简介：Evidence-basedpointselectionmethodsmeanselectingacupuncturepointsonthebasisofevidenceofclinicalefficacy.Whilemostofthisevidencecurrentlyderivesfromhistoricalliterature,whichrepresentstheaccumulatedclinicalexperienceofovertwomillennia,thereisalsoagrowingbodyofevidencebeingestablishedthroughacupunctureresearch.

简介：Therehasbeenaparadigmshiftinmedicineawayfromtradition,anecdoteandtheoreticalreasoningfromthebasicsciencestowardsevidence-basedmedicine(EBM).Inpalliativecarehowever,statisticallysignificantbenefitsmaybemarginalandmaynotberelatedtoclinicalmeaningfulness.Thetypicaltreatmentvs.placebocomparisonnecessitatedby‘goldstandard'randomisedcontrolledtrials(RCTs)isnotnecessarilyapplicable.Thecomplexmultimorbidityofendoflifecareinvolvesconsiderationsofthepatient'sphysical,psychological,socialandspiritualneeds.Inaddition,thefieldofpalliativecarecoversaheterogeneousgroupofchronicandincurablediseasesnolongerlimitedtocancer.Adequatesamplesizescanbedifficulttoachieve,reducingthepowerofstudiesandhighattritionratescanresultininadequatefollowupperiods.Thisreviewusesexamplesofthemanagementofcancer-relatedfatigueanddeathrattle(noisybreathing)todemonstratethecurrentstateofEBMinpalliativecare.ThefutureofEBMinpalliativecareneedstobeasdiverseasthepatientswhoultimatelyderivebenefit.Non-RCTmethodologiesofequivalentquality,validityandsizeconductedbycollaborativeresearchnetworksusinga‘mixedmethodsapproach'arelikelytoposethecorrectclinicalquestionsandderiveevidencebasedyetclinicallyrelevantoutcomes.

简介：Purpose:Proctalgiafugax(PF)isabenignanorectalconditionwhichhasbeendescribedintheliteraturesincethenineteenthcenturycommonlypresentingtogeneralsurgeons.Thereislittlehighlevelevidenceonthesubjectanditstherapeuticmodalities.Weaimedthroughthissystematicliteraturereviewtooutlinethe

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简介：Inthisarticle,theauthorsholdthattheevidence-basedmedicine(EBM)isanewmedicalactionproducedatthehistoricmomentinclinicalpractice,whichispromotingdevelopmentofthemedicineandeventhewholelifescienceinafullynewtrainofthoughtendmethod.FurtherthebrieflyintroducedcontentsaretheeffectofEBM,thedifficultyofutilizingintheacupunctureclinicalpracticeandhowtoresolvethem.ItishighlyrecommendedthatthedoctorsoftheacupuncturesciencefieldshouldstudyEBManditseffectanddifficultiesinpracticeasearlieraspossible,insistentlyassimilatenewknowledgeandkeepabreastofthetimes'progresstofacilitatethefurtherdevelopmentofacupunctology.

简介：摘要After severe COVID-19 disease, many patients will experience a variety of problems with normal functioning and will require rehabilitation services to overcome these problems. The principles of and evidence on rehabilitation will allow an effective response. These include a simple screening process; use of a multidisciplinary expert team; four evidence-based classes of intervention (exercise, practice, psychosocial support, and education particularly about self-management); and a range of tailored interventions for other problems. The large number of COVID-19 patients needing rehabilitation coupled with the backlog remaining from the crisis will challenge existing services. The principles underpinning vital service reconfigurations needed are discussed.

简介：针灸学属于传统经验医学，循证医学是新兴的医学方法学，是经验医学的发展。自上个世纪90年代以来，中国从事针灸学研究的工作者已开始吸收和借鉴循证医学的方法和原理，用于指导针灸临床研究与医疗实践，现在国内已有越来越多的针灸临床工作者采用和遵循循证医学的原则和方法。从目前Cochrane图书馆发表的与针灸有关的系统评价来看，以往认为有效的针灸疗法却没有足够的证据表明有效，这与目前国内RCT质量不高直接有关。今后，发展并形成针灸临床研究专业化队伍和针灸临床研究中心，才能从根本上提高针灸临床研究和评价的水平。同时，发展中国循证针灸学，应结合中国针灸学的自身特点，如重视古籍中的原始研究证据，开展高质量的随机对照试验，重视非随机研究的系统评价等等。

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简介：AbstractBackground:The use of autologous free-tissue transfer is an increasingly utilized tool in the ladder of reconstructive options to preserve and restore function in patients with head and neck cancer. This article focuses on the evidence surrounding perioperative care that optimizes surgical outcomes and describes one tertiary center's approach to standardized free-flap care.Data Sources:This article examines English literature from PubMed and offers expert opinion on perioperative free-flap care for head and neck oncology.Conclusion:Free-flap reconstruction for head and neck cancer is a process that, while individualized for each patient, is best supported by a comprehensive and standardized care pathway. Surgical optimization begins in the preoperative phase and a thoughtful approach to intraprofessional communication and evidence-based practice is rewarded with improved outcomes.

简介：AbstractObjective:Nasopharyngeal carcinomas (NPC) are tumors arising from epithelium of the nasopharynx. The 5-year survival rate of primary NPC is 80% with significant risks of recurrence. The objective here is to provide an evidence-based systemic review of the diagnostic value of different modalities in detecting local, regional, and distal recurrent NPC, as well as the associated costs with these modalities.Methods:MEDLINE, EMBASE, and the Cochrane review database were queried. Two hundred and twenty-three abstracts were generated using the inclusion criteria: patients >18 years of age; histopathological reference standard; and modalities pertaining to imaging or microbiology.Results:Twenty-four manuscripts fulfilled the inclusion criteria and 5 surveillance tools identified: endoscopy, MR, FDG-PET, Tc-99m MIBI and 201TI SPECT, and EBV DNA.Conclusions:For local surveillance, endoscopy is the gold standard recommendation, with increased efficacy if Narrow Band Imaging or contact endoscopy are utilized. MRI and FDG-PET is also recommended to help with local to distal spread; however, Tc-99m MIBI and 201TI SPECT are options as well. EBV DNA is recommended as a cheap and accessible adjunct surveillance tool if an available as an option.

简介：AbstractBackground:A steady progress on schistosomiasis control in the Peoples’ Republic of China (P.R. China) was achieved and broadened into the twelve-year medium and long term national plan (MLNP) which marled the implementation of an integrated control strategy across all endemic areas in P.R. China in 2004. To understand the endemic trends of schistosomiasis to assess the effectiveness of an integrated strategy, we conducted an analysis of schistosomiasis surveillance data spanned from 2005 to 2015.Methods:The schistosomiasis sentinel surveillance data from sentinel sites were collected and analyzed from 2005 to 2015. In these sentinel sites, residents aged 6 years or above were screened annually by indirect hemagglutination assay (IHA), while only antibody positives were followed by stool examination either Kato-katz method (KK) and/or hatching technique (HT). Domestic animals raised in sentinel sites were examined by HT for confirming the infection of schistosomes. Snail investigation was conducted each year through systematic sampling method combined with environmental sampling method. The snails collected from field were tested by microscopic dissection method. The infection rates of schistosomes in residents, domestic animals and snails, as well as the indicators reflecting the snails’ distribution were calculated and analyzed. ANOVA analysis was used to examine the changes of the number of eggs per gram feces in population and Chi-square test was used to examine any change in proportions among groups.Results:A total of 148 902 residents from sentinel sites attended this study and 631 676 blood samples were examined by IHA test during the 11 covered years. The annual average antibody positive rates presented a significant decrease trends, from 17.48% (95% CI: 17.20–17.75%) in 2005 to 5.93% (95% CI: 5.71–6.15%) (χ2= 8890.47, P < 0.001) in 2015. During 2005–2015, the average infection rate of schistosomes in residents declined from 2.07% (95% CI: 1.96–2.17%) to 0.13% (95% CI: 0.09–0.16%), accompanied by significant decrease of infection intensity in population. In 2015, the stool positives were only found in farmers, fishermen and boatmen with infection rate of 0.16% (95% CI: 0.11–0.20%), 0.17% (95% CI: 0–0.50%) respectively. The infection rate of schistosomes in domestic animals dropped from 9.42% (538/5711, 95% CI: 8.66–10.18%) to 0.08% (2/2360, 95% CI: 0–0.20%) from 2005 to 2015. Infections were found in eight species of domestic animals at the beginning of surveillance while only two cattle were infected in 2015. Totally 98 ha of new snail habitats were found, while 94.90% (93/98) distributed in lake and marshland regions. The percentage of frames with snails decreased from 16.96% (56 884/33 5391, 95% CI: 16.83–17.09%) in 2005 to 4.28% (18 121/423 755, 95% CI: 4.22–4.34%) in 2014, with a slightly increase in 2015. Meanwhile, the infection rate of schistosomes in snails was decreased from 0.26% (663/256 531, 95% CI: 0.24–0.28%) to zero during 2005–2015.Conclusions:The infection rate of schistosomes declined significantly, providing evidence that the goal of the MLNP was achieved. Elimination of schistosomiasis as a public health problem defined as WHO was also reached in P.R. China nationwide. Surveillance-response system should be improved and strengthened to realize the final goal of schistosomiasis elimination.

简介：AbstractBackground:China still suffers heavily from rabies, although reported human cases continue to decrease year over year. There are far fewer laboratory-confirmed human cases than clinically diagnosed cases, which is a big problem that needs to be addressed. In this report, we summarize analyses of all specimens from human cases tested in our laboratory over the past 15 years, in order to promote laboratory diagnosis of rabies.Methods:From 2005 to 2019, a total of 271 samples from 164 suspected rabies cases were collected from local hospitals by the local Centers for Disease Control and Prevention (CDCs) in China. Saliva, cerebrospinal fluid (CSF), serum (blood) and urine were collected for ante-mortem diagnosis, and brain tissue, neck skin tissue and cornea were collected for post-mortem diagnosis. All of the specimens were tested by reverse transcription-polymerase chain reaction (RT-PCR), and brain tissues were also tested using fluorescent antibody test (FAT). The number of positive test results obtained using different fluids or tissues, and at different stages of the disease, were compared using a chi-square test and a more effective sampling program is recommended.Results:As the national reference laboratory for rabies surveillance in China, our laboratory has tested 271 samples from 164 suspected rabies cases collected by local CDCs since 2005. We found that saliva gave the highest number of positive test results (32%), compared with CSF and other fluids. We also found that serum or blood specimens collected in the last 3 days of life can test positive by RT-PCR.Conclusions:Serum or blood samples collected in the last 3 days of a patient’s life can be used to measure viral RNA, which means that serum samples, as well as saliva and CSF, can be used to detect viral RNA for anti-mortem diagnosis of rabies. Because of our findings, we have modified our "National Surveillance Project for Human Rabies", by adding the collection and testing of serum samples from the end of the survival period. This will improve our national surveillance and laboratory diagnosis of human rabies.

简介：AbstractBackground:Zoonoses are public health threats that cause severe damage worldwide. Zoonoses constitute a key indicator of One Health (OH) and the OH approach is being applied for zoonosis control programmes of zoonotic diseases. In a very recent study, we developed an evaluation system for OH performance through the global OH index (GOHI). This study applied the GOHI to evaluate OH performance for zoonoses in sub-Saharan Africa.Methods:The framework for the OH index on zoonoses (OHIZ) was constructed including five indicators, 15 subindicators and 28 datasets. Publicly available data were referenced to generate the OHIZ database which included both qualitative and quantitative indicators for all sub-Sahara African countries (n = 48). The GOHI algorithm was used to estimate scores for OHIZ. Indicator weights were calculated by adopting the fuzzy analytical hierarchy process.Results:Overall, five indicators associated with weights were generated as follows: source of infection (23.70%), route of transmission (25.31%), targeted population (19.09%), capacity building (16.77%), and outcomes/case studies (15.13%). Following the indicators, a total of 37 sub-Sahara African countries aligned with OHIZ validation, while 11 territories were excluded for unfit or missing data. The OHIZ average score of sub-Saharan Africa was estimated at 53.67/100. The highest score was 71.99 from South Africa, while the lowest score was 40.51 from Benin. It is also worth mentioning that Sub-Sahara African countries had high performance in many subindicators associated with zoonoses, e.g., surveillance and response, vector and reservoir interventions, and natural protected areas, which suggests that this region had a certain capacity in control and prevention or responses to zoonotic events.Conclusions:This study reveals that it is possible to perform OH evaluation for zoonoses in sub-Saharan Africa by OHIZ. Findings from this study provide preliminary research information in advancing knowledge of the evidenced risks to strengthen strategies for effective control of zoonoses and to support the prevention of zoonotic events.

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简介：AbstractObjective:To analyze the temporal trends of maternal mortality ratio (MMR) due to obstetric hemorrhage and its specific causes in Chinese mainland from 2000 to 2019, to identify whether the rate of change has accelerated or slowed down during this period, and to find the prior cause of obstetric hemorrhage that needs to be intervened in the future.Methods:Individual information on maternal deaths and total number of live births from 336 surveillance sites across 31 provinces in Chinese mainland was collected from the National Maternal and Child Health Surveillance System between 2000 and 2019. Maternal death was defined according to the World Health Organization’s criterion. The final underlying cause of death was confirmed by the national review and was coded according to International Classification of Diseases -10. Linear trends for changes in characteristics of maternal deaths were assessed using linear or logistic models with the year treated as a continuous variable. The MMR and 95% confidence intervals (CI) for regions or causes were estimated by Poisson’s distribution. Joinpoint regression was used to assess the accurate temporal patterns.Results:The national MMR due to obstetric hemorrhage was 18.4 per 100,000 live births (95% CI: 15.0-22.2) in 2000. It peaked in 2001 (22.1 per 100,000 live births, 95% CI: 18.3-26.4) and was lowest in 2019 (1.6 per 100,000 live births, 95% CI: 1.0-2.3). For specific regions, the MMR due to obstetric hemorrhage in rural areas and western regions both experienced a slight rise, followed by a rapid decline, and then a slow decline. For specific causes, no change point was found in joinpoint analysis of the national MMR caused by placenta previa, postpartum uterine atony, and retained placenta (the annual percent change was -12.0%, -10.5%, and -21.0%, respectively). The MMR caused by postpartum hemorrhages (PPH) significantly declined by 8.0% (95% CI: 1.9-13.6) per year from 2000 to 2007. The annual percent change of MMR caused by PPH accelerated further to -25.0% between 2007 and 2011, and then decreased to -7.8% between 2011 and 2019. The proportion of maternal deaths due to antepartum hemorrhages increased from 7.6% (8/105) in 2000 to 14.3% (4/28) in 2019. The changes in the proportion of causes were different for maternal deaths due to PPH. The proportion of postpartum uterine atony increased from 39.0% (41/105) in 2000 to 60.7% (17/28) in 2019, and the proportion of uterine rupture also increased from 12.3% (13/105) in 2000 to 14.3% (4/28) in 2019. However, the proportion of retained placenta decreased from 37.1% (39/105) in 2000 to 7.1% (2/28) in 2019.Conclusion:Over the last 20 years, the intervention practice in China has proved that targeted interventions are beneficial in reducing the MMR due to obstetric hemorrhage. However, the MMR has reached a plateau and is likely to increase for some specific causes such as uterine rupture. China needs to develop more effective interventions to reduce maternal deaths due to obstetric hemorrhage, especially for postpartum uterine atony and uterine rupture.

简介：性健康或可勃起的机能障碍(编辑)现状指南提供常规药方或另外的著名外来的治疗的彻底的概述选择。在过去的10-15年，然而，国际研究人员的过多证实了单个、全面的生活方式变化能阻止并且潜在地改善我们考察的编辑应该等同分级A或为我们也考察的编辑铺平1个证据建议的生活方式证据为人参属人参的证据，一普通(OTC)有实验室调查，在约15年的多重积极使随机化的审判和几i的35年的历史的饮食的补充也许现在是至少在编辑指南讨论并且甚至强调生活方式和另外的非常规的干预以便病人们能探索的时间多种潜在地，与他们的医生和罐头一起的synergistic选择改进他们生活的质量和数量。例如，在编辑指南在生活方式修正上忽略一致、积极数据等于忽略食谱和生活方式变化减少风险或改善心血管的疾病。

简介：AbstractIt has been reported that liver fibrosis could be reversed after eliminating liver injuries. This article systematically summarizes the evidence of fibrosis regression based on histology, liver stiffness, and serum biomarkers, and discusses several clinically relevant challenges. Evidence from liver biopsy has been regarded as the gold standard in the assessment of fibrosis regression. Semi-quantitative staging and grading systems are traditionally and routinely used to define regression. Recently, the predominantly regressive, indeterminate, and predominantly progressive score was proposed, based on the regressive features from "hepatic repair complex" , to provide additional information regarding the quality of fibrosis. For non-invasive assessment, although liver stiffness and serum biomarkers could be applied to reflect the dynamic changes of liver fibrosis, other confounding factors such as liver inflammation have to be considered. In conclusion, both histology and non-invasive methods can provide evidence regarding fibrosis regression. The predictive value of fibrosis regression in long-term prognosis warrants further investigation.

简介：Theuseofenteralfeedingaspartofthemanagementofacutepancreatitisdatesbackalmosttwodecades.Thisreviewdescribestheindicationsforandlimitationsofenteralfeedingforthetreatmentofacutepancreatitisusingup-to-dateevidence-baseddata.Asystematicreviewwascarriedouttoanalysecurrentdataontheuseofenteralnutritioninthemanagementofacutepancreatitis.Relevantliteraturewasanalysedfromtheviewpointsofenteralvsparenteralfeeding,earlyvsdelayedenteralnutrition,nasogastricvsnasojejunalfeeding,andearlyoraldietandimmunonutrition,particularlyglutamineandprobioticsupplementation.Finally,currentapplicableguidelinesandtheeffectsoftheseguidelinesonclinicalpracticearediscussed.Thelatestmeta-analysessuggestthatenteralnutritionsignificantlyreducesthemortalityrateofsevereacutepancreatitiscomparedtoparenteralfeeding.Tomaintaingutbarrierfunctionandpreventearlybacterialtranslocation,enteralfeedingshouldbecommencedwithinthefirst24hofhospitaladmission.Also,thesafetyofnasogastricfeeding,whicheasestheadministrationofenteralnutrientsintheclinicalsetting,islikelyequaltonasojejunalfeeding.Furthermore,anearlylow-fatoraldietispotentiallybeneficialinpatientswithmildpancreatitis.Despitetheinitialencouragingresults,thecurrentevidencedoesnotsupporttheuseofimmunoenhancednutrientsorprobioticsinpatientswithacutepancreatitis.