七氟烷和异丙酚对单肺通气肺内分流和氧合的影响

目的：比较相似的麻醉深度下（BIS维持于40～60范围）,七氟烷和异丙酚对单肺通气（OLV）期间患者肺内分流和氧合的影响。方法：80例作肺叶切除术的患者,随机分为七氟烷组（S组）和异丙酚组（P组）。两组患者均采用全麻复合连续硬膜外麻醉,全麻诱导方法相同,插入双腔管后S组以七氟烷维持,P组以异丙酚维持。在OLV前的双肺通气（TLV）阶段和OLV阶段前40 min内取9个时间点采集动脉血和右心房血进行血气分析,同时记录血流动力学指标以及相关的临床数据。结果：相比TLV期间,OLV下两组患者的平均动脉血氧分压均有明显下降（P〈0.05）,但组间比较差异无显著性（P〉0.05）。OLV下两组肺内分流明显增多（P〈0.05）,其中S组的肺内分流更明显（P〈0.05）。结论：较低浓度七氟烷和异丙酚在OLV期间均使肺内分流增加,但七氟烷增加肺内分流更明显,两者对动脉血氧分压影响相似。     

单肺通气期间非通气侧肺持续给氧对氧合及肺内分流的影响

目的探讨单肺通气（OLV）期间非通气侧肺持续吹入氧对减少肺内分流和预防低氧血症的作用。方法择期开胸手术患者22例,ASAⅠ-Ⅱ级,随机分为对照组（A组）、观察组（B组）2组,每组各11例。B组在OLV期间非通气侧肺持续吹入氧气（1～3L／min）,A组在OLV期间非通气侧肺的支气管导管直接开口于大气中;并于OLV前（T1）、OLV 30min（T2）、OLV 60min（T3）、关胸双肺通气（TLV）30min,分别采动脉血作血气分析并计算肺内分流率（Qs／Qt值）。结果在OLV 30min及OLV 60min时,B组动脉血氧分压显著高于A组（P〈0．05）;OLV 30min时B组Qs／Qt显著低于A组（P〈0．05）。结论OLV期间非通气侧肺持续吹入氧气可以明显提高动脉血氧分压,减少肺内分流,减小低氧血症的发生率。     

七氟烷预处理对肺癌单肺通气患者肺内分流和动脉氧分压的影响

目的观察七氟烷预处理对肺癌患者单肺通气(one lung ventilation,OLV)期间肺内分流和动脉氧分压的影响。方法 2011年3月至8月我院胸外科30例行肺癌切除术患者,分为七氟烷预处理组(S组,n=15,男性12例,女性3例,年龄40～68岁,平均55岁,体质量50～71 kg)和对照组(P组,n=15,男性13例,女性2例,年龄38～69岁,平均52岁,体质量48～73 kg)。2组全麻诱导方法相同,插入双腔管后S组以七氟烷预处理维持麻醉至OLV前,单肺通气时2组均采用丙泊酚、瑞芬太尼维持麻醉。在诱导后双肺通气(two lung ventilation,TLV)平卧位(T1)、侧卧位(T2)、OLV 30 min(T3)、60 min(T4)、90 min(T5)及术毕(T6)共6个时间点,采集动脉血和右心房血进行血气分析,计算肺内分流率(intrapulmonary shunt,Qs/Qt),同时记录血流动力学指标以及相关的临床数据。结果 TLV时(T1～T2)2组Qs/Qt与P(O2)差异不显著(P>0.05)。OLV期间(T3～T5)2组Qs/Qt较TLV时明显增高(P<0.05);P(O2)明显降低,(P<0.05)。T3～T5时S组Qs/Qt较P组降低(P<0.05)。结论与丙泊酚-瑞芬太尼麻醉相比,七氟烷预处理能降低肺癌单肺通气患者肺内分流,对动脉氧分压无明显提高。     

不同方式七氟烷处理对胸外科手术单肺通气患者氧化应激水平的影响

目的:探讨不同方式七氟烷处理对胸科手术单肺通气(one lung ventilation,OLV)患者氧化应激水平的影响。方法:胸科手术单肺通气患者80例,随机分为4组,即全凭静脉组(P组,丙泊酚及瑞芬太尼维持麻醉)、七氟烷预处理组(S1组,七氟烷吸入30 min后行OLV)、七氟烷后处理组(S2组,OLV后吸入七氟烷)、七氟烷全程吸入组(S3组,全程吸入七氟烷)。分别在麻醉诱导前(T0)、OLV前(七氟烷预处理30 min后)(T1)、OLV结束后30 min(七氟烷后处理30 min)(T2)和24 h(T3)采集桡动脉血。在T1和T2时间点同时取支气管肺泡灌洗液。采用化学比色法测定血清和支气管肺泡灌洗液丙二醛(malondialdehyde,MDA)、超氧化物歧化酶(superoxide dismutase,SOD)、乳酸脱氢酶(lactate dehydrogenase,LDH)、一氧化氮(nitric oxide,NO)含量及活性。结果:在OLV结束后30 min(T2)和24 h(T3),4组患者血清MDA、SOD、LDH、NO水平均较麻醉诱导前(T0)和OLV前(T1)高(P<0.05),而七氟烷各组(S1、S2、S3组)的MDA、LDH、NO水平较全凭静脉组(P组)明显降低,SOD水平则明显增高(P<0.05),S1、S2、S3组间无差异(P>0.05)。在OLV结束后30 min(T2),4组患者支气管肺泡灌洗液中MDA、SOD、LDH、NO水平均较OLV前(T1)高(P<0.05),但七氟烷各组(S1、S2、S3组)的MDA、LDH、NO水平较全凭静脉组(P组)明显降低,SOD水平则明显增强(P<0.05),S1、S2、S3组间无差异(P>0.05)。结论:不同时间七氟烷处理均能降低单肺通气患者血清和支气管肺泡灌洗液MDA、LDH和NO含量,增强SOD活性,提示七氟烷具有抗氧化应激损伤作用。     

全麻复合硬膜外阻滞对老年人单肺通气的临床观察

目的探讨全麻复合胸段硬膜外阻滞对老年人单肺通气（OLV）肺内分流的影响及安全性。方法选择ASAⅠ-Ⅱ级择期开胸手术老年病人86例,随机分为2组,全麻复合硬膜外阻滞组（GEA组）和全麻组（GA组）,每组43例。2组病人在开胸前双肺通气15min（T-）时及开胸后OLV10min（T2）、30min（T3）、60min（T4）时,分别采动脉血及混合静脉血,观察2组病人动静脉血气分析情况及肺内分流率（QS／QT）值及血流动力学变化。结果2组病人麻醉后术中心率（HR）和平均动脉压（MAP）均较稳定;GEA组麻醉后MAP、HR较麻醉前明显下降（P〈0．05）,也明显低于GA组各对应时点（P〈0．05）,末梢血氧饱和度（SpO2）麻醉插管后较麻醉前上升,OLV后无明显下降趋势;所有病人pH值、PaO2、PaCO2、混合静脉血氧分压（PVO2）均在正常范围内;2组PaO2插管后明显上升（P〈0．05）,OLV后各时点较T1明显下降,GEA组T2、T3、T4低于GA组（P〈0．05）,T3、T4较T2有上升趋势;2组QS／QT值T2、T3、T4较T1明显上升（P〈0．05）,T2、T3、T4GEA组高于GA组（P〈0．05）,T3、T4较T2有下降趋势。结论全麻复合硬膜外阻滞用于老年病人OLV期间可增加肺内分流,使PaO2有所下降,但在正常范围内,术中应严密监测以提高手术麻醉的安全性。     

丙泊酚及七氟烷对单肺通气老年患者脑氧供需平衡的影响

目的 探讨丙泊酚及七氟烷对行肺切除术的老年患者单肺通气(OLV)时脑氧供需平衡的影响.方法 将60例择期行肺切除术的老年患者随机分为丙泊酚复合芬太尼全凭静脉麻醉组(P组)和七氟烷复合芬太尼吸入麻醉组(S组),每组各30例.均以脑电双频指数(BIS)40～60为目标,应用丙泊酚或七氟烷完成麻醉.两组患者分别于麻醉诱导前(T1)、插管后双肺通气(TLV)15 min(T2)、OLV 30 min(T3)、恢复双肺通气(rTLV)15 min(T4)时采集桡动脉及颈静脉球部血行血气分析,并按公式计算肺内分流(Qs/Qt)及脑血流量/脑氧代谢率(CBF/CMRO2),CBF/CMRO2>20或<15宝义为脑氧失衡.结果 两组患者均顺利完成手术.两组在T2时间点的血氧饱合度(SjvO2)均较同组T.时间点显著升高(P值均＜0.05).S组T2、T3、T4时间点的SjvO2均显著高于P组同时间点(P值均＜0.05).两组均有患者发生脑氧失衡,S组在T3时间点脑氧失衡的发生率为60%,显著高于P组的30%(P＜0.05).两组在T3时间点的Qs/Qt均较同组Tz时间点显著增加(P值均＜0.05),动脉血氧分压(paO2)均较同组T2时间点显著下降(P值均＜0.05).结论 OLV期间,BIS为40～60,七氟烷并未显著抑制肺血管收缩反应,与丙泊酚相比对机体氧合无显著影响;丙泊酚对脑氧供需匹配良好,优于七氟烷.     

单肺通气时不同潮气量对血液氧合及肺内分流的影响

目的研究单肺通气（OLV）时不同潮气量对血液氧合及肺内分流的影响。方法选择20例择期中、下段食道癌患者,ASAⅠ～Ⅱ级,全麻后,双肺通气（TLV）潮气量（VT）均采用10ml／kg,呼吸频率（f）12次/min,OLV期间在保持分钟通气量不变的情况下所有病人均在开胸后行OLV。依次采用OLV1（VT=15ml／kg,f=8次／min）,通气25min;OLV2（VT=10ml／kg,f=12次／min）,通气25min;OLV3（VT=8ml／kg,f=15次／min）,通气25min;OLV4（VT=6ml／kg,f=20次／min）,通气25min。在OLV前以及每组通气25min后分别进行动脉血及混合静脉血血气分析。同时监测气道吸气压力（Paw）及计算出肺内分流率（Qs／Qt）。结果TLV与OLV比较：OLVPaO2均下降（P〈0．01）,Qs／Q增加及Paw均增高（P〈0．01）。OLV时,PaO2在OLV4时有明显增高（P〈0．01）,PaO2在OLV1时增加（P〈0．05或P〈0、01）,Qs／Qt在OLV1时比较OLV2、OLV3增加（P〈0．05）。结论单肺通气时采用OLV2（VT=10ml／kg,f=10;K／min）,OLV3（VT=8ml／kg,f=15次／min）,对氧合及肺内分流影响较其他两组小,是比较理想的通气方式。     

右美托咪定对单肺通气时缺氧性肺血管收缩及氧合的影响

目的 探讨右美托咪定对单肺通气时缺氧性肺血管收缩及氧合的影响.方法 将40例择期行单肺通气下肺叶切除术的肺癌患者分为对照组和治疗组,各20例,记录患者一般临床资料,并分别于麻醉诱导前（T0）、侧卧位双肺通气（TLV）后10 min（T1）、单肺通气（OLV）后10 min （T2）、OLV后60min（T3）及侧卧位恢复TLV后10min（T4）行血气分析计算肺内分流率（Qs/Qt）及氧合指数.结果 两组患者手术时间及OLV时间差异均无统计学意义（均P＞0.05）;治疗组异丙酚的用量显著少于对照组,差异有统计学意义（P＜0.05）;治疗组在T2、T3时肺内分流率少于对照组,氧和指数明显增加,差异均有统计学意义（均P＜ 0.05）.结论 右美托咪定可以缓解OLV时肺内分流、提高氧合,在一定程度上预防OLV时低氧血症的发生.     

七氟烷预先吸入对单肺通气患者肺功能及氧化应激的影响

目的：探讨七氟烷预先吸入对食管癌患者单肺通气（one lung ventilation,OLV）期间肺功能及氧化应激的影响。方法：60例拟行食管癌切除术患者,随机分为七氟烷预先吸入组（SP组）、丙泊酚静脉组（P组）及七氟烷全程吸入组（S组）。3组患者全麻诱导均为静脉注射咪达唑仑0.04 mg/kg,芬太尼3~4 μg/kg,靶控输注丙泊酚血浆靶浓度3 μg/ml,静脉注射罗库溴铵0.6~0.8 mg/kg,插入双腔管后SP组以七氟烷预先吸入维持麻醉至OLV前,OLV后与P组相同,采用丙泊酚、瑞芬太尼维持麻醉,七氟烷全程吸入组全程七氟烷吸入维持麻醉。麻醉诱导后（T1）、OLV开始前（T2）、OLV 30 min（T3）、OLV 60 min（T4）、OLV结束前（T5）及术毕（T6） 共6个时间点,采集桡动脉血和右心房血进行血气分析,计算Qs/Qt值,于T1、T3~T6时取右心房血样,测定血清超氧化物歧化酶（superoxide dismutase,SOD）活性和丙二醛（malondialdehyde,MDA）的浓度,同时记录血流动力学指标以及相关的临床数据。结果：与T1时比较,T3～T5（OLV期间）,3组Qs/Qt有明显增高（P<0.01）,PaO2明显降低（P<0.01）,T3～T6时血清SOD活性降低（P<0.05）,MDA浓度升高（P<0.05）;组间比较：与P组、S组相比,SP组在T4时Qs/Qt降低（P<0.05）,T5时血清SOD活性升高、MDA浓度降低（P<0.05）;S组与P组相比,S组在T3时Qs/Qt降低（P<0.05）,T5时Qs /Qt增加（P<0.05）,T3～T6时血清SOD活性稍降低,MDA浓度稍升高,但无统计学差异（P >0.05）;PaO2在3组各对应时点比较差异无统计学意义（P >0.05）。结论：OLV前用七氟烷预先吸入可降低食管癌患者OLV的肺内分流率,减轻OLV的氧化应激反应,对氧分压无明显改善。     

支气管封堵器法选择性肺叶隔离对开胸患者肺内分流及血气的影响

目的 探讨选择性左下肺肺叶隔离对开胸患者肺内分流及血气的影响.方法 选择40例经胸食道下段或贲门手术患者,将其分为A、B两组(n=20),两组患者均采用支气管堵塞法肺隔离单肺通气(OLV).A组:行左肺隔离,术中右肺单肺通气;B组:行左下肺隔离,术中右肺单肺通气+左上肺通气.术中维持呼气末二氧化碳分压(PET CO2)在正常范围,并维持血氧饱和度(SpO2)95％以上,在OLV前(T0)、OLV后20min(T1)、OLV后40 min(T2),OLV后60 min(T3),OLV结束后20min(T4)抽取动脉血行血气分析.观察血气变化和计算术中肺内分流量.结果 与T0和T4时间点比较,两组患者在T1、T2和T3时间点的动脉血氧分压(PaO2)明显下降(P＜0.01);A组下降幅度大于B组,B组T1、T2、T3时间点的PaO2明显高于A组(P＜0.05).与T0和T4时点比较,两组患者在T1、T2和T3时间点的肺内分流率(Qs/Qt)明显增加(P＜0.01);B组T1、T2、T3时间点的Qs/Qt值明显低于A组(P＜0.05).结论 选择性左下肺肺叶隔离可减少开胸患者OLV时肺内分流,并明显提高OLV时氧分压,减少术中低氧血症的发生.     

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.