Clinical practice guidelines play an important role in practitioner and patient decisions regarding appropriate clinical health care and in health policy formation. In the guideline development process, inappropriate methodologies and development strategies significantly influence the quality of guidelines; therefore, research and evaluation of guidelines have great significance. The original Appraisal of Guidelines for Research and Evaluation (AGREE) instrument was published in 2003 by a group of international guideline developers and researchers. AGREE has important significance for the quality guarantee and successful implementation of guidelines, and has extensively achieved endorsement since 2003. In 2009, The AGREE Collaboration has developed the AGREE II by refining the original AGREE instrument. At present, the AGREE II has already replaced the original AGREE instrument; however, related introduction regarding AGREE II has not been found in China. The authors of this article briefly introduce the AGREE II, and believe that it will add value to research and evaluation of the guidelines as a whole.

Based on entire literature retrieval about low back pain treated with acupuncture and moxibustion, Clinical Practice Guideline for Low Back Pain Treated with Acupuncture and Moxibustion was drafted according to method of evidence quality and recommended intensity grading system(GRADE). This article specificly introduces the aim and available diseases of the guideline. The principle and recommended plans are also detailedly explained.
Acupuncture Therapy ; methods ; standards ; China ; Humans ; Low Back Pain ; therapy ; Moxibustion ; methods ; standards ; Practice Guidelines as Topic

Purpose: To explore the therapeutic method for lameness caused by lumbar spinal stenosis. Methods: 28 cases of the patients with lameness were treated by puncturing Dachangshu (BL 25), Weizhong (BL 40), Chengshan (BL 57) and Kunlun (BL 60) and simultaneously another 26 cases were treated with routine method for control study. Results:After the treatments for four weeks, the scores of the symptoms in the two groups were remarkably elevated. In the acupuncture treatment, the results showed remarkable effect in 4 cases, effect in 21 cases. In the routine treatment, the results showed remarkable effect in 4 cases and effect in 8 cases. Conclusion: acupuncture treatment is better than the routine conventional treatment for lameness caused by lumbar spinal stenosis.

Background The imbalance of cell cycle regulation results in proliferative vitreoretinopathy (PVR).Studing the effects of cyclin dependent kinase (CDK) and CDK inhibitor (CKI) on the cell cycle regulation of retinal pigment epithelial (RPE) cells and fibroblasts in PVR formation is of important significance.Objective This study was to investigate the expressing trend of p21 ,p27 and CDK inhibitors in retinas of different ages of rabbits and explore the relationship between p21 or p27 and cell growth.Methods Nine clean New Zealand rabbits were assigned to 10-week group,20-week group and 30-week group according to the age and 3 rabbits for each.The eyeballs were enucleated binocularly after the animals were sacrificed and retinas were isolated.Real-time PCR and Western blot were employed to detect the expressions of p21 and p27 mRNA and their proteins in retinas of the rabbits.The use and care of the animals followed the Regulations for the Administration of Affair Concerning Experimental Animals by State Science and Technology Committee.Results The relative expressing levels of p21 mRNA were 1.631±0.063,1.506±0.012 and 1.585 ±0.015, and those of p27 m RNA were 1.581 ± 0.048,1.470 ± 0.012 and 1.490 ±0.013 in the 10-week group,20-week group and 30-week group, respectively, showing significant differences among the groups (p21 mRNA: F=9.311,P=0.014;p27 mRNA: F=12.360, P=0.007) , and the p21 and p27 mRNA expressing levels were significantly higher in the 10-week group and 30-week group than those in the 20-week group (all at P＜ 0.05).The expressing levels of p21 protein were 0.675 ± 0.061,0.089 ±0.001 and 0.200 ± 0.007, and those of p27 protein were 0.928±0.019,0.183±0.005 and 0.576±0.089 in the 10-week group,20-week group and 30-week group, respectively, with remarkable differences among the groups (p21 : F =228.905, P＜0.001;p27 : F =148.957,P＜0.001), and the expressions were significantly raised in the 10-week group and 30-week group in comparison with the 20-week group (all at P＜0.01).Significantly positive correlations were found in the expressing levels of p21 and p27 both in transcriptional and protein levels (mRNA : r =0.906, P＜0.01;protein : r =0.913, P＜0.01).Conclusions The expressions of p21 and p27 up-regulate in the retinas of developing stage of rabbits but gradually reduce with adultness.However, p21 and p27 levels appear to be increasingly raised with aging of the rabbits.It is implied that p21 and p27 play a balancing role in the process of cycle regulation in retina cells.

Objective To develop the knee osteoarthritis (KOA) TCM syndrome evaluation scale. Methods Resrarch team collected subjective symptoms from all kinds of syndrome types of KOA and classified the subjective symptoms, which formed the first version of item pool containing 24 subjective symptoms. Expert questionnaires were conducted to calculate the weight coefficient of items, and formed the item pool of the Knee Osteoarthritis TCM Syndrome Evaluation Scale. According to the patient's attention to the 11 items, the items were weighted.Results The Knee Osteoarthritis TCM Syndrome Evaluation Scale contained 11 items, including pain, swelling and stiffness with different weighted scores.Conclusions The Knee Osteoarthritis TCM Syndrome Evaluation Scale were introduced to assess the KOA outcomes on the basis of TCM syndromes. It showed the characteristic of TCM and TCM syndrome.It could provide an objective and standardized measurement for TCM treating KOA.

Objectives To explore different factors (clinical presentations and laboratory investigations ) between the severe and mild Guillain-Barré syndrome (GBS) in southeast China ,and to find the predictors of severe GBS. Meth?ods Retrospective analysis was conducted on 101 cases of patients with GBS admitted to our Hospital from Jan. 2006 to Nov. 2015, who were divided into mild and severe groups according to Hughes scale. The different factors were compared between these two groups such as age, sex, precursor infection factors, the initial symptoms, bulbar dysfunction, cranial nerves involvement, autonomic nervous dysfunction, peripheral nerve axonal damage to find the predictors for the severe GBS. Results Severe GBS more frequently presented with non-paresthesia as initial symptom (P<0.001) , bulbar dysfunc?tion (P<0.001), cranial nerves involvement (P=0.025), autonomic nervous dysfunction (P=0.018), motion system involve?ment (P = 0.004) and peripheral nerve axonal damage (P<0.001). After multivariable logistic regression analysis, we found that the axon damage(P=0.008, OR=4.632), bulbar dysfunction(P=0.010, OR=10.420), and cranial nerves in?volvement(P=0.047, OR=0.076)were the independent risk factors for sever GBS. Conclusion Axon damage, bulbar dys?function, and cranial nerves involvement might be significant predictors of sever GBS.

AIM: To investigate the effect of cyclophosphamide(CTX) on proliferation and apoptosis of mesangial cells(GMC) of rat in vitro. METHODS: GMC proliferation was detected by MTT method, GMC apoptosis was examined by inverted microscopy for phase-contract and fluoroscopy and flow cytometry analysis. The levels of Fas and Bcl-2 were also detected by immunohistology. RESULTS: The proliferation of GMC were inhibited by CTX, methylprednisolone(MP), low molecular weight heparin(LMWH). Apoptosis of GMC was induced by CTX, the apoptosis rate of GMC was 8.2%, and the Fas level was increased. CONCLUSION: CTX could inhibit proliferation and induce apoptosis of GMC possibly by enhancing the Fas level.

Because of its specificity , significant effect , low side effect , molecular targeted therapy has been applied in the treatment of breast cancer .Recently, various molecular targeted drugs have been exploited including targeted HER family, VEGF, multi-targeted therapeutic drugs , and drugs combination .

OBJECTIVETo compare the clinical effect of the double eyelid blepharoplasty with central minimal incision and with three minimal incisions. Methods: From Jul. 2010 to May 2012, 268 cases (Group A) received double eyelid blepharoplasty with central minimal incision, while 102 cases (Group B) underwent double eyelid blepharoplasty with three minimal incisions. Photos were taken immediately, and 1,2, 4, 8,12 weeks after operation. Operation time, recovery time and postoperative complications were evaluated and recorded. The operation time and recovery time were analyzed by Wilcoxon rank sum test. The postoperative complications were analyzed by chi square test. The satisfactory degree was analyzed by t test.

RESULTSThe operation time in Group A was (25.63 ± 3.74) min, compared with that (29.90 ± 4.13) min in Group B (Z = -8.011, P <0.01). Meanwhile, the recovery time in Group A was shorter than that in Group B (Z = -15.887, P <0.01). The occurrence rate of postoperative complications,including hematoma,recurrence and scar hyperplasia in Group A was also lower than that in Group B. At the same time, the satisfactory degree in Group A was(97.302 ± 1.764), which was higher than that(88.628 10.880) in Group B (t = 12.650, P <0.05).

CONCLUSIONSThe double eyelid blepharoplasty with central minimal incision, which is suitable for all cases except those who has serious blepharochalsais, has more advantages than double eyelid blepharoplasty with three minimal incisions.

Blepharoplasty ; adverse effects ; methods ; Cicatrix ; pathology ; Eyelids ; surgery ; Hematoma ; Humans ; Hyperplasia ; Photography ; Postoperative Complications ; Prospective Studies ; Recurrence

Objective This paper aims to find a best position of ephedrine hydrochloride nasal drops by comparing earache occurred in hyperbaric oxygen(HBO )therapy while using ephedrine hydrochloride nasal drops in two positions: laying in lateral position of 45°with head leaning back; laying down flat, so as to supply reference for prevention of earache. Methods We selected 300 cases of HBO patients who were firstly treated by HBO and randomly divided into the observation group and the control group with 150 cases in each group. All these patients were treated by large medical hyperbaric oxygen tank. On the first to third day, ephedrine hydrochloride nasal drops were put into the patients before they were sent into the oxygen tank. Patients in the observation group lay in lateral position of 45°with their head leaning back, and those in the control group were in horizontal position. We put three drops of 1% of ephedrine hydrochloride nasal drops respectively into their nasal cavity. When they came out of the oxygen tank, we asked them if they felt earache and checked their tympanic membrane so as to make a comparison. Results It was found that earache, rate of tympanic membrane injury and the extent of such injury in the observation group was obviously less than that in the control group, there was difference in statistics between these two groups. Conclusions Before HBO treatment, ephedrine hydrochloride nasal drops that put in lateral position of 45°with patients head leaning back can reduce the possibilities of earache occurred in HBO. It was also observed that such position was an ideal one which had anatomical characteristics of Eustachian tube and was safer than laying down flat, so such position is more practical.