Clinical practice guidelines are systematically developed clinical multi-discipline advisory statements which assist providers, recipients and other stakeholders to make informed decisions about appropriate health interventions. Chinese government and some clinical academic communities began to develop the domestic guidelines after 2000. Nevertheless, there were still some shortcomings presented in the domestic guidelines if assessed by the advanced appraisal instrument of the developed countries. There were four aspects as follow. The first, misunderstood the guidelines are the rule or text book. The second, ignored presentation of the procedure about development of guidelines. The third, there were a lack of high level evidences. The fourth, not declared editorial independence. However, it is necessary to develop the domestic guideline of China. With rising conflicts between the increasing needs for health care and shortage of our environment resource, development of the guidelines become one of the key steps in the process of clinical practice.

Clinical practice guidelines have been widely applied worldwide.Compared with the developed countries,however,the development of guidelines still has many limitations in China,which is mainly due to the lack of a guideline for guiding this process.Such a guideline,defined as “a structured and coordinated programme designed with the specific aim of producing several clinical practice guidelines should be able to specify the development,dissemination,implementation,evaluation,and update of each clinical practice guideline.Furthermore,the lack of high-quality randomized controlled trials and cohort studies also restricts the development of high-level guidelines.After the development of such a guideline for developing guidelines,we can expect the faster development of Chinese clinical practice guidelines that are more carefully designed,more reliable,and more practical.

Mitogen-activated protein kinase (MAPK) signaling pathways are involved in multiple important cellular responses. To activate their downstream protein kinases by phosphorylation is a crucial manner for MAPK family members to fulfill their physiological functions. Downstream of MAPKs, there exist three structurally related MAPK-activated protein kinases (MAPKAPKs or MKs), i.e., MK2, MK3 and MK5. Once upon activated by MAPKs, MKs signal to different cellular targets, to regulate gene expression at the levels of transcription and translation, control cytoskeleton remodelling and cell cycle, and mediate cell migration and embryonic development. Recently, based on the gene knockout studies, the function divisions among different MK subfamily members are gradually clear, leading to tremendous advancements of our knowledge on MKs.

There are some characteristics in the teaching of amateurish adult medical students.As a bridge connecting basic medicine and clinical medicine,pathophysiology is very important in medical education.Aiming at the specialties of amateurish adult medical students,it has very realistic significance for us to explore and reform the teaching methods of pathophysiology,in order to improve the teaching quality and effect.

Objective:To investigate the role of recombinant E.coli LLO/OVA on regulating the function of murine CD4+ CD25+ Treg cells.Methods:After E.coli LLO/OVA or E.coli OVA vaccination,the murine spleen CD4+ CD25+ Treg,CD4+ CD25- T and CD11c cells were collected respectively by magnetic beads sorting.The concentration of IL-10 in the supernatant of mix cocultured CD4+ CD25+ Treg and CD11c cells,and the suppression role of CD4+ CD25+ Treg cells on the proliferation of CD4+ CD25- T cells were determined.The percentage of OVA specific CD8+ T cells in mouse spleen was analyzed by flow cytometry.The number of metastatic tumor nodules in lungs of the mice transplanted with B16-OVA subcutaneouly was compared before and after dilition of CD4+ CD25+ Treg cells in mice.Results:Compared to E.coli OVA,E.coli LLO/OVA significantly downregulated IL-10 secretion of CD4+CD25+Treg cells and attenuated the suppressive effect of CD4+ CD25+ Treg on the proliferation of CD4+ CD25- T cells(P

0.05). The HDL-C level of B 2B 2 genotype (1.46?0.20)mmol/L was significantly higher than that of B 1B 1 genotype (0.90?0.21) mmol/L and B 1B 2 genotype (1.25?0.22)mmol/L, P

Objective To evaluate the surgical technique of titanium miniplates in reconstruction of laminar roof after a posterior approach in intraspinal tumor surgery. Methods From August, 2007 to March, 2009, 11patients underwent intraspinal tumor surgery with osteotomy and reconstruction of laminar roof, titanium miniplates were used for fixing in the re-implantation. There were 2 intramedullary tumors,9 extramedullary tumors. The target of surgery was the cervical spine in 2 cases, the cervicothoracic spine in 4 cases, the thoracic spine in 2 cases, the thoracolumbar spine in 2 cases, and the lumbar spine in 1 cases. The patitens were followed up for 6 months to 2years. Local pain,bony healing and spinal malformation were assessed. Results In the 11 patients, there was no case of dural, nerve root, or spinal cord injury due to laminar roof reconstruction. One patient complained of moderate to severe local pain during follow-up and 2 patients complained of occasional slight pain at the surgical site. No limitation of activity occurred. Bony healing was confirmed radiologically or CT scan in 9 patients. There were no patients demonstrated a new spinal malalignment, and no patients developed stenosis of the spinal canal. Conclusions The reconstruction of the laminar roof using titanium miniplates will benefit the recovery of normal structure of spine,and maintain the stability of spine,and avoid the occurrence of stenosis of the spinal canal.

Many medical journals have already digitalized their publishing procedure,but not achieved digital publishing yet.Utilizing digital technology,digital publishing can achieve the functions that paper media cannot,such as information storage,fast search,real-time publishing,individualized information and interaction with readers.These functions entail digitalization of medical journals,and involve a range of macro- and micro-modifications,including laws,industry policies,personnel training,and culture development.There is a long way to go for Chinese medical journals to enter the stage of digital publishing.

This retrospective analysis showed that the most frequent pathogen causing bacterial liver abscess was Klebsiella pneumoniae in 138 patients.Compared with the patients without diabetes mellitus,it was found that:( 1 ) the percentage of diabetic patients having typical abdominal pain was lower ( P ＜ 0.05 ) ; ( 2 ) neutrophilic granulocytosis was more marked,but albumin and hemoglobin levels were lower in diabetic patients( P＜0.05 ) ; ( 3 )more diabetic patients were complicated with urinary tract infection and suffered from septicemia( P＜0.05 ) ; (4) the clinical course of treatment in diabetic patients was much more prolonged( P＜0.05 ).

BACKGROUND:In treatment of lumbar diseases, lumbar fusion therapy fails in 20%of cases and may lead to a series of complications such as pain, intervertebral space col apse, and delayed kyphosis deformity.
OBJECTIVE:To observe the effect of nucleus pulposus on interbody fusion after removing the anterior column disc of rabbit lumbar vertebra.
METHODS:A total of 36 healthy Japanese white rabbits were randomly and equal y divided into three groups, with 12 rabbits in each group. (1) Group of anterior longitudinal ligament+bone grafting:The L3 intercalated disc were wel exposed and anterior longitudinal ligament was stripped, obtaining a space to L3 intercalated disc, then the iliac bone was implanted. (2) Group of excising anterior 1/3 disc+bone grafting:After the anterior 1/3 disc tissue was excised, the iliac bone was implanted and sutured as Group of anterior longitudinal ligament+bone grafting. (3) Group of excising anterior 1/3 disc+fixation:After the anterior 1/3 disc tissue was excised, the iliac bone was implanted and the anterior column fixation was performed.
RESULTS AND CONCLUSION:Biomechanical testing showed that, at 12 weeks, the verticality tensile force in the group of anterior longitudinal ligament+bone grafting was obviously higher than other two groups, and have better fusion rate and could bear stronger force. Lateral position lumbar radiography showed that, the bone graft was absorbed and no new bone grew into the intervertebral space in the group of excising anterior 1/3 disc+bone grafting at 12 weeks;the formation of osseous bridge was found in the group of excising anterior 1/3 disc+fixation;complete bony fusion was found in the group of anterior longitudinal ligament+bone grafting. Histological examinations showed that, at 12 weeks, no bone tissue formed in the group of excising anterior 1/3 disc+bone grafting;a smal amount of bone trabecula and osteocytes were observed in the group of excising anterior 1/3 disc+fixation;a great quantity of newborn bone trabecula and osteocytes, remodeling lamel ar bone and canalis haversi structure were observed in the group of anterior longitudinal ligament+bone grafting. The stability of anterior column has notable effect on interbody fusion, after the anterior column disc is destroyed, the free nucleus pulposus may affect spinal fusion, so restoring the stability of the anterior column may promote interbody fusion, but stil cannot get solid spinal fusion.