阿托伐他汀对心肌肥大的抑制作用及FoxO1表达的影响

目的探讨阿托伐他汀(atorvastatin)对血管紧张素Ⅱ(AngⅡ)诱导的肥大心肌细胞的抑制作用及对转录因子FoxO1表达的影响。方法将H9C2细胞分为3组,对照组:未给予任何干预;心肌肥大组:给予AngⅡ(10-7 mol/L)刺激细胞;阿托伐他汀组:预先给予atorvastatin(10-5 mol/L),30min后AngⅡ(10-7 mol/L)刺激细胞。western-blotand real time PCR检测H9C2细胞FoxO1蛋白及mRNA含量,脑钠肽(brain natriuretic pepide,BNP)作为判断心肌肥大的指标。结果 AngⅡ诱导心肌细胞肥大后FoxO1表达较正常心肌细胞明显降低(P<0.05),而给予阿托伐他汀干预的肥大心肌细胞其FoxO1表达较肥大心肌明显升高(P<0.05)。结论阿托伐他汀可能通过上调FoxO1表达,从而抑制心肌肥大。     

阿托伐他汀对血管平滑肌细胞增殖和血红素氧化酶1表达的影响

目的探讨阿托伐他汀对血管平滑肌细胞增殖的影响及对血红素氧化酶1（HO-1）表达的作用。方法采用酶消化法分离大鼠血管平滑肌细胞。取4－6代细胞用于实验,胰岛素样生长因子1（IGF-1）刺激血管平滑肌细胞增殖,以不同浓度（0、0.01、0.1、1和10μmol/L）阿托伐他汀、10μmol/L阿托伐他汀＋锌原卟啉Ⅸ（ZNPPⅨ）进行干预。采用四唑盐（MTT）比色法观察细胞的增殖。逆转录聚合酶链反应（RT-PCR）半定量分析细胞HO-1 mRNA的表达。结果IGF-1可促进血管平滑肌细胞增殖,与空白组比较,IGF-1组细胞计数明显增加（P〈0.01）,随着阿托伐他汀浓度的提高,血管平滑肌细胞计数逐渐减少（P〈0.01）,加入ZNPPⅨ后血管平滑肌细胞增殖恢复。空白组和IGF-1组血管平滑肌细胞HO-1有少量表达,随着阿托伐他汀浓度的增加,HO-1的表达增强,呈剂量依赖性。与空白组和IGF-1组比较,0.01μmol/L组HO-1增加不明显,0.1μmol/L组HO-1开始有较明显增加,10μmol/L组HO-1表达达高峰（P〈0.01）。结论阿托伐他汀可抑制血管平滑肌细胞的增殖和诱导HO-1的表达。诱导HO-1表达是阿托伐他汀抑制血管平滑肌细胞增殖的机制之一。     

阿托伐他汀对AngⅡ诱导内皮细胞VCAM-1和ICAM-1 mRNA表达的影响

目的:观察阿托伐他汀对于血管紧张素Ⅱ(AngⅡ)诱导的培养人脐静脉内皮细胞表达血管细胞粘附分子-1(VCAM-1)和细胞间粘附分子-1(ICAM-1)mRNA的影响,探讨阿托伐他汀的非降脂作用和潜在的治疗作用.方法:培养人脐静脉内皮细胞,取生长良好的第2、3代细胞进行实验.将细胞分为三组:对照组、AngⅡ组、阿托伐他汀干预组.对照组加培养液,AngⅡ组以不同浓度的AngⅡ与细胞共孵育24 h,干预组首先用不同浓度的阿托伐他汀(0.05μmol/L,0.1 μmol/L,1.0 μmol/L,10 μmol/L)分别作用1 h,而后加1 μmol/L Ang Ⅱ与细胞共育24 h.半定量RT-PCR测定粘附分子ICAM-1和VCAM-1mRNA的表达.结果:Ang Ⅱ能上调ICAM-1和VCAM-1的表达,阿托伐他汀在一定程度上可抑制上述作用.结论:阿托伐他汀可抑制粘附分子ICAM-1和VCAM-1 mRNA表达,可能具有增加粥样斑块稳定性和延缓动脉粥样硬化进程的作用.     

阿托伐他汀抑制血管紧张素Ⅱ诱导心房肌细胞肥大及对缝隙连接蛋白40的影响

目的观察阿托伐他汀对血管紧张素Ⅱ（AngⅡ）诱导的心房肌细胞肥大及缝隙连接蛋白40（Cx40）表达的影响。方法20只1周龄左右Wistar大鼠,用于体外心房肌细胞的分离培养与鉴定。设置正常对照组、AngⅡ（1μmol/L）组、AngⅡ＋二甲亚砜组和AngⅡ＋阿托伐他汀0.1、1.0、10μmol/L共6组。72h后利用氚标亮氨酸掺入法检测心房肌细胞蛋白合成速率,逆转录聚合酶链反应分别检测脑钠肽的前体（Nppb）、转化生长因子（TGF）-β1Cx40 mRNA的表达。结果与正常对照组相比,AngⅡ组氚标亮氨酸掺入量和Nppb mRNA表达呈显著性增加（P〈0.05）,同时TGF-β1mRNA高表达而Cx40mRNA低表达,阿托伐他汀逆转上述变化,10μmol/L组作用最强（P〈0.05）,而作为溶剂的二甲亚砜无明显作用。结论阿托伐他汀可能通过抑制Nppb mRNA的高表达来逆转AngⅡ诱导的心房肌细胞肥大,抑制TGF-β1RNA的高表达减轻心房纤维化,同时可能通过增强Cx40 mRNA的表达来逆转缝隙连接蛋白的重构,最终减低房颤发生率。     

血管紧张素Ⅱ通过上调富含半胱氨酸蛋白61表达诱导HEK293T细胞凋亡

目的探讨富含半胱氨酸蛋白61（Cyr61）在血管紧张素Ⅱ（AngⅡ）诱导HEK293 细胞功能中的改变及作用。方法 HEK293T细胞于体外培养,并应用CRISPR/Cas9技术敲低HEK293T细胞Cyr61基因。将细胞分为四组：（1）对照组;（2）Cyr61 敲低组;（3）AngⅡ组;（4）AngⅡ+Cyr61敲低组,以10-7 mol/L AngⅡ处理细胞,48 h收集细胞用流式细胞仪检测细胞凋亡,通过 实时荧光定量PCR(qRT-PCR)技术及蛋白质免疫印迹技术检测细胞Cyr61及Bcl-2的mRNA及蛋白表达量。结果Cyr61敲低 组Cyr61蛋白水平较正常对照组明显下降（P<0.05）,AngⅡ干预48 h 后Cyr61蛋白和mRNA表达水平显著升高（P<0.05）,Bcl-2 蛋白和mRNA表达水平明显下降（P<0.05）,敲低Cyr61 后Bcl-2 蛋白和mRNA表达水平明显升高（P<0.05）,与对照组凋亡率 （11.88±1.46）%相比,Cyr61敲低组凋亡率为（3.87±0. 83）%,AngⅡ干预组HEK293T细胞凋亡率为（26.94±3.73）%（P<0.05）,与 AngⅡ干预组相比,Cyr61 敲低+AngⅡ组凋亡率为（15.76±1.31）%（P<0.05）。结论Cyr61 表达量的上调与AngⅡ诱导的 HEK293T细胞损伤有关,下调Cyr61的表达可以有效地保护AngⅡ诱导的细胞损伤。     

阿托伐他汀抑制心房肌细胞CTGF及Cx43的表达

目的探讨阿托伐他汀(atorvastatin)对血管紧张素Ⅱ(AngⅡ)诱导的心房肌细胞结缔组织生长因子(con-nective tissue growth factor,CTGF)及缝隙连接蛋白43(Connexin 43,Cx43)表达的影响。方法 18只雌雄对半1周龄左右Wistar大鼠,用于体外心房肌细胞的分离培养与鉴定。设置6组(n=18):正常对照组、AngⅡ(终浓度1μmol/L)组、AngⅡ+二甲基亚砜(DMSO)组、AngⅡ+atorvastatin(0.1、1.0、10μmol/L)组,作用72 h后RT-PCR分别检测CTGF、TGF-β1及Cx43的mRNA表达。结果与正常对照组相比,AngⅡ组CTGF、TGF-β1和Cx43 mRNA表达呈显著增加(P<0.05),阿托伐他汀逆转上述变化,10μmol/L组作用最强(P<0.05),而作为溶剂的DMSO无明显作用(P>0.05)。结论阿托伐他汀可能通过抑制AngⅡ诱导的心房肌细胞CTGF mRNA的高表达来减轻心房纤维化,同时可能通过下调Cx43 mRNA的表达来逆转缝隙连接蛋白的重构,最终减低房颤发生率。     

氟伐他汀对血管紧张素Ⅱ诱导的系膜细胞AT1受体和Ⅳ型胶原表达的影响

目的:观察血管紧张素Ⅱ(angiotensinⅡ,AngⅡ)诱导的正常大鼠肾小球系膜细胞(HBZY-1)血管紧张素Ⅱ1型受体(angiotensinⅡtype 1 receptor,AT1R)蛋白和Ⅳ型胶原(ColⅣ)蛋白的表达情况及氟伐他汀对AT1R和ColⅣ表达的影响,探讨其肾脏保护作用的可能机制。方法:将HBZY-1细胞分为3组:①阴性对照组;②不同浓度(0.1,1.0,10μmol/L)AngⅡ刺激组;③1.0μmol/L AngⅡ加不同浓度(0.1,1.0,10μmol/L)氟伐他汀干预组,蛋白质印迹法检测各组AT1R蛋白的表达,酶联免疫吸附实验(ELISA法)检测各组ColⅣ蛋白的表达。结果:AngⅡ刺激后,HBZY-1细胞AT1R及ColⅣ的表达随AngⅡ浓度增加而增强;氟伐他汀能够剂量依赖性地抑制AT1R和ColⅣ的表达。结论:氟伐他汀能够抑制AngⅡ诱导的HBZY-1细胞AT1R和ColⅣ的表达,同时AT1R和ColⅣ的表达存在正相关,推断氟伐他汀可能通过下调AT1R影响ColⅣ的表达,进而改善高血压肾脏硬化。     

氟伐他汀及氯沙坦对血管紧张素Ⅱ诱导人足细胞VEGF表达的影响

目的:观察氟伐他汀及氯沙坦对血管紧张素Ⅱ(angiotensinⅡ,AngⅡ)刺激人足细胞血管内皮细胞生长因子(vascu-lar endothelial growth factor,VEGF)表达的影响。方法:采用不同浓度的(10-9～10-5 mol/L)AngⅡ刺激人足细胞24 h以确定最适干预浓度;选择最适干预浓度(10-7 mol/L)的AngⅡ刺激0、6、12、24 h以确定最适干预时间;AngⅡ(10-7 mol/L)和不同浓度的(10-7～10-5 mol/L)氟伐他汀共同干预足细胞24 h以确定氟伐他汀最适干预浓度;AngⅡ(10-7 mol/L)和不同浓度的(10-6～10-4mol/L)氯沙坦共同干预足细胞24 h以确定氯沙坦最适干预浓度;氟伐他汀和氯沙坦(均为10-6 mol/L)共同干预足细胞24 h。Western blot检测人足细胞VEGF的表达。结果:①10-7 mol/L AngⅡ刺激人足细胞24 h后表达VEGF增加最明显;②氟伐他汀干预组与AngⅡ刺激组比较,VEGF表达明显下降,浓度10-5 mol/L下降最明显。氯沙坦干预组与AngⅡ刺激组比较,VEGF表达明显下降...     

血管紧张素Ⅱ诱导血管平滑肌细胞肥厚过程中MAPK对细胞周期素依赖性激酶抑制因子的调节作用

目的观察在血管紧张素Ⅱ(AngⅡ)诱导血管平滑肌细胞(VSMC)肥厚过程中,丝裂原活化蛋白激酶(MAPK)活性和细胞周期素依赖性激酶抑制因子p27、p21、p57蛋白表达量的变化,探讨MAPK对细胞周期素依赖性激酶抑制因子的调节作用。方法分离SD大鼠主动脉中层平滑肌,贴壁法培养平滑肌细胞,无血清培养基培养静止后,加入AngⅡ1×10-6 mol/L和/或豆蔻酸佛波酰乙酯(PMA)20nmol/L,以无血清培养基培养的VSMC作对照。在刺激后90min收集细胞,用免疫沉淀法检测MAPK活性的改变。在刺激后6和24h收集细胞,用Western blotting法检测p27、p57和p21蛋白表达量。结果AngⅡ可以使MAPK活性升高,但其升高幅度较低(仅较对照组增加了138%),未能抑制p27蛋白的表达,不能使VSMC增殖。PMA和AngⅡ共同作用时,可以轻度抑制p27蛋白的表达,但仍未能使VSMC增殖。结论MAPK通路是VSMC胞外增殖肥厚刺激信号进入核内的一条重要信息传导通路。     

辛伐他汀对自发性高血压大鼠外周血单个核细胞白细胞介素-1β表达的影响

目的 研究不同剂量的辛伐他汀对血管紧张素Ⅱ (angiotensin Ⅱ,AngⅡ)刺激的自发性高血压大鼠(SHR)外周血单个核细胞白细胞介素-1β(interleukin-1β, IL-1β)mRNA的表达及蛋白分泌的影响.方法 分离36只雄性SHR外周血单个核细胞,并随机分为6组(n=6):空白对照组(仅加入培养液),Ang Ⅱ(10-6 mol/L)组, Ang Ⅱ(10-6 mol/L)+DMSO组, Ang Ⅱ(10-6 mol/L)+辛伐他汀(1×10-6 mol/L)组, Ang Ⅱ(10-6 mol/L)+辛伐他汀(5×10-6 mol/L)组, Ang Ⅱ(10-6 mol/L)+辛伐他汀(10×10-6 mol/L)组,利用RT-PCR检测各组单个核细胞IL-1 βmRNA的表达, ELISA法检测各组单个核细胞IL-1β蛋白的分泌.结果 Ang Ⅱ(10-6 mol/L)组与空白对照组相比,IL-1β的mRNA表达及蛋白的分泌均明显升高(mRNA:P＜0.05,蛋白:P＜0.01),而辛伐他汀干预各组呈剂量依赖性抑制Ang Ⅱ刺激的IL-1β mRNA的表达及蛋白的分泌,差异均有统计学意义(P＜0.01).结论 辛伐他汀抑制Ang Ⅱ刺激的高血压外周血单个核细胞炎症因子IL-1β蛋白的分泌与抑制IL-1β基因的表达有关,且呈剂量依赖性.     

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.