A Protocol for Developing Chinese Clinical Practice Guidelines of Hypertension

To improve the standard screening, diagnosis, and treatment of hypertension in patients in China;realize the standardization of clinical practice of hypertension;and improve the prevention and control level of hypertension in China, it is both important and necessary to develop a clinical practice guideline for hypertension according to a recognized methodology. Jointly sponsored by the National Center for Cardiovascular Diseases, Chinese Medical Doctor Association, Hypertension Committee of the Chinese Medical Doctor Association, Chinese Society of Cardiology, and Hypertension Committee of Cross-Straits Medicine Exchange Association, the “Chinese Clinical Practice Guidelines of Hypertension” was proposed. Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences, Guideline and Standards Research Centre of Chinese Medical Association Publishing House, Lanzhou University Institute of Health Data Science, and Lanzhou University GRADE Center will provide methodological support for the guidelines.

Methodological and reporting quality of comprehensive hypertension guidelines published between 2017 and 2022

Hypertension,also known as high blood pressure,is a serious medical condition that may cause severe health problems,such as heart attack and stroke.According to the World Health Organization(WHO),^([1])an estimated 1.28 billion adults worldwide aged 30–79 years had hypertension in 2021,two-third of whom were living in low-and middle-income countries.Many national and international clinical practice guidelines(CPGs)on the diagnosis,evaluation,and treatment of hypertension have been published to promote its control.Among these,comprehensive hypertension guidelines provide broader direction to more target users,especially primary healthcare practitioners,than“narrow”types of guidelines.

Analysis of COVID-19 Guideline Quality and Change of Recommendations:A Systematic Review

Background.Hundreds of coronavirus disease 2019(COVID-19)clinical practice guidelines(CPGs)and expert consensus statements have been developed and published since the outbreak of the epidemic.However,these CPGs are of widely variable quality.So,this review is aimed at systematically evaluating the methodological and reporting qualities of COVID-19 CPGs,exploring factors that may influence their quality,and analyzing the change of recommendations in CPGs with evidence published.Methods.We searched five electronic databases and five websites from 1 January to 31 December 2020 to retrieve all COVID-19 CPGs.The assessment of the methodological and reporting qualities of CPGs was performed using the AGREE II instrument and RIGHT checklist.Recommendations and evidence used to make recommendations in the CPGs regarding some treatments for COVID-19(remdesivir,glucocorticoids,hydroxychloroquine/chloroquine,interferon,and lopinavir-ritonavir)were also systematically assessed.And the statistical inference was performed to identify factors associated with the quality of CPGs.Results.We included a total of 92 COVID-19 CPGs developed by 19 countries.Overall,the RIGHT checklist reporting rate of COVID-19 CPGs was 33.0%,and the AGREE II domain score was 30.4%.The overall methodological and reporting qualities of COVID-19 CPGs gradually improved during the year 2020.Factors associated with high methodological and reporting qualities included the evidence-based development process,management of conflicts of interest,and use of established rating systems to assess the quality of evidence and strength of recommendations.The recommendations of only seven(7.6%)CPGs were informed by a systematic review of evidence,and these seven CPGs have relatively high methodological and reporting qualities,in which six of them fully meet the Institute of Medicine(IOM)criteria of guidelines.Besides,a rapid advice CPG developed by the World Health Organization(WHO)of the seven CPGs got the highest overall scores in methodological(72.8%)and reporting qualities(83.8%).Many CPGs covered the same clinical questions(it refers to the clinical questions on the effectiveness of treatments of remdesivir,glucocorticoids,hydroxychloroquine/chloroquine,interferon,and lopinavirritonavir in COVID-19 patients)and were published by different countries or organizations.Although randomized controlled trials and systematic reviews on the effectiveness of treatments of remdesivir,glucocorticoids,hydroxychloroquine/chloroquine,interferon,and lopinavir-ritonavir for patients with COVID-19 have been published,the recommendations on those treatments still varied greatly across COVID-19 CPGs published in different countries or regions,which may suggest that the CPGs do not make sufficient use of the latest evidence.Conclusions.Both the methodological and reporting qualities of COVID-19 CPGs increased over time,but there is still room for further improvement.The lack of effective use of available evidence and management of conflicts of interest were the main reasons for the low quality of the CPGs.The use of formal rating systems for the quality of evidence and strength of recommendations may help to improve the quality of CPGs in the context of the COVID-19 pandemic.During the pandemic,we suggest developing a living guideline of which recommendations are supported by a systematic review for it can facilitate the timely translation of the latest research findings to clinical practice.We also suggest that CPG developers should register the guidelines in a registration platform at the beginning for it can reduce duplication development of guidelines on the same clinical question,increase the transparency of the development process,and promote cooperation among guideline developers all over the world.Since the International Practice Guideline Registry Platform has been created,developers could register guidelines prospectively and internationally on this platform.

Three new triterpenoid saponins from Aralia echinocaulis

Objective:To study the active ingredients in the root bark of Aralia echinocaulis.Methods:Three triterpenoid saponins were separated from the 70%ethanol extracts and purified by column chromatography and their structures were determined by spectroscopic analysis.Compound 1 and 3 were evaluated for antioxidant activity by the in vitro DPPH free radical scavenging ability and the protective effect of OH-induced DNA oxidative damage.Results:Compound 1 was a new type of triterpenoid saponin,named as echinocaulisaglycone 3-O-β-Dglucopyranoside(echinocaulisaponin A),and it had good antioxidant activity.Compound 2 was similar to compound 1,named as 1-hydroxyl-echinocaulisaglycone 3-O-β-D-glucopyranoside(echinocaulisaponin B).Compound 3 was also a new type of triterpenoid saponin,named as echinocaulisaglyconeⅡ3-O-a-L-arabinopyranosyl-(1’’→4’)-β-D-glucopyranosiduronic acid(echinocaulisaponin C),and its antioxidant activity was weaker than compound 1.Conclusion:In this study,three new compounds were discovered and two of them were carried out in vitro anti-oxidation studies,laying the foundation for further research on the treatment of related diseases(cardiovascular disease,arthritis,age-related macular degeneration,etc.)through anti-oxidation or quenching free radical function.