s:Primary chronic intestinal pseudo-obstruction (PCIPO)is a rare digestive syndrome characterized by derangement of gut propulsive motility which resembles mechanical obstruction, in the absence of any obstructive process. Treatment of intestinal pseudo-obstruction involves nutritional, pharmacological and surgical therapies, but it is often unsatisfactory and the long-term outcome is generally poor in the majority of cases. This article is aimed at reviewing the current knowledge on etiology, clinical features and management of patients affected by PCIPO.

Enteral resuscitation is a new concept, but the treatment supplied has been already well known. Enteral resuscitation has been used widely for critical patients, which is benefit for their recovery. It is a safe and effective method for critical patients which could result in the amelioration of the hormonal stress response to promote the intestine function and improve outcome, and it is good in cost-effectiveness. Complications are minimal.

Transjugular intrahepatic portosystemic shunt (TIPS) has been developed for two decades in order to treat portal hypertension accompanying with upper gastrointestinal hemorrhage and refractory ascites.TIPS may cause the development of hepatic encephalopathy (HE).TIPS induces portalsystemic shunt and leads to hemodynamics chaos. Hepatic encephalopathy belongs to the complications of the portal hypertension. There are many possible predictors of the post-TIPS HE. The relationship between TIPS and HE was reviewed.

Objective: To develop a new rat model for studies of enteral nutrition support.Methods: After acute pancreatitis models induced by laparotomy,32 SPF rats were put a catheter always used for epidural anesthesia, through pylorus to 5 cm of jejunum below Treitz ligament, and sutured and fixed apart at the entrance, stomach, peritoneum, neck, and the tail, which then connected to an one-time infusion tube. By regulating the infusion tube on the pulley, the enteral nutrition input was kept uniform.Results: The routes All rats were successfully built in all rats for TEN, with an average input time of 7days in which rats well tolerated without diarrhea. All rats got positive nitrogen balance after TEN for 3-4 days. No extrusion, bending, or leakage of the infusion tubes happened.Conclusion: This rat model of enteral feeding had advantages of simplicity, firmness, reliability and cheapness, which could be used in large-scale and fulfill the need of experimental EN study in small animals like rats.

Objective: To investigate changes in species and amounts of intestinal flora after reconstruction of upper digestive tract, and the relationship with the infective complications.Methods: 52 patients with advanced malignancy being performed reconstruction of upper gastrointestinal tract was prospectively observed .The species of bacteria and counts of the colony forming units(CFU) were measured from juice taking from the upper jejunum through nasointestinal tube during operation, the second day and the fifth day after operation. Meanwhile, the plasma endotoxin concentration was determined with the modified chromogenic limulus assay.Results: There weren't significant changes of intestinal flora in species and amounts between groups (P＞0.05.) No any signs of bacterial translocation were seen. There was no significant difference for the level of plasma endotoxin between groups.Conclusion: There is no disorder of intestinal flora and bacterial translocation during the perioperative period after upper digestive tract reconstruction successfully.

Objective: To investigate the immune regulation mechanism and anti-inflammatory effect of ω-3 fatty acids on sepsis patients.Methods: Totle 18 patients were divided into two groups,therapy group and control group. The control group was given routine therapy while the theray group was given routine therapy and fish oil.The expression of HLA-DR on peripheral monocytes was measured by flow cytometry at the beginning and 5 d during therapy, in parallel with serum c-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),and severity of the disease(APACHE Ⅱ score),serum and oxygenation index(PaO2/FiO2)Results: Compared with conventional group,serum concentration of CRP, IL-6 and TNF-α in patients of therapy group were significantly reduced,and oxygenation index improved. There was no difference in the expression of HLA-DR and APACHE Ⅱscore between two groups.Conclusion:Fish oil can decrease the elevated mediators of inflammation on sepsis patients,and can't regulation the expression of HLA-DR on peripheral monocytes.

Objective: To evaluate feasibility of using European Nutritional Risk Screening 2002(NRS2002) for nutritional status assessment in primary hospital.Methods: 799 patients were enrolled in this study.697 patients who were according NRS request were assessed using NRS method in hospitalization day.The patient whose NRS scores were higher than 3 were justified under nutritional risk.102 patients who were not according NRS request were assessed by exeamining the serum albumin(ALB) in the next day.The patients whose serum ALB was lower than 35 g/L were justified malnutrition.Results: There were 697 patients could be evaluated by NRS method.Body Mass Index(BMI) was lower than 18.5 in 159(22.8%) cases and NRS scores were ≥3 in 240 cases(34.4 %) among 697 cases.Serum albumin was lower than 35 g/L in 31 (30.4%) cases among 102 cases who could not be evaluated by NRS method because of incapable of standing up(66/102,64.7%) and ascites or hydrothorax(17/102,16.7%) and concomitance of above-mentioned causes(11/102,10.8%) and coma(8/102,7.8%).Conclusion: Assessment of nutritional status of hospitalized patients in primary hospital using NRS2002 method is feasible.The patients who could not be evaluated by NRS 2002 method can be assessed by assaying serum ALB.

Objective: To investigate the effects of trentment with hydroxythy starch(130/0.4) on the serum albumin and immunologic function in postoperative patients with obstructive jaundice.Methods: 24 patients with obstructive jaundice were randomly divided into the control group(n=12) and hydroxythy starch(130/0.4) (HS) group(n=12). The serum ALB was detected 1d, 3d, 5d, 7d after the operation,and the immunologic index were detected 1d and 7d after the operation.Results: The ALB content of control group and HS group were not significantly different in the postoperative 1d and 7 d(P>0.05) and had significant differences in the postoperative 3 d, 5 d (P<0.05).All immunologic index had no significant differences in the postoperative 1d, 7d (P>0.05).Conclusion: The ALB content of patients with obstructive jaundice may decrease postoperatively. Treatment with hydroxylthy starch(130/0.4) can alleviate the drop of the ALB content. But it has no effects on immunologic function.

Objective: In acute pancreatitis, traditional treatment insists fasting on purpose to avoid activation of proteolytic enzymes and pancreatic enzyme secretion. The aim of our study was to evaluate the efficacy and feasibility of early oral feeding as compared to traditional fasting in patients with mild acute pancreatitis.Methods: Seventy-two patients were randomized to the two treatment groups, fasting or early oral feeding. The inclusion criteria were pancreas amylase≥3times above normal, onset of abdominal pain within 48h, acute physiological and chronic health evaluation-II score<8 and C-reactive protein(CRP)<150 mg/L. Measures were amylase, systemic inflammatory response, length of hospital stay. Results: The groups were comparable with respect to age, sex, etiology, APACHE II, time from onset of pain and amylase at admission. No significant differences were seen between the groups concerning levels of amylase, CRP, leukocytes, abdominal pain or number of gastrointestinal symptoms. The length of hospital stay time was significantly shorter in the oral feeding group (13 vs. 17 days; P<0.05).Conclusion: Early oral feeding would not exacerbate disease process. The differences between treatment groups for amylase or systemic inflammatory response were not obvious. In mild acute pancreatitis, early oral feeding was feasible and safe and may accelerate recovery.

Objective: To investigate the influence of fast tract surgery on the humoral immunity and the chief clinical index of gastric cancer patients.Methods: 56 patients with gastric cancer from December 2007 to June 2008 were randomly divided into two groups: experiment group(fast tract surgery group, n=28)and control group(conventional treatment group, n=28 ). The changes of serum levels of humoral immunity and the chief clinical index were analysed and compared.Results: The serum levels of humoral immunity in both group were decreased. The serum levels of C3 and C4 on the postoperative 1st day were(0.845±0.126)g/L and(0.212±0.070)g/L respectively(P<0.05) in FTS group.The serum levels of IgA, IgM and IgG on the postoperative 3rd day were(1.603±0.468)g/L,(0.845±0.187)g/L,(9.548±1.920)g/L respectively(P<0.05) in FTS group. The duration of antibiotic use, first passage of flatus, the lengh of hospital stay, the occurance of postoperative complications in FTS group were also significiantly lower than those in control group (P<0.01, P<0.05).Conclusion: Fast tract surgery affectes on the humoral immunity of gasrtic cancer patients, and it might contribute to the improved outcomes of postoperative patients.