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.

ObjectiveThis paper aims to investigate the differential mechanisms underlying the staged therapeutic effects of Qijia Rougan formula on liver fibrosis using proteomic technology. MethodsThe staged rat model of liver fibrosis was established by subcutaneous injection of carbon tetrachloride （CCl₄） and olive oil. One hundred and four SD rats were randomized into thirteen groups：a normal group，a two-week model group，a four-week model group，a six-week model group，an eight-week model group，a two-week Qijia Rougan formula group，a four-week Qijia Rougan formula group，a six-week Qijia Rougan formula group，an eight-week Qijia Rougan formula group，a two-week compound Biejia Ruangan tablet group，a four-week Compound Biejia Ruangan Tablet group，a six-week Compound Biejia Ruangan Tablet group，and an eight-week compound Biejia Ruangan tablet group. After two weeks of drug intervention，liver tissue and abdominal aortic blood samples were collected from the rats for testing. Hematoxylin-eosin （HE） staining，Masson staining，and Picro Sirius red staining were used to observe pathological damage and collagen fiber deposition in liver tissues. Immunohistochemistry （IHC） was employed to detect the contents of fibrosis markers in liver tissues. The contents of liver function indicators in the serum were measured using a fully automated biochemical analyzer，and the levels of liver fibrosis indicators in the serum were assessed by enzyme-linked immunosorbent assay （ELISA）. Liver tissues from the normal group，each model group，and each Qijia Rougan formula group were subjected to label-free quantitative proteomic analysis to identify differential proteins among the groups，with key proteins validated by Western blot. Finally，bioinformatics analysis was performed on the differential proteins. Results（1） The staged rat model of liver fibrosis constructed with CCl₄ and olive oil showed pathological results at the 2^nd，4^th，6^th，and 8^th weeks of modeling that were consistent with the Metavir standards for the F1，F2，F3，and F4 stages. Compared with those in the normal control group，the protein expressions of α-smooth muscle actin （α-SMA） and Collagen Ⅰ were significantly increased in each stage （P<0.05）. The levels of liver function indicators in the serum，including alanine aminotransferase （ALT），aspartate aminotransferase （AST），alkaline phosphatase （ALP），direct bilirubin （DBIL），and total bilirubin （TBil） in each model group，were significantly elevated in each stage （P<0.01）. The levels of liver fibrosis indicators in the serum，including procollagen Ⅲ peptide （PⅢP），type Ⅳ collagen（Ⅳ-C），hyaluronic acid （HA），and laminin （LN） in each model group，were significantly increased in each stage （P<0.05，P<0.01）. This study successfully established a staged rat model of liver fibrosis. （2） Compared with the model groups at each stage，the administration groups showed a reduction in hepatocyte ballooning degeneration，a more orderly arrangement of hepatocytes，and a decrease of inflammatory cell infiltration. The blue-stained collagen fibers became significantly thinner and finer，with reduced and narrowed fibrous septa. The areas of collagen fibers and Picro Sirius red staining were reduced （P<0.05）. The positive areas of α-SMA and Collagen Ⅰ expression were significantly decreased （P<0.05）. The levels of ALT，AST，ALP，DBIL，and TBil in the rats of the model groups at each stage were significantly reduced （P<0.05，P<0.01）. The levels of PⅢP，Ⅳ-C，HA，and LN in the rats of the model groups at each stage were significantly decreased （P<0.05）. Among these，the improvements in all indicators were most significant in the F3 stage （P<0.01）.（3） The proteomic results show that a total of 165 differential proteins exhibit a callback trend when comparing the model groups at four stages with the normal group，and when comparing the Qijia Rougan formula group with the model group. Western blot analysis reveals that the levels of NAD（P）H：quinone oxidoreductase 1 （NQO1），mitogen-activated protein kinase 1 （MAPK1），arginase 1 （Arg1），and glutathione S-transferase α1 （GSTA1） were consistent with the proteomic results. Bioinformatics results reveal that 165 differentially expressed proteins are enriched in multiple signaling pathways. Notably，signaling pathways such as drug metabolism-cytochrome P450，arginine biosynthesis，and the peroxisome proliferator-activated receptor （PPAR） signaling pathway were found to be closely associated with liver fibrosis，suggesting that the Qijia Rougan formula may exert its staged regulatory effects on liver fibrosis by regulating these pathways. ConclusionThe Qijia Rougan formula may achieve staged regulation of liver fibrosis by regulating drug metabolism-cytochrome P450，arginine biosynthesis，and the PPAR signaling pathway.

Background/Aims: The pathophysiology of refractory gastroesophageal reflux disease (RGERD), which differs from proton pump inhibitor dependent gastroesophageal reflux disease (DGERD), remains incompletely elucidated. This study aims to compare esophageal motility patterns, transdiaphragmatic pressure gradients (TPG), and reflux profiles between RGERD and DGERD patients, and to delineate dynamic pressure gradient-esophagogastric junction (EGJ) interactions in these patients. Methods: In this retrospective study, 274 patients who underwent 24-hour impedance-pH monitoring and high-resolution manometry, along with an assessment of proton pump inhibitor responsiveness, were classified as RGERD (32.5%), DGERD (54.4%), or non-GERD (13.1%). Clinical characteristics, TPG, esophageal motility, and reflux metrics were compared between RGERD and DGERD patients. Subgroup analysis excluding hiatal hernia (HH) was conducted to investigate the pathophysiology of RGERD. Results: The RGERD group exhibited a significantly higher proportion of chest pain compared to the DGERD group. Regarding reflux profiles, RGERD patients without HH (RGERDHH- group) experienced increased weakly acidic reflux (P < 0.001) and prolonged bolus exposure (P = 0.006) compared to their counterparts (DGERDHH- group). Mechanistically, the RGERDHH- group showed reduced lower esophageal sphincter basal pressure (P = 0.010) and EGJ contractile integral (P = 0.005). Notably, following a wet-swallow, the RGERDHH- group experienced the significant elevation in gastric pressure and TPG. Correlation analyses revealed weakly acidic reflux and bolus exposure were positively correlated with gastric pressure variation, and inversely correlated with lower esophageal sphincter basal pressure. Conclusions Transient gastric pressure elevation and compromised EGJ barrier function drive weakly acidic reflux and esophageal bolus exposure. This pressure gradient-barrier mismatch underpins the refractoriness of RGERD.

[Objective] To study the molecular biological mechanism for a case of ABO blood group B subtype, and perform three-dimensional modeling of the mutant enzyme. [Methods] The ABO phenotype was identified by the tube method and microcolumn gel method; the ABO gene of the proband was detected by sequence-specific primer polymerase chain reaction (PCR-SSP), and the exon 6 and 7 of the ABO gene were sequenced and analyzed. Homologous modeling of Bw.03 glycosyltransferase (GT) was carried out by Modeller and analyzed by PyMOL2.5.0 software. [Results] The weakening B antigen was detected in the proband sample by forward typing, and anti-B antibody was detected by reverse typing. PCR-SSP detection showed B, O gene, and the sequencing results showed c.721 C>T mutation in exon 7 of the B gene, resulting in p. Arg 241 Trp. Compared with the wild type, the structure of Bw.03GT was partially changed, and the intermolecular force analysis showed that the original three hydrogen bonds at 241 position disappeared. [Conclusion] Blood group molecular biology examination is helpful for the accurate identification of ambiguous blood group. Homologous modeling more intuitively shows the key site for the weakening of Bw.03 GT activity. The intermolecular force analysis can explain the root cause of enzyme activity weakening.

Intraoperative cell salvage (IOCS) has been widely applied as an important blood conservation measure in surgical operations. However, there is currently a lack of clinical practice guidelines for the implementation of IOCS in patients with malignant tumors. This report aims to provide clinicians with recommendations on the use of IOCS in patients with malignant tumors based on the review and assessment of the existed evidence. Data were derived from databases such as PubMed, Embase, the Cochrane Library and Wanfang. The guideline development team formulated recommendations based on the quality of evidence, balance of benefits and harms, patient preferences, and health economic assessments. This study constructed seven major clinical questions. The main conclusions of this guideline are as follows: 1) Compared with no perioperative allogeneic blood transfusion (NPABT), perioperative allogeneic blood transfusion (PABT) leads to a more unfavorable prognosis in cancer patients (Recommended); 2) Compared with the transfusion of allogeneic blood or no transfusion, IOCS does not lead to a more unfavorable prognosis in cancer patients (Recommended); 3) The implementation of IOCS in cancer patients is economically feasible (Recommended); 4) Leukocyte depletion filters (LDF) should be used when implementing IOCS in cancer patients (Strongly Recommended); 5) Irradiation treatment of autologous blood to be reinfused can be used when implementing IOCS in cancer patients (Recommended); 6) A careful assessment of the condition of cancer patients (meeting indications and excluding contraindications) should be conducted before implementing IOCS (Strongly Recommended); 7) Informed consent from cancer patients should be obtained when implementing IOCS, with a thorough pre-assessment of the patient's condition and the likelihood of blood loss, adherence to standardized internally audited management procedures, meeting corresponding conditions, and obtaining corresponding qualifications (Recommended). In brief, current evidence indicates that IOCS can be implemented for some malignant tumor patients who need allogeneic blood transfusion after physician full evaluation, and LDF or irradiation should be used during the implementation process.

[Objective] To analyze the loss rate of platelet donors and evaluate the strategies for establishing a platelet donor bank. [Methods] A total of 1 443 donors who joined the HLA and HPA gene donor bank for platelets in Henan Province from 2018 to 2020 were included in this study. Data on the total number of apheresis platelet donations, annual donation frequency, age at enrollment, donation habits (including the number of platelets donated per session and whether they had previously donated whole blood), and enrollment location were collected from the platelet donor information management system. Donor loss was determined based on the date of their last donation. The loss rates of different groups under various conditions were compared to assess the enrollment strategies. [Results] By the time the platelet bank was officially operational in 2022, 421 donors had been lost, resulting in an loss rate of 29% (421/1 443). By the end of 2023, the overall cumulative loss rate reached 52% (746/1 443). The loss rate was lower than the overall level in groups meeting any of the following conditions: total apheresis platelet donations exceeding 50, annual donation frequency of 10 or more, age at enrollment of 40 years or older, donation of more than a single therapeutic dose per session, or a history of whole blood donation two or more times. Additionally, loss rates varied across different enrollment locations, with higher enrollment numbers generally associated with higher loss rates. [Conclusion] Through a comprehensive analysis of donor loss, our center has adjusted its strategies for establishing the donor pool. These findings also provide valuable insights for other blood collection and supply institutions in building platelet donor banks.

Objective To investigate the effects of acupoint application at Tianshu(ST25)combined with kidney-warming and spleen-invigorating therapy on clinical efficacy,intestinal function,and the expressions of Toll-like receptor 4(TLR4)and nuclear factor kappa-B(NF-κB)in patients with ulcerative colitis(UC).Methods A total of 100 UC patients with depletion and deficiency of spleen-kidney complicated with internal accumulation of pathogenic dampness syndrome,treated in the Department of Proctology,Shanghai Municipal Hospital of Traditional Chinese Medicine Affilated to Shanghai University of Traditional Chinese Medicine from June 2022 to June 2024,were selected and randomly divided into four groups(Groups A,B,C,D)using a random number table method,with 25 patients in each group.Group A received standard mesalazine treatment.Group B received Kidney-Warming and Spleen-Invigorating Formula(composed of Psoraleae Fructus,Myristicae Semen,Euodiae Fructus,Schisandrae Chinensis Fructus,Codonopsis Radix,Poria,Atractylodis Macrocephalae Rhizoma,etc.)combined with standard mesalazine treatment.Group C received acupoint application at Tianshu(the medicinal paste for application composed of Caryophylli Flos,Cinnamomi Cortex,Atractylodis Macrocephalae Rhizoma,Euodiae Fructus,Coptidis Rhizoma,etc.)combined with standard mesalazine treatment.Group D received Kidney-Warming and Spleen-Invigorating Formula+acupoint application at Tianshu+standard mesalazine treatment.All groups were treated continuously for 12 weeks.The time for disappearance of clinical symptoms was compared among the four groups.Serum immune cytokines[β-defensin-1,total immunoglobulin A(IgA),interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-α)],peripheral blood levels of TLR4 and NF-κB,protein expression levels of TLR4 mRNA and NF-κB p65 mRNA in intestinal mucosal tissue,and changes in intestinal microbiota were observed before and after treatment.The clinical efficacy of the four groups was evaluated.Results(1)Compared to the other three groups,Group D had the shortest time for disappearance of clinical symptoms such as abdominal pain,diarrhea,mucopurulent bloody stools,and tenesmus(P＜0.05).The time for disappearance of various clinical symptoms in Groups B and C was similar(P＞0.05)but was shorter than that in Group A(P＜0.05).(2)After treatment,the serum levels of β-defensin-1,IgA,IL-6,and TNF-α in all four groups were significantly lower than those before treatment(P＜0.05).Post-treatment intergroup comparisons showed statistically significant differences(P＜0.01),with Group D exhibiting the greatest reduction,significantly lower than the other three groups(P＜0.05).The levels in Groups B and C were similar(P＞0.05)but were lower than those in Group A(P＜0.05).(3)After treatment,the peripheral blood levels of TLR4 and NF-κB,and the protein expression levels of TLR4 mRNA and NF-κB p65 mRNA in intestinal mucosal tissue showed a decreasing trend in all four groups(P＜0.05).Post-treatment intergroup comparison results were statistically significant(P＜0.01),with Group D showing the greatest reduction,significantly lower than the other three groups(P＜0.05).All above levels in Groups B and C were similar(P＞0.05)but were lower than those in Group A(P＜0.05).(4)After treatment,the relative contents of Bifidobacterium and Lactobacillus increased(P＜0.05),while those of Saccharomyces and Clostridium decreased(P＜0.05)in Groups B,C,and D.Post-treatment intergroup comparison results were statistically significant(P＜0.01).Group D showed a significant increase in Bifidobacterium and Lactobacillus and a significant decrease in Saccharomyces and Clostridium,with the magnitude of change significantly greater than that in the other three groups(P＜0.05).The quantities of these bacteria in Groups B and C were similar(P＞0.05),but the improvement was significantly greater than that in Group A(P＜0.05).(5)After 12 weeks of treatment,Group D had the highest total effective rate at 100.00％(25/25).The total effective rates of Groups B and C were similar,both at 84.00％(21/25),but were higher than that of Group A(56.00％,14/25).The intergroup difference was statistically significant(x2=16.310,P＜0.01).Conclusion The comprehensive treatment regimen of acupoint application at Tianshu combined with Kidney-Warming and Spleen-Invigorating Formula,on the basis of standard mesalazine treatment,has a positive impact on UC patients with depletion and deficiency of spleen-kidney complicated with internal accumulation of pathogenic dampness syndrome.This treatment method can effectively improve clinical symptoms,regulate β-defensin-1 and IgA levels,enhance immune defense function,downregulate the expression levels of TLR4 and NF-κB,and alleviate inflammatory response.Compared to monotherapies,it is more effective on improving treatment outcomes.

Objective To investigate the anxiety and its related factors in medical staff during field training,so as to provide evidence for psychological education before field training.Methods A total of 81 medical staff who participated in field training were recruited in this cross-sectional study as research objects.The Hamilton Anxiety Scale(HAMA)and self-compiled questionnaires of related factors were used to measure the general states of the staff.Univariate analysis was used to screen relevant variables that affect anxiety,and then a logistic regression model was used for multivarate analysis to determine independent influencing factors.Results The detection rate of anxiety was 14.81%in the research objects.There were significant differences in the degree of anxiety among the medical staff with different variables such as gender,the number of exercises attended,childlessness,parental physical condition,tolerable training time,pastime activities,and personal title(P<0.05).Multivariate regression analysis indicated that gender and parental physical status were independent factors affecting anxiety(P<0.05).Conclusion During field training,a part of medical staff has anxiety,which may affect by multi-factors such as personal,family,and training environment.Therefore,psychological education and counseling before field training should be performed from multiple aspects.

Objective To discuss the effect of probucol combined with tirofiban treatment on serum lipid peroxide levels and vascular endothelial function in patients with angina pectoris after interventional surgery of coronary heart disease(CHD).Methods A total of 120 patients with angina pectoris occurring after interventional surgery from January 2018 to December 2022 at the People's Hospital of Inner Mongolia Autonomous Region of China were enrolled in this study.Using random digital table method,the patients were divided into observation group(n=60)and control group(n=60).The patients of the control group received tirofiban,while the patients of the observation group received tirofiban plus probucol.All the preoperative and postoperative 7-day relevant indicators were recorded.The main observation indicator was the overall effective rate,and the secondary observation indicators included the frequency and duration of angina attacks,Seattle Angina Questionnaire(SAQ)score,cardiac function,myocardial injury markers,serum lipid peroxide levels,endothelial function and adverse reactions.Results The total effective rate in the observation group was 91.67％(55/60),which was higher than 78.33％(47/60)in the control group,the difference was statistically significant(P＜0.05).After treatment,the improvement degree of angina pectoris,SAQ score,LVEF,serum superoxide dismutase(SOD),nitric oxide(NO)in the observation group were higher than those in the control group,while the LVESD,LVEDD,serum creatine kinase isozyme(CK-MB),lactate dehydrogenase(LDH),creatine kinase(CK),malondialdehyde(MDA),endothelin-1(ET-1)in the observation group were lower than those in the control group,the differences in the above indexes were statistically significant(all P＜0.05).Conclusion For patients with angina pectoris occurring after interventional surgery of CHD,probucol combined with tirofiban has exact efficacy,which can promote the recovery of cardiac function,reduce myocardial injury,regulate serum lipid peroxide levels,and improve vascular endothelial function.

Objective This study aimed to investigate whether Trichinella spiralis Ts87 protein can facilitate immune evasion by degrading the mouse neutrophil extracellular traps(NETs).Methods First,we used bioinformatics tools to analyze the physicochemical properties of Ts87 and,through sequence homology alignment,confirmed its classification within the nuclease family.Molecular cloning and protein purification techniques were then employed to obtain high-purity Ts87 protein,and its nuclease activity was confirmed.Additionally,we compared the primary sequence of Ts87 with known active sites from human lysosomal DNase IIα and the structurally characterized Burkholderia thailandensis DNase II.This enabled us to predict potential active sites.Ts87 enzymatic mutants were generated using site-directed mutagenesis,and their functions were confirmed through enzymatic activity experiments.The extracellular nucleic acid content of mouse bone marrow neutrophils and the immunofluorescence staining of mouse NETs were assessed in vitro to verify whether the Ts87 protease mutants exhibited a decreased ability to degrade NETs.Finally,after immunizing mice with Ts87,calculated larvae burden and the degradation of NETs in vivo were observed by immunostaining the MPO and CitH3 expression in the intestinal NETs of the mice.Results High-purity Ts87 protein was successfully obtained and confirmed to possess nuclease activity,capable of degrading NETs in vitro.The Ts87 mutants exhibited reduced capacity in degrading NETs.In vivo experiments in mice demonstrated that the production of anti-Ts87 antibodies in immunized mice reduced the degradation of NETs,facilitating NET-mediated attack on the parasites and resulting in decreased larvae burden in the mice.Conclusions Trichinella spiralis can utilize Ts87 nuclease to evade capture by NETs,providing potential vaccine and drug targets for the prevention and treatment of trichinellosis.