Table of Content

20 June 2024, Volume 19 Issue 6

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Applications of Digital Health in Cerebrovascular Diseases: Current Trends and Future Perspectives

FENG Zhiyuan, LI Zixiao, WANG Chunjuan

2024, 19(6):  607-612.  DOI: 10.3969/j.issn.1673-5765.2024.06.001

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Digital health broadly refers to the development and use of digital technology to improve health knowledge and practice areas, including smart devices, digital consumers, the internet of things and other related health services. In recent years, digital health has developed rapidly in the field of cerebrovascular diseases. It has been applied in primary prevention and secondary prevention, as well as in the diagnosis and treatment of cerebrovascular diseases in the acute phase and rehabilitation. The related studies show that well-developed digital health products can predict the risk of cerebrovascular disease, help patients in the acute phase through telemedicine, enhance the compliance of patients with secondary prevention, and assist rehabilitation training after discharge. Digital health allows more clinical data to be shared instantly, patients to be treated more timely, and can reduce medical costs to some extent. This paper discussed the application of digital health in cerebrovascular disease and its possible development trend in the future.

Research on Cerebrovascular Diseases Enabled by Digital Healthcare and Artificial Intelligence

WANG Chunjuan

2024, 19(6):  613-613. 

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Research Progress on the Basic Medical Abilities of Large Language Models and Their Clinical Applications in Cerebrovascular Diseases

LIU Xien, LIU Shaohui, ZHOU Kaiyin, YOU Xinxin, ZHOU Yuxuan, NING Chen, FU Xiangling, WU Ji

2024, 19(6):  614-620.  DOI: 10.3969/j.issn.1673-5765.2024.06.002

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In recent years, large language models have demonstrated remarkable intelligence capabilities across various general domains and have been widely and effectively applied in multiple industries. However, due to the high level of specialization and complexity of scenarios in clinical medicine, there is no consensus on whether large language models can provide accurate, reliable, and efficient medical services. This study reviewed the progress of large language models in clinical medicine from the following aspects: evaluation of medical knowledge and basic medical capabilities; research progress on specific capability requirements in clinical scenarios; research progress on clinical diseases such as cerebrovascular diseases and related clinical applications.

Applications and Prospects of Artificial Intelligence and Machine Learning in the Management of Cardiovascular and Cerebrovascular Diseases: An Interpretation of the American Heart Association’s Scientific Statement on Improving Cardiovascular Outcomes Using Artificial Intelligence

MENG Lingshe, WANG Chunjuan

2024, 19(6):  621-631.  DOI: 10.3969/j.issn.1673-5765.2024.06.003

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Cardiovascular and cerebrovascular diseases are among the leading causes of death and disability worldwide. Despite continuous advancements in medical technology, the diagnosis and treatment of these diseases still face many unresolved challenges. The emergence of artificial intelligence and machine learning provides new approaches to addressing these issues. The American Heart Association’s 2024 scientific statement highlights the applications and challenges of artificial intelligence and machine learning in clinical scenarios, including imaging analysis, electrocardiogram interpretation, bedside monitoring, wearable devices, genomics, and electronic health records. This paper aims to introduce these aspects and analyze the advantages of artificial intelligence and machine learning in the field of cerebrovascular diseases, providing a reference for the future development of artificial intelligence and machine learning in this area in China.

Establishment and Evaluation of the Prediction Models of the Relationship between Cardiovascular and Cerebrovascular Diseases and Meteorological Factors

SHANG Yuanyuan, DU Zhengjing, CHEN Jingyi, PENG Bo, LONG Jieqi

2024, 19(6):  632-639.  DOI: 10.3969/j.issn.1673-5765.2024.06.004

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Objective  To explore the relationship between the incidence of cardiovascular and cerebrovascular diseases and meteorological factors, and to predict the incidence risk levels of cardiovascular and cerebrovascular diseases using machine learning methods, with the aim of providing the scientific basis for disease prevention and control. 
Methods  Patients with cardiovascular and cerebrovascular diseases, whose information were provided by the Guizhou Center for Disease Control and Prevention, were selected as subjects. The predictive factors of the model were determined through correlation analysis, and the prediction models for the risk of cardiovascular and cerebrovascular diseases were constructed based on four machine learning models: support vector machine, extreme gradient boosting, light gradient boosting machine, and random forest. The included patients were divided into the training set and the testing set in the ratio of 8∶2. The training set was used for model training and parameter optimization, and the testing set was used to evaluate the effect of the model. The predictive performance of each model was mainly evaluated by accuracy.
Results  A total of 16 383 patients over 60 years of age with cardiovascular and cerebrovascular diseases were included in this study, including 6507 women. The number of daily cases was unbalanced, in which the diagnostic types included acute myocardial infarction, stroke, angina pectoris, and sudden cardiac death. The number of daily cases was correlated with 26 meteorological factors in 3 categories including air pressure, air temperature, and humidity, and was positively correlated with air pressure and relative humidity, but negatively correlated with air temperature. The GridSearchCV function was used to find the optimal weight ratio, the machine learning method was used to construct the model, and the output model index parameters were verified through the testing set. The light gradient boosting machine model performed best in the prediction task, with an accuracy of 85.68%, a precision of 82.56%, a recall of 85.68%, and the F1 score was 79.56% (all P<0.05). The INP value of the temperature of  72 h before the onset of cardiovascular and cerebrovascular diseases was 63 814, which was the most important meteorological factor affecting the number of daily cases. The temperatures of 48 h before the onset and 24 h before the onset respectively ranked second and third, corresponding to INP values of 62 002 and 43 216. 
Conclusions  The prediction models of cardiovascular and cerebrovascular diseases based on machine learning methods have high predictive value. Among them, the light gradient boosting machine model presented the best performance.




Study on the Feasibility and Safety of Digital Subtraction Angiography through Distal Transradial Artery Access versus Transradial Approach

REN Weichao, YANG Haihua, YUAN Jinglin, DUAN Chunmiao, MA Ning, WANG Tiejun

2024, 19(6):  640-646.  DOI: 10.3969/j.issn.1673-5765.2024.06.005

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Objective  To compare the feasibility and safety of DSA between distal transradial artery access (dTRA) and transradial approach (TRA), and to optimize the puncture approach strategy for neurointerventional therapy.
Methods  Patients who planned to undergo DSA in the Department of Neurology, Daxing District People’s Hospital from July 2022 to January 2023 were continuously included. According to the method of generating random numbers by computer, the patients were randomly divided into the dTRA group and the TRA group. Patients who completed puncture according to the predetermined approach were included in the analysis. Demographic information, past medical history, and other baseline data of the two groups were collected. The internal diameter of puncture vessels, puncture time, puncture times, and other surgical process indexes, as well as postoperative complications such as arm pain, numbness, swelling, radial artery occlusion, and arteriovenous fistula, were compared between the two groups. A multivariate logistic regression model was used to analyze the influencing factors on the success rate of dTRA first puncture.
Results  In this study, 320 patients who intend to undergo DSA were included, of which 306 patients were included in the data analysis, with 153 patients in the dTRA group and 153 patients in the TRA group. There was no statistical difference in baseline data between the two groups. The internal diameter of puncture vessels in the dTRA group was smaller than that in the TRA group [(1.97±0.42) mm vs. (2.23±0.44) mm, P<0.001]. There was no statistical difference in the success rate of the first puncture between the two groups. However, compared with the TRA group, the dTRA group had longer puncture time (P=0.008), more puncture times (P=0.022), longer total operation time (P=0.003), and larger radiation dose (P=0.027). Compared with the TRA group, the dTRA group had a lower postoperative pain score (P＜0.001), lower incidence of numbness and swelling (P＜0.001), and lower incidence of radial artery occlusion (P=0.002). None of the patients in the TRA group had arteriovenous fistula after the operation, and two patients in the dTRA group had arteriovenous fistula, the difference was not statistically significant. Multivariate logistic regression model analysis showed that the internal diameter of the distal radial artery (OR 3.860, 95%CI 1.364-10.924, P=0.011) and the history of atrial fibrillation (OR 0.121, 95%CI 0.018-0.831, P=0.032) were the risk factors affecting the success rate of dTRA first puncture. 
Conclusions  Compared with TRA, dTRA can reduce the incidence of complications such as radial artery occlusion, numbness, swelling, and pain, and improve the comfort of patients.




Study on the Predictive Value of the Intracranial and Carotid Arteries Coexisting Atherosclerotic Plaque Distribution Characteristics for the Risk of Ischemic Stroke Recurrence

ZHAO Chenyang, LI Jin, LI Dongye, QIAO Huiyu, ZHAO Xihai, ZHOU Dan

2024, 19(6):  647-654.  DOI: 10.3969/j.issn.1673-5765.2024.06.006

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Objective  To investigate the predictive value of intracranial and carotid arteries coexisting atherosclerotic plaque distribution characteristics for the risk of stroke recurrence.
Methods  Patients with ischemic stroke within 2 weeks and at least one carotid plaque were consecutively included and underwent multi-contrast MR vessel wall imaging for extracranial carotid arteries and MRA for intracranial arteries at baseline. All patients were followed up for at least 1 year to record stroke recurrence. The distribution characteristics of atherosclerotic plaque in different segments of the extracranial carotid artery and the incidence of coexisting intracranial artery stenosis in anterior circulation and extracranial carotid artery atherosclerotic plaques in different segments were analyzed. Univariate and multivariate Cox regressions were used to calculate the predictive value of coexisting intracranial artery stenosis in anterior circulation and carotid artery atherosclerotic plaques in different segments for stroke recurrence.
Results  A total of 117 patients were included, with a mean age of (62.6±11.8) years, including 85 males. The median follow-up time was 12.0(11.1-12.8) months, and 31(26.5%) patients experienced stroke recurrence. Coexisting intracranial artery stenosis in the anterior circulation and atherosclerotic plaques in the segment of the carotid bulb was significantly associated with stroke recurrence (HR 2.535, 95%CI 1.085-5.922, P=0.032). After adjusting for confounding factors (age, sex, and BMI), this association remained statistically significant (HR 2.903, 95%CI 1.114-7.565, P=0.029). No significant association was found between intracranial artery stenosis in anterior circulation coexistent with atherosclerotic plaque in other segments of the carotid artery and stroke recurrence (P>0.05).
Conclusions  In patients with ischemic stroke and at least one carotid plaque, coexisting intracranial artery stenosis in anterior circulation and atherosclerotic plaque in the segment of the carotid bulb was independently associated with stroke recurrence.




Expression Changes and Significance of N⁶-Methyladenosine and its Regulatory Proteins in Cerebral Ischemia

YE Weizhen, ZHAO Shunying, JIANG Mingyu, HUANG Qiuru, WEN Shaohong, DONG Wen, CHEN Qingfang, LIU Xiangrong

2024, 19(6):  655-663.  DOI: 10.3969/j.issn.1673-5765.2024.06.007

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Objective  To explore the expression changes of N6-methyladenosine (m6A) and its regulatory proteins in mouse models with cerebral ischemia and to provide a reference for finding potential molecular targets for cerebral ischemia therapy.
Methods  A total of 60 male C57BL/6J mice were randomly divided into 4 groups: sham-operated group, 1 day post-ischemia group, 3 days post-ischemia group, and 7 days post-ischemia group, with 15 mice in each group. The model of right middle cerebral artery occlusion was established in C57BL/6J mice by thread embolization method. Reperfusion was achieved  after 1 hour of ischemia. RNA extraction and dot blotting were used to detect the levels of RNA m6A in the ischemic side of the mouse brain. Fluorescence quantitative reverse transcription PCR was used to detect the mRNA expression of methyltransferase 3 (Mettl3); methyltransferase 14 (Mettl14); FTO alpha-ketoglutarate dependent dioxygenase (Fto); alkB homolog 5, RNA demethylase (Alkbh5); YTH N6-methyladenosine RNA binding protein 1 (Ythdf1); Ythdf2; and Ythdf3 in the  ischemic side of the mouse brain. Western blot was used to measure the protein expression levels of Mettl3, Mettl14, Fto, Alkbh5, Ythdf1, Ythdf2, and Ythdf3 in the ischemic side of the brain. Meanwhile, immunofluorescence staining was used to observe the expression changes of Mettl3, Fto, Ythdf1, Ythdf2, and Ythdf3 in the neurons of the ischemic side of the brain. 
Results  Compared with the sham-operated group, the m6A level of the brain tissue RNA in 3 days post-ischemia group was increased (1.620±0.339 vs. 1.000±0.192, P=0.0343). ①Expression of methyltransferase: the mRNA level of Mettl3 decreased (0.675±0.059 vs. 1.000±0.131, P=0.0331) in 7 days post-ischemia group. The protein levels of Mettl3 (0.548±0.107 vs. 1.000±0.056, P=0.0398) and Mettl14 (0.534±0.218 vs. 1.000±0.018, P=0.0108) decreased in 1 day post-ischemia group. The protein levels of Mettl3 (0.410±0.341 vs. 1.000±0.056, P=0.0084) and Mettl14 (0.429±0.283 vs. 1.000±0.018, P=0.0026) decreased in 3 days post-ischemia group. Immunofluorescence staining revealed a reduction of Mettl3 expression in the neurons around the cerebral infarction area in 3 days post-ischemia group. ②Expression of demethylase: Fto protein levels were decreased in 1 day post-ischemia group (0.405±0.209 vs. 1.000±0.142, P=0.0108) and 3 days post-ischemia group (0.530±0.125 vs. 1.000±0.142, P=0.0412). Immunofluorescence staining showed that the expression of Fto in the neurons around the cerebral infarction area decreased after 3 days of cerebral ischemia. ③Expression of m6A binding protein: Ythdf1 mRNA level decreased in 1 day post-ischemia group (0.708±0.046 vs. 1.000±0.117, P=0.0331), while Ythdf3 mRNA level was increased (1.473±0.093 vs. 1.000±0.142, P=0.0012). The mRNA levels of Ythdf1 (0.593±0.240 vs. 1.000±0.117, P=0.0034) and Ythdf2 (0.664±0.177 vs. 1.000±0.200, P=0.0100) in 3 days post-ischemia group decreased, while the mRNA level of Ythdf3 was increased (1.451±0.281 vs. 1.000±0.142, P=0.0018). The protein levels of Ythdf1 (0.486±0.177 vs. 1.000±0.091, P=0.0197) and Ythdf3 (0.536±0.107 vs. 1.000±0.125, P=0.0400) in 1 day post-ischemia group were decreased. The protein levels of Ythdf1 (0.404±0.299 vs. 1.000±0.091, P=0.0079), Ythdf2 (0.279±0.189 vs. 1.000±0.261, P=0.0136), and Ythdf3 (0.450±0.220 vs. 1.000±0.125, P=0.0157) in 3 days post-ischemia group were decreased. Immunofluorescence staining further showed a decrease in the expression of m6A binding proteins Ythdf1, Ythdf2, and Ythdf3 in the neurons around the cerebral infarction area 3 days after ischemia. 
Conclusions  Post-ischemic downregulation of Fto in mice may lead to an elevation of m6A levels.The expression trends of Ythdf1, Ythdf2, and Ythdf3 proteins are generally consistent, indicating the existence of functional redundancy.




Research on the Endoplasmic Reticulum Stress Mechanism of Apoptosis Induced by Ischemic Retinal Injury

YU Wenxuan, LIANG Bing, CAO Yongliang

2024, 19(6):  664-671.  DOI: 10.3969/j.issn.1673-5765.2024.06.008

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Objective  To analyze the effects of ischemia on the expression of endoplasmic reticulum stress (ERS)-related proteins glucose regulated protein78 (GRP78), C/BEBP homologous protein (CHOP), and cysteinyl aspartate specific proteinase (Caspase)-12 during the apoptotic process of retinal ganglion cells (RGCs), and to investigate the molecular level pathogenesis of ischemic retinal injury (IRI)-induced RGCs apoptosis, to provide a new idea and method for the prevention and treatment of IRI. 
Methods  The anterior chamber high intraocular pressure method was applied to produce a rat right eye IRI model. Forty healthy male SD rats were randomly divided into the normal control group, 30-min IRI group, 60-min IRI group, and 120-min IRI group according to the ischemic time, with 10 rats in each group. Hematoxylin-eosin (HE) staining was applied to observe the changes in retinal histomorphology in different groups of rats; immunohistochemical (IHC) staining was applied to observe the expression and localization of apoptosis-related factors such as B-cell lymphocyte/leukemia-2 (Bcl-2), Bcl-2 associated X protein (Bax), and Caspase-3 in different groups; immunofluorescence (IF) staining was applied to observe the expression and localization of ERS-related proteins such as GRP78, CHOP and Caspase-12 in other groups.
Results  HE staining results showed that compared with the normal control group, retinal edema, increased thickness of the inner retinal layer, disturbed distribution of retinal cells, decreased number of RGCs, and increased vacuolar tissues were observed in the IRI groups. IHC staining results showed that only a small amount of Bax and Caspase-3 proteins were expressed in the retina of the normal control group, while Bax and Caspase-3 proteins were mainly expressed in the ganglion cell layer and the inner nuclear layer of the retina in the IRI groups. The expression of Bax and Caspase-3 proteins in the retina of the IRI groups was significantly higher than that of the normal control group, and the differences between the IRI groups were also statistically significant. A large amount of Bcl-2 protein was observed in the ganglion cell layer and inner nuclear layer of the retina in the normal control group. Compared to the normal control group, the expression of Bcl-2 protein in the retina of each IRI group was significantly reduced, and the differences between the IRI groups were also statistically significant. The results of IF staining showed that the positive expressions of GRP78, CHOP, and Caspase-12 in the retina of the normal control group were small, while their expressions in the ganglion cell layer and the inner nuclear layer in the retina of the IRI groups were significantly increased compared with the normal control group.
Conclusions  IRI can induce apoptosis in the retinal cells, and its mechanism may be related to the activation of ERS-related pathways.




Chinese Expert Consensus on Hypertension Management in Stroke Patients

Beijing Hypertension Association, Chinese Stroke Association Hypertension Prevention and Management Branch

2024, 19(6):  672-698.  DOI: 10.3969/j.issn.1673-5765.2024.06.009

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Stroke patients with elevated blood pressure are associated with death and poor recovery of neurological function. Active and effective blood pressure control is very important for improving prognosis. Based on existing evidence-based medical evidence, this consensus recommended the timing, target, and medication measures for early blood pressure reduction therapy for hemorrhagic and ischemic stroke. Considering the current situation of multiple diseases coexisting in clinical practice, the consensus also recommended the timing, target, and medication measures of blood pressure reduction in stroke patients with special conditions such as heart failure, carotid artery stenosis, aortic dissection, renal failure, atrial fibrillation, and pulmonary infection. At the same time, the consensus introduced the content of blood pressure management for primary and secondary prevention of stroke. It is conducive to guiding the standardized management of hypertension in stroke patients in clinical practice.



Paroxysmal Nocturnal Hemoglobinuria with Posterior Reversible Encephalopathy Syndrome: A Case Report

ZHAO Xin, XUE Wei, ZHU Xinli, JING Dongqing, HONG Fan, GUO Xiao, LIU Junling

2024, 19(6):  699-705.  DOI: 10.3969/j.issn.1673-5765.2024.06.010

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Posterior reversible encephalopathy syndrome (PRES) is a clinical-imaging syndrome dominated by reversible neurological damage and specific imaging manifestations, and paroxysmal nocturnal hemoglobinuria (PNH) is a clinically rare disease. This paper described a case of an elderly male patient with PNH who had long-term chronic hemolytic anemia. After irregularly taking low-dose immunosuppressants and short-term intermittent infusion of 10 U of washed erythrocytes, he developed a PRES with headache, seizures, mental behavioural abnormalities, abnormally high blood pressure, and trace subarachnoid hemorrhage. It should be differentiated from diseases such as cerebral venous and venous sinus thrombosis and reversible cerebral vasoconstriction syndrome. The aim of this paper is to improve the clinicians’ ability to prevent and identify this type of patients at an early stage.

Research Progress on the Potential Role of Taurine in Cerebro-Metabolic Disease and its Mechanism

WEN Jiaqi, PANG Jiangxia, CHEN Chao, JIANG Changchun, HAO Xiwa

2024, 19(6):  706-713.  DOI: 10.3969/j.issn.1673-5765.2024.06.011

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The concept of cerebro-metabolic disease, which centers on cerebrovascular damage caused by metabolic risk factors, has been proposed and is in the early stages of exploration. The prevention and treatment of cerebro-metabolic disease focus on the control of metabolic risk factors. At present, the clinical drug strategy is still based on the individual intervention of each metabolic risk factor, which brings a lot of trouble to patients due to the variety of drugs used and the high dosage. Therefore, there is an urgent need for a synergistic drug with multiple targets to reduce the drug burden and improve the efficacy in patients with cerebro-metabolic disease. Taurine, as a conditionally essential amino acid, has a variety of biological effects such as regulation of glycolipid metabolism, osmotic pressure regulation, cell membrane stabilization, antioxidation, anti-aging, etc., which has potential clinical value for cerebro-metabolic disease treatment. This paper focused on the pleiotropy of taurine and discussed the mechanism of taurine in cerebro-metabolic disease and its clinical application prospects.



Interpretation of the American Stroke Association Code ICH Expert Consensus Statement

LI Zhiming, WANG Zijie, LI Qi

2024, 19(6):  714-724.  DOI: 10.3969/j.issn.1673-5765.2024.06.012

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The acute treatment of intracerebral hemorrhage (ICH) has long been a focus of attention. In 2024, ICH experts from multiple countries have proposed the early comprehensive management plan for acute spontaneous ICH, termed Code ICH, which was published in Stroke. The expert consensus provided detailed recommendations on the brain injury mechanism of acute phase, early integrated diagnosis and treatment strategies, and future research directions for ICH. This paper will interpret and analyze the expert consensus.

Application of Case-Based Learning Combined with Teacher-Standardized Patient in Clinical Communication Teaching for Post-Stroke Neurogenic Bladder

HAO Qiang, WANG Shouyang, LIU Zhu, ZHANG Yong

2024, 19(6):  725-728.  DOI: 10.3969/j.issn.1673-5765.2024.06.013

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Objective  To explore the effect of case-based learning (CBL) combined with teacher-standardized patient (TSP) in the teaching of doctor-patient communication for post-stroke neurogenic bladder.
Methods  Sixty residents undergoing standardized training at Beijing Tiantan Hospital, Capital Medical University, were included and randomly divided into a control group and an experimental group. The control group received traditional lecture-based learning, while the experimental group received the CBL combined with the TSP approach. The teaching content was a course on doctor-patient communication regarding post-stroke neurogenic bladder, with a total of 12 class hours. After the teaching sessions, residents’ doctor-patient communication skills were assessed using TSP and the set elicit give understand end scale (set the stage, elicit information, give information, understand the patient’s perspective, and end the encounter; SEGUE). 
Results  There were no significant differences between the control group and the experimental group in terms of age, gender, theoretical exam scores, and operational exam scores at baseline. Following the teaching sessions, residents in the experimental group scored significantly higher than the control group on the SEGUE in the areas of setting the stage [(4.6±0.6) points vs. (3.7±0.8) points, P＜0.0001], eliciting information [(8.6±1.1) points vs. (7.3±0.9) points, P＜0.0001], giving information [(3.7±0.5) points vs. (3.3±0.6) points, P=0.0099], understanding the patient’s perspective [(3.5±0.4) points vs. (2.4±0.7) points, P＜0.0001], and total score [(22.1±1.5) points vs. (18.5±2.0) points, P＜0.0001]. There was no significant difference between the experimental group and the control group in ending the encounter [(1.7±0.6) points vs. (1.7±0.5) points, P=0.6305].
Conclusions  The teaching method of CBL combined with TSP can significantly improve the doctor-patient communication skills of residents in dealing with post-stroke neurogenic bladder. This teaching strategy holds promise as an effective means to enhance doctor-patient communication skills in medical education and improve the quality of medical service.


A Preliminary Study on the Training Course of Difficult Conversation Skills for Neurology Residents

YIN Hexiang, ZHOU Lixin, YAO Ming, ZHU Yicheng, CUI Liying, NI Jun

2024, 19(6):  729-734.  DOI: 10.3969/j.issn.1673-5765.2024.06.014

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Objective  A preliminary training course on difficult conversation skills was developed for neurology residents to explore the feasibility and effects of difficult conversation skills training. 
Methods  Two difficult conversation skills training courses focusing on specific clinical scenarios of particular relevance to neurologic practice were conducted among the neurology residents in Peking Union Medical College Hospital, once a month for 2 hours each time. The topics were: giving bad news, communicating with “difficult” patients or family members, discussing not implementing cardiopulmonary resuscitation and other rescue measures, and discussing the hospice care of patients in severe or critical condition with their families. Standardized patients and residents were invited to complete simulation-based teaching and the learning of doctor-patient communication ethics knowledge, skill, and strategies under the guidance of teachers. An anonymous online survey was used to assess residents’ satisfaction with the course. The self-assessment questionnaire of difficult conversation skills was used to analyze the improvement of residents’ skills in 11 dimensions before and after the course. Set the stage, elicit information, give information, understand the patient’s perspective, and end the encounter (SEGUE) was used to assess the communication ability of partial residents after one year of the course.
Results  A total of 14 residents participated in the course, and 12 (85.7%) completed the questionnaire, of which 9 (75.0%) were female, and 10 (83.3%) were junior residents, including first- and second-year residents. Overall, the residents reacted positively to the training course and gained improvements in most aspects addressed in the questionnaire to different extents. All residents who completed the questionnaire were satisfied with the course, and 3 of the 4 residents who completed the SEGUE evaluation got a grade of A.
Conclusions  Difficult conversation skills training using specific clinical scenarios stimulation based on real neurologic cases was well accepted by neurology residents. The residents had a high degree of satisfaction with the course and the course had a positive influence on the participants. Their ability of difficult conversations has been improved to different degrees after the training.