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.

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.

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.

Interleukin-12 can induce the production of INF-?, up-regulate the inhibitive factor of angiogenesis such as IP-10, MIG, TIMP, TNF-?, down-regulate the induced factor of angiogenesis such as VEGF, bFGF, MMP, inhibit the angiogenesis of tumor together and accelerate the regression of tumor. Interleukin-12 can inhibit the angiogenesis of tumor, which is independent of the immune system.

Objective To screen the influencing factors related to prolonged mechanical ventilation (PMV). Methods Series of parameters of 154 elderly patients with pneumonia or COPD exacerbation were collected before using ventilator, after weaning of ventilator or at the 21st day of ventilating, respectively. Results By single factor analysis, PMV related to not only age, lying on bed, white blood cell, neutrophil, P (A-a)O 2, BUN, Cr, upper digestive tract bleeding, heart rate(HR), and blood pressure(BP) before using ventilator, but also related to heart function and consciousness after ventilator weaning or ventilating for 21 days. By multiple factor analysis, age, P (A-a) O 2 , heart function when ventilating for 21 days were related to PMV. Age≥82.0, P (A-a)O 2 ≥95.0 mm Hg, heart function≥grade 3 were high risk factors of PMV. Furthermore, it was found that the accuracy rate for meeting with those three parameters among 8 elderly patients with PMV was 87.5%. Conclusions Age, P (A-a)O 2 and heart function when ventilating for 21 days might be the independent factors of PMV.

Objective To investigate the applicative value in stages of pre-infarction period using dynamic perfusion CT. Methods Dynamic perfusion CT was performed in 32 cases of cerebral hypoperfusion. The ratios of side-to-side were measured at hypoperfusion areas in the regional cerebral ischemia. The stages of pre-infarction period were made as the following: (Ⅰ 1) TTP was delayed, MTT, rCBF and rCBV were normal; (Ⅰ 2) TTP and MTT were delayed, rCBF was normal, and rCBV was normal or slightly increased; (Ⅱ 1) TTP and MTT were delayed, rCBF was decreased, and rCBV was normal or slightly decreased; (Ⅱ 2) TTP and MTT were delayed, rCBF and rCBV were decreased. Results There were 4 cases in stage Ⅰ 1. Regional hypoperfusion was revealed only by TTP map. The mean ratios of rCBF, rCBV, MTT, and TTP were 1.00, 1.00, 1.00, and 1.30, respectively. In stage Ⅰ 2, the areas of delayed TTP and MTT were found in all 13 cases. The rCBF and rCBV maps appeared normal in 8 cases. Another 5 cases showed normal rCBF and slightly increased rCBV areas. The mean ratios of rCBF, rCBV, MTT, and TTP were 1.00, 1.03, 1.38, and 1.30, respectively. In stage Ⅱ 1, the areas of delayed TTP and MTT were revealed in all 8 cases. The depiction of decreased rCBF was also found in 8 cases. The areas of decreased rCBV were showed in 5 cases, and normal rCBV maps were revealed in 3. The mean ratios of rCBF, rCBV, MTT, and TTP were 0.56, 0.94, 1.49, and 1.47, respectively. In stage Ⅱ 2, the areas of delayed TTP and MTT were revealed in all 4 cases, in whom depiction of decreased rCBF and rCBV was also found. The mean ratios of rCBF, rCBV, MTT, and TTP were 0.42, 0.59, 1.57, and 1.55, respectively. Conclusion CT perfusion imaging and its parameters' analysis may play an increasing role to delineate the depiction of cerebral hypoperfusion in pre-infarction period. Analyzing the relationship of rCBF, rCBV, MTT, and TTP is very helpful to know the status of the capillary vessels in regional cerebral hypoperfusion area and to provide functional information with our stages of pre-infarction period.

The choice of medicines is a key point in the treatment of hypertension.There are hundreds of antihypertensive drugs in China,including Traditional Chinese Medicines(TCM),chemical medicines and all kinds of compound preparation.But the rates of treatment and control of hypertension in China are very low,the situation of hypertension management in China is critical.In this article we compared the differences in the drug treatment among Chinese,American and European guidelines for the management of hypertension,and discussed the principles of choosing antihypertensive drugs.Chinese,American and European guidelines all mention that the specific drug classes may differ in some effect or in special groups of patients,so certain compelling indication requires certain antihypertensive drug classes.Three guidelines also emphasize the benefits obtained from the combination therapy and recommend the long-acting drugs or preparations with 24 h efficacy.The main differences among the three guidelines is whether to recommend the firstline drugs.Thiazide-type diuretics are recommended by American guideline(JNC7) in drug treatment for most patients with uncomplicated hypertension.But the European and Chinese guidelines do not recommend the first-line drugs,and the major classes of antihypertensive agents are suitable for the initiation and maintenance of therapy.Traditional Chinese medicines are invaluable resource of China,all kinds of antihypertensive TCM are widely used in the clinical,but owing to the deficiency of the high-quality evidence for TCM,the part of TCM is not included in the 2004 Chinese guideline for the management of hypertension.The choice of antihypertensive drugs is determined by its efficacy and safety.When safety and efficacy are equal,the lowest cost drug should be preferred.For the majority of patients without a compelling indication for another class of drug,a low dose of thiazides diuretic should be considered as the first choice in China.2004 Chinese guideline for the management of hypertension is based on many scientific evidences,and its publication is very important for the prevention and cure of hypertension in China.Nowadays,we must strengthen the dissemination and implementation of guideline,promote the rational use of antihypertensive drugs and improve the control rate of hypertensive in China.

Through analysis on compliment on drawbacks in medical services in a third - grade hospital during the year of 2003 - 2004, the author gives a picture of the stracture of the medical services today and tells a trend of such compliement goes from service itself security and guatity of the services. Facing the now challenge and charges on compliment today, the anthor holds the idea that establishing 3 new principles, 3 nes reformations and 3 new services to make sure the parients are satisfied.

Objective To intruduce a method of making cerebral perfusion mapping and measurement using dynamic CT with a personal computer. Methods We generated the cerebral perfusion mapping and measurement from a series dynamic CT images with a personal computer. The theoretic basis of our technique is central volume principle. The application software was made using visual C++ language with Windows 98 platform. Results This method was applied to a case of transient ischemic attack (TIA). The cerebral perfusion mapping contributed to display the abnormal area of ischemia, which showed as normal imaging appearances in routine CT and MR images. Conclusion Personal computer aided mapping and measurement of cerebral perfusion with dynamic CT is a simple and accessible technique for delineating the hemodynamic response, including abnormal regional cerebral blood flow, blood volume, mean transit time, and time to peak in cases of hyperacute ischemic stroke which was viewed as normal imaging findings in routine CT and MR examination. This method is more suitable to examine emergency cases than MR perfusion imaging and may be used in any facility where CT scanner and personal computer are available.