Objective:To investigate the efficacy of Ginkgo biloba tablets as an adjunctive therapy to conventional western medicine in treating cerebral infarction beyond the intravenous thrombolysis time window.Methods:A total of 96 patients with cerebral infarction beyond the intravenous thrombolysis time window who were treated at Bayannur Hospital from December 2021 to December 2023 were included in this study. Using the random digital table method, these patients were assigned to an observation group and a control group ( n = 48 per group). The control group received conventional Western medicine treatment, while the observation group received Ginkgo biloba tablets in addition to conventional Western medicine. Cerebral hemodynamics, oxidative stress indicators, and levels of nerve injury markers were measured and compared between the two groups. Additionally, the neurological deficits and self-care abilities of the patients were assessed, and any adverse reactions, such as gastrointestinal discomfort and gingival bleeding, were recorded throughout the treatment period. Results:After treatment, the average blood flow velocities of the anterior, middle, and posterior cerebral arteries in the observation group were significantly higher than those in the control group [(50.31 ± 5.22) cm/s vs. (43.25 ± 4.47) cm/s, (60.82 ± 6.14) cm/s vs. (52.63 ± 5.31) cm/s, (44.97 ± 4.63) cm/s vs. (39.85 ± 4.02) cm/s, t = -7.12, -6.99, -5.78, all P < 0.001]. Additionally, the serum catalase levels in the observation group were significantly higher than those in the control group, while the malondialdehyde levels were significantly lower in the observation group [(124.03 ± 12.74) U/mL vs. (104.25 ± 11.01) U/mL, (3.11 ± 0.32) mmol/L vs. (4.02 ± 0.43) mmol/L, t = -8.14, 11.76, both P < 0.001]. The levels of S100β protein and neuron-specific enolase in the observation group were also significantly lower than those in the control group ( t = 9.32, 17.32, both P < 0.001). The National Institutes of Health Stroke Scale scores in the observation group were significantly lower than those in the control group, and Barthel Index scores in the observation group were significantly higher than those in the control group ( t = 17.46, -9.09, both P < 0.001). There was no statistically significant difference in the overall incidence of adverse reactions, such as gastrointestinal discomfort and rashes, between the two groups ( χ2 = 0.38, P > 0.05). Conclusions:The use of Ginkgo biloba tablets as an adjunctive therapy to conventional Western medicine in patients with cerebral infarction beyond the thrombolysis time window can promote the recovery of cerebral hemodynamics, reduce oxidative stress responses, and provide neuroprotective effects. This treatment can improve patients' neurological function and self-care abilities while ensuring high safety.

Objective:To systematically evaluate the barriers for clinical nurses to implement enteral nutrition.Methods:Qualitative studies on barriers for clinical nurses to implement enteral nutrition were electronically retrieved from PubMed, Cochrane Library, CINAHL, PsycINFO, Embase, Web of Science, China National Knowledge Infrastructure, WanFang Data, and China Biology Medicine disc. The search period was from establishing of the database to January 15, 2024. The included literature was subjected to quality evaluation, and the aggregative synthesis method was used for Meta-synthesis.Results:A total of 11 articles were included, 30 results were extracted, and ten categories were summarized to form four integrated results, including individual factors (poor patient compliance, complex and diverse clinical conditions of patients, insufficient cognitive and executive abilities of nurses), evidence related factors (weak applicability of evidence, excessive evidence and recommendations related to enteral nutrition), organizational factors (lack of multidisciplinary team collaboration, lack of supervision from management departments, lack of enteral nutrition training), and resource-related factors (insufficient human resources, inadequate medical or infrastructure resources) .Conclusions:There are multiple barriers for clinical nurses to implement enteral nutrition. Clinical nurses should improve the nutritional knowledge of patients and their families, strengthen the training of clinical nurses on enteral nutrition, integrate clinical situations, continuously improve evidence, strengthen multidisciplinary collaboration, unify standards and regulations, strengthen organizational management, allocate resources reasonably to improve the decisions and practices of enteral nutrition management.

Objective:To propose a deep learning（DL）-based ultrasound imaging auxiliary tool for automatic segmentation and recognition of the brachial plexus（BP），and to enhance the accuracy and safety of clinical procedures.Methods:It was a multicenter study that collected 773 healthy subjects from Peking University Third Hospital and its branch campuses，the Third Medical Center of the Chinese PLA General Hospital，and Shanghai Eighth People's Hospital between August 2024 and February 2025. Brachial plexus（BP）images in the interscalene groove were captured used high-frequency ultrasound by senior sonographers，a dataset comprising 1 289 standardized images were constructed and the improved model（CHA-TransUNet）was trained. The test set was input into 6 different models（CHA-TransUNet，R50-Unet，TransUnet，SegFormer，SwinUnet，MISSFormer）for segmentation. Segmentation accuracy was evaluated using metrics including the Dice similarity coefficient（DSC），95% Hausdorff distance（HD95）and mean intersection over union（mIoU），and was compared with the segmentation results of 3 ultrasound physicians with varying experience levels（junior physicians and senior physicians）to validate the model's segmentation efficacy.Results:The CHA-TransUNet model established based on a dataset of 1 289 standardized images achieved segmentation results for the BP with a DSC of 90.15%，mIoU of 91.02%，and HD95 of 8.08. Its accuracy was higher than other mainstream models（DSC：90.15% vs. 87.60%，87.77%，81.35%，84.78%，84.55%），significantly better than junior physicians（DSC：90.15% vs. 68.73%， Z=-127.76， P<0.001），and approached the level of senior physician（DSC：90.15% vs. 86.15%， Z=-31.33， P=0.549）. The model demonstrated superior boundary recognition in complex anatomical structures（e.g.，C6/C7 nerve roots）compared to ultrasound physicians（junior and senior）（HD95：8.08 vs. 26.34，17.44，56.80）. Conclusions:This study proposes an analysis model for BP ultrasound images，CHA-TransUNet. This model achieves segmentation and recognition of the BP with relatively complex pathways and structures. The model exhibits high accuracy and stability，outperforming current mainstream network models and junior physicians while approaching the performance level of senior physicians. It assists junior physicians or trainees in more accurately identifying and localizing the BP.

Objective:To investigate the efficacy of Ginkgo biloba tablets as an adjunctive therapy to conventional western medicine in treating cerebral infarction beyond the intravenous thrombolysis time window.Methods:A total of 96 patients with cerebral infarction beyond the intravenous thrombolysis time window who were treated at Bayannur Hospital from December 2021 to December 2023 were included in this study. Using the random digital table method, these patients were assigned to an observation group and a control group ( n = 48 per group). The control group received conventional Western medicine treatment, while the observation group received Ginkgo biloba tablets in addition to conventional Western medicine. Cerebral hemodynamics, oxidative stress indicators, and levels of nerve injury markers were measured and compared between the two groups. Additionally, the neurological deficits and self-care abilities of the patients were assessed, and any adverse reactions, such as gastrointestinal discomfort and gingival bleeding, were recorded throughout the treatment period. Results:After treatment, the average blood flow velocities of the anterior, middle, and posterior cerebral arteries in the observation group were significantly higher than those in the control group [(50.31 ± 5.22) cm/s vs. (43.25 ± 4.47) cm/s, (60.82 ± 6.14) cm/s vs. (52.63 ± 5.31) cm/s, (44.97 ± 4.63) cm/s vs. (39.85 ± 4.02) cm/s, t = -7.12, -6.99, -5.78, all P < 0.001]. Additionally, the serum catalase levels in the observation group were significantly higher than those in the control group, while the malondialdehyde levels were significantly lower in the observation group [(124.03 ± 12.74) U/mL vs. (104.25 ± 11.01) U/mL, (3.11 ± 0.32) mmol/L vs. (4.02 ± 0.43) mmol/L, t = -8.14, 11.76, both P < 0.001]. The levels of S100β protein and neuron-specific enolase in the observation group were also significantly lower than those in the control group ( t = 9.32, 17.32, both P < 0.001). The National Institutes of Health Stroke Scale scores in the observation group were significantly lower than those in the control group, and Barthel Index scores in the observation group were significantly higher than those in the control group ( t = 17.46, -9.09, both P < 0.001). There was no statistically significant difference in the overall incidence of adverse reactions, such as gastrointestinal discomfort and rashes, between the two groups ( χ2 = 0.38, P > 0.05). Conclusions:The use of Ginkgo biloba tablets as an adjunctive therapy to conventional Western medicine in patients with cerebral infarction beyond the thrombolysis time window can promote the recovery of cerebral hemodynamics, reduce oxidative stress responses, and provide neuroprotective effects. This treatment can improve patients' neurological function and self-care abilities while ensuring high safety.

Objective:To systematically evaluate the barriers for clinical nurses to implement enteral nutrition.Methods:Qualitative studies on barriers for clinical nurses to implement enteral nutrition were electronically retrieved from PubMed, Cochrane Library, CINAHL, PsycINFO, Embase, Web of Science, China National Knowledge Infrastructure, WanFang Data, and China Biology Medicine disc. The search period was from establishing of the database to January 15, 2024. The included literature was subjected to quality evaluation, and the aggregative synthesis method was used for Meta-synthesis.Results:A total of 11 articles were included, 30 results were extracted, and ten categories were summarized to form four integrated results, including individual factors (poor patient compliance, complex and diverse clinical conditions of patients, insufficient cognitive and executive abilities of nurses), evidence related factors (weak applicability of evidence, excessive evidence and recommendations related to enteral nutrition), organizational factors (lack of multidisciplinary team collaboration, lack of supervision from management departments, lack of enteral nutrition training), and resource-related factors (insufficient human resources, inadequate medical or infrastructure resources) .Conclusions:There are multiple barriers for clinical nurses to implement enteral nutrition. Clinical nurses should improve the nutritional knowledge of patients and their families, strengthen the training of clinical nurses on enteral nutrition, integrate clinical situations, continuously improve evidence, strengthen multidisciplinary collaboration, unify standards and regulations, strengthen organizational management, allocate resources reasonably to improve the decisions and practices of enteral nutrition management.

Objective:To propose a deep learning（DL）-based ultrasound imaging auxiliary tool for automatic segmentation and recognition of the brachial plexus（BP），and to enhance the accuracy and safety of clinical procedures.Methods:It was a multicenter study that collected 773 healthy subjects from Peking University Third Hospital and its branch campuses，the Third Medical Center of the Chinese PLA General Hospital，and Shanghai Eighth People's Hospital between August 2024 and February 2025. Brachial plexus（BP）images in the interscalene groove were captured used high-frequency ultrasound by senior sonographers，a dataset comprising 1 289 standardized images were constructed and the improved model（CHA-TransUNet）was trained. The test set was input into 6 different models（CHA-TransUNet，R50-Unet，TransUnet，SegFormer，SwinUnet，MISSFormer）for segmentation. Segmentation accuracy was evaluated using metrics including the Dice similarity coefficient（DSC），95% Hausdorff distance（HD95）and mean intersection over union（mIoU），and was compared with the segmentation results of 3 ultrasound physicians with varying experience levels（junior physicians and senior physicians）to validate the model's segmentation efficacy.Results:The CHA-TransUNet model established based on a dataset of 1 289 standardized images achieved segmentation results for the BP with a DSC of 90.15%，mIoU of 91.02%，and HD95 of 8.08. Its accuracy was higher than other mainstream models（DSC：90.15% vs. 87.60%，87.77%，81.35%，84.78%，84.55%），significantly better than junior physicians（DSC：90.15% vs. 68.73%， Z=-127.76， P<0.001），and approached the level of senior physician（DSC：90.15% vs. 86.15%， Z=-31.33， P=0.549）. The model demonstrated superior boundary recognition in complex anatomical structures（e.g.，C6/C7 nerve roots）compared to ultrasound physicians（junior and senior）（HD95：8.08 vs. 26.34，17.44，56.80）. Conclusions:This study proposes an analysis model for BP ultrasound images，CHA-TransUNet. This model achieves segmentation and recognition of the BP with relatively complex pathways and structures. The model exhibits high accuracy and stability，outperforming current mainstream network models and junior physicians while approaching the performance level of senior physicians. It assists junior physicians or trainees in more accurately identifying and localizing the BP.

Objective To explore the interventional effect of repetitive transcranial magnetic stimulation (rTMS) on tardive dyskinesia (TD) in schizophrenic patients. Methods A total of 105 schizophrenic patients were selected as subjects and randomly divided into 1 Hz treatment group, 10 Hz treatment group and control group, with 35 patients in each group. All three groups received rTMS treatment for 12 weeks. The Abnormal Involuntary Movement Scale (AIMS), Scale for the Assessment of Negative Symptoms (SANS), Positive and Negative Syndrome Scale (PANSS) and Treatment Emergent Symptom Scale (TESS) scores were compared among the three groups. Physiological indicators such as electrocardiogram, blood routine, blood biochemistry and hormone levels were monitored. Results After treatment, the total AIMS scores in the 1 Hz and 10 Hz treatment groups were significantly lower than before treatment, and those in the 1 Hz and 10 Hz treatment groups were significantly lower than those in the control group (P < 0.05). The reduction rates of AIMS scores in the 1 Hz and 10 Hz treatment groups were 68.6% and 65.7%, respectively, which were significantly higher than the 22.9% in the control group (P < 0.05). After treatment, the total SANS and PANSS scores in the 1 Hz and 10 Hz treatment groups were significantly lower than before treatment, and those in the 1 Hz and 10 Hz treatment groups were significantly lower than those in the control group (P < 0.05). There was no statistically significant difference in the total AIMS score, efficacy and total PANSS score between the 1 Hz and 10 Hz treatment groups (P>0.05). There were no significant differences in the total TESS scores and physiological indicators among the three groups before and after treatment (P>0.05). Conclusion Both 1 Hz and 10 Hz rTMS can effectively improve TD in schizophrenic patients with good safety and have no significant side effects or physiological damage.

Objective:To explore the effect of intervention model based on comprehensive nutrition management on glucose and lipid metabolism and pregnancy outcome in patients with gestational diabetes mellitus (GDM).Methods:104 GDM patients admitted to Shanxi Bethune Hospital from February 2022 to March 2023 were randomly divided into control group and experimental group, with 52 cases in each group. The control group implemented routine management measures and nutrition guidance, while the experimental group implemented an intervention model based on comprehensive nutrition management on the basis of routine management. The indexes of glucose and lipid metabolism (glycosylated hemoglobin, fasting blood glucose, 2 h postprandial blood glucose, total cholesterol, triglyceride and low density lipoprotein cholesterol), pregnancy outcome, self-management ability and self-efficacy were compared between the two groups before and after intervention.Results:Before the intervention, there was no significant difference in general situation, glucose and lipid metabolism index, self-management ability and self-efficacy between the two groups ( P>0.05). After the intervention, the level of glucose and lipid metabolism index in the experimental group was significantly lower than that in the control group, with statistical significance ( P<0.05). The incidence of adverse pregnancy outcome in the experimental group was significantly lower than that in the control group, with statistical significance ( P<0.05). The scores of self-management ability and self-efficacy in the experimental group were significantly higher than those in the control group, with statistical significance ( P<0.05). Conclusion:The intervention model based on comprehensive nutrition management can effectively improve the glucose and lipid metabolism index and pregnancy outcome of GDM patients, and significantly improve their self-management ability and self-efficacy related to nutrition management, which has high clinical application and promotion value.

Objective:To explore the impact of CACNA1C rs58619945 genotype on the cortical thickness of attentional networks in patients with Bipolar 1 disorder type (BD-Ⅰ). Methods:From August 2013 and August 2019, a total of 155 BD-Ⅰ patients were recruited from the outpatient and inpatient Departments of the Affiliated Brain Hospital of Guangzhou Medical University, along with 82 healthy controls (HC) from the community and university. Genotype for the CACNA1C rs58619945 locus was determined for all BD-I patients and HC subjects, followed by 3.0 T magnetic resonance imaging scans to measure the cortical thickness in the alert, orienting, and executive control subnetworks. General linear models (GLMs) were used to evaluate the impact of CACNA1C rs58619945 on the cortical thickness of attentional networks. Concurrently, attentional dimension functions were assessed using repeatable battery for the assessment of neuropsychological status (RBANS) and Cambridge neuropsychological test automated battery rapid visual information processing (CANTAB RVP) test. This study was approved by the Medical Ethics Committee of the Affiliated Brain Hospital of Guangzhou Medical University(Ethics No. 2023-056). Results:Compared with the HC group, the BD-Ⅰ patients had shown reduced thickness in bilateral prefrontal cortex, bilateral posterior cingulate cortex, and bilateral superior temporal cortex( P<0.05). A significant interaction between the CACNA1C genotype and the cortical thickness(HC vs.BD) of right prefrontal cortex, right posterior parietal cortex and right superior temporal cortex was noted( P<0.05). Partial correlation analysis has demonstrated a significant correlation between CANTAB RVP and RBANS attention indices and cortical thickness in the right prefrontal cortex, right posterior cingulate cortex( P<0.05), and right superior temporal cortex predominantly among carriers of the BD-Ⅰ G allele. Conclusion:The G allele of CACNA1C rs58619945 is associated with cortical thickness of the right prefrontal cortex, right posterior cingulate cortex, and right superior temporal cortex in BD-Ⅰ, which are part of the alerting and orienting network.

Background Organic ultraviolet (UV) filters are widely used in personal care products. So far, relevant studies on organic UV filters in indoor dust have been reported. Objective This study aims to establish a thermal desorption combined with gas chromatography-mass spectrometry (TD-GCMS) method to identify organic UV filters in indoor air collected from different indoor environments, so as to reveal the pollution levels and characteristics of organic UV filters in indoor environment. Methods Based on the standard indoor air sampling protocol, a total of 60 samples were collected from eight different kinds of indoor environments (male and female dormitory rooms, offices, labs, barber shops, printing shops, hotels, and private cars) on and nearby Minhang Campus of Shanghai Jiao Tong University from August to November, 2020. The concentrations of six common organic UV filters, including homosalate (HMS), 2-ethylhexyl salicylate (EHS), 3-(4-methylbenzylidene)-camphor (4-MBC), isoamyl 4-methoxycinnamate (IMC), octocrylene (OC), and octyl 4-methoxycinnamate (EHMC), in the air of different indoor environments were detected by TD-GCMS. Furthermore, the correlations of individual organic UV filters in different indoor environments were analysed. Results Under optimized detection conditions, the correlation coefficients of the quantitative standard curves of selected six organic UV filters were all at or above 0.997. The relative standard deviations of 1 mg·L⁻³ samples ranged from 1.74% to 7.11%, and the recoveries ranged from 67.17% to 106.5%. The relative standard deviations of 10 mg·L⁻³ samples ranged from 3.59% to 8.76%, and the recoveries ranged from 78.80% to 126.60%. The detection rates of the other five organic UV filters except IMC were all at or more than 92% in eight different kinds of indoor air. The median concentration of total organic UV filters was 75.17 ng·m⁻³, and EHS presented the highest median concentration of 28.55 ng·m⁻³. Regarding different indoor environments, the highest concentration of total organic UV filters was found in the female dormitory samples, 154.98 ng·m⁻³. The respective pair-analysis among HMS, EHMC, OC, and EHS of all indoor air samples reached a significant level of correlation (r=0.40-0.61, P<0.01). Conclusion The TD-GCMS method is satisfactory for the determination of organic UV filters in indoor air. EHS, EHMC, HMS, OC, and 4-MBC are identified in selected eight indoor environments, and they may have similar sources of pollution.