Objective To summarize the characteristics of neurological symptoms in patients with aortic dissection.Methods The clinical data including symptoms,signs,and imaging of 865 consecutive patients with aortic dissection were analyzed retrospectively.Results Neurological symptoms occurred in 225 cases (26.0％) with aortic dissection.The most common symptom was dizziness (56 cases,6.5％),followed by syncope (49,5.7％),single lower limb sensory disturbances(47,5.4％),single lower extremity weakness(27,3.1％),coma (22,2.5％),paraplegia (19,2.2％),headache (13,1.5％)and hemiplegia (9,1.0％).The first manifestation of five cases was the neurological symptoms,including syncope (2),dizziness(1)and headache (2).Patients with type A aortic dissection were more vulnerable to the neurological symptoms than those with type B aortic dissection (34.6％ vs 14.7％),and the symptoms with significantly higher occurrence were syncope,coma,hemiplegia,paraplegia and lower limb sensory disturbances.Conclusion Neurological symptoms are common in patients with aortic dissection,especially in those with type A aortic dissection.

Objective To investigate the clinical features of stroke in young adults with infective endocarditis (IE).Methods This is a retrospective analysis of clinical data of young patients (aged between 18 and 44 years) diagnosed with IE in Beijing Anzhen Hospital affiliated to Capital Medical University from January 2003 to March 2013.Results Three hundred IE patients (209 male and 91 female) were enrolled with mean age of (31.8 ± 7.8) years old.Fourteen of them were prosthetic valve endocarditis.All of the cases were found vegetations.The vegetations were mainly distributed in the mitral valve and/or aortic valve (262/300 patients).Congenital heart disease and rheumatic valvular disease were most frequently background diseases.Thirty-five cases (11.7％) were complicated with stroke.Among them,21 cases were with cerebral infarction (including 7 subjects with hemorrhagic transformation),9 cases with cerebral hemorrhage,3 cases with subarachnoid hemorrhage,and 2 with reasons unknown.Within the 21 cerebral infarction cases,the infarction sites were mainly distributed in internal carotid artery system with 5 cases involving bilateral internal carotid artery systems and 2 vertebro-basilar artery systems.As to the cerebral hemorrhage,lobar were the bleeding sites in all cases,and mainly distributed in internal carotid artery system.The proportions of left-sided endocarditis and rheumatic valvular disease were significantly higher in patients with stroke than those without [100.0％ (35/35) vs 86.4％ (229/265),P =0.02;22.8％ (8/35) vs 6.4％ (17/265),P =0.001,respectively].Regression analysis showed that the OR of the rheumatic valvular disease for stroke in young IE patients was 4.950 (95％ CI 1.626-15.072),and the OR of stroke for death was 8.387 (95％ CI 1.997-35.225),respectively.Conclusions Stroke is common in young patients with IE.Cerebral infarction often involves multiple vascular systems,and is prone to hemorrhagic transformation.Intracerebral hemorrhage often occurs in lobar.Rheumatic valvular disease might be a risk factor for stroke in young patients with IE,which is an independent risk factor for death of these patients.

Equity of the essential medicine system involves social justice,being important in health services availability equity.The essential medicine system,in practice in China,has to a certain extent improved the equity of health service availability,yet found with poor equity in the process due to differences in insurance,regional diversity,pricing of essential medicine,and poor implementation of the system at primary medical institutions.Such equity needs to be further improved in the future in such aspects,consistence of different insurance reimbursement percentages,further support to underdeveloped areas,encouragement of market competition,and better compliance of primary medical institutions in implementing the system.

Objective To analyze causes for complications after proximal femoral intramedullary nail treating unstable femoral intertrochanteric fractures in the elderly.Methods A total of 172 cases of unstable intertrochanteric fractures treated with proximal femoral intramedullary nail from December 2001 to May 2007 were reviewed upon postoperative complications to find out the causes for complications and discuss countermeasures.Results Of all, 149 cases were followed up for 6-42 months(mean 18. 5 months), which showed excellence rate of 89. 0% in aspect of functional recovery of the hip. Postoper-ative systemic complications occurred in 26 cases and local complications in 21.Condusions Proxi-real femoral intramedullary nail can be used in most elderly patients with unstable intertrochanteric frac-tures. A thorough evaluation of physiological function, treatment of preoperative comorbidities and aug-mentation of surgical technique are prerequisites for operation safety and decrease of complications.

Objective Identifying the factors of psychological pressure from medical disputes on clinical doctors and possible solutions. Methods Self-rating Anxiety Scale (SAS) and the Occupational Stress Indicator (OSI) were called into play, to study 52 clinical doctors in a tertiary hospital in a city, who had encountered medical disputes in recent two years. In parallel, 63 clinical doctors without such disputes and 50 non-clinical workers were randomly selected as the control group for questionnaires. Results Clinical doctors with such an experience were commonly found to be anxious, and their SAS score (58. 27±11.38)averaged higher than those in the control group. Doctor-patient relationship, legal liabilities and clinical positions were found to be positively correlated to psychological pressure of clinical doctors. Conclusions Medical disputes tend to add to psychological pressure of the doctors. Clinical doctors deserve psychological counseling and training and improvement of their working conditions.

10.3969/j.issn.2095-4344.2013.26.018

Endocannabinoid system has several kinds of receptors, all of which have correspondence ligands and pathways of synthesis and degradation, and they belong to G-protein coupled receptors family. Recently studies show that stimulation of cannabinoid receptors has inhibitory effects on gastrointestinal motility and secretion. In this article, we introduce the compositions of the cannabinoid family members, includingtheir receptors, ligands, and antagonists, and their effects on the gastrointestinal motility and secretion. Useful information can be provided for the further study on the effects of endocannabinoid system on gastrointestinal motility and secretion, providing theoretic evidences for clinical use of cannabinoid.

Translational medicine is a new term recently which aims to eliminate the barrier between preclinical and clinical medicine,to efficiendy and effectively translate basic scientific findings into drugs and medical devices that benefits patients.This article discussed the meaning of translational medicine in cultivating postgraduates of neurology.According to the preliminary attempt,it is beneficial for postgraduates to form translational medicine philosophy and be high-quality medical talents.

Vascular dementia (VaD) is one of the most common dementia types in the elderly population. Its incidence is only second to Alzheimer's disease. At present, the diagnosis of VaD mainly based on the clinical manifestations, neuroimaging and neuropsychological scales of the patients. It still lacks higher sensitive and specific metabolism indexes. Magnetic resonance spectroscopy is a noninvasive technique for detecting the energy of living tissues and the changes of metabolism. In recent years, it has been more and more used to patients with VaD and has achieved initial results in the diagnosis, differential diagnosis and cognition-related studies of

Objective To evaluate the effect of hyperuricemia on vascular complications of type 2 diabetes and analysis of the possible mechanism. Methods 586 cases with T2DM were divided into two groups: normal serum uric acid (n=397) and hyperuricemia (n=189).The morbidity of macrovascular and microvascular complications and the serum levels of CRP,TNF,IL-1,IL-2,IL-6,IL-8 and PAI-1 were detected. Results (1)Hyperuricemia group showed higher BMI, blood pressure, TG,TC,LDL,WHR ratio and lower serum HDL-C than the group with normal uric acid (all P<0.05).(2)Group with hyperuricemia showed higher morbidities of macrovascular and microvascular complications than the group with normal uric acid (all P<0.05).(3) Group with hyperuricemia had higher levels of CRP,TNF,IL-6,IL-8,PAI-1 (all P<0.05). Conclusions (1) Hyperuricemia is associated with obesity and dyslipidemia.(2) Hyperuricemia may cause atherosclerosis by inflammation of vascular endothelium, resulting macrovascular and microvascular complications.