Small fiber neuropathy is a peripheral neuropathy that selectively involves unmyelinated C-type fibers and (or) thin myelinated Aδ-type fibers. It is mainly manifested as abnormal pain and temperature perception and autonomic symptoms. Changes in certain inflammatory markers and antibodies related to autoimmune diseases can occur in patients with immune-related small fiber neuropathy. This article aims to explore the immunological progress in small fiber neuropathy.

Amyotrophic lateral sclerosis is a progressive neurodegenerative disorder involving primarily motor neurons in the cerebral cortex,brainstem and spinal cord.The clinical diagnosis of ALS may be categorized into four levels of certainty according to clinical and electrophysiological examination,depending on the presence of upper and lower motor neuron signs together in the same topographical anatomic region in either the brainstem(bulbar cranial motor neurons),or cerival,or thoracic,or lumbosacral spinal cord(anterior horn motor neurons).Electromyography is of great importance in the diagnosis of ALS.Neruoimaging studies and clinical laboratory studies are helpful to exclude other disorders.

Experiments in vitro demonstrated for the first time that an EtOAc extract of roots of Rubus crataegifolius Bge.can markedly inhibit the for mation of lipid peroxide in rat brain,heart. liver and kidney tissucs. When administered intragastrically for 15 successive days,the EtOAc extract markedly inhibited the formation of lipid peroxide in plasma and tissues of liver and brain of mice. The above results showed that the EtOAc extract from roots of R. crataegifolius Bge.had anti-lipid peroxidation effect.

55 ?s ranged from 5 0%～100 0% (mean 60 6%) The ratio of block ranged from 0 0%～90 0% (mean 29 3%) FD ranged from 1 4～4 0 (mean 2 56) There were remarkably increased jitter, block and FD in 51 patients with definite or probable ALS It was also found that there was a negative correlation between extensor digitorum communis strength grades and the ncreased jitter with or without block and FD ( P

Early diagnosis and symptomatic therapy of amyotrophic lateral sclerosis(ALS)can profoundly influence care and quality of life of the patient and relatives,and may increase survival time.Medication with riluzole should be initiated as early as possible.PEG is associated with improved nutrition and should be inserted early.Noninvasive positive pressure ventilation improves survival and quality of life.Palliative end-of-life care should be provided to ALS patient.

Objective Through the study of medical services cost accounting , we want to find the laws and provide a theoretical basis for government departments to develop standards of medical service prices and control health care costs . Methods On the basis of department cost accounting, we use financial accounting software, to provide medical service items for collection and sharing in accordance with the project income ratio , workload standards.Results Dialysis the three costs dominate factors, the proportion of disposable materials (60.03%)is the key factor affecting the cost.Conclusion Hygiene material spending accounted for a larger proportion of total expenditure , in order to effectively control the medical expense in dialysis patients, efforts should be made to reduce the cost of hemodialysis consumables.

To improve the class effectiveness,different teaching methods were chosen based on the characteristics of pharmacy students,such as to stimulate the students’ interest,raise the independently ability,design the appropriate multimedia content and practice.

Objective To analyze the symptoms and signs in forty-five Lambert-Eaton myasthenia syndrome (LEMS) patients retrospectively. Characteristics of electrophysiological examinations were investgated. Methods Forty-five LEMS patients were reviewed and information gathered regarding clinical complains neurological symptoms, and other concomitant diseases. The records showed that repetitive nerve stimulation (RNS) and nerve conduction velocity (NCV) were performed in all patients. Needle electromyography (EMG) and skin sympathetic response (SSR) were performed in some patients. Results (1) The mean age of neurological clinical onset age was (51.2 ±6. 8) years old. The two most common symptoms were slight weakness of lower extremities ( n = 35 ) and upper extremities (n= 5). Dysarthria was found in 3 patients and neck weakness in 2 patients. Tendon reflex decreased and disappeared in 38 patients. Autonomic nervous system manifestations were presented in 30 patients. (2) RNS increasing was observed in all patients from 156% to 636%. Low frequency RNS abnormalities were found in 29 patients.Sensory nerve conduction velocity abnormalities or sensory nerve conduction velocity combined motor nerve conduction velocity abnormalities were found in 19 patients ( 42% ). Of the 30 patients who underwent a needle EMG examination, 20 had myogenic or neurological damage. Thirteen abnormal findings were observed in 25 patients who underwent SSR examination. Conclusion The most common manifestations were weakness in lower extremities and autonomic nervous system dysfunction. Many abnormal electrophysiological results were found in LEMS patients, including NCV and EMG abnormalities. These findings indicated that clinical manifestations exceed the neuromuscular junction and perhaps included the peripheral nerve and muscle.

Objective To explore the correlation between diffuse neurogenic changes on electromyography and diagnosis of amyotrophic lateral sclerosis (ALS).Methods Retrospective study was performed based on database of motor neuron disorders collected from January,2002 to December,2008.The category of disease with diffuse neurogenic changes at the first examination was summarized.The electromyography (EMG) manifestation in ALS patients at the first examination and the results after follow-up were reviewed.The factors affecting EMG manifestation in ALS were analyzed with binary Logistic regression.Results In 298 patients with diffuse neurogenic changes on EMG,192 cases (64.4％ ) were diagnosed of ALS,36 ( 12.1％ ) progressive muscular atrophy,13 (4.4％ ) Kennedy' s disease,10 (3.4％)Hirayama disease,9 ( 3.0％ ) cervical spondylosis combined with lumbar spondylosis,6 ( 1.3％ ) spinal muscular disease,5 ( 1.7％ ) multifocal motor neuropathy,5 ( 1.7％ ) ALS-plus disease,4 ( 1.3％ )myopathy,3( 1.0％ ) hereditary motor neuropathy,3 ( 1.0％ ) axonal motor neuropathy,2(0.7％ ) postpolio syndrome,and 10 (3.4％) with no definite diagnosis.In total 213 patients who were diagnosed with ALS after follow-up,at their first examinations,8 (3.8％) had neurogenic changes in two regions and 13(6.1％ ) had neurogenic changes in one region,and they all developed to diffuse neurogenic changes after follow-up for 3 to 24 months.Logistic regression analysis showed that the EMG change at first examination was not related to duration from onset,symptom location at onset,age at onset and gender.Conclusion Diffuse neurogenic changes on EMG can present in many disease including ALS.Neurogenie changes in one or two regions on EMG can be the manifestation of ALS at early stage.

Objective To assess the correlations between muscle strength and amplitude of compound muscle action potential(CMAP)with blood potassium level in hypokalemic periodic paralysis after long exercise test(ET).Methods ET of abductor digiti minimi(ADM)was performed on 78 patients with hypokalemic periodic paralysis.Ulnar and median CMAP amplitude,blood potassium level,muscle strength of ADM,palmar interossei muscle and abductor pollicis brevis were measured before and 120 minutes after exercise.The correlations of muscle strength,CMAP amplitude and blood potassium level were analyzed.Results Ulnar CMAP amplitude was(4.6 ±2.7)mV after ET and(9.6 ±3.2)mV before ET(t =16.047,P =0.000)in 78 patients with hypokalemic periodic paralysis,respectively.Median CMAP amplitude was(10.9 ± 4.2)mV after ET and(11.2 ± 3.9)mV before ET(t =0.673,P =0.822),respectively.After ET,muscle strength of ADM decreased in 76 patients,score on MRC was less than Ⅲ in ADM but V in palmar interossei muscle and abductor pollicis brevis in 41 patients,the blood potassium level was tested in 10 of them,which was(3.8 ±0.3)mmol/L before ET and(3.9 ±0.4)mmol/L after ET(t =0.395,P =0.702).Conclusion In patients with hypokalemic periodic paralysis,blood potassium level is not the key factor affecting muscle strength and CMAP amplitude after ET.