Methods for development of a core outcome set for clinical trials integrating traditional Chinese medicine and Western medicine

Clinical trial outcome reporting differs between studies integrating traditional Chinese medicine (TCM) and Western medicine, so that some clinical trials are not eligible for inclusion in a systematic review. The excluded studies are therefore less widely disseminated, and even valid studies are less likely to yield impact. This problem may be addressed by developing core outcome sets (COSs) for integrative medicine in specific healthcare areas. The first stage of development is to define the scope of the COS for integrative medicine, the second stage is to establish the need for such a COS, and the third stage is to develop a protocol and register the COS. The final stage involves three steps: (i) development of a comprehensive list of outcomes (including efficacy outcomes and safety outcomes and TCM syndromes) using systematic review, qualitative or cross-sectional research, and reviews of package inserts and medical records; (ii) merging and grouping of outcomes within domains; (iii) conducting two rounds of Delphi survey and consensus meetings with a range of stakeholders. The final COS will include a general COS and core TCM syndrome- set. Development of COSs for clinical trials of integrative medicine may help to standardize outcome reporting and reduce publication bias in the future.     

The state of frailty in research: A mapping review of its clinical applicability to practice

Research on frailty has expanded in the last decade, but direct evidence supporting its implementation in clinical practice may be limited. This mapping review synthesizes the contexts-of-use and overall clinical applicability of recent pre-COVID frailty research. We sampled 476 articles from articles published on frailty in PubMed and EMBASE in 2017–2018, of which 150 articles were fully appraised for the contexts-of-use, definitions, and interventions. A clinical applicability framework was used to classify articles as practice-changing, practice-informing, or not practice-informing. Of the 476 sampled articles, 31% (n = 150) used frailty in functions that could inform a clinical indication: predictor or mediator (26%, n = 125), selection criterion (3%, n = 15), and effect modifier (2%, n = 10). Articles spanned all health disciplines, and cohort studies comprised 91% (n = 137) of studies and trials 9% (n = 13). Thirty-eight frailty definitions using varied cut-offs and a wide range of interventions were identified. Among all articles, 13% (n = 63) of articles were practice-informing, 2% (n = 11) potentially practice-changing, and 0.2% (n = 1) clearly practice-changing. Lack of well-defined intervention and identifiable effect (96%) or originality (83%) were predominant reasons reducing applicability. Only a minority of recent frailty research provides direct evidence of applicability to practice. Future research on frailty should focus on translating frailty, as a risk factor, into a clinical indication and address definition ambiguity.     

Loss of GRB2 associated binding protein 1 in arteriosclerosis obliterans promotes host autophagy

Background:Arteriosclerosis obliterans (ASO) is a major cause of adult limb loss worldwide. Autophagy of vascular endothelial cell (VEC) contributes to the ASO progression. However, the molecular mechanism that controls VEC autophagy remains unclear. In this study, we aimed to explore the role of the GRB2 associated binding protein 1 (GAB1) in regulating VEC autophagy.Methods:In vivo and in vitro studies were applied to determine the loss of adapt protein GAB1 in association with ASO progression. Histological GAB1 expression was measured in sclerotic vascular intima and normal vascular intima. Gain- and loss-of-function of GAB1 were applied in VEC to determine the effect and potential downstream signaling of GAB1.Results:The autophagy repressor p62 was significantly downregulated in ASO intima as compared to that in healthy donor (0.80 vs. 0.20, t = 6.43, P < 0.05). The expression level of GAB1 mRNA (1.00 vs. 0.24, t = 7.41, P < 0.05) and protein (0.72 vs. 0.21, t = 5.97, P < 0.05) was significantly decreased in ASO group as compared with the control group. Loss of GAB1 led to a remarkable decrease in LC3II (1.19 vs. 0.68, t = 5.99, P < 0.05), whereas overexpression of GAB1 significantly led to a decrease in LC3II level (0.41 vs. 0.93, t = 7.12, P < 0.05). Phosphorylation levels of JNK and p38 were significantly associated with gain- and loss-of-function of GAB1 protein.Conclusion:Loss of GAB1 promotes VEC autophagy which is associated with ASO. GAB1 and its downstream signaling might be potential therapeutic targets for ASO treatment.     

目标教学路径在实习护生带教中的应用研究

目的：探讨目标教学路径在实习护生带教中的应用效果及意义。方法护生入科后随机分为对照组和观察组，对照组采用传统带教模式，即根据教学大纲要求带教老师自行安排教学内容；观察组采用目标教学路径模式进行带教。实习结束后，比较两组护生的理论知识、操作技能、临床能力、职业素质及对带教工作的满意度。结果对照组和观察组理论知识得分为（92．85 ± 2．03）分、（95．65 ± 2．19）分，操作技能得分为（88．95 ± 2．84）分、（93．56 ± 2．19）分，临床能力得分为（7．39±0．34）分、（7．95±0．54）分，职业素质得分为（87．12±4．05）分、（89．59 ± 3．81）分，满意度得分为（95．02±4．10）分、（97．91 ± 3．03）分，两组各项评价指标经统计学检验，观察组均优于对照组，差异有统计学意义（P＜0．05）。结论目标教学路径能够统一教学内容，明确教学目标；规范教学行为，保证教学质量；加强职业素养，提高带教满意度。因此，目标教学路径带教模式优于传统带教模式。     

Chirurgie bariatrique et fantasmes de métamorphose

ObjectivesIn this study, we will show that the believing of an “identity metamorphosing” of the subject with obesity by bariatric surgery is a fantasy construction built by both patients and caregivers. We will analyze the reasons and the repercussions of these fantasies on the care, both on the patients’ subjective experiences and on caregivers’ practices. At last, we will propose the idea that the surgical event and his consequences will be inscribed, at the opposite of a “metamorphosis”, in a subjective continuity for the operated person, as the insistence of symptomatic expressions across and beyond the organic and compartmental changes linked to the surgery reflects it.Materiel and MethodsMost of the patients investigated for this study were treated with Sleeve Gastrectomy and Roux-en-Y Gastric Bypass but some of them were not treated yet and expected for a surgery. In all cases (i.e. when they were not operated yet and when they were asking for a second surgery because in failure by gaining weight), they were brought to discuss on their surgery request. Surgery-experienced patients also have to comment the surgery's effects on their body and its image, their eating behaviors and their relationships with the others (companion, friends, family, etc.). For caregivers, the results are extracted from different clinical discussions about patients or about ways of caring all along the multidisciplinary support. Patients and caregivers were both asked to talk about their representations on bariatric surgery.ResultsWe observed two types of fantasies: “split” fantasy built by patients and “recovery” fantasy built by caregivers. The “split” fantasy is the believing of a magical and ideal surgery that allows “identity metamorphosing” of the subject with obesity. For these patients, “split” fantasies can be related to the desire of the other or can appear through weight's objectives. For the caregivers, and as “split” fantasies, “recovery” fantasies can be related to an idealization of the operation in itself and the obesity “psychiatrization”. On the other side, we have seen that some psycho-sensory symptoms emerged after surgery: patients present disgust for aliments they used to appreciate. By discussing with these patients, we realize that these aliments were associated with traumatic experiences and memories that potentially lead them to construct their obesity. These symptoms seem to be an opened-door to the operated subject's unconscious and are related to the subject's psychical continuity.ConclusionThe identity metamorphosing resulting from bariatric surgery is a fantasy built by both patients and caregivers. These fantasies have an influence on the medical support and potentially lead the treatment to failure. They should be identified and analyzed before the request, during the transformations due to the operation itself, and after weight stabilization (when the operated subject continues to reorganize his relationships to the other and to the culture pressure). Also, as the symptoms produced by bariatric surgery mobilize traumatic memories from before, they reveal a subjective truth: the traumatic past cannot be erased by body changes. And if the patient's past continues to be ignored by caregivers, it is condemned to repeat itself and potentially compromising the treatment at term. Thus, caregivers should be able to pay attention to the subjective continuity of the patient's history in order to ameliorate the reception and the accompaniment of persons with obesity in a bariatric surgery procedure.     

【开放获取】特应性皮炎湿包疗法临床应用专家共识

【摘要】 湿包疗法治疗特应性皮炎安全有效，但如何合理、有效、安全地使用已经成为临床工作中受关注的问题。为此，我国皮炎湿疹领域部分专家依据国内外研究数据和临床经验，结合中国患者的特点，在深入讨论的基础上制定本共识，涉及湿包疗法的作用机制、适应证和禁忌证、治疗方法、疗效与安全性、特殊人群以及家庭湿包疗法等方面，为临床医生提供具体的指导意见。     

多次法根管治疗与一次性根管治疗牙体牙髓病临床疗效观察

目的分析牙体牙髓病患者接受多次法根管治疗与一次性根管治疗的临床疗效。方法将2019年6月~2020年9月作为研究时间段,选取期间我院接诊的74例牙体牙髓病患者,其中12例有牙源性上颌窦炎,另将随机数字表法作为分组依据,将全部病例分为对照组(行多次法根管治疗,纳入37例)、研究组(行一次性根管治疗,纳入37例),对组间牙齿咀嚼情况、治疗效果展开分析。结果研究组牙齿咬合力、牙龈指数(GI)、牙龈出血指数(SBI)在治疗后均优于对照组,且治疗效果(97.29%)优于对照组(78.38%),P<0.05。结论一次性根管治疗对改善牙体牙髓病患者牙齿咀嚼功能、临床症状有较好效果,值得推广。