Clinical teaching mode based on the theory of empowerment is a combination of the theory of em -powerment and clinical teaching activities .It emphasizes a student -centered philosophy .By empowering students in clinical teaching , the teachers can continuously stimulate the students 'initiative and thereby give full play to the students'potential.Starting from a discussion on of cases in clinical teaching , this thesis builds an effective student -leading mode of clinical teaching based on the theory of empowerment , tries to construct a clinical teaching theoretical system based on the theory of empowerment and explores strategies for practice , in order to improve clinical teaching effectiveness and promote reform in clinical teaching education .

Objective: To investigate the effects of traditional rehabilitation training, motor relearning and transcranial direct current stimulation on FMA,ARAT score and ADL of stroke patients. Methods: Sixty-five patients with initial stroke who were admitted to Rehabilitation center of Beijing rehabilitation hospital from August 2016 to August 2018 were selected. All the patients were randomly divided into two groups: the control group and the experimental group. On this basis, the experimental group received transcranial direct current stimulation for 6 weeks, while the control group received only false stimulation. The arm motion survey test scale (ARAT) and the simplified fugl-meyer motor function scale (FMA) were used to evaluate the upper limb motor function of patients, and the modified Barthel index scale (MBI) was used to evaluate the daily living activity ability of patients. Results: There was no significant difference in FMA score, ARAT score and MBI score before and after treatment between the two groups (P > 0.05). After treatment, FMA and ARAT scores of the upper limbs in the experimental group were (39.44±4.09) and (18.92±3.28), respectively, while those in the control group were (34.22±4.20) and (15.30±3.22), respectively. The differences between the two groups were statistically significant (t=3.239, 2.939, all P < 0.05). Conclusion Traditional rehabilitation training, exercise relearning combined with transcranial direct current stimulation (TDCS) for stroke patients improved the upper limb motor function to some extent, and effectively improved the daily living ability of the patients. It is worth popularizing in clinic.

Objective To investigate the effect of blood specimen collection from umbilical vein catheter on catheter usage condition and relevant complications. Methods 80 premature infants with indwelling umbilical vein catheter were divided into the blood collection group and the non-blood collec-tion group, then the hospitalization time, catheter indwelling time and rate of catheter-related complications were compared. The 40 premature infants in the blood colleetion group were subsequently divided into the experimental group in which blood was collected from umbilical vein catheter and the control group in which blood was collected from peripheral blood vessel, then the blood collection time, success rate and influence on newborns were compared. Results There was no significant difference in hospitalization time, catheter indwelling time and rate of catheter-related complications between the blood collection group and the non-blood collection group. There was statistical significance in blood collection time, success rate and adverse reaction on suffering newborns between the experimental group and the control group. Conclusions There was no obvious influence on the regular service of the catheter if only the method is correct and operating procedure is normative, also it possesses advantages such as no pain, high success rate, peripheral vascular protection, etc. So, it can be used as one of the ways to collect blood speci-men for critical newborns.

Objective To explore the relationship between minimum blood phosphorus and the long-term prognosis of patients in the neurological intensive rehabilitation unit.Methods The clinical data of patients in the neurological intensive rehabilitation ward of Beijing Rehabilitation Hospital Affiliated to Capital Medical University from December 2020 to June 2022 were analyzed.The data included gender,age,primary diagnosis,Glasgow coma scale(GCS),biochemical phosphorus ion levels(at admission,lowest,highest),white blood cell count(WBC),neutrophil/lymphocyte count ratio(NLR),C-reactive protein(CRP),and procalcitonin(PCT),length of stay in intensive care unit(ICU),total length of stay,6-month and 1-year location,and 6-month and 1-year case mortality.Patients were divided into hypophosphatemia group(serum phosphorus<0.80 mmol/L)and non-hypophosphatemia group(serum phosphorus≥0.80 mmol/L)according to the minimum blood phosphorus during hospitalization,the differences of the above indexes in different blood phosphorus level groups were compared.Multivariate Logistic regression analysis was used to evaluate the relationship between univariate variables and 6-month and 1-year prognosis.The receiver operator characteristic curve(ROC curve)was obtained,area under the curve(AUC)and its 95%confidence interval(95%CI)were calculated to evaluate the value of blood phosphorus level in predicting prognosis of patients in neurological intensive rehabilitation ward in 6 months and 1 year.Results A total of 276 patients were included,including 168 patients in the hypophosphatemia group and 108 patients in the non-hypophosphatemia group.Patients in the hypophosphatemia group had higher PCT and CRP[PCT(μg/L):0.08(0.04,0.16)vs.0.05(0.03,0.14),CRP(mg/L):12.05(3.00,27.63)vs.5.35(1.53,18.88),both P<0.05],lower prealbumin[g/L:0.19(0.14,0.22)vs.0.21(0.17,0.26),P<0.01],longer length of stay in ICU and total length of stay[length of stay in ICU(days):36.0(25.0,78.8)vs.28.0(21.3,46.8),total length of stay(days):116.5(60.0,180.0)vs.78.0(40.2,129.0),both P<0.01],higher 6-month and 1-year mortality[6-month mortality:13.10%(22/168)vs.3.70%(4/108),1-year mortality:26.19%(44/168)vs.11.11%(12/108),both P<0.05]than those in the non-hypophosphatemia group.At 6-month and 1-year follow-up,there was statistical significance between the two groups in different living places(P<0.05).Logistic regression analysis showed that the lowest blood phosphorus level was an independent risk factor for the prognosis of patients in neurological intensive rehabilitation ward[6-month:odds ratio(OR)and 95%CI were 0.160(0.032-0.798),P=0.024;1-year:OR and 95%CI were 0.286(0.091-0.895),P=0.032,respectively].ROC curve analysis showed that the minimum blood phosphorus level had a certain value in predicting the prognosis of patients with severe neurological rehabilitation(6-month:AUC=0.66,95%CI was 0.58-0.75;1-year:AUC=0.62,95%CI was 0.54-0.70,both P<0.01).Conclusions Patients with hypophosphatemia had a longer length of stay in ICU,total length of stay,and higher mortality at 6-month and 1-year compared to those in the non-hypophosphatemia group.The lowest blood phosphorus during hospitalization can predict prognosis at both 6-month and 1-year marks.

Objective:To explore the role and mechanism of miR-485-5p targeted regulation of WNT7B in regulating osteogenic differentiation of bone marrow mesenchymal stem cell (BMSC). Methods:15 osteoporotic patients who underwent hip replacement due to hip fracture in Tianjin Hospital from January to October 2023 were collected, and bone tissues in the femoral head in the area of reduced bone density detected by the dual-energy X-ray absorptiometry (DXA) method were collected (osteoporosis group); 15 patients who underwent joint replacement due to osteoarthritis were matched according to their age and body mass index, and bone tissues in the femoral head in the area of normal bone density were collected (no osteoporosis group). MiR-485-5p and WNT7B were detected using qRT-PCR technology; the target genes and potential mechanisms of miR-485-5p were predicted using bioinformatics technology, and the relationship between miR-485-5p and WNT7B was analyzed by dual luciferase reporter system. The miR-485-5p overexpression (mimic) and inhibitor (inhibitor) were constructed and divided into control, miR-485-5p group and miR-485-5p inhibitor group. After alkaline phosphatase staining (ALP) and alizarin red staining (ARS), osteogenesis-related proteins were detected by Western blot (ALP, BMP-2, Runx2, OPN, OCN); expression of osteogenic proteins was detected by transfection of miR-485-5p inhibitor and WNT7B siRNA into BMSC. Results:The relative expression of miR-485-5p in the osteoporosis group was 7.54±0.49, which was higher than that in the no-osteoporosis group with significant difference ( t=4.11, P<0.001), while the relative expression of WNT7B was significantly lower ( t=3.38, P<0.001), which was negatively correlated with miR-485-5p; bioinformatics analysis found that miR-485-5p targeted 666 genes, miR-485-5p could bind the 3'UTR of WNT7B, and the main mechanism was related to the Wnt/β-catenin signaling pathway; ALP activity and calcium deposition were reduced in the miR-485-5p group compared with the control group, and ALP, BMP-2, Runx2, OPN, OCN, WNT7B and β-catenin proteins were 0.78±0.13, 0.68±0.16, 0.59±0.19, 0.54±0.14, 0.74±0.12, 0.49±0.17, 0.52±0.19, respectively, which were significantly reduced compared with the control group ( t=3.214, P<0.001; t=3.637, P<0.001; t=3.479, P<0.001; t=4.062, P<0.001; t=4.271, P<0.001; t=4.164, P<0.001; t=4.621, P<0.001), and ALP activity, calcium deposition were reduced; ALP, BMP-2, Runx2, OPN, OCN in miR-485-5p inhibition group, WNT7B and β-catenin protein relative expression were 1.29±0.21, 1.24±0.19, 1.16±0.24, 1.31±0.27, 1.45±0.25, 1.05±0.19, 1.41±0.26, respectively, which were significantly higher compared with the control group ( t=3.156, P<0.001; t=3.645, P<0.001; t=3.473, P<0.001; t=3.954, P<0.001; t=4.006, P<0.001; t=3.889, P<0.001; t=4.513, P<0.001). The relative expression of OPN, WNT7B and β-catenin proteins in the miR-485-5p inhibition group were 1.42±0.21, 1.38±0.32, 1.16±0.2.ALP activity was significantly lower in the miR-485-5p inhibition+WNT7Bi group, with lighter ARS staining, fewer bone deposits, and reduced bone-forming related proteins OPN, WNT7B and β-catenin relative expression of 1.08±0.19, 0.71±0.22, and 0.84±0.25, which were all significantly reduced ( t=3.675, P<0.001; t=3.401, P<0.001; t=3.354, P<0.001). Conclusion:MiR-485-5p overexpression slowed down the process of osteogenic differentiation and caused down-regulation of the expression of related proteins, whereas miR-485-5p inhibition promoted osteogenic differentiation and was negatively correlated with WNT7B in the bone tissues of osteoporosis patients. MiR-485-5p binds to the WNT7B mRNA target, which in turn influences the expression of related proteins of WNT7B, and the mechanism of its action is that miR-485-5p targeted to regulate WNT7B-mediated Wnt/β-catenin signalling pathway inhibits BMSC osteogenic differentiation.

Objective:To explore the effect of situational simulation interactive training on rehabilitation compliance and motor function of stroke patients with hemiplegia.Methods:A total of 140 hemiplegic patients with stroke from July 2017 to October 2019 in Beijing Rehabilitation Hospital Affiliated to Capital Medical University were selected and divided into control group and observation group, 70 cases in each group. Routine treatment and rehabilitation nursing were used in the control group, and situational simulation interactive training were used in the observation group on the basis of the control group. Both groups were followed up for 6 months. Fugl-Meyer Assessment (FMA), World Health Organization Quality of Life Scale Brief (WHOQOL-BREF), Fugl-Meyer Assessment (FMA), self-made rehabilitation training compliance questionnaire and self-made nursing satisfaction questionnaire were used to evaluate the quality of life, motor ability, cognitive ability before intervention and after follow-up, rehabilitation compliance and nursing satisfaction after follow-up of the two groups.Results:There was no significant difference in FMA, WHOQOL-BREF and MMSE scores between the two groups before intervention ( P>0.05). After follow-up, the scores of FMA, WHOQOL-BREF and MMSE in the observation group were 62.57±6.52, 80.65±9.25, 25.30±3.24, significantly higher than 52.68±7.23, 66.68±8.34, 20.36±3.12 in the control group, the difference was statistically significant ( t value was 8.499, 9.385,9.189, P<0.05). After follow-up, the total compliance rate and satisfaction rate of the observation group were 92.86% (65/70) and 94.29% (66/70), respectively, while those of the control group were 78.57% (55/70) and 80.00% (56/70), respectively, the difference between the two groups was statistically significant (Fisher's exact test, P<0.05). Conclusions:The situation simulation rehabilitation training can effectively improve the motor function, rehabilitation compliance and nursing satisfaction of stroke patients with hemiplegia.

ObjectiveTo observe the variation in content of vascular endothelial growth factor （VEGF） in patients with Alzheimer's disease （AD） and to investigate efficacy of Yangxue Qingnao granule on AD and the effect on VEGF. MethodA total of 60 patients with cognitive impairment ［30 of AD and 30 of amnestic mild cognitive impairment （aMCI）］ were selected， and another 30 healthy people with Montreal Cognitive Assessment （MoCA）≥26 and age， gender， and complications insignificantly different from the patients were included as healthy control. The venous blood of aMCI group， AD group， and the healthy control group was collected at the enrollment to measure the level of serum VEGF. Then， the aMCI and AD patients were randomized into the observation group and the control group， with 30 patients in each group. The control group was given Donepezil Hydrochloride （5 mg·d^-1）， while the observation group received Donepezil Hydrochloride （5 mg·d^-1） and Yangxue Qingnao granule. MoCA was used to evaluate the severity of cognitive impairment. After the treatment for 6 months， the clinical efficacy and adverse reactions of the two groups were compared， and the serum VEGF levels were detected again by enzyme-linked immunosorbent assay （ELISA）. ResultThe serum content of VEGF in AD patients was significantly lower than that in aMCI patients and healthy people （P<0.05）. Serum VEGF levels in aMCI patients were significantly decreased compared with those in healthy people （P<0.05）. After treatment for 6 months， the serum VEGF level in the observation group was significantly higher than that before treatment， and was higher than that in the control group （P<0.05）. MoCA scores in the observation group were higher than those in control group （P<0.05）. The incidence of adverse reactions was insignificantly different between both groups. ConclusionThe serum levels of VEGF significantly decreased in aMCI and AD patients， suggesting that angiogenesis might be involved in the pathophysiological process of AD and correlated with the early stage of AD. Yangxue Qingnao granule， as a safe adjuvant therapy， showed ideal effect on aMCI and AD， as manifested by the improvement of cognitive function. The mechanism is the likelihood that it can elevate the expression of angiogenic factors such as VEGF， promote angiogenesis， and then improve the microcirculation of cortex.

Objective:To explore any effect of intermittent theta burst stimulation (iTBS) and of different sequencing of rehabilitation training on upper limb dysfunction after a stroke.Methods:Thirty-six patients with upper limb motor dysfunction after subacute subcortical cerebral infarction were divided at random into a control group, an experimental group 1, and an experimental group 2, each of 12. The control group was given prosthetic stimulation and upper limb function rehabilitation training. Experimental group l received focal iTBS stimulation on M1 immediately followed by upper limb rehabilitation training. Experimental group 2 received the same treatment but in reverse order. The experiment lasted four weeks. Upper limb functioning and ability in the activities of daily living (ADL) were quantified before and after the interventions using the Fugl-Meyer upper extremity assessment (FMA-UE) and the modified Barthel index (MBI). Cortical latency (CL) was also recorded.Results:Before the treatment there were no significant differences among the three groups, but afterward a significant increase was observed in the average FMA-UE and MBI scores of both experimental groups accompanied by a significant decrease in CL. There was no significant difference between the two experimental groups′ results, on average.Conclusion:Supplementing upper limb rehabilitation training with iTBS can significantly improve the upper limb functioning of ischemic stroke survivors, and the sequencing of the training has no effect on the therapeutic results.

The core symptoms of Parkinson's disease include motor symptoms and non-motor symptoms. For the motor symptoms, the rehabilitation includes the basic training of joints, gait training, the training of core muscle group and posture balance, the training of oral, facial, neck muscle and pharyngeal reflex, the training of lip movement, vocalization, sound volume, rhythm and speed, and the training of deep breathing exercises and abdominal pressure. For the non-motor symptoms, the rehabilitation includes the training of memory, attention, problem solving ability, activities of daily living and others, psychotherapy, family support, social participation, and other comprehensive treatments combined with medicine.