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 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
From the process of sedimentation the mathematical relationships among deposition Volume and powder properties as well as sedimentation parameters were deduced. Based on the formula a mathematical model was set up and...From the process of sedimentation the mathematical relationships among deposition Volume and powder properties as well as sedimentation parameters were deduced. Based on the formula a mathematical model was set up and simulated through the computer. At last the validity of mathematical model was supported by the representative experiment on Ti-Mo system FGM prepared by co-sedimentation.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
This paper briefly summarized the development history, product catalogue and magnetic properties of non- oriented electrical steel sheets at Baosteel, as well as the development and application of high-value-added ste...This paper briefly summarized the development history, product catalogue and magnetic properties of non- oriented electrical steel sheets at Baosteel, as well as the development and application of high-value-added steel grades. Recent advances in manufacturing electrical steel sheets were also introduced, including technologies for controlling inclusion,for producing high-grade steel strips by a tandem rolling mill and for controlling the transverse thickness difference of steel sheets, and the development of environmentally friendly coatings.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
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.
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From the process of sedimentation the mathematical relationships among deposition Volume and powder properties as well as sedimentation parameters were deduced. Based on the formula a mathematical model was set up and simulated through the computer. At last the validity of mathematical model was supported by the representative experiment on Ti-Mo system FGM prepared by co-sedimentation.
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）.
文摘This paper briefly summarized the development history, product catalogue and magnetic properties of non- oriented electrical steel sheets at Baosteel, as well as the development and application of high-value-added steel grades. Recent advances in manufacturing electrical steel sheets were also introduced, including technologies for controlling inclusion,for producing high-grade steel strips by a tandem rolling mill and for controlling the transverse thickness difference of steel sheets, and the development of environmentally friendly coatings.
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.
