Reliability and External Validity of AMSTAR in Assessing Quality of TCM Systematic Reviews

Objective. The aim of this study is to measure the reliability and external validity of AMSTAR by applying it to a sample of TCM systematic reviews. Study Design and Methods. We tested the agreement, reliability, construct validity, and feasibility of AMSTAR through comparisons with OQAQ. Statistical analyses were performed by using SPSS 13.0. Results. A random of sample with 41 TCM systematic reviews was selected from a database. The interrater agreement of the individual items of AMSTAR was moderate with a mean kappa of 0.50 (95% CI: 0.26, 0.73). The ICC for AMSTAR against OQAQ (total score of 9 items, excluding item 10) was 0.87 (95% CI: 0.76, 0.93). Conclusions. Although there is room for improvement on few items, the new tool is reliable, valid, and easy to use for methodological quality assessment of systematic reviews on TCM

Circulating tissue factor-positive procoagulant microparticles in patients with type 1 diabetes

Aim: To investigate the count of circulating tissue factor-positive (TF+) procoagulant microparticles (MPs) in patients with type 1 diabetes mellitus (T1DM). Methods: This case-control study included patients with T1DM and age and sex-matched healthy volunteers. The counts of phosphatidylserine-positive (PS+) MPs and TF(+)PS(+)MPs and the subgroups derived from different cell types were measured in the peripheral blood sample of the two groups using multicolor flow cytometric assay. We compared the counts of each MP between groups as well as the ratio of the TF(+)PS(+)MPs and PS(+)MPs (TF(+)PS(+)MPs/PS(+)MPs). Results: We recruited 36 patients with T1DM and 36 matched healthy controls. Compared with healthy volunteers, PS(+)MPs, TF(+)PS(+)MPs and TF(+)PS(+)MPs/PS(+)MPs were elevated in patients with T1DM (PS(+)MPs: 1078.5 +/- 158.08 vs 686.84 +/- 122.04/mu L, P &lt;0.001; TF(+)PS(+)MPs: 202.10 +/- 47.47 vs 108.33 +/- 29.42/mu L, P &lt;0.001; and TF(+)PS(+)MPs/PS(+)MPs: 0.16 +/- 0.04 vs 0.19 +/- 0.05, P = 0.004), mostly derived from platelet, lymphocytes and endothelial cells. In the subgroup analysis, the counts of total and platelet TF(+)PS(+)MPs were increased in patients with diabetic retinopathy (DR) and with higher HbA1c, respectively. Conclusion: Circulating TF(+)PS(+)MPs and those derived from platelet, lymphocytes and endothelial cells were elevated in patients with T1DM.De tre första författarna delar förstaförfattarskapet.</p

Validity and Reproducibility of a Revised Semiquantitative Food Frequency Questionnaire (SQFFQ) for Women of Age-group 12-44 Years in Chengdu

To find a credible nutritional screening tool for evaluating relationship between nutritional status and diseases in Chengdu female residents, the reliability and validity of a revised semi-quantitative food frequency questionnaire (SQFFQ) were tested. The validity was assessed by comparing the SQFFQ with the \u2018standard\u2019 method of 3 days\u2019 dietary recall, and the reliability was assessed by comparing the first SQFFQ with the second SQFFQ at 4 weeks interval. Correlation analysis showed that, for reliability, the average correlation coefficient (CC) of 22 kinds of nutrients was 0.66 and reduced to 0.60 after adjusting for energy; the average of intra-class correlation coefficients (ICC) was 0.65. For validity, the average CC was 0.35 and remained stable after adjusting for CC of energy or nutrients. Validity of 17 nutrients in SQFFQ survey had correlation with result of 3 days\u2019 dietary recall. The results showed that the revised SQFFQ can be used for investigating the role of nutrients in development of disease in Chengdu female residents

Recombinant mycobacterium tuberculosis fusion protein for diagnosis of mycobacterium tuberculosis infection: a short-term economic evaluation

ObjectivesRecombinant Mycobacterium tuberculosis fusion protein (EC) was anticipated to be used for the scale-up of clinical application for diagnosis of Mycobacterium tuberculosis infection in China, but it lacked a head-to-head economic evaluation based on the Chinese population. This study aimed to estimate the cost-utility and the cost-effectiveness of both EC and tuberculin pure protein derivative (TB-PPD) for diagnosis of Mycobacterium tuberculosis infection in the short term.MethodsFrom a Chinese societal perspective, both cost-utility analysis and cost-effectiveness analysis were performed to evaluate the economics of EC and TB-PPD for a one-year period based on clinical trials and decision tree model, with quality-adjusted life years (QALYs) as the utility-measured primary outcome and diagnostic performance (including the misdiagnosis rate, the omission diagnostic rate, the number of patients correctly classified, and the number of tuberculosis cases avoided) as the effective-measured secondary outcome. One-way and probabilistic sensitivity analyses were performed to validate the robustness of the base-case analysis, and a scenario analysis was conducted to evaluate the difference in the charging method between EC and TB-PPD.ResultsThe base-case analysis showed that, compared with TB-PPD, EC was the dominant strategy with an incremental cost-utility ratio (ICUR) of saving 192,043.60 CNY per QALY gained, and with an incremental cost-effectiveness ratio (ICER) of saving 7,263.53 CNY per misdiagnosis rate reduction. In addition, there was no statistical difference in terms of the omission diagnostic rate, the number of patients correctly classified, and the number of tuberculosis cases avoided, and EC was a similar cost-saving strategy with a lower test cost (98.00 CNY) than that of TB-PPD (136.78 CNY). The sensitivity analysis showed the robustness of cost-utility and cost-effectiveness analysis, and the scenario analysis indicated cost-utility in EC and cost-effectiveness in TB-PPD.ConclusionThis economic evaluation from a societal perspective showed that, compared to TB-PPD, EC was likely to be a cost-utility and cost-effective intervention in the short term in China

Correlation between surrogate endpoints and overall survival in unresectable hepatocellular carcinoma patients treated with immune checkpoint inhibitors: a systematic review and meta-analysis

Abstract This study aimed to assess the therapeutic effect of immune checkpoint inhibitors (ICIs) in patients with unresectable hepatocellular carcinoma (uHCC) and investigate the correlation between surrogate endpoints and overall survival (OS). A systematic literature search included phase I, II, and III clinical trials comparing ICIs to placebo or other therapies for uHCC treatment. Correlations between OS and surrogate endpoints were evaluated using meta-regression analyses and calculating the surrogate threshold effect (STE). The correlation analysis showed a weak association between OS and progression-free survival (PFS), with an R2 value of 0.352 (95% CI: 0.000–0.967). However, complete response (CR) exhibited a strong correlation with OS (R2 = 0.905, 95% CI: 0.728–1.000). Subgroup analyses revealed high correlations between OS and PFS, CR, stable disease (SD), and DC in phase III trials (R2: 0.827–0.922). For the ICI + IA group, significant correlations were observed between OS and SD, progressive disease (PD), and grade 3–5 immune-related adverse events (irAEs) (R2: 0.713–0.969). Analyses of the correlation between survival benefit and risk of mortality across various time points showed a strong association within the first year (R2: 0.724–0.868) but a weak association beyond one year (R2: 0.406–0.499). In ICI trials for uHCC, PFS has limited utility as a surrogate endpoint for OS, while CR exhibits a strong correlation with OS. Subgroup analyses highlight high correlations between OS and PFS, SD, and DC in phase III trials. Notably, the ICI + IA group shows significant associations between OS and SD, PD, and grade 3–5 irAEs. These findings offer valuable insights for interpreting trial outcomes and selecting appropriate endpoints in future clinical studies involving ICIs for uHCC patients

Combination of α-blocker and 5α-reductase inhibitor for treatment of benign prostatic hyperplasia

Purpose: This study compared the efficacy of an α-blocker monotherapy alone with a combination of α-blocker plus 5α-reductase in treatment of benign prostatic hyperplasia (BPH). Methods: Medline (PubMed), EMBASE, CENTRAL (Cochrane databases) and Google Scholar were searched until May 2015 using the following search terms: ([α-blocker] AND 5α-reductase inhibitor) AND benign prostatic hyperplasia; and benign prostatic hyperplasia AND (adrenergic alpha blockers OR 5 alpha reductase inhibitor). Randomized controlled trials (RCTs) that included men with a clinical diagnosis of BPH were included. Eligible studies had to have an intervention group that received combination therapy (5α reductase inhibitor plus α-blocker) and a control group that received only α-blocker. Quality assessment and sensitivity analysis were performed. Results: Six studies were included. Combination therapy was found to significantly reduce urinary retention incidence rate (OR=0.286, 95%CI: 0.199 - 0.412,

The relationship between external and internal validity of randomized controlled trials: A sample of hypertension trials from China

Objective: To explore the relationship between the external validity and the internal validity of hypertension RCTs conducted in China. Methods: Comprehensive literature searches were performed in Medline, Embase, Cochrane Central Register of Controlled Trials (CCTR), CBMdisc (Chinese biomedical literature database), CNKI (China National Knowledge Infrastructure/China Academic Journals Full-text Database) and VIP (Chinese scientific journals database) as well as advanced search strategies were used to locate hypertension RCTs. The risk of bias in RCTs was assessed by a modified scale, Jadad scale respectively, and then studies with 3 or more grading scores were included for the purpose of evaluating of external validity. A data extract form including 4 domains and 25 items was used to explore relationship of the external validity and the internal validity. Statistic analyses were performed by using SPSS software, version 21.0 (SPSS, Chicago, IL). Results: 226 hypertension RCTs were included for final analysis. RCTs conducted in university affiliated hospitals (P < 0.001) or secondary/tertiary hospitals (P < 0.001) were scored at higher internal validity. Multi-center studies (median = 4.0, IQR = 2.0) were scored higher internal validity score than single-center studies (median = 3.0, IQR = 1.0) (P < 0.001). Funding-supported trials had better methodological quality (P < 0.001). In addition, the reporting of inclusion criteria also leads to better internal validity (P = 0.004). Multivariate regression indicated sample size, industry-funding, quality of life (QOL) taken as measure and the university affiliated hospital as trial setting had statistical significance (P < 0.001, P < 0.001, P = 0.001, P = 0.006 respectively). Conclusion: Several components relate to the external validity of RCTs do associate with the internal validity, that do not stand in an easy relationship to each other. Regarding the poor reporting, other possible links between two variables need to trace in the future methodological researches

Antidepresivos para el síndrome de ovario poliquístico

Antecedentes: La prevalencia de depresión en pacientes con síndrome de ovario poliquístico (SOPQ) es alta; un estudio ha revelado que supera en cuatro veces la de las pacientes sin SOPQ. Por lo tanto, es importante la evaluación sistemática de la efectividad y la seguridad de los antidepresivos para las pacientes con SOPQ. Objetivos: Evaluar la efectividad y la seguridad de los antidepresivos en cuanto al tratamiento de la depresión y otros síntomas en pacientes con SOPQ. Métodos de búsqueda: Se realizaron búsquedas en las siguientes bases de datos desde su inicio hasta junio de 2012: el registro de ensayos del Grupo Cochrane de Trastornos Menstruales y Subfertilidad (Cochrane Menstrual Disorders and Subfertility), el Registro Cochrane Central de Ensayos Controlados (Cochrane Central Register of Controlled Trials), MEDLINE, EMBASE, PsycINFO y Chinese National Knowledge Infrastructure, el metaRegister of Controlled Trials (controlled-trials.com), el National Institute of Health Clinical Trials register (clinicaltrials.gov) y en el portal de búsqueda de la World Health Organization International Trials Registry Platform (www.who.int/trialsearch/Default.aspx). Criterios de selección: Sólo se incluyeron en la revisión los ensayos controlados aleatorios (ECA) que estudiaban la efectividad y la seguridad de los antidepresivos en pacientes con SOPQ. Obtención y análisis de los datos: La calidad metodológica de los ensayos fue evaluada de forma independiente por dos revisores, de forma paralela a la extracción de datos. El riesgo de sesgo en los estudios incluidos se evaluó en seis dominios: 1. generación de secuencia: 2. ocultación de la asignación; 3. cegamiento de los participantes, personal y evaluadores de resultados; 4. completitud de los datos de resultado; 5. informe selectivo de los resultados; 6. otras fuentes potenciales de sesgo. Resultados principales: No se encontraron estudios que informaran ninguno de los resultados primarios de la revisión (puntuaciones de la depresión y del trastorno del estado de ánimo relacionado, calidad de vida y eventos adversos). Sólo un estudio con 16 mujeres era elegible para la inclusión. Este estudio comparó sibutramina versus fluoxetina en pacientes con SOPQ, e informó sólo resultados endócrinos y metabólicos. Estuvo poco claro si las participantes tenían problemas psicológicos al inicio. No se hallaron diferencias significativas entre los grupos para ninguno de los resultados medidos. Conclusiones de los autores: No existen pruebas sobre la efectividad y la seguridad de los antidepresivos para el tratamiento de la depresión y otros síntomas en pacientes con SOPQ

The external validity of randomized controlled trials of hypertension within China: from the perspective of sample representation.

OBJECTIVE: To explore external validity of randomized controlled trials (RCTs) of hypertension within China from the view of sample representation. METHODS: Comprehensive literature searches were performed in Medline, Embase, Cochrane Central Register of Controlled Trials (CCTR) et al and advanced search strategies were used to locate hypertension RCTs as well as observational studies conducted in China during 1996 to 2009 synchronously. The risk of bias in RCTs and observational studies was assessed by two modified scales respectively, and then both types of studies with 3 or more grading scores were included for the purpose of evaluating of external validity. Following that the study characteristics relative to sample representation were extracted from RCTs and observational studies synchronously, and the later were taken as external references for validating sample representation of RCTs. RESULTS: 226 hypertension RCTs and 21 observational studies were included for final analysis. Comparing samples with observational studies, the mean age of samples within RCTs was 54.46 years, significantly lower than that of observational studies (66.35 years) (P=0.002). The average disease course in patients of RCTs was 3.89 years and grade III hypertensive patients accounted for 17%; both were lower than that of the observational studies (12.96 years, P<0.001; 34%, P=0.026 respectively). In addition, the proportions of patients with complications due to heart failure, stroke, diabetes, or coronary heart disease in RCTs were 8%, 5%, 12% and 11% correspondingly, all of which were significantly less than that of observational studies (11%, 18%, 17% and 29%). CONCLUSION: Sample characteristics within hypertension RCTs were significantly different from those in observational studies. The samples in most RCTs were under-represented. It's feasible to take samples of observational studies as a mirror of the actual composition of hypertension patients in the real world, if the reporting of observational studies is abundant and available