经皮穴位电刺激辅助全麻对乳腺癌根治术中镇痛效应和血流动力学的影响

目的 观察经皮穴位电刺激（TEAS）辅助全麻下对乳腺癌根治术中镇痛效应和血流动力学的影响。方法 选取来自温州医科大学附属第一医院2019 年7 月～2020 年2 月全麻下行乳腺癌根治术患者80 例,按随机数字表法随机分成两组：TEAS 组和对照组,每组各40 例。TEAS 组在麻醉诱导前30 min 行TEAS（取穴为双侧合谷、内关、足三里、三阴交）,直至手术结束。对照组予相同位置贴电极片,不予电刺激处理。两组患者均采用常规诱导后置入喉罩全麻。记录两组术中各时间点的MAP、HR 和脑电双频谱值（BIS）、拔管时间、术中麻醉用药情况。结果 两组患者的一般情况和手术情况无差异。TEAS 组的拔管时间较对照组缩短,术中瑞芬太尼用量减少（P＜0.05）;TEAS 组在插管后即刻（T1）、插管后5 min（T2）、拔管后即刻（T6）、拔管后3 min（T7）的MAP 水平显著低于对照组（P＜0.05）,TEAS 组在插管后即刻（T1）、插管后5 min（T2）、拔管后即刻（T6）的HR 水平显著低于对照组（P＜0.05）;TEAS 组的T1 时刻BIS 值显著低于对照组（P＜0.05）。结论 经皮穴位电刺激辅助全麻可以增强乳腺癌根治术中镇痛效应,减轻术中应激反应。     

经皮穴位电刺激对胃癌根治术患者围术期血流动力学及免疫因子水平的影响

目的 探讨经皮穴位电刺激（transcutaneous electrical acupoint stimulation,TEAS）对胃癌根治术患者围术期血流动力学及免疫因子水平的影响。方法 选择择期全麻行腹腔镜胃癌根治术的患者80例,ASA I或II级。随机分为观察组和对照组。于术前30 min开始对观察组患者双侧足三里、合谷及三阴交穴给予电刺激;对照组则在目标穴位贴电极片,但不给予电刺激。分别在麻醉前30 min(T0)、插管时（T1）、切皮时（T2）、气腹时（T3）、拔管时（T4）记录所有患者的HR及MAP水平;于手术前和术后第1天分别取3 mL外周静脉血用于检测血浆IL-2、IL-6及IL-10浓度水平。结果 与对照组相比,观察组MAP及HR在T1、T2、T3、T4时均要更低,差异有统计学意义（P<0.05）。手术前两组患者的IL-2、IL-6及IL-10浓度水平相比较,差异无统计学意义（P>0.05）;术后第1天观察组IL-2、IL-6及IL-10浓度水平高于对照组,差异有统计学意义（P<0.05）。结论 TEAS能够有利于保持胃癌根治术围术期血流动力学稳定,...     

经皮穴位电刺激在结核病患者肺部手术中的应用

[目的]分析经皮穴位电刺激(transcutaneous electrical acupoint stimulation,TEAS)在肺结核患者肺部手术中的镇痛作用及对单肺通气时肺氧合功能的影响。[方法]选择62例在全麻下行开胸脓胸清除术的肺结核患者,随机分为2组:T组(TEAS组),F组(假TEAS组)。两组取穴均为双侧后溪、支勾、内关、合谷,T组从麻醉诱导前30min开始用韩氏穴位神经电刺激仪刺激直至手术结束,F组仅将不干凝胶电极片贴于穴位并连接韩氏穴位神经电刺激仪,不给予电刺激。两组麻醉诱导及维持方法相同。分别于术前、术中及术后相应时间点记录血流动力学及呼吸力学指标,并抽取动脉血行血气分析,记录术中、术后舒芬太尼使用情况。[结果]两组患者一般情况比较差异无统计学意义(P＞0.05),且两组患者各时点的平均动脉压(mean blood pressure,MAP)、呼吸生理学指标及血气分析指标差异均无统计学意义(P＞0.05)。而与F组比较,T组单肺通气期间心率显著降低(P＜0.05),各时段舒芬太尼使用量、患者自控静脉镇痛(patient controlled intravenous analgesia,PCIA)总按压次数、有效按压次数及视觉模拟评分法(visual analogue scale,VAS)评分均较低,差异有统计学意义(P＜0.05)。[结论]TEAS能有效减少肺结核患者围术期麻醉镇痛药物的使用,有较好镇痛作用,但对患者肺氧合功能无显著影响。     

经皮穴位电刺激在乳腺手术麻醉中的应用

[目的]观察不同穴位组合下经皮穴位电刺激(TEAS)在乳腺肿物切除术静脉麻醉中的临床效果。[方法]将60例择期行单侧乳腺肿物切除术的女性患者,随机分为A、B两组(n=30):A组,静脉全麻+TEAS患侧内关穴、合谷穴;B组,静脉全麻+TEAS患侧内关透外关穴、合谷透劳宫穴、双侧肩井穴。用韩氏穴位电刺激仪进行穴位刺激后行静脉全麻,TEAS持续至术毕,观察并记录TEAS前、TEAS 30 min、麻醉后5 min、麻醉后10 min、手术切皮后5 min、手术结束、苏醒各时间点(分别表示为T1、T2、T3、T4、T5、T6、T7)的脑电双频谱指数(bispectral index,BIS)、心率(heart rate,HR)、平均血压(mean blood pressure,MBP)、Sp O2的变化及切皮时体动反应、苏醒质量,并对有关指标进行统计学分析。[结果](1)TEAS后30 min(T2),B组较A组的BIS值、HR、MBP明显降低,差异有统计学意义(P0.05);在苏醒时(T7),B组较A组BIS值高,差异有统计学意义(P0.05)。(2)麻醉全过程丙泊酚及芬太尼的总用量,B组明显低于A组,差异有统计学意义(P0.05)。[结论]经皮穴位电刺激有强化、协同镇静效应,能显著减少丙泊酚和芬太尼的用量,在全麻乳腺肿物切除术静脉麻醉中有辅助作用。而TEAS患侧内关透外关穴、合谷透劳宫穴及双侧肩井穴的临床效果优于常规穴位刺激,值得临床推广应用。     

术前TEAS预保温策略对胸腔镜下肺叶切除术老年患者麻醉后恢复及术后认知功能的影响

目的 探讨术前经皮穴位电刺激(TEAS)预保温策略对胸腔镜下肺叶切除术老年患者麻醉后恢复及术后认知功能的影响.方法 选择2018年1月至2019年12月在该院接受全身麻醉下行择期胸腔镜下肺叶切除术的老年患者150例为研究对象,分为穴位组(AW组)、充气加温毯预热组(PA组)和对照组(C组),每组50例.入麻醉准备间后,AW组采用穴位刺激仪对大椎及腰阳关穴进行电刺激30 min,PA组全身加盖充气加温毯30 min,C组在相应穴位贴电极,但不给予电刺激.观察并记录T0(入准备间)、T1(出准备间)、T2(麻醉诱导后)、T3(切皮后30 min)、T4(切皮后60 min)、T5(切皮后90 min)、T6(入PACU 10 min)时的核心体温;分析患者入准备间、术后24 h血清白细胞介素(IL)-1β、IL-6、肿瘤坏死因子(TNF)-α水平.术前24 h、术后3 d,采用简易智力状态检查量表(MMSE)评分、蒙特利尔认知评估量表(MoCA)评分、术后恢复质量评估量表(PQRS)评估患者认知功能.结果 T1时PA组、AW组患者体温明显高于C组(P<0.05),T2时AW组患者体温明显高于C组(P<0.05).PA组、AW组苏醒时间均明显短于C组(P<0.01).苏醒期寒战发生率AW组4.0％,PA组8.0％,C组32.0％,3组比较差异有统计学意义(P<0.01).术后24 h PA组血清IL-6水平明显低于C组(P<0.01),AW组血清IL-6、TNF-α水平明显低于其他2组(P<0.01).POCD发生率AW组4.0％,PA组6.0％,C组20.0％,3组比较差异有统计学意义(χ2=8.444,P=0.015).结论 术前TEAS预保温策略可减少胸腔镜肺叶切除老年患者围术期低体温的发生,缩短患者麻醉苏醒时间,降低炎症因子水平及POCD的发生率.     

氟比洛酚酯对单肺通气患者围术期炎性细胞因子的影响

目的观察氟比洛酚酯对胸腔镜单肺通气（OLV）肺癌手术患者炎性细胞因子的影响,探讨其对急性肺损伤（ALI）的保护作用。方法将30例拟行肺叶切除术的肺癌患者随机分为氟比洛酚酯组（F组）和对照组（C组）,各15例。两组患者分别在麻醉诱导后（T1）,OLV45min（T2）、90min（T3）及术后2h（T4）采取静脉血,测定血清肿瘤坏死因子-α（TNF-α）及白细胞介素-6（IL-6）、IL-10浓度。结果两组TNF-α、IL-6浓度T2时点明显高于T1（P〈0.05）,IL-10浓度T3及T4时点明显高于T1（P〈0.05）。与C组相比,F组T3、T4时点TNF-α、IL-6浓度均较低（P〈0.05）,IL-10浓度较高（P〈0.05）。结论氟比洛酚酯可减轻胸腔镜下肺癌手术围术期的炎性反应,减轻ALI程度。     

右美托咪定对肺癌胸腔镜手术中单肺通气氧化应激反应及炎症性反应的影响

目的研究右美托咪定对肺癌胸腔镜手术中单肺通气氧化应激反应及炎症性反应的影响,旨在为临床治疗提供相应的理论依据。方法选取我院在2014年7月至2016年7月期间收治的88例拟行肺癌胸腔镜手术治疗的肺癌患者。采用随机抽取的方式将患者分成两组（每组44例）,观察组患者在术前静脉输注右美托咪定,对照组输注生理盐水。记录两组患者手术时间、术中单肺通气时间、OLV时间、液体总量、术中失血量、尿量;比较两组患者在切皮前（T1）、开胸后单肺通气开始时间（T2）、单肺通气30min（T3）、单肺通气时间60min（T4）、单肺通气结束（T5）、手术结束（T6）各时段中PETCO2、气道压峰值(Pmax)的变化情况。同时观察两组患者T1与T6时点IL-8、IL-10、TNF-ɑ、肺表面活性蛋白A（SP-A）的浓度。结果两组患者在OLV时间、液体总量、手术时间、术中失血量、尿量中比较差异无统计学意义（P>0.05）;两组患者不同时点PETCO2、Pmax变化情况比较差异无统计学意义（P>0.05）;两组患者在T1时点IL-8,IL-10,TNF-ɑ,SP-A比较差异无统计学意义（P>0.05）,术后两组患者各指标水平均有升高,但是观察组患者IL-8,TNF-ɑ,SP-A的上升程度明显低于对照组,差异有统计学意义(P<0.05,而IL-10升高程度两组患者比较差异无统计学意义（P>0.05）。结论将右美托咪定运用在麻醉诱导前能抑制肺癌胸腔镜手术中单肺通气时产生的氧化应激反应以及炎症性反应,值得在临床上推广运用。     

支气管封堵器下肺叶隔离在胸腔镜手术中对每搏量变异度及低氧血症的影响

目的探析支气管封堵器下肺叶隔离在胸腔镜手术中对每搏量变异度及低氧血症的影响。方法选取院内82例行胸腔镜手术合并支气管封堵管通气治疗的患者,按随机数字表法均分为A、B两组,各41例患者。A组行支气管封堵器法肺隔离单肺通气技术,B组行支气管封堵器法选择性肺叶隔离通气,观察两组目标肺萎缩及手术视野暴露情况、各时间节点［麻醉后通气前（T0）、平卧位麻醉后双肺通气10 min（T1）、改变体位至侧卧位再双肺通气10 min（T2）、支气管封堵器肺隔离单肺通气或选择性肺叶隔离通气10 min（T3）、手术结束前双肺通气10 min（T4）］的每搏量变异度及血气分析情况。结果两组患者目标肺萎缩及手术视野暴露均达到预期目标效果,优良率为100.00%,两组比较差异无统计学意义（P>0.05）。两组患者收缩压（SBP）、舒张压（DBP）、心排血量（CO）以及每搏输出量（SV）值在各时间节点间比较差异均无统计学意义（P>0.05）。两组患者T3时SBP、DBP值显著高于本组T1时（P<0.05）;B组T4时每搏量变异度（SVV）值显著高于A组（P<0.05）;两组患者各时间节点PaCO2水平组间比较差异无统计学意义（P>0.05）。B组T1、T2、T3的PaO2水平均显著高于A组（P<0.05）;B组T1、T2、T3的 Qs/Qt值均显著低于A组（P<0.05）。结论支气管封堵器下选择性肺叶隔离可显著减少胸腔镜手术患者的肺内分流量,提高氧分压,降低术中低氧血症的发生率,且SVV值高,值得临床应用。     

氯胺酮对胸腔镜下肺叶切除病人围术期炎性细胞因子的影响

目的：观察氯胺酮对胸腔镜下（VATS）肺叶切除单肺通气（OLV）病人围术期炎性细胞因子的影响。方法：拟行肺叶切除术肺癌病人30例,随机分为氯胺酮组（K组）和对照组（C组）,每组各15例。两组患者分别在麻醉诱导后（T1）、OLV45min（T2）、OLV90rain（1r3）及术后2h（T4）采取静脉血,测定血清肿瘤坏死因子（TNF）-α、白细胞介素（IL）-6、IL-8、IL-10浓度。结果：两组,TNF-α、IL-6和IL-8于T2明显上升（P〈0．05）,IL-10于B明显上升（P〈0．05）,K组T3、T4时TNF-α、IL-6和IL-8均明显低于C组（P〈0．05）,而IL-10高于C组（P〈0．05）。结论：氯胺酮可减轻胸腔镜下肺叶切除病人肺的炎性因子的释放。     

经皮穴位电刺激对腹腔镜结直肠癌根治术后疼痛和快速康复的影响

目的 探讨经皮穴位电刺激（transcutaneous electrical acupoint stimulation,TEAS）对腹腔镜结直肠癌根治术后疼痛和快速康复的影响。方法 选取2021年7～12月于温州医科大学附属第一医院择期全身麻醉下行腹腔镜结直肠癌根治术的患者作为研究对象,根据Stata SE 15生成的随机数将患者分为TEAS组和对照组。TEAS组患者在麻醉诱导前30min应用刺激仪于双侧足三里和三阴交进行电刺激,刺激时间30min;对照组患者在相同穴位贴电极片,但不予任何电刺激处理。观察两组患者的术后疼痛和快速康复相关指标。结果 TEAS组患者拔管后躁动等级显著低于对照组（P<0.01）。TEAS组患者拔管后数字评分量表（numeric rating scale,NRS）评分显著低于对照组（P<0.01）,术后24h、48h活动时和静息时的躯体痛、内脏痛NRS评分均显著低于对照组（P<0.05）。TEAS组患者术后首次进水时间早于对照组（P<0.05）。结论 术前给予腹腔镜结直肠癌根治术患者TEAS,可显著减轻术后躯体、内脏疼痛,减少术后躁动的发生,提高患者术后的舒适度和康复质量。     

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.