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.

Comparative Assessment of APTT Reagents for Evaluating Anticoagulant Sensitivity of Fucosylated Glycosaminoglycans (FGs) Derived from Sea Cucumbers.

Fucosylated glycosaminoglycans (FGs) derived from sea cucumbers exhibit potent intrinsic Xase (iXase) inhibition, anticoagulation, and antithrombosis. Plasma activated partial thromboplastin time (APTT), a widely used screening test worldwide, is crucial for evaluating anticoagulant efficacy. However, the applicability of these commercially available APTT reagents for assessing anticoagulation of FGs remains unreported. In this study, we investigated the disparity between ellagic acid and colloidal silica APTT reagents in evaluating anticoagulation of dHG-5 and dHLFG-4, two depolymerized FGs, and elucidated the underlying rationale. The results demonstrated that dHG-5 and dHLFG-4 exhibited heightened sensitivity to the ellagic acid APTT reagent both in vitro and in vivo, and did not significantly affect the activation of APTT reagents for plasma. In addition, both ellagic acid and colloidal silica APTT reagents inhibited the anti-iXase of dHG-5 and dHLFG-4, and the inhibition of the ellagic acid APTT reagent was less pronounced compared to the colloidal silica APTT reagent. These findings suggest that the reduced impact of the ellagic acid APTT reagent on the anti-iXase activity of dHG-5 and dHLFG-4 is responsible for the increased sensitivity in plasma APTT analysis. This study offers valuable insights into the characteristics of two APTT reagents applied for assessing the anticoagulant activity of FG-related compounds.

Quantitative simulation and verification of the tourism economic resilience in urban agglomerations.

The concept of tourism economic resilience emphasizes the sustainable development level of tourism economy under uncertainty and risk. Focusing on urban agglomerations, this study aims to describe how the tourism economic resilience is developing, explore whether the resilience level is enhanced with urban agglomerations and whether spatial elements affect resilience levels. With the combination of the aggregation and diffusion effects and crowding effects of regional development, the study uses a combination of dynamic evaluation method, spatial kernel density, and mathematical models of urban agglomeration development to quantitatively analyze the spatiotemporal dynamic evolution of tourism economic resilience from 2006 to 2019, simulates and verifies its development patterns. The conclusions show that: (1) The tourism economic resilience in urban agglomerations is closely related to regional development and prosperity; (2) The development of tourism economic resilience also follows the spatial economic development pattern which moves towards equilibrium in aggregation process; (3) The tourism economic resilience of urban agglomerations has a fluctuation climbing node, generally presents as a wave-like upward trend with fluctuations and stages; (4) The evolutionary trend of tourism economic resilience in urban agglomerations presents as a slight wave-like upward curve that changes with time and co-opetition.

Spatial dynamics and influencing factors of carbon rebound effect in tourism transport: Evidence from the Yangtze-river delta urban agglomeration.

Economic efficiency gains in tourism are considered a crucial approach to reducing carbon emissions in the tourism sector, especially in tourism transport. However, as a significant source of carbon emissions from tourism activities, the total carbon emissions from tourism transport have not decreased proportionally to the reduction in the intensity, despite China's overall improvement in the tourism economic efficiency. This phenomenon is commonly known as the "rebound effect", which means that although technological progress can achieve emission reductions by efficiency improvement, but it can also indirectly stimulate socio-economic growth and creates new energy demands, results in expected emission reductions being offset by the additional economic growth effect. Based on the multi-source data structure, this paper takes Yangtze-river delta urban agglomeration as an example, quantitatively evaluated the carbon rebound effect of tourism transport through the rebound effect measurement model; simulated the spatiotemporal dynamics evolution pattern of the carbon rebound effect in tourism transport through the spatial kernel density; extracted and identified the dominant factors of carbon rebound effect in tourism transport by the geographic detector. The conclusions summarized as follow: (1) The overall carbon emissions from tourism transport in the agglomeration primarily exhibit a weak rebound effect. (2) The carbon rebound effect is significantly influenced by spatiotemporal factors, which impact its development trend and interaction relations. (3) The level of tourism consumption exerts the greatest influence on the carbon rebound effect of tourism transport, while environmental regulation intensity is commonly employed as a measure to address the rebound effect. This paper aims to enhance the diversity of research on carbon emissions in tourism transport while addressing the existing limitations in spatial-temporal extension. The objective is to restrain the spread of the carbon rebound effect at the regional level, thereby providing a novel decision-making reference for the sustainable development of regional tourism.