低浓度罗哌卡因复合吗啡、芬太尼术后镇痛对肠蠕动的影响

目的:比较低浓度甲磺酸罗哌卡因氯化钠注射液(威赛因)复合吗啡、芬太尼术后镇痛对肠蠕动的影响.方法:选择120例择期手术病人,ASA Ⅰ～Ⅱ级,其中妇产科、普通外科各60例.各科手术病人根据不同的镇痛方法随机等分成三组,组Ⅰ:0.178%罗哌卡因+0.005%吗啡+0.005%氟哌利多,组Ⅱ:0.178%罗哌卡囚+0.0005%芬太尼+0.005%氟哌利多,组Ⅲ:对照组.于镇痛治疗后4、8、12、24、36h进行随访,观察疼痛程度、镇静状态、平均动脉压、心率、呼吸频率、脉搏氧饱和度,并记录肠蠕动恢复时间.结果:组Ⅰ与组Ⅱ均取得较好的镇痛效果,VAS评分显著低于组Ⅲ(P＜0.01);普通外科病人肠蠕动恢复时间较妇产科病人长(P＜0.05);组Ⅱ较组Ⅰ、Ⅲ肠蠕动恢复时间明显缩短(P＜0.05).结论:低浓度罗哌卡因复合吗啡、芬太尼行病人术后自控镇痛均能获得良好的效果,且罗哌卡因与芬太尼联用可缩短肠蠕动的恢复时间.     

术后镇痛对肠蠕动影响的临床研究

为比较不同的术后镇痛药物配方和不同手术种类对病人术后肠蠕动恢复情况的影响,选择270例,ASAⅠ-Ⅱ级病人,其中,妇产科、骨科及普通外科各90例,各科手术病人根据不同的镇痛方案随机分为3组：组Ⅰ,0．125％布比卡因＋0．005％吗啡氟哌利多;组Ⅱ,0．125％布比卡因＋0．0005％芬太尼＋0．005％氟哌利多;组Ⅲ,对照组。上述各组按比例配制,总容量为100ml。自控镇痛（PCA）指标设置;负荷量5.0ml,背景剂量2.0ml/h,PCA剂量2.0ml,锁定时间10min,持续镇痛36h。于镇痛治疗4、8、12、24、36h进行观察,同时记录各时点疼痛程度（VAS评分法）、镇静状态（Ramsay评分法）、肱动脉平均动脉压（MAP）、心率（HR）、呼吸频率（RR）、脉搏氧饱和度（SpO2)测定值,并记录肠蠕动恢复时间。结果显示：组Ⅰ与组Ⅱ均取得较好的镇痛效果,VAS评分显著低于组Ⅲ（P＜0．01）,但组Ⅰ与组Ⅱ无明显差异（P＞0．05）;各科病人肠蠕动恢复时间内普通外科＞妇产科＞骨科（P＜0．05）;组Ⅰ与组Ⅲ相比,肠蠕动恢复时间无明显差异（P＞0．05）,但组Ⅱ组较Ⅰ、Ⅲ肠蠕动恢复时间明显缩短（P＞0．05）;镇痛期间各组MAP、HR、RR与麻醉前比较均无明显差异,SpO2都保持在95％以上。结果表明：吗啡、芬太尼分别与低浓度布比卡因复合行病人自控硬膜外镇痛（PCEA）能获得良好的术后镇痛效果;术后肠蠕动的恢复与手术种类分类密切;吗啡与布比卡因联用不影响肠蠕动的恢复,芬太尼与布比卡因联用可缩短肠蠕动的恢复时间。     

芬太尼复合新斯的明用于硬膜外术后镇痛对肠蠕动的影响

目的观察芬太尼复合新斯的明用于上腹部手术后硬膜外腔镇痛(PCEA)对肠蠕动的影响。方法选择90例上腹部手术患者,随机分为3组,每组各30例,各组配方分别为0.1%罗哌卡因 0.001%芬太尼 新斯的明1mg 氟哌利多2.5mg 0.9%生理盐水共100ml、0.1%罗哌卡因 0.001%芬太尼 氟哌利多2.5mg 0.9%生理盐水共100ml和0.1%罗哌卡因 吗啡5mg 氟哌利多2.5mg 0.9%生理盐水共100ml。手术结束后均按各组配方开始PCEA,背景流量2ml/h,自控量0.5毫升,锁定时间15分钟。分别纪录4、8、12、24、36和48h镇痛效果及首次肛门排气时间。结果3组术后按视觉模拟评分法(VAS)评分,术后镇痛效果差异无统计学意义,首次肛门排气时间差异有统计学意义(P<0.05)。结论芬太尼复合新斯的明应用于上腹部手术后镇痛可以加速胃肠蠕动的恢复,有利于手术后患者的康复。     

格拉司琼、氟哌利多用于妇科术后硬膜外镇痛抗呕吐作用的比较

目的:观察格拉司琼、氟哌利多与吗啡、左布比卡因配伍用于妇科术后硬膜外镇痛抗呕吐的临床效果。方法:105例ASAⅠ～Ⅱ级,在腰-硬联合麻醉下行择期妇科手术病人,随机分为三组,每组35例,术毕均行硬膜外镇痛。镇痛液配方:Ⅰ组为格拉司琼3mg+吗啡3mg+0.75%左布比卡因15ml;Ⅱ组为氟哌利多5mg+吗啡3mg+0.75%左布比卡因15ml;Ⅲ组为吗啡3mg+0.75%左布比卡因15ml。所有药液均用生理盐水稀释总量为100ml,注入一次性镇痛泵备用。所有病人术毕向硬膜外腔预注0.25%左布比卡因5ml+吗啡1～1.5mg作为负荷量,然后接镇痛泵恒速输注,2ml/h。记录术后48h内病人镇痛效果及恶心、呕吐等不良反应的发生情况。结果:三组病人镇痛效果均满意,呼吸和循环功能平稳,呕吐发生率Ⅰ组小于Ⅱ组(P<0.05),Ⅱ组小于Ⅲ组(P<0.05)。Ⅱ组有1例出现锥体外系症状。结论:格拉司琼、氟哌利多与吗啡、左布比卡因配伍注入硬膜外腔均能有效地减少术后呕吐的发生,格拉司琼抗呕吐效果优于氟哌利多。     

不同浓度及容量罗哌卡因硬膜外术后镇痛效果的临床观察

目的:观察不同浓度、不同容量罗哌卡因在上腹部手术病人术后硬膜外腔的镇痛效果及不良反应.方法:120例上腹部手术后病人随机分为4组:Ⅰ组30例,0.05%罗哌卡因+芬太尼1 mg/L,8 mL/h;Ⅱ组30例,0.1%罗哌卡因+芬太尼2 mg/L,4 mL/h;Ⅲ组30例,0.2%罗哌卡因+芬太尼4 mg/L,2 ml,/h;Ⅳ组30例,0.1%布比卡因+芬太尼2 mg/L,4 mL/h.各组病人硬膜外自控镇痛(PCEA)每次2 mL,锁定时间15 min.各组负荷量为芬太尼50 μg+0.75%罗哌卡因或布比卡因(2 mL)+生理盐水至4 mL.观察病人静息和咳嗽疼痛评分及不良反应.结果:镇痛效果及术后4,12,32,48 h疼痛评分,Ⅰ、Ⅱ、Ⅳ组之间无明显差异(P＞0.05),但明显优于Ⅲ组(P＜0.05),且48 h PCEA消耗量、总按压次数与有效按压次数之比(TPCA/EPCA)Ⅲ组明显高于Ⅰ、Ⅱ、Ⅳ组(P＜0.05).Ⅲ组术后当日还需辅助使用其他镇痛药.皮肤瘙痒、恶心、呕吐、镇静程度4组之间无明显差异(P＞0.05).Ⅳ组出现血压下降12例(40%),自觉咳嗽无力6例(20%),Ⅲ组自觉咳嗽无力4例(13.33%).结论:0.05%罗哌卡因+芬太尼1 mg/L、8 mL/h或0.1%罗哌卡因+芬太尼2 mg/L、4 mL/h对手术后病人不仅有良好的镇痛效果,而且对运动神经影响及循环影响轻微.     

不同浓度盐酸罗哌卡因用于宫颈癌根治患者术后镇痛疗效观察

目的:通过临床观察了解不同浓度盐酸罗哌卡因硬膜外自控镇痛对宫颈癌患者术后疼痛和早期活动的影响。方法:选择择期行宫颈癌的病人60例,ASAⅠ-Ⅱ级。随机分为0.125%盐酸罗哌卡因(Ⅰ组)、0.15%盐酸罗哌卡因(Ⅱ组)和0.20%盐酸罗哌卡因(Ⅲ组),均复合2μg/ml芬太尼,每组各20例。观察各组48h内的镇痛效果、排气时间、下床活动时间、术后不良反应。结果:术后VAS评分Ⅱ、Ⅲ组明显低于Ⅰ组,改良Bromage评分Ⅰ、Ⅱ组显著低于Ⅲ组,三组病人Ramsay评分,不良反应发生情况,排气时间,术后第一次下地时间等差异均无统计学意义。结论:三组均适合宫颈癌根治的术后镇痛,其中0.15%盐酸罗哌卡因术后镇痛效果好,而无明显运动阻滞,更适合推荐用于宫颈癌根治患者术后镇痛。     

甲磺酸罗哌卡因复合吗啡用于术后患者自控硬膜外镇痛的观察

目的评价甲磺酸罗哌卡因复合吗啡用于术后患者自控硬膜外镇痛的临床效果.方法选择腰麻-硬膜外联合麻醉下行下腹部及下肢手术、ASAⅠ-Ⅱ级的患者60例,随机均分为二组:B组:布比卡因150mg+吗啡4mg+氟哌利多5mg+生理盐水配至100ml;J组:甲磺酸罗哌卡因238.4mg+吗啡4mg+氟哌利多5mg+生理盐水配至100ml分别于术毕硬膜外腔给予负荷量后接止痛泵.观察0~48小时内各时段视觉模拟评分(VAS),镇静评分(Ramsay评分),血压、心率、呼吸、SPO2变化及不良反应.结果各时段VAS评分、Ramsay评分两组均无显著性差异(P>0.05).结论甲磺酸罗哌卡因复合吗啡用于术后患者自控硬膜外镇痛效果确切、安全、可靠.     

不同配伍曲马多用于硬膜外术后镇痛效应的比较

目的比较不同配伍曲马多用于硬膜外术后的镇痛效应.方法 80例(ASAⅠ～Ⅱ级)妇科腹式全宫切除术的患者随机分成4组,T1组(n=20):镇痛药液为1%曲马多+0.01%氟哌利多+0.125%布比卡因;T2组(n=20):2%曲马多+0.01%氟哌利多+0.125%布比卡因;T3组(n=20):0.5%曲马多+0.01%氟哌利多+0.005%吗啡+0.125%布比卡因;M组(n=20):0.01%吗啡+0.01%氟哌利多+0.125%布比卡因.采用负荷剂量+持续剂量给药模式.结果 VAS评分T1组2.8±0.4,T2组2.0±0.2,T3组1.4±0.4,M组1.1±0.5;M组与T1组比较差异有显著性(P<0.01),与T2组比较差异有显著性(P<0.05),T3与T1及T2组比较差异有显著性(P<0.05),M组与T3组比较差异无显著性(P>0.05).并发症:恶心、呕吐的发生率分别为0～5%和0～5%,嗜睡、皮肤瘙痒为5%～10%.结论曲马多用于硬膜外术后镇痛强度比吗啡的1/200还弱,如与吗啡联合使用时有协同增效作用,其镇痛强度是吗啡的1/100.     

不同浓度的罗哌卡因和吗啡应用于硬膜外自控镇痛效果的比较

目的 比较几组不同浓度的罗哌卡因和吗啡用于手术后硬膜外自控镇痛(PCEA)的镇痛效果.方法 选择ASAⅠ-Ⅱ级下腹部以下的手术患者350例,按术后镇痛药液配方随机分为7组(N=50).A组,0.075%罗哌卡因 0.06mg/ml吗啡;B组,0.125%罗哌卡因 0.06mg/ml吗啡;C组0.125%罗哌卡因 0.08mg/ml吗啡;D组0.2%罗哌卡因 0.09mg/ml吗啡;E组0.2%罗哌卡因 0.08mg/ml吗啡;F组0.25%罗哌卡因 0.06mg/ml吗啡;G组0.25%罗哌卡因 0.08mg/ml吗啡;配成100ml药液中每组均加用氟哌啶醇5mg.负荷剂量为0.125%罗哌卡因 吗啡2mg 6ml,持续剂量为2ml/h,按压剂量为2ml,锁定时间为15min.结果 (1)A组VAS评分明显高于其他组(P＜0.05);E、F、G组VAS评分明显低于其他组(P＜0.05).(2)A组患者按压次数或实际有效进药次数(D1/D2)比值大于5的比例高于其他组(P＜0.05).各组罗哌卡因和吗啡用量无显著差异性(P＞0.05).Ramesay评分各组无差异性.(3)A、B、C三组肛门排气时间及Bromage评分差异不显著(P＞0.05).D、E、F、G四组Bromage评分明显高于其他组(P＜0.05).(4)镇痛期间所有患者无呼吸抑制,但C、E、G三组皮肤瘙痒和恶心呕吐不良反应出现例数高于其他组(P＜0.05).结论 0.125%罗哌卡因 0.06mg/ml吗啡 氟哌啶醇5mg复合配置镇痛效果较好,副作用少.     

芬太尼配伍小剂量吗啡用于硬膜外术后镇痛效果的观察

目的探讨芬太尼配伍小剂量吗啡用于成人硬膜外术后镇痛的效果。方法将33例择期手术患者随机分3组，组Ⅰ：o．125％盐酸罗哌卡因＋0．004％芬太尼。组Ⅱ：0.125％盐酸罗哌卡因＋0．006％芬太尼。组Ⅲ：0．125％盐酸罗哌卡因＋0．004％芬太尼＋0．03％吗啡。术后定时进行镇痛、镇静评分及不良反应的观察。结果镇痛评分组Ⅱ、组Ⅲ明显低于组Ⅰ（P〈0．05），镇静评分组Ⅰ明显低于组Ⅱ、组Ⅲ，不良反应率组Ⅰ、组Ⅲ明显低于组Ⅱ（P〈0．05）。结论芬太尼配伍小剂量吗啡用于成人硬膜外术后镇痛能取得较满意的效果。     

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.