their residues in animal-derived foodstuffs will threaten human health.Consequently,a high-performance liquid chromatography(HPLC)method integrated with supramolecular solvent microextraction was successfully established for simultaneous quantification of sulfonamide residues sulfachlorpyridazine,sulfamethoxazole,sulfamethoxypyridazine and sulfadimethoxine in milk matrices.This approach exhibited prominent characteristics of operational simplicity,environmental sustainability,and high extraction efficiency.The supramolecular solvents prepared by tributyl octylphosphine tetrafluoroborate and tetrahydrofuran were employed as extraction solvents.The analytes underwent isolation and concentration via dispersive liquid-liquid microextraction(DLLME)prior to quantitative determination using high-performance liquid chromatography(HPLC).The composition and microscopic morphology of the supramolecular solvent were characterized through a series of analytical techniques,including phase diagram,Fourier transform infrared spectroscopy,scanning electron microscopy,and inverted fluorescence microscopy and so on.The density and pH value of supramolecular solvents were determined.The extraction conditions were optimized through the one-factor experiments.The experimental results demonstrated that under the optimal extraction conditions,the four kinds of sulfonamide antibiotics exhibited excellent linearity within respective detection range(R2 ≥ 0.9998)and the limits of detection(LOD)were 0.67-1.45 μg/L.Compared with literature methods,this approach offered some advantages such as simplicity of operation and less reagent consumption,and could be used for analysis and detection of sulfonamide antibiotic residues in milk samples.The present method provided technical support for food safety regulation and paved a new way for the application of supramolecular solvents in the field of extraction and separation.

A method for determination and targeted screening of diflorasone components in health products using ultra performance liquid chromatography-quadrupole time of flight mass spectrometry(UPLC-Q-TOF/MS)was established.Four representative diflorasone and esters(diflorasone,diflorasone diacetate,diflorasone-17-propionate,and diflorasone-21-propionate)were selected to optimize the pretreatment conditions,and 10 mL of extraction solvent dosage,15 min of extraction time and 5 g of salting-out agent as the optimal conditions were selected by response surface methodology.The results showed that the four analytes exhibited good linearity within the concentration range of 2.0?100 μg/L with the chromatographic peak area,and the correlation coefficients(R2)were all greater than 0.9990,while the results of recovery and relative standard deviation could satisfy the requirements of determination.The common characteristic ions of diflorasone and esters werem/z121 andm/z335,and their specific structures were obtained by analyzing the cleavage pathway based on the optimized determination conditions.A targeted screening method for other esters of diflorasone based on characteristic ions guidance strategy was established.This method had many advantages such as high efficiency,high sensitivity and good reproducibility,and could be used for targeted screening of diflorasone and esters in health products.The developed characteristic ion guided strategy could be employed to construct mass spectral databases for various glucocorticoids,enabling comprehensive targeted screening across a broad range of compounds.

Follicular Helper T Cells(TFH)are a specialized subset of CD4+T cells that predominantly lo-calize within lymphoid follicles.These cells play a crucial role in facilitating B cell proliferation,differentia-tion,and antibody production,thereby thereby serving as a pivotal component of the adaptive immune re-sponse against infections.Given the significant function of TFH cells in regulating humoral immunity,they have become a focal point in the research of infectious diseases and related vaccine development in recent years.This review summarizes the surface markers of T follicular helper(Tfh)cells,their differentiation reg-ulatory mechanisms,and the latest research progress of Tfh cells in SARS-CoV-2 infection and vaccine stud-ies.It aims to provide new theoretical foundations and research insights for optimizing the design of SARS-CoV-2 vaccines and enhancing the cross-protection ability against SARS-CoV-2 variants.

Objective To explore the therapeutic mechanism of hot compress with Sangzhi Shengjiang Decoction(manily composed of Zingiberis Rhizoma Recens,Mori Ramulus,Cinnamomi Ramulus,Speranskiae Tuberculatae Herba,and Cervi Cornus Colla)in relieving pain and improving hemorheology of patients with femoral head necrosis(FHN).Methods A total of 104 patients with FHN who admitted to Guang'anmen Hospital Baoding,China Academy of Chinese Medical Sciences from May 2022 to May 2024 were randomly divided into the control group and the treatment group according to the random number table method,with 52 cases in each group.The control group was treated with Alendronate Sodium orally,and the treatment group was given hot compress with Sangzhi Shengjiang Decoction on the basis of treatment for the control group.The course of treatment for the two groups covered three months.Before and after the treatment,the traditional Chinese medicine(TCM)syndrome score,Harris score of joint function,Visual Analogue Scale(VAS)score for pain,and the levels of hemorheology indicators,bone metabolism indicators,and bone mineral density(BMD)of proximal femur and lumbar trabecular bone in the two groups were observed.After treatment,the clinical efficacy of patients in the two groups was evaluated.Results(1)After three months of treatment,the total effective rate of the treatment group was 92.31％(48/52)and that of the control group was 71.15％(37/52),and the intergroup comparison(tested by chi-square test)showed that the clinical efficacy of the treatment group was significantly superior to that of the control group(P<0.01).(2)After treatment,the scores of TCM symptoms such as soreness and weakness in the waist and knee,claudication,restlessness and insomnia,and soreness and heaviness of lower limbs in the two groups were decreased compared with those before treatment(P<0.05),and the decreases in the treatment group were significantly superior to that in the control group(P<0.01).(3)After treatment,the Harris scores of joint function in the two groups were increased(P<0.05)and the VAS scores for pain were decreased compared with those before treatment(P<0.05),and the increase of Harris scores and the decrease of VAS scores in the treatment group were significantly superior to those in the control group(P<0.01).(4)After treatment,the levels of hemorheology indicators such as erythrocyte sedimentation rate(ESR),whole blood low-shear viscosity(LBV),and whole blood high-shear viscosity(HBV)in the two groups were improved compared with those before treatment(P<0.05),and the improvement in the treatment group was significantly superior to that in the control group(P<0.01).(5)After treatment,the levels of bone metabolism indicators such as serum N-terminal mid-fragment of osteocalcin(N-MID)β-C-terminal telopeptide of type Ⅰ collagen(β-CTX)and total procollagen type Ⅰ N-terminal propeptide(T-PINP)levels of patients in the two groups were decreased compared with those before treatment(P<0.05),and serum 25-hydroxy vitamin D[25-(OH)D]level was increased compared with that before treatment(P<0.05).The decrease of serum N-MID,β-CTX and T-PINP levels and the increase of serum 25-(OH)D level in the treatment group were significantly superior to those in the control group(P<0.01).(6)After treatment,BMD of proximal femur and lumbar trabecular bone in the two groups was increased compared with that before treatment(P<0.05),and the increase in the treatment group was significantly superior to that in the control group(P<0.01).Conclusion Hot compress with Sangzhi Shengjiang Decoction exerts certain efficacy for the treatment of patients with FHN.The therapy is effective on reducing the scores of TCM syndrome,relieving pain,improving joint function,regulating bone metabolism and bone density,improving hemorheology indicators,and presenting remarkable therapeutic effect.

Objective: To evaluate the feasibility of dynamic contrast-enhanced MRI (DCE-MRI) in differentiating tumor deposits (TDs) from metastatic lymph nodes (MLNs) in rectal cancer. Materials and Methods: A retrospective analysis was conducted on 70 patients with rectal cancer, including 168 lesions (70 TDs and 98 MLNs confirmed by histopathology), who underwent pretreatment MRI and subsequent surgery between March 2019 and December 2022. The morphological characteristics of TDs and MLNs, along with quantitative parameters derived from DCE-MRI (K trans , kep, and v e) and DWI (ADCmin, ADCmax, and ADCmean), were analyzed and compared between the two groups.Multivariable binary logistic regression and receiver operating characteristic (ROC) curve analyses were performed to assess the diagnostic performance of significant individual quantitative parameters and combined parameters in distinguishing TDs from MLNs. Results: All morphological features, including size, shape, border, and signal intensity, as well as all DCE-MRI parameters showed significant differences between TDs and MLNs (all P < 0.05). However, ADC values did not demonstrate significant differences (all P > 0.05). Among the single quantitative parameters, v e had the highest diagnostic accuracy, with an area under the ROC curve (AUC) of 0.772 for distinguishing TDs from MLNs. A multivariable logistic regression model incorporating short axis, border, v e, and ADC mean improved diagnostic performance, achieving an AUC of 0.833 (P = 0.027). Conclusion The combination of morphological features, DCE-MRI parameters, and ADC values can effectively aid in the preoperative differentiation of TDs from MLNs in rectal cancer.

Objective To explore the mechanism of Taohong Siwu Decoction in recovering joint muscle strength and bone mineral density(BMD)in patients after hip preservation surgery for osteonecrosis of the femoral head(ONFH).Methods A total of 110 ONFH patients admitted to Guang'anmen Hospital Baoding Branch,China Academy of Chinese Medical Sciences from April 2022 to April 2024 were enrolled.The patients were equally randomized into a control group and a study group using a random number table,with 55 cases in each group.All patients underwent core decompression surgery and then were given postoperative conventional western medical treatment,and the study group received additional modified Taohong Siwu Decoction.The course of treatment lasted for 8 weeks.Before and after treatment,the two groups were observed in the changes of traditional Chinese medicine(TCM)syndrome scores,Visual Analogue Scale(VAS)score for pain,Harris hip score,joint muscle strength,bone mineral density(BMD),hemorheological parameters(including plasma viscosity,whole blood high-shear viscosity,and whole blood low-shear viscosity),and bone metabolism markers[including alkaline phosphatase(ALP),osteocalcin(BGP),and bone morphogenetic protein 2(BMP-2)].After treatment,the clinical efficacy was evaluated between groups.Results(1)After 8 weeks of treatment,the total effective rate in the study group was 92.73%(51/55),which was significantly higher than that in the control group(72.73%,40/55).The intergroup comparison showed a statistically significant difference(χ2=7.698,P＜0.01).(2)After treatment,scores for hip pain,soreness and weakness of the lower back and knees,mental fatigue,and deep-thin-choppy pulse decreased in both groups compared with those before treatment(P＜0.05).Moreover,the magnitude of reduction in all these scores was significantly greater in the study group than that in the control group(P＜0.01).(3)After treatment,the VAS scores for pain severity decreased in both groups compared with baseline(P＜0.05),while the Harris scores for joint function increased in both groups(P＜0.05).Furthermore,the magnitude of reduction in VAS scores and the magnitude of improvement in Harris scores were both significantly greater in the study group than those in the control group(P＜0.01).(4)After treatment,plasma viscosity,high-shear whole blood viscosity,and low-shear whole blood viscosity decreased in both groups compared with those before treatment(P＜0.05).Additionally,the reductions in all these parameters were significantly more pronounced in the study group than in the control group(P＜0.01).(5)After treatment,serum alkaline phosphatase(ALP)levels decreased in both groups(P＜0.05),while serum osteocalcin(BGP)and bone morphogenetic protein-2(BMP-2)levels increased in both groups(P＜0.05).Crucially,the magnitude of reduction in serum ALP levels and the magnitude of elevation in serum BGP and BMP-2 levels were all significantly greater in the study group than those in the control group(P＜0.01).(6)After treatment,in the study group,the number of patients with Grade 3 muscle strength significantly decreased while the number with Grade 4 muscle strength significantly increased compared with those before treatment(P＜0.05).In contrast,although the control group showed some improvement in joint muscle strength,the changes were not statistically significant(P＞0.05).After treatment,the intergroup comparisons showed that the study group had a significantly smaller number of patients with Grade 3 muscle strength and a significantly larger number with Grade 4 muscle strength than the control group(P＜0.01).(7)After treatment,both local femoral head BMD and average BMD increased in both groups compared with those before treatment(P＜0.05).The magnitude of increase in both local and average BMD was significantly greater in the study group than that in the control group(P＜0.01).Conclusion The application of Taohong Siwu Decoction in the treatment of in patients after hip preservation surgery for ONFH is effective on reducing TCM syndrome scores,alleviating pain,improving joint function and hemorheology,and restoring BMD and bone metabolism indicators,which enhances the overall clinical efficacy for the patients.