ObjectiveTo systematically review the methodological quality of guidelines concerning attention-deficit/hyperactivity disorder (ADHD) in children and adolescents, and to compare differences and similarities of the drugs recommended, in order to provide guidance for clinical practice. MethodsGuidelines concerning ADHD were electronically retrieved in PubMed, EMbase, VIP, WanFang Data, CNKI, NGC (National Guideline Clearinghouse), GIN (Guidelines International Network), NICE (National Institute for Health and Clinical Excellence) from inception to December 2013. The methodological quality of included guidelines were evaluated according to the AGREE Ⅱ instrument, and the differences between recommendations were compared. ResultsA total of 9 guidelines concerning ADHD in children and adolescents were included, with development time ranging from 2004 to 2012. Among 9 guidelines, 4 were made by the USA, 3 in Europe and 2 by UK. The levels of recommendations were Level A for 2 guidelines, and Level B for 7 guidelines. The scores of guidelines according to the domains of AGREE Ⅱ decreased from "clarity of presentations", "scope and purpose", "participants", "applicability", "rigour of development" and "editorial independence". Three evidence-based guidelines scored the top three in the domain of "rigour of development". There were slightly differences in the recommendations of different guidelines. ConclusionThe overall methodological quality of ADHD guidelines is suboptimal in different countries or regions. The 6 domains involving 23 items in AGREE Ⅱ vary with scores, while the scores of evidence-base guidelines are higher than those of non-evidence-based guidelines. The guidelines on ADHD in children and adolescents should be improved in "rigour of development" and "applicability" in future. Conflicts of interest should be addressed. And the guidelines are recommended to be developed on the basis of methods of evidence-based medicine, and best evidence is recommended.
ObjectiveTo compare four different transfection reagents for transfection efficiency of rat heart myoblast cells H9C2, to choose the optimal transfection method.MethodsThe plasmids of enhanced green fluorescent protein (EGFP) gene were transfected as exogenous genes to H9C2 cells from four different transfection regents including FuGENE HD, DNA-In CRISPR, Lipofectamine 3000 and Lipofectamine 2000. Fluorescence intensity was measured by fluorescence microscopy and fluorescence microplate reader to evaluate transfection efficiency. The effects of four transfection reagents on cell viability were measured by Cell Counting Kit-8 (CCK-8) reagents.ResultsTransfection efficiency of Lipofectamine 3000 was the highest (>50%), while that of DNA-In CRISPR was the lowest (<1%). The cytotoxicity of Lipofectamine 3000 was the lowest in the four transfection reagents and the cell viability was 94.55% after 48-hour transfection.ConclusionTransfection regent Lipofectamine 3000 has the relatively high transfection efficiency as well as the lowest cytotoxicity, which is more suitable for use in H9C2 cells by transfection.
ObjectiveTo systematically review the correlation between HDL-C level and lung cancer. MethodsSuch databases as PubMed, EBSCO, ISI Web of Science, The Cochrane Library (Issue 8, 2015), VIP, and CNKI Data were electronically searched from inception to September 23th, 2015 to collect studies about the correlation between HDL level and lung cancer. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed using Stata 12.0 software. ResultsFifteen studies involving 2 015 lung cancer patients and 15 505 controls were finally included. The results of meta-analysis showed that the total HDL-C level in the lung cancer group was lower than that in the control group (SMD=-0.68, 95%CI-0.97 to -0.40, P=0.000). Further subgroup analysis showed that the incidence of lung cancer of different clinical classification (SMDⅠ~Ⅱ=-0.65, 95%CI -1.07 to -0.23, P=0.002; SMDⅢ~Ⅳ=-0.61, 95%CI -0.73 to -0.50, P=0.000), different pathological types (the small cell lung cancer excluded) (SMDAC=-0.76, 95%CI -1.13 to -0.38, P=0.000; SMDSC=-1.51, 95%CI -2.47 to -0.56, P=0.010; SMDSCLC=-1.19, 95%CI -1.42 to -0.95, P=0.000), different quality scores (SMD≥6 score=-0.60, 95%CI -0.89 to -0.29, P=0.000; SMD< 6 score=-0.77, 95%CI -1.48 to -0.0, P=0.015), the number of different studies (SMD≥100 cases=-0.48, 95%CI -0.80 to -0.15, P=0.004; SMD< 100 cases=-0.80, 95%CI -1.33 to -0.27, P=0.003), smoking (SMD=-1.47, 95%CI -2.51 to -0.43, P=0.006) and Asia (SMD=-0.92, 95%CI -1.21 to -0.63, P=0.000) was correlated with the level of HDL-C. ConclusionThe level of HDL-C is related to the incidence of lung cancer, and low HDL-C level may increase the risk of lung cancer. In view of the limitations of the studies, the above conclusions need a great many large samples and adjust the smoking status of the prospective cohort study at home and abroad to verify.
ObjectiveTo investigate the association of high density lipoprotein cholesterol (HDL-C) and cholesterol ester transfer protein (CETP) TaqIB mutation with non-arteritic anterior ischemic optic neuropathy (NA-AION) in the Shaanxi Han ethnic population. MethodsThe study cohort consisted of 45 individuals that had been diagnosed with NA-AION and 45 healthy controls (matched for age, gender). None of the cases or controls had a history of diabetes, serious cardio-cerebral vascular diseases, liver and kidney dysfunction that might influence plasma lipid levels. Plasma HDL-C was detected by enzyme-linked immunosorbent one-step, through the Toshiba TBA-40FR automatic biochemical analyzer. CETP TaqIB gene polymorphism was determined by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) techniques for analysis. B2B2 genotype was only a fluorescence band with 535 bp; B1B1 genotype was 2 fluorescence bands with 361, 174 bp; B1B2 genotype was 3 fluorescence bands with 535, 361, 174 bp. The relative risk of genotype, HDL-C and disease occurrence was analyzed by logistics regression analysis. ResultsThere have no significant difference between NA-AION patients and controls about plasma total cholesterol level and triglyceride level (t=1.907, 1.877; P > 0.05). The plasma HDL-C levels were significantly lower in NA-AION patients than in controls (t=2.367, P=0.022). Compared with controls, the prevalence of B1B1 genotype and B1 allele was higher (χ2=17.289, P=0.001), the prevalence of B2 allele (χ2=15.648, P=0.000) was lower in NA-AION patients. The lower concentration of HDL-C was risk factor of NA-AION (odds ratio=6.143, 95% confidence interval 1.262-29.895, χ2=27.676;P=0.013). The proportion of B1B1 genotype was significantly higher in NA-AION patients than in controls (odds ratio=2.24, 95% confidence interval 2.427-36.323, χ2=10.526; P=0.001). ConclusionsThe low plasma HDL-C is independent risk factor for NA-AION and is associated with the development of NA-AION in the Shaanxi Han ethnic population. CETP TaqIB mutation is associated with low plasma HDL-C in NA-AION in the Shaanxi Han ethnic population.
目的:调查我院腹膜透析患者死亡和转HD治疗的原因及相关影响因素。方法: 收集腹膜透析患者在我院死亡14例,转HD治疗 2 6例;查阅40例患者在我院的完整病历资料,调查其死亡及转HD治疗的原因及感染病原菌、营养等指标。结果: 14例腹膜透析死亡患者主要原因为肺部感染合并心脑血管疾病及消化道出血,均占(29%,4/14)。643%(9 / 14)的死亡患者HBlt;90 g/L,ALBlt;30 g/l;71.4%(10 / 14)的腹膜透析死亡患者合并钙磷失调。 26例腹膜透析患者转HD的首要原因和次要原因分别为腹透相关性腹膜炎(50%,13/26)和透析液引流不畅(42%,11/26)。72.7%透析液引流不畅的腹透患者经影像学诊断漂管,27.3%患者为拔管手术证实网膜堵塞管口。结论: 1.肺部感染性疾病合并合并心脑血管系统及消化系统,为腹膜透析患者死亡的主要原因,与全身营养状况不良,钙磷失调有关。 2. 腹膜透析相关性腹膜炎仍为腹膜透析患者退出转HD治疗的主要原因。 3.因透析液引流不畅而拔管为转HD治疗的第二位原因,漂管和网膜阻塞管口为透析液引流不畅的原因。
Objective Through conducting a meta-analysis using the methodology of Cochrane review, to assess the effectiveness and safety of graft-versus-host disease (GVHD) prophylaxis with antithymocyte globulins (ATGs) in allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods Such databases as PubMed (1966 to March 2011), EMbase (1974 to March 2011), the Science Citation Index databases (1900 to March 2011), The Cochrane Library (1996 to March 2011), CBMdisc (1978 to March 2011), and CNKI (1979 to March 2011) were electronical1y searched. The references of all identified studies were retrieved for collecting more randomized controlled trials (RCTs) and non-RCTs. Two reviewers independently screened the trials according to inclusion and exclusion criteria, abstracted the data, and assessed the methodology quality of the included studies. Meta-analyses were performed using RevMan 5.0.2 software. Results Thirteen clinical trials were included, of which 2 were RCTs involving 310 patients and the other 11 were non-RCTs involving 1480 patients. The results of meta-analyses showed that compared with the Non-ATG group, the pooled risk ratio (RR) and 95%CI of the ATG group in acute GVHD II-IV incidence rate, acute GVHD III-IV incidence rate, chronic GVHD (limited plus extensive) incidence rate, chronic GVHD (extensive) incidence rate, overall survival (OS) rate, non-relapse mortality (NRM) rate, and relapse rate were 0.77 (0.67, 0.87), 0.54 (0.44, 0.68), 0.58 (0.51, 0.65), 0.35 (0.26, 0.46), 1.14 (1.04, 1.25), 0.81 (0.69, 0.93), and 1.24 (0.98, 1.57), respectively. Conclusion The addition of ATGs to GVHD prophylaxis can reduce the incidence of acute and chronic GVHD, decrease NRM, and increase OS, but has no obvious interference with relapse rate.
Objective To assess the effectiveness and safety of nine lipid-lowing agents in the national essential drug list (2000) and provide evidence for the adjustment and selection of essential drugs. Methods Based on principles of health technology assessment (HTA) and evidence-based medicine, we searched for all published clinical studies about these drugs from the following databases: MEDLINE (1966-2002.8), The Cochrane Library, EMBASE (1974-2002), CBMdisk (1979-2002.8) and VIP (1989-2002.8), the database of National Center for Adverse Drug Reaction(ADR) Monitoring of China and the database of WHO Uppsala drug monitoring center. Included studies were appraised, analyzed and compared for the reduction of triglyceride (TC) or low density lipoprotein (LDL-C), the prevention for the coronary events and the incidence of ADR. Results The results from comparative trials for lipid-lowing agents showed that the equivalent dose of statins for 25% reduction of LDL-C was atorvastatin 10 mg/d, simvastatin 20 mg/d, pravastatin 40mg/d, lovastatin 40 mg/d, cerivastatin 0.3 mg/d and fluvastatin 80 mg/d. It was difficult to compare fenofibrate with gemfibrozil, acipimox with statins or fibrates based on available data. The study on the primary and secondary prevention of cardiovascular events showed that pravastatin and lovastatin were effective in primary prevention, and long-term use could reduce the incidence of cardiovascular disease.Gemfibrozil could reduce the mortality from coronary heart disease (CHD) but the overall mortality was not changed. Pravastatin, simvastatin, atorvastatin, fluvastatin, gemfibrozil and fenofibrate had a confirmed effect in secondary prevention. Data from large-scale clinical trials and the reports from ADR monitoring center of England, America, Canada and Australia suggested that the statins which had rare ADR were safe and tolerated. Rhabdomyolysis was rare but had a serious adverse reaction associated with statins. The rate of fatal rhabdomyolysis related to cerivastatin was the highest among 6 statins. The safety of simvastatin, lovastatin and atorvastatin was lower than cerivastatin but higher than simvastatin and atorvastatin. The number of ADR reports of fenofibrate was fewer than that of gemfibrozil. Conclusions At present, the best evidence focused on pravastatin, simvastatin and lovastatin are widely used and have a confirmed safety and efficacy. Atorvastatin, fluvastatin and fenofibrate still need more data to confirm their effects on coronary heart disease prevention. The drugs which were shown to be inferior or insufficient evidence are cerivastatin, gemfibrozil and acipimox.
ObjectiveTo survey and analyze the trend of congenital heart disease (CHD) of regions distribution and medical payment model in Children's Hospital of Gansu Province over the past 11 years, and to provide evidence for diagnosis and treatment strategies for CHD children. MethodsMedical records of the CHD children hospitalized in the Children's Hospital of Gansu Province from 2001 to 2011 were completely collected. Regional distribution, year and other basic information of them were extracted. Data was then analyzed using the SPSS 16.0 software. ResultsA total of 591 CHD children were included. Most of them came from Middle-Long, accounting for 68.87%; while the number of CHD children in the region of East-Long and He-xi had a tendency of growth by year, with average growth speed of 189.42% and 27.62%, respectively. Most of them came from the region which is economic class Ⅲ, accounting for 35.64% (highest) with average growth speed (203.45%). Most of the treatment costs were self-supported before 2005, and health insurance and other social aids were consistently increasing after 2005. Most of the institutions for initial visit were town-level hospitals, accounting for 55.50%, and with average growth speed of 170.18%. ConclusionThe medical demand of CHD children in less-developed regions in Gansu province increases year by year. Government-guided healthcare system should be established and improved so as to basically guarantee the prevention and treatment of CHD in less-developed regions.
ObjectiveTo analyze the expression and prognostic value of PHD Finger Protein 19 (PHF19) in non-small cell lung cancer (NSCLC) based on gene chip data. MethodsThe data about The Cancer Genome Atlas (TCGA) lung cancer patients were downloaded to analyze the expression of PHF19 in lung cancer. The data sets GSE30219 and GSE50081 were downloaded from the Gene Expression Omnibus (GEO), and the patients were screened into the training set and the validation set respectively, thus analyzing the relationship between PHF19 expression, gender, age, tumor clinical stage, pathological type and disease-free survival (DFS), as well as their relationship with overall survival (OS). Gene Ontology (GO)-Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis and immune infiltration analysis were performed on PHF19 and co-expression related genes in lung cancer patients through the online database. ResultsThe data from TCGA and GEO showed PHF19 was highly expressed in lung cancer (P<0.001), and PHF19 expression was related to tumor stage. The NSCLC patients in the PHF19 low expression group had longer DFS and OS than those in the high expression group (P<0.05). Multivariate COX regression analysis showed PHF19 was an independent prognostic factor in NSCLC patients (P<0.05). A nomogram drawing to predict the survival rate of lung cancer patients and verifying the C index showed the model has good accuracy. Gene enrichment analysis showed PHF19 high expression is mainly related to the cell cycle, cell nucleus, chromatin, etc. Immune infiltration analysis showed PHF19 is closely related to immune cell infiltration. ConclusionsPHF19 can be used as an indicator to predict the prognosis of NSCLC. PHF19 high expression is an independent predictor of poor prognosis of NSCLC and may be a new target for its treatment.