TENASCIN在野百合碱诱导肺动脉高压大鼠右心室结构重建中的表达及意义

目的观察Tenascin(TN)在野百合碱诱导肺动脉高压(肺高压)大鼠右心室组织中的表达变化,探讨其在心室结构重建过程中的作用.方法72只SD大鼠随机分为模型组和对照组,野百合碱一次性皮下注射法复制肺动脉高压模型,右心导管法测定肺动脉压力并计算右室/(左室+室间隔)[RV/(LV+SP)]比值,逆转录聚合酶链反应(RT-PCR)、蛋白免疫印迹(Western blot)等方法检测TN表达变化.结果用药14d后大鼠出现右心室肥大,模型组大鼠(RV/(LV+SP)(0.282±0.0472),与对照组(0.237±0.154)相比差异有显著性(P＜0.05);第21天mPAP升高,模型组大鼠肺动脉压力(26.38±3.86)mmHg明显高于对照组(15.12±1.78)mmHg(P＜0.01);TN mRNA在对照组大鼠右心室组织中微量表达,模型组大鼠TN mRNA表达水平于用药7 d后显著升高(0.34±0.14),与对照组(0.19±0.07)比较差异有显著性(P＜0.01).模型组大鼠右心室组织中TN-C蛋白表达量明显增加.结论TN在肺动脉高压右心室组织中表达增加,可能在右心室结构重建过程中发挥重要作用.     

CTGF在低氧性肺血管重建中的作用

目的:通过建立低氧性肺动脉高压大鼠模型,探讨结缔组织生长因子(CTGF)在大鼠低氧性肺血管重建中的作用。方法:通过间断常压低氧法建立大鼠低氧性肺动脉高压模型,用右心导管法测定平均肺动脉压(mPAP);称重计算右心室肥厚指数[RV/(LV S)];肺组织切片经HE染色后图像分析技术定量检测大鼠肺小动脉的形态改变;免疫组织化学染色法测定肺小动脉管壁CTGF蛋白表达,并经图像分析半定量检测其表达强度。结果:3周后,低氧组大鼠的mPAP、RV/(LV S)、反映管壁增厚的管壁厚度占血管外径的百分比和管壁面积占血管总面积的百分比两指标均高于正常对照组(P<0.01)。正常对照组大鼠肺小动脉壁CTGF蛋白未表达;低氧组大鼠肺小动脉壁外膜CTGF明显表达,内膜略有表达,中膜几乎无表达。结论:常压低氧3周可成功建立肺动脉高压大鼠模型,CTGF与低氧性肺血管重建密切相关。     

阿托伐他汀对低氧大鼠肺血管重建的影响

目的探讨阿托伐他汀对低氧性肺血管重建的影响,为临床应用此药治疗肺动脉高压提供实验依据。方法将30只SD大鼠随机分为3组对照组、低氧组(模型组)、低氧+阿托伐他汀组(用药组)各10只,按文献资料复制低氧性肺动脉高压大鼠模型,低氧时间为4周,每周低氧6d,8h/d。观察各组大鼠右心室收缩压,右心室肥大指数、光镜及透射电镜下观察肺小血管的变化。结果与模型组比较,用药组大鼠右心室压力明显下降,分别为(30.08±2.80)mmHg和(26.15±3.19)mmHg;右心室肥大指数减小,分别为(0.32±0.01)和(0.28±0.03),差别有显著性意义(P<0.05)。显微镜下视野中模型组较对照组肌型小动脉数量明显增多,肺小血管充血明显,小血管周围及肺间质内可见大量炎性细胞浸润,肺泡隔增宽,肺小动脉管壁明显增厚管腔明显变小,而在用药组中,上述显微结构改变明显减轻。电镜下见模型组大鼠肺小动脉内皮细胞呈立方形或柱状,突向管腔、有的甚至脱落,胞质内线粒体等细胞器明显增多并多呈泡状。中膜平滑肌细胞增生,平滑肌细胞内可见线粒体明显增多,多呈泡状,肿胀变性明显;而在用药组中,肺小血管内皮细胞及平滑肌细胞的上述改变明显减轻。结论阿托伐他汀具有一定的抑制低氧性肺血管重建的作用。     

雌激素对低氧性肺血管重建的作用

目的观察17-β雌二醇对低氧性肺动脉高压大鼠肺血管重建的作用。方法采用间断常压低氧法建立大鼠低氧性肺动脉高压模型,以右心导管法测定肺动脉压力(mPAP);测定右心室肥厚指数[RV/(LV S)];肺组织切片采用HE染色,经图像分析技术测定大鼠肺小血管管壁厚度指标[管壁厚度与血管外径的百分比(WT%)和管壁面积与血管总面积的百分比(WA%)];用放射免疫法测定血清中17β雌二醇浓度。将24只SD大鼠随机分成正常对照组、低氧组、雌激素预防组(每天低氧前腹腔注射17β雌二醇30μg/kg,共3周)、雌激素治疗组(低氧3周后每天腹腔注射17β雌二醇30μg/kg,共7d)。结果(1)低氧组大鼠的mPAP、RV/(LV S)(%)、WT%和WA%均高于正常对照组(P<001);血清中17β雌二醇浓度与正常对照组比较无显著性差异(P>005)。(2)雌激素预防组、雌激素治疗组的大鼠mPAP、RV/(LV S)(%)、WT%和WA%均低于低氧组(P<005),而血清中17β雌二醇浓度高于低氧组和正常对照组(P<001)。结论17β雌二醇能有效降低低氧性肺动脉高压大鼠的肺动脉压力、阻抑右心室肥厚,对低氧性肺动脉高压血管重建具有预防和治疗作用。     

西地那非对肺动脉高压大鼠肺动脉压力影响的实验研究

目的研究西地那非对肺动脉高压发生、发展的延缓及逆转作用,探讨其与内皮素系统的关系。方法单侧肺切除1周后叠加野百合碱60 mg.kg-1皮下注射建立肺动脉高压大鼠模型,在野百合碱注射后治疗组大鼠给予西地那非1.7 mg.kg-1.d-1,3周后测量大鼠平均肺动脉压(mPAP)、右心室重量与(左心室 室间隔)重量比值[RV/(LV S)]、肺小血管管壁厚度与血管外径比值,免疫组织化学检测大鼠肺小血管壁平滑肌细胞内皮素-1A型受体(ETA-R)的表达,放射免疫法检测血浆内皮素-1浓度。结果治疗组大鼠mPAP、[RV/(LV S)]、肺小血管管壁厚度与血管外径比值均低于对照组(P<0.05),肺小血管壁平滑肌细胞ETA-R的表达较对照组降低(P<0.05),血浆内皮素-1浓度较对照组升高,但无统计学意义。结论西地那非对单侧肺切除叠加野百合碱注射引起的肺动脉高压、右心室肥厚及肺血管结构重建具有良好的延缓和逆转作用。     

腺病毒介导eNOS转染高肺血流肺动脉高压大鼠模型的研究

目的 观察腺病毒介导的内皮型一氧化氮合酶基因(eNOS)转染对高肺血流肺动脉高压大鼠模型肺动脉高压形成的影响.方法 随机将40只大鼠分为假手术组、手术组、实验组和对照组,每组10只.手术组、实验组和对照组采用套管连接法建立左向右分流肺动脉高压模型,实验组采用气管吸入法转染重组腺病毒AdCMVeNOS,采用免疫组化法观察eNOS蛋白表达,采用比色法测定肺组织eNOS活性,测量各组大鼠平均肺动脉压(mPAP)、右心室平均压(mRVP)、平均颈动脉压(mCAP)、右心肥厚指数(RVHI),采用HE染色观察肺动脉形态学改变,计算管壁厚度与血管外径比值(WT%).结果 实验组免疫组化染色可见全层血管壁内棕黄色颗粒,eNOs表达强度明显高于对照组(P<0.05),假手术组eNOS表达的阳性细胞介于实验组与对照组之间.手术组和对照组的eNOS活性比假手术组明显降低(P<0.05);实验组的eNOS活性显著高于对照组,且较假手术组亦明显升高(P<0.05).手术组和对照组大鼠的mRVP、mPAP、RVHI和WT%均明显高于假手术组(P<0.05).与对照组相比,实验组大鼠mRVP、mPAP、RVHI和WT%均显著降低(P<0.05);手术组与对照组各值之间差异不明显.结论 腺病毒介导的eNOS基因转染能够上调高肺血流肺动脉高压大鼠肺组织中eNOS表达及其活性,延缓肺动脉高压的发展和肺血管的重塑.     

低氧大鼠肺内血管内皮细胞生长因子表达与肺血管重建的关系

目的　了解低氧性肺动脉高压时肺内血管内皮生长因子 (VEGF)与肺血管重建的关系。方法　将 2 0只雄性 Wistar大鼠分为低氧性肺动脉高压组 (n=10 )和对照组 (n=10 )两组 ,肺动脉高压组以常压低氧建立大鼠肺动脉高压模型。以微导管法测定各组大鼠肺动脉压 ,采用免疫组织化学染色法检测模型大鼠肺内 VEGF的表达 ,对肺组织切片进行图象分析。结果　低氧 3周后 ,肺动脉高压组大鼠形成明显的肺动脉高压 ,肺小动脉壁细胞数增多 ,管壁增厚和管腔狭窄 ,管壁厚度占外径的百分比 (WT%)为 31.4%± 2 .6 %,管壁面积占血管总面积的百分比 (WA%)为 5 2 .8%± 3.4%,分别与正常对照组 16 .0 %± 1.8%和 2 8.7%± 2 .3%相比明显升高 (P<0 .0 1) ;肺小动脉内膜的 VEGF免疫阳性染色在低氧大鼠组为 2 .5 1± 0 .2 5 ,与正常对照组 1.2 7± 0 .15相比明显增强 (P<0 .0 1) ,低氧大鼠组 VEGF免疫阳性染色强度与 WT%和 WA%呈明显正相关 (r分别为 0 .792和 0 .785 ,P <0 .0 1)。结论　低氧所致 VEGF的合成增多在低氧性肺血管重建和肺动脉高压的发病过程中起一定的作用。     

低氧大鼠肺组织核因子κB表达的变化

目的探讨核因子κB(NF-κB)在慢性低氧大鼠肺组织表达的变化及其在低氧性肺动脉高压发病中的作用。方法将20只雄性SD大鼠随机分为正常对照组和低氧组,以常压低氧3周复制肺动脉高压模型。采用微导管法测定大鼠平均肺动脉压(m PAP);对大鼠肺组织切片采用HE染色,经图像分析技术测定大鼠肺小动脉管壁厚度占血管外径的百分比(W T%)和管壁面积占血管总面积的百分比(W A%);采用免疫组化法检测两组大鼠肺组织NF-κB的表达情况。结果①低氧组大鼠m PAP为(29.1±4.5)mmHg,正常组大鼠m PAP为(16.8±2.6)mmHg,两组比较差异具有统计学意义(P<0.001);②低氧组大鼠W T%为(22.36±2.99)%、W A%为(69.14±5.38)%,正常对照组W T%为(13.30±2.77)%、W A%为(46.75±6.54)%,两组之间的差异有统计学意义(P均<0.01);③正常组和低氧组大鼠肺组织内均存在NF-κB阳性染色,以细支气管上皮细胞为明显,正常组大鼠NF-κB核染色阳性细胞百分比为(12.23±1.08)%,低氧组大鼠NF-κB核染色阳性细胞百分比为(29.11±1.12)%,两组比较差异有统计学意义(P<0.001)。结论NF-κB在慢性低氧大鼠肺内表达增加,可能参与了低氧性肺动脉高压的发病过程。     

肾上腺髓质素1-50对大鼠慢性低氧性肺动脉高压的调节作用

目的:探讨肾上腺髓质素1-50(ADM1-50)对大鼠慢性低氧性肺动脉高压和肺血管结构重建的作用及其机制.方法:20只雄性Wistar大鼠随机分为对照组(n=7)、低氧组(n=6)和低氧 ADM1-50组(n=7).对于低氧 ADMi-50组大鼠,通过皮下埋放微量渗透泵持续给予ADM1-50(300ng/h).低氧饲养2周后,以右心导管法测定肺动脉平均压(mPAP),检测右心室与左心室加室间隔的比值[RV/(LV S)],观测肺血管显微和超微结构的变化,以硝酸还原酶法测定血浆一氧化氮(NO)含量,以敏感硫电极法测量大鼠血浆中硫化氢(H2S)含量.结果:低氧2周后大鼠mPAP较对照组明显增高[(24.9±6.8)mmHg vs(14.3±2.4)mmHg,P＜0.01,1 mmHg=0.133 kPa];RV/(LV S)也较对照组明显增高[(0.318±0.054)vs(0.182±0.007],P＜0.01).肺动脉显微和超微结构发生明显改变.低氧组大鼠血浆NO和H2S含量明显低于对照组.低氧 ADM1-50组大鼠mPAP明显低于低氧组大鼠[(14.9±3.0)mmHg vs(24.9±6.8)mmHg,P＜0.01];RV/(LV S)也明显低于低氧组[(0.185±0.011)vs(0.318±0.054),P＜0.01].ADMi-50使低氧大鼠血浆NO和H2S的含量明显升高.结论:ADM1-50可能通过促进低氧大鼠体内NO和H2S的生成,对低氧性肺动脉高压和肺血管结构重建的形成发挥调节作用.     

野百合碱复合单肺切除所致肺血管重建中内皮源性一氧化氮合酶的表达

目的　观察野百合碱复合单肺切除所致肺血管重建中内皮源性一氧化氮合酶(eNOS)的表达。　方法　健康雄性SD大鼠,随机分为两组(n =2 5 ) :(M +P)组左肺切除术后1周皮下注射野百合碱6 0mg/kg ;对照组假手术处理。于手术前0周,手术后14 ,2 1,2 8,35d再次开胸经右心室置入导管测定肺动脉平均压(mPAP) ,检测右心室/左心室+室间隔[RV/ (LV +S) ]比值。肺小动脉阻塞评分法检测肺血管内膜增厚程度。病理图像分析系统检测肺肌型小动脉中膜厚度占血管外径百分比(WT % )。RT PCR法和免疫组织化学法检测肺动脉eNOSmRNA和蛋白的表达。　结果　与对照组比较,(M +P)组mPAP、RV/ (LV +S)、WT %和肺小动脉阻塞分数明显升高(P <0 .0 1) ,肺组织eNOSmRNA表达在注射野百合碱左肺切除后14 ,2 1,2 8,35d明显降低并呈时间依赖性(P <0 .0 1)。左肺切除后5周,(M +P)组肺血管eNOS蛋白表达显著低于对照组。eNOSmRNA表达水平与肺高压程度、RV/ (LV +S)、WT %改变存在显著负相关性(P <0 .0 1)。　结论　eNOS表达下调可能在野百合碱复合单肺切除所致的肺动脉高压和肺血管结构重建中起重要作用。     

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.