ObjectiveTo assess the effectiveness of tele-medicine and self-management goal(SMG) setting technique used in the diabetes management in the community setting.Methods It is a control-group study.415 type 2 diabetic residents were recruited from the Shanghai Wuliqiao community based on existing medical records.The subjects were divided into two groups,the study group was cared by general practitioners (GPs) specialists cooperation through the tele-medicine mechanism,the other was a control group.For the study group,a cooperation pathway between community health care centers and general hospitals were established.Standardized training and guidelines were provided to community health workers,regarding the setting of management goals of blood glucose and blood pressure,treatment plan,patient education,and SMG techniques.Fasting blood glucose ( FBG ) and 2 h postprandial blood glucose (2hBG) in the study group were monitored,followed by community health workers visiting monthly with seminars for diabetes education.At the baseline and the 12tb month,FBG,2hBG,HbA1C,blood pressure,triglyceride,total cholesterol,body mass index,waist-hip ratio were determined in each group.A survey was conducted to evaluate the costs of diabetes treatments,the knowledge base related to their disease,lifestyle,and the awareness of the new care model.The rates of achieving the goal of blood glucose,blood pressure,and HbA1Ccontrol were calculated.Internet case discussion between GPs-Specialists and referral to certain specialists were implemented when some patients did not reach the control goal.ResultsBy the 12 month follow up,FBG,2hBG,HbAIc,blood pressure of the study group were lower than the baseline,and as well as the control group with statical significance (P＜0.05).There are other improvcments:diabetes knowledge (29.1％ vs 5.5％ ),healthy diet (9.6％ vs -10.4％ ),blood glucose monitoring (30.3％ vs 10.8％ ),support for diabetes care in community (35.7％ vs 9.4％ ),and the preference of the new model (63.8％ vs 17.9％ ) with statistical significauce (P＜0.01 ).As for the medical costs,the study group's monthly costs were consistently lower than the control's.( -3.39Yuan vs 32.26 Yuan,P＜0.05).ConclusionsThe new diabetes care model based on GPs-Specialists tele-medicine and SMG in community opens the door to the community based care model formulation in regard to the health quality and costs control.The deployment of more technologies and management techniques could be explored further to improve the outcomes of community based chronic disease care model.

Objective To study the effect of magnetic stimulation on the expression of B cell lymphoma/leukemia gene 2 ( Bcl-2 ) and caspase-3 genes, and the apoptosis of neurons in rats with spinal cord injury (SCI).Methods Sixty rats were randomly divided into a magnetic stimulation group, a model group and a sham-operation group. An SCI model was established in the magnetic stimulation and model groups. The magnetic stimulation was applied at the 6th, 12th, 24th and 72nd hour after the operation to the rats in the magnetic stimulation group, and sham magnetic stimulation was given to the model group and sham-operation group rats at the same time points. Two hours after treatment, 5 rats of each group were sacrificed and their injured spinal cords were sectioned. The gene expressions were detected using immunohistochemical techniques, and apoptosis of neurons was observed by the TUNEL method. Results Few apoptotic cells were found in the sham-operation group, but more were found in the model group. Apoptotic cells in the magnetic stimulation group were significantly fewer than in the model group. The expression of both Bcl-2 and caspase-3 in the magnetic stimulation and model groups was significantly higher than in the sham-operation group at the different time points. Expression of Bcl-2 in the magnetic stimulation group was significantly higher than in the model group, but expression of caspase-3 in the magnetic stimulation group was significantly lower than in the model group. Conclusions Magnetic stimulation up-regulates the expression of Bcl-2 genes and down-regulates the expression of caspase-3 in injured neurons. Magnetic stimulation might have protective and rehabilitative effects after human SCI.

Objective To investigate the removal effect of immunoadsorption (IA) on associated antibodies and the efficacy in late-onset myasthenia gravis (MG). Methods A total of 25 late-onset MG patients were randomly selected to enroll in this study. IA therapy was given to 10 patients (IA group), while immunoglobin (0.4 g·kg-1·d-1) was administrated to the other 15 patients for 5 days(Ig group). The titers of Titin antibody (Titin-ab), acetylcholine receptor antibody (AchR-ab) and presynaptic membrane antibody (PrsmR-ab) were detected before and after the treatment. Quantitive MG (QMG) score was assessed before and immediately after the entire course of treatment. The clinical efficacy, the duration of respiratory support and in-hospital were compared between two groups. The correlation between three antibodies and QMG score was also analyzed. Results Compared with that before treatment, the Titin-ab PIN values, the AchR-ab PIN values, and the PrsmR-ab P/N values of IA group were all decreased significantly after treatment (P<0.05, respectively). The P/N value of Titin-ab in IA group was decreased by 54.7%～3.5%, which was significantly higher than that in Ig group(19.9%±3.1%) (P<0.01). QMG score reduced by 42.4%± 4.2% and 23.8%±3.7% in IA group and Ig group respectively (P<0.01, respectively). Symptoms were effectively ameliorated by both treatments, but the effective power of IA group was higher than that of Ig group (70% vs 40%, P<0.05). Remission time of IA group was significantly shorter than that of Ig group [(5.38±0.42) d vs (8.4±1.54) d, P=0.008), so was the duration of in-hospital [(13.50±0.50) d vs (16.50±0.50) d, P<0.05). The number of respiratory support in IA group was less than that in Ig group (1/10 vs 6/15, P<0.05). By the Pearson correlation analysis, the decrease of Titin-ab showed a better longitudinal correlation with the decrease of QMG score than the other two antibodies (r=0.6315, P<0.01). Conclusion IA can rapidly and effectively clear the pathogenic antibodies of late-onset MG patients and its short-term clinical efficacy is better than immunoglobin.

Objective To investigate the clinical and pathological features of Uurich congenital muscular dystrophy (UCMD). Methods The clinical aspects of 3 patients with UCMD, 2 with Duchenne muscular dystrophy (DMD) and 1 with congenital muscular dystrophy 1A (MDC1A) were analyzed. And the muscle specimens from these patients were studied using immunohistochemistry and immunofluorescence staining. Results UCMD was clinically characterized by neonatal hypotonia with proximal contracturos and distal hyperlaxity at birth or early infancy. Histochemical staining revealed muscle frber hypoplasia andinterstitium proliferation. Immunohistochemistry staining with anti-collagen Ⅵ antibody revealed complete(1/3) or partial (2/3) deficiency of collagen Ⅵ in the sarcolemma and interstitial matrix. Partial deficiency was better demonstrated by immunofluorescence staining. Conclusions The proximal contractures and distal hyperlaxity is the clinical hallmark of UCMD. Collagen Ⅵ immunolabelling can confirm the diagnosis of UCMD.

OBJECTIVETo study the prevalence of epilepsy in Jinshan--a rural area of Shanghai and to provide data for development of protocol on prevention and therapy of epilepsy.

METHODSStratified cluster sampling was used in Zhujing town, Jinshan district, Shanghai in 2000. In a door to door survey, all inhabitants in the study area were interviewed on seizures using a standardized protocol to include all new cases with epilepsy.

RESULTSThe crude prevalence of epilepsy was 3.11 per thousand among the population size of 48,628 and the adjusted prevalence was 3.62 per thousand with 3.65 per thousand in male and 2.50 per thousand in female. The prevalence rates of males were more than that of females in both places. Two peaks of epilepsy prevalence in Jinshan district Shanghai were noticed: in the age groups of 10 - 30 years old and older than 60 years. The highest prevalence appeared in rural area was 3.70 per thousand, much higher than that 2.45 per thousand in town.

CONCLUSIONThe prevalence of epilepsy in this district was lower than that in other districts of China.

Age Factors ; China ; epidemiology ; Epilepsy ; epidemiology ; Female ; Humans ; Male ; Prevalence ; Sex Factors

Objective To understand the possible pathogenesis of sporadic multiple system atrophy (MSA).Methods The immunoreactivity and ultrastructural features of glial cytoplasmic inclusions (GCIs) in 12autopsy patients with MSA and 4 normal control groups were studied. All regional sections from eachsubject were evaluated with HE staining, KIuver-Barrera (KB), Holzer's, modified Gallyas-Braak's (GB)methods and immunohistochemical staining with α-synuclein and ubiquitin antibodies. Pontine white matterwith abundant GCls from case 1 was examined, using conventional electron microscopy, Gallyas-Braak'selectron microscopy and immunoelectron microscopy.Results The presence of GCls as constantly demonstrated in all MSA patients. Strong α-synucleinimmunoreactivity was observed in all of the ubiquitinated GCls. However, the density of α-synuclein positiveGCIs differed from case to case, and there was no relationship between the density of GCls and age, sex,or MSA subtype. Ultrastructural features indicated that argyrophilic granule-associated filaments of about 25nm in diameter were the predominant constituents of GCls, and the anti α-synuclein antibody selectivelylabeled in these filaments. No GCls and α-synuclein immunoreaction were found in control brain tissues.Conclusions GCI was a pathognomonic change in sporadic MSA patients. Accumulation of α-synuclein inGCIs may occur during the early stags of MSA. Seletcive α-synuclein positive abnormal microtubules inGCls therefore play an important role in the pathogenesis of MSA.

PurposeTo study the characteristics of contingent negative variation (CNV) in vascular dementia.MethodsCNV was tested and compared in 24 vascular dementia (VD) patients and 22 normal aged persons. Results The data showed that in compare with normal controls the latencies of early component and late component of CNV in VD were greatly prolonged and closely correlated to the extent of dementia. The amplitude of early component was greatly reduced. The reactive time (RT) was prolonged prominently and also correlated with the extent of dementia. The occurrence of postimperative negative variation (PINV) increased. Conclusions The value of CNV can be used to reflect the extent of dementia. Test the CNV in series may help to evaluate the cognitive impairment in VD.

Objective: To develop Auditory Verbal Memory Test (AVMT) suitable for Chinese elderly. Method:100 normal elderly and 22 patients with mild to moderate Alz heimer' s disease were evaluated by AVMT, mini mental state examination. 40 person randomly selected from the 100 sample were assessed in follow up by AVMT, Wechsler Memory Scale ( Chinese Revised Version), information and similaritias subtests of Wechsler Adult Intelligence Scale - Chinese Revised Version (WAIS- RC) . Results: The correlation between inter- raters was 0.99, test- retest reliability at 3 months interval were 0.87～0.94. Education was a prominent influence factor of memory and recognition of AVMT. There were significant correlation between third recall, short delayed recall and total scores of VMS- RC, between long delayed recall and verbal sceres of WAIS - RC. Semantic clustering strategy showed gradual strongly correlation with measures of recall ability in higher education group. Performance of Alzheimer group was poorer than that of matched normal control. Scores of long delayed re call differed most obviously in group comparison. Conclusion: AVMT had good reliability and validity

Objective: To analyze the ability of Chinese characters reading and characteristics of alexia among patients with mild, moderate and severe Alzheimer's Disease(AD). Methods: Chinese characters reading test was performed in 20 normal controls(average MMSE total score is 27.7), 20 mild AD(average MMSE is 21.2),20 moderate AD(average MMSE is 15.2) and 20 severe AD(average MMSE is 6.9). Chinese characters reading test consists of 22 mark-symbol characters, 17 phonetic symbol characters and 17 meaning-symbol characters. Results: No significant difference were found in scores of Chinese characters reading test among normal controls, patients with mild, moderate AD group. Compared with moderate AD, severe AD showed manifest decline for scores of phonetic symbol characters and meaning-symbol characters reading. There wasn't significant different visual paralexia among 4 groups. Surface alexia occurred at early stage of AD and advanced at late stage of AD. These wrong reading were seen frequently in meaning-symbol characters. Deep alexia occurred only at late stage of AD. Compound words phanomenon is the major class of deep alexia. Conclusion: Ability of Chinese characters reading was helpful to estimate premorbid intelligence of the patients with dementia. There are different classes of alexia between Chinese and western languages.

Objective To test the efficacy and safety of nicergoline in treatment of vascular dementia patients with mild or moderate cognitive impairment. Methods A multicenter,double blind,randomized,efficient drug controlled clinical trial was carried out All the subjects met the DSM-Ⅲ criteria for vascular dementia We used MMSE and WMS as main assessing items and ADL,CGI as secondary assessing items. Results 103 subjects were assessed MMSE were raised in both groups after the treatment and more obvious in nicergoline group than in anecetan group (1 62?2 33 and 2 88?2 85 respectively) WMS raised in nicergoline group (5 04?10 61),but not in anecetan group (1 98?9 49) ADL and CGI (SI) showed decreased scores in both groups Total efficiency of nicergoline was 80 0% and of anecetan was 56 6%. Conclusions Nicergoline was an effective drug in treatment of vascular dementia and more effective than anecetan Using nicergoline 60 mg per day was safe