Objective To analyze the hot topics and trends of medical research integrity in China and to provide references for future studies. Methods The CNKI, WanFang Data and VIP databases were searched from inception to December 2021. Data on the number of publications, journals, institutions, authors, keywords, and emergent themes were analyzed using bibliometric methods and CiteSpace software. Results A total of 324 studies were included. The results showed that the number of publications increased annually, and "Chinese Journal of Medical Science Research Management" and Peking University were the journal and institution with the most publications, respectively. The three most prolific authors published five studies each, and the publications were mainly concerned with identifying and preventing issues, in addition to education regarding medical research integrity. Conclusion Medical research integrity in China has attracted significant attention. Several leading journals in this research field have emerged; however, there is no clearly dominant research team. The depth and breadth of the research remain to be improved. It is suggested that researchers focus on the effectiveness of strategies for preventing issues, promoting the establishment of the lifelong education system and improving related rules and regulations to advance the development of medical research integrity in China.
Objective To systematically review the methodological quality of guidelines concerning pharmacological intervention for complicated hypertension. Methods The databases and relevant guideline websites such as MEDLINE, EMbase, CBM, WangFang Data, National Guideline Clearinghouse (NGC), Guidelines International Network (GIN), National Institute for Health and Clinical Excellence (NICE) and Clinical Practice Guideline Network (CPGN) were searched to collect the clinical guidelines concerning pharmacological intervention for complicated hypertension. By adopting the Appraisal of Guidelines for Research and Evaluation (AGREE), the methodological quality of guidelines was assessed. Meanwhile the similarities, differences and features of drug recommendation in guidelines for different areas and diseases were analyzed by means of analogy comparison.Results A total of 21 guidelines concerning pharmacological intervention for complicated hypertension were included. The number of guidelines concerning hypertension complicated with coronary heart disease (CHD), stroke, diabetes mellitus (DM) and kidney disease (KD) was 5, 5, 7 and 4, respectively. The publication year ranged from 2000 to 2011. According to the AGREE instrument, 19 and 2 guidelines were graded as Level B and C, respectively. The overall guidelines got low average scores in the domain of “Stakeholder involvement” and “Applicability”, including 9 evidence-based guidelines. There were totally 4 and 3 classes in terms of the level of evidence and recommendation, respectively; moreover, 10 and 6 expression forms were adopted in the level of evidence and recommendation, respectively. For hypertension with angina pectoris, -blocker (BB) and calcium channel blocker (CCB) were recommended unanimously. For hypertension with myocardial infarction, angiotensin converting enzyme inhibitor (ACEI) and BB were recommended unanimously. For hypertension with heart failure, ACEI, angiotensin-receptor blocker (ARB) and BB were recommended unanimously. For hypertension with later stage of post-stroke, 76.47% guidelines recommended diuretic (D) and ACEI. For hypertension with acute stroke, recommendations were mainly based on the guidelines developed by American Heart Association/American Stroke Association (AHA/ASA). For hypertension with DM or KD, the guidelines basically recommended that systolic/diastolic pressure should be controlled in the range of less than 130/80 mmHg. For hypertension with DM, ACEI were recommended unanimously, followed by D and CCB. For hypertension with KD, ACEI/ARB was recommended, while 3 of the 5 guidelines recommending CCB were from Asian. Conclusion The overall methodological qualities of complicated hypertension guidelines differs, with high proportion of evidence-based guidelines. The classification criteria of the levels of evidence and recommendation are still suboptimal. For hypertension with CHD, DM, KD and later stage of stroke, results from high quality clinical evidence are consistent, and the recommendations are basically unanimous, with no regional and quality difference. But in some clinical researches beyond reaching a consensus at present, the recommendation discrepancy exists, and there still remains controversy for hypertension with acute stroke.
Objective To investigate the incidence of urolithiasis in infants aged 0-3 years old fed by milk powder tainted with melamine in the middle area of the Anhui province, as well as its relationship to gender, age, milk powder consumption and drinking water. Methods Questionnaires were distributed to 1079 infants who were screened for urolithiasis by ultrasound examination from September 25, 2008 to October 17, 2008. Data was collected by Epidata and analyzed by SPSS 13.0 software. Results A total of 646 (59.87%) male infants and 433 (40.13%) female infants underwent ultrasound examination in Anhui Provincial Hospital. Of these, 86 infants were diagnosed with urolithiasis with an incidence of 7.97%, including 62 males (72.09%) and 24 females (27.91%). The mean age of those infants with urolithiasis was 1.85±0.77, and all of calculus was located in kidney. The relationship between the incidence of urolithiasis and gender, age, drinking water, feeding bottle sanitation, birth status, as well as the amount of milk powder intake was assessed by using the Pearson Chi-square test. Results showed that significant differences were noted in the incidence of urolithiasis among infants of different genders or with different drinking water sources (Plt;0.05). The result of multiple logistic regression analyses indicated that gender was related to the incidence of urolithiasis (Plt;0.05). The incidence of urolithiasis in female infants was only 58.7% of that in male infants (OR 0.587, 95%CI 0.359 to 0.959). Conclusion The incidence of urolithiasis in infants aged 0-3 years of old in the middle area of Anhui province is relatively high and has anatomical specificity. Further data during the follow-up of these cases should be collected.
Objective To systematically review simple hypertension guidelines through methods as follows: (a) compare differences and similarities of the recommended drugs; (b) analyze differences of the recommended frequencies in different regions and quality levels; and (c) explore the recommended evidence basis, so as to better understand relevant guidelines. Methods Uncomplicated hypertension guidelines concerning pharmacological interventions were identified (terminated by March 2012) in Ovid, EMbase, Chinese Biomedical Disc (CBM) and WangFang database as well as guideline websites including NGC (National Guideline Clearinghouse), GIN(Guidelines International Network), NICE(National Institute for Health and Clinical Excellence) and CPGN (Clinical Practice Guideline Net, guidelines concerning pharmacological intervention in simple hypertension were included. A total of 6 domains (involving 23 items) in the Appraisal of Guidelines for Research and Evaluation (AGREE) were applied to assess the methodological quality of the guidelines. A comparative study was performed regarding the recommendations in guidelines from different regions as well as of different methodological qualities. Results A total of 27 guidelines concerning pharmacological intervention in simple hypertension were included, involving 6 continents, 13 counties, 3 regions and 3 international organizations. Publication dates ranged from 2003 to 2012. According to the AGREE instrument, 4, 17 and 6 guidelines were graded as Level A, B and C, respectively. There were only 2 domains, “Scope and Purpose” and “Clarity of Presentations”, getting high average scores (more than 60%) among all guidelines. The average scores of guidelines in different domains of AGREE varied with regions. There were 8 evidence-based guidelines which got higher average scores in each domain of AGREE than those of non-evidence-based guidelines. Guidelines varied with the standards of classifying ideal, normal, high normal blood pressure and hypertension. Diuretics were the first agent recommended by all guidelines, and the other recommendations were correlated with age and race. There was a tendency to recommend diuretics as basic drugs in two-drug combination therapy in North America, while calcium channel blockers (CCBs) were the most recommended agents in Asian guidelines. Conclusion The overall methodological quality of simple hypertension guidelines is suboptimal in different countries or regions. The 6 domains involving 23 items in AGREE vary with scores, while the scores of evidence-based guidelines are higher than those of non-evidence-based guidelines. There are differences in the standards of classifying ideal, normal, high normal blood pressure and hypertension. The first-line drug recommendations differ in regions and relate to age and race. Two-drug combination therapy regimens also vary with region.
Objective To systematically assess the effectiveness and safety of atorvastatin in patients with dilated cardiomyopathy (DCM) complicating chronic heart failure (CHF). Methods Databases including PubMed, The Cochrane Library, EMbase, CNKI, CBM, and VIP were searched from inception to November 2011 to collect randomized controlled trials (RCTs) on atorvastatin for DCM accompanied with CHF. According to the inclusion criterion, relevant articles were screened. Then we extracted data, assessed quality, and performed meta-analysis using RevMan 5.0. Results A total of 11 RCTs involving 648 patients were included. The result of meta-analyses showed that compared with the control group at the sixth month after treatment, in the atorvastatin group, left ventricular ejection fraction (LVEF) obviously (MD=3.92, 95%CI 1.93 to 5.92, P=0.000 1) and 6-minute walk distance (MD=13.15, 95%CI 5.47 to 20.83, P=0.000 8) increased. Besides, serum level of CRP obviously decreased in the atorvastatin group (MD=1.91, 95%CI 3.03 to 0.79, P=0.000 9). Conclusion Current evidence indicates that atorvastatin, based on routine treatment, can improve cardiac function to some extent, increase LVEF, and reduce serum levels of inflammatory markers for patients with DCM complicating CHF. Therefore, atorvastatin is likely to be a safe and effective drug for non-ischemic cardiomyopathy due to DCM, which still has to be proved by more large-scale and high-quality clinical trials.
Objective To evaluate the effectiveness and safety of clarithromycin extended-release and immediate-release formulations in the treatment of patients with acute exacerbation of chronic bronchitis. Methods The randomized controlled trials (RCTs) of clarithromycin extended-release and immediate-release formulations in the treatment of patients with acute exacerbation of chronic bronchitis were searched in the following electronic databases: The Cochrane Library (Issue 1, 2010), PubMed (2000 to Jan. 2010), EMbase (1980 to Dec. 2009), CBM (2000 to Jan. 2010), and WanFang Data (2000 to Jan. 2010). Two reviewers independently screened the included studies, abstracted the data and assessed the quality. The RevMan 5.0 software was used to conduct meta-analyses. Results A total of four RCTs involving 2041 patients were included, and the Jadad scales of all studies were more than five. The results of meta-analyses showed that there was no significant difference between the extended-release formulation group and the immediate-release formulation group in aspects of the clinical cure rate (RR=0.93, 95%CI 0.96 to 1.03), the pathogen eradication rate (RR=0.99, 95%CI 0.94 to 1.04), and the adverse reaction incidence rate (RR=1.06, 95%CI 0.90 to 1.25). Conclusion As the present evidence shows, there is no significant difference in effectiveness and safety between the clarithromycin extended-release and immediate-release formulations in the treatment of patients with acute exacerbation of chronic bronchitis.
Objective To assess the efficacy and safety of rosiglitazone in treating type 2 diabetes mellitus (T2DM) with essential hypertension (HBP). Methods Such databases as The Cochrane Library (Issue 4, 2009), PubMed (1970 to May 2010), CBM (1978 to May 2010), CNKI (1996 to May 2010), WanFang Database (1999 to May 2010), VIP (1996 to May 2010), and Google Scholar were searched on computer, and the relevant journals such as Chinese Journal of Diabetes Mellitus were also hand researched to investigate references and collect randomized controlled trials (RCTs) about rosiglitazone (experimental group) compared with non-rosiglitazone (control group) in treating T2DM with HBP. The data were extracted according to the inclusion and exclusion criteria by two reviewers independently, the quality of the included studies was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0, and meta-analysis was conducted by using RevMan 5.0 software. Results Among 10 RCTs involving 738 patients, one was in English from Greece, while nine were in Chinese. The average score quality of the included studies was in C level. The results of meta-analyses showed that the experimental group was more effective than the control group in lowering blood pressure levels (SBP: WMD= –17.83 mmHg, 95%CI –27.63 to –8.02; DBP: WMD=–7.81 mmHg, 95%CI –10.18 to –5.44), blood glucose levels (FBG: WMD= –1.66 mmol/L, 95%CI –3.08 to –0.23; PBG: WMD= –2.38 mmol/L, 95%CI – 4.12 to –0.64), triglyceride (TG) levels (WMD= –0.29 mmol/L, 95%CI –0.43 to –0.14), low-density lipoprotein cholesterol (LDL-C) levels (WMD= –0.76 mmol/L, 95%CI –1.02 to –0.50), insulin levels (FINS: WMD= –7.06 mU/L, 95%CI –9.47 to –4.65; PINS: WMD= –98.86 mU/L, 95%CI –116.38 to –81.34), glycosylated hemoglobin (HbA1c) levels (WMD=–0.75%, 95%CI –1.07 to –0.42), and insulin resistance index (HOMA-IR) (WMD= –1.61, 95%CI –2.18 to –1.05); the experimental group was more effective than the control group in increaseing the high-density lipoprotein cholesterol levels (HDL-C) (WMD=0.21 mmol/L, 95%CI 0.12 to 0.30), and insulin sensitivity index (ISI) (WMD=1.64, 95%CI 1.48 to 1.80); the therapeutic effect for hypertension was greater in the experimental group than in the control group (OR=9.35, 95%CI 4.76 to 18.35); there were no significant differences in cholesterol levels (TC) (WMD= –0.22 mmol/L, 95%CI –0.55 to 0.10), body mass index (BMI) (WMD= –0.26 kg/m2, 95%CI –0.86 to 0.33), heart rates (HR) (WMD=0.50 bpm, 95%CI –4.98 to 5.98), and urine albumin excretion (UAE) (WMD= –16.00mg/24h, 95%CI –37.90 to 5.90); additionally, there were also no significant differences in adverse reactions between the two groups, such as edema (OR=3.01, 95%CI 0.62 to 14.54), gastro-intestinal discomfort (OR=1.19, 95%CI 0.63 to 2.24), headache and fatigue (OR=9.79, 95%CI 0.51 to 186.95), and anemia (OR=2.38, 95%CI 0.09 to 59.90). Conclusion To treating patients suffering from T2DM with HBP, the rosiglitazone is much effective than the control group in lowering blood pressure, blood glucose and lipid, reducing insulin resistance and improving β-cell function.
Objective To analyze the EEG characteristics and clinical significance of subclinical epilepsy from frontotemporal lobe.Methods A collection of patients with epilepsy who had subclinical seizures monitored by 24-hour video EEG from January 2020 to January 2021 in the Neurology Department of General Hospital of Tianjin Medical University General Hospital, and analyzed the duration of seizures and the number of seizures on the EEG.The characteristics and clinical significance of onset time (sleep period/waking period), interictal discharge, and number of leads involved in seizures.Results A total of 18 patients were enrolled, and 280 clinical seizures (11/18) and 34 clinical seizures (9/18) were captured. Among them, 2 patients had both subclinical seizures and clinical seizures. Frontal lobe origin, 235 subclinical seizures and 15 clinical seizures; temporal lobe origin, 26 subclinical seizures and 19 clinical seizures; frontotemporal lobe origin, subclinical seizures 19 times, no clinical seizures were captured. In the subclinical seizure group (11/18), there were 163 sleep episodes (58.2%) and 117 (41.8%) during waking phase; in the clinical seizure group (9/18), 16 episodes during sleep (47.1%) , 18 seizures (52.9%) in the awake period. Among the leads involved in seizures, <6 leads, 270 subclinical seizures, and no clinical seizures; ≥6 leads, subclinical seizures 10 times, and 34 clinical seizures. In the total duration of seizures: the clinical seizure group was (27.43±17.73) s, with a median value of 30s; the subclinical seizure group was (20.10±15.68) s, with a median value of 13 s. In the analysis of Spearman related factors, the subclinical seizure group was positively correlated with the sleep period (P=0.000), and negatively correlated with the normal nuclear magnetic field (P=0.004).Conclusion The epilepsy originated from the frontotemporal lobe has the characteristics of short clinical seizures, fewer leads involved, more likely to occur during sleep, and subclinical seizures that are more likely to occur when the MRI is abnormal. Therefore, strengthening the monitoring of long-term video EEG for patients with epilepsy and attaching importance to the interpretation of EEG during sleep will help to detect the subclinical seizures of patients and further improve the management of patients with epilepsy.
Objectives Performance of critical injury treatment among extremely-hit areas after great earthquake was retrospectively analyzed to provide references for policy-making as reducing mortality and disable rate besides increasing rehabilitation rate for global post-quake medical relief. Methods Retrospective analysis, primary research and secondary research were comprehensively applied. Results 1.According to incomplete statistics datum, there were 30,620 self-save injured among extremely-hit areas in 72 post-quake hours. And, the number of critical injured took 22% of the total inpatient injured. 2. Mortalities decreased successively from that of municipal healthcare centers in extremely-hit areas to that municipal medical units in peripheral quake-hit areas and then to those of municipal, provincial and MOH-affiliated hospitals as 12.21%, 4.50%, 2.50% and 2.17% respectively. 3. Injured with fractures on body, limbs or unknown-parts, severe conditions as well as other kinds of non-traumatic diseases received in second-line hospitals were much more than those treated in first-line hospitals with more severe injuries. 4. Among 10,373 injured in stable conditions transferred to third-line hospitals, 99.07% were discharged off hospitals with mortality as 0.017% during 4 post-quake months. Conclusions The medical relief model as “supervising body helping subordinate unit, severely-stricken areas assisting extremely-hit ones, quake-hit areas supporting both extremely-hit and severely-stricken ones, and save-saving amp; mutual assistance applied between extremely-hit areas” is roughly established for injured from severely-stricken areas after Wenchuan earthquake. 2. “Four concentration treatment” principle for those injured in critical conditions did effectively reduce mortality（15.06%→2.9%）. 3. Timely, scientific and standard on-site triage and post-medical transfer under guidance of accurate injury information determine rescue effect for the injured, while there is large space to fulfill as for treatment for critical diseases among extremely-hit areas under extreme conditions after Wenchuan earthquake.