Extending the Grading of Recommendations Assessment, Development and Evaluation (GRADE) in Traditional Chinese Medicine (TCM): The GRADE-TCM.

AIM: To extend and form the "Grading of Recommendations Assessment, Development and Evaluation in Traditional Chinese Medicine" (GRADE-TCM). METHODS: Methodologies were systematically reviewed and analyzed concerning evidence-based TCM guidelines worldwide. A survey questionnaire was developed based on the literature review and open-end expert interviews. Then, we performed expert consensus, discussion meeting, opinion collection, external examination, and the GRADE-TCM was formed eventually. RESULTS: 265 Chinese and English TCM guidelines were included and analyzed. Five experts completed the open-end interviews. Ten methodological entries were summarized, screened and selected. One round of consensus was conducted, including a total of 22 experts and 220 valid questionnaire entries, concerning 1) selection of the GRADE, 2) GRADE-TCM upgrading criteria, 3) GRADE-TCM evaluation standard, 4) principles of consensus and recommendation, and 5) presentation of the GRADE-TCM and recommendation. Finally, consensus was reached on the above 10 entries, and the results were of high importance (with voting percentages ranging from 50 % to 81.82 % for "very important" rating) and strong reliability (with the Cr ranging from 0.93 to 0.99). Expert discussion meeting (with 40 experts), opinion collection (in two online platforms) and external examination (with 14 third-party experts) were conducted, and the GRADE-TCM was established eventually. CONCLUSION: GRADE-TCM provides a new extended evidence-based evaluation standard for TCM guidelines. In GRADE-TCM, international evidence-based norms, characteristics of TCM intervention, and inheritance of TCM culture were combined organically and followed. This is helpful for localization of the GRADE in TCM and internationalization of TCM guidelines.

Assessment of a 60-Biomarker Health Surveillance Panel (HSP) on Whole Blood from Remote Sampling Devices by Targeted LC/MRM-MS and Discovery DIA-MS Analysis.

Telehealth, accessing healthcare and wellness remotely, should be a cost-effective and efficient way for individuals to receive care. The convenience of having a reliable remote collection device for blood tests will facilitate access to precision medicine and healthcare. Herein, we tested a 60-biomarker health surveillance panel (HSP), containing 35 FDA/LDT assays and covering at least 14 pathological states, on 8 healthy individuals' ability to collect their own capillary blood from a lancet finger prick and directly compared it to the traditional phlebotomist venous blood and plasma collection methods. All samples were spiked with 114 stable-isotope-labeled (SIL) HSP peptides and quantitatively analyzed by liquid chromatography-multiple reaction monitoring-mass spectrometry (LC/MRM-MS) scheduled method targeting 466 transitions from 114 HSP peptides and by a discovery data-independent acquisition mass spectrometry (DIA-MS) method. The average peak area ratio (PAR) of the HSP quantifier peptide transitions from all 8 volunteers' capillary blood (n = 48), venous blood (n = 48), and matched plasma (n = 24) was <20% coefficients of variation (CV). Heat map analysis of all 8 volunteers demonstrated that each individual had a unique biosignature. Biological replicates from capillary blood and venous blood clustered within each volunteer in k-means clustering analysis. Pearson statistical analysis of the three biofluids indicated that there was >90% similarity. Discovery DIA-MS analysis of the same samples using a plasma spectral library and a pan-human spectral library identified 1121 and 4661 total proteins, respectively. In addition, at least 122 FDA-approved biomarkers were identified. DIA-MS analysis reproducibly quantitated (<30% CV) ∼600-700 proteins in capillary blood, ∼800 proteins in venous blood, and ∼300-400 proteins in plasma, demonstrating that an expansive biomarker panel is possible with current mass spectrometry technology. Both targeted LC/MRM-MS and discovery DIA-MS analysis of whole blood collected on remote sampling devices are viable options for personal proteome biosignature stratification in precision medicine and precision health.

Does high-speed rail improve China's urban environmental efficiency? Empirical evidence from a quasi-natural experiment.

Whether high-speed rail (HSR) can promote the coordination between the economy and environment is a critical issue that needs to be investigated. We used balanced panel data of 281 prefecture-level or above cities in China from 2005 to 2017 to consider the opening of HSR as a quasi-natural experiment. We integrated the difference-in-differences (DID) model, the spatial difference-in-differences (SDID) model, and social network analysis (SNA) to empirically investigate the impact of HSR on urban environmental efficiency (UEE). The results showed that HSR significantly improved UEE by 4.6% annually during the study period, although the effect of HSR on UEE exhibited a time lag and varied dramatically in different cities. An analysis of the mechanism showed that the effect of technological innovation and the structural effect brought by the opening of HSR were the main contributors to the improved UEE. Further analysis showed that HSR service centrality also significantly improved UEE and HSR opening and HSR service centrality both had positive spatial spillover effects on the UEE of neighboring cities. Several policy implications are proposed accordingly to make full use of the advantages of HSR to improve UEE for China.

Relationship between FDI, fiscal expenditure and green total-factor productivity in China: From the perspective of spatial spillover.

Deeply investigating the relationship between foreign direct investment (FDI), fiscal expenditure and green total-factor productivity (GTFP) is beneficial to formulating effective policies to promote the high-quality development in China. Based on theoretical mechanism analysis, with panel data of China's mainland 30 provinces during 2003-2017, this paper utilizes spatial econometric model to empirically explore the effects of FDI, fiscal expenditure and their interaction item on the growth of GTFP in China. The results show that FDI significantly promote the growth of the local and its neighboring GTFP, and both fiscal expenditure and the interaction between FDI and fiscal expenditure exert significantly negative effects on the growth of GTFP in the local and its neighboring regions. A series of robustness checks and the endogeneity test can ensure the reliability of these results. In addition, great heterogeneity can be found across China's different regions in the relationship between FDI, fiscal expenditure and GTFP. The conclusions suggest that it is necessary to give fully play to the synergy between FDI and fiscal expenditure and formulate regionally targeted policies to improve GTFP and promote high-quality development in China.

Predictive accuracy of three clinical risk assessment systems for cardiac complications among Chinese pregnant women with congenital heart disease.

OBJECTIVE: To compare the predictive accuracy of three risk assessment systems for cardiac complications among pregnant women with congenital heart disease (CHD). METHODS: In a retrospective study, data were assessed from women with CHD at more than 20weeks of pregnancy who attended Shanghai Obstetrical Cardiology Intensive Care Center, China, between January 1, 1993 and December 31, 2014. CARPREG and ZAHARA risk scores, and modified WHO (mWHO) risk classification were applied retrospectively. Predictive accuracy was compared by receiver operating characteristic curve analysis. RESULTS: A total of 730 women were included. The frequency of expected versus observed cardiac events was, respectively, 5.0% versus 7.8%, 27.0% versus 47.1%, and 75.0% versus 75.0% among patients with CARPREG scores of 0, 1, and >1; and 2.9% versus 5.8%, 7.5% versus 36.5%, 17.5% versus 30.8%, 43.1% versus 50.0%, and 70.0% versus 17.6% among those with ZAHARA scores of 0-0.50, 0.51-1.50, 1.51-2.50, 2.51-3.50, and 3.51 or more. For mWHO risk classifications I-IV, the cardiac event rate was 0%, 8.2%, 26.7%, 18.4%, and 15.4%, respectively. The area under the curve was 0.71 (95% confidence interval [CI] 0.67-0.76; P<0.001) for mWHO, 0.68 (95% CI 0.60-0.75; P<0.001) for ZAHARA, and 0.63 (95% CI 0.57-0.71; P=0.001) for CARPREG. CONCLUSION: The mWHO risk classification was the best system for predicting cardiac complications among Chinese pregnant women with CHD.

[A cross-sectional investigation on cognition and health education needs on child neglect among parents/carers to the preschool children in Guangdong Province].

OBJECTIVE: To investigate the cognition and health education needs on child neglect among parents/carers to the preschool children in Guangdong Province. METHODS: A total of 621 parents/carers of preschool children aged 3-6 years from four cities (Dongguan, Huizhou, Zhongshan, and Foshan) in Guangdong Province completed self-designed questionnaires concerning the cognition and health education needs on child neglects. RESULTS: Only 5.4% of the parents/carers had a good knowledge of child neglect, and 55.9% had never heard about this term. About 90.5%-90.7%of the surveyed parents/carers were willing to learn more about child neglect and 94.6%-97.4% of them agreed that education on child neglect was necessary. It was found that normal brochures, books, newspapers, and magazines were the preferred way of education for parents/carers (77.0%); also nearly half of the parents/carers welcomed courses (55.6%) or lectures (49.1%). Most of them believed that awareness raising activities should be carried out in kindergarten (70.5%), public places (61.4%) or by providing collective training for teachers in kindergarten (59.6%). CONCLUSIONS: Most parents/carers of preschool children in Guangdong Province have a poor knowledge of child neglect. Efforts should be made to strengthen awareness raising activities on this topic via appropriate pathways.

A rapid, economical, and reproducible method for human serum delipidation and albumin and IgG removal for proteomic analysis.

Serum is a readily available source for diagnostic assays, but the identification of disease-specific serum biomarkers has been impeded by the dominance of human serum albumin (HSA) and immunoglobulin G (IgG) in the serum proteome. Therefore, in order to observe lower-abundance serum proteins, removal or depletion of at least these two proteins is required. However, the depletion method needs to be inexpensive and reproducible. We describe such a protocol that combines delipidation by centrifugation, IgG removal with Protein G Sepharose, and HSA depletion with sodium chloride/ethanol precipitation. The protocol is streamlined to increase reproducibility and is compatible with many proteomic platforms, including two-dimensional gel electrophoresis, and high-performance liquid chromatography either offline or coupled online with a mass spectrometer. The reproducible depletion of lipids, IgG, and HSA permits a higher load of the remaining serum proteins, facilitating the identification of disease biomarkers.

Improvements in two-dimensional gel electrophoresis by utilizing a low cost "in-house" neutral pH sodium dodecyl sulfate-polyacrylamide gel electrophoresis system.

Two-dimensional gel electrophoresis (2-DE) is widely used for initial protein separation in proteomics. Commercial products using neutral pH sodium dodecyl sulfate-polyacrylamide gel electrophoresis ((SDS-PAGE)/(Bis (2-hydroxyethyl) imino-tris (hydroxymethyl) methane-HCl, or Bis-Tris)) have greatly improved this technique, but cost and limited sizes restrict their applications. An "in-house" system is presented, resulting in better resolution, separation, and new spot visualization and improved resolution when compared to Tris-HCl gels. Their utility is demonstrated using albumin-depleted serum samples, rabbit heart left ventricle, and human immunodeficiency virus type 1 (HIV-1).