Search

目的 利用精益六西格玛（lean six sigma，LSS）管理中的界定、测量、分析、改进和控制（define，measure，analyze，improve，control；DMAIC）模型，优化妊娠合并脑血管病患者就医流程，提高患者就医效率，保障母婴安全。 方法 2021年12月，首都医科大学附属北京天坛医院根据DMAIC模型，对危重孕产妇的就诊流程进行优化：梳理就诊流程，明确到院—医嘱开立、采血—送检、医嘱开立—影像学检查为院内延误的关键环节，对上述环节进行流程跟踪及分析，找出延误原因，并采取改进措施，优化流程。本研究回顾性纳入流程优化前（2019年1月—2021年12月）的妊娠合并脑血管病患者为优化前组，流程优化后（2022年1月—2023年12月）的患者为优化后组。比较两组患者就诊流程中的到院—医嘱开立、采血—送检、医嘱开立—影像学检查、到院—办理住院的时间。 结果 急诊就诊流程优化后，妊娠合并脑血管病患者的总体就诊效率提高。到院—医嘱开立 [24.0（13.5～38.5）min vs. 39.0（17.5～98.0）min，P=0.027]、医嘱开立—影像学检查[48.0（10.0～73.0）min vs. 65.5（22.7～90.7）min，P=0.025]以及到院—办理入院总时间[120.0（93.0～149.0）min vs. 218.0（123.0～382.7）min，P＜0.001]均较优化前缩短，差异有统计学意义；采血—送检时间有缩短趋势，但优化前后差异无统计学意义。 结论 使用DMAIC模型能够明确流程优化的关键环节，优化妊娠合并脑血管病患者的急诊就诊流程。 文章导读： 妊娠合并脑血管病是严重危害孕产妇和胎儿健康的急重症，本研究基于DMAIC模型，通过科学的论证，对医院急诊接诊此类患者的流程进行了优化，结果显示，流程优化后可以显著缩短患者的院内延误时间，提高救治效率。 Abstract: Objective To optimize the medical treatment process of pregnant women with cerebrovascular diseases using the define, measure, analyze, improve, control (DMAIC) model in the lean six sigma (LSS) management, improve the efficiency of medical treatment, and ensure the safety of both mothers and infants. Methods In December 2021, Beijing Tiantan Hospital, Capital Medical University optimized the medical treatment process for critically ill pregnant women according to the DMAIC model with the measures listed below: sorting out the medical treatment process, identifying the key nodes of hospital delays, such as hospital arrival to medical order issuance, blood sampling to testing, and medical order issuance to imaging examination, tracking and analying the processes of the above nodes, finding out the reasons for the delay, and taking improvement measures to optimize the process. This study retrospectively included pregnant women with cerebrovascular diseases before process optimization (from January 2019 to December 2021) as the pre-optimization group, and patients after process optimization (from January 2022 to December 2023) as the post-optimization group. The time of hospital arrival to medical order issuance, blood sampling to testing, medical order issuance to imaging examination, and hospital arrival to hospitalization was compared between the two groups. Results After the optimization of the medical treatment process, the overall efficiency of emergency treatment for pregnant women with cerebrovascular diseases was improved. After optimization, the time of hospital arrival to medical order issuance [24.0 (13.5-38.5) min vs. 39.0 (17.5-98.0) min, P=0.027], medical order issuance to imaging examination [48.0 (10.0-73.0) min vs. 65.5 (22.7-90.7) min, P=0.025], and hospital arrival to hospitalization [120.0 (93.0-149.0) min vs. 218.0 (123.0-382.7) min, P

目的 在立德树人视域下，根据“价值塑造、能力培养、知识传授”三位一体学生培养目标和职业核心能力要求，编制以脑血管病情景模拟案例为载体的教学效果评价问卷，并评价其信效度。 方法 采用访谈、专家函询等方法构建脑血管病情景模拟案例教学效果评价问卷。在山东第二医科大学2021级护理专业学生中随机抽取50名进行问卷填写和意见收集，进一步完善问卷。另外随机抽取130名学生进行正式问卷填写，并对问卷进行条目分析、效度和信度评价。 结果 本研究形成了脑血管病情景模拟案例教学效果评价问卷，该问卷包括能力培养、价值引领、案例编制3个维度，共25个条目。130份正式调查问卷中有125份为合格问卷，信效度检验显示：探索性因子分析提取3个公因子，累计方差贡献率为65.68%。问卷整体的Cronbach’α系数为0.914，能力培养、价值引领和案例编制维度的Cronbach’α系数分别为0.917、0.941和0.937。问卷具有良好的可靠性、稳定性。各维度得分与总分的相关系数r值在0.607～0.799之间。 结论 本研究形成的问卷具有良好的信效度，可以作为情景模拟案例教学效果的评价工具。 Abstract: Objective To compile a questionnaire for evaluating the teaching effects of cerebrovascular disease scenario simulation cases in accordance with the training objectives and occupational core competence requirements of students in the trinity of “value shaping, ability training and knowledge imparting” from the perspective of morality education. Methods Interviews and expert consultations were used to construct the evaluation questionnaire for cerebrovascular disease scenario simulation case teaching. Fifty nursing students in grade 2021 at Shandong Second Medical University were randomly selected to fill in the questionnaire, and their opinions were collected to the questionnaire. In addition, 130 students were randomly selected to complete a formal questionnaire. Then the questionnaire items were analyzed, and the validity and reliability were evaluated. Results In this study, a questionnaire was developed to evaluate the teaching effects of cerebrovascular disease scenario simulation cases, which included 25 items across three dimensions: ability cultivation, value guidance, and case compilation. A total of 125 out of the 130 formal questionnaires were qualified. The reliability and validity tests showed that three common factors were extracted by exploratory factor analysis, and the cumulative variance contribution rate was 65.68%. The Cronbach’α coefficient of the whole questionnaire was 0.914, and the Cronbach’α coefficients of the ability cultivation, value guidance and case compilation dimensions were respectively 0.917, 0.941 and 0.937, indicating good reliability and stability of the questionnaire. The correlation coefficient between each dimension score and the total score were 0.607-0.799. Conclusions The questionnaire developed in this study has good reliability and validity, and can be used as an evaluation tool for the teaching effects of scenario simulation cases.

目的 探索脑血管病患者主观性失眠与慢性期功能预后的关系。 方法 本研究是对多中心、大型前瞻性研究——中国卒中后抑郁发生及其结局的前瞻性队列研究（prospective cohort study on the incidence and outcome of patients with post-stroke depression in China，PRIOD）的事后分析。选取PRIOD中入组患者人数较多的15个中心，对入组的脑血管病患者进行发病5年后的电话随访。收集患者的一般资料、临床特点。根据《精神障碍诊断与统计手册》（第五版）中失眠的诊断标准编制调查问卷，收集失眠及相关睡眠问题，评估患者是否存在主观性失眠以及睡眠时间。采用mRS评估患者的功能预后。采用多因素logistic回归分析脑血管病患者主观性失眠与功能预后的关系。 结果 本研究共纳入698例患者，其中319例（45.70%）为主观性失眠患者，仅17.55%（56/319）服用助眠药物。logistic回归分析显示，主观性失眠与脑血管病患者功能预后存在显著关联：校正协变量后，与无失眠患者相比，主观性失眠患者功能残疾风险较高（OR 1.64，95%CI 1.11～2.42，P=0.013）；亚组分析显示，在基线为首次脑血管病发作患者中，与无失眠患者相比，主观性失眠患者功能残疾的风险较高（OR 1.74，95%CI 1.13～2.68，P=0.013）。 结论 主观性失眠是导致脑血管病慢性期功能残疾的危险因素。 Abstract: Objective To explore the relationship between subjective insomnia and functional prognosis in the chronic phase of patients with cerebrovascular disease. Methods This study is a post-hoc analysis of the multicenter, large-scale prospective study— prospective cohort study on the incidence and outcome of patients with post-stroke depression in China (PRIOD). Fifteen centers with a high number of patients enrolled in the PRIOD were selected, and the patients were followed up by telephone 5 years after the onset of cerebrovascular disease. General information and clinical characteristics were collected. According to the diagnostic criteria of insomnia in the Diagnostic & Statistical Manual of Mental Disorders (Fifth Edition), a questionnaire was compiled to collect data on insomnia and related sleep issues, and to assess the presence of subjective insomnia and sleep duration. The functional prognosis was evaluated by mRS. Multivariate logistic regression was used to analyze the relationship between subjective insomnia and functional prognosis in cerebrovascular disease patients. Results A total of 698 patients were included, of which 319 (45.70%) had subjective insomnia. Only 17.55%(56/319) were taking sleep aids. Logistic regression analysis revealed a significant association between subjective insomnia and functional prognosis in cerebrovascular disease patients: after adjusting for covariates, subjective insomnia patients had a higher risk of functional disability compared to those without insomnia (OR 1.64, 95%CI 1.11-2.42, P=0.013). Subgroup analysis showed that among patients experiencing their first cerebrovascular event at baseline, those with subjective insomnia had a higher risk of functional disability compared to those without insomnia (OR 1.74, 95%CI 1.13-2.68, P=0.013). Conclusions Subjective insomnia is a risk factor for functional disability in the chronic phase of patients with cerebrovascular disease.

数字健康广义上是指发展和利用数字技术提高健康的知识和实践领域，包括智能设备、数字消费者、物联网等相关的健康服务等。近年来，数字健康技术在脑血管病领域发展迅速，在脑血管病的一级预防、二级预防及急性期和康复阶段的诊疗中均有应用。相关研究结果提示，开发良好的数字健康产品可预测脑血管病的发生风险，助力脑血管病急性期远程医疗，提高患者二级预防的依从性，辅助患者出院后的功能康复训练。数字健康可使更多临床数据得到即时共享，让患者得到更及时的救治，同时也在一定程度上降低医疗成本。本文讨论数字健康在脑血管病领域的应用现状，展望其未来的发展趋势。 Abstract: 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.

心脑血管疾病是全球主要的致死和致残病因之一。尽管医疗技术不断进步，心脑血管疾病的诊治仍存在许多亟待解决的问题，人工智能与机器学习的出现为应对这些问题提供了新途径。美国心脏学会2024年发布的科学声明从影像分析、心电图判读、床旁监护、可穿戴设备、基因组学及电子健康记录等方面介绍了人工智能与机器学习在临床中的应用及面临的挑战。本文对该指南进行介绍，并分析人工智能与机器学习在脑血管病领域中应用的优势，为我国未来在这一领域的研究提供参考。 Abstract: 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.

摘要： 预测模型是用来预测个体发生目标事件概率或预测结局值的统计模型。预测模型结果可视化展现是开发预测模型全流程中必不可少的一部分。良好的预测模型展现形式不仅可以使预测结果具有更好的可读性、可解释性，也在很大程度上决定了其使用方式和便利性。本文将详细介绍各种预测模型的展现形式，并阐述各自的优缺点。随后结合脑血管病临床预测模型研究，通过研究示例逐一介绍不同展现形式在脑血管病研究中的应用。 Abstract: A prediction model is a statistical model used to predict the probability of an individual with a target event or to predict the outcome value. Visualization of prediction model results is an essential part of the whole process of developing a prediction model. A good presentation of a prediction model can not only make the prediction results more readable and interpretable, but also determine its use and convenience to a large extent. This paper provided a detailed introduction to various forms of prediction model presentation and reported their advantages and disadvantages. Combining clinical prediction model research on cerebrovascular disease, this paper introduced the application of each presentation in cerebrovascular disease research through research examples.

目的 通过对比网络远程招生与非网络远程招生方式下脑血管病方向统招硕士研究生的一般情况和成绩等信息，探讨网络远程招生方式对生源质量的影响。 方法 以首都医科大学附属北京天坛医院2017—2022年脑血管病方向的统招硕士研究生为研究对象，根据招生方式将其分为两组，2017—2019年招收的统招硕士研究生为非网络远程招生组，2020—2022年招收的为网络远程招生组。本研究主要通过历年的研究生复试名单来获取研究数据，收集的信息包括考生的性别、年龄、民族、毕业院校、是否是应届生等基本信息以及其初试成绩和复试成绩，并对两组考生的上述指标进行差异化分析。 结果 2017—2022年，首都医科大学附属北京天坛医院脑血管病方向的统招硕士研究生生源数量总体呈增长趋势。在所招收的统招硕士研究生中，女性88名（33.98%），比例低于男性，民族以汉族（246名，94.98%）为主，来源以应届毕业生（203名，78.38%）为主，网络远程招生组与非网络远程招生组相比，上述指标的差异均不具有统计学意义。网络远程招生组生源的平均年龄显著小于非网络远程招生组[（23.1±1.1）岁 vs.（23.5±1.3）岁，P=0.014]。网络远程招生组神经病学和外科学（神经外科）专业的统招硕士研究生复试成绩均显著高于非网络远程招生组[神经病学，（255.5±12.3）分 vs.（241.0±13.8）分，P

在全球脑血管病医疗工作者的共同努力下，近年来脑血管病的诊疗取得了长足的进步。众多高质量的临床研究涵盖了脑血管病多个领域和热点，例如：缺血性卒中急性期取栓/溶栓，针对心房颤动的干预，血压管理等其他卒中急性期干预措施，为脑血管病的临床诊疗提供了扎实可靠的循证医学证据，并促进了脑血管病疾病负担的降低。本文对2023年脑血管病领域重要的临床研究进展进行回顾，帮助读者更好地了解这些临床研究的精华，并期待未来涌现出更多、更好的脑血管病临床研究。 Abstract: Cerebrovascular clinicians from different countries all over the world made great progress in the diagnosis and treatment of cerebral vascular diseases in recent years. Numerous high-quality clinical studies cover multiple fields and hotspots of cerebral vascular disease, such as thrombectomy/thrombolysis in the acute phase of ischemic stroke, intervention for atrial fibrillation, blood pressure management and other acute phase intervention measures, providing solid and reliable evidence-based medical evidence for clinical diagnosis and treatment in cerebral vascular disease, and promoting the reduction of cerebral vascular disease burden. This paper reviews the important clinical research progress in the field of cerebral vascular disease in 2023, helping readers better understand the advantages and great significance of these clinical studies, and looking forward to more and better cerebral vascular disease clinical studies in the future.

卒中是重要的致死性和致残性疾病，给个人、家庭及社会带来沉重负担，是严重的公共健康问题，受到社会的高度关注。卒中组织化服务在一定程度上可以提高相关机构的卒中医疗质量，提升卒中诊疗和康复的连贯性、系统性和科学性，降低卒中死亡率和致残率，改善患者的临床预后和生活能力。英国国家卒中临床指南2023版对英国国家卒中临床指南2016版中的卒中组织化服务部分内容进行了更新，本文介绍该指南2023年更新版本中卒中的组织化服务推荐要点并进行解读。 Stroke is a major fatal and disabling disease, bringing heavy burden to individuals, families, and society, which has become a serious public health problem and attracted great attention. To a certain extent, Organisation of stroke services could improve the medical quality of stroke service institutions, enhance the coherence, systematicity, and scientificity of stroke diagnosis, treatment, and rehabilitation, reduce the mortality and disability of stroke, and improve the clinical prognosis and living ability of stroke patients. The National Clinical Guideline for Stroke for the United Kingdom and Ireland (2023 edition) has updated the part of Organisation of stroke services. The paper will explain the update points of this part.

针对脑血管病的危险因素积极进行早期干预管理是减少脑血管病危害最有效的方法。本章节介绍脑血管病高危人群管理的推荐意见，包括对不可干预和可干预血管危险因素的控制，阿司匹林在缺血性卒中一级预防中的应用以及首次卒中风险评估等方面。 Abstract: Early intervention to manage the risk factors of cerebrovascular disease is the most effective way to reduce the harm of cerebrovascular diseases. This chapter presents recommendations for the management of populations at high risk for cerebrovascular disease, including control of non-interventionable and interventionable vascular risk factors, the use of aspirin in the primary prevention of ischaemic stroke, and the risk assessment of first-time stroke.

随着精准医疗时代的到来，在脑血管病领域，基因组学研究受到越来越多的关注。基因组学数据的高维复杂性，使得机器学习成为分析基因组学数据的最为有效的工具之一。本文对机器学习的基本概念、主要步骤、算法分类以及各算法在脑血管病领域基因组学研究中的应用现状进行介绍，以期为未来脑血管病基因组学研究提供参考。 Abstract: With the advent of the era of precision medicine, genomics research is gradually gaining widespread attention in the field of cerebrovascular diseases. Due to the high-dimensional and complexity of genomics data, machine learning is now an effective tool for analyzing genomics data. This article introduced the basic concepts of machine learning, the main steps, the classification of algorithms and the application of each algorithm of machine learning in genomics research in the field of cerebrovascular diseases, in order to provide a reference for future genomics research in cerebrovascular diseases.

《中国脑血管病临床管理指南（第2版）》是中国卒中学会组织专家根据近年来脑血管病领域研究的新进展、获取的新证据，对2019年第1版《中国脑血管病临床管理指南》进行的修订、补充和完善。该版指南涵盖脑血管病的全方位临床管理，包括卒中的组织化管理、高危人群管理、缺血性和出血性卒中以及脑静脉系统血栓形成的临床管理、卒中的康复管理等，旨在为从事卒中防治、护理、康复的相关专业人员和社会工作者，以及政府部门相关管理机构、卫生事业管理人员、医药企业、卫生保健需求方和其他利益相关者提供指导意见。 Abstract: The Second Edition of Chinese Stroke Association Guidelines for Clinical Management of Cerebrovascular Diseases is an updated and enhanced version of the first edition, which was first published in 2019. This latest edition has been meticulously compiled by a panel of authoritative experts from the Chinese Stroke Association, incorporating recent breakthroughs and novel evidence within the field of cerebrovascular diseases. The guideline provides a comprehensive overview of clinical management strategies for cerebrovascular diseases, including structured stroke care, management of high-risk populations, therapeutic interventions for both ischemic and hemorrhagic strokes, clinical management of cerebral venous sinus thrombosis, and stroke rehabilitation management. The primary objective is to provide guidance for professionals and social workers engaged in stroke prevention, care, and rehabilitation, as well as governmental agencies, healthcare administrators, pharmaceutical companies, healthcare providers, and other stakeholders.

永存动脉是永久性颈内动脉和椎基底动脉之间的异常吻合，是一种较罕见的脑血管变异。通常，永存动脉具有供血功能，不引起任何特殊临床症状，但若伴发动脉粥样硬化性病变和其他血管变异，会导致临床表现复杂化。目前，超声是临床评估头颈血管病变的首选检查方法，正确诊断永存动脉，可以更准确地解释与其相关的临床表现，在进行相应手术或介入操作时，可避免不当操作的风险。永存动脉多为影像学检查偶然发现，其影像学表现具有特征性。目前，国内外不乏对永存动脉的影像学诊断报道，但缺乏超声对永存动脉分型及其血流动力学的评估报道。本文结合文献，创新性地提出永存动脉的超声诊断思路和分型，旨在提高对永存动脉的早期准确诊断率。 Abstract: Persistent artery is an abnormal anastomotic branch between the permanent internal carotid artery and the vertebrobasilar artery, which is a rare cerebrovascular variation. Typically, persistent arteries have a blood supply function and do not cause specific clinical symptoms; however, when accompanied by atherosclerotic lesions of the arteries and other vascular variants, they result in a complex clinical presentation. At present, ultrasonography is the first choice for clinical evaluation of cerebral and cervical vascular abnormalities. Correct diagnosis of persistent arteries improves clinical interpretation and reduces the risk of improper operation during related surgical or interventional procedures. Most persistent arteries are discovered incidentally through imaging, and their imaging manifestations are characteristic. There are many reports on the imaging diagnosis of persistent arteries at home and abroad, but few on ultrasonography staging and hemodynamics. Based on the literature, this paper innovatively proposed an ultrasound diagnostic concept and staging of the persistent artery in an effort to improve the early and accurate diagnosis of the persistent artery.

目的 分析国家自然科学基金脑血管病领域面上项目结题情况，探讨该领域研究现状和存在问题，预测发展趋势，为决策提供参考。 方法 通过国家自然科学基金大数据知识管理服务门户网站获得2019—2021年申请代码为H0906（脑血管结构、功能异常及相关疾病）结题面上项目的基本信息，采用Excel软件、Power Query组件对结题项目的成果产出、依托单位分布、地域分布、研究方向分布进行分析，使用VOSviewer软件对研究热点进行分析。 结果 2019—2021年申请代码为H0906的结题项目有177项，依托于51家单位（其中14家承担110项，占62.15%），产出学术论文1532篇，培养人才324名。依托单位中综合类院校承担96项（54.24%），每项产出论文9.52篇，较医科类院校多1.91篇。依托单位所属19个省（直辖市），其中上海市、江苏省、北京市、广东省、湖北省、重庆市等6省（直辖市）结题113项（63.84%），授权专利数30项（90.91%），参加国际会议27人次（75.00%）。H0906下设18个研究方向，涉及缺血性脑血管病研究107项（60.45%）。关键词聚类分析显示，脑血管病领域基础研究热点是炎性反应、小胶质细胞、神经保护及神经再生等。 结论 国家自然科学基金脑血管病领域面上项目成果产出类型多样，以论文和人才培养为主，依托单位以综合性院校为主，地域分布不均衡，研究方向相对集中，以缺血性脑血管病为主。 Abstract: Objective To analyze the completion condition of general projects in the field of cerebrovascular diseases of National Natural Science Foundation of China, and discuss the status and existing problems of basic research in this field. Predict the development trend and provide reference for decision-making. Methods Through the big data knowledge management service portal of the National Natural Science Foundation of China, the basic information of the concluding projects with application code H0906 (cerebrovascular structure, function abnormalities and related diseases) during 2019 to 2021 were obtained. Excel software and Power Query components were used to analyze the research achievements, supporting institution distribution, regional distribution and research direction distribution of the concluding project, and VOSviewer software was used to analyze research hotspots. Results There were 177 concluding projects with code H0906 during 2019 to 2021, supported by 51 institutions (14 of which undertook 110 projects, 62.15%). 1532 academic papers were produced and 324 talents were cultivated. Among the supporting institutions, comprehensive colleges and universities undertook 96 projects (54.24%), and each project produced 9.52 academic papers, with 1.91 papers more than that from medical colleges and universities. Among the supporting institutions from 19 provinces and cities, Shanghai, Jiangsu, Beijing, Guangdong, Hubei, Chongqing 6 provinces and cities completed 113 projects (63.84%), the number of authorized patents was 30 (90.91%), and 27 person-time participated in international conferences (75.00%). There were 18 research directions under H0906, involving 107 projects of ischemic cerebrovascular diseases (60.45%). Keyword cluster analysis showed that the basic research hotspots in the field of cerebrovascular diseases were inflammatory response, microglia, neuroprotection and nerve regeneration. Conclusions Research achievements of general projects in the field of cerebrovascular diseases of National Natural Science Foundation of China were of various types, were mainly papers and talent training, supported by comprehensive colleges and universities with unbalanced geographical distribution, and research directions were relatively concentrated, which were mainly ischemic cerebrovascular diseases.

目的 探讨基于微信平台辅助的标准化病人联合病例导入式教学法在脑血管病住院医师规范化培训中的应用效果。 方法 本研究纳入于2020年3月—2023年3月在兰州大学第二医院神经内科进行住院医师规范化培训的学员共70人，随机分为对照组和观察组，每组35人。对照组采取传统带教模式，观察组使用微信提前发送脑血管病典型病例信息，随后进行讨论总结，并对相应标准化病人进行模拟诊疗过程，4个月后对比两组学员综合理论、临床实践技能操作考核成绩以及对带教的满意度。 结果 观察组学员综合理论考核成绩为（89.74±2.53）分，临床实践技能操作考核成绩为（90.31±2.54）分，分别高于对照组的（84.26±3.94）分和（84.20±3.33）分，差异均有统计学意义（P＜0.05）。观察组学员的满意度为91.43%，高于对照组的60.00%，差异有统计学意义（P＜0.05）。 结论 在神经科住院医师规范化培训中依托微信平台应用标准化病人联合病例导入式教学法对学员进行培训，有助于学员综合理论、临床实践技能操作考核成绩提高，可推广应用。 Abstract: Objective To investigate the effect of standardized patients assisted by WeChat platform combined with case-introduction teaching method in residency training of cerebralvascular disease residents physicians. Methods A total of 70 trainees who received residents training in the Department of Neurology, Lanzhou University Second Hospital from March 2020 to March 2023 were recruited in this study. They were randomly divided into control group and observation group, with 35 in each group. While the control group adopted the traditional teaching method, the observation group used WeChat to send the information of classic cerebrovascular disease cases in advance, then discussed and summarized, and carried out the simulated diagnosis and treatment process for corresponding standardized patients. Compared comprehensive theoretical performance and practical skills of the two groups, as well as satisfaction with the teaching after four months. Results The scores of the observation group were (89.74±2.53) points in comprehensive theory assessment and (90.31±2.54) points in clinical practice skill operation assessment, which were higher than those in the control group (84.26±3.94) points in comprehensive theory assessment and (84.20±3.33) points in clinical practical skill operation assessment, respectively. The difference was statistically significant (P

对脑血管病患者的脑组织氧合情况实施床旁监测，对脑血管病的诊治及预后改善有重要价值。近红外光谱成像（near infrared spectroscopy，NIRS）作为一项新兴的脑成像技术，具有价格低廉、操作便捷、非侵入性等优点，逐渐成为脑血管病研究的焦点。本文介绍了NIRS的基本原理，探讨了NIRS在急性脑梗死早期识别、梗死后再灌注疗效评估、大面积脑梗死继发恶性脑水肿预测等方面的应用价值，预测了NIRS在大脑近皮层出血病情监测中的应用前景。此外，在蛛网膜下腔出血诊疗领域，NIRS通过动态监测脑氧饱和度，在迟发性脑缺血监测及术后功能结局预测等方面也有着较大的应用潜力。最后，本文基于NIRS的优势和不足，展望了未来适合NIRS应用的临床场景。加强NIRS在脑血管病领域的研究，将使实时评估脑血管病院前、院内的精准动态成为可能。 Bedside monitoring of cerebral oxygenation in patients with cerebrovascular diseases is of great value for the diagnosis, treatment and prognosis of cerebrovascular diseases. As a novel brain imaging technology, near infrared spectroscopy (NIRS) has the advantages of low price, good convenience and non-invasiveness. It has gradually become the focus of cerebrovascular disease research. This article introduced the basic principle of NIRS, the application of NIRS in early recognition of acute cerebral infarction, efficacy evaluation of reperfusion after infarction, and prediction of malignant cerebral edema secondary to large cerebral infarction, and also the application prospect of NIRS in monitoring the hemorrhage near cerebral cortex. For patients with subarachnoid hemorrhage, NIRS may play a great potential role in monitoring delayed cerebral ischemia and predicting postoperative functional outcome by dynamical monitoring cerebral oxygen saturation. Finally, based on the advantages and disadvantages of NIRS, we looked forward to the clinical scenarios suitable for NIRS application in the future. Further NIRS research in cerebrovascular disease will make accurate pre-hospital and in-hospital real-time dynamic assessment of cerebrovascular disease possible.

目的 对人类基因组工作草图公布以来卒中遗传学、基因组学领域已发表的论文进行文献计量学研究，分析该领域的研究现状、热点及发展趋势。 方法 以一代测序（2000—2007年）、全基因组分型芯片（2008—2015年）和二代测序（2016年至今）为代表性技术，将2000年至今划分为3个阶段。在Web of Science核心合集检索脑血管病领域发表的遗传学、基因组学方面的英文文献，对文献的发表时间、地区、研究机构等信息进行汇总，使用VOSviewer 1.6.18进行统计分析并对结果进行可视化。使用H指数评估论文产出数量与论文水平。 结果 共纳入8833篇英文文献。美国是卒中遗传学、基因组学领域文献的最主要贡献者，发文量高达3291篇，H指数为182，发文量和H指数在所有国家/地区中均居首位。中国发文1765篇，H指数为66，分别排名第2位和第10位。国际卒中遗传学联盟是该研究领域的重要参与者，联盟和主要负责人的发文量居所有作者的前20名。卒中遗传学、基因组学的研究热点从早期的关联分析和荟萃分析，逐步过渡到近几年兴起的孟德尔随机化研究。 结论 在卒中遗传学、基因组学领域，我国虽然起步较晚，但在发文总量上有赶超的趋势。我国卒中相关的临床和科研人员应积极参与国内和国际学术合作，进一步提升我国在该领域的影响力。 Abstract: Objective To explore the research status, hotspots, and trends in the field of stroke genetics and genomics according to bibliometric analysis on published literature since publication of the working draft of human genome. Methods The last two period (from 2000 to the present) was divided into 3 stages based on representative genomic technologies, namely first-generation sequencing (2000—2007), whole-genome genotyping microarray (2008—2015), and next-generation sequencing (2016—now). All of the published literature (written in English) on cerebrovascular disease genetics and genomics were retrieved from core collection of Web of Science. Year of publication, country/area, and institution of the literature were summarized. VOSviewer 1.6.18 was used for statistical and visual analysis. The H-index was used to evaluate the quantity and the impact of the literature. Results A total of 8833 English literature was included in this analysis. The United States was the main contributor to the literature on stroke genetics and genomics, and published 3291 articles with an H-index of 182, both ranking first in the quantity and H index of papers. China published 1765 papers with an H-index of 66, ranking second in the quantity and tenth in H-index. The International Stroke Genetics Consortium (ISGC) was an important contributor in this field of stroke genetics and genomics. ISGC and its principal directors ranked among the top 20 authors in the number of publications. The hotspots gradually shifted from association analysis and meta-analysis in the early stage to Mendelian randomization in recent years. Conclusions In the field of stroke genetics and genomics, although our country started late, there is a trend of catching up in the total number of publications. Clinical and scientific researchers in China should strengthen domestic and international academic cooperation to further enhance the China’s influence in this field.

摘要： 目的 以脑血管病介入治疗方向博士为例，对我国临床医学博士研究生教育和专科医师规范化培训并轨（以下简称专培并轨）培养模式进行初步探索，以期对专培并轨培养模式提供有益的见解。 方法 2018年1月—2022年10月，通过文献分析法，对相关文献进行检索，了解现阶段医学教育改革现状；向首都医科大学脑血管病介入方向在校的150名博士研究生发放调查问卷，并对其中33名进行访谈，对脑血管病介入治疗方向博士关于专培并轨培养模式的认同及认知情况进行调查。 结果 收回有效问卷125份（83.3%）。125名博士对专培并轨制度的整体了解情况，非常了解12名（9.6%），一般了解95名（76.0%），不了解18名（14.4%），不同类型的学生专培并轨的认知差异有统计学意义（P

真实世界研究由于其研究结果更贴近真实世界，在临床研究领域逐渐受到关注和重视。真实世界研究不是并列于观察性研究和试验性研究的某种特定的研究设计类型，在真实世界研究的数据分析中更需要关注混杂因素和协变量的控制。正确识别混杂因素和协变量以及合理应用统计方法对其进行控制，可有效提高研究结论的准确性和真实性。本文介绍了真实世界研究中混杂因素和协变量控制的常见方法，包括分层分析、协方差分析、多因素回归、倾向性评分、疾病风险评分和工具变量分析等，并结合脑血管病的临床研究应用实例展开分析，以期为研究者理解与应用相关方法提供参考。 Abstract: Real-world studies have increasely become the focus in the field of clinical research because their findings are closer to the real world. However, real-world study is not a specific type of research design parallel with observational studies and experimental studies, and the control of confounding factors and covariates in the data analysis of real-world studies should be paid more attention. Correct identification of confounding factors/covariates and reasonable application of statistical methods can effectively improve the accuracy and authenticity of research conclusions. This article introduced the common methods of confounding factors/covariates control in real-world studies, including hierarchical analysis, analysis of covariance, multi-factor regression, propensity score, disease risk score and instrumental variable analysis, and cases analysis combined with clinical research application of cerebrovascular disease, so as to provide reference for understanding and applying the relevant methods.

真实世界研究起源于实用性临床试验，在真实临床实践中评估干预的有效性和安全性，对随机对照试验以外临床疗效评价进行补充。然而，此类研究缺乏随机化，因此对混杂偏倚的控制尤为重要。倾向性评分法对多个混杂因素/协变量进行校正，是真实世界研究控制混杂因素的重要分析方法。本文介绍匹配法、分层法、协变量校正法和逆概率加权法这4种倾向性评分法，并阐述各自的优缺点。随后结合脑血管病临床研究特点，通过研究案例重点介绍倾向性评分法在脑血管病真实世界研究中的应用。 Abstract: Real-world studies, originating from pragmatic clinical trials, evaluate the effectiveness and safety of interventions in real clinical practice, as a supplement for randomized controlled trials to evaluate the effectiveness of intervention measures in real clinical environment. However, the control of confounding factors is particularly important as this type of study lacks randomization. The propensity score method, which can adjust for multiple confounders/covariates, is an important analysis method for controlling confounders in real world studies. This article introduced four methods of propensity score and discussed their advantages and disadvantages; and introduced the application of propensity score method in the real-world research on cerebrovascular disease through case studies, combined with the characteristics of clinical research on cerebrovascular disease.

摘要： 探讨血管介入模拟器在临床医学实习生脑血管病教学中的应用效果。 方法 选取2020年7月—2021年12月在解放军总医院第八医学中心神经内科实习的61名临床医学本科生为研究对象，其中33名试验组学员采用血管介入模拟器+传统教学模式进行培训，28名对照组学员采用传统教学模式进行培训。实习结束时通过出科理论知识、实践操作考核成绩以及问卷调查评价两种脑血管病带教模式的效果。 结果 试验组学员出科时理论知识[（88.61±4.05）分 vs.（83.43±4.21）分，P＜0.001]、实践操作[（89.73±3.32）分 vs.（85.54±3.17）分，P＜0.001]考核成绩均高于对照组。问卷调查结果显示：试验组学员对神经内科产生兴趣的程度、对脑血管病认识的程度、自学能力、文献阅读水平均优于对照组，差异有统计学意义（均P＜0.05）。 结论 血管介入模拟器应用于脑血管病临床实习带教中提高了实习生对神经内科的兴趣，培养了实习生的学习主动性，提高了脑血管病临床实习的教学效果。 Abstract: Objective To explore the efficacy of vascular interventional simulator in the clinical teaching of cerebrovascular disease for interns. Methods This study included 61 clinical interns in neurology from the Eighth Medical Center of Chinese PLA General Hospital between July 2020 and December 2021, selecting 33 interns as study group and 28 as control group. The study group received training with vascular interventional simulator combined with traditional teaching method, and the control group received traditional teaching method. The efficacy of two teaching methods were evaluated by questionnaire survey, theoretical knowledge examination, clinical operation examination. Results The scores of theoretical knowledge [ (88.61±4.05) vs. (83.43±4.21), P

中枢胰岛素参与大脑的多种生理功能，对多种行为和代谢产生影响。中枢胰岛素抵抗的定义是脑细胞不能对胰岛素作出反应。胰岛素受体表达下调、胰岛素受体不能结合胰岛素以及胰岛素信号级联错误激活等原因都有可能导致中枢胰岛素抵抗。中枢胰岛素抵抗与脑血管病有着密切的关系。通过高胰岛素-正葡萄糖钳夹结合影像技术、经鼻给药、丝氨酸磷酸化与总磷酸化胰岛素受体底物比率和测定神经源性血浆外泌体中胰岛素受体底物1的水平及其磷酸化状态等方法可以对中枢胰岛素抵抗进行评估。探索中枢胰岛素抵抗机制与脑血管病的关系将有助于为脑血管病的治疗提供新的方向和靶点。 Abstract: Central insulin is involved in a variety of physiological functions of the brain and affects a variety of behaviors and metabolism. Central insulin resistance is defined as the inability of brain cells to respond to insulin. Central insulin resistance may be caused by down-regulation of insulin receptor expression, failure of insulin receptor to bind insulin, or incorrect activation of insulin signal cascade. There is a close relationship between central insulin resistance and cerebrovascular disease. Central insulin resistance can be assessed by hyperinsulinemic euglycemic clamp combined imaging technology, intranasal administration, ratio of serine phosphorylation to total phosphorylated insulin receptor substrates and determinating IRS-1 level and its phosphorylation status in neurogenic plasma exosomes. Exploring the relationship between central insulin resistance and cerebrovascular disease will help to provide new directions and targets for treatment of cerebrovascular diseases.

目的 脑血管病是我国主要的慢性非传染性疾病之一，其诊疗服务形成海量的医疗数据，数据的安全应用与管理是亟待解决的问题，基于区块链的数字身份技术具有去中心化、多方共识、公开透明、防篡改和可溯源等特征，给脑血管病的数据管理与应用提供了优化的工具。本研究旨在探索基于区块链数字身份在脑血管病医疗数据临床研究中的应用架构。 方法 采用区块链技术，通过发行者、控制者、解析者、证明者和个人身份数据账户等角色，实现脑血管病医疗数字身份进行去中心化。研究选取了200个测试用户，对建立的模式进行基于数据交换和医疗影像数据的测试。 结果 基于数据交换的测试中，对于单用户，职责目录的保存并返回保存页面平均响应时间为1.261 s，职责目录查看的平均响应时间为0.08 s，提交数据目录并返回页面的平均响应时间为1.269 s。基于区块链及数字身份的医疗影像数据交换系统在测试期间运行稳定，在网络中断再通后能自动恢复对外提供服务。基于医疗影像数据场景中，写入通量为9090次/秒，平均响应时间为14.98 s，平均每秒遍历9012条数据。可靠性检查结果较好，容错能力达到1/3节点。 结论 基于区块链的数字身份能够保障数据安全、促进数据共享流通，在脑血管病的诊疗和管理领域有较好的应用前景。 Objective To explore the application and prospect of blockchain-based digital identity in medical data management of cerebrovascular diseases. Methods Blockchain technology was used to decentralize cerebrovascular disease medical digital identities through the roles of issuer, controller, parser, prover and personal identity data account. A total of 200 subjects were selected to test the practicality and feasibility of the system based on the data exchange and medical imaging data. Results In the test of data exchange, for a single user, the average response time between saving and returning to save page of responsible directory was 1.261 seconds. For viewing the responsible directory, the average response time is 0.08 seconds. The average response time of submitting the data catalog and returning the page is 1.269 seconds. The system operated stably during the test, and can automatically resume services after network interruption and restoration. In the test of medical imaging data, the write flux was 9090 times per second, the average response time was 14.98 seconds, and an average of 9012 pieces of data are traversed per second. The reliability of the system was feasible, with the fault-tolerant capacity of 1/3 node. Conclusions Blockchain-based digital identity can ensure data security and promote data sharing and exchange, which has a promising prospect in the field of diagnosis, treatment and management of cerebrovascular diseases.

随着诊疗技术的发展，脑血管病的诊疗越来越多地需要其他相关学科的参与和合作，既往基于卒中单元为基础的合作模式需要更多的科室加入和更深入的合作方式。例如：缺血性卒中超急性期的再灌注治疗需要神经内科、神经外科、急诊科、神经重症监护科、神经介入科、放射科和康复科的配合；在卒中二级预防阶段，急性和亚急性期的卒中患者更强调营养支持和康复锻炼。融合性卒中单元作为卒中单元的升级模式，旨在促进神经病学、神经外科、康复部门的深入合作，以不同的合作模式，抓住分秒必争的契机，实施最佳临床实践，为患者争取更好的临床结果。探索脑血管病融合病房的初衷就是为了探索深入合作的融合病房模式，进一步加强再灌注治疗、二级预防、围手术期管理等卒中诊疗多环节的多科室协作，为构建适合不同医疗机构的卒中诊疗多科室联合模式提供参考。 Abstract: The development of cerebrovascular disease diagnosis and treatment technology facilitated more and more relevant disciplines mutual cooperation. Moreover, the stroke unit-based cooperation model requires further collaboration between more disciplines. For example, the reperfusion treatment in superacute stage of stroke requires the collaboration of neurology, neurosurgery, emergency, neurointensive care unit, neurointervention, radiology and rehabilitation disciplines. On the stage of stroke secondary prevention, it is emphasized on nutrition support and rehabilitation exercise in acute and subacute stroke patients. As the upgraded model of stroke unit, syncretic stroke unit is aimed to promote the in-depth cooperation of neurology, neurosurgery, rehabilitation departments with different cooperation patterns in multiple links of stroke diagnosis and treatment, to take any chance and carry out best clinical practice for better outcomes, so as to provide reference for multi-disciplines collaboration of stroke care in different medical institutions.

随着精准医学和大数据时代来临，构建标准化临床样本库成为脑血管病基础和转化研究的重要前提。脑血管病全血样本不稳定、批次效应强、难转运，其标准化采集、保存和运输全血样本成为构建脑血管病临床样本库的关键问题。首都医科大学附属北京天坛医院脑血管病生物样本库基于国际标准化组织的方案，形成了我国脑血管病全血样本采集、保存、运输全过程标准框架。该解决方案实现了全血样本标准、规范、及时、可靠的收集与管理，可为脑血管病临床诊疗、疾病研究、药物开发等方向提供技术保障。 Abstract: With the advent of the era of precision medicine and big data, the construction of a standardized clinical sample database has become an important prerequisite for the basic and transformational research of cerebrovascular diseases. Cerebrovascular disease whole blood samples are unstable, batch effect is strong, difficult to transport, so how to standardize the collection, preservation and transportation of whole blood samples has become a key issue in the construction of cerebrovascular disease clinical sample database. Based on the scheme of International Standardization Organization, the center for biological sample database of cerebrovascular diseases in Beijing Tiantan Hospital Affiliated to Capital Medical University developed the standard framework for the whole process of collection, preservation and transportation of whole blood samples of cerebrovascular diseases in China. The solution realizes the standard, normative, timely and reliable collection and management of whole blood samples, and can provide technical support for clinical diagnosis and treatment, disease research and drug development of cerebrovascular diseases.

目的 通过中国国家卒中登记Ⅱ（China national stroke registry Ⅱ，CNSRⅡ）的数据，分析入院收缩压（systolic blood pressure，SBP）、舒张压（diastolic blood pressure，DBP）及平均动脉压（mean arterial pressure，MAP）与脑出血患者死亡和功能结局的关系。 方法 收集CNSRⅡ数据库中自发性脑出血患者的人口学信息和临床数据，应用logistic回归分析患者入院时不同SBP分层、SBP、DBP和MAP对患者短期和长期预后（包括院内死亡、3个月死亡及预后不良和1年预后不良）的影响。 结果 共有1048例脑出血患者的资料纳入统计分析，平均年龄62.1±12.5岁，男性666例（63.5%）。入院时平均SBP为162.1±28.9 mmHg，平均DBP为95.1±17.6 mmHg，平均MAP为117.4±20.1 mmHg。与入院SBP 120～139 mmHg的患者相比，入院SBP 180～199 mmHg（OR 17.53，95%CI 2.25～136.66，P=0.0063）和SBP≥200 mmHg的患者（OR 21.74，95%CI 2.74～172.55，P=0.0036）的在院死亡风险均增加。入院SBP每升高10 mmHg，患者在院死亡风险（OR 1.25，95%CI 1.14～1.37，P

目的 探讨急性轻型卒中患者出现卒中相关前庭症状的临床特征、演变规律，分析其持续存在的危险因素。 方法 前瞻性连续纳入2020年9月-2021年9月首都医科大学附属北京天坛医院神经病学中心发病7 d内，存在前庭症状的急性轻型（NIHSS

目的 探讨差异化培养结合多种教学法对不同基础的脑血管病亚专科医师的培训效果。 方法 选取2015年1月-2017年12月在复旦大学附属华山医院培养的96名脑血管病亚专科医师，根据 不同的脑血管病亚专科临床工作时间、学历、职称、医院等级以及导师初评分为初级、中级和高级3组， 针对性地采用差异化教学培养模式。采用学员自评和导师评价综合评估教学效果，评价等级分为好、 较好、一般、较差和差5个等级。 结果 初级、中级和高级组的“好”评率分别为81.8%、71.4%和72.7%，平均75.3%±4.3%，无“一 般”“较差”和“差”评。差异化培养结合多种教学方法具有“因才施教”、阶梯性、系统性和全面性 的特点。 结论 在现实存在的参差不齐水准的脑血管病亚专科医师中，差异化培养结合多种教学方法的教 学模式可达到较好的亚专科医师培训效果。 Abstract: Objective To investigate the training effect of differential training combined with multiple teaching methods for sub-specialists of cerebrovascular disease with different basis and background. Methods A total of 96 sub-specialists from Huashan Hospital of Fudan University between January 2015 to December 2017 were selected as subjects. According to everyone’s background (clinical work years, education background, professional title, hospital level and mentor), all the subjects were divided into 3 groups: primary, middle and high level groups. The differential training was carried out based on different goal, form and content, which was combined with multiple teaching methods. Training effect was evaluated by composite score of self, mutual and teacher’s assessment, and the evaluation results included 5 grades: good, better, general, poor and bad. Results The evaluation results showed that the rate of good grade for 3 groups were 81.8%, 71.4% and 72.7%, respectively, with the average rate was 75.3±4.3%, and without general, poor and bad. This kind of training method had the characteristics of "teaching students in accordance with aptitude", step by step, systematicness and comprehensiveness. Conclusions The differential training combined with multiple teaching methods could significantly improve the training effect for sub-specialists of cerebrovascular disease with different basis and background.

【摘要】 目的 探讨博士研究生普通招考考试现状和问题，以及灰色关联在博士招生考试成绩分析中的 意义。 方法 分析2014-2018年首都医科大学附属北京天坛医院脑血管病研究方向神经外科和神经内科博士研究生普通招考初试成绩、复试成绩与总成绩的灰色关联度。 结果 与初试成绩相比，2014-2018年度脑血管病研究方向神经外科和神经内科博士研究生复试成绩均与普通招考总成绩灰色关联度更大。 结论 复试综合能力对博士普通招考影响更大，各高校应重视复试阶段的科学量化。 【Abstract】 Objective To discuss the current status and problems of entrance examination for doctoral students, and the significance of the scores analysis of doctoral entrance examination based on grey correlation analysis. Methods To calculate grey relational grade between the initial test scores, the retest scores and total scores of the doctoral general entrance examination in cerebrovascular disease from 2014 to 2018. Results Compared with the initial test score, the retest score was more associated with the total score of the general entrance examination for doctoral students from 2014 to 2018 in both neurosurgery and neurology. Conclusions The comprehensive ability of students in the retest had a greater impact on the doctoral general entrance examination, so it should be paid more attention to the scientific quantification of the retest in the universities.

首都医科大学附属北京天坛医院从建立神经内科，搭建神经病学学科建设平台的过程中， 以脑血管病为中心，全面发展神经病学各个亚专业，创建了包括多个神经科学相关临床专业、临床和 基础研究、统计学在内的神经病学中心。本文介绍了天坛医院瞄准国际前沿脉动，创新发展各个学科， 注重青年人才培养，在基础和临床研究领域做出了国际一流的突出成绩，改写国际指南，使得神经病 学科全面发展，其卓有成效的发展模式为全国神经病学中心建设和人才培养提供了典范和经验。 Abstract: This paper introduced the construction and development of neurology discipline since the establishment of department of neurology in Beijing Tian Tan Hospital. Over the past few decades, the various sub-disciplines in department of neurology centered with cerebrovascular diseases(CVD) have been greatly developed, and a center for neurological diseases including several clinical specialties related to neuroscience, clinical and basic research, and statistics has been established. Especially aiming at international frontier fields, the center comprehensively and innovatively developed the subdisciplines, strengthened the training of young talents, and made world-class outstanding achievements in basic and clinical research which led to the updating of international guidelines. The fruitful development model of neurology center in Beijing Tian Tan hospital provides a reference for the construction of national neurology centers and talent training.