ObjectiveTo explore the clinical characteristics and risk factors for 30-day mortality in hospitalized patients with bloodstream infections (BSI) caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). MethodsData were obtained retrospectively from the electronic medical records of inpatients at a tertiary A-grade hospital in Shanghai from January 2016 to December 2023. The collected variables included age, gender, department, surgical treatment, empirical antibiotic therapy, Pitt Bacteremia score (PBS), Charlson comorbidity index (CCI), INCREMENT-CPE score (ICS), length of hospital stay, the time from CRKP-BSI to discharge and, etc. The follow-up period ended upon discharge, with the follow-up outcomes defined as in-hospital mortality or discharge. The endpoint was defined as death within 30 days (including day 30) caused by CRKP-BSI or infection-related complications. Patients who survived within 30 days after CRKP-BSI were classified into the survival group, while those who died within 30 days were classified into the death group. Independent risk factors for 30-day mortality in patients with CRKP-BSI were analyzed using univariate and multivariate Cox regression analysis. ResultsA total of 71 hospitalized patients with CRKP-BSI, comprising 51 males and 20 females, with an average age of (65.12±18.25) years, were included during the study period. The M (P₂₅, P₇₅) of hospital stay were 37.00 (24.00, 56.00) days, and M (P₂₅, P₇₅) of the duration from CRKP-BSI to discharge or death were 18.00 (7.00, 35.00) days. There were 20 deaths (28.17%) in the death group and 51 survivors (71.83%) in the survival group. The results of multivariate Cox regression analysis showed that the ICS as an independent risk factor for 30-day mortality in CRKP-BSI patients (HR=1.379, 95%CI: 1.137‒1.671, P=0.001). Each 1-point increase in the ICS was associated with a 37.9% increase in the risk of mortality. ConclusionThe ICS is found to be a risk factor for 30-day mortality in patients with CRKP-BSI, which may facilitate the prediction for the risk of 30-day mortality and thereby support clinical decision-making for patients with CRKP-BSI.

Pelvic floor muscle training (PFMT) is the first-line intervention for non-surgical treatment of female patients with stress urinary incontinence (SUI). However, due to the particularity of the physiological position of the pelvic floor muscles, 13% to 53% of patients are unable to perform PFMT correctly after the initial visit. In view of this, scholars at China and abroad put forward some other sports rehabilitation methods and achieve good clinical results. In this paper, exercise rehabilitation methods for female SUI patients were reviewed, including PFMT, core muscle training, Pilates, yoga, physical activities, etc., in order to provide reference for medical personnel to formulate scientific and feasible exercise rehabilitation programs for female SUI patients.

Objective:To construct a structured education course for patients with neurogenic bladder during the rehabilitation period.Methods:This study consisted three stages of current situation survey, literature search, and expert consultation. From February 2022 to February 2023, a current survey was conducted on the self-management needs of 62 patients with neurogenic bladder. In April 2023, a literature search was conducted to summarize the best evidence on nursing and management of neurogenic bladder, and form the initial version of course indicators and content. From April to May 2023, 14 experts were selected for consultation, and the Delphi method was used to demonstrate the course indicators and content, and to construct the final draft of the course.Results:A total of 62 patients with neurogenic bladder were included, they have requirements for water management, bladder function training, and dietary requirements, etc. A total of 2 053 articles were retrieved, and 14 articles were ultimately included, including eight guidelines, four evidence summaries, one expert consensus, and one systematic review. The expert authority coefficients for the two rounds of expert consultation were 0.93 and 0.92, respectively. The Kendall coordination coefficient of various indicators in the second round of expert consultation was 0.227 to 0.288 ( P<0.01). After two rounds of expert consultation, a structured education course for patients with neurogenic bladder during the rehabilitation period was finally developed, including six primary indicators, 21 secondary indicators, and 30 tertiary indicators. Conclusions:The structured education course for patients with neurogenic bladder during the rehabilitation period, based on current situation survey, high-quality evidence, and expert consultation, is comprehensive in content and reasonably designed, which can provide supportive assistance for future nursing health education and management for patients with neurogenic bladder.

Objective To evaluate the correlation between 3D morphological parameters of aneurysms based on the computer-assisted semi-automated measurement and the risk of aneurysm rupture.Methods From October 2019 to October 2022,patients with ruptured multiple aneurysms admitted to the Department of Neurosurgery of Xuanwu Hospital,Capital Medical University were retrospectively included.Aneurysmal morphological parameters(including aneurysmal diameter,maximum diameter,width,neck width,volume,flow angle,parental artery diameter,surface area,wave index and non-spherical index)were measured by computer-assisted semi-automated measurement methods.The length-to-width ratio,wide-to-neck ratio,aspect ratio and size ratio were calculated,and the aneurysm location information was recorded.The ruptured aneurysms in multiple aneurysms were included in the ruptured group,and the remaining aneurysms were included in the unruptured group.Uni variable analysis and binary Logistic analysis were used to evaluate the differences in morphological parameters and location information between the ruptured and unruptured groups.Results All 56 patients with multiple ruptured aneurysms and a total of 126aneurysms were included in the group for analysis.Concerning morphology,including diameter＞5 mm(51.8％[29/56]vs.15.7％[11/70],P＜0.01),maximum diameter＞6mm(57.1％[32/56]vs.25.7％[18/70],P＜0.01),flow angle＞107°(57.1％[32/56]vs.35.7％[25/70],P=0.016),wide-to-neck ratio＞1.1(50.0％[28/56]vs.30.0％[21/70],P=0.022),aspect ratio＞1.1(46.4％[26/56]vs.25.7％[18/70],P=0.015)and size ratio＞1.9(57.1％[32/56]vs.10.0％[7/70],P＜0.01),there was significant difference between the ruptured and unruptured group;Concerning locations,aneurysms are mainly located in the posterior communicating segment of the internal carotid artery(39.3％[22/56])and the middle cerebral artery(23.2％[13/56])in ruptured group,while in the middle cerebral artery(28.6％[20/70])and the non-posterior communicating segment of internal carotid artery(27.1％[19/70])in unruptured group,and there was significant difference in distribution of aneurysm locations(P=0.003).Multivariate Logistic regression analysis showed that size ratio＞1.9 was an independent risk factor for aneurysm rupture(OR,11.62,95％CI 2.40-56.15;P=0.002).Concerning locations,posterior communicating artery aneurysms had a significantly higher risk of rupture compared with the non-posterior communicating segment of internal carotid artery(OR,19.25,95％CI 2.19-169.51;P=0.008).Conclusion For multiple intracranial aneurysms,the size ratio of the three-dimensional morphological parameters of aneurysms＞1.9 is an independent risk factor for aneurysm rupture,and the rupture risk of posterior communicating artery aneurysms is significantly higher than that of non-posterior communicating segment of internal carotid artery.

Objective To create a semi-automatic technology based on convolutional neural networks for saccular aneurysm segmentation.Methods The single-center data of Xuanwu Hospital of Capital Medical University in the database of"China Intracranial Aneurysm Program"from July 2017 to July 2020 were retrospectively included,and all data were anonymized before analysis.Baseline data were collected from all patients,including sex,age(≥60 years and＜60 years),DSA model,number of DSA sequences,and aneurysm information,including the number of aneurysms,diameter(≥5 mm and＜5 mm),neck width(wide neck,narrow neck),and location(bifurcation,sidewall).According to the ratio of 8∶1∶1,the data were randomly divided into training set,test set and validation set by random number table method.The DSA 3D tomography data of all patients were completed in the contrast machine using the 3D rotary DSA mode,and the aneurysms shown in the DSA 3D tomography data were annotated by 3 experienced neurosurgeons,and the standard label of the aneurysm was finally generated.The proposed aneurysm segmentation method consisted of a training stage and a segmentation stage.In the training stage,the model was trained end-to-end by using the DSA 3D tomography image data of the training set,the segmentation label of the aneurysm and the vascular edge information extracted by the Marching Cubes algorithm,and the segmentation index of the model was monitored on the test set to retain the model with the highest segmentation index.In the segmentation stage,the physician selects a point inside the aneurysm on the DSA 3D tomography image of the aneurysm in the validation set,intercepts the volume of interest(VOI),inputs the trained optimal model of vascular and aneurysm segmentation,obtains the segmentation result of the aneurysm,and locates the segmented VOI back to the original DSA 3D tomography image to obtain the final aneurysm outline.The segmentation results of the segmentation network model were compared with standard labels to calculate the Dice similarity coefficient(DSC).The validation set data was stratified by aneurysm diameter,neck width,and location to compare the segmentation results in different datasets.We calculated the bounding boxes for the length,width,and height of the aneurysm segmentation mask,and used the maximum of these as the longest diameter of the aneurysm compared to the maximum diameter in the standard label.In the validation set,the standard label manual acquisition time was counted and compared with the segmentation network model acquisition time(from the time of locating the aneurysm to obtaining a satisfactory aneurysm neck segmentation).Results Finally,969 DSA sequences from 756 patients were included to show 3D tomographic data for 1 094 aneurysms.Among them,604 patients with 877 aneurysms with a total of 783 DSA sequences were included in the training set,117 aneurysms with a total of 100 DSA sequences in 77 patients were included in the test set,and 100 aneurysms with a total of 86 DSA sequences were included in 75 patients in the validation set.(1)The baseline comparison results of each dataset showed that there were statistically significant differences between the datasets of aneurysm diameter(P=0.003)and aneurysm location(P=0.003).There was no significant difference between the remaining baseline data sets(all P＞0.05).(2)The mean DSC of centralized aneurysm segmentation was 0.868±0.078.The mean DSC of aneurysm segmentation≥5 mm diameter was higher than that of aneurysms with＜5 mm diameter(0.891±0.041 vs.0.855±0.088,P=0.038).The DSC values of narrow-necked,wide-necked,bifurcated and lateral wall aneurysms were 0.882±0.065,0.859±0.085,0.876±0.072 and 0.863±0.080,respectively,and there was no significant difference between the groups(all P＞0.05).(3)The maximum diameter of the mask obtained by the aneurysm segmentation model in the validation set was in good agreement with the maximum diameter of the standard label obtained by manual segmentation([5.78±3.18]mm vs.[5.37±2.92]mm,r=0.97).In the validation set,the average time of manual segmentation and neural network segmentation of aneurysms was 2.5 min and 34 s,respectively.Conclusion In this study,a semi-automatic saccular aneurysm segmentation technique based on convolutional neural network can accurately segment aneurysms and is helpful to improve aneurysm morphology analysis.

The neural circuit is the material carrier for the realization of brain function,consisting of a complex network of different neurons.Neural circuit identification technology tracks the structure and activity of specific neural circuits,to study their adequacy and necessity for brain function,which is crucial for understanding the pathogenesis of brain diseases.As a high-tech tool in the fields of neuroscience and brain science,neural circuit identification technology has been gradually introduced into basic traditional Chinese medicine(TCM)research in recent years.This systematic review considers the principles of neural circuit identification technology and progress in its application in the field of TCM neuroscience.We note that future developments in this field should be based on the overall concept of TCM characteristics and the design of syndrome differentiation and treatment.Further research on the neural circuit mechanisms of diverse method of TCM in diseases will help to promote the deep integration of TCM and modern neuroscience.

Chemogenetic technology is a receptor-ligand system that regulates cell viability and function by changing receptor specificity and affinity, and it achieves precise neuronal regulation by specifically regulating neurons and neural circuits. At present, this technique is widely used in the study of neural circuits. This article briefly describes the application and progress of chemogenetic technology in the study of depression neural circuits, reviews the application of chemogenetic technology in several brain regions closely related to depression, such as ventral tegmental area, nucleus accumbens, prefrontal cortex, hippocampus and lateral habenula, and discusses the potential and challenges of chemogenetic technology as a technology for precise regulation of neural activity in future research, in order to provide reliable ideas and directions for chemogenetic technology in the study of depression neural circuits.

Objective:To report the results of national surveillance on the distribution and antimicrobial resistance profile of clinical Gram-positive bacteria isolates from bloodstream infections in China in 2022.Methods:The clinical isolates of Gram-positive bacteria from blood cultures in member hospitals of National Bloodstream Infection Bacterial Resistant Investigation Collaborative System（BRICS）were collected during January 2022 to December 2022. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical and Laboratory Standards Institute（CLSI）. WHONET 5.6 and SPSS 25.0 software were used to analyze the data.Results:A total of 3 163 strains of Gram-positive pathogens were collected from 51 member units，and the top five bacteria were Staphylococcus aureus（ n=1 147，36.3%），coagulase-negative Staphylococci（ n=928，29.3%）， Enterococcus faecalis（ n=369，11.7%）， Enterococcus faecium（ n=296，9.4%）and alpha-hemolyticus Streptococci（ n=192，6.1%）. The detection rates of methicillin-resistant Staphylococcus aureus（MRSA）and methicillin-resistant coagulase-negative Staphylococci（MRCNS）were 26.4%（303/1 147）and 66.7%（619/928），respectively. No glycopeptide and daptomycin-resistant Staphylococci were detected. The sensitivity rates of Staphylococcus aureus to cefpirome，rifampin，compound sulfamethoxazole，linezolid，minocycline and tigecycline were all >95.0%. Enterococcus faecium was more prevalent than Enterococcus faecalis. The resistance rates of Enterococcus faecium to vancomycin and teicoplanin were both 0.5%（2/369），and no vancomycin-resistant Enterococcus faecium was detected. The detection rate of MRSA in southern China was significantly lower than that in other regions（ χ2=14.578， P=0.002），while the detection rate of MRCNS in northern China was significantly higher than that in other regions（ χ2=15.195， P=0.002）. The detection rates of MRSA and MRCNS in provincial hospitals were higher than those in municipal hospitals（ χ2=13.519 and 12.136， P<0.001）. The detection rates of MRSA and MRCNS in economically more advanced regions（per capita GDP≥92 059 Yuan in 2022）were higher than those in economically less advanced regions（per capita GDP<92 059 Yuan）（ χ2=9.969 and 7.606， P=0.002和0.006）. Conclusions:Among the Gram-positive pathogens causing bloodstream infections in China， Staphylococci is the most common while the MRSA incidence decreases continuously with time；the detection rate of Enterococcus faecium exceeds that of Enterococcus faecalis. The overall prevalence of vancomycin-resistant Enterococci is still at a low level. The composition ratio of Gram-positive pathogens and resistant profiles varies slightly across regions of China，with the prevalence of MRSA and MRCNS being more pronounced in provincial hospitals and areas with a per capita GDP≥92 059 yuan.

Objective:To explore the expressions of zinc homeostasis-related proteins,G protein-coupled receptor 39(GPR39)and ANO1 mRNA in the sperm of patients with asthenozoospermia(AS),and analyze their correlation with sperm motility.Methods:We collected semen samples from 82 male subjects with PR+NP＜40％,PR＜32％and sperm concentration＞15 × 106/ml(the AS group,n=40)or PR+NP≥40％,PR≥32％and sperm concentration＞15 × 106/ml(the normal control group,n=42).We analyzed the routine semen parameters and measured the zinc content in the seminal plasma using the computer-assisted sperm analysis system,detected the expressions of zinc transporters(ZIP13,ZIP8 and ZNT10),metallothioneins(MT1G,MT1 and MTF),GPR39,and calcium-dependent chloride channel protein(ANO1)in the sperm by real-time quantitative PCR(RT qPCR),examined free zinc distribution in the sperm by laser confocal microscopy,and determined the expressions of GPR39 and MT1 proteins in the sperm by immunofluorescence staining,followed by Spearman rank correlation analysis of their correlation with semen parameters.Results:There was no statistically significant difference in the zinc concentration in the seminal plasma between the AS and normal control groups(P＞0.05).Compared with the controls,the AS patients showed a significantly reduced free zinc level(P＜0.05),relative expressions of MT1G,MTF,ZIP13,GPR39 and ANO1 mRNA(P＜0.05),and that of the GPR39 protein in the AS group(P＜0.05).No statistically significant differences were observed in the relative expression levels of ZIP8,ZNT10 and MT1 mRNA between the two groups(P＞0.05).The relative expression levels of GPR39,ANO1,MT1G and MTF mRNA were positively correlated with sperm motility and the percentage of progressively motile sperm(P＜0.05).Conclusion:The expressions of zinc homeostasis proteins(MT1G,MTF and ZIP13),GPR39 and ANO1 mRNA are downregulated in the sperm of asthenozoospermia pa-tients,and positively correlated with sperm motility.

Autism spectrum disorder(ASD)is a pervasive neurodevelopmental disorder with onset in infancy or early childhood.Mendelian randomization(MR)is a statistical method used to infer causal relationships between exposures and outcomes.This article summarizes MR studies related to ASD.Existing research supports a causal relationship between maternal inflammatory bowel disease in children with ASD,parental education levels,screen time exposure,obesity,insomnia,serum transferrin,decreased blood selenium,abnormal signals in brain functional MRI,interleukin-6,phosphodiesterase 2A,mitogen-activated protein kinase kinase 3,mitochondrial ribosomal protein L33,serotonin,and ASD.However,it does not support a causal relationship between parental rheumatoid arthritis,systemic lupus erythematosus,neonatal jaundice in children with ASD,cytomegalovirus infection,asthma,oral ulcers,vitamin D levels,and ASD.This article reviews the etiological factors related to ASD and MR studies,aiming to explore and deepen the understanding of the pathophysiology of ASD.It provides strong statistical support for the prevention,diagnosis,and treatment of ASD,and offers new methods and strategies for the etiological analysis of complex traits.