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.

For patients with malignant pancreatic cancer combined with vascular invasion,radical pancreaticoduodenectomy with vascular resection and anastomosis is the treatment of choice.Because this procedure is difficult to manage and with high risks,it is a great challenge to surgeons.A 50-year old patient with pancreatic head cancer whose portal vein and superior mesenteric vein were involved received radical pancreaticoduodenectomy in the Second Affiliated Hospital of Harbin Medical University.In the surgery,the tumor and its surrounding tissues were dissected,and then the portal vein and splenic vein were reconstructed.The patient was discharged at the 10th day after the surgery with favorable prognosis.

Objective Previous study had shown that signal transduction was changed when Hela cells were transfected with HLA-B27gene.An increase of monocyte chemotactic protein-1(MCP-1)of Hela cells was observed.To determine the role of MCP in the pathogenesis of ankylosing spondylitis(AS),expression of MCP-1,2,3and4in peripheral blood mononuclear cells(PBMC),synovial fluid mononuclear cells(SFMC)and synovial tis-sues of AS patients were tested.Methods Gene expression profiles of PBMC from AS patients and healthy volun-teers were determined by cDNA microarray with1176target gene filter.The differentiated expressed gene MCP-1in PBMC,SFMC and synovial tissue of AS patients were confirmed by semi-quantitative RT-PCR.Results The gene expression profile of SFMC of AS patients was significantly different from those of PBMC from AS and PBMC from healthy volunteers.The MCP-1level was positively correlated with MCP-3(r=0.76,P=0.03).The expressions of MCP-1were higher in synovial tissues of AS than those of healthy volunteers(P=0.0035).MCP-1levels in monocytes of AS patients and control subjects were increased after LPS stimulation for4hours.Conclusions There is increased expression of MCP-1in SFMC and synovial tissue of AS patients.The results indicate that MCP-1may play a potential key role in the homing of cells migrating from blood to joint and in the pathogenesis of joint inflammation in AS patients.

Objective To evaluate the clinical parameters that can predict whether a patient can get significant improvement at the 10th week,or whether a patient can have an extended length of remission after discontinuing the infusion in ankylosing spondylitis(AS)patients treated with three standard infusions of in- fliximab.Methods Sixty-three AS patients were given three infusions of 5 mg/kg of infliximab at week 0,2 and 6;and were evaluated serially before each infusion and week 10.Afterwards.patients were followed by telephone interview until their disease activity was≥60% of the baseline level.At that point,disease was con- sidered to relapse.Clinical parameters at baseline as well as at week 2 were used to identify factors which might predict an improvement at week 10,or predict a delayed relapse.A predictor was regarded as being use- ful if the area under the curve(AUC)more than 0.75 when analyzed by receiver operator calculations(ROC). Results No parameters at baseline have sufficient predictive value.However,ASAS20(Assessment in Anky- losing Spondylitis International working Group criteria)at week 2 predicts improvement at week 10.and also duration of remission after discontinuing the infliximab at week 6.Conclusion The response to one pulse of infliximab is the best predictor of subsequent response as well as rate of relapse after discontinuing the inflix- imab.