Decreased organ function and metabolic deficiency are typical among elderly patients.High nutrition risks often result in poor clinical outcomes.Therefore,nutrition risk screening is recommended for the elderly inpatients, and a detailed nutrition support scheme shall be established for patients with a score≥3.Enteral nutritional support is the first choice for elderly patients with basically normal gastrointesternal functions,while patenteral nutrition support should be customized.Appropriate application of pharmacologic nutrients can also improve clinical outcomes.

Objective To recognize the developments and achievements of the clinical neuropathology in China from 1955 to 2009.Methods Retrospective survey of literatures related clinical neuropathology published in Chinese Journal of Neurology (CJN) from the first issue in 1955 to the No.12 issue in 2009 was conducted; Total literatures of CJN and literatures of the clinical neuropathology were respectively counted and the percentage of the latter was analyzed in different periods; Proportion of autopsy and biopsy literatures was also analyzed.According to categories of nervous system diseases,their relative percentages were respectively counted.The percentages of clinical neuropathological literatures and autopsy literatures of CJN were compared with the data of the same period of J Neurol Neurosurg Psychiatry (JNNP).Results (1) The percentages of clinical neuropathological literatures in total literatures of CJN were 18.11％ (65/359),20.81％ (103/495),17.05％ (22/129),15.50％ (230/1484),11.58％ (176/1520) and 16.04％ (309/1927),respectively,in 1955-1959,1960-1969,1970-1979,1980-1989,1990-1999,2000-2009.The percentage variation trend in different periods from 1955 to 2009 had significant difference (trend x2 =7.977,P =0.005) ; But there was no significant difference in the variation trend of the percentage of clinical neuropathological literatures between CJN and JNNP from 1955 to 2009.(2) The percentages of autopsy in the total clinical neuropathological literatures of CJN from 1995 to 2009 appeared gradually to decline; Compared with JNNP,the percentages of autopsy in the total clinical neuropathological literatures of CJN during 1980-2009 were lower,and there was significant difference in the variation trend of the percentage of autopsy in the total clinical neuropathological literatures between CJN and JNNP.(3) The main types of neurological diseases in the neuropathological literatures were tumors,infectious diseases and cerebrovascular diseases from 1955 to 1989,while myopathies became the most main disease type during 1990-2009; Compared with the same period JNNP,the clinical neuropathological literatures of the rare and difficult diseases and neurodegenerative diseases in CJN were relatively less.Conclusions Neuropathology is important in the clinical neuroscience research.From 1955 to 2009,main achievements of clinical neuropathological researches in China mainland lie in tumors,cerebrovascular diseases,infectious diseases and myopathies.But in recent years,due to the lack of autopsy cases,it is to the disadvantage of exploring pathogenesis of neurodegenerative diseases and understanding some rare and difficult diseases.

Objective To investigate the clinical presentation, hormonal profile and metabolic abnormalities in subgroups of women with PCOS and explore a reasonable classification for PCOS. Methods A cross-sectional study of 192 women with PCOS (14-38 years of age) was performed. The patients were divided into 3 groups of A, B and C according to the revised 2003 consensus on diagnostic criteria and also divided into 2 groups according to body mass index(BMI) : group A(n=110), long term anovulation, clinical and biochemical evidence of high androgen level, ovary enlargement with its size larger than 10 ml or number of small follicles of 2-9 mm ≥12 under ultrasound with exclusion of other diseases caused by high androgen;group B(n=46), long term anovulation, clinical and biochemical evidence of high androgen level;group C(n=36), long term anovulation, ovary enlargement with its size larger than 10 ml or number of small follicles of 2-9 mm ≥12 under ultrasound with exclusion of other disease caused by high androgen; obesity PCOS group (OB-PCOS,n=70),BMI≥25(kg/m~2); no obesity PCOS group (NOB-PCOS,n=122), BMI

Objective To explore the clinical features of spongiform encephalopathies occurred in the elderly and causes of misdiagnosis. Methods Clinicopathological diagnosis of a 79 year old man with acute spongiform encephalopathy was reported. Clinical, EEG and MRI characteristics of eight old patients with spongiform encephalopathy in China confirmed by neuropathology were reviewed. Results Elder patients with spongiform encephalopathies had an acute onset and a rapid developing course, and all patients presented with progressive dementia accompanied by various clinical manisfestations of extrapyramidal diseases. EEG recordings with typical periodic sharp wave complexes (PSP) was shown in six cases, and abnormal T2 signal in both basal ganglia by MRI in one case. Three cases were misdiagnosed as cerebral vascular disease and one cse as encephalitis herpes cimplex. Conclusions Spongiform encephalopathy in the elderly should be paid more attention to since their early clinical symptoms are similar to that of the acute cerebral vascular diseases. It is suggested that early diagnosis of spongiform encephalopathy could be made basing on the combination of the typical clinical characteristics and dynamic EEG findings, and brain biopsy if necessary, to avoid nosocomial spreading.

Objective To investigate the oligodendroglial cytoplasmic inclusion (OCI) in the central nervous system of multiple system atrophy (MSA) and to evaluate its roles in pathologic diagnosis of MSA.Methods Modified Gallyas Braak staining was used to investigate tissue samples of the brain and the spinal cord of 4 cases with MSA, which were previously diagnosed by clinical and routine pathologic methods. Eight cases with motor neuron disease and 6 cases without nervous system disease were used for control study.Results OCIs were demonstrated by Gallyas barrak method in the white matter of the brain and the spinal cord of 3 cases with MSA. They look like sickle , semilunar , and flame shaped. Their main distributions were transverse fibers of the basis pontine, the white matter of the cerebellum, striatopallidal fibers and lateral column of the spinal cord. While OCIs were not found in the brain and the spinal cord of one case without typical clinical features and pathologic findings. Nor did all of the control cases.Conclusions OCIs may be regarded as pathologic marker of the sporadic forms of MSA. It also suggests that OCIs are related to degenerative process of myelinated fibers in MSA.

Objective To evaluate the effect of Beijing' s separation of clinic from pharmacy reform.Methods Use difference-in-difference method based on dataset on patients having Urban Worker Medical Insurance from twelve state-owned hospitals.Results The reform incurs a decrease in the outpatient and inpatient expenditure on medicine per visit (30％ and 21％,respectively),a decline in hospital's pharmaceutical ratio (9 percentages and 4 percentages,respectively); reduces the outpatient and inpatient expenditure per visit (19 ％ and 8 ％,respectively),with a decrease in the out-of-pocket part (23％ and 3％,respectively),and a slight increase in the Medical Insurance's part (2％); raises hospital's turnover (11％),outpatient's visits (22％),and inpatient visits (43％).Conclusion The reform encourages physicians to prescribe more scientifically,and hence reduces patient 's expenditure on medicine and hospital's pharmaceutical ratio; leads to a decrease in patience' s expenditure per visit;raises hospital's turnover; and doesn't cause a significant increase in the expenditure from social medical insurance.

To have a better understandings of the clinical features and pathology of the central nervous system of thrombotic thromocytopenic purpura(TTP) in order to avoid its misdiagnosis and improper treatment, we reported here the clinical features of the central nervous system of 2 cases with TTP and pathologic changes in the brain of one case of them.The result showed that in 2 young women presented with atypical clinical features and laboratory findings of TTP, the main presentations of the central nervous system included language disturbances, hemiplegia, delirium, scream, confusion, unconsciousness.Both of them had an acute progresive course. One case died after steroids therapy alone and the other got complete remissions after conbined treatment with plasmapheresis and steroids. Pathological examination of the brain of the died case showed widespread hyaline thrombosis in small vessels and ischaemic changes of the neurons in the hippocampus and the cerebral cortex. Our conclusion is there are various patterns of clinical presentations of the CNS in TTP and the disturbances are due to widespread thrombotic microangiopathy and failure of cerebral perfusion.

Objective To evaluate the effect of omega-3 polyunsaturaed fatty acid on liver function, donor's T lymphocytes and acute rejection following orthotopic liver transplantation in rats. Methods Orthotopie liver transplantation from BN (RT1 n) to Lewis was performed. Normal saline (NS, n = 6), parenteral nutrition (PN, n = 6) or parenteral nutrition and Omega-3 fatty acid (OM, n = 6) was given through internal jugular vein catheter respectively beginning the first day for consecutive 6 days. At 7thday, the liver function and pathological changes of the transplant liver were observed. The percentage of CD4+ , CD8+, CD4+ CD25+ and CD8+ CD28- T lymphocytes were analyzed by flow-cytometry. Results In OM group the CD4+, CD8+ , CD4+ CD25+ and CD8+ CD28- T lymphocytes significantly decreased, compared with NS (t = 4.28, P < 0.01 ; t = 2.63, P < 0.05 ; t = 2.59, P < 0.05 ; t = 8.86, P <0.01)or PN group(t =8.06, P<0.01; t =3.57, P<0.01; t =5.35, P<0.01; t =7.98, P<0.01). The ratio of CD4+ to CD8+ significantly decreased in OM group compared with NS group and PN group(t = 6.25, P<0.01; t=4.92, P<0.01). RAI (rejection activity index) in NS group, PN group and OM group was 7.17 +0.98, 6.17±0.75 and 4.33±0.52, respectively. The rejection grade in OM group was siguificanfly alleviated than that in NS group and PN group(t =6.25, P <0.01;t =4.92, P <0.01). Conclusion Omega-3 fatty acid inhibits T lymphocytes, especially help T lymphocytes, alleviates acute rejection. The suppressor T cell and the regulatory T cell were not responsible for the alleviation of the rejection.

Objective To summarize the clinical outcomes after the optimization of nutrition support in elderly patients after hepatic carcinoma surgery.Methods The clinical data of 52 elderly patients with hepatic carcinoma in Beijing Hospital were collected and analyzed from 2007 to 2009(research group).Nutritional Risk Screening(NRS)2002 was applied for the nutrition risk screening at admission.NRS 2002 score≥3 was regarded as at nutritional risk.Enteral nutrition(EN)or EN combined with parentoral nutrition(EN+PN)supports were provided during the peri-operative stage.The control group included 30 patients from 2005-2007 under the same conditions with rescareh group but only received PN supports pest-operatively.Nutritional parameters,complications,lengh of hospital stay,and healthcare expenditures were analyzed.Results Body weight and plasma albumin were no significantly different in two groups(P>0.05)by the 7th post-operative day.The incidence of infection-relatod complications and length of hospital stay were significantly lower in research group than in control group (P<0.05).Conclusions Nutrition risk screening should be performed for the elderly patients with hepatic carcinoma after admission.Optimization of peri-operative nutrition support can reduce complications and improve the clinical outcomes.

Objective To investigate the release pattern of insulin after the load of glucose in patients with polycystic ovary syndrome ( PCOS ) and normal oral glucose tolerance.Methods Sixty-three patients with PCOS were undertaken oral glucose tolerance test (OGTT) and insulin release test,while 34 women with normal menstrual cycle served as control.Results Among 63 patients with PCOS,33 cases were obese with body mass index over 25 kg/m2,including 5 with abnormal OGTT.All 30 non-obese patients with PCOS had normal OGTT.The prevalences of insulin resistance were 78.8％,16.7％,and 9.0％ in obese PCOS,non-obese PCOS,and control groups,respectively.Abnormal insulin release curve were found in 84.5％,70.0％,and 14.7％ of subjects in these 3 groups,respectively.In 58 PCOS patients with normal OGTT,the prevalence of insulin resistance was 44.8％,and 75.9％with abnormal insulin release curve. Among them,body mass index of 32 patients,whose homeostasis model assessment for insulin resistance (HOMA-IR) and fasting insulin remained in normal range,was similar to those of control group [ ( 20.52 ± 2.86 vs 20.01 ± 2.54 ) kg/m2,P＞0.05].Conclusion These findings indicate that insulin release test is useful in detecting insulin resistance.Insulin release is elevated in PCOS patients even with normal OGTT.