Nutrition support therapy plays an important role in the treatment of severe acute pancreatitis (SAP).This article reviews the hot topics and new ideas in nutrition support therapy for SAP in recent years.Damage of intestinal mucosal barrier plays an important role in the progression of pancreatitis.Enteral nutrition can protect the function of intestinal mucosal barrier and early enteral nutrition can significantly reduce patients′mortality rate and incidence rate of complications.Nutrition support for SAP patients via a nasogastric tube has comparable safety and effect to the nutrition support via a nasojejunal tube.At present,there are no enough experience and clinical studies on semi -el-emental or elemental enteral nutrition preparations,and immune -enhancing enteral nutrition preparations and probiotics are not recommen-ded as conventional means.

Obesity is growing rapidly and becomes an important public health problem worldwide. Epidemiologic data revealed that obesity increased the risk of a variety of disease,including digestive system tumor. Therefore,investigating the molecular mechanism of carcinogenic effect of obesity may provide new clues for management of obesity-associated digestive system tumor. In this article,the progress in research on effect of obesity on digestive system tumorigenesis and its potential mechanism were summarized.

Objective To determine the expression of c-myc and CD24 in colorectal carcinoma,colo-rectal polyp and normal mucosa,and to explore the role and correlation of them in the carcinogenesis of colorec-tal carcinoma. Methods The expression of c-myc and CD24 in colorectal carcinoma(n = 60),colorectal ade-nomatous polyp(n = 45),colorectal hyperplastic polyp(n = 15)and the adjacent non-cancerous tissue(n =30)was observed by immunohistochemical assay. Results The positive rate of c-myc in colorectal carcinoma were 73. 3% ,significantly higher than that in colorectal adenomatous polyp 44. 4%( χ2 = 9. 016 8,P <0. 01),colorectal hyperplastic polyp 13. 3%(χ2 = 18. 215 9,P < 0. 01)and adjacent non-cancerous tissue 6. 7%(χ2 = 25. 133 0,P < 0. 01);the positive rate of CD24 in colorectal carcinoma was 76. 7% ,significantly higher than that in colorectal hyperplastic polyp 6. 7%(χ2 = 25. 133 0,P < 0. 01)and adjacent non-cancerous tissue 3. 3%(χ2 = 43. 107 4,P < 0. 01). c-myc expression in colon cancer was significantly correlated with cancer site(χ2 = 8. 352 3,P < 0. 01),lymph node metastasis(χ2 = 4. 275 1,P < 0. 05),differentiation (χ2 = 4. 115 3,P < 0. 05)and TNM stage(χ2 = 5. 739 9,P < 0. 05). CD24 expression in colon cancer was significantly correlated with cancer size(χ2 = 9. 333 6,P < 0. 01),lymph node metastasis(χ2 = 7. 693 0,P <0. 01),differentiation(χ2 = 5. 870 0,P < 0. 05)and TNM stage(χ2 = 4. 498 7,P < 0. 05). There was a pos-itive correlation relationship between CD24 and c-myc in colorectal carcinoma tissue(χ2 = 10. 824 9,r = 0. 39, P < 0. 05). Conclusion The expression of c-myc and CD24 are high in colorectal cancer,having a significant correlation with some of the clinicaopathological features. c-myc is likely to act as a downstream target gene of CD24 signaling pathway,whose expression is probably regulated by CD24 in colorectal carcinoma tissue.

Objective To investigate the clinical significance of changes of serum amylase, CRP and SAA in the diagnosis of acute pancreatitis. Methods The levels of serum and urine amylase, CRP and SAA in patients of mild acute pancreatitis (MAP) and severe acute pancreatitis (SAP) at 24 h, 48 h, 72 h and the seventh day after the onset of pancreatitis were measured. Results The levels of serum, urine amylase, CRP and SAA in SAP patients at 24h were (904.5±402.2)U/L, (2280.3±1207.3)U/L, (155.6±36.2) mg/L, (521.9±109.4)mg/L, respectively, and significantly higher than those of MAP patients (P＜0.05 or P＜0.001). The peak value of serum amylase appeared at 24h, however, the peak value of urine amylase, CRP and SAA appeared at 48 h, and the corresponding values were (2173.5±1110.6) U/L, (185.3±41.4) mg/L and (717.5±144.2)mg/L, respectively. The levels of serum and urine amylase significantly decreases in MAP and SAP patients at the seventh day (P＜0.05). The levels of serum CRP and SAA significantly decreased in MAP patients at the seventh day (P＜0.05), however, the levels of serum CRP and SAA did not significantly decrease in SAP patients at the seventh day (P＞0.05). Serum levels of CRP and SAA were related to the severity of acute pancreatitis. Meanwhile CRP showed a positive correlation with SAA (r = 0.761, P＜0.05). Conclusions The change of serum levels of amylase, CRP and SAA can help early diagnose acute pancreatitis; CRP and SAA may predict the development of SAP at early stage.

Objective To investigate the prevalence of undernutrition, nutritional risks, and the application of nutrition supports in different hospitals in Shandong province, and to estimate the related complication rate.Methods Totally 2792 patients from different hospitals in Shandong were enrolled, and their nutritional risks were assessed using Nutritional Risk Screening (NRS) 2002. The application of nutritional supports, the length of hospital stay, and the incidences of infectious and non-infectious complications were documented. Results The incidences of undernutrition and nutritional risk among patients in large hospitals were significantly higher than those in middle and small hospitals (5.6%, 1.6%, 2. 7%; 27.3%, 15.4%, 18.3%; P =0. 000). The overall rate of nutritional support was 43. 60%, and there were significant difference among patients in different hospitals (51.5 %, 30. 8 %, 20.9 %, P = 0. 000). Parenteral nutrition was most widely applied. Among the 483 patients in large hospitals, the incidence of complication in patients with nutritional risks was significantly higher than those without nutritional risks (31.3% versus 13.7%, P =0. 000). Of the "with nutritional risk" patients, the infectious complications were significantly lower in the nutritional support group (P = 0. 000). Of the patients without nutritional risks, there was no statistical difference between the nutritional support group and the non-support group. (P ＞ 0. 05). Conclusions NRS 2002 is a useful tool for the assessment of nutritional status among inpatients. Proper nutritional support can reduce the incidence of complications for patients with nutritional risks.

Objective To investigate the differences of miRNA-21 and miRNA-146a expression between colorectal neoplasms tissues and serum of the patients with colorectal neoplasm,and the clinical significance was analyzed.Methods The endoscopic biopsy tissues and serum samples of 100 colorectal cancer (CRC),80 colorectal adenoma (CRA)patients and 65 healthy controls were collected.The expressions of miRNA-21 and miRNA-146a were detected by quantitative real time polymerase chain reaction.The relationship between the expression and clinicopathological features were analyzed.And then,the diagnostic value of expression difference of serum miRNA in colorectal neoplasm were evaluated. The Mann-WhitneyU test and Kruskal-Wallis test were performed for comparisons between groups,and the correlation of miRNA expression between tissues and serum was analyzed by Spearman test.Results
The expressions of miRNA-21 in the tissues of CRC and CRA were 8.573 ±0.898 and 7.746 ±1 .183, respectively,which were significantly higher than that of healthy controls 6.160 ±0.835 (U =120.129 and 33.230,both P <0.01).The expressions of miRNA-21 in the serum of CRC and CRA were 1 .829± 0.303 and 1 .624 ±0.226,respeotively,which were higher than that of healthy controls 1 .391 ±0.221 (U =40.353 and 15 .512,both P < 0.01 ).The expression of miRNA-21 in the serum and tissues of patients with CRC were both higher than those of patients with CRA (U =11 .384 and 10.189,both P <0.01).The expression of miRNA-21 in patients with CRC was associated with TNM stage and lymph node metastasis.The expression level of miRNA-21 in CRA was correlated with histological types.The results of Spearman analysis indicated that the expression of miRNA-21 in the tissues and serum of patients with CRC was positively correlated (r=0.459,P <0.01).The expression of miRNA-146a in the tissues and serum of CRC patients were 2.556±0.351 and 0.249±0.038,respectively,which were lower than those of healthy controls (3.428 ±0.328 and 0.279 ±0.053)(U =102.134 and 30.111 ,both P <0.01).The expression in the tissues and serum of CRA patients were 3.255 ±0.332 and 0.290±0.036, respectively,which were also lower than those of healthy controls,however the difference was not statistically significant (U = 3.936 and 3.180,both P > 0.05 ).The expression of miRNA-146a in the tissues and serum of CRC patients were both lower than those of CRA patients (U =73.809 and 21 .123, both P <0.01).The degree of decreased expression of miRNA-146a in CRC patients was correlated with TNM staging and tumor differentiation degree,however there was no correlation between the expression in CRA and clinical features.According to receiver operating characteristic (ROC)curve analysis,the AUC of miRNA-21 ,miRNA-146a and a combination of them in CRC and health individuals was 0.889, 0.791 and 0.863,respectively;in CRA and health individuals was 0.784,0.692 and 0.761 ,respectively;in CRC and CRA was 0.705 ,0.820 and 0.713,respectively.Conclusion The different expressions of miRNA-21 and miRNA-146a had potential values in early detection of colorectal cancer.

Objective To evaluate the effectiveness and predictive value of high-resolution manometry(HRM) for POEM in treating achalasia. Methods A total of 84 achalasia patients categorized into subtypes by HRM, who also underwent POEM, were enrolled in our study. Eckardt score, Barium esophagogram and HRM were performed before, 6 months and 1 year after POEM. Results POEM was successfully performed in all 84 patients. No perforation occurred in any patient. The Eckardt scores and esophageal diameter after POEM significantly reduced compared with those before(P<0. 05). The 4s-IRP decreased from 33. 4±9. 0 mmHg (1 mmHg =0. 133 kPa) to 14. 6±3. 8 mmHg six months after POEM (P<0. 05) and to 16. 4±3. 9 mmHg one year after POEM (VS preoperate, P<0. 05). The LESP before treatment was 41. 8±15. 4 mmHg, decreasing to 18. 4±7. 1 mmHg six months after POEM (P<0. 05) and 20. 7±7. 6 mmHg one year after POEM (VS preoperate, P <0. 05) . When categorizing patients into 3 subtypes by HRM, 4s-IRP of type II showed the most dramatic decrease six months after POEM(62. 8%), followed by typeⅠ(53. 5%), while type III had the least decrease(41. 8%). The mean decreasing rate of LESP in type III was 42. 3% six months after POEM, followed by typeⅠ(55. 3%) , while type II showed the highest rate(57. 8%). Conclusion POEM is a safe treatment for achalasia and has significant short-term efficacy with Type II responding best to POEM. HRM plays a vital role in typing AC and predicting the effectiveness of POEM and can be useful in selecting an appropriate treatment.

Objective To determine the expression of CD24 in colorectal carcinoma, and to explore the relationship between CD24 and the clinicopathological features of colorectal carcinoma.Methods The expression of CD24 in 62 cases of colorectal carcinoma, 47 cases of adenomas, 15 cases of colorectal polyps and 30 cases of the adjacent non-cancerous tissues were observed by immunohistochemical assay.The relationship between CD24 and the clinicopathological features was analyzed.Results The positive rates of CD24 in colorectal carcinoma 72.6％ and adenomas 63.8％ were significantly higher than those in colorectal hyperplastic polyps 13.3％ (x2 =17.83, P =0.00;x2 =11.61, P =0.00) and adjacent non-cancerous tissues 6.7％ (x2 =35.15, P =0.00;x2 =24.64, P =0.00).The expression of CD24 in colorectal carcinoma had a significant correlation with the tumor diameter (x2 =5.48, P =0.02), tumor differentiation (x2 =8.86, P =0.00), Duke staging (x2 =11.47, P =0.00) and lymph node metastasis (x2 =8.92, P =0.00).Conclusion The expression of CD24 is high in colorectal carcinoma, having a significant correlation with the size of tumor, degree of differentiation, Duke stage and lymph node metastasis.

Objective To evaluate the value of the Bedside Index for Severity in Acute Pancreatitis (BISAP) in diagnosing severe acute pancreatitis. Methods Sixty-eight patients with suspected diagnosis of severe acute pancreatitis were collected and were scored by BISAP, APACHE Ⅱ , Ranson and CTSI scoring systems, respectively. BISAP scoring system included the blood urea nitrogen, impaired mental status,systemic inflammatory response syndrome, age, and pleural effusion. The diagnosis criteria of severe acute pancreatitis was BISAP ≥ 3 points or APACHE IⅡ ≥ 8 points, Ranson ≥ 3 points, CTSI ≥ 3 points. The diagnostic accuracy of SAP of these scoring systems was calculated. Results Among these 68 cases, 63.2％(43/68) were graded ≥ 3 points in BISAP scoring system;60.3％ (41/68) were marked ≥8 points in APACHE Ⅱ scoring system; 60.3％ (41/68) were scored ≥ 3 points in Ranson scoring system; and 67.6％(46/68) were scored ≥3 points in CTSI scoring system. There was no statistical difference between BISAP scoring system and other three scoring systems in diagnosing severe acute pancreatitis. Conclusions As a new and simple scoring system, BISAP scoring system can be widely used in the diagnosis of severe acute pancreatitis.

Objective To detecte the expression of COX-2,VEGF-C and lymphatic vessel density (LVD)in pancreatic cancerous and paracancerous tissues,and investigate their correlation.Methods The expression of COX-2.VEGF-C and LVD in 40 cases of pancreatic cancer tissues and paracancerous tissues and 12 cases of normal pancreas was detected by tissue chip and immunohistochemical assays,and the relationship between them and the cljnicopathological parameters was analyzed. Results The expression of COX-2,VEGF-C in pancreatic cancer tissues were 70.0%(28/40)and 67.5%(27/40),respectively,which were significantly higher than that in paracancerous tissues(42.5%,17/40)and(35.0%,14/40),and that in normal pancreas(8.3%,1/12)and(25.0%,3/12).The LVD in pancreatic cancerous,paracancerous and normal pancreatic tissues were 4.75±2.77,15.2 ±4.70 and 1.67±1.15,respectively.The expression of COX-2 in cancerous tissues and LVD in paracancerous tissues was correlated with tumor differentiation and lymph metastasis;the expression of VEGF-C Was correlated with lymph metastasis.LVD in paracancerous tissues was correlated with the expression of COX-2 and VEGF-C.Conclusions Pancreatic cancer lymphangiogenesis mainly existed in paracancerous tissues,COX-2 and VEGF-C may play an important role in the lymphangiogenesis.