To develop the clinical practice guidelines for the treatment of sepsis with traditional Chinese medicine (TCM) therapy alone or TCM combined with antibiotics. The methods and process for developing the international clinical practice guidelines were fully consulted between a group of doctors. A total of 25 experts from 14 units were involved in the development of this guideline. The major clinical questions that needed to be solved were raised first, and the best available evidence to solve them was researched. Finally, according to the principle set by the GRADE system, the available evidence was graded with levels ranging from high to low. This formed the recommendation strengths, which included strong recommendation and weak recommendation, or an expert consensus recommendation. The guideline identified the terms and definition for sepsis. For example, it identified its epidemiological characters, the advantages of TCM treatment on sepsis, the diagnosis and its features, the complications, and its rehabilitation and health maintenance. The guideline has put forward 14 recommendations, among which 4 were strong recommendations and 6 were weak recommendations, in addition to 4 expert consensus recommendations. The methods and processes for developing international clinical practice guidelines were fully consulted under the guide of relevant laws and regulations, and relevant technical documents. Based on the best existing evidence, and combined with the characteristics of TCM and the clinical realities, we developed Clinical practice guidelines for the treatment of sepsis with TCM therapy alone or TCM combined with antibiotics, with full reference to the experts' experience and patients' preferences.
Background: Novel coronavirus pneumonia (NCP) is often changing rapidly and fatal. Early detection and early triage of coronavirus disease 2019 (Covid-19) is the key to success management of the disease. An easily obtainable yet accurate variable for both diagnosis and prognosis is urgently needed. We aim to report predictive Value of the Neutrophil-to-Lymphocyte Ratio(NLR) for diagnosis and worse clinical course of the COVID-19, which have not been well demonstrated. Methods: Our study consisted of two stages, at the first stage, a retrospective, single-center, cohort study including was conducted in Heilongjiang, on admission, demographic, clinical, and laboratory data were collected and compared between patients with COVID-19 and patients with non COVID-19; we used multivariable logistic regression methods to explore the risk factors associated with COVID-19;A receiver operating characteristic(ROC) analysis was conducted to calculate the area under the curve(AUC) to assess predictive value of NLR for diagnosis of COVID 19. At the second stage, we conducted retrospective, multi-center and large sample study in 43 hospitals from ten provinces of China, COVID-19 patients with laboratory-confirmed divided into three groups including mild cases, ordinary cases and severe cases. Multivariate logistic regression methods were used to identify the risk factors for the deterioration of COVID-19, along with, a receiver operating characteristic (ROC) curve was also drawn to assess impact on the clinical course of the COVID-19. Findings: We recruited a total of 635 patients with COVID-19 and 27 cases with non COVID-19(Viral pneumonia) from 28 January to 25 February. A total of 88 cases were enrolled with a retrospective, single-center, cohort study from Heilongjiang province, of these, COVID-19 cases were 61(69%) and non COVID-19 cases were 27(31%). On admission, fever (69%) was the most common symptoms, cough (56%) and fatigue(53%). An average(SD) of NLR of COVID-19 patients and non- COVID-19 patients were3.48±2.04 and 2.21±1.14, respectively. multivariable regression showed increasing odds of COVID-19 patients associated with NLR(odds ratio 1.752, 95% CI 1.111-2.763, per 1 unit increase; p=0.016). In addition, the area under the curve (AUC) of NLR was 0.707 and cutoff value was 2.22. At the second stage, 635 patients with COVID were enrolled with a retrospective, multi-center, large sample study in the 43 settings from 10 provinces, of these, mild case were 86(14%), ordinary cases [486(76%)],severe cases[63(10%)], common symptoms was at onset of disease were cough[356(56%)], an average of NLR of 635 patients was 4.04±4.68, and elevated NLR with the deterioration of clinical course[mild case(2.73±2.28), ordinary cases(3.58±3.07), severe cases(9.38±10.52), P<0.0001], in multivariable logistic regression model, compared to mild group, fever(OR 5.739, 95% CI 2.849-11.564) and cough(OR 3.265, 95% CI 1.675-6.331) were associated with ordinary cases, increasing odds of NLR was associated with ordinary cases (OR 1.199, 95% CI 1.010-1.422, per 1 unit increase; p=0.038). Fever(OR 7.587, 95% CI 2.601- 22.132),cough(OR 6.493, 95% CI 2.257-18.682) and shortness of breath(OR 4.133, 95% CI 1.125-15.179) were associated with severe cases, increasing odds of NLR (OR 1.342, 95% CI 1.122-1.605, per 1 unit increase; p=0.001), and increasing odds of age (OR 1.036, 95% CI 1.001- 1.073, per 1 unit increase; p=0.041) were associated with severe cases. The area under the curve (AUC) of NLR was 0.727 and cutoff value was 4.06, additionally, AUC of lymphocytes was 0.719 and cutoff value was 0.765. Interpretation: NLR as inflammatory markers with rapid, convenient characteristics, NLR≥2.22 could be utilized as a predicting indicator for the early recognition COVID-19 and facilitate detection timely; meanwhile, NLR≥4.06 and lymphocytes≤0.765 were as predicting indicator for severe COVID-19 and can facilitate to further prevent worse progress of clinical course. In addition, cough, shortness of breath, abnormal chest radiological findings were also associated with worse outcome.Funding Statement: The study was supported by" National Science and Technology Major Project" (2018ZX10101001-005-003, 2018ZX10101001-005-004).Declaration of Interests: All authors declare that they have no competing interests.Ethics Approval Statement: The study was approved by National Administration of Traditional Chinese Medicine, Administration of Traditional Chinese Medicine of 10 provinces and the institutional board of 43 participating setting.
To find the status of outcome indicators reported in published randomized controlled trial(RCT) of traditional Chinese medicine(TCM) for essential hypertension in the past two years, we searched for relevant information from four Chinese databases, three English databases and two clinical trial registries in this study, from January 2018 to September 2019. The outcome indicators of RCT were extracted and categorized from trials and the risk of bias was assessed by ROB tools from the Cochrane Collaboration. A total of 125 RCTs and 15 RCT protocols were finally included after study screening. The results showed that the RCT outcomes mainly included efficacy and safety outcomes. Efficacy indicators mainly included blood pressure measurement, quality of life assessment, blood biochemical indicators, urine analysis, arterial ultrasound, vascular endothelial function indicators, hematocrit, hemorheology indicators and other indicators. The safety indicators mainly included general physical examination items, heart, liver and kidney function tests, blood, urine, and stool routine examinations as well as adverse drug reactions/events. The current RCTs cannot distinguish primary and secondary outcomes, and the RCT protocols didn't report efficacy criteria clearly. They both didn't report health economic indicators and the methodological qualities were relatively low. In view of the current status on outcome indicators reported in TCM RCTs, constructing a core outcome set of TCM for essential hypertension and improving the methodology quality of RCTs will help to accurately reflect the actual efficacy of TCM intervention.
Background: Few studies have examined the association between treatment given time and clinical outcomes, which is indeed of great importance to clinical management of coronavirus disease 2019 (COVID-19). We performed this study to explore whether early treatment brings favorable clinical outcomes. Methods: In this retrospective multicenter study, we included patients aged 18 to 87 years with confirmed COVID-19 on admission from 54 hospitals in nine provinces of China from 21 January to 10 March, 2020. Final date of follow-up was March 17, 2020. All patients were treated by Lung cleansing & detoxifying decoction combined with western medicine. Patients were divided into four groups according to the interval from the first date of onset of symptoms to the date of starting a treatment, i.e., ≤1 week group (≤7 days), 1-2 weeks group (>7 days and ≤14 days), 2-3 weeks group (>14 days and ≤21 days) and >3 weeks group (>21 days). Multivariable Cox proportional hazard ratio (HR) models were used to estimate unadjusted and adjusted HRs and 95% confidence intervals (CIs) for the association between the treatment given time and clinical outcomes (time to recovery, days of viral shedding, duration of hospital stay, course of disease, fever and CT images). Findings: Of the 782 patients (median age was 46 years old, and 405 (52%) were male), there were 321 (41%) patients in ≤1 week group, 221 (28%) in 1-2 weeks group, 123 (16%) in 2-3 weeks group and 117 (15%) in >3 weeks group. Compared to patients in later treatment group (greater than 3 weeks), patients in earlier treatment groups of less than 1 week, 1 to 2 weeks, or 2 to 3 weeks had higher likelihood of recovery, with adjusted HR (95% CI) of 3.81 (2.65-5.48), 2.63 (1.86-3.73) and 1.92 (1.34-2.75), respectively. The median days of viral shedding was 13 days and 12 days in 2-3 weeks group and <2 weeks group respectively, shorter than that in >3 weeks group (P=0.0137). The median course of disease decreased from 34 days to 24 days, 21 days and 18 days when treatment was given every one week in advance compared to that was given later than 3 weeks from the onset of symptoms (P<0.0001). Treatment within 1 week since onset of symptoms was related with a decrease of 1 to 4 days in terms of median duration of hospital stay compared to later treatment (P<0.0001). Interpretation: Earlier treatment was associated with favorable outcomes, including sooner recovery, shorter time to viral shedding, and shorter duration of hospital stay. This paper demonstrated that early treatment could be an effective strategy in the epidemic control, and can provide evidence for government and international organizations to develop the policy of COVID-19.Funding Statement: This study was supported by "National Science and Technology Major Project" (2018ZX10101001-005-003, 2018ZX10101001-005-004).Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: The study was approved by National Administration of Traditional Chinese Medicine, Administration of Traditional Chinese Medicine of nine provinces and the institutional board of 54 participating setting. Due to the urgency of the treatment of COVID-19, the requirement for informed consent from study participants was replaced by verbal consent.
Qingfei Paidu decoction (QFPDD) showed to be beneficial for the treatment of coronavirus disease 2019 (COVID-19) in China. This study aimed to systematically assemble the evidence on the efficacy and safety of QFPDD combined with Western medicine treatments (WMT) for COVID-19. Systematic review and meta-analysis. A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, CNKI, CSTJ, CBM, Wanfang Data for clinical trials with a control arm until January 13, 2022. Studies matched the selection criteria were included. Data extraction and quality assessment of the included studies were independently conducted by two reviewers. Review Manager 5.4 was used for meta-analysis. A total of 9 trials including 1108 COVID-19 patients met the selection criteria. Meta-analysis demonstrated that QFPDD combined with WMT reduced aggravation rate (AR) by 71% [risk ratio (RR) = 0.29, 95% confidence intervals (CI) (0.17, 0.51)], increased effective rate (ER) by 13% [RR = 1.13, 95%CI (1.04, 1.22)], shortened 4.78 days of viral shedding [95%CI (-5.79, -3.77)] and 4.45 days of hospital stay [95%CI (-6.05, -2.86)], also decreased the incidence of adverse events (AE) by 56% [RR = 0.44, 95%CI (0.22, 0.89)]. QFPDD combined with WMT might reduce the proportion of severe cases and the incidence of AE, shorten the duration of viral shedding and length of hospital stay. More randomized controlled trials (RCTs) are required to confirm our findings in the future.
Coronavirus disease 2019 (COVID-19) causes symptoms ranging from mild to severe. Indicators for identifying severe COVID-19 infection have not been well identified, especially for young patients.Both neutrophil-lymphocyte ratio (NLR) [area under curve (AUC): 0.80; the odds ratios (OR) and 95% confidence intervals (95% CI): 1.30 (1.13-1.50)] and platelet-lymphocyte ratio (PLR) [AUC: 0.87; OR (95% CI): 1.05 (1.01-1.09)] were determined to be indicators for recognition of patients with severe COVID-19 in young patients less than age 40.NLR and PLR are useful indicators for identifying patients with severe COVID-19, especially in young patients less than age 40.
Objective
To analyze the effect of Maixuekang Capsule on the treatment outcome of coronary heart disease (CHD) by propensity score.
Methods
Based on the electronic medical record database of 22 large-scale tertiary hospitals nationwide, this study matched the coronary heart disease patients using and not using Maixuekang capsule according to a certain standard (1∶1). After matching, there were 2 464 cases in the patients group (group A) and the patients group (group B). In the database, the recombination of recovery and improvement is defined as effective treatment, and invalid , death and other are combined as ineffective treatment population. The effectiveness of the two groups after the re combination is compared by propensity score.
Results
The results of χ2 test showed that the difference between the two groups was statistically significant (P 0, and there was statistical significance (P<0.01).
Conclusions
The therapeutic effect of Maixuekang capsule on coronary heart disease is higher than that of patients without the drug.
Key words:
Propensity score; Maixuekang capsule; Coronary disease; Electronic health records
Dissolved gas analysis (DGA) of insulation oil is widely used in potential fault analysis for transformers. In order to improve the accuracy of fault diagnosis, a hybrid model which combines the FRVM with the depth belief network (DBN) is proposed to establish the mapping relationship between gas and fault types. Considering that DBN needs to extract a huge amount of feature information, this paper uses FRVM to separate the discharge and overheating faults, and then uses DBN to realize further fault diagnosis. The diagnosis accuracy is studied when IEC ratio, Rogers ratio, Dornenburg ratio and non-cod ratios are used as input parameters, and the results show that the correct rate of diagnosis is highest when the non-cod ratios are used as characteristic parameter. In addition, the method has better performance compared with single DBN, support vector machine and artificial neural network, and it has the ability to diagnose multiple faults.
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