Objective To systematically assess the efficacy and clinical significance of antibiotic prophylaxis in severe acute pancreatitis (SAP), so as to provide references for its rational clinical application. Methods For collecting the randomized controlled trials (RCTs) about antibiotic prophylaxis in SAP, a search was conducted in MEDLINE, EMbase, Cochrane Central Register of Controlled Trials, CBM and CNKI from the date of their establishment to August, 2010. After the clinical studies meeting the inclusive criteria were extracted and their quality was assessed. Meta-analysis was conduced by using RevMan 5.0 software. Results Twelve RCTs were included with a total of 777 patients. The results of Meta-analysis showed compared with the control group, the antibiotic prophylaxis group was not associated with a statistically significant reduction in mortality (RR=0.75, 95%CI 0.50 to 1.12), in the incidence of infected pancreatic necrosis (RR 0.82, 95%CI 0.63 to 1.09), in surgical interventions (RR=0.97, 95%CI 0.74 to 1.26), and in the incidence of nonpancreatic infections (RR=0.73, 95%CI 0.48 to 1.10). Conclusion Antibiotic prophylaxis for SAP does not reduce mortality, infected necrosis, or surgical intervention.
Objective To explore the potential mechanism of the occurrence and development of lupus nephritis (LN) and identify key biomarkers and immune-related pathways associated with the progression of LN. Methods We downloaded a dataset from the Gene Expression Omnibus database. By analyzing the differential expression of genes and performing weighted gene co-expression network analysis (WGCNA), as well as Gene Ontology enrichment, Disease Ontology enrichment, and Kyoto Encyclopedia of Genes and Genomes pathway enrichment, we explored the biological functions of differentially expressed genes in LN. Using three machine learning models, namely LASSO regression, support vector machine, and random forest, we identified the hub genes in LN, and constructed a line diagram diagnosis model based on the hub genes. The diagnostic accuracies of the hub genes were evaluated using the receiver operating characteristic curve, and the relationship between known marker gene sets and hub gene expression was analyzed using single sample gene set enrichment analysis. Results We identified a total of 2297 differentially expressed genes. WGCNA generated 7 co-expression modules, among which the cyan module had the highest correlation with LN. We obtained 347 target genes by combining differential genes. Using the three machine learning methods, LASSO regression, support vector machine, and random forest, we identified three hub genes (CLC, ADGRE4P, and CISD2) that could serve as potential biomarkers for LN. The area under the receiver operating characteristic curve (AUC) analysis showed that these three hub genes had significant diagnostic value (AUCCLC=0.718, AUCADGRE4P=0.813, AUCCISD2=0.718). According to single sample gene set enrichment analysis, the hub genes were mainly associated with apoptosis, glycolysis, metabolism, hypoxia, and tumor necrosis factor-α-nuclear factor-κB-related pathways. Conclusions By combining WGCNA and machine learning techniques, three hub genes (CLC, ADGRE4P, and CISD2) that may be involved in the occurrence and development of LN are identified. These genes have the potential to aid in the early clinical diagnosis of LN and provide insight into the mechanisms underlying LN progression.
Objective To systematically review the effectiveness and safety of alanyl-glutamine dipeptide for severe acute pancreatitis (SAP). Methods Such databases as MEDLINE, EMbase, CENTRAL, VIP, WanFang Data, CBM and CNKI were electronically searched from inception to October, 2012 for randomized controlled trials on alanyl-glutamine dipeptide for SAP. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. Then, meta-analysis was performed using RevMan 5.2. Results Five trials were included involving a total of 227 patients. The results of meta-analysis showed that: compared with the control group, the alanyl-glutamine dipeptide group had the lower incidence of SAP complications (RR=0.41, 95%CI 0.20 to 0.82), the lower incidence of infected pancreatic necrosis (RR=0.12, 95%CI 0.02 to 0.89), less time for alleviating bellyache (MD= –0.90, 95%CI –1.72 to –0.08). There was a tendency in decreasing SAP mortality (RR=0.15, 95%CI 0.02 to 1.19) and lessening the recovery time of blood amylase (SMD=0.37, 95%CI –0.04 to 0.79). Conclusion Current evidence shows that, alanyl-glutamine dipeptide can lower the incidence of complications and the incidence of infected pancreatic necrosis, and shorten the time for alleviating bellyache in SAP patients. Due to the limited quality of the included studies, the above conclusion needs to be verified by more high quality studies.
Objective To analyze the effectiveness of conservative medical treatments for ectopic pregnancy (EP): methotrexate (MTX) + mifepristone + Ectopic Pregnancy II decoction (EP-II) vs. methotrexate + mifepristone. Methods A total of 95 patients with EP in Shenzhen Shajing Affiliated Hospital of Guangzhou Medical University from January 2009 to January 2011 were randomly divided into two groups: 45 patients in the experimental group were treated with MTX, mifepristone and EP II decoction, while the other 50 patients in the control group were treated with MTX and mifepristone. The effectiveness of the two groups was analyzed with SPSS 13.0 software. Results There were significant differences in the time of serum β-HCG return to normal (16.13±8.13 ds vs. 22.05±7.15 ds, Plt;0.05), time of EP mass absorption (30.46±7.56 ds vs. 39.99±18.26 ds, Plt;0.05) and tubal patency rate (80% vs. 75%, Plt;0.05) between the two groups. But there were no significant differences in effective rate (95.56%, 43/45 vs. 94%, 47/50, χ2=0.0809, Pgt;0.05) and side effects. Conclusion The combination of methotrexate, mifepristone and EP II decoction for ectopic pregnancy is more effective than mifepristone and methotrexate in coordinately killing the embryo, shortening the time of serum β-HCG return to normal and the time of EP mass absorption, and improving the function of oviducts.
Scientism and humanism are two main views on the development of medicine, which run through both theory and practice. Under the guidance of the modern medical concept of " bio-psycho-social”, the views of scientism and humanism on medicine have reached an unprecedented level of development and integration, which jointly determine the connotations and demands of current medicine. As one of the current mainstream medical models, evidence-based medicine (EBM) has played an important role in the management of current medical theories and practices. Meanwhile, EBM has also encompassed views of scientism and humanism in its own development and has successfully shaped the knowledge and methodological system. EBM will continue to gain insight into the characteristics of views of scientism and humanism in the future of medicine to improve itself and should pay more attention to the development of humanism view. As an important branch discipline of EBM, evidence-based Chinese medicine may become a model of the perfect combination of scientism view and humanism view.
Evidence-based medicine (EBM) provides a reliable evidence decision-making model for the medical field. The concepts and methods of EBM are gradually extended to other disciplines. At present, the paradigm of evidence-based science (EBS) is formally proposed, which is not only based on a methodological cooperation between different disciplines, but also a deeper potential driving force in optimizing the operation process of knowledge. The advantages of EBS helps promote its extension to other disciplines through standardization concepts and systematic methods, through which the common theories and supporting organization of EBS are formed. Under the guideline of EBS, the evidence-based concepts and methods will play a supportive role in scientific development.
ObjectivesTo analyze the citation of evidence in traditional Chinese medicine (TCM) clinical pathways in China, and to provide suggestions for future development and revision of TCM clinical pathways.MethodsTCM clinical pathways released on the websites of national administration of TCM and China association of Chinese medicine were obtained, with the retrieval time limit to June 2019. Two researchers separately utilized the Excel to extract data and performed a descriptive analysis.ResultsA total of 405 TCM clinical pathways were included, involving internal medicine, surgery, gynecology and pediatrics. Internal medicine accounted for the largest proportion of the TCM clinical pathways (133). All the 405 pathways cited references as evidence, among which the maximum and minimum quantities of cited references were 11 and 1, respectively, and the median was 3. More than 90% of the TCM clinical pathways cited the evidence in the parts of diagnosis and efficacy evaluation. For parts of TCM and western medicine treatment, the proportion of TCM clinical pathways which cited evidence was less than 75%; for parts of rehabilitation and nursing, the proportion of TCM clinical pathways which cited evidence was less than 2%. The types of evidence being cited were standard indicators (683), clinical practice guidelines (488), textbooks (236), consensus opinions, ancient books and clinical surveys. The released time was reported in 89.25% of the cited evidence; the largest time interval was between the release time of the standard indicators (evidence) and that of the TCM pathways. Among the evidence released more than 15 years before the release of the TCM pathways, the proportion of standard indicators was the highest (57.12%).ConclusionsThe published TCM clinical pathways are all developed based on evidence, however, the evidence citation ratio in different parts varies greatly. In some TCM clinical pathways, the cited evidences are not reported normatively, and some evidence are poor in timeliness.
This paper introduces the development and changes of clinical practice guidelines based on the enlightenment of the Reporting Items for Practice Guidelines in Health Care (RIGHT), and provides policy recommendations.
A comprehensive evaluation system of Chinese patent medicine (CPM) is considered as a critical tool to measure the value of CPM. The "guideline for multi-dimensional and multi-criteria comprehensive evaluation for Chinese patent medicine" (abbreviated as guideline) has been released, proposing a comprehensive evaluation system of CPM (1st) comprising six aspects: safety, effectiveness, economy, applicability, scientificity and standardization. This paper elaborated the development method and explained the evaluation dimensions and criteria, so as to help the researchers understand and use the comprehensive evaluation system in the future when evaluating CPM.
Our team proposed and constructed an Expert-knowledge and Data-driven Comprehensive Evaluation Model of Chinese Patent Medicine (EDCEM-CPM) using the machine learning algorithm. This model could improve the system of the comprehensive evaluation of the Chinese patent medicine in technology and provide measurement tools for Chinese patent medicine according to its characteristics. The model evaluates the multi-dimensional value of Chinese patent medicine by data pre-treatment, clustering algorithms, and data training steps, such as automatic learning weighting. This evaluation model is already in practice. In this paper, we introduced the establishment of the model with the calculation process for reference.