本文是GRADE(Grading of Recommendations Assessment,Development,and Evaluation)系列文章的导论。该系列文章为使用GRADE系统提供指导,介绍如何将该系统用于系统评价、卫生技术评估(HTAs)及临床实践指南中备选方案的证据质量评价和...本文是GRADE(Grading of Recommendations Assessment,Development,and Evaluation)系列文章的导论。该系列文章为使用GRADE系统提供指导,介绍如何将该系统用于系统评价、卫生技术评估(HTAs)及临床实践指南中备选方案的证据质量评价和推荐强度评级。GRADE方法始于提出一个明晰的问题,包括对所有重要结果的详细说明。证据被收集和汇总后,GRADE提供了明确的标准来评价其质量,包括研究设计、偏倚风险、不精确性、不一致性、间接性及效应量大小。根据支撑证据质量及备选方案带来的预期和非预期结果间的平衡情况,推荐强度以强/弱(或表述为"有条件的"/"任意的")作为特征。GRADE建议用简洁、透明、信息量丰富的结果总结表来汇总证据(以显示证据质量及每一重要结果的相对效应量和绝对效应量),和(或)以证据概要表形式额外提供证据质量评价理由的详细信息。本系列的后续文章涉及如何采用GRADE方法明确构建问题、评价证据质量及形成推荐意见。展开更多
A cross-sectional prevalence study of Parkinson’s disease in China was under taken in 1997-98. We assessed 29454 residents aged ≥55 years from 79 rural and 58 urbancommunities in Beijing, Xi’an, and Shanghai, who w...A cross-sectional prevalence study of Parkinson’s disease in China was under taken in 1997-98. We assessed 29454 residents aged ≥55 years from 79 rural and 58 urbancommunities in Beijing, Xi’an, and Shanghai, who were selected through stratified, multistage, cluster sampling.With a standardised diagnostic protoco l, we identified 277 people with the disease. Prevalence of Parkinson’s disease for those aged ≥65 years was 1.7%(95%CI 1.5-1.9). We estimate that 1.7 million people in China have the disease (aged ≥55 years). Our findings suggest that prevalence of Parkinson’s disease in Ch ina is similar to that in developed countries.展开更多
引言血管性认知损害（vascular cognitive impairment,VCI）诊断共识的缺乏（体现为多种不同评估方案的使用）,妨碍了对其理解和治疗的推进.多个国家的大量临床医生和研究人员参与了2个阶段血管性认知损害分类共识研究（Vascular Impair...引言血管性认知损害（vascular cognitive impairment,VCI）诊断共识的缺乏（体现为多种不同评估方案的使用）,妨碍了对其理解和治疗的推进.多个国家的大量临床医生和研究人员参与了2个阶段血管性认知损害分类共识研究（Vascular Impairment of Cognition Classification Consensus Study,VICCCS）,旨在就VCI的诊断原则（VICCCS-1）和诊断方案（VICCCS-2）达成一致意见.本文提供了VICCCS-2的相关内容.方法使用VICCCS-1达成的原则和已发表的诊断指南作为在线德尔菲（Delphi）调查的参考基点,以期对VCI的临床诊断达成共识.结果共进行了6轮调查,每轮有65～79名专家参与,他们就VICCCS修订的轻度和重度VCI的诊断指南达成共识,并肯定了美国国立神经疾病与卒中研究所-加拿大卒中网（National Institute of Neurological Disorders and Stroke–Canadian Stroke Network,NINDS-CSN）发布的神经心理学评估方案和对影像学检查的推荐意见.讨论VICCCS-2建议规范化应用NINDS-CSN推荐的神经心理学和影像学评估方案诊断VCI,以促进研究协作.展开更多
GRADE建议通过检查95%可信区间(CI)为决定不精确性的最佳方法。在指南实际运用中,如果CI的上、下限值代表了真实效应,而临床实际情况与之不符时,必须降低证据质量级别(即对效应估计值的把握度)。除外当效应值很大且可信区间提示效应稳健...GRADE建议通过检查95%可信区间(CI)为决定不精确性的最佳方法。在指南实际运用中,如果CI的上、下限值代表了真实效应,而临床实际情况与之不符时,必须降低证据质量级别(即对效应估计值的把握度)。除外当效应值很大且可信区间提示效应稳健,而总样本量不大且事件数很少的情况,其他应考虑因不精确性而降低证据质量级别。作此决定时,可计算有足够检验效能的单个试验所需的病例数(定义为"最优信息样本量",即optimal information size,OIS)。对连续型变量,我们建议用类似方法,首先考虑可信区间上、下限值,再计算OIS。系统评价(SR)所需方法略有不同。如果95%CI不包括相对危险度(RR)为1,且总事件发生数或病例数超过OIS标准,则精确性良好。如果95%CI包括了明显获益或危害(我们建议以RR值<0.75或>1.25作粗标准),即使达到OIS要求,因不精确性而降低证据质量级别较恰当。展开更多
Gastric polyps become a major clinical problem because of high prevalence and tendency to malignant transformation of some of them. The development of gastric hyperplastic polyps results from excessive proliferation o...Gastric polyps become a major clinical problem because of high prevalence and tendency to malignant transformation of some of them. The development of gastric hyperplastic polyps results from excessive proliferation of foveolar cells accompanied by their increased exfoliation, and they are macroscopically indistinguishable from other polyps with lower or higher malignant potential. Panendoscopy allows detection and differentiation of gastric polyps, usually after obtaining histopathological biopsy specimens. Unremoved gastric hyperplastic polyps may enlarge and sometimes spontaneously undergo a sequential progression to cancer. For this reason, gastric hyperplastic polyps larger than 5 mm in size should be removed in one piece. After excision of polyps with atypical focal lesion, endoscopic surveillance is suggested depending on histopathological diagnosis and possibility of confirming the completeness of endoscopic resection. Because of the risk of cancer development also in gastric mucosa outside the polyp, neighboring fragments of gastric mucosa should undergo microscopic investigations. This procedure allows for identification of patients who can benefit most from oncological endoscopic surveillance. If Helicobacter pylori(H. pylori) infection of the gastric mucosa is confirmed, treatment strategies should include eradication of bacteria, which may prevent progression of intestinal metaplasia. The efficacy of H. pylori eradication should be checked 3-6 mo later.展开更多
The reactive force-field(ReaxFF)interatomic potential is a powerful computational tool for exploring,developing and optimizing material properties.Methods based on the principles of quantum mechanics(QM),while offerin...The reactive force-field(ReaxFF)interatomic potential is a powerful computational tool for exploring,developing and optimizing material properties.Methods based on the principles of quantum mechanics(QM),while offering valuable theoretical guidance at the electronic level,are often too computationally intense for simulations that consider the full dynamic evolution of a system.Alternatively,empirical interatomic potentials that are based on classical principles require significantly fewer computational resources,which enables simulations to better describe dynamic processes over longer timeframes and on larger scales.Such methods,however,typically require a predefined connectivity between atoms,precluding simulations that involve reactive events.The ReaxFF method was developed to help bridge this gap.Approaching the gap from the classical side,ReaxFF casts the empirical interatomic potential within a bond-order formalism,thus implicitly describing chemical bonding without expensive QM calculations.This article provides an overview of the development,application,and future directions of the ReaxFF method.展开更多
Bacterial infection of implanted scaffolds may have fatal consequences and,in combination with the emergence of multidrug bacterial resistance,the development of advanced antibacterial biomaterials and constructs is o...Bacterial infection of implanted scaffolds may have fatal consequences and,in combination with the emergence of multidrug bacterial resistance,the development of advanced antibacterial biomaterials and constructs is of great interest.Since decades ago,metals and their ions had been used to minimize bacterial infection risk and,more recently,metal-based nanomaterials,with improved antimicrobial properties,have been advocated as a novel and tunable alternative.A comprehensive review is provided on how metal ions and ion nanoparticles have the potential to decrease or eliminate unwanted bacteria.Antibacterial mechanisms such as oxidative stress induction,ion release and disruption of biomolecules are currently well accepted.However,the exact antimicrobial mechanisms of the discussed metal compounds remain poorly understood.The combination of different metal ions and surface decorations of nanoparticles will lead to synergistic effects and improved microbial killing,and allow to mitigate potential side effects to the host.Starting with a general overview of antibacterial mechanisms,we subsequently focus on specific metal ions such as silver,zinc,copper,iron and gold,and outline their distinct modes of action.Finally,we discuss the use of these metal ions and nanoparticles in tissue engineering to prevent implant failure.展开更多
The features of JAK-STAT signaling in liver cells are discussed in the current review. The role of this signaling cascade in carcinogenesis is accentuated. The possible involvement of this pathway and alteration of it...The features of JAK-STAT signaling in liver cells are discussed in the current review. The role of this signaling cascade in carcinogenesis is accentuated. The possible involvement of this pathway and alteration of its elements are compared for normal cholangiocytes, cholangiocarcinoma predisposition and development. Prolactin and interleukin-6 are described in detail as the best studied examples. In addition, the non-classical nuclear translocation of cytokine receptors is discussed in terms of its possible implication to cholangiocarcinoma development.展开更多
文摘本文是GRADE(Grading of Recommendations Assessment,Development,and Evaluation)系列文章的导论。该系列文章为使用GRADE系统提供指导,介绍如何将该系统用于系统评价、卫生技术评估(HTAs)及临床实践指南中备选方案的证据质量评价和推荐强度评级。GRADE方法始于提出一个明晰的问题,包括对所有重要结果的详细说明。证据被收集和汇总后,GRADE提供了明确的标准来评价其质量,包括研究设计、偏倚风险、不精确性、不一致性、间接性及效应量大小。根据支撑证据质量及备选方案带来的预期和非预期结果间的平衡情况,推荐强度以强/弱(或表述为"有条件的"/"任意的")作为特征。GRADE建议用简洁、透明、信息量丰富的结果总结表来汇总证据(以显示证据质量及每一重要结果的相对效应量和绝对效应量),和(或)以证据概要表形式额外提供证据质量评价理由的详细信息。本系列的后续文章涉及如何采用GRADE方法明确构建问题、评价证据质量及形成推荐意见。
文摘A cross-sectional prevalence study of Parkinson’s disease in China was under taken in 1997-98. We assessed 29454 residents aged ≥55 years from 79 rural and 58 urbancommunities in Beijing, Xi’an, and Shanghai, who were selected through stratified, multistage, cluster sampling.With a standardised diagnostic protoco l, we identified 277 people with the disease. Prevalence of Parkinson’s disease for those aged ≥65 years was 1.7%(95%CI 1.5-1.9). We estimate that 1.7 million people in China have the disease (aged ≥55 years). Our findings suggest that prevalence of Parkinson’s disease in Ch ina is similar to that in developed countries.
文摘引言血管性认知损害（vascular cognitive impairment,VCI）诊断共识的缺乏（体现为多种不同评估方案的使用）,妨碍了对其理解和治疗的推进.多个国家的大量临床医生和研究人员参与了2个阶段血管性认知损害分类共识研究（Vascular Impairment of Cognition Classification Consensus Study,VICCCS）,旨在就VCI的诊断原则（VICCCS-1）和诊断方案（VICCCS-2）达成一致意见.本文提供了VICCCS-2的相关内容.方法使用VICCCS-1达成的原则和已发表的诊断指南作为在线德尔菲（Delphi）调查的参考基点,以期对VCI的临床诊断达成共识.结果共进行了6轮调查,每轮有65～79名专家参与,他们就VICCCS修订的轻度和重度VCI的诊断指南达成共识,并肯定了美国国立神经疾病与卒中研究所-加拿大卒中网（National Institute of Neurological Disorders and Stroke–Canadian Stroke Network,NINDS-CSN）发布的神经心理学评估方案和对影像学检查的推荐意见.讨论VICCCS-2建议规范化应用NINDS-CSN推荐的神经心理学和影像学评估方案诊断VCI,以促进研究协作.
文摘GRADE建议通过检查95%可信区间(CI)为决定不精确性的最佳方法。在指南实际运用中,如果CI的上、下限值代表了真实效应,而临床实际情况与之不符时,必须降低证据质量级别(即对效应估计值的把握度)。除外当效应值很大且可信区间提示效应稳健,而总样本量不大且事件数很少的情况,其他应考虑因不精确性而降低证据质量级别。作此决定时,可计算有足够检验效能的单个试验所需的病例数(定义为"最优信息样本量",即optimal information size,OIS)。对连续型变量,我们建议用类似方法,首先考虑可信区间上、下限值,再计算OIS。系统评价(SR)所需方法略有不同。如果95%CI不包括相对危险度(RR)为1,且总事件发生数或病例数超过OIS标准,则精确性良好。如果95%CI包括了明显获益或危害(我们建议以RR值<0.75或>1.25作粗标准),即使达到OIS要求,因不精确性而降低证据质量级别较恰当。
文摘Gastric polyps become a major clinical problem because of high prevalence and tendency to malignant transformation of some of them. The development of gastric hyperplastic polyps results from excessive proliferation of foveolar cells accompanied by their increased exfoliation, and they are macroscopically indistinguishable from other polyps with lower or higher malignant potential. Panendoscopy allows detection and differentiation of gastric polyps, usually after obtaining histopathological biopsy specimens. Unremoved gastric hyperplastic polyps may enlarge and sometimes spontaneously undergo a sequential progression to cancer. For this reason, gastric hyperplastic polyps larger than 5 mm in size should be removed in one piece. After excision of polyps with atypical focal lesion, endoscopic surveillance is suggested depending on histopathological diagnosis and possibility of confirming the completeness of endoscopic resection. Because of the risk of cancer development also in gastric mucosa outside the polyp, neighboring fragments of gastric mucosa should undergo microscopic investigations. This procedure allows for identification of patients who can benefit most from oncological endoscopic surveillance. If Helicobacter pylori(H. pylori) infection of the gastric mucosa is confirmed, treatment strategies should include eradication of bacteria, which may prevent progression of intestinal metaplasia. The efficacy of H. pylori eradication should be checked 3-6 mo later.
基金the National Science Foundation,grant CBET-1032979the Fluid Interfaces Reactions,Structures and Transport(FIRST)+2 种基金funded by the US Department of Energy,Office of Energy,Office of Basic Energy Sciencessupport from a grant from the US Army Research Laboratory through the Collaborative Research Alliance(CRA)for Multi Scale Multidisciplinary Modeling of Electronic Materials(MSME)the Research Board of the Ghent University(BOF)and BELSPO in the frame of IAP/7/05.
文摘The reactive force-field(ReaxFF)interatomic potential is a powerful computational tool for exploring,developing and optimizing material properties.Methods based on the principles of quantum mechanics(QM),while offering valuable theoretical guidance at the electronic level,are often too computationally intense for simulations that consider the full dynamic evolution of a system.Alternatively,empirical interatomic potentials that are based on classical principles require significantly fewer computational resources,which enables simulations to better describe dynamic processes over longer timeframes and on larger scales.Such methods,however,typically require a predefined connectivity between atoms,precluding simulations that involve reactive events.The ReaxFF method was developed to help bridge this gap.Approaching the gap from the classical side,ReaxFF casts the empirical interatomic potential within a bond-order formalism,thus implicitly describing chemical bonding without expensive QM calculations.This article provides an overview of the development,application,and future directions of the ReaxFF method.
基金M.G-G and U.E have received funding from the postdoctoral fellowship programme Beatriu de Pinós,funded by the Secretary of Universities and Research(Government of Catalonia)and by the Horizon 2020 programme of research and innovation of the European Union under the Marie Sklodowska-Curie grant agreement No 801370R.A.P is supported by the Spanish Ministry by the Ram´on y Cajal Program(RYC2018-025977-I)Additional financial support was provided by the Government of Catalonia(2017 SGR 708)and MINECO/FEDER project(RTI2018-096088-J-100).
文摘Bacterial infection of implanted scaffolds may have fatal consequences and,in combination with the emergence of multidrug bacterial resistance,the development of advanced antibacterial biomaterials and constructs is of great interest.Since decades ago,metals and their ions had been used to minimize bacterial infection risk and,more recently,metal-based nanomaterials,with improved antimicrobial properties,have been advocated as a novel and tunable alternative.A comprehensive review is provided on how metal ions and ion nanoparticles have the potential to decrease or eliminate unwanted bacteria.Antibacterial mechanisms such as oxidative stress induction,ion release and disruption of biomolecules are currently well accepted.However,the exact antimicrobial mechanisms of the discussed metal compounds remain poorly understood.The combination of different metal ions and surface decorations of nanoparticles will lead to synergistic effects and improved microbial killing,and allow to mitigate potential side effects to the host.Starting with a general overview of antibacterial mechanisms,we subsequently focus on specific metal ions such as silver,zinc,copper,iron and gold,and outline their distinct modes of action.Finally,we discuss the use of these metal ions and nanoparticles in tissue engineering to prevent implant failure.
文摘The features of JAK-STAT signaling in liver cells are discussed in the current review. The role of this signaling cascade in carcinogenesis is accentuated. The possible involvement of this pathway and alteration of its elements are compared for normal cholangiocytes, cholangiocarcinoma predisposition and development. Prolactin and interleukin-6 are described in detail as the best studied examples. In addition, the non-classical nuclear translocation of cytokine receptors is discussed in terms of its possible implication to cholangiocarcinoma development.
