Background:Physical diagnosis is the first course of clinical medicine and the first contact with patients during clinical practice.Evidence-based physical diagnosis is a helpful tool in both education and practice.We...Background:Physical diagnosis is the first course of clinical medicine and the first contact with patients during clinical practice.Evidence-based physical diagnosis is a helpful tool in both education and practice.We aim to compare the accuracy of physical signs based on practice experience and research evidence.Methods:A questionnaire was designed and administered using convenience sampling to collect empirical estimates of physical signs.The literature search was conducted using Medline,EMBASE,and the Cochrane Library up to December 2023.Included studies independently compared diagnostic performance between physical signs and acceptable diagnostic standards.Hierarchical summary receiver operating characteristic models were used to summarize test accuracy data across studies.The pooled sensitivity,specificity,likelihood ratios,and diagnostic odds ratio were calculated.Results from the two parts were compared.Results:A total of 1971 respondents completed the questionnaire,and 37 studies reporting the performance of physical signs were included in the review.Compared with synthesized results of meta-analysis,estimations of palpable liver(sensitivity and specificity),palpable spleen(sensitivity and specificity),Traube space dullness(sensitivity and specificity),shifting dullness(sensitivity),right upper quadrant(RUQ)tenderness(sensitivity and specificity),Murphy sign(specificity),and distended abdomen(sensitivity)had relatively good concordance.The sensitivity of bulging flanks and the specificity of the distended abdomen were underestimated.The specificity of bulging flanks,shifting dullness,and sensitivity of the Murphy sign were overestimated.Conclusions:Variable results were observed in the comparison between clinical experience and evidence-based medicine.Evidence-based physical diagnosis should be introduced during teaching and emphasized throughout a career as a guide for accumulating expertise.展开更多
Background:Acupuncture therapy provides a complementary and alternative approach to treating major depressive disorder(MDD),but its efficacy and safety have still not been comprehensively assessed.Recently published s...Background:Acupuncture therapy provides a complementary and alternative approach to treating major depressive disorder(MDD),but its efficacy and safety have still not been comprehensively assessed.Recently published systematic reviews remain confusing and inconclusive.Objective:This systematic review evaluated the efficacy and safety of acupuncture therapy alone or combined with antidepressants for adult patients with mild and moderate MDD.Search strategy:Chinese Biomedical Literature Database,China National Knowledge Infrastructure Database,Wanfang Database,Chinese Science and Technology Journal Database,Pub Med,Embase,and Cochrane Library were searched from their inceptions to March 2025.Inclusion criteria:Randomized controlled trials that compared acupuncture therapy with antidepressants,or acupuncture therapy plus antidepressants with acupuncture therapy or antidepressants for adult patients with mild and moderate MDD were included.Data extraction and analysis:Five reviewers independently extracted data from original literature using a standardized form,and the data were verified by two reviewers to ensure accuracy.Statistical meta-analyses,publication bias analyses,and subgroup analyses were performed by using Review Manager 5.3 software.The Grading of Recommendations Assessment,Development,and Evaluation approach was used to assess the certainty of the evidence.Results:A total of 60 eligible studies including 4675 participants were included.Low-certainty evidence showed that compared with antidepressants,acupuncture therapy(standardized mean difference[SMD]=-0.57;95%confidence interval[CI]=[-0.87,-0.27];I^(2)=86%;P=0.006)or acupuncture therapy plus antidepressants(SMD=-1.00;95%CI=[-1.18,-0.81];I^(2)=77%;P<0.00001)may reduce the severity of depression at the end of treatment.Low-certainty evidence indicated that compared with acupuncture therapy alone,acupuncture therapy plus antidepressants slightly reduced the severity of depression at the end of treatment(SMD=-0.38;95%CI=[-0.61,-0.14];I^(2)=18%;P=0.002).Similar results were also found for acupuncture's relief of insomnia.The reported adverse effects of acupuncture therapy were mild and transient.For most of the subgroup analyses,acupuncture type,scale type,and the course of treatment did not show a significant relative effect.Conclusion:Acupuncture therapy may provide antidepressant effects and relieve insomnia with mild adverse effects for adult patients with mild and moderate MDD.But the certainty of evidence was very low.More high-quality,well designed,large-scale studies with long-term follow-up are needed in the future.展开更多
Background:Muscular strength is a powerful marker of current health status and robust predictor of age-related disease and disability.Handgrip strength(HGS)using isometric dynamometry is a convenient,feasible,and wide...Background:Muscular strength is a powerful marker of current health status and robust predictor of age-related disease and disability.Handgrip strength(HGS)using isometric dynamometry is a convenient,feasible,and widely used method of assessing muscular strength among people of all ages.While adult HGS norms have been published for many countries,no study has yet synthesized available data to produce international norms.The objective of this study was to generate international sex-and age-specific norms for absolute and body size-normalized HGS across the adult lifespan.Methods:Systematic searches were conducted in 6 databases/web search engines(MEDLINE,SPORTDiscus,Embase,Web of Science,CINAHL,and Google Scholar)up to December 1,2023.We included full-text peer-reviewed observational studies that reported normative HGS data for adults aged ≥20 years by sex and age.Pseudo data were generated using Monte Carlo simulation following harmonization for methodo-logical variation.Population-weighted Generalized Additive Models for Location,Scale,and Shape were used to develop sex-and age-specific norms for absolute HGS(kg)and HGS normalized by height(Ht,m)squared(i.e.,HGS/Ht^(2)in kg/m^(2)).Norms were tabulated as percentile values(5th to 95th)and visualized as smoothed percentile curves.Results:We included data from 100 unique observational studies representing 2,405,863 adults(51.9%female)aged 20 to 100+years from 69 countries and regions tested from the year 2000 onward.On average,absolute and normalized HGS values negligibly improved throughout early adulthood,peaked from age 3039 years(at 49.7 kg(males)and 29.7 kg(females)for absolute HGS or 16.3 kg/m^(2)(males)and 11.3 kg/m^(2)(females)for HGS/Ht^(2)),and declined afterwards.The age-related decline in HGS accelerated from middle to late adulthood and was slightly larger for males than for females during middle adulthood.Conclusion:This study provides the world’s largest and most geographically comprehensive international norms for adult HGS by sex and age.These norms have utility for global peer-comparisons,health screening,and surveillance.展开更多
Hepatitis C virus(HCV)is a global health concern associated with significant morbidity and mortality.Before the approval of second-generation direct-acting antiviral agents(DAAs),interferon therapy and liver transplan...Hepatitis C virus(HCV)is a global health concern associated with significant morbidity and mortality.Before the approval of second-generation direct-acting antiviral agents(DAAs),interferon therapy and liver transplantation constituted the mainstay of treatment.The introduction of well-tolerated oral DAAs in late 2013 has revolutionized HCV management with over 95%cure rates.The predominance of HCV-related liver transplantations has declined following the widespread approval of DAAs.Despite the unparallel efficacy observed among these novel therapies,pharmaceutical costs continue to limit equitable access to healthcare and likely contribute to the differential HCV infection rates observed globally.To reduce the burden of disease worldwide,essential agenda items for all countries must include the prioritization of integrated care models and access to DAAs therapies.Through transparent negotiations with the pharmaceutical industry,the consideration for compassionate release of medications to promote equitable division of care is paramount.Here we provide a literature review of HCV,changes in epidemiologic trends,access issues for current therapies,and global inequities in disease burden.展开更多
In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a n...In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development;we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control(including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.展开更多
Background In China's Mainland,patients with neovascular age-related macular degeneration(nAMD)have approximately an 40%prevalence of polypoidal choroidal vasculopathy(PCV).This disease leads to recurrent retinal ...Background In China's Mainland,patients with neovascular age-related macular degeneration(nAMD)have approximately an 40%prevalence of polypoidal choroidal vasculopathy(PCV).This disease leads to recurrent retinal pigment epithelium detachment(PED),extensive subretinal or vitreous hemorrhages,and severe vision loss.China has introduced various treatment modalities in the past years and gained comprehensive experience in treating PCV.Methods A total of 14 retinal specialists nationwide with expertise in PCV were empaneled to prioritize six questions and address their corresponding outcomes,regarding opinions on inactive PCV,choices of anti-vascular endothelial growth factor(anti-VEGF)monotherapy,photodynamic therapy(PDT)monotherapy or combined therapy,patients with persistent subretinal fluid(SRF)or intraretinal fluid(IRF)after loading dose anti-VEGF,and patients with massive subretinal hemorrhage.An evidence synthesis team conducted systematic reviews,which informed the recommendations that address these questions.This guideline used the GRADE(Grading of Recommendations,Assessment,Development,and Evaluation)approach to assess the certainty of evidence and grade the strengths of recommendations.Results The panel proposed the following six conditional recommendations regarding treatment choices.(1)For patients with inactive PCV,we suggest observation over treatment.(2)For treatment-na?ve PCV patients,we suggest either anti-VEGF monotherapy or combined anti-VEGF and PDT rather than PDT monotherapy.(3)For patients with PCV who plan to initiate combined anti-VEGF and PDT treatment,we suggest later/rescue PDT over initiate PDT.(4)For PCV patients who plan to initiate anti-VEGF monotherapy,we suggest the treat and extend(TE)regimen rather than the pro re nata(PRN)regimen following three monthly loading doses.(5)For patients with persistent SRF or IRF on optical coherence tomography(OCT)after three monthly anti-VEGF treatments,we suggest proceeding with anti-VEGF treatment rather than observation.(6)For PCV patients with massive subretinal hemorrhage(equal to or more than four optic disc areas)involving the central macula,we suggest surgery(vitrectomy in combination with tissue-plasminogen activator(tPA)intraocular injection and gas tamponade)rather than anti-VEGF monotherapy.Conclusions Six evidence-based recommendations support optimal care for PCV patients'management.展开更多
Objective:To systematically review the clinical practice guidelines(CPGs)for the treatment of patients with coronavirus disease 2019(COVID-19)using Chinese herbal medicine(CHM),assess the methodological quality as wel...Objective:To systematically review the clinical practice guidelines(CPGs)for the treatment of patients with coronavirus disease 2019(COVID-19)using Chinese herbal medicine(CHM),assess the methodological quality as well as clinical credibility and implementability of specific recommendations,and summarize key recommendations.Methods:As of April 2022,we conducted a comprehensive search on major electronic databases,guideline websites,academic society websites,and government websites to assess the methodological quality and clinical applicability of the included CPGs using the Appraisal of Guidelines for Research and Evaluation(AGREE)II tool and Evaluation-Recommendations EXcellence(AGREE-REX)instructions,respectively.Results:The search yielded 61 CPGs,which were mostly published in 2020;moreover,98.4%of the CPGs were published in China.Only five CPGs achieved a high-quality AGREE II rating;further,six CPGs could be directly recommended,with most of the CPGs still showing much room for improvement.CPGs had a low overall score in the AGREE-REX evaluation,with the domains of clinical applicability,values and preferences,and implementability being standardized in 21.80%±12.56%,16.00%±11.81%,and 31.33%±14.55%of the CPGs,respectively.Five high-quality CPGs mentioned 56 Chinese herbal formulas.Half of the recommendations had moderate or strong evidence level in the GRADE evaluation.The most frequently recommended herbal medicines were Lianhua Qingwen granule/capsule and Jinhua Qinggan granule;however,the strength of recommendation for each prescription varied across CPGs and populations.Conclusions:The overall quality of current CPGs for COVID-19 for CHM still needs to be improved;moreover,the strength of the evidence remains to be standardized across CPGs.展开更多
The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is the cause of a rapidly spreading illness,coronavirus disease 2019(COVID-19),affecting more than seventeen million people around the world.Diagnos...The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is the cause of a rapidly spreading illness,coronavirus disease 2019(COVID-19),affecting more than seventeen million people around the world.Diagnosis and treatment guidelines for clinicians caring for patients are needed.In the early stage,we have issued"A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV)infected pneumonia(standard version)";now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline.We formed a working group of clinical experts and methodologists.The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas:chemoprophylaxis,diagnosis,treatments,and discharge management.We searched the literature for direct evidence on the management of COVID-19,and assessed its certainty generated recommendations using the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)approach.Recommendations were either strong or weak,or in the form of ungraded consensus-based statement.Finally,we issued 34 statements.Among them,6 were strong recommendations for,14 were weak recommendations for,3 were weak recommendations against and 11 were ungraded consensus-based statement.They covered topics of chemoprophylaxis(including agents and Traditional Chinese Medicine(TCM)agents),diagnosis(including clinical manifestations,reverse transcription-polymerase chain reaction(RT-PCR),respiratory tract specimens,IgM and IgG antibody tests,chest computed tomography,chest X-ray,and CT features of asymptomatic infections),treatments(including lopinavirritonavir,umifenovir,favipiravir,interferon,remdesivir,combination of antiviral drugs,hydroxychloroquine/chloroquine,interleukin-6 inhibitors,interleukin-1 inhibitors,glucocorticoid,qingfei paidu decoction,lianhua qingwen granules/capsules,convalescent plasma,lung transplantation,invasive or noninvasive ventilation,and extracorporeal membrane oxygenation(ECMO)),and discharge management(including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge).We also created two figures of these recommendations for the implementation purpose.We hope these recommendations can help support healthcare workers caring for COVID-19 patients.展开更多
To compare and characterize hypertriglyceridemia-induced acute pancreatitis(HTG-AP)across the geographical regions,we conducted a systematic review and a multi-center cohort study.We conducted a systematic review and ...To compare and characterize hypertriglyceridemia-induced acute pancreatitis(HTG-AP)across the geographical regions,we conducted a systematic review and a multi-center cohort study.We conducted a systematic review and random effects meta-analysis of studies reporting HTG-AP.Also,we separately characterized HTG-AP in a multi-center retrospective cohort study involving eight centers in China.The key outcomes of interest included the pooled proportion of HTG-AP and its severity parameters after adjusting for the effect of confounding factors through logistic regression.Our systematic review identified 110 studies from 15 countries accounting for 3,057,428 participants(35%female,median age 50 years).The pooled proportion of HTG-AP was 11.6%globally while the Eastern and Western countries reported the proportions as 16.3%and 5.4%,respectively(P<0.01).The pooled mortality rate was remarkably higher in Eastern countries(4.1%)than in Western countries(1.0%)(P<0.01).3,224 participants(37%female,median age 48 years)were included in our multi-center cohort study,and the proportion of HTG-AP was much higher at 35.9%with a nearly three-fold higher mortality rate compared with acute pancreatitis(AP)due to other etiologies(odds ratio(OR):2.77,95%confidence interval(CI):1.60 to 4.81).The proportion of patients with HTG-AP is remarkably higher in Eastern countries,particularly China,than in Western countries.Furthermore,compared with other causes of AP,HTG-AP has a poorer prognosis and may warrant aggressive management.展开更多
Background:Conducting a systematic review(SR)is a time-intensive process and represents the first phase in developing a clinical practice guideline(CPG).Completing a CPG through the Program in Evidence-Based Care(PEBC...Background:Conducting a systematic review(SR)is a time-intensive process and represents the first phase in developing a clinical practice guideline(CPG).Completing a CPG through the Program in Evidence-Based Care(PEBC),a globally acknowledged guideline program supported by Ontario Health(Cancer Care Ontario),typically takes about 2 years.Thus,expediting an SR can significantly reduce the overall time required to complete a CPG.Our recently published review identified two artificial intelligence(AI)tools,DistillerSR and EPPI-Reviewer that reduced time in the title and abstract screening in an SR process when developing a CPG.However,the consistency and generalizability of these tools remain unclear within or across different SRs related to cancer.This study protocol aims to evaluate and compare the performance of DistillerSR and EPPI-Reviewer against human reviewers for title and abstract screening(Stage I screening)in cancer CPG development.Methods:We will conduct a retrospective simulation study to evaluate and compare the performance of DistillerSR and EPPI-Reviewer across 10 previously published CPGs by PEBC.These CPGs include the five cancer types with the highest incidence(lung,breast,prostate,colorectal,and bladder).We will run 30 simulation trials for one CPG per AI tool.Primary outcomes are workload savings and time savings in Stage I screening.The secondary outcome is the percentage of missing articles among the final included articles.This informs the accuracy and comprehensiveness of the AI tools.Descriptive and inferential statistical analysis will be conducted to evaluate the outcomes.Results:This is a study protocol.The data presented in the tables are illustrative examples rather than actual study results,in accordance with the journal’s standard structure.All data included in the final study will be thoroughly validated.Discussion:This will be the first study to investigate and compare the performance of DistillerSR and EPPI-Reviewer in Stage I screening of SRs in CPGs across different cancer types.These findings will inform the reliable use of AI tools in future cancer-related CPGs.The results from this retrospective study will need to be confirmed by prospective studies.展开更多
Promoting the international acceptance of clinical studies about traditional Chinese medicine(TCM)interventions is a key strategy for internationalization of TCM.However,the complexities of TCM interventions—in terms...Promoting the international acceptance of clinical studies about traditional Chinese medicine(TCM)interventions is a key strategy for internationalization of TCM.However,the complexities of TCM interventions—in terms of the theories,practice patterns,and components—pose challenges to the design and implementation of clinical studies that are well accepted by the international community.This article summarized the current status of clinical studies about TCM interventions that were published in international journals,explored underlying barriers hindering the international acceptance,and discussed potential strategies for future development.展开更多
Severe pneumonia is one of the most common infectious diseases and the leading cause of sepsis and septic shock.Preventing infection,balancing the patient’s immune status,and anti-coagulation therapy are all importan...Severe pneumonia is one of the most common infectious diseases and the leading cause of sepsis and septic shock.Preventing infection,balancing the patient’s immune status,and anti-coagulation therapy are all important elements in the treatment of severe pneumonia.As multi-target agents,Xuebijing injection(XBJ)has shown unique advantages in targeting complex conditions and saving the lives of patients with severe pneumonia.This review outlines progress in the understanding of XBJ’s anti-inflammatory,endotoxin antagonism,and anticoagulation effects.From the hundreds of publications released over the past few years,the key results from representative clinical studies of XBJ in the treatment of severe pneumonia were selected and summarized.XBJ was observed to effectively suppress the release of pro-inflammatory cytokines,counter the effects of endotoxin,and assert an anticoagulation effect in most clinical trials,which are consistent with experimental studies.Collectively,this evidence suggests that XBJ could play an important and expanding role in clinical medicine,especially for sepsis,septic shock and severe pneumonia.展开更多
Background:The effects of acupuncture have varied in different randomized controlled trials(RCTs),and there are many factors that influence treatment effect of acupuncture in different outcomes,with conflicting result...Background:The effects of acupuncture have varied in different randomized controlled trials(RCTs),and there are many factors that influence treatment effect of acupuncture in different outcomes,with conflicting results.Objective:To identify factors and their impact on the treatment effect of acupuncture in different outcomes.Methods:Acupuncture RCTs were searched from 7 databases including Medline(Pub Med),Embase,Cochrane Central Register of Controlled Trials,China National Knowledge Infrastructure,Wanfang Database,VIP Database,and China Biology Medicine disc between January 1st,2015 and December 31st,2019.Eligible studies must compare acupuncture to no acupuncture,sham acupuncture,or waiting lists,and report at least 1patient-important outcome.A multi-level meta-regression was conducted using a 3-level robust mixed model and univariate analyses were performed for all independent variables,even those excluded from the multivariable model due to collinearities.We used thresholds of 0.2 and 0.4 for the difference of standardized mean differences(SMDs),categorising them as small(<0.2),moderate(0.2–0.4),or large(>0.4) effects.Results:The pain construct analysis involved 211 effect estimates from 153 studies and 14 independent variables.High-frequency acupuncture treatment sessions produced larger effects compared to low-frequency sessions [large magnitude,the difference of adjusted SMDs 0.46,95% confidence interval(CI) 0.07 to 0.84;P=0.02].The non-pain symptoms construct analysis comprised 323 effect estimates from 231 studies and 15 independent variables.Penetrating acupuncture showed moderately larger effects when compared to non-penetrating acupuncture(0.30,95% CI 0.06 to 0.53;P=0.01).The function construct analysis included 495 effect estimates from 274 studies and 14 independent variables.Penetrating acupuncture and the flexible acupuncture regimen showed moderately larger effects,compared to non-penetrating acupuncture and fixed regimen,respectively(0.40,95% CI 0 to 0.80;P=0.05;0.29,95% CI 0.06 to 0.53;P=0.01).Conclusions:High-frequency acupuncture sessions appear to be a more effective approach to managing painful symptoms.Penetrating acupuncture demonstrated greater effect in relieving nonpainful symptoms.Both penetrating acupuncture type and flexible acupuncture regimen were linked to significant treatment effects in function outcomes.Future studies should consider the factors that are significantly associated with the effects of acupuncture in patient-important outcomes.展开更多
Purpose: Medication compliance for chronic medications has been well studied, but there is a gap in the literature regarding compliance within the perioperative period. Our objective was to determine the incidence of ...Purpose: Medication compliance for chronic medications has been well studied, but there is a gap in the literature regarding compliance within the perioperative period. Our objective was to determine the incidence of patient non-compliance with preoperative medication instructions for adult non-emergent surgery. Additional objectives were to identify predictors of compliance, describe medication instructions by drug type, and explore the impact of non-compliance. Patients and Methods: This historical chart review evaluated preoperative compliance to medication instructions in 393 adults undergoing non-emergent surgeries at Hamilton Health Sciences between May 1, 2012, and April 30, 2013. Seven patient factors (age;sex;American Society of Anesthesiologists class;number of medications;type of surgery;time between preoperative appointment to surgery;the individual collecting the medication list) were evaluated as potential predictors of non-compliance and analyzed using logistic regression analysis. Consequences of non-compliance were assessed by impact on intraoperative blood pressure, blood glucose level, drop in hemoglobin, bronchospasm, and case delays. Results: One hundred forty-six (37.2%) patients were non-compliant with one or more medication reconciliation instructions provided by the anesthesiologist. No significant associations were observed for any patient risk factors and non-compliance. Non-compliance was not associated with any clinically significant consequences. Conclusions: Our study shows that 37.15% of adult patients undergoing non-emergent surgery were non-compliant with medication instructions, although patients did not receive any written instructions for 46% of their medications. We did not identify any predictive patient factors or adverse outcomes associated with non-compliance.展开更多
To the Editor:Acute pancreatitis(AP)is the most common gastrointestinal condition that leads to acute hospitalization.[1]The incidence of AP has increased in recent decades,with a current global incidence of 34/100,00...To the Editor:Acute pancreatitis(AP)is the most common gastrointestinal condition that leads to acute hospitalization.[1]The incidence of AP has increased in recent decades,with a current global incidence of 34/100,000,probably due to a rising trend of obesity and gallstone disease.AP is associated with remarkable pain,reduced quality of life(QoL),and even death,thus posing a heavy socioeconomic burden.In addition,approximately 22%of AP patients experience recurrent AP(RAP)and 10%of AP patients progress to chronic pancreatitis.[2]Petrov and Yadav[3]have,therefore,argued that AP should not be considered as an acute and self-limiting disease.Treatment and long-term care after AP have drawn widespread attention,which has improved patients’physical and mental health.展开更多
Introduction In Brazil,approximately 5%are born with a congenital disorder,potentially fatal without surgery.This study aims to evaluate the relationship between gastrointestinal congenital malformation(GICM)mortality...Introduction In Brazil,approximately 5%are born with a congenital disorder,potentially fatal without surgery.This study aims to evaluate the relationship between gastrointestinal congenital malformation(GICM)mortality,health indicators,and socioeconomic factors in Brazil.Methods GICM admissions(Q39-Q45)between 2012 and 2019 were collected using national databases.Patient demographics,socioeconomic factors,clinical management,outcomes,and the healthcare workforce density were also accounted for.Pediatric Surgical Workforce density and the number of neonatal intensive care units in a region were extracted from national datasets and combined to create a clinical index termed'NeoSurg'.Socioeconomic variables were combined to create a socioeconomic index termed SocEcon'.Simple linear regression was used to investigate if the temporal changes of both indexes were significant.The correlation between mortality and the different indicators in Brazil was evaluated using Pearson's correlation coefficient.Results Over 8 years,Brazil recorded 12804 GICM admissions.The Southeast led with 6147 cases,followed by the Northeast(2660),South(1727),North(1427),and Midwest(843).The North and Northeast reported the highest mortality,lowest NeoSurg,and SocEcon Index rates.Nevertheless,mortality rates declined across regions from 7.7%(2012)to 3.9%(2019),a 51.7%drop.The North and Midwest experienced the most substantial reductions,at 63%and 75%,respectively.Mortality significantly correlated with the indexes in nearly all regions(p<0.05).Conclusion Our study highlights the correlation between social determinants of health and GICM mortality in Brazil,using two novel indexes in the pediatric population.These findings provide an opportunity to rethink and discuss new indicators that could enhance our understanding of our country and could lead to the development of necessary solutions to tackle existing challenges in Brazil and globally.展开更多
Background:Whether the time course of post-stroke depression (PSD) can be used to predict the quality of life (QoL) of patients with late-stage stroke remains unclear,this study investigated whether persistent depress...Background:Whether the time course of post-stroke depression (PSD) can be used to predict the quality of life (QoL) of patients with late-stage stroke remains unclear,this study investigated whether persistent depression at 1 year after stroke predicts QoL at 5 years following stroke.Methods:We analyzed the demographic and clinical data of patients with stroke in 56 hospitals across China that participated in the Prospective Cohort Study on the Incidence and Outcome of Patients with PSD in China Study.Follow-up assessments were performed at the following time points after stroke:in person,2 weeks,3 months,6 months,and 1 year;by telephone,5 years.National Institutes of Health Stroke Scale (NIHSS) score on admission,recurrence,disability,depression,QoL,and chronic complications were recorded.Depression was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders.QoL was measured using short form-12 (SF-12).Multivariable ordinal logistic regression analysis was used to identify factors that independently affected the physical component summary (PCS) and mental component summary (MCS) scores of the SF-12.Results:Of the 801 patients evaluated in this study,80 had persistent depression.The multivariable regression analysis of data obtained at 5 years showed that persistent depression at 1 year (odds ratio [OR]:0.48;95% confidence interval [CI]:0.29-0.81) and disability at 5 years (OR:0.34;95% CI:0.23-0.49) were associated with poor MCS scores at 5 years.Old age,a high NIHSS score on admission,disability at 5 years,and stroke recurrence within 5 years were associated with poor PCS scores at the 5-year follow-up.Conclusions:Persistent depression at the 1-year follow-up could predict poor MCS scores at the 5-year follow-up.The development of interventional strategies targeting post-stroke patients with persistent depression is warranted.展开更多
To the Editor:Colorectal cancer(CRC)remains a leading cause of cancer-related death worldwide.[1]In addition to the classical adenoma-to-carcinoma model of colorectal carcinogenesis,the serrated neoplastic pathway acc...To the Editor:Colorectal cancer(CRC)remains a leading cause of cancer-related death worldwide.[1]In addition to the classical adenoma-to-carcinoma model of colorectal carcinogenesis,the serrated neoplastic pathway accounts for 20%–30%of CRCs.Sessile serrated lesions(SSLs),the most common premalignant serrated polyp subtype,share many of the genomic characteristics of post-colonoscopy CRCs and are thus recognized as their precursor lesions.However,SSLs can be easily missed due to their flat shape and subtle endoscopic features.Sometimes they can also be difficult to distinguish from other types of polyps,especially hyperplastic polyps(HPs),which are believed to have no malignant potential.[2]Approximately 10%of polyps initially diagnosed as HPs endoscopically are reclassified as SSLs after histopathological examination,reflecting diagnostic difficulties in colonoscopy.[3,4]Current guidelines recommend“diagnose-and-leave”and“resect-and-discard”strategies for diminutive polyps,which might lead to SSLs being left in situ or diagnoses being missed,[5]raising the risk of recurrence and post-colonoscopy cancers.Furthermore,it remains debatable in the gastrointestinal community whether the risks of resecting SSLs outweigh the reduction in cancer risk.Any strategy that improves the diagnostic accuracy of SSLs could have a meaningful clinical impact.展开更多
Objective This study aimed to summarize the characteristics and methodological quality of systematic reviews on the application of artificial intelligence(AI)in clinical diagnosis and treatment.Methods We systematical...Objective This study aimed to summarize the characteristics and methodological quality of systematic reviews on the application of artificial intelligence(AI)in clinical diagnosis and treatment.Methods We systematically searched seven English-and Chinese-language literature databases to identify sys-tematic reviews on the application of AI,deep learning,or machine learning in the diagnosis and treatment of any disease published in 2020.We evaluated the methodological quality of the included systematic reviews using“A Measurement tool for the assessment of multiple systematic reviews”(AMSTAR).We also conducted meta-analyses on the diagnostic accuracy of AI on selected disease categories with a large number of included studies and low clinical heterogeneity.Results A total of 40 systematic reviews reporting 1,083 original studies were included,covering 31 diseases from 11 groups of diseases.Eleven systematic reviews were related to neoplasms and nine were systematic reviews related to diseases of the digestive system.We selected digestive system diseases for the meta-analysis.The pooled sensitivities(with 95%confidence interval(CI))of AI to assist the diagnosis of helicobacter pylori,gastrointestinal ulcers,hemorrhage,esophageal tumors,gastric tumors,and intestinal tumors(with 95%CI)were 0.91(0.83-0.95),0.99(0.76-1.00),0.95(0.83-0.99),0.90(0.85-0.93),0.90(0.82-0.95),and 0.93(0.88-0.96),respectively,and the pooled specificities were 0.82(0.77-0.87),0.97(0.86-1.00),1.00(0.99-1.00),0.80(0.71-0.87),0.93(0.87-0.97),and 0.89(0.85-0.92),respectively.The AMSTAR items“the list of included studies”(n=39,97.5%)and“the characteristics of the included studies”(n=39,97.5%)had the highest compliance among the reviews;the compliance was relatively low to the items“the consideration of publication status”(n=1,2.5%),“the consideration of scientific quality”(n=19,47.5%),“data synthesis methods”(n=18,45.0%),and“the evaluation of publication bias”(n=13,32.5%).Conclusions The main subjects of systematic reviews on AI applications in clinical diagnosis and treatment pub-lished in 2020 were diseases of the digestive system and neoplasms.The methodological quality of the systematic reviews on AI needs to be improved,paying particular attention to publication bias and the rigorous evaluation of the quality of the included studies.展开更多
Background:Since the outbreak of coronavirus disease 2019(COVID-19),human mobility restriction measures have raised controversies,partly because of the inconsistent findings.An empirical study is promptly needed to re...Background:Since the outbreak of coronavirus disease 2019(COVID-19),human mobility restriction measures have raised controversies,partly because of the inconsistent findings.An empirical study is promptly needed to reliably assess the causal effects of the mobility restriction.The purpose of this study was to quantify the causal effects of human mobility restriction on the spread of COVID-19.Methods:Our study applied the difference-in-difference(DID)model to assess the declines of population mobility at the city level,and used the log-log regression model to examine the effects of population mobility declines on the disease spread measured by cumulative or new cases of COVID-19 over time after adjusting for confounders.Results:The DID model showed that a continual expansion of the relative declines over time in 2020.After 4 weeks,population mobility declined by-54.81%(interquartile range,-65.50%to-43.56%).The accrued population mobility declines were associated with the significant reduction of cumulative COVID-19 cases throughout 6 weeks(ie,1%decline of population mobility was associated with 0.72%[95%CI:0.50%-0.93%]reduction of cumulative cases for 1 week,1.42%2 weeks,1.69%3 weeks,1.72%4 weeks,1.64%5 weeks,and 1.52%6 weeks).The impact on the weekly new cases seemed greater in the first 4 weeks but faded thereafter.The effects on cumulative cases differed by cities of different population sizes,with greater effects seen in larger cities.Conclusions:Persistent population mobility restrictions are well deserved.Implementation of mobility restrictions in major cities with large population sizes may be even more important.展开更多
基金supported by the National Natural Science Foundation of China(32170788)the National High Level Hospital Clinical Research Funding(2022-PUMCH-B-023)+2 种基金the Beijing Natural Science Foundation(7232123)the Beijing Natural Science Foundation(L232016)funding from Peking Union Medical College(2023zlgc0501).
文摘Background:Physical diagnosis is the first course of clinical medicine and the first contact with patients during clinical practice.Evidence-based physical diagnosis is a helpful tool in both education and practice.We aim to compare the accuracy of physical signs based on practice experience and research evidence.Methods:A questionnaire was designed and administered using convenience sampling to collect empirical estimates of physical signs.The literature search was conducted using Medline,EMBASE,and the Cochrane Library up to December 2023.Included studies independently compared diagnostic performance between physical signs and acceptable diagnostic standards.Hierarchical summary receiver operating characteristic models were used to summarize test accuracy data across studies.The pooled sensitivity,specificity,likelihood ratios,and diagnostic odds ratio were calculated.Results from the two parts were compared.Results:A total of 1971 respondents completed the questionnaire,and 37 studies reporting the performance of physical signs were included in the review.Compared with synthesized results of meta-analysis,estimations of palpable liver(sensitivity and specificity),palpable spleen(sensitivity and specificity),Traube space dullness(sensitivity and specificity),shifting dullness(sensitivity),right upper quadrant(RUQ)tenderness(sensitivity and specificity),Murphy sign(specificity),and distended abdomen(sensitivity)had relatively good concordance.The sensitivity of bulging flanks and the specificity of the distended abdomen were underestimated.The specificity of bulging flanks,shifting dullness,and sensitivity of the Murphy sign were overestimated.Conclusions:Variable results were observed in the comparison between clinical experience and evidence-based medicine.Evidence-based physical diagnosis should be introduced during teaching and emphasized throughout a career as a guide for accumulating expertise.
基金supported by the National Natural Science Foundation of China(No.82474644)the National Key R&D Foundation of China(No.2017YFC1703600)+1 种基金the Shenzhen“Sanming Project”(No.202101007)the Shenzhen Science and Technology Program(No.JCYJ2022081810080300)。
文摘Background:Acupuncture therapy provides a complementary and alternative approach to treating major depressive disorder(MDD),but its efficacy and safety have still not been comprehensively assessed.Recently published systematic reviews remain confusing and inconclusive.Objective:This systematic review evaluated the efficacy and safety of acupuncture therapy alone or combined with antidepressants for adult patients with mild and moderate MDD.Search strategy:Chinese Biomedical Literature Database,China National Knowledge Infrastructure Database,Wanfang Database,Chinese Science and Technology Journal Database,Pub Med,Embase,and Cochrane Library were searched from their inceptions to March 2025.Inclusion criteria:Randomized controlled trials that compared acupuncture therapy with antidepressants,or acupuncture therapy plus antidepressants with acupuncture therapy or antidepressants for adult patients with mild and moderate MDD were included.Data extraction and analysis:Five reviewers independently extracted data from original literature using a standardized form,and the data were verified by two reviewers to ensure accuracy.Statistical meta-analyses,publication bias analyses,and subgroup analyses were performed by using Review Manager 5.3 software.The Grading of Recommendations Assessment,Development,and Evaluation approach was used to assess the certainty of the evidence.Results:A total of 60 eligible studies including 4675 participants were included.Low-certainty evidence showed that compared with antidepressants,acupuncture therapy(standardized mean difference[SMD]=-0.57;95%confidence interval[CI]=[-0.87,-0.27];I^(2)=86%;P=0.006)or acupuncture therapy plus antidepressants(SMD=-1.00;95%CI=[-1.18,-0.81];I^(2)=77%;P<0.00001)may reduce the severity of depression at the end of treatment.Low-certainty evidence indicated that compared with acupuncture therapy alone,acupuncture therapy plus antidepressants slightly reduced the severity of depression at the end of treatment(SMD=-0.38;95%CI=[-0.61,-0.14];I^(2)=18%;P=0.002).Similar results were also found for acupuncture's relief of insomnia.The reported adverse effects of acupuncture therapy were mild and transient.For most of the subgroup analyses,acupuncture type,scale type,and the course of treatment did not show a significant relative effect.Conclusion:Acupuncture therapy may provide antidepressant effects and relieve insomnia with mild adverse effects for adult patients with mild and moderate MDD.But the certainty of evidence was very low.More high-quality,well designed,large-scale studies with long-term follow-up are needed in the future.
基金supported by European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska Curie grant agreement(No.101028929)BJFis supported by National Heart Foundation of Australia Postdoc-toral Fellowship(No.106588)+1 种基金BG is supported by Australian Government Research Training Program ScholarshipDPLis supported by Clive Kearon Award,McMaster University.Additional funding information can be found in Supplemen-tary Funding.
文摘Background:Muscular strength is a powerful marker of current health status and robust predictor of age-related disease and disability.Handgrip strength(HGS)using isometric dynamometry is a convenient,feasible,and widely used method of assessing muscular strength among people of all ages.While adult HGS norms have been published for many countries,no study has yet synthesized available data to produce international norms.The objective of this study was to generate international sex-and age-specific norms for absolute and body size-normalized HGS across the adult lifespan.Methods:Systematic searches were conducted in 6 databases/web search engines(MEDLINE,SPORTDiscus,Embase,Web of Science,CINAHL,and Google Scholar)up to December 1,2023.We included full-text peer-reviewed observational studies that reported normative HGS data for adults aged ≥20 years by sex and age.Pseudo data were generated using Monte Carlo simulation following harmonization for methodo-logical variation.Population-weighted Generalized Additive Models for Location,Scale,and Shape were used to develop sex-and age-specific norms for absolute HGS(kg)and HGS normalized by height(Ht,m)squared(i.e.,HGS/Ht^(2)in kg/m^(2)).Norms were tabulated as percentile values(5th to 95th)and visualized as smoothed percentile curves.Results:We included data from 100 unique observational studies representing 2,405,863 adults(51.9%female)aged 20 to 100+years from 69 countries and regions tested from the year 2000 onward.On average,absolute and normalized HGS values negligibly improved throughout early adulthood,peaked from age 3039 years(at 49.7 kg(males)and 29.7 kg(females)for absolute HGS or 16.3 kg/m^(2)(males)and 11.3 kg/m^(2)(females)for HGS/Ht^(2)),and declined afterwards.The age-related decline in HGS accelerated from middle to late adulthood and was slightly larger for males than for females during middle adulthood.Conclusion:This study provides the world’s largest and most geographically comprehensive international norms for adult HGS by sex and age.These norms have utility for global peer-comparisons,health screening,and surveillance.
文摘Hepatitis C virus(HCV)is a global health concern associated with significant morbidity and mortality.Before the approval of second-generation direct-acting antiviral agents(DAAs),interferon therapy and liver transplantation constituted the mainstay of treatment.The introduction of well-tolerated oral DAAs in late 2013 has revolutionized HCV management with over 95%cure rates.The predominance of HCV-related liver transplantations has declined following the widespread approval of DAAs.Despite the unparallel efficacy observed among these novel therapies,pharmaceutical costs continue to limit equitable access to healthcare and likely contribute to the differential HCV infection rates observed globally.To reduce the burden of disease worldwide,essential agenda items for all countries must include the prioritization of integrated care models and access to DAAs therapies.Through transparent negotiations with the pharmaceutical industry,the consideration for compassionate release of medications to promote equitable division of care is paramount.Here we provide a literature review of HCV,changes in epidemiologic trends,access issues for current therapies,and global inequities in disease burden.
基金supported(in part)by the Entrusted Project of National Center for Medical Service Administration,National Health and Family Planning Commission China(No.[2019]099)the First Level Funding of the Second Medical Leading Talent Project in Hubei Provincethe Special Project for Emergency of the Ministry of Science and Technology(2020YFC0841300)。
文摘In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development;we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control(including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.
文摘Background In China's Mainland,patients with neovascular age-related macular degeneration(nAMD)have approximately an 40%prevalence of polypoidal choroidal vasculopathy(PCV).This disease leads to recurrent retinal pigment epithelium detachment(PED),extensive subretinal or vitreous hemorrhages,and severe vision loss.China has introduced various treatment modalities in the past years and gained comprehensive experience in treating PCV.Methods A total of 14 retinal specialists nationwide with expertise in PCV were empaneled to prioritize six questions and address their corresponding outcomes,regarding opinions on inactive PCV,choices of anti-vascular endothelial growth factor(anti-VEGF)monotherapy,photodynamic therapy(PDT)monotherapy or combined therapy,patients with persistent subretinal fluid(SRF)or intraretinal fluid(IRF)after loading dose anti-VEGF,and patients with massive subretinal hemorrhage.An evidence synthesis team conducted systematic reviews,which informed the recommendations that address these questions.This guideline used the GRADE(Grading of Recommendations,Assessment,Development,and Evaluation)approach to assess the certainty of evidence and grade the strengths of recommendations.Results The panel proposed the following six conditional recommendations regarding treatment choices.(1)For patients with inactive PCV,we suggest observation over treatment.(2)For treatment-na?ve PCV patients,we suggest either anti-VEGF monotherapy or combined anti-VEGF and PDT rather than PDT monotherapy.(3)For patients with PCV who plan to initiate combined anti-VEGF and PDT treatment,we suggest later/rescue PDT over initiate PDT.(4)For PCV patients who plan to initiate anti-VEGF monotherapy,we suggest the treat and extend(TE)regimen rather than the pro re nata(PRN)regimen following three monthly loading doses.(5)For patients with persistent SRF or IRF on optical coherence tomography(OCT)after three monthly anti-VEGF treatments,we suggest proceeding with anti-VEGF treatment rather than observation.(6)For PCV patients with massive subretinal hemorrhage(equal to or more than four optic disc areas)involving the central macula,we suggest surgery(vitrectomy in combination with tissue-plasminogen activator(tPA)intraocular injection and gas tamponade)rather than anti-VEGF monotherapy.Conclusions Six evidence-based recommendations support optimal care for PCV patients'management.
文摘Objective:To systematically review the clinical practice guidelines(CPGs)for the treatment of patients with coronavirus disease 2019(COVID-19)using Chinese herbal medicine(CHM),assess the methodological quality as well as clinical credibility and implementability of specific recommendations,and summarize key recommendations.Methods:As of April 2022,we conducted a comprehensive search on major electronic databases,guideline websites,academic society websites,and government websites to assess the methodological quality and clinical applicability of the included CPGs using the Appraisal of Guidelines for Research and Evaluation(AGREE)II tool and Evaluation-Recommendations EXcellence(AGREE-REX)instructions,respectively.Results:The search yielded 61 CPGs,which were mostly published in 2020;moreover,98.4%of the CPGs were published in China.Only five CPGs achieved a high-quality AGREE II rating;further,six CPGs could be directly recommended,with most of the CPGs still showing much room for improvement.CPGs had a low overall score in the AGREE-REX evaluation,with the domains of clinical applicability,values and preferences,and implementability being standardized in 21.80%±12.56%,16.00%±11.81%,and 31.33%±14.55%of the CPGs,respectively.Five high-quality CPGs mentioned 56 Chinese herbal formulas.Half of the recommendations had moderate or strong evidence level in the GRADE evaluation.The most frequently recommended herbal medicines were Lianhua Qingwen granule/capsule and Jinhua Qinggan granule;however,the strength of recommendation for each prescription varied across CPGs and populations.Conclusions:The overall quality of current CPGs for COVID-19 for CHM still needs to be improved;moreover,the strength of the evidence remains to be standardized across CPGs.
基金supported(in part)by the National Key Research and Development Program of China(2020YFC0845500)the Special Project for Emergency of Hubei Province(2020FCA008)the First Level Funding of the Second Medical Leading Talent Project in Hubei Province。
文摘The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is the cause of a rapidly spreading illness,coronavirus disease 2019(COVID-19),affecting more than seventeen million people around the world.Diagnosis and treatment guidelines for clinicians caring for patients are needed.In the early stage,we have issued"A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV)infected pneumonia(standard version)";now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline.We formed a working group of clinical experts and methodologists.The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas:chemoprophylaxis,diagnosis,treatments,and discharge management.We searched the literature for direct evidence on the management of COVID-19,and assessed its certainty generated recommendations using the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)approach.Recommendations were either strong or weak,or in the form of ungraded consensus-based statement.Finally,we issued 34 statements.Among them,6 were strong recommendations for,14 were weak recommendations for,3 were weak recommendations against and 11 were ungraded consensus-based statement.They covered topics of chemoprophylaxis(including agents and Traditional Chinese Medicine(TCM)agents),diagnosis(including clinical manifestations,reverse transcription-polymerase chain reaction(RT-PCR),respiratory tract specimens,IgM and IgG antibody tests,chest computed tomography,chest X-ray,and CT features of asymptomatic infections),treatments(including lopinavirritonavir,umifenovir,favipiravir,interferon,remdesivir,combination of antiviral drugs,hydroxychloroquine/chloroquine,interleukin-6 inhibitors,interleukin-1 inhibitors,glucocorticoid,qingfei paidu decoction,lianhua qingwen granules/capsules,convalescent plasma,lung transplantation,invasive or noninvasive ventilation,and extracorporeal membrane oxygenation(ECMO)),and discharge management(including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge).We also created two figures of these recommendations for the implementation purpose.We hope these recommendations can help support healthcare workers caring for COVID-19 patients.
基金supported by the National Key Research and Development Program of China(2024YFA0918504)Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(2024-RW320-01)+2 种基金the National Natural Science Foundation of China(32170788,82460135)Beijing Natural Science Foundation(7232123,7244390,L248074)the National High Level Hospital Clinical Research Funding(2022-PUMCH-B-023).
文摘To compare and characterize hypertriglyceridemia-induced acute pancreatitis(HTG-AP)across the geographical regions,we conducted a systematic review and a multi-center cohort study.We conducted a systematic review and random effects meta-analysis of studies reporting HTG-AP.Also,we separately characterized HTG-AP in a multi-center retrospective cohort study involving eight centers in China.The key outcomes of interest included the pooled proportion of HTG-AP and its severity parameters after adjusting for the effect of confounding factors through logistic regression.Our systematic review identified 110 studies from 15 countries accounting for 3,057,428 participants(35%female,median age 50 years).The pooled proportion of HTG-AP was 11.6%globally while the Eastern and Western countries reported the proportions as 16.3%and 5.4%,respectively(P<0.01).The pooled mortality rate was remarkably higher in Eastern countries(4.1%)than in Western countries(1.0%)(P<0.01).3,224 participants(37%female,median age 48 years)were included in our multi-center cohort study,and the proportion of HTG-AP was much higher at 35.9%with a nearly three-fold higher mortality rate compared with acute pancreatitis(AP)due to other etiologies(odds ratio(OR):2.77,95%confidence interval(CI):1.60 to 4.81).The proportion of patients with HTG-AP is remarkably higher in Eastern countries,particularly China,than in Western countries.Furthermore,compared with other causes of AP,HTG-AP has a poorer prognosis and may warrant aggressive management.
基金supported by the Hamilton Health Sciences Foundation(RD-241).
文摘Background:Conducting a systematic review(SR)is a time-intensive process and represents the first phase in developing a clinical practice guideline(CPG).Completing a CPG through the Program in Evidence-Based Care(PEBC),a globally acknowledged guideline program supported by Ontario Health(Cancer Care Ontario),typically takes about 2 years.Thus,expediting an SR can significantly reduce the overall time required to complete a CPG.Our recently published review identified two artificial intelligence(AI)tools,DistillerSR and EPPI-Reviewer that reduced time in the title and abstract screening in an SR process when developing a CPG.However,the consistency and generalizability of these tools remain unclear within or across different SRs related to cancer.This study protocol aims to evaluate and compare the performance of DistillerSR and EPPI-Reviewer against human reviewers for title and abstract screening(Stage I screening)in cancer CPG development.Methods:We will conduct a retrospective simulation study to evaluate and compare the performance of DistillerSR and EPPI-Reviewer across 10 previously published CPGs by PEBC.These CPGs include the five cancer types with the highest incidence(lung,breast,prostate,colorectal,and bladder).We will run 30 simulation trials for one CPG per AI tool.Primary outcomes are workload savings and time savings in Stage I screening.The secondary outcome is the percentage of missing articles among the final included articles.This informs the accuracy and comprehensiveness of the AI tools.Descriptive and inferential statistical analysis will be conducted to evaluate the outcomes.Results:This is a study protocol.The data presented in the tables are illustrative examples rather than actual study results,in accordance with the journal’s standard structure.All data included in the final study will be thoroughly validated.Discussion:This will be the first study to investigate and compare the performance of DistillerSR and EPPI-Reviewer in Stage I screening of SRs in CPGs across different cancer types.These findings will inform the reliable use of AI tools in future cancer-related CPGs.The results from this retrospective study will need to be confirmed by prospective studies.
基金supported by National Key R&D Program of China(Grant No.2023YFC3503304)National Science Fund for Distinguished Young Scholars(Grant No.82225049)+1 种基金Fundamental Research Funds for the Central Public Welfare Research Institutes(Grant No.2020YJSZX-3)1.3.5 project for disciplines of excellence,West China Hospital,Sichuan University(Grant No.ZYGD23004).
文摘Promoting the international acceptance of clinical studies about traditional Chinese medicine(TCM)interventions is a key strategy for internationalization of TCM.However,the complexities of TCM interventions—in terms of the theories,practice patterns,and components—pose challenges to the design and implementation of clinical studies that are well accepted by the international community.This article summarized the current status of clinical studies about TCM interventions that were published in international journals,explored underlying barriers hindering the international acceptance,and discussed potential strategies for future development.
基金This work was supported by the second batch of"Ten thousand plan"-National high-level talents special support plan(No.W02020052)National Natural Science Foundation of China(No.82072247,82204937)+1 种基金Natural Science Foundation of Beijing(No.L222150)the China Scholarship Council(No.202206557005)。
文摘Severe pneumonia is one of the most common infectious diseases and the leading cause of sepsis and septic shock.Preventing infection,balancing the patient’s immune status,and anti-coagulation therapy are all important elements in the treatment of severe pneumonia.As multi-target agents,Xuebijing injection(XBJ)has shown unique advantages in targeting complex conditions and saving the lives of patients with severe pneumonia.This review outlines progress in the understanding of XBJ’s anti-inflammatory,endotoxin antagonism,and anticoagulation effects.From the hundreds of publications released over the past few years,the key results from representative clinical studies of XBJ in the treatment of severe pneumonia were selected and summarized.XBJ was observed to effectively suppress the release of pro-inflammatory cytokines,counter the effects of endotoxin,and assert an anticoagulation effect in most clinical trials,which are consistent with experimental studies.Collectively,this evidence suggests that XBJ could play an important and expanding role in clinical medicine,especially for sepsis,septic shock and severe pneumonia.
基金Supported by the National Natural Science Foundation of China (No.81973968)the China Academy of Chinese Medical Sciences (No.CI2021A03503, GH201901, and 2020YJSZX-1)。
文摘Background:The effects of acupuncture have varied in different randomized controlled trials(RCTs),and there are many factors that influence treatment effect of acupuncture in different outcomes,with conflicting results.Objective:To identify factors and their impact on the treatment effect of acupuncture in different outcomes.Methods:Acupuncture RCTs were searched from 7 databases including Medline(Pub Med),Embase,Cochrane Central Register of Controlled Trials,China National Knowledge Infrastructure,Wanfang Database,VIP Database,and China Biology Medicine disc between January 1st,2015 and December 31st,2019.Eligible studies must compare acupuncture to no acupuncture,sham acupuncture,or waiting lists,and report at least 1patient-important outcome.A multi-level meta-regression was conducted using a 3-level robust mixed model and univariate analyses were performed for all independent variables,even those excluded from the multivariable model due to collinearities.We used thresholds of 0.2 and 0.4 for the difference of standardized mean differences(SMDs),categorising them as small(<0.2),moderate(0.2–0.4),or large(>0.4) effects.Results:The pain construct analysis involved 211 effect estimates from 153 studies and 14 independent variables.High-frequency acupuncture treatment sessions produced larger effects compared to low-frequency sessions [large magnitude,the difference of adjusted SMDs 0.46,95% confidence interval(CI) 0.07 to 0.84;P=0.02].The non-pain symptoms construct analysis comprised 323 effect estimates from 231 studies and 15 independent variables.Penetrating acupuncture showed moderately larger effects when compared to non-penetrating acupuncture(0.30,95% CI 0.06 to 0.53;P=0.01).The function construct analysis included 495 effect estimates from 274 studies and 14 independent variables.Penetrating acupuncture and the flexible acupuncture regimen showed moderately larger effects,compared to non-penetrating acupuncture and fixed regimen,respectively(0.40,95% CI 0 to 0.80;P=0.05;0.29,95% CI 0.06 to 0.53;P=0.01).Conclusions:High-frequency acupuncture sessions appear to be a more effective approach to managing painful symptoms.Penetrating acupuncture demonstrated greater effect in relieving nonpainful symptoms.Both penetrating acupuncture type and flexible acupuncture regimen were linked to significant treatment effects in function outcomes.Future studies should consider the factors that are significantly associated with the effects of acupuncture in patient-important outcomes.
文摘Purpose: Medication compliance for chronic medications has been well studied, but there is a gap in the literature regarding compliance within the perioperative period. Our objective was to determine the incidence of patient non-compliance with preoperative medication instructions for adult non-emergent surgery. Additional objectives were to identify predictors of compliance, describe medication instructions by drug type, and explore the impact of non-compliance. Patients and Methods: This historical chart review evaluated preoperative compliance to medication instructions in 393 adults undergoing non-emergent surgeries at Hamilton Health Sciences between May 1, 2012, and April 30, 2013. Seven patient factors (age;sex;American Society of Anesthesiologists class;number of medications;type of surgery;time between preoperative appointment to surgery;the individual collecting the medication list) were evaluated as potential predictors of non-compliance and analyzed using logistic regression analysis. Consequences of non-compliance were assessed by impact on intraoperative blood pressure, blood glucose level, drop in hemoglobin, bronchospasm, and case delays. Results: One hundred forty-six (37.2%) patients were non-compliant with one or more medication reconciliation instructions provided by the anesthesiologist. No significant associations were observed for any patient risk factors and non-compliance. Non-compliance was not associated with any clinically significant consequences. Conclusions: Our study shows that 37.15% of adult patients undergoing non-emergent surgery were non-compliant with medication instructions, although patients did not receive any written instructions for 46% of their medications. We did not identify any predictive patient factors or adverse outcomes associated with non-compliance.
基金funded by grants from National Natural Science Foundation of China(No.32170788)National Clinical Key Specialty Construction Project(No.ZK108000)+1 种基金National High Level Hospital Clinical Research Funding(No.2022-PUMCH-B-023)Beijing Natural Science Foundation(No.7232123)
文摘To the Editor:Acute pancreatitis(AP)is the most common gastrointestinal condition that leads to acute hospitalization.[1]The incidence of AP has increased in recent decades,with a current global incidence of 34/100,000,probably due to a rising trend of obesity and gallstone disease.AP is associated with remarkable pain,reduced quality of life(QoL),and even death,thus posing a heavy socioeconomic burden.In addition,approximately 22%of AP patients experience recurrent AP(RAP)and 10%of AP patients progress to chronic pancreatitis.[2]Petrov and Yadav[3]have,therefore,argued that AP should not be considered as an acute and self-limiting disease.Treatment and long-term care after AP have drawn widespread attention,which has improved patients’physical and mental health.
文摘Introduction In Brazil,approximately 5%are born with a congenital disorder,potentially fatal without surgery.This study aims to evaluate the relationship between gastrointestinal congenital malformation(GICM)mortality,health indicators,and socioeconomic factors in Brazil.Methods GICM admissions(Q39-Q45)between 2012 and 2019 were collected using national databases.Patient demographics,socioeconomic factors,clinical management,outcomes,and the healthcare workforce density were also accounted for.Pediatric Surgical Workforce density and the number of neonatal intensive care units in a region were extracted from national datasets and combined to create a clinical index termed'NeoSurg'.Socioeconomic variables were combined to create a socioeconomic index termed SocEcon'.Simple linear regression was used to investigate if the temporal changes of both indexes were significant.The correlation between mortality and the different indicators in Brazil was evaluated using Pearson's correlation coefficient.Results Over 8 years,Brazil recorded 12804 GICM admissions.The Southeast led with 6147 cases,followed by the Northeast(2660),South(1727),North(1427),and Midwest(843).The North and Northeast reported the highest mortality,lowest NeoSurg,and SocEcon Index rates.Nevertheless,mortality rates declined across regions from 7.7%(2012)to 3.9%(2019),a 51.7%drop.The North and Midwest experienced the most substantial reductions,at 63%and 75%,respectively.Mortality significantly correlated with the indexes in nearly all regions(p<0.05).Conclusion Our study highlights the correlation between social determinants of health and GICM mortality in Brazil,using two novel indexes in the pediatric population.These findings provide an opportunity to rethink and discuss new indicators that could enhance our understanding of our country and could lead to the development of necessary solutions to tackle existing challenges in Brazil and globally.
文摘Background:Whether the time course of post-stroke depression (PSD) can be used to predict the quality of life (QoL) of patients with late-stage stroke remains unclear,this study investigated whether persistent depression at 1 year after stroke predicts QoL at 5 years following stroke.Methods:We analyzed the demographic and clinical data of patients with stroke in 56 hospitals across China that participated in the Prospective Cohort Study on the Incidence and Outcome of Patients with PSD in China Study.Follow-up assessments were performed at the following time points after stroke:in person,2 weeks,3 months,6 months,and 1 year;by telephone,5 years.National Institutes of Health Stroke Scale (NIHSS) score on admission,recurrence,disability,depression,QoL,and chronic complications were recorded.Depression was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders.QoL was measured using short form-12 (SF-12).Multivariable ordinal logistic regression analysis was used to identify factors that independently affected the physical component summary (PCS) and mental component summary (MCS) scores of the SF-12.Results:Of the 801 patients evaluated in this study,80 had persistent depression.The multivariable regression analysis of data obtained at 5 years showed that persistent depression at 1 year (odds ratio [OR]:0.48;95% confidence interval [CI]:0.29-0.81) and disability at 5 years (OR:0.34;95% CI:0.23-0.49) were associated with poor MCS scores at 5 years.Old age,a high NIHSS score on admission,disability at 5 years,and stroke recurrence within 5 years were associated with poor PCS scores at the 5-year follow-up.Conclusions:Persistent depression at the 1-year follow-up could predict poor MCS scores at the 5-year follow-up.The development of interventional strategies targeting post-stroke patients with persistent depression is warranted.
基金CAMS Innovation Fund for Medical Sciences(CIFMSNo.2022-I2M-1-003)Peking Union Medical College(No.2019zlgc0503)
文摘To the Editor:Colorectal cancer(CRC)remains a leading cause of cancer-related death worldwide.[1]In addition to the classical adenoma-to-carcinoma model of colorectal carcinogenesis,the serrated neoplastic pathway accounts for 20%–30%of CRCs.Sessile serrated lesions(SSLs),the most common premalignant serrated polyp subtype,share many of the genomic characteristics of post-colonoscopy CRCs and are thus recognized as their precursor lesions.However,SSLs can be easily missed due to their flat shape and subtle endoscopic features.Sometimes they can also be difficult to distinguish from other types of polyps,especially hyperplastic polyps(HPs),which are believed to have no malignant potential.[2]Approximately 10%of polyps initially diagnosed as HPs endoscopically are reclassified as SSLs after histopathological examination,reflecting diagnostic difficulties in colonoscopy.[3,4]Current guidelines recommend“diagnose-and-leave”and“resect-and-discard”strategies for diminutive polyps,which might lead to SSLs being left in situ or diagnoses being missed,[5]raising the risk of recurrence and post-colonoscopy cancers.Furthermore,it remains debatable in the gastrointestinal community whether the risks of resecting SSLs outweigh the reduction in cancer risk.Any strategy that improves the diagnostic accuracy of SSLs could have a meaningful clinical impact.
文摘Objective This study aimed to summarize the characteristics and methodological quality of systematic reviews on the application of artificial intelligence(AI)in clinical diagnosis and treatment.Methods We systematically searched seven English-and Chinese-language literature databases to identify sys-tematic reviews on the application of AI,deep learning,or machine learning in the diagnosis and treatment of any disease published in 2020.We evaluated the methodological quality of the included systematic reviews using“A Measurement tool for the assessment of multiple systematic reviews”(AMSTAR).We also conducted meta-analyses on the diagnostic accuracy of AI on selected disease categories with a large number of included studies and low clinical heterogeneity.Results A total of 40 systematic reviews reporting 1,083 original studies were included,covering 31 diseases from 11 groups of diseases.Eleven systematic reviews were related to neoplasms and nine were systematic reviews related to diseases of the digestive system.We selected digestive system diseases for the meta-analysis.The pooled sensitivities(with 95%confidence interval(CI))of AI to assist the diagnosis of helicobacter pylori,gastrointestinal ulcers,hemorrhage,esophageal tumors,gastric tumors,and intestinal tumors(with 95%CI)were 0.91(0.83-0.95),0.99(0.76-1.00),0.95(0.83-0.99),0.90(0.85-0.93),0.90(0.82-0.95),and 0.93(0.88-0.96),respectively,and the pooled specificities were 0.82(0.77-0.87),0.97(0.86-1.00),1.00(0.99-1.00),0.80(0.71-0.87),0.93(0.87-0.97),and 0.89(0.85-0.92),respectively.The AMSTAR items“the list of included studies”(n=39,97.5%)and“the characteristics of the included studies”(n=39,97.5%)had the highest compliance among the reviews;the compliance was relatively low to the items“the consideration of publication status”(n=1,2.5%),“the consideration of scientific quality”(n=19,47.5%),“data synthesis methods”(n=18,45.0%),and“the evaluation of publication bias”(n=13,32.5%).Conclusions The main subjects of systematic reviews on AI applications in clinical diagnosis and treatment pub-lished in 2020 were diseases of the digestive system and neoplasms.The methodological quality of the systematic reviews on AI needs to be improved,paying particular attention to publication bias and the rigorous evaluation of the quality of the included studies.
基金supported by the grants from the National Natural Science Foundation of China(Nos.71704122 and 71974138)National Science and Technology Major Project(No.2018ZX10302206)1·3·5 project for disciplines of excellence,West China Hospital,Sichuan University(No.ZYYC08003)。
文摘Background:Since the outbreak of coronavirus disease 2019(COVID-19),human mobility restriction measures have raised controversies,partly because of the inconsistent findings.An empirical study is promptly needed to reliably assess the causal effects of the mobility restriction.The purpose of this study was to quantify the causal effects of human mobility restriction on the spread of COVID-19.Methods:Our study applied the difference-in-difference(DID)model to assess the declines of population mobility at the city level,and used the log-log regression model to examine the effects of population mobility declines on the disease spread measured by cumulative or new cases of COVID-19 over time after adjusting for confounders.Results:The DID model showed that a continual expansion of the relative declines over time in 2020.After 4 weeks,population mobility declined by-54.81%(interquartile range,-65.50%to-43.56%).The accrued population mobility declines were associated with the significant reduction of cumulative COVID-19 cases throughout 6 weeks(ie,1%decline of population mobility was associated with 0.72%[95%CI:0.50%-0.93%]reduction of cumulative cases for 1 week,1.42%2 weeks,1.69%3 weeks,1.72%4 weeks,1.64%5 weeks,and 1.52%6 weeks).The impact on the weekly new cases seemed greater in the first 4 weeks but faded thereafter.The effects on cumulative cases differed by cities of different population sizes,with greater effects seen in larger cities.Conclusions:Persistent population mobility restrictions are well deserved.Implementation of mobility restrictions in major cities with large population sizes may be even more important.
