Neonatal necrotizing enterocolitis (NEC)is a major cause of morbidity and mortality in premature infants.The most important etiology in the pathogenesis of NEC is structural and immunological intestinal immaturity.Probiotic bacteria prevent or limits disease propagation in NEC.The unique characteristics of developing intestinal epithelia focusing on gut development and colonization as well as the inflammatory propensity of immature epithelia are highlighted in this paper.Additionally, potential mechanisms of beneficial probiotic interaction with immature intestinal epithelia including immunomodulation, upregulation of cytoprotective genes, prevention and regulation of apoptosis and maintenance of barrier function are reviewed.Probiotics may restore or supply essential bacterial strains needed for gut maturation and homeostasis.Oral administration of probiotics has been suggested as a promising strategy for prevention of NEC.

Intestinal tract is the central organ of the body's stress,and it has an important barrier function to prevent the harmful substances,such as bacteria and toxins,from the gut into the body.The main factors of intestinal barrier dysfunction are ischemia and hypoxia and endotoxin damage,and it is essential to explore the protective methods of the intestinal mucosa barrier in the early stage to prevent the organ metabolism disorder induced by intestinal derived endotoxin and bacterial translocation.Glutamine,which can effectively protect the integrity of the intestinal mucosa,maintain the normal intestinal permeability and improve the cell immunity,has been used to intensive adult patients and need further studies in the clinical application of newborns.

Objective:To explore the effects of levocarnitine adjunctive therapy on serum nutritional index and inflammatory factor level in maintenance hemodialysis patients. Methods:Totally 62 patients with hemodialysis were randomly divided into the observation group and the control group with 31 cases in each. The observation group was treated with 1g levocarnitine injection with intravenous in-jection after the dialysis, and the control group was treated with 0. 9% physiological saline injection with the same volume after the di-alysis. After 3-month treatment, the nutritional indices including Hb, Alb, TC, TG, LDL-C and HDL-C and the change in inflamma-tory factors including C-reactive protein (CRP), IL-6, IL-8 and TNF-α of the patients in the two groups were studied and compared. Results:After the treatment, the level of Hb and Alb was improved in the observation group (P<0. 05), while the level of TC, TG, HDL-C and LDL-C had no significant change (P>0. 05). All of the indices showed no significant change in the control group (P>0. 05). After the treatment, the level of Hb and Alb in the observation group was higher than that in the control group (P<0. 05). After the treatment, the level of CRP, IL-6, IL-8 and TNF-α was reduced in the observation group (P<0.05), while the control group had no significant changes in the indices (P>0. 05). All of the indices in the observation group was better than those in the control group (P<0. 05). Conclusion:Levocarnitine used in the treatment of patients with hemodialysis can effectively improve the nutritional status and inflammatory factors level without obvious effects on lipid metabolism, which is very important for the reduction of complication and the improvement of life quality, and worthy of clinical promotion.

Diabetic macular edema (DME) is a leading cause of vision loss in diabetic patients.It is very important to correctly select a treating approach for DME.At present,the treating methods of DME include retinal laser photocoagulation,application of the glucocorticoid,intravitreous injection of anti-vascular endothelial growth factor (VEGF) drugs,administration of inhibitor of protein kinase C,vitrectomy and combined treatment etc.However,each method has its advantage and disadvantage.Retinal photocoagulation,vitrectomy,intravitreous injection and drug delivery system implantation are invasive treatment methods,and they can not rescue damaged retinal photoreceptors.Therefore,it is recommended that DME should be early diagnosed and effective treatment.The research status at home and abroad and future development trends of DME treatment were summarized.

Objective To investigate the clinical and pathological prognostic factors in patients with carcinoma of ampulla of Vater treated by pancreatoduodenectomy.Methods The clinical and pathological factors of patients with carcinoma of ampulla of Vater who were operated from February 1994 to February 2009 at the Urumqi General Hospital of Lanzhou Military Region were retrospectively analyzed.The survival curves of these patients were also analyzed.Results The post-operative 1-,3-,5-year survival rates were 90％,63％,55％ respectively.The diameter of the majority of tumor (58.3％) was less than 2.0 cm.Of all the patients with carcinoma of ampulla of Vater,48.7％ were in T1 stage,41.7％ had high grade differentiation,73.0％ had no lymphatic metastasis.Univariate analysis showed that gender,age,tumor diameter,biopsy or not,the type of operation,the value of pre-operative serum bilirubin and the value of serum CA19-9 were not related to survival.The gross type of tumor (P =0.018),histological type (P =0.000),grade of differentiation (P =0.003),depth of infiltration (P =0.003),lymphatic metastasis (P =0.014) and TNM stage (P =0.031) were significant impact factors of survival.Multivariate analysis showed histological type and depth of infiltration were independent prognostic factors of surviva1 (P =0.002,P =0.005).Conclusion Grossly ulcerated carcinoma,mucinous adenocarcinoma on histology,low degree of differentiation,T2/T3 stage,lymphatic metastasis and clinical stage of Ⅱb were all significantly associated with poor prognosis in patients with carcinoma of ampulla of Vater treated by pancreatoduodenectomy.Histological type and the depth of infiltration were the most important risk factors of survival.

Objective To evaluate the accuracy of the soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) and lipopolysaccharide binding protein (LBP) as diagnostic indices for neonatal serious bacterial infections (SBI). Methods A total of 171 newborns were enrolled in the study, and were classiifed into SBI group (including early-onset and late-onset), non-SBI group according to clinical manifestations, laboratory examinations and the time of disease onset. Serum sTREM-1, LBP and C-reactive protein (CRP) levels were measured. Receiver operator characteristic curve (ROC) was drawn, and the area under curve (AUC) was calculated. Each index was evaluated for the diagnostic value of neonatal SBI. Results The sTREM-1 and LBP levels were signiifcantly higher in SBI group than those in non-SBI group (P=0.000). The AUC of ROC for sTREM-1, LBP and CRP in early-onset SBI was 0.888, 0.839 and 0.706, respectively. The AUC of ROC for sTREM-1, LBP and CRP in late-onset SBI was 0.860, 0.865 and 0.705, respectively. Conclusions Both sTREM-1 and LBP are useful for the diag-nosis of neonatal SBI.

Objective To investigate the therapeutic efficacy of refractory glaucoma with compound trabeculectomy.Methods 26 eyes (24 cases ) of refractory glaucoma were treated with compound trabeculectomy.Results Followed up 1 year.There were functional filtering blebs in 20 eyes ;and the IOP was below 21mmHg in 16 eyes without any antiglaucoma drug and in 8 eyes with 1-2 categories of lower IOP drugs after 12 months.The mean IOP at 1 week,1 month,3 months,6months and 12months was (7.9 ± 3.1 ) mm Hg,( 13.5 ± 3.7 ) mm Hg,( 18.2 ±3.8)mm Hg,( 18.1 ±3.5)mm Hg,( 19.1 ±4.8)mm Hg,significantly higher than the IOP preoperatively( 38.2 ±5.6)mm Hg( P ＜0.01 ).Conclusion It was safe and effective of treating refractory glaucoma with compound trabeculectomy.

Objective To explore the relationship of course experience,course engagement and learning outcomes in medical nursing.Methods Adapted Course Experience Questionnaire and Selfestablished Course Engagement Questionnaire were used to collect data of 142 nursing undergraduates of which 126 were valid.The data were analyzed by regression analysis.Results Course experience had significant impact on course engagement,t=4.621,2.477,4.538,P＜0.01 or 0.05.Course engagement had significant impact on learning outcomes,t=2.439,P＜ 0.05.Course experience had significant impact on learning outcomes,P＜ 0.05.Conclusions It is proposed that the clinical courses should provide students with good experience,increase the deep learning engagement,and reform evaluation methods to improve the students' academic achievement.

Objective To investigate the relationship between levels of homocysteine ( Hcy ) and serum uric acid( UA) and stability of carotid atherosclerotic plaque in young patients with cerebral infarction .Methods 150 cases of cerebral infarction in young patients carried the carotid ultrasonography were divided into the non -plaque group ( n=37),stable plaque group(n=52) and unstable plaque group(n=61) according to the results.The levels of Hcy and UA in the three groups of patients were detected and analyzed statistically .Results The stable plaque group′s Hcy and UA levels were (15.92 ±2.52)μmol/L and (294.85 ±25.52)μmol/L,which were significantly higher than those of the non-plaque group(t=7.33,6.89,all P<0.05);The unstable plaque group′s Hcy and UA levels were (23.17 ±3.82 )μmol/L and ( 388.57 ±26.61 )μmol/L, which were significantly higher than those of the the non-plaque group and stable plaque group(t=9.82,10.02,6.90,7.12,all P<0.05).Conclusion There is a close correlation between the stability of carotid artery plaque and the levels of Hcy and UA .

Background Primary iris stromal cysts is a rare clinical disease.In recent years,the pathological findings of primary iris stromal cysts are different from previous literature reports.It is very important to understand the pathological characteristics of primary iris stromal cysts for illuminating its pathogenesis and accurate treatment.Objective This study was to analyze the pathological types and clinical manifestations of primary iris stromal cysts.Methods Histopathological sections of 14 patients with primary iris stromal cysts from January 1979 to December 2012 in Tianjin Eye Hospital were retrospectively analyzed.The primary iris stromal cysts were typed based on the hematoxylin-eosin staining,periodic acid-Schiff (PAS) staining and immunochemistry, and the clinical chacteristics upon different types were evaluated.Results In 14 specimens of primary iris stromal cysts,squamous epithelial type was found in 9 specimens,lens epithelial type in 3 specimens and ciliary body epithelial type in 2 specimens.The primary iris stromal cysts of squamous epithelial type were constituted of non-cuticular stratified squamous epithelium cells,and sporadic goblet cells were found in some specimens.The primary iris stromal cysts of lens epithelial type were consisted of lens epithelium cells and lens capsular analogic tissue and the cysts were tightly adherent to the lens.Crystalline lens dysplasia were seen in 2 specimens.The primary iris stromal cysts of ciliary body epithelial type showed single or stratified ciliary body like epithelium cells.Iris-ciliary dysplasia or anterior chamber angle abnormality was displayed in 1 specimen in this type of cysts.Under the slit lamp microscope,superior-temporal clear cysts were often seen in the primary iris stromal cysts of squamous epithelial type, and translucent cysts or diffuse swelling cysts were exhibited in the lens epithelial type and might be accompanied with lens dysplasia and cataract.Diffuse swelling was found in the cysts of ciliary body epithelial type which were often associated with chamber dysplasia and infantile glaucoma.Conclusions Primary iris stromal cysts are pathologically classified into squamous epithelial type, lens epithelial type and ciliary body epithelial type and present with different clinical appearances.