Use of Evidence-Based Research Approach in RCTs of Acupuncture-Related Therapies for Primary Dysmenorrhea: A Meta-Research.

OBJECTIVE: To assess the use of evidence-based research (EBR) approach in randomized controlled trials (RCTs) of acupuncture-related therapies for primary dysmenorrhea (PD). METHODS: PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Database, and China Science and Technology Journal Database were searched from January 2013 to December 2022 for RCTs of acupuncture on PD. The full text and references of each RCT were read to assess whether systematic reviews (SRs) or other types of studies with similar research questions and end-users' perspectives were cited to justify and design the trial. In addition, the discussion section were analyzed to evaluate whether trials placed the new result in the existing SRs to draw a conclusion. Multivariable logistic regression was used to find variables that associated with 3 aspects of EBR approach: (1) citing clinical studies for justification, (2) citing relevant studies that obtain the perspectives of end users, and (3) citing clinical studies for results discussion. RESULTS: Of 473 RCTs included, 45.67% (216) of the trials cited relevant similar studies, 21.56% (102) referenced to the studies that collected end-users' perspectives, and 10.99% (52) placed result in the context of the previous research. Few RCTs appropriately applied EBR approach. Among all the included studies, 3.17% (15) of the trials used SRs to inform study questions but none of them used updated SRs with acceptable quality; 1.05% (5) of the trials cited SRs of end-user's perspectives in the justification and design of the study, and only 1 trial added results in existing SR to draw a conclusion. Year of publication, language, funding, registration, ethical approval and number of sites were significantly associated with 1 of the 3 aspects of EBR approach. CONCLUSIONS: Few RCTs in acupuncture-related therapies for PD used the EBR approach to minimize research redundancy. Researchers, research institutes, funding agencies, ethics committees, journals and peer reviewers in acupuncture should make efforts to use and promote the EBR approach to ensure the value of new trials.

Does the likelihood of malignancy in thyroid nodules with RAS mutations increase in direct proportion with the allele frequency percentage?

BACKGROUND: Genomic testing has enhanced pre-surgical decision making for cytologically indeterminate thyroid nodules, but there remains uncertainty regarding RAS mutations. The addition of extra genetic alterations to previous driver mutation panels has been shown to improve predictive value. This study aims to evaluate the relationship between the mutant allele frequency (AF) and likelihood of malignancy in thyroid nodules with RAS mutations. METHODS: A retrospective cohort review was performed evaluating patients with indeterminate cytology (Bethesda categories III, IV and V) and ThyroSeq® v3 testing demonstrating a RAS mutation, who underwent surgery. Univariate and multivariate regression analyses were used to evaluate relationships between AF, other genetic alterations, and malignancy. RESULTS: Thirty-nine patients met criteria, 77% of the thyroid nodules (30/39) were found to be malignant. None demonstrated aggressive pathology. On univariate regression, there was no relationship between AF and likelihood of malignancy. There was, however, a significant correlation between AF and the rate of an additional genetic alteration. Multivariate analysis found a trend between RAS, a second genetic alteration and malignancy, but it did not reach statistical significance. CONCLUSIONS: There was no direct relationship between the level of allelic frequency in thyroid nodules expressing RAS mutations and the likelihood of malignancy. There was a statistically significant relationship between increasing AF and the presence of a second genetic abnormality, suggesting a possible progression from initial driver mutation and then a second genetic alteration prior to malignant transformation.

Factors Associated with the Magnitude Of acUpuncture treatment effectS (FAMOUS): a meta-epidemiological study of acupuncture randomised controlled trials.

OBJECTIVE: To identify factors and assess to what extent they impact the magnitude of the treatment effect of acupuncture therapies across therapeutic areas. DATA SOURCE: Medline, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang Database, VIP Database, and China Biology Medicine disc, between 2015 and 2019. STUDY SELECTION: The inclusion criteria were trials with a total number of randomised patients larger than 100, at least one patient-important outcome and one of two sets of comparisons. DATA ANALYSIS: The potential independent variables were identified by reviewing relevant literature and consulting with experts. We conducted meta-regression analyses with standardised mean difference (SMD) as effect estimate for the dependent variable. The analyses included univariable meta-regression and multivariable meta-regression using a three-level robust mixed model. RESULTS: 1304 effect estimates from 584 acupuncture randomised controlled trials (RCTs) were analysed. The multivariable analyses contained 15 independent variables . In the multivariable analysis, the following produced larger treatment effects of large magnitude (>0.4): quality of life (difference of adjusted SMDs 0.51, 95% CI 0.24 to 0.77), or pain (0.48, 95% CI 0.27 to 0.69), or function (0.41, 95% CI 0.21 to 0.61) vs major events. The following produced larger treatment effects of moderate magnitude (0.2-0.4): single-centred vs multicentred RCTs (0.38, 95% CI 0.10 to 0.66); penetration acupuncture vs non-penetration types of acupuncture (0.34, 95% CI 0.15 to 0.53); non-pain symptoms vs major events (0.32, 95% CI 0.12 to 0.52). The following produced larger treatment effects of small magnitude (<0.2): high vs low frequency treatment sessions (0.19, 95% CI 0.03 to 0.35); pain vs non-pain symptoms (0.16, 95% CI 0.04 to 0.27); unreported vs reported funding (0.12, 95% CI 0 to 0.25). CONCLUSION: Patients, clinicians and policy-makers should consider penetrating over non-penetrating acupuncture and more frequent treatment sessions when feasible and acceptable. When designing future acupuncture RCTs, trialists should consider factors that impact acupuncture treatment effects.

[Overview of systematic reviews of acupuncture clinical research published in international journals].

The systematic reviews (SRs) of acupuncture published before December 31 of 2020 in PubMed, Cochrane and EMbase databases were searched, and the publication overview of international acupuncture SRs were analyzed. As a result, a total of 717 SRs were included, and the overall number of published SRs showed a fluctuating upward trend. A total of 15 categories of diseases were involved, of which 113 SRs suggested that acupuncture was effective, and 12 SRs did not support acupuncture, and the remaining SRs showed uncertain conclusions. It is suggested that the standard of evidence-based medicine should be adopted to standardize the design of acupuncture trial and improve the level of clinical research; SRs should include high-quality literature that met the standards according to the principles and methods of PRISMA, so as to provide reliable clinical evidence for acupuncture.

[Analysis on influencing factors of acupuncture curative effect based on experts' experience].

To explore the influencing factors of acupuncture curative effect in literature of experts' experience. The journal literature of experts' experience was retrieved from China National Knowledge Infrastructure (CNKI) and PubMed, starting from inception to September 4, 2020, and the influencing factors of acupuncture curative effect were extracted and analyzed. A total of 499 articles were included, involving 495 articles in Chinese and 4 articles in English. The influencing factors of acupuncture curative effect mainly include five aspects: diagnostic method, acupoint selection of acupuncture, acupuncture manipulation, regulating mind of acupuncture and acupuncture time, and provide reference for acupuncture protocol design in clinical trials.

Corrigendum: Exercising With a Six Pack in Virtual Reality: Examining the Proteus Effect of Avatar Body Shape and Sex on Self-Efficacy for Core-Muscle Exercise, Self-Concept of Body Shape, and Actual Physical Activity.

[This corrects the article DOI: 10.3389/fpsyg.2021.693543.].

[Clinical study on acupuncture and moxibustion for frozen shoulder: an evidence map].

The clinical evidences on acupuncture and moxibustion for the treatment of frozen shoulder were sorted and summarized systematically. The relevant articles of frozen shoulder treated with acupuncture and moxibustion were searched from PubMed, EMbase, Cochrane database of systematic review (CDSR), Cochrane database of controlled trials register (CENTRAL), China national knowledge infrastructure (CNKI), Wanfang, VIP, and Chinese biomedical literature databases (SinoMed), from database inception to May 31, 2021. Using AMSTAR-2, the methodological quality of the included systematic reviews was evaluated. With evidence map, the current status of clinical evidence was summarized on acupuncture and moxibustion in treatment of frozen shoulder. A total of 266 original studies and 6 systematic reviews were included finally. At present, many randomized controlled trials are designed with small sample size and the simple acupuncture and moxibustion therapy is dominant as the intervention, e.g. warm acupuncture, acupuncture with filiform needle, acupotomy and electroacupuncture. The outcomes considered in the current trials focus on clinical effective rate, the score of shoulder pain, the score of shoulder function and the score of quality of life. Most of the studies have shown that acupuncture and moxibustion is advantageous as an adjunctive therapy for frozen shoulder, but its clinical evidence is few in terms of the recurrence rate and safety. Moreover, it needs to improve the evidence quality of the relevant studies on acupuncture and moxibustion for frozen shoulder.

Effect of Acupuncture on Outcomes of in vitro Fertilisation: A Scoping Review.

OBJECTIVES: To identify, examine and summarize the available evidence on the effectiveness and safety of acupuncture for in vitro fertilisation (IVF) outcomes. METHODS: Eight electronic databases, including PubMed, EMBASE, Cochrane Database of Systematic Review, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Database and VIP Database, were searched, supplemented by manual searches. Two researchers independently conducted the literature screening, data extraction, and methodological quality assessments. A narrative description was provided to show the general information and specific characteristics of the included studies. A bubble plot was used to visually display the overall effects of acupuncture on IVF outcomes. RESULTS: Eighty-two studies were identified, including 64 primary studies and 18 systematic reviews. Transcutaneous electrical acupoint stimulation, electric acupuncture and manual acupuncture were applied in most studies and compared with no acupuncture, sham acupuncture and placebo acupuncture control groups. Sixty-three (98.4%) primary studies reported clinical pregnancy rate, and positive effects of acupuncture were found in 34 studies (54.0%). Live birth rate was reported in only 18 (28.1%) primary studies, of which 10 (55.6%) showed positive results. In addition, only 8 and 2 systematic reviews showed that acupuncture could increase clinical pregnancy events and live birth events, respectively. However, none of these reviews was of high methodological quality. CONCLUSIONS: Available evidence suggests that acupuncture therapy could improve clinical pregnancy rates. However, whether acupuncture could increase live birth events was difficult to determine based on the few studies that have reported this outcome indicator. Furthermore, the methodological quality of most systematic reviews was assessed as critically low or low. Studies with a rigorous design and standardized implementation should be performed to refine the available evidence.

BRAF V600E mutation is associated with aggressive features in papillary thyroid carcinomas ≤ 1.5 cm.

BACKGROUND: While some studies suggest that the BRAF V600E mutation correlates with a high-risk phenotype in papillary thyroid microcarcinoma (PTMC), more evidence is necessary before this mutation can be used to help guide decision making in the management of small thyroid nodules. This study investigated whether BRAF V600E mutation is associated with aggressive features in PTMC (≤ 1 cm) and small PTC (1-1.5 cm). METHODS: Retrospective chart review was performed on 121 patient cases. Patients who underwent thyroid surgery for PTMC (≤ 1 cm) or small PTC (1-1.5 cm) were included if molecular testing was done for BRAF V600E mutation. Two study groups were created based on tumour size: PTMC (n = 55) and small PTC (n = 66). The groups were analysed for the presence of a BRAF V600E mutation and aggressive features, including macroscopic extrathyroidal extension (ETE), lymph node metastasis (LNM), and high-risk histological features (tall cell, columnar cell, hobnail, solid/trabecular, and diffuse sclerosing). The Fischer exact test was used to calculate statistical significance. RESULTS: BRAF V600E mutations were detected in 43.6% of PTMC and 42.4% of small PTC. Of the mutated PTMC nodules, 54.1% demonstrated aggressive characteristics as compared to 19.4% of the non-mutated PTMCs (p = 0.010). Of the mutated small PTC tumours, 82.1% had aggressive features. In contrast, 28.9% of the non-mutated small PTCs showed aggressive features (p < 0.001). CONCLUSIONS: Our findings demonstrate an association between a BRAF V600E mutation and aggressive features in PTMC (≤ 1 cm) and small PTC (1-1.5 cm). Therefore, determining the molecular status of these thyroid nodules for the presence of BRAF V600E can help guide patient management.

Exercising With a Six Pack in Virtual Reality: Examining the Proteus Effect of Avatar Body Shape and Sex on Self-Efficacy for Core-Muscle Exercise, Self-Concept of Body Shape, and Actual Physical Activity.

This study investigates the Proteus effect from the first-person perspective and during avatar embodiment in actual exercise. In addition to the immediate measurements of the Proteus effect, prolonged effects such as next-day perception and exercise-related outcomes are also explored. We theorized the Proteus effect as altered perceived self-concept and explored the association between virtual reality (VR) avatar manipulation and self-concept in the exercise context. While existing studies have mainly investigated the Proteus effect in a non-VR environment or after VR embodiment, we aim to contribute to the literature by addressing this concern to explore how the Proteus effect works in actual VR exercise. Through a 2 (avatar body shape: with a six pack vs. normal) × 2 (sex: male vs. female) between-subject experiment, the results partially support the Proteus effect. Regarding actual physical activity, embodying an avatar with a six pack during exercise creates fewer body movements. No significant effect was found for perceived exertion. We also explored the role of sex as a potential moderator in the association of the Proteus effect on exercise outcomes. The Proteus effect was supported by immediate and next-day self-efficacy for core-muscle exercise only among female participants. The between-subject design allowed us to probe how avatar manipulation of muscular body shape with a six pack as opposed to normal body shape influences participants' self-concept and exercise outcomes, as limited VR studies have employed within-subject comparisons. This also contributes to the literature by providing an upward comparison (e.g., muscular with a six pack vs. normal) as opposed to the previous downward comparison regarding body fitness (e.g., normal vs. obese). The overall results supported the Proteus effect in the context of core-muscle exercise when comparing normal and ideal body shape avatars. However, the Proteus effect as an altered self-concept and its effects on self-efficacy for exercise were supported among females but not males. Whereas the female participants who embodied avatars with a six pack associated themselves more with the muscular concept than other people, the male participants who embodied avatars with a six pack perceived themselves as more normal than others. Theoretical and practical implications are discussed.

[Release Risk of Phosphorus by Sediments and Its Influencing Factors in Ponds and Ditches of a New Urban District Park].

This study examined five ponds and three ditches in the Shufengwan Sports Park in a new urban district of Hefei City, from which surface-layer sediments and overlying water samples were collected during autumn, winter, and summer. The equilibrium phosphate concentrations (EPC0) of the sediments and its response to exogenous carbon or nitrogen were then measured. The resulting EPC0values were used to assess the risk of phosphorus release by the sediments. Finally, major factors influencing phosphorous release were identified using the Partial Least Squares Regression (PLSR) method. The sediments in the urban park exhibited a light-to-moderate level of phosphorous pollution, with the total phosphorus content (TP) ranging from 209.28 to 713.51 mg·kg-1 and biologically available phosphorus accounting for 18.51%-36.21% of the total phosphorus content. Under ambient background, the EPC0 values in pond sediments were 0.012-0.142 mg·L-1, with a mean value of 0.057 mg·L-1, while in ditches the values ranged from 0.036 to 0.156 mg·L-1 with an average value of 0.078 mg·L-1. The addition of exogenous carbon increased the EPC0 values (by approximately 47.5% in pond 3), and thus increased the risk of phosphorus release from sediments, in pond 1, 3, and ditch 1. However, EPC0 values of the other ponds and ditches decreased (in particular, by approximately 58.6% in pond 5), indicating that the risk of phosphorus release decreased. After the addition of exogenous nitrogen, the EPC0 values of almost all ponds and ditches declined to varying degrees (except in ditches 1 and 2 during the summer). In particular, in the EPC0 value of pond 2 declined by approximately 51.6%. The declining values imply that nitrogen was a limiting factor in phosphorus uptake by sediments in ponds and ditches. According to the results of PLSR, nitrogen and phosphorus had different effects on the EPC0 values of sediments in ponds and ditches.

[Effect of manual acupuncture of "Shuigou" (GV26)"Neiguan" (PC6) on neurological function and expression of apoptosis-related factors in brain tissues surrounding hematoma in intracerebral hemorrhage rats].

OBJECTIVE: To observe the effect of manual acupuncture stimulation of "Shuigou" (GV26) and "Neiguan" (PC6) on neurological function and expression of Caspase-3 and Caspase-9 in brain tissues around the intracerebral hematoma in rats with acute intracerebral hemorrhage (ICH), so as to explore its possible mechanisms underlying improvement of ICH. METHODS: Ninety-six male SD rats were randomly divided into 4 groups: control, model, acupoint and non-acupoint (24 rats in each group). The ICH model was established by injection of the rat's autologous blood into the caudate nucleus. According to the time-points of 6, 24, 48 and 72 h after ICH, each of the 4 groups was further divided into 4 subgroups. For rats of the acupoint group, the PC6 on both sides was manually stimulated by manipulating the needle with lifting-thrusting-twisting reducing techniques, while the GV26 was stimulated with strong "sparrow-pecking" method for 10 times, then, left the needles in the acupoints for 30 min. For rats of the non-acupoint group, two non-acupoints: mid-spot below the bilateral axilla and the spot 3 mm above the left side of the coccyx tip were stimulated with the same methods to PC6 and GV26, respectively. For rats of the 6 h and 24 h subgroups, the intervention was given once after waking up from modeling, and for those of the 48 and 72 h subgroups, the intervention was conducted once a day for 2 or 3 times, respectively. The neurological severity score (NSS) was used to evaluate the degree of neurological function. The immunoactivity (expression) of Caspase-3 and Caspase-9 proteins of the hematoma focus of the brain was detected by immunohistochemistry. RESULTS: Following modeling, the NSS and the expression levels of Caspase-3 and Caspase-9 proteins in the brain tissues surrounding the hematoma at each time-points (6, 24, 48 and 72h) after modeling were significantly increased in the model group relevant to the control group (P<0.01, P<0.05). Compared with the model group, the NSS at 72h and the expression levels of Caspase-3 and Caspase-9 proteins at 6, 24, 48 and 72h were significantly down-regulated in the acupoint group (P<0.05) rather than in the non-acupoint group (P>0.05). CONCLUSION: Acupuncture of GV26 and PC6 can improve the neurological function in rats with ICH, which may be related to its function in reducing the expression of Caspase-3 and Caspase-9 proteins (apoptosis-related proteins) in the brain.

Glucocorticoid resistance syndrome caused by a novel NR3C1 point mutation.

Glucocorticoid resistance syndrome (GRS) is a rare genetic disorder caused by inactivating mutations of the NR3C1 gene which encodes the glucocorticoid receptor. The phenotypic spectrum is broad but typically include symptoms of adrenal insufficiency, mineralocorticoid excess and hyperandrogenism. We report a new case associated with a novel NR3C1 mutation. A 55-year-old woman with lifelong history of low body weight, hyperandrogenism and anxiety was seen at the endocrine clinic after left adrenalectomy and salpingoophorectomy for lesions suspicious of ovarian cancer and adrenal metastasis. The tumors turned out to be a 3.5 cm benign ovarian serous adenofibroma and a 3.5 cm multinodular adrenal mass. She complained of worsened fatigue and inability to recover weight lost with surgery. Pre-operative serum and urinary cortisol were elevated, but she had no stigma of Cushing's syndrome. Plasma ACTH was elevated and a 1-mcg cosyntropin stimulation test was normal. Her fatigue persisted over ensuing years and ACTH-dependent hypercortisolemia remained stable. Low dose oral dexamethasone failed to suppress endogenous cortisol. A pituitary MRI was normal but revealed incidental brain aneurysms. Bone densitometry showed profound osteoporosis. On the bases of this contradictory clinical picture, glucocorticoid resistance syndrome (GRS) was suspected. Using next generation sequencing technology, a novel heterozygous pathogenic variant in the NR3C1 gene was detected. We speculate that vascular malformations and profound osteoporosis, findings associated to cortisol excess, reflect in our patient a variable tissue sensitivity to glucocorticoids. In conclusion, in patients with clinically unexpected ACTH-dependent hypercortisolemia, primary glucocorticoid resistance (GRS) should be considered.

Lugol's solution-induced painless thyroiditis.

Lugol's solution is usually employed for a limited period for thyroidectomy preparation in patients with Graves' disease and for the control of severe thyrotoxicosis and thyroid storm. We describe a rare case of Lugol's solution-induced painless thyroiditis. In November 2014, a 59-year-old woman was prescribed Lugol's solution four drops per day for the alleviation of menopausal symptoms. She was referred to our clinic in June 2015 for fatigue, hair loss, and a 20-lb weight loss without thyroid pain or discomfort. Physical examination revealed a normal thyroid gland. On 7 May 2015, laboratory tests revealed a suppressed thyroid-stimulating hormone (TSH) 0.01 U/L with elevated free T4 3.31 ng/dL (42.54 pmol/L). Repeat testing on 25 May 2015 showed spontaneous normalization of the free thyroid hormone levels with persistently low TSH 0.10 U/L. Following these results, a family physician prescribed methimazole 10 mg PO TID and very soon after, the TSH concentration rose to >100 U/L along with subnormal free T4 and T3 levels. Methimazole was promptly discontinued, namely within 18 days of its initiation. Over the course of the next few months, the patient spontaneously achieved clinical and biochemical euthyroidism. To our knowledge, this is a unique case of painless thyroiditis induced by Lugol's solution, which has not been reported before. Lugol's solution is a short-term medication given for the preparation of thyroidectomy in patients with Graves' disease and for the control of severe thyrotoxicosis. Iodine excess can cause both hyperthyroidism and hypothyroidism. Rarely, Lugol's solution can cause acute painless thyroiditis. LEARNING POINTS: Lugol's solution is used for thyroidectomy preparation in patients with Graves' disease and for the control of severe thyrotoxicosis and thyroid storm.Iodine excess can cause both hypothyroidism and thyrotoxicosis. Thyroid glands with an underlying pathology are particularly susceptible to the adverse effect of iodine.The prolonged off-label use of Lugol's solution can be harmful. Rarely, Lugol's solution can cause acute painful thyroiditis.

Hereditary Heterozygous C2 Deficiency: Variable Clinical and Serological Manifestations Among Three Sisters.

The causal link between inherited complement deficiencies and systemic lupus erythematosus (SLE) has been well established, although it remains a rare cause of the disease. We present the case of three biological sisters with hereditary heterozygous C2 deficiency, but who differ widely in their clinical and serological manifestations. Patient 1 is 25 years old and was diagnosed with SLE at the age of 12. Further testing revealed positive ANA and anti-dsDNA, antiphospholipid syndrome (APS) and decreased C2, C3 and C4 levels. Patients 2 and 3 are 21-year-old dizygotic twins. Both have positive ANA and antiphospholipid (APL) antibodies, and decreased C2 and C4 levels. We present a case of familial heterozygous C2 deficiency with different disease phenotypes. The presence of positive APL antibodies in all 3 patients is significant, as this association has been rarely described. The variable clinical and serological manifestations among our patients further reflect the complex and multifactorial nature of SLE.

Are There Benefits for Gestational Diabetes Mellitus in Treating Lower Levels of Hyperglycemia Than Standard Recommendations?

OBJECTIVES: The new International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommendations for diagnosis of gestational diabetes mellitus (GDM) are generating discussion regarding their universal adoption. Our centre is currently using stricter GDM diagnostic criteria than those proposed by the IADPSG. Evaluation of complication rates and their predictors in our cohort may provide insight for the care of this high-risk population. Therefore, we determined complication rates and identified antepartum maternal predictors of adverse outcomes in our cohort with mild GDM. METHODS: A retrospective cohort study was performed between 2005 and 2011. It included women with and without GDM, which was diagnosed if fasting plasma glucose levels were 5.0 or above or 2-hour post 75 gram oral glucose tolerance test (OGTT) were 7.8 mmol/L or higher. RESULTS: A total of 3712 women, with and without diabetes, were included. Rates of macrosomia and pre-eclampsia were significantly higher in the group with GDM but were lower than the rates usually reported. Macrosomia, the need for insulin therapy or caesarean section and postpartum glucose intolerance predictors included prepregnancy body mass index, excessive gestational weight gain and OGTT screening results, although no specific threshold was found. CONCLUSIONS: This study provides insight into GDM-related complications rates and the benefits of intervention in a large cohort of women with levels of hyperglycemia lower than those currently recommended for diagnosis of GDM. These findings suggest a continuous association between adverse outcomes and maternal hyperglycemia and highlight the important role of maternal risk factors other than glycemic results in the development of pregnancy-related complications. Milder forms of hyperglycemia that would not be identified by IADPSG guidelines may benefit from treatment.

Quantification of the External Validity of Randomized Controlled Trials Supporting Clinical Care Guidelines: The Case of Thromboprophylaxis.

BACKGROUND: Clinical guidelines are based on the results of several randomized controlled trials. However, due to the stringent exclusion criteria of these trials, their external validity may be low. We aimed to evaluate the external validity of the randomized controlled trials cited in the American College of Chest Physicians guidelines for the use of pharmacological thromboprophylaxis in hospitalized medical patients. METHODS: We conducted a cross-sectional, chart-review study of a random sample of patients admitted between July 1, 2013 and June 30, 2014 to the Internal Medicine ward of a large Canadian teaching university hospital. We identified the proportion of our population presenting exclusion criteria used in the randomized controlled trials cited in support of clinical care guidelines on thromboprophylaxis in the medical setting. RESULTS: Nine trials were identified for a total of 28,793 included patients following 23 distinct exclusion criteria. We included 429 patients. Median age was 65 years (interquartile ratio 51-77 years), and 236 (55%) were males. Of those not already anticoagulated at admission (n = 351), between 26% and 67% (weighted average, 51%) of our population presented at least one exclusion criterion, making them ineligible to be enrolled in randomized controlled trials. When restricting our population to patients with an indication for thromboprophylaxis based on a Padua risk score at admission ≥4, 21% to 76% (weighted average 55%) were ineligible to be enrolled in individual trials. CONCLUSIONS: Our cross-sectional study illustrates that the external validity of randomized controlled trials cited in the guidelines was low in our population, and lower when applying the risk-stratification tool recommended by guidelines. This can bias the clinicians toward treating patients that were not represented in the supporting evidence.

[Influence of transient storage on solute transport and the parameter sensitivity analysis in a suburban drainage ditch].

From September to October 2013, five in-stream tracer experiments involving slug additions of chloride were performed in Guanzhenhe Branch, a headwater stream in suburban Hefei. From the perspective of different transport mechanisms such as transient storage, lateral inflow and advection-dispersion, four scenarios were set to analyze the effects of transient storage on solute transport in the drainage ditch. And sensitivity analysis of parameters in OTIS model was conducted. The results showed that transient storage exerted a significant influence on the peak values of simulated chloride concentration breakthrough curves (BTCs) in the main channel, and the REs (relative errors) of peak values in the BTCs ranged from 24.23% to 117.26%, which were much higher than those of the peak times. Meanwhile, the effects on simulated BTCs of transient storage markedly exceeded those of lateral inflow. Correlation analysis results showed that A(s)/A were significantly correlated with the peak value REs and the peak time RE's, respectively. Moreover, the ranking of parameter sensitivity in OTIS model was A > A(s) > α > D.

[Characteristics of nitrogen and phosphorus retention in two different channel forms in a typical headwater stream in the suburb of Hefei City, China ].

To investigate the characteristics of ammonium and phosphorus retention in two typical channel forms, deep pool and winding ditch in headwater stream, four field tracer experiments were conducted in a first-order stream of Ershibu River in Hefei suburban, in which a solution of biologically active (NH4Cl and KH2PO4) and conservative (NaCl) tracers was released to the head of each reach at a constant rate. According to the data sets of tracer experiments, mechanisms of ammonium and phosphorus retention were interpreted by using OTIS model code, transient storage metrics and nutrient spiraling theory. Study results showed that: (1) The value of As in deep pool was larger than that in winding ditch, whereas its value of hydrological parameter α was lower by an order of magnitude than that of winding ditch; (2) The value of NH(4)+ -λ in main channel was higher by two to three orders of magnitude than that of NH(4)+ -λs,in transient storage zone in deep pool, but in winding ditch the two parameters were closer in terms of numerical size; (3) In deep pool, the value of NH+(4) -Vf was higher by an order of magnitude than that of SRP-Vf, in winding ditch, however, not only the two values of NH(4)+ -Vf and SRP-Vf were close to each other, but NH(4)+ -Sw was nearly equal to SRP-Sw in numerical size as well; (4) The value of NH(4)+ -U was larger by two to three orders of magnitude than that of SRP-U in deep pool, whereas in winding ditch NH(4)+ -U was just larger by one to two orders of magnitude than SRP-U in size; (5) In general, significant difference existed between deep pool and winding ditch in the effect on ammonium and phosphorus retention, and marked retention efficiency was observed for ammonium rather than SRP in deep pool.

[Nitrogen and phosphate pollution characteristics and eutrophication evaluation for typical urban landscape waters in Hefei City].

To understand the water environment regimes of the city-circling water system in Hefei City, six typical landscape waters were chosen to investigate pollution characteristics of nitrogen and phosphate and evaluate water eutrophication level according to the monitoring data of water physicochemical characteristics and chlorophyll content from September 2012 to July 2013. Study results showed that (1) the six waters mentioned above have been seriously polluted by nitrogen and phosphorus loadings, with the monthly mean values of total nitrogen (TN) and total phosphorus (TP) concentrations far exceeding the universally accepted threshold values of water eutrophication; (2) the nitrogen contents in the waters of Nanfeihe River, Heichiba and Yuhuatang scenic spots exhibited a markedly monthly variation, and both TP and PO(3-)(4)-P in Nanfeihe River showed a fluctuated characteristic with high concentrations while presenting a significant upward trend in Yuhuatang scenic spot; (3) the average values of TN/TP ratios for Yuhuatang and Heichiba scenic spots were 104.7 and 158.3, respectively, and the ratios for Baohe Park, Yinhe Park, Xiaoyaojin Park, and city segment of Nanfeihe River were 16.8, 18.7, 6.4 and 16.8, respectively, indicating that the scenic waters of Yuhuatang and Heichiba were phosphate-limited whereas Xiaoyaojin Park was nitrogen-limited; (4) all the six scenic waters were, in general, subsumed under just two broad categories, namely Hechiba scenic spot and Nanfeihe River, which were seriously polluted, and clustered together, and the others fall into the second class; and (5) water eutrophication appraisal result indicated that the six waters were all in the state of eutrophication, and could be arranged in the order of eutrophication level, Yinhe Park > Heichiba scenic spot > city segment of Nanfeihe River > Xiaoyaojin Park > Yuhuatang scenic spot > Baohe Park.