The members of guideline development of traditional Chinese medicine and integrative medicine were not chosen according to strict standards at present. The major problems in clinical guideline development include the insufficiency of evidence and the missing recommendation according to evidence reliability. In order to establish a clinical guideline for the treatment, we should abide by the principle for guideline development in this field. Firstly, a guideline development group must be set up and the evidences are needed to be classified correctly. To facilitate the clinical practice, the recommendations in the treatment guideline should be divided into different classes and the referring recommendation reasons should be given at the same time. Only when the guideline development principles and procedures are strictly followed can a clinical guideline for the treatment suitable to the situation in China be established.

ObjectiveTo investigate the causes of postoperative recurrence of hyperthyroidism, and the indications for and modality of reoperation. Method Data of 31 reoperative cases with postoperative recurrence of hyperthyroidism were analyzed retrospectively.ResultsAll 31 patients were cured by reoperation. The incidence of complication was 6 5%,which was not significantly different compared with primary operation treatment. Conclusions Not enough amount of resection of the thyoid in the primary surgery caused postoperative recurrence of hyperthyroidism. Secondary operation was the therapy of choice for the treatment of postoperative recurrence. Careful intraoperative dissection helps to avoid injuries of recurrent nerve, and parathyroid and massive bleeding. Enough residual volume of the thyroid gland should be removed to prevent postoperative re-recurrence.

BACKGROUND: At present, the scale for evaluating cervical vertigo symptoms and functions applied in clinic can evaluate the overall curative effect in patients with cervical spondylosis of vertebral artery type (CSA).However, this scale lacks the content of functional status and emotional function for evaluating daily life function.OBJECTIVE: To develop a functional scale for cervical spondylosis of vertebral artery type (FS-CSA) including functional status and emotional function based on the vertigo disorder scale made abroad.DESIGN: Cross-sectional survey, interview evaluation after pretest, internal consistency, retest consistency and construct validity were measured by the method of Chronbach's c, Pearson correlation coefficients and factor analysis, respectively.SETTING: Clinical Epidemiology/DME Center, Guangzhou University of Traditional Chinese Medicine.PARTICIPANTS: Totally 111 consecutive patients with CSA, 30 men and 81 women aged 31 to 72 years, in the Clinic for Cervical Spondylosis of Guangdong Provincial Hospital of Traditional Chinese Medicine were recruited from May 2001 to March 2002. Altogether 36 patients had risk factors of vertebral-base artery atherosclerosis. There were 14 cases of mild vertigo, 61 cases of moderate vertigo, and 36 cases of severe vertigo. Informed consent was obtained from the participants.METHODS: FS-CSA was made according to clinical actual condition Functional status (going for a walk during the day by yourself, walking around the house in the dark, doing strenuous housework, social activity,traveling for business or recreation, getting into or out of bed, reading books or newspaper; each item was divided into three categories "No,anxious, worried about your illness, and feeling frustrated; each item consisted of three categories "No, Sometimes, and Yes"). Patients with CSA were evaluated by means of interview and 14 of them were retested. Internal consistency, construct validity and correlation coefficients of the scale were measured with SPSS 10.0 software.tional status dimensionality, emotional functional dimensionality as well as internal consistency of the total scale in FS-CAS: Chronbach's α value was 0.875 9, 0.645 3 and 0.859 5, respectively; retest consistency value was extracted common factor was consistent with the two dimensionalities.tool quantifies the life quality of the patients with CSA and can make a uate curative effects of drugs or screen the best treatment scheme; therefore, it has clinical application value.

[Objective]To discuss a reasonable treatment for unstable intertrochanteric hip fractures in senile patients by comparing the effects of hemiarthroplasty and DHS fixation.[Method]Totally 126 intertrochanteric hip fractures in senile patients with complete clinical data were retrospectively analyzed,who were treated with hemiarthroplasty or DHS fixation from June 2002 to October 2005.Of the 126 patients,53 were treated with hemiarthroplasty,73 were treated with DHS fixation.All of them had multiple medical co-morbidities and were combined with severe osteoporosis.According to modified Even-Jensen classification,all of them belonged to unstable fractures.Comparison was made between the two treated groups in terms of operative time,blood transfusion during or after surgery,time for bed rest postoperatively,postoperative complications and St.Michael hip score one year after surgery.[Result]The average duration of follow-up for hemiarthroplasty and DHS fixation was 16 and 18 months respectively.Compared with the group of DHS fixation,the group of hemiarthroplasty experienced shorter time for bed rest postoperatively,fewer postoperative complications and higher St.Michael score 1 year after surgery,and the differences between two groups had statistical significance(P0.05).[Conclusion]Cemented hemiarthroplasty has the advantages of allowing early full weight bearing after surgery,low complication rate and satisfactory functional recovery.It is a reasonable treatment for unstable intertrochanteric hip fractures in senile patients.

Objective To research the effect of Shengmai capsules on cadiocyte apoptosis with chronic congestive heart failure (CHF) in rats. Methods Seventy five SD female rats were randomly divided into 5 groups:sham-operation group (A), CHF model group (B), CHF model treated by Shengmai capsules group (C), CHF model treated by Captopril group (D), CHF model treated by Shengmai capsule and Captopril group (E). Suprarenal abdominal artery constriction was operated to prepare CHF rat models. After 7 weeks treating respectively, the apoptosis rate of cadiocyte and the content of myocardia Bcl-2 in rats were detected. Results Apoptotic cells ratio of myocardia was higher in group B than in group A (P

Objective To discuss our tentative application of the anatomic plate in the treatment of distal tibia fractures in order to develop a new effective fixation technique for this kind of fracture. Methods From November 2000 to September 2001, the authors applied Linkdistal tibia anatomical plates in the treatment of distal tibia fractures, which involved metaphysis in 12 cases, including 8 males and 4 females, aged from 18 years ～66 years, with 38 years on average. All the cases were of high energy injuries and complicated with ipsilateral fibular fracture. According to AO/ASIF classification: three were type A1, five were A2, three were A3, and one was B1; three of them were close fractures, five were type IO1 open fractures, and four were IO2. Results All the cases healed at one stage without infection or exposure of the implant. Bone callus could be found 2 3 weeks after operation. Bone union was achieved within 3～6 months, with 4 months on average. No delayed union or non union occurred. Functions of ankle joints recovered completely. Conclusion The anatomical plate for distal tibia is supperior to the traditional plates in both biomechanical and biological aspects. It is the best choice for the treatment of distal tibia fractures.

Based on the principle of evidence-based medicine, the efficacy and safety of consciousness-restoring and orifice-opening (CROO) acupuncture manipulation in treating stroke are systematically assessed. All reports of clinical trials of CROO acupuncture manipulation in treating stroke were collected and random-effect model of Meta-analysis was performed by using the statistical software of Review Manager (RevMan4.1). Sensitivity and heterogeneity were analyzed and tested; funnel-plot analysis was used to identify the publication bias. Comprehensive efficacy (Odds Ratio, OR) of CROO acupuncture manipulation in treating stroke was: OR of cure and markedly effective rate between groups being 3.65 and 95% confidence interval (CI) in the range of 1.70～7.83, OR for decreasing long-term death rate being 0.21 and 95% CI in the range of 0.08～0.52. Stratified analysis showed that OR of stroke sequela was 4.01 and OR of cerebral vascular infarction was 4.45. Adverse drug reaction was not found in all of the reports. Funnel-plot analysis showed the possible existence of publication bias. [ Conclusion]CROO acupuncture manipulation has certain effect in treating stroke, especially in treating acute stage of cerebral vascular infarction, and could reduce long-term death rate of stroke. Heterogeneity may result from the difference of trial designs and inclusive criteria. Funnel-plot analysis shows the possible existence of publication bias. This conclusion is rather limited and will get more evidence if multi-center, double-blinded, randomized and controlled trials could be carried out.

Objective To evaluate the reliability and validity of Morisky questionnaire in measurement of the compliance with hypertensive medications. Methods Seventy-four eligible subjects were selected and asked to fill a Morisky questionnaire about their adherence in taking antihypertensive drugs during the past 1 month; nineteen of them received two surveys at 3～7 day intervals. The internal consistency (Cronbach ? coefficients),test-retest reliability (interclass correlation coefficients),construct validity and convergent validity were calculated. Results The Cronbach ? coefficient of the questionnaire was 0.749 and the interclass correlation coefficients between the items and the total scores of the questionnaires ranged from 0.71 to 1.00. Factor analysis yielded one factor with an accumulated contribution rate of 57.3%,and the loading values of all items on this factor were above 0.6. The Spearman correlation coefficients between the Morisky scores and the adherence assessment by the subjects themselves were over 0.3 (P

Objective To assess the clinical value of the mi nimally invasive plate fixation technique in treatment of metaphyseal comminute d fractures of long tubular bones.Methods Sixty-eight patients with metaphyseal comminuted fractures o f femur or tibia were treated with min imally invasive percutaneous plati ng and early recovery movement from April 1999to October 2001.Results All the patients were followed up for a mean time of 10months.The postopera tive radiograph showed that reducti on and internal fixation were satisfactory in sixty-five patients.Lateral angular deformity of 8?occurred in one c ase,and 2cm shortage of the lower lim b in two cases.Sixty-eight patients obt ained bone union and satisfactory clinical function.There were no deep i nfec-tion,nonunion or other complicatio ns.Conclusion For metaphyseal comminuted fractur es of long bones of lower extremities,minimally invasive percutaneous plate fixation is o f significant value due to the advant ages of less iatrogenic trauma,rigid fixation and early movement.[

Objective To obtain an accurate prevalence of dementia and Alzheimer's disease (AD) in large sample of ≥75 year old elderly living in Guangzhou city. Methods From August 1994 to December 1995, the study was conducted in Liwan District of Guangzhou, China. A two stage cluster sampling design was used to obtain a large sample. ‘Jiedao’ (resident unit in China) was the primary sampling units (PSU),‘Jumin Xiaozu’ (resident group) was the secondary sampling units (SSU). Systematic sampling and simple random sampling procedures were used for the first and second stages, respectively. The study was divided into two phases: a door to door survey of the entire sample aged ≥75 years (4 735 persons), followed by a clinical examination of suspected cases for positive and differential diagnosis. In the first phase, mini mental status examination (MMSE) was used as screening method for dementia. In the second phase, dementia and AD were clinically diagnosed according to the criteria of Diagnostic and Statistical Manual for Mental Disorders (DSM III R) , National Institute of Neurological and Communicative Disorders (NINCDS) and Stroke Alzheimer's Disease and Related Disorders Association (ADRDA). Results The sensitivity and specificity of MMSE were 0 7451 and 0 7496 respectively while the positive predictive value was 0 2251. The prevalence of dementia in individuals aged 75 years and over was 8 90%, in which male and female were found to be 2 91% and 13 11%, and that of AD was 7 49%, male and female found to be 2 01% and 11 36% respectively. The prevalence of vascular dementia (VD) was 1 16%. Of the subjects with dementia, 84 24% was diagnosed Alzheimer's disease, 13% VD, and 2 76% dementia with other causes. The proportion of AD increased obviously by every 5 years. Conclusions The prevalence of dementia in ≥ 75 year persons was lower in Guangzhou than that in Shanghai, but was higher than that in other regional studies within China. In ≥75 year male and/or poorly educated female were more easily suffered from AD. The proportion of AD in dementia was higher in this study than that in others. These figures indicated that as a screening tool for dementia MMSE need improving and should be combined with ADL and POD together.