The aim of this study was to systematically evaluate the quality of the clinical practice guidelines (CPGs) for diabetes mellitus published in China over the period of January 2007 to April 2017.
We searched the China National Knowledge Infrastructure, Chinese Biomedical Literature database, VIP database and WanFang databases and guideline websites for CPGs for diabetes mellitus published between January 2007 and April 2017 in China. Two reviewers independently screened the literature according to the inclusion and exclusion criteria and extracted data. We used the the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool (Canadian Institutes of Health Research, Ottawa, Canada) to evaluate the quality of the included guidelines, calculated the scores of each domain and evaluated the consistency among the assessors via use of the intragroup correlation coefficient. And then we compared the results with Chinese CPGs and international CPGs. We conducted a subgroup analysis based on different classification criteria and compared scores of each domain subgroup analyses.
A total of 98 guidelines were identified. The correlation coefficient within the group was 0.93, suggesting that the consistency between the evaluators was good. The scores of the six domains of AGREE II were described in median (IQR) as follows: scope and purpose 53.7 (50.0–59.7), stakeholder involvement 31.5 (27.3–37.0), rigour of development 19.1 (15.3–22.2), clarity of presentation 59.3 (50.0–64.8), applicability 18.1 (13.9–25.7) and editorial independence 0.0 (0.0–0.0). The mean score in each domain of quality of Chinese diabetes CPGs was lower than that of CPGs published worldwide but higher than the mean score of Chinese guidelines of all topics. A funding source, the updated version, organisation and publishers of the guidelines and target fields are all the factors influencing the quality of CPGs to a certain degree.
A large number of Chinese diabetes CPGs have been produced. Their quality remain unsatisfactorily low compared with CPGs worldwide, there is still room for improvement. Chinese guideline developers should pay more attention to the transparency of methodology, and use the AGREE II instrument to develop and report guidelines.
by Dongsheng Wang, Xuhui Deng, Bei Wang, Na Zhang, Chengzhi Zhu, Zixuan Jiao, Rong Li, Qirong ShenLeaf surface fertilization with liquid fertilizer produced from amino acids constitutes a potentially important source of nitrogen and is important for plant production. However, few reports have focused on the plant growth promotion by novel liquid fertilizers created by new amino acid resources, let alone the influence on leaf microbiota. In this study, the effects of liquid fertilizer, created by amino acids hydrolyzed from animal hairs with or without the PGPR strain Bacillus amyloliquefaciens SQR9, on crop yield and leaf microbiota were investigated. The results showed that leaves sprayed with amino acid liquid fertilizer (AA) and liquid biological fertilizer (AA9) persistently increased cowpea yields compared to the control amended with chemical fertilizer (CF). Fertilization with amino acid fertilizer showed no significant difference in microbial composition compared with the CF treatment; however, the introduction of functional microbes altered the microbial composition. Pearson correlation analysis, VPA analysis and SEM models all revealed that the amino acids liquid fertilizer application, but not the functional strain or the altered microbiota, performed as the direct driver attributing to yield enhancement. We conclude that leaf fertilization with a novel amino acid liquid fertilizer can greatly enhance the crop yield and that the addition of beneficial microbes may perform the role in further altering the composition of leaf microbiota.
by Chao-Ping Chen, Pei-Tseng Kung, Yueh-Hsin Wang, Wen-Chen TsaiObjectives
Despite the ease of health care access and the waiver of copayments for cancer patients, treatment is delayed in a small proportion of Taiwanese patients diagnosed with cervical cancer. In this study, we explored the relationship between the time interval from diagnosis to treatment and survival in cervical cancer patients.Material and methods
The study was a retrospective population-based observational study conducted between 2004 and 2010. In Taiwan, 12,020 patients were newly diagnosed with cervical cancer from 2004 to 2010, and 9,693 patients (80.6%) were enrolled in our final analysis.Results
Most of the patients received treatment within 90 days of diagnosis (n = 9,341, 96.37%). After adjustment for other variables, patients who received treatment between 90 and 180 days and >180 days after diagnosis had a 1.33 (95% CI: 1.02–1.72, P P 180 days after diagnosis.Conclusion
A longer interval between diagnosis and treatment is associated with poorer prognosis among cervical cancer patients.
The use of negative‐pressure wound therapy (NPWT) has displayed significant clinical benefits in the healing of infected wounds. However, the effects of NPWT on bacterial colonisation and infection of traumatic wounds has been controversial. The aim of this study is to evaluate the impact of NPWT treatment in rabbits with a contaminated full‐thickness wound on bacterial behaviour, including colony morphology, spatial distribution, fissional proliferation, and bacterial bioburden. Full‐thickness wounds were created on the back of rabbits, and were inoculated with bioluminescent Staphylococcus aureus. The wounds were treated with sterile gauze dressings and NPWT with continuous negative pressure (−125 mm Hg). Wound samples were harvested on days 0 (6 hours after bacterial inoculation), 2, 4, 6, and 8 at the centre of wound beds before irrigation. Scanning electron microscopy and transmission electron microscopy (TEM) analyses were performed to determine the characteristic bacteriology. Laser scanning confocal microscopy was performed to obtain bioluminescent images, which were used to observe spatial distribution of the GFP‐labelled S. aureus within the tissue and quantify the bacterial bioburden. NPWT resulted in sparse amounts of scattered bacteria on the wound surface or as sparsely spaced single colonies within the tissue. Wound bioburden on day 8 in the NPWT and gauze groups was 34.6 ± 5.5% and 141.9 ± 15.4% of the baseline values (N = 6), respectively (P < .0001). TEM showed a lack of S. aureus active fission within NPWT‐treated tissue. NPWT can impact S. aureus colony morphology and spatial distribution both on the surface and within wound tissue, and reduce S. aureus as early as 48 hours after therapy initiation. Additionally, NPWT inhibits bacterial fissional proliferation in microcolonies.
To investigate anticoagulant adherence and its associated factors, including demographics, clinical variables, atrial fibrillation (AF) severity, knowledge, satisfaction with services, perceived barriers, perceived benefits, symptom severity and self-efficacy in patients with AF.
This is a cross-sectional study.
A convenient sample of patients with AF were recruited from cardiology clinics of two teaching hospitals in Taiwan.
Data were collected using the study questionnaires, including the AF-related symptom subscale of the AF Severity Scale, the Knowledge of Warfarin Anticoagulation Treatment Scale, the Satisfaction Scale about Service and Warfarin Treatment, the perceived benefits subscale of the Beliefs about Anticoagulation Survey, the Concerns about Anticoagulation Therapy Scale, The Self-efficacy for Appropriate Medication Use Scale and the short-form Adherence to Refills and Medications Scale.
A total of 151 patients with AF participated in the study; 53 treated with warfarin and 98 treated with novel oral anticoagulants (NOACs). The difference in adherence to warfarin (mean=8.6; SD=1.6) and NOACs (mean=8.9; SD=2.0) was statistically insignificant. Multiple linear regression analysis showed that perceived barriers (β=0.18, p=0.017) and self-efficacy (β=–0.48, p(2,149)=38.11, p
We found no better adherence to NOACs compared with warfarin. Patients with greater self-efficacy and perceived fewer barriers showed better adherence to anticoagulation therapy.
This study aimed to investigate the experience of patients with wet age-related macular degeneration (wAMD) in treatment decision-making process.
A descriptive qualitative study was designed by using semistructured interviews, and the data analysis was conducted with the thematic analysis approach.
A convenient and purposive sample of 21 participants diagnosed with wAMD was recruited from May 2018 to September 2018. The study was conducted in the Eye Clinic of Southwest Hospital of Army Medical University in Chongqing located in the southwest of China.
The mean age of the participants was 64.48 years (ranging 50–81 years), and the duration of the disease ranged from 6 months to 48 months. Four major themes were identified from the original data analysis. These themes included facing the darkness (choosing from light and darkness and living in pain), constraints on decision making (doctor-oriented decision making, inadequacy of options and time), weighing alternatives (family influence, financial burden and maintaining social function) and decision-making support (professional decision-making assistance and peer support).
This is a qualitative study attempting to explore the patient experience of treatment decision making for wAMD disease in China. Previous literature has focused on treatment effect and symptoms, rather than the individual experience and the wide contexts from a sociocultural perspective. Further studies, such as cross-sectional studies, can be used to describe the status and determine the influencing factors of decision0making process, so as to develop an impact factor model of decision making and to formulate an intervention for patients with wAMD.
To estimate the prevalence and influencing factors of physical activity (PA) and sedentary behaviour (SB) in rural areas of China.
A multistage, stratified cluster sampling method was used to obtain samples in the general population of Henan province in China.
38 515 participants aged 18–79 years were enrolled from the Henan Rural Cohort Study for the cross-sectional study.
The International Physical Activity Questionnaire was used to assess the levels of PA and SB. Multiple logistic regression analysis was used to calculate ORs and 95% CIs of potential influencing factors with physical inactivity.
The age-standardised prevalence of light PA and sitting >7.5 hours per day were 32.74% and 26.88% in the general Chinese rural adults, respectively. Gender differences were: 34.91%, 29.76% for men and 31.75%, 25.16% for women, respectively. The prevalence of participants with both light PA and sitting >7.5 hours per day was 13.95%. Education at least junior middle school, divorced/widowed/unmarried, RMB1000> per capita monthly income ≥RMB500, sitting >7.5 hours per day were negatively associated with light PA. For sitting >7.5 hours per day, the negative factors were being men, divorced/widowed/unmarried, heavy smoking, Fishery products, vegetable and fruits intake .
Physical inactivity and SB were high in rural China. There is an increased need to promote a healthy lifestyle to the rural population.
The Henan Rural Cohort Study has been registered with the Chinese Clinical Trial Register.
Registration number: ChiCTR-OOC-15006699. http://www.chictr.org.cn/showproj.aspx?proj=11375
Despite the publication of hundreds of trials on gout and hyperuricemia, management of these conditions remains suboptimal. We aimed to assess the quality and consistency of guidance documents for gout and hyperuricemia.
Systematic review and quality assessment using the appraisal of guidelines for research and evaluation (AGREE) II methodology.
PubMed and EMBASE (27 October 2016), two Chinese academic databases, eight guideline databases, and Google and Google scholar (July 2017).
We included the latest version of international and national/regional clinical practice guidelines and consensus statements for diagnosis and/or treatment of hyperuricemia and gout, published in English or Chinese.
Two reviewers independently screened searched items and extracted data. Four reviewers independently scored documents using AGREE II. Recommendations from all documents were tabulated and visualised in a coloured grid.
Twenty-four guidance documents (16 clinical practice guidelines and 8 consensus statements) published between 2003 and 2017 were included. Included documents performed well in the domains of scope and purpose (median 85.4%, range 66.7%–100.0%) and clarity of presentation (median 79.2%, range 48.6%–98.6%), but unsatisfactory in applicability (median 10.9%, range 0.0%–66.7%) and editorial independence (median 28.1%, range 0.0%–83.3%). The 2017 British Society of Rheumatology guideline received the highest scores. Recommendations were concordant on the target serum uric acid level for long-term control, on some indications for urate-lowering therapy (ULT), and on the first-line drugs for ULT and for acute attack. Substantially inconsistent recommendations were provided for many items, especially for the timing of initiation of ULT and for treatment for asymptomatic hyperuricemia.
Methodological quality needs improvement in guidance documents on gout and hyperuricemia. Evidence for certain clinical questions is lacking, despite numerous trials in this field. Promoting standard guidance development methods and synthesising high-quality clinical evidence are potential approaches to reduce recommendation inconsistencies.
New ischaemic cerebral lesions (NICL) detected by diffusion-weighted imaging MRI are common after carotid artery stenting (CAS), with an occurrence rate ranging from 18% to 57%. Many studies reported occurrence of NICL could increase risk of future cerebrovascular events and cognitive impairment. However, controversies about determinants for occurrence of NICL after CAS exist among studies, and one risk factor embodied in an article may not be in another. Aim of this study is to introduce a protocol for a systematic review and meta-analysis to identify risk factors associated with occurrence of NICL after CAS.
All relevant literature referring to risk factors for occurrence of NICL after CAS will be searched on the major databases, such as PubMed, Embase, Web of Science and the Cochrane Library until 31 December 2018. Literature, which must be randomised controlled trials, case–control studies or cohort studies, will be included in accordance with the prespecified eligibility criteria. The risk of bias will be assessed using the Cochrane Collaboration criteria and the quality of evidence will be assessed with the corresponding scale. Data will be extracted with a form prepared before and analysed using RevMan V.5.3 analyses software. Heterogeneity will be assessed using I2 statistic. Our systematic review will be performed according to the guidance from the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.
There is no need for ethical approval because primary data will not be attained. The systematic review will be presented at international conferences and published in peer-reviewed journals.
In this study, we aimed to present the epidemiological characteristics of elevated blood pressure among middle and high school students aged 12–17 years in Jiangsu Province.
Hypertension, which is considered a rare disease in children, is an important early precursor to long-term cardiovascular damage, and elevated blood pressure in childhood is a strong predictor of hypertension in adulthood.
Physical examination and questionnaire investigation among children aged 12–17 years in Jiangsu Province were conducted from 2017 to 2018.
Physical measurements included height, weight, blood pressure and history of menarche/first spermatorrhoea. Questionnaire investigation included family type, delivery mode, lifestyle habits and psychological test.
In our study we investigated 17 791 middle and high school students, consisting of 8701 female students and 9090 male students. The prevalence of screening elevated blood pressure among students aged 12–17 years was 20.0% (95% CI 19.2% to 20.9%) for female students and 22.3% (95% CI 21.5% to 23.2%) for male students. The prevalence of screening elevated blood pressure for urban male middle and high school students was higher than that of elevated blood pressure for rural male middle and high school students. However, similar phenomenon cannot be observed among female students. For both male and female students, body mass index (BMI), obesity/overweight and menarche/first spermatorrhoea can be a risk factor contributing to elevated blood pressure, and sleep time and regional distribution might be important factors that need to be investigated in depth.
We found a relatively high prevalence of screening elevated blood pressure among students aged 12–17 years for both female and male students in Jiangsu Province. The risk factors can be BMI, obesity/overweight and menarche/first spermatorrhoea.
This study examines the incidence and spatial clustering of phenylketonuria (PKU) in China between 2013 and 2017.
Data from the Chinese Newborn Screening Information System were analysed to assess PKU incidence with 95% CIs by province, region and disease severity. Spatial clustering of PKU cases was analysed using global and local spatial autocorrelation analysis in the geographic information system.
The database contained 4925 neonates with confirmed PKU during the study period, corresponding to an incidence of 6.28 (95% CI: 6.11 to 6.46) per 100 000 neonates screened. Incidence was highest in the provinces of Gansu, Ningxia and Qinghai, where it ranged from 19.00 to 28.63 per 100 000 neonates screened. Overall incidence was higher in the northern part of the country, where classical disease predominated, than in the southern part, where mild disease predominated. PKU cases clustered spatially (global Moran’s I=0.3603, Z=5.3097, p
China shows an intermediate PKU incidence among countries, and incidence differs substantially among Chinese provinces and between northern and southern regions. Our results suggest the need to focus efforts on screening, diagnosing and treating PKU in high-incidence provinces.
The use of peripherally inserted central catheters (PICCs) are an integral part of caring for hospitalised children. We sought to estimate the incidence of and identify the risk factors for complications associated with PICCs in an advanced registered nurse practitioners (ARNP)-driven programme.
Retrospective cohort study.
Single-centre, large quaternary children's hospital.
Hospitalised children who had PICC inserted from 1 January 2010 to 31 December 2016.
A total of 2558 PICCs were placed during the study period. Mean age at PICC insertion was 8.7 years, mean dwell time was 17.7 days. The majority of PICCs (97.8%) were placed by ARNP. Most were placed in a single attempt (79.6%). Mean PICC residual external length outside was 2.1±2.7 cm. The rate of central line-associated bloodstream infection (CLABSI), thrombosis and significant bleeding were 1.9%, 1% and 0.2%, respectively. The CLABSI rate in infants and early childhood was higher than those aged ≥5 years (2.8%, 3.1%, respectively vs 1.3%). In a multivariate analysis after adjustment of confounding effects of race and gender, infants (OR= 2.24, CI=1.14 to 4.39, p=0.02) and early childhood cohort (OR=2.37, CI=1.12 to 5.01, p=0.02) were associated with significantly higher odds of developing CLABSI compared with ≥5 years old. In the early childhood cohort, PICCs with longer residual external catheter length (OR=1.30, 95% CI=1.07 to 1.57, p=0.008) and those placed in the operating room (OR=5.49, 95% CI=1.03 to 29.19, p=0.04), were associated with significantly greater risk of developing CLABSI.
The majority of PICCs were successfully placed by ARNPs on the first attempt and had a low incidence of complications. Infants required more attempts for successful PICC placement than older children. The presence of residual external catheter length and placement in the operating room were independent predictors of CLABSI in younger children.
Identifying the spatial patterns of childhood overweight/obesity (OW/OB) can help to guide resource allocation for preventive intervention in China. This study aims to estimate rates of childhood OW/OB across counties within Shandong Province, using geographic techniques to identify sex-specific spatial patterns of childhood OW/OB as well as the presence of spatial clusters.
Shandong Province in China.
Data on 6 216 076 children and adolescents aged 7–18 years from the Primary and Secondary Schoolchildren Physical Examination Database for Shandong Province were used in this study. Spatial patterns of sex-specific prevalence of childhood OW/OB were mapped. Global autocorrelation statistic (Moran’s I) and the Local Indicator of Spatial Association (LISA) were applied to assess the degree of spatial autocorrelation.
The overall prevalence of childhood OW/OB in Shandong province were 15.05% and 9.23%, respectively. Maps of the sex-specific prevalence of OW/OB demonstrate a marked geographical variation of childhood OW/OB in different regions. Prevalence of childhood OW/OB had a significant positive spatial autocorrelation among both boys and girls. LISA analysis identified significant clusters (or ‘hot spots’) of childhood OW/OB in the eastern coastal region, central region and southwestern region.
The prevalence of childhood OW/OB is highly spatially clustered. Geographically focused appropriate intervention should be introduced in current childhood OW/OB prevention and control strategy.
Pneumoconiosis is characterised by diffuse fibrosis in lung tissue, and its incidence is on the rise. At present, there are limited therapeutic options for pneumoconiosis. Pulmonary rehabilitation (PR) has been widely used to treat pneumoconiosis，however, there is limited evidence concerning its efficacy. Therefore, we plan to conduct a systematic review to investigate the efficacy and safety of PR for pneumoconiosis.
The following databases will be searched from their inception to 1 April 2019: PubMed, Embase, The Cochrane Library, Web of Science, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Chongqing VIP and Wanfang Data. Randomised controlled trials of PR for pneumoconiosis will be included. Primary outcomes will include 6 min walk distance and St. George’s Respiratory Questionnaire. Study selection, extraction of data and assessment of study quality each will be independently undertaken. Statistical analysis will be conducted using Review Manager software.
This systematic review will provide up-to-date information on PR for pneumoconiosis. The review does not require ethical approval and will be disseminated electronically through a peer-reviewed publication or conference presentations.
To adapt the Child Food Neophobia Scale (CFNS) cross-culturally for use among 12-36-month-old Chinese toddlers and to perform a preliminary assessment of its construct validity and reliability.
Food neophobia is the fear of eating new or unfamiliar foods, which affects the type and quality of individual dietary intake, especially during early childhood. However, measurements of child food neophobia have rarely been reported in China due to a lack of reliable and valid measurements.
The CFNS was translated and adapted into a Chinese version (CFNS-CN) through a forward translation, reconciliation, a back translation, expert review and pretesting. The construct validity and reliability of the CFNS-CN were tested in 390 caregivers of 12–36 months old Chinese toddlers through convenience sampling in Changsha Maternal and Child Health Care Hospital, Hunan Province, China. The internal consistency, confirmatory factor analysis (CFA) and reliability were estimated.
The kappa coefficients indicated moderate to perfect agreement between the test and retest, and Cronbach’s α coefficient was 0.91. A normal 2/df, CMIN/DF=3.302, Comparative Fit Index, CFI=0.993, Tucker-Lewis Index, TLI=0.986 and root mean square error of approximation, RMSEA=0.077 were found. The CFA results showed that the model indicators were acceptable. High food neophobia was observed in 25.1% of individuals.
The CFNS-CN showed good internal consistency reliability and construct validity. The CFNS-CN may become an effective tool for assessing food neophobia in Chinese toddlers.
This trial was pre-registered at the China Clinical Trial Registration Center under registration number ChiCTR1800015890.
To assess the efficacy and safety of green-light laser photoselective vaporisation of the prostate (PVP) compared with transurethral resection of the prostate (TURP) for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).
Systematic review and meta-analysis, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement.
PubMed, EMBASE, the Cochrane Library until October 2018.
Randomised controlled trials and prospective studies comparing the safety and efficacy of PVP versus TURP for LUTS manifesting through BPH.
Perioperative parameters, complications rates and functional outcomes including treatment-related adverse events such as International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), postvoid residual (PVR), quality of life (QoL) and International Index of Erectile Function (IIEF).
22 publications consisting of 2665 patients were analysed. Pooled analysis revealed PVP is associated with reduced blood loss, transfusion, clot retention, TUR syndrome, capsular perforation, catheterisation time and hospitalisation, but also with a higher reintervention rate and longer intervention duration (all p
PVP is an effective alternative, holding additional safety benefits. PVP has equivalent long-term IPSS, Qmax, QoL, PVR, IIEF efficacy and fewer complications. The main drawbacks are dysuria and reintervention, although both can be managed with non-invasive techniques. The additional shortcoming is that PVP does not acquire histological tissue examination which removes an opportunity to identify prostate cancer.
Millions of patients are currently suffering from pain and dysfunction caused by osteoarthritis (OA), and billions of dollars have been invested into treatment. Because there is no effective treatment that can reverse the progression of knee OA, it is important to determine the risk factors that may influence the progression. However, although there are many studies that examine risk factors for progression, there are only a few that specifically focus on the impact of each risk factor for predicting progression of knee OA. This study aimed to develop a cohort of patients with primary knee OA in the Beijing area to establish models that identify the influence of each risk factor on the prediction of knee OA progression.
This is a prospective, multicentre, hospital-based cohort study. The study population comprises 2000 patients with primary knee OA from the Beijing area. The recruitment and baseline visits started in December 2017 and will finish in November 2018. After baseline visits, the patients will be followed for 3 years or until the occurrence of primary outcomes. Demographic variables will be collected during the baseline visit. Influencing factors including occupational exposures, family history and treatment will be collected at baseline and each follow-up visit. The primary outcome measure is a comprehensive index which will be combined with clinical WOMAC score, imaging K-L grade and clinical outcomes. These data will also be collected at baseline and each follow-up visit.
This study protocol has been approved by Peking University Third Hospital Medical Science Research Ethics Committee. All the eligible participants will give written informed consent. The findings will be published in peer-reviewed journals and presented at national or international conferences. Besides, the results will be disseminated to all participants via the social software ‘WeChat’.