Comparative Study on the Payment of Medical Insurance for Innovative Drugs Between China and Foreign Countries / 医药导报

Payment by diagnosis related groups(DRG)is an important research direction in China's current medical insurance payment reform.However,it limits the clinical development and utilization of innovative medicines to a certain extent.Additional payments for innovative medicines have been thoroughly studied in many countries.This paper conducted an analysis and summary of the global experience regarding additional payment for innovative medicines under the DRG payment system.U-sing the United States,France,and Germany as case studies,this paper also examined the current state of medical insurance pay-ment for innovative medicines in China and the influence of DRG payment on the development of such medicine.In addition,it has put forward explicit policy recommendations,including the establishment of inclusion criteria,the selection of appropriate payment modes,the implementation of dynamic adjustment mechanisms,the enhancement of payment methods,etc.This paper aims to provide references to comprehensively promote DRG payment reform while further establishing and enhancing medical in-surance payment mechanisms related to innovative medicines in the context of China's national conditions.

Risk identification and prevention and control for medical insurance fund utilization based on fault tree analysis / 中华医院管理杂志

Strengthening the supervision of medical insurance funds is an important measure to promote the healthy and sustainable development of the medical security system. In January 2022, a tertiary general hospital in Beijing carried out risk identification and prevention and control practices for the use of medical insurance funds. By using such methods as fault tree analysis and risk matrix, the probability and impact of events were quantitatively evaluated, high-risk events during the use of medical insurance funds were identified, and corresponding risk prevention and control measures were developed, relying on intelligent regulatory systems. From January to November 2022, the hospital outpatient medical insurance refusal amount(20 080 yuan) caused by such high-risk events as exceeding drug instructions, exceeding medical insurance indications, and exceeding age limits decreased by 42.30% compared to the same period in 2021(11 585 yuan). The discharge and settlement time of medical insurance patients decreased from 3 working days to 1 working day. This practice had effectively improved the quality and efficiency of hospital medical insurance fund supervision, improved patients′ medical experience, and provided reference for strengthening the safe and standardized use of medical insurance funds by medical institutions.

Hypercalcium crisis and postoperative hungry bone syndrome caused by primary hyperparathyroidism: a case report / 临床耳鼻咽喉头颈外科杂志

To review the diagnosis and treatment of a case of hypercalcium crisis caused by primary hyperparathyroidism（PHPT） and prophylactic treatment of hungry bone syndrome. In a 32-year-old male with hypercalcemia, the main manifestations were loss of appetite, nausea, polyuria, polydipsia, fatigue, lethargy, etc. parathyroid hormone, serum calcium increased, thyroid function was normal, thyroid color ultrasound and MRI showed space-occupying behind the right thyroid, radionuclide examination showed abnormal imaging agent concentration in the right parathyroid area, there was a history of pathological fracture. Clinically diagnosed as hypercalcemia crisis secondary to PHPT.

Endovascular mechanical thrombectomy combined with continuous intrasinus thrombolysis for the treatment of severe hemorrhagic cerebral venous sinus thrombosis: a case series study / 国际脑血管病杂志

Objective:To investigate the feasibility and safety of endovascular mechanical thrombectomy (EMT) combined with continuous intrasinus thrombolysis for the treatment of severe hemorrhagic cerebral venous sinus thrombosis (CVST).Methods:The clinical and imaging data of 5 consecutive patients with severe hemorrhagic CVST who received EMT combined with continuous intrasinus urokinase thrombolysis in Beijing Tiantan Hospital from March 2019 to February 2020 were retrospectively analyzed.Results:The average age of 5 patients was 39 years (range, 19-65 years). Two were males and 3 were females. Risk factors associated with CVST were identified in 3 patients. Four had more than two venous sinuses involved, with a total of 10 blood vessels affected by CVST. The affected venous sinus thrombus burden was high, the lesion volume was large, and the clinical manifestations were severe. The average duration of heparin anticoagulation therapy before EMT was 2.3 d (range, 0.5-7 d), and the average duration of intrasinus thrombolysis was 64 h (range, 30-95 h). After treatment, 1 vessel was completely recanalized and 7 vessels were partially recanalized. Four patients who achieved recanalization had good long-term clinical outcomes (modified Rankin Scale score: 0-2 at 3 months, 0-1 at 1 year). One patient failed to achieve recanalization and underwent decompressive craniectomy due to intracranial hypertension, had residual hemiparesis at 1-year follow-up. No procedure-related complications occurred.Conclusion:EMT combined with continuous intrasinus thrombolysis is a potential treatment option for patients with severe hemorrhagic CVST.

Effect of enoxaparin on subacute in-stent thrombosis after stenting in patients with symptomatic middle cerebral artery stenosis / 国际脑血管病杂志

Objective:To investigate whether the use of enoxaparin after stenting in patients with symptomatic middle cerebral artery stenosis can reduce the risk of subacute in-stent thrombosis (IST).Methods:Patients with symptomatic middle cerebral artery stenosis underwent stenting in the Department of Neurology, Drum Tower Clinical Medical School, Nanjing University of Chinese Medicine from January 2020 to December 2022 were retrospectively included. The patients were divided into an enoxaparin group and a control group based on whether to use enoxaparin after surgery. The demographic and baseline data and the incidence of perioperative complications were compared between the two groups. Multivariate logistic analysis was used to determine the independent influencing factors of postoperative subacute IST.Results:A total of 86 patients were enrolled, including 61 males (70.93%), and aged 58.03±10.14 years old. Forty-eight patients (55.81%) were treated with enoxaparin. The incidence of subacute IST in the enoxaparin group was significantly lower than that in the control group (2.08% vs. 13.16%; χ2=4.008, P=0.045), and there was no statistically significant difference in the incidence of symptomatic intracranial hemorrhage compared to the control group (2.08% vs. 2.63%; χ2=0.028, P=0.867). Multivariate logistic regression analysis showed that the use of enoxaparin after stenting was an independent protective factor of subacute IST (odds ratio 0.042, 95% confidence interval 0.005-0.901; P=0.042). Conclusion:The use of enoxaparin after stenting in patients with symptomatic middle cerebral artery stenosis can reduce the incidence of subacute IST without increasing the incidence of symptomatic intracranial hemorrhage.

Efficacy and safety of intravenous tirofiban after endovascular therapy in patients with intracranial atherosclerotic stroke / 国际脑血管病杂志

Objective:To investigate the efficacy and safety of intravenous tirofiban after endovascular therapy in patients with acute intracranial large atherosclerotic stroke.Methods:Patients with acute intracranial large atherosclerotic stroke received endovascular therapy in the Stroke Center, Nanjing Drum Tower Hospital from January 2018 to December 2020 were enrolled. The incidence of symptomatic intracranial hemorrhage in patients of tirofiban group and non-tirofiban group during perioperative period and the outcome after procedure at 90 d were analyzed.Results:A total of 172 patients were included. Their average age was 66.0 years and 126 patients were male (73.3%). Ninety-two patients (53.5%) used tirofiban, and 120 (69.8%) had good outcomes. Compared with the non-tirofiban group, the tirofiban group had a significantly higher rate of good outcome at 90 d after procedure (77.2% vs. 61.3%; P=0.023). The reocclusion rate was significantly lower (7.6% vs. 18.8%; P=0.039), while there was no statistically significant difference in the incidence of symptomatic intracranial hemorrhage during periprocedureal period (4.3% vs. 3.8%; P=0.990). There was a significant independent correlation between the use of tirofiban intravenously and the good outcome at 90 d after procedure, both in the overall patients (odds ratio 0.208, 95% confidence interval 0.064-0.680; P=0.009) and the patients with severe stroke (odds ratio 0.181, 95% confidence interval 0.050-0.658; P=0.009) were all the same. Conclusion:For patients with acute intracranial large atherosclerotic stroke who received intravascular therapy, intravenous tirofiban can significantly improve the clinical outcome at 90 d after procedure, and will not increase the risk of symptomatic intracranial hemorrhage.

Effect of the number of retrieval attempts on the outcomes after successful recanalization of mechanical thrombectomy in patients with acute ischemic stroke / 国际脑血管病杂志

Objective:To investigate the effect of the number of retrieval attempts on the outcomes after successful recanalization of mechanical thrombectomy in patients with acute ischemic stroke.Methods:Patients with acute large vessel occlusive ischemic stroke underwent mechanical thrombectomy and successful postoperative recanalization in the Stroke Center of Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January 2019 to May 2020 were retrospectively enrolled. According to the number of retrieval attempts during the procedure, the patients were divided into <3-attempt group and ≥3-attempt group. The demographic data, procedure-related indexes, periprocedural complications and outcomes at 90 d after the procedure were compared between the two groups.Results:A total of 106 patients, aged 69.8±1.3 years, were enrolled, and 55 were males (51.9%). Eight-three patients (78.3%) were in the <3-attempt group, and 23 (21.7%) were in the ≥3-attempt group. Forty-one patients (38.7%) had good outcomes (the modified Rankin Scale score ≤2) at 90 d, and 11 (10.4%) died. There were no significant differences in the incidence of intracranial hemorrhage (30.4% vs. 20.5%; χ2=1.019, P=0.313), the good outcome rate at 90 d (34.8% vs. 39.8%; χ2=0.188, P=0.665) and mortality (8.7% vs. 10.8%; P=0.999) between the ≥3-attempt group and <3-attempt group, but the incidence of symptomatic intracranial hemorrhage was significantly higher than that in the <3-attampt group (13.0% vs. 1.2%; P=0.031). Multivariate logistic regression analysis showed that the number of retrieval attempts was not significantly associated with poor outcome. Conclusion:The more retrieval attempts may be related to symptomatic intracranial hemorrhage, but it does not affect the clinical outcomes of patients with successful recanalization at 3 months.

Application of side branch protection technique in interventional treatment of intracranial atherosclerotic stenosis / 中国医师杂志

Objective:To investigate the application of side branch protection technique in interventional treatment of intracranial arteriosclerosis stenosis.Methods:We reviewed the patients who underwent interventional treatment of intracranial arteriosclerosis stenosis from November 2018 to May 2021 in Affiliated Drum Tower Hospital of Nanjing University Medical School, and analyzed the role of side branch protection technique in the prevention and treatment of complications. Relevant evaluation indicators including: (1) imaging: patency of blood flow in target vessels and branch vessels; (2) clinical presentation: ischemic stroke or transient ischemic attack (TIA) events within 72 hours and one month follow-up results.Results:A total of 9 patients underwent side branch protection during interventional treatment for intracranial arteriosclerosis stenosis, the blood flow of target vessels was improved obviously after operation, and the blood flow of the affected branches was not affected; no stroke or TIA events occurred in 72 hours after operation and one month follow up.Conclusions:Proper application of side branch protection technique can reduce the perioperative complications effectively during the interventional treatment for intracranial arteriosclerosis stenosis.

Intervention Mechanism of Bushen Huoxuetang on Osteoporosis Related to Endocrine Therapy in Breast Cancer Based on PI3K/Akt/HIF-1α Signaling Pathway / 中国实验方剂学杂志

ObjectiveTo predict the underlying mechanism of Bushen Huoxuetang in treating osteoporosis related to endocrine therapy in breast cancer by network pharmacology and to verify the results through in vitro cell model. MethodThe main effective components and targets of Bushen Huoxuetang were screened out through network pharmacology， and the targets of osteoporosis related to endocrine therapy in breast cancer were further obtained. The intersected targets were analyzed by Gene Ontology （GO） functional annotation and Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway enrichment. Kaplan Meier plotter was used to analyze the survival of crucial targets. Finally， the inhibitory activity against cell proliferation was evaluated by in vitro methye thiazolye telrazlium（MTT） assay. The key targets and pathways were verified by Western blot， and the mRNA expression of the key targets was evaluated by real-time polymerase chain reaction（Real-time PCR）. ResultA total of 716 active components and 249 key targets of Bushen Huoxuetang were obtained from network pharmacology. There were 135 common targets， among which protein kinase B（Akt）1 and hypoxia-inducible factor-1α （HIF-1α） were two key targets. Additionally， 531 biological processes， 62 cellular components， 162 molecular functions， and 145 signaling pathways including breast cancer and endocrine resistance were involved. The key targets were effectively enriched in phosphatidylinositol 3-kinases（PI3K）/Akt and HIF-1 signaling pathways. According to the MTT assay， the cell proliferation rate and cell motility of MCF-7 and T47D cells in the luminal A cell line were reduced by Bushen Huoxuetang treatment （22.5， 45， 90 g·L-1， and 45， 90， 180 g·L-1） for 48 h as compared with the blank group. As revealed by Western blot， MCF-7 cells were treated with Bushen Huoxuetang （0， 15， 60 g·L-1） for 48 h， and the relative expression of p-PI3K， PI3K， p-Akt， Akt， and HIF-1α was decreased in a dose-dependent manner as compared with the blank group （P<0.05， P<0.01）. Real-time PCR was used to detect the mRNA expression of the key target HIF-1α. The results showed that the mRNA expression of HIF-1α in MCF-7 cells was decreased with the increase in the dose （P<0.01）， and the change was in a concentration-dependent manner. ConclusionThe mechanism of Bushen Huoxuetang in the treatment of osteoporosis related to endocrine therapy in breast cancer may be related to the key targets including Akt1 and HIF-1α through the PI3K/Akt/HIF-1α signaling pathway.

Changes of humoral and cellular immune indexes in peripheral blood of children with Kawasaki disease at different stages / 中国医师进修杂志

Objective:To investigate the dynamic change characteristics of peripheral blood interferon-γ (INF-γ), interleukin (IL)-4 levels and T helper cell (Th)1/Th2 balance in acute, subacute and restoration stages of children with Kawasaki disease (KD).Methods:Forty-one children with KD received treatment in Women′s and Children′s Hospital Affiliated of School of Medicine University of Electronic Science and Technology of China, Chengdu Women′s and Children′s Central Hospital from May 2017 to January 2020 were enrolled as the observation group, and 41 healthy children examinee from the same period were enrolled as the control group. Children with KD of the observation group were performed with tuberculin pure protein derivative (PPD) test when acute and restoration stage of KD respectively. Peripheral venous blood were drawn from KD children of the observation group in acute, subacute and restoration stage and the control group respectively, serum immune globulin IgG, IgA, IgM and IgE, serum IFN-γ and IL-4 levels were detected by enzyme linked immunosorbent assay (ELISA).Results:Positive rates of PPD test in the restoration stage was higher than that in the acute stage: 65.85%(27/41) vs.17.07%(7/41), there was statistical difference ( χ2 = 20.10, P<0.05). The levels of serum IgG, IgA, IgM and IgE in the acute stage , subacute stage and restoration stagewere gradually decreased ( P<0.05). The levels of serum IgG, IgA, IgM and IgE in the restoration stage and the control group had no significant differences ( P>0.05). The levels of serum IFN-γ and IFN-γ/IL-4 in the acute stage , subacute stage and restoration stage were gradually increased ( P<0.05), the level of IL-4 was gradually decreased ( P<0.05), but the levels of serum IFN-γ, IL-4 and IFN-γ/IL-4 in the restoration stage and the control group had no significant differences ( P>0.05). Conclusions:Among the children with KD in acute stage, serum level of IFN-γ is decreased while serum IL-4 level is increased, and Th1/Th2 balance shifts to Th2. Along with the stabilization of disease, the levels of serum IFN-γ and IL-4 are normalized, and Th1/Th2 balance presents a recovering trend and they almost recover to normal after entering the restoration stage.

Application of heuristic teaching combined with anchored instruction in emergency department nursing teaching / 中华医学教育探索杂志

Objective:To explore the application value of heuristic teaching combined with anchored instruction in nursing teaching in emergency department.Methods:A total of 80 nursing students assigned to the Emergency Department of The First Affiliated Hospital of Air Force Medical University from July 2019 to October 2020 were divided into control group and research group, with 40 cases in each group. The control group used traditional teaching, and the research group used heuristic teaching combined with anchored instruction. At the end of the practice, the teaching effect was evaluated through the examination results (theoretical examination and scenario simulation practice skills examination) and questionnaire survey of teaching quality and teaching satisfaction. SPSS 22.0 was used for t test and chi-square test. Results:The theoretical examination scores [(93.20±2.88) vs. (90.53±3.06)] and the practical skill examination scores (basic operation examination, specialized operation examination and comprehensive quality) of the study group were higher than those of the control group, and the difference was statistically significant ( P<0.05). The overall situation of teaching quality and teaching satisfaction of nursing students in the study group was significantly higher than that in the control group, and the difference was statistically significant ( P<0.05). Conclusion:Heuristic teaching combined with anchored instruction is helpful to improve the theoretical knowledge, practical skills, operation level and comprehensive quality of nursing students, and has good popularization value in clinical nursing teaching.

High-dose Dual Therapy for Treatment of Helicobacter pylori Infection: A Meta-analysis of Randomized Controlled Trials / 胃肠病学

Background: High-dose dual therapy (HDDT) is a novel regimen for the eradication of Helicobacter pylori (Hp) infection, however, its efficacy and safety remain unclear. Aims: To evaluate the efficacy, safety and compliance of HDDT for Hp eradication. Methods: Randomized controlled trials (RCTs) on HDDT for eradication of Hp infection were retrieved from PubMed, Embase, The Cochrane Library, Web of Science from the date of database establishment to October 2020. Literatures were enrolled according to the inclusion and exclusion criteria, and the data were extracted. RevMan 5.2 software was used for performing meta-analysis. Results: Nine RCTs including 2 627 patients were included. Meta-analysis results showed that no significant differences in ITT eradication (85.4% vs. 79.8%, RR=1.03, 95% CI: 0.96-1.10, P=0.40), PP eradication (88.7% vs. 83.4%, RR=1.01, 95% CI: 0.95-1.08, P=0.68), and compliance (96.5% vs. 95.9%, RR=1.01, 95% CI: 0.99-1.02, P=0.37) were found between HDDT and the guideline-recommended regimens, however, the incidence of adverse events was significantly decreased in HDDT (15.3% vs. 27.0%, RR=0.57, 95% CI: 0.42-0.76, P=0.000 2). Conclusions: There are no significant differences in eradication rates and compliance between HDDT and the guideline-recommended regimens, however, HDDT is much safer.

Summary of the 19th China Cerebrovascular Disease Congress / 中华神经科杂志

The 19th China Cerebrovascular Disease Congress, sponsored by the Chinese Medical Association and the Chinese Society of Neurology, was held in Nanjing from April 11 to 13, 2019. At this meeting, experts in clinical and basic research on cerebrovascular diseases at home and abroad were invited and the latest research progress, clinical research and diagnosis and treatment guidelines at home and abroad were introduced. What is particularly wonderful is the case discussion of difficult cerebrovascular disease.

Isolated cortical vein thrombosis: a case series study / 国际脑血管病杂志

Objective:To investigate the clinical and imaging characteristics of isolated cortical vein thrombosis (ICVT) in order to improve the understanding of this rare disease.Methods:From December 2013 to September 2019, patients with ICVT admitted to Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School were collected retrospectively. Their clinical manifestations, imaging examination, treatment and prognosis were analyzed.Results:A total of 6 patients with ICVT were enrolled in the study, including 3 males and 3 females, with an average age of 37 years. The main clinical manifestations were acute seizures (5/6, 83.3%), focal neurological deficits (3/6, 50.0%), and headache (3/6, 50.0%). In the imaging examination, the direct signs of ICVT were spot sign and cord sign, and the indirect signs were cerebral lobe hemorrhage, infarction, or edema.Conclusions:Seizures, focal neurological deficits and headaches are common manifestations of ICVT. Multimodality imaging examinations are helpful for early diagnosis of the disease.

Etiology and pathogenesis of ischemic stroke in young adults / 国际脑血管病杂志

In recent years, the incidence of stroke in young adults, especially ischemic stroke, has been increasing worldwide. Due to its high disability, high mortality, and high recurrence, it has brought a serious burden to society and families. The common causes of ischemic stroke in young adults include large artery atherosclerosis and small vessel occlusion, while the rare causes such as patent foramen ovale, hereditary cerebral small vessel disease, cerebral artery dissection, moyamoya disease, vasculitis, and cryptogenic stroke also account for a high proportion. Its pathogenesis is complex, and diagnosis and treatment are difficult. This article reviews the latest research progress of the pathogenesis of ischemic stroke in young adults.

Deep cerebral vein thrombosis: a case series study / 国际脑血管病杂志

Objective:To investigate the clinical and imaging characteristics of deep cerebral vein thrombosis (DCVT).Methods:From December 2006 to December 2019, patients with DCVT admitted to Nanjing Drum Tower Hospital were enrolled retrospectively. The clinical manifestations, imaging examinations, treatment and prognosis of the patients were analyzed.Results:A total of 11 patients with DCVT were enrolled in the study, including 4 females and 7 males. Their average age of onset was 41.6 years. Their most common clinical manifestations were acute or subacute onset headache (11/11, 100%), disturbance of consciousness (5/11, 45.5%), and seizures (4/11, 36.4%). All 11 patients involved straight sinus, 9 involved the great cerebral vein, 5 involved the internal cerebral vein, and 1 involved the basilar vein. All patients were complicated with other venous sinus thrombosis, and 3 were complicated with superficial cortical venous thrombosis. Early CT plain scan (within 1 week of onset) of 8 patients (72.3%) showed high-density point sign of great cerebral vein or cord sign of straight sinus. Head MRI showed that 90.9% (10/11) of patients had brain parenchymal damage, thalamic involvement (5/11, 45.5%) was the most common, followed by deep white matter (4/11, 36.4%). One patient received urokinase interventional thrombolysis and died on the 6 th day of onset. The remaining 10 patients improved after receiving anticoagulant therapy. Follow up of 4 months to 13 years showed that 4 patients left with mild to moderate disability (the modified Rankin scale score 1-3), and 6 returned to normal. Conclusions:Headache, disturbance of consciousness and seizures are common clinical manifestations of DCVT. Imaging examination shows that the possibility of DCVT should be warned when the thalamus or deep white matter is involved. It is necessary to pay attention to the high-density thrombus spot sign and cord sign on early CT plain scan. DCVT patients with cortical venous thrombosis progressed rapidly in the acute phase, and the outcomes were poor.

Summary of the 19th China Cerebrovascular Disease Congress / 中华神经科杂志

The 19th China Cerebrovascular Disease Congress,sponsored by the Chinese Medical Association and the Chinese Society of Neurology,was held in Nanjing from April 11 to 13,2019.At this meeting,experts in clinical and basic research on cerebrovascular diseases at home and abroad were invited and the latest research progress,clinical research and diagnosis and treatment guidelines at home and abroad were introduced.What is particularly wonderful is the case discussion of difficult cerebrovascular disease.

Correlation between acute stress hyperglycemia and hemoglobin A1c in patients with cerebral infarction / 中华老年医学杂志

Objective:To investigate whether the basal blood glucose level before cerebral infarction has an impact on acute stress hyperglycemia.Methods:A total of 366 patients with cerebral infarction admitted into the neurology department of our hospital from February 2008 to May 2012 were enrolled in this study. Acute stress hyperglycemia was reflected by stress-induced glucose up-regulation ratio (SIGUR), and the basal glucose before cerebral infarction was reflected by glycosylated hemoglobin A1c (HbA1c). The correlation between SIGUR and HbA1c was analyzed in the different populations. The difference in SIGUR was compared among the non-diabetic group, diabetes with poor blood glucose control group (HbA1≥6.5%) and diabetes with well blood glucose control group (HbA1c<6.5%). The relationship between high level of SIGUR (Q4) and HbA1c was performed through logistic regression analysis.Results:SIGUR was correlated with HbA1c, no matter in the non-diabetic, diabetic or total populations ( r=-0.200, 0.195 and 0.324, P=0.010, 0.011 and 0.000). The level of SIGUR was higher in diabetes with poor blood glucose control group than in the non-diabetes and diabetes with well blood glucose control group ( F=25.842, P=0.000), but there was no significant difference between the non-diabetic group and diabetes with well blood glucose control group ( P>0.05). Logistic regression analysis showed that the high level of SIGUR was correlated to HbA1c in the total populations ( OR=1.460, P=0.000). In the diabetic group, the probability of higher SIGUR level was increased along with the increased HbA1c level ( OR=1.237, P=0.021), while the probability of higher SIGUR level was decreased along with the increased HbA1c level in the non-diabetic group ( OR=0.233, P=0.010). Conclusions:Acute stress hyperglycemia is correlated to the basal blood glucose before cerebral infarction, and blood glucose increases more prominently in those patients with high basal blood glucose level, especially in the diabetic patients.

Correlation between brainstem infarction and stress induced glucose up-regulation ratio / 中国医师进修杂志

Objective To investigate the relationship between the stress induced glucose up-regulation and brainstem infarction. Methods Three hundred and sixty-six patients of cerebral infarction in the department of neurology were included in this study. Stress induced glucose up-regulation was reflected by stress induced glucose up-regulation ratio (SIGUT), and the level of SIGUT was compared between groups of brainstem and non-brainstem infarction. SIGUT was categorized into 4 groups according to the quartiles, and relative variables were compared among 4 groups. The level-risk relationship between high level of SIGUT and brainstem infarction was performed through logistic regression. Results The level of SIGUT was higher in group of brainstem infarction than that in group of non-brainstem infarction: 1.060 ± 0.272 vs.1.159 ± 0.301(P＝0.020). The percent of male, diabetes, brainstem infarction and level of FBG, HbA1c, NIHSS was obviously different in the 4 groups of SIGUT according to the quartiles (P<0.05). High level of SIGUT was correlated to brainstem infarction in the single-factor or multivariable logistic regression adjusted for relative variable (P < 0.05). Conclusions Stress induced glucose up-regulation is correlated to the brainstem infarction, which is prone to happen in brainstem infarction, and the magnitude is more prominent.

Reflections on simulation-based medical education / 中华医学教育探索杂志

Simulation-based medical education can ensure medical safety, reduce medical errors and improve students' clinical skills. At present, the main problems in medical teaching are the conflict between doctors and patients, the contradiction between medical teaching and ethics, the shortage of teaching resources and the lack of a universal assessment standard. The advantages of simulation-based medical education are its safety, repeatability, standardization, controllability, relative authenticity, and the cultivation of humanistic spirit and teamwork for students. Simulation-based medical education has two major limits. First, its teaching effect relies on the function and quality of each model. Second, simulation cannot replace clinical practice. This article proposes the following ways and means for promoting the simulation-based medical education: training of faculty is the core, establishment of courses is the focus, cooperation and communication is an important way to promote development, and phased and refined development is the future direction.