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ImportanceMyopia in school-aged children is a public health issue worldwide; consequently, effective interventions to prevent onset and progression are required.ObjectiveTo investigate whether SMS text messages to parents increase light exposure and time outdoors in school-aged children and provide effective myopia control.Design, Setting, and ParticipantsThis randomized clinical trial was conducted in China from May 2017 to May 2018, with participants observed for 3 years. Of 528 965 primary school–aged children from Anyang, 3113 were randomly selected. Of these, 268 grade 2 schoolchildren were selected and randomly assigned to SMS and control groups. Data were analyzed from June to December 2021.InterventionsParents of children in the SMS group were sent text messages twice daily for 1 year to take their children outdoors. All children wore portable light meters to record light exposure on 3 randomly selected days (2 weekdays and 1 weekend day) before and after the intervention.Main Outcomes and MeasuresThe co–primary outcomes were change in axial length (axial elongation) and change in spherical equivalent refraction (myopic shift) from baseline as measured at the end of the intervention and 3 years later. A secondary outcome was myopia prevalence.ResultsOf 268 grade 2 schoolchildren, 121 (45.1%) were girls, and the mean (SD) age was 8.4 (0.3) years. Compared with the control group, the SMS intervention group demonstrated greater light exposure and higher time outdoors during weekends, and the intervention had significant effect on axial elongation (coefficient, 0.09; 95% CI, 0.02-0.17;P = .01). Axial elongation was lower in the SMS group than in the control group during the intervention (0.27 mm [95% CI, 0.24-0.30] vs 0.31 mm [95% CI, 0.29-0.34];P = .03) and at year 2 (0.39 mm [95% CI, 0.35-0.42] vs 0.46 mm [95% CI, 0.42-0.50];P = .009) and year 3 (0.30 mm [95% CI, 0.27-0.33] vs 0.35 mm [95% CI, 0.33-0.37];P = .005) after the intervention. Myopic shift was lower in the SMS group than in the control group at year 2 (−0.69 diopters [D] [95% CI, −0.78 to −0.60] vs −0.82 D [95% CI, −0.91 to −0.73];P = .04) and year 3 (−0.47 D [95% CI, −0.54 to −0.39] vs −0.60 D [95% CI, −0.67 to −0.53];P = .01) after the intervention, as was myopia prevalence (year 2: 38.3% [51 of 133] vs 51.1% [68 of 133]; year 3: 46.6% [62 of 133] vs 65.4% [87 of 133]).Conclusions and RelevanceIn this randomized clinical trial, SMS text messages to parents resulted in lower axial elongation and myopia progression in schoolchildren over 3 years, possibly through increased outdoor time and light exposure, showing promise for reducing myopia prevalence.Trial RegistrationChinese Clinical Trial Registry Identifier: ChiCTR-IOC-17010525

Background: Few studies have reported the burden of generalized pustular psoriasis (GPP), a severe and potentially life-threatening skin disease, especially at a national level. Objectives: The aim of this study is to estimate the nationwide burden of GPP in China and make a systemic review of the published data. Methods: We conducted a population-based study using Urban Basic Medical Insurance in China from 2012 to 2016. GPP cases were identified by primary diagnoses including the international classification of Diseases codes (ICD-10: L40.1 and ICD-9: 694.3). A systematic review was conducted using relevant databases up to January 2022. Results: The crude prevalence and incidence of GPP in 2016 were 1.403 (95% confidence interval [CI]: 1.115–1.691) and 0.629 (95% CI: 0.483–0.775) per 100,000 person-years, respectively. The rates were higher in males than in females for both prevalence (1.429 vs. 1.135) and incidence (0.635 vs. 0.520). The prevalence and incidence showed a bimodal age distribution, with the first peak occurring in the 0- to 3-year age-group and the second peak occurring in the 30- to 39-year age-group. The per capita total cost per year for 1 patient with GPP was 609.26 (± 45.77) US dollars. Seven studies were identified in a systematic review, according to which the prevalence (per 100,000) of GPP tended to be higher in Asian countries (0.746–8.178 in Japan and 12.230 in Korea) than in France (0.176), Sweden (6.25), and Brazil (0.7). Conclusions: This is the largest study concerning the disease burden of GPP, and in this study, the prevalence seemed to be higher in Asia. Although the direct economic burden of GPP did not seem high during the study period, the future usage of biologics and the humanistic burden should also be considered for policy-related decision-making.

Pseudomyxoma peritonei (PMP) is an extremely rare condition. Information regarding the disease burden of PMP in developing countries is limited. This study aimed to determine the epidemiology of PMP in China.PMP data were extracted from the national databases of Urban Basic Medical Insurance. All cases were identified using the International Classification of Diseases (ICD) codes and Chinese diagnostic terms. The national prevalence from 2012 to 2016 and incidence in 2016 were estimated.In total, 153 patients with PMP were identified. The crude prevalence of PMP in 2016 was 2.47 (95% confidence interval [CI] 1.71 to 3.23) per million person-year, with a higher prevalence in females than males. Prevalence increased with age, with the first peak in those aged 15-29 years and the highest in those aged80 years. The crude incidence of PMP in 2016 was 1.19 (95% CI 0.59 to 1.78) per million person-years. Similar to the prevalence, the rates were higher in women than in men. The incidence also increased with age, with the highest prevalence in those aged80 years. Besides, the most frequent comorbidities before and after the first diagnosis of PMP were unspecified secondary malignancies and malignancies of unspecified sites, followed by abdominal malignant tumours.The rate of PMP was lower in mainland China than in European countries and increased with advancing age. Women were more likely to have PMP than men. Furthermore, an insufficient understanding of this rare disease presents a major challenge in accurately evaluating the disease burden.

Background: The responses of intravenous immunoglobulin (IVIg) or corticosteroids as the initial treatment on pregnancy with ITP were unsatisfactory. This study aimed to assess the safety and effectiveness of prednisone plus IVIg versus prednisone or IVIg in pregnant patients with immune thrombocytopenia (ITP). Methods: Between 1 January 2010 and 31 December 2020, 970 pregnancies diagnosed with ITP at 19 collaborative centers in China were reviewed in this observational study. A total of 513 pregnancies (52.89%) received no intervention. Concerning the remaining pregnancies, 151 (33.04%) pregnancies received an initial treatment of prednisone plus IVIg, 105 (22.98%) pregnancies received IVIg alone, and 172 (37.64%) pregnancies only received prednisone. Results: Regarding the maternal response to the initial treatment, no differences were found among the three treatment groups (41.1% for prednisone plus IVIg, 33.1% for prednisone, and 38.1% for IVIg). However, a significant difference was observed in the time to response between the prednisone plus IVIg group (4.39 ± 2.54 days) and prednisone group (7.29 ± 5.01 days; p Conclusion: These findings suggest that prednisone plus IVIg may represent a potential combination therapy for pregnant patients with ITP.

Objectives: A lot of medication risks related to high-dose methotrexate (HDMTX) therapy still remain to be identified and standardized. This study aims to establish an evidence-based practice guideline for individualized medication of HDMTX. Methods: The practice guideline was launched by the Division of Therapeutic Drug Monitoring, Chinese Pharmacological Society. The guideline was developed following the WHO handbook for guideline development and the methodology of evidence-based medicine (EBM). The guideline was initially registered in the International Practice Guidelines Registry Platform (IPGRP-2017CN021). Systematic reviews were conducted to synthesis available evidence. A multicenter cross-sectional study was conducted by questionnaires to evaluate patients’ perception and willingness on individualized medication of HDMTX. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to rate the quality of evidence and to grade the strength of recommendations. Results: Multidisciplinary working groups were included in this guideline, including clinicians, pharmacists, methodologists, pharmacologists and pharmacoeconomic specialists. A total of 124 patients were involved to integrate patient values and preferences. Finally, the guideline presents 28 recommendations, regarding evaluation prior to medication (renal function, liver function, pleural effusion, comedications, genetic testing), pre-treatment and routine dosing regimen, therapeutic drug monitoring (necessity, method, timing, target concentration), leucovorin rescue (initial timing, dosage regimen and optimization), management of toxicities. Of them, 12 are strong recommendations. Conclusions: We developed an evidence-based practice guideline with respect to HDMTX medication using a rigorous and multidisciplinary approach. This guideline provides comprehensive and practical recommendations involving the whole process of HDMTX medication to health care providers.

Xiaoke Pills are Chinese and Western medicine compound preparations with effects of nourishing kidney and Yin,and supplementing Qi and promoting fluid. It is widely used in clinical treatment of type 2 diabetes( Qi and Yin deficiency syndrome),and continuously included in 2010,2013 and 2017 editions of Chinese prevention guide for type 2 diabetes. For the purpose of accurate positioning and rational use in clinic,it is necessary to further define the curative effect,indications,medication precautions and contraindications of Xiaoke Pills,in order to improve medication safety. This consensus was reached by reference of international clinical guidelines and expert consensus approach based on clinical evidence-based evidence,expert experience and standard specification. The evidence-based evaluation was oriented to clinical problems summarized by no less than 200 front-line clinical physicians in two rounds.GRADE system was adopted for quality classification and evaluation of the evidences,and then the nominal group method was used to form consensus recommendations or suggestions. This consensus defined the curative effect advantages,target users,dosage,administration method,contraindications and precautions of Xiaoke Pills,and provided valuable reference for the clinical use of the drug. Thisconsensus still needs to be updated and revised based on new clinical problems and evidence-based evidence in practical application in the future.

Xiyanping Injection is widely used in the treatment of respiratory infectious diseases. However,its package insert is still less instructive for physicians in understanding the specific clinical application of Xiyanping Injection. To discover potential clinical advantages of Xiyanping Injection,the team invited clinical experts of traditional Chinese medicine and western medicine from the field of respiratory diseases,pharmacists and methodologists of evidence-based medicine to compile the consensus. The consensus was based on a combination of clinical research evidence and expert experience,involving recommendations for clinical problems supported by clini-cal evidence as well as consensus suggestions for clinical problems with no clinical evidence. The consensus recommended the indication,timing of intervention,usage,dosage,course of treatment,combined medication of Xiyanping Injection used for adults,and introduced the safety and precautions of its clinical application. It is suitable for guiding clinical medical workers to rationally use Xiyanping Injection in the treatment of adultapos;s respiratory infectious diseases.

Kangfu Xiaoyan Suppository is widely used in the treatment of gynecological inflammatory diseases. Long-term clinical application and a certain amount of research evidences show that Kangfu Xiaoyan Suppository can alleviate the clinical symptoms of pelvic inflammatory diseases,reduce the recurrence rate,and relieve sequelae,with a better safety and economic characteristics. As a type of nationally protected traditional Chinese medicine and type B medicine included in medical insurance,it has been selected as a Chinese patent medicine for rectal administration. It was included in the Guidelines for diagnosis and treatment of common gynecological diseases of traditional Chinese medicine published by the Chinese Academy of Traditional Chinese Medicine in 2012,the Pelvic inflammatory diseases diagnosis and treatment guidelines issued by the Infectious Diseases Collaborative Group of the Obstetrics and Gynecology Branch of the Chinese Medical Association in 2014,and the group standard of Single use of traditional Chinese medicine/combined antibiot guidelines for clinical practice-pelvic inflammatory diseases of the Chinese Academy of Traditional Chinese Medicine in 2017. To further enhance clinicians' understanding of the drug and better guide its rational clinical use,experts from the field of gynecology of traditional Chinese and Western medicine were invited to develop and compile this expert consensus. This consensus takes full account of clinical evidences and expert clinical experience,and form recommendations for clinical problems based on evidences and consensus recommendations for clinical problems without evidence by nominal grouping method. The expert consensus is mainly formed in the consideration of six factors: quality of evidence,economy,efficacy,adverse reactions,patient acceptability and others. Based on clinical research evidences and expert experience,this consensus provides a preliminary reference for the clinical use of the drug in a concise and clear format. However,evidence-based support is still required in a large number of high-quality studies,and this consensus will be revised in the future according to new clinical problems and the update of evidence-based evidence in practical application.

This prospective study included 68,759 Chinese male adults from Kailuan cohort of China who had a standardized medical examination between 2006 and 2007 and were followed up for approximately 8 years until occurrence of ASCVD, cancer or death or until December 31, 2014. Subjects were divided into four categories based on the quartiles of TC, LDL-C and non-HDL-C. Cox regression models were used to estimate hazard ratios (HRs) and their 95% confidence intervals (CIs). During follow-up, 2,916 males developed ASCVD and 1,884 developed cancer. Compared with the lowest quartile, the upper-most quartiles of TC, LDL-C and non-HDL-C were all associated with increased ASCVD risk (HR 1.53; HR 1.16; HR 1.55); however, the upper-most quartiles of TC, LDL-C and non-HDL-C were all negatively associated with cancer (HR0.84; HR 0.82; HR 0.80) and these associations were present after exclusion of incident cancers during the first 4 years of follow-up. In a word, we report that high TC, LDL-C and non-HDL-C concentrations increased ASCVD incidence in a male population and that these lipid profiles were inversely associated with total cancer and several individual cancers.

Hugan Tablets is a Chinese patent medicine,it has the function of anti-inflammation and reducing transaminase. Based on questionnaire investigation of doctors and a systematic review of research literature on Hugan Tablets,using international clinical practice guidelines' developing methods,with the best available evidence and fully combining expert experience,and following the principle of " evidence-based,consensus-based and experience-based",Expert consensus statement on Hugan Tablets in clinical practice was developed by more than 30 multidisciplinary experts from the nationwide,aimed at guiding and standardizing the rational use of Hugan Tablets by clinicians and to improve clinical efficacy and safety. The expert consensus adopts internationally recognized recommendation criteria for classification of evidence: GRADE. The formation of expert consensus adopts the nominal group technique. Six main considerations are quality of evidence,curative effect,safety,economical efficiency,patient acceptability and other factors. If there is sufficient evidence,a " recommendation" is formed,using GRADE grid voting rule. If there isn' t sufficient evidence,a " consensus opinion" is formed,using majority counting rule. Focus on the indication,usage and dosage,drug use in special population and safety of Hugan Tablets,two recommendations and eight consensus opinions were put forward. Through expert meetings and correspondence,a nationwide consultation and peer review was conducted. This consensus applies to clinicians in hospitals and grass-roots health services,to provide guidance and reference for the rational use of Hugan Tablets.

Diemailing~® Kudiezi Injection( DKI) is widely used in the treatment of cerebral infarction,coronary heart disease and angina pectoris. Long-term clinical application and related research evidence showed that DKI has a good effect in improving the clinical symptoms of cardiovascular and cerebrovascular diseases. However,this injection has not been included in any clinical practice guideline. It has been found that the use of DKI is in wrong way in clinical practice in recent years. Therefore,clinical experts from the field of cardiovascular and cerebrovascular diseases nationwide are invited to compile this expert consensus in order to guide clinicians.GRADE system is used to grade the quality of evidence according to different outcomes according to degrading factors. Then it forms the recommendation or consensus suggestion through the nominal group method. The formation of expert consensus mainly considers six factors: quality of evidence,economy,efficacy,adverse reactions,patient acceptability and others. Based on these six aspects,if the evidence is sufficient,a " recommendation" supported by evidence is formed,and GRADE grid voting rule is adopted. If the evidence is insufficient,a " consensus suggestions" will be formed,using the majority voting rule. In this consensus,the clinical indications,efficacy,safety evidences and related preliminary data of DKI were systematically and comprehensively summarized in a concise and clear format,which could provide valuable reference for the clinical use of DKI. This consensus has been approved by China association of Chinese medicine which is numbered GS/CACM 202-2019.

In 2013,China pharmaceutical regulatory department issued guiduance on postmarketing drug safety monitoring for industry. It aimed to encourage industry to carry out postmarketing drug safety monitoring including hospital-based intensive monitoring of postmarketing Chinese patent medicine. Subsequently,more and more such kind of studies have been performed all over China. However,in view of the current situation in this field,the development of hospital-based intensive monitoring of postmarketing Chinese patent medicine lacks standardization,such as unreasonable design,omission of reports about adverse drug reactions,inadequate process of quality control,non-standardized interpretation of adverse reactions,etc. Therefore,it is necessary to formulate relevant technical specifications to guide this area. The developing of this technical specification refered to the international post-marketing safety monitoring model and advanced design concepts and methods. We developed it under the guidance of relevant laws,regulations and technical documents in China. Meanwhile the characteristics of Chinese patent medicines and the real situation in this area were considered. The aim of this technical specification is to obtain the incidence,type,degree and clinical manifestation of adverse drug reactions of Chinese patent medicines,to find new risk signals of adverse reactions,to identify risk factors,and to provide a basis for the formulation of risk management and control plans. This specification has been approved by China association of Chinese medicine which is numbered T/CACM011-2016.

Xiyanping Injection is a commonly used medicine in clinical treatment,which is recommended by many pediatric disease guidelines/consensus. However,the instraction is relatively simple and lack of guidance for clinical application,which affects the efficacy and brings safety risks. Therefore,more detailed clinical guidance is urgently needed. This consensus is formulated by clinical experts of traditional Chinese medicine and Western medicine in pediatrics. This consensus follows Manual for the clinical experts consensus of Chinese patent medicine which published by China Association of Chinese Medicine. The study identified clinical problems using clinical investigation,searched the literature based on PICO clinical problems,using GRADE system to carry out evidences evaluation,classification and recommendation,and adopted the nominal grouping method to reach expert consensus. The consensus combines evidence-based evidence with expert experience,sufficient evidence of clinical problems would lead to " recommendations",and clinical problems with insufficient evidence will lead to " consensus suggestions". This expert consensus recommends the indications,intervention time for treatment,route of drug administration,dose conversion,the indications of being used alone,suitability and taboos of medicine combination,and introduces the safety and clinical application,to provide reference for clinical using.

To evaluate the effects of incretin-based therapies on body weight as the primary outcome, as well as on body mass index (BMI) and waist circumference (WC) as secondary outcomes.Databases including Medline, Embase, the Cochrane Library, and clinicaltrials.gov (www.clinicaltrials.gov) were searched for randomized controlled trials (RCTs). Standard pairwise meta-analysis and network meta-analysis (NMA) were both carried out. The risk of bias (ROB) tool recommended by the Cochrane handbook was used to assess the quality of studies. Subgroup analysis, sensitivity analysis, meta-regression, and quality evaluation based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were also performed.A total of 292 trials were included in this study. Compared with placebo, dipeptidyl-peptidase IV inhibitors (DPP-4Is) increased weight slightly by 0.31 kg [95% confidence interval (GLP-1 RAs were more effective than DPP-4Is in lowering the three indicators. Overall, the effects of GLP-1 RAs on weight, BMI, and WC were favorable.

Quality problem or issue Chinese medical institutions need clinical guidelines to improve healthcare quality. Unfamiliarity with clinical methodology and procedures leads to poor quality. Initial assessment This study examined 327 clinical guidelines made in China during the period of 2006–10 and found these clinical guidelines have many problems in terms of guideline making procedures-compliant process, conflicts of interest disclosure. Choice of solution Chinese Medical Association organized a working group in 2014 to make a national [Guideline for Clinical Guidelines Constitution/Amendment] and invited multidiscipline experts to prove its possibility. Implementation Experts investigated and reviewed numerous domestic and foreign published literature within the past 2 years, concluded that a clinical guideline should have following seven components: I. Objective; II. General Principle; III. Procedure and Methodology; IV. Confirmation, Publication and Dissemination; V. Update and Amendment; VI. Implementation and Outcome Validation; VII. Reference. Evaluation The [Guideline for Clinical Guidelines Constitution/Amendment] will improve the quality of Chinese clinical guidelines and regulate applications, as well as outcome evaluations of clinical guidelines in China. Lessons learned Standardized methodology and procedures are important for constituting high-quality clinical guidelines.

This prospective study included 68,759 Chinese male adults from Kailuan cohort of China who had a standardized medical examination between 2006 and 2007 and were followed up for approximately 8 years until occurrence of ASCVD, cancer or death or until December 31, 2014. Subjects were divided into four categories based on the quartiles of TC, LDL-C and non-HDL-C. Cox regression models were used to estimate hazard ratios (HRs) and their 95% confidence intervals (CIs). During follow-up, 2,916 males developed ASCVD and 1,884 developed cancer. Compared with the lowest quartile, the upper-most quartiles of TC, LDL-C and non-HDL-C were all associated with increased ASCVD risk (HR 1.53; HR 1.16; HR 1.55); however, the upper-most quartiles of TC, LDL-C and non-HDL-C were all negatively associated with cancer (HR0.84; HR 0.82; HR 0.80) and these associations were present after exclusion of incident cancers during the first 4 years of follow-up. In a word, we report that high TC, LDL-C and non-HDL-C concentrations increased ASCVD incidence in a male population and that these lipid profiles were inversely associated with total cancer and several individual cancers.

To report the design, methods and baseline data of the Anyang Childhood Eye Study (ACES), aiming to determine the prevalence, incidence and risk factors of myopia and other ocular diseases in children in central China.The ACES was a school-based cohort study conducted in Anyang city. Students have been examined and will be followed-up annually for 3-5 years. Ocular examinations included visual acuity, identification of amblyopia and strabismus, ocular biometry, optical coherence tomography, retinal photography, cycloplegic autorefraction, accommodative response, peripheral refraction, visual perception and so on. A questionnaire survey was performed to collect risk factors for myopia including near work, outdoor activity, parental myopia, birth history, habits of wearing spectacles and reading, living habits, food habits and so on.Of 3112 grade 1 and 2363 grade 7 students eligible for the ACES, 2893 (93.0%) and 2267 (95.9%) participated in the study, with a mean age of 7.1 years (range 5.7-9.3 years) and 12.7 years (range 10.0-15.9 years), and proportions of male to be 57.8% and 50.0%, respectively. The prevalence rates of myopia, high myopia, emmetropia and hyperopia were 3.9%, 0.1%, 72.9% and 23.3% in grade 1, and 67.3%, 2.7%, 31.4% and 1.2% in grade 7, respectively. Similar data were found in the children confined in 6-year-old and 12-year-old ages.The ACES is the first large-scale cohort study in China with baseline response rates over 90%. Continuous documentation of changes and risk factors of refractive errors in these cohorts would provide new insights into myopia control in school-aged children.

To assess and compare the effectiveness and safety of methylphenidate immediate-release tablets (IR-MPH), methylphenidate controlled release tablets (OROS-MPH) and atomoxetine (AHC) for attention deficit hyperactivity disorder (ADHD) in Chinese children.Randomized or clinical controlled trials on the effectiveness and safety of IR-MPH, OROS-MPH and AHC for ADHD were searched in electronic databases of CNKI, VIP, CBMDISC online, PubMed, Embase and MEDLINE. Two reviewers independently extracted the data and assessed the quality of the included literatures.Eight trials were finally included. IR-MPH, OROS-MPH and AHC were effective for ADHD. OROS-MPH was superior to IR-MPH in the improvement of peer relationship, CGI-I score, mother satisfaction and psychosomatic problems. There were no significant differences in the effectiveness between the AHC and IR-MPH groups. The adverse events related to the therapy with IR-MPH, OROS-MPH or AHC were mild and the incidence rates of adverse events were not significantly different among the three groups.The effectiveness of OROS-MPH for the treatment of ADHD is probably superior to IR-MPH, and the effectiveness between AHC and IR-MPH is similar. The three drugs demonstrate the safety and well tolerance.

To report the thickness of the peripapillary retinal nerve fibre layer (pRNFL) in Chinese children and examine its association with refractive error, axial length (AL) and optic disc parameters.Population-based cross-sectional study.A total of 2893 seven-year-old children from 11 randomly selected primary schools in Anyang, central China.Participants underwent ophthalmic examinations including optical biometry, cycloplegic autorefraction and spectral-domain ocular coherence tomography.Retinal nerve fibre layer thickness in 16 radial sections, cycloplegic spherical equivalent, AL.The mean (SD) average RNFL thickness was 102.01(8.02) µm. The average RNFL thickness decreased with smaller disc area (r = 0.18, RRetinal nerve fibre layer thickness decreased with increasing AL, higher myopia, bigger cup area, smaller disc and rim area, and a smaller nerve head volume, but the coefficient of determination for all these associations was small. The RNFL in myopes was significantly thinner than emmetropes or hyperopes, but with small absolute differences. The study provides RNFL values for healthy 7-year-old Chinese children. Follow up of this cohort to observe the change of RNFL thickness with myopia and possible change in detected associations with age is planned.

Chronic gastritis (CG) is an inflammatory condition of the gastric mucosa, induced by various causes. A commonly-seen disease in clinical practice, it is found in about 80%-90% of patients undergoing gastroscopic examination. The prevalence rate in the general population remains unclear. It is generally considered that its incidence rate accords with Helicobacter. pylori infection rate and the prevalence of CG is 30%-80% in China. Possible etiological factors include H. pylori infection, smoking, drinking alcohol, food allergies, duodenal juice reflux, drug-induced injuries, heredity, immunity, and radiation. (1-8) Some patients with CG have no obvious clinical manifestations, and symptomatic patients mainly show symptoms of non-specific dyspepsia. In H. pylori related CG, the disease will persist unless the H. pylori infection is eradicated. There is a higher risk of gastric cancer if chronic atrophic gastritis (CAG) is accompanied by intestinal metaplasia or dysplasia; it is commonly believed that the canceration rate of atrophic gastritis is 0.5%-1% annually. (9)

Myopia in school-aged children is a major public health problem in Asians that has been extensively studied. Multifocal lenses (MLs) are advocated as a substitute for single vision lenses (SVLs) to slow myopia progression in children, but results vary greatly across studies. We systematically searched currently available randomized controlled trials that compared the effects of MLs and SVLs in children. A meta-analysis of nine of these trials showed that MLs with powers ranging from +1.50 to +2.00D were associated with a statistically significantly decrease in myopia progression in school-aged children compared with SVLs. The benefit was greater in children with a higher level of myopia at baseline and sustained for a minimum of 24 months. Asian children appeared to have greater benefit from intervention with MLs than white children.

Purpose: To describe the rationale, design, methodology and baseline characteristics of the Handan Eye Study (HES), a population-based study to determine the prevalence and impact of visual impairment and major ocular diseases in Chinese adults living in a rural region north China. Methods: Population-based, cross-sectional study. 6830 Han people aged 30 years and older from 13 villages of Yongnian County, Handan city, Hebei province, China were recruited. The interviews covered demographic, behavioral, and ocular risk factors as well as healthrelated and vision-related quality of life. Ocular examination included measurement of visual acuity (VA), intraocular pressure, anterior and posterior segment examinations, visual field testing, and anterior segment, fundus and optic disc photography/imaging. Physical examination included measurement of height and weight, blood pressure, electrocardiogram, fasting blood glucose, lipid levels, urea nitrogen and creatinine as well as tests of physical function including walking speed. Results: Of the 7557 individuals eligible for the Handan Eye Study (HES), 6830 (90.4%) subjects participated the study. The majority of participants were female (53.6%), the average (± standard deviation) age was 52.3 (± 12.3) years, and 100% were self-identified Han people. In contrast to the non-participants, those who participated were more likely to be female, elderly, married, and had more years of education (P < 0.05). Conclusion: The HES successfully examined over 90% of eligible Han Chinese adults aged 30 and older from a rural region of north China. Results from the HES will provide key information about the prevalence, risk factors, impact, and trends of ocular disease in rural regions of China.

A systematic review was undertaken, including studies that evaluated the incidence of the blood system adverse events of Tripterygium wilfordii (TWP). Medline, Embase and the Cochrane library were searched for relevant studies, including RCT, cohort studies and case series, of patients treated with TWP published in English and Chinese from inception up until May 25th, 2013 with the keywords including "Tripterygium wilfordii", "toxicity", "reproductive", "side effect", "adverse", "safety" and "tolerability". Relevant information was extracted and the incidence of the blood system adverse events was pooled with MetaAnalyst software. Besides, subgroup and sensitivity analyses were performed based on age, mode of medicine, observation time and disease system. According to inclusion and exclusion criteria, a total of 49 articles were included in the meta-analysis, they were split into 54 researches incorporated in the analysis. There is a large degree of heterogeneity among the studies, so data was analyzed using random-effects model and the summary estimates of incidence of the blood system adverse events was 6.1%. The weighted combined incidence of three major blood system adverse events were white-blood cells decreasing 5.6% (95% CI, 4.3% - 7.3%), hemoglobin decreasing 1.7% (95% CI, 0.5% - 5.0%) and platelet decreasing 1.8% (95% CI, 1.0% - 3.1%), respectively . Sensitivity analyses based on 45 studies with high quality showed the combined value was close to the summary estimate of total 54 studies. The current evidence indicates that the incidence of the blood system adverse events induced by TWP was high; attentions should be paid on to the prevention and treatment of the blood system adverse events.

To investigate the use of simple pooling and bivariate model in meta-analyses of diagnostic test accuracy (DTA) published in Chinese journals (January to November, 2014), compare the differences of results from these two models, and explore the impact of between-study variability of sensitivity and specificity on the differences.DTA meta-analyses were searched through Chinese Biomedical Literature Database (January to November, 2014). Details in models and data for fourfold table were extracted. Descriptive analysis was conducted to investigate the prevalence of the use of simple pooling method and bivariate model in the included literature. Data were re-analyzed with the two models respectively. Differences in the results were examined by Wilcoxon signed rank test. How the results differences were affected by between-study variability of sensitivity and specificity, expressed by I2, was explored.The 55 systematic reviews, containing 58 DTA meta-analyses, were included and 25 DTA meta-analyses were eligible for re-analysis. Simple pooling was used in 50 (90.9%) systematic reviews and bivariate model in 1 (1.8%). The remaining 4 (7.3%) articles used other models pooling sensitivity and specificity or pooled neither of them. Of the reviews simply pooling sensitivity and specificity, 41(82.0%) were at the risk of wrongly using Meta-disc software. The differences in medians of sensitivity and specificity between two models were both 0.011 (P0.001, P=0.031 respectively). Greater differences could be found as I2 of sensitivity or specificity became larger, especially when I275%.Most DTA meta-analyses published in Chinese journals(January to November, 2014) combine the sensitivity and specificity by simple pooling. Meta-disc software can pool the sensitivity and specificity only through fixed-effect model, but a high proportion of authors think it can implement random-effect model. Simple pooling tends to underestimate the results compared with bivariate model. The greater the between-study variance is, the more likely the simple pooling has larger deviation. It is necessary to increase the knowledge level of statistical methods and software for meta-analyses of DTA data.

To prospectively investigate the association of high-density lipoprotein cholesterol(HDL-C) with cancer among Chinese adults with or without diabetes mellitus in Kailuan cohort of China. This prospective study included 91149 participants (diabetic group: 7912; health control group: 83237) from

To prospectively observe the effects of undercorrection of myopia on myopia progression and axial elongation in a population of 12-year-old Chinese children. A total of 2,267 children in the Anyang Childhood Eye Study were examined at baseline, and 1,769 were followed for 1 year. Ocular examinations included cycloplegic autorefraction, axial length, visual acuity, vertometry, and accommodative lag. Questionnaires were completed by children and parents. Undercorrection of myopia was determined at baseline if presenting visual acuity could be improved by at least 2 lines with subjective refraction. Of 253 myopic children with spectacles and available information, 120 (47.4 %) were undercorrected (−4.63D to −0.50D) and 133 (52.6 %) were fully corrected. In a multivariate model adjusting for age, gender, number of myopic parents, time spent on near work and outdoor activities per day, usage and time for wearing spectacles per day, children with undercorrection had significantly more baseline myopia (P

Background There have been a limited number of population-based studies investigating the associations between cardiovascular disease risk factors and early age-related macular degeneration (AMD). Methods A total of 7,557 eligible people aged 30 or older were recruited from 2006 to 2007. Cardiovascular risk factors and serum lipids including total cholesterol, total triglycerides, low density lipoprotein cholesterol, high density lipoprotein cholesterol, and fasting plasma glucose, and urines were assessed. Digital photographs of the optic disk and macula fields (Early Treatment of Diabetic Retinopathy Study) were taken and graded after the modified Wisconsin Age-related Maculopathy Grading System. Logistic regression models were constructed to assess odds ratios and 95% confidence intervals. Cases of late AMD were excluded. Results Of 6,577 subjects included in the analysis, there were 200 (3.04%) cases with early AMD. Multivariate analysis showed that higher age, untreated hypertension, coronary heart disease, and smoking were associated with an increased risk of early AMD. After adjusting for other variables in the final model, no variable was significantly associated with hyperpigmentation while smoking was significantly associated with an increased risk of hypopigmentation; higher age and any cardiovascular disease were associated with an increased risk of large drusen, and higher age, smoking, untreated hypertension, and coronary heart disease were associated with an increased risk of soft drusen. Conclusion Our findings support the associations between smoking, coronary heart disease, and early AMD.

To describe the clinical characteristics, overall survival as well as to evaluate the prognostic factors in Chinese diffuse large B cell lymphoma (DLBCL) patients.DLBCL patients who were initially diagnosed and treated in Peking University Cancer Hospital from January 1995 to December 2008 were identified and analyzed,retrospectively.The 5-year OS rates were estimated with Kaplan-Meier. Log-rank test was used to compare the survival curves of the different groups. The multivariate analysis of prognostic factors was conducted with Cox regression model, which included all statistically significant prognostic factors in the univariate analyses.A total of 525 DLBCL patients were included in this retrospective analysis, of whom, 294 were male and 231 female (male:female=1.27:1). The median age at the initial diagnosis was 55 (range 16-90) years, and 37.0% (n=194) were 60 years and above. Regarding the clinical staging at the initial diagnosis, 54 patients (10.3%) were diagnosed as Stage I of the disease, 152 (28.9%) as Stage II, 117 (22.3%) as Stage III and 202 (38.5%) as Stage IV. The "B symptoms" and increased serum LDH were presented in 206 (39.2%) and 192 (36.6%) patients, respectively. A total of 197 (37.5%) patients were treated with rituximab (R). The survival follow-up continued till 31 January 2014 with a median follow-up time of 77.5 (range: 0-205) months. A total of 267 patients (50.9%) died during the follow-up period. The medial overall survival (OS) time was 84 months, and 5-year OS rate was 52.3%. There were six statistically significant prognostic factors that were identified in both univariate and multivariate analyses: gender, Ann Arbor stage, B symptom, serum LDH, age at initial diagnosis and rituximab treatment. The relative risk (RR) of these prognostic factors in the multivariate analyses were: age60 years / ≤ 60 years=1.380 (95%CI 1.078-1.765), male / female=1.315 (95%CI 1.025-1.687), stage III/stage I=3.034 (95%CI 1.667-5.522), stage IV/I=3.748(95%CI 2.102-6.681), with B symptoms/without B symptoms=1.278(95%CI 0.999-1.636), serum LDH increased/LDH not increased=1.351(95%CI 1.057-1.726), without R treatment / with R treatment=1.543 (95%CI 1.182-2.015).Compared with the IPI, age50 years/ ≤ 50 years was a statistically significant factor in both univariate and multivariate analyses RR=1.478 (95%CI 1.148-1.902), P=0.002.Six factors were related to DLBCL survival: gender, Ann Arbor stage, B symptom, serum LDH, age at initial diagnosis and rituximab treatment. Compared with the IPI, several specific factors may predict a poor prognosis in Chinese DLBCL patients: male, age50 years and the presence of "B symptoms". But this result is not conclusive until these factors are further tested.

To systematically evaluate the incidence of liver injury in multi-drug resistant tuberculosis (MDR-TB) patients with the treatment of second-line anti-TB drugs.Medline (January 1, 1966 to March 1, 2014), Embase (January 1, 1974 to March 1, 2014) and the Cochrane library (January 1, 1993 to March 1, 2014) with four Chinese databases including VIP (January 1, 1989 to March 1, 2014), CBMDisc (January 1, 1978 to March 1, 2014), CNKI (January 1, 1994 to March 1, 2014)and Wanfang (January 1, 1998 to March 1, 2014), were systematically searched with the keywords including "Tuberculosis", "multidrug-resistant", "MDR-TB", "side effect", "adverse", "safety" and "tolerability" for the follow-up studies of MDR-TB patients with liver injury during the treatment of second-line anti-TB drugs. The relevant information was extracted and the data were analyzed using the random-effects model. Subgroup and sensitivity analyses were performed based on the diagnostic criteria, study population, study design, history of anti-TB treatment and treatment length.A total of 26 articles with 3 875 MDR-TB patients were included, of which 373 patients developed liver injury, and the weighed combined incidence of liver injury was 7.7%(95%CI:5.5%-10.8%). There was some heterogeneity among the studies. Subgroup analyses showed that the incidence of liver injury was higher in groups with treatment length ≥ 18 months and non-Asian populations, but there was no significant difference between the groups (P0.05). Among the 26 articles, only nine of them reported the diagnostic criteria of liver injury, while the criteria were not uniform.The incidence of liver injury during the treatment of second-line anti-TB drug in MDR-TB patients was high, and the diagnostic criteria were not uniform. We should pay attention to the prevention and treatment of liver injury, and develop standard diagnostic criteria for it.

To comprehensively understand the situation of research of the use of ulinastatin in clinical treatment, and to display the results with visual images.The keywords of Bikunin, Ulinastatin, Urinastatin, urinary trypsin inhibitor in association with disease, treatment, therapy were searched with search engine from several academic websites with June 30th, 2012 (for English literature) or January 31st, 2013 (for Chinese literature) as the deadline. Bibexcel extracting keywords of diseases and that involving pathophysiology and biology accompanying the diseases and treatment mechanism of the diseases were used. Diseases were classified by ICD10, and the keywords of treatment mechanism were classified according to researchers' understanding and therapist suggestion. Word co-occurrence matrix of diseases and treatment mechanism words were constructed, and were expressed more accurately and intuitively by analyzing multidimensional scaling (MDS). Data were analyzed and charts were produced respectively using UCINET, SPSS 20.0 and Excel 2013 software.A total of 3 660 articles were included for the analysis, including 1 428 in English and 2 232 in Chinese. In English literature, 97 diseases with 796 times were analyzed and 17 disease categories distributed in ICD10. In Chinese literature, 220 diseases with 2 153 times were analyzed and 14 disease categories distributed in ICD10. Seventy-four and 33 words involving treatment mechanism were respectively from English and Chinese literature, respectively, which could be roughly divided into three categories: immunity/inflammation, coagulation and genetic/metabolic. The word co-occurrence matrix analysis and MDS showed that the key word for mechanism of treatment appeared widely in different diseases, and a single disease might be expressed with different terms, while different diseases might have common foundation for ulinastatin treatment, though the foci of indication were also different. All data were found to be able to form visual images according to the aim of investigation.According to the data retrieved in this study, the field of ulinastatin treatment was quite widespread, involving hundreds of diseases, which were distributed in more than 10 categories of ICD10, and almost 100 keywords involving treatment mechanism were found. Although those diseases were varied, they have a common therapeutic foundation based on the word co-occurrence matrix analysis. All the present data were successfully transformed into visual image expression to achieve the goal of this study. On the other hand, the resolving methods and problems used in this study will be helpful for further similar studies.

To conduct a meta-analysis on the effects of atropine in slowing myopia progression and to compare Asian and white children and randomized controlled trials (RCTs) and observational studies.Randomized controlled trials and observational studies that assessed the effects of all concentrations of atropine in slowing myopia progression in children were searched from MEDLINE, EMBASE, and the Cochrane Library up to April 2013. Jadad scoring was used to evaluate the quality of RCTs, and the Newcastle-Ottawa Scale was used for observational studies.Four RCTs and seven cohort studies (a kind of observational study) with 1815 children aged 5 to 15 years were included. The children had a baseline refraction of -0.50 to -9.75 diopters (D) and were followed up for 22.0 months (range, 12.0 to 36.5 months). The weighted mean differences in myopia progression in RCTs and cohort studies of Asian children were 0.55 D per year (p0.01) and 0.54 D per year (p0.001), respectively, and 0.35 D per year (p = 0.01) in cohort studies of white children. Compared with placebo, the risk of fast myopia progression (1.0 D per year) using atropine was significantly decreased in both RCTs (odds ratio [OR], 0.14; p0.01) and cohort studies (OR, 0.08; p0.01), and the benefit of slow myopia progression (0.50 D per year) using atropine was significantly increased in both RCTs (OR, 6.73; p0.01) and cohort studies (OR, 22.10; p0.01).Atropine could significantly slow myopia progression in children, with greater effects in Asian than in white children. Randomized controlled trials and cohort studies provided comparable effects.

This study aimed to provide an epidemiological modeling method to evaluate the risk of metabolic syndrome (MS) development in the coming 5 years among 35-74 year-olds from Taiwan.A cohort of 13 973 subjects aged 35-74 years who did not have metabolic syndrome but took the initial testing during 1997-2006 was formed to derive a risk score which tended to predict the incidence of MS. Multivariate logistic regression was used to derive the risk functions and using the 'check-up center' (Taipei training cohort)as the overall cohort. Rules based on these risk functions were evaluated in the remaining three centers (as testing cohort). Risk functions were produced to detect the MS on a training sample using the multivariate logistic regression models. Started with those variables that could predict the MS through univariate models, we then constructed multivariable logistic regression models in a stepwise manner which eventually could include all the variables. The predictability of the model was evaluated by areas under curve (AUC) the receiver-operating characteristic (ROC) followed by the testification of its diagnostic property on the testing sample. Once the final model was defined, the next step was to establish rules to characterize 4 different degrees of risks based on the cut points of these probabilities, after being transformed into normal distribution by log-transformation.At baseline, the range of the proportion of MS was 23.9% and the incidence of MS in 5-years was 11.7% in the non-MS cohort. The final multivariable logistic regression model would include ten risk factors as: age, history of diabetes, contractive pressure, fasting blood-glucose, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, body mass index and blood uric acid. AUC was 0.827(95% CI: 0.814-0.839) that could predict the development of MS within the next 5 years. The curve also showed adequate performance in the three tested samples, with the AUC and 95% CI as 0.813 (0.789-0.837), 0.826 (0.800-0.852) and 0.794 (0.768-0.820), respectively. After labeling the degrees of the four risks, it was showed that over 17.6% of the incidence probability was in the population under mediate risk while over 59.0% of them was in the high risk group, respectively.Both predictability and reliability of our Metabolic Syndrome Risk Score Model, derived based on Taiwan MJ Longitudinal Health-checkup-based Population Database, were relatively satisfactory in the testing cohort. This model was simple, with practicable predictive variables and feasible form on degrees of risk. This model not only could help individuals to assess the situation of their own risk on MS but could also provide guidance on the group surveillance programs in the community regarding the development of MS.

OBJECTIVES: Only limited data are available regarding smoking and health in later life and, in particular, in the older Chinese population. This paper reports the relationship between smoking and mortality in a Chinese cohort aged 70 years and older. SETTING: A population-based study conducted in Hong Kong. PARTICIPANTS: A cohort comprising 2030 subjects aged 70 and older were assembled in 1991–1992 and followed for 36 months. DESIGN: A prospective cohort study. MEASUREMENTS: Baseline information regarding smoking status as well as several social and health variables were obtained through face-to-face interview at the respondent's place of residence. The outcome variables were mortality from all causes as well as from cancer and cardiovascular and respiratory diseases. Causes of death were ascertained from death certificates. RESULTS: The prevalence rates of smoking at baseline were 24.9% in men and 8.2% in women. A total of 534 deaths occurred during the 36-month follow-up period. Of these, 447 were attributable to three main causes: cancer, cardiovascular disease, and respiratory disease. Elevated mortality risks from all causes were observed among both male (RR = 1.4; 95% CI, 0.9-1.9) and female (RR = 1.6; 95% CI, 1.0–2.5) current smokers, but the 95% confidence intervals overlapped. Significant association between current smoking and combined mortality from these three major causes was found in men; it was also found in women after excluding those with these diseases at baseline. More than a 3-fold increased risk of cancer mortality was found in current smokers of both sexes. Although nonsignificant associations were found between former smokers and mortality risks in men, women who were former smokers had increased mortality risks from all causes as well as from cancer and respiratory diseases. CONCLUSIONS: This 3-year prospective study of an older Chinese cohort reveals the impact of smoking on health during later life, especially in women. Smoking cessation, particularly in older men, should be beneficial in reducing mortality. Smoking cessation should begin as early as possible for women. J Am Geriatr Soc 47:1445–1450, 1999.

To study the association between the clustering manifestation of factors as overweight and central obesity, family heredity, immoderate alcohol drinking, tobacco smoking, hyperlipidemia, hyperglycemia and the prevalence of hypertension.Data was from a program related to the comprehensive prevention and control strategies on cardiac-cerebral vascular disease carried out in the communities of Shanghai, to describe the relationship between the clustering of risk factors and hypertension. This program included 15 158 people with complete data at the age of 35 - 74, from 2008 - 2011. Both single factor and multi-factor analysis were used and longitudinal study was performed to further explore the causal relationship.The overall prevalence of hypertension at the baseline survey was 41.9%. The associated ORs (age-adjusted) of hypertension parallelly increased with the number of risk factors under clustering. The associated OR of the males with 1, 2, 3, 4 as well as 5 and above risk factors were 3.157 [95% confidence interval (CI): 2.152 - 4.630], 6.428 (95%CI: 4.435 - 9.319), 11.797 (95%CI: 8.135 - 17.105), 19.723 (95%CI: 13.414 - 29.000), 33.051 (95%CI: 21.449 - 50.930) respectively. In females with 1, 2, 3 as well as 4 risk factors, the associated ORs were 2.917 (95%CI: 2.374 - 3.585), 6.499 (95%CI: 5.307 - 7.959), 15.717 (95%CI: 12.609 - 19.591) and 31.719 (95%CI: 21.744 - 46.270), respectively. For longitudinal study, the 2-year incidence of hypertension in males and females were 1.9% and 1.6%, respectively. Compared to those people without risk factors, the incidence was higher in the people with a larger number of clustering. When the clustering number reaching 2 or 3 in females, the relative risk (RR) were 2.111 (95%CI: 1.024 - 4.350) and 3.000 (95%CI: 1.287 - 6.995) respectively, with statistically significant difference.The risk of hypertension parallelly increased with the clustering number of relevant risk factors. Comprehensive prevention and control on related risk factors was required.