Objective To analyze the effects of tactile vibration feedback training combined with 1 Hz repetitive tran-scranial magnetic stimulation on limb balance and walking ability of stroke patients with hemiplegia.Methods From August 2021 to August 2023,98 patients with stroke and hemiplegia who were diagnosed and treated in Daxing District People's Hospital were selected and divided into training group and stimulation group according to different treatment schemes with 49 in each.The training group was given tactile vibration feedback training,and the stimula-tion group was given tactile vibration feedback training combined with 1 Hz repetitive trans-cranial magnetic stimula-tion.The clinical symptoms,ability of keeping balance and walk,life situation and curative effect of the two groups were analyzed.Results After 8 weeks of treatment,the scores of mouth and drooling points,language impairment points,and hemiparalysis points in the two groups were all lower than those before treatment(P<0.05),and the above indexes in the stimulation group were even lower than those in the training group(P<0.05).After 8 weeks of treatment,the scores of Lindmark Balance Reaction,Berg Balance scale(BBS),stride length,10-meters maximum walking speed(10 mMWS),Barthel index(BI)and Functional Independence Measure(FIM)in both groups were higher than those before treatment(P<0.05),and the above indexes in the stimulation group were higher than those in the training group(P<0.05).After 8 weeks of treatment,the total effective rate in the stimulation group(91.84％)was higher than that in the training group(69.39％)(P<0.05).Conclusions Tactile vibration feedback training plus 1 Hz repetitive trans-cranial magnetic stimulation can significantly alleviate the clinical symptoms of stroke patients with hemiplegia and can improve their ability of keeping balance,walking and management of daily life.

Objective:To analyze the clinical and radiological features of patients with hypoplasia of the internal carotid artery.Methods:Four patients with hypoplasia of the internal carotid artery (including 3 patients with congenital absence of the internal carotid artery), admitted to our hospital from January 2010 to December 2021, were chosen in our study. The clinical data and imaging features of these patients were retrospectively analyzed.Results:The age of these patients ranged from 31 to 73 years, and two patients were female. Clinically,2 patients presented with dizziness, 1 patient presented with limb weakness, and 1 patient was asymptomatic. In 3 patients with congenital absence of the internal carotid artery, DSA results showed that the internal carotid artery was not developed, and CT bone window showed that the internal carotid artery canal was absent; 1 patient with hypoplasia of the internal carotid artery showed thin imaging in DSA results. One patient was combined with anterior communicating artery aneurysm and left internal carotid artery aneurysm. One patient was with vertebral arterial dolichoectasia. The collateral circulation compensation: type A was noted in 3 patients and type C was noted in 1 patient.Conclusion:The patients with hypoplasia of the internal carotid artery are usually asymptomatic, and patients with congenital absence of the internal carotid artery can have ischemic symptom; these patients can be complicated with vascular abnormalities such as aneurysm and vascular thickening.

Objective:To analyze the clinical and radiological features of patients with hypoplasia of the internal carotid artery.Methods:Four patients with hypoplasia of the internal carotid artery (including 3 patients with congenital absence of the internal carotid artery), admitted to our hospital from January 2010 to December 2021, were chosen in our study. The clinical data and imaging features of these patients were retrospectively analyzed.Results:The age of these patients ranged from 31 to 73 years, and two patients were female. Clinically,2 patients presented with dizziness, 1 patient presented with limb weakness, and 1 patient was asymptomatic. In 3 patients with congenital absence of the internal carotid artery, DSA results showed that the internal carotid artery was not developed, and CT bone window showed that the internal carotid artery canal was absent; 1 patient with hypoplasia of the internal carotid artery showed thin imaging in DSA results. One patient was combined with anterior communicating artery aneurysm and left internal carotid artery aneurysm. One patient was with vertebral arterial dolichoectasia. The collateral circulation compensation: type A was noted in 3 patients and type C was noted in 1 patient.Conclusion:The patients with hypoplasia of the internal carotid artery are usually asymptomatic, and patients with congenital absence of the internal carotid artery can have ischemic symptom; these patients can be complicated with vascular abnormalities such as aneurysm and vascular thickening.

Objective:To analyze the design and test results of case-introduced papers in Clinical Comprehensive Course graduation test for assistant general practitioners of batch 2015 and 2016, so as to provide references for enhancing the comprehensive abilities of students to analyze clinical problems during training.Method:Brief cases were introduced to part of the questions in the paper. The difficulty coefficient of the paper and the degree of distinction and reliability of the test results of students in the two batches were calculated and analyzed, and the results of their answers to different questions (single choice questions & brief case-introduced questions) were compared. SPSS 15.0 was used to perform chi-square test or t-test. Results:①The test papers for the two batches and the two parts in the papers all conformed to the testing purpose and have achieved the objective of training. The difficulty coefficient of the paper and the distinction and reliability degrees of the results were all reasonable. ②There was a statistically significant difference in the difficulty coefficient of the single choice questions in the papers of the two batches ( P<0.05), but no significant difference in the brief case-introduced questions ( P>0.05). ③There was no statistical difference in the difficulty coefficient of test questions in the two papers ( P>0.05), but a statistically significant difference was found in the difficulty coefficient of brief case-introduced questions ( P<0.05). ④There was a significant difference in the average scores of students in the two batches ( t=8.18, P<0.01) and in the frequency distribution of each fraction frequency in the "single choice question" ( P<0.01), but no difference in the frequency distribution of brief case-introduced questions ( P>0.05). ⑤There was a significant difference in the average scores of single choice questions of students in the two batches ( P<0.01), and no statistically significant difference in the average scores of brief case-introduced questions ( t=1.22, P>0.05). Conclusion:Students of batch 2015 and 2016 accepted the "brief case-introduced questions". These questions requires students with greater abilities, thus can effectively distinct their training outcomes. Generally speaking, introduction of cases in the teaching of assistant general practitioners has made great achievements.

By compiling the practice set of "brief problem examples", we continue to advance case-oriented teaching in the "3+2" assistant general practitioner training "clinical comprehensive course". However, we have found that 10.7% of the questions provided by the instructors are still concerned with large-scale equipment, and operation methods etc., suggesting that parts of the teachers' consciousness in general medicine is still urgent to be enhanced. According to the analysis of the graduation test results of the students of Grade 2015, it is obvious that the average scores of the students after the examination reform have not been significantly affected. The questionnaire survey shows that most of the teachers and students think that it is of positive significance to adopt a "brief medical record problem", and 91.5% of the teachers and 81.7% of the students do not affect the examination paper form and do not affect the answers. As for the compiled 1 exercises, 86.6% of the teachers and 67.8% of the students agreed. In view of the supple-mental effect of the form of "brief medical record problem" to case introduction teaching, it is necessary to compile the exercise set suitable for this course and apply it to specific teaching activities.

Objective Based on the objective test (A type) results of the 2014 comprehensive clinical course graduation test of 3+2 assistant general practitioners training,this article analyzed the differences between different teaching units,so as to provide objective basis for improving the teaching level of each unit.Method We established a database with EXCEL 2000,and put each question's ID and points,and the score of each student into the computer,so we could get the difficulty coefficient,distinction degree and reliability of the test paper,and calculate the difficulty coefficient and difference of each question.Then we analyzed the difficulty coefficient,the difference and the reliability of the 122 students' testing results,and compared the accuracy to the same question of the 6 teaching units.Result The objective test's (A type) difficulty coefficient is 0.77,distinction degree is 0.19,and reliability is 0.99.The highest score of the 122 students is 47 points,and the lowest score is 28 points,the average score is (38.5 ± 3.9) points.In the 50 questions,3 questions' difficulty coefficient is less than 0.4,14 questions' difficulty coefficient is between 0.4-0.7,33 questions' difficulty coefficient is above 0.7,so the difficulty degree of the paper is relatively low.In the 50 questions,23 questions' distinction degree is less than 0.15,17 questions' distinction degree is between 0.15-0.30,10 questions' distinction degree is above 0.30,so the distinction degree of the paper is relatively high.In the 50 questions,20 questions' accuracy appears larger differences between each unit:9 questions' accuracy has decreased significantly among 1-2 units,4 questions' accuracy decreased significantly among 3 units,3 questions' accuracy decreased significantly among 4 units,only 1 unit has high accuracy among 2 questions,and 2 questions' accuracy decreased significantly among all units.These problems are related to the teachers' teaching ability,the difficulty in mastering the key points of the curriculum,the lack of the concept of the general practitioners training.Conclusion The design of the examination paper is basically in line with the study purpose and the objectives of the training course.This examination paper was highly reliable,and suitable for the professional theory and ability test.There are site differences between each unit,which can provide an objective basis for improving the teaching level of different teaching unit,and we will solve the problems in the form of collective preparation next step.