As a mature neuromodulation technique with sufficient evidence and wide application， transcranial magnetic stimulation （TMS） has become a highly promising approach for the treatment of insomnia disorder. However， there is still a lack of unified standards for formulation of treatment regimens， technical operations， indications and contraindications， treatment of adverse reactions， and application in special populations. In order to standardize the application of TMS in the diagnosis and treatment of insomnia disorder， Professional Committee of Sleep and Neuromodulation of Chinese Sleep Research Society organized the compilation of the technical specifications. This document systematically elaborates on the technical principles and stimulation modes of TMS， summarizes the clinical evidence for its application in the treatment of primary insomnia disorder and comorbid conditions such as depression and cognitive impairment， clarifies the key points for formulating treatment regimens （including stimulation coils， targets， modes， and intensity）， refines the technical specifications such as treatment room setup， personnel qualifications， operation procedures， and efficacy evaluation， and provides recommendations for the management of adverse reactions and principles for use in special populations， which provides a comprehensive expert consensus and practical guidance for the standardized clinical application of TMS in the treatment of insomnia disorder.

AIM: To investigate expression differences and mechanism of action of serine/threonine kinase 1(AKT1), ATP synthase F1 subunit(ATP5F1), and Bcl-2-associated anti-apoptotic gene 3(BAG3)in the occurrence and progression of pterygium.METHODS:Pterygium-related gene expression data were retrieved from GEO database to screen differentially expressed genes(DEGs). String and Cytoscape were used to construct protein-protein interaction(PPI)networks and identify core targets. GO/KEGG enrichment analyzed mitochondrial metabolic pathways. The pterygium samples(head/body)were collected; pathological features were evaluated by HE staining, and the expression of AKT1, ATP5F1, and BAG3 was detected via immunohistochemistry(IHC).RESULTS:A total of 1 264 DEGs were identified(585 upregulated, 679 downregulated). GO analysis showed significant enrichment of mitochondrial pathways regarding to biological processes, cell components and molecular functions; KEGG analysis highlighted oxidative phosphorylation and chemical carcinogenesis-reactive oxygen species(ROS)pathways. The head and body pterygium samples were collected from 28 cases(28 eyes)that received pterygium surgery, including 7 males(7 eyes)and 21 females(21 eyes), with a mean age of 69.32±8.98 years. HE staining showed more severe dysplasia, disordered stroma, and inflammation in the pterygium head versus the body. IHC detection confirmed significantly lower AKT1, ATP5F1, and BAG3 expression in the head compared with the body(all P<0.05).CONCLUSION:GEO-based bioinformatics and experiments confirmed that AKT1/ATP5F1/BAG3(mitochondrial genes)had significant differential expression in pterygium, correlating with pathological progression. They may regulate mitochondrial metabolism to mediate pterygium progression, offering new insights for targeted therapy.

ObjectiveTo analyze the effects of the progestin-primed ovarian stimulation （PPOS） protocol on embryo euploidy rate and clinical pregnancy outcomes in infertile patients. MethodsWomen who underwent Preimplantation genetic testing for aneuploidy （PGT-A） cycles were selected as study participants （a total of 656 cycles and 3 081 blastocysts）. Participants were divided into two age groups （≤35 years and >35 years） and further stratified by ovarian stimulation protocol： the Progestin-Primed Ovarian Stimulation （PPOS） group （n=48 and 60， respectively）， the Luteal Phase Long Protocol （LP） group （n=160 and 57， respectively）， and the Gonadotropin-Releasing Hormone Antagonist Protocol （AP） group （n=220 and 111， respectively）. Baseline characteristics， ovarian stimulation outcomes， and embryo development parameters were compared among the three protocols within each age group. Additionally， clinical pregnancy outcomes of the first frozen embryo transfer （FET） cycle were compared. The primary outcome measure was the embryo euploidy rate. Results① In the ≤35 years age group， baseline follicle-stimulating hormone （bFSH） levels were significantly higher in the PPOS group compared to the LP and AP groups， and the bFSH/bLH ratio was significantly higher in the PPOS group than in the AP group （P < 0.05）. In the >35 years age group， bFSH levels in both the PPOS and AP groups were significantly higher than in the LP group （P < 0.05）.② In the ≤35 years group， there were no significant differences in the rates of metaphase II （MII） oocytes， 2-pronuclei （2 PN） zygotes， cleavage， 2 PN cleavage， blastocyst formation， high-quality embryos， or embryo euploidy between the PPOS group and either the LP or AP groups. However， the PPOS group showed significantly lower values for the following parameters compared to the other two groups： total oocytes retrieved， number of MII oocytes， number of 2 PN zygotes， number of cleaved embryos， number of 2 PN cleaved embryos， number of blastocysts formed， number of high-quality embryos， number of high-grade blastocysts， number of transferable embryos， number of cryopreserved embryos， number of biopsied blastocysts， number of euploid embryos， and the rate of obtaining at least one euploid embryo. In the >35 years group， no significant differences were observed among the PPOS， LP， and AP groups in the rates of MII oocytes， 2 PN cleavage， blastocyst formation， or in the number of euploid embryos， euploidy rate， and the rate of obtaining at least one euploid embryo. However， the PPOS group had significantly lower numbers of total oocytes retrieved， MII oocytes， 2 PN zygotes， cleaved embryos， 2 PN cleaved embryos， blastocysts formed， transferable embryos， and cryopreserved embryos compared to the LP group （P<0.05）. The high-quality embryo rate was significantly lower in the PPOS group than in the AP group （P<0.05）. The numbers of high-quality embryos， high-grade blastocysts， and biopsied blastocysts were significantly lower in the PPOS group than in both the LP and AP groups （P<0.05）. Notably， the 2 PN fertilization rate was significantly higher in the PPOS group than in the AP group， and the cleavage rate was significantly higher in the PPOS group than in both the LP and AP groups （P<0.05）.③ No significant differences were found among the three groups in the biochemical pregnancy rate， clinical pregnancy rate， live birth rate， early miscarriage rate， and late miscarriage rate following the first FET cycle. ConclusionCompared to the other two protocols， the PPOS protocol does not significantly affect embryo euploidy or clinical pregnancy rates. However， in freeze-all cycles with PGT-A， the PPOS protocol does not reduce the rate of chromosomally normal embryos but may decrease the total number of available embryos. It may not be the optimal choice for younger women， but it can be considered as a viable option for women of advanced maternal age.

Objective To investigate the clinicopathological characteristics, diagnostic key points, and treatment strategies of penile metastatic extramedullary plasmacytoma(EMP). Case Report A 47-year-old male patient presented with a painless indurated nodule on the dorsal side of the penis and had a previous history of plasmacytoma in the nasal cavity and tibia. He subsequently underwent complete excision of the penile lesion. Postoperative histopathological examination confirmed the diagnosis of anaplastic plasmacytoma. Immunohistochemical analysis showed positive staining of CD138, CD38, MUM1, and CD79a, with Ki-67(+60%). Light chain restriction was also identified. No local recurrence or distant metastasis was observed during the 5-month follow-up. Conclusion Metastatic EMP of the penis is an extremely rare condition, and the diagnosis relies on pathological examinations combined with immunohistochemical analysis. Surgical resection can be an effective treatment modality for localized lesions;however, long-term follow-up is essential to monitor disease progression.

ObjectiveTo focused on patients with unexplained repeated implantation failure （URIF） and compare the clinical efficacy of different administration routes of granulocyte colony-stimulating factor （G-CSF） in patients undergoing frozen-thawed embryo transfer cycles. MethodsA retrospective case-control study was conducted. A total of 187 patients with URIF who received medical treatment were enrolled in this study. According to whether G-CSF was used on the day of endometrial transformation and its administration route in frozen-thawed embryo transfer cycles， the patients were divided into three groups： control group （without G-CSF， n=71）， subcutaneous injection group （subcutaneous G-CSF， n=72）， and intrauterine infusion group （intrauterine G-CSF infusion， n=44）. The pregnancy outcomes among the three groups were compared， and Logistic regression analysis was performed. ResultsThere were significant differences in biochemical pregnancy rates among the three groups （P<0.05）， indicating statistical significance in the overall comparison. In terms of numerical trend， the biochemical pregnancy rate was in the order： subcutaneous injection group > intrauterine infusion group > control group. Further pairwise comparison showed that only the difference between the subcutaneous injection group and the control group was statistically significant （P<0.017）， while no significant differences were found between the other groups （P>0.017）. The overall comparison of early miscarriage rates among the three groups also showed a significant difference （P<0.05）， indicating a statistically significant difference in the distribution among the groups. The numerical trend was： intrauterine perfusion group > subcutaneous injection group > control group. Pairwise comparison results showed that only the difference between the intrauterine perfusion group and the control group was statistically significant （P<0.017）， while there was no statistically significant difference between any other two groups （P>0.017）.Multivariate Logistic regression analysis showed that endometrial thickness on the day of transformation， number of transferred embryos， and subcutaneous G-CSF injection were independent factors associated with an increased biochemical pregnancy rate， where as age was an independent factor for a decreased biochemical pregnancy rate. For clinical pregnancy outcome， endometrial thickness on the day of transformation， number of transferred embryos， and subcutaneous G-CSF injection were also independent factors for an increased clinical pregnancy rate， while BMI was an independent factor for a decreased clinical pregnancy rate. ConclusionSubcutaneous injection of G-CSF only improved the biochemical pregnancy rate in URIF patients. Multivariate Logistic regression analysis showed that subcutaneous G-CSF injection was a favorable factor for clinical pregnancy rate in URIF patients； however， no significant improvement in clinical pregnancy rate was observed among the three groups. Both the comparison of pregnancy outcomes and the results of multivariate logistic regression analysis indicates that intrauterine perfusion of G-CSF has no significant therapeutic effect in the treatment of patients with URIF.

AIM: To characterize the current status, research hotspots, and evolutionary differences in clinical studies on amblyopia published in Chinese and English from 2015 to 2025, and to provide a reference for the clinical diagnosis and treatment as well as relevant research of amblyopia.METHODS: Clinical studies on amblyopia in both Chinese and English were retrieved from the CNKI, VIP, Wanfang and Web of Science(WoS)databases. Bibliometric and visualization analyses of publication output, institutions, authors, and keywords were conducted using Cite Space 6.4.R1 and VOS viewer 1.6.19.RESULTS: Totally 1 302 publications were included, comprising 920 Chinese and 382 English publications. The publications of Chinese literature declined after 2019, while that of English literature showed an upward trend. Relevant studies involved 18 countries, and the institutional cooperation connections of English literature were relatively closer. The core author cooperation networks of both Chinese and English literature presented multi-cluster distribution. A total of 360 and 283 keyword nodes were obtained from Chinese and English literature, respectively. The high-frequency keywords of both literatures covered four aspects, including amblyopia types, research populations, evaluation indicators, and treatment methods. Both Chinese and English studies focus on anisometropic and strabismic amblyopia. Chinese studies predominantly investigated children of different age groups, whereas adult amblyopia received earlier attention in the English literature. Visual acuity, contrast sensitivity, and stereopsis were the major outcome measures of common interest, while optical correction and occlusion therapy remained the mainstay treatments. Totally 19 and 13 keyword clusters were identified in the Chinese and English literatures, respectively. Burst analysis indicated that digital treatment such as binocular dichoptic training appeared relatively early in English literature. In recent years, quality of life and risk factor screening for amblyopia received increasing attention. In Chinese literature, growing focus was placed on digital visual training and traditional Chinese medicine intervention. In addition, neuroimaging evaluation based on resting-state functional magnetic resonance imaging was conducted much earlier in English studies.CONCLUSION:From 2015 to 2025, Chinese and English clinical research on amblyopia has shown diversified development, with substantial similarities in the major types of amblyopia investigated, visual function assessment, and basic treatment modalities, but differences in the timing and emphasis of some research hotspots. Clinical research on amblyopia is gradually expanding from improvement in visual acuity toward restoration of binocular visual function, multidimensional outcome assessment, and investigation of visual neural mechanisms, while treatment strategies are becoming increasingly digitalized and individualized. Future research should further optimize standardized treatment, strengthen investigations into adult amblyopia, binocular digital vision training, visual neural mechanisms, and multidimensional outcome assessment, and evaluate the clinical value of integrated traditional Chinese and Western medicine interventions through high-quality clinical studies.

Objective:To construct a risk prediction model for non-suicidal self-injury (NSSI) in adolescents with mood disorders, providing a basis for identifying and intervening in high-risk patients.Methods:A convenience sampling method was used to retrospectively analyze 724 adolescent patients with mood disorders admitted to the open ward of Qingdao Mental Health Center from January 2019 to July 2023. Patients admitted from January 2019 to December 2022 (641 cases) were randomly divided into a modeling group and an internal validation group in a 7∶3 ratio, while patients admitted from January to July 2023 (83 cases) were used as an external validation group. A binary multivariate logistic regression analysis was used to construct a nomogram prediction model for NSSI risk in adolescents with mood disorders. The predictive performance of the model was evaluated using the area under the curve (AUC), sensitivity, and specificity.Results:There were 179 males and 545 females, aged 15 (14, 17) years old. Among the 724 patients, 449 were in the modeling group, 192 in the internal validation group, and 83 in the external validation group. The incidence of NSSI in the modeling group was 32.96% (148/449). Reduced food intake ( OR=10.980, 95% CI 4.462-27.017), passive contact ( OR=4.681, 95% CI 1.986-11.031), Hamilton Depression Rating Scale-17 score >17 ( OR=12.235, 95% CI 4.657-32.141), Hamilton Anxiety Rating Scale score>15 ( OR=27.888, 95% CI 8.700-124.630), Insomnia Severity Index score >15 ( OR=6.357, 95% CI 2.257-17.899), and higher levels of past self-injury ( OR=1.663, 95% CI 1.428-1.935) were independent risk factors for NSSI in adolescents with mood disorders (all P<0.05). The AUC of the nomogram model based on these six factors was 0.973, with a sensitivity of 0.94 and a specificity of 0.89. Conclusions:The risk prediction model for NSSI in adolescents with mood disorders has good discrimination, accuracy, and practicality, and can help identify high-risk NSSI populations among adolescents with mood disorders.

Objective:To explore the implementation method of the "daily-monthly-quarterly" quality control model based on total quality management (TQM) theory in nursing quality management, and evaluate its application effectiveness.Methods:A quasi-experimental research method was used. The quarterly quality control model employed at Shanxi Medical University Second Hospital from 2018 to 2019 was set as the control group, and the"day-month-quarter" quality control model based on TQM implemented from 2020 to 2022 was set as the observation group. The nurse practice environment assessment scores from 2018 to 2022 were analyzed; the nursing quality-sensitive indicators between the two groups were compared, including the incidence rate of overall adverse event, falls among hospitalized patients, pressure ulcers of stage 2 and above, unplanned extubations, and catheter-related infections (central venous catheter-related bloodstream infections, ventilator-associated pneumonia, and catheter-associated urinary tract infections).Results:The nurse practice environment assessment scores from 2018 to 2022 were (69.11 ± 19.66), (75.20 ± 18.70), (77.60 ± 17.65), (82.45 ± 16.44), and (88.00 ± 15.06). The differences compared to the previous year were statistically significant ( t=3.63-9.24, all P<0.05).After the intervention, the incidence rates of overall adverse events, falls among hospitalized patients, unplanned extubation, central venous catheter-related bloodstream infections, and ventilator-associated pneumonia in the control group were 0.385% (499/129 678), 0.072% (94/129 678), 0.051% (66/129 678), 0.037% (23/62 390), and 0.746% (43/5 761). Compared to 0.258% (551/213 851), 0.048% (103/213 851), 0.033% (71/213 851), 0.019% (19/98 642), and 0.444% (88/19 826) in the observation group. The differences were statistically significant ( χ2values were 3.89-42.83, all P<0.05). There were no statistically significant differences in the incidence rates of pressure ulcers of stage 2 and above and catheter-associated urinary tract infections (both P>0.05). Conclusions:The "daily-monthly-quarterly" quality control model based on TQM is beneficial in improving nursing quality and ensuring patient safety.

Objective:To explore the application effect of high-fidelity intelligent simulator combined with scenario simulation for emergency response training in the Department of Radiology, and to improve the emergency preparedness of medical, nursing, and technical staff in managing contrast agent adverse reactions.Methods:From January to July 2024, 132 medical, nursing, and technical staff from the Department of Radiology of a tertiary hospital in Chengdu City, China were selected as the training subjects. The high-fidelity intelligent simulator combined with scenario simulation teaching mode was used to conduct emergency response training for the participants. The differences in theoretical knowledge and post competence regarding contrast agent adverse reactions among the staff were compared before and after the training. A self-made questionnaire was used to investigate their needs and satisfaction of the emergency response training. SPSS 26.0 was used for data analysis. The differences in theoretical knowledge and post competence scores before and after training were compared using the paired samples t test. Results:After the training, the average score of theoretical knowledge examination increased from (84.32±10.19) points to (90.34±7.87) points, and the difference was statistically significant ( P<0.001). After the training, the scores of knowledge reserve, operational skills, situational decision-making ability, professional literacy, comprehensive literacy, and overall post competency were all significantly higher than those before the training ( P<0.05). The satisfaction score of emergency response training was (4.17±0.25) points. Conclusions:High-fidelity intelligent simulator combined with scenario simulation training improved the emergency preparedness and teamwork of radiology staff in clinical emergencies. The training received high recognition and satisfaction from the participants, which is of great significance for clinical emergency response and patient safety.

Gastric cancer is a malignant tumor of the digestive system with strong invasiveness and a high metastasis rate.Its morbidity and mortality rank among the top five in the world and the prognosis is closely related to the disease stage.Multidisciplinary comprehensive treatment based on systemic antitumor drugs is generally adopted in patients with advanced or metastatic gastric can-cer,but the prognosis is typically poor.With the in-depth research on the tumor microenvironment,the development of multi-omics technology,and the application of immunotherapy and neoadjuvant chemoradiotherapy,the therapeutic effect of advanced gastric can-cer has been initially improved,and immunotherapy has become the most potential of the treatment strategies.Many studies have found that Helicobacter pylori(Hp)infection status is closely related to the efficacy of immunotherapy for gastric cancer,especially im-mune checkpoint inhibitors(ICIs),but there is not clear whether it has advantages or disadvantages.This article reviews the current research on the efficacy of Hp on ICIs in advanced gastric cancer to provide ideas for further research on the interaction between Hp in-fection and tumor immunotherapy.