Clinical Practice Guidelines of Rehabilitation: Methodological Quality / 中国康复理论与实践

@#Objective To evaluate the methodological quality of clinical practice guidelines of rehabilitation using Appraisal of Guidelines for Research and Evaluation (AGREE) II.Methods Clinical practice guidelines of rehabilitation were searched in databases such as PubMed, EMBASE, Wanfang database, CNKI, China Biology Medicine disc and related websites from medlive.cn, National Institute for Health and Care Excellence, National Guideline Clearinghouse, Scottish Intercollegiate Guidelines Network, World Health Organization, and Guidelines International Network from establishment to January 11, 2020. Two researchers reviewed literatures and assessed the methodological quality of the guidelines independently by using AGREE II; any disagreements needed to be discussed in a consensus meeting.Results A total of 84 guidelines were included in the study, with 67 foreign guidelines and 17 domestic guidelines. The average score rate for all the guidelines was 48.1%, in which 49.9% for the foreign guidelines and 40.7% for the domestic guidelines. In the six areas of AGREE II, the average score rate of the foreign guidelines was higher than that of domestic ones (|Z| > 2.034, P < 0.05), expect applicability; the average score rate of clarity and independence improved with the launch of AGREE Ⅱ ( Z > 2.130, P < 0.05). The average scores rate ranged from high to low followed as range and purpose (41.6%), clarity (39.9%), participants (24.5%), rigor (23.2%), independence (15.5%) and applicability (12.9%). Conclusion Clinical practice guidelines of rehabilitation is mainly of low quality by AGREE II. Guideline developers need to work after AGREE Ⅱ standard in the future.

Clinical Practice Guidelines of Rehabilitation: Development Status / 中国康复理论与实践

@#Objective To analyze the development trends and issues of clinical practice guidelines of rehabilitation.Methods Clinical practice guidelines of rehabilitation were retrieved from PubMed, EMBASE, China Biology Medicine disc, CNKI, Wangfang database, Medlive, National Institute for Health and Care Excellence, National Guideline Clearinghouse, Scottish Intercollegiate Guidelines Network, World Health Organization and Guidelines International Network from establishiment to January 11, 2020. The number, publication date, distribution of countries, journals, institutions, subject areas and methods for developing guidelines of included literatures were analyzed. Results A total of 84 clinical practice guidelines of rehabilitation were included, in which there were 17 published in Chinese and 67 in English. The top four countries that published rehabilitation guidelines were the United States (19 articles), China (17 articles), the United Kingdom (12 articles) and Canada (11 articles). The guidelines were developed mainly by the health professional societies and associations (49 articles). The main health conditions involved stroke (12 articles), cardiovascular disease (9 articles), shoulder joint injury (5 articles), pulmonary disease (5 articles) and spinal cord injury (5 articles). There were 35 guidelines expressiong evidence classification and recommendation intensity (42%), and 22 guidelines (26%) would update regularly.Conclusion Clinical practice guidelines of rehabilitation focuse on neurological and musculoskeletal system diseases and cardiopulmonary dysfunction. There are relatively few published clinical practice guidelines for rehabilitation. Most guidelines are based on literature review or expert opinions, while a few are evidence-based. It is proposed to implement standardized approaches to develop clinical practice guidelines of rehabilitation.

Surgical treatment for distal humerus type C fractures / 中国骨伤

Distal humerus type C fracture is a rare and complicated intra-articular injury. Non-surgical treatment is difficult to achieve accurately reduction and reconstruction of articular surface, while open reduction and internal fixation is the best treatment option. Olecranon osteotomy could provide adequate surgical exposure, and is the most commonly used surgical method, but complications such as non-union osteotomy, internal fixation failure occurred. To avoid sacrificing integrity of olecranon, paratricipital approach, triceps reflecting approach, triceps reflectin ganconeus pedicle approach, triceps splitting and triceps tongue-shaped flap approach have been applied to fracture revealed. However, there is a certain contradiction of choice between surgical exposure and extension function of elbow due to limitations of different approaches. With the promotion of "double-column" theory, double plates has significant mechanical advantages over single plates. Even if parallel double-plate has more advantageous than vertical double-plate in vitro biomechanical experiments, it is not clear whether there is any difference between two methods in clinical application. Elbow arthroplasty may be the final choice for C-type fractures that could not be reconstructed on articular surface, but its long-term efficacy remains to be observed due to technical limitations.

Inhibitory effect of kaempferol on inflammatory response of lipopolysaccharide-stimulated human mast cells / 药学学报

This study is to investigate the inhibitory effect of kaempferol on inflammatory response of lipopolysaccharide(LPS)-stimulated HMC-1 mast cells. The cytotoxicity of kaempferol to HMC-1 mast cells were analyzed by using MTT assay and then the administration concentrations of kaempferol were established. Histamine, IL-6, IL-8, IL-1β and TNF-α were measured using ELISA assay in activated HMC-1 mast cells after incubation with various concentrations of kaempferol (10, 20 and 40 µmol.L-1). Western blot was used to test the protein expression of p-IKKβ, IκBα, p-IκBα and nucleus NF-κB of LPS-induced HMC-1 mast cells after incubation with different concentrations of kaempferol. The optimal concentrations of kaempferol were defined as the range from 5 µmol.L-1 to 40 µmol.L-1. Kaempferol significantly decreased the release of histamine, IL-6, IL-8, IL-1β and TNF-α of activated HMC-1 mast cells (P<0.01). After incubation with kaempferol, the protein expression of p-IKKβ, p-IKBa and nucleus NF-κB (p65) markedly reduced in LPS-stimulated HMC-1 mast cells (P<0.01). Taken together, we concluded that kaempferol markedly inhibit mast cell-mediated inflammatory response. At the same time, kaempferol can inhibit the activation of IKKβ, block the phosphorylation of IκBα, prevent NF-KB entering into the nucleus, and then decrease the release of inflammatory mediators.

Case-control studies on complex tibial plateau and posterior condylar fractures treated through combined anterior-posterior (small incision or micro-incision) approach / 中国骨伤

<p><b>OBJECTIVE</b>To study the therapeutic effects of combined anterior-posterior (small incision or micro-incision) approach for complex tibial plateau and posterior condylar fractures.</p><p><b>METHODS</b>From 2000 to 2008, 79 patients (81 limbs) with complex tibial plateau and posterior condylar fractures were reviewed. There were 45 males and 34 females, ranging in age from 19 to 66 years, with an average of 40.6 years. Thirty-nine limbs were treated using small incision through combined anterior-posterior approach, in which 13 limbs were Schatzker type IV, 15 limbs were type V ,and 11 limbs were type VI. Other 42 limbs were treated using micro-incision through combined anterior-posterior approach, in which 18 limbs were Schatzker type IV, 16 limbs were type V, and 8 limbs were type VI. The Rasmussen scores for knee joint and radio scores were used to evaluate therapeutic effects after the treatment. The complications such as cutaneous necrosis and incision infection were observed.</p><p><b>RESULTS</b>All the patients were followed up. According to Rasmussen criterion, in small incision group, 16 limbs got an excellent result, 13 good, 7 fair and 3 bad; in micro-incision group,above data were 19, 11, 8 and 4 respectively. Comparison between the two groups, P = 0.924. Comparison of complications such as cutaneous necrosis and incision infection: in small incision group,10 limbs had the complications, and in micro-incision group were 4 limbs; the occurrence rate of small incision group were higher than that of micro-incision group (P = 0.047).</p><p><b>CONCLUSION</b>There are no significant differences between the two groups in the knee joint function rehabilitation; however, there is smaller rate for cutaneous necrosis and incision infection in micro-incision group.</p>