阿霉素诱导大鼠心衰模型的建立

目的:通过阿霉素(Adriamyc in,ADR)腹腔注射给药(Adriamyc in,ADR)试图造成大鼠心衰,探讨建立大鼠阿霉素心衰动物模型的给药方案,为研究心衰的发病机制和有效治疗措施提供理想的动物模型。方法:雄性W istar大鼠25只,随机分成模型组(n=15)和对照组(n=10)。模型组:腹腔注射ADR(4 mg/kg,用注射用水配制成2 mg/m l溶液,即2 m l/kg,每周1次,共6周,累积总量24 mg/kg;对照组:注射相同体积的注射用水。于末次注射停药后2周,测量体重(BW)、心室质量(VW)、动脉收缩压(ASP)、动脉舒张压(ADP)、左室收缩压(LVSP)、左室舒张末压(LVEDP)及左室最大压力上升及下降速度(±dp/dtm ax),并作病理切片观察其组织学变化。结果:与对照组相比,模型组ASP、LVSP、±dp/dtm ax均明显减小,LVEDP明显升高;病理学结果证实符合心肌病样改变。结论:多次间断腹腔注射一定剂量的阿霉素可明显损害心脏的功能,是建立大鼠慢性充血性心力衰竭模型的一种简便可靠的方法。     

阿霉素诱导和腹主动脉缩窄术复制大鼠慢性心力衰竭模型的比较

目的:通过阿霉素诱导和腹主动脉缩窄术分别建立大鼠慢性心力衰竭(CHF)模型,比较二者的优缺点,为后续实验选择合适的动物模型提供依据。方法:40只雄性SD大鼠随机分为三组,腹腔注射阿霉素诱导复制CHF模型组(ADR组,n=8)、腹主动脉缩窄术复制CHF模型组(AAC组,n=8)、假手术组(SO组,n=8,除不进行腹主动脉缩窄术外,其他制作程序与AAC组相同)。8周后在体检测大鼠心电图和心功能指标:心率(HR)、左室峰压(LVSP)、左室舒张期末压(LVEDP)、室内压变化速率(±dp/dtmax),计算大鼠心脏质量/体质量(HW/BW),并观察各组大鼠心肌形态学变化。结果:与SO组相比,ADR组与AAC组HW/BW均增加(P<0.01),(LVSP-LVEDP)×HR、LVSP、±dp/dtmax明显减低(P<0.01),LVEDP明显升高(P<0.01);病理切片显示SO组大鼠心肌纤维排列整齐、心肌细胞大小、形态正常,ADR组大鼠心肌细胞排列紊乱、胞质呈溶解状态、核深染,可见心肌纤维溶解断裂、心肌细胞间隙明显增宽,AAC组大鼠心肌纤维排列紊乱、心肌细胞肥大、间质中有炎症细胞浸润、间质增生。结论:腹腔注射阿霉素诱导及腹主动脉缩窄术均是复制大鼠CHF模型的有效方法,但前者操作简单、对大鼠损伤较小,大鼠病死率低,是我们后续实验较为理想的大鼠CHF模型选择。     

人参总皂苷合黄连小檗碱对慢性心衰大鼠心肌肌球蛋白重链的影响

目的:探讨人参总皂苷(GS)合黄连小檗碱(Ber)对慢性心衰大鼠心肌肌球蛋白重链(α-MHC,β-MHC)表达的影响.方法:连续12 d皮下注射较大量异丙肾上腺素(ISO)建立慢性心衰大鼠模型,ISO总量80 mg/kg,随机分为模型组、GS+Ber组、卡托普利组、参麦注射液组,另设对照组.GS+Ber组各以20 mg/(kg.d)灌胃,卡托普利组以45 mg/(kg.d)灌胃,参麦注射液组以5 mL/(kg.d)腹腔注射,模型组和对照组以蒸馏水灌胃.4 wk后检测各组血流动力学指标、心脏质量指数,实时荧光定量PCR检测α-MHC,β-MHC mRNA表达.结果:对照组与各组相比,左室内压峰值(LVSP)、左室等容收缩期压力上升最大速率(+dp/dtmax)、左室舒张期压力下降最大速率(-dp/dtmax)以及α-MHC mRNA表达明显下降,左室舒张末压(LVEDP)、心脏质量指数以及β-MHC mRNA表达显著升高(均P<0.01);GS+Ber组、卡托普利组与模型组相比,LVSP,±dp/dtmax,α-MHC mRNA表达明显升高,LVEDP、心脏质量指数以及β-MHC mRNA表达显著降低(P<0....     

运动康复联合参附注射液对心肌病心衰大鼠血流动力学的影响

目的 观察运动康复联合参附注射液对心肌病所致心力衰竭大鼠血流动力学的影响.方法 将50只SD雄性大鼠随机分为安静对照组(10只)与造模组(40只),造模组大鼠采用盐酸多柔比星腹腔注射7周造模,造模成功后的36只大鼠,按随机数字表法,分为模型组、参附组、运动康复组、运动康复参附组,每组9只.分别用生理盐水、参附注射液、运动康复、运动康复联合参附注射液干预4周,检测大鼠左室收缩压峰值(LVSP)、左舒张末压力(LVEDP)、左室等容收缩末期压力上升最大速度(+dp/dtmax)、左室压力下降最大速度(-dp/dtmax)等血流动力学指标.结果 与模型组比较,参附组、运动康复组、运动康复参附组在LVSP、LVEDP、+dp/dtmax、-dp/dtmax差异有统计学意义(P<0.05);与运动康复参附组比较,参附组、运动康复组在LVSP、+dp/dtmax、-dp/dtmax差异有统计学意义(P<0.05);与运动康复参附组比较,参附组在LVEDP差异有统计学意义(P<0.05).结论 运动康复、参附注射液、运动康复联合参附注射液都能改善心衰大鼠血流动力学指标,提高心衰大鼠心脏功能,而运动康复联合参附注射液效果最好.     

3/4肾切除并异丙肾皮下注射致慢性心衰合并肾衰模型的制备

目的:研究大鼠3/4肾切除并异丙肾上腺素(ISO)皮下注射致慢性心衰合并肾衰模型的制备.方法:雄性SD大鼠经“两次手术切除法”行3/4肾切除,1周后分成2组,分别皮下注射ISO(70 mg/kg或100 mg/kg,分2次,间隔24 h),对照组给予假手术并注射生理盐水,4周后比较各组大鼠存活率、心衰及肾衰情况.试剂盒法测定血清肌酐、尿素氮,Bradford法测定24 h尿蛋白量,左心室插管术测定左室收缩压(LVSP)、左室舒张压(LVDP)、左室舒张末压(LVEDP)及左室压力最大上升及下降速率(±dp/dtmax).称重法测定心脏重量参数.切片HE染色观测心肌病理情况.结果:对照组大鼠无死亡,大小剂量模型存活率分别为73％、87％,与对照组相比,大小剂量模型组大鼠血清各项指标、尿蛋白明显升高,LVSP下降,LVDP和LVEDP均上升,心脏重量参数比升高,提示左室舒张和收缩功能损伤,发生左室心衰和左室心肌肥厚重构.且大剂量组与小剂量组比较心肾功能差异有统计学意义.结论:3/4肾切除并ISO(100 mg/kg)皮下注射较ISO(70 mg/kg)皮下注射,更易同时诱发大鼠左室心衰及肾衰.     

大豆异黄酮对阿霉素致心衰大鼠心功能的影响

目的:观察大豆异黄酮(soybean isoflavones,SI)对阿霉素(adriamycin,ADR)致心力衰竭大鼠心功能的影响.方法:取成年雄性SD大鼠30只,随机分为空白对照组、阿霉素组及大豆异黄酮低、中、高剂量组,每组6只.大豆异黄酮低、中、高剂量组分别予SI 30、60、120 mg·kg-1·d1灌胃,1次/d,连续6 d;其他两组灌注等量生理盐水.第7天除空白对照组外,其余4组一次性腹腔注射盐酸阿霉素10mg/kg,复制急性心衰大鼠模型,利用MedLab-U/4c生物信号采集处理系统采集心室内压并分析.电镜观察心肌细胞超微结构变化.结果:与对照组相比,阿霉素组左室收缩峰压(LVSP)、室内压最大上升速率( dp/dtmax)、室内压最大下降速率(-dp/dtmax)、心肌纤维收缩成分缩短速度的最大值(Vpm)显著降低(P ＜0.01);与阿霉组相比,高剂量大豆异黄酮组LVSP、±dp/dtmax和Vpm显著升高(P ＜0.05或P ＜0.01).电镜显示阿霉素组大鼠心肌细胞线粒体水肿、破裂、嵴消失,肌原纤维变性、溶解、大片坏死.闰盘间隙增宽,心肌间质纤维化.高剂量大豆异黄酮组,心肌肌原纤维病变明显减轻,部分排列紊乱,无坏死和溶解;部分线粒体水肿.结论:高剂量大豆异黄酮可减轻阿霉素对心肌的毒性作用,明显改善心衰大鼠心脏的收缩功能,表明该药有一定的抗心衰作用.     

苦参碱对急性心肌缺血大鼠血流动力学的影响

目的研究苦参碱对急性心肌缺血大鼠血流动力学的影响。方法将SD大鼠随机分为8组:正常对照组,假手术组,模型组,丹参组,硝酸甘油组,苦参碱2.5、5、10mg/kg剂量组。应用左冠状动脉前降支(LAD)结扎法制备大鼠急性心肌缺血模型,记录结扎前、结扎后5、15、30和60min大鼠左心室收缩压(LVSP)、左心室终末舒张压(LVEDP)、左心室内压最大上升速率( dp/dtmax)和左心室内压最大下降速率(-dp/dtmax)等指标。结果与对照组和假手术组比较,左冠状动脉前降支结扎后5、15、30,60min,模型组大鼠LVSP、 dp/dtmax、-dp/dtmax明显降低(P<0.05或P<0.01),LVEDP明显升高(P<0.01)。与模型组比较,左冠状动脉前降支结扎后5、15、30、60min,静脉注射苦参碱2.5、5和10mg/kg均可使大鼠LVSP、 dp/dtmax、-dp/dtmax明显升高(P<0.05或P<0.01),LVEDP明显降低(P<0.05或P<0.01)。此作用在左冠状动脉前降支结扎后15、30min最明显,且随着药物剂量增加,药物作用时间延长。结论静脉注射苦参碱可改善急性心肌缺血大鼠的心功能。     

大豆异黄酮对阿霉素心衰大鼠心功能的影响

目的: 观察大豆异黄酮对阿霉素心衰大鼠心功能的影响。方法: 取成年雄性SD大鼠24只,随机分为3组:(1)对照组,(2)阿霉素组,(3)大豆异黄酮+阿霉素组。第3组每天予大豆异黄酮120 mg/kg灌胃1次,连续6天,其它两组灌注等量生理盐水。第7天一次性腹腔注射阿霉素10 mg/kg,复制心衰大鼠模型,利用MedLab-U/4c生物信号采集处理系统采集心室内压并分析。结果: 与对照组相比,阿霉素组左室收缩峰压(LVSP)、室内压最大上升速率(+dp/dt_max)、室内压最大下降速率(-dp/dt_max)、心肌纤维收缩成分缩短速度的最大值(Vpm)显著降低(P<0。05~P<0。01)。与阿霉素组相比,大豆异黄酮+阿霉素组LVSP、±dp/dt_max和Vpm均升高(P<0。05~P<0。01)。结论: 大豆异黄酮可减轻阿霉素对心肌的毒性作用,可明显改善心衰大鼠的心脏收缩功能,表明该药有一定的抗心衰作用。     

rhNRG-1β对阿霉素心肌病大鼠的治疗作用

目的 探讨rhNRG-1β对阿霉素心肌病(adriamycin-induced dilated eardiomyopathy,ADR-DCM)大鼠损伤心肌的治疗作用.方法 雄性sD大鼠52只,参照Schwarz的方法 成功制备阿霉素心肌病大鼠23只(余29只死亡),分为:①给药组(rhNRG-1,n=8),rhNRG-1β 20μg/kg;②阴性对照组(赋形剂,n=8),注射方法 同给药组;③阳性对照组(地高辛,n=7),0.0625 mg/kg,注射方法 同给药组.另选取同批次正常鼠作为正常对照组(CON,n=8).测定心功能、血流动力学指标,心质/体质量比(HW/BW),窒壁厚度,并对心肌组织进行病理学检查及血清肌钙蛋白T、BNP水平测定.结果 与正常对照组比较,各模型组LVSP和±dp/dtmax显著降低(P<0.01),LVEDP明显升高(P<0.01),左窒壁厚度明显下降(P<0.05),各模型组心肌细胞明显受损,病理评分均升高(P<0.05),血TNT及血BNP水平明显增高(P<.05);与地高辛组、赋形剂组及给药前比较,给药组(rhNRG-1β)给药后LVSP和±dp/dtmax值均明显升高(P<0.05),LVEDP明显降低(P<0.05),HW/BW比值及左室壁厚度差异无显著性(P>0.05),心肌细胞坏死、变性程度轻,且病理评分明显降低(P<0.05),血清肌钙蛋白T(Tropomyosin binding componet,TnT)水平及血脑钠肽(brain natriuretic peptide,BNP)水平显著下降(P<0.05).结论 rhNRG-1β可有效减轻阿霉素心肌病大鼠的心肌损伤,改善心功能,纠止心衰.     

木脂素对阿霉素心肌损伤的改善作用

目的 研究五味子木脂素对阿霉素(ADR)所致大鼠心肌损伤的保护作用.方法 动物分为正常组、模型组、木脂素组、阳性药组.大鼠心肌损伤模型组采用2.5 mg/kg ADR于每周期第5天腹腔注射,连续6个周期.木脂素组分为高剂量组(100 mg/kg)、中剂量组(50 mg/kg)、低剂量组(25 mg/kg),每天灌胃一次.正常组和模型组分别灌胃给予蒸馏水;阳性药组灌胃维生素C(83 mg/kg),1次/d.实验结束后,观察心率变化;检测心肌组织丙二醛(MDA)和谷胱甘肽S-转移酶(GST)的改变.结果 与模型组相比,木脂素可有效改善ADR引起的心率减慢(P<0.05)、左心室收缩压(LVSP)和左心室舒张末压(LVEDP)降低(P<0.05)、左室内压最大上升速率(+dp/dt)、左室内压最大下降速率(-dp/dt)升高(P<0.05);使心肌组织GST活力水平升高(P<0.05),MDA水平降低(P<0.05).结论 木脂素对阿霉素引起大鼠心肌损伤具有改善作用.     

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.