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 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 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

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 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.

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.

ObjectiveTo evaluate the impact of omega-3 fatty acids intervention on clinical outcomes in postoperative patients with parenteral nutrition (PN). MethodsLiteratures relating to the evaluation of the clinical outcomes after supplementation with omega-3 fatty acids after selective surgeries were searched in databases including PubMed, EMBASE, Cochrane Library, Web of Science, Chinese Biomedical Databases, China National Knowledge Infrastructure, and Wanfang Database etc. All the eligible studies were randomized controlled trials and their results were published from January 1996 to June 2010. The methodological quality was assessed using Jadad scale, Schulz allocation concealment tool, and methodology review. Meta analysis was conducted using RevMan 5.1 software. The impact was described in terms of complications of infection, case-fatality rate, length of postoperative hospital stay, and length of postoperative ICU stay. ResultsTotally 320 articles were found and 17 randomized controlled trials ( n =1213 ) entered final meta analysis study. The results showed a significant decrease in the infectious complication rates of postoperative patients receiving omega-3 fatty acids intervention [risk ratio (RR) =0.44, 95％ confidence interval (CI) (0.30, 0.64), P ＜0.0001] ; meanwhile, the length of hospital stay was significantly shortened [mean difference (MD) =- 1.65 ; 95％ CI ( - 2.72, - 0.58), P =0.003]. However,the length of ICU stay showed no significant difference [MD =-0.31,95％ CI ( - 1.20, 0.58), P =0.500].ConclusionOmega-3 fatty acids interventions can benefit postoperative patients by reducing the morbidity of postoperative infectious complications and shortening the length of hospital stay.