Toutianliang manipulation is the most representative compound needling technique of traditional reinforcing and reducing and has the remarkable efficacy on heat syndrome with muscle and bone involved for example. Professor ZHANG Jin is one of the famous acupuncture master in China and has contributed his lifelong to the research of acupuncture manipulation techniques. He has summarized 24 single-type manipulations and has given the comprehensive explanation of the manipulations for meridian conduction, reinforcing or reducing techniques for the excess or deficiency. In the paper, Toutianliang manipulation was introduced briefly and the key operation steps had been discussed.
Acupuncture Therapy ; history ; methods ; China ; History, 20th Century ; History, 21st Century ; Humans

Objective To evaluate the quality of the examination paper of the theory of Clinical Diagnostics,to explore and reflect on the teaching methods,so as to improve the quality of teaching.Methods Finals results of Clinical Diagnostics including 40 clinical undergraduates of Capital Medical University were analyzed.SPSS 20.0 was used to make analysis of the frequency,means statistics and normality of the examination paper.Kuder Richardson/Cmnbacha formula,percentage unification methods and so on were used to calculate confidence,validity,difficulty and degrees of distinction.Acquisition of relevant knowledge was assessed according to score distribution,while test paper quality was evaluated based on indicators including confidence,validity,difficulty and degrees of distinction.Results Test scores of 40 students were between 61 to 96 (83.64 ± 8.07).The degree of confidence (γ) for choice questions and subjective questions was 0.65 and 0.59 respectively;The validity (V) was 0.27;The overall difficulty (P) of the examination was 0.84;The degrees of distinction (D) were between 0.16 to 0.30.And the total points losing rate was 16.36％.Conclusion The examination is of medium difficulty and good degree of distinction,but the teaching strategies still need further adjustment in order to improve the students' ability of flexible application of the basic knowledge.

Capital Medical University Pediatrics Online Course which has been set since June 2013 provides students with more personalized and efficient learning platform in line with modern educational concepts.The paper has introduced the application platform,basic framework and usage of the Online Course,analyzing the characteristics of excellent teaching resources,bilingual teaching,students' participation and students' learning more in line with manifestations habits,and finally reflected on the subsequent development of Pediatrics Online Course in the future.

Objective:To investigate effects of the modified adhesion retention on the surrounding tissues of dental implant.Methods:182 patients with tooth defects were randomly divided into 2 groups,The patients in control group (n =89) received the traditional retention,in the test group(n =93) received modified adhesion retention.The bone loss at the near and far edges of the implant,alveolar bone height and thickness,the pictorial view of pink esthetic score variables(PES),the modified plaque index(mPLI),the modified sulcus bleeding index (mSBI) and the satisfaction were recorded and compared 1 year after treatment.Results:Compared with control group,the test group showed less bone loss(P＜0.05),more alveolar bone height and thickness(P＜0.05).The satisfaction of the comfort,chewing and language function,retention,esthetics,PES,mPLI and mSBI improved to varying degrees(P＜0.05).Conclusion:The modified adhesion retention is more effective than the traditional retention in stabilizing the bone support of implant and reduce bacterial infection.

Objective To compare the clinical effects of high flow nasal cannula (HFNC) and non-rebreathing oxygen face mask (NRB) in post-extubation patients.Methods 88 critically ill patients with machinery ventilations were divided into HFNC group and NRB group randomly.Blood gas analysis and hemodynamic parameters were assessed 1 hour prior to extubation and 6 hours after extubation.The primary clinical outcomes measured were ventilation-free days,re-intubation patient numbers,length of stay in ICU (Intensive Care Unite),total duration of hospitalization and mortality.The scant of breath degree and comfortableness of patient were recorded according to the Visual analogue scale.The measurement data were described by mean ± standard deviation ((x) ± s) and analyzed with t test,enumeration data were described by number of cases and composition ratio and analyzed with X2test,P ＜ 0.05 was considered to have statistical difference.Results There was no significant difference in clinical features between the two groups,The oxygenation index of HFNC group is significantly higher than that of NRB group after extubation [(251.4 ±43.9) vs.(201.7 ±60.7),P =0.037)].There were more ventilator-free days in the HFNC group than NRB group [(4.2 ± 2.1) vs.(3.4 ± 2.8),P =0.037)] and fewer patients required reintubation (P =0.028).The rate of ventilator associated pneumonia is also lower than NRB group (P =0.024).The patients' scant of breath feeling were obviously allevated comparing with the NRB group [(2.9 ± 1.1) vs.(3.7 ± 1.8),P =0.042)].The oxygenation index of NRB group significantly decreased after extubation [(242.9 ±68.4vs.201.7 ±60.7 P =0.048)].The two groups demonstrated similar hemodynamic patterns before and after extubation.And there were no statistically significant clinical differences in PaCO2,length of ICU stay,total duration of hospitalization or mortality.Conclusions Compared with NRB,HFNC is a more safe and effective clinical tool in the prevention and treatment of critical adult patients with extubation failure.

Serum folate and vitamin B12 were measured in 171 healthy children under 14 years of age, 30 normal adults and 30 samples of normal cord blood. All the 171 children had been supplied with adequate folic acid and vitamin B12 before measurements. The results -were: 1. The lower limits of normal serum folate values were 6.1 nmol/L under 4 years, 8.4 nmol/L at age of 4-14 years and 5.0 nmol/L in adults. 2. The lower limits of normal serum vitamin B12 values were 459 pmol/L under 1 year and 107 pmol/L at age of 1 year to adults.

Objective To observe prospectively and systematically the effect and safety of rhendostati injection (endostar) combined with FOLFOX as a second line chemotherapy for advanced/metastatic colorectal cancer. Methods 23 patients with histological confirmed advanced/metastatic colorectal cancer after first line chemotherapy failure were observed. The dosage of 15 mg/time of endostar solved in 500ml normal saline was slowly intravenously dropped 4 h from day 1 to day 14. Oxaliplatin 85 mg/m~2 iv 2-3 h dl, d15. CF 200 mg/m~2 iv 2 h followed by 5-Fu 400 mg iv bolus and 5-Fu 600 mg/m~2 iv 22 h dl-2, d15-16 were given, every 4 weeks as one cycle. Efficacy was evaluated after 2 cycles according to RECIST criteria. Results 23 cases had been completed totally 56 cycles. Among 23 cases, 8 cases were PR, 12 cases SD, and 3 cases PD. The objective response rate (RR) was 34.8 % (8/23), and the disease control rate (DCR) was 87.0 % (20/23). The median time to progression was 7 months. The 1-year survival rate were 50.0 %. The 2-year survival rate was 40.0 %. The occurrence rate of G3/4 toxicities was low, including neutropenia(21.7 %), anemia(4.3 %), thrombocytopenia (13.0 %). Those toxicities were mainly related with the chemotherapy agents. Meanwhile transient electrocardiogram changes mild ST-T of changes occurred in 3 cases. 2 cases were mild hypertension and were symptomatically controlled. Conclusion There are better efficacies of endostar combined with FOLFOX chemotherapy for advanced/metastatic colorectal cancer, and it is low toxic and tolerable. It is worth of further clinical observation. More experiences need to be accumulated.

BACKGROUND: Numerous evidence has demonstrated that the magnesium aloy with excelent mechanical properties can degradein vivo, and can be used as vascular stent materials, bone fixation materials, porous materials for bone repair. But it is not reported in the biliary stent. OBJECTIVE:To observe the degradation procedures and evaluate the changes of mechanical characteristics of biliary stents made of magnesium aloy (AZ 31B) in human bilein vitro. METHODS:The baloon-expandable biliary stents were made of magnesium aloy with laser sculpture. Then, 15 stents treated with micro-arc oxidation on the surface served as experimental group and another 15 stents without micro-arc oxidation as control group. A dynamic numerical simulation system was establishedin vitro to simulate the internal environment of human biliary tract. Al of the biliary stents were placed into this system. Their shapes were observed, and their qualities and radical forces were measured every 20 days. At the same time, their surfaces were scanned by scanning electron microscope. RESULTS AND CONCLUSION:(1) The degradation speeds of the stents in the experimental group were obviously slower than those in the control group. The fracture of the connecting rods in control group and experimental group appeared 20 days and 40 days later, respectively. The peak time of degradation in the control group and experimental group were 30 days and 50 days, respectively. The stents were fuly biodegraded within 70 days in the control group while within 90 days in the experimental group. With time, the stent surface became more rough, and the density, area and depth of etch pits were al increased in the two groups. At the same stage, the degradation speed of the control group was more rapid than that in the experimental group. (2) The qualities and radical forces of the stents were gradualy reduced with time in both groups. However, the degradation speed of stents in the experimental group was much slower than that in the control group. In summary, the degradation speed of the biliary stents made of magnesium aloy treated with micro-arc oxidation is appropriate and can meet the clinical requirement for the degradation time of biliary stents. This novel material could potentialy be used for the preparation of biliary stents.

Objective: To explore the safety and efficacy of left atrial (LA) endocardial vagal denervation catheter ablation for treating the patients with refractory vasovagal syncope (VVS).
Methods: A total of 57 consecutive refractory VVS patients with severe symptom and positive response to head-up tilt test (HUT) were enrolled. There were 22 male at the mean age of (43 ± 13) years. The patients had no response or couldn’t tolerate routine treatment. LA model was re-established by three-dimensional mapping system, 10 patients received high-frequency stimulation technique for ganglionated plexi (GP) ablation and 47 received regional catheter ablation at 5 anatomic sites of GP for LA endocardial vagal denervation treatment. In-operative vagal response including hypotension, sinus bradycardia or asystole were observed, the endpoint of ablation was abolition of evoked vagal relfexes. Periodical follow-up was conducted to record the syncope recurrence and to re-examine ECG and HUT in all patients.
Results: There were 52/57(91.2%) patients had positive vagal response by radiofrequency application and reached the endpoint of ablation; 4 patients couldn’t receive obvious evoked vagal relfexes. During (36 ± 22) months follow-up period, there were 52 (91.2%) cases without syncope recurrence, 11 cases still having palpitation, amaurosis and dizziness as the precursors of syncope while the symptoms were much better then they were before. No complication occurred.
Conclusion: LA endocardial vagal denervation catheter ablation is a safe and effective method for treating the patients with refractory VVS, it may also effectively prevent VVS recurrence.

Objective:To explore the application method and effect of online teaching of pediatrics in undergraduate clinical medicine.Methods:From March to August, 2020, two classes of pediatrics were selected as research objects: 67 students from Batch 2016 "5+3" clinical medicine class were taught by providing recorded teaching resources and online communication and answering questions (hereinafter referred to as "recorded courses"); 39 students from Batch 2015 "5+3" clinical medicine class were taught by live courses and online communication and answering questions (hereinafter referred to as "live courses"). Through the questionnaire survey on the two groups of students, the effect of the two online teaching methods were compared and the medical students' views and suggestions on them were collected. SPSS 26.0 was used for statistical analysis.Results:Most of the students in the two groups (98.1%) agreed with the effect of the online teaching of pediatrics and thought it could meet their learning needs. There was no significant difference in the online teaching effect between recorded courses group and live courses group ( P > 0.05). However, they had a poor recognition with the implementation of complete online teaching in the future, while they preferred the combination of online teaching with practical exercises in offline hospitals. Conclusion:Online teaching of pediatrics has been recognized by medical students. The two online teaching methods have their own advantages: recorded courses are more planned and the content is more rigorous; live courses are more interactive and flexible. However, considering that medicine is a highly practical subject, it still needs to be supplemented by offline practice while giving full play to the advantages of online teaching.