The background,features,dimension and contents of 22 international appraisal tools for clinical guidelines were analyzed,and their history,evolution,rules and problems were described,in order to provide the evidence for developing appraisal tools for domestic clinical guidelines. In the study,it was found that the guideline evaluation tools have been classified and there is a constant strive to achieve the balance between comprehensiveness and practicability. But the existing evaluation tools are insufficient for clinical practical contents of guidelines. The scoring system should be improved. In addition,conflicts of interest,value choice and patients' involvement should be considered increasingly, and should become an important part of the guideline evaluation tools.

Objective To study the effects of repetitive transcranial magnetic stimulation(rTMS) of the supplementary motor area(SMA)on the cortical excitability in patients with Parkinson's disease(PD).Methods Sixteen patients with PD were included in this study.The motor evoked potentials(MEP)and the N30 component of somatosensory evoked potentials(SEP) were assessed for each patient before and after 1200 pulses of rTMS of the SMA at 5 Hz and an intensity of 100% of relaxed motor threshold (RMT) for the abductor pollicis brevis.Results Ten minutes after the rTMS intervention,the peak-to-peak amplitude of the SEP component P20-N30 increased significantly(P<0.05),with the P/F index decreased simultaneously(P<0.05).The MEP amplitude increased significantly,and reached the highest value at 10min after the rTMS intervention. Conclusion 5 Hz rTMS of the SMA can improve the excitability of the SMA itself temporarily.Meanwhile,it can induce a short-lasting facilitation of the excitability of M1 connected with SMA.

Objective To investigate the clinical value of breast augmentation with autologous fat graft using water jet-assisted liposuction (WAL) technique.Methods From October 2010 to December 2012,20 patients underwent Water Jet-Assisted Lipoplasty and breast augmentation with autologous fat tissue (average,210 ml volume injected per breast).Pretreatment and posttreatment TN,bilateral SN and MP were measured,and the outcomes were statistically analysed using paired t test,combined with photos of pretreatment and posttreatment.Follow-up ranged from 3 months to 2 years.Results The results were satisfactory.All the patients got good shape of breasts.There was no infection in all the patients.TN and SN were signifigantly increased at 3 month after operation [(88.7±2.9) cm vs.(87.2±4.2) cm,P＜0.01],[left (20.1± 1.5) cm,right (20.1 ±1.5) cm,vs left (19.5±1.5) cm,right (19.5±1.6) cm,P＜0.01].MP was also increased compared with measurement of pre-operation [(4.6±0.4) cm vs.(4.2±0.9) cm,P＜0.05].Conclusions It is a good option to use water jet-assisted liposuction technique in the treatment of breast augmentation with autologous fat graft.

Aim To investigate the immunoregulative action of polysacchrides of Spirulina platensis ( PSP ) on peripheral blood mononuclear cells ( PBMCs) in pa-tients with chronic hepatitis B virus infection. Meth-ods Proliferation and cycle of PBMCs from patients with chronic hepatitis B virus infection were measured by MTT colorimetry and flow cytometry respectively. The concentration of IFN-γ, IL-2 , IL-4 in supernatants of PBMCs were examined by ELISA. The mRNA ex-pression of IFN-γin PBMCs from patients with chronic hepatitis B virus infection was detected by RT-PCR. Results PSP could induce proliferation of PBMCs in patients with chronic hepatitis B virus infection. In ad-dition, PSP could increase the protein expression of IFN-γ and IL-2 in supernatants of PBMCs in patients with chronic hepatitis B virus infection, and PSP could also enhance the mRNA expression of IFN-γof PBMCs in patients with chronic hepatitis B virus infection. However, PSP inhibited the protein expression of IL-4 of PBMCs in patients with chronic hepatitis B virus in-fection. Conclusion PSP can promote the immune function and plays an important immunoregulation function on patients with chronic hepatitis B virus in-fection.

Objective To investigate the infection prevention effect of prophylactic use of antibiotics for cancer inpatients with leukocyte count ≤ 1 × 109/L.Then to provide the basis for rational use of antibiotics.Methods It was retrospectively surveyed that the infection situation and prophylactic usage of antibiotics in the 426 cancer inpatients with leukocyte count ≤ 1 × 109/L caused by radiotherapy and chemotherapy.Results In the 426 inpatients,the infection rates of patients with and without prophylactic use of antibiotics were 11.0％ and 20.9％ respectively.The difference was statistically significant (x2 =6.815,P =0.009).The leukocyte count median values of patients with and without infection were 0.73 × 109/L and 0.77 × 109/L respectively.The difference had no statistical significance(Z =-1.257,P =0.209).The main infection sites were lower respiratory tract,upper respiratory tract and gastrointestinal tract with infection rates of 48％,12％ and 11％,respectively.The top five pathogens were Klebsiella pneumonia,Enterobacter cloacae,Escherichia coli,Enterobacter aerogenes and Staphylococcus aureus.The most use of antibiotics were cephalosporin.Conclusion When the leukocyte counts of cancer inpatients are less than or equal to 1 × 109/L induced by chemotherapy and radiotherapy,reasonable prophylactic use of antibiotics can reduce hospital infection rates.

Objective:To establish mice models of Staphylococcus aureus bloodstream infections so as to investigate the inflammatory responses and histopathological changes in bloodstream infections (BSIs) mice.Methods:C57BL/6 mice were inoculated with S.aureus intravenously or intraperitoneally to induce BSIs.Survival rate , weight loss and murine sepsis scores ( MSS ) were ob-served.Blood samples and tissue homogenates were plated on agar to determine bacterial burden .Inflammatory proteins ( CRP,PCT) and cytokines ( IL-1β, IL-6 and TNF-α) were determined by ELISA kits.Histopathologic changes were also assessed by pathological inflammation scores(PIS),macroscopic and microscopic examination.Results: About 70% survival rate was observed in 4.5×108 CFU/ml S.aureus induced BSIs mice.Body weight decreased and sepsis scores increased significantly since 24 h post-infection in BSIs mice,and more prominent in IV group.The counts of WBC began to significantly increase at 3 h post-infection,while CRP and PCT levels peaked at 48 hours in IV and IP groups ( 60.80 ±5.63 vs 40.58 ±7.54 for CRP;6.796 ±1.16 vs 2.740 ±0.36 for PCT ) . Moreover,the levels of IL-1β,IL-6 and TNF-αin serum and tissue homogenates ( liver,lungs,and kidneys ) were significantly elevated in BSIs mice.Pathological changes in tissues (liver,lungs and kidneys) and higher pathological inflammation scores (PIS) were also observed in BSIs mice.Conclusion:Our study represents an effective approach for S.aureus BSIs model to mimic human sepsis.Our results demonstrated that inflammation protein (PCT,CRP) and cytokines(IL-6,IL-1βand TNF-α) play an important role in the in-flammatory response and histopathological changes during BSIs caused by S .aureus.

Objective To explore the characteristics of EEG frequency in recruits and veterans and their relationship with depression scale scores.Methods Fifty-five newly enlisted soldiers formed the recruits group and 68 demobilized soldiers the veterans group.A general information survey,EEGs and the Hamilton depression scale (HAMD) were administered to all of the subjects.According to the HAMD scores,35 of the 123 were designated as the abnormal group,while 88 formed the normal one.Eighteen of the 35 with EEG abnormalities served as a doubleabnormal group to be compared with the remaining 17 cases with abnormal HAMD scores and normal EEGs (the single-abnormal group),and 9 of the 18 with higher HAMD scores as the higher group,and the other 9 cases as the lower group.The EEG frequency spectrum and the power percentages from the δ to γ frequency bands were calculated as δ:0.5-4 Hz,(o):4-8 Hz,α:8-13 Hz,β:13-25 Hz,γ:25-40 Hz.Results Forty-six of the subjects (37.4％) had abnormal EEG results,35 had abnormal HAMD scores,and 18 (51.4％ of the soldiers with abnormal HAMD scores) had both abnormalities.The veterans had lower δ band power percentage in all channels than the recruits,but in the (0) band it was the reverse.In the left channels the veterans had lower α and γ band power percentages than the recruits.Compared with the normal,all channels in the EEGs of subjects with abnormal HAMD scores had significantly higher δ band power percentages.The higher the δ band power percentage a subject had,the higher his HAMD score.Conclusion There is some correlation between changes in EEG power percentages and the possibility and severity of depression.Objective and subjective EEG evaluation can help improve the positive rate of diagnosis,and thus the management of the army.

Objective：To establish a capillary gas chromatography(CGC) method for identifying the origin fungi of traditional Chinese medicine Hongqu. Methods：The volatile components of 7 species of Monascus including M. purpureus Went, M.aurantiacus Lee, M. serorubesceus　Sato, M. albidus Sato, M. barkeri Dangerd, M. ruber van　Tieghem, and　M.fuliginosus　Sato were analyzed by capillary gas chromatography method. Inlet temperature and detector temperature were 280℃，temperature program were 130℃,5 min→10℃/min→200℃, 10 min FID was used for detection. Results：The variety and contents of the volatility components in Monascus had obvious differences which can be distinguished easily by the main fingerprint peaks within 20 min. Conclusion：This method is useful to identify of Monascus fungi.

This study was aimed to build up a diagnosis and treatment procedure of traditional Chinese medicine (TCM) for HIV/AIDS headache. Domestic and foreign articles correlated to HIV/AIDS headache diagnosed and treat-ed by TCM were summarized. The specialist questionnaire of clinical diagnosis and treatment standard operating pro-cedures of TCM for HIV/AIDS headache was designed by focus group discussions. And the national specialist ques-tionnaire survey was carried out twice. The results showed that the standard operating procedure of TCM clinical di-agnosis, treatment, nursing and therapeutic efficacy assessment for HIV/AIDS headache was preliminarily established. It was concluded that this regulation identified concept, etiology and pathogenesis of HIV/AIDS, established TCM standard diagnosis and treatment service. It also demonstrated features of propaganda and education, follow-ups, con-secutive diagnosis and treatment inside or outside the hospital.

This study was aimed to establish traditional Chinese medicine (TCM) diagnosis and treatment procedure of varicella zoster virus (VZV) in AIDS, and to construct questionnaires for key points and revision of the procedure. The TCM draft of diagnosis and treatment procedure for VZV in AIDS was established through literature retrieval and peer review. Two rounds of surveys were carried out to investigate the confirmation and advice of in-group specialist to key points of TCM or integrative medicine draft including diagnosis, treatment and nursing. Then, diagnosis and treatment procedure were revised according to survey results. The results showed that the recovery of complete ques-tionnaires in the first-round survey was 96%. More confirmation of specialists were given to concept, clinical feature, cause, mechanism, case history and general examination, diagnostic criteria, syndrome differentiation and treatment of dampness-heat of liver channel syndrome, skin, dietary and psychological nursing, treatment course and therapeutic effect standard. The coefficient of variations (CVs) of experiential effective recipe, moxibustion and massage, auxiliary examination, syndrome differentiation and treatment of dampness stagnancy due to spleen deficiency syndrome and qi stagnation and blood stasis syndrome, and western medicine treatment were large. The weight coefficients of all items were within 0.043 6 and 0.046 2. The Cronbach Coefficient Alpha (CCA) was 0.996 and the split-half reliability R was 0.86. Recovery of complete questionnaires in the second-round survey was 100%. More confirmation of special-ists were given to outline, cause, mechanism, case history and general examination, diagnostic criteria, syndrome dif-ferentiation and treatment of three syndromes, experiential effective recipe, skin, dietary and psychological nursing. The CV was 0. The CV of auxiliary examination, moxibustion and massage was 0.063 8, which was less than those of first-round survey. The consistency of specialist was relatively increased. The weight coefficients of all items in the second-round survey were within 0.058 2 and 0.059 0. The CCA was -0.041 and the split-half reliability R was 0.79. A new revised procedure was preliminarily established according to results of two rounds of surveys. It was concluded that the activeness, concentration and coordination of specialists were good in two rounds of surveys. Con-sensus in key points of the procedure draft was reached including diagnosis, treatment and nursing.