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

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 ).

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 assess the usefulness of left ventricular contrast echocardiography in diagnosis of left ventricular myocardium noncompaction.Methods Contrast echocardiography was done in ten patients who were diagnosed or suspected with left ventricular noncompaction by common transthoracic echocardiography,for further study of the trabecular muscles extent,the continuity of the endocardium,the compact myocardium thickness,and the contrast agent in the trabecula recessus.Results By contrast echocardiography,noncompaction myocardium thickness can be perspicuously observed,the turgor of the contrast agent was vividly detected in the trabecular recessus.Especially for the measurement of compaction myocardium,the contrast echocardiography was more accurate than in the condition of the common echocardiography.Conclusions Left ventricular contrast echocardiography can be used in the diagnosis of left ventricular noncompaction,it was a good added method of conventional echocardiography.

Objective To detect the expression of type Ⅰ collagen, type Ⅲ collagen, prolyl-4-hydroxylases (PH4) and matrix metalloproteinase 1 (MMP-1) in sacral ligament fibroblasts under stress, to understand the collagen synthesis and metabolism in stress situations change. Methods Eight patients who underwent abdominal hysterectomy for uterine benign disease were enrolled in this study. Primary sacral ligament fibroblasts were isolated by explant. After mechanical loading, gene expression of type Ⅰ , Ⅲ collagen, PH4 and MMP-1 were measured. Results Stress of 8% continuing for 24 hours, collagen Ⅰ (1. 13 ± 0.24), collagen Ⅲ (1.05 ± 0. 31) mRNA expression and PH4 expression (1.11 ± 0. 31) compared with static groups (1) showed increasing trends;when the stress were 4% and 12%, collagen Ⅰ (0. 86 ± 0. 26 and 0. 85 ± 0. 25), collagen Ⅲ showed increasing trends (0. 74 ± 0. 29 and 0. 83 ± 0. 38) mRNA expression were decreased. After removal of the stress, in the stress of 4% for 1 hour, collagen Ⅰ (0.79±0.40, 0.97±0.24 and 1.46 ±0.75), collagen Ⅲ (0.86±0.40, 0.99±0.60 and 1.59±0.82) and PH4 (1.11 ±0. 51, 1.17 ±0. 54 and 1.37 ±0. 39) mRNA expression increased gradually. In 8% stress group, collagen Ⅰ mRNA expression (1.16 ± 0. 62, 1.01 ± 0. 51 and 1.05 ± 0. 80) reached the peak in day 1, and collagen Ⅲ (0.99 ±0.69, 1.59 ±0.55 and 1.03 ±0.91) and PH4 (1.05 ±0.31, 1.07 ±0. 80 and 0. 85 ±0. 31) mRNA expression reached the peak in day 2, then decreased. 4% and 8% of the stress with time after the change, MMP-1 mRNA expression have peaked at day 1. Conclusions Moderate stress could contribute to pelvic floor collagen synthesis, too much or too little stress is not conducive to the synthesis of collagen. Collagen Ⅰ and collagen Ⅲ on the stress response may be different, the former have faster reaction than the latter. PH4 were involved in the synthesis of collagen, while MMP-1 may play a role in collagen degradation.