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.

Ceramide (Cer),as the center molecular of sphingolipids metabolism,functions as a bioactive mediator of different cellular processes,such as cell growth,differentiation,senescence and apoptosis,besides being structural component of cellular membrane.It can inhibit cell proliferation and promote cell apoptosis via multiple signal pathawys.Chemicals anti-cancer properties based on Cer metabolism that upregulate its level are confirmed in plenty of experimental researches,and parts of research productions are applied in anticancer clinic experiments.

The check methods of thyroid nodules include palpation,serum thyroid hormone and high-frequency ultrasound.When the diagnosis is difficult,fine-needle aspiration (FNA) is carried to differentiate benign and malignant nodules.In clinical practice,approximately 20％ of FNA-derived cytology reports can not meet the standard of benign or malignant.Some specific molecular biomarkers are applied to the derivative detection of FNA,which achieve considerable progress and improve the preoperative diagnostic rate.

Objective To investigate the change of plasma L-threonine (L-Thr) ,D-threonine (D-Thr) ,L-alanine (L-Ala) and D-alanine (D-Ala) in the patients with primary hepatocellular carcinoma (HCC) by using the reversed-phase high-performance liquid chromatography (RP-HPLC) .Methods The o-phthaldialdehyde (OPA) and N-acetyl-L-cysteine (NAC) column with pre-column derivatization was adopted to perform the separation .The mobile phase was 20 mmol/L sodium dihydrogen phosphate solution and acetonitrile with a programmed gradient elution and the flow rate of 1 .0 mL/min .The excitation wavelength was set at 350 nm and the emission wavelength was set at 450 nm .Results The threonine and alanine enantiomers could be simultaneously determined by this method .The regression equation showed the good linear correlation The limits of detection (LOD) for L-Thr ,D-Thr ,L-Ala and D-Ala were 11 .4 pg/mL ,9 .77 pg/mL ,4 .11 pg/mL and 3 .50 pg/mL respectively .The recovery rate was 90 .22% -105 .7% .With-in-day and between-day RSD was 1 .04% -4 .11% .Conclusion The threonine and alanine enantiomers could be simultaneously de-termined by this method .The regression equation showed the good linear correlation The limits of detection (LOD) for L-Thr ,D-Thr ,L-Ala and D-Ala were 11 .4 pg/mL ,9 .77 pg/mL ,4 .11 pg/mL and 3 .50 pg/mL respectively .The recovery rate was 90 .22%-105 .7% .Within-day and between-day RSD was 1 .04% -4 .11% .

Objective Through the English newspaper reading activities to create the information transmission platform based on the medium of English,so as to improve the students' ability of receiving,understanding,conversion,processing,and output information.Methods Two natural classes of seven-year program students of Grade 2011 with no difference in Englishproficiencywere selected at randomas control group(30) and the experimental group(30).And reform on reading course has been performed in the experimental class by incorporating English newspaper reading into traditional teaching routine,while the control class maintain the traditional teaching routine.After the teaching,through CET 4 test scores to evaluate the teaching effect.Independent t-test was conducted on the performances of CET 4 between the experimental class and controlled class with the level of test α=0.05.Results The control group was higher than the experimental group inthe total scoreof CET 4 and the performance oflistening and reading,and there was significant difference between the two groups(P of totalscore=0.000,P of listening score=0.002,P of reading score=0.001).But there was no statistically significant difference in writing subtests between the two groups(P=0.072).Conclusion By adopting English newspaper reading and broadcasting in class,students' overall ability of using English has been greatly enhanced,especially the listening comprehension and reading comprehension; however,there is no significant change in the development of students' writing ability due to the tasks designed.

Objective To assess the effectiveness of Exenatide on non‐alcoholic fatty liver disease(NAFLD) with diabetes mellitus by evaluating fatty liver index(FLI) variation .Methods One hundred and two NAFLD patients with type 2 diabetes melli‐tus were enrolled and divided into two groups .One group were treated with Exenatide and another with Oral antidiabetic agents . The data of BMI ,blood fat ,HbA1c ,ALT ,AST ,GGT ,FLI and so on were collected at enrollment and the end point of 24 weeks treatment .The effectiveness of Exenatide were analysed by Kolmogorov‐Smirnov and Pearson correlation coefficient (r) analysis . Results The indicators of metabolic disorder ,the parameters of liver biochemistry and fatty liver disease (FLI) were significantly improved (P<0 .05) after 24 weeks treatment by Exenatide .While only BMI showed significant decrease after 24 weeks treatment with Oral antidiabetic agents(P<0 .05) .The rest of the parameters in oral antidiabetic agants group showed no significant differ‐ence (P>0 .05) .Conclusion Exenatide has a positive effect on non‐alcoholic fatty liver disease treatment who with type 2 diabetes mellitus ,especially for liver fat accumulation .

By using the famous American pedagogical and psychological scientist Gagne,Robert's opinion about the component and organization of study diathesis mentioned in his book named Principle of Teaching Design, the author analyzes the construction of diathesis of Chinese students : the innate diathesis , the acquired diathesis and the naturally developed diathesis. Based on the knowledge and ability that high quality medical talents should have in the future, the article prefer the thought and methods to cultivate high quality medical talents by complying with the modern psychological theory.

Objective To study on application of problem-based learning in experimental teaching of medical statistics for medical undergraduates and to improve the quality of experimental teaching in medical statistics. Methods 72 medical undergraduates were selected at random. They were devided into the PBL group and the control group were observed for a term. Results The comparison of a questionnaire showed a clear preference for PBL group over the control group. Most of the constituent ratios in the PBL group were higher than the control group, showing significant difference(P

Hepatitis B virus infection is still a major public health issue in the world,and antiviral therapy is the key therapeutic regimen to delay disease progression and improve outcome in patients with chronic hepatitis B (CHB).Various international guidelines recommend nucleos(t) ide analogues (NAs) and long-acting interferon as the first-line antiviral therapy.However,long-term administration of NAs has the disadvantages of long course of treatment,low HBeAg seroconversion rate,extremely low HBsAg clearance or seroconversion rate,low safety,and drug resistance.Therefore,it is an important issue to increase the seroconversion rates of HBeAg and HBsAg in treatment-experienced patients and realize clinical cure in the treatment of CHB.In recent years,many global randomized clinical trials including OSST,Switch,and ARES have shown that a combination of NAs and PEG-IFN or sequential therapy with NAs and PEG-IFN can increase the seroconversion rates of HBeAg and HBsAg in CHB patients and realize clinical cure,which provides a new direction for NAs in the treatment of CHB patients.