GRADE in Systematic Reviews of Acupuncture for Stroke Rehabilitation: Recommendations based on High-Quality Evidence.

Systematic reviews (SRs) of randomized controlled trials (RCTs) have demonstrated acupuncture's effectiveness in stroke rehabilitation. The current study reviews the quality of evidence in SRs of acupuncture in stroke rehabilitation, and rates the strength of recommendation for its use based on this evidence using the GRADE (grading of recommendations, assessment, development and evaluations) approach. A comprehensive literature search was performed using multiple databases (e.g., Medline, Embase) with advanced search strategies. Two authors independently selected articles, collected data, and assessed the methodological quality of each identified SR according to AMSTAR (a measurement tool to assess systematic reviews) and OQAQ (Oxman and Guyatt's overview quality assessment questionnaire). Outcomes related to stroke rehabilitation were evaluated. SRs of high methodological quality (AMSTAR score ≥9 and OQAQ score ≥7) were graded using GRADE. Ultimately, acupuncture yields benefits in stroke rehabilitation (neurological function improvement: RR = 1.34; swallowing improvement: RR = 1.61, 1.49, 1.07; disability: SMD = 0.49 or 0.07). Poor evidentiary quality and insufficient information about harm led to weak recommendations. In conclusion, acupuncture may improve stroke rehabilitation, as the GRADE approach indicated a weak recommendation for acupuncture's usage in this context.

Effects of eight environmental endocrine disruptors on insulin resistance in patients with polycystic ovary syndrome: a preliminary investigation / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the relationship between 8 endocrine-disrupting chemicals in the serum and insulin resistance in patients with polycystic ovary syndrome (PCOS).</p><p><b>METHODS</b>This study was conducted among 60 patients with PCOS, including 23 with insulin resistance (PCOS-IR) and 37 without insulin resistance (PCOS-NIR), and 29 non-PCOS women seeking medical attention for infertility or menstrual disorder (control group). The serum levels of 6 phthalic acid esters (PEAs), bisphenol A (BPA) and octylphenol (OP) were measured in all the subjects.</p><p><b>RESULTS</b>The levels of PAEs, BPA and OP showed no significant differences between PCOS patients and the control group (P>0.05). The serum level of OP was significantly lower in patients PCOS-IR than in those with PCOS-NIR (47.89 ng/ml vs 60.24 ng/ml, P<0.05).</p><p><b>CONCLUSION</b>PEAs and BPA do not produce obvious effect on the pathogenesis of PCOS or contribute to insulin resistance, but OP may play a role in insulin resistance in PCOS patients.</p>

Methodological quality assessment of systematic reviews correlated to traditional Chinese medicine published in China / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To assess the methodological quality of systematic reviews or Meta-analysis of traditional Chinese medicine published in China, and to validate the applicability of OQAQ (Overview Quality Assessment Questionnaire) and AMSTAR (a measurement tool to assess systematic reviews) in traditional Chinese medicine (Chinese Medical).</p><p><b>METHODS</b>Comprehensive literature retrieve was performed in CBM, CNKI, VIP as well as hand searching in Chinese Journal of Evidence-Based Medicine. The retrieve was started from January 1, 1999 and terminated by December 2008. The methodological quality of traditional Chinese medicine correlated systematic reviews was evaluated using OQAQ and AMSTAR simultaneously.</p><p><b>RESULTS</b>A total of 115 systematic reviews involved 17 types of diseases, of which, the cardio-/cerebrovascular diseases was dominant (36 papers, 31.30%). The mean OQAQ score was 2.50 (95% CI: 2.22, 2.76). No significant correlation was found in OQAQ score with publication year (P = 0.35) and different disease types (P = 0.28). High consistency was observed in evaluations of systematic reviews by using OQAQ and AMSTAR (both Kappa values > 0.75). Compared with the OQAQ, AMSTAR incorporated 3 additional items: the topics, publication bias, and conflict of interest, etc. Although 98.26% of systematic reviews proposed protocols in prior, 53.04% failed to analyze the publication bias. Besides, 57.39% neglected to address the potential conflict of interest.</p><p><b>CONCLUSIONS</b>Poor methodological quality in systematic reviews of Chinese Medical published in China needs to be improved and emphasized. It is necessary to integrate the special characteristics of traditional Chinese medicine itself when choosing topics of systematic reviews. It is essential to establish quality assessment tools targeting systematic reviews of traditional Chinese medicine.</p>

Reliability and validity regarding the Chinese version of the International Physical Activity Questionnaires (long self-administrated format) on women in Chengdu,China / 中华流行病学杂志

Objective To test the reliability and validity of International Physical Activity Questionnaires (long self-administrated format)( IPAQ), Chinese version on women of 12-44 years old, in Chengdu city. Methods Clustered sampling was used, according to the age distribution of investigated population. One community, one university and two middle schools (including one high school and one junior high school) in Chengdu were selected. The reliability study was conducted in a 28-day period.Participants were contacted three times within 28 days (on the 1st , the 8th and the 28th day respectively).In the validity study, participants completed the same questionnaire and Bouchard physical activity diary(PA diary) each day for seven days between visit 1 and visit 2 before comparing the IPAQ's result with Bouchard physical activity diary's for validity study. Pearson or Spearman' correlation coefficients were calculated for validity and interclass correlation coefficients for reliability according to date distribution.Results (1)One hundred and eighty six participants were recruited for the reliability study. All of them completed the first questionnaire with 143(76.88%) and 172 (92.50%) finished the second and third questionnaires. One hundred and fifty eight participants were recruited in the validity study. Qualified questionnaire accounted for 90.59 % (143). (2) Results from the test-retest reliability of the Chinese version of long self-administrated format (IPAQ) showed: the ICC after one week ranged from 0.7373 to 0.972(mean:0.870) which were higher than those interval's reliability [ ICC= 0.472-0.948 for three weeks interval (mean:0.721), and 0.473-0.925 for four weeks interval (mean:0.696)]. The ICCs of three weeks interval and four weeks interval were not significantly different. ICCs for vigorous physical activity and leisure time physical activity were the best. (3)The validity for different intensity, total physical activity and sitting time showed the correlation coefficients between IPAQ and PA diary ranged from 0.445 to 0.696, with correlation for vigorous physical activity the best (r=0.696). Conclusion IPAQ-C seemed a reliable and validated measure of physical activity for 12-44 year-old women in Chengdu city.

Evidence grading system and its usage in clinical decision-making analysis / 中华流行病学杂志

<p><b>OBJECTIVE</b>To explore feasibility of applying evidence grading system in clinical decision-making analysis.</p><p><b>METHODS</b>Using grading system as well as a quantitative approach to generate the threshold NNT((T)), and conducting clinical decision-making analysis through one study on Asymptomatic carotid atherosclerosis.</p><p><b>RESULTS</b>NNT((T)) was 12, comparing with no-intervention in the ACA study that NNT = 6. NNT < NNT((T)) indicated the benefits of intervention outweigh the risks and costs.</p><p><b>CONCLUSION</b>To obtain the rate of adverse event and the specifying approximate cost were vital in the process of applying grading system in clinical decision-making.</p>