Crohn's disease (CD) has gradually become a common disease in China,more and more patients need surgical treatment.But the result of operation varied,as the surgical outcome is hampered by the poor general condition of the patients and risk factors of postoperative complications.The present review has summerized the objectives and goals of surgical treatment of CD,including saving lives,relieving clinical symptoms,improving the quality of life and postponing recurrence.Based on the clinical experiences of author,the common risk factors of postoperative complications were also listed,including malnutrition,complicating infection and preoperative immunosuppressive therapy.Basic principles of surgical treatment for CD mainly consist of psycological preparation of the patients and surgeons,correcting malnutrition and nutrition risks,controlling infection and other measures.Meanwhile,the rules of surgery should be simplistic,minimally traumatic and gut-saving,and clinical pathways should be followed to improve the surgical outcomes.

With the increasing understanding of the pathogenesis of Crohn's disease and the advent of biological therapy,the therapeutic strategies of Crohn's disease have changed a lot in recent years.In this review,we concerned the progress in the management of active disease,maintenance of medically induced remission,and surgical options of Crohn's disease.The new concept of "top-down" approach to the treatment of Crohn's disease evolved recently was also discussed.

Crohn's disease(CD) is a lifelong disease and the precise aetiology is still unknown.Differences in the definitions and diagnosis between clinicians make direct influence on therapeutic efficacy on CD.This article overviewed the progresses on the definitions such as staging,relapse,and diagnosis of Crohn's disease in these years in order to decrease the mistakes and be helpful to institute sensible and effective therapeutic regimen.

During the management of Crohn's disease,there are some special situations that may be encountered by the clinicians,such as postoperative recurrence,fistulating disease in CD,pediatric CD,pregnancy,psychosomatics,and extra-intestinal manifestations.In this review,we concerned the progress in these fields in recent years.

Bone marrow mesenchymal stem cells(MSCs) are a sort of somatic stem cells deriving from the mesoderm.They are capable of self-renewing,differentiating into mesenchymal or non-mesenchymal tissues,anti-inflammatory,reducing oxidative stress and immunomodulatory.MSCs exert their protective effect on various tissues,especially the ischemia-reperfusion injured tissue.This review summarizes the repairative potential of MSCs on ischemia-reperfusion injury.

Altering the natural history of disease has been the goal of medical therapy for Crohn's Disease(CD) in recent years.The conventional approach has been the "step-up" therapy.With the introduction of biological agents (such as infliximab),there is growing evidence that the "top-down" approach is justified in a subgroup of high-risk patients.The new algorithms is not only associated with superior clinical remission rates,but also may have the potential to alter the natural history of the disease,including inducing mucosal healing,reducing the rate of complications,surgeries and mortality.Further study will have to determine which subgroup of patients will benefit most from this early aggressive biological therapy approach.

Altering the natural history of disease has been the goal of medical therapy for Crohn's Disease (CD) in recent years. The conventional approach has been thestep-up therapy. With the introduction of biological agents (such as infliximab) , there is growing evidence that the top-down approach is justified in a subgroup of high-risk patients. The new algorithms is not only associated with superior clinical remission rates, but also may have the potential to alter the natural history of the disease, including inducing mucosal healing, reducing the rate of complications, surgeries and mortality. Further study will have to determine which subgroup of patients will benefit most from this early aggressive biological therapy approach.

Abdominal compartment syndrome(ACS)is an important factor contributing to the multiple organ dysfunction syndrome which is commonly seen in patients with severe acute pancreatitis(SAP).As a life-saving procedure,decompressive laparotomy is widely applied to patients with SAP complicated with ACS,especially to patients with edema of the visceral tissues caused by massive fluid resuscitation at the early stage of the disease.However,decompressive laparotomy should be adopted with caution since it is associated with enteroatmospherie fistula,intraabdominal infection,postoperative ileus,third space losses,hypothermia and hemia.Therefore,decompressive laparotomy should only be considered after conservative management had failed.The indications for decompressive laparotomy are as follows:(1)intraabdominal pressure＞25 nnn Hg;(2)adequate ventilation of the patient is difficult;(3)pereutaneous drainage of ascites is not helpful.Timely temporal abdominal closure is helpful in preventing complications.Infected peripanereatie necrosis is the indication for peripancreatic exploration or necroseetomy.A thorough knowledge of decompressive laparotomy is essential for individualized management of patients with SAP complicated with ACS.

Marine microorganisms,which live in special biotic environment,have been proven to be potential in producing novel bioactive substances.In past three decades,nearly 300 new compounds have been isolated and determined from marine fungi,and most of them showed antitumor,antibacterial and antiviral activities.This paper reviewed new advances in the studies of antitumor compounds from marine fungi in the recent ten years.

Objective This study was designed to evaluate the effect of laparoscopic-assisted subtotal colectomy(LASC)and modified Duhamel procedure in the treatment of severe functional constipation(SFC).Methods From June 2005 to October 2007,100 cases of SFC were treated by LASC combined with modified Duhamel procedure in our institute.After freed the colon under a laparoscope,we made a small incision in the lower abdomen to perform subtotal colectomy while preserved the ileocecal region.Then a side-to-side colorectal anastomosis was conducted.Results In this study,98 cases of LASC were successively completed and 2 cases were converted to open surgery.The operation time of LASC in the 98 cases ranged from 48 to 125 min mean,(76?23)min],and the total operation time was 140-225 min mean,(170?42)min].The intraoperative blood loss was 10-160 m1 mean,(35?18)m1].In the patients,the intestinal function was recovered within 25-52 hours mean,(42?12)h] after the operation;none of them developed postoperative wound infection,anastomotic stoma,or other complications.One week after the operation,2 of the 100 patients showed mild dehydration,and 2 were diagnosed as having incomplete small bowl obstruction.All of the four were cured by conservative treatments.The other 96 patients who had no complication were discharged from the hospital in 5-11 days mean,(7.0?1.5)days] postperation.One year later,the symptoms of constipation were significantly alleviated(defecation 1-3 times/d)in 90 patients;7 cases had various degrees of diarrhea(defecation 4-6 times/d);and 3 patients showed recurrence of mild constipation(defecation 1 time/2-3 d).The gastrointestinal quality of life index(GIQOL)determined in 1 year postperation was(109?20)points,which indicated good results compared to(94?23)points before the operation(maximum:144).Eighty-three cases were satisfied with their frequency of defecation.Conclusions LASC combined with modified Duhamel procedure is an effective method for the treatment of SFC,resulting in less damage,less influence to the internal environment,and quick recovery.The procedure is worth being wildly used.