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.

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.

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.

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.

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 investigate the diagnostic value of the split-hand sign in amyotrophic lateral sclerosis ( ALS).Methods Ninety ALS patients, 41 patients with other neuromuscular disorders and 71 normal controls were recruited for conventional nerve conduction study.Compound muscle action potential ( CMAP) amplitude recorded from abductor pollicis brevis ( APB) , abductor digiti minimi ( ADM) and first dorsal interosseous (FDI), CMAP amplitude ratios, CMAP amplitude differences and split-hand index ( SI) were analyzed.Results The APB/ADM CMAP amplitude ratio was significantly lower in the ALS patients (0.44(0.44)) than that in the patients with other neuromuscular disorders (1.31(0.87);z=6.967, P<0.01) and the normal controls (0.99(0.42);z=7.687, P<0.01).The FDI/ADM CMAP amplitude ratio was significantly decreased in the ALS patients ( 0.79 ( 0.46 ) ) compared with that in the normal controls ( 1.23 ( 0.39 ); z =5.899, P <0.01 ).The FDI/ADM CMAP amplitude ratio was comparable between the ALS patients and the patients with other neuromuscular disorders ( 0.93 ( 0.62 );z=1.737,P=0.081).SI was significantly lower in the ALS patients (2.42 (3.14)) than that in the patients with other neuromuscular disorders (10.10(6.54);q=7.947, P<0.05) and the normal controls (17.93(8.32);q=10.827, P<0.05).SI <5.2 can help differentiate ALS from mimic disorders, with a sensitivity of 83.33% and specificity of 96.43%.Conclusions The split-hand sign appears to be a specific feature of ALS.SI robustly differentiates ALS from mimic disorders and potentially facilitates an earlier diagnosis of ALS.

Objective To analyze and summarize the clinical characteristics of patients with spontaneous hemor -rhage of hepatic adenoma in glycogen storage disease type Ⅰa.Methods Reporting 1 case in our hospital and making a summary about general situation , category, etiology, diagnosis and treatment of the hemorrhage of hepatic adenoma with glycogen storage disease type Ⅰa through checking literatures .Results The patient was a 27 year old male who had been diagnosed as glycogen storage disease for 14 years, as well as was first found hepatic adeno-ma at the age of 17 .He once was diagnosed as intra-adenoma bleeding with persistent abdominal pain and dizziness and was underwent selective hepatic artery embolization at the age of 22.Hepatic adenoma in glycogen storage dis-ease typeⅠa generally appeared at the age of puberty .One common complication of this disease was hemorrhage of hepatic adenoma , which can be found by ultrasonography and CT .Clinical management includs observation , selec-tive hepatic artery embolization , radiofrequency ablation , surgical resection and liver transplantation .Conclusions Glycogen storage disease type Ⅰa is an autosomal recessive genetic disease with hepatic adenoma as a common complication of GSD Ⅰa, serious liver adenoma's hemorrhage can be life threatening , the radiological examination can be helpful to detect hepatic adenoma .Then appropriate intervention can improve the life quality and prognosis .

Objective To investigate the protective effects of antioxidant taurine plus metoprolol on the blood pressure(BP)and blood vessel function of elderly spontaneously hypertensive rats(SHR).Methods SHRs were divided into three groups (6 rats,each):metoprolol group (100 mg · kg-1 · d-1,intragastric administration);taurine group (200 mg · kg-1 · d-1,intraperitoneal injection);taurine plus metoprolol group(metoprolol 100 mg· kg-1 · d-1,intragastric administration ± taurine 200 mg· kg-1 · d-1,intraperitoneal injection).The control group[6 Wistar-Kyoto(WKY) rats]was treated with the same volume of sterile normal saline on the same schedule in intragastric administration and intraperitoneal injection.Blood pressure variability(BPV),diurnal variation of BP,the level of glutathion peroxidase (GSH-Px),malonaldehyde (MDA) and the aorta GSTM1 enzyme expression were evaluated before and 14 days after treatment.Results The serum GSH-Px activities were higher in metoprolol group[(2 759.8 ± 117.6) kU/L],taurine group [(2 848.0 ± 280.2) kU/L] and taurine plus metoprolol group[(3 052.8±283.7)kU/L]than in control group[(2 368.0± 60.4) kU/L] (all P＜0.05).Fourteen days after treatment,MDA level was significantly lower in taurine group[(9.5±0.7)ng/L,P＜0.01]than in control group[(13.7±1.5)ng/L].However,there was no statistical difference in MDA level between metoprolol group/taurine plus metoprolol group and control group.Forty weeks after treatment with taurine,GSTM1 protein expression was increased,but it had no statistical difference.Conclusions The combined antioxidant taurine and metoprolol can effectively decrease BPV of elderly SHRs,in which the antioxidant effect might be associated with elevated GSTM1 protein expression.