BACKGROUND The standard management of autoimmune hepatitis(AIH)is based on corticosteroids,alone or in combination with azathioprine.Second-line treatments are needed for patients who have refractory disease.However,h...BACKGROUND The standard management of autoimmune hepatitis(AIH)is based on corticosteroids,alone or in combination with azathioprine.Second-line treatments are needed for patients who have refractory disease.However,high-quality data on the alternative management of AIH are scarce.AIM To evaluate the efficacy and safety of tacrolimus and mycophenolate mofetil(MMF)and the quality of evidence by using the Grading of Recommendations Assessment,Development and Evaluation approach(GRADE).METHODS A systematic review and meta-analysis of the available data were performed.We calculated pooled event rates for three outcome measures:Biochemical remission,adverse events,and mortality,with their corresponding 95%confidence intervals(CI).RESULTS The pooled biochemical remission rate was 68.9%(95%CI:60.4-76.2)for tacrolimus,and 59.6%(95%CI:54.8-64.2)for MMF,and rates of adverse events were 25.5%(95%CI:12.4-45.3)for tacrolimus and 24.1%(95%CI:15.4-35.7)for MMF.The pooled mortality rate was estimated at 11.5%(95%CI:7.1-18.1)for tacrolimus and 9.01%(95%CI:6.2-12.8)for MMF.Pooled biochemical remission rates for tacrolimus and MMF in patients with intolerance to standard therapy were 56.6%(CI:43.4-56.6)vs 73.5%(CI:58.1-84.7),and among non-responders were 59.1%(CI:48.7-68.8)vs 40.8%(CI:32.3-50.0),respectively.Moreover,the overall quality assessments using GRADE proved to be very low for all our outcomes in both treatment groups.CONCLUSION Tacrolimus and MMF are in practice considered effective for patients with AIH who are non-responders or intolerant to first-line treatment,but we found no high-quality evidence to support this statement.展开更多
Technological developments that specifically address automation,compliance with environmental regulations,and hazard avoidance have accelerated more quickly than other drilling and completion technologies in the Unite...Technological developments that specifically address automation,compliance with environmental regulations,and hazard avoidance have accelerated more quickly than other drilling and completion technologies in the United States.This brief article provides a review of areas experiencing some of the most dramatic advances,while describing the need and addressing the solutions as they are now,and how they can be developed in the future.One aspect that all the new technologies have in common is an enhanced use of data analytics and in many cases,cloud-based solutions.A challenge that all have is a need to be able to quickly accommodate rapidly evolving requirements for emissions detection,hazard monitoring,and a reduced carbon footprint.Many solutions to the challenges require the ability to repurpose existing databases and use them for new purposes.展开更多
Dalbergia odorifera is particularly scarce,and the D. odorifera furniture and commercial raw materials on the market are mainly old furniture and agricultural tools,as well as commercially collected D. odorifera logs....Dalbergia odorifera is particularly scarce,and the D. odorifera furniture and commercial raw materials on the market are mainly old furniture and agricultural tools,as well as commercially collected D. odorifera logs. The logs and high-grade furniture made from D. odorifera are extremely expensive. It takes several decades for D. odorifera to grow into wood. At present,there is only a small area of newly planted and regenerated forest,and the planting area of D. odorifera is about 15 000 ha in Hainan Island,distributed in the low altitude area of Hainan Island. It is suggested that Hainan D. odorifera island should be built through the transformation of low-yielding forest land,the use of wasteland and marginal cultivated land,land around houses,green belt and roadside land for the cultivation of D. odorifera,and the development area can be up to 100 000-150 000 ha. It is necessary to mobilize farmers to revitalize the rural green economy,plant D. odorifera,beautify the environment,and increase the economic resources of rural trees; actively publicize the legal nature and obligation of D. odorifera protection,and create a strong atmosphere for each family to plant and protect D. odorifera.展开更多
In order to increase the productivity of grassland animal husbandry,reduce natural disasters,curb grassland degradation and solve some problems of animal husbandry development in Inner Mongolia,we should actively deve...In order to increase the productivity of grassland animal husbandry,reduce natural disasters,curb grassland degradation and solve some problems of animal husbandry development in Inner Mongolia,we should actively develop feed shrubs.Forage forests can supplement the shortage of feed caused by seasonal difference and natural disasters in natural grasslands in winter and spring,solve the difficulties in storage and transportation of feed and shortage of funds,regulate the climate,improve the soil fertility,proof wind and fix sand,thereby promoting the benign cycle of grassland ecology.In the natural grasslands of Inner Mongolia,shrubs or small arbors such as Caragana microphylla,Caragana korshinskii Kom,Hedysarum scoparium Fisch et May,Hedysarum mongolicum Turcz,Lespedeza bicolor Turcz,Hippophae rhamnoides Linn,Ulmaceae macrocarpa Hance and Kochia prostrata(L.)Schrad can be used to create forage forests.Scientific research should be actively carried out on the harvesting and cutting period,planting scale,feeding methods and breeding of improved varieties of forage forests.展开更多
Taking Scientific Outlook on Development as the guiding principle,this paper introduced the principles of innovation,coordination,green,openness and sharing. Based on gifted advantages of selenium-enriched soil and se...Taking Scientific Outlook on Development as the guiding principle,this paper introduced the principles of innovation,coordination,green,openness and sharing. Based on gifted advantages of selenium-enriched soil and selenium-enriched industry development in Guangxi,it discussed current practice,stressed green,ecological,characteristic demonstration,transformation and upgrading,and targeted poverty alleviation. Finally,it came up with perspective,practical,and operational strategies and recommendations for development of selenium-enriched industry,to provide reference for sustainable development of selenium-enriched functional industry in Guangxi.展开更多
Through the investigation of the current production situation,regional distribution,variety structure,production organization and existing problems of table grapes in Henan Province,this paper conducted an in-depth an...Through the investigation of the current production situation,regional distribution,variety structure,production organization and existing problems of table grapes in Henan Province,this paper conducted an in-depth analysis on the advantages and disadvantages of the development of table grapes industry in Henan Province.In view of the current problems and development trend,it came up with some pertinent recommendations,including transforming the concept of cultivation,adhering to the principle of"high-quality varieties,standardized cultivation,mechanized management,large-scale operation,and diversified market",strengthening brand building,and promote the integrated development of the primary,secondary and tertiary industries,so as to promote the change of table grape industry in Henan Province from"quantitative scale model"to"quality benefit model",and promote its sustainable and high-quality development.展开更多
The serious degradation of the ecological environment and the rapid expansion of stone desert have had a serious effect on the economic development of karst and rock-naked mountain areas in Southwest China. Moreover, ...The serious degradation of the ecological environment and the rapid expansion of stone desert have had a serious effect on the economic development of karst and rock-naked mountain areas in Southwest China. Moreover, these areas are still at the initial stage of industrialization, characterized by a greater significance of agriculture to the economy, face sharp contradictions among the population, the arable land and resources, and are suffering because of a shortage of investment. On the basis of this current situation, three recommendations are made in this article: "coordinating the relations among grain, ecology, population and economic development", "increasing the input of science and technology", and "adopting policies consistent with social equity in areas of poverty".展开更多
Mycophenolic acid(MPA),the active moiety of both mycophenolate mofetil(MMF)and enteric-coated mycophenolate sodium(EC-MPS),serves as a primary immunosuppressant for maintaining solid organ transplants.Therapeutic drug...Mycophenolic acid(MPA),the active moiety of both mycophenolate mofetil(MMF)and enteric-coated mycophenolate sodium(EC-MPS),serves as a primary immunosuppressant for maintaining solid organ transplants.Therapeutic drug monitoring(TDM)enhances treatment outcomes through tailored approaches.This study aimed to develop an evidence-based guideline for MPA TDM,facilitating its rational application in clinical settings.The guideline plan was drawn from the Institute of Medicine and World Health Organization(WHO)guidelines.Using the Delphi method,clinical questions and outcome indicators were generated.Systematic reviews,Grading of Recommendations Assessment,Development,and Evaluation(GRADE)evidence quality evaluations,expert opinions,and patient values guided evidence-based suggestions for the guideline.External reviews further refined the recommendations.The guideline for the TDM of MPA(IPGRP-2020CN099)consists of four sections and 16 recommendations encompassing target populations,monitoring strategies,dosage regimens,and influencing factors.High-risk populations,timing of TDM,area under the curve(AUC)versus trough concentration(C0),target concentration ranges,monitoring frequency,and analytical methods are addressed.Formulation-specific recommendations,initial dosage regimens,populations with unique considerations,pharmacokinetic-informed dosing,body weight factors,pharmacogenetics,and drug–drug interactions are covered.The evidence-based guideline offers a comprehensive recommendation for solid organ transplant recipients undergoing MPA therapy,promoting standardization of MPA TDM,and enhancing treatment efficacy and safety.展开更多
BACKGROUND Nonalcoholic fatty liver disease(NAFLD)affects more than one-quarter of the global population.Due to the lack of approved chemical agents,many patients seek treatment from traditional Chinese medicine(TCM)f...BACKGROUND Nonalcoholic fatty liver disease(NAFLD)affects more than one-quarter of the global population.Due to the lack of approved chemical agents,many patients seek treatment from traditional Chinese medicine(TCM)formulas.A variety of systematic reviews have been published regarding the effectiveness and safety of TCM formulas for NAFLD.AIM To critically appraise available systematic reviews and sort out the high-quality evidence on TCM formulas for the management of NAFLD.METHODS Seven databases were systematically searched from their inception to 28 February 2020.The search terms included“non-alcoholic fatty liver disease,”“Chinese medicines,”“systematic review,”and their synonyms.Systematic reviews involving TCM formulas alone or in combination with conventional medications were included.The methodological quality and risk of bias of eligible systematic reviews were evaluated by using A Measure Tool to Assess Systematic Reviews 2(AMSTAR 2)and Risk of Bias in Systematic Review(ROBIS).The quality of outcomes was assessed by the Grading of Recommendations Assessment,Development and Evaluation(GRADE)system.RESULTS Seven systematic reviews were ultimately included.All systematic reviews were conducted based on randomized controlled trials and published in the last decade.According to the AMSTAR 2 tool,one systematic review was judged as having a moderate confidence level,whereas the other studies were rated as having a low or extremely low level of confidence.The ROBIS tool showed that the included systematic reviews all had a high risk of bias due to insufficient consideration of identified concerns.According to the GRADE system,only two outcomes were determined as high quality;namely,TCM formulas with the HuoXueHuaYu principle were better than conventional medications in ultrasound improvement,and TCM formulas were superior to antioxidants in alanine aminotransferase normalization.Other outcomes were downgraded to lower levels,mainly because of heterogeneity among studies,not meeting optimal information sample size,and inclusion of excessive numbers of small sample studies.Nevertheless,the evidence quality of extracted outcomes should be further downgraded when applying to clinical practice due to indirectness.CONCLUSION The quality of available systematic reviews was not satisfactory.Researchers should avoid repeatedly conducting systematic reviews in this area and focus on designing rigorous randomized controlled trials to support TCM formula applications.展开更多
This study aimed to develop a guideline for therapeutic drug monitoring（TDM） of vancomycin. We adopted the new guideline definition from the Institute of Medicine（IOM）, adhered closely to the six domains of the Ap...This study aimed to develop a guideline for therapeutic drug monitoring（TDM） of vancomycin. We adopted the new guideline definition from the Institute of Medicine（IOM）, adhered closely to the six domains of the Appraisal of Guidelines for Research ＆ Evaluation Ⅱ（AGREE Ⅱ）, and made recommendations based on systematic reviews. We established a Guideline Steering Group and a Guideline Development Group, formulated 12 questions in the form of Population, Intervention, Comparison, Outcome（PICO） and completed a literature search. As far as we know, we will develop the first evidenced-based guideline for vancomycin TDM under the framework of the Grade of Recommendations Assessment, Development and Evaluation（GRADE）.展开更多
Background:Multiple risk or protective factors for postoperative pancreatic fistula(POPF)have been suggested in the literature of surgical specialities.We aimed to map existing evidence regarding the risk factors for ...Background:Multiple risk or protective factors for postoperative pancreatic fistula(POPF)have been suggested in the literature of surgical specialities.We aimed to map existing evidence regarding the risk factors for POPF to help guide future clinical treatment.Methods:We performed an umbrella review by searching the Web of Science,PubMed,Embase,and Cochrane databases until June 19,2023.Meta-analyses(MAs)that included≥2 studies were included.Methodological quality was assessed using AMSTAR2 scores and Grading of Recommendations Assessment,Development,and Evaluation(GRADE)tools were used to quantify the strength of the evidence.Results:Of the 42 MAs,1 was rated as having high methodological quality,and 4 were rated as moderate.Among the 82 outcomes,6 were supported by high-quality evidence.Moderate-quality evidence was found for 13 outcomes.The remaining outcomes had either low-or very low-quality evidence.In pancreaticoduodenectomy(PD),protective factors for all-grade POPF include pancreaticogastrostomy(PG)[vs.pancreaticojejunostomy(PJ),moderate quality],external pancreatic ductal stent(vs.no stents,high quality).Risk factors for all-grade POPF in PD include pancreatic duct occlusion(vs.no occlusion,moderate quality)and sealant(vs.no sealant,moderate quality).Polyglycolic acid mesh[vs.no mesh,moderate quality]was a protective factor for clinically relevant POPF(CR-POPF)in PD,omental/falciform ligament wrapping(vs.no wrapping,low quality),and artery-first PD(vs.standard,low quality).In distal pancreatectomy(DP),no factors for all-grade POPF were rated as high-or moderate-quality evidence.Polyglycolic acid mesh(vs.no mesh,moderate quality)was a protective factor for CR-POPF in DP.No factors were rated as high-or moderate-quality evidence in other types of pancreatectomy.In addition,high-and moderate-quality evidence showed that there was little difference in the incidence of pancreatic fistula in PD between minimally invasive and open surgery,duct-to-mucosa and invaginated PJ,Roux-en-Y and conservative reconstruction,extended and standard lymphadenectomy,and in the incidence of pancreatic fistula in DP between fibrin sealant patch and no patch.Conclusions:This umbrella review found varying levels of evidence for the associations between different surgery-related risk factors for POPF.Given the wealth of existing evidence of relatively low quality,future research should focus on improving its credibility.展开更多
China is one of the largest countries in the world in terms of planted forests area. Planted forests play an important role in soil and water conservation, food source, timber supply and energy security, but there are...China is one of the largest countries in the world in terms of planted forests area. Planted forests play an important role in soil and water conservation, food source, timber supply and energy security, but there are still many problems waiting for immediate resolution. Based on the current development status of planted forest in China, the paper made an comprehensive analysis for the positive impact and existing problems with regard to planted forests, and then came up with policy recommendations for promoting sustainable management of planted forests, mainly including: 1) to accelerate planted forests development and improve the quality; 2) to strengthen the protection and management, and quicken the development of planted forests; 3) to enhance the scientific planning for planted forests; 4) to reinforce the management for forests harvesting so as to promote the reasonable utilization of planted forests; 5) to perfect the management system for planted forest resources and improve the managerial capacity; 6) to complete related laws and regulations and improve the policy guarantee system; 7) to reinforce the forest tenure reform and establish a sound planted forest land transference system. Finally, the paper presented the future action framework for guiding the sustainable management of planted forests in China.展开更多
文摘BACKGROUND The standard management of autoimmune hepatitis(AIH)is based on corticosteroids,alone or in combination with azathioprine.Second-line treatments are needed for patients who have refractory disease.However,high-quality data on the alternative management of AIH are scarce.AIM To evaluate the efficacy and safety of tacrolimus and mycophenolate mofetil(MMF)and the quality of evidence by using the Grading of Recommendations Assessment,Development and Evaluation approach(GRADE).METHODS A systematic review and meta-analysis of the available data were performed.We calculated pooled event rates for three outcome measures:Biochemical remission,adverse events,and mortality,with their corresponding 95%confidence intervals(CI).RESULTS The pooled biochemical remission rate was 68.9%(95%CI:60.4-76.2)for tacrolimus,and 59.6%(95%CI:54.8-64.2)for MMF,and rates of adverse events were 25.5%(95%CI:12.4-45.3)for tacrolimus and 24.1%(95%CI:15.4-35.7)for MMF.The pooled mortality rate was estimated at 11.5%(95%CI:7.1-18.1)for tacrolimus and 9.01%(95%CI:6.2-12.8)for MMF.Pooled biochemical remission rates for tacrolimus and MMF in patients with intolerance to standard therapy were 56.6%(CI:43.4-56.6)vs 73.5%(CI:58.1-84.7),and among non-responders were 59.1%(CI:48.7-68.8)vs 40.8%(CI:32.3-50.0),respectively.Moreover,the overall quality assessments using GRADE proved to be very low for all our outcomes in both treatment groups.CONCLUSION Tacrolimus and MMF are in practice considered effective for patients with AIH who are non-responders or intolerant to first-line treatment,but we found no high-quality evidence to support this statement.
文摘Technological developments that specifically address automation,compliance with environmental regulations,and hazard avoidance have accelerated more quickly than other drilling and completion technologies in the United States.This brief article provides a review of areas experiencing some of the most dramatic advances,while describing the need and addressing the solutions as they are now,and how they can be developed in the future.One aspect that all the new technologies have in common is an enhanced use of data analytics and in many cases,cloud-based solutions.A challenge that all have is a need to be able to quickly accommodate rapidly evolving requirements for emissions detection,hazard monitoring,and a reduced carbon footprint.Many solutions to the challenges require the ability to repurpose existing databases and use them for new purposes.
基金Supported by the Applied Technology Research and Development Demonstration and Extension Project in Hainan Province(ZDXM2014101)
文摘Dalbergia odorifera is particularly scarce,and the D. odorifera furniture and commercial raw materials on the market are mainly old furniture and agricultural tools,as well as commercially collected D. odorifera logs. The logs and high-grade furniture made from D. odorifera are extremely expensive. It takes several decades for D. odorifera to grow into wood. At present,there is only a small area of newly planted and regenerated forest,and the planting area of D. odorifera is about 15 000 ha in Hainan Island,distributed in the low altitude area of Hainan Island. It is suggested that Hainan D. odorifera island should be built through the transformation of low-yielding forest land,the use of wasteland and marginal cultivated land,land around houses,green belt and roadside land for the cultivation of D. odorifera,and the development area can be up to 100 000-150 000 ha. It is necessary to mobilize farmers to revitalize the rural green economy,plant D. odorifera,beautify the environment,and increase the economic resources of rural trees; actively publicize the legal nature and obligation of D. odorifera protection,and create a strong atmosphere for each family to plant and protect D. odorifera.
文摘In order to increase the productivity of grassland animal husbandry,reduce natural disasters,curb grassland degradation and solve some problems of animal husbandry development in Inner Mongolia,we should actively develop feed shrubs.Forage forests can supplement the shortage of feed caused by seasonal difference and natural disasters in natural grasslands in winter and spring,solve the difficulties in storage and transportation of feed and shortage of funds,regulate the climate,improve the soil fertility,proof wind and fix sand,thereby promoting the benign cycle of grassland ecology.In the natural grasslands of Inner Mongolia,shrubs or small arbors such as Caragana microphylla,Caragana korshinskii Kom,Hedysarum scoparium Fisch et May,Hedysarum mongolicum Turcz,Lespedeza bicolor Turcz,Hippophae rhamnoides Linn,Ulmaceae macrocarpa Hance and Kochia prostrata(L.)Schrad can be used to create forage forests.Scientific research should be actively carried out on the harvesting and cutting period,planting scale,feeding methods and breeding of improved varieties of forage forests.
基金Supported by Key Science and Technology Project for Innovation-driven Development of Guangxi"High Efficient and Safe Use of Selenium-enriched Soil Resources"(2017AA19015)Scientific Research and Technological Development Program Project of Guangxi Province(Gui Ke He 415104001-22)+2 种基金Key Research and Development Program of Guangxi(Gui Ke AB16380088 and Gui Ke AB16380164)Scientific Research and Technological Development Program Project of Nanning City(20152054-13)Scientific Research and Technological Development Program of Xixiangtang District of Nanning City(2015312)
文摘Taking Scientific Outlook on Development as the guiding principle,this paper introduced the principles of innovation,coordination,green,openness and sharing. Based on gifted advantages of selenium-enriched soil and selenium-enriched industry development in Guangxi,it discussed current practice,stressed green,ecological,characteristic demonstration,transformation and upgrading,and targeted poverty alleviation. Finally,it came up with perspective,practical,and operational strategies and recommendations for development of selenium-enriched industry,to provide reference for sustainable development of selenium-enriched functional industry in Guangxi.
基金Characteristic Forest and Fruit Special Project of Science and Technology Support Action Plan for"Regional Distribution,Large-scale Operation,Standardized Production,and Industrialized Development of High-quality Wheat,Peanuts,Grass and Livestock,Fruits and Vegetable Industries in Henan Province(202004)Project for Co-construction of Modern Agriculture Comprehensive Demonstration County between Henan Academy of Agricultural Sciences and the Counties(Yu Nong Ke[2021]No.30).
文摘Through the investigation of the current production situation,regional distribution,variety structure,production organization and existing problems of table grapes in Henan Province,this paper conducted an in-depth analysis on the advantages and disadvantages of the development of table grapes industry in Henan Province.In view of the current problems and development trend,it came up with some pertinent recommendations,including transforming the concept of cultivation,adhering to the principle of"high-quality varieties,standardized cultivation,mechanized management,large-scale operation,and diversified market",strengthening brand building,and promote the integrated development of the primary,secondary and tertiary industries,so as to promote the change of table grape industry in Henan Province from"quantitative scale model"to"quality benefit model",and promote its sustainable and high-quality development.
文摘The serious degradation of the ecological environment and the rapid expansion of stone desert have had a serious effect on the economic development of karst and rock-naked mountain areas in Southwest China. Moreover, these areas are still at the initial stage of industrialization, characterized by a greater significance of agriculture to the economy, face sharp contradictions among the population, the arable land and resources, and are suffering because of a shortage of investment. On the basis of this current situation, three recommendations are made in this article: "coordinating the relations among grain, ecology, population and economic development", "increasing the input of science and technology", and "adopting policies consistent with social equity in areas of poverty".
基金supported by the National Natural Science Foundation of China(NSFC)(No.72304007)the Huatong Guokang Medical Research Fund(No.2023HT010)。
文摘Mycophenolic acid(MPA),the active moiety of both mycophenolate mofetil(MMF)and enteric-coated mycophenolate sodium(EC-MPS),serves as a primary immunosuppressant for maintaining solid organ transplants.Therapeutic drug monitoring(TDM)enhances treatment outcomes through tailored approaches.This study aimed to develop an evidence-based guideline for MPA TDM,facilitating its rational application in clinical settings.The guideline plan was drawn from the Institute of Medicine and World Health Organization(WHO)guidelines.Using the Delphi method,clinical questions and outcome indicators were generated.Systematic reviews,Grading of Recommendations Assessment,Development,and Evaluation(GRADE)evidence quality evaluations,expert opinions,and patient values guided evidence-based suggestions for the guideline.External reviews further refined the recommendations.The guideline for the TDM of MPA(IPGRP-2020CN099)consists of four sections and 16 recommendations encompassing target populations,monitoring strategies,dosage regimens,and influencing factors.High-risk populations,timing of TDM,area under the curve(AUC)versus trough concentration(C0),target concentration ranges,monitoring frequency,and analytical methods are addressed.Formulation-specific recommendations,initial dosage regimens,populations with unique considerations,pharmacokinetic-informed dosing,body weight factors,pharmacogenetics,and drug–drug interactions are covered.The evidence-based guideline offers a comprehensive recommendation for solid organ transplant recipients undergoing MPA therapy,promoting standardization of MPA TDM,and enhancing treatment efficacy and safety.
基金Evidence-based Capacity Building Project for Basic Traditional Chinese Medicine-Specialized Diseases,No.2019XZZX-XH012Shanghai Three-year Action Plan for Accelerating the Development of Traditional Chinese Medicine,No.ZY(2018-2020)-CCCX-2002-01.
文摘BACKGROUND Nonalcoholic fatty liver disease(NAFLD)affects more than one-quarter of the global population.Due to the lack of approved chemical agents,many patients seek treatment from traditional Chinese medicine(TCM)formulas.A variety of systematic reviews have been published regarding the effectiveness and safety of TCM formulas for NAFLD.AIM To critically appraise available systematic reviews and sort out the high-quality evidence on TCM formulas for the management of NAFLD.METHODS Seven databases were systematically searched from their inception to 28 February 2020.The search terms included“non-alcoholic fatty liver disease,”“Chinese medicines,”“systematic review,”and their synonyms.Systematic reviews involving TCM formulas alone or in combination with conventional medications were included.The methodological quality and risk of bias of eligible systematic reviews were evaluated by using A Measure Tool to Assess Systematic Reviews 2(AMSTAR 2)and Risk of Bias in Systematic Review(ROBIS).The quality of outcomes was assessed by the Grading of Recommendations Assessment,Development and Evaluation(GRADE)system.RESULTS Seven systematic reviews were ultimately included.All systematic reviews were conducted based on randomized controlled trials and published in the last decade.According to the AMSTAR 2 tool,one systematic review was judged as having a moderate confidence level,whereas the other studies were rated as having a low or extremely low level of confidence.The ROBIS tool showed that the included systematic reviews all had a high risk of bias due to insufficient consideration of identified concerns.According to the GRADE system,only two outcomes were determined as high quality;namely,TCM formulas with the HuoXueHuaYu principle were better than conventional medications in ultrasound improvement,and TCM formulas were superior to antioxidants in alanine aminotransferase normalization.Other outcomes were downgraded to lower levels,mainly because of heterogeneity among studies,not meeting optimal information sample size,and inclusion of excessive numbers of small sample studies.Nevertheless,the evidence quality of extracted outcomes should be further downgraded when applying to clinical practice due to indirectness.CONCLUSION The quality of available systematic reviews was not satisfactory.Researchers should avoid repeatedly conducting systematic reviews in this area and focus on designing rigorous randomized controlled trials to support TCM formula applications.
文摘This study aimed to develop a guideline for therapeutic drug monitoring（TDM） of vancomycin. We adopted the new guideline definition from the Institute of Medicine（IOM）, adhered closely to the six domains of the Appraisal of Guidelines for Research ＆ Evaluation Ⅱ（AGREE Ⅱ）, and made recommendations based on systematic reviews. We established a Guideline Steering Group and a Guideline Development Group, formulated 12 questions in the form of Population, Intervention, Comparison, Outcome（PICO） and completed a literature search. As far as we know, we will develop the first evidenced-based guideline for vancomycin TDM under the framework of the Grade of Recommendations Assessment, Development and Evaluation（GRADE）.
基金supported by National Natural Science Foundation of China(Grant No.82002578)Sichuan Science and Technology Program(Grant No.2023YFS0094)to J.L.+3 种基金1·3·5 Project for Disciplines of Excellence-Clinical Research Incubation Project,West China Hospital,Sichuan University(20HXFH021)to N.C.1·3·5 Project for Disciplines of Excellence,West China Hospital,Sichuan University(ZYJC21049)Sichuan Science and Technology Program(Grant No.2022NSFSC0680)to X.XSichuan Science and Technology Program(Grant No.2022YFS0296)to Y.Z。
文摘Background:Multiple risk or protective factors for postoperative pancreatic fistula(POPF)have been suggested in the literature of surgical specialities.We aimed to map existing evidence regarding the risk factors for POPF to help guide future clinical treatment.Methods:We performed an umbrella review by searching the Web of Science,PubMed,Embase,and Cochrane databases until June 19,2023.Meta-analyses(MAs)that included≥2 studies were included.Methodological quality was assessed using AMSTAR2 scores and Grading of Recommendations Assessment,Development,and Evaluation(GRADE)tools were used to quantify the strength of the evidence.Results:Of the 42 MAs,1 was rated as having high methodological quality,and 4 were rated as moderate.Among the 82 outcomes,6 were supported by high-quality evidence.Moderate-quality evidence was found for 13 outcomes.The remaining outcomes had either low-or very low-quality evidence.In pancreaticoduodenectomy(PD),protective factors for all-grade POPF include pancreaticogastrostomy(PG)[vs.pancreaticojejunostomy(PJ),moderate quality],external pancreatic ductal stent(vs.no stents,high quality).Risk factors for all-grade POPF in PD include pancreatic duct occlusion(vs.no occlusion,moderate quality)and sealant(vs.no sealant,moderate quality).Polyglycolic acid mesh[vs.no mesh,moderate quality]was a protective factor for clinically relevant POPF(CR-POPF)in PD,omental/falciform ligament wrapping(vs.no wrapping,low quality),and artery-first PD(vs.standard,low quality).In distal pancreatectomy(DP),no factors for all-grade POPF were rated as high-or moderate-quality evidence.Polyglycolic acid mesh(vs.no mesh,moderate quality)was a protective factor for CR-POPF in DP.No factors were rated as high-or moderate-quality evidence in other types of pancreatectomy.In addition,high-and moderate-quality evidence showed that there was little difference in the incidence of pancreatic fistula in PD between minimally invasive and open surgery,duct-to-mucosa and invaginated PJ,Roux-en-Y and conservative reconstruction,extended and standard lymphadenectomy,and in the incidence of pancreatic fistula in DP between fibrin sealant patch and no patch.Conclusions:This umbrella review found varying levels of evidence for the associations between different surgery-related risk factors for POPF.Given the wealth of existing evidence of relatively low quality,future research should focus on improving its credibility.
基金funded by FAO National Forest Programme Facility: Developing the National Guidelines on Responsible Management of Planted Forests in China (PR.No.38817)
文摘China is one of the largest countries in the world in terms of planted forests area. Planted forests play an important role in soil and water conservation, food source, timber supply and energy security, but there are still many problems waiting for immediate resolution. Based on the current development status of planted forest in China, the paper made an comprehensive analysis for the positive impact and existing problems with regard to planted forests, and then came up with policy recommendations for promoting sustainable management of planted forests, mainly including: 1) to accelerate planted forests development and improve the quality; 2) to strengthen the protection and management, and quicken the development of planted forests; 3) to enhance the scientific planning for planted forests; 4) to reinforce the management for forests harvesting so as to promote the reasonable utilization of planted forests; 5) to perfect the management system for planted forest resources and improve the managerial capacity; 6) to complete related laws and regulations and improve the policy guarantee system; 7) to reinforce the forest tenure reform and establish a sound planted forest land transference system. Finally, the paper presented the future action framework for guiding the sustainable management of planted forests in China.
