There exist differences in the epidemiological characteristics,clinicopathological features,tumor biological characteristics,treatment patterns,and drug selections between gastric cancer patients from the Eastern and ...There exist differences in the epidemiological characteristics,clinicopathological features,tumor biological characteristics,treatment patterns,and drug selections between gastric cancer patients from the Eastern and Western countries.The Chinese Society of Clinical Oncology(CSCO)has organized a panel of senior experts specializing in all sub-specialties of gastric cancer to compile a clinical guideline for the diagnosis and treatment of gastric cancer since 2016 and renews it annually.Taking into account regional differences,giving full consideration to the accessibility of diagnosis and treatment resources,these experts have conducted expert consensus judgment on relevant evidence and made various grades of recommendations for the clinical diagnosis and treatment of gastric cancer to reflect the value of cancer treatment and meeting health economic indexes in China.The 2021 CSCO Clinical Practice Guidelines for Gastric Cancer covers the diagnosis,treatment,follow-up,and screening of gastric cancer.Based on the 2020 version of the CSCO Chinese Gastric Cancer guidelines,this updated guideline integrates the results ofmajor clinical studies from China and overseas for the past year,focused on the inclusion of research data from the Chinese population for more personalized and clinically relevant recommendations.For the comprehensive treatment of non-metastatic gastric cancer,attentions were paid to neoadjuvant treatment.The value of perioperative chemotherapy is gradually becoming clearer and its recommendation level has been updated.For the comprehensive treatment of metastatic gastric cancer,recommendations for immunotherapy were included,and immune checkpoint inhibitors fromthird-line to the first-line of treatment for different patient groups with detailed notes are provided.展开更多
In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a n...In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development;we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control(including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.展开更多
China is one of the countries with the highest incidence of gastric cancer.There are differences in epidemiological characteristics,clinicopathological features,tumor biological characteristics,treatment patterns,and ...China is one of the countries with the highest incidence of gastric cancer.There are differences in epidemiological characteristics,clinicopathological features,tumor biological characteristics,treatment patterns,and drug selection between gastric cancer patients from the Eastern and Western countries.Non-Chinese guidelines cannot specifically reflect the diagnosis and treatment characteristics for the Chinese gastric cancer patients.The Chinese Society of Clinical Oncology(CSCO)arranged for a panel of senior experts specializing in all sub-specialties of gastric cancer to compile,discuss,and revise the guidelines on the diagnosis and treatment of gastric cancer based on the findings of evidence-based medicine in China and abroad.By referring to the opinions of industry experts,taking into account of regional differences,giving full consideration to the accessibility of diagnosis and treatment resources,these experts have conducted experts’consensus judgement on relevant evidence and made various grades of recommendations for the clinical diagnosis and treatment of gastric cancer to reflect the value of cancer treatment and meeting health economic indexes.This guideline uses tables and is complemented by explanatory and descriptive notes covering the diagnosis,comprehensive treatment,and follow-up visits for gastric cancer.展开更多
Background Clinical practice guidelines （CPGs） play an important role in healthcare in China as well as in the world. However, the current status and trends of Chinese CPGs are unknown. The aim of this study was to ...Background Clinical practice guidelines （CPGs） play an important role in healthcare in China as well as in the world. However, the current status and trends of Chinese CPGs are unknown. The aim of this study was to systematically review the present situation and the quality of Chinese CPGs published in the peer-reviewed medical literature. Methods To identify Chinese CPGs, a systematic search of relevant literature databases （CBM, WANFANG, VIP, and CNKI） was performed for the period January 1978 to December 2010. We used the AGREE II instrument to assess the quality of the included guidelines. Results We evaluated 269 guidelines published in 115 medical journals from 1993 to 2010 and produced by 256 different developers. Only four guidelines （1%） described the systematic methods for searching and selecting the evidence, 14 （5%） guidelines indicated an explicit link between the supporting evidence and the recommendations, only one guideline used the Grading of Recommendations Assessment, Development and Evaluation （GRADE） system. Thirty-one guidelines （12%） mentioned updates and the average frequency of update was 5.5 years; none described a procedure for updating the guideline. From the assessment with the Appraisal of Guidelines for Research and Ecaluation II （AGREE II）, the mean scores were low for the domains ＂scope and purpose＂ （19%） and ＂clarity of presentation＂ （26%） and very low for the other domains （＂rigour of development＂ 7%, ＂stakeholder involvement＂ 8%, ＂applicability＂ 6% and ＂editorial independence＂ 2%）. Conclusions Compared with other studies on the quality of guidelines assessed with the AGREE instrument in other countries, Chinese CPGs received lower scores, which indicates a relatively poor quality of the guidelines. However, there was some increase over time.展开更多
AIM:To conduct a randomized trial to evaluate the role ofusing high-dose iodized oil transcatheter arterialchemosmbolization(TACE)in the treatment of largehepatocellular carcinoma(HCC).METHODS:From January 1993 to Jun...AIM:To conduct a randomized trial to evaluate the role ofusing high-dose iodized oil transcatheter arterialchemosmbolization(TACE)in the treatment of largehepatocellular carcinoma(HCC).METHODS:From January 1993 to June 1998,473 patientswith unresectable hepatocellular carcinoma ware divided intotwo groups:216 patients in group A received more than20mL iodized oil during the first TACE treatment;257patients in group B received 5-15mL iodized oil in the sameway.The Child's classification and ICG-R15 for evaluatingthe liver function of the patients ware done before thetreatment.During the TACE procedure the catheters wasinserted into the target artery selectively and the tumorvessels ware demonstrated with contrast medium in thehepatic angiography.The anticancar drugs mixed withiodized oil(Lipiodol)ware Epirubicin and Mitomycin.Ingroup A,112 cases received 20-29mL Lipiodol in the firstprocedure,85 cases 30-39mL,19 cases more than 40mL.The largest dose was 53 mL and the average dose was28.3mL.In group B,119 cases received 5-10mL Lipiodol,138 cases received 11-15mL,and the average dose was11.8mL.RESULTS:High-dose Lipiodol chemoembolization causedtolerable side effects and a little hurt to the liver function inthe patients with Child grade A or ICG-R15<20.But thepatients with child grade B or ICG-R15>20 had higher risk ofliver failure after high-dose TACE.More type Ⅱ and type Ⅱlipiodol accumulations in CT scan after 4 weeks of TACEware seen in the group A patients than those in the group Bpatients(P<0.01).The resection rate and complete tumornecrosis rate in group A ware higher than those of group B(P<0.05).The 1-,2-,3-year survival rates of group Apatients with Child grade A ware 79.2%,51.8% and 34.9%,respectively,better then those of group B(P<0.001).CONCLUSION:High-dose Lipiodol can result in morecomplete tumor necrosis by blocking both arteries and small portal veins of the tumor.High-dose TACE for treatment oflarge and hypervascular hepatocallular carcinoma ispractically acceptable with the better effect than 展开更多
Syncope belongs to the transient loss of consciousness(TLOC), characterized by a rapid onset, short duration, and spontaneous complete recovery. It is common in children and adolescents, accounting for 1% to 2% of eme...Syncope belongs to the transient loss of consciousness(TLOC), characterized by a rapid onset, short duration, and spontaneous complete recovery. It is common in children and adolescents, accounting for 1% to 2% of emergency department visits.Recurrent syncope can seriously affect children's physical and mental health, learning ability and quality of life and sometimes cardiac syncope even poses a risk of sudden death. The present guideline for the diagnosis and treatment of syncope in children and adolescents was developed for guiding a better clinical management of pediatric syncope. Based on the globally recent development and the evidence-based data in China, 2018 Chinese Pediatric Cardiology Society(CPCS) guideline for diagnosis and treatment of syncope in children and adolescents was jointly prepared by the Pediatric Cardiology Society, Chinese Pediatric Society, Chinese Medical Association(CMA)/Committee on Pediatric Syncope, Pediatricians Branch, Chinese Medical Doctor Association(CMDA)/Committee on Pediatric Cardiology, Chinese College of Cardiovascular Physicians, Chinese Medical Doctor Association(CMDA)/Pediatric Cardiology Society, Beijing Pediatric Society, Beijing Medical Association(BMA). The present guideline includes the underlying diseases of syncope in children and adolescents, the diagnostic procedures, methodology and clinical significance of standing test and headup tilt test, the clinical diagnosis vasovagal syncope, postural orthostatic tachycardia syndrome, orthostatic hypotension and orthostatic hypertension, and the treatment of syncope as well as follow-up.展开更多
Background Gastric varices （GV） are life-threatening for patients with portal hypertension. Endoscopic injection with butyl cyanoacrylate （BC）, the mainstay of the therapy for GV, has been reported to be effective...Background Gastric varices （GV） are life-threatening for patients with portal hypertension. Endoscopic injection with butyl cyanoacrylate （BC）, the mainstay of the therapy for GV, has been reported to be effective for hemostasis of bleeding varices, but its efficacy in the obliteration of GV and impact on the survival of patients still needs clarification. Here we summarized our experience of 10 years＇ practice to evaluate the efficacy and safety of endoscopic therapy using BC for GV patients. Methods From January 1997 to April 2006, GV cases treated with endoscopic injection using BC were collected. The ＂sandwich method＂ and the ＂modified sandwich method＂ were used to inject BC intravascularly. Retrograde analysis was made on the data of treatment and follow-up. Results A total of 635 GV cases treated with endoscopic injection using BC were collected, most of them （90.2%） suffered from post-hepatitis cirrhosis. Emergency hemostasis was achieved in 139 out of 146 sessions （95.2%）. Complications occurred in 32 cases （5.2%）, including hemorrhage due to early expulsion of tissue glue （3.1%）, septicemia （1%） and ectopic thrombosis （0.5%）, such as spleen infarction. Endoscopic follow-up in 503 patients showed complete disappearance （76.9%）, collapse （17.3%） or remnants （5.8%） of gastric varices. A total of 550 patients were followed up clinically for 3 to 115 months. Of these patients, 44 had recurrent bleeding （8.0%） and 44 died from hepatic failure, recurrent bleeding, hepatic carcinoma or other causes. The longest survival was 115 months, with a median survival of 25 months. Survival rates at 1,2, 3, 4 and 5 year were 95%, 92%, 90%, 83% and 81%, respectively. Conclusions Endoscopic sclerotherapy with BC is effective for the hemostasis of bleeding GV, as well as obliteration of GV which contributes to less rebleeding and better survival. The modified sandwich method may be useful to minimize ectopic embolism, which we speculated to result from excess iodized 展开更多
Octenyl succinic anhydride （OSA） modified early Indica rice starch was prepared in aqueous slurry systems using response surface methodology. The paste properties of the OSA starch were also investigated. Results in...Octenyl succinic anhydride （OSA） modified early Indica rice starch was prepared in aqueous slurry systems using response surface methodology. The paste properties of the OSA starch were also investigated. Results indicated that the suitable parameters for the preparation of OSA starch from early Indica rice starch were as follows： reaction period 4 h, reaction temperature 33.4℃, pH of reaction system 8.4, concentration of starch slurry 36.8% （in proportion to water, w/w）, amount of OSA 3% （in proportion to starch, w/w）. The degree of substitution was 0.0188 and the reaction efficiency was 81.0%. The results of paste properties showed that with increased OSA modification, the starch derivatives had higher paste clarity, decreased retrogradation and better freeze-thaw stability.展开更多
BACKGROUND:The traditional hand-sewn Roux-en-Y choledochojejunostomy is technically complicated,and the incidence of postoperative complications has remained high.A set of novel magnetic compressive anastomats was int...BACKGROUND:The traditional hand-sewn Roux-en-Y choledochojejunostomy is technically complicated,and the incidence of postoperative complications has remained high.A set of novel magnetic compressive anastomats was introduced to facilitate choledochojejunostomy and improve the prognosis of patients.METHODS:After ligating the common bile duct for 7 days,16 dogs were randomly divided into two groups (n=8 per group).Anastomats were used in the study group,and the traditional hand-sewn method was used in the control group for standard Roux-en-Y choledochojejunostomy.We compared the operation time,incidence of complications,gross appearance,and pathological disparity in stoma between the two groups in 1-month and 3-month follow-up examinations.RESULTS:The time spent on constructing the anastomosis for the study group was significantly shortened.Although no anastomotic stenosis occurred in the two groups,the narrowing rate of biliary-enteric anastomosis was much higher in the control group.There was one case of bile leakage in the control group,whereas no bile leakage occurred in the study group.A smoother surface,an improved layer apposition,and a lower local inflammatory response were identified in the anastomosis of the study group.CONCLUSION:The structures of the novel magnetic compressive anastomats are simple,and they are time-saving,safe and efficient for performing Roux-en-Y choledocho- jejunostomy procedures in a canine model of obstructive jaundice.展开更多
The New Vacuum Solar Telescope （NVST） is a one meter vacuum solar telescope that aims to observe fine structures on the Sun. The main goals of NVST are high resolution imaging and spectral observations, including me...The New Vacuum Solar Telescope （NVST） is a one meter vacuum solar telescope that aims to observe fine structures on the Sun. The main goals of NVST are high resolution imaging and spectral observations, including measurements of the solar magnetic field. NVST is the primary ground-based facility used by the Chinese solar research community in this solar cycle. It is located by Fuxian Lake in southwest China, where the seeing is good enough to perform high resolution observations. We first introduce the general conditions at the Fuxian Solar Observatory and the primary science cases of NVST. Then, the basic structures of this telescope and instruments are described in detail. Finally, some typical high resolution data of the solar photosphere and chromosphere are also shown.展开更多
Due to the complexity of the splenic hilar vessels, their anatomical variation and the narrow and deep space, as well as the bleeding-prone splenic parenchyma and the difficulty to manage splenic or vascular bleeding ...Due to the complexity of the splenic hilar vessels, their anatomical variation and the narrow and deep space, as well as the bleeding-prone splenic parenchyma and the difficulty to manage splenic or vascular bleeding at the splenic hilum,the procedure remains challenging and technically demanding procedure for the performance of laparoscopic pancreas- and spleen-preserving splenic hilar lymph nodes dissection. Based on our experiences, we gradually explored a set of procednral operation steps called ＂Huang＇s three-step maneuver＂. In this paper, we not only provide the concrete operation steps for the surgeon, but we also provide our recommended technique of pulling and exposure for assistants. This new maneuver simplifies the complicated procedure and improves the efficiency of laparoscopic spleen-preserving splenic hilar lymphadenectomy, making it easier to master and allowing for its widespread adoption.展开更多
AIM: To observe the therapeutic effects of dexamethasone on rats with severe acute pancreatitis (SAP) and investigate the influences of dexamethasone on the inflammatory mediators and NF-κB expression in multiple org...AIM: To observe the therapeutic effects of dexamethasone on rats with severe acute pancreatitis (SAP) and investigate the influences of dexamethasone on the inflammatory mediators and NF-κB expression in multiple organs of SAP rats as well as the mechanisms involved. METHODS: Ninety Sprague-Dawley (SD) rats with SAP were randomly divided into the model group (n = 45) and dexamethasone treatment group (n = 45), and another 45 rats were selected for the sham operation group. All groups were randomly subdivided into the 3 h, 6 h and 12 h groups, each group containing 15 rats. The survival of all groups and pathological changes of multiple organs (liver, kidney and lung) were observed at different time points after the operation. The pathologicalscore of multiple organs was carried out, followed by the determination of amylase, endotoxin and TNF-α contents in blood. The tissue microarray was used to detect the expression levels of NF-κB p65 protein in multiple organs. RESULTS: There was no marked difference between the model group and treatment group in the survival rate. The amylase content of the treatment group was significantly lower compared to the model group at 12 h (P < 0.01, 7791.00 vs 9195.00). Moreover, the endotoxin and TNF-α levels of the treatment group were significantly lower than that of the model group at 6 h and 12 h (P < 0.01, 0.040 vs 0.055, 0.042 vs 0.059 and P < 0.05, 58.30 vs 77.54, 38.70 vs 67.30, respectively). Regarding the changes in liver NF-κB expression, the model group significantly exceeded the sham operation group at 3 h (P < 0.01, 1.00 vs 0.00), and the treatment group significantly exceeded the sham operation group at 12 h (P < 0.01, 1.00 vs 0.00), whereas no marked difference was observed between the model group and treatment group at all time points. The kidney NF-κB expression level in the treatment group significantly exceeded the model group (P < 0.05, 2.00 vs 0.00) and the sham operation group (P < 0.01, 2.00 vs 0.00) at 12 h. No NF-κB expression in the lung was found 展开更多
AIM To investigate the effect and mechanism of moxibustion in rats with ulcerative colitis.METHODS A rat colitis model was established by administering 4% dextran sulphate sodium solution. Seventy male rats were rando...AIM To investigate the effect and mechanism of moxibustion in rats with ulcerative colitis.METHODS A rat colitis model was established by administering 4% dextran sulphate sodium solution. Seventy male rats were randomly divided into seven groups: Healthy controls(HC), ulcerative colitis model group(UC), UC with 7 d of moxibustion(UC-7), UC with 14 d of moxibustion(UC-14), UC with mesalazine gavage(UC-W), HC with 7 d of moxibustion(HC-7), HC with 14 d of moxibustion(HC-14). Moxibustion was applied to the bilateral Tianshu(ST25). Gut microbiome profiling was conducted by 16 S r RNA amplicon sequencing, and PCR and ELISA determined the expression of inflammatory cytokines in colon mucosa and serum, respectively. RESULTS Moxibustion treatment restored the colonic mucosa and decreased submucosal inflammatory cell infiltration in colitis rats. Rats treated with moxibustion and mesalazine had significantly lower levels of the dominant phyla Proteobacteria and the genera Saccharibacteria, Sphingomonas and Barnesiella than colitis rats, and they could restore the microbiome to levels similar to those observed in healthy rats. UC rats had reduced alpha diversity, which could be alleviated by moxibustion therapy, and UC-7 had a higher alpha diversity than UC-14. This finding suggests that short-term(7 d) but no longer term(14 d) moxibustion treatment may significantly affect the gut microbiome. The potential bacterial functions affected by moxibustion may be ascorbate and aldarate metabolism, and amino acid metabolism. Compared with HC group, the levels of the cytokines interleukin-12(IL-12)(P < 0.05) and IL-6, IL-17, IL-23, interferon-γ, lipopolysaccharide, Ig A, tumour necrosis factor-α and its receptors 1(TNFR1) and TNFR2(P < 0.01) were all increased, whereas anti-inflammatory cytokine IL-2 and IL-10(P < 0.01) and transforming growth factor-β(P < 0.05) were decreased in UC rats. These changes were reversed by moxibustion.CONCLUSION Our findings suggest that moxibustion exerts its therapeutic effect by repairing mucos展开更多
文摘There exist differences in the epidemiological characteristics,clinicopathological features,tumor biological characteristics,treatment patterns,and drug selections between gastric cancer patients from the Eastern and Western countries.The Chinese Society of Clinical Oncology(CSCO)has organized a panel of senior experts specializing in all sub-specialties of gastric cancer to compile a clinical guideline for the diagnosis and treatment of gastric cancer since 2016 and renews it annually.Taking into account regional differences,giving full consideration to the accessibility of diagnosis and treatment resources,these experts have conducted expert consensus judgment on relevant evidence and made various grades of recommendations for the clinical diagnosis and treatment of gastric cancer to reflect the value of cancer treatment and meeting health economic indexes in China.The 2021 CSCO Clinical Practice Guidelines for Gastric Cancer covers the diagnosis,treatment,follow-up,and screening of gastric cancer.Based on the 2020 version of the CSCO Chinese Gastric Cancer guidelines,this updated guideline integrates the results ofmajor clinical studies from China and overseas for the past year,focused on the inclusion of research data from the Chinese population for more personalized and clinically relevant recommendations.For the comprehensive treatment of non-metastatic gastric cancer,attentions were paid to neoadjuvant treatment.The value of perioperative chemotherapy is gradually becoming clearer and its recommendation level has been updated.For the comprehensive treatment of metastatic gastric cancer,recommendations for immunotherapy were included,and immune checkpoint inhibitors fromthird-line to the first-line of treatment for different patient groups with detailed notes are provided.
基金supported(in part)by the Entrusted Project of National Center for Medical Service Administration,National Health and Family Planning Commission China(No.[2019]099)the First Level Funding of the Second Medical Leading Talent Project in Hubei Provincethe Special Project for Emergency of the Ministry of Science and Technology(2020YFC0841300)。
文摘In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development;we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control(including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.
文摘China is one of the countries with the highest incidence of gastric cancer.There are differences in epidemiological characteristics,clinicopathological features,tumor biological characteristics,treatment patterns,and drug selection between gastric cancer patients from the Eastern and Western countries.Non-Chinese guidelines cannot specifically reflect the diagnosis and treatment characteristics for the Chinese gastric cancer patients.The Chinese Society of Clinical Oncology(CSCO)arranged for a panel of senior experts specializing in all sub-specialties of gastric cancer to compile,discuss,and revise the guidelines on the diagnosis and treatment of gastric cancer based on the findings of evidence-based medicine in China and abroad.By referring to the opinions of industry experts,taking into account of regional differences,giving full consideration to the accessibility of diagnosis and treatment resources,these experts have conducted experts’consensus judgement on relevant evidence and made various grades of recommendations for the clinical diagnosis and treatment of gastric cancer to reflect the value of cancer treatment and meeting health economic indexes.This guideline uses tables and is complemented by explanatory and descriptive notes covering the diagnosis,comprehensive treatment,and follow-up visits for gastric cancer.
文摘Background Clinical practice guidelines （CPGs） play an important role in healthcare in China as well as in the world. However, the current status and trends of Chinese CPGs are unknown. The aim of this study was to systematically review the present situation and the quality of Chinese CPGs published in the peer-reviewed medical literature. Methods To identify Chinese CPGs, a systematic search of relevant literature databases （CBM, WANFANG, VIP, and CNKI） was performed for the period January 1978 to December 2010. We used the AGREE II instrument to assess the quality of the included guidelines. Results We evaluated 269 guidelines published in 115 medical journals from 1993 to 2010 and produced by 256 different developers. Only four guidelines （1%） described the systematic methods for searching and selecting the evidence, 14 （5%） guidelines indicated an explicit link between the supporting evidence and the recommendations, only one guideline used the Grading of Recommendations Assessment, Development and Evaluation （GRADE） system. Thirty-one guidelines （12%） mentioned updates and the average frequency of update was 5.5 years; none described a procedure for updating the guideline. From the assessment with the Appraisal of Guidelines for Research and Ecaluation II （AGREE II）, the mean scores were low for the domains ＂scope and purpose＂ （19%） and ＂clarity of presentation＂ （26%） and very low for the other domains （＂rigour of development＂ 7%, ＂stakeholder involvement＂ 8%, ＂applicability＂ 6% and ＂editorial independence＂ 2%）. Conclusions Compared with other studies on the quality of guidelines assessed with the AGREE instrument in other countries, Chinese CPGs received lower scores, which indicates a relatively poor quality of the guidelines. However, there was some increase over time.
基金the"9.5"National Major Project of National Committee of Sciences and Technology,No.96-907-03-02
文摘AIM:To conduct a randomized trial to evaluate the role ofusing high-dose iodized oil transcatheter arterialchemosmbolization(TACE)in the treatment of largehepatocellular carcinoma(HCC).METHODS:From January 1993 to June 1998,473 patientswith unresectable hepatocellular carcinoma ware divided intotwo groups:216 patients in group A received more than20mL iodized oil during the first TACE treatment;257patients in group B received 5-15mL iodized oil in the sameway.The Child's classification and ICG-R15 for evaluatingthe liver function of the patients ware done before thetreatment.During the TACE procedure the catheters wasinserted into the target artery selectively and the tumorvessels ware demonstrated with contrast medium in thehepatic angiography.The anticancar drugs mixed withiodized oil(Lipiodol)ware Epirubicin and Mitomycin.Ingroup A,112 cases received 20-29mL Lipiodol in the firstprocedure,85 cases 30-39mL,19 cases more than 40mL.The largest dose was 53 mL and the average dose was28.3mL.In group B,119 cases received 5-10mL Lipiodol,138 cases received 11-15mL,and the average dose was11.8mL.RESULTS:High-dose Lipiodol chemoembolization causedtolerable side effects and a little hurt to the liver function inthe patients with Child grade A or ICG-R15<20.But thepatients with child grade B or ICG-R15>20 had higher risk ofliver failure after high-dose TACE.More type Ⅱ and type Ⅱlipiodol accumulations in CT scan after 4 weeks of TACEware seen in the group A patients than those in the group Bpatients(P<0.01).The resection rate and complete tumornecrosis rate in group A ware higher than those of group B(P<0.05).The 1-,2-,3-year survival rates of group Apatients with Child grade A ware 79.2%,51.8% and 34.9%,respectively,better then those of group B(P<0.001).CONCLUSION:High-dose Lipiodol can result in morecomplete tumor necrosis by blocking both arteries and small portal veins of the tumor.High-dose TACE for treatment oflarge and hypervascular hepatocallular carcinoma ispractically acceptable with the better effect than
文摘Syncope belongs to the transient loss of consciousness(TLOC), characterized by a rapid onset, short duration, and spontaneous complete recovery. It is common in children and adolescents, accounting for 1% to 2% of emergency department visits.Recurrent syncope can seriously affect children's physical and mental health, learning ability and quality of life and sometimes cardiac syncope even poses a risk of sudden death. The present guideline for the diagnosis and treatment of syncope in children and adolescents was developed for guiding a better clinical management of pediatric syncope. Based on the globally recent development and the evidence-based data in China, 2018 Chinese Pediatric Cardiology Society(CPCS) guideline for diagnosis and treatment of syncope in children and adolescents was jointly prepared by the Pediatric Cardiology Society, Chinese Pediatric Society, Chinese Medical Association(CMA)/Committee on Pediatric Syncope, Pediatricians Branch, Chinese Medical Doctor Association(CMDA)/Committee on Pediatric Cardiology, Chinese College of Cardiovascular Physicians, Chinese Medical Doctor Association(CMDA)/Pediatric Cardiology Society, Beijing Pediatric Society, Beijing Medical Association(BMA). The present guideline includes the underlying diseases of syncope in children and adolescents, the diagnostic procedures, methodology and clinical significance of standing test and headup tilt test, the clinical diagnosis vasovagal syncope, postural orthostatic tachycardia syndrome, orthostatic hypotension and orthostatic hypertension, and the treatment of syncope as well as follow-up.
文摘Background Gastric varices （GV） are life-threatening for patients with portal hypertension. Endoscopic injection with butyl cyanoacrylate （BC）, the mainstay of the therapy for GV, has been reported to be effective for hemostasis of bleeding varices, but its efficacy in the obliteration of GV and impact on the survival of patients still needs clarification. Here we summarized our experience of 10 years＇ practice to evaluate the efficacy and safety of endoscopic therapy using BC for GV patients. Methods From January 1997 to April 2006, GV cases treated with endoscopic injection using BC were collected. The ＂sandwich method＂ and the ＂modified sandwich method＂ were used to inject BC intravascularly. Retrograde analysis was made on the data of treatment and follow-up. Results A total of 635 GV cases treated with endoscopic injection using BC were collected, most of them （90.2%） suffered from post-hepatitis cirrhosis. Emergency hemostasis was achieved in 139 out of 146 sessions （95.2%）. Complications occurred in 32 cases （5.2%）, including hemorrhage due to early expulsion of tissue glue （3.1%）, septicemia （1%） and ectopic thrombosis （0.5%）, such as spleen infarction. Endoscopic follow-up in 503 patients showed complete disappearance （76.9%）, collapse （17.3%） or remnants （5.8%） of gastric varices. A total of 550 patients were followed up clinically for 3 to 115 months. Of these patients, 44 had recurrent bleeding （8.0%） and 44 died from hepatic failure, recurrent bleeding, hepatic carcinoma or other causes. The longest survival was 115 months, with a median survival of 25 months. Survival rates at 1,2, 3, 4 and 5 year were 95%, 92%, 90%, 83% and 81%, respectively. Conclusions Endoscopic sclerotherapy with BC is effective for the hemostasis of bleeding GV, as well as obliteration of GV which contributes to less rebleeding and better survival. The modified sandwich method may be useful to minimize ectopic embolism, which we speculated to result from excess iodized
基金Project (No. 2003C12009) supported by the Science and TechnologyMinistry of Zhejiang Province, China
文摘Octenyl succinic anhydride （OSA） modified early Indica rice starch was prepared in aqueous slurry systems using response surface methodology. The paste properties of the OSA starch were also investigated. Results indicated that the suitable parameters for the preparation of OSA starch from early Indica rice starch were as follows： reaction period 4 h, reaction temperature 33.4℃, pH of reaction system 8.4, concentration of starch slurry 36.8% （in proportion to water, w/w）, amount of OSA 3% （in proportion to starch, w/w）. The degree of substitution was 0.0188 and the reaction efficiency was 81.0%. The results of paste properties showed that with increased OSA modification, the starch derivatives had higher paste clarity, decreased retrogradation and better freeze-thaw stability.
基金supported by a grant from the National Natural Science Foundation of China (30830099)
文摘BACKGROUND:The traditional hand-sewn Roux-en-Y choledochojejunostomy is technically complicated,and the incidence of postoperative complications has remained high.A set of novel magnetic compressive anastomats was introduced to facilitate choledochojejunostomy and improve the prognosis of patients.METHODS:After ligating the common bile duct for 7 days,16 dogs were randomly divided into two groups (n=8 per group).Anastomats were used in the study group,and the traditional hand-sewn method was used in the control group for standard Roux-en-Y choledochojejunostomy.We compared the operation time,incidence of complications,gross appearance,and pathological disparity in stoma between the two groups in 1-month and 3-month follow-up examinations.RESULTS:The time spent on constructing the anastomosis for the study group was significantly shortened.Although no anastomotic stenosis occurred in the two groups,the narrowing rate of biliary-enteric anastomosis was much higher in the control group.There was one case of bile leakage in the control group,whereas no bile leakage occurred in the study group.A smoother surface,an improved layer apposition,and a lower local inflammatory response were identified in the anastomosis of the study group.CONCLUSION:The structures of the novel magnetic compressive anastomats are simple,and they are time-saving,safe and efficient for performing Roux-en-Y choledocho- jejunostomy procedures in a canine model of obstructive jaundice.
基金Supported by the National Natural Science Foundation of China
文摘The New Vacuum Solar Telescope （NVST） is a one meter vacuum solar telescope that aims to observe fine structures on the Sun. The main goals of NVST are high resolution imaging and spectral observations, including measurements of the solar magnetic field. NVST is the primary ground-based facility used by the Chinese solar research community in this solar cycle. It is located by Fuxian Lake in southwest China, where the seeing is good enough to perform high resolution observations. We first introduce the general conditions at the Fuxian Solar Observatory and the primary science cases of NVST. Then, the basic structures of this telescope and instruments are described in detail. Finally, some typical high resolution data of the solar photosphere and chromosphere are also shown.
基金National Key Clinical Specialty Discipline Construction program of China (No. [2012] 649)
文摘Due to the complexity of the splenic hilar vessels, their anatomical variation and the narrow and deep space, as well as the bleeding-prone splenic parenchyma and the difficulty to manage splenic or vascular bleeding at the splenic hilum,the procedure remains challenging and technically demanding procedure for the performance of laparoscopic pancreas- and spleen-preserving splenic hilar lymph nodes dissection. Based on our experiences, we gradually explored a set of procednral operation steps called ＂Huang＇s three-step maneuver＂. In this paper, we not only provide the concrete operation steps for the surgeon, but we also provide our recommended technique of pulling and exposure for assistants. This new maneuver simplifies the complicated procedure and improves the efficiency of laparoscopic spleen-preserving splenic hilar lymphadenectomy, making it easier to master and allowing for its widespread adoption.
基金Technological Foundation Project of Traditional Chinese Medicine Science of Zhejiang Province, NO. 2003C130 and NO. 2004C142 Foundation Project for Medical Science and Technology of Zhejiang province, No. 2003B134+3 种基金 Grave Foundation Project for Technological and Development of Hangzhou, No. 2003123B19 Intensive Foundation Project for Technology of Hangzhou, NO. 2004Z006 Foundation Project for Medical Science and Technology of Hangzhou, No. 2003A004 and Foundation Project for Technology of Hangzhou, No. 2005224
文摘AIM: To observe the therapeutic effects of dexamethasone on rats with severe acute pancreatitis (SAP) and investigate the influences of dexamethasone on the inflammatory mediators and NF-κB expression in multiple organs of SAP rats as well as the mechanisms involved. METHODS: Ninety Sprague-Dawley (SD) rats with SAP were randomly divided into the model group (n = 45) and dexamethasone treatment group (n = 45), and another 45 rats were selected for the sham operation group. All groups were randomly subdivided into the 3 h, 6 h and 12 h groups, each group containing 15 rats. The survival of all groups and pathological changes of multiple organs (liver, kidney and lung) were observed at different time points after the operation. The pathologicalscore of multiple organs was carried out, followed by the determination of amylase, endotoxin and TNF-α contents in blood. The tissue microarray was used to detect the expression levels of NF-κB p65 protein in multiple organs. RESULTS: There was no marked difference between the model group and treatment group in the survival rate. The amylase content of the treatment group was significantly lower compared to the model group at 12 h (P < 0.01, 7791.00 vs 9195.00). Moreover, the endotoxin and TNF-α levels of the treatment group were significantly lower than that of the model group at 6 h and 12 h (P < 0.01, 0.040 vs 0.055, 0.042 vs 0.059 and P < 0.05, 58.30 vs 77.54, 38.70 vs 67.30, respectively). Regarding the changes in liver NF-κB expression, the model group significantly exceeded the sham operation group at 3 h (P < 0.01, 1.00 vs 0.00), and the treatment group significantly exceeded the sham operation group at 12 h (P < 0.01, 1.00 vs 0.00), whereas no marked difference was observed between the model group and treatment group at all time points. The kidney NF-κB expression level in the treatment group significantly exceeded the model group (P < 0.05, 2.00 vs 0.00) and the sham operation group (P < 0.01, 2.00 vs 0.00) at 12 h. No NF-κB expression in the lung was found
基金Supported by National Natural Science Foundation of China,No.81473758National Basic Research Programme of China(973 programme),No.2015CB554500
文摘AIM To investigate the effect and mechanism of moxibustion in rats with ulcerative colitis.METHODS A rat colitis model was established by administering 4% dextran sulphate sodium solution. Seventy male rats were randomly divided into seven groups: Healthy controls(HC), ulcerative colitis model group(UC), UC with 7 d of moxibustion(UC-7), UC with 14 d of moxibustion(UC-14), UC with mesalazine gavage(UC-W), HC with 7 d of moxibustion(HC-7), HC with 14 d of moxibustion(HC-14). Moxibustion was applied to the bilateral Tianshu(ST25). Gut microbiome profiling was conducted by 16 S r RNA amplicon sequencing, and PCR and ELISA determined the expression of inflammatory cytokines in colon mucosa and serum, respectively. RESULTS Moxibustion treatment restored the colonic mucosa and decreased submucosal inflammatory cell infiltration in colitis rats. Rats treated with moxibustion and mesalazine had significantly lower levels of the dominant phyla Proteobacteria and the genera Saccharibacteria, Sphingomonas and Barnesiella than colitis rats, and they could restore the microbiome to levels similar to those observed in healthy rats. UC rats had reduced alpha diversity, which could be alleviated by moxibustion therapy, and UC-7 had a higher alpha diversity than UC-14. This finding suggests that short-term(7 d) but no longer term(14 d) moxibustion treatment may significantly affect the gut microbiome. The potential bacterial functions affected by moxibustion may be ascorbate and aldarate metabolism, and amino acid metabolism. Compared with HC group, the levels of the cytokines interleukin-12(IL-12)(P < 0.05) and IL-6, IL-17, IL-23, interferon-γ, lipopolysaccharide, Ig A, tumour necrosis factor-α and its receptors 1(TNFR1) and TNFR2(P < 0.01) were all increased, whereas anti-inflammatory cytokine IL-2 and IL-10(P < 0.01) and transforming growth factor-β(P < 0.05) were decreased in UC rats. These changes were reversed by moxibustion.CONCLUSION Our findings suggest that moxibustion exerts its therapeutic effect by repairing mucos
