Objective To investigate the association of baseline cerebral blood flow （CBF） and cerebral metabolic rate of oxygen （CMRO2） with sleep structure disorder after thrombolytic therapy in stroke patients， as well as their value in clinical assessment. Methods A total of 145 patients with stroke were enrolled as subjects， and all of them received thrombolytic therapy in our hospital from January 2023 to June 2025. Before thrombolytic therapy， 3.0 T magnetic resonance imaging was used to obtain relative CBF （rCBF） and relative CMRO2 （rCMRO2）， and rCBF/rCMRO2 ratio was calculated. At week 1 after thrombolysis， overnight polysomnography （PSG） was conducted to obtain parameters such as total sleep time， sleep efficiency， the proportion of each NREM stage， and REM sleep duration. According to the presence or absence of sleep structure disorder， the subjects were divided into disorder group and non-disorder group. The Pearson correlation method was used for correlation analysis. A multivariate logistic regression analysis was used to identify the influencing factors for sleep structure disorder in subjects after thrombolytic therapy. The receiver operating characteristic （ROC） curve was plotted to analyze the performance of rCBF/rCMRO2 ratio in predicting sleep structure disorder in subjects after thrombolytic therapy. Results Compared with the non-disorder group， the disorder group had significantly higher age， infarct volume， NIHSS score on admission， and proportion of patients with infarction in the thalamus （P<0.05）. Compared with the non-disorder group， the disorder group had significantly lower rCBF， rCMRO2， rCBF/rCMRO2 ratio， total sleep time， proportion of NREM 3 sleep， proportion of REM sleep， and sleep efficiency （P<0.05） and significantly higher proportion of NREM 1 sleep and sleep arousal index （P<0.05）. The Pearson correlation analysis showed that rCBF， rCMRO2， and rCBF/rCMRO2 ratio were positively correlated with total sleep time， proportion of NREM 3 sleep， proportion of REM sleep， and sleep efficiency （P<0.001） and were negatively correlated with the proportion of NREM 1 sleep and sleep arousal index （P<0.001）. The Logistic regression analysis showed that age， infarct volume， infarction location （thalamus）， and NIHSS score on admission were risk factors for sleep structure disorder in stroke patients after thrombolytic therapy （P<0.05）， while rCBF， rCMRO2， and rCBF/rCMRO2 ratio were protective factors against sleep structure disorder （P<0.05）. The ROC curve analysis showed that rCBF/rCMRO2 ratio had an area under the ROC curve of 0.901 （95% CI 0.869-0.938） in predicting sleep structure disorder in stroke patients after thrombolytic therapy， with a sensitivity of 95.50% and a specificity of 82.40%. Conclusion Baseline rCBF， rCMRO2， and rCBF/rCMRO2 ratio are closely associated with sleep structure disorder in stroke patients after thrombolytic therapy， among which rCBF/rCMRO2 ratio has excellent performance in predicting sleep structure disorder and can be used as a sensitive indicator for clinical assessment of high-risk patients.
Stroke

Objective:To explore the effectiveness of interprofessional cooperative simulation in teaching emergency care for shock patients among intensive care unit (ICU) undergraduate nursing students.Methods:An interprofessional cooperative simulation-based teaching faculty team was established for ICU undergraduate nursing students, and a shock case library was developed. Using convenience sampling, 32 ICU undergraduate nursing students in 2022 were selected as the control group and received conventional simulation-based teaching, with students rotating through roles as nurses, standardized patients, doctors, and family members. In the experimental group, 34 ICU undergraduate nursing students in 2023 and 24 ICU clinical medicine interns were recruited to act as doctors for interprofessional cooperative simulation-based teaching. Each group was divided into subgroups, with each subgroup consisting of 4-5 nursing students. One group completed simulation-based training per month for a total of 8 sessions, with each session lasting 3 hours. The teaching adopted the on-site "tidal ward" in situ simulation, and the scenarios included patient history collection and health assessment, shock emergency care, nursing evaluation, and health education. The differences between the two groups of nursing students were compared in terms of ICU exit theoretical assessment score, objective structured clinical examination skill assessment score, and satisfaction with simulation-based teaching. SPSS 22.0 was used for independent samples t test and Mann-Whitney U test. Results:The experimental group achieved significantly higher scores in theoretical assessment (84.65±8.06), total score of satisfaction with simulation-based teaching (101.00±5.13), and clinical learning and multiprofessional team dimensions (47.32±3.35) compared to the control group ( P<0.001). The experimental group achieved higher scores in objective structured clinical examination skill assessment (81.40±7.22), guiding feedback and reflection (37.50±3.04), and judgmental thinking and clinical reasoning (16.00±2.03) compared to the control group, though the differences were not significant ( P=0.977, 0.668, and 0.636). Conclusions:Interprofessional cooperative simulation enhances the shock patient emergency care abilities and satisfaction with simulation-based teaching for undergraduate nursing students.

IgG4-related sclerosing cholangitis (IgG4-SC) is an IgG4-related disease charac-terized by bile duct wall thickening and luminal stricture. Its pathogenesis involves complex multi-dimensional regulation, including immune imbalance, genetic epigenetic regulation, microbial ecolo-gical abnormalities, and activation of fibrotic pathways. Due to the lack of specificity in clinical mani-festations, IgG4-SC is easily misdiagnosed as biliary tract diseases such as cholangiocarcinoma and primary sclerosing cholangitis in the early stage, leading to diagnostic difficulties. At present, gluco-corticoids are the preferred treatment option. Although most patients can quickly recover in the early stages, high recurrence rates and hormone dependence limit the long-term effectiveness of treatment. The authors combine the latest research progress at home and abroad to deeply analyze the pathogenesis, clinical manifestations, and diagnosis of IgG4-SC, focusing on treatment strategies and cutting-edge advances, in order to provide reference and inspiration for clinical practice.

Over the past 40 years,prenatal ultrasound in China has undergone a transformative evolution,from basic grayscale imaging to the integration of artificial intelligence(AI).Initial efforts focused on identifying major fetal anomalies and establishing standardized screening systems.In subsequent decades,advances such as 3D/4D imaging,quantitative diagnostic models and multimodal approaches enhanced the accuracy and scope of assessments.Recently,the emergence of AI-driven diagnostics,early trimester screening and multi-omics integration have ushered Chinese prenatal ultrasound into an era of precision and intelligence.Chinese scholars have not only adopted global innovations,but also contributed original,locally adapted solutions and multidisciplinary frameworks.Looking ahead,future development will emphasize intelligent assistance,equitable access,evidence-based systems,and cross-disciplinary integration-driving continued improvement in birth defect prevention and maternal-fetal health.

Over the past 40 years,prenatal ultrasound in China has undergone a transformative evolution,from basic grayscale imaging to the integration of artificial intelligence(AI).Initial efforts focused on identifying major fetal anomalies and establishing standardized screening systems.In subsequent decades,advances such as 3D/4D imaging,quantitative diagnostic models and multimodal approaches enhanced the accuracy and scope of assessments.Recently,the emergence of AI-driven diagnostics,early trimester screening and multi-omics integration have ushered Chinese prenatal ultrasound into an era of precision and intelligence.Chinese scholars have not only adopted global innovations,but also contributed original,locally adapted solutions and multidisciplinary frameworks.Looking ahead,future development will emphasize intelligent assistance,equitable access,evidence-based systems,and cross-disciplinary integration-driving continued improvement in birth defect prevention and maternal-fetal health.

The placenta is a regulator of maternal-fetal circulation，regulating nutrient and waste exchange，endocrine function，and immune response. The placental vascular structure is the basis of the placental exchange function and the key to maternal-fetal circulation. Placental vascular changes may affect fetal growth and cardiovascular development，and even the origin of postnatal health and disease. The placenta is crucial in fetal growth and development and future health，but our understanding of placental vascular structure is still insufficient. This article reviews the imaging methods and progress of placental imaging，focusing on the placental microvascular imaging technology，which aims to provide a method reference for prenatal evaluation and monitoring of placental vascular structure by realizing the visualization of placental vascular structure. Based on this new technology，it is expected to provide new ideas for the study of the hemodynamic mechanisms of fetal growth and cardiovascular development in the future.

Objective:To explore the effectiveness of interprofessional cooperative simulation in teaching emergency care for shock patients among intensive care unit (ICU) undergraduate nursing students.Methods:An interprofessional cooperative simulation-based teaching faculty team was established for ICU undergraduate nursing students, and a shock case library was developed. Using convenience sampling, 32 ICU undergraduate nursing students in 2022 were selected as the control group and received conventional simulation-based teaching, with students rotating through roles as nurses, standardized patients, doctors, and family members. In the experimental group, 34 ICU undergraduate nursing students in 2023 and 24 ICU clinical medicine interns were recruited to act as doctors for interprofessional cooperative simulation-based teaching. Each group was divided into subgroups, with each subgroup consisting of 4-5 nursing students. One group completed simulation-based training per month for a total of 8 sessions, with each session lasting 3 hours. The teaching adopted the on-site "tidal ward" in situ simulation, and the scenarios included patient history collection and health assessment, shock emergency care, nursing evaluation, and health education. The differences between the two groups of nursing students were compared in terms of ICU exit theoretical assessment score, objective structured clinical examination skill assessment score, and satisfaction with simulation-based teaching. SPSS 22.0 was used for independent samples t test and Mann-Whitney U test. Results:The experimental group achieved significantly higher scores in theoretical assessment (84.65±8.06), total score of satisfaction with simulation-based teaching (101.00±5.13), and clinical learning and multiprofessional team dimensions (47.32±3.35) compared to the control group ( P<0.001). The experimental group achieved higher scores in objective structured clinical examination skill assessment (81.40±7.22), guiding feedback and reflection (37.50±3.04), and judgmental thinking and clinical reasoning (16.00±2.03) compared to the control group, though the differences were not significant ( P=0.977, 0.668, and 0.636). Conclusions:Interprofessional cooperative simulation enhances the shock patient emergency care abilities and satisfaction with simulation-based teaching for undergraduate nursing students.

Objective:To analyze the echocardiographic and genetic characteristics of fetuses with common arterial trunk（CAT）.Methods:A retrospective analysis was conducted on 77 480 fetal echocardiograms examined at the Maternal-Fetal Medicine center in Fetal Heart Disease of Beijing Anzhen Hospital from November 2010 to November 2024.Among them，106 fetuses were initially diagnosed with CAT，and 95 cases were ultimately confirmed（0.1%，95/77 480）. The echocardiographic and genetic features of CAT fetuses were analyzed. According to the modified Van Praagh classification，CAT was divided into types A1-A4［with ventricular septal defect（VSD）］and B1-B4（without VSD）based on the origin of the pulmonary artery branches and the presence or absence of a VSD. Additionally，CAT was categorized into isolated and complex types based on the presence of associated intracardiac or extracardiac anomalies.Results:① Among the 95 confirmed CAT fetuses，type A accounted for 90.5%（86/95），and type B accounted for 9.5%（9/95）. All 9 type B CAT fetuses exhibited no overriding of the arterial trunk ， with 8 cases showing left ventricular hypoplasia accompanied by mitral atresia or absence.② Of the 95 CAT fetuses，14 were isolated（14.7%，14/95） ， and 81 were complex（85.3%，81/95）.The main associated intracardiac anomalies included：single ventricle（22 cases），complete atrioventricular septal defect（12 cases），anomalous pulmonary venous drainage（10 cases），right aortic arch with mirror-image branching（16 cases），and persistent left superior vena cava（14 cases）. ③ Genetic testing was performed in 31 fetuses，with 18 showing positive results，primarily 22q11.21 deletion syndrome（29.0%，9/31）. Conclusions:Apart from VSD，the most common intracardiac anomaly associated with CAT fetuses is single ventricle. Type B CAT without trunk overriding is often associated with left ventricular hypoplasia and mitral atresia or absence. The most frequent genetic abnormality in CAT fetuses is 22q11.21 deletion syndrome. Prenatal echocardiography should clarify the CAT subtype and associated anomalies，and genetic testing is strongly recommended for perinatal counseling and prognostic evaluation.

With advancements in prenatal diagnostic technology and postnatal clinical rescue，the survival rate of children with congenital heart disease（CHD）has significantly improved. However，neurodevelopmental delay or disorder has become the most common complication，profoundly affecting the quality of life throughout their lifetime. The risk factors and pathogenic mechanisms underlying CHD associated neurodevelopmental abnormalities remain unclear. This paper focus on the current status of neurodevelopmental outcomes in children with CHD and the potential risk factors，summarize prenatal and postnatal imaging methods for neurodevelopmental assessment，explore possible pathogenic mechanisms，and outline an integrated prenatal and postnatal neurodevelopmental evaluation framework for CHD patients. This review aims to provide comprehensive literature support for both scientific research and clinical evaluation of neurodevelopment in children with CHD.

Ultrasound medicine is crucial to assist clinical diagnosis and treatment. The application of artificial intelligence in ultrasound medicine has received extensive attention to assist in clinical diagnosis and improve diagnostic accuracy and prognosis. However，the generalization of existing models is limited by small sample size，data heterogeneity，and patient privacy protection. Federated learning，as a distributed learning paradigm，enables multiple centers to conduct local training and aggregate model parameters to jointly train a global model，effectively increasing the sample size and data diversity without exchanging raw data，thereby protecting patient privacy. This approach has promising clinical application prospects. However，there are still challenges in optimizing the defense capability，performance，and diverse applicability of the model. This article reviews the application and challenges of federated learning in ultrasound image analysis and diseases diagnosis.