Feeding intolerance in preterm infants,which is an important issue that the neonatal pediatri-cians have to work out,leads to malnutrition of early preterm infants and growth restriction which have an impact on later behavioral and cognitive outcomes. Feeding intolerance is related to the immature of gastrointestinal function,perinatal asphyxia,infection and other diseases. Minimal enteral feeding,prokinetic agents and supple-mentation of the enteral probiotics,are used generally,but at present there is no guidelines for the prevention and treatment.

A spore is another life cycle form of Bacillus anthracis for resisting starvation.When conditions are favorable for growth, the dormant spore will germinate,go through outgrowth, and are ultimately converted back into a growing cell. As the first step back to vegetative growth, germination could be induced by nutrients and a variety of non-nutrient agents. Nutrient germinants trigger cation release and water absorption by binding to receptors in the spore′s inner membrane.Then the spore′s peptidoglycan cortex is hydrolyzed and the spore core rehydrates, which allows the resumption of spore metabo-lism and macromolecular synthesis.This paper reviews the nutrient germinant receptor and cortex lytic enzymes in the spore germination process of B.anthracis.

Objective To study the characteristics,operative timing,repair methods for iatrogenic bile duct injury caused by laparoscopic cholecystectomy.Methods Clinical data of 30 cases of iatrogenic bile duct injury found during or after laparoscopic cholecystectomy were studied retrospectively.Results There were type Ⅱ 1 bile duct injury in 9 patients,type Ⅱ 2 in 4 patients,type Ⅱ 3 in 2 patients,and type Ⅱ 4 in 15 patient.17 cases underwent immediate repair,13 cases did early repair.All cases followed up from 5 months to 10 years,the follow-up rate was 83.3％.1 case with end-to-end anastomosis and biliary stent underwent Roux-en-Y choledochojejunostomy for biliary stenosis 13 months postoperatively,4 cases underwent secondary Roux-en-Y choledochojejunostomy because of obstructive jaundice and the cicatricial anastomotic orifice stenosis one to one and half years after primary repairs.The remaining cases were doing well up to the end of the follow-up.Conclusion Most iatrogenic bile duct injury after laparoscopic cholecystectomy were high in position,while Roux-en-Y choledochojejunostomy is the mainstay of repair.

Objective To investigate value of peripheral NLR and PLR for the survival of patients with primary gastric cancer.Methods The clinical data of 132 primary gastric cancer patients and 30 healthy controls were analyzed by the Kaplan-Meier, Log-rank test and multivariate COX regression.Results NLR, PLR levels of the case group were significantly higher than that in the healthy control group (t=6.67, P=0.000;t=13.23, P=0.000); the higher the age, the greater tumor diameter, the higher the degree of differentiation, lymph node metastasis, and not be treated with surgery, NLR and PLR could increase (P<0.05);NLR and PLR showed a significant positive correlation (r=0.3164, P=0.0002);survival time of low NLR group was (57.59 ±2.23) months and high NLR group was (35.22 ±3.09) months(P<0.05);survival time of low PLR group was (54.09 ±2.66) months and high PLR group was (35.22 ±2.75 ) months(P<0.05);age, clinical stage, lymph node metastasis and NLR, PLR levels were independent factors for the overall survival in patients with gastric cancer ( P<0.05 ) .Conclusion NLR and PLR of gastric cancer patients increase significantly and are closely related to tumor size, metastasis, clinical stage, and the deterioration, which showes some predictive value for the survival prognosis of the patients.

Objective To explore the methods of early diagnosis of arteriosclerosis obliterans of lower extremity (ASOLE).Methods The related literatures on ASOLE detection means adopted clinically were reviewed,and their advantages and disadvantages were compared.Results Asymptomatic ASOLE could be discovered by determination of ankle brachial index (ABI) and toe brachial index (TBI),which was a good index for arterial function assessment of lower extremity.Pulse wave velocity (PWV) was more vulnerable and less sensitive than ABI,and therefore more suitable for screening of a large sample.ASI was an index to assess arterial structure and function,and it had a good correlation with PWV.Flow-mediated dilation (FMD) was a measurement evaluating the function of endothelial cell;Pulse wave measurement was simple,sensitive,and its result was reliable.Color Doppler ultrasonography could localizate the lesion and determine the degree of stenosis at the same time.Multiple-slice CT angiography (MSCTA) was more accurate than color Doppler ultrasonography,but its inherent shortcomings,such as nephrotoxicity of contrast agent,was still need to be resolved.3D-contrast enhancement magnetic resonance angiography (CE-MRA) had little nephrotoxicity,but a combination of other imaging methods was necessary.Microcirculation detections required high consistency of the measurement environment,but they were simple,sensitive and noninvasive,and therefore could be used for screening of ASO.Conclusion Publicity and education of high-risk groups,and reasonable selection of all kinds of detection means,are helpful to improve the early diagnosis of ASOLE.

Objective T o observe the therapeutic effect of Radix Astragali Injectio on psoriasis and it s possible pharmaceutical mechanism. Methods Two groups of patients with psoriasis vulgaris were treated with either comprehensive regi men or comprehensive regimen plus Radix Astragali Injectio. The clinical respons es in both groups were compared. Meanwhile, the effects of Radix Astragali Decoc tion and Injectio on proliferation of vaginal epithelium, PCNA expression, diffe rentiation of tail scale epidermis and plasma ET－1 were assessed in mouse mode l. Results It was shown that psoriatic lesions began to fade significantly earli er in Radix Astragali group than in routine comprehensive treatment group. The c linical cure rate was significantly higher in Radix Astragali group also. Animal experiment indicated that Radix Astragali Injectio had effects on all 4 indices mentioned above and the effects of the Injectio was stronger than that of the D ecoction. Conclusions Radix Astragali Injectio is effective for psoriasis vulgar is. Its therapeutic effects may be explained by blocking multiple pathogenetic l inkage.

A new benzene derivative microintegerrin C (1) and a new norsesquiterpenoid microintegerrin D (2), along with six known compounds (3-8), were isolated and identified from stems and leaves of Micromelum integerrimum by various chromatographies such as silica gel, Sephadex LH-20, RP-18 column chromatography and HPLC. Their structures were mainly identified based on the spectral data analysis such as 1D-, 2D-NMR and HR-EI-MS. All known compounds were isolated from this plant for the first time.

Morphea complicated by Hashimoto's thyroiditis is reported in two sisters.Case 1:a 64-year-old female presented with skin rashes on the anterior neck,trunk and bilateral anterior shins for 5 years,itching skin rashes on the perineum for 4 years,and Hashimoto's thyroiditis for 9 years.Physical examination revealed grade 1 enlargement of firm thyroid gland without exophthalmos or pretibial myxedema.Dermatological examination showed pink patches on the neck and breast,sclerosis and atrophy of skin over the back,porcelain-white patches on the perineum.Histopathological findings suggested the diagnosis of morphea on the breast and lichen sclerosus et atrophicus on the perineum.Case 2:a 55-year-old female,who was the younger sister of case 1,suffered from gradual sclerosis and atrophy of skin in the left inframammary region and abdominal region for 4 years,as well as Hashimoto's thyroiditis for 3 years.Similarly,physical examination revealed grade 1 enlargement of firm thyroid gland without exophthalmos or pretibial myxedema.Hypopigmentation,sclerosis and atrophy of skin were observed in the left inframammary region,abdominal region and central back region.Histopathological examination suggested a diagnosis of morphea.According to the clinical and histopathological manifestations,periodic acid-Schiff staining and thyroid gland function test results,the 2 cases were both diagnosed as morphea complicated by Hashimoto's thyroiditis.

Microwave-assisted extraction was optimized with response surface methodology for HPLC-fluorescence determination of puerarin and daidzein in Radix Puerariae thomsonii.The optimized extraction procedure was achieved by soaking the sample with 70% methanol（1∶15,v/v）for 30 min,and then microwave irradiation for 11 min at a power of 600 W.Coupling the extraction process with HPLC-fluorescence presented good recovery,satisfactory precision,and good linear relation.Compared with a method from the Chinese Pharmacopoeia,the proposed method enables higher extraction efficiency and more accurate analytical results.It can be of potential value in quality assessment of Radix Puerariae thomsonii medicinal materials.

Objective To investigate the roles of glutamate signaling pathway in melanin transfer.MethodsEpidermal melanocytes and keratinocytes were isolated from human foreskin tissue followed by purification and primary culture.Immunofluorescence microscopy was conducted to observe the intracellular distribution of N-methy-D-aspartate receptor 1 (NMDAR1) and NMDAR2A in melanocytes.Some melanocytes were classified into 4 groups to be pretreated with MK801 (the NMDAR antagonist dizocilpine maleate) at 100μmol/L for 5 minutes followed by treatment with NMDA(an NMDAR agonist) at 100 μmol/L (MK801-pretreated group 1),pretreated with MK801 at 100 μmol/L for 1 hour followed by treatment with NMDA at 100μmol/L (MK801-pretreated group 2),treated with MK801 at 100 μmol/L for 5 minutes (MK801 group),treated with NMDA at 100 μmol/L for 5 minutes (NMDA group),respectively,then,confocal microscopy was performed to measure the intracellular calcium (Ca2+) concentration of the melanocytes.The distribution of β-tubulin was visualized by confocal microscopy in melanocytes treated with MK801 at 100 μmol/L for 24 hours.Some melanocytes and keratinocytes were cocultured with or without MK801 at 100 μmol/L for 24 or 48 hours,then,scaning microscopy was carried out to observe the junction structure between melanocytes and keratinocytes,and alkali method coupled with spectrophotometric analysis to determine melanin content in keratinocytes.Results The intracellular calcium concentration of melanocytes was decreased by MK-801,but increased by NMDA at 100 μmol/L,and the increase was blocked by the pretreatment with MK-801 for 5 minutes or 1 hour.After incubation with MK-801 at 100 μmol/L for 24 hours,a more intense staining for β-tubulin was observed around the nuclei of melanocytes.There was a significant reduction in the number of filopodia on the surface of and between melanocytes and keratinocytes after treatment with MK-801 at 100 μmol/L for 48 hours.Also,the content of melanin(represented as the absorbance value at 375 nm) transferred from melanocytes into keratinocytes was statistically reduced in coculture system treated with MK-801 at 100 μmol/L compared with that without treatment (0.158 ± 0.003 vs.2.203 ± 0.006,t =6.323,P ＜ 0.01 ).Conclusions The glutamate signaling pathway exerts a regulatory effect on intracellular calcium concentration of distribution of β-tubulin in,filopodia formation of melanocytes and melanin transfer between melanocytes and keratinocytes.