In February 2020, the American College of Gastroenterology (ACG) published the latest guideline on chronic pancreatitis, and put forward practical recommendations on the etiology, natural history, diagnosis, treatment, prognosis and follow-up of chronic pancreatitis. This paper aims to provide references for the diagnosis and treatment of chronic pancreatitis in China by interpreting the main content of the guideline and comparing it with related guidelines or consensuses domestically and abroad.
Objective To study the effect of autogenous bone marrow on guided bone regeneration (GBR),and evaluate the repairing ability of GBR in bone defect with autogenous bone marrow. Methods Ten mm segmental defects were produced in both radii of 18 rabbits. The defect was bridged with a silicon tube. Autogenous bone marrow was injected into the tube on the experimental group at 0, 2,4 weeks after operation, and peripheralblood into the control group at thesame time. The X-ray, gross, histological and biochemical examinations were observed invarious times. Results The new bone formation of experimental group was prior to that of control group; calcium and alkaline phosphatase of experimental groupwere higher than those of control group. The experimental group had all been healed at the tenth week, but no one healed in control group. Conclusion It can be conclude that autogenous bone marrow can stimulate bone formation and facilitate GBR in bone defect.
Diabetic retinopathy (DR) is the most common cause of preventable blindness in the working-age population. In addition to optimizing the hyperglycemia, hypertension, hyperlipidemia and other risk factors, regular fundus examination is essential for early diagnosis asymptomatic DR and timely treat the sight-threatening DR, so as to reduce blindness and severe visual impairment caused by DR. Clinical practice guidelines for the screening and management of DR have been implemented throughout the world, but there are reasonable differences between existing guidelines in the recommended timing of first retinal examination, screening intervals, methods for examination and criteria for referral to an ophthalmologist. It is of great clinical significance to have a detailed understanding of the current guidelines for DR screening and their clinical basis.
Evidence-based guidelines for diagnosis and treatment of diabetic retinopathy in China (2022) is based on evidences in recent clinical trials and a system of Grading of Recommendations, Assessment, Development and Evaluation of evidence quality and strength of recommendations. The main key points around why the diabetic macular edema (DME) changes the classification, what thresholds for initiating anti-vascular endothelial growth factor (VEGF) drug therapy; eyes with center-involved DME (CI-DME) and good vision for clinical significant macular edema still treated by focal laser even with good vision, the clinical pathway for CI-DME changes first-line treatment from laser to anti-VEGF, loading dose of anti-VEGF for CI-DME in non-proliferative diabetic retinopathy (DR) from 3 injections up to 4-5 injections is recommended; severe non-proliferative DR and proliferative DR with vision impairment but without hemorrhages and retinal traction could be considered first treatment of anti-VEGF comparing to initiate pan-retinal photocoagulation (PRP) (weakly recommended), PRP is still gold-standard for progressive non-perfusion area of retina. With the rapid development of DR evaluation devices such as optical coherence tomography, wide-angle optical coherence tomography angiography and wide-angle fluorescein fundus angiography, imaging biomarkers have been provided for the degree of DR lesion, treatment response and prognosis. It is believed that the clinical practice will be promoted a new height by the 2022 edition of Chinese DR guideline.
ObjectiveTo study the function and effectiveness of self-manufacture osteotomy guide device in osteotomy. MethodsA guide device was manufactured, which could guide the drill and osteotome. Sixty femoral moulds which cover with bubble were used as human femurs, and a 3 cm long, 1 cm wide crack was made in the femoral moulds supracondylar to imitate operation incision. The femoral moulds were divided into 3 groups (n=20): non-guiding group (group A), simple drill guiding group (group B), and drill-osteotome guiding group (group C). The osteotomy time, the variation range of the drill holes (incision side and the contralateral side), the variation range of the osteotome incisions (incision side and the contralateral side), and the match rate of drill holes and osteotome incision were recorded. And between February 2013 and January 2014, the osteotomy guide device was used to guide proximal tibia osteotomy in 6 patients with tibia infected nonunion to excise of infected bones. ResultsThe osteotomy time of groups B and C was significantly less than that of group A, and it was significantly less in group C than group B (P<0.01). The match rate of drill holes and osteotome incision in groups B and C was significantly higher than that of group A, and group C was significantly higher than group B (P<0.05). The variation range of the drill holes in both incision side and contralateral side of groups B and C was 0, which was significantly less than that of group A (P<0.01). The variation range of the osteotome incisions in both incision side and contralateral side of groups B and C was significantly less than that of group A, group C was significantly less than group B (P<0.01). Preliminary clinical results showed that the osteotomy guide device was simple to use, and precise in guidance for drill and osteotome, so it could reduce the time for repeated targeting during drilling and osteoming. The osteotomy time was 8.3-11.2 minutes (mean, 9.5 minutes). The surface of osteotomy was smooth and no split;and there was rich callus formation during bone transport. Six patients were followed up 13-25 months (mean, 16 months). The bone healing index was 0.92±0.13. ConclusionThe osteotomy guide device can reduce the damage to surrounding tissue and bone caused by drill and osteotome, reduce the difficulty of osteotomy, and significantly shorten the cost time.
Based on the site visit on the current application and practice of evidence-based medicine in USA, we find the difference between China and USA so as to further promote and plan the development of evidence-based medicine in China.
Surgical management of osteoarthritis of the knee: evidence based guideline contains 38 recommendations pertaining to the preoperative, perioperative, and postoperative care of patients with knee osteoarthritis (KOA) who are considering surgical treatment. Compared with the domestic consensus on diagnosis and treatment for KOA, this clinical practice guideline (CPG) prepared by the American Academy of Orthopedic Surgeons (AAOS) has some advantages in terms of methodology selection and recommendation. Therefore, it is necessary for us to interpret this CPG to speed up the understanding and dissemination of the CPG. The ultimate aims are to: ① strengthen the standardization and understanding of surgical treatment of KOA; ② enhance the understanding of clinicians for this CPG in treating KOA; ③ speed up the development of guideline development methodologies in China; ④ provide methodological guidance for the development of CPG based on the current situation in China.
The patency of vascular access is of great significance to hemodialysis patients. Combining with guidelines and literature associated with vascular access for dialysis in recent years, the authors interpret the effectiveness and limitations of prophylactic drug strategies, including using fish oil, anticoagulation, anti-platelet, lipid-lowering agents, etc., in order to promote the proper use of these agents in clinical practice, and improve the effect of prophylaxis and treatment of vascular access dysfunction.
ObjectiveTo evaluate the reliability and validity of Guideline Implementation Success Assessment Tool (A-GIST). MethodsWith the guideline for the prevention and treatment of type 2 diabetes mellitus in China (2020 edition) as the target guideline, health care providers and patients from different hospitals across the country were investigated by questionnaire using A-GIST. Spearman-Brown coefficient and Cronbach's α coefficient were used to evaluate the split-half reliability and internal consistency reliability, while the structural validity, convergent validity and discriminant validity were investigated by confirmatory factor analysis based on structural equation. ResultsThe internal consistency reliability and split half reliability coefficients of the whole tool and each dimension ranged from 0.650 to 0.986. The scale-level content validity index (S-CVI/Ave) of content validity was 0.846. Confirmatory factor analysis showed that, the χ2/df of two sections of the tool were 8.695 and 6.123, respectively. The root mean square residual (RMR), the standard root mean square residual (SRMR) and the root mean square error of approximation (RMSEA) were under or almost under the threshold. Besides, the goodness-of-fit index (GFI) of them were 0.901 and 0.822, the adjusted goodness-of-fit index (AGFI) were 0.836 and 0.787, and the parsimonious normed fit index (PNFI) were 0.545 and 0.788, respectively. ConclusionGuideline Implementation Success Assessment Tool (A-GIST) was proved to be valid and reliable, and it shows that it is necessary to optimize the items under the dimensions of maintenance and evaluation of diagnosis and treatment effect in the future.