Orthostatic hypotension （OH） is a condition characterized by a drop in blood pressure upon standing from a reclining position， which can lead to syncope in severe cases. It is a prevalent cardiovascular issue，particularly affecting the elderly and those with compromised health， and can be triggered or exacerbated by a multitude of neurological and non-neurological disorders. Its clinical significance is increasingly apparent and is the cause of impaired quality of life and potentially adverse outcomes， including coronary artery disease， heart failure，stroke， cognitive dysfunction， and increased mortality. Given its impact， clinicians must prioritize its management.The goal of managing orthostatic hypotension is to improve quality of life and alleviate symptoms， rather than simply normalizing blood pressure. Non-pharmacological interventions are the key to successful treatment.

Objective

To assess and compare the long-term risk of stroke in patients with acute myocardial infarction （AMI） who have preexisting versus new-onset atrial fibrillation （AF）.

Methods

Patients diagnosed with AMI and AF from 72 secondary and tertiary hospitals in Tianjin， China， between August 2016 and June 2023 were enrolled. The study population was divided into those with a prior diagnosis of AF （preexisting AF group） and those without a prior diagnosis of AF （new-onset AF group）. The primary outcomes included stroke， ischemic stroke， and hemorrhagic stroke， with secondary outcomes induding all-cause mortality， cardiovascular mortality， all bleeding and major bleeding. Multivariate Cox regression and Kaplan-Meier survival curves were used to analyze the effects of preexisting and new-onset AF on the outcomes in patients with AMI. Propensity score matching with a 1 ∶1 ratio for preexisting AF versus newonset AF was performed. Additionally， subgroup analyses and multivariable competing risk analyses were performed.

Results

A total of 5530 patients were identified， comprising 1819 with preexisting AF patients and 3711 with new-onset AF. Multivariate Cox regression showed no significant differences in the risk of stroke（HR=1.10， 95%CI: 0.98-1.23， P=0.103）， ischemic stroke （HR=1.10， 95%CI: 0.98-1.23， P=0.092）， hemorrhagic stroke （HR=0.99， 95%CI: 0.64-1.54， P=0.959）， all-cause mortality （HR=0.94， 95%CI: 0.84-1.06， P=0.342），cardiovascular mortality （HR=1.04， 95%CI: 0.89-1.21， P=0.626）， all bleeding （HR=1.03， 95%CI: 0.88-1.20，P=0.729） or major bleeding （HR=0.75， 95%CI: 0.52-1.07， P=0.115） between patients with preexisting AF and new-onset AF. After 1 ∶1 propensity score matching， 1 452 preexisting AF patients and 1452 new-onset AF patients were included. Kaplan-Meier survival curves showed that compared with preexisting AF， there was no significant difference in the risk of stroke （P=0.130）， ischemic stroke （P=0.120）， hemorrhagic stroke （P=0.560），all-cause death （P=1.000）， cardiovascular death （P=0.062）， all bleeding （P=0.220）， or major bleeding （P=0.500）in patients with new-onset AF.

Conclusion

The prognosis of patients with new-onset AF combined with AMI is comparable to those with preexisting AF and AMI. Therefore the risk of stroke， ischemic stroke，hemorrhagic stroke， death， cardiac death， all bleeding and major bleeding should be vigilantly managed in both groups.

Objective

To explore the assessment value of Charlson comorbidity index （CCI）on short-term and long-term clinical prognosis of patients experiencing syncope.

Methods

Patients with syncope who visited the cardiology department of the Second Hospital of Tianjin Medical University from June 18， 2018 to July 19， 2021 were enrolled. we identified the syncope type of the patient， and baseline data were obtained and CCI were calculated through clinical assessment and survey study. According to the CCI classification， the disease burden of patients was classified as: very low （CCI 0）， low （CCI 1-2）， moderate （CCI 3-4）， and severe （CCI ≥5）. Logistic regression analysis was used to evaluate the association of CCI with short-term （30 days） and long-term （1， 2， and 3 years） risk of syncope recurrence， readmission， and death in syncope patients.

Results

A total of 313 patients were included， with reflex syncope in 57， cardiac syncope in 134， and other causes in 122. Multivariate Logistic regression showed that for every 1-point increase in CCI， the risk of patient readmission at 30 days and 1 year of follow-up increased by approximately 0.4 times（OR=1.417， 95%CI: 1.057-1.899） and 0.3 times （OR=1.300， 95%CI: 1.051-1.608）， respectively. Furthermore，the risk of mortality at 1， 2， and 3 years post-discharge was significantly elevated by approximately 0.8 times（1 year: OR=1.785， 95%CI: 1.270-2.509； 2 years: OR=1.771， 95%CI: 1.179-2.662； 3 years: OR=1.785，95%CI: 1.176-2.709）. However， increased CCI did not significantly predict the risk of syncope recurrence at short- and long-term follow-up （P＞0.05）.

Conclusion

CCI is positively associated with short- and longterm risk of readmission and risk of death in patients with syncope， it does not significantly correlate with the risk of syncope recurrence. Early identification of high-risk patients using CCI with focused surveillance and early intervention， and individualized treatment and rehabilitation plans based on co-morbidities may help reduce syncope readmission rates and mortality.

Objective

To investigate the relationship the correlation between stroke risk factors and geographical distribution within Shanxi Province， China.

Methods

Using the key disease surveillance data of Shanxi Province in 2019， this study included 10，087 study subjects. Data were gathered through on-site questionnaires and physical examinations， followed by a complex weighting of stroke risk factors and stroke prevalence indicators. Demographic characteristics associated with stroke risk were analyzed using the chi-square and Fisher's exact tests. Multifactorial logistic regression models were used to analyze stroke risk factors and associations across different geographic regions.

Results

（1） The study included 10，087 adults， with 2，000 from Taiyuan City （central region of Shanxi Province）， 2，100 from Datong City （northern region of Shanxi Province）， and 5，987 from Yuncheng City （southern region of Shanxi Province）. Of the participants， 4，482 （44.4%） were male and 5，605 （56.3%） were female. （2） There were significant regional differences in the prevalence of stroke risk factors， including hypertension， diabetes mellitus， atrial fibrillation or valvular heart disease， smoking history， previous stroke， family history of stroke， and lack of exercise，（P＜0.05）. The prevalence of hypertension， physical inactivity， significant overweight or obesity， family history of stroke， and atrial fibrillation or valvular heart disease increased in the same direction， while the prevalence of diabetes mellitus and dyslipidemia decreased gradually from north to south. The prevalence of smoking decreased gradually from north to south in the studied population. The Datong population had the highest percentage of transient ischemic attack， while the Taiyuan population had the highest percentage of dyslipidemia and Yuncheng had the lowest. （3） The study found that hypertension and age were positively associated with stroke incidence across all three regions， even after adjusting for confounders on two occasions. Additionally， diabetes mellitus and family history of stroke were positively associated with stroke incidence in Taiyuan， while middle school education was negatively associated with stroke incidence compared to elementary school education or lower. The risk factors for stroke in Datong include dyslipidemia， atrial fibrillation or valvular heart disease， and physical inactivity. In Yuncheng， the risk factors for stroke include dyslipidemia， diabetes mellitus， physical inactivity， family history of stroke， and retirement. The incidence of stroke in Yuncheng was positively associated with dyslipidemia， diabetes mellitus， physical inactivity， family history of stroke， retirement， and male gender relative to female gender.

Conclusion

The survey revealed significant regional differences in stroke risk factors and prevalence across Shanxi Province. The prevalence of stroke was highest in the south and lowest in the north， exceeding the national average. Hypertension was found to be a consistent significant factor across all three regions， with Taiyuan showing the highest impact.Stroke risk factors varied by region， highlighting the importance of region-specific preventative strategies.

Objective

To investigate the association between health anxiety metacognition， disease acceptance， and fear of disease progression in stroke patients with hemiplegia.

Methods

Using convenience sampling method， 160 stroke patients with hemiplegia admitted to the Third People's Hospital of Yancheng City from January 2022 to January 2023 were included as the research subjects. These patients completed a questionnaire survey that included the General Situation Survey Form， meta-cognitions about health questionnaire （MCQ-HA）， acceptance of illness scale （AIS）， and fear of progression questionnaire-short from（FoP-Q-SF）. Quantitative data such as health anxiety metacognitive level score， disease acceptance score，and fear disease score were analyzed. Pearson correlation analysis was used to investigate the relationships between health anxiety metacognition， disease acceptance， and fear of disease progression in stroke patients with hemiplegia. Multiple stepwise regression analysis was then conducted to identify factors influencing disease acceptance and fear of disease progression in this patient population.

Results

The score of metacognitive level of health anxiety in 160 stroke patients with hemiplegia was （40.72±10.90）. The disease acceptance score was （19.82±4.78）； The score of fear disease progression was （43.05±8.45）； The results showed that metacognition of health anxiety in stroke patients with hemiplegia was negatively correlated with disease acceptance （r=-0.215--0.652， P＜0.05）， and positively correlated with the progression of fear disease（r=0.229-0.869， P＜0.05）. Multiple stepwise regression analysis showed that the metacognitive level of health education was a influencing factor on disease acceptance and fear of disease progression in stroke patients with hemiplegia.

Conclusion

Metacognition of health concerns in stroke patients with hemiplegia is closely related to disease acceptance and fear of disease progression. The level of metacognition in health education is an influencing factor on disease acceptance and fear of disease progression in stroke patients.

Objective

To investigate the clinical and imaging characteristics of microcerebral hemorrhage cases misdiagnosed as acute minor stroke， thereby offering guidance for the administration of intravenous thrombolysis in minor stroke patients.

Methods

This retrospective cohort study included 194 patients with ischemic stroke who received intravenous thrombolysis with Alteplase at Beijing Chaoyang Hospital and affiliated hospitals from January 1 to December 31， 2023. It retrospectively analyzed the microcerebral hemorrhage cases that were misdiagnosed as minor stroke and underwent intravenous thrombolysis or nearly underwent thrombolysis.

Results

Among 194 patients， 89 were diagnosed with minor stroke， including 2 patients with microcerebral hemorrhage who were misdiagnosed as minor stroke and treated with intravenous thrombolysis or nearly treated with thrombolysis. These cases comprised thalamic microcerebral hemorrhage， and a small amount of subdural hemorrhage， respectively.

Conclusion

Patients with microcerebral hemorrhage exhibited relatively mild clinical symptoms， showing only mild lateral or limb numbness， without headache， dizziness， nausea and vomiting， and impaired consciousness， which are common in cerebral hemorrhage. Cranial CT scans were often unclear， rendering them susceptible to underdiagnosis or misdiagnosis of minor ischemic stroke. Therefore， it is crucial to accurately identify microcerebral hemorrhage in patients with minor stroke who are ready for intravenous thrombolysis.

Objective

To bolster the evidence for the early clinical application of implantable cardiac monitors （ICM） in high-risk patients and to optimize effective pacemaker therapy， by retrospectively analyzing the predictors for the need for pacemaker therapy in patients with unexplained syncope who underwent implantation of an ICM.

Methods

A total of 127 patients hospitalized for unexplained syncope and received ICM implantation at Beijing Friendship Hospital， Capital Medical University， between December 2019 and June 2022， were consecutively enrolled. Among them， 52 patients diagnosed with bradyarrhythmias through ICM monitoring met the criteria for permanent pacemaker （PPM） implantation（PPM indication group）， while 75 patients did not exhibit bradyarrhythmias （non-PPM indication group）.Both groups were followed up until June 2024. During the follow-up， syncope/presyncope-related events were recorded， and etiological analysis and corresponding treatments were conducted. Predictors for the need for PPM implantation due to bradyarrhythmias detected by ICM were also evaluated.

Results

Patients in the PPM indication group were older （P=0.030） and had a slower minimum heart rate （P＜0.001）， with a higher incidence of pauses exceeding 2 seconds （P＜0.001）. First-degree atrioventricular block （AVB）， firstdegree AVB combined with right bundle branch block （RBBB）， or left bundle branch block （LBBB） were more common in this group （P＜0.001， P=0.039， and P=0.016， respectively）. Multivariate analysis identified the minimum heart rate （P=0.024）， PR interval （P＜0.001）， and pauses ＞2 seconds （P＜0.001） detected by HOLTER monitoring as independent predictors of the need for PPM implantation due to bradyarrhythmias diagnosed by ICM. Moreover， the area under curve （AUC） of the receiver operating characteristic curve for the combined predictive value of these three factors was higher （AUC=0.840， 95% CI: 0.770-0.909）.

Conclusion

The minimum heart rate， PR interval， and pauses ＞2 seconds detected by HOLTER monitoring are significant risk factors for predicting the need for PPM implantation guided by ICM. Early ICM implantation may be particularly beneficial for high-risk patients with unexplained syncope.

Objective

To analyze the distribution patterns of pathogenesis syndrome elements in patients with vertigo， based on the principles of syndrome differentiation and diagnosis.

Methods

Retrospective collection of questionnaire survey data from 235 patients with vertigo in the Department of Cerebrology of Jiangyin Traditional Chinese Medicine Hospital from March 2021 to March 2023 was conducted. χ² tests were utilized for statistical analysis of the distribution of pathogenesis and syndrome elements across different age and gender groups， and the patterns of disease location and syndrome element combinations were examined.

Results

The frequency of syndrome elements in pathogenesis appeared in the following frequency: yin deficiency （25.96%）， blood stasis （16.60%）， phlegm turbidity （16.60%）， qi deficiency（13.62%）， blood deficiency （10.64%）， wind （6.81%）， hyperactivity of yang （5.11%）， fire （2.89%）， and qi stagnation （1.70%）. There were no significant differences in the rates of yin deficiency， phlegm turbidity， qi deficiency， blood deficiency， wind， hyperactivity of yang， fire， and qi stagnation between the younger group and the middle-aged and elderly group （P＞0.05）. However， the rate of blood stasis in the young group was significantly lower than that in the middle-aged and elderly group （5.38% vs 23.94%， χ²=13.996， P＜0.001）.The rates of yin deficiency， blood stasis， phlegm turbidity， qi deficiency， blood deficiency， wind， hyperactivity of yang， fire， and qi stagnation in men were not statistically significant compared with those in women （P＞0.05）. The frequency of disease location syndrome elements is kidney （45.66%）， spleen （21.39%）， liver （19.65%），gallbladder （6.94%）， heart （2.89%）， stomach （2.31%）， and lung （1.16%） in turn. The combination of syndrome elements mainly focuses on the combination of two syndrome elements and three syndrome elements. The first three syndromes are single pathogenesis syndrome element+single target （40.85%）， two pathogenesis syndrome elements （21.70%） and single syndrome element+two target （17.87%） in turn.

Conclusion

The pathogenesis syndrome elements of vertigo are mainly yin deficiency， blood stasis， phlegm turbidity， and qi deficiency， and the disease location syndrome elements are mainly kidney， spleen and liver. Dual and triple syndrome element combinations are the most frequent， and blood stasis is more prevalent in middle-aged and elderly patients.

Objective

To investigate the effect of edaravone dexborneol on cognitive impairment after acute cerebral infarction.

Methods

From August 2022 to August 2023， 174 patients with acute cerebral infarction were admitted in the Department of Neurology， the First Affiliated Hospital of Shihezi University. According to whether edaravone dexborneol should be used or not， the patients were divided into two groups: Edaravone dexborneol group （70 cases） and conventional treatment group （104 cases）.The routine treatment group received the routine treatment of cerebral infarction according to the Chinese guidelines for the diagnosis and treatment of acute ischemic stroke 2018， while edaravone dexborneol group was given edaravone dexborneol in addition to the routine treatment group. Stroke scores， including National Institutes of Health stroke scale （NIHSS）， modified Rankin Scale （mRS） and mini-mental state examination（MMSE）， were assessed before admission and 90 days post-treatment. The clinical efficacy of both groups was then analyzed. The differences of NIHSS， mRS， and MMSE scores between the two groups were compared by rank sum test， and the differences of clinical efficacy between the two groups were compared by χ² test， rank sum test was used to compare the cognitive domain of MMSE in edaravone dexborneol group from admission to 90 days after treatment.

Results

There was no significant difference in NIHSS， mRS， and MMSE scores between the two groups at admission （P＞0.05）， the scores of NIHSS and mRS in the edaravone dexborneol group were lower than those in the routine group ［1（0， 2） vs 1（0， 3） ； 1（0，1） vs 1（0， 1）］， the scores of MMSE were significantly higher in the treatment group than in the control group ［29（27， 30） vs 28（25， 30）］ （Z=-2.013， -2.407， -2.396；P=0.044， 0.016， 0.017）. The total effective rate in edaravone dexborneol group was significantly higher than that in routine treatment group （35.7% vs 14.4%， χ²=12.000， P=0.007）. The changes of cognitive domain of MMSE in edaravone dexborneol group at 90 days after admission showed that the ability of orientation， attention， calculation，recall， retelling， writing， and rewriting were significantly improved with the difference statistically significant（P＜0.05）.

Conclusion

Edaravone dexborneol was effective in the treatment of cognitive impairment after acute cerebral infarction.

Objective

To investigate the effect of Wuchong Tongluo Capsule in preventing and treating restenosis after vertebrobasilar artery stenting.

Methods

One hundred and fifty patients diagnosed with vertebrobasilar artery stenting， exhibiting the traditional Chinese medicine syndrome of wind， phlegm， and blood stasis due to stroke， were enrolled at our hospital from October 2019 to September 2021. These patients were randomly assigned to two groups using a double-blind method: a control group（75 cases） treated with conventional Western medicine and a treatment group （75 cases） additionally administered Wuchong Tongluo Capsule. The blood lipid levels ［total cholesterol （TC）， triglyceride （TG），low density lipoprotein cholesterol （LDL-C）］， serum inflammatory factors ［interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， hypersensitive C-reactive protein （hs-CRP）］， peak systolic flow velocity （PSV），and diastole of the two groups before and after treatment were compared end-stage flow velocity （EDV），carotid intima media thickness （IMT）， plaque number， plaque size score， TCM syndrome score and restenosis rate were compared. At the same time， liver enzyme indexes ［alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， γ glutamyl transferase （GGT）］， serum creatinine （Scr） were compared between the two groups before and after treatment. Gastrointestinal reactions before and after treatment were also compared.

Results

There were no significant differences in PSV， EDV， IMT， plaque number， plaque size score and TCM syndrome score between the two groups before surgery （P＞0.05）. 6 months after surgery，the values of TC， TG， LDL-C， IL-6， TNF-α， hs-CRP， PSV， EDV， IMT， plaque number， plaque size integral，TCM syndrome volume and restenosis rate in the treatment group were lower than those in the control group（P＜0.05）. There was no significant difference in ALT， AST， GGT， Scr and gastrointestinal reaction between the two groups before and after 6 months treatment （P＞0.05）.

Conclusion

In the postoperative treatment of patients with vertebrobasilar artery stenting， the addition of Wuchong Tongluo capsule on the basis of conventional western medicine can effectively improve hemodynamics， reduce plaque burden， ameliorate TCM syndrome， regulate inflammatory factors and lipid levels， demonstrating a favorable impact on the prevention and treatment of restenosis.

Objective To analyze the correlation between methylenetetrahydrofolate reductase （MTHFR） polymorphism and cerebral microbleeds （CMB） in Tibetan population in Tibet.

Methods

From January 2020 to December 2022， 150 Tibetan patients with small cerebrovascular disease （including 69 with CMB） and 50 healthy controls， matched by gender and age， were collected from the People's Hospital of Tibet Autonomous Region. All patients underwent cranial MRI. Logistic regression was employed to identify the risk factors for CMB. The patients were divided into lobar and deep/infratentorial cerebral microbleeds group， and t-tests， Mann-Whitney U-tests， or χ² tests were used to analyze the epidemiologic measurements and MTHFR C677T polymorphism between these groups.According to the microbleed anatomical rating scale （MARS）， cases were stratified into mild （22）， moderate（28）， and severe （19） groups， with CMB counts calculated accordingly. The number of CMB was calculated according to MARS. χ² tests were used to compare the distribution of MTHFR C667T gene polymorphism across CMB severity groups.

Results

Homocysteine （HCY） （OR=0.256， P=0.018） and uric acid （OR=4.460，P=0.021） were identified as independent risk factors for CMB compared with those without microbleeds.There were significant differences in age （68.51±10.13 vs 61.25±8.13； t=2.637， P=0.013） and number of CMB ［6（1， 16） vs 4（1， 13）； Z=-2.347， P=0.023］ between patients with different locations of CMB， while no significant differences were found in HCY and MTHFR C667T gene polymorphism distribution. In the severity-stratified analysis， HCY levels progressively increased with MARS severity， showing significant difference among 3 groups ［（15.81±6.33）μmol/L vs （17.08±6.97）μmol/L vs （19.40±7.01）μmol/L； F=4.576，P=0.013］. Patients with severe CMB had a higher proportion of TT genotype （26.3%）， with a significant difference among the three groups （χ²=17.692， P=0.007）. Compared with the healthy control， patients with CMB had a lower proportion of CC in MTHFR C677T （47.8% vs 60.0%） and a higher proportion of TT（10.2% vs 4.0%）， though this difference was not statistically significant （P＞0.05）.

Conclusion

Although the prevalence of the TT genotype in Tibetan patients with CMB is not high， the risk associated with hyperhomocysteinemia is relatively elevated， warranting prompt identification and management.

Objective

To assess the impact of standardized management protocols on the prevention and treatment of incontinence associated dermatitis （IAD） in intensive care units （ICU）

Methods

A total of 100 stroke patients with incontinence admitted to the ICU of Beijing Tiantan Hospital， affiliated to Capital Medical University， from May 2022 to December 2023， were enrolled in this study. They were divided into the control group （50 cases） and the intervention group （50 cases） according to the order of admission time. The control group received routine care， whereas the intervention group underwent standardized skin management procedures on the basis of routine care in the control group. Data collected include the IAD incidence， onset time， severity， treatment cost， and patient family satisfaction for two groups of patients.The independent sample t-test was utilized to compare the differences in IAD severity score， occurrence time， treatment cost， and satisfaction score between the two groups. The chi-square test was employed to compare the differences in IAD incidence between the two groups.

Results

Compared with the control group， the intervention group had a lower incidence of IAD （4.00% vs 18.00%）， a delayed onset time［（12.23±1.32）d vs （8.63±1.85）d］， lower severity score ［（15.85±4.24） points vs （25.43±4.63） points］，reduced treatment costs ［（4342.53±2687.62） yuan vs （5619.31±3426.27） yuan］， and higher patient family satisfaction scores ［（22.07±2.35） points vs （16.84±2.44） points］， with statistically significant differences（χ²=5.010）， P=0.025； t=27.184， P＜0.001； t=33.543， P＜0.001； t=15.035， P＜0.001； t=4.845， P=0.026）.

Conclusion

The implementation of standardized management protocols in stroke patients with incontinence admitted to the ICU can effectively reduce the incidence and severity of IAD， delay its onset， lower treatment costs， and improve patient family satisfaction.

Objective

To investigate the effects of butylphthalide on serum inflammatory markers in a rat model of vascular cognitive impairment （VCI）， and to clarify the specific mechanism of butylphthalide.

Methods

A total of 49 specific pathogen-free Sprague-Dawley rats， aged two months and weighing approximately （170±20） grams， were randomly assigned， with 40 males and 40 females used for VCI rat model creation. The VCI rat model was established by repeated bilateral carotid artery occlusion combined with modified hypotension. The successfully modeled rats were randomly divided into three groups: model， positive control， and butylphthalide treatment. Sham-operated rats in the sham group underwent the same surgical procedures as the model group but without carotid occlusion，receiving only normal saline via oral gavage. Seven days after successful modeling， the model group received intragastric administration of normal saline， the positive drug group received intragastric administration of nimodipine hydrochloride solution， and the butylphthalide treatment group received intragastric administration of butylphthalide solution. After 30 days of continuous administration， serum levels of tumor necrosis factor-alpha （TNF-α） and interleukin （IL）-6 were measured， and cognitive function was assessed using the Morris water maze method ［including positioning cruise experiment（5 consecutive days of testing）， spatial exploration experiment， and visible platform experiment］. ANOVA and non-parametric test were used to analyze the escape latency of seeking the platform measured by the positioning cruise experiment， the time required to cross the platform for the first time measured by the space exploration experiment， the time to find the platform measured by the visual platform experiment， and the TNF-α and IL-6 data of the brain tissue of the rats in each group. LSD method was used to compare pairwise differences between groups.

Results

After treatment， the escape latency of the positive drug group ［1-5 d:（70.23±25.20） s， （68.44±19.29） s， （42.92±22.30） s， （32.33±21.42） s， （26.68±22.40） s］， the butylphthalide treatment group ［1-5 d: （62.81±19.73） s， （52.02±15.51） s， （35.55±12.80） s， （26.25±7.52） s， （19.28±6.17） s］，and the model group ［1-5 d: （96.23±6.67） s， （87.35±27.57） s， （77.90±20.56） s， （54.27±19.11） s，（49.01±27.26） s］， with the most significant reduction observed in the positive control and butylphthalide treatment groups compared to the model group （F=23.950， P＜0.001）. In the spatial exploration experiment，the time required for the first platform crossing by rats in the positive drug group ［（16.54±5.64） s］and butylphthalide treatment group ［（15.28±4.86） s］ was significantly shorter than that in the model group［（27.45±13.69） s］ （all P＜0.001）. In the visible platform experiment， significant differences in escape latency were found among the positive control group ［（15.64±6.51） s］， butylphthalide treatment group ［（14.02±6.71） s］，model group ［（16.00±5.80） s］， and sham group ［（11.19±2.94） s］， but no significant pairwise differences were observed between the model， positive control， and butylphthalide treatment groups （all P＞0.05）. Serum levels of TNF-α and IL-6 in the positive drug group ［（29.09±4.76） pg/ml， （70.61±8.34） pg/ml］ and the butylphthalide treatment group ［TNF-α: （29.11±4.79） pg/ml， IL-6: （56.39±8.23） pg/ml］ were significantly lower than those in the model group ［TNF-α: （35.68±5.76） pg/ml， IL-6: （90.61±15.23） pg/ml］ （all P＜0.001）.

Conclusion

Butylphthalide may improve the cognitive function in VCI rats by reducing the levels of TNF-α and IL-6 in the cerebral cortex of VCI rats.

Currently， studies on the treatment of pediatric vasovagal syncope with pacemaker implantation are very limited. This article reports a case of a 7-year-old male child who experienced recurrent syncope. A tilt table test induced a prolonged cardiac arrest lasting up to 31 seconds. After through consultation with the family a pacemaker with closed loop stimulation function was implanted in the patient， and he was treated with Metoprolol Tartrate. Follow-up assessments showed significant treatment benefits，with no recurrence of syncope， and the tilt table test showing that the pacing function prevented a decrease in blood pressure and heart rate. This article also reviews and summarizes the literature from 1990 to 2024， encompassing 23 pediatric cases of vasovagal syncope treated with pacemakers， aiming to explore personalized diagnostic and treatment approaches for this patient population..

Intracranial plasmacytoma refers to plasma cell tumors that infiltratethe skull， meninges， and brain tissue. Primary intraparenchymal plasmacytomas， which are characterized by the presence of plasma cell tumors within the brain without involvement of the dura mater or skull， are exceedingly uncommon. This paper reports a case of a patient initially diagnosed with cerebral infarction elsewhere， who was subsequently identified as having an isolated intracranial plasmacytoma. The aim of this report is to contribute to a more comprehensive understanding of the disease's presentation and diagnosis， thereby enhancing clinical awareness and knowledge of this rare entity.

Hemichorea associated with non-ketotic hyperglycemia （HC-NH） is a group of diseases characterized by the onset of extrapyramidal symptoms alongside hyperglycemia. The pathogenesis is currently unclear. This article presents a case of an elderly patient with HC-NH， with the aim to improve relevant auxiliary examinations and treatments to enhance clinical recognition and management of this disease.

Objective

To explore the application of Balint group activities within a team learning framework for enhancing the training of specialist physicians.

Methods

Physicians who received specialized training at Peking University Third Hospital from May 2019 to October 2022 were enrolled as subjects. Balint group activities were conducted once a month for a total of 6 months in a team learning mode，leading to the gradual development and refinement of a comprehensive medical record database for Balint group activities. The JSE-HP Scale and SEGUE Scale were used to evaluate the changes in empathy and communication abilities after the activities. Paired t-tests were used to compare the differences before and after training for specialized physicians.

Results

The total score of the JSE-HP scale increased significantly after participating in the Balint group activity in team learning mode （105.36±6.27） compared to before participating in the group activity （89.43±5.60）， with the difference statistically significant （t=-8.795，P＜0.001）. Similarly， the total score of the SEGUE scale increased significantly after participating in the Balint group activity in team learning mode （22.14±1.61） compared to before participating in the group activity （20.57±1.70）， with the difference also being statistically significant （t=-7.778， P＜0.001）.

Conclusion

Incorporating Balint group activities in team learning mode can improve empathy and communication skills， which is advantageous for their professional development.

Sitting intolerance is a group of clinical syndromes associated with postural change，particularly when transitioning from a supine to a sitting position or during periods of sedentary behavior.The main manifestations include dizziness， headache， blurred vision， palpitations， and chest tightness， with syncope potentially occurring in severe instances. Its frequent attacks will seriously affect the quality of life，and overall well-being of children. In 2020， the two types of children's sitting intolerance， sitting tachycardia syndrome and sitting hypertension， were proposed for the first time. Up to date， the understanding of sitting intolerance diseases in children has been still at the initial stage. This review has introduced the classification，diagnosis， possible pathophysiological mechanisms， risk factors， differential diagnosis， and treatment of sitting intolerance in children， aiming to improve the knowledge of sitting intolerance in children among pediatric healthcare professionals， arouse more attention to sitting intolerance in children， and improve the diagnosis and treatment of sitting intolerance.

Transient perivascular inflammation of the carotid artery （TIPIC） is a rare clinical entity characterized by neck pain， typically described as a dull ache， and is often unilateral with variable intensity. This pain can be localized to the lateral neck area and the carotid artery bifurcation. The mechanism of TIPIC is still unclear， possibly due to non-specific inflammation. Imaging examinations are pivotal for diagnosing TIPIC， mainly including the appearance of the vascular wall and the surrounding area. The former mainly refers to the manifestations that affect the blood vessel wall itself. The latter mainly refers to the local infiltration around blood vessels， manifested as irregular soft tissue replacing the adipose tissue around the blood vessels， and mostly occurs at the posterior or lateral part of the bifurcation of the carotid artery. Sonographically， TIPIC is characterized by an "onion-skin" pattern of abnormal hypoechoic soft tissue surrounding the vessels and hypoechoic plaques on the vascular intima. The vascular wall can be eccentrically thickened， but there is typically no significant luminal narrowing or only a mild reduction without hemodynamic impact. Contrast-enhanced imaging reveals the presence of microbubble perfusion enhancement in low echogenic soft tissue lesions. MRI shows a marked perivascular thickening. MRI with contrast shows the enhancement of the perivascular tissue. CT shows a thin， regular hypodense wall thickening， without significant stenosis. Fluorodeoxyglucose positron emission tomography depicts a significant focal uptake surrounding perivascular changes. TIPIC may resolve spontaneously， typically within two weeks. This article reviews the imaging diagnosis of TIPIC.