Many kinds of medical education standards came out at home and abroad in the new era to lead and evaluate the development of medicinal education.The Forth Militay Medical University,after analyzing the characteristics and the insufficiency of these standards,believe that health view,medical model and the other five aspects will be the key factors for the research of military surgeon educational standard for undergraduates majoring in clinical medicine.

Objective:To investigate the correlation between mean platelet volume (MPV) and clinical outcome in patients with acute ischemic stroke (AIS) after intravenous thrombolysis.Methods:Consecutive patients with AIS treated with standard dose alteplase intravenous thrombolysis in the Department of Neurology, the Second People's Hospital of Hefei from July 1, 2019 to August 30, 2020 were enrolled retrospectively. The clinical, laboratory, and imaging data of the patients were collected. The modified Rankin Scale was used to evaluate the clinical outcome at 90 d after onset, and a score of >2 was defined as a poor outcome. Multivariate logistic regression model was used to analyze the independent correlation between MPV and clinical outcome. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of MPV for clinical outcome. Results:A total of 104 patients with AIS who received intravenous thrombolytic therapy were included, including 40 males (38.5%), 64 females (61.5%), and their age was 68.7±12.5 years. The baseline median National Institutes of Health Stroke Scale (NIHSS) score was 6 (interquartile range, 4-11), and the time from onset to intravenous thrombolysis was (128.5±55.9) min. Seventy-five patients (72.1%) had a good outcome, 29 (27.9%) had a poor outcome, and there was no death. The baseline NIHSS score, C-reactive protein, MPV, MPV/platelet count ratio and the proportion of patients with anterior circulation infarction in the poor outcome group were significantly higher than those in the good outcome group (all P<0.05). Multivariate logistic regression analysis showed that MPV (odds ratio [ OR] 1.868, 95% confidence interval [ CI] 1.277-2.732; P=0.001) and baseline NIHSS score ( OR 1.199, 95% CI 1.083-1.328; P<0.001) were the independent risk factors for poor outcome. ROC curve analysis showed that the area under the curve for predicting poor outcome was 0.714 (95% CI 0.606-0.821; P=0.001). The optimal cut-off value was 11.25 fl, the predictive sensitivity and specificity were 65.5% and 70.5%, respectively. Conclusions:There was a significant independent correlation between MPV and the clinical outcome in patients with AIS after intravenous thrombolysis. A higher baseline MPV had a certain predictive value for poor outcome.

Objective To investigate the correlation between cognitive function and cerebral microbleeds (CMBs) in patients with acute cerebral infarction.Methods The clinical and imaging findings in patients with acute stroke were analyzed retrospective.CMBs were counted according to the findings of MRI.The general conditions,CMB site and leukoaraiosis severity of the patients were recorded in detail.The cognitive function of the patients was assessed with the Montreal cognitive assessment scale (MoCA) the next day in the hospital.MoCA assessment follow-up was conducted at 3,6 and 9 months.The changes in cognitive function of the patients with acute cerebral infarction and its relationship with CBMs were analyzed.Results A total of 82 patients with ischemic stroke were enrolled in the study,33 of them had CBMs and 49 had no CBMs.The systolic blood pressure (155.03 ± 19.68 mm Hg vs.142.20 ± 21.22 mm Hg;t =2.762,P =0.007) and the National Institutes of Health Stroke Scale (NIHSS) score (6.21 ±4.57 vs.4.00 ±3.98; t =2.322,P =0.023) in the CBM group were significantly higher than those in the non-CBM group.Multivariate logistic regression analysis showed that the systolic blood pressure level (odds ratio [OR] 1.032,95％ confidence interval [CI] 1.008-1.057; P=0.009) and the NIHSS score (OR 1.163,95％ CI 1.013-1.311;P=0.014) were the independent predictors of CBMs in patients with acute cerebral infarction.CMBs were closely associated with MoCA scores,and the longer follow-up time,the correlation would stronger.The executive function (rs =0.318,P =0.004),visual space function (rs =0.403,P =0.000) and calculation function (rs =0.362,P=0.001) in patients with CMBs were significantly impaired.The more serious of CMBs,the lower of the scores in above 3 cognitive domains,and the damage would be more serious.Conclusions CMBs are closely associated with cognitive function impairment in patients with acute cerebral infarction.The more serious of CMBs,the more serious of cognitive function impairment will be,and with the extension of time,cognitive function impairment in patients with CMBs will aggravate.

Objective To explore the plasma level of retinol binding protein 4 (RBP4) in patients with es-sential hypertension (EH) of Xinjiang Kazakans and the relations between plasma RBP4 level and blood pressure, blood lipids,blood glucose, insulin, and HOMA-IR. Methods 81 Kazakans cases who were investigated between August and November of 2008 were selected as subjects. They were divided into EH group(n=41)and control group (n=40). Blood pressure was measured. Fasting venous blood was drawn to detect the plasma RBP4, fasting insulin (FINS), fasting plasma glucose(FPG), total cholesterol(TC), triglyceride(TG), high density lipoprotein cholesterol (HDL-C)、low density lipoprotein cholesterol (LDL-C), apoprotein-A1 (APO-A1) and apoprotein-B (APO-B), and concentration in EH group was significantly higher than that in control group[ (32.74±9.93) mg/L vs (21.92± pressure (DBP),FPG,and HOMA-IR in EH group(r,=0.618,0.775,0.565,0.317,0.369,P<0.01 or P< showed that SBP was independent factor to affect the RBP4 level in EH group(Standardized Coefficients is 0.591, t=5. 695, P=0.000). Conclusion The plasma RBP4 concentration is increased in patients with EH of Kazakans, and is positively correlated with SBP,DBP,FPG,HOMA-IR in EH group. RBP4 may involve in the development of EH by promoting insulin resistance.

ObjectiveTo explore the relationship between serum sCD40L level and coronary stenosis degree in acute coronary syndromes(ACS) patients with different glucose tolerance conditions.Methods154 patients with ACS were divided into normal glucose tolerance group ( NGT),impaired glucose tolerance group (IGT) and type 2 diabetes group (T2DM) according to the OGTT.The levels of serum sCD40L were detected by ELISA,and all patients underwent coronary angiography in order to calculate their Gensini score.Then the relationship between serum sCD40L level and coronary stenosis was analyzed by statistics.ResultsThe Gensini scores of IGT[(41.8 ± 19.8)score] and T2DM groups [(40.1 ± 18.7)score] were higher than NGT group [(21.9 ± 15.3)score] ( P ＜0.01 ),but there was no statistical difference between IGT and T2DM ( P ＞ 0.05 ) group.The serum sCD40L levels of IGT[(2.46 ± 0.79 )ng/ml]were higher than NGT group [(2.12 ± 0.81 )ng/ml] ( P ＜ 0.05 ),and the serum sCD40L levels in T2DM group [( 2.57 ± 0.68) ng/ml] were obviously higher than NGT group [( 2.12 ± 0.81 ) ng/ml] ( P ＜ 0.01 ).The serum sCD40L levels in T2DM group were higher IGT group,but there was no statistical difference between T2DM and IGT groups( P ＞0.05).Statistical analysis revealed that serum sCD40L levels had no statistical difference among the three groups and it had no relationship with coronary stenosis ( r =-0.147,P ＞0.05).ConclusionsCD40/CD40L activation would occur in the patients of ACS with wildly abnormal blood sugar,not only in those who had diabetes with much higher blood sugar.The serum sCD40L level in the ACS patients with abnormal glucose tolerance had no relationship with the severity of coronary stenosis.

Due to the narrow time window of traditional reperfusion therapy and the presence of the risk of reperfusion injury, it is of great significance to study the pathogenesis of ischemic stroke and explore methods to reduce reperfusion injury from the perspective of pathophysiology. This article expounds the functions of von Willebrand factor (vWF) and platelet glycoprotein (GP) Ⅰb and their roles in hemostasis, thrombosis, and inflammation. It is believed that pharmacological blockade of the interaction of vWF-GP Ⅰb may contribute to the treatment of ischemic stroke. In addition, its clinical significance in ischemic stroke and ischemic brain injury was further discussed.

In recent years, the concept of " microbiome-gut-brain axis" has been proposed to reveal the wide connection between gut microbiome and nervous system diseases. As a common and frequently occurring disease of nervous system, the occurrence and outcome of ischemic stroke are closely related to gut microbiome. This article reviews the relationship between gut microbiome and risk factors of ischemic stroke and immune inflammation after stroke.

Objective:To investigate the predictive value of monocyte-to-high-density lipoprotein cholesterol ratio (MHR) for early neurological deterioration (END) and hemorrhagic transformation (HT) after intravenous thrombolysis in patients with acute ischemic stroke (AIS).Methods:Patients with AIS received IVT in Hefei Second People's Hospital from May 2020 to January 2022 were retrospectively enrolled. Blood collection was completed and MHR was calculated before intravenous thrombolysis. END was defined as an increase of ≥2 from the baseline in the National Institutes of Health Stroke Scale (NIHSS) score or ≥1 from the baseline in motor function score at any time within 7 d after admission. HT was defined as intracranial hemorrhage newly found by CT/MRI within 24 h after intravenous thrombolysis. Multivariate logistic regression analysis was used to determine the independent predictors of END and HT, and the receiver operating characteristic (ROC) curve was used to analyze the predictive value of MHR for END and HT. Results:A total of 186 patients with AIS treated with IVT were included, of which 50 (26.9%) had END and 31 (16.7%) had HT. The median MHR was 0.43. The MHR in the END group was significantly higher than that in the non-END group (0.49 vs. 0.40; P=0.008), and the MHR in the HT group was significantly higher than that in the non-HT group (0.52 vs. 0.40; P=0.013). All patients were divided into 4 groups (MHR1, MHR2, MHR3 and MHR4) according to the MHR quartile from low to high. Multivariate logistic regression analysis showed that after adjusting for confounding factors, taking MHR1 as a reference, MHR3 (odds ratio [ OR] 6.317, 95% confidence interval [ CI] 1.465-27.237; P=0.013) and MHR4 ( OR 8.064, 95% CI 1.910-34.051; P=0.005) were the significant independent predictors of END; Taking MHR1 as a reference, MHR4 ( OR 5.147, 95% CI 1.194-22.182; P=0.028) was the significant independent predictor of HT. The ROC curve analysis showed that the area under the curve of MHR for predicting END was 0.628 (95% CI 0.554-0.698; P=0.008). When the optimal MHR cutoff value was 0.41, its sensitivity and specificity for predicting END was 74.0% and 53.7% respectively. The area under the curve of MHR for predicting HT was 0.642 (95% CI 0.569-0.711; P=0.013). When the best cutoff value was 0.44, the sensitivity and specificity of MHR for predicting HT were 77.4% and 58.1% respectively. Conclusion:Higher MHR is a risk factor for END and HT after intravenous thrombolysis in patients with AIS, but the predictive value of MHR for END and HT is limited.

Ischemic stroke is the second leading cause of disability and death worldwide, which brings heavy burden to society and families. Epidemiological studies have shown that vitamin D level are associated with the prevalence of hypertension, diabetes, atherosclerosis, and cerebrovascular events. This article reviews the relationship between vitamin D level and ischemic stroke risk, infarct volume in acute phase, severity of neurological deficit and functional outcome, and discusses the impact of vitamin D supplementation on ischemic stroke, and expects to provide new ideas for the prevention and treatment of ischemic stroke.

Ischemic stroke is the main cause of death and disability in adults, and its incidence is increasing year by year. Obstructive sleep apnea (OSA) is the most common type of sleep-disordered breathing, which can increase the risk of ischemic stroke and affect the outcomes of patients. There is an increasing amount of research on the relationship between OSA and ischemic stroke. This article reviews the bidirectional relationship between OSA and ischemic stroke, the mechanism of OSA causing ischemic stroke, and the diagnosis and treatment of OSA in patients with ischemic stroke.