Ayurveda and in silico Approach: A Challenging Proficient Confluence for Better Development of Effective Traditional Medicine Spotlighting Network Pharmacology / 中国结合医学杂志

Coalescence of traditional medicine Ayurveda and in silico technology is a rigor for supplementary development of future-ready effective traditional medicine. Ayurveda is a popular traditional medicine in South Asia, emanating worldwide for the treatment of metabolic disorders and chronic illness. Techniques of in silico biology are not much explored for the investigation of a variety of bioactive phytochemicals of Ayurvedic herbs. Drug repurposing, reverse pharmacology, and polypharmacology in Ayurveda are areas in silico explorations that are needed to understand the rich repertoire of herbs, minerals, herbo-minerals, and assorted Ayurvedic formulations. This review emphasizes exploring the concept of Ayurveda with in silico approaches and the need for Ayurinformatics studies. It also provides an overview of in silico studies done on phytoconstituents of some important Ayurvedic plants, the utility of in silico studies in Ayurvedic phytoconstituents/formulations, limitations/challenges, and prospects of in silico studies in Ayurveda. This article discusses the convergence of in silico work, especially in the least explored field of Ayurveda. The focused coalesce of these two domains could present a predictive combinatorial platform to enhance translational research magnitude. In nutshell, it could provide new insight into an Ayurvedic drug discovery involving an in silico approach that could not only alleviate the process of traditional medicine research but also enhance its effectiveness in addressing health care.

Democracia e neoliberalismo: avanços e insuficiências no processo de consolidação da cidadania / Democracy and neoliberalism: advances and insufficiency in the process of consolidation of citizenship / Democracia y neoliberalismo: avances e insuficiencia en el proceso de consolidación de la ciudadanía

O presente estudo tem por objetivo, a partir de suas reflexões teóricas, realizar um balanço crítico da democracia liberal enquanto direito político e sua relação com os contextos de dois momentos do neoliberalismo, ortodoxo e heterodoxo, dos governos de FHC e Lula respectivamente, evidenciando as disputas de significados em torno de mecanismos democráticos no embate entre as forças sociais populares e as forças do neoliberalismo. Como referência de conteúdo para pensar esses momentos do neoliberalismo, lança-se mão de análise a partir da teoria democrática deliberativa, como alternativas possíveis para o avanço da democracia como processo argumentativo entre opiniões diversas, isto é, a possibilidade de que os arranjos argumentativos contribuam para a mobilização de grupos em desvantagem visando à consolidação da cidadania, via a participação ativa dos indivíduos. Adota uma metodologia qualitativa com uma revisão de literatura que visa a dar conta dos conceitos políticos e da dimensão da historicidade que perpassam estas disputas de significados. Para tanto, o estudo se apoia nas concepções de Santos (2013), Dagnino (2004a; 2004b), Nogueira (2011), Avritzer (2000), Boito Jr. (2018), Maranhão (2014) e Saad Filho (2018). Conclui-se que o neoliberalismo tem promovido uma participação que se apresenta mais como representação de interesses particulares, e que mesmo com as inflexões causadas pela ampliação de mecanismos de participação durante o neoliberalismo heterodoxo, ainda é necessário avançar em termos de uma participação mais autônoma do sujeito coletivo, na relação sociedade-Estado, e que os arranjos deliberativos ­ traduzidos aqui como instrumentos legítimos que buscam viabilizar a demarcação de territórios como formas ampliadas de participação do corpo coletivo ­ sejam capazes de propiciar que interesses distintos possam argumentar sobre suas posições.(AU)

The present study aims, from its theoretical reflections, to carry out a critical assessment of liberal democracy as a political right and its relationship with the contexts of two moments of neoliberalism, orthodox and heterodox, of the governments of FHC and Lula respectively, evidencing the disputes of meanings around democratic mechanisms in the clash between popular social forces and the forces of neoliberalism. As a content reference to think about these moments of neoliberalism, an analysis is made from the deliberative democratic theory, as possible alternatives for the advancement of democracy as an argumentative process between different opinions, that is, the possibility that the argumentative arrangements contribute for the mobilization of disadvantaged groups aiming at the consolidation of citizenship, through the active participation of individuals. It adopts a qualitative methodology with a literature review that aims to account for the political concepts and the dimension of historicity that permeate these disputes of meanings. Therefore, the study is based on the concepts of Santos (2013), Dagnino (2004a; 2004b), Nogueira (2011), Avritzer (2000), Boito Jr. (2018), Maranhão (2014) and Saad Filho (2018). It is concluded that neoliberalism has promoted participation that presents itself more as a representation of particular interests, and that even with the inflections caused by the expansion of mechanisms of participation during heterodox neoliberalism, it is still necessary to advance in terms of a more autonomous participation of the collective subject, in the society-State relationship, and that deliberative arrangements ­ translated here as legitimate instruments that seek to enable the demarcation of territories as expanded forms of participation by the collective body ­ are capable of enabling different interests to argue about their positions.(AU)

El presente estudio pretende, a partir de sus reflexiones teóricas, realizar una valoración crítica de la democracia liberal como derecho político y su relación con los contextos de dos momentos del neoliberalismo, ortodoxo y heterodoxo, de los gobiernos de FHC y Lula respectivamente, evidenciando las disputas de sentidos en torno a los mecanismos democráticos en el choque entre las fuerzas sociales populares y las fuerzas del neoliberalismo. Como referencia de contenido para pensar estos momentos del neoliberalismo, se hace un análisis desde la teoría democrática deliberativa, como posibles alternativas para el avance de la democracia como proceso argumentativo entre diferentes opiniones, es decir, la posibilidad de que los arreglos argumentativos contribuyan para la movilización de grupos desfavorecidos con el objetivo de la consolidación de la ciudadanía, a través de la participación activa de los individuos. Adopta una metodología cualitativa con una revisión de literatura que tiene como objetivo dar cuenta de los conceptos políticos y la dimensión de historicidad que permean estas disputas de significados. Por lo tanto, el estudio se basa en los conceptos de Santos (2013), Dagnino (2004a; 2004b), Nogueira (2011), Avritzer (2000), Boito Jr. (2018), Maranhão (2014) y Saad Filho (2018). Se concluye que el neoliberalismo ha promovido una participación que se presenta más como una representación de intereses particulares, y que aún con las inflexiones provocadas por la expansión de los mecanismos de participación durante el neoliberalismo heterodoxo, aún es necesario avanzar en términos de una participación más autónoma. del sujeto colectivo, en la relación sociedad-Estado, y que los arreglos deliberativos ­traducidos aquí como instrumentos legítimos que buscan viabilizar la demarcación de territorios como formas ampliadas de participación del cuerpo colectivo­ son capaces de posibilitar que distintos intereses se discutan sobre sus posiciones.(AU)

Angiographic determinants for side branch treatment in distal unprotected left main coronary artery bifurcation percutaneous coronary intervention with single stent crossover technique

 Background: The aim of this study was to analyze angiographic parameters such as bifurcation angle, diameter at the polygon of confluence (POC) and SYNTAX score in predicting the need for side branch treatment with single-stent crossover technique from distal unprotected left main coronary artery (ULMCA) to the major side branch.Methods: This was a retrospective and observational study. A total of 83 patients with distal ULMCA lesions were enrolled. Patients who underwent provisional single-stent crossover technique were compared with patients that required side branch treatment though plain old balloon angioplasty (POBA) 5 (6.0%) or stenting 7 (8.4%). Angiographic parameters, bifurcation angle, diameter at the POC and the SYNTAX score were analyzed for their ability to predict the need for side branch treatment.Results: Mean age of patients was 58.2±5.3 years. Males constituted 61 (73.5%) patients. Post main branch stenting 5 (6.0%) and 7 (8.4%) patients required side branch treatment with POBA and stent implantation, respectively. Binary regression revealed bifurcation angle (Z: 1.15, OR: 0.99, 95% CI: 0.97-1.01, p=0.25), diameter at the POC (Z: 1.1, OR: 0.82, 95% CI: 0.32-2.13, p=0.272) and SYNTAX score (Z: 1.51, OR: 1.18, 95% CI: 0.95-1.45, p=0.132) did not correctly predict the requirement of side branch treatment.Conclusion: Left main coronary artery to main branch stenting can be performed safely with single-stent crossover technique, irrespective of presence of side branch disease across a wide range of bifurcation angles, diameters at the POC and SYNTAX scores.

Drainage of the basal vein of Rosenthal into the confluence of sinuses / 대한해부학회지

An adult female was found to have a variation of the left basal vein of Rosenthal after presenting with complaints of headache. The vein, in this case, drained directly into the confluence of sinuses instead of the great vein of Galen. Variation of the basal vein is likely due to the embryonic development of the deep cerebral venous system as primitive structures either differentiate further or regress with age. Such changes may result in the uncommon presentation seen in this case. To our knowledge, this is the first case reported of the basal vein draining into the confluence of sinuses.

Confluencia del pensamiento martiano y marxista desde el análisis de la cultura en Juan Marinello / Convergence of Marxist and Jose Marti-related thinking from the analysis of culture in Juan Marinello Vidaurreta

RESUMEN Juan Marinello Vidaurreta, eminente trabajador de las letras, que no cambió la pluma por la política, sino que hizo de la política incesante gestión de creación espiritual. Vivió tres etapas decisivas de Cuba: los rezagos de la colonia española; la República mediatizada, que combatió; y el socialismo, que ayudó a consolidar. El objetivo es demostrar la confluencia del pensamiento martiano y marxista desde el análisis de la cultura en la obra de Juan Marinello Vidaurreta. Se asumió la concepción dialéctica materialista como metodología general para conocer el objeto de investigación en sus antecedentes y tendencias actuales. Además permitió ampliar el conocimiento sobre el tema objeto de estudio, a través del análisis de texto, el contenido y el discurso; la crítica de fuentes posibilitó extraer inferencias a partir de la teoría preexistente y la información empírica acopiada. El pensamiento marinelliano se fue formando como resultado de la influencia del movimiento progresista cubano, del pensamiento martiano y marxista-leninista, lo más avanzado del pensamiento latinoamericano y universal. Subyace en su obra una concepción integradora y totalizadora de la cultura, de base martiana y marxista.

ABSTRACT Juan Marinello Vidaurreta eminent worker of the letters that did not change the pen by the policy, but that made of the policy, incessant management of spiritual creation. He lived three decisive stages of Cuba: the lags of the Spanish colony; the mediated Republic, which fought; and socialism, which helped to consolidate. The objective is to demonstrate the confluence of Marti's and Marxist thinking from the analysis of culture in the work of Juan Marinello Vidaurreta. The dialectical materialist conception was assumed as general methodology to know the object of research in its antecedents and current trends. In addition it allowed expanding the knowledge on the subject under study, through the analysis of text, content and discourse; the critique of sources made it possible to draw inferences from the preexisting theory and the empirical information collected. Marinellian thought was formed as a result of the influence of the Cuban progressive movement, of Marti and Marxist-Leninist thought, the most advanced of Latin American and universal thought. It underlies in his work an integrative and totalizing conception of the culture, of Marti base and marxist.

Clinical Study on Huoxue Rongluo Particles Combined with Acupuncture at Eight Confluent Acupoints in Treatment of Spastic Cerebral Infarction Paralysis / 中国中医药信息杂志

Objective To observe the clinical efficacy of Huoxue Rongluo Particles combined with acupuncture in the eight confluent points of spastic cerebral infarction paralysis and its effects on Glu and Asp levels of serum. Methods Totally 60 patients were divided into two groups: the experimental group and the control group. Both groups received basic Western medicine treatment, and the experimental group received Huoxue Rongluo Particles additionally, one dose a day for two times orally taken; Acupuncture was on eight confluent acupoint, every two days. 15 d is a treatment course, with 6 courses in total. Clinical spasticity index (CSI) and TCM symptom scores before treatment and the treatment of half month, 1 month, 3 months were observed. The levels of Glu and ASP in serum were detected, and TCM clinical efficacy was observed. Results The CSI score, levels of Glu and Asp in serum and TCM symptom scores of the patients after half-month, one-month, and three-month treatment were lower than those before treatment (P0.05). The TCM symptom scores in experimental group was lower than the control group after half-month, one-month and three-month treatment (P<0.05). The total TCM effective rate was 86.67% (26/30) in experimental group, and 80.00% (24/30) in the control group, with the experimental group better than the control group (P<0.05). Conclusion Huoxue Rongluo Particles combined with acupuncture eight confluence acupoints in the treatment of spastic cerebral infarction paralyzed patients can relieve spasm degree, improve TCM clinical symptoms, which mechanism may be related to reducing serum excitatory neurotransmitters.

Morphometric analysis of the inferior vena cava related to lumbar vertebra and the aortic bifurcation on Multidetector Computed Tomography (MDCT) / Análisis morfométrico de la vena cava inferior relacionado con las vértebras lumbares en la bifurcación aórtica mediante Tomografía Computadorizada Multidetector (TCMD)

Vascular structures are in greater danger during lumbar surgery. The purpose of this study is to describe the morphology of the inferior vena cava (IVC) related to the lumbar vertebra and aortic bifurcation (AB) and assessing the role of demographic values in these relations to decrease the risk of complications in the surgical interventions. The study was performed on Multidetector Computed Tomography (MDCT) images of 100 male and 100 female cases with an age range from 50 to 84 years. The morphometric values of the IVC obtained from the coronal, sagittal and the axial reformatted images were measured and compared with the demographic values. The distance from the IVC to the 1st lumbar vertebra (L1) and 2nd lumbar vertebra (L2) were measured as (26.5 mm and 18.1 mm) in males and (21.1 mm and 14.2 mm) in females with a high level of significance between genders; the distance from the IVC to the iliocaval confluence (IC), 3rd lumbar vertebra (L3) and 4rd lumbar vertebra (L4) were measured as (6.5 mm, 10.5 mm and 6.9 mm) in males and (4.9 mm, 9.1 mm and 5.5 mm) in females with significance between genders. The level of the IC was detected 46 % of males, 39 % of females at the level of lower third of L4. The vertical distance between the IC and the AB was measured and negative correlation between genders based on age was detected. Demographic values are important to consider the relationship of the IVC, the lumbar vertebra and the AB. The IVC was located further from the lumbar vertebra in males compared to females. Age increase played role in the approaching of the AB and the IC to each other in both gender and the IC to the promontory level in males.

Las estructuras vasculares corren gran peligro durante la cirugía lumbar. El propósito de este estudio fue describir la morfología de la vena cava inferior (VCI) en relación con las vértebras lumbares y la bifurcación aórtica (BA), junto con evaluar los valores demográficos de estas relaciones para disminuir el riesgo de complicaciones en las intervenciones quirúrgicas. Se utilizaron tomografías computadorizadas multidetector (TCMD) de 100 casos de hombres y mujeres entre 50 a 84 años de edad. Los valores morfométricos de la VCI se obtuvieron desde imágenes coronales y sagitales reformateadas, medidas y comparadas con los valores demográficos. Se midió la distancia de la VCI a la 1a (L1) y 2a vértebra lumbar (L2), en hombres de 26,5 mm y 18,1 mm respectivamente, y en mujeres de 21,1 mm y 14,2 mm, respectivamente, con un alto nivel de significancia entre el sexos. La distancia desde la VCI a la confluencia iliocava (CI), 3a (L3) y 4a vértebra lumbar (L4) fue para los hombres de 6,5 mm, 10,5 mm y 6,9 mm, respectivamente, y en mujeres de 4,9 mm, 9,1 mm y 5,5 mm respectivamente, con significancia entre los sexos. El nivel de la IC se detectó en 46 % de los varones y en el 39 % de las mujeres, a nivel de tercio inferior de L4. La distancia vertical entre la CI y la BA se tuvo una correlación negativa entre sexos en base a la edad. Los valores demográficos son importantes al considerar la relación de la VCI, las vértebras lumbares y la BA. La VCI se encuentra a una distancia mayor de las vértebras lumbares en hombres que en mujeres. El incremento de la edad jugó un papel importante en la aproximación de la BA y la IC, tanto entre sí como según sexo, con la CI a nivel del promontorio en los hombres.

Short Axillary Vein and an Axillary Venous Ladder Formed by Basilic and Brachial Veins – An Anatomical and Clinical Perspective

Knowledge of anatomic variants of veins in the arm and axilla play a key role in planning of successful venous access. Possible anatomic variants of axillary vein, brachial vein and basilic vein and their clinical implications have been well described in the literature. We report a rare case of formation of a short axillary vein associated with complex venous communications between the basilic and brachial veins forming a venous ladder in the axilla, in formalin embalmed male cadaver. Axillary vein was formed in the upper part of the axilla by the fusion of basilic vein and unpaired brachial vein, and it was about 3cm in length. The higher-up confluence of basilic and brachial veins was also associated with presence of three communicating veins between the basilic and brachial veins in the axilla. Knowledge of reported venous variations is very useful during preoperative venous mapping and also for planning and execution of various surgical invasive procedures involving these veins.

Abnormal low confluence of the hepatic ducts in cases of choledocholithiasis / 中华普通外科杂志

Objective To study the diagnosis and treatment of choledocholithiasis in patients with low left and right posterior hepatic duct confluence.Methods Clinical data of 12 patients suffering from cholelithiasis with a low confluence of the left and right posterior hepatic ducts admitted between January 2000 to June 2013 were retrospectively analyzed.Results Of the 12 cases,the left and right posterior hepatic ducts joined between 2 cm below hilus hepatis and the superior border of the duodenum in 8 cases,below the superior border of the duodenum in 4 cases.Seven cases had a low confluence of the right and left hepatic ducts,and 5 cases had right posterior duct low confluence.As for bile duct stricture:the opening stricture at the junction of the right and left hepatic ducts were found in 4 cases,the opening stricture in the right hepatic ducts were found in 3 cases,the opening stricture of the left hepatic duct were found in 2 cases.There were left and right bile duct stones in 7 cases,right intrahepatic bile duct stones in 3 cases,left intrahepatic bile duct stones in 2 cases.Cystic duct joined the right hepatic duct in 5 cases,left hepatic duct in 2 cases.Seven cases with a low confluence of the right and left hepatic ducts were with double T tube drainage; five of low right hepatic duct confluence were treated by T tube drainage.The right posterior branch of hepatic ducts were injured in four cases and right hepatic duct was injured in one.Conclusions Low confluence of left and right posterior hepatic ducts often leads to misdiagnosis during surgery of cholelithiasis.Magnetic resonance cholangio-pancreatography or endoscopic retrograde cholangiopancreatography was helpful before cholecystectomy to avoid iatrogenic injury of biliary tract.

A second ERCP for the failure of pre-cut ERCP / 中华消化内镜杂志

Objective To study the therapeutic value of a second ERCP for the patients with failure of pre-cut ERCP.Methods A total of 167 cases of pre-cut ERCP failure were recruited to the study,among which 109 cases were diagnosed as common bile duct stones and/or benign papillary stenosis,and 58 cases as biliopancreatic lesion.ERCP failed with standard intubation for more than 20 minutes,even with pre-cut or fenestration.A second ERCP was preformed after rest of 3-5 days.The position sequence of intubation for most patients was horizontal,the front and rear.Results The success rate was 79.6％ (133 cases) for the patients with a second ERCP,85 patients received the procedures via the horizontal intubation,36 via anterior,and 12 via posterior intubation.The treatments were performed after successful completion of the endoscopic cannulation.One patient had retroperitoneal infection with duodenal perforation,another patient had severe pancreatitis,who were cured by the intervention methods.Conclusion The success rate of a second ERCP is high with proficient intubation skills.

A Unique Type of Dural Arteriovenous Fistula at Confluence of Sinuses Treated with Endovascular Embolization: A Case Report / 신경중재치료의학

Dural arteriovenous fistula (DAVF) is classically defined as abnormal arteriovenous connections located within the dural leaflets. Though the exact etiology is still not clear, they are generally accepted as acquired lesions. However, some DAVFs formed as the congenital disorders are called dural arteriovenous malformations and these lesions with a marked cortical venous reflux are considered to be aggressive and warrant an early intervention. The authors describe a case of 35-year-old man presented with unique type of DAVF. The fistula was located adjacent to the confluence of venous sinuses with multiple feeders. The feeders drained into a large venous pouch just anterior to the confluence which had a bilateral venous drainage. This was associated with multiple cerebellar venous ectasia along the draining cortical vein. It was managed by staged endovascular procedures and complete cure could be achieved. The pathogenesis and technique of embolization of this complex fistula/malformation are also discussed.

Impact of pancreatobiliary reflux in normal pancreatobiliary junction on gallbladder / 中华消化内镜杂志

Objective To explore the impact of pancreatobiliary reflux (PBR) in normal pancreatobiliary junction on gallbladder.Methods A total of 54 patients receiving cholecystectomy for gallbladder diseases underwent ultrasonography to evaluate the thickness of gallbladder wall,inner layer and gallbladder wall blood flow before operation.The bile juice was sampled during ERCP in 45 patients with common bile duct stone and during cholecystectomy in 9 patients to detect amylase level.All patients with normal pancreatobiliary junction enrolled in the study were assigned into PBR group (n =24) and controlled group (n =30) according to their bile amylase level.Resected gallbladder specimens were examined histopathologically and then tested for expression of COX2,Ki-67 and p53 immunohistochemically.Results PBR group included 20 cases of cholelithiasis and 4 gallbladder polyp,among which 23 were occult PBR (OPBR) and 1 high confluence of pancreatobiliary ducts (HCPBD),which was similar to pancreatobiliary maljunction (PBM) pathologically.The control group recruited 28 cases of cholelithiasis and 2 gallbladder polyp.There were no differences in frequency of inflammation,hyperplasia,metaplasia or expression of p53 between the two groups (p ＞ 0.05),while higher presence of dysplasia and higher expression of COX2 and Ki-67 were seen in PBR group (p ＜ 0.05).Conclusion In patients with OPBR,although hyperplasia and metaplasia in gallbladder epithelium were similar to those induced by cholelithiasis,dysplasia and active proliferation might relate to progress to malignancy.

La confluencia en la relación de pareja como limitante para el crecimiento personal: una visión gestáltica / Confluence in the couple relationship as a limit for the personal growth: a gestalt vision

El presente artículo es producto de una investigación que pretende dar a conocer la forma en que la confluencia afecta las relaciones de pareja, influyendo en el crecimiento personal de los miembros de la misma. Desde un punto de vista gestáltico, a través de una investigación cualitativa y el método fenomenológico, se analizó la experiencia personal de los participantes respecto al tema, y el significado que tiene para ellos esa experiencia. Las participantes en esta investigación son 4 mujeres de entre 22 a 35 años de edad, quienes autodefinen su relación de pareja como conflictiva, y quienes mantuvieron una relación de confluencia (noviazgo o matrimonio) en algún momento de su vida. Las técnicas de recolección de datos utilizadas fueron la entrevista individual y la autobiografía. Conforme al análisis realizado durante esta investigación se encontró que: la confluencia y la codependencia mantienen características similares, sin embargo la diferencia esencial básicamente se refiere a que la primera es considerada un mecanismo de defensa desde la Gestalt, mientras que la segunda se califica más como una enfermedad (Melody, Wells y Miller, 2003; Barnetche, De Maqueo y De Martínez, citados por Ruíz, 2007). Además, se identificó que los principales factores que favorecen la confluencia en una relación de pareja son la historia personal, la baja autoestima y la falta de límites claros. También, se encontró que los sentimientos predominantes en una relación confluente son el miedo a la soledad, la desconfianza en la pareja y los celos. Por lo tanto, se concluye que la confluencia sí limita el crecimiento personal pues la persona se enfoca en su relación de pareja más que en sí misma.

Confluence in the couple relationship as a limit for the personal growth. A Gestalt vision. Frequently, when someone decides to establish a couple relationship, this individual starts to worry more for the other person than for oneself, people worry more about the couple's needs to be satisfied while the own needs are left in a second place. Finally, the people are immersed in a not very satisfactory couple relationship, in which they are afraid to show the other person how they are in fact or what they wish, so the individuals end up depending, to a great extent, on the other person, to such a point that they cede the other person the responsibility of their own happiness. In this kind of relationships it is very difficult that someone gets to have enough confidence in the partner when there is the fear to abandonment and to loneliness. All this contributes to the existence of diverse problems in the population in general, whether they are physical, psychological or emotional; because human beings live each time less happily, due to the lack of satisfactory interpersonal relationships, in which the people feel understood and listened, and in which they can develop fully without existing the fear to rejection and to abandonment. On the other hand, the relationships based on the confluence seem to abound everywhere and in any culture or social stratum.

Eight-Points-Acupuncture and Ancient Chinese Contraindications in Acupuncture:Two Methods of Improving Acupuncture Treatment Based upon Ancient Chinese Sources,and Clinical Experiences / 针灸推拿医学（英文版）

According to ancient and present Chinese sources the Eight Confluent Points are essentials of acupuncture and can treat all kinds of diseases. They exert a fundamental influence on the Twelve Regular Meridians and their mobilization can be seen as a necessity for a successful acupuncture treatment. For this they should play a major role in acupuncture. In European acupuncture teachings there is also the opinion that by too much needling of the Eight Confluent Points the qi of the organism might get exhausted which will deteriorate the patient's symptoms and eventually will create new symptoms. Here it will be shown that deterioration as well as the creation of new symptoms due to acupuncture is caused by not observing the contraindications in acupuncture as set up in ancient China provided that syndrome differentiation,point selection and stimulation have been correct. In opposition to this,all of the Eight Extraordinary Channels are to be activated at first and then the Twelve Regular Meridians are to be mobilized in order to achieve therapeutic effects.

The clinic meaning in low confluence of cystic duct / 临床外科杂志

Objective Discussing the clinic meaning which cystic duct is low confluence to CBD.Method Combining the anatomy of cystic duct,analyzing 5 cases with low confluence of cystic duct.Results Cystic duct were opened and caught out stones,then closed by direct future in 2 cases. The cystic duct were not cut out in all cases.They were fine without any discomforts such as abdomen pain,abdomen bulge over 2 years.Conclusions Anatomic should becareful in the cases with low confluence of cystic duct.The stones in the cystic duct should be taken out.The cystic duct may be left longer.Simple longer cystic duct may be no clinical meanings.

Significance of Cerebral Venography in Surgery of Petroclival Meningiomas

OBJECTIVE: A thorough understanding of the related venous structure is mandatory for successful removal of the petroclival meningiomas. This study was planned to investigate the guideline for safe ligation and incision of transverse or sigmoid sinuses and the importance of drainage pattern of vein of Labb in surgical removal of petroclival meningiomas. MATERIALS AND METHODS: The authors reviewed the venogram of the consecutive 37 cases of petroclival meningiomas and retrospectively analyzed their surgical findings. The drainage pattern of confluence of Herophili was classified as Type A(confluent and equal on both sides), Type B(confluent and non-dominant on tumor side), Type C(confluent and dominant on tumor side) and Type D(unilateral drainage only) as these findings gave the information on safe ligation and resection of the sinus. Usefulness of intraoperative test clamping of sinus for safe ligation was also reviewed. The vein of Labb was analyzed with respect to its draining point and its collaterals to other superficial veins. RESULTS: Contraindications of the sinus ligation and resection according to the drainage pattern at the confluence of Herophili were Type C(n=10, 27%)and Type D(n=4, 11%). Patients with Type A(n=12, 32%)and Type B(n=11, 30%) were tolerable to sinus ligation ipsilateral to tumor, if the test clamping proved to be safe. Identification of no brain swelling, after intraoperative test clamping of the sinus for more than 30 minutes performed in 7 out of 11 cases, was a reliable indicator of safe sinus ligation. The drainage pattern of the vein of Labb, especially low-lying type, could predict the possibility of postoperative hemorrhage and infarction. Its drainage into tentorium or superior petrosal sinus, however, made the transtentorial approach impossible, leading to restricted operative field. CONCLUSION: For a successful removal of the petroclival meningiomas preoperative venogram should be examined carefully. The extent of exposure in a planned approach can be estimated by analyzing the variation of sinuses and the drainage pattern of vein of Labb.

A Case of Total Anomalous Pulmonary Venous Confluence in Adult Diagnosed by Echocardiography

Total anomalous pulmonary venous confluence(TAPC), a rare cyanotic congenital anomaly of the heart especially in adult, is now diagnosed by echocardiography instead of cardiac catheterization with high sensitivity and specificity. The key points are identification of pulmonary veins, pulmonary venous confluence draining anomalously to the heart. RVDVO on M-mode, abnormal echo free space posterior to left atrium on 2D-echo are basic characteristics of TAPVC. Peak velocity and flow profile measurement on the doppler provide additional informations : obstruction and anomalous vessels. A case of 23 year old male with supracardiac type TAPVC diagnosed by echocardiography was corrected successfully by surgery.