Objective To evaluate the effect of detailed disease management model in community management of hyperuricemic patients.Methods One hundred and fifty patients with primary hyperuricemia were randomly divided into detailed management group and conventional group from April to June 2012,patients in two groups were managed by different models for 1 year.The weight,height,biochemical indexes including blood uric acid and serum lipids were measured and a questionnaire survey was conducted with the items of disease awareness score,smoking,drinking,diet,standard treatment,satisfaction of treatment etc.before and after management.Results One hundred and thirty six patients completed the study including 68 in detailed management group and 68 in conventional group.After one year management,the blood uric acid,triglyceride,low density lipoprotein (all P ＜ 0.01) were statistically lower than baseline in detailed management group,while there were no statistical differences of these indexes in conventional group (P ＞ 0.05).The disease awareness score increased from (65.4 ±5.4) to (82.7±4.2) (Z=-10.2,P＜ 0.01),high purine diet rate fell from 47.1％ to 7.4％ (x2 =33.6,P ＜ 0.01),the standard treatment rates increased from 10.3％ to 85.3％ (x2 =76.6,P ＜0.01),treatment satisfaction rate increased from 51.5％ to 88.2％ (x2 =21.8,P ＜0.01) in detailed management group.In detailed management group,the blood uric acid (Z =-7.4,P ＜ 0.01),total cholesterol (Z =-0.01,P ＜ 0.01),triglyceride (Z =-2.4,P ＜ 0.01) and low density lipoprotein (Z =-3.2,P =0.03) and high purine diet rate were lower (x2 =27.1,P ＜ 0.01),the standard treatment rate (x2 =70.6,P ＜ 0.01) and treatment satisfaction rate were higher (x2 =5.6,P =0.02) than those in conventional group after 1 year management.Conclusion Detailed disease management is an applicable and effective model for community management of hyperuricemic patients.

Objective To evaluate the value of photodynamic diagnosis for early detection of bladder cancer using narrow band imaging fluorescence cystoscopy. Methods A total of 28 cases of painless hematuria underwent narrow band imaging(NBI) endoscopy and biopsy. The procedure was as follows: biopsies were taken from lesions that were either fluorescing or nonfluorescing using endoscopy by NBI system) and then TUR was performed on them. Results Of the 28 cases, 79 biopsies were taken. Histopathologic examination showed that 32 of them were of urothelial cell carcinoma. Compared with white light cystoscopy, NBI had a sensitivity of 100% (32/32) ,flat small fluorescence positive lesions were found in peritumoral or other regions, which could not be detected by white light cystoscopy. Conclusion Photodynamic diagnosis using NBI fluorescence cystoscopy is useful for detection of early bladder cancer.

Objective To investigate the correlation between cerebral artery stenosis (MCAS) and mild cognitive impairment (MCI).Methods Continuous selected 636 cases of 50-80 years old inpatients or outpatients who examined by transcranial color Doppler ultrasound (TCD) in April 2012 to April 2013 in our hospital.Keep the mini-mental state examination (MMSE) and clinical dementia rating (CDR) as the evaluation of cognitive function.Results Detected 124 cases of MCAS patients (MCAS group) and 512 cases of non-MCAS patients (non-MCAS group).Forty-four cases MCI were detected in MCAS group with the prevalence rate was 35.5％(44/124),and 114 cases of patients with MCI were detected in non-MCAS group with the prevalence rate was 22.3％ (114/512),the difference was statistically significant (P ＜ 0.05).Single factor analysis showed that there were no significant difference between two groups in waist circumference,hypertension,coronary heart disease,hyperlipidemia,smoking,diastolic blood pressure and total cholesterol,uric acid,fasting glucose,C-reactive protein (P ＞ 0.05); There were significantly different between two groups in age,gender,education level,MCAS,history of diabetes,systolic blood pressure and triglyceride,low density lipoprotein-cholesterol,high-density lipoprotein-cholesterol(P ＜ 0.05).Multiple factors analysis showed that the MCAS (OR =1.899,95％ CI 1.224-2.946),history of diabetes (OR =1.764,95％ CI 1.191-2.612),systolic blood pressure(OR =1.012,95％ CI 1.003-1.022),gender (OR =0.558,95％ CI 0.380-0.821),and age (OR =1.029,95％ CI 1.010-1.049) was the independent risk factor for MCI.Conclusion The MCAS related with MCI occurrence and development.

Objective To summarize the clinical features,neuroimaging findings and pathological characteristics of demyelinating pseudotumors(DPT)of the brain,and to differentiate it from glioma. Methods The clinical features,neuroimaging findings and pathological characteristics of 35 patients with demyelinating pseudotumors of the brain were summarized,and the diagnosis for 18 of them was confirmed by bioscopy.Results Demyelinating pseudotumors affected adults of both sexes.The onset age of patients ranged from 9 to 69 years old.There was no definite antecedent,and the clinical syndromes were atypical. Neuroimaging scans showed multiple lesions in cerebral hemisphere,while the lesion in brain stem and spinal cord was single.The symptom and neuroimaging were not parallel.While with many or large lesions, the symptoms and signs were less.The lesions were not enhanced on CT scan,but appeared round or patch enhancement on MRI scan.Nine patients with DWI all appeared high density.The myelin basic protein was useful for diagnosis.The typical pathological changes were demyelination,perivascular inflammatory infiltration and reactive gliosis.The Creutzfeuldt cells were also found in these patients.The lesions might become small or disappear after treatment,but could not serve as the criterion to exclude brain neoplasm. Conclusions DPT is a distinct demyelination disease entity,which is confusable with brain neoplasm.It is difficult to distinguish DPT from brain neoplasm with the clinical features and conventional neuroimaging scan.But DWI scan is useful.The pathological changes accord with demyelination,and Creutzfeuldt cells are also found.It is important to apply corticosteroid treatment or biopsy rather than being anxious to excise the lesions.

Objective to investigate the level of platelet leukocyte aggregates in patients with acute cerebral infarction and their short term prognosis.Methods 105 patients with acute cerebral infarction onset within 24 hours were selected continuously,then platelet leukocyte aggregates including neutrophil aggregates (PNA) and platelet monocyte aggregates (PMA) and platelet lymphocyte aggregates (PlyA) were detected by flow cytometry within 24 hours of admission and the incidence of 14 days.modified Rankin Scale(mRS) was performed at 14 days of onset,as a prognostic indicator,and the mRS score was good at 3.The score >3 mRS was divided into poor prognosis.The level of platelet leukocyte aggregates was detected in 50 healthy subjects.Results (1) The platelet leukocyte aggregates in patients with acute cerebral infarction group were significantly higher than that of the healthy group,which was statistically significant (P<0.05).(2)MRs score <3 group and mRS score >3 score comparison,the difference of white blood cell aggregates was statistically significant(P<0.05).Conclusion leukocyte aggregates could be used as an index of short-term prognosis in patients with acute cerebral infarction.

Objective To report the experience in the use of laparoscopic extravascular stent for the treatment of the nutcracker syndrome. Methods Five patients (4 men and 1 woman) aged 20 to 35 years (mean 25) underwent laparoscopic extravascular stent of the left renal vein (LRV) for treatment of nutcracker syndrome associated with severe recurrent gross hematuria and left gonadal vein varices. All patients met the criteria for establishing the diagnosis of nutcracker syndrome. Ultrasonography, computed tomography, and magnetic resonance imaging revealed visible entrapment of the LRV between the superior mesenteric artery and aorta. Bleeding from the left ureteral orifice was detected by cystoscopy in 3 cases. An externally reinforced graft was selected to form an external stent around the LRV to relieve the compression. Results The mean operation time was 67 min (65-70min). No complications occurred during surgery. The postoperative follow-up was 9 to 39 months (mean 28). Total relief was achieved in 4 men without a relapse of symptoms and abnormalities were not found in urine tests. There was partial relief for the female patient due to microscopic hematuria after the operation. In all the 5 cases, Color Doppler ultrasonography showed that the blood outflow was smooth, the inner diameter and flow velocity of the aortomesenteric portion of the LRV were both decreased, and the gonadal vein varices had diminished in diameter. Conclusions The laparoscopic extravgscular stent of the renal vein could be a feasible approach for re-establishing free renal venous outflow in patients with nutcracker syndrome. This slightly invasive treatment could eliminate the symptoms of the condition.

Objective To explore the acquired immunity against Schistosoma japonicum infections in the offspring of mother-mice infected with Trichinella spiralis.Methods The offspring of mother-mice infected with Trichinella spiralis and the mice after passively transferring the offspring's sera were sacrificed at day 42 post infection with S. japonicum cercariae. The percentage of reduction in worm burdens was calculated to determine the protective effects. Results Comparing with the control group, the reduction rates of the worm were 24.31% in the offspring, 18.65% and 20.77% in mice with passively transferring the offspring's sera by intravenous injection and muscular injection respectively. Conclusion The offspring of mother-mice infected with Trichinella spiralis and the mice with passively transferring the offspring's sera could acquire protective immunity against Schistosoma japonicum infections.

Objective:To identify the tannin-related constituents in the extracts of pomegranate peel by HPLC-ESI-MS. Methods:The separation was performed on a Kromasil C18 column (250 mm × 4. 6 mm,5 μm) with the mobile phase of water and acetonitrile. The flow rate was maintained at 1. 0 ml·min-1 and the detection wavelength was set at 256nm. The samples were analyzed in negative modes. Results:Five tannin-related constituents including gallic acid, punicalin,punicalagin,corilagin and ellagic acid were identified from the extracts of pomegranate peel. Conclusion:The new method is accurate and rapid. It can be used to identify the tannin-related constituents in pomegranate peel and provide new ideas for the research of active components in traditional Chinese medicine as well.

Objective To explore the clinical characteristics of vestibular migraine in patients from the clinic and ward of the neurological department in comprehensive hospitals.Methods A total of 226 patients diagnosed as vestibular migraine were enrolled in the study.Clinical data were collected and analyzed,including the medical history,clinical symptoms and signs,as well as the result of diagnostic examinations.Results The mean age of the patients at the visit was 51.7 years old,with the male to female ratio of 1:1.48.The occurrence of vertigo and migraine varied in order,with 53.1％ (120/226) patients presented migraine several years before vertigo.The duration time of vertigo ranged from seconds to days,with 1.8％ (4/226) patients presented no headache during the whole course.Several punctate long T2 or high FLARE (fluid attented inversion recovery) signals scattered at the centrum ovale.Conclusions Vestibular migraine has complex mechanism and presents multiple clinical manifestations with certain regularities of the onset.Differential diagnosis should be made from the similar diseases.

Objective To assess the effect of continuous renal-replacement therapy (CRRT) dose on the outcome of acute renal failure (ARF) patients with meta-analysis of randomized controlled trials (RCTs). Methods Studies were identified by systematic search of peer-reviewed publications in Medline, EMBASE and Cochrane library database through June 2010. All the RCTs that compared the incidence of clinical outcome such as mortality, need for chronic dialysis between standard and low dose CRRT were eligible. The pooled relative risk (RR) for clinical outcome was compiled using a random-effects model. Heterogeneity was evaluated by means of subgroup and sensitivity analysis. Results Six eligible studies were identified. By meta-analysis, standard dose CRRT was associated with non-significant 13% mortality risk reduction (RR 0.87, 95%CI 0.70-1.07, P=0.19)and 13% composite outcome risk reduction of chronic dialysis dependence and mortality (RR 0.87, 95%CI 0.69-1.09, P=0.21), but the trend toward increased chronic dialysis dependence risk among survivors (RR 1.43, 95%CI 0.94-2.18, P=0.09). The overall test for heterogeneity among cohort studies was significant (P=0.001, I2=76.2%). The risk of mortality was modality was significantly lower in some studies of which delivered dose was moer than 35 ml·kg-1·min-1,modality was continuous venous-venous hemofiltration (CVVH) and major cause was non-sepsis treated with standard dose CRRT. Conclusions Standard dose CRRT in patients with ARF does not improve survival, renal recovery and composite outcome, but decreases mortality in important subgroups including those with higher delivered dose, CVVH and non-sepsis.