乌司他丁对术中单肺通气患者氧自由基、促炎性细胞因子的影响

目的 研究乌司他丁对术中单肺通气患者血液中氧自由基、促炎性细胞因子变化的影响.方法 将肺叶切除术中需行单肺通气的60例患者(ASAⅡ～Ⅲ级)随机分为对照组(C组)和乌司他丁组(U组),每组30例.U组术前给 于乌司他丁10000 U·kg-1,分别于麻醉诱导后、单肺通气60 min、术后24 h抽取混合静脉血,测血浆超氧化物歧化酶(SOD)、丙二醛(MDA)、白细胞介素6(IL-6)、白细胞介素8(IL-8)和肿瘤坏死因子α(TNF-α)水平,并两组进行比较.结果 与麻醉诱导后相比较,在单肺通气60 min、术后24 h时C组SOD明显降低(P＜0.05),而U组的SOD明显升高(P＜0.05),且显著高于C组(P＜0.05);两组MDA、IL-6、IL-8、TNF-α在单肺通气60 min、术后24 h时均显著升高(P＜0.05),但U组均明显低于C组(P＜0.05).结论 对于开胸手术术中需单肺通气患者,乌司他丁能够有效减轻术后炎症反应.     

预注乌司他丁对单肺通气开胸侧肺萎陷时TNA-a、IL-6浓度的变化

目的 探讨预注乌司他丁干预对单肺通气开胸侧肺萎陷时TNA-a 、IL-6浓度变化的影响.方法 30例择期行单肺通气开胸的手术病人,随机分为乌司他丁组(U组,n=15)和对照组(C组,n=15).所有病人均采用静注芬太尼、异丙酚和琥珀酰胆碱麻醉诱导,行双腔支气管插管,以恒速输注异丙酚、吸入异氟醚和间断追加潘库溴铵维持麻醉,行控制呼吸.U组在麻醉诱导后静注乌司他丁10 000 U·kg-1,稀释至100 mL后30 min内注射完毕,C组静注等量生理盐水.所有病人麻醉诱导后(T0)、单肺通气60 min(T1)、术毕(T2)分别采中心静脉血3 mL,应用酶联免疫法(ELISA)测定肿瘤坏死因子(TNA a)、白细胞介素6(IL 6)的浓度.结果 两组病人T0时点的TNA-a、IL-6的浓度变化无差异(P＞0.05).与C组相比,U组T1、T2时点TNA-a、IL-6浓度明显降低(P<0.01).结论 预注乌司他丁干预,可抑制单肺通气肺萎陷时TNA-a 、IL-6的过度释放,可能与减轻萎陷肺损伤有关.     

乌司他丁对体外循环心内直视术患者具脑保护的作用

目的:探讨围麻醉期乌司他丁对体外循环(C阳)下行心脏手术患者全身及脑部炎性反应的影响及其脑保护作用.方法:择期心脏瓣膜置换患者24例,随机分为乌司他丁组(U组)和对照组(C组).U组患者在麻醉后和转机时分别静脉泵注乌司他丁,泵注时间均为1 h.C组患者则给予等量容积的生理盐水代替.分别于麻醉后手术前(T1)、体外循环开始后30 min(T2)、体外循环结束后1 h(T3)、4 h(T4)和20 h(T5)同时抽取动脉血和颈静脉球血.采用ELISA法测定动静脉血浆中TNF-α、IL-6及颈静脉球血S100B蛋白的浓度,并计算同一时点颈静脉球血和动脉血之差△TNF-α、△IL-6值.结果:与各自T1相比,两组患者血浆TNF-α、IL-6、△TNF-α、△IL-6的浓度在T2、T3、T4、T5明显升高(P＜0.01或P＜0.05)且C组升高的幅度明显大于U组(P＜0.01或P＜0.05).与T1相比,两组患者血浆S100B蛋白水平在体外循环开始后明显升高(P＜0.01),T3达到高峰,T4开始下降,T5明显下降.U组T2、T3、T4、T5的S100B蛋白浓度升高的水平明显低于C组(P＜0.01).结论:乌司他丁可减轻CPB心脏手术患者全身和脑局部炎性反应,可降低颈静脉球血浆中S100B蛋白水平升高的幅度,具有一定的脑保护作用.     

乌司它丁治疗开胸手术中行单肺通气的老年患者15例

目的观察乌司他丁对老年患者在单肺通气下行肺部手术治疗中的肺保护作用。方法 30例择期行肺叶切除术患者随机分为两组,对照组（n=15）：乌司他丁组（n=15）：术前静脉注射乌司他丁10 000 U/kg。麻醉诱导插双腔气管导管,分别于麻醉前（T0）、麻醉诱导后30 min（T1）单肺通气后30 min（T2）、单肺通气后90 min（T3）、术毕双肺通气30 min（T4）、胸内操作结束后2 h（T5）、术后24 h（T6）7个时点记录MAP、HR、取桡动脉血测定超氧化物歧化酶（SOD）、丙二醛（MDA）及IL-8。结果 T1时点组患者血浆SOD活性均下降,MDA产生增加。对照组SOD活性于T3、T4、T5明显高于术前水平（P〈0.05）,差异有显著性。乌司他丁组在SOD活性水平于T4、T5点高于对照组（P〈0.05）,差异有显著性。对照组和乌司他丁组的MDA含量在T4、T5点均明显高于术前水平（P〈0.05）,差异有显著性,且乌司他丁组于T3、T4、T5点明显高于对照组（P〈0.05）,差异有显著性。对照组IL-8于T3、T4、T5时均显著升高（P〈0.05）,乌司他丁组T3、T4时也较T0显著增高（P〈0.05）,但于T4、T5时明显低于对照组（P〈0.05）。结论乌司他丁可以减少行胸科手术的老年患者单肺通气时氧自由基的产生及炎症因子的释放,可能有助于减轻炎性反应对肺的损害。     

心脏瓣膜置换术中乌司他丁的应用对炎症相关因子与术后认知功能的影响

目的:观察乌司他丁对心脏瓣膜置换术患者全身炎症反应因子和术后认知功能的影响?方法:42例择期心脏瓣膜置换术患者,随机分为2组,乌司他丁组(U组)和对照组(C组),每组21例?U组于麻醉诱导后立即静脉泵入乌司他丁1.2万U/kg,CPB预充液加入乌司他丁0.6万U/kg,主动脉开放前5 min,体外循环机中加入乌司他丁0.6万U/kg;C组给予等容量生理盐水?于切皮前(T1)?体外循环结束后10 min(T2)?30 min(T3)?1 h(T4)?3 h(T5)和术后24 h(T6)时测定血浆白细胞介素(interleukin,IL)-6,IL-10?肿瘤坏死因子(tumor necrosis factor,TNF)-α和S100β蛋白,及用简易智能状态检测法(mini-mental state examination,MMSE)评估患者术前1 d和术后3 d认知状态,评定术后认知功能障碍(postoperative cognition disorders,POCD)?结果:与T1比较,两组在T2~T6时的IL-6?IL-10?TNF-α?S100β的浓度明显升高(P < 0.05);与C组比较,U组在T2~T6时点的IL-6?TNF-α?S100β浓度显著降低(P < 0.05),IL-10浓度显著升高(P < 0.05);通过MMSE评定,对照组7例发生POCD(33.3%),U组2例发生POCD(9.5%),具有显著统计学差异(P < 0.01)?结论:乌司他丁可降低心脏瓣膜置换手术患者POCD的发生率,其机制可能通过抑制体外循环的炎症反应,降低脑损伤,从而降低POCD的发生?     

盐酸戊乙奎醚复合乌司他丁对行开胸术患者术后认知功能的影响及机制研究

目的 探讨盐酸戊乙奎醚复合乌司他丁对行开胸术患者术后认知功能的影响.方法 将120例行开胸肺癌根治术患者分为盐酸戊乙奎醚复合乌司他丁组(HU组)、盐酸戊乙奎醚组(H组)、乌司他丁组(U组)和对照组(C组).采集动脉血检测氧合指数(OI)、肿瘤坏死因子α(TNF-α)、白细胞介素(IL)-6和IL-8,检测血清中S-100β和神经元特异性烯醇化酶(NSE)水平,评估简易精神状态评价量表(MMSE)评分.结果 与H组和U组相比,HU组T3～4时TNF-α均降低,T2～4时IL-6和IL-8均降低,而OI升高(P＜0.05);与H组和U组相比,HU组患者T5～8时血清S-100β和NSE水平均降低(P＜0.05);与H组和U组相比,HU组患者T6～7时MMSE评分升高(P＜0.05).结论 盐酸戊乙奎醚复合乌司他丁可减轻开胸术单肺通气时炎症反应,改善术后认知功能.     

乌司他丁对体外循环手术患者脑炎性反应的影响

目的：探讨乌司他丁对体外循环心脏手术患者脑炎性反应的影响。方法：选择24例择期行心脏瓣膜置换术患者,随机分为乌司他丁组(U组)和对照组(Ｃ组),每组12例。U组患者给予乌司他丁2.4×104U／kg,其中1.2×104U／kg于麻醉诱导后静脉注射,0.6×104U／kg加于体外循环预充液中随转流进入体内,0.6×104U／kg于主动脉开放前约5min加入体外循环机内。C组患者用等量容积的生理盐水代替。于麻醉后手术前（T1）、体外循环结束后60min(T2)、体外循环结束后6h（T3）同时抽取动脉血与颈静脉球血,测定肿瘤坏死因子α(TNFα),白细胞介素6,8,10（IL-6,IL-8,IL-10）,并计算颈静脉球血与动脉血各细胞因子之差△TNFα,△IL-6,△IL-8,△IL-10。结果：C组T2时动脉血TNFα,IL-6,IL-8,IL-10及△TNFα,△IL-8,△IL-10显著升高(P<0. 01),T3时TNFα,IL-6,IL-8,IL-10及△TNFα,△IL-6,△IL-10明显升高(P<0. 01),△IL-8亦升高(P<0. 05); U组T2时IL-6,IL-8,IL-10显著升高(P<0.01),TNFα,△TNFα,△IL-10亦升高(P<0.05),T3时IL-6,IL-8,IL-10,△TNFα,△IL-8显著升高(P<0.01),△IL-6,△IL-10亦升高(P<0.05)。T2时U组动脉血TNFα,IL-6及△TNFα,△IL-8低于C组(P<0.05),动脉血IL-8显著低于C组(P<0.01);T3时U组动脉血TNFα及△IL-6低于C组(P<0.05),U组动脉血IL-6,IL-8显著低于C组(P<0.01),动脉血IL-10与△IL-10高于C组(P<0.05)。结论：乌司他丁可以减轻体外循环手术患者全身和脑局部的炎性反应。     

右美托咪定对单肺通气患者血清TNF-α、IL-6和IL-10变化的影响

目的：观察右美托咪定对单肺通气患者血清TNF-α、IL-6和IL-10变化的影响。方法选择择期全麻单肺通气下行开胸手术患者48例,采用随机数字表法分为右美托咪定组（D组）和对照组（C组）,各24例。D组麻醉诱导前10 min经静脉输注右美托咪定1滋g/kg,随后以0.5滋g/（kg·h）的速率输注至术毕前30min。C组给予等量0.9%氯化钠溶液。于麻醉诱导前（T0）、单肺通气即刻（T1）、单肺通气30min（T2）、单肺通气90min（T3）、双肺通气后30 min（T4）和术后120min（T5）时间点采用酶联免疫吸附法测定血清TNF-α、IL-6和IL-10浓度,同时观察HR、MAP、SpO2的变化。结果两组患者各时点HR、MAP、SpO2差异均无统计学意义（均P＞0.05）。与T0时比较,两组患者T2～T5时血浆TNF- α和IL-6浓度升高（P＜0.05）,与 C组比较,D组T2～T5时血浆TNF- a和IL-6浓度降低（P＜0.05）。与T0时比较,两组患者T3～T5时血浆IL-10浓度升高（P＜0.05）,两组IL-10浓度的差异无统计学意义（P＞0.05）。结论围手术期静脉持续输注右美托咪啶可降低炎性因子TNF-α和IL-6的释放,明显减轻单肺通气患者围术期的炎性反应。     

乌司他丁对体外循环心脏直视手术患者血浆IL-6的影响

目的 观察乌司他丁(ulinastatin,UTI)对体外循环(Cardiopulmonary bypass,CPB)心脏直视手术患者血浆IL-6的影响,以了解UTI对CPB所致的肺损伤是否具有保护作用.方法 选择40例主动脉阻断时间在30 min以上的心脏直视手术患者,随机分为实验组(U组)20例,对照组(C组)20例.U组按1.2万u/kg体重计算UTI用量,分别在麻醉诱导和CPB开始时按0.6万u/kg静注UTI共两次,C组用等量生理盐水替代,用法同U组.分别于麻醉诱导前(T0),CPB 10min(T1),CPB 30 min(T2),CPB结束后1 h(T3),CPB结束后3 h(T4),CPB结束后6 h(T5)抽取桡动脉血,用ELISA法测定血浆白细胞介素-6(IL-6)的浓度.同时测定T0、T3、T4、T5等时间点的血浆肺泡动脉血氧分压差(A-aDO2).结果 两组患者T1至T5IL-6均较T0明显升高(P＜0.05),均在T4达高峰.T3至T5两组A-aDO2均较T0明显升高(P＜0.05),A-aDO2在T4达高峰.U组T1至T5时IL-6和T3至T5时A-aDO2均明显低于C组(P＜0.05).结论 UTI可明显减少CPB术后IL-6的过度释放,减轻术后肺泡动脉血氧分压差,对改善肺氧合保护肺功能有一定的作用.     

乌司他丁对体外循环心内直视手术中炎性细胞因子的影响

目的 观察乌司他丁在体外循环心内直视手术中对炎性细胞因子水平的影响.方法 30例体外循环心内直视手术患者随机分为乌司他丁组(U)和对照组(C),每组各15例.乌司他丁组(U)总量给予乌司他丁12000 IU/kg,分别在体外循环前静脉滴入半量,体外循环机内加入半量.对照组(C)用等量的生理盐水.分别在切皮前(T1)、体外循环开始后30 min(T2)、体外循环停止(T3)、体外循环结束后2h(T4)、体外循环结束后4h(T5)、体外循环结束后24 h(T6)采集血标本,测定血清中的肿瘤坏死因子(TNF-α)、白细胞介素-2(IL-2)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10).结果 两组T2、T3、T4、L、T6各时间点TNF-α、IL-2、IL-6、IL-8、IL-10均明显高于T1(P＜0.01或P＜0.05),而U组TNF-α、IL-2、IL-6、IL-8明显低于C组(P＜0.01或P＜0.05),IL-10均明显高于C组(P＜0.01或P＜0.05).结论 体外循环导致白细胞激活,大量炎性介质释放和自由基产生,激发全身炎症反应综合症.乌司他丁应用于体外循环心内直视手术中可以减少TNF-α、IL-2、IL-6、IL-8的释放,促进抑炎细胞因子IL-10的分泌,从而减轻有效地降低由于CPB引发的炎症反应,减轻心肌的缺血再灌注损伤,起到保护心肌的作用.     

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.