An analysis of the results of examination of diagnostics teaching in the middle of the semester of 2008 grade is made to discuss the pnoblems existing in teaching and learning so as to improve the teaching quality.

BACKGROUND: Geshu (BL 17) is one of eight influential points of blood, acting on tonifying blood, nourishing blood, activating blood circulation and resolving stasis.OBJECTIVE: To explore the effect of Geshu (BL 17) on activating blood circulation and resolving stasis in blood stagnation syndrome with acupuncture.DESIGN: Randomized controlled and normal controlled observations were designed.SETTING: Union Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology.PARTICIPANTS: Totally 65 cases of blood stagnation syndrome were selected from inpatients in Department of Acupuncture and Moxibustion in Union Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology.METHODS: Totally 65 cases were randomized into experiment group (33cases) and the control (32 cases). In the control, the patent Chinese drug,longxuejie was administrated orally for activating blood circulation and resolving stasis, 4 tablets/time, 3 times/day, 15 days made 1 course of treatment. In experiment group, Geshu (BL 17) was localized bilaterally; after routine sterilization on the points, a filiform needle, 25 mm in length was inserted and manipulated with even technique after arrival of qi for 5 minutes. In 15 minutes of needle retaining, the needle was manipulated for another 5 minutes and retained for 10 minutes, and then, the needle was withdrawn. The treatment was given once a day. Radioimmunoassay (RIA)was applied to determine the levels of 6-K-P and thromboxane B2 (TXB2)in plasma. Criteria on clinical therapeutic effects: Being cured is determined by slight red tongue, retarded and forceful pulse, disappearance of limb pain, skin and mucosal ecchymosis and dysmenorrhea, basic recovery of motor function in hemiplegia and disappearance of numbness. Being effective is by dark red tongue, slightly hesitant pulse, alleviation of limb pain, reducing of skin and mucosal ecchymosis, alleviation of dysmenorrhea, partial recovery of motor function in hemiplegia and alleviation of numbness. No effect is by none of any change of clinical symptoms in comparison before and after treatment.MAIN OUTCOME MEASURES: ① Observation of therapeutic effects between two groups. ② Observation of plasma 6-K-P and TXB2 levels and 6-K-P/TXB2RESULTS: Totally 65 cases were all in the result analysis. ① Observation of therapeutic effects between two groups: The therapeutic effect in experiment group was higher remarkably than that in the control [be cured:(15,10); be effective: (13,11)]. ② Comparison of plasma 6-K-P levels: In experiment group, it was higher remarkably after treatment compared with that before treatment [(159.28±16.48), (117.25±16.47) μg/L, P ＜ 0.05]. In the control, it was higher remarkably after treatment compared with that before treatment [(133.51±13.97), (114.64±16.39) μg/L, P ＜ 0.05]. ③Comparison of plasma TXB2 level: In experiment group, it was lower remarkably after treatment compared with that before treatment [(98.21±11.38), (110.45±1067) μg/L, P ＜ 0.05]. In the control, it was lower remarkably after treatment compared with that before treatment [(101.15 ±12.14), (109.21±11.58) μg/L, P ＜ 0.05]. ④ Plasma 6-K-P/TXB2: In experiment group, it was higher remarkably after treatment compared with that before treatment (1.621±0.203, 1.101±0.316, P ＜ 0.05). In the control,it was higher remarkably after treatment compared with that before treatment (1.322±0.216, 1.234±0.305, P ＜ 0.05).CONCLUSION: Acupuncture on Geshu (BL 17) increases 6-K-P level and 6-K-P/TXB2 and reduces TXB2 level. It is explained that acupuncture on Geshu (BL 17) regulates imbalance of PGI2-TXA2 system in blood stagnation syndrome so that the blood circulation is activated and stasis is resolved.

Objective To observe the BMD threshold of hip fracture in the elderly, analyze the pre-imposing factors leading to femoral neck fracture or intertrochanteric fracture, and provide some evidences for fracture prevention. Methods The BMD examination were performed on 496 fractured patients over 60 years old which were grouped after admission according to their age, gender and fracture types, and then the results were statistically analyzed. Results The BMD of fracture cases in the elderly over 60 years old was 2.5 s less than peak bone volume. There is no obvious difference in BMD between femoral neck fracture and intertrochanteric fracture among various age groups. According to our study, most hip fractures happened at the age of 60-79 years, accounting for 73%of all hip fractures. Conclusions Decreased bone mass or osteoporosis is an important factor leading to hip fracture in the elderly. The fracture types (femoral neck fracture or intertrochanteric fracture) depend mainly on the impaction force to the hip, not only on the BMD change.

ObjectiveTo investigate the clinical efficacy of heat-sensitivepoint Yaoyangguan(GV3)moxibustion for sciatica and preliminarily explore the mechanism of its action.MethodOne hundred and twelve sciatica patients were randomly allocated to heat-sensitive point Yaoyangguan moxibustion (observation), non-heat-sensitive point Yaoyangguan suspended moxibustion (control) and medication groups. The observation group received heat-sensitive point Yaoyangguan moxibustion; the control group, non-heat-sensitive point Yaoyangguan suspended moxibustion; the medication group, oral administration of Yaobitong capsules. The clinical symptoms were scored, the Pain Rating Index (PRI), the Visual Analogue Scale (VAS) and the Present Pain Intensity (PPI) scores were counted and serum IL-8 content was measured in the three groups beforeand after 15 days of treatment.ResultAfter 15 days of treatment, all the three treatments had a certain therapeutic effect on sciatica. The therapeutic effect was bestin the observation group (P<0.05). The PRI, VAS and PPI scores and serum IL-8 contentdecreased in all the three groups compared with before treatment (P<0.05) and were lower in the observation group than in the control and medication groups (P<0.05). There was no statistically significant difference between the control and medication groups (P>0.05).ConclusionHeat-sensitive point Yaoyangguan moxibustion has a better therapeutic effect than non-heat-sensitive point Yaoyangguan suspended moxibustion and oral administration of Yaobitong capsules. This method is an ideal treatment for sciatica. The mechanism may be related to a posttreatment decrease in inflammatory factors in the diseased region.

Objective To investigate the clinical efficacy of heat-sensitive point Dazhui(GV14) moxibustion in treating cervical spondylotic radiculopathy. Method Ninety-six patients with cervical spondylotic radiculopathy were randomly allocated to a heat-sensitive point Dazhui moxibustion (observation) group of 30 cases, a non-heat-sensitive point Dazhui suspended moxibustion (control) group of 33 cases and a medication group of 33 cases. The observation group received heat-sensitive point Dazhui moxibustion; the control group, non-heat-sensitive point Dazhui suspended moxibustion; the medication group, oral administration of Jingtong granules. The clinical symptoms were assessed and serum hypersensitive C-reactive protein (HsCRP) and interleukin-8 (IL-8) were measured in the three groups before and after 15 days of treatment. Result All the three treatments had a certain effect on cervical spondylotic radiculopathy. The therapeutic effect was best in the observation group (P<0.05). After treatment, serum HsCRP and IL-8 contents decreased in all the three groups compared with before (P<0.05). They were even lower in the observation group than in the control and medication groups (P<0.05) but had no statistically significant differences between the control and medication groups (P>0.05). Conclusion The therapeutic effect of heat-sensitive point Dazhui moxibustion is better than those of non-heat-sensitive point Dazhui suspended moxibustion and oral Jingtong granules. It is a more ideal way to treat cervical spondylotic radiculopathy. The mechanism of its action may be related to post-treatment decrease in inflammatory factors in the lesion.

OBJECTIVETo observe the clinical effectiveness of warm needling combined with element calcium on postmenopausal osteoporosis, and to explore its action mechanism.

METHODSEighty-five postmenopausal patients were randomly divided into an observation group (43 cases) and a control group (42 cases). Both the two groups were treated with oral administration of caltrate-D tablet, 600 mg per day, once a day before sleep for one year. Patients in the observation group were treated with warm needling at Dazhu (BL 11), Shenshu (BL 23), Xuan-zhong (GB 39), once a day; 30 days of treatment were taken as a course, and totally 4 courses were given with an interval of 60 days between courses. The bone mineral density (BMD) of the lumbar vertebra and hip joint, and the level of serum bone gla protein (S-BGP) and hydroxyproline/creatinine (Hyp/Cr) were observed before and after treatment in the two groups.

RESULTS(1)After treatment, the BMD in the observation group was significantly increased [lumbar vertebra (0. 811±0. 024) g/cm2 vs (0. 892±0.019) g/cm2, femoral neck (0. 512±0.014) g/cm2 vs (0. 554±0. 015) g/cm2, femoral trochanter (0. 716±0. 028) g/cm2 vs (0.769±0.026) g/cm2, Ward's trigonum (0. 590±0. 013) g/cm2 vs (0. 660±0. 017) g/cm2, all P<0. 05)]; the improvement in the observation group was more significant than that in the control group (all P<0. 05). (2)After treatment, the index of bone metabolism in the control group was increased, and the serum S-BGP, the Hyp/Cr in the control group were higher than those in the observation group (both P<0. 05).

CONCLUSIONThe treatment of warm needling combined with element calcium on postmenopausal osteoporosis is significant, which is likely to be achieved by reducing the bone metabolism of postmenopausal patients.

Acupuncture Therapy ; Bone Density ; Calcium ; metabolism ; Female ; Humans ; Middle Aged ; Osteoporosis, Postmenopausal ; metabolism ; physiopathology ; therapy

Objective: To study laparoscopic ultrasound assisted hepatectomy in treatment of intrahepatic and extrahepatic bile duct stones. Methods: The data of 52 patients with hepatolithiasis who underwent laparoscopic hepatectomy from May 2014 to January 2019 at the Fuyang District First People's Hospital in Hangzhou were analyzed retrospectively. There were 28 men and 24 women. The median age was 56 years. Operative laparoscopic ultrasonography was used to detect the location, size, distribution of stones and their relations to blood vessels. A total of 43 patients underwent anatomic hepatectomy, while 38 patients underwent choledochoscopic stone extraction. A " T" tube was used according to intraoperative conditions. Results: Laparoscopic surgery was successfully carried out in 50 patients, while conversion to open surgery was required in 2 patients because of adhesions and bleeding. Laparoscopic ultrasonography revealed intrahepatic calcifications in 5 patients and choledochoscopy in 2 patients. Postoperative complications included 5 patients who devleoped abdominal abscesses. The operation time was (289.0±132.0) minutes. The intraoperative blood loss was (451.0±256.0) ml. The hospitalization after operation was (12.0±3.0) days. In 52 patients, 4 patients had residual stones and the residual rate was 7.7%. All of them were completely removed by T-tube sinus 8 weeks after operation. Conclusions Laparoscopic ultrasound helped to detect relevant bile ducts containing stones, reduced chance of bleeding in surgery, helped to clarify location and distribution of stones, improved accuracy of diagnosis, and reduced unnecessary hepatectomy by clearly defining intrahepatic bile duct stones intraoperatively. The residual intrahepatic and intrahepatic bile duct stones rates were reduced, and the safety and accuracy of the operations were improved.

Objective To study the safety,efficacy and advantages of enhanced recovery after surgery (ERAS) combined with clinical pathway management in laparoscopic common bile duct exploration and lithotomy (Laparoscopic common bile duct exploration,LCBDE).Methods 78 patients who underwent LCBDE in the Department of Hepatobiliary and Pancreatic Surgery in the First Hospital of Fuyang District in Hangzhou were selected as the non-ERAS group (the control group).76 patients who underwent LCBDE treated with fast track surgery and ERAS clinical pathway management were selected as the ERAS group.The data between the two groups which included the postoperative insulin resistance index,changes in C-reactive protein,duration of postoperative analgesic use and analgesia,timing of first passage of postoperative flatus,postoperative abdominal tube removal,postoperative bile leakage,recurrence of biliary stones,intestinal ileus and other complications.Results All the two groups were discharged home successfully.On preoperative 7 day,the differences on the postoperative insulin resistance index and the levels of C reactive protein were significantly different (P＜0.05).The time to first get out of bed after operation,the postoperative analgesic use,the time to first passage of flatus,the time to postoperative abdominal drainage tube removal,and the time to clamping of the T tube after operation were significantly different (all P＜0.05).The postoperative complications of pulmonary infection,abdominal infection and the incidence of prolonged intestinal ileus were significantly different (all P＜0.05).Conclusions ERAS combined with clinical pathway management reduced postoperative stress reaction and complication rate.The treatment accelerated recovery and shortened hospital stay for patients who underwent LCBDE,which led to good social and economic benefits.

Objective To prospectively survey the well-known experts of critical care and endocrine secretion to summarize their experience in treating diabetes mellitus complicated by sepsis for the purpose of providing guidance of theory and practice in making treatment schemes of traditional Chinese medicine for such disease.Methods The questionnaires were designed and submitted to the experts.The statistic analysis was undertook to investigate the rules.Results A total of 30 questionnaires were released and 28 were retrieved.The experts generally believed that eight-principle syndrome differentiation was the most useful method in the syndrome differentiation and treatment of this disease.The heat,stasis and toxin were usually acted as the main pathogenic factors while damp and phlegm commonly act as secondary pathogenic factors.They thought that weak body resistance under the invading of evil was the key mechanisms in the deterioration of the disease and they chose clearing heat,activating blood and detoxication as 3 core treatment principles.Conclusions The summarized opinions from the experts should be act as important reference in treating this disease,but its effectiveness and possibility for further generalization need to be validated in the clinical practice.

Objective:To evaluate whether additional radical surgery is necessary following non-curative endoscopic resection of early colorectal cancer.Method:Clinicopathological data in 104 patients following non-curative endoscopic resection of early colorectal coucer at the Department of General Surgery, Peking University First Hospital between Jan 2011 and Dec 2021.Results:Lymph node metastasis and/or residual cancer was found in 23 patients (22%), including 12 cases of lymph node metastasis, 7 cases of residual cancer and 4 patients with both residual cancer and lymph node metastasis. Univariate analysis indicated that vascular infiltration, positive vertical margin, and female gender were risk factors for lymph node metastasis. Risk factors for residual cancer were tumors ≥2 cm in size, negative lift sign, infiltration depth of ≥1 000 μm, and positive horizontal and vertical margins. Multivariate Logistic regression analysis revealed that vascular invasion, positive vertical margins, and being female were independent risk factors for lymph node metastasis, while positive vertical margins was independent risk factor for residual cancer. Salvage surgery lasted for a median of 184 (156-233) minutes, with an estimated blood loss of 50 (20-100) ml and an average postoperative hospital stay of 9 (8-11) days. Seven cases of Clavein-Dindo Ⅱ or higher complications were observed, including pulmonary embolism in 1 case , anastomotic leakage in one, lymphatic fistula in one, bowel obstruction in 2 cases and urinary tract infection in 2 cases.Conclusion:Salvage surgery is mandatory for early endoscopic non-curative resection of colorectal cancer.