Table of Content

20 September 2017, Volume 12 Issue 09

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Pure

WANG Yong-Jun

2017, 12(09):  771-772.  DOI: 10.3969/j.issn.1673-5765.2017.09.001

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Patients with Severe Neurological Diseases Should Pay More Attention to Prevention of Venous Thromboembolism—New Progress of Venous Thromboembolism Prevention

YANG Zhong-Hua

2017, 12(09):  773-775.  DOI: 10.3969/j.issn.1673-5765.2017.09.002

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The Influence of Aspirin on Early Development of Acute Respiratory Distress Syndrome in Severe Cerebrovascular Disease

WEN Miao, YANG Bo, WEI Na, ZHANG Jing, YAN Jing, PU Yue-Hua, YANG Zhong-Hua

2017, 12(09):  776-780.  DOI: 10.3969/j.issn.1673-5765.2017.09.003

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Objective To investigate the influence of Aspirin on the early development of acute respiratory distress syndrome (ARDS) incidence rate in patients with severe cerebrovascular disease. Methods This was a prospective cohort study. A total of 309 patients admitted to the neurologic intensive care unit (NICU) of our hospital within 48 hours after onset of severe cerebrovascular disease with a Glasgow Coma Scale (GCS) score ≤8 points were consecutively enrolled. Subjects of entry included sex, age, medical history, medication preceding onset, baseline score of GCS, primary disease, whether the patient underwent anesthesia and/or received craniotomy, early ARDS occurrence, mechanical ventilation time, length of stay in NICU, mortality rate, etc. The ARDS incidence rates of two groups were compared. Meanwhile, the clinical factors of patients of ARDS and non-ARDS groups were compared. Results There was a significant reduction of ARDS incidence rate in aspirin group (n =106) as opposed to non-aspirin group (n =203) 20.8% vs 30.5% (P =0.045). Patients of the aspirin group had a higher average age[(62.41±10.69) vs (57.40±14.80), P =0.002], a larger percentage of combined hypertension (50.9% vs 38.4%, P =0.035), more coronary heart disease (31.1% vs 20.2%, P =0.032), and higher rate of taking statins (26.4% vs 8.4%, P =0.002). Ischemic stroke accounted for a larger proportion of the primary disease in this group. As opposed to non-ARDS group (223 cases), ARDS group (n =86) had lower GCS scores [(3.87±1.61) vs (6.48±1.51), P =0.043], less mechanical ventilation time [6 (5-8)d vs 0 (0-3)d, P =0.001], and required longer NICU stay [8 (6-10)d vs 3 (2-4)d, P =0.001], but had no significant difference in mortality rate. Conclusion Regular use of aspirin can reduce early ARDS incidence rate in severe cerebrovascular diseases, but cannot reduce mechanical ventilation time, duration of stay in NICU or morality rate.

Study on Transcranial Doppler in Predicting Delayed Cerebral Ischemia after Subarachnoid Hemorrhage with Higher Modified Fisher Grade

WU Jian-Wei, GUO Jun-Ping, JIA Jiao-Kun, DING Ze-Yu,YANG Zhong-Hua, ZHAO Xing-Quan

2017, 12(09):  781-785.  DOI: 10.3969/j.issn.1673-5765.2017.09.004

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Objective To investigate whether the predictive reliability of an increase in the mean blood flow velocity ratio of the ipsilateral to contralateral middle cerebral arteries (I/C mBFV) ≥120 cm/s is higher than that of the conventional absolute flow velocity (mBFV) for delayed cerebral ischemia (DCI) in higher modified Fisher grade. Methods Patients admitted into NICU of Beijing Tiantan Hospital, Capital Medical University from November 2011 to November 2013 who underwent transcranial Doppler sonography (TCD) and diagnosed with subarachnoid hemorrhage (SAH) ≥3 by modified Fisher grade were consecutively enrolled into study retrospectively. The mBFV value in bilateral middle cerebral arteries and I/C mBFV were recorded. The end point was delayed cerebral ischemia (DCI). The I/C mBFV and middle cerebral artery mBFV ≥120 cm/s were calculated for predicting the sensitivity, specificity, positive predictive value and negative predictive value of DCI. Results A total of 44 patients were included in the study, among which, 18 patients developed DCI, with incidence rate of 41%. For middle cerebral artery mBFV ≥120 cm/s, the sensitivity, specificity, positive predictive value and negative predictive value of TCD in predicting DCI were 77.8%, 50%,

53.8%, 75%, respectly. For I/C mBFV ≥1.5, the sensitivity, specificity, positive predictive value and negative predictive value of TCD in predicting DCI were 71.8%, 41.7%, 50%, 71.4%, respectively. Conclusion For SAH patients with higher modified Fisher grade, TCD was still an important tool for predicting DCI. The predictive value of mBFV ≥120 cm/s was higher than that of I/C mBFV ≥1.5.

The Levels and Correlation Studies of Homocysteine and Uric Acid in Plasma in Patients with Transient Ischemic Attack

ZHAO Xing-Jun, LIU Fang, MENG Ying, WEI Wei, LI Yi-Cai, LIU Zhi-Hui,LIU Jun-Ling

2017, 12(09):  786-789.  DOI: 10.3969/j.issn.1673-5765.2017.09.005

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Objective To investigate the levels and correlation of homocysteine (HCY) and uric acid (UA) in blood plasma of patients with transient ischemic attack (TIA). Methods The blood preparation of 110 patients with TIA and 115 normal subjects were collected. The levels of HCY and UA were respectively measured by fluorescence immunoassay and colorimetry. Results The levels of the HCY and UA in plasma of TIA patients were (20.47±7.32) μmol/L and (341.17±84.31) μmol/L respectively. The levels of HCY and UA in the common group plasma were (15.28±4.62) μmol/L and (298.67±64.59) μmol/L respectively. The contents of the HCY and UA in plasma of TIA group were significantly higher than that of the common group (All P <0.001). The Pearson correlation analysis showed that there was a positive correlation between HCY and UA in plasma of TIA patients (r =0.239, P =0.012). Logistic regression analysis revealed that the UA [odds ratio (OR) 1.017, 95% confidence interval (CI) 1.012-1.023, P <0.001] and HCY (OR 1.077, 95%CI 1.003-1.156, P =0.041)were the independent risk factors for TIA. Conclusion The contents of the HCY and UA in plasma of TIA group were both increased and were associated with each other.

Correlation Study on the Awareness, Treatment, Control Rate of Hypertension and Its Influential Factors in Shijingshan District, Beijing

TIAN Ai-Hong, TIAN Rui, ZHANG Run-Hua, DONG Li-Guang,HAO Chun-Yi, SHEN Ling-Xia, PAN Yue-Song, JIANG Yong, WANG Yong-Jun, LIU Gai-Fen

2017, 12(09):  794-799.  DOI: 10.3969/j.issn.1673-5765.2017.09.007

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Objective To investigate the awareness, treatment, control rate and influencing factors of hypertension in Beijing Shijingshan community, and to provide evidence for the prevention and control of hypertension. Methods Through random cluster sampling in Shijingshan District, Beijing, communitybased cross-sectional survey were conducted in residents after having achieved their previous informed consent. Questionnaire and general physical examination were performed upon subjects. Information such as demography, behavioral lifestyle, disease history, medication history, data of systolic pressure and diastolic pressure, etc., were collected and those who had completed data

were enrolled into study. The awareness, treatment, control rate of hypertension were analyzed statistically based on different age group and gender. And the influential factors were analyzed by multivariate logistic regression. Results A total of 3854 subjects had completed data. Among which, there were 2562 cases of female and 1292 cases of male. The prevalence, awareness, treatment and control rate of hypertension were 47.90% (1846/3854), 78.49% (1449/1846), 67.77% (1251/1846) and 48.75% (900/1846) respectively. The prevalence, awareness, treatment and control rate of male with hypertension were 54.33% (702/1292), 75.64% (531/702), 63.11% (443/702) and 45.30% (318/702) respectively. The prevalence, awareness, treatment and control rate of female with hypertension were 44.65% (1144/2562), 80.24% (918/1144), 70.63% (808/1144) and 50.87% (582/1144) respectively. The awareness and treatment rate of hypertension in female were the lowest in the 40-<50 years group, and the control rate was the lowest in the 70-≤81 years group. The awareness, treatment and control rate of male hypertension increased gradually with age, and the lowest was 40-<50 years group. Multivariate analysis showed that age, dyslipidemia, family history of hypertension and BMI were common factors affecting the awareness, treatment and control rate of hypertension. Conclusion The levels of awareness, control and treatment rate of hypertension in the residents of Shijingshan community in Beijing still need further enhancement. The prevalence, awareness, control, treatment rate of hypertension in female were higher than those of male.

Influences of Interfering Unique Long Region 83 Gene on Angiopoietins and Vascular Endothelial Growth Factor Expressions in Human Cytomegalovirus Infected Human Brain Vascular Smooth Muscle Cells

LIU Lei, WANG Jia-Wei

2017, 12(09):  800-807.  DOI: 10.3969/j.issn.1673-5765.2017.09.008

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Objective Unique long region 83 (UL83 ) gene is the symbol of human cytomegalovirus (HCMV) reactivated infection. This study is to investigate relationships between UL83 and vulnerable plaques rupture related factors, including angiopoietin (Ang) and vascular endothelial growth factor (VEGF) in HCMV infected human brain vascular smooth muscle cells (HBVSMCs). Methods (1) Cytoflowmetry was used to identify the efficiency of fluorescein amidite (FAM) labeled small interfering RNA (siRNA) transfection into HBVSMCs. (2) Three groups of siRNA were transfected into HBVSMCs infected with HCMV AD169 (MOI=10) in advance, and combined

with groups of blank, infected and infected but ineffective interfered to find which siRNA could silence UL83 gene to the greatest extent. (3) The messenger ribonucleic acid (mRNA) and protein expressions of Ang-1, Ang-2 and VEGF-A were detected at different time from 0, 6, 12, 24, 48 until 72 hours after HBVSMCs infected with HCMV AD169 (MOI=10), respectively. (4) mRNA and protein expressions of Ang-1, Ang-2 and VEGF-A in blank, infected & effective interfered, infected but ineffective interfered and only infected HBVSMCs were compared. Results A total of 95.95% of HBVSMCs had been transfected with FAM labelled siRNA after 6 hours. Forty-eight hours after transfected with siRNA, relative expression of UL83 mRNA within HBVSMCs infected with HCMV AD169 (MOI=10) reduced 78.7% at most, while 72 hours after transfected with siRNA, relative expression of UL83 encoded pp65 protein reduced 81.3% at most. Relative mRNA and protein expressions of Ang-1 0, 6, 12, 24, 48 and 72 hours after HBVSMCs infected with HCMV AD169 (MOI=10) gradually reduced (P <0.01), while relative mRNA and protein levels of Ang-2 and VEGF-A gradually increased (P <0.01). After silencing UL83 gene with effective siRNA, both reduction of Ang-1 expression and increase of Ang-2, VEGF-A expressions had been halted. Conclusion HCMV AD169 can reduce Ang-1 expression but increase Ang-2, VEGF-A expressions at the same time. Silence HCMV AD169 UL83 gene expression may halt such trend, which suggests the potential capability of HCMV making target cells producing angiogenic microenvironment through UL83 gene.

Protective Effect of Panax Notoginseng Saponins on Cerebral Ischemia–reperfusion Injury in Rats

GENG Jian-Hong, LIU Zhi-Hui, WANG Yan, HAN Guo-Sheng, LI Jian

2017, 12(09):  808-811.  DOI: 10.3969/j.issn.1673-5765.2017.09.009

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Objective To observe the effect of panax notoginseng saponins (PNS) on expression of apoptosis inducing factor (AIF) in hippocampus of rats with cerebral ischemia-reperfusion, and to investigate the mechanism of neuroprotective effect of PNS. Methods A total of 68 male Wista rats were randomly divided into sham operation group, normal saline control group and PNS treatment group, respectively. The saline control group and each PNS group were re-divided into ischemia-reperfusion 0 h, 2 h, 4 h, 6 h subgroups according to the intervention time points. The modified suture method was used to complete the rat middle cerebral artery occlusion (MCAO) model preparation. The suture was pulled out 2 h later, to cause formation of ischemia-reperfusion. After MCAO 2 h reperfusion at 0 h, 2 h, 4 h, 6 h point in time, intraperitoneal injection of low dose PNS (50 mg/kg), moderate dose PNS (100 mg/kg) and high dose of PNS (150 mg/kg) were given to the PNS treatment group; equivalent-volume of normal saline were given to the control groups, respectively. Immunohistochemistry assay was used to detect the expressions of AIF in the hippocampus of ischemic sides in ischemia-reperfusion rat. Results Compared to sham operation group, the number of AIF positive cells in the saline control group and PNS group significantly increased (All P <0.01). Compared to the saline control group, the number of AIF positive cells in PNS group significantly decreased (All P <0.01). Compared to low and moderate dosage group in PNS group, the number of AIF positive cells in high dose group

significantly decreased (All P <0.01). Conclusion The PNS may decrease hippocampus AIF expression in cerebral ischemia–reperfusion rat, which maybe have protective effect through the inhibition of AIF expression.

Effects of Functional Electrical Stimulation Combined with Rehabilitation of Treadmill Training on Lower Limbs Function of Stroke Patients at Acute Phase

ZHANG Xiao-Hua, REN Li-Jie, ZENG Jing,WANG Yao

2017, 12(09):  812-816.  DOI: 10.3969/j.issn.1673-5765.2017.09.010

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Objective To observe and discuss the impact of the functional electrical stimulation (FES) combined with rehabilitation of treadmill training on lower limb function in patients with stroke at acute phase. Methods A total of 120 cases of patients with acute cerebral apoplexy hemiplegia were divided into control group and observation group by random number table method. All patients received conventional drug treatment. The control group were treated by Bobath technology routine rehabilitation training mainly including the bridge type training, sit stand an ankle dorsiflexion, regular training, etc. Daily training 1 times, each time 45 min, a week 5 d, 2 weeks training. In observation group, patients were treated based on the therapy of the control group and were further given FES system combined with rehabilitation treadmill training, every 20 minutes, 5 days a week, 2 weeks training. The Functional walking scale (Functional ambulation category, FAC), Fugl-meyer lower limb function rating scale, the Barthel index score rating scale were used before and after treatment, respectively. Results (1) Before the treatment, differences of the above-mentioned indicators in patients between two groups had no statistical significance; (2) after treatment, the control group and the observation

group patients FAC scores, lower limb FMA score, the Barthel index score had significant differences with that of before treatment. After treatment, the above indexes in the observation group were significantly better than that in the control group (all P <0.001). Conclusion Functional electrical stimulation combined with rehabilitation treadmill training can significantly improve the lower limb function in patients with stroke at acute phase, and improve the ability of daily life activities.

Analysis of Influential Factors for Ischemic Stroke of Pediatric Moyamoya Disease

WANG Jia,ZHANG Dong, WANG Rong, ZHAO Ji-Zong

2017, 12(09):  817-821.  DOI: 10.3969/j.issn.1673-5765.2017.09.011

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Objective To investigate the clinical and angiographic characteristics of pediatric Moyamoya disease (MMD). Methods A restrospective analysis was conducted based on the clinical data of 176 pediatric MMD patients who were divided into cerebral infarction group and non-cerebral infarction group. Interblock characteristic and imaging parameters were used to evaluate risk factors for cerebral infarction by multivariates analysis. Results In our study, cerebral infarction was higher in girls than in boys (P =0.006). Between the infarction group and control group, the stenosis degree of anterior cerebral artery (ACA), middle cerebral artery (MCA) and internal carotid artery (ICA) were the risk factors of cerebral infarction (P <0.001, 0.014, <0.001). Multivariate analysis showed that ICA stenosis [odds ratio (OR) 6.945, 95% confidence interval (CI) 1.406-34.302, P =0.017], posterior choroidal artery compensatory (OR 0.780, 95%CI 0.780-0.324, P =0.000), compensatory posterior communicating artery (OR 3.288, 95%CI 1.521-7.111, P =0.002) were independently associated with the occurrence of cerebral infarction. Conclusion In pediatric Moyamoya disease, occlusion or stenosis of cerebral artery and some of well-formed collaterals did correlate with cerebral infarction occurrence.

Analysis of Influencing Factors of Cognitive Impairment in Patients with Acute Ischemic Stroke

CHEN Yong-Ming, LV Wei, ZHANG Jian-Ming, JIA Xiao-Lin, MENG Xia

2017, 12(09):  822-826.  DOI: 10.3969/j.issn.1673-5765.2017.09.012

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Objective To evaluate the influencing factors of cognitive impairment after acute ischemic stroke. Methods The study included 3285 patients who were subjects from the Study on Oxidative Stress in Patients with Acute Ischemic Stroke. The cognitive function of patients were determined by minimental state examination (MMSE), and the influence factors of cognitive impairment in patients with acute ischemic stroke were evaluated in multiple logistic regression analysis. Results The prevalence of cognitive impairment after acute ischemic stroke was 26.46% (n =869), and the difference between the groups in the aspect of patient's age, sex, place of residence, education, exercise, and National Institutes of Health Stroke Scale (NIHSS) score were statistically significant. Logistic regression analysis showed that the risk factors of cognitive impairment after acute ischemic stroke were hyperlipidemia [odds ratio (OR) 1.38, 95% confidence interval (CI) 1.01-1.89, P =0.043), women (OR 1.30, 95%CI 1.04-1.63, P =0.020), high National Institutes of Health Stroke Scale (NIHSS) score (OR 1.26, 95%CI 1.24-1.30, P <0.001), living in rural areas (OR 1.25, 95%CI 1.02- 1.53, P =0.026) and advanced age (OR 1.03, 95%CI 1.02-1.04, P <0.001). High education level (OR 0.77, 95%CI 0.63-0.92, P =0.015) and frequent exercise (OR 0.80, 95%CI 0.66-0.97, P =0.020) were

protective factors. Conclusion We should comprehensively take into account the influencing factors of cognitive impairment in patients with acute ischemic stroke.

Clinical Significance Analysis of Asymmetry from Vestibular Autorotation Test in Vestibular Diseases  

YAN Xiao-Yan, WANG Kai, HAN Yu-Liang

2017, 12(09):  827-830.  DOI: 10.3969/j.issn.1673-5765.2017.09.013

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Objective To investigate the clinical significance of asymmetry results from vestibular autorotation test (VAT). Methods All patients were divided into 3 groups by horizontal gain: abnormal asymmetry and decreased horizontal gain group (Group A), abnormal asymmetry and increased horizontal gain (Group B), and abnormal asymmetry and normal horizontal gain (Group C). Then the disease constitution of the 3 groups were compared. Results Group A (n =56) had 45 patients (80.4%) of peripheral vestibular diseases and 11 patients (19.6%) of central vestibular diseases. All the patients (100%) in group B (n =35) had central vestibular diseases. Group C (n =17) had 15 patients (88.2%) of peripheral vestibular diseases and 2 patients (11.8%) of central vestibular diseases. The incidence rates of central vestibular disease in Group B were significantly higher than those in Groups A and C (P <0.001). Conclusion The abnormal asymmetry mostly indicated peripheral vestibular diseases, however, the abnormal asymmetry with increased horizontal gain suggested the possibility of central vestibular diseases.

Advances in Prognostic Scores of Status Epilepticus

YUAN Fang, JIANG Wen

2017, 12(09):  832-835.  DOI: 10.3969/j.issn.1673-5765.2017.09.014

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Status epilepticus (SE) is a common and life-threatening neurological emergency disease with a high mortality rate. An accurate patient stratification and outcome prediction will assist physicians to optimize individualized medical intervention strategies and bring utmost benefits for patients with SE. There are four prognostic scores in SE: the Status Epilepticus Severity Score (STESS), the Epidemiology based Mortality score in SE (EMSE), the modified STESS (mSTESS), and the END-IT score. This paper reviewed the advances in prognostic scores of SE, presented their design methods, and analyzed advantages and limitations of each score, with the aim to facilitate better clinical assessment and research of SE prognostic scores.

The Definition Evolution of Status Epilepticus

GAO Qiong, JIANG Wen

2017, 12(09):  836-841.  DOI: 10.3969/j.issn.1673-5765.2017.09.015

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Status epilepticus is well recognized as a common neurologic emergency requiring prompt treatment. The definition of status epilepticus lays a foundation for the research and clinical practice. With the in-depth recognition to physiopathologic mechanism of such a disease, the concept of status epilepticus got revised and improved constantly, from abstract to specific, convulsions to non-convulsions,precise time of duration and prominent refractory concept. This paper mainly focused on concept transition of status epilepticus.

Neurology: American Academy of Neurology Issued Guideline for Reducing Adult Brain Injury Following Cardiopulmonary Resuscitation

YANG Zhong-Hua

2017, 12(09):  842-842.  DOI: 10.3969/j.issn.1673-5765.2017.09.016

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Typical Cases and Clinical Management of Patent Foramen Ovale-related Disease

FU Qiang, GUO Cai-Xia, GONG Xi-Ping, FANG Rui-Le, YU Dan-Dan, JU Yi, LIU Li-Ping, MO Da-Peng, DONG Ke-Hui,CHEN Bu-Xing

2017, 12(09):  846-849.  DOI: 10.3969/j.issn.1673-5765.2017.09.018

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Cerebral Aneurysm Treatment: Modern Neurovascular Techniques

LIU Ai-Hua

2017, 12(09):  850-851.  DOI: 10.3969/j.issn.1673-5765.2017.09.019

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Application of Adenosine to Facilitate the Clipping of Cerebral Aneurysms

JI Wen-Jun

2017, 12(09):  852-853.  DOI: 10.3969/j.issn.1673-5765.2017.09.020

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Psychogenic Dizziness

ZHU Cui-Ting, JU Yi

2017, 12(09):  854-858.  DOI: 10.3969/j.issn.1673-5765.2017.09.021

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Chronic dizziness, which has long been known to have no clear vestibular dysfunction, is called psychogenic dizziness. The proposed Phobic Postural Vertigo and visual vertigo couldn’t account for the range of psychiatric symptoms in patients with chronic dizziness, and didn’t raise fully effective interventions. In order to define betterly “psychogenic dizziness” disease entity and describe the etiology, clinical manifestation and relative mechanisms, the scholars elicited the concept of chronic subjective dizziness in 2004-2005 and updated as the Persistent Postural-Perceptual Dizziness on the basis of chronic subjective dizziness and Phobic Postural Vertigo in 2014. This article will discuss the process of cognition of Persistent Postural- Perceptual Dizziness in detail, and elucidate its pathogenesis, clinical manifestations, diagnosis and treatment, and its relationship with psychogenic diseases.

Psychological Analysis and Management of Interaction between Patients and Doctors in Stroke Ward

JIA Zheng-Chang, HE Fan-Ping, ZHAO Jing

2017, 12(09):  859-862.  DOI: 10.3969/j.issn.1673-5765.2017.09.022

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This paper discussed the present situation of the doctor-patient relationship from the aspects of the relationship between subject and object, personality, defense mechanism, transference and counter transference, and maslow's need theory, and put forward some positive suggestions, such as: to establish group psychological treatment in the patients to solve similar psychological problems, and to apply the concept of narrative medicine; to have Bart Lin team training for medical staff, to improve physicians doctor-patient communication skills, to understand the limitation of their own ability and responsibility, to clarify their own career orientation, to improve the professional identity, to provide better service to patients, which was beneficial to establish a good doctor-patient relationship.

Research Progress of the Association between cAMP Signalling Pathway and Vascular Remodeling

GAO Fei, HU Xiao-Lu, CHEN Kang-Ning

2017, 12(09):  863-868.  DOI: 10.3969/j.issn.1673-5765.2017.09.023

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Cyclic adenosine monophosphate (cAMP) signaling pathway, as an important intracellular messenger delivery system, is related to modulation of multiple physiological processes. Recent studies found that activated cAMP signaling pathway could suppress vascular remodeling involved in cardiovascular and cerebrovascular diseases and it might be expected to become new target for treatment of these diseases. This paper is to illustrate the association between cAMP signaling pathway and vascular remodeling from the aspect that cAMP signaling pathway may suppress vascular endothelial inflammation, intimal hyperplasia and blood platelets excessive activation.

Clinical Applications of Argatroban in the Treatment of Acute Ischemic Stroke

QUAN Ke-Hua, MA Lin, PAN Yue-Song, YANG Xiao-Meng, CHEN Wei-Qi, WANG Yi-Long, CHEN Hui-Sheng

2017, 12(09):  869-873.  DOI: 10.3969/j.issn.1673-5765.2017.09.024

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Argatroban is a direct thrombin inhibitor with the advantages of rapid onset, short duration of effect, less tendency of bleeding and no immunogenicity, which can effectively prevent thrombosis and secondary microthrombosis. Several studies home and abroad had proved that argatroban could effectively improve the neurologic symptoms and daily activity ability of patients with acute ischemic stroke, and it also had therapeutic effect in patients with acute atherosclerotic stroke or cardioembolic stroke. Compared with aspirin, ozagrel and and other antiplatelet drugs or heparin, argatroban has higher safety. Due to the different mechanism of action, the combination therapy with aspirin, clopidogrel and other antiplatelet drug or recombinant tissue plasminogen activator (rt-PA) may show the possibility of synergistic effect. This paper focuses on the clinical application of argatroban in the treatment of acute ischemic stroke.

Application of Seminar Teaching Method in Clinical Teaching of Management of Complex Cerebrovasular Disease with Hybrid Operation

ZHANG Qian, GE Pei-Cong, ZHANG Dong, WANG Rong, ZHANG Yan, WANG Shuo, ZHAO Yuan-Li, ZHAO Ji-Zong

2017, 12(09):  874-876.  DOI: 10.3969/j.issn.1673-5765.2017.09.025

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Objective To explore the value of seminar teaching method in clinical teaching of management of complex cerebrovascular disease with hybrid operation. Methods Thirty trainee doctors in neurosurgical department at Beijing Tiantan Hospital were randomized into seminar method and traditional lecture-based learning (LBL) groups. After the course entitled “management of complex cerebrovascular disease with hybrid operation”, case analysis and clinical operating skill examinations and self-evaluation questionnaire were performed. Results The seminar method group achieved a higher score than the LBL group for case analysis test [(84.13±7.29) vs (79.00±4.97), P =0.032)]. Moreover, self-evaluation of case analysis ability [(1.60±0.51) vs (1.13±0.64), P =0.043], multidisciplinary collaboration ability [(1.53±0.52) vs (1.07±0.59), P =0.035] and competence for hybrid operation [(1.47±0.51) vs (0.93±0.70), P =0.034] in seminar teaching method group were much better than those of the traditional teaching group. Clinical operating skill examination and self-evaluation of operating skill had no significant difference between groups. Conclusion The seminar teaching method was better for clinical teaching in management of complex cerebrovascular disease with hybrid operation. It can effectively improve the trainee doctor’s ability of case analysis, multidisciplinary collaboration and competence for hybrid operation.

Progress of Drug Clinical Trial Methodology and Pilot Study on New Model of Good Clinical Practice Teaching

ZHENG Hua-Guang, WANG Yi-Long, LI Shu-Ya, ZHAO Xing-Quan, WANG Chun-Xue, WANG Yong-Jun

2017, 12(09):  877-880.  DOI: 10.3969/j.issn.1673-5765.2017.09.026

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Objective To investigate how to improve good clinical practice (GCP) Guideline in clinical trials and traditional teaching methods. Methods Key Performance Indicators (KPI) for GCP was established by the qualitative method. Online teaching and offline teaching of KPI were used. Continuous quality improvement was carried by complying with the KPI during the monitoring and inspection of clinical trials. GCP rules for pragmatic clinical trial (PCT) were set up and compared with the international regulations. Results KPI for GCP based on the qualitative research was representative and operable, which can help to understand and comply with the GCP guideline. Continuous quality improvement through KPI could be helpful for quality improvement of drug clinical trial. Conclusion The quality of drug clinical trial can be improved by the new teaching method of GCP of establishing the KPIs and continuous quality improvement.

The Application of Micro-Video Learning Modal of Neurological Disease Continuing Education in the General Practitioners

HUO Mo-Fei, Wang Lei

2017, 12(09):  881-884.  DOI: 10.3969/j.issn.1673-5765.2017.09.027

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Objective To find out the demands of general practitioners for continuing education about neurological disease, and investigate the recognition degree of neurological disease continuing education based on Micro-Video modal. Methods General practitioners were organized to watch Micro-Videos about the neurological disease, and then completed the questionnaire to investigate the demands of the neurological disease continuing education, and to perform difference examination of frequency distribution of demand of each item of learning content and the appropriateness of application of Micro-Video learning. Results There were 228 general practitioners having completed effective investigation, 205 (89.9%) ones of which thought the continuing education was very necessary or necessary. In the difference examination of frequency distribution between the demand level of each learning context and appropriateness of learning by Micro-Video, the difference of frequency distribution between the demand level of “Professional Theory Learning”, “Knowledge of New Technology and New Instrument”, “Latest Developments of the Medical Profession” and the appropriateness of learning by Micro-Video had no statistical significance. The difference of frequency distribution between the demand level of “Clinical Thinking”, “Skill Operation”, “Communication Skills”, “Medical Laws and Regulations” and the appropriateness of learning by Micro-Video had statistical significance. Conclusion The general practitioners had a great demand for continuing education about

neurological disease. Some lessons which were strong theoretical knowledge and needed repeated watching to understand or memorize like “Professional Theory Learning”, “Knowledge of New Technology and New Instrument”, “Latest Developments of the Medical Profession” got high recognition by learning form of Micro-Video. Some lessons like “Clinical Thinking”, “Skill Operation”, “Communication Skills”, “Medical Laws and Regulations” were not very suitable for complete learning form of Micro-Video.