Good clinical practice should be based on evidence. Evidence quality should be based on critical appraisal in evidence based medicine (EBM). Evaluation of evidence quality plays an important role in evidence level clarifying, which is the core of EBM. Different recommendations for clinical practice often derive from evidence levels. Thus evidence quality evaluation is the first and most important step in EBM. There are lots of standards to evaluate evidence quality in the world. However there are two aspects of the evaluation, one is methodological evaluation and the other is reporting evaluation. This article collected a series of standards for clinical trials quality evaluation according to different research designs. It is hoped that the resource and introduction about the quality evaluation of clinical trials be helpful for medical researchers in China. Only being familiar with all kinds of standards of methodology and reporting, researchers could publish high quality scientific papers.
Biomedical Research ; Evidence-Based Medicine ; Guidelines as Topic ; Humans ; Meta-Analysis as Topic ; Randomized Controlled Trials as Topic

Objective To investigate the causes of visual disability and to evaluate the curative effect of visual disability aids test paired for improving the visual function in the patients with visual disability.Methods By adopting the visual acuity disability rating standards in the 2006 second national disabled sampling survey,100 patients with visual disability undergoing fitting visual aids in the ophthalmology department of the Second Affiliated Hospital of Chongqing Medical University were selected.The causes of visual disability were identified by means of ophthalmological examinatiom at the same time wearing far or near low vision aids observed the improvement degree of eyesight.Results The first cause of visual disability was retinal disease(25.00％).In wearing the distant visual aids,the off-blindness rate was 94.59 ％ and the off-disability rate was 82.43 ％;after wearing the near visual aids,the cases of near visual acuity≥0.50 accounted for 92.31％.Conclusion Retinopathy is a leading cause of adult vision disability;the aids for visual disability in the patients with visual rehabilitation have remarkable curative effect,and can improve the quality of life in the patients with visual disability.

【Objective】To observe the therapeutic effect of Qi-strengthening and yin-nourishing,stasis-removing and regeneration-promoting therapy for clinical diabetic nephropathy(CDN)and to explore its mechanism.【Methods】Eighty CDN patients with Qi-yin deficiency and stasis blocking kidney collaterals were randomized into groups A and B at the proportion of 3∶1 by using random number table.Group B(n=20)was given routine western treatment involving decreasing blood glucose,blood pressure and blood lipid,taking good quality diet with low protein,regulating water-electrolyte disturbance and acid-base balance,and preventing and curing complicated infection.Group A(n=60)was treated with Qi-strengthening and yin-nourishing,stasis-removing and regeneration-promoting herbal medicine(mainly composed of Radix Astragali,Fructus Mori,Radix Scrophulariae,Radix Angelicae Sinensis,Radix Salviae Miltiorrhizae,Radix et Rhizoma Rhei,Stigma Maydis and Rhizoma Chuanxiong).After treatment,the therapeutic effect was compared in the two groups.Meanwhile,the changes of fasting blood glucose,renal kidney,24-hour urinary protein,blood rheology,blood lipid and fibrinogen(FIB),as well as plasma endothelin 1(ET-1),tumor necrosis factor ?(TNF-?)and interleukin 1(IL-1)were observed.【Results】Qi-strengthening and yin-nourishing,stasis-removing and regeneration-promoting herbal medicine relieved the symptoms and signs of the patients,decreased 24-hour urinary protein content,and improved the renal function parameters in renal compensatory and decompensatory stages.The herbal medicine could also decrease blood lipid and fasting blood glucose levels,improve blood rheology indexes,and decrease serum IL-1 and ET-1 levels(P

Objective: To discuss the effect of group counseling on the self-control of male adolescents drug addicts. Methods: 90 male adolescents drug addicts who accepted group counseling were identified as test group, while another 97 male adolescents drug addicts who accepted no intervention as control group. Self Control Scale developed by Grasmick in 1993 was used to assess the outcome. Results: The total scores in the test group decreased from 52.06?6.67 to 47.68? 8.67, and all dimension scores were at significant level (P

Objective to analyze the relation between glycosylated hemoglobin (HbA1c) of pregnant women with gestational diabetes mellitus (GDM) and neonatal blood glucose.Methods HbA1c values of 743 pregnant women with GDM are detected,and according to HbA1c level,they were divided into 3 groups,such as G1 (HbA1c＜5.5％),G2 (5.5％≤HbA1c≤6.5％) and G3 (HbA1c＞6.5％).Newborn babies' blood glucose values of the women in each group are monitored respectively in the 1st hour and at the 4th and 8th hour.Neonatal hypoglycemia and incidence of threshold blood glucose in the three groups are compared by SPSS 17.0 software.Results (1) The incidence of neonatal hypoglycemia in G1 and G2 are both higher than thatin G3 in the 1st hour (P＜0.05).The incidence of neonatal hypoglycemia in G3 is higher than that in G1 and G2 at the 4th and 8th hour (P＜0.05).(2) With time extending,the incidence of neonatal hypoglycemia declines in G1 and G2 (P＜0.05),but there is no obvious decline in G3 (P＞0.05).(3)The incidence of threshold blood glucose in G3 and G2 are higher than that in G1 in the 1st hour,and at the 4th,8th hour(P＜0.05),and there is no obvious statistical difference between G2 and G3 (P＞0.05).(4)With time extending,the incidence of threshold blood glucose declines in G1 (P＜0.05),but it doesn't decline in G3 evidently(P＞0.05).And there was no obvious decline in G2 in the 4 hours after babies were born(P＞0.05).(5)A mother's HbA1c level has a negative correlation with her baby's blood glucose in 1 hour after birth(r=-0.401,P＜0.05).Conclusion The higher HbA1c level of pregnant women with GDM increases,the higher risks of their neonatal hypoglycemia and threshold blood glucose are.

To explore the characteristics and influenced factors associated with the onset of vertigo disease, analysis of 3 719 cases of hospitalized patients with vertigo disease from the real world. Analysis the date of patients diagnosed with vertigo disease from the hospital information system of 19 grade-III class-A hospital from 2004 to 2011, include general information, the doctor's advice, other diseases combined, diagnostic information and the relationship with the onset of 24 solar terms, and the treatment drugs. The median age of hospitalized patients with vertigo disease was 59, the number of women (65.91%) was more than men (34.09%), manual workers (85.32%) were the majority career, most patients (81.63%) condition were general by the time they were hospital admission, patients more like admitted to neurologist (70.34%) when they first time to outpatient serves, hospitalization days were in 8-14 days (46.65%), 46.04% of the patients in the hospital total cost is in 5 000 RMB to 10 000 RMB, 73.86% of patients paid by National Health Medical Insurance. Hypertension (20.79%) was the most common underlying health problems, The most common syndromes was deficiency of liver-Yin and kidney-Yin(44. 21%) , followed by hyperactivity of liver-yang, disease of phlegm turbidity in mongolia and deficiency of Qi and blood. There were more deficiency syndrome and less excess syndrome. The highest rate of hospital admission solar terms in 2009 was the insects awaken throttle (5.21%), In 2010, the highest rate solar terms of hospital admission was the rain throttle (6.14%). The most frequently used traditional Chinese medicine was gastrodine injection (20.55%), the most frequently used western medicine for betahistine (10.19%), gastrodine injection was the most traditional Chinese medicine that combination with other western medicine. Hypertension was the most underlying health problems in the patients with vertigo disease in the real world, although the mental factors should also be attention. Liver was the most closely internal organs with vertigo, and solar terms in spring was the highest-frequency time. Gastrodine injection was the most commonly used traditional Chinese medicin in clinical to treat vertigo diserse, the therapeutic regimen combining with traditional Chinese and western medicine has more advantages. We should pay more attention to the guidance of Chinese medicine "syncretism between heaven and man", to keep up with the rhythm of change, adapt to the changes in the human body growth and decline of the Yin and Yang, by adopting the method of syndrome differentiation in traditional Chinese medicine to prevention and treatment vertigo disease.
Adolescent ; Adult ; Aged ; Benzyl Alcohols ; therapeutic use ; Betahistine ; therapeutic use ; Diagnosis, Differential ; Female ; Glucosides ; therapeutic use ; Humans ; Male ; Medicine, Chinese Traditional ; methods ; Middle Aged ; Vertigo ; diagnosis ; drug therapy ; epidemiology ; Young Adult

BACKGROUND: The middle ear is a little aerated cavity with a complex anatomy and a deep location. Computed tomagraphy virtual endoscopy (CTVE) can be used to reconstruct the stereoscopic images of internal surface of hollow organs using spiral CT volumetric data, providing findings similar to fiberendoscope.OBJECTIVE: To vedfy the ability to show the normal middle ear and the clinical application of virtual endoscopy based on 64-detector CT data.DESIGN, TIME AND SETTING: A confirmatory controlled observation was performed at Department of Radiology, First Affiliated Hospital of Sun Yat-sen University between October 2005 and March 2006.PARTICIPANTS: A total of 33 patients (66 ears) with suspected middle ear disease who underwent spiral CT examination were included in this study. Among included ears, 35 were normal, and 31 were impaired, including 24 ears presenting with chronic suppurative otitis media (10 simple otitis media, 5 granulomatous otitis media, and 9 middle ear cholesteatoma), 2 ears with post-operative recurred suppurative otitis media, 2 ears with carcinoma of middle ear, and 2 ears with temporal bone fracture, and lear with foreign body granuloma.METHODS: CT images of the temporal bone were obtained using 0.5 mm thick axis slices with a soft reconstruction kemel at 0.3 mm intervals. Virtual endoscopic images of middle ear on CT were generated from volumetric data using the Navigator software. CTVE images were observed from multiple directions using the Fly Through software, and compared with the axial and coronal images and surgery findings.MAIN OUTCOME MEASURES: The following structures were observed: auditory ossicle and joints, superior, middle, and inferior tympanum, sinus tympani, external acoustic meatus, tympanum, facial recess, tegmental wall, anterior and superior ligaments of malleus, posterior ligament of incus, and retrotympanum.RESULTS: A series of images were acquired as the virtual endoscope moved from the extemal auditory canal to the middle ear cavity. CTVE displayed the structures of normal middle ear with high details in 100%, except the anterior and posterior limbs of stapes in 68.6% (24/35) and 74.3 %(26/35), respectively. In the ears with supperative otitis media, the destruction of bone of handle, head of malleus, long and short limbs of incus, and limbs of stapes was found on CTVE in 91.7%(22/24), 95.8%(23/24), 95.8%(23124), 100%(24/24), and 87.5%(21/24), respectively. CTVE clearly showed the destruction of promontory, tegmental wall and facial nerve tube in one ear with carcinoma. CTVE showed the dislocation of incudomallear joint in one ear with temporal bone fracture. It took about 10-15 minutes to perform CTVE.CONCLUSION: CTVE can be used as a noninvasive and reliable method in displaying normal and pathologic middle ears. In cases of suspected bony destruction and confirmed trauma, it is helpful for diagnosis and surgical planning. CTVE of the middle ear can currently be considered as a complementary technique to conventional CT, and it is time-saving and reserves clinical generalization.

Objective To evaluate the clinical value of multiplex ligation-dependent probe amplification (MLPA) technique used in karyotype analysis of chorionic villi from missed abortion. Methods Feb 2008 to Oct 2008, 91 patients with missed abortion diagnosed by hormonal measurement, type B ultrasound and physical exam matched with 20 normal pregnant women undergoing artificial abortion were enrolled in this study. Chorionic villi was obtained by suction dilation and curettage in aseptic condition, then those villi was cultured and analyzed by traditional cytogenetic karyotyping method, in the mean time, the DNA extracted from villi was detected by MLPA. The results of chromosomal G-banding of chorionic villi were compared between two methods. Results The diagnostic concordance of MLPA and traditional karyotyping was observed in 92% (84/91) cases, there were 84 cases in the case group with diagnostic concordance by traditional karyotyping and MLPA except 7 cases of euploidy could not be detected by MLPA. The 84 cases included 40 normal karyotype,29 trisomy of euchromosome, 1 double trisomy of euchromosome, 10 monosomy X , 1 monosomy X combined with trisomy of euchromosome, 2 chimaera of X chromosome, 1 structural abnormity of euchromosome. Among 7 cases with discordance diagnosis, 2 cases with trisomy and 5 cases with tetrasomy of euchromosome were identified in traditional karyotyping, however, they were all diagnosed with normal disomy by MLPA. Of 20 villi from normal pregnancy, two methods got the consistent results. Conclusion The MLPA was rapid and efficacy method used for analyzing aneuploids in chorionic villi.

Objective To investigate the effect of rosuvastatin on the morphine tolerance in rats and the underlying mechanism.Methods Forty-eight male Sprague-Dawley rats,weighing 200-250 g,were randomly divided into 6 groups (n =8 each):control group (group C),morphine tolerance group (group MT),rosuvastatin control group (group RC),rosuvastatin 0.4 mg/kg group (group R1),rosuvastatin 2.0 mg/kg group (group R2)and rosuvastatin 10.0 mg/kg group (group R3).Morphine tolerance was induced by subcutaneous injection of morphine 10.0 mg/kg at 8:00 and 16:00 everyday for 5 consecutive days.The equal volume of normal saline was given in groups C and RC.Normal saline 10 ml/kg was injected through a gastric tube into stomach everyday at 30 min after subcutaneous injection of normal saline or morphine for 5 consecutive days in groups C and MT.Rosuvastatin 10,0.4,2.0 and 10.0 mg/kg were injected through a gastric tube into stomach everyday at 30 min after subcutaneous injection of normal saline or morphine for 5 consecutive days in groups RC,R1,R2 and R3,respectively.The paw withdrawal latency to nociceptive thermal stimulation was measured 1 day before (T1) and 1 day after morphine tolerance was induced (T2).The percentage of maximal possible effect (MPE) was calculated.The rats were sacrificed after the last measurement of pain threshold and the L5 segment of the spinal cord was removed for determination of the expression of extracellular signal-regulated kinase (ERK) and phosphorylated ERK (p-ERK)(by Western blot) and contents of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) (by ELISA).Results Compared with group C,MPE was significantly decreased at T2 and the expression of p-ERK and contents of IL-1β and TNF-α were increased in groups MT and R1 (P ＜ 0.05).Compared with group MT,MPE was significantly increased at T2 and the expression of p-ERK and contents of IL-1β and TNF-α were decreased in groups RC,R2 and R3 (P ＜ 0.05).There was no significant difference in the indicators mentioned above between groups R2 and R3,and in the expression of ERK between the six groups (P ＞ 0.05).Conclusion Rosuvastatin can attenuate the morphine tolerance in rats by inhibiting the phosphorylation of ERK and decreasing the level of IL-1β and TNF-α.

Objective To investigate the long-term prognosis and possible risk factors of acute kidney injury(AKI)following cardiac surgeries. Methods Clinical data of 941 patients undergoing open heart surgery from January 2004 to June 2007 were retrospectively analyzed.Survival and renal function of above patients were informed through telephone or clinic follow-up till February 2010.Long-term survival was analyzed using risk-adjusted Cox proportional hazards regression model. Results Of the 941 patients after cardiac surgery,275(29.2%)developed AKI and 666(70.8%)did not.Survival was worse in patients with AKI(67.8%vs 85.6%,P<0.01)and was proportional to its severity (AKIN 1,2 and 3 stages:70.7%,62.3%and 58.6%,P<0.01).Although 90.5% of patients had complete renal recovery after AKI at discharge of hospital,they still had an increased risk for death during follow-up compared with patients without AKI (69.6% vs 85.6%,P<0.01).In the Cox proportional hazards regression model,age(HR=2.238),anemia (HR=1.625),prolonged operation time (HR=1.153),AKI severity (HR=1.473)were independent risk factors for long-term prognosis after cardiac surgery.At the end of the follow-up,patients with AKI had statistically higher Scr than non-AKI patients(107.6 μmol/L vs 83.0 μmol/L,P=0.014),and among those AKI patients,34.0%progressed into CKD 3-5 stages,34.8%developed double serum creatinine. Conclusions AKI is a risk factor for the long-term prognosis of cardiac surgery.Patients with complete renal recovery after AKI still has an increased risk for death and poor renal function compared with patients without AKI.