氟比洛芬酯联合罗哌卡因关节腔注射在膝关节镜术后镇痛中的应用

目的:观察氟比洛芬酯超前镇痛联合罗哌卡因关节腔注射对膝关节镜手术后镇痛的效果。方法:择期行关节镜手术患者60例,随机分为三组,每组20例,F组;手术开始前给予氟比洛芬酯100 mg,L组手术结束后关节腔内注射0.5%罗哌卡因20 ml,FL组手术开始前给予氟比洛芬酯100 mg,手术结束后关节腔内注射0.5%罗哌卡因20 ml;观察术后2 h、4 h、8 h、12 h、24 h VAS评分,凝血功能异常及恶心、呕吐等不良反应,术后24 h使用镇痛药的次数和患者满意度。结果:三组术后2 h、4 h VAS评分差异无统计学意义(P>0.05),在术后8 h、12 h、24 h FL组VAS评分要小于F组和L组(P<0.05),FL组患者满意度要高于F组和L组(P<0.05)。结论:氟比洛芬酯超前镇痛联合罗哌卡因关节腔注射,比单独应用镇痛更持久,效果更好,值得在关节镜术后镇痛中推广。     

右美沙芬复合小剂量吗啡用于术后镇痛

[目的]观察不同剂量右美沙芬复合小剂量吗啡用于上腹部手术后镇痛的临床效果。[方法]择期全麻上腹部手术病人131例随机分为4组,即A组(吗啡30 mg 右美沙芬10 mg)、B组(吗啡30 mg 右美沙芬20 mg)、C组(对照组吗啡30 mg)、M组(吗啡50 mg),术后均使用100 ml一次性镇痛泵镇痛。记录术后3、6、24、48 h VAS、Ramsay镇静评分、活动后VAS评分和48 h内使用吗啡总量并记录可能出现的副作用。[结果]术后6、24 h M组、B组VAS明显低于对照(P<0．05),A组6 h明显低于对照(P<0．05)。活动后VAS在6、24 h吗啡与B组明显低于对照(P<0．05),而A组与对照差异无显著性(P<0．05),且在6 h显著高于M组(P<0．05)。各组术后镇静评分无差异(P<0．05)。术后48 h吗啡总量M组明显高于其他3组(P< 0．05),A、B组明显低于C(P<0．05)组。术后恶心呕吐病例吗啡组明显高于其他3组(P<0．05)。[结论]小剂量右美沙芬与吗啡联合应用可增加吗啡的镇痛效果,减少吗啡用量和副作用,发挥节约吗啡作用,并减少自身的副作用。     

右美托嘧啶关节腔内注射用于膝关节镜术后镇痛的临床观察

目的:观察膝关节镜术后膝关节腔内给予两种不同剂量的右美托嘧啶的临床镇痛效果。方法:60例全身麻醉下行膝关节镜手术患者,随机分为三组,每组20例。A组:关节腔内不给予任何药物;D_1组:关节腔内注射100μg右美托嘧啶(生理盐水稀释至15 ml);D_2组:关节腔内注射50μg右美托嘧啶(生理盐水稀释至15 ml)。记录术后1、2、8、16、24 h患者静息、运动时的VAS评分,术毕2 h改良的Ramsay镇静评分,术毕首次需要氟比洛芬酯的时间,24 h内氟比洛芬酯的用量以及术后相关的不良反应。结果:与A组比较,D_1、D_2两组术后1、2、8 h静息与运动时的VAS评分明显降低(P<0.05);三组术后16、24 h的VAS评分差异无统计学意义(P>0.05);D_1与D2组各时点静息与运动时的VAS评分差异无统计学意义(P>0.05)。D_1、D_2两组术毕至首次用氟比洛芬酯的时间长于A组,且24 h内氟比洛芬酯总量少于A组,差异有统计学意义(P<0.05)。术后2 h改良的Ramsay镇静评分三组间差异无统计学意义(P>0.05)。结论:100μg、50μg的右美托嘧啶关节腔内注射可为膝关节镜术后提供短时间的良好的镇痛效果,延长术毕首次需要镇痛药的时间以及减少术后镇痛药的用量。     

富血小板血浆应用于前交叉韧带重建术的疗效

目的探讨前交叉韧带重建术中及术后应用富血小板血浆的临床疗效。方法选取2016年7月至2017年7月安徽医科大学第一附属医院运动创伤与关节镜外科收治的符合纳入标准的膝关节前交叉韧带(ACL)断裂的患者70例,按住院号末位奇偶数分为试验组及对照组,两组均采用自体腘绳肌腱重建ACL,试验组采用富血小板血浆(PRP)浸泡移植肌腱及关节腔注射,对照组采用生理盐水浸泡肌腱及关节腔注射。试验组术后第3周开始,连续3周每周在关节腔内注射PRP,对照组术后不作特殊处理。测量两组患者术前1天及术后第3天大、小腿周径,术后3、6、12个月采用视觉模拟评分法(VAS)、Lysholm评分及国际膝关节文献委员会膝关节评估表(IKDC)评估术后膝关节功能及疼痛;术后6、12个月行膝关节MRI检查。结果术后随访12～17个月,平均14个月。术后第3天,试验组大、小腿周径与术前差值均小于对照组(P <0. 05);术后3、6、12个月,两组患者VAS评分、膝关节Lysholm评分及膝关节IKDC评分均较术前提高(P <0. 05);两组患者术后VAS评分差异无统计学意义(P> 0. 05);两组患者术后Lysholm评分及IKDC评分差异有统计学意义,且试验组术后3、6个月时膝关节Lysholm评分及膝关节IKDC评分均优于对照组(P <0. 05),试验组术后12个月膝关节Lysholm评分及膝关节IKDC评分较对照组稍高,但差异无统计学意义(P> 0. 05)。试验组术后6个月MRI评分优于对照组(P <0. 05),术后12个月两组MRI评分比较差异无统计学意义(P> 0. 05)。随访期间两组患者均未出现膝关节感染、切口愈合不良及膝关节僵硬等术后并发症。结论 PRP能够改善ACL重建术后患者早期膝关节功能,缓解膝关节肿胀,促进移植韧带重塑。     

小剂量吗啡关节腔内注射用于膝关节镜术后镇痛的临床研究

目的观察小剂量吗啡关节腔内注射应用于膝关节镜术后镇痛的效果。方法采用随机、双盲研究。选择蛛网膜下隙麻醉下行膝关节镜手术的患者60例,随机均分为吗啡组和对照组。吗啡组术后在关节腔内注射盐酸吗啡2 mg,对照组注射等体积0.9%氯化钠溶液。记录给药后2、4、8、16、24、48和72 h时在膝关节被动伸直和屈曲90°状态下的疼痛视觉模拟评分(VAS评分)及不良反应。结果术后4、8、16、24、48和72 h,吗啡组在膝关节被动伸直及屈曲90°状态下的疼痛VAS评分均显著低于对照组(P值均<0.05)。两组均未发生严重不良反应。结论小剂量吗啡关节腔内注射可以有效缓解膝关节镜术后的疼痛。     

64例膝关节镜术后关节腔内注射不同剂量盐酸氢吗啡酮的镇痛效果研究

目的:探讨膝关节镜术后关节腔内注射不同剂量盐酸氢吗啡酮对患者术后镇痛效果.方法:选取行膝关节镜手术患者64例,手术麻醉方案均采用腰硬联合麻醉,穿刺点L3-4,0.75％布比卡因1～2 mL注入蛛网膜下腔.手术结束后即刻关节腔内注射盐酸氢吗啡酮,根据注射剂量大小不同将其分为小剂量组(32例,单次注射0.2～0.3 mg盐酸氢吗啡酮)和大剂量组(32例,单次注射0.3～0.6 mg).观察两组术后不同时点的视觉模拟评分(VAS)、生理应激反应指标及追加术后疼痛药物(氟比洛芬脂)情况,并统计两组不良反应发生率.结果:两组术后镇痛4 h、8 h、12 h的VAS评分比较,差异均无统计学意义(P>0.05),但小剂量组术后镇痛16 h的VAS评分低于大剂量组,差异具有统计学意义(P<0.05);两组镇痛12 h、24 h的血皮质醇(Cor)、去甲肾上腺素(NE)表达显著高于术毕时点(P<0.05),但两组术毕、镇痛12 h、24 h上述指标比较,差异无统计学意义(P>0.05);小剂量组追加氟比洛芬酯率25.00％、追加次数(1.2±0.4)次分别高于大剂量组18.75％、(1.1±0.3)次,但两组差异并无统计学意义(P>0.05);两组术后血尿、肝肾功能均无异常,两组不良反应率比较差异无统计学意义(P>0.05).结论:膝关节镜术后腔内注射0.2～0.3 mg盐酸氢吗啡酮能较好抑制生理疼痛应激反应,且并不增加术后追加镇痛药物用量和不良反应.     

依托考昔片对全膝关节置换术后患者早期镇痛与提高活动度的效果分析

目的：评价单膝人工关节置换术后在连续硬膜外注射吗啡加术后静点帕瑞昔布钠基础上使用口服依托考昔片对患者早期镇痛及活动度提高的效果,探索较为有效、规范的围手术期镇痛方案。方法66例全膝关节置换术后患者随机分为观察组与对照组。两组术后均使用连硬外注射吗啡与术后48 h 内静点帕瑞昔布钠,观察组在此基础上使用口服依托考昔片,对照组不使用口服镇痛药物。记录并比较术后24、48、72 h 静息和活动时VAS 评分,以及术后第2、3天膝关节最大活动度。结果观察组与对照组术后24、48 h 静息 VAS 评分差异无统计学意义（P ＞0．05）,观察组术后72 h 静息 VAS 评分及术后24、48、72 h 活动时 VAS 评分均低于对照组（P ＜0．05）;观察组术后第2、3天膝关节活动度优于对照组（P ＜0．05）。结论在硬膜外和静脉镇痛方式基础上使用口服依托考昔片可有效缓解全膝关节置换术后患者早期疼痛,同时可提高膝关节活动度,从而有效提升患者术后康复效果。     

超声引导下持续股神经阻滞在全膝关节置换术后镇痛的效果观察

目的 观察超声引导下持续股神经阻滞在全膝关节置换术后镇痛的效果与不良反应,与传统静脉自控镇痛进行对照研究.方法 选择2015年8月至2016年3月该院择期行单侧膝关节置换术患者40例,分为A、B两组,每组20例.A组采用超声引导下持续股神经阻滞镇痛,B组采用静脉自控镇痛.比较两组术后4、8、12、24、48 h静息视觉模拟评分(VAS),术后24、48、72 h持续被动运动时的VAS评分,术后2、3、4、5、6d肌力分级及膝关节最大被动屈伸活动度,术后不良反应发生情况,两组血清C-反应蛋白(CRP)及白细胞介素-6(IL-6)的水平,下肢超声监测深静脉血栓发生情况及血清D-二-聚体水平的变化.结果 A组患者术后各时间点静息状态VAS评分明显低于B组(P<0.05),A组术后24、48、72 h持续被动功能锻炼时的VAS评分明显低于B组(P<0.05).A组患者术后第2、3、4天被动屈伸活动度明显高于B组(P<0.05),两组患者术后各时间点患肢肌力无明显差异(P>0.05).A组患者术后自控镇痛按压次数少于B组(P<0.05).两组患者加用镇痛药情况无明显差异(P>0. 05).A组术后6、24 h CRP水平低于B组(P<0.05).两组患者术后IL-6水平均高于术前(P<0.05),但组间无明显差异(P>0.05).两组患者超声结果显示下肢深静脉血栓形成情况比较差异无统计学意义(P>0.05).A组患者围术期D-二聚体水平低于B组(P<0.05).结论 超声引导下持续股神经阻滞应用于膝关节置换手术患者的术后镇痛,镇痛效果确切,能减轻术后应激损伤,降低术后并发症的发生率,有利于巩固手术治疗效果.     

关节腔注射右美托咪定对膝关节镜术后镇痛的效果

目的 观察关节腔内注射右美托咪定对膝关节镜术后镇痛的效果.方法 择期行膝关节镜手术患者40例,随机分为生理盐水组（关节腔注射生理盐水20 ml）和右美托咪定组（关节腔注射右美托咪定1 μg/kg加生理盐水配置成20 ml）,每组各20例.于术后1、2、4、6、10、12、24 h时以视觉模拟评分（VAS）评价术后镇痛效果,术后当患者VAS评分≥4时静脉注射氯诺昔康8 mg镇痛,每8小时可重复注射1次.记录术后首次需要氯诺昔康镇痛的时间、术后24 h内氯诺昔康的用量及用药后的不良反应.结果 术后6h内右美托咪定组镇痛效果优于生理盐水组（P＜0.05）,右美托咪定组术后首次需要氯诺昔康镇痛的时间（320±115 min）较生理盐水组（69±46 min）延迟,24 h内总用量（8.7±1.9 mg）低于生理盐水组（16.8±2.5mg）（P＜0.05）.结论 关节腔内注射右美托咪定用于膝关节镜术后镇痛能够产生良好的镇痛效果,延长术后首次需要镇痛药辅助的时间.     

硬膜外腔注射氢吗啡酮在膝关节镜术后镇痛的临床应用

目的 探讨硬膜外腔注射氢吗啡酮用于膝关节镜术后镇痛的效果和不良反应.方法 方便选择该院2016年1—12月硬膜外麻醉下行膝关节镜手术患者120例,按照随机数字表法分为H1、H2、M、C 4组,每组30例.手术开始后10 min H1、H2两组分别于经硬膜外腔注射含有氢吗啡酮0.1 mg和0.3 mg的生理盐水5 mL,M组注射含吗啡1 mg的生理盐水5 mL,C组为对照组.记录术后4、6、8、12和24 h患者在屈膝关节90°状态下的疼痛视觉模拟评分(VAS),记录术后24 h内需要追加镇痛药物的患者例数以及术后不良反应的发生情况.结果 术后4、6、8、12 h的VAS评分H1、H2和M 3组均低于C组(P<0.01);术后24 h的VAS评分,H2组(2.2±0.9)分低于M组(3.6±1.0)分(P<0.01).术后需要追加镇痛药物的患者例数,H1组9例、H2组1例、M组5例明显少于C组22例(P<0.01).结论 硬膜外腔注射氢吗啡酮和吗啡用于膝关节镜手术术后均可获得良好的镇痛效果,0.3mg氢吗啡酮的镇痛效果更好且副作用更少.     

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.     

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

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.