Objective To identify the clinical and neurophysiological features of multiple system atrophy (MSA) and explore diagnostic values using various techniques in electro neurophysiology Methods Forty four subjects diagnosed as multiple system atrophy (MSA) during 1983 to 2001 in PUMC Hospital were studied retrospectively about their clinical features, routine electromyography (EMG), nerve conductive velocity (NCV), somatosensory evoked potential (SEP), motor evoked potential (MEP), brainstem auditory evoked potential (BAEP) and visual evoked potential (VEP) The clinical features and the electroneurophysiologic results were analyzed in different subgroups (probable MSA and possible MSA, OPCA and non OPCA, classified MSA and unclassified MSA) Results Most patients were found to be suffered from autonomic failure (88 6%) and cerebella dysfunction (88 6%) The pyramidal sign was seen in 72 7% of patients No remarkable statistical differences were found in all of the above three domains The incidence of Parkinsonism was 36 4% of all the patients, which showed significant differences between probable and possible MSA (54 5% vs 18 2%), non OPCA and OPCA (50% vs 7 1%), unclassified MSA and classified MSA (52% vs 15 8%) EMG was abnormal in 7 patients (38 1%), all of them were neurogenic impairments The rates of abnormal EMG were varied differently between probable and possible MSA (54 5% vs 22 2%), non OPCA and OPCA (53 8% vs 14 3%), unclassified MSA and classified MSA (58 3% vs 12 5%), but without statistical differences The abnormal rates in BAEP,SEP, VEP and MEP were 56 7%, 28%, 23 1% and 20 0%, respectively, and there were no significant differences between subgroups Conclusions It should be hard to divide MSA into groups only by the clinical manifestations All EPs were abnormal in some extent The most sensitive test is BAEP in current study, but there were no differences among the subgroups in the rates of abnormal EPs The difference of EMG and NCV between the groups showed that the technique might be helpful in the diagnosis of MSA

The author proposed detailed introduction of handling of complications in the Australian AR-DRGs program,introduced considerations of complications by AR-DRGs from two aspect-the level of disease complications and the complexity of clinical treatments.The authors specifically described CCL and PCCL evaluations.This paper provides reference for the localization of DRGs program design.

ObjectiveTo investigate the causes, operation time, and microscopic repairing procedures of contusive iridodialysis. Methods23cases(23 eyes) who had partial iridodialysis due to contusions of the eyeballs underwent the microscopic repair during 7 to 18 days after injury. Viscoelastic agent and other auxiliary devices were used in the operation. ResultsAll eyes were fully corrected with approximate round-shaped pupils and their visual function improved. 1 eye with raised intraocular pressure was performed with trabeculectomy. ConclusionTimely repair of partial iridodialysis performed under microscope was safe and effective.

Objective:To investigate the effect of Operation Maps application on relieving anxiety of patients of the nurses of operation room preoperative visits. Methods:39 cases of operation were randomly divided into the application of operation maps 19 cases and routine visit group 20 cases, regular visiting group received routine preoperative interview content, and on the basis of content, the original application mapping group are visited by nurses carrying atlas album, and according to the related content the nurses explain to patients in the album when they introduce the patients the operating room environment surgery, surgical notes, position, etc. At the same time, the self rating anxiety scale measurement measures the anxiety of patients when they are admitted and after into operation room, and blood pressure, heart rate, pain intensity, the first time getting out of bed, exhaust time, clearing time, and they compare the difference. Results:The anxiety values of the original application mapping group mapping group, systolic blood pressure, heart rate are lower than regular visits group(t=2.28, t=4.756, t=10.28;P<0.05). Intensity of pain after operation in the two groups , get out of bed the first time, exhaust time showed no significant differences(t=3.04, t=3.06, t=2.56;P<0.01). Conclusion:Application of operation atlas of systematic, standardized preoperative visit is an important psychological guidance, and it can reduce the anxiety level of patients and effectively improve the quality of medical operation period.

Objective To systematically analyze therapeutic effects of extracorporeal photopheresis (ECP) on refractory steroid-resistant,-dependent or-intolerant graft-versus-host disease (GVHD),to compare remission rates of skin GVHD in detail.Methods Databases were searched for studies concerning remission rates of GVHD after the treatment with ECP,and relevant data were extracted and pooled by using meta-analysis with STATA 12.0 software.Results A total of 22 literatures were reviewed,including 787 patients with refractory GVHD.Meta-analysis showed that the pooled complete remission (CR) rate and overall remission (OR) rate were 57％ (95％ CI:47％-66％) and 79％ (71％-86％) respectively in patients with acute GVHD,27％ (21％-33％) and 63％ (58％-69％) respectively in patients with chronic GVHD,77％ (71％-82％) and 87％ (82％-91％) in patients with acute skin GVHD,as well as 39％ (30％-48％) and 70％ (63％-77％) in patients with chronic skin GVHD.Conclusion ECP is an effective therapy for refractory GVHD,especially for skin GVHD.

Primary aldosteronism (PA) is a common form of secondary endocrine hypertension,which is characterized by hypertension,hypokelamia,myathenia,elevated serum aldosterone concentration and suppressed plasma renin activity.Besides,accumulating research evidences showed that parathyroid hormone (PTH) level was elevated in patients with primary aldosteronism,accompanied by secondary hyperparathyroidism.This review systemically introduces the interaction between aldosterone and PTH in PA patients.

Continuous renal replacement therapy( CRRT) employs convection and adsorption to re-move pro-and anti-inflammatory mediators from plasma, helping to restore the immunologic homeostasis. CRRT also provide uninterrupted clearance of retained endogenous and exogenous toxins, along with acid-base,electrolyte,hemodynamics and volume homeostasis.CRRT may improve outcomes in critically ill pa-tients with sepsis-induced acute kidney injury,septic shock and multiple organ dysfunction syndrome.Region-al citrate anticoagulation, as compared to unfractionated heparin, report better filter survival times and less bleeding.Antibiotic dosing decisions should be individualized to take into account patient-related,CRRT-relat-ed,and drug-related factors.

Objective To observe the effect of bone marrow mononuclear cells (BMMNCs) transplantation on high mobility group box1 (HMGB1) migration in stroke mouse. Methods BMMNCs were harvest and injected intravenously into stroke mouse model; modified neurological severity scores(mNSS) were tested; brain infarct vol-ume and related protein expression levels were measured, then HMGB1 migration were observed. Results mNSS score and brain infarct volume in transplantation group weresignificantly lower than vehicle group , while HMGB1 expression were significantly higher than vehicle group. The expression levels of RAGE and TNF-α in transplanta-tion group were significantly lower than vehicle group. Immunofluorescence assay showed that the release of HMGB1 in brain penumbra area of transplanted mouse was significantly less than vehicle groups. Conclusions BMMNCs transplantation could inhibit the release of HMGB1 in mouse brain.

Objective To explore the changes of the levels of CA-125 antigen(CA125) and vascular endothelial growth factor (VEGF) in serum and peritoneal fluid in patients with endometriosis (EMT), and the relationship with EMT. Methods One hundred and twenty patients with EMT (EMT group)and 98 patients with uterine fibroids (control group) were enrolled in this study. The levels of CA125 and VEGF in serum and peritoneal fluid were detected by enzyme linked immunosorbent assay (ELISA), and the results were compared. Results The levels of serum CA125,VEGF in EMT group were significantly higher than those in control group:(40.31±11.14) kU/L vs.(24.71±9.19) kU/L,(59.75±6.87) ng/L vs. (36.38±8.12) ng/L, there were significant differences(P<0.05). The levels of serum CA125,VEGF inⅠ-Ⅱphase andⅢ-Ⅳphase in EMT group had no significant differences ( P>0.05). The levels of peritoneal fluid CA125,VEGF in EMT group were significantly higher than those in control group:(311.46± 107.29) kU/L vs.(158.17± 55.42) kU/L,(73.28 ±10.40) ng/L vs. (40.21 ±9.84) ng/L, there were significant differences (P<0.05). The levels of peritoneal fluid CA125,VEGF in Ⅲ-Ⅳ phase were significantly higher than those in Ⅰ-Ⅱ phase in EMT group:(387.41±70.91) kU/L vs. (308.42±81.21) kU/L, (69.22±7.13) ng/L vs. (55.44±8.23) ng/L, there were significant differences (P<0.05). In EMT group, the levels of CA125 and VEGF in serum were significantly lower those in peritoneal fluid:(40.31±11.14) kU/L vs. (311.46±107.29) kU/L, (59.75±6.87) ng/L vs. (73.28 ±10.40) ng/L, there were significant differences (P<0.05). Conclusions The levels of CA125 and VEGF in serum and peritoneal fluid are closely related to EMT. Peritoneal fluid in monitoring of EMT may be more sensitive and reliable than serum.

Objective To evaluate the prognostic value of combing pre-procedural red cell distribution width(RDW)with serum uric acid(SUA)levels in patients with acute coronary syndrome(ACS)undergoing percutaneous coronary intervention(PCI).Meth-ods A total of 1 52 consecutive patients with ACS who underwent successful PCI within 12 hours after onset of symptom were en-rolled.RDW and SUA were determined within 12 hours before PCI.The patients were divided into 3 groups according to the cut-off values showed by receiver operating characteristic(ROC)curve:73 cases in group I,RDW<14.5% and SUA<402 μmol/L;50 cases in group Ⅱ,RDW< 14.5% and SUA≥ 402 μmol/L,RDW≥ 14.5% and SUA< 402 μmol/L;29 patients in group Ⅲ,RDW>14.5% and SUA>402 μmol/L.The pre-procedural RDW and SUA status associated with 30 days any cause mortality and major adverse combined cardiac events including revascularization,non-fatal recurrent myocardial infarction,secondary heart failure,rehos-pitalization and death were analyzed.Results Pre-procedural RDW and SUA level predicted 30 days cardiac mortality,RDW and SUA level correlated linearly(r=0.336,P =0.001).30 days major adverse combined cardiac events and any cause mortality were significantly different among the three groups(P =0.031,P =0.012).Conclusion Pre-procedural RDW≥ 14.5% and SUA≥402μmol/L indicates poor prognosis in ACS patients underwent successful PCI.Therefore the combination of RDW and SUA measure-ment should be taken into consideration for risk stratification to decide about the management strategies in ACS patients.