Systematic review of clinical practice guidelines for kidney disease in China: application of the Appraisal of Guidelines Research and Evaluation-China

Objective To evaluate the quality of clinical practice guidelines for kidney diseases in China and provide reference for selecting suitable high-quality guidelines for primary care and developing standardized guidelines. Methods The China Guideline Clearinghouse, China Biology Medicine disc, VIP Database, Wanfang Database and CNKI, and other resources were searched from January 2013 to July 2018. In accordance with the criteria for inclusion and exclusion, the published guidelines for kidney diseases were screened. The Appraisal of Guidelines Research and Evaluation-China (AGREE-China) was used to systematically assess the current status of domestic guidelines for kidney diseases. Results A total of 18 guidelines for kidney diseases were included, covering different types of kidney disease such as glomerulonephritis, nephrotic syndrome, end-stage renal disease and other diseases. The overall score ranged from 30 to 68, with an average score of 47.3. The average scores of these guidelines were 20.1, 12.8, 0.5, 9.9 and 3.9 in five review fields including scientificity/rigorism, effectiveness/safety, economy, availability/feasibility, and conflicts of interest, respectively. Of these 18 guidelines, 8(44.4%) guidelines were strongly recommended, and 10(55.6%) guidelines were weakly recommended. Conclusions There are still deficiencies in scientificity/rigorism and economy in current guidelines for kidney diseases in China. The AGREE-China can be used as an evaluation tool for guidelines for kidney diseases in accordance with China's situation, while its practicability and feasibility still need further verification and improvement.     

构建数据协作机制应对突发公共卫生事件中的医疗不确定性

本文首先回顾了新型冠状病毒肺炎在全球蔓延后,由医疗不确定性造成的医疗决策困难,并剖析了这一突发公共卫生事件中医疗不确定性形成的原因和无效治疗带来的风险及医疗资源浪费。在此基础上,围绕如何在面临突发公共卫生事件时快速建立数据协作机制开展了现状回顾和讨论思考,即以数据为驱动,打破“数据孤岛”、提高“低价值数据”的数据质量和利用率,从而为应对相关事件提供有效证据。     

Association of Angiotensin Receptor Blockers with Incident Parkinson Disease in Patients with Hypertension: A Retrospective Cohort Study

BackgroundAngiotensin receptor blockers (ARBs), which are commonly used antihypertensives, have been proposed to lower the risk of Parkinson disease by reducing oxidative stress based on animal and in vitro studies. Thus, this study aimed to test this association in patients with newly diagnosed hypertension.MethodsThis retrospective cohort study enrolled 107,207 patients with newly diagnosed hypertension between 2001 and 2013. The hazard ratios for Parkinson disease were calculated for ARB treatment compared with those who never used ARBs and among the 5 subgroups receiving different cumulative ARB dosages.ResultsWe identified 527 (1.1%) Parkinson disease cases among patients with ARB treatment in a median observation period of 8.4 years compared to the 1,255 (2.2%) Parkinson disease cases among those without ARB treatment in a median observation period of 6.8 years. Overall, risk for developing Parkinson disease was statistically lower in the ARB-treated group with a hazard ratio of 0.56 (95% confidence interval: 0.51-0.63) than those without ARB.ConclusionsARB treatment was associated with a statistically important reduction of Parkinson disease risk in patients with newly diagnosed hypertension. Therefore, ARB may constitute an effective neuroprotective strategy to lower Parkinson disease risk in such patients.     

The Arg16Gly polymorphism of the β2-adrenergic receptor and left ventricular systolic function

Backgroundβ-Adrenergic receptors (ARs), including β1- and β2-AR, are involved in modulation of cardiac contractility and heart rate. Arg16Gly, a functional polymorphism in the β2-AR gene, has been reported to influence exercise capacity in heart failure patients. This study examined the association of the β2-AR Arg16Gly polymorphism with left ventricular (LV) systolic function in a biethnic population-based sample.MethodsEchocardiograms and the β2-AR Arg16Gly polymorphism were analyzed in 267 normotensive (54% African Americans) and 252 severe hypertensive (53% African Americans) adults without coronary heart disease or diabetes.ResultsThe frequencies of Gly16Gly16, Arg16Gly16, and Arg16Arg16 were 28.1%, 54.3%, and 17.6%, respectively, in normotensives, and 31.4%, 47.6%, and 21.0%, respectively, in hypertensives. In normotensives, the Gly16Gly16 homozygotes displayed greater fractional shortening (35.9% ± 4.3% v 34.1% ± 4.7% v 34.0% ± 3.9%, P = .01), ejection fraction (65.0% ± 5.8% v 62.5% ± 6.4% v 62.6% ± 5.4%, P = .01), midwall shortening (18.6% ± 1.6% v 17.9% ± 1.9% v 18.0% ± 1.6%, P = .02), and stress-corrected midwall shortening (110.1% ± 9.3% v 106.1% ± 10.6% v 108.1% ± 10.8%, P = .03) compared to the Arg16Gly16 and Arg16Arg16 groups. These associations were independent of age, sex, ethnicity, heart rate, body mass index, systolic blood pressure, LV end-diastolic dimension, and field center. No significant associations between the β2-AR Arg16Gly polymorphism and echocardiographic measures were found in hypertensives.ConclusionsThe Arg16Gly polymorphism of β2-AR may be a marker for LV chamber function and contractility in normotensive adults.     

Combined Use of Immunoreactivities of RIG-I with Efp/TRIM25 for Predicting Prognosis of Patients With Estrogen Receptor-positive Breast Cancer

BackgroundWe previously identified estrogen-responsive finger protein (Efp) as an estrogen-induced gene, and showed that the positive immunoreactivity of Efp is a poor prognostic factor for patients with breast cancer. We also demonstrated that Efp has distinctive roles in innate immunity by activating pattern recognition receptor retinoic acid-inducible gene I (RIG-I). The clinical value of RIG-I protein expression in breast cancer had not been evaluated in relationship with patients’ prognosis.Patients and MethodsTissue samples of estrogen receptor-positive invasive breast cancer were obtained from 145 female patients with breast cancer who underwent surgical treatment. Immunoreactivities of RIG-I and Efp were analyzed with the antibodies generated for the present study.ResultsPositive immunoreactivity of RIG-I was correlated with lower disease-free survival (P = .032) and was an independent poor prognostic factor (P = .043). RIG-I immunoreactivity was positively correlated with that of Efp (P = .0004). Patients with positive immunoreactivities of both RIG-I and Efp proteins were associated with a lower disease-free survival rate (P = .005).ConclusionsPositive immunoreactivity of RIG-I has clinical significance as a poor prognostic factor in patients with estrogen receptor-positive breast cancer. A positive correlation of RIG-I and Efp immunoreactivities was observed, and the combination of their immunoreactivities can be used to predict patients’ prognosis.     

Solitary thoracic intradural extramedullary ependymoma

Intradural extramedullary ependymomas of the cervical or thoracic spine are extremely rare. We present a 62-year-old woman with progressive thoracic back pain over 9 months. Magnetic resonance imaging rerevealed a thoracic intradural extamedullary tumour which was surgically removed in total. Histologic examination identified the tumour as ependymoma, WHO Grade II. Our radiological and surgical findings are consistent with the hypothesis that these turnouts develop from heterotopic glial tissue pinched off from the neural tube during its closure.