We summarized our accumulated clinical and teaching experiences and explored the regularity of acupuncture needling and teaching. It is of great importance in pressing hand during inserting needle. Stroking and pressing are two crucial parts which deserve more attention, and seldom useage of pressing hand should be abolished. Operating hand needs practice before inserting needle, while it should fully relaxed during inserting. Blending "touching", "stretch" "gathering" "erupting" and "advancing" in single moment, applying appropriate dynamic mode of inserting needle such as "join 3 forces as one" "3 points in a line" expertly and naturally. In addition, enough attention should be paid on "altering direction" and "shifting point". Inserting deftly and powerfully, no/slight sensation, deqi when inserting needle are the highest reflection as an acupuncturist.
Acupuncture ; education ; Acupuncture Therapy ; instrumentation ; methods ; China ; Humans ; Teaching

Abstract: The first-line drug artemisinin is widely used against malaria. Commercially available artemisinin is extracted from plants. However, the lack of sufficient raw material, artemisinin and the cost associated with the drug's manufacture have limited the supply of ACT to most malaria sufferers in the Developing World. As such, it is important to develop a low cost, fine to environment and high-quality method to supply sufficient and reliable quantities of artemisinin in the future. The field of synthetic biology, which utilizes cell factories to manipulate microbial metabolism to enhance the production of artemisinin and its intermediates, has a particularly strong impact by providing new platforms for chemical production. After a brief introduction of the artemisinin biosynthetic pathway, the present review focuses on the introduction of artemisinin biosynthetic genes, such as the genes encoding amorpha-4, 11-diene monooxygenase, NADPH: cytochrome P450 oxidoreductase, artemisinic aldehyde delta 11(13) reductase and aldehyde dehydrogenase. The review also addresses general considerations for potential contributions of synthetic biology to artemisinin production, with an emphasis on factors influencing interest compounds production in chassis cells.

OBJECTIVETo observe the therapeutic effect of Bushen Qiangdu Recipe (BSQDR) on osteoporosis and bone loss in patients with ankylosing spondylitis (AS).

METHODSPatients with AS were randomly assigned to two groups. The 288 patients in the treatment group received BSQDR (consisting of cibotii rhizoma, antler, prepared rehmannia root, epimedium herb, rhizoma drynariae, teasel root, eucommia bark, pangolin scales, etc., one dose daily, taken in two portions, once in the morning and once in the evening). The 72 patients in the control group received SIDSM and sulfasalazine. The therapeutic course for both was six months. Clinical symptoms, pillow distance from the wall, hand distance from the ground, jaw distance from the handle, chest mobility, Schober test, spinal mobility and other signs of disease activity indices (ESR and CRP) were observed in patients before and after treatment. The bone mineral density (BMD) testing was performed in the lumbar spine, the femur, the forearm, and the heels, etc. Osteocalcin (BGP), calcitonin, parathyroid hormone (PTH), etc. bone metabolic indices were detected.

RESULTSBASFI, BASDAI, the overall assessment, the spinal pain, pillow distance from the wall, hand distance from the ground, jaw distance from the handle, chest mobility, Schober test, spinal mobility, and so on were all improved to some extent when compared with before treatment in the treatment group (P<0.05). The ESR and CRP decreased to various degrees, showing statistical significance when compared with before treatment (P <0.01). BGP increased and PTH decreased, showing statistical difference when compared with before treatment (P<0.05). The BMD in patients' lumbar spine, femoral neck, Ward's triangle, femoral trochanter increased to various degrees. The calcaneal intensity index, blood uric acid (BUA) and SOS values also increased more than before treatment, showing statistical significance (P<0.05). Long-term oral administration of BSQDR was safe, with no obvious adverse reaction.

CONCLUSIONSBSQDR showed significant effect in treatment of AS. It could regulate the bone metabolic level in patients, attenuate the immune inflammatory response, improve the spine and joint activities functions, increase bone formation, reduce bone resorption, thereby, enhancing the BMD, showing significant therapeutic effect on osteoporosis in AS patients.

Adult ; Bone Density ; Bone Resorption ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Osteoporosis ; drug therapy ; metabolism ; Phytotherapy ; Spondylitis, Ankylosing ; drug therapy ; metabolism ; Young Adult

Chromosome Mapping ; Enhancer Elements, Genetic ; Erythropoietin ; genetics ; Exercise ; Humans ; Military Personnel ; Physical Endurance ; Polymorphism, Single Nucleotide ; Young Adult

Objective To explore a good of treating posttraumatic deviated nose. Methods Clinical data of 136 patients with posttraumatic deviated nose were analyzed.Closed nasal bone replacement was employed in 34 patients with the disease history of 20-30 days,while open rhino- plasty approach was employed in 102 patients with the disease history over 6 months to correct their postt- raumatic deviated nose,and straightening the septum and ectomizing the inferior turbinate were done if necessary.Results The follow-up was over one year.In the 34 patients with the disease history of 20- 30 days,the outcome was excellent in 28 cases and good in 6.In the 102 patients with the disease history over 6 months,the outcome was excellent in 81 cases and good in 21.The deformity of nose was corrected satisfactorily.Normal nasal shape and good ventilation were obtained.Conclusion Posttraumatic devi- ated nose deformities are often caused by delayed and inaccurate treatment.Closed nasal bone replace- ment can be employed for the patients with trauma history less than one month,and open rhinoplasty ap- proach and straightening the septum and restoration of the nasal shape are employed for other patients.In this way good results can be obtained.

Objective To investigate the relationship between hypertension,other vascular risk factors and mild cognitive impairment and its subtype.Methods A total of 297 outpatients and inpatients were collected from the Departments of Neurology in 4 municipal hospitals in Qingdao from April 2011 to September 2011.The unified questionnaires of cognitive impairment status in the departments of neurology in Qingdao city were developed.The risk factors for mild cognitive impairment and its subtype were investigated.Results Univariate analysis showed that low levels of education (odds ratio [ OR] 0.239,95％ confidence interval [ CI] 0.129 -0.442; P =0.000),hypertension (OR 1.928,95％ CI 1.107 - 3.358; P =0.019) and hyperlipidemia (OR 1.812,95％ CI 1.041 -3.155; P =0.034) were all the risk factors for mild cognitive impairment; Multivariate logistic regression analysis showed that low levels of education (OR 0.807,95％ CI 0.742 - 0.878; P =0.000) and hypertension (OR 1.788,95％ CI 1.004 -3.146; P =0.048 ) were the independent risk factors for mild cognitive impairment; and hypertension (OR 2.091,95％ CI 1.030 -4.242; P=0.041) was an independent risk factor for non-amnestic mild cognitive impairment,and was mainly impaired visuospatial and executive abilities (P =0.026).Conclusions Hypertension is an independent risk factor for mild cognitive impairment and its subtype-non-amnestic mild cognitive impairment,and it mainly impairs executive ability.

Objective This study reviews the 198 consecutive mitral valve operations for elderly patients(＞ 65 y) with ischemic mitral insufficiency performed at Anzhen Hospital between January 2000 and june 2016.The results for mitral valve reconstruction are compared with those for biological mitral valve replacement.Methods From January 2000 to June 2016,198 elderly patients with ischemic mitral insufficiency underwent mitral valve reconstruction (n =150) or biological mitral valve replacement(n =48).All of them coronary artery bypass gafting was performed at the same time.Preoperative clinical characteristics,procedural characteristics,major and minor complications after surgery,preoperative and postoperative left ventricular ejection fraction (LVEF) by echocardiography,and outcome (survivor or death,mitral regurgitation,NYHA degree) were assessed.Results There was no significant difference between the two groups in the rate of mortality during hospitalization and early postoperative cardiac function.The proportion of severe MR in 1,3,and 5 years after MVP were 5.1％ 、6.3％、7.7％ respectively.There was no MVR due to the recurrent moderate-to-severe reflux.There were 2 SBE but no reflux appeared after MVR.There was no significant difference in cardiac function and mortality between the two groups within 5 years.Conclusion There is no significant difference between CABG + MVP and CABG + MVR(BV) in cardiac function and mortality in the treatment of elderly patients with IMR.,There was a possibility of MR recurrence after CABG + MVP.There was no MR after CABG + MVR(BV),but the risk of SBE is higher than MVP.We can select operation mode personalized according to the type of mitral valve disease and cardiac function.

Objective To investigate the synergistic efficacy of different antibiotic combinations against KPC-2 carbapenemase producing Klebsiella pneumoniae strains in vitro and search for effective antibiotic combination.Methods During 2008 - 2009,a total of 24 strains of K.pneumoniae producing KPC-2 carbapenemase were collected from 8 hospitals in the First Affiliated Hospital of Medical School of Zhejiang University,Ningbo LiHuiLi Hospital,Zhejiang People's Hospital,Hangzhou Third Hospital,the Second Hospital of Shaoxing,Hangzhou First Hospital,Fudan University Huashan Hospital,General Hospital of Nanjing Military Region.MLST technique was used for epidemiological analysis.The MIC of antibiotics,such as amikacin,minocycline,imipenem,amoxicillin/clavulanic-acid,ceftazidime,meropenem,gentamicin,cefoxitin,cefepime,rifampicin,polymyxinB,ciprofloxacin were determined by an agar dilution method,the MIC of tigecycline and piperacillin/tazobactain were determined by Etest.The antibacterial activities of cefepime in combination with amoxicillin/clavulanic-acid,amikacin,or ciprofloxacin,amikacin with ciprofloxacin,imipenem with amikacin,ciprofloxacin,polymyxinB,or minocycline,polymyxin B with rifampicin,ceftazidime with amoxicillin/clavulanic-acid were assessed by chequerboard synergy agar dilution tests against all the isolates.Results MLST showed 5 STs among 24 strains of KPC-2 carbapenemase producing K.pneumoniae,and the most prevalent clone was ST11 (15 strains).All isolates were susceptible to polymyxin B and tigecycline,and the resistance rate of minocycline was 4.2％.The synergetic effects were observed in cefepime-amoxicillin/clavulanic acid,imipenem-amikacin,ceftazidime-amoxicillin/clavulanic acid combinations as 19 isolates,13 isolates,and 13 isolates,respectively.Conclusions KPC-2 carbapenemase producing K.pneumoniae is sensitive to polymyxin B,tigecycline and minocycline.The synergetic effect is predominant in cefepime-amoxicillin/clavulanic acid,imipenem-amikacin ceftazidime-amoxicillin/clavulanic acid combinations in vitro,their clinical efficacy are worthy of further observation.

Objective To investigate the differences of the vascular risk factors for anterior circulation and posterior circulation ischemic stroke.Methods The unified diagnosis and treatment questionnaires of ischemic stroke in Qingdao city were developed.The data of 943 consecutive patients with acute ischemic stroke treated in the Departments of Neurology in 11 hospitals with imaging facilities such as computerized tornography (CT) or magnetic resonance imaging (MRI) in Qingdao city and its surrounding counties from June 2008 to February 2009 were retrospectively collected.The risk factors for anterior circulation and posterior circulation ischemic stroke were analyzed.Results Univariate analysis showed that there were significant differences in the age,sex,history of coronary heart disease,hyperlipidemia,atrial fibrillation and basdine National Institutes of Health Stroke Scale (NIHSS) score between anterior circulation and posterior circulation ischermic stroke (all P ＜0.05).Multivariate logistic regression analysis showed that the age (odds ratio [ OR ] 1.025,95％ confidence interval [ CI ] 1.009-1.042) and the baseline NIHSS score (OR 1.052,95％ CI 1.019-1.086) tended to the interior circulation ischernic stroke,whereas coronary heart disease (OR 0.512,95％ CI 0.341-0.768) and hyperlipidemia (OR 0.585,95％ CI 0.386-0.884) tended to posterior circulation ischemic stroke,and hyperlipidemia was an independent risk factors for posterior circulation ischemic stroke.Conclusions Vascular risk factors exerted different effects on anterior circulation and posterior circulation ischemic stroke.

Objective To develop a scale of assessing inpatient′s risk factors of chemotherapy drugs permeability. Methods Designed a questionnaire for expert information collecting based on literature review,and employed the Delphi method to develop a set of indicators to measure inpatient′s effective store seepage risk factors. Fifteen experts finished the 2-round survey. Results Expert's enthusiasm was high, the two rounds of enquiry for effective questionnaire recovery rate was 100%. Expert's authority was very high, the average duration of clinical practice was 23.8 years, the average duration of nursing management was 13.1 years, the rate of familiarity about this kind of research was 100%, the recognition degree in the accumulation of theoretical knowledge, the clinical practice and the home or abroad research degree was 93%, 100%and 73%respectively. Two rounds of enquiry for expert advice of Cronbach's alpha coefficient was 0.96 and 0.98 respectively, experts tend to agree that the scale had good consistency, high credibility, delivery system eventually formed contains, vein, the static drop time (static) chemotherapy, more routine chemotherapy, liquid type, drug factors, social support, cooperation degree, liquid volume, mission 11 dimensions such as level of understanding, the nurse puncture store effective seepage risk factors assessment of 42 items. Conclusion The inpatient′s effective store seepage risk factor assessment scale developed by using the Delphi method is reliable for assessing effective store seepage risk factor of hospitalized patients .