The traditional management of severe intraabdominal infection include source control and antibiotics application.Fluid resuscitation and open abdomen management are recent development in the treatment of severe intraabdominal infection.The overall morbidity of severe intraabdominal infection was decreased under 20％ by these comprehensive treatment.Because of edema,inflammation and gastrointestinal dysfunction,the intraabdominal pressure was increased,the peritoneal infusion pressure was decreased and the perfusion was insufficient,and leaving abdomen open can reverse these condition,and is helpful for debridement and drainage of the source of infection,as well as management of bleeding and intestinal fistula.Entero-atmospheric fistula is the main severe complication after open abdomen,and it should be prevented by temporary abdominal closure and early closure of the wound.

Impaired recognition of foreign nucleic acid initiates abnormal mucosal immune responses in intestine.Very little is known on how microbial DNA activates intracellular DNA sensors and controls the function of antigen-presenting cells to shape mucosal immune responses in inflammatory bowel disease (IBD).In current review,we will introduce mucosal dendritic cell population,describe newly identified cGAS-cGAMP-STING complex,and identify certain IBD susceptibility genes that associate with impaired microbial DNA recognition in human.

With the rise of the incidence of Crohn's disease,clinicians began to recognize and pay attention to this disease.There is no effective method to cure the Crohn's disease currently,and the complications of the Crohn's disease are numerous and complex.Therefore,early diagnosis and treatment are very important.Due to many factors,the problen of diagnostic delay is widespread.Female patients diagnosed younger than 40 years old,the presence of ileal disease,use of non-steroidal anti-inflammatory agents,smoking history,parental symptoms are risk factors of diagnostic delay of Crohn's disease.Delayed diagnosis might increase the risk of complications,especially intestinal stenosis and operation-related complications.Crohn's disease needs to be early diagnosed and treated to improve the prognosis of patients.

Objective To determine the effectiveness and medical cost-effectiveness of clinical rehabilitation for promoting the functional recovery of sub-acute cerebral infarction patients.Methods Totally 247 sub-acute patients with cerebral infarction were randomly divided into a clinical rehabilitation group of 129 and a routine rehabilitation group of 118.The clinical group received a standardized rehabilitation intervention and drug treatment,while the routine rehabilitation group received routine rehabilitation therapy and drug treatment.The Fugl-Meyer assessment (FMA) and the modified Barthel index (MBI) were used to compare the two groups after the treatment and 3 and 6 weeks later.The hospital cost for six weeks was also compared between the 2 groups.Results At 3 and 6 weeks,improvement in the average FMA and MBI scores was observed in both groups but the inter-group differences were not significant.The total hospital cost of the clinical group was,however,significantly less than that of the others.Conclusion Clinical rehabilitation can improve the motor function and ability in the activities of daily living of stroke patients.It also has economic benefits.

Crohn disease (CD) is a chronic inflammatory disease which progressively affects the digestive tract with unknown etiology. During the disease course, intestinal fibrosis will gradually develop in many CD patients and results in irreversible fibrosis stricture, causing refractory abdominal pain and even intestinal obstruction, and necessitating one or more surgical interventions. Thus far the exact etiology of CD remains unknown. It is believed that genetic, environmental and immunologic factors are involved, which may also predict the development of intestinal fibrosis. Recent studies have found the association of mutations in genes, such as NOD2, ATG16L1, CX3CR1, IL-23R and MMP3 with the fibrogenic phenotype of CD. In addition, serum extracellular matrix molecules, growth factors, miRNAs and microbial antibodies have also been linked to the fibrogenesis in CD patients, however the results of researches were divergent. Therefore it is of significance to explore noninvasive markers of intestinal fibrosis with high sensitivity and specificity, and the high-throughput proteomic technique may be an approach that deserves further investigation. Screening the high-risk patients for the fibrostenotic phenotype of CD by susceptibility genes, and early detection of intestinal fibrosis using noninvasive serum markers, will help improve the treatment outcomes and reduce the surgical rates. The article aims at summarizing the current susceptibility genes and serum markers of intestinal fibrosis in CD.

Crohn's disease (CD) is a chronic inflammatory disorder affecting any part of the digestive tract which relapses and remits throughout the disease course. It occurs in individuals with genetic susceptibility and involves an abnormal response of the immune system to the external environment. Besides, improved hygiene, abuse of antibiotics, westernization of diet with high sugar and fat are thought to be associated with rapidly increasing incidence of CD. Certain components of foods may influence gut inflammation through antigen presentation and alteration of the microflora. This article aims mainly to review diet-related clinical studies to outline its roles in the pathogenesis and progress of disease, and then give some evidence-based suggestions.
Crohn Disease ; Diet ; Genetic Predisposition to Disease ; Humans

In order to learn the enzymatic hydrolysis characteristics of steam-explosion pretreated corn straw by cellulase, the effects of substrate concentration, cellulase concentration and temperature were determined. The kinetics of the hydrolysis reaction could be described with the Michealis-Menten equation, and the hydrolysis reaction obeyed the classical first-order reaction rate in the first three hours. In the condition of 45 degrees C and pH 5.0 and the stirring rate 120 r/min, the Michealis constant (Km) and maximum rate (Vm) for 1.2 FPU/mL of cellulase were 11.71 g/L and 1.5 g/(L x h). The kinetic model, including the parameters such as substrate concentration, enzymatic concentration and temperature, was suit for the hydrolysis reaction under the temperature range from 30 degrees C-50 degrees C.
Catalysis ; Cellulase ; chemistry ; Hydrolysis ; Kinetics ; Plant Stems ; Steam ; Zea mays

Multiple factors can lead to treatment failure and death in the patients with intra-abdominal infection.These factors include advanced age,malignancy,significant cardiovascular compromise,significant liver and renal diseases,hypoalbuminemia,diffuse peritonitis,delayed initial source control,delayed and unexpected initial source control,and suspected infection with resistant pathogens.Scoring system such as Mannheim Peritonitis Index (MPI) and complicated intra-abdominal score can also help to evaluate the risk of intra-abdominal infection patients.Sepsis and septic shock are important risk factors.Treatment strategies include prompt resuscitation and organ function support,early appropriate source control measures,effective antibiotics coverage of pathogens,prevention and treatment of resistant bacterial.

OBJECTIVETo investigate the effect of hyperglycemia within postoperative 48 hours on gastrointestinal (GI) fistula patients without preoperative diagnosis of diabetes undergoing selective GI reconstruction.

METHODSClinical data of GI fistula patients with age of 18 to 70 years and without diffuse peritonitis and systemic infection undergoing definitive GI reconstruction at Intestinal Fistula Center of Jinling Hospital from September 2012 to December 2015 were retrospectively analyzed. According to the highest blood glucose (BG) value detected within postoperative 48 hours, patients were divided into normoglycemia (BG<6.9 mmol/L), mild hyperglycemia (6.9 to 11.4 mmol/L) and severe hyperglycemia (BG≥11.5 mmol/L) groups. Clinical manifestations were compared among three groups. Effects of postoperative hyperglycemia on associated parameters, including postoperative surgical site infection, anastomotic leakage, intestinal nutrition recovery, hospital stay and hospitalization cost were investigated.

RESULTSA total of 314 patients were enrolled, of whom postoperative gastric fistula occurred in 6 cases, small intestinal fistula in 95 cases, ileocolonic anastomotic fistula in 116, and colorectal fistula in 97 cases. One hundred and ninety-three (61.5%) patients experienced hyperglycemia, including 148 cases of mild hyperglycemia group and 45 cases of severe hyperglycemia group, the other 121 cases were of normoglycemia group. There were no significant differences in gender, BMI, ratio of smoking, ratio of alcohol user and primary diseases among 3 groups (all P>0.05). Older patients were vulnerable to postoperative hyperglycemia and patients who developed hyperglycemia were also prone to have increased ASA score (all P=0.000). Hyperglycemia patients had significantly higher ratio of postoperative ileocolonic anastomotic fistula (mild hyperglycemia group: 40.5%, 60/148; severe hyperglycemia group: 44.4%, 20/45) than normoglycemia cases (29.8%,36/121). Compared to normoglycemia group, ratio of intra-operative transfusion case was higher (P=0.001), operative time was longer (P=0.026), ratio of number of anastomosis >2 was higher (P=0.001), ratio of receiving laparoscopic-assisted operation was lower (P=0.005), ratio of postoperative surgical site infection was higher (P=0.006), incidence of anastomotic leakage was higher (P=0.004), ratio of re-operation was higher (P=0.004), intestinal nutrition recovery time was longer (P=0.001), ICU stay was longer (P=0.001), total hospitalization time was longer (P=0.000) and hospitalization cost was more expensive (P=0.000) in both two hyperglycemia groups. Multivariate regression analysis showed that mild hyperglycemia and severe hyperglycemia were independent risk factors to predict surgical site infection (OR=1.99, 95%CI: 1.12 to 3.54, P=0.019; OR=3.02, 95%CI: 1.36 to 6.70, P=0.007) and anastomotic leakage (OR=7.59, 95%CI: 1.68 to 34.34, P=0.009; OR=13.4, 95%CI: 2.50 to 71.65, P=0.002). Multivariate linear regression analysis indicated that intestinal recovery time of normoglycemia group was 2 days shorter and 3 days shorter, and hospitalization time of normoglycemia group was 2 days shorter and 10 days shorter as compared with mild hyperglycemia and severe hyperglycemia group, respectively.

CONCLUSIONSElevated postoperative BG is common in GI fistula patients receiving selective GI reconstruction. Postoperative hyperglycemia is significantly associated with surgical site infection, anastomotic leakage and prolonged intestinal recovery. BG control treatment should be recommended for those patients with postoperative hyperglycemia.

OBJECTIVESTo evaluate the essentials for successful management of entero-cutaneous fistulas and their.

METHODSWe analyzed. The therapeutic results of 1 168 cases treated in a single center from January. 1971 to December. 2000.

RESULTSIn these patients, the cure rate of fistulas was 93% and 37.1% after non-operative treatment. Most cases died of sepsis (60/65 cases, 93.2%) with a total mortality of 5.5%. In 659 cases who had undergone operation for enteric fistula, 647 (98.2%) recovered. The cure rate, mortality rate and successful rate of operation (94.2%, 4.4%, 99.7%) in the period of January. 1985 - December. 2000 were better than those (90.4%, 8.2%, 95, 5%) in the early period of January 1971 December 1984 (P < 0.05).

CONCLUSIONSThe change of therapeutic strategy, improved technique in control of sepsis, rational nutritional support and careful monitoring of vital organs are essential to the management of enteric fistulas. How to increase the spontaneous closure of fistula, the therapeutic rate of specific enteric fistula (e.g. IBD, radiation enteritis) and the operative rate of enteric fistula in the early period requires further study.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Digestive System Fistula ; mortality ; therapy ; Female ; Humans ; Infant ; Male ; Middle Aged ; Nutritional Physiological Phenomena ; Postoperative Complications ; microbiology ; mortality ; Treatment Outcome