腹腔置管引流联合抗生素治疗重症急性胰腺炎的临床疗效评价

目的探讨腹腔置管引流联合抗生素治疗重症急性胰腺炎(SAP)的临床疗效评及安全性。方法选择2011年5月至2012年5月解放军第九二医院收治的SAP患者54例,依据随机数字表法分为观察组和对照组,各27例。对照组患者在常规治疗的基础上早期腹腔置管引流,观察组在对照组的基础上给予联合抗生素治疗。测定腹腔灌洗前、灌洗后24、48、72 h的腹水淀粉酶、血清淀粉酶、血清肿瘤坏死因子α(TNF-α)、白细胞介素8(IL-8)和C反应蛋白水平。观察两组患者肠道功能恢复时间、全身炎症反应综合征(SIRS)持续时间和多器官功能障碍综合征(MODS)的发生率。结果治疗后24、48、72 h,两组患者腹水淀粉酶、急性生理和慢性健康状况评分系统Ⅱ评分、血清淀粉酶,血清TNF-α、IL-8和C反应蛋白均呈下降趋势(P<0.05),且观察组改善情况优于对照组(P<0.05)。观察组患者肠道功能恢复时间、SIRS持续时间显著短于对照组,MODS发生率显著低于对照组,差异均有统计学意义(均P<0.05)。结论胰腺炎相关性腹水在SAP病情进展过程中起重要作用,早期腹腔内置管引流可明显改善患者病情,减轻炎症反应,联合抗生素灌洗可有效清除血清中促炎因子,控制腹腔内感染,降低并发症发生率。     

围胰腺区域性微创治疗大鼠重症急性胰腺炎的实验研究

目的 观察围胰腺区域性微创治疗方案对重症急性胰腺炎(SAP)大鼠的影响.方法 72只SD大鼠随机分为自然病程组(SAP组)、常规治疗组(R组)、DDFA治疗组(DDFA组)、微创治疗组(W组),各组分配18只.每组分6、12、24 h三个时间点,每时间点分配6只.采用5%牛黄胆酸钠逆行胰管注射法建立大鼠SAP模型.建模后按时间点分批采血并测血白细胞、血淀粉酶,提取血清测IL-6、TNF-α、PL-A2,吸取腹腔液测淀粉酶,取胰腺组织制作病理切片.结果 各组各时间点间腹腔液淀粉酶含量及血淀粉酶含量、白细胞计数、血清IL-6、TNF-α、PL-A2含量、病理评分比较均有显著性差异.结论 围胰腺区域性微创治疗方案能显著降低大鼠血白细胞、淀粉酶、IL-6、TNF-α、PL-A2、腹水淀粉酶、胰腺组织病理评分,是阻止SAP进展的有效方法.     

护理干预对重症急性胰腺炎患者穿刺置引流术后疗效的影响

目的：观察护理干预对16例重症急性胰腺炎患者穿刺置引流灌洗后疗效。方法：对16例重症急性胰腺炎患者早期进行置管引流灌洗治疗配合护理干预措施后,监测腹腔灌洗前后体温、呼吸、心率、APACHⅡ分值及灌洗前、灌洗护理24、48、72小时后腹水、血清淀粉酶含量的变化,分析护理效果。结果：经灌洗治疗和灌洗治疗护理后监测体温、呼吸、心率、APACHEⅡ分值及腹水、血清淀粉酶在灌洗前、灌洗护理24、48、72小时后变化,差异均有统计学意义（P<0.01）。16例患者灌洗治疗配合护理干预后因发生假性动脉瘤大出血死亡1例外,病情均好转、治愈。结论：重症急性胰腺炎穿刺置管引流灌洗后严密观察病情,配合精心护理,有利于降低重症急性胰腺炎的病死率、并发症的发生率。是提高临床疗效预防并发症和病情进一步发展的有效措施。     

经皮芒硝超声导入对重症急性胰腺炎模型大鼠胰腺及相关性腹水的影响

目的观察经皮芒硝超声导入对急性胰腺炎(SAP)模型大鼠胰腺及相关性腹水(PAAF)的影响。方法将60只雄性SD大鼠随机分为SAP对照组、芒硝外敷组、超声导入组,每组20只。采用胰胆管逆行注入5%牛磺胆酸钠的方法制备重症急性胰腺炎(SAP)模型。72h后处死,检测各组大鼠腹水量、血清肿瘤坏死因子α(TNF-α)、腹水淀粉酶(AMY)变化,对胰腺组织进行病理学检查。结果芒硝外敷组及超声导入组腹水量、血清TNF-α、腹水AMY等均显著低于SAP对照组[腹水量:(11.7±1.0)g、(7.9±1.5)g比(16.3±2.4)g,P0.05或P0.01;TNF-α:(93.38±11.27)ng/L、(56.15±17.30)ng/L比(120.46±20.16)ng/L,P0.05或P0.01;AMY:(13 296.0±428.2)U/L、(7236.0±578.6)U/L比(17 548.0±537.6)U/L,P0.05或P0.01],芒硝外敷组及超声导入组病理评分均显著低于对照组[(7.6±0.6)分、(5.2±1.2)分比(9.8±0.5)分,P0.05或P0.01],提示芒硝外敷组及超声导入组较对照组胰腺组织炎症、水肿、出血、坏死程度减轻,其中超声导入组改善更优于芒硝外敷组(P0.05)。结论芒硝外敷能改善SAP模型大鼠的炎症和PAAF,经皮芒硝超声导入法疗效优于传统芒硝外敷。     

连续性血液净化治疗心血管术后急性肾功能衰竭的时机探讨

目的 探讨连续性血液净化(CBP)治疗心血管术后急性肾功能衰竭(ARF)的疗效.方法 将入选病人按CBP实施前的病情严重程度分为全身炎症反应综合征(SIRS)组13例,多器官功能障碍(MODS)组12例;进行APACHEⅢ评分及常规检测血尿素氮(BUN)和血肌酐(Scr)水平,同时采用放射免疫分析法检测病人血浆中炎症介质白细胞介素(IL)6、肿瘤坏死因子8、(TNF-α)水平.结果 CBP实施24 h后APACHEⅢ评分、血BUN、血Scr,IL-6、8、TNF-α,均较CBP实施前显著降低[(分别为(61±15)vs(81±20),(19±5)mml/L vs(26±5)mmoVL,(312±87)/μmol/L vs(458±107)μmol/L,(544±154)ng/L vs(842±132)ng/L,(18±7)ng/L vs(25±8)ng/L,(43±15)ng/L vs(59±17)ng/L].SIRS、MODS组病人的存活率分别为84.62%、41.67%(P<0.05);CBP实施前和实施24 h后MODS组ARF病人的APACHEⅢ评分、血BUN、血Scr,血清IL6、IL-8均显著高于SIRS组.结论 APACHEⅢ评分为60～90分时可能是心血管术后发生ARF实施CBP治疗的较理想时机.     

大黄对急性胰腺炎炎症反应的影响

目的：探讨白介素－1（IL－1）、肿瘤坏死因子α（TNF-α）在急性胰腺炎发病中的作用，观察大黄对急性胰腺炎的治疗效果。方法：将120只大鼠随机分成：假手术组，对照组，大黄喂养组，大黄腹腔灌洗组。采用1．5％牛磺胆酸负逆行胰胆管注射建立AEP模型，并于模型制成后24h,48h,72h测定血液，腹水中IL－1、TNF-α及淀粉酶的水平。结果：对照组大鼠血液，腹水中IL－1、TNF-α及淀粉酶的水平较假手术组明显增高，以大黄喂养及腹腔灌洗后上述指标均明显下降，结论：IL1－、TNF-α参与AEP发病机理，大黄显著降低血液，腹水中IL－1、TNF-α的含量可能是大黄治疗急性胰炎的一种机制。     

白藜芦醇对急性肺损伤大鼠的抗炎作用研究

目的通过动物实验验证中药虎杖主要成分白藜芦醇对急性肺损伤大鼠的抗炎保护作用。方法 40只SD大鼠随机分为空白对照组、肺损伤模型组、溶剂对照组和白藜芦醇治疗组,每组各10只。气道内滴注细菌内毒素脂多糖(LPS)制备急性肺损伤模型,溶剂对照组腹腔注射单体溶解剂(脂肪乳),白藜芦醇治疗组腹腔注射白藜芦醇及溶解剂,分别在造模前24 h、造模时及造模后24 h内进行腹腔内注射。造模后48 h进行标本采集,肺组织进行病理染色检查并检测肺泡灌洗液(BALF)中性粒细胞比值、肿瘤坏死因子-α(TNF-α)及乳酸脱氢酶(LDH)的含量。结果白藜芦醇治疗组的肺泡灌洗液中性粒细胞比值及TNF-α数值为(68.432±20.623)、(92.644±11.322)ng/L,高于溶剂对照组的(87.023±4.032)、(106.654±4.606)ng/L,差异有统计学意义(P0.05);两组肺泡灌洗液中LDH数值比较,差异无统计学意义(P0.05)。结论白藜芦醇治疗组能显著减轻急性肺损伤引起的病理改变,白藜芦醇对急性肺损伤大鼠具有抗炎保护作用。     

纳美芬对缺血性脑卒中患者血清IL-8、TNF-α、IL-6的影响

目的分析和探讨纳美芬对缺血性脑卒中患者血清IL-8、TNF-α、IL-6的影响。方法选择从2012年12月至2014年12月在本院进行治疗的缺血性脑卒中患者90例,以45例为1组,随机分为观察组和对照组,对照组行常规治疗,在此基础上观察组行纳美芬治疗。观察并对比治疗前后两组患者血清IL-8、TNF-α、IL-6的变化。结果治疗前观察组患者血清IL-8、TNF-α、IL-6水平分别是(55.13±11.44)ng/L、(74.57±12.16)ng/L、(629±119)ng/L,对照组分别是(56.21±10.99)ng/L、(4.78±12.68)ng/L、(36±130)ng/L,两组无比较差异(P0.0)。治疗14 d时观察组患者血清IL-8、TNF-α、IL-6水平分别是(38.22±10.88)ng/L、(45.44±11.35)ng/L、(314±99)ng/L,对照组分别是(48.13±9.99)ng/L、(66.35±12.55)ng/L、(453±88)ng/L,两组比较差异有统计学意义(P0.05)。治疗20 d时观察组患者血清IL-8、TNF-α、IL-6水平分别是(22.14±9.13)ng/L、(21.25±6.62)ng/L、(231±88)ng/L,对照组分别是(23.57±9.88)ng/L、(21.13±5.68)ng/L、(243±80)ng/L,两组无比较差异(P0.0)。结论在缺血性脑卒中的治疗中纳美芬能在较短时间内显著降低患者血清IL-8、TNF-α、IL-6的表达,但进入缓解期后其影响较小。     

持续血液滤过治疗脓毒血症并急性肾衰的临床观察

目的探讨持续血液滤过治疗脓毒血症合并急性肾衰的治疗效果。方法收集2007年1月至2011年10月47例脓毒血症合并急性肾衰患者的临床资料,观察连续静脉-静脉血液滤过(CVVH)治疗前后患者的心率(HR)、呼吸(R)、氧合指数(PaO2/FiO2)、血氧饱和度(SaO2)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)以及APACHEⅡ评分等指标的变化,并对其临床表现及预后进行分析。结果 CVVH治疗72h,33例患者的临床症状明显改善,其中29例患者的HR、R、PaO2/FiO2、SaO2恢复正常,APACHEⅡ评分明显下降[(14.8±6.2)分vs(11.1±5.4)分,P<0.05)],血清IL-6[(70.3±17.1)ng/Lvs(31.2±14.9)ng/L]及TNF-α[(60.5±18.2)ng/Lvs(35.3±15.3)ng/L]亦明显下降(P<0.05);另外14例患者的临床症状无改善甚至恶化,HR、R、PaO2/FiO2、SaO2及APACHEⅡ评分无改善,但血清IL-6[(73.1±18.3)ng/Lvs(45.5±17.4)ng/L]及TNF-α[(64.3±16.7)ng/Lvs(39.4±16.4)ng/L]明显下降(P<0.05)。治疗7～10d,18例患者死亡;其中早期采用CVVH治疗的27例患者有10例死亡,非早期采用CVVH治疗的20例患者有8例死亡,两者比较差异无统计学意义(P>0.05)。结论持续血液滤过治疗脓毒血症合并急性肾衰能够有效降低患者血清中炎症介质的水平,改善病情;但脓毒血症合并急性肾衰患者的病情复杂且进展快,尚不能判断早期使用持续血液滤过治疗可以有效降低其死亡率。     

沙利度胺对腹腔转移伴腹水的晚期胃腺癌治疗研究

目的：探讨沙利度胺治疗腹腔转移伴腹水的晚期胃腺癌的疗效及其可能机制。方法：选择胃腺癌66例,经腹水细胞学证实为恶性腹腔积液,随机分为对照组和实验组,对照组采用顺铂和5-FU腹腔灌注,而实验组在上述腹腔灌注的基础上加用沙利度胺400 mg口服,每晚1次。治疗第2天即开始询问饮食、夜间睡眠情况、消化道症状（恶心呕吐、腹痛、腹泻）和便秘及止痛药使用情况,称体重连同放出腹水量并作记录。4周后同上法放净腹水并观察记录,两次均留取10 ml置于-70℃冰箱中冷藏行指标检测。结果：①对照组和实验组治疗前后腹水中TNF-α、VEGF和IL-6的浓度及腹水量比较,对照组和实验组治疗前分别为（97.13±10.85）ng/L、（468.46±39.52）ng/L、（53.42±17.78）ng/L、（967.00±67.52）ml和（98.53±11.34）ng/L、（483.46±37.54）ng/L、（51.76±17.21）ng/L、（946.00±71.64）ml,对照组和实验组治疗后分别为（89.87±8.94）ng/L、（396.40±35.76）ng/L、（49.74±15.42）ng/L、（769.00±53.79）ml和（59.34±7.62）ng/L、（214.81±23.72）ng/L、（32.63±19.20）ng/L、（575.00±43.79）ml,VEGF、TNF-α、IL-6检测指标及腹水量两组治疗前比较差异无统计学意义（P〉0.05）,治疗后比较差异有统计学意义,TNF-α、VEGF、IL-6和腹水量P值分别为〈0.05、〈0.01、〈0.05和〈0.05。②两组在饮食增加、夜间睡眠改善、降低消化道症状、体重增加和镇痛药减少方面比较差异有统计学意义,P值分别为〈0.01、〈0.05、〈0.05、〈0.05、〈0.05。结论：加用沙利度胺口服治疗腹腔转移伴腹水的晚期胃腺癌能使腹水减少并提高生活质量。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.