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.

Objective To investigate the value of serum α-hydroxybutyric dehydrogenase(α-HBDH),cysteine-rich protein 61(CYR61)and gasdermin D(GSDMD)level testing in patients with sepsis-combined cardiomyopathy for clinical diagnosis and prognostic assessment.Methods A total of 244 sepsis patients who underwent consultation and treatment in Baotou Central Hospital from May 2020 to December 2023 were selected as the study subjects,and were separated into a study group(combined cardiomyopathy,n=106)and a control group(uncombined cardiomyopathy,n=138)according to whether they were combined cardiomyopathy or not.The levels of α-HBDH,CYR61 and GSDMD were measured by enzyme linked immunosorbent assay(ELISA)method.Pearson and Spearman methods were used to analyze the correlation of α-HBDH,CYR61,and GSDMD with systolic and diastolic blood pressure,left ventricular ejection fraction(LVEF)and acute physiology and chronic health evaluationⅡ(APACHE II)score.Multifactorial Logistic regression was used to analyze the factors affecting sepsis-combined cardiomyopathy.Receiver operator characteristic(ROC)curves were used to assess the diagnostic value of α-HBDH,CYR61 and GSDMD for sepsis-combined cardiomyopathy and their validity for prognostic prediction.Results Serum α-HBDH(278.35±18.89ng/ml vs 253.47±12.75ng/ml),CYR61(18.23±4.14mg/L vs 14.48±2.67mg/L)and GSDMD(12.39±3.28mg/L vs 9.46±2.17mg/L)levels were higher in the study group compared to the control group,and the differences were statistically significant(t=12.261,8.572,8.377,all P<0.05).The levels of α-HBDH(291.93±19.22ng/ml),CYR61(20.33±3.43mg/L)and GSDMD(14.01±3.09mg/L)were higher in the death patients compared to the survived patients(268.71±13.09ng/ml,16.74±2.88mg/L,11.24±2.55mg/L),and the differences were statistically significant(t=7.402,5.839,5.044,all P<0.05).Correlation analysis showed that α-HBDH,CYR61,and GSDMD were negatively correlated with systolic blood pressure,diastolic blood pressure and LVEF(r=-0.631～-0.422,all P<0.05),α-HBDH,CYR61,GSDMD were negatively correlated with APACHE II score(r=0.531,0.507,0.611,all P<0.05).Multifactorial Logistic regression analysis showed that systolic blood pressure,diastolic blood pressure,and LVEF were protective factors affecting sepsis-combined cardiomyopathy(Wald χ2=6.823,7.986,10.875,all P<0.05),and α-HBDH,CYR61,and GSDMD were risk factors affecting sepsis-combined cardiomyopathy(Wald χ2=9.376,6.849,7.435,all P<0.05).From the ROC curve analysis,it was known that the combined application of α-HBDH,CYR61,and GSDMD was more effective in the diagnosis of sepsis-combined cardiomyopathy(Z=2.369,2.454,2.573),the combined application of α-HBDH,CYR61,and GSDMD were superior for prognostic prediction in sepsis-combined cardiomyopathy(Z=2.352,2.468,2.581),and the differences were statistically significant(all P<0.05).Conclusion Serum α-HBDH,CYR61 and GSDMD levels are increased in patients with sepsis-combined cardiomyopathy,and they are correlated with prognosis.The combination of these three tests has a higher diagnostic value and prognostic value in sepsis combined cardiomyopathy.

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.

Objective To investigate the value of serum α-hydroxybutyric dehydrogenase(α-HBDH),cysteine-rich protein 61(CYR61)and gasdermin D(GSDMD)level testing in patients with sepsis-combined cardiomyopathy for clinical diagnosis and prognostic assessment.Methods A total of 244 sepsis patients who underwent consultation and treatment in Baotou Central Hospital from May 2020 to December 2023 were selected as the study subjects,and were separated into a study group(combined cardiomyopathy,n=106)and a control group(uncombined cardiomyopathy,n=138)according to whether they were combined cardiomyopathy or not.The levels of α-HBDH,CYR61 and GSDMD were measured by enzyme linked immunosorbent assay(ELISA)method.Pearson and Spearman methods were used to analyze the correlation of α-HBDH,CYR61,and GSDMD with systolic and diastolic blood pressure,left ventricular ejection fraction(LVEF)and acute physiology and chronic health evaluationⅡ(APACHE II)score.Multifactorial Logistic regression was used to analyze the factors affecting sepsis-combined cardiomyopathy.Receiver operator characteristic(ROC)curves were used to assess the diagnostic value of α-HBDH,CYR61 and GSDMD for sepsis-combined cardiomyopathy and their validity for prognostic prediction.Results Serum α-HBDH(278.35±18.89ng/ml vs 253.47±12.75ng/ml),CYR61(18.23±4.14mg/L vs 14.48±2.67mg/L)and GSDMD(12.39±3.28mg/L vs 9.46±2.17mg/L)levels were higher in the study group compared to the control group,and the differences were statistically significant(t=12.261,8.572,8.377,all P<0.05).The levels of α-HBDH(291.93±19.22ng/ml),CYR61(20.33±3.43mg/L)and GSDMD(14.01±3.09mg/L)were higher in the death patients compared to the survived patients(268.71±13.09ng/ml,16.74±2.88mg/L,11.24±2.55mg/L),and the differences were statistically significant(t=7.402,5.839,5.044,all P<0.05).Correlation analysis showed that α-HBDH,CYR61,and GSDMD were negatively correlated with systolic blood pressure,diastolic blood pressure and LVEF(r=-0.631～-0.422,all P<0.05),α-HBDH,CYR61,GSDMD were negatively correlated with APACHE II score(r=0.531,0.507,0.611,all P<0.05).Multifactorial Logistic regression analysis showed that systolic blood pressure,diastolic blood pressure,and LVEF were protective factors affecting sepsis-combined cardiomyopathy(Wald χ2=6.823,7.986,10.875,all P<0.05),and α-HBDH,CYR61,and GSDMD were risk factors affecting sepsis-combined cardiomyopathy(Wald χ2=9.376,6.849,7.435,all P<0.05).From the ROC curve analysis,it was known that the combined application of α-HBDH,CYR61,and GSDMD was more effective in the diagnosis of sepsis-combined cardiomyopathy(Z=2.369,2.454,2.573),the combined application of α-HBDH,CYR61,and GSDMD were superior for prognostic prediction in sepsis-combined cardiomyopathy(Z=2.352,2.468,2.581),and the differences were statistically significant(all P<0.05).Conclusion Serum α-HBDH,CYR61 and GSDMD levels are increased in patients with sepsis-combined cardiomyopathy,and they are correlated with prognosis.The combination of these three tests has a higher diagnostic value and prognostic value in sepsis combined cardiomyopathy.

Objective:To analyse the pathogenicity of a family with Fabry disease and to characterise its clinical phenotype and genetic variants.Methods:A proband with Fabry disease admitted to Beijing Anzhen Hospital, Capital Medical University in December 2021 was enrolled. Clinical data, including medical history, biochemical parameters, echocardiography, and electrocardiogram, were collected from the proband and family members. The proband and his daughter underwent α-galactosidase A (α-Gal A) enzyme activity assay and Sanger sequencing of the GLA gene. Candidate variants were analyzed and classified according to the American College of Medical Genetics and Genomics guidelines.Results:The male proband (69 years old) presented with chronic renal insufficiency, electrocardiogram findings of ST-T changes, bundle branch block, and left ventricular high voltage, and echocardiographic evidence of left ventricular hypertrophy. His α-Gal A activity was markedly reduced, and genetic testing identified a hemizygous GLA c.511G>C (p.Gly171Arg) variant on the X chromosome. The proband′s asymptomatic daughter also exhibited significantly decreased α-Gal A activity and carried the heterozygous GLA c.511G>C (p.Gly171Arg) variant. Based on the American College of Medical Genetics and Genomics guidelines, this variant was classified as “likely pathogenic” and considered the underlying cause of Fabry disease in this family.Conclusion:The proband manifested chronic renal insufficiency and cardiac hypertrophy, with the GLA c.511G>C (p.Gly171Arg) variant identified as the likely-pathogenic cause of Fabry disease in this family.

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.