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.

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.

Objective To investigate the relationship between ST resolution and early prognosis of the patients with acute ST-elevation myocardial infarction (STEMI) receiving percutaneous coronary intervention (PCI).Methods A total of 80 consecutive patients with STEMI underwent primary PCI within 12 hours.ST segment elevation amplitude sum was measured and compared before PCI and 1 hour after PCI,and the percentage of declining was calculated.According to thrombolysis in myocardial infarction (TIMI) grading after PCI,the infarction related artery blood flow was recorded and compared.Ten of them who had experienced clear ST resolution (≥30％) before PCI were set aside.Among the other 70 patients,the ST resolution was calculated and the patients were divided into group A (41 cases,ΣSTE resolved ≥50％) and group B (29 cases,Σ STE resolved ＜ 50％).The left ventricular ejection fraction (LVEF),serious adverse cardiac events (MACE,including myocardial infarction,or revascularization,malignant arrhythmia,heart failure and death) in two groups during hospitalization was compared.Results The LVEF in postoperative 1 week in group A was higher than that in group B [(51.90 ± 5.06)％ vs.(46.87 ± 4.01)％,P ＜ 0.05].The incidence of in-hospital MACE during hospitalization in group A was lower than that in group B [7.3％ (3/41) vs.24.1％ (7/29)] (P ＜ 0.05).Conclusions Degree of ST resolution early after recanalization in acute STEMI patients receiving emergency PCI degree can better reflect the level of myocardial tissue perfusion and indirectly predict cardiac systolic function and in-hospital MACE.It can be used as evaluation index of early prognosis.

With dramatic decline of genome sequencing cost,high-throughput sequencing technologies have been applied in clinical laboratory field,and play an increasingly important role in clinical diagnosis and treatment in complex diseases.Based on omics techniques,clinical laboratory data recording patient's diagnosis information has become the important independent medical research resources of the major health industry.Because these data include the patient's identity information,there are a series of ethical issues to be solved,such as protection of patients' informed consent right,patient privacy protection,information security protection,when carrying out the medical health big data research.Based on these problems,it proposed clinical laboratory data should be standard extraction,establishment of clinical laboratory data base for teaching,training,in order to improve the utilization of medical resources.Moreover,it is best to implement the written informed consent during the process of sample collection,informing the patient the data collected in diagnosis and treatment process may be used in related research in future.

Objective To study the clinical value of serum cardiac troponin Ⅰ (cTnⅠ) in patients with unstable angina pectoris (UAP) and minor myocardial damage.Methods The serum cTnⅠ level of 60 UAP patients (UAP group) were determined.The patients whose cTnⅠ were ≥ 0.1 μ g/L were ascribed to cTnⅠ positive group,and the patients whose cTnⅠ were ＜ 0.1 μ g/L were ascribed to cTnⅠ negative group.The correlation among clinical data,coronary arterial lesions and adverse cardiac events were analyzed.Forty healthy people were selected as control group.Results The positive rate of cTnⅠ in UAP group (35.0％,21/60) was significantly higher than that in control group (0),and there was statistical difference (P ＜ 0.01).The incidence rate of coronary arterial multi-branch lesions and/or severe stenosis in cTnⅠ positive group (19.0％,4/21) was higher than that in cTnⅠ negative group (5.1％,2/39),but there was no statistical difference (P ＞ 0.05).The incidence rate of 90 d adverse cardiac events in cTnⅠ positive group (33.3％,7/21) was significantly higher than that in cTnⅠ negative group (5.1％,2/39),and there was statistical difference (P ＜ 0.01).Conclusions Low-level cTnⅠ demonstrates minor myocardial damage sensitively and specifically.cTnⅠ level detected quantitatively can help to assess prognosis and provide risk stratification of UAP patients.

Objective To investigate the evaluation value of oxygenation index at different times of mechanical ventilation (MV) on the prognosis of patients with acute respiratory distress syndrome (ARDS).Methods A retrospectively analysis was conducted. A total of 228 patients with ARDS admitted to Department of Emergency of China Medical University Affiliated First Hospital from February 2014 to June 2016 were enrolled. All patients underwent MV treatment, and recruitment maneuver (RM) was performed by pressure-controlled ventilation (PCV) 30 minutes after the implementation of the protective ventilation strategy. Arterial blood gas analysis was performed at MV immediately, after RM and at 6, 12, 24 hours of MV, and oxygenation index was calculated. Vital signs, laboratory data, ultrasonic echocardiography, sequential organ failure assessment (SOFA) score, duration of MV, and ventilator related parameters of patients were collected. The patients were divided into survivors and non-survivors according to the prognosis of 28 days. The survivors were subdivided into high and low oxygenation group (oxygenation index was ≥ 150 mmHg and < 150 mmHg, respectively, 1 mmHg = 0.133 kPa). Differences in clinical indicators between survivors and non-survivors were compared. The correlation between the oxygenation index after RM and the oxygenation index at each time after MV was analyzed by bivariate correlation analysis. Receiver operating characteristic (ROC) curve was plotted to analyze predictive value of oxygenation index measured at different times for the 28-day outcome of patients with ARDS.Results Among 228 patients, 99 patients died within 28 days, and 129 survived, with mortality rate of 43.4%. ① The oxygenation index after RM and at 6, 12, 24 hours after MV in survivors and non-survivors showed a continuously increased tendency, which was significantly lower in non-survivors than that in survivors (allP < 0.05). There was no significant difference in the duration of MV between high oxygenation group and low oxygenation group at MV immediately and after RM, but the duration of MV in high oxygenation group was significantly shorter than that of the low oxygenation group at 6, 12, 24 hour of MV (allP < 0.01). ② After ventilation for 24 hours, serum creatinine (SCr), brain natriuretic peptide (BNP), lactate (Lac), right ventricular internal diameter, and SOFA score in non-survivors were significantly higher than those of survivors, and arterial partial pressure of oxygen (PaO2), platelet (PLT) and right ventricular ejection fraction (RVEF) were significantly lower than those of survivors (allP < 0.05). ③ After 24 hours ventilation, positive end-expiratory pressure (PEEP), tidal volume (VT), and minute ventilation (VE) in non-survivors were significantly higher than those of survivors, and static compliance of thorax (Cdyn) was significantly lower than that of survivors (allP < 0.01). ④ It was shown by correlation analysis that the oxygenation index after RM was positively correlated with those at 6, 12, 24 hours of MV (r values were 0.856, 0.765, and 0.758, respectively, allP < 0.001). ⑤ It was shown by ROC curve that the area under the ROC curve (AUC) of the oxygenation index after RM for predicting 28-day prognosis was 0.688. When the cut-off value was 80.75 mmHg, the sensitivity was 97.7%, and the specificity was 42.4%, which could only be used for preliminary judgment of prognosis. The AUC of oxygenation index at 6, 12,24 hours of MV for 28-day survival of ARDS patients were 0.719, 0.727, 0.754, respectively. When the cut-off values were 171.50, 192.14, and 161.75 mmHg, the sensitivity was 69.8%, 67.4%, 86.0%, and the specificity was 78.8%, 78.8%, and 63.6%, respectively. It indicated that the predictive value was higher, and no significant difference was found among the oxygenation index at different time points.Conclusions The oxygenation index after the early stage of RM can preliminarily determine the prognosis of patients. The predictive value of oxygenation index after MV for 28-day survival of ARDS patients was higher, so the oxygenation index measured at 6 hours of MV may be considered to evaluate the prognosis of patients with ARDS.

Objective To investigate the self‐management and cognitive situation of the patients with gestational diabetes melli‐tus (GDM) dietary and to discuss the influence of individualized diet intervention on patients .Methods Forty‐one pregnant women diagnosed with GDM were selected as the research objects .logistic regression analysis was used as well as questionnaire to evaluate the influence factors of comprehensive evaluation of the follow diet control ,detecting the 2 h plasma glucose(2 h PG) ,hemoglobin (HbAlc) ,total cholesterol (TC) ,three acyl glycerin (TG) change in value after individualized nutritional intervention ,which were compared with pre‐intervention index .Results (1)90 .2% of diet cognitive received diet educators ,26 .8% of the patients thought only diet and exercise therapy could effectively control blood sugar .Patients got 2 .4% correct overall about questions about food and 85 .4% patients followed diet .(2)Logistic regression analysis showed that the influencing factors of GDM patients following di‐et were age ,BMI ,cultural degree ,receiving diet education ,self monitoring of blood sugar ,regular review to the hospital regularly . (3) After the intervention(41 cases) ,the level of 2 h PG ,HbAlc ,TC ,TG of 38 cases were significantly lower than before ,and the difference was statistically significant (P<0 .01) .Conclusion Individualized diet intervention treatment in GDM patients shows obvious effect .

Objective To investigate the expressions of thymidylate synthase (TS) and adenosine triphosphate (ATP)-binding cassette superfamily G member 2 (ABCG2) in advanced gastric cancer (GC) and to explore their correlation with clinical pathological features.Methods A total of 80surgical specimens of advanced gastric cancer patients were collected.The expressions of TS and ABCG2 in gastric cancer tissues and adjacent normal gastric tissues were detected by immunohistochemical method.The expression of P-glycoprotein in gastric cancer tissues was also examined.The correlations between TS,ABCG2 and clinical pathological features and P-glycoprotein were analyzed.Chi-square test was performed for two groups comparison and Kruskal-Wallis H test were used for multi-groups comparison.Results The positive rates of both TS and ABCG2 in gastric cancer tissues [85.0％ (68/80) and 90.0％ (72/80)] were higher than those of adjacent normal gastric tissues [62.5 ％ (50/80) and 78.7 ％ (63/80)],the differences were statistically significant (x2 =11.466 and 16.463,P=0.009 and 0.001).There were close correlation between the expression of TS,ABCG2 and tumor TNM stage,differentiation status,invasion depth (TS:x2 =30.686,61.470 and 40.545 ; ABCG2:x2=48.192,63.150 and 47.512; all P＜0.01).The later the tumor staged,the worse the cells differentiated and the deeper the tumor invaded,the higher level they expressed.Both TS and ABCG2expressions in gastric cancer tissues were correlated with the expression level of P glycoprotein (x2 =43.977and 29.509,both P＜0.01).Conclusion TS and ABCG2 may be potential indexes to predict the degree of malignancy,progression,drug resistance and prognosis in gastric cancer.

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.

OBJECTIVE To investigate the different methods to calculate the rate of missing report on nosocomial infections.METHODS We had two methods to define the case of nosocomial infections,one was that the cases(infected) during the month we investigated,the other was that patients infected during the in hospital time.Then we got two different rates and "actually" nosocomial infection cases and compare the difference of the two results.(RESULTS) It was significant difference between these two results(P