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.

Objective To study the expression of vascular endothelial growth factor C (VEGF-C), which is known to be capable of inducing cell proliferation of lymphatic endothelium and development of lymphatic vessels, and to study its correlation with cervical lymph node metastasis in human laryngeal carcinomas. Methods The expression of VEGF-C protein in the cancer, its adjacent tissue, and normal tissue obtained from resected specimens of 46 cases of laryngeal cancer was assessed with an immunohistochemical staining assay followed by light microscopic examination, and its relationship with cervical lymph node metastasis was analyzed. Results Immunohistochemical staining of VEGF-C was different obviously in different localities of the resected. The expression of VEGF-C protein was observed in all the central portion, peripheral tissue, and normal tissue of the postoperative specimens. The positive rate of intratumoral VEGF-C was significantly higher than that of adjacent and normal tissue. It was also noted that the positive rate of intratumoral VEGF-C was well correlated with pathological grades, T stages and stages of lymph node metastasis. Conclusions The results suggested that VEGF-C may be a factor of lymphatic metastasis of laryngeal cancer, and it is possible to be used as a predictor of lmphatic metastasis of laryngeal cancer.

Objective To explore influence of Naoxintong capsule combined with edaravone on clinical efficacy and vascular endothelial function of patients with type-2 diabetes complicated with cerebral infarction.Methods 80 cases of patients with type-2 diabetes complicated with cerebral infarction treated in Shengsi People's Hospital in Zhejiang from January 2014 to January 2016 were selected as the objects, and were divided into control group and study group randomly, forty-one cases in each group.The control group were given edaravone treatment, and the study group were added Naoxintong capsule on the basis of the control group, treatment for two weeks in the two groups.Clinical therapeutic effect of the two groups and changes of TCM syndrome score before and after treatment were compared, and scores of nerve function defect and daily life ability were evaluated, and changes of blood glucose and glycosylated hemoglobin levels were detected, and endothelin ( ET-1 ) , nitric oxide ( NO ) , thromboxane B2 ( TXB2 ) and 6-keto prostaglandin F1(6-keto-PGF1) were tested before and after treatment in the two groups.Adverse reactions were observed in the two groups in treatment. Results The total effective rate of the study group was significantly higher than that of the control group(P<0.05), and TCM syndrome scores of the two groups were significantly decreased after treatment in the two groups(P<0.05), which of the study group was significantly lower than that of the control group(P<0.05).After treatment, NIHSS score of the two groups significantly decreased(P<0.05), and ADL score significantly increased(P<0.05), and changes of the study group were significantly higher than those of the control group(P <0.05).Fasting blood glucose and glycosylated hemoglobin levels significantly decreased in the two groups(P<0.05), which of the study group were significantly lower than those of the control group ( P <0.05 ).Levels of ET-1 and TXB2 significantly decreased ( P <0.05 ) , levels of NO and 6-keto-PGF1 significantly increased ( P <0.05 ) , and changes in the study group were significantly higher than those in the control group(P<0.05).There was no significant difference in incidence of adverse reactions between the two groups.Conclusion The effect is obvious of Naoxintong capsule combined with edaravone in treratment of patients with type-2 diabetes complicated with cerebral infarction, and can improve vascular endothelial function of patients.It can be widely used in clinical.

Objective To evaluate the efficacy and safety of sodium aescinate for abdominal operation in general surgery.Methods A multicenter,prospective and open labeled trail was conducted.Data of 2001 patients in PPS group who had undergone either conventional treated (n =500) or sodium aescinate treated (n =1 501) for abdominal operation in general surgery were analyzed.In the sodium aescinate treated group,sodium aescinate was given by ivgtt 12 h before the surgery started,and 20 mg daily after the surgery for 6 days.Time to recovery of gastrointestinal sounds (TRGS),time to recovery of passage of gas (TRPG),and time to recovery of bowel movements (TRBM) were recorded to evaluate the bowl function recovery.The difference of incision edema was observed by the evaluate edema level.Results The TRGS of sodium aescinate treated group was significantly shorter than that of the conventional treated group,P ＜ 0.01.The TRPG of sodium aescinate treated group was significantly shorter than that of the conventional treated group,P ＜ 0.01.The TRBM of sodium aescinate treated group was significantly shorter than that of the conventional treated group,P ＜ 0.01.The incision edema of sodium aescinate treated group was better than that of conventional treated group.The rate of adverse event was low in the sodium aescinate treated group,phlebitis was the most common one,accounting for 0.66％.No serious adverse event happened.Conclusion Sodium aescinate is effective and safe in accelerating patients recovery in general surgery.

MEDLINE,Ovid,CNKI,and Vip Database were retrieved for articles of diuretics induced hyponatremia.6 retrospective studies,2 prospective studies,and 31 case reports were included.Pearson correlation coefficient of the cumulative dose and serum sodium level was-0.121 (P =0.757).It is suggested that serum sodium level should be closely monitored while administrating diuretics,especially in patients with high-risk of hyponatremia.

OBJECTIVE: To study the expression of human ether-α-go-go-related gene (herg) and hERG protein expressed by the gene in laryngeal carcinoma compared with the control group(mucosa adjacent to cancer of 2 cm). METHOD: Expression of herg and hERG protein was detected by immunohistochemistry (SP) and real-time PCR in resected tissue of laryngeal carcinoma and mucosa adjacent to cancer of 2 cm. RESULT: (1) By immunohistochemistry, the positive expression rate of hERG in laryngeal carcinoma was 76.7% (23/30), while it was 10.0% (2/20) in mucosa adjacent to cancer of 2 cm, the difference between which was statistically significant (P < 0.05). (2) By real-time PCR, the expression level of herg mRNA in laryngeal carcinoma is 2.25 times higher than that in mucosa adjacent to cancer of 2 cm. CONCLUSION Herg is highly expressed in tissue of laryngeal carcinoma, and it may be have some relevance to the happening and development of laryngeal carcinoma.
ERG1 Potassium Channel ; Ether-A-Go-Go Potassium Channels ; metabolism ; Humans ; Laryngeal Neoplasms ; metabolism ; RNA, Messenger

Objective To investigate the efficiency of the modified posterolateral curved incision with double intermuscular approach in the treatment of posterolateral tibial plateau fractures.Methods From August 2009 to March 2013,15 men and 17 women aged 28 to 77 (mean,46.25) years with posterolateral spitting or collapse tibial plateau fractures were treated to undergo a modified posterolateral approach.All types of fractures were closed,without nerve or artery injury.The duration from injury to fixation was 3-18 (mean,7.13) days.The modified posterolateral approach was preformed to expose tibial anterolateral condyle and posterolateral condyle through intermuscular space of anterior tibial muscle,popliteus muscle and soleus muscle.After open reduction,anterolateral fractures and posterolateral fractures were fixed by the T-shaped plate and Golf shaped plate respectively.Results All of the 32 patients were followed up from 6 months to 36 months (in average of 15.3 months).Postoperative X-ray showed satisfied fractures without obvious collapse of the articular surface.At the last follow-up,the Rasmussen scores were range from 6 to 18 (in average of 14.06),namely 14 cases excellent,15 cases good,3 cases fair.The knee joint functions were evaluated according to HSS.The HSS results showed that there were 12 cases excellent,16 cases good,3 cases fair and 1 case bad.None of the cases suffered from injuries of crucial blood vessel or nerves.No incision necrosis,wound infection or fixation failure occurred during follow-up.Conclusion Open reduction and internal fixation via modified posterolateral approach can expose posterolateral and anterolateral tibial plateau fracture in one incision.Fibular head osteotomy can be avoided.The present approach could also reduce surgical injury,minimize the possibilities of incision necrosis or plate exposure.The modified posterolateral approach can be recommended in clinical practice.

Objective To analyse the clinical characteristics of infants in two months old of lingual thyroglossal duct cysts (LTGDC) and raise the levels of diagnosis and treatment.Methods A comparative analysis was made between the clinical data of 23 cases in two months old of LTGDC and those of 20 cases in one to seven years old of cervical thyroglossal duct cysts (TGDC) (control group).Results The clinical manifestation appeared obviously differences between LTGDC and TGDC.The main performance of LTGDC was laryngeal stridor,and 74％ of them went to emergency department because of dyspnea.They would be misdiagnosed as congenital laryngomalacia or laryngomalacia with pneumonia.The lesion located in the posterosuperior of lingual bone and behind the root of tongue,which was easy to lead to throat obstruction because it extruded laryngeal cavity.Electronic laryngoscopy was the first choice,it helped to identify laryngomalacia,epiglottis cyst and hemangioma.Laryngeal CT or MRI was very important to diagnose LTGDC which was quasi-circular low density shadow with clear boundary,or not extruded to laryngeal cavity,or show lesion range and surrounding structures avoiding misdiagnosis.As treatment depended surgery which was selfretaining laryngoscope,it was minimally invasive and without scar.Cervical anterior mass in the midline was the first symptoms in all 20 cases of TGDC.The neck ultrasound examination was the first selection,and the lesion showed fluid dark space with clear boundary,it should take the neck percutaneous surgical operation.Conclusion The clinical manifestation of infants in two months old of LTGDC appears obviously different from TGDC.LTGDC is a common cause of laryngeal stridor with breathing difficulties.It will be misdiagnosed as congenital laryngomalacia and lead to asphyxia or death easily.

Objective To investigate the effect of mild hypothermia preconditioning against ischemia/ reperfusion (I/R) injury of cultured primary cortical rats neurons,and to compare the protective effect of mild hypothermia only and with its combination with drugs.Methods Cortical neurons of neonatal Sprague-Dawley (SD) rat within 24 hours after birth were harvested and cultured in vitro.On the 3rd day,the cells were cultured in a medium containing 2.5 mg/L cytosine arabinoside to inhibit the growth of glial cells and fibroblast.Having cultured for 6 days they were randomly divided into blank control group,glutamate damaged group (cultured with 200 μmol/L glutamate for 0.5 hour after washing),mild hypothermia preconditioning group (cultured under 33.5 ℃ for 24 hours before injury induced by glutamate),mild hypothermia combining with edaravone preconditioning group,and the hypothermia combining with propofol preconditioning group (medium containing 100 μmol/L edaravone and 3 mg/L propofol).They were cultured under 33.5 ℃ for 24 hours before injury induced by glutamate.After 24 hours of culturing in various medium,apoptosis ratio was observed by flow cytometry.Cell surviving rate was determined with methylthiazolete trazolium (MTT),c-fos protein expression was assayed,and morphologic change of cells with hematoxylin-eosin (HE) staining under the microscope,and uhrastructure changes were observed after uranyl acetate and lead citrate staining under transmission electron microscope.Results The apoptosis ratio and c-fos protein in glutamate damaged group were significantly higher than those in blank control group [apoptosis ratio:(9.85 ± 0.76)％ vs.(0.94 ± 0.20)％,c-fos (ng/L):6.96 ± 0.75 vs.1.65 ± 0.59,both P＜0.01],the cell surviving rate was significantly lower than that in blank control group [(0.20 ± 0.02)％ vs.(0.97 ± 0.03)％,P＜0.01].Mild hypothermia preconditioning reversed surviving rate,apoptosis ratio and c-fos protein,and the effect of hypothermia combining with propofol preconditioning was obviously better [cell surviving rate:(0.80 ± 0.04)％ vs.(0.20 ± 0.02)％,apoptosis ratio:(2.26 ± 0.54)％ vs.(9.85 ± 0.76)％,c-fos (ng/L):2.98 ± 0.46 vs.6.96 ± 0.75,all P＜0.01].The morphology of cortical neurons in blank control group was normal.Most of the cells in glutamate damaged group showed bluish black cytoplasm with pyknic nuclei,with crimpled axons and of them were fractured,and cell number was obviously decreased.In each pre-conditional groups,decrease in cell number was unconspicuous,and only a few cells showed apoptosis.Under transmission electron microscope,it was found that cell membrane,mitochondria and rough endoplasmic reticulum were intact in blank control group,but with reduction in organelles,severely swollen mitochondria,even with formation of vacuole or pyknosis,serious dilation of rough endoplasmic reticulum,with loss of cristac with loss of vacuoles or pyknosis,and marked dilatation of intemal reticular endoplasm,and loss of cristac with vacuolation and chromatin were observed under electron microscope in glutamate damaged group.Compared with the glutamate damaged group,these pathologic changes were markedly alleviated in protected groups.Conclusions Mild hypothermia preconditioning can inhibit glutamate-induced injury to cortical neurons.The protective effect of mild hypothermia combined with propofol is better.

BACKGROUND:Mesenchymal stem cel s-released factors can form a microenvironment inhibiting malignant tumor cel proliferation, and moreover, salinomycin also inhibits the growth of tumor cel s. OBJECTIVE:To explore the effect of salinomycin with umbilical cord blood mesenchymal stem cel s in breast cancer MCF-7 cel s and its action mechanism, in order to seek a new target and therapeutic strategy to treat breast cancer. METHODS:Logarithmically growing MCF-7 cells were randomly divided into control, umbilical cord blood mesenchymal stem cell group and combination group. Cells in the control group were given no treatment, while those in the other two groups were given umbilical cord blood mesenchymal stem cell suspension or umbilical cord blood mesenchymal stem cell suspension combined with salinomycin, respectively. RESULTS AND CONCLUSION:Forty-eight hours after the intervention, the proliferation and invasion of MCF-7 cel s and expression of POSTN protein in cel s were significantly reduced in the combination group compared with the other two groups. These findings indicate that the combination of umbilical cord blood mesenchymal stem cel suspension and salinomycin effectively reduces the proliferation and migration of MCF-7 cel s, and this combined use provides a new insight into the treatment of breast cancer.