Objective To investigate the efficacy and the collective brain responses of acupuncture for post-stroke limb numbness.Methods A total of 24 patients with post-stroke limb numbness and 23 matched healthy participants were recruited.Both groups received coordinated acupuncture treatment to regulate their physical and mental state,three times a week for 4 weeks.Changes in limb numbness assessed by the visual analog scale(VAS)were observed before and after acupuncture.Functional magnetic resonance imaging(fMRI)scans were conducted on the participants during the scanning process with acupuncture intervention.Blood oxygen level-dependent(BOLD)data were collected in three states:resting state,acupuncture task state,and needle retention state.Data processing was performed using software such as fMRIPrep and brainIAK.Intersubject correlation(ISC)analysis was conducted to compare the ISC values of different brain regions between the two groups under different conditions.Results Acupuncture treatment significantly reduced the VAS scores of limb numbness.No significant changes in ISC values in both groups during resting state.Under acupuncture conditions,the patient group exhibited significantly increased ISC values in the left precentral gyrus,left paracentral lobule,left postcentral gyrus,left insula,left anterior cingulate gyrus,right middle frontal gyruss and right anterior cingulate gyrus.Under the needle retention condition,a slight negative activation was observed in the bilateral precentral gyrus of the control group.In the patient group,the ISC values of the left superior frontal gyrus,left precentral gyrus,left paracentral lobule,left precuneus,left postcentral gyrus,left insula,left anterior cingulate gyrus,left thalamus,right superior frontal gyrus,right middle frontal gyrus,right precentral gyrus,and right anterior cingulate gyrus showed a significant increase compared to the resting state.Conclusion Acupuncture can improve post-stroke limb numbness symptoms and induce a specific pattern of collective brain activation in patients.This activation involves the precentral gyrus,postcentral gyrus,thalamus,insula,frontal lobe and cingulate gyrus.Acupuncture may enhance the processing of sensory information by activating the somatosensory-motor network and the cortical-thalamic-cortical loop.It may also modulate the central executive network and the descending pain control pathway to promote the relief of pain symptoms.

【Objective】 To explore the diagnosis and treatment of mixed germ cell tumor (MGCT). 【Methods】 Clinical data of 11 confirmed MGCT cases treated in our hospital during Mar.2017 and Aug.2022 were retrospectively analyzed. The clinical characteristics, treatment methods and therapeutic effects were analyzed. The relevant literature and guidelines were discussed. 【Results】 MGCT cases accounted for 18.3% (11/60) of testicular cancer(TC) cases and 21.2% (11/52) of germ cell tumor (GCT) cases treated in our department during the same period. All 11 MGCT cases had unilateral lesions, which were on the left side in 7 cases, and on the right side in 4 cases, with a ratio of left to right side of 1.75∶1. The age of onset ranged from 21 to 52 years, average (29.8±8.7) years. All cases received unilateral radical orchiectomy(RO), 7 received retroperitoneal lymph node dissection(RPLND) (1 robotic RPLND), 6 received postoperative chemotherapy, and 1 received postoperative radiotherapy. During the follow-up of 2 to 66 [average (31.9±20.9)months] , no recurrence or metastasis were observed. 【Conclusion】 MGCT is a relatively rare malignant tumor in clinical practice, with worse prognosis than seminoma germ cell tumor (SGCT). Standardized diagnosis and treatment based on the special characteristics of each pathological type can improve the survival.

Sequencing-based spatial transcriptomics(ST)is an emerging technology to study in situ gene expression patterns at the whole-genome scale.Currently,ST data analysis is still complicated by high technical noises and low resolution.In addition to the transcriptomic data,matched histopathological images are usually generated for the same tissue sample along the ST experiment.The matched high-resolution histopathological images provide complementary cellular phenotypi-cal information,providing an opportunity to mitigate the noises in ST data.We present a novel ST data analysis method called transcriptome and histopathological image integrative analysis for ST(TIST),which enables the identification of spatial clusters(SCs)and the enhancement of spatial gene expression patterns by integrative analysis of matched transcriptomic data and images.TIST devises a histopathological feature extraction method based on Markov random field(MRF)to learn the cellular features from histopathological images,and integrates them with the transcrip-tomic data and location information as a network,termed TIST-net.Based on TIST-net,SCs are identified by a random walk-based strategy,and gene expression patterns are enhanced by neighborhood smoothing.We benchmark TIST on both simulated datasets and 32 real samples against several state-of-the-art methods.Results show that TIST is robust to technical noises on multiple analysis tasks for sequencing-based ST data and can find interesting microstructures in dif-ferent biological scenarios.TIST is available at http://lifeome.net/software/tist/and https://ngdc.cncb.ac.cn/biocode/tools/BT007317.

Background::It is crucial to improve the quality of care provided to ICU patient, therefore a national survey of the medical quality of intensive care units (ICUs) was conducted to analyze adherence to quality metrics and outcomes among critically ill patients in China from 2015 to 2019.Methods::This was an ICU-level study based on a 15-indicator online survey conducted in China. Considering that ICU care quality may vary between secondary and tertiary hospitals, direct standardization was adopted to compare the rates of ICU quality indicators among provinces/regions. Multivariate analysis was performed to identify potential factors for in-hospital mortality and factors related to ventilator-associated pneumonia (VAP), catheter-related bloodstream infections (CRBSIs), and catheter-associated urinary tract infections (CAUTIs).Results::From the survey, the proportions of structural indicators were 1.83% for the number of ICU inpatients relative to the total number of inpatients, 1.44% for ICU bed occupancy relative to the total inpatient bed occupancy, and 51.08% for inpatients with Acute Physiology and Chronic Health Evaluation II scores ≥15. The proportions of procedural indicators were 74.37% and 76.60% for 3-hour and 6-hour surviving sepsis campaign bundle compliance, respectively, 62.93% for microbiology detection, 58.24% for deep vein thrombosis prophylaxis, 1.49% for unplanned endotracheal extubations, 1.99% for extubated inpatients reintubated within 48 hours, 6.38% for unplanned transfer to the ICU, and 1.20% for 48-hour ICU readmission. The proportions of outcome indicators were 1.28‰ for VAP, 3.06‰ for CRBSI, 3.65‰ for CAUTI, and 10.19% for in-hospital mortality. Although the indicators varied greatly across provinces and regions, the treatment level of ICUs in China has been stable and improved based on various quality control indicators in the past 5 years. The overall mortality rate has dropped from 10.19% to approximately 8%.Conclusions::The quality indicators of medical care in China’s ICUs are heterogeneous, which is reflected in geographic disparities and grades of hospitals. This study is of great significance for improving the homogeneity of ICUs in China.

The perivascular space is formed by the pia mater around the blood vessels and participates in the fluid exchange and waste clearance in the brain. The enlarged perivascular space (EPVS) indicates the disorder of brain clearance mechanism, which is closely related to the occurrence and development of a variety of clinical diseases. In recent years, there are a lot of studies on the pathogenesis and influencing factors of EPVS. This article reviews its anatomy, neuroimaging, pathogenesis, and risk factors.

A large number of studies have shown that the elevated lipoprotein (a) is a risk factor for ischemic stroke, but the specific mechanism is still unclear. Therefore, this article reviews the role of elevated lipoprotein (a) in ischemic stroke, its mechanism, and intervention measures.

Post-stroke cognitive impairment (PSCI) directly affects the outcome of patients with stroke. Enlarged perivascular spaces (EPVS) suggest the impairment of brain clearance mechanism and may affect cognitive function. More and more studies have confirmed that the presence of EPVS will aggravate PSCI. This article reviews the relationship between EPVS and PSCI.

Objective:To investigate the acceptance of advance care planning and its influencing factors in heart failure patients.Methods:A total of 208 patients with heart failure were surveyed by general data questionnaires and advance care planning acceptance questionnaires.Results:The total score of advance care planning acceptance of heart failure patients was (44.26 ± 11.73), the score of feeling dimension was (13.67 ± 5.72), the score of attitude dimension was (30.59 ± 6.33). 53.4%(111/208) of patients were willing to accept the talking about advance care planning. Regression analysis results showed that education level, New York Heart Association (NYHA) classification, communication status with medical staff and whether they had received life-sustaining treatment were important factors influencing of the acceptance of advance care planning in patients with heart failure.Conclusion:Patients with heart failure had higher acceptance of advance care planning. In clinical work, it is necessary to strengthen the scientific popularization of advance care planning in patients with low education level, low NYHA grade and no exposure to life-sustaining treatment. And strengthen the daily communication with patients to prepare for the follow-up advance care planning related communication.

Objective: To observe the changes of liver function, virology and serology and the safety of drug withdrawal in pregnant women who are chronic hepatitis B virus (HBV) carriers. Methods: A prospective clinical cohort was established to enroll pregnant women who are chronic HBV carriers and they were divided into the nucleoside/nucleotide analogs (NAs) intervention group and the non-NAs intervention group according to patients' wishes. Liver function, HBV DNA and HBV serological markers were detected at gestation, postpartum 6 weeks, 12 weeks, 24 weeks, 36 weeks and 48 weeks. Results: 351 patients were enrolled, 320 in the NAs intervention group and 31 in the non-NAs intervention group. The proportion of postpartum hepatitis flares in both groups was higher than that in pregnancy (39.4% vs 12.5%, P < 0.001; 38.7% vs 3.2%, P = 0.001). Six weeks postpartum was the peak period of hepatitis flares, and 96.0% (121/126) of the hepatitis flares occurred within 24 weeks postpartum. At 6 weeks postpartum, there were 6 cases of alanine aminotransferase (ALT) ≥ 10 times upper limit of normal (ULN) in the NAs intervention group. The rate of the hepatitis flare after drug withdrawal was 16.7% (34/203). Conclusion Regardless of the presence or absence of NAs intervention, pregnant women who are chronic HBV carriers have a certain proportion of hepatitis flares during pregnancy and postpartum, and the hepatitis flare even have a tendency to be severe. Therefore, drug withdrawal after delivery is not always safe, which requires close observation and classification. At 6 weeks postpartum, the incidence of hepatitis flares was high, and those who meet the treatment indications can get better therapeutic effects if given appropriate treatment. The vast majority (96%) of postpartum hepatitis flares occur within 24 weeks, so it is recommended to follow up to at least 24 weeks postpartum after discontinuation.