With the wide application of clinical guidelines and standardization of Chinese medicine (CM), guidelines of CM and/or integrative medicine (IM) were also emerging. By the guideline evaluation instruments such as the Appraisal of Guidelines Research and Evaluation (AGREE) Instrument and Conference on Guideline Standardization (COGS), a preliminary assessment of 11 clinical guidelines for CM and/or IM published before October 2008 was performed. Methodological description of evidence collection or synthesization was absent in most clinical guidelines, and evidence-grading criteria were listed in only one of the eleven guidelines. Inadequate standardization of guideline development, single professional background of guideline developers, and lack of high-grade evidence were the current problems. It was suggested that guideline development group should include individuals from multiple relevant professional fields. Stress should be laid on evidence collection and recommendation grading. Guideline developers should follow the rigorous development methodology of evidence-based guidelines, and the methods for evaluating evidence and grading recommendations should be set up according to the characteristics of medical literature of CM. In addition, more attention should be paid to appraise the quality of clinical practice guidelines of CM and IM.

ObjectiveTo analyze the systolic function of subendocardial myocardium of the left ventricle in patients with diabetes mellitus (DM) and DM associated hypertension by speckle tracking imaging (STI).Methods The left ventricular ejection fraction(LVEF) and left ventricular mass index (LVMI) of all subjects including 30 patients with diabetes mellitus(DM group),25 patients with DM associated hypertension (DH group) and 30 healthy volunteers (control group) were normal and near.The common parameters of echocardiogram were measured and the peak systolic longitudinal strain of subendocardial myocardium were analyzed from the long-axis view at the levels of mitral annulus,papillary muscle and apex by STI.All above parameters were compared among three groups.ResultsNo significant difference in all parameters was found between the control group and two patient groups,but the ratio of E/A was significantly lower in the two patient groups than that of control group ( P ＜0.01).The peak systolic longitudinal strain of some segments were significantly lower in the two patient groups than that of control group ( P ＜0.01).The peak systolic longitudinal strain of the subendocardial myocardium of all segments in the two patient groups were different decrease compared with the control group( P ＜0.01 or P ＜ 0.001).The peak systolic longitudinal strain of the subendocardial myocardium of the DH group except some segments were decrease compared with the DM group ( P ＜0.01).ConclusionsSTI may be early used to identify the left ventricular systolic function in patients with diabetes mellitus.

Objective To investigate the efficacy of metholrexate combined with rmifepristone and laparoscopic surgery for treating ectopic pregnancy.Methods 85 patient with ectopic pregnancy were selected.41 cases treated with methotrexate and mifeprisione were considered as the control group,while 44 cases with laparoscopic surgery were considered as the observalion group on the voluntary basis.The clinical efficacy,serum β-HCG value and recovery time after 7d were compared between the two groups.Results After the treatment,the cure rate in the observation group was 100％ which was significantly higher than 90％ of the control group ( P ＜ 0.05 ),the serum β-HCG value of the observation group was lower and the restoration normal time was shorter than the control group ( P ＜0.05).Conclusions Laparoscopic surgery and conservative treatment of methotrexate combined with mifepristone are effective in the treatment of ectopic pregnancy.However,the clinical efficacy of the laparoscopic surgery is better and it has rapid recovery time,and it can completely cure the patients.

The blood-brain barrier (BBB) exerts its central nervous system (CNS) protective function as it hinders the delivery of diagnostic and therapeutic agents to the brain. With the development of nanotechnology during the last thirty years, the nanocarriers for delivering drugs make it possible to transport drugs across the BBB. The brain-targeted drug delivery system usually consists of two parts: nanocarriers and brain-targeted strategies. In this review, several kinds of nanocarriers are introduced for brain-targeted drug delivery. We focus on several possible strategies for brain-targeting and comment on their advantages and disadvantages in application.

Objective To compare the distribution patterns and analyze the antimicrobial resistance of pathogens of different clinical samples .Methods All pathogens were isolated from clinical specimens(blood ,urine and wound) ,the distribution of patho-gens and drug resistance were monitored continuously from October 2012 to October 2013 in Daling hospital .Results 279 strains weredetectedfrombloodculture.Thedistributionincidenceof Escherichiacoli,Klebsiellapneumoniae,coagulasenegativeStaphy-lococci(CNS) ,Staphylococcus aureus ,Enterococcus f aecalis were 28 .67% ,12 .19% ,13 .62% ,9 .68% and 8 .60% respectively .574 strains were detected from urine culture .The distribution incidence of Escherichia coli ,Candida ,Pseudomonas aeruginosa ,K leb-siella pneumoniae ,Enterococcus f aecalis were 38 .68% ,18 .64% ,7 .84% ,7 .49% and 3 .66% respectively .292 strains were detected from wound secretion .The distribution incidence of Staphylococcus aureus ,Escherichia coli ,CNS ,Pseudomonas aeruginosa ,En-terococcus f aecalis were 17 .12% ,14 .38% ,10 .27% ,7 .53% ,5 .48% respectively .Conclusion Clinical using of antimicrobial agents should monitor drug resistance and consider various factors .

Objective:To investigate the eruption of cystic lesion associated impacted permanent teeth(CAIPT)of the jaws after fe-nestrating decompression in adolescents and to analyze the related factors that affect the eruption of CAIPT.Methods:32 cases of CAIPT were examined restrospectively by panoramic radiographs.The subjects were divided into erupted group(n =22),and nonerupt-ed group(n =10).Patient age,angulation of the CAIPT,the cusp depth,eruption space and the level of dental root formation meas-ured on intial panoramic radiograph,were subjected to statistical analysis.Results:The eruption of the impacted mandibular molar was significantly related to the cusp depth,level of dental root formation and the patient's age(P <0.05).The eruption of the impacted man-dibular premolar was significantly related to the cusp depth,level of dental root formation,the angulation of the tooth and the patient's age (P <0.05),but not to dental space for the eruption(P >0.05).Conclusion:The patient's age,angulation of impacted permanent teeth,cusp depth,eruption space,level of dental root formation should be considered in the management of CAIPT.

Objective To investigate the awareness rate of TCM knowledge, the application, and demand situation of Chinese appropriate techniques in health clinics in towns and townships of Hunan Province;To put forward the countermeasures of TCM continuing education. Methods 50%of the training doctors were adopted randomly from 4 training courses in health clinics in towns and townships in Hunan Province. The student number of each course was 49, 51, 53, 53, respectively. Self-designed questionaires were used to investigate 206 training doctors. Results 168 (81.55%) doctors’ degrees were technical secondary school degree and college degree;186 (90.29%) doctors’ professional titles were physician assistant and physician;The awareness rate of TCM knowledge was 63.83%;Different study backgrounds of doctors had different effects on the rate of TCM knowledge (χ2=42.42, P=0.01). The using rates of TCM appropriate techniques were all lower than 30%. 96.60%of doctors in health clinics in towns and townships hope to learn one or more TCM appropriate techniques to help diagnose and treat disease. Conclusion The degree, professional title, mastery of TCM knowledge, and TCM appropriate techniques were not optimistic. The doctors in health clinics in towns and townships showed strong desire for TCM appropriate techniques. The health department should combine the actual situation of doctors in health clinics in towns and townships and develop targeted TCM continuing education.

Objective To learn therapeutic effect of the combined treatment of mecobalamin and salvia milti-orrhiza ligustrazine on diabetic peripheral neuropathy.To provide effective and reliable operation method for the treat-ment of disease.Methods 163 cases with diabetic peripheral neuropathy were randomly divided into observation group(86 cases)and control group(77 cases).The observation group was treated with mecobalamin combined salvia miltiorrhiza ligustrazine,the control group was treated with mecobalamin.The sensory conduction velocity (SNCV) and motor conduction velocity (MNCV)were measured in the two groups before and after treatment.The therapeutic effects were evaluated after one course.Results The MNCV and SNCV of the two groups were higher than before treatment,the difference was statistically significant (t =24.298,25.546,18.737,15.733,14.284,14.886,9.337, 9.402,all P <0.05).The SNCV and MNCV in the observation group were significantly higher than those in the con-trol group (t =9.119,11.103,7.429,6.352,all P <0.05).The markedly effective rate of the observation group was 48.8% (42 /86),the total effective rate was 90.7% (78 /86),which were higher than those of the control group,the differences were statistically significant (χ2 =9.010,7.937,all P <0.05).The incidence rate of adverse reaction of the observation group was 5.8% (5 /86),which of the control group was 6.5% (5 /77),the difference was not statis-tically significant (χ2 =0.033,P >0.05).Conclusion In the treatment of diabetic peripheral neuropathy,the com-bined treatment of mecobalamin and salvia miltiorrhiza ligustrazine has better curative effect and low incidence rate of adverse reaction,with good clinical application value.

The process of late lung development is disturbed in bronchopulmonary dysplasia (BPD).One of the keys in late lung development is secondary septation, in which secondary septa arise from primary septa, producing plenty of small alveoli, which significantly increase the surface area of gas exchange.Secondary septation,together with architectural changes to the vascular structure of the lung which minimize the distance between the blood and the inspired air, are the targets of late lung development.BPD is a disease of premature infants in which development of the alveoli is stunted caused by many factors including volutrauma,inflammation,and oxygen toxicity.Compared with early lung development, the later development of the immature lung remains unclear.This paper is to emphasize remarkable latest research of arrested late lung development and BPD.

Objective To evaluate the short-term effect of elemene combined with transcatheter hepatic arterial chemoembolization (TACE) interventional therapy for the treatment of moderate and advanced liver cancer.Methods A total of 63 patients with moderate and advanced liver cancer were randomized into test group(31 cases) and control group(32 cases). Both groups were given TACE, and additionally, the test group was given intra-arterial infusion of Elemene Emulsion(400-600 mg/m2)together with MAO(Mitomycin C 4-6 mg/m2 , adriamycin 20-40 mg/m2, Oxaliplatin 50-85 mg /m2), and the control group was given intra-arterial infusion of MAO. Short-term effect was evaluated by the clinical outcomes of tumor size, progression-free survival(PFS), total survival rate and adverse reactio n. Results(1)The overall response rate(ORR) in the test group was superior to that in the control group, and the difference was statistically significant(P<0.05) .(2)PFS in the test group covered 125 days, and that in the control group covered 118 days, the difference being significant (P<0.05); the median survival time(MST) in the test group was 257 days, and that in the control group was 214 days,the difference being insignificant(P>0.05).(3) No severe toxic or side effect was found in t he twogroups, the difference being not significant(P>0.05). The test group tended to have milder adverse reaction. Conclusion Intra-arterial infusion Elemene Emulsion combined with TACE interventional therapy is effective in increasing ORR, prolonging PFS, promoting adverse reaction endure and relieving symptoms of weakness, abdominal distension and pain.