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.

Objective To explore the risk factors for noncontiguous spinal fractures(NSFs)in the elderly.Methods The clinical data of 614 elderly patients with spinal fracture from January 2013 to December 2019 were analyzed retrospectively.Patients were divided into the NSFs group and the Non-NSFs group according to whether NSFs occurred or not.Univariate analysis and multivariate Logistic regression analysis were used to screen the risk factors of NSFs.Results Univariate analysis showed that female(P=0.003),high-energy violent injury(P=0.032),osteoporosis(P=0.004),fracture in spring(P=0.020),and previous spinal fracture history(P<0.001)were associated with the occurrence of NSFs.Multivariate Logistic regression analysis showed that fracture in spring(P=0.024),previous spinal fracture history(P<0.001)and high-energy violent injury(P=0.038)were the independent risk factors for the occurrence of NSFs in the elderly.Conclusion High-energy violent injury,fracture in spring and previous spinal fracture history are the independent risk factors for the occurrence of NSFs in the elderly.Therefore,elderly patients with the above risk factors should be examined more carefully and comprehensively to avoid missed diagnosis and delayed diagnosis.In order to reduce the incidence of this disease,corresponding measures should be taken according to the preventable risk factors.

Objective To analyze the risk factors for increased drainage volume after open transforaminal lumbar interbody fusion(TLIF),and to establish a predictive model and then validate it.Methods The clinical data of 680 patients who underwent open TLIF at the General Hospital of Northern Theater Command from January 2016 to December 2019 were collected and the patients were randomly divided into the training group(n=476)and the validation group(n=204).Taking the predictive factors screened out by LASSO regression analysis as independent variables,a multivariate Logistic regression predictive model was constructed.The model was internally validated through the receiver operating characteristic(ROC)curve,Hosmer-Lemeshow goodness-of-fit test,and calibration curve,and its clinical utility was assessed via decision curve analysis(DCA).Results LASSO regression analysis screened out four predictive variables:age,number of surgical segments,operative duration,and intraoperative blood loss.The multivariate Logistic regression predictive model demonstrated that age≥60 years,number of surgical segments≥4,operative duration≥2 hours,and intraoperative blood loss≥200 mL were independent influencing factors for the increased postoperative drainage volume in patients undergoing TLIF(P<0.05).ROC curve analysis revealed an area under the curve(AUC)of 0.816(95%CI:0.798 to 0.867)in the training group and 0.783(95%CI:0.685 to 0.823)in the validation group,indicating that the predictive model had good discriminatory ability.Additionally,the Hosmer-Lemeshow goodness-of-fit test and calibration curve indicated that the predictive model had a good degree of fit,and the predicted probability was basically consistent with the actual probability,demonstrating a good calibration.The DCA results confirmed that this predictive model could be applied in clinical practice.Conclusion The risk factors for increased drainage volume after open TLIF include age,number of surgical segments,operative duration,and intraoperative blood loss.The predictive model established based on these factors demonstrates good performance,and it can be applied in clinical guidance for the selection of drainage tube removal time after TLIF.

Protective ileostomy is an important bridging procedure in low anterior resection for rectal cancer, aimed at preventing severe anastomotic complications. It has been shown to significantly reduce the risk of pelvic infections resulting from anastomotic leakage. However, whether ileostomy plays a positive clinical role in preventing anastomotic leaks remains a subject of considerable debate. The procedure for creating a protective ileostomy is relatively simple and convenient, making it a commonly used approach in clinical practice. Nevertheless, as a traumatic surgical procedure, ileostomy itself may lead to a range of complications. Therefore, it is crucial to comprehensively understand the potential complications associated with ileostomy, develop optimized management strategies, and carefully select appropriate patients for preventive ileostomy, as these steps hold significant clinical value. This article provides a systematic review of the types, development, and application of preventive ileostomy, as well as the management and prevention strategies for common complications. The aim is to offer valuable guidance to clinical surgeons in optimizing stoma management and minimizing complications in rectal cancer sphincter-preserving surgery.

Extended reality(XR)technology includes virtual reality(VR),augmented reality(AR)and mixed reality(MR)Combining virtual environments with physical world,the extended reality(XR)technology has great potential in rehabilitation of patients with stroke.This article reviews the intervention effects of XR technology on the functions of limb,swallowing,speech and cognition and psychological outcomes in patients with stroke.Based on this review,issues in application of XR are identified and targeted solutions are proposed,thereby offering a guidance for application of XR technology in stroke rehabilitation in China.

Porcine deltacoronavirus(PDCoV)is the main pathogen of porcine deltacoronavirus dis-ease.After infection,pigsmanifest a series of main symptoms,such as persistent vomiting,watery diarrhea and severe dehydration.Pigs at almost all growth stages are likely to be infected with the virus,especially suckling piglets are much sensitive to the virus.Once PDCoV infects the host,it u-sually causes significant immunosuppression.In recent years,studies on the immunosuppressive mechanism of PDCoV have gradually attracted widespread attention.The results showed that mul-tiple proteins of PDCoV were involved in the regulation of host innate immunity,revealing the mechanism of these proteins in regulating host innate immunity.In this paper,the interaction mechanism between PDCoV protein and host innate immunity were rsummarized,which will pro-vide a theoretical basis for further understanding the pathogenesis of PDCoV and effective preven-tion and control of porcine delta coronavirus disease.

This study aims to investigate the medication rules of patented traditional Chinese medi-cine(TCM)compound formulas and molecular mechanisms of core drugs for treating sepsis using data mining and network pharmacology approaches.In the present study,we first searched the PubMed database,Web of Science database,and the China National Knowledge Infrastructure(CNKI)since the establishment of the library to April 30,2024 for the relevant literature on the treatment of sepsis by traditional Chinese medicine.The prescriptions were then statistically ana-lyzed for drug frequency and association analysis to obtain the core drugs.Then we screened the ef-fective active ingredients of the core drugs by TCMSP and other database platforms,obtained sep-sis-related genes in GeneCards and other databases,and statistically intersected targets,and predic-ted the mechanism of action of the core TCMs by subjecting the intersected targets to PPI analy-sis,GO function and KEGG pathway enrichment analysis.Finally,the relationship between key tar-gets and herbal components was examined in reverse by molecular docking method.The results showed that 64 compound formulas were obtained,with a total of 150 Chinese medicines,which were mostly sweet in taste,cold in nature,and belonged to the spleen,stomach and intestinal me-ridians.According to the association rules,the core drugs were identified as"mirabilite-peach ker-nel-rheum officinale".There were 79 intersecting targets between the core drugs and sepsis,with core targets such as IL-1β,EGFR and SRC.MAPK,TNF,IL-17 and other signaling pathways are involved to mediate inflammatory responses,apoptosis and other biological processes to exert ther-apeutic effects on sepsis.The molecular docking results indicated that the docking activity of the key targets with the main components of the drug,and sennoside E_qt has the lowest binding ener-gy and the best docking activity with SRC.In conclusion,this study showed that the prescription of Chinese medicine for sepsis is mostly based on tonifying the spleen and clearing heat.The mecha-nism of action of the core drug"mirabilite-peach kernel-rheum officinale"in the treatment of sep-sis is multilevel and multifaceted,which provides a certain theoretical basis for the treatment of sepsis by traditional Chinese medicine.

Objective To carry out quality control testing of anesthesia ventilators to ensure the reliability and safety during their clinical use.Methods Totally 88 anesthesia ventilators used in some hospital underwent quality control testing in terms of tidal volume,peak airway pressure and positive end-expiratory pressure by using a gas flow analyzer according to JJF(E)61-2020 Calibration Specification of Anesthetic Machines,which included 31 ones,36 ones,12 ones and 9 ones respectively from brand A,B,C and D.The Kruskal-Wallis test was used to analyze the variability of the measured values and errors of the performance indicators between different brands of anesthesia ventilators,the chi-square test was applied to discussing the variability of the accuracy class of the performance indicators between different brands of anesthesia ventilators,and the Pearson correlation coefficient was adopted to investigate the correlation between the years of use and the absolute values of the relative errors of the performance indicators.Results The 88 anesthesia ventilators had the overall pass rate for quality control testing being 42.05%,of which,brand B had the highest pass rate(52.78%)and brand C had the lowest pass rate(8.33%).Brand B gained advantages in tidal volume when compared with brand A,C and D,with the differences being significant(P<0.05);brand A behaved the best in peak airway pressure and positive end-expiratory pressure when compared with brand B,C and D,with the differences being significant(P<0.05).Brand A had the highest proportion(63.08%)of distinction and credit in terms of the three performance indicators.The absolute value of the relative error in tidal volume was positively correlated with the years of use at the 3 measurement points for setting values of 400,600,and 800 mL respectively(P<0.05),and there was a significant correlation between the absolute value of the relative error and the years of use at a peak airway pressure setting of 10 cmH2O(1 cmH2O=98.07 Pa)(P<0.05).Conclusion Quality control testing of anesthesia ventilators contributes to finding the risks during their application,which can be an effective tool to ensure the safety of anesthesia ventilators used in medical institutions.[Chinese Medical Equipment Journal,2025,46(9):75-80]

Objective To compare the clinical efficacy of high-dose tigecycline(TGC)and polymyxin B(PMB)in the treatment of pulmonary infection due to carbapenem-resistant organism(CRO).Methods Clinical data of pa-tients with CRO pulmonary infection and received PMB or high-dose TGC combined with other antimicrobial treat-ment regimens in Department of Critical Care Medicine of Xiangya Hospital,Central South University from January 2019 to March 2022 were analyzed retrospectively,including basic information,pathogen detection results,antimi-crobial use regimen,clinical efficacy,30-day mortality,bacterial clearance rate,etc.Results A total of 173 pa-tients were included in analysis,with 103 in the TGC group and 70 in the PMB group.Compared with TGC group,PMB group had a higher score of acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)(25.0 vs 20.0,P＜0.001),but clinical efficacy rates were not statistically different(67.1％vs 52.4％,P=0.054).Stratified analysis revealed that when the APACHE Ⅱ score was ≥15 points,compared with TGC group(n=78),PMB group(n=66)had a higher APACHE Ⅱ score(27.0 vs 22.0,P=0.005)and a higher clinical efficacy rate(66.7％vs 47.4％,P=0.020).After adjusting confounding factors through logistic regression analysis,it was found that PMB treatment was a protective factor for clinical efficacy rate compared with TGC treatment.Conclusion For treating pulmonary infection caused by CRO in patients,PMB-based treatment regimen has a significant protec-tive effect on the clinical efficacy rate compared with the high-dose TGC-based treatment regimen.

Objective The aim of this study is to investigate the plaque characteristics of different subtypes of middle cerebral artery(MCA)infarction,lenticulostriate artery(LSA)characteristics,and hemodynamic characteristics through high-resolution magnetic resonance vessel wall imaging(HR-MRI VWI)and perfusion weighted imaging(PWI).Methods A retrospective analysis was conducted on patients with unilateral acute or subacute MCA infarction who underwent HR-MRI VWI and PWI examinations at Qinhuangdao First Hospital from January 2022 to April 2024.Patients were divided into three groups according to the type of infarction:artery-to-artery embolism(AA),branch occlusive disease(BOD),branch occlusive disease and artery-to-artery embolism(BOD-AA).Clinical data,plaque characteristics,lenticulostriate artery characteristics,and hemodynamic characteristics were compared and analyzed among the three groups.To determine factors associated with BOD,the BOD and BOD-AA groups were merged into a BOD+group which was then compared with the AA group.To determine factors associated with the AA group,the BOD-AA and AA groups were combined into an AA+group,followed by comparison with the BOD group.Results A total of 42 patients with unilateral acute or subacute MCA infarction were included according to the inclusion and exclusion criteria.Among them,9 patients were classified as having AA,14 patients as having BOD,and 19 as having BOD-AA.The results showed that the degree of stenosis was higher in the AA+group than in the BOD group,and the difference was statistically significant(Z=-2.536,P<0.05);The number of LSA on the affected side was higher in the BOD+group than in the AA group[2.00(1.50,3.00)vs.3.00(3.00,4.00)],and the difference was statistically significant(Z=-2.889,P<0.05);The relative cerebral blood flow(rCBF)of the centrum semiovale was lower in the AA+group than in the BOD group[0.90(0.84,0.93)vs.0.99(0.97,1.03)],and the difference was statistically significant(Z=-4.555,P<0.05);The rCBF in the basal ganglia was lower in the BOD+group than in the AA group[0.89(0.83,0.93)vs.1.01(0.98,1.04)],and the difference was statistically significant(Z=-4.280,P<0.05).Conclusion Patients in BOD+have a lower degree of stenosis compared to AA group.The spatial relationship between plaques and LSA varies across different subtypes of MCA infarction.Plaques in BOD+patients are positioned closer to the LSA orifice and thus have a higher tendency to occlude the LSA orifice.The affected side has few LSAs and the rCBF in the LSA perfusion area.is lower.