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Objective To systematically evaluate the efficacy of different analgesic methods in re-lieving the pain in hip and femoral shaft fractures patients during spinal anesthesia position by using network meta-analysis.Methods The articals of randomized controlled trials(RCTs)that analgesia was performed in patients with hip and femoral shaft fractures during the spinal anesthesia position placement were retrieved from the following database from the establishment of the database to August 2022,PubMed,the Cochrane Library,Web of Science,EMbase,China Biology Medicine(CBM),CNKI,VIP,and Wanfang databases.Literature screening,data extraction and bias risk assessment were conducted by two researchers separately.Stata 17.0 and RevMan 5.3 software were used for statistical analysis.Results A total of 28 RCTs with 1 773 patients were included.The surface under the cumulative ranking(SUCRA)curve showed that and PENG block(94.4%)had the best effect on reducing the VAS pain score of placement position,followed by FIBcombinedwith IVA(83.8%)and FIB(71.1%),and PENG block(98.2%)had the best effect on reducing VAS pain score during spinal anesthesia,followed by FIB(71.1%)and FNB(55.6%),and PENG block(84.1%)had the best effect on shortening the time of spinal anesthesia operation,followed by FNB(70.7%)and FIB(68.5%),and PENG block(99.1%)had the best effect on improving the quality of positioning,followed by FIB(73.1%)and FNB(52.9%).Conclusion Nerve blocks or the combina-tion with IVA can reduce pain scores during position placement and spinal anesthesia,shorten anesthesia operation time,and improve quality of position placement in patients with hip and femoral shaft fractures.PENG block has the best analgesic effect in patients with hip or femoral shaft fractures during positioning and spinal anesthesia.
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Objective To analyse the impact of the reform of the payment method according to disease DRG on the level and structure of the average hospital inpatient costs of hypertensive patients,and to provide a reference for hospitals to fine-tune their management and improve their health insurance payment policies.Methods Data on the hospitalization expense of patients with hypertension was collected a Grade-III tertiary general hospital in Xinjiang Province during September 2020-August 2021 and September 2021-August 2022.The New gray correlation anglysis and Structural variation analysis were used to analyze the structural changes and mutual relationship of the average hos-pitalization expense.Results There is a significantly decrease on the average hospitalization expense of patients with hypertension.The structural variation degree of the average hospitalization expense in FV23 and FV25 were 25.42%and 6.20%respectively.The top two factors affecting the contribution rate of structural change were the inspection fee and clinical laboratory test fee.The cumulative contribution rate of the factors including inspection fee,materials fee,clinical laboratory fee and drugs fee was 95.94%in FV23.The cumulative contribution rate of clinical laboratory test fee and treatment fee was 69.03%in FV25.Conclusion The average hospitalization expense of patients with hy-pertension disease has been effectively controlled.The inspection fee and clinical laboratory test fee were still the main factors affecting the average hospitalization expense.The management mode of day care unit can improve the payment efficiency of medical insurance funds.It's necessary to pay attention to the cost that reflects the value of medical staff's technical labor service.
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Art therapy plays an important role in enhancing the emotional expression of patients, treating mental and psychological diseases, and promoting the recovery of cancer patients.Due to its extensive meaning and various intervention measures, strengthening the guidance and monitoring of art therapy are important in improving the medical quality of related fields.Clinical practice guidelines are important tools to guide and standardize medical behavior, and also are important guarantees for the implementation effect of medical behavior.Therefore, this article will summarize the current situation of art therapy guidelines, and on this basis, reflect on the formulation and implementation of relevant guidelines and recommendations.
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Perineal tear is a common complication of vaginal delivery and will seriously affect the quality of life of these women, if is severe. Given to there was no evidence-based clinical guideline for the prevention and management of perineal tear in China, this evidence-based guideline was developed, based on the methods of WHO handbook for guideline development. Systematic reviews were conducted according to the Cochrane handbook and GRADE was used to assess the quality and certainty of the evidence. Detailed recommendations are provided for 19 clinical questions in the prevention and management of perineal laceration, aiming to guide clinical practice and improve the quality of life of this group of women.
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Objective:To analyze the research status of umbrella review by bibliometric methods.Methods:The citation search was performed via Web of Science Core Collection database to obtain studies on umbrella review from inception to December 31, 2021. VOSviewer1.6.16 was used to extract the included authors, countries, institutions and keywords, and generate the cooperative network graph of high-productivity authors, countries, institutions, and clustering graph of high-frequency keywords. CiteSpace5.7.R5W was used to detect burst terms.Results:A total of 755 articles or reviews were included. The quantity of studies had been increasing over time. The United Kingdom was the country with the most published papers (297), and the University of College London was the institution with the most published papers (77). A total of 3 863 authors participated in the umbrella review research, of which Solmi M had the largest number of papers with 28 papers published. The main authors formed three groups, with little cooperation between the groups. Research hotspots focused on chronic diseases such as cardiovascular disease, diabetes, cancer, mental health and its health management. Besides, diabetes, heart failure and Mediterranean diet were the frontier fields.Conclusions:Umbrella review is in the development stage, and the amount of studies is increasing. The United Kingdom is in a leading position in this field. The members of each team work closely together, but there is a lack of cross-team cooperation. Chronic diseases and their management are currently research hotspots and key research contents.
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Based on literature research and Delphi expert consensus method, the important acupoints for cancer pain was summarized to provide evidence basis for the formulation of
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Humanos , Pontos de Acupuntura , Terapia por Acupuntura , Dor do Câncer/terapia , Meridianos , Neoplasias/terapia , PublicaçõesRESUMO
In order to standardize the clinical diagnosis and treatment decision-making with traditional Chinese medicine for pa-tients of coronavirus disease 2019(COVID-19) and put the latest clinical study evidence into clinical practice, the international trust-worthy traditional Chinese medicine recommendations( TCM Recs) working group started the compilation of Living Evidence-based Guideline for Combination of Traditional Chinese and Western Medicine for Treatment of COVID-19 on the basis of the standards and re-quirements of WHO handbook, GRADE and RIGHT. This proposal mainly introduces the formulation methods and processes of the living guidelines in details, such as the composition of the working group, the collection and identification of clinical issues and out-comes, the production of the living systematic review and the consensus of recommendations. The guidelines will continue to monitor the clinical study evidences of TCM in the prevention and treatment of COVID-19, and conduct regular evidence updating, retrieval and screening. When there is new study evidence, the steering committee will evaluate the possibility of the evidence to change clinical practice or previous recommendations, so as to decide whether the recommendations for the guidelines shall be implemented or upda-ted. The main criteria considered in the guideline updating are as follows:(1) There are new high-quality randomized controlled trial(RCT) evidences for TCM uninvolved in the previous edition of the guidelines;(2) as for the TCM involved in the guidelines, living sys-tematic review shows that new evidence may change the direction or strength of the existing recommendations. The specific implementation of the living evidence-based guidelines will take this proposal as the study basis and framework, in order to ensure the standardization of the formulation process and methods. This will be the first exploration of the methodology for living guidelines in the field of TCM.
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Humanos , COVID-19/terapia , China , Medicina Baseada em Evidências , Medicina Tradicional Chinesa , Guias de Prática Clínica como Assunto , SARS-CoV-2RESUMO
Objective Antibody drugs are one of the hot topics in biomedical research.This study aims to develop egg yolk antibodies (IgYs) against human isomaltase and determine their biological activities.Methods The purified recombinant isomaltase protein was used as an antigen to immunize egg-laying hens in combination with complete Freund adjuvant (CFA).Anti-isomahase IgYs were extracted by water dilution-sodium sulfate extraction assay and further analyzed for their purity,specificity,titer and stability by SDS-PAGE,Western blot and ELISA respectively,and their inhibitory effect on human alpha-glycosidase enzymes was evaluated by the PNPG method.Results Anti-isomaltase IgYs were obtained,with a titer of 1 ∶ 12800,capable of specifically binding human isomaltase,and with a good thermal stability,acid/alkali stability and pepsin resistance.Conclusion Anti-human isomaltase IgYs were successfully prepared,which may provide an experimental ground for further investigation of oral antihyperglycemic agents for type Ⅱ diabetes mellitus.
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Objective To explore the impact of smoking on coronary plaque characteristics on optical coherence tomography(OCT) in young patients with acute coronary disease(ACS).Methods We assessed the atherosclerotic plaque characteristics and vulnerability by OCT and coronary angiography in 60 ACS patients aged 45 years or younger in Beijing Anzhen Hospital, from June 2014 to June 2017. The patients were divided into the smoking group(n=33) and the non-smoking group(n=27) to compare the plaque characteristics and vulnerability.Results Smoking patients showed a less extent of fibrosis(48.55%vs. 77.8%,P=0.032)and microchannels(18.2%vs. 44.4%,P=0.033), and a greater extent of plaque rupture (24.2%vs. 3.7%,P=0.033) compared with non-smoking patients. In multivariate analysis, smoking was the only independent predictors of plaque rupture(OR 8.320, 95%CI 0.969-71.435,P=0.027) and less fibrosis (OR 0.269, 95%CI 0.086-0.837,P=0.020). Conclusions Patients who are smokers have less extensive fibrosis and a greater extent of plaque rupture, showing more extensive vulnerable plaque phenotype. Therefore, smoking is one of the major risk factors of advanced cardiovascular events in young patients.
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To assess the clinical efficacy of Chinese medical injection (CMI) for heart failure by using network Meta-analysis method. The relative randomized controlled trials (RCTs) of CMI for heart failure were retrieved from China National Knowledge Infrastructure (CNKI), WanFang Database, Chinese Biomedical Literature Database (SinoMed), PubMed, Cochrane Library and EMbase in July 2017. RCTs on the comparison of two kinds of CMIs for heart failure were included. Two researchers independently completed the literature screening, data extraction and quality evaluation according to the pre-determined inclusion and exclusion criteria, and the results were crossed checked. The data were analyzed by Win Bugs, and STATA software was used for plotting. Finally, 13 RCTs were included, involving 5 kinds of CMIs and 1 538 patients. According to the quality evaluation, the appropriate random dividing methods were reported in only two RCTs, double-blindness was used in only one RCT, and even none of the RCTs mentioned allocation concealment. Network Meta-analysis showed that Shenmai injection had the greatest effect in the clinical efficacy for patients with heart failure, which was followed by Shenfu Injection. However, Shenfu Injection was most effective in improving the patients' left ventricular ejection fraction (LVEF), which was followed by Shenmai Injection. Therefore, Shenfu Injection and Shenmai Injection had certain advantages in treating heart failure. However, due to the limited sample size and the poor literature quality, more studies were required to verify the strength of evidence. We suggest that further studies shall pay more attention to the improvement of the methodological quality, increase the follow-up period, and strengthen the observation of cardiovascular end points.
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Objective To assess the abstracts on randomized controlled trials ( RCT) in non-small cell lung cancer ( NSCLC) published in Chinese and their influencing factors.Methods RCT in NSCLC published in Chinese were included according to the CONSORT statement and their influencing factors were analyzed by RevMan 5.3 soft-ware.Results The titles were identified as random, randomization, blinding, statistical method, recruited partici-pants, trial registry and fund-supported, respectively, in 20%of the 2677 abstracts included in this study.Con-clusion The titles are identified as random, randomization, blinding, statistical method, recruited participants, trial registry and fund-supported in RCT published in Chinese.Although the abstracts are improved after the publication of CONSORT, they need to be further brushed up.
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Objective To assess the methodological and ethical quality of randomized controlled trials (RCT) of non-small cell lung cancer ( NSCLC ) in China. Methods The methodological and ethical quality on RCT of NSCLC, covered in CBM, CNKI, VIP and Wanfang was assessed according to the Jadad Scale and Berdeu Scale respectively. Results The average methodological and ethical quality was 62. 24% according to the Jadad Scale and was 18. 79% according to the Berdeu Scale. Correlation analysis showed that the methodological quality was closely correlated with the ethical quality, except that of curative effect of invasive therapy (OR=1. 064, 95%CI:0. 832-1. 361, P>0. 05). Conclusion The methodological and ethical quality of RCT of NSCLC in China is low. The methodological quality is positively correlated with the ethical quality.
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Objective: Curcumin nanoparticles lyophilized powder (CNLP) were prepared by antisolvent method which was optimized using single factor method. In this process, acetone was used as solvent, deionized water was used as antisolvent, tween-80 was used as surfactant and mannitol was used as lyoprotectant. Methods: The main factors affecting the particle size of CNLP included the concentration of curcumin, volume ratio of solvent and antisolvent, dosage of surfactant, precipitation time, stirring speed, and dosage of lyoprotectant. The contrast experiments on dissolution in vitro was done between CNLP and raw curcumin powder. Results: The mean particle size of CNLP was (172.2 ± 4.6) nm; The Zeta potential of CNLP redissolving in water was (-19.7 ± 3.7) mV. The SEM graphs indicated the raw curcumin was in irregular and massive shape and its particle size was about 20 μm. The CNLP exhibited regular block structure and its particle size was about 170 nm which was obviously reduced compared with raw curcumin. The mean particle size of CNLP obtained from laser particle analyzer was in accord with the morphology of CNLP. The saturated solubility of CNLP was 41.32 times of raw curcumin powder in deionized water, 1.74 times in simulated gastric fluid and 4.11 times in simulated intestinal fluid through saturated solubility test, respectively. The dissolution rate of CNLP was 14.51 times of raw curcumin powder in water dissolution medium, 2.33 times in simulated gastric fluid and 44.79 times in simulated intestinal fluid through dissolution determination, respectively. Conclusion: The preparation process of CNLP using antisolvent method could improve the drawback of poor water solubility and enhance the bioavailability of curcumin.
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To assess the clinical effect and safety of Chinese traditional medicine injection combined with radiotherapy for esophageal cancer. The relative randomized controlled trials (RCTs) of Chinese medical injections (CMI) combined with radiotherapy as well as simple radiotherapy for esophageal cancer were searched from PubMed, Cochrane Library, EMBASE, Chinese Biomedical Literature Database(CBM), China National Knowledge Infrastructure (CNKI), Wanfang Database and VIP Database as at September 2014. Two researchers completed the data extraction and quality evaluation independently. The data were analyzed by GeMTC 0.14.3 and Stata 12. 0 software. Finally, 43 RCTs involving 3 289 patients were finally included. The star network was constructed by different comparison groups. The results of network meta-analysis showed that the seven CMIs combined with radiotherapy was superior to simple radiotherapy in the treatment of esophageal cancer in efficacy, quality of life, and reduction in the incidence of nausea and leucopenia, but with no significant difference among the seven CMIs. Probability ranking result showed a great possibility for Shenqi Fuzheng and astragalus polysaccharide injections in improving the overall response rate and quality of life, which were followed by cinobufagin and kangai injections. However, only one study was included for Shenqi Fuzheng and astragalus polysaccharide injections. Therefore, cinobufagin or kangai injections were preferred in improving the overall response rate and quality of life. Aidi or compound sophora injections were better than other CMIs in reducing? the incidences of nausea (III-IV) and leukopenia. More RCTs of Shenqi Fuzheng and astragalus polysaccharide injections combined with radiotherapy for patients with esophageal cancer were expected in the future to confirm our results. Moreover, study findings will be reported, particularly for the adverse events in radiotherapy for esophageal cancer.
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Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Terapia Combinada , Medicamentos de Ervas Chinesas , Neoplasias Esofágicas , Tratamento Farmacológico , RadioterapiaRESUMO
Objective To assess the CSCD-covered 7 journals of pediactrics.Methods The average number of refe rences,cited half life, H index, citation half life, self citation, IF, immediate index, self-cited rate of each paper pub-lished in 2013 in 7 journals of pediactric, covered in China Science and Technology Journal Citation Index Database, were divided into positive correlation group and negative correlation group.Their Spider Web maps were plotted.The papers published in the 7 journals of pediactrics were assessed.Results The top 3 journals, assessed according to the average number of references, IF, and immediate index, were Chinese Journal of Pediatrics,Chinese Journal of Prac-tical Pediatrics, and Chinese Journal of Evidence-based Pediatrics while the top 3 journals, assessed according to their citation half life , self citation, cited half life, and self cited rate, were Chinese Journal of Evidence-based Pe-diatrics,Chinese Journal of Pediatrics, and Journal of Clinical Pediatrics.Conclusion The academic level of the 7 journals of pediatrics is rather high.Chinese Journal of Evidence-based Pediatrics and Chinese Journal of Pediatrics have the highest assessment score.There is a large room for the other 4 journals to improve their academic level.
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Objective To assess the effect of PRISMA statement on intervention-related systematic reviews and meta-analyses published in Evidence-based medicine .Methods Intervention-related systematic reviews and meta-analyses published in Evidence-based medicine from 2001 to 2011 were assessed according to the PRISMA scale and analyzed by Meta Analysist software.Results Seventy intervention-related systematic reviews and meta-analyses involving 14-disease spectra were included in this study.PRISMA statement and systematic reviews and meta-analysespublished by au-thors in colleges and universities could improve their academic level (P<0.05), fund support and the number of authors showed no significant effect on their academic level.Conclusion Literature retrieval methods,literature screening methods,bias assessment methods, and other analyzing methods used systematic reviews and meta-analyses published in Evidence-based medicine and their academic level can be improved by PRISMA statement.
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Objective To assess the academic level of papers on systematic reviews and meta-analysis published in Chinese Journal of Pediatricsand methodology they used.Methods Basic data were extracted from 13 papers on sys-tematic reviews and meta-analysis published in Chinese Journal of Pediatrics .The methodology they used was assessed according to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) and ANSTAR Scale and analyzed using the RevMan5.0.Results The PRISMA score was 14-23.5 (mean 20.0±3.11) and the AMSTAR score was 3-7.5 (mean 6.04±1.38) for the methodology used in papers on systematic reviews and meta-analysis published in Chinese Journal of Pediatrics .Conclusion The methodology used in papers on systematic reviews and meta-analy-sis published in Chinese Journal of Pediatrics is not quite valid and should thus be improved .
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Objective To assess the methodology of papers on systematic reviews and meta-analysis of interventions published in Journal of Evidence-Based Medicine .Methods Basic data were extracted from 70 papers on systematic reviews and meta-analysis of interventions published in Journal of Evidence-Based Medicinefrom 2001 to 2011 .Methodology used in these papers was assessed according to the AMSTAR Scale.The data were input into the Excelland analyzed using the SPSS7.0 and Meta-Analyst software.Results The methodology used in 34 papers (48.6%) was assessed using the Cochrane bias risk assessment tools.Fund support, number of authors and their affiliated institutions did not sig-nificantly affect the total score of methodology used in the 70 papers .Conclusion The methodology used in papers on systematic reviews and meta-analysis of interventions published in Journal of Evidence-Based Medicine is not quite valid as its early design program and retrieval strategies are imperfect , and it does not provide the excluded literature list and the interest conflict.
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<p><b>OBJECTIVE</b>To study diagnosis and therapeutic efficacy of transient oeteoporods of the hip (TOH).</p><p><b>METHODS</b>From January 2005 to February 2010, 5 patients with TOH were treated with traditional methods. All the patients were male, with an average age of 38.6 years (ranged, 27 to 46 years). The clinical manifestation, physical examination and imageology characteristic was investigated. The therapeutic efficacy was evaluated by Harris hip score.</p><p><b>RESULTS</b>All the patients were followed up, the duration ranged from 12 to 36 months (averaged, 24 months). The Harris hip score before treatment were 63.1, 86.0, 74.9, 63.6 and 64.8 respectively, while after 6 months treatment, the scores improved to 90.5, 94.5, 89.7, 93.9 and 87.8 respectively. Moreover, 6 months later, the abnormal signal disappeared in MR imaging and X-ray.</p><p><b>CONCLUSION</b>Transient osteoporosis of the hip is a self-resolving condition and a self-limited disease, the expectant treatment is useful for it.</p>
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Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Articulação do Quadril , Imageamento por Ressonância Magnética , Osteoporose , Diagnóstico , Terapêutica , Estudos RetrospectivosRESUMO
<p><b>BACKGROUND</b>Dual anti-platelet treatment with aspirin and clopidogrel is established foundation for patients undergoing percutaneous coronary intervention (PCI) to prevent thrombotic events. The present study was conducted to examine whether the CYP2C19 681G > A polymorphism and cigarette smoking had independent or interactive effect on response to clopidogrel.</p><p><b>METHODS</b>Among 722 Chinese Han patients undergoing elective coronary stent placement due to stable angina pectoris, a loading dose of 300 mg clopidogrel was given to all patients and a daily maintenance dose of 75 mg for a minimum of 12 months. CYP2C19 681G > A polymorphism was genotyped. The platelet reactivity was measured by light transmittance aggregometry (LTA) with 5 µmol/L adenosine diphosphate (ADP) induced. The poor response was defined as 10% or less absolute difference between aggregation at baseline and 24 hours after loading dose of clopidogrel.</p><p><b>RESULTS</b>The results showed that the poor-response to clopidogrel was presented in 105 patients (14.5%). Overall, the genotype GA/AA carriers were likely to be poor-responsive cases (19.6% vs. 11.0%, P = 0.001) with odds ratio (OR) of 1.971 (95%CI: 1.296 - 2.998, P = 0.002), compared with the GG homozygotes. Meanwhile, compared with nonsmokers, the smokers showed lower rate of poor-response (10.9% vs. 17.3%, P = 0.015) with OR of 0.582 (95%CI: 0.374 - 0.904, P = 0.016). The smokers with GG genotype had the lowest risk with OR of 0.487 (95%CI: 0.246 - 0.961, P = 0.038) while nonsmokers with GA/AA genotype had the highest risk of poor-response with OR of 1.823 (95%CI: 1.083 - 3.068, P = 0.024), compared with nonsmokers with GG genotype. However, there was no significant interaction between genotype and smoking.</p><p><b>CONCLUSION</b>Our study indicated that both CYP2C19 polymorphism and smoking independently affected response to clopidogrel.</p>