Objective:To explore the relationship among serum neutrophil gelatinase associated lipocalin (NGAL), cystatin C (Cys-C) levels and cardiac, renal function;and diagnostic value of NGAL and Cys-C for early renal damage in aged patients With coronary heart disease (CHD).Methods:According to NYHA cardiac function classi-fication,a total of 84 aged CHD patients Were divided into class I group (n=30),class Ⅱ group (n=28)and classⅢ-Ⅳ group (n=26).Another 31 aged healthy objects Were selected as healthy control group.Serum N terminal pro B-type natriuretic peptide (NT-proBNP),NGAL and Cys-C etc. levels Were measured,and the correlation a-mong serum NGAL,Cys-C levels and cardiac function,estimated glomerular filtration rate (eGFR)Were analyzed. The accuracy of serum NGAL and Cys-C diagnosing renal insufficiency Was evaluated by receiver operator character-istic curve (ROC).Results:Along With NYHA class increased,there Were significant increase in serum levels of NGAL [(36.96±21.23)μg/L vs.(87.80±61.40)μg/L vs.(141.21±92.96)μg/L vs.(198.15±98.46)μg/L] and Cys-C [(0.75±0.64)mg/L vs.(1.40±1.88)mg/L vs.(2.33±2.03)mg/L vs.(3.45±1.81)mg/L]in healthy control group,NYHA I,Ⅱ,Ⅲ-Ⅳ groups,and they Were highest in NYHA class Ⅲ-Ⅳ group,there Was significant difference in serum NGAL level betWeen any tWo groups among the four groups (P<0.01),and so Was serum Cys-C level (P<0.05 or <0.01)except healthy control group and NYHA class I group (P>0.05). Pearson correlation analysis indicated that serum NGAL and Cys-C levels Were positively correlated With NT-proBNP (r=0.842,0.718,P<0.01 both),and negatively correlated With eGFR (r=-0.689,-0.448,P<0.01 both), and serum NGAL level had closer correlation With NT-proBNP and eGFR.Area under ROC of serum NGAL and Cys-C Were 0.884 and 0.744 respectively in diagnosing renal insufficiency.Conclusion:Serum NGAL and Cys-C lev-els have good correlation With cardiac and renal function in aged CHD patients,Which are sensitive and accurate in-dexes for diagnosing early renal damage.

Objective:To survey the needs and requirements of the general practice department in general hospitals from the perspective of grassroots health care personnel.Methods:From July 2020 to February 2022, a qualitative study on needs and requirements for the general practice department in general hospitals was conducted. Twenty eight participants from community health service centers in Beijing, Xi′an and Guangzhou were selected for the in-depth interviews.Results:The participants expressed their opinions and suggestions on the community needs and requirements for general practice department in general hospitals as follows. (1) The necessity of establishing department of general practice in general hospitals: the general hospitals had advantages to meet the medical needs of the community; the teaching and training should be focus on the way of thinking in the general practice, while the training needs for research ability was less required. (2) The cooperation between general hospital and its community teaching base: to implement the joint teaching rounds and joint home visits were effective ways for collaboration, which may ensure the quality of clinical faculty in the community bases. (3)The training needs of the community: rational use of drugs was most required, sub-specialty training was another concern for general practitioners in grassroots level. (4) The requirements for general practice department in the general hospital: in addition to complete organizational structure, daily teaching work needs to be implemented, and horizontal and vertical connection to relevant health institutions also need to be strengthened. Meanwhile, the teaching work should be a considerable part in the department performance assessment, and excellent clinical ability was also required to facilitate the effective referral of patients from the community.Conclusions:The study shows the necessity of establishing department of general practice in general hospitals, and various needs from the community teaching base, which providing reference for improving the construction of general practice department in the future.

Objective:To develop a Beijing norm of Memory and Executive Screening (MES) scale to facilitate its further promotion and application in the future.Methods:Study subjects were selected based on the inclusion and exclusion criteria, including patients who visited the memory clinic of Xuanwu Hospital of Capital Medical University from March 20, 2017 to January 6, 2021, and normal people recruited simultaneously from community, and trained and qualified investigators conducted questionnaire surveys through face-to-face interviews. Then strict quality control, data collection and statistical analysis were performed.Results:A total of 607 participants were included, including 239 normal people, 293 individuals with subjective cognitive decline (SCD), and 75 individuals with mild cognitive impairment (MCI). There was a negative correlation between the scores of MES and age ( r=-0.19, P<0.001), but a positive correlation between scores of MES and education level ( r=0.29, P<0.001). The optimal cut-off value of this scale in Beijing was 86 points, the area under curve (AUC) of the cut-off value to distinguish MCI was 0.847 (normal people vs MCI) and 0.826 (SCD vs MCI), and after adding demographic variables, AUC showed slight increase (0.847 to 0.850 and 0.826 to 0.847), whereas the differences were not statistically significant ( Znormal peoplevsMCI=0.49, ZSCDvsMCI=1.21, P>0.05). And there was no statistically significant difference between MES and Montreal Cognitive Assessment scales in diagnostic power for normal people and people with MCI ( Zscale alone=1.03, Zafter adding demographic variables=1.13, P>0.05). Conclusions:The MES scale has a better distinguishing power for MCI, and its optimal cut-off value in Beijing is 86 points, which is different from previous studies. In the future, the sample size needs to be further expanded to verify this norm.

From September 2020 to August 2021, 34 general practice trainees in Xuanwu Hospital, Capital Medical University were were randomly divided into the control group and trial group with 17 in each group. The control group adopted the traditional clerkship method for outpatient clinical teaching; the trial group independently received patients with the supervision of clinical instructors, and the Leicester assessment package (LAP) was used for evaluation and training. The performance of two groups were assessed using the Beijing General Practitioner's Graduation Assessment and Admissions Patient Score Sheet. The LAP training was also given to control group at the late stage of the study, and the application of LAP was assessed with a questionnaire survey in two groups of trainees. The results showed that the performance of trial group was better than that of control group in terms of medical history collection [(23.12±1.05) vs. (21.18±0.88), t=-5.82, P<0.01 ], physical examination [(24.88±1.62) vs. (23.12±1.58), t=-3.22, P< 0.01 ], case analysis [(22.94±0.90) vs. (20.82±0.73), t=-7.55, P<0.01 ] and total score [(86.59±2.65) vs. (80.12±2.45) t=-7.40, P<0.01]. For assessment of LAP, all 34 trainees gave 5 points in items of improving patient care, knowledge and skills, communication skills, professional quality, reception skills, clinical thinking, clinical judgment, decision-making skills, and learning interest with the application of LAP in outpatient clinical teaching; the satisfaction of the trainees on the pertinence, teaching effect and LAP training method of the instructing physicians was 100% (34/34). It is suggested that the application of LAP for evaluation and implementation in general practice outpatient teaching will help to improve the teaching quality and the patient receiving ability of general practitioners.