ObjectiveTo investigate the value of rectumaerated MSCT examination in diagnosis of mesorectal infiltration of rectal cancer and lymph node metastasis staging. MethodsFrom January 2010 to July 2010, the data of 68 patients with rectal cancer confirmed by pathology were analyzed in the First Affiliated Hospital of Liaoning Medical University. All the patients underwent rectumaerated MSCT preoperatively and postoperative pathology was taken as the gold standard for evaluation of the accuracy, sensitivity, specificity, positive or negative predictive values of MSCT in diagnosis of mesorectal infiltration and lymph node metastasis.ResultsIn rectum-aerated MSCT scanning, rectum and sigmoid colon was fully expanded, perirectal fat space was clear between perirectal fat space and relatively high density rectal wall and very low density enteric cavity. For mesorectal infiltration of degree Ⅰ, Ⅱ, and Ⅲ, the accuracies were 92.6%（63/68）, 91.1%(62/68), and 95.6%(65/68), respectively; sensitivities were 91.2%(31/34), 85.0%(17/20), and 92.9%(13/14), respectively; specificities were 94.1%(32/34), 93.8%(45/48), and 96.3%(52/54), respectively; positive predictive values were 93.9%(31/33), 85.0%(17/20), and 86.7%(13/15), respectively; negative predictive values were 91.4%(32/35), 93.8%(45/48), and 98.1%(52/53), respectively. For lymph node metastasis in N0, N1, and N2, the accuracies were 92.6%(63/68）,85.3%(58/68）, and 92.6%(63/68）, respectively; sensitivities were 86.2%(25/29), 90.0%(27/30), and 66.7%(6/9), respectively; specificities were 97.4%(38/39), 81.6%(31/38), and 96.6%(57/59), respectively; positive predictive values were 96.2%(25/26), 79.4%(27/34), and 75.0%(6/8), respectively; negative predictive values were 90.5%(38/42), 92.1%(35/38), and 95.0%(57/60), respectively. ConclusionsRectumaerated MSCT scaning can clearly show the depth of rectal carcinoma infiltration in the mesorectum, and N staging of mesorectal lymph node metastasis of MSCT has a higher consistency with that of pathological staging. Rectumaerated MSCT scanning is an important referenced method for clinical preoperative staging and individualized chemotherapy regimen.
背景 通过确保对卫生服务使用者和其他特定领域卫生保健决策者关注的指标进行常规测量，核心指标集（core outcome set，COS）可以提高研究的相关性。到目前为止，已经形成了 200 多个 COS，但这些报告的透明度还不理想。如果 COS 的报告不够完整和透明，COS 研究将无法实现其目标。 方法与结果 鉴于这些问题，由经验丰富的 COS 制定者、方法学家、期刊编辑、COS 潜在用户（临床试验者、系统评价员和临床指南制定者）以及患者代表组成的一个国际性工作组，制定了核心指标集报告标准（Core Outcome Set-STAndards for Reporting，COS-STAR）声明，作为 COS 研究报告的指南。其形成过程先后包括初始报告条目产生阶段、代表关键利益相关方群体的 200 名人员的两轮德尔菲问卷调查，最后是一个共识会议。COS-STAR 声明由一个包含 18 个条目的清单组成，这些条目是确保所有 COS 研究报告透明度和完整性的必要条目。条目清单重点规范了形成特定 COS 的研究报告需涉及的前言、方法、结果和讨论部分。COS-STAR 声明的一个局限性在于其形成过程中缺乏低、中收入国家的代表性意见。而 COS 对在这些国家和地区开展的研究具有同等的相关性，故今后该指南可能需要不断完善，以应对这些国家和地区 COS 形成的任何其他挑战。 结论 随着 COS 研究的不断开展，COS-STAR 声明将成为提高 COS 研究报告质量的有力工具，并使所有 COS 使用者受益。
ObjectivesTo systematically review the safety of traditional Chinese medicine injection based on clinical centralized monitoring studies that have been carried out and listed so far, to understand basic situation of adverse reactions and explore the risk factors of traditional Chinese medicine injections and to provide evidence for clinical rational use of drugs and optimizing centralized monitoring methods. MethodsCFDA, CNKI, VIP, WanFang Data, Sinomed, PubMed and The Cochrane Library databases were electronically searched to collect studies on safety monitoring of listed traditional Chinese medicine injections from inception to February, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed by using Excel software. ResultsA total of 14 studies involving 14 varieties of injections, 296 200 cases were included. The highest incidence rate of adverse reactions was found in the XueBiJing injection (2.54%). The related factors of ADR extraction were age, sex, drug combined usage, time from administration, allergic history, administration days, indication, dose and distribution of the tube. ConclusionsThe safety of traditional Chinese medicine injection is generally high. Middle and old age is an important factor in the occurrence of ADR. The incidence of ADR is relatively high in the first 6 days of drug use, and the incidence of ADR is more likely to be caused by irrational use of drugs in clinic, and the history of allergy may be related to the occurrence of ADR. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusion.
Evidence-based Chinese medicine (EBCM) is one of the innovative achievements in the development of evidence-based medicine (EBM) in China. The EBCM has made initial progress: the evidence-based scientific decision-making model has become popular; a series of key technologies for evidence-based evaluation and research of traditional Chinese medicine (TCM) have been established; several technical specifications have been formulated in line with international standards; clinical evidence database of TCM has been established; a number of high quality clinical trials have been published in internationally renowned journals; and the International Forum on Evidence based Chinese Medicine(EBCM) has become a brand conference. Difficulties in EBCM development mainly involve: lack of high quality clinical evidence, difficulty in producing evidence, and decentralization of research team. Based on opportunities and challenges of the development of TCM, this article proposed the short-term and long-term goals, implementation paths and five key directions for the development of EBCM in the future, and puts forward three suggestions for further development of EBCM.
This paper introduces the process of design and implementation on the clinical evidence database of acupuncture (ACU-CED), including establishing expert groups on the basis of demands to formulate top-design, project implementation plans and standard, comprehensively searching publications of clinical randomized controlled trials (RCTs) of acupuncture and moxibustion, conducting strictly data extraction and evaluation, and eventually achieve automatic utilization of clinical evidence. ACU-CED will become the first structural data platform with the function of searching-screening-result, analysis-data, and statistics-evidence extraction, which fills in gapes in database of clinical evidence sources, increases efficiency of evidence transformation, and reduces waste of resources. It will also achieve auto-completion of systematic review/meta-analysis as well as visualization of clinical evidence, so as to provide evidence for clinical decision, guidelines and disease spectrum of acupuncture therapy.
Skin cancer is a significant public health issue, and computer-aided diagnosis technology can effectively alleviate this burden. Accurate identification of skin lesion types is crucial when employing computer-aided diagnosis. This study proposes a multi-level attention cascaded fusion model based on Swin-T and ConvNeXt. It employed hierarchical Swin-T and ConvNeXt to extract global and local features, respectively, and introduced residual channel attention and spatial attention modules for further feature extraction. Multi-level attention mechanisms were utilized to process multi-scale global and local features. To address the problem of shallow features being lost due to their distance from the classifier, a hierarchical inverted residual fusion module was proposed to dynamically adjust the extracted feature information. Balanced sampling strategies and focal loss were employed to tackle the issue of imbalanced categories of skin lesions. Experimental testing on the ISIC2018 and ISIC2019 datasets yielded accuracy, precision, recall, and F1-Score of 96.01%, 93.67%, 92.65%, and 93.11%, respectively, and 92.79%, 91.52%, 88.90%, and 90.15%, respectively. Compared to Swin-T, the proposed method achieved an accuracy improvement of 3.60% and 1.66%, and compared to ConvNeXt, it achieved an accuracy improvement of 2.87% and 3.45%. The experiments demonstrate that the proposed method accurately classifies skin lesion images, providing a new solution for skin cancer diagnosis.
Objective To systematically review the intervention effects and safety of cardiovascular polypill for the relevant risk factors of coronary heart disease. Methods The randomized clinical trials (RCTs) on polypill in intervening coronary heart disease were searched in PubMed, CENTRAL, ICTRP, CBM, CNKI, WanFang and VIP from their inception to September 2012. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the methodological quality. Then the analysis was conducted. Results A total of 5 RCTs from overseas were included. The descriptive analysis showed that: a) as for blood pressure, polypill was obviously superior to placebo in reducing SBP and DBP with a significant difference, but it didn’t reveal difference compared to the hypotensive drugs used alone; b) as for serum lipid, polypill was obviously superior to placebo in reducing TC, TG and LDL-C with a significant difference, but there was no difference between polypill and standard drug treatment; c) as for glucose, polypill was obviously superior to placebo in reducing glucose with a significant difference; d) as for adverse reaction, such adverse events as cough, bleeding tendency or gastritis, liver and kidney dysfunction were reported in the included studies; e) as for drug compliance, polypill showed no differences compared with either standard treatment or placebo. Conclusion Polypill has intervention effects on the relevant factors of coronary heart disease, such as hypertension and serum lipid, etc. Due to quantity limitation of the included trials, the above conclusion still needs to be further proved by performing more large scale and high quality studies. For lack of adequate evidence, this review does not recommend polypill as a primary care for cardiovascular disease.
Objective To explore the change of particles of Shuanghuanglian Injection (SHLI) admixed with different infusion solutions, and provide a reference for selecting rational menstruum. Methods A comprehensive literature search was executed to collect all the studies on the compatibility of SHLI with different infusion solutions. The reporting quality of the included studies was assessed; particles-related data were extracted and analyzed systematically. Results A total of 338 studies were identified, and 24 studies were included after screening. The quality of the included studies were poor and had heterogeneous outcomes. Generally, the particles of mixture increased dramatically, and there were significant differences among different pharmaceuticals, drug batches and infusion solutions. The pH of solvent had a greater impact on the particles, and the concentration and storage time of prepared liquor were other important factors. The particles of SHLI admixed with Normal Saline were less than 5%, 10% glucose injection and other solvents. Conclusion The particles of SHLI admixed with Normal Saline are the fewest, and commonly can be the preferred solvent. Factors on rational drug use are worthy of further studies; and more attention is needed for the scientificalness of study design.
Objective To investigate the effect of quercetin on human breast cancer cells and related mechanism. MethodsHuman breast cancer cell line MDA-MB-435S was treated by different concentrations of quercetin (12.5, 25, 50, 100 and 200 μmol/L). The inhibition ratio of human breast cancer cell was measured by trypan blue dye exclusion test, the proliferation cycle of human breast cancer cell was analyzed by flow cytometry and the expression of caspase-3 mRNA was determined by RT-PCR. ResultsQuercetin could inhibit the proliferation of breast cancer cell in the dose- and time-dependent manner. Quercetin could change the cell cycle of breast cancer cell, with the concentrations of quercetin increasing, the percentages of breast cancer cell at G0/G1 phase decreased, which increased at S phase, and increased at G2/M phase followed decrease. Quercetin could activate the expression of caspase-3 mRNA in breast cancer cell. ConclusionQuercetin can inhibit proliferation and induce apoptosis of human breast cancer cell, the mechanism may be associated with the change of cell cycle and the upregulation of caspase-3 expression.
The Core Outcome Set-STAndards for Reporting (COS-STAR) is a latest guide tool made by Core Outcome Measures in Effectiveness Trials (COMET) group. It can enhance the transparency and completeness of Core Outcome Set (COS) report. This paper introduces the generation process, report items and application of COS-STAR to provide reference for domestic similar researches.