This review examines the effects of parenteral nutrition(PN) or enteral nutrition(EN) on pancreatic exocrine secretion and severe acute pancreatitis(SAP). There is no evidence that PN support in SAP affects the underlying disease process,but it may prevent the malnutrition and complications.In recent years,EN is considered to be used in that it preserves gut barrier function.PN,in contrast,may result in mucosal atrophy,bacterial translocation and increased rates of catheter related sepsis.The effects of EN on pancreatic exocrine secretion and natural course of SAP are discussed.The safety and feasibility of EN in SAP have been established. EN may even be superior to PN.Some patients,however,cannot tolerate enteral feeding and PN still has a role.

Objective　To study the influence of Lipofundin vs Intralipid on lipid energy metabolism of cirrhotic patients undergoing surgery.Methods　Twenty-five patients with liver disease were randomly assigned to two PN groups:LCT group(n=12) and MC/LCT group (n=13).Fat energy in group LCT was supplied by 20%-Intralipid,Group MCT/LCT was supplied by 20%-Lipofundin.All patients were on parenteral nutrition for 7 days.Intravenous fat tolerance test (IVFTT) was measured at pre-op,post-op d1、post-op d7.Carnitine （CNT） level in serum and urine,and AKBR were tested at the pre-op、post-op d1、d7.Results　The elimination rate of the MCT was faster than that of LCT at pre-op and post-op d7,the elimination rate of LCT at post-op d1 was faster than that of at pre-op and post-op d7.Serum CNT increased in both groups,urine CNT markedly decreasd at postoperation,but in LCT group CNT was at lower level as compared with MCT group at post-op d7,P＜0.05.AKBR was markedly decreased in both groups post-op,but at post-op d7,AKBR in MCT group was higher than in LCT group,P＜0.01.Conclusions　These results indicated that Lipofundin was an ideal energy source for the cirrhotic patients.

Intestinal ischemia is a severe and life-threatening acute abdomen. Although its incidence is low,early diagnosis remains relatively difficult. The efficiencies of conventional laboratory biochemical tests are low. In recent years, many new markers for the early diagnosis of intestinal ischemia have been developed. In this article,we summarize their diagnostic efficiencies and relevant factors.

The relationship of the nutritional and colorectal tumor was reviewed.The epidemiology of oral nutrition and colorectal tumor was investigated.The nutritional support in patients with colorectal tumor was discassed.The use of some amino acids and fatty acids might not only improve the hosts nutritional condition,but also serve as methods to treat tumor.

Objective To investigate the clinical values of serum histidine decarboxylase(HDC),intestinal fatty acid binding protein(I-FABP),and diamine oxidase(DAO)for diagnosing intestinal mucosal injury (IMI)in patients with intestinal obstruction.Methods The expression levels of serum HDC,I-FABP,and DAO in 28 patients with strangulated intestinal obstruction,19 patients with simple intestinal obstruction,17 patients with acute simple appendicitis,and 20 healthy control were determined by enzyme-linked immunosorbent assay (ELISA)before clinical treatment,and then the areaa under receiver operating characteristic curves(AUC)of these diagnostic indicators were compared.In addition,the incidences of systemic inflammatory response syndrome (SIRS)and infectious complications were closely observed.The difference of the expressions of HDC,I-FABP,and DAO and their relationship with SIRS and infectious complications were compared among these patients and controls.Results The expression levels of serum HDC, I-FABP, and DAO were the highest in patients with strangulated intestinal obstruction (all P < 0.001), and the expression levels of these three indicators were significantly higher in patients with simple intestinal obstruction than in those with acute simple appendicitis or healthy controls (all P<0.05).The AUC of HDC (0.913) was significantly larger than that of I-FABP (0.877, P =0.000) and DAO (0.873, P = 0.000).When the cut-off value of HDC ≥31.00 ng/ml, the sensitivity, specificity, false negative rate, and false positive rate of HDC were 74.5% , 94.6% , 25.5% , and 5.4% , respectively,which were all better than those of I-FABP and DAO.There were significant differences of the incidence of SIRS ( P = 0.046) and abdominal infection (P = 0.027) among patients with strangulated intestinal obstruction, patients with simple intestinal obstruction, and patients with acute simple appendicitis, while lung infection showed no such significant difference (P = 0.728).The expression level of serum HDC was significantly higher in patients with strangulated intestinal obstruction who were also suffered from SIRS ( P = 0.000) or abdominal infection ( P =0.002) than that of uninfected patients.Meanwhile, the expression levels of serum I-FABP and DAO were significantly higher in the SIRS patients with strangulated intestinal obstruction than that of uninfected patients ( P = 0.027, P=0.017, respectively).The expression levels of HDC, I-FABP, and DAO were significantly correlated with the incideces of SIRS and abdominal infection ( all P < 0.05 ) , among which the level of HDC and the incidence of SIRS had the highest correlation (R = 0.608, P = 0.001).Conclusion HDC can be an effective indicator for diagnosing IMI in patients with intestinal obstruction.

Protein phosphatase 2A(PP2A)is a major Ser/Thr phosphatase involved in sevelral cellular signal transduction pathways.The reversible phosphorylation of proteins is accomplished by opposing activities of kinases and phosphatases.PP2A controls the specific dephosphorylation of thousands of phosphoprotein substrates and thus regulates physiological and biochemical processes of organism.The changes of the physiological activities of PP2A closely relate to apoptosis and regeneration of injured intestinal epithelial cell,and PP2A may be a regulatory factor in balancing the apoptosis and regeneration of intestinal epithehal cell.

The tight junction of intestinal epithelium plays an important role in maintaining the function of intestinal barrier and regulating the cell differentiation. The intestinal epithelial cells interact with neighboring cells and the extracellular matrix and then affect the epithelial barrier as well as the proliferation, polarization, and apoptosis of cells. As an important cell junction, the tight junction of intestinal epithelium participates in a series of signal transduction pathways including the classic cyclic adenosine monophosphate-protein kinase A-cyclic adenosine monophosphate response element-binding, inositol trisphosphate, Ras-mitogen-activated protein kinase, phosphatidylinositol 3-kinase, and in some special pathways including zonula occludents protein 1-associated Y-box factor,cyclin related protein, phosphorylation, and methylation. Furthermore, regulations of gene and protein expression of the tight junction are also complex, while disorders of such regulations may lead to clinical diseases, such as disruption of the intestinal barrier, refractory infection, and even cancers. This article reviews the research advances in gene expressions, related signal transduction, and self-regulation in the tight junction of intestinal epithelium.

Many peptide transporters have been identified in mammals, among which PepT1 has been widely studied. PepT1, a member of proton-coupled oligopeptide transporter (POT) superfamily, is a peptide transporter of low affinity and high capacity and is mainly expressed in the brush border membrane of intestinal epithelial cells. PepT1 plays an important role in the absorption of di/tri-peptide (the degradation products of protein in intestinal tract). Meanwhile, it mediates the transport of peptide-like drugs and the bacterial products. Therefore,the changes of the functional expression of PepT1 in the gastrointestinal tract may dramatically affect the internal and external environmental stability and drug absorption. This paper reviews the structural features and function,distribution, transport mechanisms, and regulatory factors of PepT1.

Probiotics modulate the biological functions (and even cell apoptosis) of intestinal epithelial cells,intestinal macrophages,intestinal dendritic cells,and T cells via cell signaling pathways including nuclear factor-kappa B (NF-κB) and mitogen-activated protein kinase (MAPK) pathways.Peroxisome proliferator-activated receptor γ (PPARγ) and heat shock protein (hsp) are targets for probiotics or their products.

Objective To study the effect of probiotics on the change of intestinal permeability and inflammatory reaction after surgery of colorectal cancer.Methods Sixty patients who underwent colonic surgery were randomly divided into two groups:probiotic group and control group,with 30 cases in each group.Each group received nutritional support of the same nitrogen and calorie from day 3 to day 7 after operation.The patients in probiotic group were orally administrated probiotic(2 g/d)from the first day after surgery for 7 days.Every patient's body temperature and heart rate were observed after operation,and white blood cell counts were observed before operation and on day 1,5,8 after operation.The levels of microbial DNA in whole blood and plasma D-lactate,and urine lactulose/mannito(L/M)ratio were measured before operation and on day 1 and day 8 after operation,respectively.In addition,the occurrence of postoperative systemic inflammatory response syndrome(SIRS)and complications of inflammation were closely observed.Results The average heart rate in postoperative 5 days was significantly lower in probiotics group than that in control group(P0.05).Conclusion Probiotics can decrease intestinal permeability and maintain the intestinal barrier function after operation.It may be helpful for the recovery of patients with early inflammatory response after surgery of colorectal cancer.