The re-evaluation of the effectiveness of new drugs is of great importance when they are in post-market for there exist some limitations in clinical trials before these drugs are put on the market. The large sample multi-centre randomized controlled trial is the best method of re-evaluation of the effectiveness of new drugs. It could appropriately evaluate not only the large-term efficacy and safety of drugs, but the treatment effect on the survival state and its complications as well. This method will also lead to a great social amp; economic benefit.
The randomized controlled trial is the best evidence in the evidence-based medicine. The cardiovascular disease internal department is the typical example of the evidence-based medicine. A serial large-scale randomized controlled trials provided the evidence and improved clinical treatment level. For normal development of a large-scale randomized controlled trials need to enhance the standard management.
【摘要】 目的 探讨经尿道等离子双极电切术（PKRP）治疗前列腺增生的安全性及临床疗效。 方法 2009年2-12月，采用PKRP治疗前列腺增生患者76例，记录手术时间、手术疗效及术后并发症。 结果 患者手术时间35～130 min，平均55 min。术中失血60～150 mL，均未输血。手术切除前列腺质量18～72 g。无直肠和膀胱穿孔，无电切综合征（TURS）及闭孔神经反射发生，无一例发生真性尿失禁，无死亡。术后随访2～6个月，IPSS评分平均为9分，最大尿流率平均为16.7 mL/s。 结论 PKRP是治疗前列腺增生的理想方法之一。【Abstract】 Objective To evaluate the efficacy of transurethral plasmakinetic resection of the prostate (PKRP) on benign prostatic hyperplasia. Methods A total of 76 patients with benign prostatic hyperplasia from February to December 2009 were treated with PKRP. The operative duration, therapeutic effect and postoperative complications were observed and recorded. Results The operative duration ranged from 35 to 130 minutes (average 55 minutes).The intraoperative blood loss was 60-150 mL, and no one needed transfusion.The prostate gland excised weight was 18-72 g. There were no intestinal and bladder perforation, no transurethral resection syndrome (TURS) or obturator nerve reflex occurs, and no urinary incontinence or death.IPSS score was nine and the maximal average uroflow was 16.7 mL/s during the 2-6 month follow-up. Conclusion PKRP is one of the ideal methods treating benign prostatic hyperplasia, especially for high-risk patients with benign prostatic hyperplasia.
Objective To review randomized controlled trials of blood pressure (BP) lowering therapy on stroke prevention to provide evidence for clinical practice. Methods We searched Medline (1966-2003.6) and the large-sample randomized controlled trials on BP lowering regimen in patients with stroke history were reviewed. Endpoints included the ocurrance of stroke, coronary heart disease and mortality. Results Three trials of PATS, PROGRESS and HOPE were analysed. The review showed that stroke recurrent risk was reduced by 28%, CHD risk decreased by 15% and total mortality risk reduced by 11% in BP lowering treatment group compared with placebo control group. Stroke risk was reduced not only in hypertensive patients with previous cerebrovascular diseases but also in non-hypertensive patients. Conclusions BP lowering therapy is beneficial for the secondary prevention of stroke.
Objective To investigate the expressions of CD90, IGF1R, and hTERT protein in hepatocellular carcinoma, and the correlations of each other in the development of carcinoma. Methods The expressions of CD90, IGF1R, and hTERT protein in hepatocellular carcinoma were detected by S-P immunohistochemical staining, 20 cases of normal liver tissues were collected as contrast, and to compare the relations between expression and prognosis or survival rate. Results The positive rate of CD90, IGF1R, and hTERT protein in hepatocellular carcinoma group were obviously higher than that in contrast group（P＜0.05）, which was 63.9% vs. 0, 52.8% vs.5.0%, and 47.2% vs.0, respectively. The positive rate of CD90, IGF1R, and hTERT protein were higher in UICC Ⅲ-Ⅳ stage group than that in UICC stage Ⅰ-Ⅱ group（P＜0.05）, which was 79.2% vs.33.3%, 70.8% vs.16.7%, and 62.5% vs.16.7%, respectively. There was a statistically significant positive correlation observed between the expressions of CD90 and IGF1R protein （Kendall’s tau-b=0.563 1, P＜0.05）, so it was with CD90 and hTERT protein （Kendall’s tau-b=0.363 6, P＜0.05）. The survival rates of positive expressions of CD90, IGF1R, and hTERT protein were lower than negative expressions of CD90, IGF1R, and hTERT（P＜0.05）, which was 21.7% vs.50.0%, 17.6% vs.43.8%, and 20.0% vs.38.9%, respectively. Conclusions The expressions of CD90, IGF1R, and hTERT may have correlations with the progress of HCC, and may serve as a marker for HCC prognosis potentially.
Objective To summarize the mechanism research progress of tendon-derived stem cells (TDSCs) in the reconstruction of fibrocartilage zone at bone-tendon junction (BTJ). Methods The domestic and abroad related literature about TDSCs in the reconstruction of fibrocartilage zone at BTJ was summarized and analyzed. Results TDSCs can be induced to osteocytes, fibrochondrocytes, and tenocytes in vitro. Therefore, TDSCs have potential to reconstruct fibrocartilage zone at BTJ. Factors, such as mechanical stimulation, bioactive factor, extracelluar matrix, inflammatory factors, and so on, may influence osteogenic or chondrogenic differentiation of TDSCs. Conclusion Because of the specificity of origin and location of TDSCs, TDSCs have the potential to be the seed cells for BTJ fibrocartilage zone repair. By applying external stimuli, TDSCs can be induced to form structures which are similar to fibrocartilage zone.
ObjectiveTo review the research progress on the role and mechanism of matrix stiffness in regulating endothelial cell sprouting. MethodsThe related literature at home and abroad in recent years was extensively reviewed, and the behaviors of matrix stiffness related endothelial cell sprouting in different cell cultivation conditions were analyzed, and the specific molecular mechanism of matrix stiffness regulating related signal pathways in endothelial cell sprouting was elaborated. Results In two-dimensional cell cultivation condition, increase of matrix stiffness stimulates endothelial cell sprouting within a certain range. However, in three-dimensional cell cultivation condition, the detailed function of matrix stiffness in regulating endothelial cell sprouting and angiogenesis are still unclear. At present, the research of the related molecular mechanism mainly focuses on YAP/TAZ, and roles of its upstream and downstream signal molecules. Matrix stiffness can regulate endothelial cell sprouting by activating or inhibiting signal pathways to participate in vascularization. ConclusionMatrix stiffness plays a vital role in regulating endothelial cell sprouting, but its specific role and molecular mechanism in different environments remain ambiguous and need further study.
ObjectiveTo evaluate the efficacy and safety of dupilumab in the treatment of moderate-to-severe asthma. MethodsA retrospective study was conducted among patients with moderate-to-severe asthma who were treated with dupilumab and inhaled corticosteroids (ICS) combined with long acting beta-agonist (LABA) in Department of Respiratory, Beijing Chao-yang Hospital from May, 2021 to April, 2022. Paired t-test or Mann-Whitney U test was applied to compare the Asthma Control Test (ACT) scores, number of acute exacerbations per year, type 2 inflammatory biomarkers, blood total IgE and results of pulmonary function tests, including forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1 as percentage of predicted (FEV1%pred), FEV1/FVC, peak expiratory flow (PEF), maximal expiratory flows (MEF) at 75% (MEF75), 50% (MEF50) and 25% (MEF25) of the vital capacity PEF, and maximal mid-expiratory flow (MMEF) or FEF25%-75%, at the end of follow-up with those before treatment. Adverse reactions were recorded during the treatment. ResultsA total of 47 patients with moderate-to-severe asthma were included in the study, among them 17 and 30 received treatment with dupilumab or ICS/LABA. At the time of 12 months after treatment with dupilumab, the patients' ACT score and pulmonary function tests were significantly increased compared with those at the baseline. In contrast, patients' fractional exhaled nitric oxide (FeNO), blood total IgE, blood basophil counts and annual acute exacerbations were significantly decreased in comparison with those at the baseline. The doses of oral corticosteroids added by 7 patients at the baseline was gradually reduced and finally discontinued after treatment of dupilumab. There were 4, 2, 1 and 1 patients developed injection site reaction, pruritus, erythema and fatigue, respectively, which were mild and recovered without treatment. There was no serious adverse reaction observed, and only 1 case developed herpes zoster which was recovered after treatment. ConclusionDupilumab shows marked efficacy in the treatment of moderate-to-severe asthma with favorable safety.
Evidence-based medicine is the methodology of modern clinical research and plays an important role in guiding clinical practice. It has become an integral part of medical education. In the digital age, evidence-based medicine has evolved to incorporate innovative research models that utilize multimodal clinical big data and artificial intelligence methods. These advancements aim to address the challenges posed by diverse research questions, data methods, and evidence sources. However, the current teaching content in medical schools often fails to keep pace with the rapidly evolving disciplines, impeding students' comprehensive understanding of the discipline's knowledge system, cutting-edge theories, and development directions. In this regard, this article takes the opportunity of graduate curriculum reform to incorporate real-world data research, artificial intelligence, and bioinformatics into the existing evidence-based medicine curriculum, and explores the reform of evidence-based medicine teaching in the information age. The aim is to enable students to truly understand the role and value of evidence-based medicine in the development of medicine, while possessing a solid theoretical foundation, a broad international perspective, and a keen research sense, in order to cultivate talents for the development of the evidence-based medicine discipline.
ObjectiveTo systematically review the prevalence of enuresis in Chinese children and adolescents. MethodsA computer search was conducted for epidemiological research on the prevalence of enuresis among Chinese children and adolescents in databases including CNKI, WanFang Data, VIP, SinoMed, PubMed, Embase, and Web of Science. Two researchers independently carried out literature screening, data extraction, and quality evaluation. Meta-analysis was executed using R language, with baujat plots and subgroup analysis to investigate heterogeneity sources, and leave-one-out for sensitivity analysis. ResultsA total of 38 papers were included, encompassing 327 065 participants, with 18 392 children suffering from enuresis. The aggregate prevalence rate was 5.59% (95%CI 4.58% to 6.81%). The prevalence rate showed a significant decreasing trend with increasing age, with rates at ages 5, 12, and 18 being 12.30% (95%CI 9.96% to 15.11%), 2.07% (95%CI 1.68% to 2.56%), and 1.95% (95%CI 0.90% to 4.20%), respectively. The incidence rate in male children was higher at 6.36% (95%CI 5.49% to 7.36%) than that in female children at 4.30% (95%CI 3.57% to 5.16%). Using DSM-IV as the diagnostic criteria, the prevalence rate was 3.78% (95%CI 2.58% to 5.52%), while it was 5.99% (95%CI 4.75% to 7.52%) using ICCS as the criteria. ConclusionThe prevalence of enuresis among Chinese children and adolescents is affected by factors such as region, age, gender, and diagnostic standards. The prevalence is higher in South China, decreases with age, and is significantly higher in males than in females.