Objective To assess the methodological quality of systematic reviews or meta-analyses of intervention published in the Chinese Journal of Evidence-Based Medicine, so as to provide evidence for improving the domestic methodological quality. Methods The systematic reviews or meta-analyses of intervention published from 2001 to 2011 were identified by searching the Chinese Journal of Evidence-Based Medicine. The methodological quality of included studies was assessed by AMSTAR scale. The Excel software was used to input data, and Mata-Analyst software was used to conduct statistical analysis. Results A total of 379 studies were included. The average score of AMSTAR was 6.15±1.35 (1.5-9.5 point). Just some items of AMSTAR scale were influenced by the following features of included studies: publication date, funded or not, number of author, author’s unit, and number of author’s unit. The total AMSTAR score of studies published after 2008 was higher than those published before 2008 (P=0.02), but the improvement of methodological quality was limited. While the total AMSTAR score of studies published by 3 or more than 3 authors were higher than those published by 2 or less than 2 authors (P=0.04). Conclusion The methodological quality of the included studies published in the Chinese Journal of Evidence-Based Pediatrics is uneven. Although the methodological quality improves somewhat after the publication of AMSTAR scale, there is no big progress, so it still needs to be further improved.
Objective To evaluate the reliability and validity of IBS-QOL scale in irritable bowel syndrome (IBS) patients. Methods IBS-QOL scale was applied to survey the quality of life of 123 IBS patients. The split-half and internal consistency method were used to evaluate the reliability, and with the construct method to evaluate the validity. Results The split-half reliability was 0.86. Cronbach’s α-coefficient of all domains was between 0.71 and 0.89 except body image and food avoidance; In the correlation analysis, the correlations between items and its subscale structure were above 0.60 (except interference with activity), but there were no correlations between items and other subscale structure. Eight components from factorial analysis were in accordance with theoretical structure.The cumulative contribution rate was 72.7%. Conclusions The reliability and validity of IBS-QOL scale are acceptable. It might be useful for us to assess the QOL of IBS patients in China.
ObjectiveTo investigate the effect of pulmonary rehabilitation on pulmonary function,perception of dyspnea and quality of life in stable COPD patients of different severity. Methods300 patients with COPD in stable stage were divided into a moderate COPD group (n=120),a severe COPD group (n=100) and a very severe COPD group (n=80). Each group was randomly subdivided into a control group and a treatment group. The treatment groups received pulmonary rehabilitation for 6 months in addition to usual care,and the control groups received usual care without pulmonary rehabilitation. Pulmonary function(FEV1),6 minute walking distance (6MWD),modified medical research council (mMRC) scale,and acute exacerbation frequency of COPD were compared before and after intervention and among groups. ResultsAfter pulmonary rehabilitation for 6 months,the quality of life score and 6MWD were significantly improved in the treatment groups with moderate,severe,very severe COPD,and the increscent of 6MWD was greatest in the severe COPD patients. The mMRC of the patients with very severe COPD improved significantly after pulmonary rehabilitation(P<0.05). Lung function before and after the intervention in three groups all showed no significant difference (P>0.05). The acute exacerbation frequency of the severe COPD patients was significantly reduced by pulmonary rehabilitation (P<0.05), while there was no significant change in the moderate and very severe groups (P>0.05). ConclusionPulmonary rehabilitation can improve exercise tolerance and quality of life of COPD patients with different severity,reduce acute exacerbation frequency in severe COPD,reduce the dyspnea degree in very severe COPD. Pulmonary rehabilitation is a cost-effective treatment for stable COPD.
Objective To evaluate the subjective outcomes of sleepiness behavior and mood status applying continuous positive airway pressure（CPAP） in adults of elderly and middle-aged with obstructive sleep apnea syndrome（OSAS）. Methods Nine randomized controlled trails comparing nocturnal CPAP with inactive control appliances in adults with OSAS with the use of computerized search in related medical databases（MEDLINE，EMBASE，CBMdisk，etc） were included.The quality of literature was reviewed，and all data were extracted by two reviewers independently.Meta analysis was conducted used RevMan 4.2 software.Results 9 RCT involving 665 patients of elderly and middle-aged met the inclusion criteria.Meta analysis indicated that the score of Epworth sleepiness scale（ESS） and general health questionnaire-28（GHQ-28） declined significantly after CPAP treatment on effectiveness with WMD（random） －2.94，95 %CI －4.68 to －1.20，or WMD（fixed） －2.26，95 %CI －3.79 to －0.72，Plt;0.01.Nevertheless，hospital anxiety and depression scale（HADS） was not significantly different between CPAP and control with WMD（random） －0.89，95%CI －1.98 to 0.20，Pgt;0.05.Conclusion Current clinical evidence suggested that CPAP was effective in improving day-time subjective outcomes of sleepiness behavior and general mental health status in OSAS patients of elderly and middle-aged，although evidence of improving emotion disorder of anxiety and depression was not confirmed.
Objective To evaluate the value of Epworth sleepiness scale ( ESS) in evaluating the severity of obstructive sleep apnea hypopnea syndrome ( OSAHS) . Methods A total of 340 cases with suspected OSAHS were enrolled. The ESS scores and polysomnography ( PSG) monitoring data were analyzed. According to the PSG monitoring results the patients were classified into non-OSAHS, mild, moderate and severe OSAHS groups. The average ESS scores and the ratio of patients whose ESS score was ≥9 were compared among the four groups. The diagnostic value of ESS score was evaluated by ROC curve. The correlation of ESS scores with age, apnea hypopnea index ( AHI) , the lowest SpO2( LSpO2 ) and microarousal index was analyzed. Results The ESS scores had an ascending tendency as the severity of OSAHS was increased but only in the severe OSAHS cases the difference was significant statistically compared with the other three groups ( P lt; 0. 05) . The mean ESS scores in the four groups were 9. 96 ± 4. 81,10. 21 ±5. 48, 11. 48 ±5. 28 and 13. 52 ±5. 84, respectively. There was no statistical significance while comparing the ratio of patients whose ESS scores were ≥9 among the four groups. The analysis of ROC curve showed the area under the ROC curve ( AUC) was lesser( 0. 601) and a best cutoff could not be obtained. When ESS score ≥9 was made as the cutoff in screening OSAHS patients the sensitivity was 70. 0% and the misdiagnosis rate was 63. 21% . The ESS scores had positive correlation with the apnea hypopnea index ( AHI)( r =0. 240, P lt; 0. 01) and negative correlation with LSpO2 ( r = - 0. 198, P lt;0. 01) . The ESSscores had no correlation with age or the microarousal index ( P gt; 0. 05) . Conclusions The ESS score has some significance in screening severe OSAHS patients but can not exactly reflect the severity of OSAHS patients among Chinese population, suggesting ESS score has limited value in the evaluation of OSAHS severity. The ESS score ≥9 as a cutoff is not a reliable parameter to estimate the severity of OSAHS. A more effective scoring system need to be established for better screening of OSAHS patients.
Objective To observe the serumlevel of neuron-specific enolase( NSE) in patients with pulmonary encephalopathy and its changes after treatment with mechanical ventilation. Methods Twentyone patients with pulmonary encephalopathy were enrolled. Glasgow coma scale( GCS) , serumNSE level, and arterial blood gas were evaluated at three time-points: before mechanical ventilation, after 12 hours mechanical ventilation, and the moment of consciousness. Results 18 patients recovered consciousness, and 3 patients remained in persistent coma and died. GCS and arterial blood gas improved obviously after 12 hours mechanical ventilation. Meanwhile, the serumNSE concentration decreased significantly after 12 hours mechanical ventilation [ ( 24. 54 ±6. 65) μg/L] and at the moment of consciousness [ ( 14. 19 ±2. 91) μg/L] compared with before mechanical ventilation( P lt; 0. 05, P lt; 0. 01) . Conclusion Dynamic measurment of serumNSE may be a useful biomarker for assessing the severity of cerebral injury and predicting prognosis.
Objective To study the characteristics of pulmonary impact injury under closure and open states of glottis. Methods One hundred and eight rabbits were randomly divided into two groups (54 each group). Open state of glottis group(open group): impact injuries with opened glottis; closure state of glottis group (closed group): impact injuries with closed glottis. Parameters were set up with various combinations of driven pressures and compress percentage and the model of rabbit blunt chest trauma were established. Pathological changes were examined and abbreviated injury scale (AIS), water containing and mortality were recorded. Results Two and four rabbits died in open group and closed group respectively under the condition of 30% for compress percentage and 8 250 mmHg for driven pressures. In most cases, AIS values of closed group were significantly higher than that of open group (Plt;0.05). AIS values were positively related to driven pressures and compress percentage (r=0.9313, 0.7847; Plt;0.01, 0.01). Quantities of contained water in lung of closed group were significantly higher than that of open group(t=2.28,Plt;0.01). Conclusion The severity of injury, the increased mortality and earlier occurrence of traumatic acute lung injury were the characteristics of pulmonary impact injury under the closure states of glottis.
Objective To evaluate the relationship of the organ injury scale （OIS） with clinical characteristics and survival in penetrating cardiac trauma patients. Methods A retrospective review identified 224 patients with penetrating cardiac trauma. A grade assigned on the basis of the American Association for the Surgery of Trauma OIS was assigned to each case studied. Clinical data, including Glasgow coma scale（GCS）, revised trauma score（RTS）, injury severity score （ISS）, penetrating thoracic trauma index （PTTI）, penetrating trauma index （PTI）, and outcomes were analyzed for association with OIS grade. Results The majority of patients were either grade Ⅳ/ or Ⅴ , with grade Ⅵ having the highest mortality. Patients of grade Ⅰ to Ⅲ were mostly Sub-clinical type patients, and grade Ⅳ to Ⅵ were mostly pericardial tamponade type and hemorrhagic shock type patients. The OIS grade was significantly negative correlated with postinjury duration and GCS （r=-0. 18, -0.16）, and positive correlated with transfusion, ISS, PTTI, PT1, and death（r=0. 17,0. 22,0. 40,0. 41,0. 29）. Conclusion The OIS appears to correlate with severity of injury and survival, and it may be useful in predicting outcomes in patients with penetrating cardiac injury.
Objective To introduce a new functional self-assessment scale of amyotrophic lateral sclerosis (ALS). Methods By comparing current different ALS functional scales and combining relative cl inical experience and numeric pain intensity scale, ALS self-assessment scale was set down by International Association of Neural Restoration. Results ALS self-assessment scale included 3 categories with 18 items, adopting 10 points grading system, namely 10 was defined as the normal, 0 as the worst, and the total scores was 180. This scale included: ① Bulbus medullae function: speech, swallowing, sal ivation, and tongue extension. ② Limbs function: left arm movement, left hand movement, right arm movement, right hand movement, left leg movement, right leg movement, trunk movement, head-up, walking, and cl imbing stairs. ③ Others: breathing, muscular tone, pain, and muscle discomfort. Conclusion ALS self-assessment scale is specifically designed for ASL patients. It can evaluate patient’s function comprehensively and is simple and convenient, consuming less time.
Objective To evaluate proton MR spectroscopy (1H-MRS) for detection of the motor cortex and adjacent brain in amyotrophic lateralsclerosis (ALS) patients with apparent upper motor neuron involvement after olfactory ensheathing cells(OECs) transplantation. Methods From December 2004 to February 2005, 7 patients with clinically definite ALS who could safely undergo MRS were admitted into the perspective study. The neurological status, ALS functional rating scale (ALSFRS), EMG, and 1H-MRS taken before and 2 weeks after operationswere carefully analyzed. The NAA/Cr and Cho/Cr ratios were measured in the cerebral peduncle,genu and posterior limb of the internal capsule, corona radiata and precentral gyrus. Results The ALSFRS in 2 cases mproved obviously whose ALSFRS increased from 30 to 33 and from 29 to 34 respectively. And 5 cases remained stable 2 weeks after OECs transplantation. Statistical analyses for all seven cases showed both theNAA/Cr and Cho/Cr ratios decreased, but in the two cases with ALSFRS improvement the NAA/Cr increased in the certain anatomic position which confirmed the neurological and EMG findings. Conclusion The proton MR spectroscopy is a suitablenoninvasive measure for ALS evaluation. The preliminary study suggests that twoof the seven ALS cases improved apparently shortterm after OECs transplantation. More patients are required for the clinical study and longer followup duration is needed for future research.