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.

Atherosclerosis is a complex pathological condition resulting from lipid deposition， chronic inflammatory responses， and fibrosis， with a prolonged disease course and multifactorial etiology. Based on the traditional Chinese medicine （TCM） theory of accumulation syndrome， atherosclerosis can be classified under this category， with its pathogenesis involving phlegm， blood stasis， deficiency， and accumulation. This paper proposed a stage-based intervention strategy using the four therapeutic principles of "attacking， supplementing， dispersing， dissipating"， and divided into six stages based on the pathological progression， including the stage of accumulation before formation， the stage of accumulation already formed， the stage of nucleus accumulation， the stage of nucleus accumulation decay， the stage of nucleus accumulation consolidation， and the stage of severe stenosis of nucleus. At different stages， the intervention focuses on reinforcing healthy qi and consolidating the root， tonifying the kidneys and spleen， dispersing and removing turbidity， removing phlegm stagnation， promoting qi circulation， dispersing accumulations and removing stasis， attacking accumulation and expelling stasis， directing the turbid downward and dispersing accumulation， and treatment would be adjusted based on specific symptoms， which provides a theoretical framework for the prevention and treatment of atherosclerosis with TCM.

BackgroundMigraine is a common chronic neurological disease， and patent foramen ovale （PFO） has been closely associated with migraine. Current research primarily focuses on the pathological mechanism and the therapeutic effects of interventional closure， with limited attention paid to the impact of PFO on sleep quality in migraine patients. ObjectiveTo compare the difference in sleep quality between PFO-positive and PFO-negative migraine patients， and to analyzes influencing factors of sleep quality in PFO-positive migraine patients， so as to provide references for clinical interventions to improve sleep quality in PFO-positive migraine patients. MethodsA total of 673 migraine patients who met the diagnostic criteria of migraine in the International Classification of Headache Disorders， third edition （ICHD-3）， and all patients underwent contrast-enhanced transcranial Doppler （c-TCD） and transthoracic echocardiographic right heart contrast echocardiography （cTTE） in the Third Hospital of Mianyang from January 2020 to October 2024. Basic demographic data were collected using a self-designed questionnaire， headache severity was assessed with the Visual Analogue Scale （VAS）， and sleep quality was invaluated using the Pittsburgh Sleep Quality Index （PSQI）. PFO patients was diagnosed through c-TCD combined with c-TTE. Binary logistic regression analysis was employed to examine the influencing factors of sleep quality in PFO-positive migraine patients. ResultsA total of 673 （100.00%） migraine patients were enrolled， including 223 PFO-positive cases （33.14%） and 450 PFO-negative cases（66.86%）. The PFO-positive group showed significantly more severe headache severity （χ²=15.799， P<0.01） and poorer sleep quality （χ²=14.377， P<0.01） compared with PFO-negative group. PFO-positive patients demonstrated significantly higher barrier factor scores of sleep quality， sleep latency， sleep efficiency， sleep disturbance， hypnotic medication use， and daytime dysfunction compared with PFO-negative counterparts （t=3.634， 3.269， 2.785， 3.428， 2.907， 3.637， Bonferroni adjust P<0.05/7=0.007）.By contrast， no significant difference was noted in sleep duration scores between the two groups（t=2.349， Bonferroni adjust P>0.05/7=0.007）.The Binary Logistic regression analysis revealed that age （OR=1.021， 95% CI： 1.001~1.041）， headache severity （OR=6.030， 95% CI： 4.085~8.901）， and PFO grade （OR=1.893，95% CI： 1.288~2.784）were significant influencing factors for sleep quality in migraine patients with PFO. ConclusionMigraine patients with PFO-positive exhibited poorer sleep quality compared wtih PFO-negative patients. Older age， higher headache servity， and more severe PFO grade are identified as risk factors for impaired sleep quality in PFO-positive migraine patients.

In the era of big data, neuroimaging and algorithmic analyses have propelled brain science research and brain mapping. Acupuncture, widely recognized as an effective surface stimulation therapy, has demonstrated therapeutic efficacy for various brain conditions such as stroke and depression. However, the mechanisms linking acupuncture to brain function and its modulatory effects on brain activity require systematic exploration. Additionally, there is an urgent need to scientifically reinterpret traditional meridian theory and enhance its clinical applicability. Therefore, we propose the initiative of constructing a "brain mapping atlas of meridian, collateral and body surface stimulation" to explore the patterns linking the therapeutic effects of stimulating the twelve meridians, eight extraordinary vessels, divergent channels, collateral channels, sinew channels, and skin regions to brain function. This initiative aims to provide a scientific interpretation of traditional Chinese medicine meridian theory and enhance its practical applicability. This paper begins by reviewing the current state of brain mapping. It then summarizes existing research on the relationship between acupuncture and the brain, highlighting the necessity of constructing this atlas. The paper further analyzes the methodologies and technical challenges involved. Finally, the potential applications of the brain mapping atlas of meridian, collateral and body surface stimulation, and its main significance in advancing traditional meridian theory to keep pace with the times are prospected.
Humans ; Acupuncture Therapy ; Meridians ; Big Data ; Brain/physiology* ; Brain Mapping

Objective To evaluate the resuscitation efficacy of novel lyophilized platelets(LP,thrombin-stimulated platelets)combined with lactated Ringer's(LR)solution in rabbits with hemorrhagic shock and seawater immersion.Methods Fifty rabbits were randomly assigned to 5 groups(Groups A,B,C,D and E,n=10).After all rabbits were anesthetized with 3%pentobarbital sodium at a dose of 1 mL/kg,soft tissue injury was inflicted in the left lower limb.The blood loss from the soft tissue injury was quantified after gauze hemostasis.The right lower limb was subjected to femoral artery catheterization,followed by blood withdrawal equivalent to 26%of the total blood volume of the rabbit.The rabbits were then vertically immersed in 3%artificial seawater,with the water level reaching above the xiphoid process,and were retrieved in 15 min later.Resuscitation strategies were applied to the rabbits from different group:Group A(no resuscitation),Group B(resuscitation with LR solution),Group C(resuscitation with LR solution and fresh platelets),Group D(resuscitation with LR solution and LP),and Group E(resuscitation with LR solution and novel LP).Coagulation function test,routine blood test,blood gas analysis,and thromboelastography were conducted at baseline and at 1,2 and 4 h after injury.Results The LP and rabbit model of hemorrhagic shock and seawater immersion were successfully prepared.At 1 h after injury,the mean arterial pressure(MAP)of Groups C,D and E(infused with platelet preparations)was significantly higher than that of Group A(without resuscitation,P<0.05);the lactate(Lac)content of Group C was obviously lower than that of Groups A and B(P<0.05);the base excess(BE)and blood urea nitrogen(BUN)levels of Groups C,D and E were notably lower than those of Groups A and B(P<0.05);and the prothrombin time(PT)of Group A was significantly longer than that of before injury(P<0.05).At 2 h after injury,the MAP of Groups C and D was significantly higher than that of Groups A and B,and that of Group E was notably higher than that of Group A(P<0.05);the Lac content of Groups C and E was obviously lower than that of Groups A and B,while that of Group D was also lower than that of Group A(P<0.05);the BE and BUN levels of Groups C,D and E were remarkably lower than those of Groups A and B(P<0.05);the maximum amplitude(MA)value of Group C was higher than that of Group A,while the value of Groups A and D at this time was significantly lower than the corresponding value before injury(P<0.05);and the activated partial clotting time(APTT)of Groups A and D was statistically longer than the corresponding baseline time(P<0.05).At 4 h after injury,the MAP of Groups C,D,and E was higher than that of Groups A and B,and that of Group B was higher than that of Group A(P<0.05);the Lac and BUN levels of Groups C,D,and E were lower than those of Groups A and B(P<0.05);the BE level of Groups C and D were lower than those of Groups A and B(P<0.05);the MA value of Groups B,C,and E were higher than those of Group A(P<0.05),while the MA value and APTT value of Groups A and D were significantly lower than their corresponding baseline values(P<0.05).Conclusion For rabbits with hemorrhagic shock and seawater immersion,the novel LP combined with LR solution can significantly increase the MAP level,reduce Lac content,and sustainably maintain blood clot firmness and coagulation function.

Objective To observe the value of energy spectrum CT angiography(CTA)optimal single energy imaging combined with adaptive statistical iterative reconstruction V(ASIR-V)for optimizing visualization of thoracodorsal artery(TDA).Methods Energy spectrum CTA was prospectively performed in 60 patients to observe TDA.The images were reconstructed as 120 kVp-like combined with 40%post-set ASIR-V(group A),as well as totally 18 kinds of single energy images ranging from 45 to 70 keV(with interval of 5 keV)combined with 40%,60%and 80%post-set ASIR-V(group B),and the subjective and objective evaluation results of the images were compared between and within groups.Results Under the same post-set ASIR-V weight,significant differences of subjective scores of axial and 3D images were found among different keV levels(all P＜0.001).With the increase of keV level,subjective scores of axial images increased first and then decreased,among which subjective score of 50 keV was the highest(all P＜0.001).Under the same keV levels,with the increase of ASIR-V weight,the subjective scores of overall axial images and 3D images for displaying the main trunk of TDA,as well as contrast-to-noise ratio of axillary artery increased(all P＜0.01).Conclusion Performing CTA using 50 keV single energy imaging combined with 80%ASIR-V reconstruction could balance image contrast and noise better,hence improving visualization of TDA and its branches.

Traumatic supraorbital fissure syndrome (TSOFS) is a symptom complex caused by nerve entrapment in the supraorbital fissure after skull base trauma. If the compressed cranial nerve in the supraorbital fissure is not decompressed surgically, ptosis, diplopia and eye movement disorder may exist for a long time and seriously affect the patients′ quality of life. Since its overall incidence is not high, it is not familiarized with the majority of neurosurgeons and some TSOFS may be complicated with skull base vascular injury. If the supraorbital fissure surgery is performed without treatment of vascular injury, it may cause massive hemorrhage, and disability and even life-threatening in severe cases. At present, there is no consensus or guideline on the diagnosis and treatment of TSOFS that can be referred to both domestically and internationally. To improve the understanding of TSOFS among clinical physicians and establish standardized diagnosis and treatment plans, the Skull Base Trauma Group of the Neurorepair Professional Committee of the Chinese Medical Doctor Association, Neurotrauma Group of the Neurosurgery Branch of the Chinese Medical Association, Neurotrauma Group of the Traumatology Branch of the Chinese Medical Association, and Editorial Committee of Chinese Journal of Trauma organized relevant experts to formulate Chinese expert consensus on the diagnosis and treatment of traumatic supraorbital fissure syndrome ( version 2024) based on evidence of evidence-based medicine and clinical experience of diagnosis and treatment. This consensus puts forward 12 recommendations on the diagnosis, classification, treatment, efficacy evaluation and follow-up of TSOFS, aiming to provide references for neurosurgeons from hospitals of all levels to standardize the diagnosis and treatment of TSOFS.

Objective:To explore the effects of the auto-prescription technique combined with noise index (NI) and adaptive statistical iterative reconstruction algorithm-veo (ASIR-V) on the radiation dose and image quality in the computed tomographic angiography (CTA) of the deep inferior epigastric artery (DIEA).Methods:The data of 150 cases who underwent DIEP CTA in the First Affiliated Hospital of Dalian Medical University were prospectively collected, and were randomized into groups A, B, and C, with 50 cases in each group. For group A, the conventional tube voltage was 120 kVp, and images were reconstructed using 40% ASIR-V. For group B, the tube voltage based on the auto-prescription technique was adopted, and images were reconstructed using 40%, 60%, and 80% ASIR-V (corresponding to the three subgroups B1-B3, respectively). For group C, the tube voltage based on the auto-prescription technique was employed, NI = 13, and images were reconstructed by 40%, 60%, and 80% ASIR-V (corresponding to subgroups C1, C2, and C3, respectively). Subsequently, the CT and SD values of the originating femoral artery of DIEA and the rectus abdominis at the same level as DIEA were measured on axial images of each group, the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated, and the radiation doses of the three groups were recorded. Finally, the image quality and noise of DIEA in each group were independently and subjectively scored by two radiologists in a blinded manner.Results:Compared to group A, groups B and C exhibited higher CT values of femoral artery ( t= -5.18, -5.17, -5.06, -6.08, -6.08, -6.07, P < 0.05) and higher image SNR and CNR ( P < 0.05), which increased gradually with the upgrading of ASIR-V ( F = 55.45, 49.70, 53.47, 68.89, P < 0.05). The two radiologists offered consistent subjective evaluations (Kappa = 0.76-0.92, P < 0.05). The images of groups B and C displayed more distinct perforating branches and emerging points of DIEA and received higher subjective scores of intramuscular course compared to those of group A. The subjective scores of image noise in subgroups B2, B3, and C2 were not significantly different from those in group A. The radiation doses in groups B and C decreased by 15.10% and 52.85%, respectively compared to those in group A ( H = 75.21, P < 0.05). Conclusion:The combination of the auto-prescription technique with NI = 13 and 60% ASIR-V can reduce the radiation dose by 52.85% while ensuring a clear display of DIEA.

Objective To explore the application value of deep learning image reconstruction(DLIR)algorithm in low-dose deep inferior epigastric artery(DIEA)computed tomography angiography(CTA).Methods A total of 59 patients undergoing DIEA CTA were prospectively selected and randomly divided into two groups:group A(29 cases)and group B(30 cases).Group A was the conventional radiation dose group(tube voltage 120 kVp),the tube current was dose modulation 3,and the iterative reconstruction algo-rithm was Karl 5.Group B was the low radiation dose group(tube voltage 120 kVp),the tube current was dose modulation 2,with DLIR reconstruction algorithm,and four levels of DLIR(1-4)were reconstructed and labeled as groups B1 to B4.The mean tube current,vol-ume CT dose index(CTDIvol),and dose length product(DLP)of group A and group B were recorded,and the effective dose(ED)was calculated.The CT and standard deviation(SD)values of the external iliac artery and psoas major muscle were measured on axial images of each group,and signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)were calculated.Two observers using double-blind method independently evaluated the DIEA on volume rendering(VR)and maximum intensity projection(MIP)images of each group using a 3-point scale,and a 5-point scale was used to evaluate the overall image quality on axial images.Results Compared with group A,the mean tube current and ED in group B were decreased by 39.33％and 44.09％,respectively(P＜0.05).With the increasing of DLIR level from groups B1 to B4,the SD value of the image gradually decreased,while SNR and CNR gradually increased(P＜0.05).The CNR in groups B3 and B4 was higher than that in group A(P＜0.05).The subjective scores of the two observers were consistent(Kappa value 0.779-0.889,P＜0.05),and there was no statistical significance between group A and group B in the perforating vessels from the DIEA,intramuscular course,and the point of emergence(P＞0.05).With the increase in DLIR level,the subjective score of the overall image quality from group B1 to group B4 showed a trend of first increasing and then decreasing,and the score of group B3 was the highest(4.50±0.51)points,which had no statistical significance compared with group A(4.45±0.51)points(P＞0.05).Conclusion DLIR can effectively reduce the radiation dose of the DIEA CT A scan and ensure the image quality,among which DLIR 3 is the recommended best reconstruction grade.

Objective To explore the application value of 1 024×1 024 reconstruction matrix combined with iterative reconstruc-tion algorithm(Karl)in deep inferior epigastric artery(DIEA)computed tomography angiography(CTA).Methods A total of 40 patients who underwent DIEA CTA were prospectively selected and the original data were reconstructed by grouping.Group A was reconstructed using a conventional 512×512 matrix combined with Karl 5 grade.Group B was reconstructed using 1 024×1 024 recon-struction matrix combined with Karl 5,7,and 9 grades,respectively,and 3 subgroups B1-B3 were obtained.The CT and standard devia-tion(SD)values of the external iliac artery and psoas major muscle were measured on axial images,and signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)were calculated.A 3-point scale was used to evaluate the perforating vessels from the DIEA,intramuscular course,point of emergence,superficial inferior epigastric artery(SIEA)and superficial inferior epigastric vein(SIEV)on volume ren-dering(VR)and maximum intensity projection(MIP)images by two observers,and a 5-point scale was used to evaluate the overall image quality on axial images.Results With the increase of Karl grade in groups B1 to B3,the SD value of the external iliac artery decreased gradually(P＜0.05),while SNR and CNR increased gradually(P＜0.05).The SD values of the external iliac artery in group B2 and group B3 were lower than those in group A(P＜0.05),and SNR and CNR were higher than those in group A(P＜0.05).There was a good consistency in the subjective evaluation between the two observers(Kappa values=0.773-0.872,P＜0.05).The perforating vessels from the DIEA,intramuscular course,point of emergence,SIEA and SIEV display and overall image quality subjective scores of group B2 and group B3 were better than those of group A(P＜0.05),and the scores of group B2 showed the greatest improvement.Conclusion The 1 024 × 1 024 reconstruction matrix combined with the Karl 7 reconstruction algorithm can optimize the image quality and improve the display of the DIEA and perforator microvessels.