Objective To formulate an evidence-based treatment plan for a patient with gestational diabetes mellitus. Methods Based on the clinical questions raised from a real-life patient of gestational diabetes mellitus, we searched ACP Journal Club (1991 to Dec. 2006), The Cochrane Library (Issue 4, 2006), MEDLINE (1966 to Dec. 2006) and Chinese Biological Medical Database (1980 to Dec. 2006) for systematic reviews, randomized controlled trials, cohort and case-control studies. We used the following keywords: gestational diabetes, metformin, and pregnancy complication. The quality of the included studies was assessed.Results One meta-analysis (from MEDLINE) and two randomized controlled trials (from the Cochrane Central Register of Controlled Trials) were included. These studies concluded that there was no clear evidence on the benefits of metformin for gestational diabetes. Based on the current evidence, integrated with clinical expertise and the patient’s values, metformin was not used for this patient. Instead, intensive dietary control, blood glucose control, and appropriate exercise were administered. After this individual treatment, the patient gave birth to a healthy baby in 39+4 Weeks. Conclusion The appropriate management for gestational diabetes mellitus has been formulated with the approach of evidence-based medicine. Large-scale, methodologically-sound trials are required.
【摘要】 目的 观察沙美特罗替卡松粉吸入剂（沙美特罗50 μg/氟替卡松500 μg）治疗稳定期Ⅲ~Ⅳ级慢性阻塞性肺疾病（COPD）的疗效及安全性。 方法 将2008年1-12月就诊的62例稳定期Ⅲ~Ⅳ级COPD患者随机分成对照组和治疗组。对照组采用常规传统治疗方法，口服茶碱缓释片、祛痰剂；治疗组在常规传统治疗的基础上，加用沙美特罗替卡松粉吸入剂。6个月后评估两组患者肺功能、血气分析、呼吸困难程度及不良反应。治疗过程中，两组各有2例患者因失访退出研究。 结果 治疗前，对照组、治疗组1 s用力呼气量（FEV1）和FEV1%预计值比较，无统计学意义（Pgt;0.05）；治疗后，治疗组FEV1和FEV1%预计值明显增加，有统计学意义（Plt;0.05）。对照组治疗前后比较无改变（Pgt;0.05），治疗组较对照组呼吸困难程度明显好转，临床症状评分明显下降，两组间差异有统计学意义（Plt;0.05）。治疗结束时两组上述各指标比较，差异有统计学意义 （Plt;0.05）。两组均有少数出现咽喉不适，患者耐受好。 结论 沙美特罗替卡松粉吸入剂治疗稳定期Ⅲ~Ⅳ级COPD患者有效。【Abstract】 Objective To observe the efficacy and safety of inhaled formulations of Seretide (salmeterol 50 μg / fluticasone 500 μg) on grade Ⅲ ~ Ⅳ stable chronic obstructive pulmonary disease (COPD). Methods Sixty-two patients of grade Ⅲ-Ⅳ stable COPD were randomly divided into control group and treatment group. The control group was treated by conventional methods, oral theophylline and expectorant agents,while the treatment group was treated by inhalation of large dosage Seretide be added in the conventional treatment based on traditional. After six months, the lung function, blood gas analysis, respiratory difficulty and adverse effects were assessed. Results Before the treatment, the differences of forced expiratory volume in one second (FEV1) and FEV1% predicted value in the two groups were not statistically significant (Pgt;0.05). After treatment, FEV1 and FEV1% predicted value of treatment group were increased significantly(Plt;0.05). The control group showed no significant change before and after treatment(Pgt;0.05). The respiratory difficulty imprvoved significantly,while clinical symptom score decreased significantly in the treatment group,which compared with the control group (Plt;0.05). A few appeared thoat discomfort in the two groups. Well tolerated in patients. Conclusion Inhaled formulations of Seretide was effective and safty on stable period COPD patients with grade Ⅲ-Ⅳ.
Purpose To investigate the expression of intercellular adhesion molecules ICAM-1 and Mac-1，in epiretinal membanes (ERM) of eyes wi th proliferative vitreoretinopathy (PVR)． Methods Twenty epiretinal membranes were obtained from eyes undergone vitrectomy for retinal detachment complicated with PVR and observed by immunohistochemical examination． Results Expressions of ICMA-1 and Mac-1 were observed in 18 and 15 membranes respectively．Expression of both adhesion molecules in 12 membranes． Conclusion The findings indicate that adhesion molecules might be involved in the development of PVR． (Chin J Ocul Fundus Dis，2000，16：71-138)
ObjectiveTo systematically review the efficacy of mobile health (mHealth) apps on weight loss.MethodsWeb of Science, PubMed, CNKI, WanFang Data and CBM databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of mHealth APPs on weight loss from inception to October 18, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 12 RCTs involving 1 074 patients were included. The results of meta-analysis showed that the apps group was superior to the control group in body weight (MD=−1.88, 95%CI −3.23 to −0.53, P=0.006). There was a decreasing trend of body mass index (BMI) in apps group (MD=−0.55, 95%CI −1.09 to 0.00, P=0.05).ConclusionsCurrent evidence shows that mHealth app can increase the efficacy of weight loss. Due to limited quality and quantity of the included studies, more highquality studies are required to verify above conclusions.
Objective To assess the effectiveness and safety of autologous stem cell transplantation after high-dose chemotherapy in first-line treatment of follicular lymphoma. Method Randomized controlled trials (RCTs) of autologous stem cell transplantation after high-dose chemotherapy in first-line treatment of follicular lymphoma were collected from MEDLINE (1990-2009), EMBASE (1990-2009), OVID (1990-2009), and the Cochrane Library (Issue 2, 2009), and the proceedings of ASH were searched manually. The methodological quality of included studies was evaluated, and data analysis was performed with software STATA 10.0 and RevMan 4.3. Result A total of 4 RCTs involving 941 patients were included. The results of meta-analysis showed that overall survival rate (HR=0.82, 95%CI 0.49 to 1.15), event-free survival rate (HR=0.35, 95%CI 0.24 to 0.47), total remission rate (RR=0.35, 95%CI 0.96 to 1.30), and secondary malignant tumor incidence rate (RR=1.68, 95%CI 0.47 to 6.07). Conclusion According to the present evidences, autologous stem cell transplantation after high-dose chemotherapy can not improve overall survival rate and total remission rate, but can improve event-free survival rate, and do not increase secondary malignant tumor incidence rate. However, more high-quality, multiple-center, large-sample randomized controlled trials are required.
Objective To investigate the etiological and clinical characteristics of the outbreak of hand-foot-mouth disease (HFMD) in Chengdu in 2008. Methods A retrospective analysis was conducted to investigate 482 children with hand-foot-mouth disease in Chengdu from January to December 2008 in terms of epidemiology and clinical characteristics. Results Among the 482 children, 76.14% of the cases were infants, and male children numbered more than female ones. The proportion in the urban area was higher than that in the rural area. May to July was the peak epidemic period. Skin rash and fever were major clinical manifestations. Three cases were diagnosed as viral encephalitis. Conclusion The incidence of hand-foot-mouth disease is related to age and season. Effective prevention measures and isolated treatment are critical for prevention and therapy.
Objective To investigate the incidence of urolithiasis in the children who ingested milk powder tainted with melamine in the Chengdu area. Methods A total of 5 795 infants were screened for urolithiasis by ultrasound examination from September 17, 2008 to December 9, 2008. The data were analyzed using SPSS 13.0 software.Results Twenty-four children were diagnosed with urolithiasis with an incidence of 0.41%, including 12 males and 12 females. The mean age of those children with urolithiasis was 2.35±1.68 years old. No significant difference was shown in the incidence of urolithiasis between males and females (Pgt;0.05). The incidence of urolithiasis in the infants aged 0-3 was significantly higher than that in the children who were more than 3 years old (Plt;0.05). Conclusion The incidence of urolithiasis in the infants aged 0-3 in Chengdu and the surrounding areas is relatively high. Further data should be collected during the follow-up of these cases.
Objective To explore the methodological characteristics of Chinese clinical practice guidelines/expert consensus based on usage of GRADE. MethodsCNKI, PubMed, WanFang Data databases, and Medlive.cn were electronically searched to collect Chinese clinical practice guidelines/expert consensus over the past 11 years from January 1st 2010 to December 31st 2020. Four reviewers independently extracted data according to the content of appraisal of guidelines quality evaluation tool AGREE Ⅱ. The clinical practice guidelines/expert consensus were divided into two groups based on whether GRADE was used or not. The changes and development of methodological quality in the past 11 years were explored between the two groups. ResultsIn recent years, the number of clinical practice guidelines/expert consensus which used the GRADE in China had increased annually. The practice guidelines/expert consensus which did not use GRADE had lower methodology quality (P<0.01). ConclusionsThe use of GRADE in clinical practice guidelines/expert consensus requires improvement, and mastering GRADE methodology can effectively improve the methodological quality of the clinical practice guidelines/expert consensus.
ObjectiveTo systematically review the researches on grading criteria for quality of evidence and strength of recommendations of traditional Chinese medicine (TCM). MethodsPubMed, EMbase, Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect researches on grading criteria for quality of evidence and strength of recommendations of traditional Chinese medicine from inception to June 2021. Two reviewers independently screened literature, extracted data; and then, descriptive analysis was performed using qualitative methods. ResultsA total of 18 studies were included. Specifically, 8 studies presented both the level of evidence and the strength of recommendations, 9 presented the level of evidence, and 1 presented the strength of recommendations. Thirteen studies considered both TCM evidence and modern medical evidence sources, 3 included only evidence from ancient literature, 1 focused only on post-marketing safety evaluation of Chinese medicine, and 1 focused only on real-world studies of TCM. ConclusionCurrently, there are numerous criteria for TCM related quality of evidence and strength of recommendations, and some are developed only for TCM characteristic evidence. Most researchers of TCM guidelines expect to fully value the significance of ancient literature and expert experience or opinion in guideline development.
ObjectiveTo evaluate the clinical efficacy of surgical intervention combined with endoscopic ultrasound-guided transluminal drainage in the treatment of infected pancreatic necrosis (IPN). MethodsA retrospective, historical control study was conducted. A total of 98 patients with acute pancreatitis (AP) complicated with IPN who met the inclusion and exclusion criteria and were admitted to the Third People’s Hospital of Chengdu from June 2016 to January 2023 were selected as the research objects. The endoscopic ultrasound-guided transluminal drainage was carried out in our hospital in June 2020. In this study, patients treated before May 2020 were divided into the non-EUS group (52 cases), and patients treated after June 2020 were divided into the EUS group (46 cases). The baseline data, surgical intervention, length of hospital stay, length of intensive care unit (ICU) stay, infection time, incidence of multiple organ dysfunction syndrome (MODS), survival situation, short-term and long-term complications, and other indicators were compared between the two groups. ResultsThe number of percutaneous catheter drainage (PCD, 1.0 vs. 1.0), the number of PCD drainage tube (1.0 vs. 2.0), the number of retroperitoneal debridement drainage (1.0 vs. 2.0), the total length of hospital stay (42.0 d vs. 45.5 d), the length of ICU stay (11.0 d vs. 14.0 d), the length of infection time (10.5 d vs. 18.5 d), the incidences of MODS [43.5% (20/46) vs. 67.3% (35/52)] and residual infection [28.3% (13/46) vs.48.1% (25/52)] in the EUS group were shorter (or lower) than those in the non-EUS group (P<0.05); but there were no significant differences in the number of endoscopic pancreatic stent implantation, the number of laparotomy, the number of laparoscopic surgery, and the incidences of abdominal bleeding, gastrointestinal fistula, gastrointestinal obstruction, chronic pancreatic fistula, chronic pancreatitis and incisional hernia between the two groups (P>0.05). ConclusionFor patients with AP complicated with IPN, surgical intervention combined with endoscopic ultrasound-guided transluminal drainage can reduce the number of PCD and drainage tube, shorten the total length of hospital stay, the length of ICU stay and infection, as well as reduce the incidences of MODS and residual infection.