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 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.

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.

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 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 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 applicative value of contrast enhanced ultrasound (CEUS) through rectumin the T-staging of rectal cancer.Methods 24 cases with rectal cancer were examined preoperatively by endorectal ultrasound (ERUS) and CEUS during May 2012 to November 2013 in our hospital.The characteristics of contrast enhanced ultrasound imaging in early and late phase of the rectal cancers were studied,and the imaging distribution and enhancement mode were observed.The preoperative staging diagnosis was conducted by consulting T staging criteria.The diagnostic results were compared with the postoperative pathologic diagnosis.Results The contrast enhanced time in rectal cancer began at 14-35s.The early tumor showed uneven nodular,ribbon or ring in high enhancement.At the advanced late,angiographic tumor showed homogeneous enhancement and continued to be observed during the whole time.Normal rectal wall ultrasonography showed spotty low enhancement or no enhancement.The overall accuracy of ERUS in T-staging was 66.7％ (16/24) and the overall accuracy of CEUS was 83.3％ (20/24) respectively.There was a significant difference in the overall accuracy between ERUS and CEUS (P＝0.018).The sensitivity,accuracy and positive predictive value of CEUS were 100.0％ (2/2),100.0％ (2/2),100.0％ (2/2) inT1 stage,83.3％ (10/12),83.3％ (10/12),100.0％ (10/10) in T2 stage,100.0％ (8/8),88.9％ (8/9),88.9％(8/9) in T3 stage,and 100.0％ (2/2),100.0％(2/2),100.0％ (2/2) in T4 stage,respectively.Conclusions As compared toroutine transrectal ultrasound,transrectal contrast enhanced ultrasound imaging on rectal cancer shows the typical sonographic characteristic imaging on microvascular focus size and borders,on characteristic infiltration zone.Therefore,contrast enhanced ultrasound improves the diagnostic accuracy of preoperative T-staging in rectal cancer surgery.

Objective To investigate the changes of electrolyte metabolism in patients undergoing moderate elective abdominal operation,and explore its relationship with postoperative complications.Methods The clinical data of 1117 inpatients (age ≥ 18 years) who had undergone moderate elective abdominal operation in the Department of General Surgery of Beijing Hospital from January 1,2011 to December 31,2011 were retrospectively analyzed.They received postoperative fasting for ≥ 3 days,and the preoperative liver function and renal function were normal.The perioperative electrolyte changes and clinical outcomes were recorded.For patients with normal preoperative electrolytes but abnormal postoperative electrolytes,its potential correlations with the postoperative infections and total complications were analyzed.Results The rates of abnormal postoperative electrolytes were as follows:potassium,24.1％ ; sodium,6.4％ ; chloride,27.6％ ; calcium,61.7％ ; magnesium,16.3％ ; and phosphorus,71％.The vast majority of ion levels were below the normal levels.The total complication rate was 19.7％ and the postoperative infection rate was 17.19％.Univariate logistic regression analysis showed that the postoperative total and infective complications were significantly associated with the increased (P =0.007) or decreased (P =0.007) serum potassium,the decreased serum sodium (P =0.016),the decreased serum phosphorus (P =0.004),and the decreased magnesium (P =0.049).Conclusions Electrolyte decrease is common after moderate elective abdominal operations.There is a certain correlation between postoperative electrolyte decrease and postoperative complications.Therefore,attention should be paid to maintain electrolyte balance during the perioperative period.

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.