Objective To explore the application effect of the Mini-CEX evaluation model based on the OBE concept in the clinical Practice teaching of neurology.Methods We Selected 100 students who will Practice in the Department of Neurology from 2022 to 2023 as the research objects,and divided them into the experimental group(n=50)and the control group(n=50).Under the guidance of the OBE concept,the experimental group was guided by learning outcomes,refined the teaching objectives,and applied the Mini-CEX evaluation mode for evaluation and feedback.In contrast,the control group adopted the traditional teaching mode.Combined with the observation data,we analyzed and compared the data of various indicators of the two groups of students at the beginning and end of the internship.Results At the end of the internship,the scores of clinical consultation,Physical examination,humanistic medicine,clinical diagnosis,health consultation,organizational effect,and overall evaluation of the experimental group were significantly improved and were higher than those of the control group.After the Practice,in terms of skill test scores,the experimental group scored higher than the control group,the difference was statistically significant(P<0.05),and the experimental group also scored higher in satisfaction evaluation than the control group.Conclusion The Mini-CEX evaluation teaching model based on the concept of OBE is applied to the clinical practice teaching of the neurology department,which can enhance the training effect of students'clinical practice skills.

Tourette syndrome(TS)is a chronic neurodevelopmental disorder.Acupuncture can effectively improve the clinical symptoms of TS patients.This article systematically summarized the clinical research status of acupuncture for the treatment of TS in recent years from the aspects of characteristic acupuncture methods,characteristic needles and comprehensive therapies,and put forward suggestions and prospects for systematically elaborating the peripheral-central mechanism of acupuncture for TS around the intestinal immunity and brain network mechanism in the future,so as to provide reference for optimizing clinical research and treatment.

Objective To explore the effect of the POC CLOUD intelligent management platform on the training of resi-dent doctors with the principles and operation of various point-of-care testing(POCT)instruments to develop quality control man-agement skills and ensure result accuracy.Methods In alignment with Standardized Training Content and Standards for Resi-dent Trainees(2022 Edition and the development of POCT teaching in departments,the POC CLOUD platform was employed to provide information-based and standardized training for resident trainees.Results The POC CLOUD platform standardized resi-dent trainees'qualifications for operating POCT instruments and facilitated a quick understanding of the instruments'status in ro-tating departments.This approach enhanced resident trainees'learning and quality control management skills,enabling them to analyze and review test results effectively.Conclusion POCT teaching method based on the POC CLOUD platform systematical-ly develops resident trainees'operational and quality control abilities,ensuring the accuracy and reliability of test results and im-proving the overall quality of resident trainees.

Objective:To observe any effects of contralateral repeated transcranial magnetic stimulation (rTMS) of the swallowing motor cortex on the swallowing and brainstem auditory evoked potentials (BAEPs) of stroke survivors with dysphagia.Methods:A total of 83 stroke survivors with dysphagia were randomly divided into an ipsilesional stimulation group ( n=22), a contralesional stimulation group ( n=21), a bilateral stimulation group ( n=20), and a control group ( n=20). In addition to their conventional dysphagia training, those in the three stimulation groups received 3Hz rTMS while the control group was given fake stimulation. The treatment was administered daily for 20 minutes, 6 days a week, for 5 consecutive weeks. Before and after the treatment, swallowing function was assessed videofluoroscopically and using the Dysphagia Outcome and Severity Scale (DOSS). The oral and pharyngeal stages of swallowing were evaluated using the videofluoroscopic dysphagia scale (VDS). Brain stem conduction was assessed using BAEPs. Results:After treatment the average DOSS scores of all 4 groups were significantly better than before the treatment. The average DOSS scores of the contralesional and bilateral sti-mulation groups were then significantly better than those of the other two groups. The sub-item and total VDS scores of all 4 groups had decreased significantly, but the average score of the bilateral stimulation group was significantly lower than the control group′s average. Ipsilesional stimulation significantly improved the VDS sub-item scores for the triggering of pharyngeal swallowing, laryngeal elevation, and pharyngeal transit time compared with the control group. In the contralesional stimulation group the average total score and the VDS sub-item scores for apraxia, premature bolus loss, oral transit times, the triggering of pharyngeal swallowing, vallecular residue, laryngeal elevation, coating on the pharyngeal wall, and pharyngeal transit time were significantly lower than those of the control group, on average. After the treatment the latencies of BAEP waves I, III and V and the I-III, III-V and I-V interpeak intervals had decreased significantly in all four groups, but the average latencies and intervals of the bilateral and contralesional groups were significantly shorter than those of the control group. The latencies and intervals of the bilateral stimulation group were then significantly shorter than those in the ipsilesional stimulation group on average. The average latency of wave V in the bilateral stimulation group (6.53±0.73ms) was significantly shorter than that in the contralesional stimulation group after the treatment.Conclusion:Bilateral rTMS over the swallowing motor cortex combined with conventional dysphagia training can significantly improve the swallowing of dysphagic stroke survivors.

Objective:To investigate the risk of stroke in elderly hypertensive(HTN)patients with varying baseline triglyceride glucose(TYG)index, and to identify the risk factors associated with stroke in this population.Methods:This study was a prospective cohort study that included 459 elderly patients with hypertension who were admitted to Beijing Anzhen Hospital from January 2018 to January 2020.The patients were divided into four groups based on their quartile of TYG index: Q1 group(TYG index≤8.02, 114 cases), Q2 group(8.028.85, 115 cases). The study compared the baseline clinical data and incidence of stroke(hemorrhagic or ischemic stroke)after two years of follow-up among the four groups, and analyzed the risk factors of stroke using Cox regression analyses.Results:This study examined 459 elderly patients with hypertension, of which 251(54.7%)were male and 208(45.3%)were female, with an average age of(71.7 ± 6.2)years(65-79 years). The study found significant differences among the four groups in various factors( P<0.05 for all). The study followed up with patients for a median of 33 months, 55 cases were lost to follow-up.Out of the remaining patients, 10.9% experienced stroke, with 3.7% being hemorrhagic stroke and 7.2% being ischemic stroke.The occurrence of stroke was observed in 5.3%, 8.7%, 13.0%, and 16.2% of patients in the Q1, Q2, Q3, and Q4 groups, respectively.The results of Kaplan-Meier survival analysis demonstrated that the risk of stroke increased gradually as the quartile increased.Specifically, compared to the Q1 group, the risk of stroke increased by 1.016 times(95% CI: 0.933-1.106, P=0.715), 1.264 times(95% CI: 1.067-1.497, P=0.007), and 1.472 times(95% CI: 1.119-1.936, P=0.006)in the Q2, Q3, and Q4 groups, respectively.Notably, both Q3 and Q4 groups showed a significant increase in the risk of ischemic stroke( HR=1.313, 95% CI: 1.016-1.697, P=0.037; HR=1.509, 95% CI: 1.113-2.046, P=0.008), while the Q4 group showed a significant increase in the risk of hemorrhagic stroke( HR=1.132, 95% CI: 1.021-1.255, P=0.019). Multivariate Cox regression analysis showed that male( HR=1.336), smoking history( HR=1.485), hyperlipidemia( HR=1.216), previous stroke( HR=1.547), sleep apnea( HR=1.484), diastolic blood pressure( HR=1.114), hemoglobin( HR=0.962), albumin/creatinine ratio( HR=1.318), low-density lipoprotein cholesterol( HR=1.125), TYG index( HR=1.293), left ventricular mass index( HR=1.103), and anti-platelet therapy( HR=0.874)were all found to be independent risk factors for stroke. Conclusions:In elderly patients with hypertension, there is a significant positive correlation between TYG index and stroke risk, particularly ischemic stroke.This suggests that TYG index could be clinically valuable in improving cerebrovascular risk stratification.

Objective:To evaluate the effect of Empagliflozin on the incidence of major adverse cardiovascular events(MACE)in elderly patients with heart failure and reduced ejection fraction(HFrEF)over a period of 1 year.Additionally, the study will analyze the influence of frailty on MACE.Methods:This study is a retrospective analysis of 577 elderly patients with type 2 diabetes and heart failure with reduced ejection fraction(HFrEF)who were consecutively admitted to Beijing Anzhen Hospital from January 2018 to December 2020.The patients were divided into three groups according to frailty index(FI): non-frailty(FI ≤ 0.210, 301 cases), moderate frailty(FI 0.211-0.310, 184 cases), and severe frailty(FI>0.311, 92 cases).Additionally, a control group of 300 elderly HFrEF patients with T2DM who did not receive Sodium glucose co-transporter type 2(SGLT-2)inhibitors was included.The MACE outcomes of different patient groups who were followed up for a year after discharge were compared.The composite outcomes of cardiac death, worsening heart failure readmission, non-fatal myocardial infarction, and non-fatal stroke were recorded and analyzed.The study also includes Cox regression analysis of relevant factors that may affect MACE outcomes.Results:A total of 877 patients were monitored for a period of 7-14 months, with a median follow-up duration of(11.4±2.3)months.Out of these patients, 47(5.4%)were lost to follow-up.During the follow-up period, 108 patients(18.7%)in the Empagliflozin group experienced major adverse cardiovascular events(MACE), which included 43 patients(7.5%)with heart failure readmission, 29 patients(5.0%)with non-fatal myocardial infarction, 23 patients(4.0%)with non-fatal stroke, and 13 patients(2.3%)with cardiovascular death.The control group had 73 cases of major adverse cardiac events(MACE), which included 33 cases(11.0%)of readmission due to heart failure, 18 cases(6.0%)of non-fatal myocardial infarction, 14 cases(4.7%)of non-fatal stroke, and 8 cases(2.7%)of cardiovascular death.The Kaplan-Meier survival analysis revealed significant differences in the risk of readmission for heart failure exacerbation and MACE among the groups.The study found that the Empagliflozin group had a significantly lower risk of MACE(18.7% vs.24.3%, HR=0.792, 95% CI: 0.639-0.982, P=0.033)compared to the control group.Additionally, as frailty level increased, the risk of MACE in each empagliflozin subgroup also increased significantly(14.6% vs.19.6% vs.30.4%, P<0.001).The moderate and severe frailty groups had a 1.342 times( HR=1.342, 95% CI: 1.116-1.768, P=0.022)and 1.933 times( HR=1.933, 95% CI: 1.207-3.854, P=0.019)higher risk of MACE compared to the non-frailty group.The study conducted a multivariate Cox regression analysis and found that several factors were independently associated with the risk of MACE, including age( HR=1.164), duration of heart failure( HR=1.225), B-type natriuretic peptide level( HR=1.221), albumin/creatinine ratio( HR=1.158), renin-angiotensin-aldosterone system blocker( HR=0.891), frailty index( HR=1.764), and empagliflozin( HR=0.792)( P<0.05 for all). Conclusions:Empagliflozin has been shown to reduce the risk of major adverse cardiovascular events(MACE)in patients with heart failure with reduced ejection fraction(HFrEF).However, it is important to note that the cardiovascular benefits of SGLT-2 inhibitors may be affected by frailty in elderly patients with heart failure.As frailty worsens, the risk of readmission and MACE may increase significantly.

Objective:To investigate factors affecting the care needs of community-dwelling elderly people.Methods:A cross-sectional study was conducted.A face-to-face questionnaire survey was conducted using random samples of elderly people aged 60 years and above in six communities in Beijing to analyze the prevalence of diseases and care needs of elderly people in different age groups, and factors influencing elderly people's care needs.Univariate and multivariate Logistic regression analyses were used to analyze factors influencing these individuals' care needs based on basic personal situations, physical health status, economic situations, psychological and social status.Results:A total of 546 community-dwelling elderly people were recruited, with a mean age of(77.88±9.12)years.Cardiovascular and cerebrovascular diseases were consistently found to be the most common diseases in all age groups(60-69 years: 57.81% or 74/128; 70-79 years: 56.49% or 87/154; 80-89 years: 76.74% or 165/215; 90 years or over: 83.67% or 41/49); Care needs for groups aged 70 year or over were higher than for the group aged between 60-69( χ2=47.209, P<0.001). Elderly people with more than 2 diseases, long-term use of more than 1 drug, occasional constipation, and feeling loneliness or holding the view that caregivers do not need basic medical knowledge had a low need for care( OR=0.172, 0.006, 0.088, 0.112, 0.005, respectively, P<0.05 for all). Those with only one child, a history of pain, willing to pay more than ￥4 000 to hire a care-giver, or with partial disability were more likely to feel the need for care( OR=548.732, 5.941, 4.265, 7.373, respectively, P<0.05 for all). Conclusions:The care needs of elderly people living at home and aged over 60 in 6 communities in Beijing are affected by multiple factors such as their family structure, physical health status, economic status and psychological status.Elderly people need to have and accept multi-dimensional care services provided by knowledgeable and skillful caregivers to improve their quality of life.

Objective:Of all spontaneous bleeding complications in patients with acute ST-elevation myocardial infarction (STEMI), upper gastrointestinal bleeding (UGIB) is the most common and of specific interest, because it can be prevented by several prophylactic measures. The purpose of this study was to investigate the in-hospital incidence, associated outcomes, and predictors of UGIB after STEMI.Methods:In this retrospective study, we analyzed the records of 2 791 patients with acute STEMI admitted to Beijing Anzhen Hospital Affiliated to Capital Medical University between January 2018 and January 2022. The patients were divided into the UGIB group ( n=61) and non-UGIB group ( n=2 730) according to the presence or absence of upper gastrointestinal hemorrhage, respectively. Baseline clinical conditions, coronary lesions, in-hospital deaths, and in-hospital adverse events were compared between the two groups. Logistic regression analysis was also performed for risk factors that could lead to UGIB. Results:The in-hospital incidence of UGIB after STEMI was 2.2% (61/2 791). Hospital stay was significantly longer in the UGIB group [8(6, 12) days vs. 5 (4, 7) days, Z=3.28, P<0.001] and in-hospital mortality was significantly higher in the UGIB group than in the non-UGIB group (9.8% vs. 0.8%, χ2=0.63, P=0.001). Patients with UGIB were significantly older than those without UGIB (63±11 years vs. 58±11 years, t=-3.75, P<0.001). The serum creatinine level of UGIB patients was significantly higher than that of non-UGIB patients [(80(62, 98) mmol/L vs. 73(64, 84) mmol/L, Z=1.68, P=0.007], the red blood cell count of UGIB patients was significantly lower than that of non-UGIB patients [4.1(3.8, 4.6)×10 12/L vs. 4.6(4.2, 4.9)×10 12/L, Z=2.61, P<0.001], and the hemoglobin concentration of UGIB patients was significantly lower than that of non-UGIB patients [129(109, 141) g/L vs. 141(130, 152) g/L, Z=2.52, P<0.001]. Brain natriuretic peptide levels were significantly higher in UGIB patients than in non-UGIB patients [331(165, 644) ng/L vs. 181(89, 333) ng/L, Z=2.42, P<0.001]. Logistic regression analysis showed that age ( OR=1.045, 95% CI 1.009-1.082, P=0.013); hemoglobin ( OR=1.594, 95% CI 1.150-2.210, P=0.005); hematocrit ( OR=0.181, 95% CI 0.060-0.546, P=0.002); and mean hemoglobin concentration ( OR=0.845, 95% CI 0.752-0.951, P=0.005) were independent risk factors for UGIB in patients with STEMI. Logistic regression analysis of risk factors for in-hospital death revealed that concurrent UGIB was an independent risk factor for in-hospital death in patients with STEMI ( OR=2.954, 95% CI 0.635-13.751, P=0.024). Conclusions:The incidence of in-hospital UGIB in STEMI patients was 2.2%, and the in-hospital mortality rate of STEMI complicated with UGIB increased to 9.8%. Concurrent UGIB was an independent risk factor for in-hospital death in patients with STEMI. The most important predictors of in-hospital UGIB in patients with STEMI were age, hemoglobin, hematocrit, and mean hemoglobin concentration.

Objective:To conduct a survey on the current situation of family nursing assistants for elderly people with chronic diseases and disability in the community from multiple dimensions such as personal information, work status, professional quality, difficult problems encountered in the nursing process, and solutions.Methods:From April to August 2022, a questionnaire survey was conducted among family nursing assistants of elderly people with chronic diseases and disability in six communities in Beijing using cluster sampling. We conducted a survey and analysis on the current situation of family nursing assistants for elderly people with chronic diseases and disability in the community from multiple dimensions, based on the presence or absence of professional qualification certificates for nursing assistants.Results:The study included 611 nursing assistants, aged (49.99±6.82) years, mainly composed of rural registered residence and education level below junior high school. Only 43.04% (263/611) of nursing assistants had professional qualification certificates for nursing assistants. Compared with those without professional qualification certificate for nursing assistants, those with professional qualification certificate for nursing assistants had statistical differences in gender, registered residence, education level, daily working hours, specific work content of care, monthly income, solutions to reduce the mobility of elderly nursing assistants, working years, feelings of caring for the daily health of elderly people with chronic diseases, psychological status, self-awareness about job, training to improve work skills, basic medical knowledge training, and reasons for not participating in training ( P<0.05). Nursing assistants reported a lack of medical and nursing knowledge and an urgent need for professional training and guidance from medical and nursing staff during the investigation of difficult issues encountered in their work. Conclusions:It is necessary to strengthen and improve the training of nursing professionals and basic medical knowledge of family nursing assistants for elderly people with chronic diseases and disability before and during work, which can help improve the level and quality of care provided by family nursing assistants.

Objective:To investigate the preventive effect of Xiyanping injection on radioactive esophagitis in patients with radical radiotherapy and chemotherapy for esophageal cancer.Methods:A total of 70 patients with esophageal cancer undergoing radical radiotherapy and chemotherapy were selected from the Department of Radiation Oncology of Jiangsu Provincial People′s Hospital from January to September 2020. They were divided into experimental group ( n=35) and control group ( n=35) according to random number table method. The control group received standard concurrent radiotherapy and chemotherapy, and the experimental group received concurrent radiotherapy and chemotherapy combined with Xiyanping. The white blood cell count, neutrophil count, procalcitonin (PCT) and interleukin-6 (IL-6) levels before and after treatment were compared between the two groups, as well as the occurrences of radioactive esophagitis and radioactive pneumonia during radiotherapy. Results:Before treatment, there were no significant differences in white blood cell count [4.57 (2.52)×10 9/L vs. 5.59 (2.23)×10 9/L] and neutrophil count [2.95 (1.66)×10 9/L vs. 3.69 (1.56)×10 9/L] between the control group and experimental group ( Z=1.44, P=0.151; Z=1.52, P=0.130). After treatment, there were no statistically significant differences in white blood cell count [4.28 (2.50)×10 9/L vs. 4.25 (1.88)×10 9/L] and neutrophil count [2.99 (2.50)×10 9/L vs. 2.94 (1.61)×10 9/L] between the two groups ( Z=0.67, P=0.503; Z=0.69, P=0.489). There were no statistically significant differences in white blood cell count and neutrophil count between the patients after treatment and before treatment in the two groups ( Z=0.77, P=0.443; Z=1.08, P=0.279; Z =1.06, P=0.289; Z=0.68, P=0.495). Before treatment, there were no statistically significant differences in serum inflammation indexes PCT [0.02 (0.03) μg/L vs. 0.02 (0.05) μg/L] and IL-6 [0.04 (0.21) μg/L vs. 0.04 (0.12) μg/L] between the two groups ( Z=0.70, P=0.482; Z=0.77, P=0.439). After treatment, there were statistically significant differences in serum inflammation indexes PCT [0.06 (0.17) μg/L vs. 0.03 (0.08) μg/L] and IL-6 [0.10 (0.25) μg/L vs. 0.01 (0.08) μg/L] between the two groups ( Z=2.08, P=0.038; Z=2.92, P=0.003). There were no statistically significant differences in serum inflammation indexes PCT and IL-6 in the experimental groups after treatment compared with before treatment ( Z=1.20, P=0.230; Z=1.19, P=0.235). In the control group, the serum inflammation index PCT level increased after treatment compared with before treatment, with a statistically significant difference ( Z=2.82, P=0.005), and the serum inflammation index IL-6 level increased compared with before treatment, but with no statistically significant difference ( Z=1.41, P=0.158). During the treatment, the incidence of radioactive esophagitis in the two groups was mainly grade Ⅰ-Ⅱ, with 24 cases in the control group and 28 cases in the experimental group. There were 8 patients with grade Ⅲ-Ⅳ radioactive esophagitis in the control group and 1 in the experimental group. There was a statistically significant difference in the occurrence of radioactive esophagitis between the two groups ( χ2=10.34, P=0.035). During the treatment period, most patients with radioactive pneumonia were rated as grade 0. There were 10 cases of mild radioactive pneumonia (grade Ⅰ-Ⅱ) in the control group had and 6 cases in the experimental group. There were 2 cases of grade Ⅲ radioactive pneumonia in the control group and experimental group respectively. There was no grade Ⅳ radioactive pneumonia in either group. There was no significant difference in radioactive pneumonia between the two groups ( χ2=1.34, P=0.720). Conclusion:Xiyanping injection can prevent the rise of serum inflammatory index PCT and reduce the severity of radioactive esophagitis in patients with esophageal cancer after treatment.