间充质干细胞在哮喘大鼠气道炎症及气道重塑中的作用

目的 探讨间充质干细胞(MSCs)在哮喘大鼠慢性气道炎症及气道重塑中的作用.方法 将18只SD雌性大鼠随机分为:正常对照组、哮喘4周组和哮喘8周组,每组6只.卵清蛋白(OVA)致敏后,雾化吸入OVA制作哮喘模型.哮喘模型成功后,测定气道压力;通过HE染色、Image-ProPlus图像分析软件分析大鼠气道平滑肌的嗜酸性粒细胞(ESO)浸润情况,测定支气管管腔的内周长、管壁面积,支气管平滑肌面积、平滑肌细胞核数;采用密度梯度离心法分离外周血单个核细胞,通过流式细胞仪检测各组MSCs的含量,并分析其与哮喘气道炎症及气道重塑的关系.结果 哮喘4周组、哮喘8周组大鼠的气道反应性、气道壁EOS计数、支气管管壁面积、支气管平滑肌面积、平滑肌细胞核数目、外周血中MSCs比例均较正常对照组显著增加(P ＜0.01,P＜0.05);哮喘两组间上述指标差异均有统计学意义(P＜0.01);Pearson线性相关显示:各组大鼠外周血单个核细胞中MSCs的含量与气道反应性、EOS浸润数、支气管壁面积、支气管平滑肌厚度及支气管平滑肌细胞核数均呈正相关(P＜0.01).结论 MSCs在哮喘状态下含量增加,可能参与了哮喘的慢性气道炎症及气道重塑.     

咪喹莫特对哮喘小鼠气道反应性及气道重塑的影响

目的:观察咪喹莫特对哮喘小鼠气道反应性,气道重塑和肺组织血管内皮生长因子(VEGF)表达的影响.方法:30只小鼠按随机数字表法分成3组,每组10只.正常对照组、哮喘组、咪喹莫特组.小鼠于第0、14天以鸡卵白蛋白(OVA)致敏,第24天开始雾化吸人1%OVA激发并持续28天,建立哮喘气道重塑模型.咪喹莫特组在吸人OVA前2 h雾化吸人咪喹莫特30 min.于最后一次雾化结束后24 h,利用肺功能仪测小鼠气道阻力;收集支气管肺泡灌洗液(BALF)进行细胞计数及分类;对肺组织切片行HE染色观察病理学改变:运用医学图像分析软件测定肺组织切片中的血管计数、血管壁平滑肌厚度、血管壁平滑肌细胞计数:用免疫组化方法检测肺组织VEGF的蛋白表达水平;用RT-PCR检测肺组织VEGF mRNA表达水平.结果:哮喘组小鼠呼气阻力(Re)高于对照组(P<0.05),咪喹莫特组Re低于哮喘组(JP<0.05);哮喘组BALF中细胞总数及各种炎症细胞数均较对照组升高(P<0.05).咪喹莫特组较哮喘组降低(P<0.05);哮喘组血管计数、血管壁平滑肌细胞计数较对照组增高,差异均有统计学意义(P<0.05),咪喹莫特组血管计数较哮喘组下降,差异有统计学意义(P<0.05);对照组VEGF蛋白和mRNA在气道不表达或轻度表达,哮喘组VEGF蛋白和mRNA表达较对照组增加,差异有统计学意义(P<0.05),咪喹莫特组能减少VEGF蛋白和mRNA的表达,与哮喘组比较差异有统计学意义(P<0.05),但较对照组仍增加,差异无统计学意义(P>0.05).结论:早期预防性雾化吸入咪喹莫特通过部分抑制哮喘肺组织VEGF蛋白和mRNA的过度表达,阻止慢性哮喘小鼠的血管生成,可在一定程度上减轻哮喘小鼠的气道重塑和气道高反应性.     

哮喘大鼠血清、支气管肺泡灌洗液及肺组织中转化生长因子-β1与哮喘气道重塑

目的 观察哮喘大鼠模型血清、支气管肺泡灌洗液(BALF)中转化生长因子-β1(TGF-β1)的含量及肺组织中TGF-β1的表达,分析其相关性及与哮喘气道重塑的关系,为临床哮喘的诊断和治疗提供理论依据.方法 Wistar大鼠随机分为2组,正常对照组和哮喘模型组,每组20只.用卵蛋白(OVA)致敏和激发制成哮喘大鼠模型,用Elisa法测定血清及BALF中TGF-β1的含量,免疫组化法测定肺组织中TGF-β1的表达,Masson染色观察胶原沉积的情况,计算机图像分析系统评价呼吸性细支气管平滑肌厚度及上皮损伤程度评分等气道重塑指标.结果 造模后,与对照组相比模型组血清中TGF-β1的含量明显减低(P<0.05);BALF中TGF-β1的含量增加(P<0.01);肺组织中TGF-β1的表达增多(P<0.01).哮喘大鼠气道黏膜上皮损害、气道平滑肌厚度、气道胶原蛋白的沉积较对照组明显增加.结论 BALF中TGF-β1的含量增加、肺组织中TGF-β1的表达增加,加重了哮喘气道重塑;血清中TGF-β1含量减少,提示可以通过检测血清中TGF-β1为哮喘的诊断提供依据、间接了解气道重塑.     

健脾补肺化痰方对幼龄哮喘大鼠EGF、MMP-9的含量影响

目的:研究表皮生长因子(EGF)、基质金属蛋白酶-9(MMP-9)在幼龄哮喘大鼠气道重塑中的表达及其之间的相关性分析,通过实验初步探讨健脾补肺化痰方对哮喘患儿平喘作用的机理,为中医药防治小儿哮喘提供新的研究思路。方法:48只SD幼龄大鼠随机分成正常对照组,哮喘模型组,辅舒酮组,健脾补肺化痰方高剂量、中剂量和低剂量组,以卵蛋白(OVA)致敏制备幼龄大鼠哮喘模型。采用HE染色观察肺病理组织学变化,采用酶联免疫法(ELISA)检测血清中EGF、肺组织MMP-9的含量变化。结果:正常对照组哮喘大鼠镜下无炎症反应,无气道重塑。模型组炎症反应很重;气道壁明显增厚,气道壁受损,气道管腔狭窄,气道平滑肌层和网状基底膜层增厚;气道上壁纤维化改变明显,具备气道重塑的特征。健脾补肺化痰方低中高剂组大鼠病理变化炎症程度依次减轻,高剂组与辅舒酮组炎症反应相当,炎症反应很轻。各组大鼠血清中EGF、肺组织MMP-9含量与模型组之间有差异性(P0.05或P0.01)。     

p-ERKl/2及ERK2mRNA在哮喘大鼠气道中的表达变化

目的 探讨细胞外信号调节激酶在哮喘大鼠气道中表达变化及其对气道平滑肌细胞增殖的影响.观察细胞外信号调节激酶是否参与了哮喘气道重构这一病理过程.方法 18只6周龄雄性wistar大鼠随机分为对照组、哮喘组、地塞米松干预组各6只.以腹腔注射10%卵蛋白和1%卵蛋白雾化吸入复制慢性哮喘模型.干预组在每次激发前给予地塞米松干预.用免疫组化与原位杂交法检测p-ERK1/2及ERK2 mRNA在不同大鼠肺组织的表达程度,采用图像分析系统进行图象分析.结果 (1)哮喘模型组气道壁面积和平滑肌厚度较对照组和干预组显著增加(P<0.05).(2)哮喘组p-ERK1/2及ERK2 mRNA在大鼠肺组织的表达程度较对照组和干预组显著增加(P<0.05).(3)直线相关性分析显示,哮喘组气道壁面积和平滑肌厚度与大鼠肺组织中p-ERK1/2表达水平呈正相关(分别为r=0.858,r=O.848,P均<0.05),哮喘组气道壁面积和平滑肌厚度与大鼠肺组织中ERK2 mRNA表达水平呈正相关,(分别为r=O.918,r=0.860,P均<0.05).结论 哮喘大鼠肺组织p-ERK1/2及ERK2 mRNA表达上调,并与气道重构密切相关,该结果提示细胞外信号调节激酶可能参与了气道重构中平滑肌的增殖过程.     

P27KiP-1蛋白对支气管哮喘大鼠气道平滑肌增生的影响

目的 探讨P27Kip-1对哮喘大鼠气道平滑肌细胞增生及气道重塑的影响.方法 清洁级雄性SD大鼠30只,随机分成对照组(C)、哮喘4周组(A1)、哮喘6周组(A2)每组10只.用卵白蛋白(OVA)致敏与激发建立大鼠哮喘模型,末次激发后24h内测气道反应性和观察气道壁炎性细胞的浸润情况,图像分析软件测定支气管壁厚度、支气管平滑肌厚度;免疫组化法检测增生细胞核抗原(PCNA)及P27Kip-1表达.结果 哮喘4周和6周组P27Kip-1蛋白表达显著低于对照组(P＜0.05),且6周组低于4周组(P＜0.05);哮喘4周和6周组PCNA表达、支气管壁厚度、支气管平滑肌厚度和气道反应性均显著高于对照组(P＜0.01),且6周组高于4周组(P＜0.01).结论 P27Kip-1可抑制气道平滑肌细胞增生进而影响气道重构与气道高反应性.     

NGF对支气管哮喘大鼠气道重塑影响及其机制

目的研究神经生长因子(NGF)在支气管哮喘气道重塑中的作用及其可能机制,为哮喘治疗寻求新的靶点。方法将30只SPF级健康雄性Wistar大鼠随机分为对照组、哮喘模型组和NGF抗体干预组。苏木精-伊红染色观察大鼠气道壁组织学改变,Masson染色观察气道上皮下胶原层厚度,免疫组化法检测肺组织血管内皮生长因子(VEGF)、Ⅲ型胶原表达。结果哮喘模型组及NGF抗体干预组支气管壁厚度、支气管平滑肌厚度、支气管平滑肌细胞核数、支气管壁血管密度、上皮下胶原层厚度、VEGF及Ⅲ型胶原的表达较对照组显著增加,NGF抗体干预组以上改变较哮喘模型组减轻,差异均有统计学意义(F=108.29~554.21,P<0.01)。大鼠支气管壁血管密度和管壁厚度与肺组织中VEGF蛋白表达,气道胶原层厚度与Ⅲ型胶原含量均呈正相关(r=0.82~0.87,P<0.05)。结论 NGF可能通过调控肺组织VEGF、Ⅲ型胶原的表达参与哮喘气道重塑。     

二甲双胍抑制哮喘模型大鼠气道重塑的研究

目的观察二甲双胍对哮喘气道重塑的影响及其可能作用机制。方法 28只B/N大鼠随机分为对照组、哮喘组、二甲双胍干预组和雷帕霉素干预组;制备哮喘模型,以二甲双胍、雷帕霉素进行干预;末次激发48小时后测定大鼠气道阻力及气道反应性,收集肺组织标本,采用组织病理学方法观察气道炎症细胞浸润、气道壁杯状细胞增生、气道壁纤维化和重塑情况以及气道平滑肌增殖情况,采用蛋白印迹法检测AMPK/mTOR通路相关蛋白的表达。结果与哮喘组相比,二甲双胍和雷帕霉素干预可显著降低乙酰胆碱气道反应性(P<0.05);减轻大鼠肺组织中炎细胞浸润以及气道壁结构的变化(P<0.05);减少气道上皮中杯状细胞增生、肺组织中胶原纤维沉积、支气管平滑肌增生(均P<0.05)。进一步研究发现,二甲双胍和雷帕霉素的作用与AMPK/mTOR通路相关,与哮喘组相比,二甲双胍和雷帕霉素干预可显著降低p-mTOR、p-p70s6k1、SKP2的表达,而p21蛋白表达明显增加(P<0.05)。两种干预措施具有相似效应(P>0.05)。结论二甲双胍可以通过激活AMPK、进而抑制mTOR通路来缓解气道高反应性和气道重塑,可能是治疗哮喘和预防气道重塑的潜在药物。     

银杏叶提取物对哮喘小鼠气道重塑的影响及机制

目的:探讨哮喘小鼠气道重塑与基质金属蛋白酶-9(MMP-9)的关系以及银杏叶的干预作用.方法:建立哮喘小鼠气道重塑模型,40只BALB/c小鼠按随机数字法分为4组:对照组,哮喘组,银杏叶干预组,地塞米松干预组.以鸡卵清蛋白(OVA)致敏并激发制备小鼠慢性哮喘模型.对肺组织切片行苏木精-伊红染色观察气道重塑情况.RT-PCR检测各组小鼠肺组织MMP-9 mRNA表达.结果:哮喘组动物出现管壁增厚、平滑肌增生、黏液分泌增加等气道重塑的特征性改变,MMP-9 mRNA水平增高.地塞米松干预组和银杏叶干预组与哮喘组比较,炎症反应轻微,平滑肌增生、粘液分泌不明显,MMP-9 mRNA水平表达降低,与对照组比较差异有统计学意义.结论:长期吸入变应原可导致气道重塑,MMP-9在气道重塑中发挥了作用,银杏叶的干预作用说明在血小板活化因子(PAF)和MMP-9之间可能存在某种联系.     

组蛋白去甲基化酶KDM2A在支气管哮喘大鼠气道炎症和气道重塑中的作用

目的 研究组蛋白去甲基化酶—赖氨酸特异性的去甲基化酶2A(KDM2A)在支气管哮喘大鼠气道炎症及气道重塑中的作用。方法 通过腹腔注射鸡卵清蛋白(OVA)致敏雾化激发哮喘大鼠模型。将18只6～8周龄SPF级SD雌性大鼠随机分为3组：对照组、哮喘4周组、哮喘8周组。哮喘模型成功后,通过HE染色观察肺组织气管及血管周围炎性细胞浸润;PAS染色观察杯状细胞增生及黏液分泌;Masson染色观察气道壁纤维化;荧光免疫组织化学法观察气道平滑肌增殖情况;Western blot法检测KDM2A蛋白表达水平。结果 哮喘4周组、哮喘8周组大鼠炎症评分、炎症细胞计数均高于对照组(P<0.01)。与对照组相比,哮喘组气道上皮中杯状细胞增生和黏液分泌、肺组织中胶原纤维沉积及气道平滑肌细胞增生均增加(P<0.01),随着OVA致敏时间延长,哮喘8周组较哮喘4周组气道炎症及气道重塑改变更严重。Western blot结果显示,哮喘4周组、哮喘8周组大鼠肺组织KDM2A表达高于对照组,哮喘8周组KDM2A表达亦高于哮喘4周组,差异均有统计学意义(P<0.01);各组大鼠肺组织KDM2A蛋白表达与气道...     

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.