Acute gastrointestinal injury (AGI) is a malfunctioning of the gastrointestinal tract in intensive care patients due to their acute illness.AGI could be divided into 4 types,including AGI grade Ⅰ:increased risk of developing gastrointestinal dysfunction or failure; AGI grade Ⅱ:gastrointestinal dysfunction; AGI grade Ⅲ:gastrointestinal failure; AGI grade Ⅳ:gastrointestinal failure complicated with distal organ dysfunction.The symptoms of AGI include vomiting and regurgitation,gastric retention,diarrhea,gastrointestinal bleeding,paralytic intestinal obstruction,bowel dilatation and abnormal bowel sounds.Intestinal rehabilitation therapy was used to promote the patients with short bowel syndrome to restore enteral or oral feeding,and it could be used to improve the gastrointestinal function in patients with AGI.The procedure of intestinal rehabilitation therapy include total parenteral nutrition,parenteral and enteral nutrition,total enteral nutrition and oral feeding.The specific therapy could be implemented according to the severity of AGI and early enteral nutrition should be tried frequently.Intestinal tissue specific nutrients should also be provided either through enteral or parenteral approaches.

Source control includes all the physical inter-ventious to treat surgical infection. The main procedures are drainage of abscesses, debridement of nonviable or infected tissue and definitive management of the anatomic abnormality which is responsible for ongoing microbial contamination. The new concept of damage control surgery expedites the wide use of percutaneous drainage of abcess and abdominal open surgery. Second-look laparotomy is another damage control procedure for the eradication of surgical infection. Surgical infection could hardly be controled without effective source control measures. Source control plays a key role in the management of surgical infection.

With the appearance of new biological agents represented by infliximab,the medical therapy of crohns' disease has made breakthrough of progress.However,the controversial still remains about the use of infliximab during perioperative period in Crohn's disease patients.The aim of this article is to explore the influence of infliximab on postoperative complications in Crohn's disease patients.

As a novel T cell population,Th17 cells are demonstrated to play an important role in autoimmune diseases,including Crohn' s disease.Several recent studies indicate the specific contributions of IL-23/Th17 axis and cytokines secreted by Th17 cells to the inflammatory bowel disease.This article is dedicated to describe the correlation between Th17 cells and Crohn' s disease.

Crohn's disease is a relapsing systemic inflammatory disease mainly affecting the gastrointestinal tract.Recently,the incidence and prevalence of Crohn's disease is increasing dramatically in Asia,and colorectal cancer is one of the most fatal complications of Crohn's disease.A thorough understanding of the carcinogenesis of Crohn' s disease and enhance the surveillance of colorectal cancer among Crohn's disease is therefore of significant importance to reduce the mortality.In this review,the tendency and molecular mechanism of carcinogenesis of Crohn's disease were discussed,and the present research on the prevention against colorectal cancer in patients with Crohn's disease was introduced.

Pancreatic enzyme replacement therapy is given to manage pancreatic exocrine insufficiency (PEI) in cystic fibrosis (CF) and following pancreatectomy, total gastrectomy or chronic pancreatitis. The article reviews on aspects of pancreatic enzyme replacement therapy containing the assement of pancreatic exocrine function, the pathogenesis of exocrine pancreatic insufficiency, pancreatic enzyme preparations and their efficiency, dosing of pancreatic enzymes, enteral nutrition and pancreatic enzyme replacement, the modulation of pancreatic exocrine and adverse reactions to pancreatic enzyme.

The disadvantages of total parenteral nutrition (TPN) in critically ill patients were increased infection rate and hepatic dysfunction.Enteral nutrition (EN) can overcome the shortcomings of TPN and cost less.However,EN may not provide enough energy and protein because of the limited gut function.The best mode of the nutritional support in the critical ill patients is PN+EN.The non protein calorie and protein needs can be decided by the measured energy expenditure and overfeeding should be avoided.To further improve the critically ill patient nutritional status,immunonutrition and ecoimmunonutrition should be considered.

Trauma and infection may cause a stress reaction to the body,which leads to the metabolic imbalance of organs and tissues,but some treatment methods can effectively reduce the negative effects of undesirable stress on body metabolism.This article focuses on the effects of trauma and infection stress on the protein metabolism,furthermore,introduces some related treatment methods.

Objectives:To observe the efficacy of enteral nutrition with short peptide elemental diet(Pepti 2000) in patients with gastrointestinal fistulas and evaluate the sensitivity of nutrition associated index in nutrition monitoring. Methods:Ten cases with gastrointestinal fistulas were administered total enteral nutrition(TEN).They received 146 kJ/(kg?d) of non protein calorie(NPC) and 0.25 g/(kg?d) of nitrogen per day. Body weight,serum albumin, transferrin(TFN), prealbumin(PA),fibronectin(FN),triglyceride and cholesterol were monitored on before and 7th and 28th after TEN. Results:Seven days after TEN,serum PA and FN levels rised significantly( P

Objective: To examine the effects of recombinant human growth hormone on the acute phase response in abdominal sepsis patients.Methods: Prospective unblinded trial was made with each patient serving as his/her own control.Eighteen abdominal sepsis patients were enrolled ranging in age from 24 to 60 yrs.All patients received 10 U/d of GH 48 hrs after performing drainage and for 7days.Results: Serum concentration of constitutive proteins,acute phase protein and cytokines were measured before and 1,3,5 and 7 days after GH administration.GH notablely increased serum constitutive protein levels(prealbumin,transferrin,fibronectin) and decreased serum acute phase protein level(CRP).Cytokine TNF-?,IL-1? and IL-6 had significant change after GH administration,but the changes were not relative to the change of acute phase response.Conclusion: Low-dose rhGH effectively modulated the acute phase response by attenuating production of the hepatic acute phase protein and increasing the synthesis of constitutive proteins.