Objective To evaluate the efficacy of acupuncture for tinnitus, hearing loss in patients with type 2 diabetes using the twirling, reinforcing-reducing method. Methods A total of 132 tinnitus, hearing loss patients with type 2 diabetes were included and divided into an observation group and a control group by random number table method, 66 in each group. Patients in both groups were acupunctured at Tinggong, Tinghui, Yifeng in the affected side, and Zhongzhu, Waiguan, Sanyinjiao, Taichong and Taixi in the both sides. Patients in the observation group were acupunctured at Taichong using the twirling reducing method, Taixi using the twirling reinforcing method, and those in the control group both of Taichong and Taixi using the needle retention method. Patients in both groups were also treated with semiconductor laser therapy and ultrashort wave therapy. All patients were treated for 1 month. The severity of tinnitus was assessed by the Tinnitus Severity Scale, and the clinical efficacy was evaluated. Results After the treatment, the Tinnitus Severity Scale score in the observation group was significantly lower than that in the control group (5.71 ± 2.19 vs. 7.14 ± 3.36;t=2.897, P<0.01). The significant improvement rate in tinnitus in the observation group was significantly higher than that in the control group (77.3%vs. 63.6%;χ2=22.091, P<0.01). The significant improvement rate in hearing loss in the observation group was no significant difference than that in the control group (72.4% vs. 63.8%; χ2=0.992, P=0.319). Conclusion Acupuncture using the twirling, reinforcing-reducing method may relieve tinnitus in tinnitus, hearing loss patients with type 2 diabetes.

Objective:To investigate the changes of natural killer (NK) cells, natural killer T (NKT) cells and T lymphocytes in the peripheral blood after nanosecond pulse ablation of hepatic vesicular hydatid in rats with different energy levels.Methods:A total of 32 SD rats were randomly divided into hepatic vesicular hydatid model group, low voltage group (1 000 V), medium voltage group (1 500 V) and high voltage group (2 000 V). The hydatid model of rats was established by selective injection of 100 μl of echinococcosis head suspension with concentration of 500/100 μl into the left hepatic portal vein in all the 4 groups. After 3 months, nanosecond pulse therapy was applied to the left lobe vesicular hydatid lesions in the low voltage group, medium voltage group and high voltage group. On the third day after treatment, flow detector was used to calculate the ratio of CD 4+ T to CD 8+ T in peripheral blood of four groups by CD 3+ T, CD 4+ T, CD 8+ T, NK cells and NKT cells. Results:CD 3+ T was expressed in the high voltage group with (62.08±2.75)%, the medium voltage group with (63.84±7.73)%, the low voltage group with (55.19±8.55)% and the control group with (54.76±8.28)% ( P<0.05). CD 4+ T number was larger in high voltage group (43.7±6.51)% than medium voltage group (38.82±5.47)%, low voltage group (37.31±6.96)% and model group (38.12±3.04)% ( P<0.05). CD 8+ T ratio in the high voltage group was (20.03±2.40)%, the medium voltage group was (21.22±1.74)%, the low voltage group was (19.00±3.06)%, and the model group (20.56±3.98)%, with no statistically significant difference ( P>0.05). NK cells ratio in high voltage group was (6.49±1.60)%, medium voltage group was (3.02±0.32)%, low voltage group was (3.42±0.91)% and model group was (3.44±0.55)% ( P<0.05). NKT cells ratio in high voltage group was (1.53±0.16)%, medium voltage group was (0.82±0.09)%, in low voltage group was (0.70±0.17)% and model group (0.78±0.10)% ( P<0.05). CD 4+ T/CD 8+ T high voltage group was (2.26±0.65), medium voltage group was (1.90±0.40), low voltage group was (1.98±0.37) and model group was (2.06±0.35) ( P<0.05). Conclusion:High voltage (2 000 V) increased number of T, NK and NKT cells in peripheral blood compared with medium voltage (1 500 V) and low voltage (1 000 V), which may be the immune response of the body caused by nanosecond pulse ablation of hepatic vesicular hydatid in rats.

OBJECTIVETo observe the clinical efficacy of acupuncture with twirling reducing method for tinnitus of excessive liver-fire type.

METHODSOne hundred and one patients with tinnitus of excessive liver-fire type were randomly divided into a twirling reducing method group (35 cases), a needle retaining group (33 cases) and a physical therapy group (33 cases). The patients in the twirling reducing method group were treated by acupuncture at Tinggong (SI 19), Tinghui (GB 2), Yifeng (TE 17), Zhongzhu (TE 3), Waiguan (TE 5), Xiaxi (GB 43), Taichong (LR 3), Qiuxu (GB 40), while the strong low-frequency twirling reducing method was applied at Xiaxi (GB 43) and Taichong (LR 3); the patients in the needle retaining group were treated with identical acupoints and needle insertion manipulation, but no reducing method was applied after needle insertion. Needles were all retained for 30 min. The patients in the physical therapy group were treated with laser and ultrashort wave. All the treatment was given once a day; one session was consisted of 7 days of treatment, and there was an interval of 2 days between sessions; totally 3 sessions were given. Before and after treatment, the tinnitus severity scale, the tinnitus handicap inventory (THI) and clinical efficacy were compared in the three groups.

RESULTSAfter treatment, the tinnitus severity scale and THI in the three groups were reduced (all<0.05), and the scores in the twirling reducing method group were lower than those in the physical therapy group (both<0.05). After treatment, the cured and markedly effective rate was 71.4% (25/35) in the twirling reducing method group, which was higher than 42.4% (14/33) in the physical therapy group (<0.05).

CONCLUSIONSThe efficacy of acupuncture with twirling reducing method for tinnitus of excessive liver-fire type is superior to that of physical therapy.

Objective:To investigate the influencing of preoperative biliary drainage on surgery-related complications after pancreaticoduodenectomy.Methods:The retrospective case-control study was conducted. The clinical data of 267 patients with periampullary space-occupying lesion who were admitted to Beijing Friendship Hospital of Capital Medical University from January 2016 to July 2020 were collected. There were 166 males and 101 females, aged 61 (range, 54?84)years. Observation indicators: (1) comparison of preoperative situations in patients with and without preoperative biliary drainage; (2) comparison of intraoperative and postoperative situations in patients with and without preoperative biliary drainage; (3) methods and efficacy of preoperative biliary drainage; (4) factors influencing surgery-related complications after pancreaticoduodenec-tomy. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(rang) or M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was conducted using the corresponding statistical methods based on data type. Multivariate analysis was conducted using the Logistic stepwise regression model. Results:(1) Comparison of preoperative situations in patients with and without preoperative biliary drainage. Of the 267 patients, there were 104 cases with preoperative biliary drainage and 163 cases without preoperative biliary drainage. Cases with malignant tumor, cases with borderline tumor, cases with chronic pancreatitis were 89, 13, 2 in patients with preoperative biliary drainage, versus 111, 41, 11 in patients without preoperative biliary drainage, showing significant differences in pathology type between them ( χ2=10.652, P<0.05). (2) Comparison of intraoperative and postoperative situations in patients with and without preoperative biliary drainage. There was no significant difference in operation time, volume of intra-operative blood loss, postoperative complications, grade B pancreatic fistula, grade C pancreatic fistula, biliary leakage, abdominal or gastrointestinal bleeding, incidence of abdominal infection, white blood cell count at postoperative day 1, white blood cell count at postoperative day 3, neutrophil-to-lymphocyte ratio at postoperative day 1, neutrophil-to-lymphocyte ratio at postoperative day 3, C-reactive protein-albumin ratio at postoperative day 1, C-reactive protein-albumin ratio at post-operative day 3, duration of hospital stay between the 104 patients with preoperative biliary drainage and the 163 patients without preoperative biliary drainage ( P>0.05). (3) Methods and efficacy of preoperative biliary drainage. Of the 104 patients with preoperative biliary drainage, there were 40 cases receiving endoscopic nasobiliary drainage with drainage time as (12±2)days, there were 38 cases receiving percutaneous transhepatic cholangial drainage with drainage time as (7±1)days, and there were 26 cases receiving endoscopic retrograde biliary drainage with drainage time as (19±2)days. The total bilirubin, direct bilirubin, aspartate transaminase, alanine aminotrans-ferase in 104 patients were (223±18)μmol/L, (134±11)μmol/L, (112±10)U/L, (160±16)U/L before biliary drainage and (144±13)μmol/L, (84±8)μmol/L, (79±8)U/L, (109±12)U/L after biliary drainage, showing significant differences in the above indicators ( t=3.544, 3.608, 2.523, 2.509, P<0.05). (4) Factors influencing surgery-related complications after pancreatocoduodenectomy. Results of multi-variate analysis showed that operation time was an independent factor influencing surgery-related complications after pancreaticoduodenectomy ( odds ratio=1.005, 95% confidence interval as 1.002?1.008, P<0.05). Conclusions:Preoperative biliary drainage does not increase the incidence of complications related to pancreaticoduodenectomy in patients with periampullary space-occupying lesion. Operation time is an independent factor influencing postoperative surgery-related complications.

Objective:To investigate the effect of the duration of preoperative biliary drainage on postoperative complications after pancreaticoduodenectomy.Methods:The clinical data of 102 patients with benign and malignant hepatopancreatic ductal periampullary tumors who underwent pancreaticoduodenectomy and preoperative biliary drainage in Beijing Friendship Hospital, Capital Medical University from January 2016 to July 2020 were retrospectively analyzed. According to the median duration of preoperative biliary drainage, the patients were divided into short-term drainage group (≤ the median duration of biliary drainage) and long-term drainage group (> the median duration of biliary drainage). The general data, the effect of biliary drainage, inflammation-related indicators and postoperative complications were compared between the two groups. Multivariate logistic regression was used to screen the risk factors related to the postoperative severe complications.Results:Of the 102 patients, 68 (66.7%) were males and 34 (33.3%) were females, with a median age of 63 years (43-80 years). The median duration of preoperative biliary drainage was 14 d. There were 68 patients in short-term drainage group and 34 patients in long-term drainage group. There were no statistically significant differences in age, gender, body mass index (BMI), hypertension, diabetes mellitus, surgery history of upper abdominal, American Society of Anesthesiologists (ASA) grade, carcinoembryonic antigen, carbohydrate antigen 125, alpha-fetoprotein, prothrombin time, pancreaticojejunostomy method, operation time, and pathological type between the two groups (all P > 0.05). However, patients in long-term drainage group had higher conversion rate, more blood loss and longer hospital stay compared with those in short-term drainage group (all P < 0.05). Before biliary drainage, alanine aminotransferase (ALT) level in short-term drainage group was higher than that in long-term drainage group ( Z = -2.59, P = 0.009), and there were no statistically significant differences in aspartate aminotransferase (AST), albumin (ALB), total bilirubin (TB) and direct bilirubin (DB) levels between the two groups before biliary drainage (all P > 0.05). After biliary drainage, DB in short-term drainage group was higher than that in long-term drainage group ( Z = -3.34, P = 0.001), and there was no statistically significant difference in ALT, AST, ALB, TB levels between the two groups (all P > 0.05). There were no statistically significant differences in the levels of white blood cells, neutrophils, lymphocytes and the ratio of neutrophils to lymphocytes between the two groups on the 1st and 3rd day after the operation (all P > 0.05). The total incidence of postoperative related complications in short-term drainage group and long-term drainage group was 63.2% (43/68), 70.6% (24/34), respectively, and the difference was statistically significant ( χ2 = 0.54, P = 0.461); the incidences of bile leakage, abdominal or gastrointestinal bleeding, intra-abdominal infection, delayed gastric emptying, all grades of pancreatic leakage, grade B and C pancreatic leakage were not statistically different between the two groups (all P > 0.05); the incidence of severe postoperative related complications in short-term drainage group was higher than that in long-term drainage group [27.9% (19/68) vs. 8.8% (3/34), χ2 = 4.90, P = 0.027]. Multivariate logistic regression analysis showed that the long-term preoperative biliary drainage was an independent protective factor for postoperative severe complications (long-term drainage vs. short-term drainage: OR = 0.253, 95% CI 0.066-0.975, P = 0.046), while BMI ( OR = 1.174, 95% CI 0.986-1.398, P = 0.071) and pathological type (benign or borderline vs. malignant tumor: OR = 0.247, 95% CI 0.043-1.419, P = 0.117) were not independent influencing factors for postoperative severe complications. Conclusions:Short-term biliary drainage (≤14 d) is a risk factor for postoperative severe complications in patients with hepatopancreatic ductal periampullary tumor undergoing preoperative biliary drainage. Preoperative biliary drainage time is not associated with postoperative total complications, pancreatic leakage, bile leakage, abdominal or gastrointestinal bleeding, intra-abdominal infection, delayed gastric emptying.

This paper summarized the clinical experience of using the method of “returning fire to its origin” for treatment of paroxysmal sympathetic hyperactivity （PSH）. According to the causes and clinical characteristics of PSH， the author believes that the deficiency of kidney qi， and the loss of yin and yang are the basis of the pathogenesis of PSH. Fright causes qi to be chaotic as the triggering mechanism of PSH. The key mechanism of PSH is that the deficiency yang with upper manifestation， and the fire does not return to its origin. The treatment should be nourishing yin and astringing yang， by taking modified Yinhuo Decoction （引火汤） internally， and receiving warm moxibustion as the first choice externally with selected acupoints Guanyuan （CV 4）， Mingmen （GV 4）， and bilateral Yongquan （KI 1）； For prevention， attention should be paid to take care of stomach qi， support healthy qi， and cultivate original qi.