Efficacy and safety of simple analgesics for acute treatment of episodic tension-type headache in adults: a network meta-analysis.

OBJECTIVE: Tension-type headache is the most common type of primary headache and results in a huge socioeconomic burden. This network meta-analysis (NMA) aimed to compare the efficacy and safety of simple analgesics for the treatment of episodic tension-type headache (ETTH) in adults. METHODS: We searched the Cochrane Library, PubMed, Web of Science, Embase, Chinese BioMedical Literature database and International Clinical Trials Registry Platform databases for eligible randomized clinical trials reporting the efficacy and/or safety of simple analgesics. A Bayesian NMA was performed to compare relative efficacy and safety. The surface under the cumulative ranking curve (SUCRA) was calculated to rank interventions. PROSPERO registration number: CRD42018090554. RESULTS: We highlighted six studies including 3507 patients. For the 2 h pain-free rate, the SUCRA ranking was ibuprofen > diclofenac-K > ketoprofen > acetaminophen > naproxen > placebo. All drugs except naproxen reported a higher 2 h pain-free rate than placebo, with a risk ratio (RR) of 2.86 (95% credible interval, CrI: 1.62-5.42) for ibuprofen and 2.61 (1.53-4.88) for diclofenac-K. For adverse events rate, the SUCRA ranking was: metamizol > diclofenac-K > ibuprofen > lumiracoxib > placebo > aspirin > acetaminophen > naproxen > ketoprofen. The adverse event rates of all analgesics were no higher than those of placebo, except for ketoprofen. Moreover, all drugs were superior to placebo in the global assessment of efficacy. In particular, the RR of lumiracoxib was 2.47 (1.57-4.57). Global heterogeneity I2 between the studies was low. CONCLUSIONS: Simple analgesics are considered more effective and safe as a placebo for ETTH in adults. Our results suggest that ibuprofen and diclofenac-K may be the two best treatment options for patients with ETTH from a comprehensive point of view (both high-quality evidence).

To our knowledge, this is the first network meta-analysis comparing the available data on adult patients with episodic tension-type headache (ETTH) treated with different simple analgesics recommended by the current guidelines.Ibuprofen (400 mg) and diclofenac-K (12.5 mg, 25 mg) are potentially the most effective and safe treatment options, supported by high-quality evidence.

Osteoporosis guidelines on TCM drug therapies: a systematic quality evaluation and content analysis.

Objective: The aims of this study were to evaluate the quality of osteoporosis guidelines on traditional Chinese medicine (TCM) drug therapies and to analyze the specific recommendations of these guidelines. Methods: We systematically collected guidelines, evaluated the quality of the guidelines using the Appraisal of Guidelines Research and Evaluation (AGREE) II tool, and summarized the recommendations of TCM drug therapies using the Patient-Intervention-Comparator-Outcome (PICO) model as the analysis framework. Results and conclusions: A total of 20 guidelines were included. Overall quality evaluation results revealed that four guidelines were at level A, four at level B, and 12 at level C, whose quality needed to be improved in the domains of "stakeholder involvement", "rigor of development", "applicability" and "editorial independence". Stratified analysis suggested that the post-2020 guidelines were significantly better than those published before 2020 in the domains of "scope and purpose", "stakeholder involvement" and "editorial independence". Guidelines with evidence systems were significantly better than those without evidence systems in terms of "stakeholder involvement", "rigor of development", "clarity of presentation" and "applicability". The guidelines recommended TCM drug therapies for patients with osteopenia, osteoporosis and osteoporotic fracture. Recommended TCM drugs were mainly Chinese patent medicine alone or combined with Western medicine, with the outcome mainly focused on improving bone mineral density (BMD).

Biosynthesis of silver nanoparticle composites based on hesperidin and pectin and their synergistic antibacterial mechanism.

Silver nanoparticles (AgNPs) were widely used in the antibacterial field because of their excellent antibacterial properties. In this study, we used hesperidin and pectin as reductants and stabilizers, and prepared uniform and stable Hesperidin-Pectin AgNPs (HP-AgNPs) by a simple microwave-assisted process. Increasing the proportion of hesperidin, P-AgNPs, HP-AgNPs1, HP-AgNPs2 and H-AgNPs were obtained respectively. With the increase of hesperidin ratio, the mean particle size and zeta potential increased gradually. Fourier transform infrared spectroscopy (FTIR) analysis showed that Ag+ was reduced by hesperidin and pectin. Antibacterial tests showed that HP-AgNPs2 showed the MIC values of 66.7 µg/mL against E. coli. In addition, HP-AgNPs2 was selected to clarify its antibacterial mechanism against E. coli. Morphological experiments showed that HP-AgNPs2 stress caused damage to the cell wall of E. coli, as well as leakage of its contents and an increase in reactive oxygen species (ROS). On the other hand, the release of Ag+ during cell co-culture was studied and the results showed that most of the Ag+ released was taken up by E. coli. The synergistic effect of hesperidin and pectin resulted in a significant enhancement of the antibacterial properties of AgNPs. These preliminary data suggest that HP-AgNPs has good antibacterial activity and may be developed as an effective antibacterial nanomaterial.

Development and Validation of a Patient-Reported Outcome Scale for Tension-Type Headache.

Objective: To validate a patient-reported outcome (PRO) measure for patients with tension-type headache (TTH). Methods: Literature analysis, interview, and group discussion were performed to develop an initial TTH-PRO. Thereafter, the initial scale was pre-evaluation in a small range of patients with TTH, and the expert panel made necessary adjustments based on the content feedback. The clinical test was carried out by using the adjusted initial scale. Based on the test results, the items were screened by the method of classical test theory to form the final scale, and the performance evaluation indicators such as validity, reliability, and responsiveness of the final scale were tested. Results: The final formed TTH-PRO scale contained three domains, six dimensions, and 30 items. The split-half reliability, Cronbach's α coefficients, and construct validity of the scale were acceptable, as was feasibility. The responsiveness in the physiological domain was fair, but the overall responsiveness still needed further clinical validation. Conclusions:The TTH-PRO scale has been developed with extensive patient input and demonstrates evidence for reliability and validity. It is complementary to existing evaluation indicators of TTH, emphasizing the patient's experience. Further studies are needed to optimize its items and to verify its clinical applicability for population in more regions and countries.

The RIGHT Extension Statement for Traditional Chinese Medicine: Development, Recommendations, and Explanation.

Nowadays, the number of traditional Chinese medicine (TCM) guidelines is constantly increasing, but its reporting quality remains unsatisfactory. One of the main reasons is that there is a lack of suitable reporting standard to guide it. In response to this long-standing problem, the Reporting Items for practice Guidelines in HealThcare (RIGHT) Working Group has invited a group of TCM clinical experts, methodologists and epidemiology, and developed the RIGHT Extension Statement for TCM (RIGHT-TCM) through a multi-staged development process, including systematic review, reporting quality evaluation and online Delphi expert consensus. The RIGHT-TCM extends two sections of the RIGHT Statement, includes basic information and recommendations section. Seven strong recommendation sub-items were added to RIGHT Statement and formed the final RIGHT-TCM. The group hopes that the RIGHT-TCM may assist TCM guideline developers in reporting guidelines, support journal editors and peer reviewers when considering TCM guideline reports, and help health care practitioners understand and implement a TCM guideline. This article will introduce its background, development, recommendations and explanation.

Survival outcomes following laparoscopic vs open surgery for non-metastatic rectal cancer: a two-center cohort study with propensity score matching.

BACKGROUND?>: Laparoscopic surgery for rectal cancer is commonly performed in China. However, compared with open surgery, the effectiveness of laparoscopic surgery, especially the long-term survival, has not been sufficiently proved. METHODS?>: Data of eligible patients with non-metastatic rectal cancer at Nanfang Hospital of Southern Medical University and Guangdong Provincial Hospital of Chinese Medicine between 2012 and 2014 were retrospectively reviewed. Long-term survival outcomes and short-term surgical safety were analysed with propensity score matching between groups. RESULTS: Of 430 cases collated from two institutes, 103 matched pairs were analysed after propensity score matching. The estimated blood loss during laparoscopic surgery was significantly less than that during open surgery (P = 0.019) and the operative time and hospital stay were shorter in the laparoscopic group (both P < 0.001). The post-operative complications rate was 9.7% in the laparoscopic group and 10.7% in the open group (P = 0.818). No significant difference was observed between the laparoscopic group and the open group in the 5-year overall survival rate (75.7% vs 80.6%, P = 0.346), 5-year relapse-free survival rate (74.8% vs 76.7%, P = 0.527), or 5-year cancer-specific survival rate (79.6% vs 87.4%, P = 0.219). An elevated carcinoembryonic antigen, <12 harvested lymph nodes, and perineural invasion were independent prognostic factors affecting overall survival and relapse-free survival. CONCLUSIONS?>: Our findings suggest that open surgery should still be the priority recommendation, but laparoscopic surgery is also an acceptable treatment for non-metastatic rectal cancer.

Efficacy and safety of different drug monotherapies for tension-type headache in adults: study protocol for a Bayesian network meta-analysis.

INTRODUCTION: Tension-type headache (TTH) is the most prevalent neurological disease, with an estimated 1.5 billion cases worldwide. Pharmacotherapy should be considered by patients with TTH who have a limited response to non-pharmacological treatment. However, recommendations for the vast array of therapeutic drugs for TTH partially overlap, with conflicting recommendations for strength in different guidelines; these may confuse the decision-making process of clinicians. Hence, the aims of this study are to analyse the available direct and indirect evidence on different drug monotherapies for TTH in adults, and to generate a treatment ranking according to their efficacy and safety outcomes by using a Bayesian network meta-analysis (NMA). METHODS AND ANALYSIS: We will systematically search the Cochrane Library, PubMed, Web of Science, Embase, China Biomedical Literature Database, International Clinical Trials Registry Platform and other resources for eligible studies. Randomised controlled trials on different drug monotherapies for TTH will be included. Two review authors (RX and YW) will independently search and select the studies, extract the data and assess the risk of bias. A Bayesian NMA will afterwards be conducted to pool the effect measures across all types of monotherapy drugs. The ranking probabilities of the efficacy and safety of different drug monotherapies will be estimated. Heterogeneity will be quantified using the Q statistic and the I² index. Inconsistency between direct and indirect evidence will be assessed by the node-splitting model. In addition, the overall quality of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. ETHICS AND DISSEMINATION: No ethical issues are foreseen. The results will be published in a peer-reviewed journal, which will be disseminated electronically and in print. PROSPERO REGISTRATION NUMBER: CRD42018090554.

A new scale for the evaluation of clinical practice guidelines applicability: development and appraisal.

BACKGROUND: This study aimed to develop the clinical practice guidelines applicability evaluation (CPGAE-V1.0) scale and to evaluate its validity and reliability. METHODS: One hundred fifty assessors were invited to rate two rounds of importance scoring of the applicability indicators by using the 5-point Likert scale. Approved indicators formed the CPGAE-V1.0 scale, consisting of 19 items, arranged into 4 domains. We enrolled eligible clinicians from 8 institutions to evaluate 9 clinical practice guidelines using the CPGAE-V1.0 scale. Content validity, construct validity, internal reliability, intra-rater reliability, and responsiveness were analyzed. RESULTS: A total of 220 clinicians participated, and the response rate was 98.6% (217/220). The CPGAE-V1.0 scale had favorable content validity. The four-factor model produced acceptable fit indices. The scale had an excellent internal consistency and item discrimination. It could identify the degree of applicability of the different dimensions between different guidelines. In all domains, 77.8% (7/9) of CPGs in the minimum-scoring domain were concentrated in the "coordination of support" domain. CONCLUSIONS: The CPGAE-V1.0 scale is a valid and reliable instrument for measuring the applicability of CPG.

Timing of spermarche and menarche among urban students in Guangzhou, China: trends from 2005 to 2012 and association with Obesity.

In Guangzhou, China, whether the trend of a decreasing pubertal age has continued in recent years remained unknown, and the association between obesity and early puberty was still controversial. Herein, we conducted a serial cross-sectional study using data from physical fitness surveillance (2005-2012), to determine the recent trends in age at spermarche and menarche among students in Guangzhou, and to investigate whether elevated BMI modified timing of spermarche and menarche. This study included 1,278,258 urban students. In boys, no significant differences were observed in median ages of spermarche (MAS) from 2005 to 2012, with overlapping 95% CIs. Similar results were observed for median ages of menarche (MAM) in girls. The Cox-Stuart trend test showed neither upward nor downward shift in MAS and MAM over time (P = 0.625; 1.000). Each year, both MAS and MAM decreased with increasing BMI. Furthermore, a higher BMI was associated with early age at spermarche and menarche, with ORs of 1.052 (95% CI = 1.045-1.059) and 1.233 (95% CI = 1.220-1.247) in 2012 for boys and girls, respectively. In conclusion, the pubertal timing has been stable in urban students from 2005 to 2012. Furthermore, obesity was associated with early timing of spermarche and menarche.

Secular trends in overweight and obesity among urban children and adolescents, 2003-2012: A serial cross-sectional study in Guangzhou, China.

Childhood and adolescent overweight and obesity are increasing in China, but limited information is available on its secular trends in Guangzhou. In this cross-sectional study, ten-wave successive data were obtained from the physical fitness surveillance for students in Guangzhou from 2003 to 2012. A total of 2,619,154 urban students aged 7-18 years were included. The age-standardized prevalence of overweight and obesity increased significantly over the period: overweight rose from 10.15% to 14.07% in boys and 6.39% to 8.11% in girls, while obesity increased from 5.65% to 8.31% for boys and 3.43% to 4.12% for girls, respectively (P < 0.05). The increasing trend was significant across almost all age-sex-specific groups (P < 0.05), especially in the last five years. The prevalence of overweight and obesity grew continuously in both sexes, but the pace of change for boys were faster than that for girls. The highest prevalence of overweight was found among 10- to 12-year-old boys, that of obesity among 7- to 9-year-old boys and girls. In conclusion, overweight and obesity have increased significantly among urban children and adolescents in Guangzhou during 2003-2012. Further analysis of influencing factors and comprehensive interventions are urgently needed to combat the obesity epidemic among urban children and adolescents in Guangzhou.

Early rigorous control interventions can largely reduce dengue outbreak magnitude: experience from Chaozhou, China.

BACKGROUND: Dengue fever is a severe public heath challenge in south China. A dengue outbreak was reported in Chaozhou city, China in 2015. Intensified interventions were implemented by the government to control the epidemic. However, it is still unknown the degree to which intensified control measures reduced the size of the epidemics, and when should such measures be initiated to reduce the risk of large dengue outbreaks developing? METHODS: We selected Xiangqiao district as study setting because the majority of the indigenous cases (90.6%) in Chaozhou city were from this district. The numbers of daily indigenous dengue cases in 2015 were collected through the national infectious diseases and vectors surveillance system, and daily Breteau Index (BI) data were reported by local public health department. We used a compartmental dynamic SEIR (Susceptible, Exposed, Infected and Removed) model to assess the effectiveness of control interventions, and evaluate the control effect of intervention timing on dengue epidemic. RESULTS: A total of 1250 indigenous dengue cases was reported from Xiangqiao district. The results of SEIR modeling using BI as an indicator of actual control interventions showed a total of 1255 dengue cases, which is close to the reported number (n = 1250). The size and duration of the outbreak were highly sensitive to the intensity and timing of interventions. The more rigorous and earlier the control interventions implemented, the more effective it yielded. Even if the interventions were initiated several weeks after the onset of the dengue outbreak, the interventions were shown to greatly impact the prevalence and duration of dengue outbreak. CONCLUSIONS: This study suggests that early implementation of rigorous dengue interventions can effectively reduce the epidemic size and shorten the epidemic duration.

Dengue Baidu Search Index data can improve the prediction of local dengue epidemic: A case study in Guangzhou, China.

BACKGROUND: Dengue fever (DF) in Guangzhou, Guangdong province in China is an important public health issue. The problem was highlighted in 2014 by a large, unprecedented outbreak. In order to respond in a more timely manner and hence better control such potential outbreaks in the future, this study develops an early warning model that integrates internet-based query data into traditional surveillance data. METHODOLOGY AND PRINCIPAL FINDINGS: A Dengue Baidu Search Index (DBSI) was collected from the Baidu website for developing a predictive model of dengue fever in combination with meteorological and demographic factors. Generalized additive models (GAM) with or without DBSI were established. The generalized cross validation (GCV) score and deviance explained indexes, intraclass correlation coefficient (ICC) and root mean squared error (RMSE), were respectively applied to measure the fitness and the prediction capability of the models. Our results show that the DBSI with one-week lag has a positive linear relationship with the local DF occurrence, and the model with DBSI (ICC:0.94 and RMSE:59.86) has a better prediction capability than the model without DBSI (ICC:0.72 and RMSE:203.29). CONCLUSIONS: Our study suggests that a DSBI combined with traditional disease surveillance and meteorological data can improve the dengue early warning system in Guangzhou.