The grading of evidence is an important factor in clinical decision-making. The current evidence grading system based on western medicine is limited in the clinical practice of traditional Chinese medicine （TCM）， therefore we propose the solutions to the development of grading system for TCM interventional evidence， following the international evidence grading standards， taking into considerations of the unique characteristics of TCM practice， based on the Grades of recommendation， assessment， development and evaluation （GARDE） evaluation system， and integrating with grading system regarding TCM classical literature and empirical evidence from modern famous doctors. The evidence from classical literature is suggested to be evaluated from three aspects including source of ancient medical records， comprehensive of treatment details， and the inheritance. The qualification of famous doctors， content integrity， and inheritance of experiences will be used to evaluate the evidence from famous doctors' experience. The multi-sourced evidence such as TCM classical literature， experience of modern famous doctors， and modern researches is mainly integrated in a qualitative way， and the overall level of evidence of TCM interventions will be graded consistently with the GRADE system based on modern research. The evidence from classical literature and modern famous doctors' experience will be assessed and considered as supplementary evidence， which will make the evaluation of clinical evidence more objectively and comprehensively， thereby guiding clinical practice further.

Yang-palm, through early systematic Zhan-zhuang training to raise qi, pats the affected area to extract pathological product outer surface using the distal of 2-5 fingers in palm dorsal. This therapy emphasizes infusing qi and extract silt. The treatment continues when pathological product scatters and disappears, so the short-term and long-term efficacy is significant, and especially suitable for the treatment of TCM arthralgia. This article introduced the clinical therapy in treating two rheumatism patients by Yang-palm, explained process and study method of Yang-palm therapy, and shared treatment experience and explored the basic principles of treatment, with a purpose to provide a new treatment for rheumatism.

Objective To assess the reliability and validity of the Pittsburgh sleep quality index (PSQI) .Methods The cross-sectional survey was conducted in the outpatient department of this hospital .544 insomnia and non-insomnia voluntary participants (18-65 years old) from July to October 2011 were assessed with PSQI and the insomnia severity index (ISI) ,which were randomly delivered to them .Results The test-retest reliability of PSQI was 0 .994 .The split-half reliability coefficient of PSQI was 0 .824 . The overall Cronbach′s alpha coefficient was 0 .845 .The confirmatory factor analysis showed that the fitting indicators for the χ2/df ,root mean square error of approximation(RMSEA) ,non-normed fit index(NNFI) ,comparative fit index(CFI) and goodness-of-fit index(GFI) were 4 .83 ,0 .09 ,0 .96 ,0 .98 and 0 .97 respectively .The correlation coefficient between the PSQI and ISI was 0 .842 . The correlations coefficients between PSQI with the questionnaire type ,interview date and interview department were -0 .046 , 0 .276 and -0 .331 .Grouping by individuals with or without insomnia ,the area under the receiver operator characteristic curve (ROC) for PSQI was 0 .944(95% CI:0 .925-0 .963) .Conclusion PSQI has good reliability and validity ,and could be used for the sleep quality comprehensive evaluation in the patients with insomnia .

Objective To build the indicators system for clinical pathway management as required by clinical pathway control.Methods An indicators system was proposed by means of evidence-based review,focus group discussions,and ratings of the indicators' importance by doctors and nurses.A multidisciplinary panel of 60 experts from across the country were selected.A 3-round Delphi survey was made on the proposed indicators.The weights of the indicators were established by analytical hierarchy process (AHP).The response rate,Cronbach's α,and the authority coefficient of experts were used as a measure of reliability.Results The response rates of the 3 rounds were 85％,70％,and 94％; the experts authority coefficient was 0.80.The ccoefficient of variation falls with the rising number of consultations.The Kendall's W ranged from 0.40 to 0.83.Following the 3 rounds,consensus was achieved among experts as such a system comprising three first-level,9 second-level,and 36 third-level indicators.Conclusion The expert consultation has achieved reliable results.The established indicators system can serve as a useful instrument for standardized development of clinical pathways management and constant improvement.

To select appropriate descriptors for response of the patient-reported outcome (PRO) scale for the main symptoms of patients with chronic obstructive pulmonary disease (COPD) complicated with pulmonary heart disease.

This paper briefly introduces item response theory (IRT) as a typical representation of modern testing theory (MTT), and systematically reviews the processes and contents of the application of IRT in the area of health measurement, including, for example, item bank development, scale revision and computerized adaptive testing. The author presents the potential benefits and the notable problems during health measuring by IRT. Then, the author asserts the need for thorough assessment of feasibility when using the IRT in patient-reported outcome research. Further research based on IRT and computerized adaptive testing in health measurement will be carried out in the field of medical care including traditional Chinese medicine and integrative medicine.

To select appropriate descriptors for responses of the Health Scale of Traditional Chinese Medicine (HSTCM).

OBJECTIVE: To test the reliability and validity of Health Scale of Traditional Chinese Medicine (HSTCM) by means of questionnaires. METHODS: A cross-sectional survey was conducted at Liwan Community of Guangzhou, Old People's Home in Guangzhou and Outpatient Department of the Second Affiliated Hospital of Guangzhou University of Chinese Medicine. A total of 652 Chinese individuals (over 18 years old) were assessed with the 88-item version of HSTCM and World Health Organization Quality of Life Measure-Abbreviated Version (WHOQOL-BREF), which were randomly delivered to them. Some socioeconomic characteristics were registered. RESULTS: A test-retest reliability (15-day interval) was found among the 76 persons who completed the questionnaires by themselves. Intra-class correlation coefficient (ICC) was 0.93. Associated 95% confidence interval (CI) was 0.89-0.96. Split-half reliability was 0.79. Inter-investigator reliability (0.93) was also good, and the ICC of HSTCM was 0.90 (95%CI 0.67-0.97). The correlation between HSTCM and WHOQOL-BREF was -0.66. The correlations of HSTCM and questionnaire deliver order, investigator, interview date and interview time were 0.06, -0.12, -0.17 and 0.20 respectively. The correlation between HSTCM and self-rated health (0.46) was greater than that between HSTCM and chronic illness (0.28). Divided by individuals with or without chronic illness, area under the ROC (receiver operator characteristic) curve for HSTCM was 0.67 (95%CI 0.63-0.71). CONCLUSION: It indicates that the HSTCM is conceptually valid with satisfactory psychometric properties and forms a basis for further applications in clinical research of traditional or integrative medicine.

BACKGROUNDTo explore the possibility of using retrovirus vector to carry HBV vector, and to prove that replication defective HBV could be normally packaged.

METHODSTwo kinds of full length of mutant HBV gene, which express dominant negative mutants, were inserted into retrovirus vector. After recombinant retroviruses were harvested, they were used to infect Hep G2 and 2.2.15 cell line. Then the expression of HBV core antigen in the Hep G2 cell was examined by immune fluorescence, and the existence of recombinant HB virion in the culture medium was examined by PCR.

RESULTSHigh titer of recombinant retroviruses were obtained in the culture medium of transfected PA317 cell line. Core antigen was detectable in the recombinant retrovirus infected Hep G2 cell. Recombinant HB virion was detectable in the culture medium of recombinant retrovirus infected 2.2.15 cell.

CONCLUSIONSThe results suggested that recombinant retrovirus could carry HBV vector and express HBV products. When structural protein is offered by wt-HBV, the recombinant retrovirus may function as HBV vector, therefore it could be used in anti?HBV gene therapy.

Genetic Therapy ; Genetic Vectors ; Hepatitis B Core Antigens ; biosynthesis ; Hepatitis B virus ; genetics ; Humans ; Recombination, Genetic ; Retroviridae ; genetics ; Tumor Cells, Cultured ; Virus Replication

AIM: To investigate the protective effect of rifampicin on rotenone-induced apoptosis of dopaminergic neurons and expression of ?-synuclein in rats.METHODS: Highly selective lesions and high expression of ?-synuclein in nigrostriatal dopaminergic neurons in rats were induced by chronic subcutaneous exposure to rotenone at dose of 1.5 mg?kg-1?d-1 for 3 weeks.At the same time,rifampicin was administered at dose of 30 mg?kg-1?d-1 by intragastric administration for 3 weeks.The changes of behavior,pathology and immunoreactivity of TH and ?-synuclein in SNc were observed.RESULTS: Obvious changes of behavior,pathology and TH immunoreactivity in SNc were observed in male SD rats injected subcutaneously with rotenone and rifampicin protected rats against these toxic effects induced by rotenone.CONCLUSION: Rifampicin has extensive protective effects against rotenone-induced neurotoxicity,which is related to inhibiting the expression and aggregation of ?-synuclein.