This article gives a brief account of the origin and development of pestle needle therapy, and its special acupoints, needling instruments and commonly used techniques, and explores the close relationship between pestle needle therapy and the traditional Chinese medical theory to seek more theory support of this therapy from traditional Chinese medicine. The article also summarizes clinical indications for pestle needle therapy and regularities in the practical application of this therapy to promote the inheritance and development of pestle needle therapy.

Objective To summarise the clinical experience on the treatment of aortic dissection with stent-graft. Methods From June 2005 to November 2008, 117 patients with aortic dissection underwent surgery with stented elephant trunk (CRONUS stent-graft)which was implanted through the aortic arch under deep hypothermic circulatory arrest, including Stanford A in 50 patients who underwent Bentall operation and total arch grafting with stented elephant trunk operation in 28, Wheat operation and total arch grafting with stented elephant trunk operation in 8, ascending aorta and total arch replacement with stented elephant trunk operation in 14 and Stanford B in 67 patients who all underwent stented elephant trunk operation. Results The location of the entry was in the ascending aorta in 35 patients, the aortic arch in 4, the proximal descending aorta in 78. Cardiopulmonary bypass time was ( 159 ±31 ) min, average cross clamp time was (95 ±23) min, and average selected cerebral perfusion and lowerbody arrest time was (27 ±8) min. The in-hospital mortality was 2.6% (3/117). One patient died of the hemorrhage shock, one died of multi-organ failure postoperatively and the third died of infective endocarditis. The complications included transient neurologic deficit in 11(9.4%), cerebrovascular accident in 6 (5. 1%, cerebral embolism in 2 and cerebral hemorrhage in 4, of which 5 cases were discharged from hospital. One case died of multiorgan failure 18 days after discharge owing to his family' s giving up treatment), hemorrhage of anastomose which was treated by reoperation in 5,hoarseness in 2, renal failure in 1. One case died of the cerebral hemorrhage after 4 months due to inappropriate anticoagulation during following up. Conclusion The treatment of the aortic dissection with stent-graft which was implanted into the descending aorta through aorta arch is safe, effective and feasible, which will be helpful to vascular reconstruction by accurately close subintimal rip and can streamline surgery with minimally invasive and less complications.

Objective It is controversial to the surgical treatment of the DeBakey I aortic dissection.The purpose of the study was to summarize the clinical experience on total arch replacement combined with implantation of stented elephant trunk into the descending aorta for DeBakey I aortic dissection.Methods From June 2005 to March 2008,41 consecutive patients with acute(in 31)or chronic(in 10)DeBakey I aortic dissection underwent total arch replacement combined with implantation of stented elephant trunk into the descending aorta.The mean age was 57(27～76)years.Thirty-two patients were male.The procedure was performed under deep hypothermic circulatory arrest and selected cerebral perfusion.The stented elephant trunk was implanted through the aortic arch under deep hypothermic circulatory arrest.The stented elephant trunk was an 8～10 cm long self-expandable graft.Concomitant procedures included Bentall operation and total arch replacement in 24,Wheat operation and total arch replacement in 6,ascending aorta and total arch replacement in 11.Computed tomography was performed in every patient before discharge to evaluate the postoperative outcomes of the procedure.Results Cardiopulmonary bypass time was(168±32)min.The cross clamp time was(109±24)min and selective cerebral perfusion and the lowerbody circulatory arrest time wsa(31±11)min.The in-hospital mortality was 4.9%(2/41).One patient died of hemorrhagic shock and another died of multi-organ failure postoperatively.Fourteen cases suffered complications and 12 cases were cured.One case died of the cerebral hemorrhage after 4 months due to inappropriate anticoagulation during follow up.Conclusion Ascending aorta and total aortic arch replacement combined with implantation of stented trunk into descending aorta is a safe,effective and feasible way in closing the residual false lumen of the descending aorta with a low morbidity and mortality.This procedure might contribute to a better long-term outcomes of DeBakey I aortic dissection.

Objective To observe the changes of urine microalbumin (mAlb), renal function and intima-media thickness(IMT) of the carotid artery in prehypertensive patients and investigate whether there are related target organ damage. Methods From August 2009 to May 2010,one hundred and eighty patients were recruited into the study and divided into 3 groups according to the 2005 revised edition of guideline for prevention and treatment of hypertension in China: Sixty normotensive subjects ( NT group,41 males, 19 females,mean age [54. 6 ± 12. 3] years old) ;Sixty prehypertensive patients( PH group,32 males,28 females,mean age [57.0 ± 12.7] years old) and 60 hypertensive patients ( EH group, 28 males, 32 females, mean age [65.0 ±12. 1] years old). Urine mAlb, serum creatinine(Cr) and IMT of the carotid artery were measured and compared among the three groups. The relationships between prehypertension and urine mAlb,serum Cr, IMT of the carotid artery were analyzed. Results In the NT group, PH group and EH group, the urine mAlb concentrations were ( 15.3 ± 7.5 ) mg/L, ( 24. 6 ± 10. 7 ) mg/L and ( 37.3 ± 20. 4) mg/L respectively ;serum Cr were ( 68.0 ± 16. 5 )μmol/L, (81.9 ± 14.9)μmol/L and (95.8 ± 22.5)μmol/L respectively; IMT of the carotid artery were ( 1.46 ± 0. 67 ) mm, ( 1.79 ± 0. 74 ) mm and( 2. 34 ± 0. 78 ) mm respectively. Urine mAlb, serum Cr and IMT of the carotid artery were significantly higher in the PH group and EH group when compared to NT group ( P ＜0. 05 or 0. 01 ); and in the EH group these indices were also significantly higher than those in the PH group( P ＜0. 01 ). Multiple linear regression analysis showed that after adjusted age, body mass index (BMI), blood pressure( BP), serum lipid and serum glucose, in the PH group,the standard partial regression coefficients of correlation between urine mAlb and systolic blood pressure (SBP), diastolic blood pressure(DBP) and serum glucose were 0. 279,0. 259 and 0. 360 respectively ( P = 0. 012, 0. 043 and ＜ 0. 001 ); the standard partial regression coefficients of correlation between serum Cr and SBP, DBP and serum glucose were 0. 317,0. 257 and 0. 377 respectively ( P = 0. 006,0. 049 and ＜ 0. 001 ). The standard partial regression coefficients of correlation between IMT of the carotid artery and age, SBP, DBP, total cholesterol and serum glucose were 0. 381,0. 375,0. 263,0. 265 and 0. 372 respectively( P ＜ 0. 001, ＜ 0. 001, = 0. 033,0. 021 and ＜ 0. 001 ). In the EH group, the standard partial regression coefficients of correlation between urine mAlb and SBP, DBP and serum glucose were 0. 378,0. 258 and 0. 283 respectively( P ＜ 0. 001, = 0. 046, and 0. 009); the standard partial regression coefficients of correlation between serum Cr and SBP, DBP and serum glucose were 0. 294,0. 261 and 0. 464respectively (P =0. 008,0. 042 and ＜0. 001 ) ;the standard partial regression coefficients of correlation between IMT of the carotid artery and age, SBP, high density lipoprotein cholesterol and serum glucose were 0. 262,0. 264, -0. 374 and 0. 306 respectively ( P = 0. 035,0. 023, ＜ 0. 001 and 0. 007 ). We found that both urine mAlb and serum Cr were significantly associated with BP and serum glucose; IMT of the carotid artery was significantly associated with age, BP, serum lipid and serum glucose. Conclusion Urine mAlb, serum Cr andIMT of the carotid artery increased in prehypertensive patients, and these indices were significantly associatedwith the level of the BP. These data indicated there were related target organ damage occurred in prehypertensive patients,the BP level was the risk factor that increased urine mAlb,serum Cr and IMT of the carotid artery.

The structure and 5-HT immunoreactivity in the brain and suboesophageal ganglion of three beetles, Ambrostoma quadriimpressum, Henosepilachna vigintioctomaculata and Oxycetonia jucunda, were first studied by means of colophony-paraffin embedding serial section technique and strepteavidin-peroxidase immunohistochemical method. The results showed that the brains of these three taxonomically closely related beetles were remarkably different in composition and size. Mushroom bodies and antennal lobes in Oxycetonia jucunda were conspicuous. Calyces and lobes of the mushroom bodies.were much developed. In contrast, calyces of Ambrostoma quadriimpressum and Henosepilachna vigintioctomaculata were extremely undeveloped. However, the postretinal fibres and circumpharyngeal nerves of Ambrostoma quadriimpressum were highly developed. In the three beetles, 5-HT immunoreactivity was present in all neuropils of the brain and the suboesophageal ganglion. The pattern of 5-HT immunoreactivity and the localization of immunoreactive somata which often clustered into groups were similar among these beetles, while the immunoreactivity intensity was distinct, especially in the lamina. The results suggest that the three beetles have given rise to adaptive radiation under the evolutionary pressure because of the long-term different life styles and living environments in which the taxonomic status of Ambrostoma quadriimpressum is relatively low. The similarity of the pattern of 5-HT immunoreactivity and localization of some positive somata among the three beetles raise the possibility that 5-HT seemes to serve similar physiological function in different insects. Furthermore, 5-HT might be involved in modulating the ingestion by regulating muscular activity and visual sensitivity.

Objective To evaluate the accuracy and feasibility of primary total knee arthroplasty (TKA) assisted by the self-made extramedullary osteotomy template on distal femur alignment.Methods We retrospectively analyzed the clinical data of 40 patients with osteoarthritis or rheumatoid undergoing primary TKA from September 2015 to March 2016.All patients were divided into two groups,extramedullary group and intramedullary group.Extramedullary group had 20 patients (4 males and 16 females) aged 65.1±6.9 years (range 51-75).Intramedullary group had 20 patients (3 males and 17 females) aged 65.7±7.9 years (range 48-75).The blood loss volume,drainage in operation,postoperative range of motion (ROM) at 1 week and 2 weeks,deviation between the ideal value and preoperative hip-knee-ankle (HKA) angle,coronal and sagittal angle of the femoral prosthesis were compared within the two groups.Results The age,gender,body mass index,deviation between the ideal value and preoperative HKA angle,Hospital for Special Surgery (HSS) scoring system,ROM of knee were not significantly different between the two groups.The operation time was 97.4± 14.0 min in extramedullary group and 111.7±9.9 min in intramedullary group (P ＜ 0.05).The blood loss was 71.8± 14.0 ml in extramedullary group and 111.7± 10.0 ml in intramedullary group (P ＜ 0.05),while the drainage volume was 167.0±74.5 ml in extramedullary group and 243.2±91.6 ml in intramedullary group (P＜ 0.05).The postoperative mean deviation of the HKA angle in extramedullary group (2.37°±0.73°) was smaller than that in intramedullary group (3.26°±1.42°).Furthermore,the coronal alignment of the femoral prosthesis in extramedullary group (89.70°±1.91°) was larger than that in intramedullary group (87.69°±2.39°).The sagittal alignment of the femoral prosthesis in extramedullary group (90.03°±2.62°) was also significantly larger than that in intramedullary group (88.07°±2.43°,P ＜ 0.05).The postoperative ROM of knee at 1 and 2 week in the extramedullary group were 101.75°±7.48° and 114.00°±7.88° respectively,while those in the intramedullary group were 101.25°±8.41° and 114.25°±8.78°.There was no statistically different between the two groups.There was no intraoperative and postoperative early complications reported in the two groups.Conclusion Although the primary TKA assisted by the selfmade extramedullary osteotomy template on distal femur alignment can shorten operation time,decrease the blood loss and increase the accuracy of coronal and sagittal alignment,the HSS score and ROM of knee are similar as intramedullary method.

Objective:To establish the quality standard for Shenyan Ⅱ granules. Methods:The characteristics of Folium Pyrrosiae were identified by microscopy. The three herbs in the preparation,rehmannia,madder and thistle were identified by TLC qualitatively. The content of ginsenoside in American ginseng was determined by HPLC. Chromatographic separation was carried out by using a WONDER CRACT ODS-2(150 mm × 46 mm,5 μm)column. The mobile phase consisted of acetonitrile-0. 1% phosphoric acid(28 ∶72)with gradient elution at a flow rate of 1. 0 ml·min -1 ,and the injection volume was 10 μl. The detection wavelength and the column temperature was 203 nm and 40 ℃,respectively. Results:The spots in TLC were clear without any interference. The linear range of ginsenoside was 38. 9- 194. 5 μg·ml -1(r = 0. 999 3). The average recovery was 98. 3% and RSD was 1. 9%(n = 6). Conclusion:The method is simple and highly specific with good repeatability,which can be used as the quality control method for Shenyan Ⅱ granules.

Objective:To establish the quality standard for Shule capsules. Methods: The microscopic characteristic identifica-tion of Figwort and Radix bupleuri was performed under a microscope. The qualitative identification of fritillary, andrographispaniculata and polygonumbistorta was studied by TLC. The content of salvianolic acid B in Salvia miltiorrhiza was determined by HPLC. The chro-matographic separation was carried out by using a phenomenex synergi 4 hydro-RP 80A (250 mm × 4. 6 mm) column. The mobile phase consisted of acetonitrile-methanol-formic acid-water(10 :30 :59 :1)with gradient elution at a flow rate of 1. 0 ml·min-1, and the injection volume was 10 μl . The detection wavelength and the column temperature was 286 nm and 20 ℃, respectively. Results:The microscopic characteristics were obvious. The spots in TLC were clear without any interference. The linear range was 10. 001-100. 007 μg·ml-1(r=1. 0000). The average recovery was 99. 3% with RSD of 1. 8% (n=6). Conclusion:The method is simple with high specificity and good repeatability, which can be used as the quality control method for Shule capsules.

Objective:To develop a recombinant protein vaccine based on KPC-2, a drug resistance target in Klebsiella pneumoniae, and evaluate its immunogenicity, protective efficacy and mechanism in a mouse model of pneumonia. Methods:KPC-2 was expressed in Escherichia coli and purified using GST affinity chromatography. A recombinant protein vaccine was prepared with KPC-2 and used to immunize New Zealand rabbits through subcutaneous injection. Serum samples were isolated from cardiac blood and Protein G chromatography was used to purify polyclonal antibodies against KPC-2. Opsonophagocytic killing assay was used to assess the bactericidal activity of the polyclonal antibodies in vitro. Female BALB/c mice were immunized three times with the recombinant protein vaccine, and the titers of specific IgG antibodies in serum were measured by indirect ELISA. One week after the last vaccination, the mice were infected with Klebsiella pneumoniae strain SRT through tracheal intubation, and received a single intravenous dose of meropenem (0.1 mg) 1 h later. The protective efficacy of the KPC-2 recombinant protein vaccine was evaluated by comparing the survival rates, bacterial colonization and histopathological changes between vaccine group and adjuvant group as well as the survival rates between meropenem group and normal saline group. Moreover, the protective efficacy of polyclonal antibodies against KPC-2 was evaluated through passive immunization. Results:The level of specific IgG antibodies in serum was significantly higher in the vaccine group than in the adjuvant group ( t=4.325, P<0.05). The survival rate in the vaccine group was also higher than that of the adjuvant group [70% (7/10) vs 10% (1/10), P<0.05]. Furthermore, lung inflammation was less severe and bacterial burden was reduced in the vaccine group as compared with those of the control group ( t=3.127, P<0.05). Both active and passive vaccination strategies demonstrated strong protective efficacy against Klebsiella pneumoniae infection, and had a synergistic effect when used in combination with antibiotic therapy. The polyclonal antibodies against KPC-2 had bactericidal activity in vitro ( t=5.427, P<0.05). Conclusions:The prepared KPC-2 vaccine has better immunogenicity and protective efficacy. It can induce strong humoral immune responses. This study suggest that drug resistance target may be used as a candidate antigen for future vaccine development.

Objective:To automatically synthesize Al 18F-1, 4, 7-triazacyclononane-1, 4, 7-triacetic acid (NOTA)-fibroblast activation protein inhibitor (FAPI)-04, perform PET/CT imaging in vivo, and evaluate its diagnostic efficacy on tumors. Methods:Al 18F-NOTA-FAPI-04 was produced in All-in-one automatic synthesis module and its quality control was conducted by high performance liquid chromatography (HPLC) equipped with a radioactive detector. Al 18F-NOTA-FAPI-04 PET/CT imaging was performed in normal BALB/c mice ( n=3) and 4T1 breast cancer models ( n=3) to determine its biodistribution. Then Al 18F-NOTA-FAPI-04 and 18F-FDG PET/CT imaging were performed in a hepatocellular carcinoma patient (male, 51 years old). Results:The synthesis time of Al 18F-NOTA-FAPI-04 was about 35 min, and the radiochemical yield was (25.2±1.9)% (attenuation correction, n=3). The product was colorless transparent solution with pH value of 7.0-7.5, and the specific activity was (46.11±3.07) GBq/μmol (attenuation correction, n=3). The radiochemical purity was above 99.0% and was still above 98.0% at room temperature after 6 h. PET/CT imaging in mice showed that physiological uptake of Al 18F-NOTA-FAPI-04 was mainly in biliary system and bladder, and Al 18F-NOTA-FAPI-04 highly concentrated in tumor xenografts. PET/CT imaging in the patient showed that Al 18F-NOTA-FAPI-04 obtained high tumor background ratio (TBR) values of 4.1, 8.9, 5.4, 4.8, 2.2 in parasternal lymph nodes, anterior diaphragmatic lymph nodes, hilar lymph nodes, pancreaticoduodenal ligament lymph nodes, abdominal aortic lymph nodes, respectively, while TBR values were 1.0, 2.8, 5.0, 2.1, 1.1 by 18F-FDG. Conclusions:Al 18F-NOTA-FAPI-04 can be synthesized with short time, high radiochemical yield and good stability using All-in-one module. Al 18F-NOTA-FAPI-04 PET/CT imaging has high contrast and excellent diagnostic efficacy on tumors.