Objective To verify the applicability of AGREE-China and select high-quality clinical practice guidelines (CPGs) or consensus for the management of fragility fractures (FF) in China by evaluating their methodological quality. Methods CBM, CNKI, WanFang Data, VIP databases and related CPGs websites were electronically searched. Two reviewers independently screened literature, extracted data, and checked each other. Quality appraisal of CPGs or consensus were evaluated by AGREE Ⅱ and AGREE-China, and weighted Kappa value and intraclass correlation coefficients (ICC) were calculated to illustrate the consistency of the two tools. Results Nine CPGs and sixteen consensuses were included. Among the six domains in AGREE Ⅱ, "scope and purpose" domain (62.22%) scored higher than "clarity of presentation" domain (45.67%). The "stakeholder involvement" domain (34.89%) and "applicability" domain (38.17%) both exceeded 30%, while "rigor of development" domain (18.79%) and "editorial independence" domain (13.33%) were lower. Among the five domains in AGREE-China, "conflict of interest" domain (72.80%) was higher, followed by "usability/feasibility" domain (49.87%), while "scientificity/preciseness" domain (20.36%), "effectiveness/safety" domain (25.20%) and "economic efficiency" domain (14.40%) were lower. The weighted Kappa value of recommendations from the two tools was 0.694 (P<0.001), showing moderate consistency. ICC values of the same items and two evaluators were all greater than 0.85 (P<0.001) with high consistency. Three high-quality CPGs were consistently selected by the two tools. Conclusion AGREE Ⅱ holds high consistency with AGREE-China; however, AGREE-China is more suitable for the quality appraisal of Chinese CPGs or consensus. The methodological quality of CPGs or consensus for the management of FF in China needs to be further improved.
OBJECTIVE This paper is aimed to observe the long-term result of reconstruction of wrist joint by replacing distal end of radius with vascularized fibular head in patient of giant tumor. METHODS From July 1978 to November 1993, 12 cases of giant tumor of distal end of radius were treated by this procedure and followed up for 6 months to 15 years, and the movement range of wrist, grip strength, and pain were evaluated. RESULTS The painful wrist released in 11 cases, only one case still existed mild pain and felt discomfortable. The average range of movement of wrist joint was 34.05 degree in volar flexion, 52.80 degree in dorsal extension, 26.25 degree in ulnar deviation, and 19.75 degree in radial deviation, and average grip strength was 44.6 kg. Compared with the contralateral side, there were accounted for 46.2%, 72.7%, 76.1%, 80.6%, and 76.7% respectively. CONCLUSION Replacement of distal end of radius with fibular head to reconstruct wrist joint can restore function of carpal joint, which is proved to be a safe and effective method.
Objective To establish a good method and culture system to isolate skin stem cell and expand it in vitro so as to lay a foundation for exploring the proliferation and differentiation mechanism of skin stem cell. Methods Skin stem cells were obtained by explant culture and identified by using alkaline phosphatase(ALP) staining and differentiating experiment in vitro. Stem cell was induced by the cocktail of conditional medium with cell growth factor (insulin like growth factor and epidermal growth factor). Results Skin stem cell colonies were derived from ear skin tissues of adult dairy goats. The colonies had some characteristics of embryonic stem cells, such as the ability to be continously passaged (Passage 5) and the morphology nest-like. They continued to be ALP positive and had the capacity of forming embryoid bodies. These cells were pluripotent and stem-like cells. In vitro these stem cell can be induced to be Follicle-like structure, Astrocyte-like cells, osteoblast-like cell. Conclusion Explant culture is a good method to isolate skin stem cell, which can be induced to be committed differentiation and trans-differentiation.
ObjectiveTo systematically review the prevalence of elder abuse in China.MethodsPubMed, EMbase, Web of Science, CNKI, VIP and WanFang Data databases were electronically searched to collect cross-sectional studies on the prevalence of elder abuse in China from inception to June 2019. Two reviewers independently screened literature, extracted data and assessed risk bias of included studies; then, meta-analysis was performed by R 3.5.1 software.ResultsA total of 11 cross-sectional studies involving 23 020 subjects were included. The results of meta-analysis showed that the prevalence of abuse among the elderly in China was 20.29% (95%CI 12.9% to 28.9%). The highest prevalence of elder abuse subtype was psychological abuse with 15.06% (95%CI 10.2% to 20.6%). The prevalence rates were 20.1% in male and 23.64% in female. The prevalence rates in individuals aged between 60 to 70, 70 to 80 and above 80 were 19.76%, 22.24% and 29.19%, respectively. Illiterates and non-illiterates were 29.39% and 22.52% respectively. Normal marital status was 28.24%, and abnormal status was 31.38%. The elderly living alone was the highest (50.67%), compared with family residents (39.42%) and elderly living in pension institutions (29.94%). The elderly without chronic diseases (16.05%) was lower than elderly with chronic diseases (25.49%), and elderly having normal capability of daily living (26.89%) was lower than elderly having reduced capability of daily living (48.78%). Urban residents were 18.46%, while rural residents were 19.69%.ConclusionsThere is a high incidence of elder abuse in China, and it tends to increase with the increase of age. There are certain differences in the prevalence of elder maltreatment among different genders, ages, educational levels, marital status, living forms and spaces, and health conditions. Due to limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusion.
ObjectiveTo retrospectively investigate the drug use of over-60-year inpatients with lung cancer in the West China Hospital of Sichuan University in 2011, and to compare with outpatients with lung cancer concurrently, so as to evaluate the rationality of drug use among over-60-year inpatients with lung cancer in the West China Hospital.
MethodsThe information of over-60-year inpatients with lung cancer as initial diagnosis in the West China Hospital in 2011 was collected from the hospital information system (HIS), including patient information, drug use information, cost information, etc. Data rearrangement and analysis by classes and costs were carried out using Microsoft Excel 2010 software.
Resultsa) There was 2 215 person-times of over-60-year inpatients with lung cancer in the West China Hospital of Sichuan University in 2011. A total of 5 classes, 63 kinds of anti-tumor and adjuvant therapy drugs were involved. The total drug use frequency was 12 398 person-times. The average medicine cost was 774.93 yuan. b) The ratio of patients using 1 to 4 kinds of drugs was 34.31%, 5 to 10 kinds was 41.9%, and 11 to 15 kinds was 12.63%. c) For etiological treatment, the ratio of chemotherapy drugs was 99.45%, and the most used was cisplatin. d) For symptomatic treatment, the ratio of analgesics was 66.69%; the ratio of antitussive drugs was 21.33%; and the ratio of skeletal related events prevention drugs was 11.98%. e) For anti-ADR treatment, the ratio of antiemetic drugs was 55.07%; the ratio of stomach protection drugs was 32.63%; and the ratio of hepatic protection drugs was 12.30%. f) For other treatment, the ratio of immunopotentiating drugs was 59.46%; and the ratio of hematopoietic growth factor was 25.42%. g) For Chinese patent medicine, drugs used over 400 person-times were Diyushengbai tablet, Javanica oil emulsion injection, Aidi injection, and Huisheng oral liquid. h) For single/combined treatment, the ratio of two-drug combined chemotherapy was 78.38%, one analgesics drug treatment was 66.21%, one hepatic protection drug treatment was 83.41%, two-drug combined antanacathartic treatment was 45.88%, one stomach protection drug treatment was 90.53%, one immunopotentiating drug treatment was 90.53%, one hematopoietic growth factor treatment was 82.31%, and one Chinese patent medicine treatment was 37.39%, respectively; and antitussive and skeletal related events prevention drugs were used alone. i) The use frequency of the top 10 drugs were: pantoprazole, tropisetron, ondansetron, diphenhydramine, thymopentin, cisplatin, Diyushengbai tablet, tramadol, Javanica oil emulsion injection, and Aidi injection. j) Compared with outpatients, inpatients drug use frequency was higher in chemotherapy, analgesics, antiemetic, stomach protection, hepatic protection drugs, and Chinese patent medicine; but lower in skeletal related events prevention drug; and similar to the drug use situation of outpatients in immunopotentiating drugs and hematopoietic growth factor drugs.
ConclusionThe antitumor therapies were mainly the combination of two chemotherapy drugs or single drug regimen for over-60-year inpatients with lung cancer in the West China hospital of Sichuan University in 2011. The most frequently used adjuvant therapies are antalgic, antiemetic and stomach protection drugs. Chinese patent medicine and immunopotentiating drugs are in common use as well.
ObjectiveTo access the current study status and the existing problems of studies on National Essential Medicines System (NEMS) in China based on systematic review methods, and provide the evidence-based evidence and references to the studies of this field.
MethodsThe following databases such as PubMed, EMbase, The Cochrane Library (Issue 3, March 2014), CNKI, WanFang Data, VIP and CBM were electronically searched to collect studies related to the policy analysis, implementation background, implementation strategies, implementation situation, implementation problem and implementation effects about NEMS in China. The retrieval time was from inception to December 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and finally conducted analysis on study types, study time, source journals, authors' units, study themes, etc. of the included studies.
ResultsA total of 1 607 articles were finally included, encompassing 56.38% qualitative studies and 43.62% quantitative studies. The number of published studies per year, the number of quantitative studies as well as the number of financiallysupported studies out of the total studies published per year had increased by year since 2009. The study topics focused on every parts during the implementation of NEMS in different proportions. The proportion of the national studies in the quantitative studies was lower than that of others. The regional distribution involved in the quantitative studies was unbalanced, and the ratio of which located on the East, the Central and the West of China was 2 to 1 to 1.
ConclusionThe implementation of NEMS and related studies are mutually promoted. More studies are needed to be carried out on remote areas as well as West China. Although the studies related to these areas tend to be standardized and evidence-based, but more in-depth studies should be well advanced. Most of the topics of the studies are widely covered, and the topics of further studies should be enforced in the detail of implementation links. Most of the studies focus on primary medical institutions, and more studies are also needed for supporting and expanding the implementation of NEMS in second and three degree medical institutions.
Ethical issues in clinical research are receiving increasing attention. The application of research projects, the registration of clinical trials and the publication of scientific researches have always been involved with ethical issues. This paper elaborates ethical development and changes in Chinese clinical research from the aspects of the development of medical ethics, the establishment of ethics laws and regulations, international certification of medical ethics committee, the advantages, challenges, opportunities and innovation and development of TCM clinical research ethics as well as the certification system of TCM research ethics.
Objective
To investigate HCV genotypes in HCV patients in West China Hospital of Sichuan University, and to analyze the major genotypes and clinical characteristics.
Methods
From March 2011 to September 2016, 4 520 HCV patients who were successfully genotyped HCV genotypes were enrolled in West China Hospital of Sichuan University. The genotypes distributions and the characteristics of laboratory characteristics of liver function, the viral loading were all analyzed. In addition, the genotypes in HCC patients, liver cirrhosis, HBC/HCV co-infection were also analyzed.
Results
HCV genotypes of HCV patients were divided into five genotypes of 1, 2, 3, 4, 6 and 23 subtypes, including predominant genotypes/subtypes 1b, 1*, 3b, 2a, 3a and 6a, accounting for 66.42%, 8.01%, 6.57%, 4.54%, 4.29%, and 3.41%, respectively. Subtype 1b was the predominant subtype for both sex. In male patients, the levels of ALT were highest in 6a subtype, while in female, the levels of ALT were highest in 3a subtype. For the 94 liver cirrhosis patients, 42 patients were 1b subtypes; as for the 6 HCC patients, 1b and 3b subtypes were the only detected.
Conclusion
HCV genotypes/subtypes of HCV patients in West China Hospital of Sichuan University have unique characteristics of distribution, while the predominant genotype/subtypes are 1b,1*, 3b, 2a, 3a, 6a.
ObjectiveTo analyze the main input and output of healthcare reform in China, and to provide references for improving the policies and measures of healthcare reform in China in future.
MethodsData from the National Health Services Survey, and the China Statistical Yearbook etc. was collected to compare and analyze the allocation of health resources, health status of residents, health service utilization, and medical burden before and after healthcare reform.
ResultsDuring the reform from 2009 to 2013, hospital health and technical personnel increased year by year. In 2013, the proportion of health and technical personnel in hospitals was up to 61.4% of the total national health technical personnel. In 2013, 65.19% of government expenditure on healthcare was used for disease treatment, and only 14.59% was used for disease prevention. Compared with the year of 2008, the two-week prevalence rate of residents increased by 5.2%, the chronic disease prevalence rate increased by 9% in 2013. Compared with the year of 2009, the annually diagnosed and treated patients increased 18.2 billion person-time, the annually discharged patients increased 59.65 million person-time in 2013. The individual residents paid 52.49% of total medical expenses.
ConclusionSince the healthcare reform, China's central and local governments have imputed a large number of health resources into hospitals for "disease treatment". That partly improved the utilization of residents' health service, but the two-week prevalence rate and chronic disease prevalence rate are rapidly growing. There is still high burden of medical expenses for the residents. China's healthcare model should be changed from "treatment-centered" to "prevention-centered" in future.
