To develop a milestone-based evaluation system for the core "knowledge and skills" competency of neurology residents that is tailored to China's medical context, so as to provide precise guidance for their training and assessment.

Smart healthcare plays an important role in easing the strain on medical resources and improving the continuity of chronic disease management. This study analysed the iatrogenic risks from the intrinsic attributes and the external environment of smart healthcare, including doctor-patient conflict risk, technical operation risk, information leakage risk, humanistic absence risk, legal risk, regulatory risk and ethical risk. Based on the " structure process result" model, suggestions were proposed to optimize the construction of a smart healthcare platform for chronic diseases, improve the legal system and industry standards, strengthen talent cultivation and capacity building, establish an integrated regulatory system, and regularly evaluate the effectiveness of chronic disease management. These suggestions provided references for creating a healthy, orderly, and safe smart healthcare environment for chronic disease patients.

Objective:To investigate the longitudinal stability of the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the Activity of Daily Living Scale (ADL).Methods:The longitudinal cognitive assessment results of 68 dementia patients admitted to the Dementia and Leukoencephalopathy Outpatient Clinic, Department of Neurology, Peking Union Medical College Hospital, from January 2021 to January 2024, were retrospectively analyzed, including the total and sub-items scores of the MMSE, MoCA, and ADL. Two different rules were applied to analyze the abnormality rates: rule 1, where the current test result being better than the previous one was considered an abnormality; rule 2, where the current test result being better than the previous average score was considered an abnormality (If a patient had only 2 cognitive assessments, rule 2 was considered the same as rule 1). Two rules were used to analyze the abnormality rates of the scales. The statistical analyses were repeated after excluding patients with possible anxiety and depression status.Results:In assessing the total score stability, MMSE showed the lowest abnormality rates [27.2% (31/114) under rule 1 and 29.8% (34/114) under rule 2], while MoCA had the highest abnormality rates [41.3% (26/63) and 46.0% (29/63), respectively]. The ADL abnormality rates were 27.7% (23/83) and 33.7% (28/83), respectively. Among MoCA sub-items, category cue, multiple choice cue, second memory trial, orientation, and clock showed higher abnormality rates [31.7%(20/63), 30.2%(19/63), 23.8%(15/63), 22.2%(14/63), 22.2%(14/63), respectively]. After excluding population with possible anxiety and depression status, the relative abnormality rates of MMSE and ADL sub-items did not significantly change, while the abnormality rate of orientation in MoCA sub-items decreased relatively.Conclusion:The MMSE and ADL exhibit good stability in long-term monitoring of dementia patients, serving as essential tools for assessing and following up cognitive changes.

Smart healthcare plays an important role in easing the strain on medical resources and improving the continuity of chronic disease management. This study analysed the iatrogenic risks from the intrinsic attributes and the external environment of smart healthcare, including doctor-patient conflict risk, technical operation risk, information leakage risk, humanistic absence risk, legal risk, regulatory risk and ethical risk. Based on the " structure process result" model, suggestions were proposed to optimize the construction of a smart healthcare platform for chronic diseases, improve the legal system and industry standards, strengthen talent cultivation and capacity building, establish an integrated regulatory system, and regularly evaluate the effectiveness of chronic disease management. These suggestions provided references for creating a healthy, orderly, and safe smart healthcare environment for chronic disease patients.

Objective:To investigate the longitudinal stability of the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the Activity of Daily Living Scale (ADL).Methods:The longitudinal cognitive assessment results of 68 dementia patients admitted to the Dementia and Leukoencephalopathy Outpatient Clinic, Department of Neurology, Peking Union Medical College Hospital, from January 2021 to January 2024, were retrospectively analyzed, including the total and sub-items scores of the MMSE, MoCA, and ADL. Two different rules were applied to analyze the abnormality rates: rule 1, where the current test result being better than the previous one was considered an abnormality; rule 2, where the current test result being better than the previous average score was considered an abnormality (If a patient had only 2 cognitive assessments, rule 2 was considered the same as rule 1). Two rules were used to analyze the abnormality rates of the scales. The statistical analyses were repeated after excluding patients with possible anxiety and depression status.Results:In assessing the total score stability, MMSE showed the lowest abnormality rates [27.2% (31/114) under rule 1 and 29.8% (34/114) under rule 2], while MoCA had the highest abnormality rates [41.3% (26/63) and 46.0% (29/63), respectively]. The ADL abnormality rates were 27.7% (23/83) and 33.7% (28/83), respectively. Among MoCA sub-items, category cue, multiple choice cue, second memory trial, orientation, and clock showed higher abnormality rates [31.7%(20/63), 30.2%(19/63), 23.8%(15/63), 22.2%(14/63), 22.2%(14/63), respectively]. After excluding population with possible anxiety and depression status, the relative abnormality rates of MMSE and ADL sub-items did not significantly change, while the abnormality rate of orientation in MoCA sub-items decreased relatively.Conclusion:The MMSE and ADL exhibit good stability in long-term monitoring of dementia patients, serving as essential tools for assessing and following up cognitive changes.

The ApoE gene is a genetic risk determinant for sporadic Alzheimer′s disease (AD). The ApoEε4 allele increases the risk of developing AD relative to the common ApoEε3 allele, whereas the ApoEε2 allele decreases the risk of developing the disease. The 3 alleles encode ApoE2, ApoE3, and ApoE4 protein isoforms, respectively. ApoE4 contributes to the pathogenesis of AD by regulating β-amyloid protein, tau protein, transactive response DNA-binding protein-43, neuroinflammation, and cerebral vascular function. The pathways associated with ApoE also offer new opportunities for the treatment of AD. In addition, studies have shown that ApoE4 also plays a toxic role in other neurological disorders. This article described the biological characteristics of ApoE, as well as the impact of ApoE4 on AD and related dementias, aiming to enhance clinical doctors′ understanding of the involvement of ApoE4 in the pathogenesis of AD and related dementia.

Objective:To analyze the clinical and imaging features of patients with COVID-19-related osmotic demyelination syndrome (ODS).Methods:COVID-19-related ODS cases diagnosed in the Department of Neurology, Peking Union Medical College Hospital from January 2020 to September 2023 were retrospectively reviewed. And their past medical history, possible triggers, clinical manifestations, imaging manifestations, treatment and prognosis were summarized.Results:A total of 5 patients with COVID-19-related ODS were included. Electrolyte disturbances acted as an inducement of ODS in all patients (5/5),4 of whom with hyponatremia. Four of 5 patients first presented with disturbance of consciousness, followed by predominant dystonia. Imaging of all patients (5/5) showed isolated extrapontine myelinolysis (EPM). With the prolongation of the course of disease, such signal intensity could return to normal, and lesions showed atrophic changes in some patients. The patients′ clinical symptoms were partly relieved within a few days to a few months after treatment.Conclusions:COVID-19-related ODS is mostly associated with hyponatremia, and EPM is more common. COVID-19 should be considered as a risk factor for ODS.

Objective To evaluate the effect of ZOPOMED-60 mycobacterium tuberculosis microscanner on detecting acid-fast bacilli in sputum smears.Methods A total of 203 qualified sputum specimens from patients treated in Chest Hospital of Guangxi Zhuang Autonomous Region in May 2023 were collected.The samples were stained by using Ziehl-Neelsen staining and fluorecent staining,respectively,and the acid-fast bacillus was detected by the manual microscopy and ZOPOMED-60 mycobacterium tuberculosis microscanner.The sensitivity,specificity,positive predictive value and negative predictive value of acid-fast bacillus were calculated using different methods based on liquid culture of mycobacterium.Results The positive rates of manual reading and instrument intelligent reading of fluorecent staining were 12.3%and 18.7%,respectively,and the positive rates of manual reading and instrument intelligent reading of Ziehl-Neelsen staining were 13.3%and 17.7%,respectively.There was no significant difference between the four reading results(P>0.05).Based on the results of liquid culture of mycobacterium,sensitivity of manual reading and instrument intelligent reading of fluorecent staining and manual reading and instrument intelligent reading of Ziehl-Neelsen staining were 40.0%,45.0%,45.0%and 53.3%,specificity were 99.3%,92.3%,100.0%and 97.2%,positive predictive values were 96.0%,71.0%,100.0%and 88.9%,and negative predictive values were 79.8%,80.0%,81.2%and 83.2%,respectively.The consistency was good.Conclusion The performance of ZOPOMED-60 mycobacterium tuberculosis microscanner in the detection of acid-fast bacilli by two staining methods is good,and it is worth popularizing.

Objective To explore the application value of transperineal three-dimensional ultrasound combined with SWE in evalu-ating the effect of delivery mode on the morphology and function of levator ANI muscle in primipara,and to provide a new method for early diagnosis of pelvic floor dysfunction(PFD).Methods A total of 92 primiparas who were re-examined 6-8 weeks after delivery in our hospital were selected as postpartum group,and divided into vaginal delivery group(n=45)and cesarean section group(n=47)accord-ing to their delivery mode,and healthy women without childbirth at the same period were selected as control group(n=43).Transperineal three-dimensional ultrasound combined with SWE was used to examine the differences in the morphological parameters and elastic param-eters of levator anal hiatus in different states among all groups.Results The hiatus area of levator anal muscle(LHA)at rest,maximum anal retraction and maximum Valsalva in the vaginal delivery group was greater than that in the cesarean section group and control group,and the cesarean section group was greater than the control group,the differences were statistically significant(P＜0.01).Compared with control group and cesarean section group,the elastic parameters of vaginal delivery group at rest and maximum anal retraction were de-creased,the difference was statistically significant(P＜0.01).There was no significant difference in elastic parameters between the cesar-ean section group and the control group(P＞0.05).The difference between maximum Valsalva state and resting state LHA(Δ A')was negatively correlated with the difference before and after contraction of bilateral PR Young's modulus(ΔE)(left r=-0.444,P=0.008;Right r=0.488,P=0.002).Conclusion Three-dimensional perineal ultrasonography combined with SWE can quantitatively evaluate the morphology and function of levator ANI muscle,and provide evidence for the early diagnosis of PFD.