Which Research Is Needed to Support Clinical Decision-Making on Integrative Medicine?——Can Comparative Effectiveness Research Close the Gap?

In clinical research on complementary and integrative medicine, experts and scientists have often pursued a research agenda in spite of an incomplete understanding of the needs of end users. Consequently, the majority of previous clinical trials have mainly assessed the efficacy of interventions. Scant data is available on their effectiveness. Comparative effectiveness research （CER） promises to support decision makers by generating evidence that compares the benefits and harms of the best care options. This evidence, more generalizable than the evidence generated by traditional randomized controlled trials （RCTs）, is better suited to inform real-world care decisions. An emphasis on CER supports the development of the evidence base for clinical and policy decision-making. Whereas in most areas of complementary and integrative medicine data on comparative effectiveness is scarce, available acupuncture research already contributes to CER evidence. This paper wil introduce CER and make suggestions for future research.

Postrandomization Confounding Challenges the Applicability of Randomized Clinical Trials in Comparative Effectiveness Research

Different from trials for regulatory approvals of new interventions aimed to test the efficacy, comparative effectiveness research （CER） is the direct comparison of existing health-care interventions （compared with active controls） to examine which treatment works best, for whom,

What Can Comparative Effectiveness Research,Propensity Score and Registry Study Bring to Chinese Medicine?

The impact of evidence-based medicine and clinical epidemiology on clinical research has contributed to the development of Chinese medicine in modem times over the past two decades.Many concepts and methods of modem science and technology are emerging in Chinese medicine research,resulting in constant progress.Systematic reviews,randomized controlled trials and other advanced mathematic approaches and statistical analysis methods have brought reform to Chinese medicine.In this new era,Chinese medicine researchers have many opportunities and challenges.On the one hand,Chinese medicine researchers need to dedicate themselves to providing enough evidence to the world through rigorous studies,whilst on the other hand,they also need to keep up with the speed of modem medicine research.For example,recently,real world study,comparative effectiveness research,propensity score techniques and registry study have emerged.This article aims to inspire Chinese medicine researchers to explore new areas by introducing these new ideas and new techniques.

A Comparative Study of Boron and Phosphorus Doping Effects in SiC: H Films Prepared by ECR-CVD

Hydrogenated silicon carbide films (SiC:H) were deposited using the electron cyclotron resonance chemical vapour deposition (ECR-CVD) technique from a mixture of methane, silane and hydrogen, and using diborane and phosphine as doping gases. The effects of changes in the microwave power on the deposition rate and optical bandgap were investigated, and variations in the photoand dark-conductivities and activation energy were studied in conjunction with film analysis using the Raman scattering technique. In the case of boron-doped samples, the conductivity increased rapidly to a maximum, followed by rapid reduction at high microwave power. The ratio of the photo- to dark-conductivity (σph/σd) peaked at microwave power of ~600 W. Under conditions of high microwave power, Raman scattering analysis showed evidence of the formation and increase in the silicon microcrystalline and diamond-like phases in the films, the former of which could account for the rapid increase and the latter the subsequent decrease in the conductivity.In the case of phosphorusdoped SiC:H samples, it was found that increase in the microwave power has the effect of enhancing the formation of the silicon microcrystalline phase in the films which occurred in correspondence to a rapid increase in the conductivity and reduction in the activation energy The conductivity increase stabilised in samples deposited at microwave power exceeding 500 W probably as a result of dopant saturation. Results from Raman scattering measurements also showed that phosphorus doping had the effect of enhancing the formation of the silicon microcrystals in the film whereas the presence of boron had the effect of preserving the amorphous structure.

Blood Oxidant/Antioxidant Status in overfed Aging Rats: Comparative Effects of Sunflower and Olive-Linseed Mixture Oil Rich Diets

Obesity, one of the most common health problems, is associated with glucose and lipid metabolism abnormalities, increased cardiovascular risk and oxidative stressI1}. Aging is also associated with an increase in oxidative stress[2]. Considering that older adults are already at risk for oxidant stress, the additional metabolic perturbations of obesity aggravated the susceptibility to oxidant stress. Modulating age-related oxidative stress via dietary interventions could reduce free radical production and significantly improve health in aging.

Comparing the Effectiveness of Coatings on Carbide andCermet Cutting Tool Inserts

A series of metal cutting experiments was performed on a CNC lathe to evaluate the performance of various coatings on different tool substrates. The workpiece material was plain medium carbon steel and the cutting tool materials were carbide and cermet inserts coated with various single as well as multilayer coatings. Machining was done under various cutting conditions of speed and feed-rate, and for various durations of Cutting. The output parameters studied were the cutting forces (axial, radial and tangential), the surface roughness of the workpiece, as well as the tool wear (crater and flank wear). From these results, the performances of the various cutting inserts are evaluated and compared. Results show that cutting forces are significantly lower when using coated cermets than when using coated carbides although different coatings on the same substrate also result in different cutting forces. However, there is less difference in the surface roughness of the finished workpiece for the various coatings and substrates.

COMPARATIVE STUDY ON THE INHIBITORY EFFECT OF GREEN TEA, COFFEE AND LEVAMISOLE ON THE HEPATOCARCINOGENIC ACTION OF DIETHYLNITROSAMINE

The present study aimed at clarifying whether Chinese green tea, coffee and levamisole (LMS) have similar Inhibitory effect on hepatocarclnogenesis induced by diethylnltrosamine (DEN) as they had been proved in our previous aflatoxin B1 (AFB1) experiments. Male Wistar rates were divided into control (A), green tea (B), coffee (C) and levamisole (D) groups. All rats received the same basic DEN treatment according to the program originally designed by Solt and Farber. During the two weeks before and one week after i. p. injection of DEN, the group B, C and D were given 2. 5% green tea, 5% coffee and 0. 1% LMS diet, respectively. The results demonstrated that coffee, LMS and , in particular,green tea showed Inhibitory effect against DEN-induced hepatocarcinogenesis, indicating that green tea can be used as chemopreventive agent for DEN-, as well as for AFB1-induced hepatocarcinogenesis.

Delayed assessment and eager adoption of laparoscopic cholecystectomy:Implications for developing surgical technologies

Despite the prevailing emphasis in the medical literature on establishing evidence,many changes in the practice of surgery have not been achieved using proper evidence-based assessment.This paper examines the adoption of laparoscopic cholecystectomy(LC)into regular use for the treatment of cholecystitis and the process of its acceptance,focusing on the limited role of technology assessment in its appraisal.A review of the published medical literature concerning LC was performed.Approximately 3000 studies of LC have been conducted since 1985,and there have been nearly 8500 publications to date.As LC was adopted enthusiastically into practice,the results of outcome studies generally showed that it compared favorably with the traditional,open cholecystectomy with regard to mortality,complications,and length of hospital stay.However,despite the rapid general agreement on surgical technique,efficacy,and appropriateness,there remained lingering doubts about safety,outcomes,and cost of the procedure that suggested that essential research questions were ignored even as the procedure became standard.Using LC as a case study,there are important lessons to be learned about the need for important guidelines for surgical innovation and the adoption of minimally invasive surgical techniques into current clinical and surgical practice.We highlight one recent example,natural orifice transluminal endoscopic surgery and how necessary it is to properly evaluate this new technology before it is accepted as a safe and effective surgical option.

Health Analytics, Economics and Medicine toward a 21st Century Health Care System

After a review of recent developments in precision medicine, population health sciences and innovative clinical trial designs, and in health economics and policy, we show how innovations in health analytics can capitalize on the advances in biomedicine and health economics towards developing a data-driven and cost-effective 21st century health care system. In particular, we propose a mutually beneficial public-private partnership that combines individual responsibility with community solidarity in building this health care system.

Comparative study of the effect of basic fibroblast growth factor and vascular endothelial growth factor on limb ischemia/reperfusion injury of rats

Objective To investigate the effect of basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) on limb ischemia/reperfusion injury of rats and the mechanism Methods The hind limb ischemia/reperfusion injury of male SD rats was induced by tourniquet for 2 hours and then reperfusing for 12 hours with administration of different agents Animals were divided into control, bFGF 10 and bFGF 50, VEGF 10 and VEGF 50 group by infusing physiological saline, 10 and 50?μg/kg bFGE, 10 and 50?μg/kg VEGF, respectively Blood was collected to determine malonyldialdehyde (MDA), and the ischemic reperfused gastrocnemius muscle and the contralateral control one were harvested together for measurement of tissue viability, water content, myeloperoxidose (MPO) activity, ATP and MDA concentration Results Compared with control group, tissue viability of ischemia/reperfusion limb in bFGF 10 and bFGF 50 group increased by 16 0% ( P <0 05) and 32 8% ( P <0 01), ATP content increased by 14 8% and 35 6% ( P <0 01), and plasma MDA level decreased by 45 2% and 56 2% ( P <0 01) 10?μg/kg bFGF had no significant effect on tissue water content, MPO activity, MDA concentration of ischemia/reperfusion limb, while 50?μg/kg of bFGF lowered these values by 15 7%, 32 5% and 13 6% ( P <0 05) and 14 7% ( P <0 01), MPO activity augmented by 44 9% and 96 1% ( P <0 01), ATP content decreased by 13 1% ( P <0 05) and 33 3% ( P <0 01) Plasma and tissue MDA concentrations in VEGF 10 group had no significant changes ( P >0 05), while in VEGF 50 group, these values were elevated by 46 4% and 38 6% ( P <0 01) Conclusion bFGF attenuated, while VEGF exacerbated ischemia/reperfusion injury of rat limb significantly, the mechanism of which was probably related to preventing or enhancing lipid peroxide, and increasing or decreasing energy store

Using sound Clinical Paths and Diagnosis-related Groups(DRGs)-based payment reform to bring benefits to patientcare: A case study of leukemia therapy

China has been undertaking a profound reform on health care.Although more than 1.16 billion people have been covered by rural and urban medical insurance to date,the level of reimbursement from insurance is very limited,especially for critical diseases such as leukemia.This places heavy economic burdens on patients.Under these circumstances,systems innovation is imperative for the efficient utilization of limited funding.In this respect,certain valuable experience from other countries may prove helpful.The prospective payment system of Diagnosis-related Groups(DRGs),Clinical Paths,and the Comparative Effectiveness Analysis adopted by the National Institute of Health and Clinical Excellence(NICE,UK),can befine tools to reduce medical costs and improve quality of services.Treatments of acute promyelocytic leukemia at Rui-Jin Hospital,and childhood acute lymphoblastic leukemia at Shanghai Children’s Medical Center,can be taken as suitable models to illustrate the crucial role of Clinical Paths in guaranteeing clinical and cost effectiveness of medical services for critical diseases,and to satisfactorily justify the feasibility of DRGs in China.

Research methods in complementary and alternative medicine： an integrative review

The scientific literature presents a modest amount ot evidence m the use or complementary ana al[erna- tire medicine （CAM）. On the other hand, in practice, relevant results are common. The debates among CAM practitioners about the quality and execution of scientific research are important, Therefore, the aim of this review is to gather, synthesize and describe the differentiated methodological models that encompass the complexity of therapeutic interventions. The process of bringing evidence-based medicine into clinical practice in CAM is essential for the growth and strengthening of complementary medicines worldwide.

A primer on multiscale modelling of infectious disease systems

The development of multiscale models of infectious disease systems is a scientific endeavour whose progress depends on advances on three main frontiers:(a)the conceptual framework frontier,(b)the mathematical technology or technical frontier,and(c)the scientific applications frontier.The objective of this primer is to introduce foundational concepts in multiscale modelling of infectious disease systems focused on these three main frontiers.On the conceptual framework frontier we propose a three-level hierarchical framework as a foundational idea which enables the discussion of the structure of multiscale models of infectious disease systems in a general way.On the scientific applications frontier we suggest ways in which the different structures of multiscale models can serve as infrastructure to provide new knowledge on the control,elimination and even eradication of infectious disease systems,while on the mathematical technology or technical frontier we present some challenges that modelers face in developing appropriate multiscale models of infectious disease systems.We anticipate that the foundational concepts presented in this primer will be central in articulating an integrated and more refined disease control theory based on multiscale modelling-the all-encompassing quantitative representation of an infectious disease system.