Objective To analyze the causal relationship between educational attainment and the risk of systemic lupus erythematosus (SLE). Methods Based on the data from publicly available genome-wide association studies, we employed single nucleotide polymorphisms (SNPs) strongly associated with educational attainment as instrumental variables. Two-sample Mendelian randomization analysis was used to investigate the causal relationship between educational attainment and SLE. The primary analysis method used was the inverse variance weighted with multiplicative random effects. Validation methods included inverse variance weighted with fixed effects and MR-Egger methods. Additionally, sensitivity analysis was conducted using the leave-one-out approach. Results Finally, 433 SNPs were included. The inverse variance weighted with multiplicative random effects analysis indicated no causal effect of educational attainment on the risk of SLE [odds ratio =1.111, 95% confidence interval (0.813, 1.518), P=0.509]. Similarly, the other two methods did not find any evidence of a causal relationship (P>0.05); however, significant heterogeneity was observed. The MR-Egger regression analysis provided no evidence of horizontal pleiotropy among the included instrumental variables (P>0.05). The leave-one-out approach did not identify any individual SNP that had a significant impact on the overall effect estimate. ConclusionIn conclusion, this study does not support a causal effect of educational attainment on the risk of SLE.
Objective To perform a systematic review and meta-analysis to evaluate the efficacy and safety of prophylactic use of antibiotics in preventing severe acute pancreatitis. Methods Randomized control trials (RCTs) of prophylactic use of antibiotics were identified from PubMed, EMbase, Cochrane Library, Web of Science, CNKI, Wangfang Database, and handly searched related literatures. The retrieval time was from inception to Dec. 2017. All the data would be analysis with the software RevMan 5.3. Results Eventually 16 RCTs of 999 participants were involved, the patients were divided into two groups: the intervention group (prophylactic use of antibiotics, n=501) and the control group (n=498). The result of meta-analysis showed that, the incidence rate of pancreatitis infectious disease and the incidence rate of peripancreatitis infectious were significant lower in the intervention group than the control group, whose OR were amount to 0.68 ［95% CI was (0.50, 0.93), P=0.02］ and 0.63 ［95% CI was (0.45, 0.88), P=0.007］ respectively. Meanwhile, concerning the rate of surgery intervention ［OR=0.79, 95% CI was (0.57, 1.08), P=0.14］ and in mortality rate ［OR=0.81, 95% CI was (0.56, 1.15), P=0.24］, there was no statistically significant. Conclusion Prophylactic antibiotic treatment can do benefit to reduce the incidence rate of pancreatitis infectious and the rate of peripancreatitis infectious disease, but can not reduce mortality in patients with severe acute pancreatitis and had no significant protective effect in patients in reducing the rate of surgery intervention and mortality rate.
The rapid advancement of causal inference is driving a paradigm shift across various disciplines. "Target trial emulation" has emerged as an exceptionally promising framework for observational real-world studies, attracting substantial attention from medical scholars and regulatory agencies worldwide. This article aims to provide an introduction to CERBOT, an online tool that assists in implementing target trial emulation studies, while highlighting the advancements in this domain. Additionally, the article provides an illustrative example to elucidate the operational process of CERBOT. The objectives are to support domestic researchers in conducting target trial emulation studies and enhance the quality of real-world studies in the domestic medical field, as well as improve the medical service level in clinical practice.
ObjectiveTo analyze the reporting and methodological quality of tranexamic acid meta-analyses published in Chinese journals. MethodsThe CNKI, WanFang Data, and CBM databases were electronically searched for meta-analyses of tranexamic acid from inception to August 12th, 2021. Two reviewers independently screened literature, extracted data, and used AMSTAR 2 and PRISMA 2009 to assess the methodological and reporting quality of publications. ResultsA total of 68 meta-analyses were included. The identified meta-analyses required improvement for items 2, 3, 4, 7, 8, 10, 12, 15, and 16 in the AMSTAR 2, and items 2, 5, 8, 12, 15, 17, 22, 24, and 27 in the PRISMA 2009 assessments, respectively. The methodological and reporting quality scores were positively correlated (rs=0.36, P=0.002). Linear regression analysis identified the mentioning of PRISMA and funding support as the independent factors potentially affecting the reporting quality score (P<0.05). ConclusionsBoth the methodological and reporting quality of the tranexamic acid meta-analyses published in Chinese journals require improvement.
N-of-1 trials are prospective clinical randomized cross-over controlled trials with multiple rounds of trial phase alternation designed with regard to a single patient. N-of-1 trials can provide clinical decision-makers with high-level evidence of the comparison of effect of intervention measures. Recently, an international team composed of many scholars published a SPIRIT extension for N-of-1 trials list (SPENT 2019) on the BMJ, with the purposes of clarifying the content design and improving the integrity and transparency of N-of-1 trial protocols. This article showed a detailed interpretation of the 14 main extension sub-items of the SPENT 2019 list with specific cases, aiming to further standardize the publication of domestic N-of-1 trials.
Randomized controlled trials are considered as the gold standard for determining the causality, and are usually used to evaluate the efficacy and safety of medical interventions. However, in some cases it is not feasible to conduct a randomized controlled trial. In recent years, a framework called “target trial emulation study” has been formally established to guide the design and analysis of observational studies based on real-world data. This framework provides an effective method for causal inference based on observational studies. In order to facilitate domestic scholars to understand and apply the framework to solve related clinical problems, this article introduces it from the basic concept, framework structure and implementation steps, development status, and prospects.
ObjectiveTo investigate whether there is a causal relationship between the intake of milk or coffee and the risk of non-alcoholic fatty liver disease (NAFLD). MethodsUsing a two-sample Mendelian randomization approach, single nucleotide polymorphisms (SNPs) associated with milk or coffee intake were used as instrumental variables, and genome-wide association study data on NAFLD were used as the outcome event. Inverse-variance weighted (IVW) and MR-Egger methods were employed to investigate the causal effect of milk or coffee intake on the risk of NAFLD. ResultsBoth analyses indicated no causal association between milk or coffee intake and the risk of NAFLD (P>0.05). Sensitivity analysis indicated the robustness of the main findings, with no outliers, heterogeneity, horizontal pleiotropy, or significant influence of individual SNPs. ConclusionThis study does not support a causal relationship between the intake of milk or coffee and the risk of NAFLD.
ObjectivesTo evaluate the reporting quality of clinical practice guidelines published in Chinese journals in 2015.MethodsCBM, CNKI, VIP and WanFang Data databases were searched to collect clinical practice guidelines published in Chinese journals from January, 2015 to December, 2015. Two reviewers independently screened literature, extracted data, and the reporting quality of clinical practice guidelines were evaluated by the Reporting Items for Practice Guidelines in Healthcare (RIGHT). Excel software was used for data analysis.ResultsA total of 74 clinical practice guidelines were included. It was found that among the seven domains of RIGHT, the reporting quality of basic information and background domains were acceptable. There were fewer problems in the domain of evidence and recommendation. There were many deficiencies in three domains, such as review and quality assurance, funding and the declaration/management of interests and other information.ConclusionsThe reporting quality of clinical practice guidelines published in Chinese journals in 2015 is low, and the full reporting rate of clinical practice guidelines need to be improved. It is suggested that guideline developers construct strict guidelines for the development and report the guidelines with international standard, thus improving the quality of the clinical practice guidelines.
Objectives To investigate calcium supplement in pregnancy for prevention of preeclampsia and relevant outcomes. Methods The Cochrane Library, PubMed, EMbase, CBM, WanFang Data, VIP and CNKI databases were searched online to collect randomized controlled trials (RCTs) of calcium supplement in pregnancy for prevention of preeclampsia and relevant outcomes from inception to July 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed by RevMan 5.3 software. Results A total of 33 RCTs involving 29 234 subjects were included. The results of meta-analysis showed that: compared with control group, the calcium supplement group was associated with lower preeclampsia (RR=0.48, 95%CI 0.38 to 0.62, P<0.000 01) and gestational hypertension (RR=0.65, 95%CI 0.55 to 0.77,P<0.000 01) incidence. The incidence of premature delivery, intrauterine growth retardation and severe preeclampsia in calcium supplement group was lower than that in placebo group, and the neonatal weight in calcium was higher than that in placebo group. However, there was no significant difference in the pregnancy cycle between the two groups. Conclusions Current evidence shows that calcium supplement is associated with lower risk of preeclampsia and gestational hypertension. Due to limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusion.
ObjectivesTo systematically review the efficacy of acupuncture for improving migraine symptoms and cerebral blood flow velocity.MethodsCBM, CNKI, VIP, WanFang Data, PubMed, EMbase and The Cochrane Library databases were electronically searched to collect randomized controlled trials (RCTs) on acupuncture for improving migraine symptoms and cerebral blood flow velocity from inception to September, 2017. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 17 RCTs involving 2 226 patients were included. The results of meta-analysis showed that, acupuncture could effectively reduce the frequency of migraine compared with placebo acupuncture (SMD=−0.97, 95%CI −1.60 to −0.34, P=0.002) and medicine group (SMD=−1.29, 95%CI −1.85 to −0.73, P<0.000 01). Acupuncture could shorten duration of headache compared with placebo acupuncture (SMD=−0.73, 95%CI −1.25 to −0.21, P=0.006) and medicine group (SMD=−0.88, 95%CI −1.32 to −0.45, P<0.000 1). Compared with placebo acupuncture, acupuncture could relieve headache intensity (SMD=−0.67, 95%CI −1.15 to −0.19, P=0.006). The acupuncture group was superior to the placebo acupuncture group (SMD=−10.99, 95%CI −16.62 to −5.36, P=0.000 1) and medicine group (SMD=−0.63, 95%CI −0.87 to −0.40, P<0.000 01) in improving the cerebral blood flow velocity.ConclusionsCurrent evidence shows that acupuncture can effectively reduce frequency of migraine, shorten duration of migraine, relieve intensity of migraine and improve cerebral blood flow velocity. Due to limited quality of the included studies, more high quality studies are required to verify above conclusion.