ObjectiveTo observe the effect of early-stage intervention with acupuncture on gastrointestinal dysfunction in critically ill patients.MethodTotally 112 critically ill patients were randomized into two groups. Based on the treatment for primary disease, the conventional group additionally received Lived Combined B. Subtilis and E. Faecium Enteric-coated Capsules, plus Alanyl Glutamine injection when parenteral alimentation was required; in addition to the treatments given to the conventional group, the acupuncture group received electroacupuncture, once a day. Before treatment, and on treatment day 7 and day14, the gastrointestinal function and nutritional state (hemoglobin, albumin), nutrition type, APACHEⅡscore, incidence rate of gastrointestinal function failure, and mortality rate were evaluated and compared.ResultAfter 7-day treatment, the gastrointestinal function scores were significantly improved in both groups (P<0.05), and there was a significant difference between the acupuncture group and conventional group (P<0.05); after 14-day treatment, the gastrointestinal function scores were significantly improved in both groups compared to that before treatment (P<0.01), and there was a significant difference between the acupuncture group and conventional group (P<0.05). Respectively after 7-day and 14-day treatment, the APACHEⅡscores were significantly improved in both groups (P<0.01), and there was a significant difference between the acupuncture group and conventional group (P<0.05); after 14-day treatment, there was a significant difference between the two groups (P<0.05). After 7-day treatment, the hemoglobin levels were insignificantly changed in the two groups (P>0.05), and the difference was insignificant between the two groups (P>0.05); after 14-day treatment, the hemoglobin levels were significantly changed in both groups compared to that before treatment (P<0.05), and there was a significant difference between the two groups (P<0.05). After 7-day treatment, the albumin levels were insignificantly changed in the two groups (P>0.05), and the between-group difference was statistically insignificant (P>0.05); after 14-day treatment, the albumin levels were significantly changed in both groups compared to that before treatment (P<0.05), and there was a significant difference between the two groups (P<0.05). In the acupuncture group, 10 patients were dead, and there were 13 dead in the conventional group, and the between-group difference in death rate was statistically insignificant (P>0.05), though the death rate was comparatively lower in the acupuncture group; in the acupuncture group, 3 patients turned from complete parenteral nutrition to mixed nutrition, while 4 patients turned to mixednutrition because of intolerance to enteral nutrition and 2 cases turned to complete parenteral nutrition in the conventional group.Conclusion The two groups of treatments both can effectively improve the gastrointestinal function, decrease the incidence rate of gastrointestinal function failure, and the efficacy in the acupuncture group was more significant than that in the conventional group;the two groups of treatments both can sustain the gastrointestinal function and nutrition supply, and improve the nutrition state of the patients, and the acupuncture group was superior to the conventional group; the two methods both can effectively reduce APACHEⅡ score and improve the prognosis, while the acupuncture group was superior to the conventional group. Regardingthe death rate and enteral nutrition, the acupuncture group produced a higher comprehensive efficacy than the conventional group.

Objective To observe the effects of tacrolimus on blood glucose, insulin, expressions of protein phos-phatase 2A and P-AKT in rats in order to explore the mechanism of hyperglycemic action of tacrolimus. Methods Sixty male SD rats (body weight 89. 83 ±4. 44 g) were randomly divided into tacrolimus group (n =40) and control group (n=20). The rats in the tacrolimus group were administrated with tacrolimus 4 mg/kg daily. The rats in the control group were given the same amount of normal drinking water daily. The rat body weight, fasting blood glucose concentration and blood concentration of tacrolimus were measured monthly. All rats were killed at 5 months after the tacrolimus administra-tion. The serum insulin levels were detected by radioimmunoassay method. The expressions of PP2A and P-AKT in liver tissues were assessed by immunohistochemistry. Results After two months of administration, the blood glucose levels in the tacrolimus group were significantly higher than those in the control group. The HOMA-IR in tacrolimus group was signif- icantly higher than that in the control group P<0. 05 ) . ISI was significantly lower than that in the control group ( P<0. 05). Immunohistochemical examination showed that the expression of PP2A in hepatocytes in the tacrolimus group was increased compared with the control group, while expression of P-AKT in hepatocytes of the tacrolimus group was decreased than that in the control group. Conclusions Tacrolimus can induce necrosis of islet cells, decrease of the amount of islet cells and insulin secretion, decease of sensitivity to insulin, and increase the resistance to insulin, therefore, leading to in-crease the blood glucose level in rats. The expression of PP2A in hepatocytes in the tacrolimus group is increased, while the expression of P-AKT is decreased. Interfering of insulin signal transduction pathways may be involved in the hyperglyce-mic effects of tacrolimus.

Objective To investigate the effective route and proper method in transfecting gene into liver graft mediated by adeno-associated virus vector.Methods Three routes including hepatic artery,portal vein and hepatic artery+portal vein,and 3 methods,i.e.routine,circulation and clamping were employed for infusion.The best infusion route and method of gene transfection into liver graft were determined by observing the color change of liver and detecting liver function and transfoetion rate of liver cells.The safety of these methods was evaluated.Results In all the infusion procedures,the color of the liver grafts turned from red to white,no apparent color differenee of the livers and no enlargement nor mottling were observed under surgical microscope.The liver color was back to normal immediately after blood flow was restored.No significantly statistical differences of the ALT values were observed among all the groups(F=0.343,1.265,0.055,P＞0.05).Adeno-associated virus vectors coding for the enhanced green fluorescence protein(AAV2-EGFP)were successfully transfected into liver cells by the 3 infusion routes 1 week later,and the difierences of transfection rates via the 3 routes had no statistical significance(F=0.080,0.091,0.045,P＞0.05).The transfoction rate of AAV2-EGFP was the highest at any time points when using the clamping method,and then followed by circulation method and routine method,with statistical differenee(F=3.880,2.976,5.129,P＜0.05).The transfection rates of AAV2-EGFP were increased progressively and peaked at the 6th week,and then they were decreased gradually.Conclusions Infusion via hepatic artery is the effective route for gene transfection and clamping the vessels can elevate the transfection rate of AAV2-EGFP.All procedures were performed without detectable liver injury.The transfection of gene into liver graft mediated by adeno-associated virus vector is a slow and persistent process.

Objective To study vascular anatomy between the pancreatic head and duodenum,providing anatomy basis for performing surgery of pancreatic head,duodenum and distal common bile duct in surgical practice. Methods Anatomy study was performed in 30 formaldehyde fixed and 10 fresh bodies in reference to blood supply to duodenum,the distal common bile and Vater ampulla. Results The anterior and posterior pancreaticoduodenal arterial arcade gives off branches to descending and horizontal portion of the duodenum. The posterior superior pancreaticoduodenal artery goes to distal common bile duct. The papilla artery arising from the posterior superior pancreaticoduodenal artery goes to Vater ampulla. Conclusions The pancreaticoduodenal anterior and posterior arterial arcades are main arteries that give off branches to the descending and horizontal portion of the duodenum,distal common bile duct and the Vater ampulla,hence should be carefully protected in duodenum-preserving resection of the pancreatic head.