Quality appraisal of clinical practice guidelines for motor neuron diseases or related disorders using the AGREE II instrument.

Objectives: This study aimed to systematically assess the quality of CPGs for motor neuron diseases (MNDs) or related disorders and identify the gaps that limit evidence-based practice. Methods: Four scientific databases and six guideline repositories were searched for eligible CPGs. Three researchers assessed the eligible CPGs using the Appraisal of Guidelines Research and Evaluation II instrument. The distribution of the level of evidence and strength of recommendation of these CPGs were determined. The univariate regression analysis was used to explore the characteristic factors affecting the quality of CPGs. Results: Fifteen CPGs met the eligibility criteria: 10 were for MND and 5 were for spinal muscular atrophy. The mean overall rating score was 44.5%, and only 3 of 15 CPGs were of high quality. The domains that achieved low mean scores were applicability (24.4%), rigor of development (39.9%), and stakeholder involvement (40.3%). Most recommendations were based on low-quality evidence and had a weak strength. The CPGs that were updated, meant for adults, and evidence based, and used a CPG quality tool and a grading system were associated with higher scores in certain specific domains and overall rating. Conclusion: The overall quality of CPGs for MNDs or related disorders was poor and recommendations were largely based on low-quality evidence. Many areas still need improvement to develop high-quality CPGs, and the use of CPG quality tools should be emphasized. A great deal of research on MNDs or related disorders is still needed to fill the large evidence gap.

[Quantitative analysis and classification of tongue inspection based on the visible reflection spectrum].

OBJECTIVE: In this study, optical data on color of tongue tips were collected by using a visible reflection spectrum system. Quantitative method of tongue inspection and classification of tongue states including pale, pale red, red and crimson manifestations were investigated. METHODS: Chromaticity coordinates of the tongue tips from 98 subjects were calculated on the basis of the visible reflection spectrum. The tongue color was quantified and classified by the visible reflection spectrum in the range from 590 nm to 780 nm, based on the higher red-band energy distribution on the tongue tip color. RESULTS: It was found that comparison and analysis of tongue tip color from different samples would be well-suited after spectrum vector normalization, and the difference of tongue tip color between different samples could be observed easily when the tongue tip optical data were sited in CIE 1931 chromaticity diagram. The tongue tip colors were analyzed quantitatively and classified by the spectral energy intensity at the wavelength of 670 nm and (or) spectral energy ratio of red bank from 590 nm to 780 nm. The results of classification showed that there was sound corresponding accuracy with the clinical diagnosis of pale tongue, pale red tongue, red tongue and crimson tongue. CONCLUSION: In this study, based on the collection of the information data on tongue tip characteristics with the visible spectrum from 380 nm to 780 nm, the quantitative analysis of tongue inspection for pale tongue, pale red tongue, red tongue and crimson tongue was established. The quantitative value for tongue tip color is an effective method for classification of the condition of the tongue tip, which provides a useful tool for the modernization of tongue inspection in traditional Chinese medicine.

Effects of Weipixiao (胃痞消) on Wnt pathway-associated proteins in gastric mucosal epithelial cells from rats with gastric precancerous lesions.

OBJECTIVE: To study the effects of Weipixiao (胃痞消, WPX) on Wnt pathway-associated proteins in gastric mucosal epithelial cells from rats with gastric precancerous lesions (GPL). METHODS: Sprague Dawley rats were randomly divided into control, model, vitacoenzyme (0.2 g·kg(-1)·day(-1)), WPX high-dose (H-WPX, 15 g·kg(-1)·day(-1)), WPX medium-dose (M-WPX, 7.5 g·kg(-1)·day(-1)) and WPX low-dose (L-WPX, 3.75 g·kg(-1)·day(-1)) groups. After successfully establishing the GPL model, the rats were consecutively administered WPX or vitacoenzyme by gastrogavage for 10 weeks. Differential expression of Leucine-rich repeat-containing G-proteincoupled receptor 5 (Lgr5), matrix metalloproteinase-7 (MMP-7), Wnt1, Wnt3a, and ß-catenin in gastric mucosal epithelial cells in all groups were immunohistochemically detected, and the images were taken and analyzed semiquantitatively by image pro plus 6.0 software. RESULTS: Gastric epithelium in the model group showed significantly higher expression levels of Lgr5, MMP-7, Wnt1, Wnt3a and ß-catenin than those of the control group(P<0.01). Interestingly, we also observed Lgr5+ cells, which generally located at the base of the gastric glandular unit, migrated to the luminal side of gastric epithelium with GPL. The expression levels of Lgr5, MMP-7, Wnt1, and ß-catenin were all down-regulated in the L-WPX group as compared with those of both model and vitacoenzyme groups (P<0.05). A similar, but nonsignificant down-regulation in expression level of Wnt3a was noted in all WPX groups (P>0.05). CONCLUSION: Our findings suggested that the therapeutic mechanisms of WPX in treating GPL might be related with its inhibitory effects on the expressions of Lgr5, MMP-7, Wnt1, ß-catenin and the aberrant activation of Wnt/ß-catenin pathway.

[Clinical observation on treatment of acute gouty arthritis by tongfengkang].

OBJECTIVE: To objectively evaluate the clinical therapeutic effect of tongfengkang (TFK) in treating acute gouty arthritis. METHODS: Adopting randomized single blinded controlled trial, the 40 patients were equally divided into two groups. The tested group was treated with TFK, the control group was treated with indomethacin and allopurinol, the therapeutic course for both groups was 10 days. RESULTS: The clinical cure rate in the tested group and the control group was 30% and 35% respectively, and the total effective rate 90% and 95% respectively, with no significant difference between the two groups (P > 0.05). The scores of blood uric acid and symptom significantly lowered in both groups after treatment (P < 0.01), but showed no significant difference between them (P > 0.05). Adverse reaction to the treatment was shown in 3 patients in the control group. CONCLUSION: The therapeutic effect of TFK is similar to that of indomethacin plus allopurinol but with less adverse reaction, it is an effective and safe remedy for treatment of acute gouty arthritis, and worthy for further studying and developing.