The primary effect is out of the conception of the psychology, which emphasizes the importance of the initial stimuli. Although the primary effect of acupuncture and moxibustion happens and is applied constantly in clinic, the conception, connotation and application of it had not been explained definitely yet. The writers attempt to explain the characteristics, theoretic significance and clinical values of the clinical primary, effect of acupuncture and moxibustion based on the conception of it so as to provide a certain of reference to the study on the clinical primary effect of acupuncture and moxibustion.
Acupuncture Therapy ; psychology ; Humans ; Moxibustion ; psychology ; Treatment Outcome

Objective To investigate the effect and the mechanism of intragastric administration of gentamicin and lactulose on stress ulcer in rats with obstructive jaundice.Methods Forty male Wistar rats were divided into 4 groups: Jaundice(Ligation of the bile duct) and intragastric administration of gentamicin and lactulose(group A),jaundice with intragastric glucose(group B),sham operation with intragastris gentamicin and lactulose(group C);and sham operation with intragastric glucose(group D).Two weeks after the operation,the respective intragastric administration was given for 7 days,and then the water immersion and restraint stress induction procedures were performed in the 4 groups.Endotoxemia levels in portal vein were measured by the Limulus test and the ulcer index was calculated.Results Group A showed significantly lower ulcer index and lower level of endotoxemia compared to group B,while the levels of endotoxemia and ulcer index in group B were increased,and group C and D also showed lower ulcer index and lower level of endotoxemia.Conclusions Endotoxemia is an important aggravating factor for stress ulcer in obstructive jaundice.Intragastric administration of lactulose and gentamicin can decrease the level of endotoxemia which is beneficial to reduce the incidence of stress ulcer in rats with obstructive jaundice.

Objective To explore the clinical value of laparoscopy in the treatment of pancreatic diseases.Methods Twelve patients with pancreatic diseases received laparoscopic surgery.Among which 9 patients with cystic diseases,4 cases underwent laparoscopic spleen-preserving distal pancreatectomy,2 cases received distal pancreatectomy and splenectomy,and 3 cases underwent pancreatic cystectomy.Laparoscopic insulinoma enucleation was performed for 2 patients who suffered from insulinoma.Besides,a patient suffered from pancreatic carcinoma recurrence received left thoracoscopic splanchnicectomy.Results All the operations were accomplished successfully,including 8 total laparoscopic surgery and 4 laparoscopic assisted surgery.The average operative time was 225 min(range 100-420 min),and the average volume of blood loss was 80 ml(range 2-150 ml).Pancreatic fistula was observed in 1 patient which was cured by conservative therapy.The postoperative average hospital stay was 7.2 d(range 5-13 d).The patient with recurrent pancreatic carcinoma survived for 6 months after operation and the pain-killing effect was satisfactory.With a follow-up of 10-36 months for other patients,the surgical effects were ideal and no recurrence occurred.Conclusion With the advantages of less trauma,less pain,fast recovery,and low morbidity rate,laparoscopic surgery is an effective and safe method for the treatment of pancreatic diseases,and thus may be widely used in the clinical settings in the future.

OBJECTIVE：To study the therapeutic effect and safety of domestic tolterodine tartrate in treating patients with urinary bladder overactivity.METHODS：56 cases of bladder overactivity were divided into two groups randomly：tolterodine and control(oxybutynin)group.The course of treatment was 6 weeks.RESULTS：The effect of tolterodine in treatment group was comparable to that of oxybutynin in control group,however,the adverse reactions in oxybutynin group were more common than those in tolterodine group.CONCLUSION：Tolterodine is a suitable drug to treat bladder overactivity.

OBJECTIVETo recognize the characteristics of desmoplastic small round cell tumor (DSRCT) and improve the standard of diagnosis.

METHODSWe retrospectively reviewed the clinical data on the treatment of 2 patients with DSRCT in terms of their conditions, tissue sources, pathologic characteristics, immunohistochemical methods, clinical manifestation, diagnosis, treatment and prognosis.

RESULTSClinical manifestations were complicated. The 2 patients were mis diagnosed before operation. Their tumors consisted of irregular nests of small and round cells, with nuclear hyperchromatism and scant cytoplasm embedded in a plenty of fibrous connective tissues. The edge of the nest was clear, with different sizes and shapes. Immunohistochemically, the 2 patients were positive for CK or EMA, NSE, des and vim of the epithelium, nerve, muscle and interstitial. They died 9 months after operation.

CONCLUSIONSThe tumor may occur in the abdomen, pelvic cavity and other sites, with different clinical manifestations. Routine examination should be replaced by immunohistochemical test for correct diagnosis of the tumor. Prognosis of most patients is not good.

Adolescent ; Carcinoma, Small Cell ; diagnosis ; Female ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Neoplasms, Connective Tissue ; diagnosis ; Retrospective Studies

ObjectiveTo evaluate the safety and effectiveness of fast track surgery (FTS) in l aparoscopy-assisted radical distal gastrectomy (LADG) for gastric cancer.MethodsSixty-one patientswith distal gastric cancer were randomly divided into three groups:FTS + LADG group (n =19) undergoing LADG and FTS treatments,LADG group (n =22) undergoing LADG and traditional perioperative cares,and FTS + ODG ( open distal gastrectomy) group ( n =21 ) undergoing ODG and FTS treatments.FTS treatments included avoidance of mechanical bowel cleansing,restrictive perioperative intravenous infusion,early ambulation,early enteral nutrition.The age,sex,body weight,anastomotic mode,number of lymph node dissected,and tumor stage,serum albumin (ALB),blood urea nitrogen (BUN),C-reaction protein (CRP),flatus time,postoperative hospital stay,medical cost,and postoperative complications were compared between three groups. ResultsThe level of ALB in FTS + LADG group were higher than in LADG group at the 4th and 7th day after surgery ( P ＜ 0.05,P ＜ 0.01 ).Compared to LADG group,the variation of ALB from preoperation to 4th day after surgery in FTS + LADG group and FTS + ODG group was significant( P ＜ 0.01,P ＜ 0.05 ).CRP level between FTS + LADG group and FTS + ODG group were different significantly at 4th and 7th day after surgery ( P ＜ 0.05,P ＜ 0.05).FTS + LADG group has earlier recovery of gastrointestinal peristalsis than other two groups ( P ＜ 0.05,P ＜ 0.05 ).The medical cost in FTS + LADG group was less than in LADG group ( P =0.003 ),but higher than in FTS + ODG group (P ＜0.01 ).ConclusionsThe practice of FTS in LADG was safe,effective,improves nutritional status,eases stress reaction,accelerates gastrointestinal peristalsis and postoperative rehabilitation.

In order to optimize acupuncture treatment protocol for functional defecation disorders, literature during past 20 years is reviewed, and factors which influences acupuncture therapeutic effect are analyzed from aspects of acupoint, acupuncture technique, etc. As for the selection of acupoint, more attention should be paid on the use of Baliao, especially Zhongliao (BL 33) and Xialiao (BL 34); when Baliao is deeply needled, it is essential to acquire scientific technique. The relationship between acupuncture parameter (including electroacupuncture waveform and frequency), acupuncture techniques (including reinforcing and reducing technique, quantity of stimulation, etc. ) and acupuncture efficacy is complicated, and the scientific values of present research conclusion are in need, of further improvement. The diagnosis and treatment awareness on types of functional defecation should be strengthened, and the mental health of the constipation patients should be concerned. The combination of acupuncture and biofeedback training can have a synergistic effect, which is benefit to achieve a better long-term effect. Based on this, acupuncture treatment protocol for functional defecation disorders can be optimized to further improve the efficacy.
Acupuncture Points ; Acupuncture Therapy ; methods ; Constipation ; physiopathology ; therapy ; Defecation ; Female ; Humans ; Male

OBJECTIVETo observe the repair of cleft palate (CP) bone defect under the application of distraction osteogenesis (DO); to investigate the correction mechanism in thin bone of palatal shelf and to search a possible new treatment approach for repair of CP.

METHODS14 cats were assigned randomly to 3 groups: (1) Empty control, 2 cats unoperated with euthanasia at the end of 2 weeks; (2) Experimental control, 2 cats underwent 8 mm x 18 mm palatal osteoectomy in saggital direction as the experimental model of CP with euthanasia in 6 weeks; (3) Experimental group, 10 cats were performed the same palatal osteoectomy as group (2), the newly designed and individual manufactured intraoral distractors were fixed to teeth by brackets and to bilateral palate bone across the defect with titanium miniscrews. 4 weeks later the transport disc (TD) osteotomy were performed and gradual distraction was started after 6 days latency period at the rate of 0.4 mm x 2/day till the TD reached the opposite edge of the CP. Roentgenographic, gross meterage and ultrastructural observation were performed 2, 4, 6, 8, 12 weeks after completion of distraction.

RESULTSAll the examinations revealed the TD recombination to the opposite bone edge of the CP, simultaneously, the proportional expansion of overlay mucoperiosteal flap was achieved. The bone defect were filled with de move osteogenesis. Roentgenographically, the new bone mineralization was along the DO vector, developed from the bone cut edges bilaterally to the central translucent zone until turned to thin fissure. Comparison of the plaster casts showed no change in the occlusion or dentomaxillofacial framework.

CONCLUSIONSThe intraoral distractor is able to get both effective distraction and steady fixation. The examination results suggest that the CP bone and soft tissue defect could be repaired and acheived functional reconstruction under DO, which could be a new treatment approach for repair of CP.

Animals ; Cats ; Cleft Palate ; surgery ; Disease Models, Animal ; Osteogenesis, Distraction ; methods

Objective To investigate the clinical features and treatment of solid pseudopapillary neoplasm (SPN) of the pancreas.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 69 patients with SPN of the pancreas who were admitted to the Qilu Hospital of Shandong University from January 2012 to July 2017 were collected.Serum tumor markers detection,enhanced computed tomography (CT) and magnetic resonance imaging (MRI) of abdomen were carried out preoperatively for all the patients,and a part of the patients received endoscopic ultrasonography (EUS).Surgery plans were formulated after completion of examinations.Observation indicators:(1) clinical features;(2) treatment situation;(3) results of pathological examination;(4)follow-up.All the patients were followed up via outpatient examination and telephone interview to detect the survival and tumor recurrence and metastasis till July 2017.Measurement data with normal distribution were presented by (x)±s and were compared by Student's t test.Count data were compared by chi-square test.Results (1) Clinical features:① epidemiologic features:the ratio of male to female was 1∶5.9;patients were aged between 9 and 65 years,including 40 under 30 years and 29 above or equal to 30 years.The onset age was (34± 15)years for male patients and (28 ± 11)years for female patients,respectively,with no statistically significant difference (t=1.364,P＞0.05).Of 69 patients,SPN was located at pancreatic uncinate process in 25 patients,at neck of pancreas in 12 patients,body and tail of pancreas in 32 patients.② Medical history:history of acute or chronic pancreatitis and abdominal trauma were denied by all the 69 patients.③ Clinical manifestation:26 patients had no obvious symptoms and were detected by physical examination;31 patients had discomfort in upper abdomen,nausea and vomiting;other patients were admitted to the hospital because of upper abdominal mass (10 patients),jaundice (1 patient) or nausea,constipation (1 patient).④ Laboratory examination:the levels of preoperative carcinoembryonic antigen (CEA) and CA19-9 were normal.⑤ Imaging examination:plane scan of the CT examination showed round or round-like low-density shadows in the 69 patients,including 51 of cystic solid lesion,13 of solid lesion and 5 of cystic lesion.Complete capsules were observed in 64 patients,blurred boundary between pancreas and adjacent viscera in 5 patients,calcified foci in the pancreatic parenchyma and capsules in 14 patients.Ten patients received MRI examination,and the T1-weighted images showed equal or slightly lower signal,T2-weighted images showed slightly higher signal in the plane scan,and T1-weighted and T2-weighted images of the tumor capsule showed continuous or non-continuous ring-like signal.The results of enhanced scan showed slightly heterogeneous enhancement of the capsule and the parenchyma of the pancreas in the arterial phase,and progressive enhancement in the venous and delayed phase,while the enhancement degree was lower than that of the normal pancreas parenchyma.The parenchyma was cloud-,papillaor mural nodule-like enhanced.Obvious enhancement was observed in capsule while not in the cystic components.The boundaries of the tumors in 5 patients were clear under EUS.Hypo-,iso-and hyperechoic regions were found in the masses,and the masses were confirmed as cyst-solidary type.Obvious calcified foci were found in 1 patient.(2) Treatment outcome:twenty-seven patients received laparoscopic surgery,including tumor expiration in 13 patients,distal pancreatectomy with preservation of spleen in 8 patients,distal pancreatectomy combined with splenectomy in 2 patients,middle pancreatectomy in 2 patients,pancreaticoduodenectomy with preservation of pylorus in 1 patient,pancreatic head resection with preservation of duodenum under the assistance of laparoscopy in 1 patient.Forty-two patients received open surgery,including tumor expiration in 12 patients,distal pancreateetomy with preservation of spleen in 10 patients,distal pancreatectomy combined with spleneetomy in 6 patients,middle pancreatectomy in 5 patients,pancreaticoduodenectomy in 7 patients (with preservation of pylorus in 2 patients) and pancreatic head resection combined with preservation of duodenum in 1 patient.One patient with SPN + hepatic metastasis received distal pancreatectomy+ metastatic foci resection in the lesser omental bursa,and then followed by radiofrequency ablation in the hepatic metastatic foci.Postoperative complications:21 of 69patients had postoperative complications,including 17 intestinal fistulas,2 abdominal bleedings,1 incomplete obstruction,1 pleural effusion + atelectasis,and all of them were cured by symptomatic treatment.(3)Pathological examination:the resection margins of 69 patients were negative.The mean diameter of the tumor was (7±4) cm (21 patients with tumor diameter ＜ 5 cm,and 48 with tumor diameter ≥5 cm).The tumor diameters of 4 in 10 male patients were above or equal to 5 cm,and the number was 44 in 59 female patients,with statistically significant difference (x2 =4.828,P＜0.05).The tumor diameters of 32 in 40 patients who aged under 30 years were above or equal to 5 cm,and the number was 16 in 29 patients who were aged above or equal to 30 years,with statistically significant difference (x2=4.895,P＜0.05).Solid,pseudo-papillary and cystic regions in the SPN tissues were seen under the light microscope.Tumor cells were surrounded the blood vessels and were arranged in the nest or sheet shape in the solid region;blood vessels were surrounded by one or multiple layers of tumor cells in the axis or pseudopapillary shape in the pseudopapillary region;large amount of mucus and clusters of blood cells were seen in the cystic regions.The result of immunohistochemistry showed that the positive rates of α1-antitrypsin,vimentin,β-catenin,progesterone receptor,CD10,synaptophysin and chromogranin A were 100.0％ (39/39),96.6％ (28/29),95.7％ (45/47),94.4％ (51/54),92.5％ (49/53),72.9％ (35/48) and 5.6％ (3/54),respectively.(4) Follow-up:63 of 69 patients were followed up for 1-68 months,with median time of 29 months.No SPN recurrence or metastasis was detected.One patient died of lung cancer at postoperative month 35 and other patients survived well.Conclusions SPN of pancreas is mostly detected in young female patients,and it could be solid or cystic.Abdominal enhanced CT or MRI examination could clarify the diagnosis.EUS-fine needle aspiration examination could provide pathological evidence for definitive diagnosis.Typical cellular morphology and pseudopapillary regions may provide hints for the diagnosis of SPN,and the diagnosis could be clarified when combined with the detection of vimentin,α 1-antitrypsin or other indexes.Complete resection of SPN and ensure negative resection margin are fundamental principles of treatment.

The standard of YY/T 0481-2004 Medical diagnostic X-ray equipment-Radiation conditions for use in the determination and characteristics has been revised and replaced in 2012. This paper first introduces the key technical problems to be solved in establishing standard radiation quality and radiation conditions by comparing the main changes of the two versions standards, including the expression of radiation quality and radiation conditions, the measurement of X-ray tube voltage, and the measuring of the practical peak voltage. Then it introduces a procedure for establishing standard radiation quality and radiation conditions.
Radiation Dosage ; Radiography ; Reference Standards