Reporting Applicability and cost benefit analysis were considered. Comments were to be made on non-RCTs, rejected trials and trials in progress or analysis where appropriate. Assessment of risk of bias in included studies Assessment of Study Quality This was performed by one reviewer and checked by a second. Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis (Review)

Activation of cannabinoid receptors decreases emesis, inflammation, gastric acid secretion, and intestinal motility. However, the effects of cannabinoids on intestinal permeability have not yet been established. The aim of the present study is to examine the effects of cannabinoids on intestinal permeability in an in vitro model. Caco-2 cells were grown until fully confluent on inserts in 12-well plates. Transepithelial electrical resistance (TEER) measurements were made as a measure of permeability. EDTA (50 M) was applied to reversibly increase permeability (reduce TEER). The effects of cannabinoids on permeability in combination with EDTA, or alone, were assessed. Potential target sites of action were investigated using antagonists of the cannabinoid (CB) 1 receptor, CB 2 receptor, transient receptor potential vanilloid subtype 1 (TRPV1), peroxisome proliferator-activated receptor (PPAR)␥, PPAR␣, and a proposed cannabinoid receptor. When applied to the apical or basolateral membrane of Caco-2 cells, ⌬ 9 -tetrahydrocannabinol (THC) and cannabidiol (CBD) enhanced the speed of recovery of EDTA-induced increased permeability. This effect was sensitive to cannabinoid CB 1 receptor antagonism only. Apical application of endocannabinoids caused increased permeability, sensitive to cannabinoid CB 1 receptor antagonism. By contrast, when endocannabinoids were applied basolaterally, they enhanced the recovery of EDTA-induced increased permeability, and this involved additional activation of TRPV1. All cannabinoids tested increased the mRNA of the tight junction protein zona occludens-1, but only endocannabinoids also decreased the mRNA of claudin-1. These findings suggest that endocannabinoids may play a role in modulating intestinal permeability and that plant-derived cannabinoids, such as THC and CBD, may have therapeutic potential in conditions associated with abnormally permeable intestinal epithelium.

Background: Cachexia is a consequence of tumor burden caused by ill-defined catabolic alterations in muscle protein turnover. Objective: We aimed to explore the effect of tumor burden and resection on muscle protein turnover in patients with nonmetastatic colorectal cancer (CRC), which is a surgically curable tumor that induces cachexia. Design: We recruited the following 2 groups: patients with CRC [n = 13; mean 6 SEM age: 66 6 3 y; BMI (in kg/m 2 ): 27.6 6 1.1] and matched healthy controls (n = 8; age: 71 6 2 y; BMI: 26.2 6 1). Control subjects underwent a single study, whereas CRC patients were studied twice before and w6 wk after surgical resection to assess muscle protein synthesis (MPS), muscle protein breakdown (MPB), and muscle mass by using dual-energy X-ray absorptiometry. Results: Leg muscle mass was lower in CRC patients than in control subjects (6290 6 456 compared with 7839 6 617 g; P , 0.05) and had an additional decline after surgery (5840 6 456 g; P , 0.001). Although postabsorptive MPS was unaffected, catabolic changes with tumor burden included the complete blunting of postprandial MPS (0.038 6 0.004%/h in the CRC group compared with 0.065 6 0.006%/h in the control group; P , 0.01) and a trend toward increased MPB under postabsorptive conditions (P = 0.09). Although surgical resection exacerbated muscle atrophy (27.2%), catabolic changes in protein metabolism had normalized 6 wk after surgery. The recovery in postprandial MPS after surgery was inversely related to the degree of muscle atrophy (r = 0.65, P , 0.01). Conclusions: CRC patients display reduced postprandial MPS and a trend toward increased MPB, and tumor resection reverses these derangements. With no effective treatment of cancer cachexia, future therapies directed at preserving muscle mass should concentrate on alleviating proteolysis and enhancing anabolic responses to nutrition before surgery while augmenting muscle anabolism after resection.

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For most surgeons and surgical educators, e-learning is relatively new and confusing. This article attempts to explain the key concepts behind e-learning, as well as its benefits and risks. E-learning has become a fixed feature within Higher and Professional Education and has been prioritized by Universities around the world, as well as all six Surgical Royal Colleges. Trainees have grown up with virtual learning environments and expect similar provision for their postgraduate studies, but have a greater need for basic science learning. Dispersal of trainees across duty rotas and geographically makes e-learning more attractive, but preserving peer and trainer communication is as important as content. Recent changes in surgical education and training have also made electronic and distance learning more attractive than previously. Initial work by the Colleges is now being evaluated and important lessons have emerged. The UK Department of Health has made medical e-learning a priority and it is now the largest e-learning provider in Europe. Changes in the World Wide Web, with a shift to more social-networking activity in education and to web-based delivery to small, ubiquitous portable devices will increase opportunities for surgical e-learning.