Levels of evidence and grades of recommendation supporting European society for medical oncology clinical practice guidelines

Background:The European Society for Medical Oncology(ESMO)guidelines are among the most comprehensive and widely used clinical practice guidelines(CPGs)globally.However,the level of scientific evidence supporting ESMO CPG recommendations has not been systematically investigated.This study assessed ESMO CPG levels of evidence(LOE)and grades of recommendations(GOR),as well as their trends over time across various cancer settings.Methods:We manually extracted every recommendation with the Infectious Diseases Society of America(IDSA)classification from each CPG.We examined the distribution of LOE and GOR in all available ESMO CPG guidelines across different topics and cancer types.Results:Among the 1,823 recommendations in the current CPG,30%were classified as LOEⅠ,and 43%were classified as GOR A.Overall,there was a slight decrease in LOEⅠ(−2%)and an increase in the proportion of GOR A(+1%)in the current CPG compared to previous versions.The proportion of GOR A recommendations based on higher levels of evidence such as randomized trials(LOEⅠ–Ⅱ)shows a decrease(71%vs.63%,p=0.009)while recommendations based on lower levels of evidence(LOEⅢ–Ⅴ)show an increase(29%vs.37%,p=0.01)between previous and current version.In the current versions,the highest proportion of LOEⅠ(42%)was found in recommendations related to pharmacotherapy,while the highest proportion of GOR A recommendations was found in the areas of pathology(50%)and diagnostic(50%)recommendations.Significant variability in LOEⅠand GOR A recommendations and their changes over time was observed across different cancer types.Conclusion:One-third of the current ESMO CPG recommendations are supported by the highest level of evidence.More well-designed randomized clinical trials are needed to increase the proportion of LOEⅠand GOR A recommendations,ultimately leading to improved outcomes for cancer patients.

Application Analysis of Nursing Students'Grades in Course Relevance Based on Association Rule Mining Algorithm Apriori

By analyzing the correlation between courses in students’grades,we can provide a decision-making basis for the revision of courses and syllabi,rationally optimize courses,and further improve teaching effects.With the help of IBM SPSS Modeler data mining software,this paper uses Apriori algorithm for association rule mining to conduct an in-depth analysis of the grades of nursing students in Shandong College of Traditional Chinese Medicine,and to explore the correlation between professional basic courses and professional core courses.Lastly,according to the detailed analysis of the mining results,valuable curriculum information will be found from the actual teaching data.

Annual Monitoring and Evaluation of the Grades of Arable Land Quality——Taking Lingchuan County as an Example

With the increasing requirement for the protection of arable land, monitor- ing the grades of arable land quality is becoming more important, which can accu- rately and fully reflect the current situation and development trends of arable land quality. It is also an important measure for protecting the quality of arable land. in the present study, the distribution and changes of arable lands of different gradient types and grades in Lingchuan County, Guangxi Zhuang Autonomous Region in 2015 were monitored and evaluated, to analyze the trends and reasons for the changes in the quality and productivity of arable lands, and to provide references for dynamic monitoring of the quality of arable land.

热敏灸治疗颈型颈椎病的Meta分析及GRADE证据等级评价

目的系统评价热敏灸及其综合疗法用于颈型颈椎病的临床效果,为热敏灸治疗颈型颈椎病提供更好的证据来源。方法收集国内外各大数据库热敏灸及其综合疗法用于颈型颈椎病的随机对照试验(RCT),通过Revman 5.3软件进行Meta分析,按照GRADE标准对结局指标进行证据质量评价。结果纳入9篇文献共855例患者,Meta分析结果提示:热敏灸及其综合疗法组在提高总有效率(RR=1.19,P<0.01)和治愈率(RR=1.73,P<0.01)、降低视觉模拟量表(VAS)评分(SMD=-0.73,P<0.01)、简化McGill疼痛问卷(SF-MPQ)评分(SMD=-1.28,P<0.05)以及NPQ颈痛量表评分(SMD=-0.81,P<0.05)方面都优于对照组;GRADE证据等级评价提示:前三者为低质量证据,后二者为极低质量证据。结论热敏灸及其综合疗法用于颈型颈椎病在提高临床效果、镇痛以及改善患者生活质量方面更具优势。

Tumor regression grades:Potential outcome predictor of locally advanced rectal adenocarcinoma after preoperative radiotherapy

AIM:To analyze tumor regression grade(TRG)for prognosis of locally advanced rectal adenocarcinoma(LARA)treated with preoperative radiotherapy.METHODS:One hundred and ninety patients with clinical stageⅡ/ⅢLARA were studied.All patients underwent radical surgery(between 2004 and 2010)after 30-Gy/10-fraction preoperative radiotherapy(preRT).All 190 patients received a short course of preRT and were reassessed for disease recurrence and survival;the slides of surgical specimens were reviewed and classified according to Mandard TRG.We compared patients with good response(Mandard TRG1 or TRG2)vs patients with bad/poor response(Mandard TRG3-5).Outcomes evaluated were 5-year overall survival(OS),5-year disease-free survival(DFS),and local,distant and mixed recurrence.Fisher’s exact test orχ2 test,logrank test and proportional hazards regression analysis were used to calculate the probability that Mandard TRG was associated with patient outcomes.RESULTS:One hundred and sixty-six of 190 patients(87.4%)were identified as Mandard bad responders(TRG3-5).High Mandard grade was correlated with tumor height(41.7%<6 cm vs 58.3%≥6 cm,P=0.050),yp T stage(75%yp T0-2 vs 25%yp T3-4,P=0.000),and yp N stage(75%yp N0 vs 25%yp N1,P=0.031).In univariate survival analysis,Mandard grade bad responders had significantly worse OS and DFSthan good responders(TRG1/2)(OS,83.1%vs 96.4%,P=0.000;DFS,72.3%vs 92.0%,P=0.002).In multivariate survival analysis,Mandard bad responders had significantly worse DFS than Mandard good responders(DFS 3.8 years(95%CI:1.2-12.2 years,P=0.026).CONCLUSION:Mandard grade good responders had a favorable prognosis.TRG may be a potential predictor for DFS in LARA after pre-RT.

Trends in the Different Grades of Precipitation over South China during 1960–2010 and the Possible Link with Anthropogenic Aerosols

Using observed daily precipitation data to classify five levels of rainy days by strength in South China （SC）,with an emphasis on the Pearl River Delta （PRD） region,the spatiotemporal variation of different grades of precipitation during the period 1960-2010 was analyzed and the possible link with anthropogenic aerosols examined.Statistical analysis showed that drizzle and small precipitation has significantly decreased,whereas medium to heavy precipitation has increased slightly over the past 50 years （although not statistically significant）.Further data analysis suggested that the decline in drizzle and small precipitation probably has a strong link to increased concentrations of anthropogenic aerosols produced by large-scale human activities related to the rapid socioeconomic development of the PRD region.These aerosols may also have led to the obvious decreasing trend in horizontal visibility and sunshine duration in SC,which is statistically significant according to the t-test.

Essential competencies for three grades of midwives in China

Objective:To identify the essential competencies for different grades of midwives in China.Methods:A nationwide modified Delphi process was implemented to amend and screen the indicators.Thirty expert panellists including practitioners (nurse-midwives),clinical managers,academic educators and obstetricians completed a two-round Delphi study through an electronic survey that was supplemented by an expert panel meeting for discussion of comments and suggestions.Results:All panellists completed two rounds of Delphi study and at least 75% of them achieved a consensus on 224 items (W1 =0.150,W2 =0.173).Seven domains were established,namely,'Professional quality','Antenatal care','Intrapartum care','Postnatal care','Neonatal care','Gynaecological care','Public health care & Integrative competency'.Generalised maternal and neonatal knowledge and perinatal care skills were set for'junior'midwives,pathological care for'senior'ones and supervisory abilities and promotion of discipline for'expert'ones.Conclusions:This research developed three grades of essential competencies for midwives in China.The next step will be assessment in clinical settings for further response.The set was in line with the concepts of International Confederation of Midwives under the domestic context.This set could be adopted as a reference in developing normalised midwifery practice,education and certification.

Effect of copper slag recovery on hydrometallurgical cut-off grades considering environmental aspects

Determining the hydrometallurgical cut-off grades specifies the destination of low grade materials and this is subjected to more benefits in mining. Copper production rate is considered as one of the fundamental issues in hydrometallurgical cut-off grades determination. Slags are remarked as one of the main sources of copper. It is not only regarded as a waste but also identified as another resource extracting base metals. Slags are characterized by copper high grade. Thus, slag copper recovery can be led to different cut-off grades and net present value(NPV). The current research scrutinizes the effect of slag recovery by both flotation and hydrometallurgical methods on the hydrometallurgical cut-off grades. For this purpose, the optimum cut-off grade algorithms of hydrometallurgical methods are developed by considering associated environmental parameters, incomes and also the costs. Then, their optimum amounts are calculated with NPV maximization as an objective function. The results indicate that considering slag copper recovery in the hydrometallurgical cut-off grade algorithms reduces the environmental costs caused by slag dumping and leads to more NPV by 9%.

Characterization and comparison of the aroma-active compounds on different grades of sesame-flavor Baijiu by headspace solid-phase microextraction and gas chromatography-olfactometry-mass spectrometry

This study investigated the aroma-active compounds and compared the differences of three different grades of sesame-flavor Baijiu by headspace solid-phase microextraction(HS-SPME)coupled with gas chromatography-olfactometry-mass spectrometry(GC-O-MS).A total of 54 aroma-active compounds were detected.Principal component analysis showed that JZ1,JZ2,and JZ3 were well separated from each other.JZ1 as the premium-grade Baijiu had the highest aroma intensities,concentrations.According to aroma intensities and concentrations,dimethyl trisulfide,butanoic acid,phenylacetaldehyde,2-furylmethanethiol,ethyl hexanoate,2,6-dimethylpyrazine,etc.could be potentially applied as volatile makers to distinguish the three different grades of sesame-flavor Baijiu as their significant difference(P<0.05)in three Baijiu samples.Roasted aroma had the significant difference(P<0.05)in three sample base on aroma profiles.Meanwhile,2-furylmethanethiol,2,6-dimethylpyrazine were related to the roasted aroma,they may be had a significant contribution to the differences of three different grades of sesame-flavor Baijiu.This study has provided a comprehensive understanding of the differences of three different grades of sesame-flavor Baijiu.

Evaluation of umami taste components of mushroom (Suillus granulatus) of different grades prepared by different drying methods

Suillus granulatus is a valuable wild edible mushroom with a strong umami taste.Different grades of S.granulatus were dried by different methods,including natural air drying(ND),hot air drying(HAD),vacuum drying(VD),and freeze drying(FD).Results showed that VD samples of all grades had the highest equivalent umami concentration(EUC)value(P<0.05).The second grade of ND samples showed the highest EUC value(P<0.05).The first grade of HAD samples showed the highest EUC value(P<0.05).The third grade of FD samples showed the highest EUC value(P<0.05).The third grade of VD samples had a higher EUC value than the other grades of samples dried by VD.Electronic tongue results indicated no significant differences between samples of all grades dried by all methods.Thus,umami taste components are affected by drying method and grade.VD is an appropriate drying method for all sample grades.ND,HAD,and FD are suitable for second-,first-,and third-grade samples,respectively.

Leveraging machine learning techniques for predicting pancreatic neuroendocrine tumor grades using biochemical and tumor markers

BACKGROUND The incidence of pancreatic neuroendocrine tumors (PNETs) is now increasing rapidly. The tumor grade of PNETs significantly affects the treatment strategy and prognosis. However, there is still no effective way to non-invasively classify PNET grades. Machine learning (ML) algorithms have shown potential in improving the prediction accuracy using comprehensive data. AIM To provide a ML approach to predict PNET tumor grade using clinical data. METHODS The clinical data of histologically confirmed PNET cases between 2012 and 2018 were collected. A method of minimum P for the Chi-square test was used to divide the continuous variables into binary variables. The continuous variables were transformed into binary variables according to the cutoff value, while the P value was minimum. Four classical supervised ML models, including logistic regression, support vector machine (SVM), linear discriminant analysis (LDA) and multi-layer perceptron (MLP) were trained by clinical data, and the models were labeled with the pathological tumor grade of each PNET patient. The performance of each model, including the weight of the different parameters, were evaluated. RESULTS In total, 91 PNET cases were included in this study, in which 32 were G1, 48 were G2 and 11 were G3. The results showed that there were significant differences among the clinical parameters of patients with different grades. Patients with higher grades tended to have higher values of total bilirubin, alpha fetoprotein, carcinoembryonic antigen, carbohydrate antigen 19-9 and carbohydrate antigen 72-4. Among the models we used, LDA performed best in predicting the PNET tumor grade. Meanwhile, MLP had the highest recall rate for G3 cases. All of the models stabilized when the sample size was over 70 percent of the total, except for SVM. Different parameters varied in affecting the outcomes of the models. Overall, alanine transaminase, total bilirubin, carcinoembryonic antigen, carbohydrate antigen 19-9 and carbohydrate antigen 72-4 affected the outcome greater than other parameters. CONCLUSION ML could be a simple and effective method in non-invasively predicting PNET grades by using the routine data obtained from the results of biochemical and tumor markers.

Aluminum potassium sulfate and tannic acid sclerotherapy for Goligher Grades Ⅱ and Ⅲ hemorrhoids: Results from a multicenter study

AIM: To show that aluminum potassium sulfate and tannic acid(ALTA) sclerotherapy has a high success rate for Grade Ⅱ and Ⅲ hemorrhoids.METHODS: This study was based on the clinical data of 604 patients with hemorrhoids who underwent ALTA sclerotherapy between January 2009 and February 2015. The objective of this study was to assess the efficacy of this treatment for Grades Ⅱ and Ⅲ hemorrhoids. Preoperative and postoperative symptoms, complications and success rate were all assessed retrospectively. Follow-up consisted of a simple questionnaire, physical examination and an anoscopy. Patients were followed-up at one day, one week, two weeks, one month, one year, two years, three years, four years and five years after the ALTA sclerotherapy.RESULTS: One hundred and sixty-nine patients were diagnosed with Grade Ⅱ hemorrhoids and 435 patients were diagnosed with Grade Ⅲ hemorrhoids. The one year, three year and five year cumulative success rates of ALTA sclerotherapy for Grades Ⅱ and Ⅲ hemo-rrhoids were 95.9% and 93.1%; 89.3% and 83.7%; and 89.3% and 78.2%, respectively. No significant differences were observed in the cumulative success rates after ALTA sclerotherapy between Grades Ⅱ and Ⅲ hemorrhoids(P = 0.09). There were forty-seven post-operative complications(low grade fever; anal pain; urinary retention; rectal ulcer; and others). No serious or life-threatening complications occurred and all cases improved through conservative treatment. At univariate analysis there were no predictive factors of failure.CONCLUSION: ALTA sclerotherapy has had a high success rate for Grade Ⅱ and Ⅲ hemorrhoids during five years of post-operative treatment. However, additional studies are needed to evaluate the efficacy of this ALTA sclerotherapy in the management of hemorrhoidal disease.

Correlation between radiologic features on contrastenhanced CT and pathological tumor grades in pancreatic neuroendocrine neoplasms

Contrast-enhanced computed tomography(CT)contributes to the increasing detection of pancreatic neuroendocrine neoplasms(PNENs).Nevertheless,its value for differentiating pathological tumor grades is not well recognized.In this report,we have conducted a retrospective study on the relationship between the 2017 World Health Organization(WHO)classification and CT imaging features in 94 patients.Most of the investigated features eventually provided statistically significant indicators for discerning PNENs G3 from PNENs G1/G2,including tumor size,shape,margin,heterogeneity,intratumoral blood vessels,vascular invasion,enhancement pattern in both contrast phases,enhancement degree in both phases,tumor-to-pancreas contrast ratio in both phases,common bile duct dilatation,lymph node metastases,and liver metastases.Ill-defined tumor margin was an independent predictor for PNENs G3 with the highest area under the curve(AUC)of 0.906 in the multivariable logistic regression and receiver operating characteristic curve analysis.The portal enhancement ratio(PER)was shown the highest AUC of 0.855 in terms of quantitative features.Our data suggest that the traditional contrastenhanced CT still plays a vital role in differentiation of tumor grades and heterogeneity analysis prior to treatment.

刮痧改善腰椎间盘突出疼痛症状的系统评价及GRADE证据质量评价

目的系统评价刮痧干预腰椎间盘突出疼痛症状的疗效与安全性,为其临床治疗提供循证依据。方法计算机检索自建库到2022年8月29日前公开发表在中国知网、万方、维普、中国生物医学文献服务系统、PubMed、Embase、Web of Science、The Cochrane Library数据库,收集关于刮痧干预腰椎间盘突出的随机对照试验(Randomized controlled trial,RCT)。文章由两名研究者独立筛选,根据Cochrane Reviewers Handbook 6.2的偏倚风险评估工具对纳入文献进行质量评价,应用RevMan 5.4软件对纳入文献的结局指标进行Meta分析,并采用GRADE系统对结局指标进行证据质量等级评价。结果最终纳入10篇RCT,共1087例患者。Meta分析结果显示:刮痧试验组治疗腰椎间盘突出患者在疼痛VAS评分[MD=-1.11,95%CI(-1.58,-0.64),P<0.00001]、日本骨科协会(JOA)评分[MD=4.47,95%CI(3.76,5.17),P<0.00001]、临床有效率[relative risk(RR)=1.13,95%CI(1.08,1.19),P<0.00001]和护理满意度[RR=1.21,95%CI(1.09,1.34),P=0.0005]方面,明显优于对照组,差异均有统计学意义(P<0.00001)。本文结局指标的证据质量为极低。结论当前证据表明,刮痧治疗腰椎间盘突出患者的疼痛症状具有良好临床疗效,并有助于提高临床护理满意度。由于部分结局证据质量较低,有待严谨的多中心、大样本随机对照试验来进一步验证其有效性,提升临床证据。

Effects of PM2.5 Exposure in Different Air Quality Grades on Daily Outpatient Visits for Childhood Asthma in Shijiazhuang, China

Asthma is a common chronic inflammatory disorder that is more prevalent in children than in adults.China has seen an increasing prevalence of childhood asthma in recentdecades[1].Earlier studies have shown that air particulate matter (PM),particularly fine particulate matter(PM2.5)[2],is an important factor triggering childhood asthma. Since nationalPM2.5data were nota vailabl euntil 2013,

Estimation of Copper and Molybdenum Grades and Recoveries in the Industrial Flotation Plant Using the Artificial Neural Network

In this paper, prediction of copper and molybdenum grades and their recoveries of an industrial flotation plant are investigated using the Artificial Neural Networks (ANN) model. Process modeling has done based on 92 datasets collected at different operational conditions and feed characteristics. The prominent parameters investigated in this network were pH, collector, frother and F-Oil concentration, size percentage of feed passing 75 microns, moisture content in feed, solid percentage, and grade of copper, molybdenum, and iron in feed. A multilayer perceptron neural network, with 10:10:10:4 structure (two hidden layers), was used to estimate metallurgical performance. To obtain the optimal hidden layers and nodes in a layer, a trial and error procedure was done. In training and testing phases, it achieved quite correlations of 0.98 and 0.93 for Copper grade, of 0.99 and 0.92 for Copper recovery, of 0.99 and 0.92 for Molybdenum grade and of 0.99 and 0.94 for Molybdenum recovery prediction, respectively. The proposed neural network model can be applied to determine the most beneficial operational conditions for the expected Copper and Molybdenum grades and their recovery in final concentration of the industrial copper flotation process.

穴位埋线治疗功能性便秘疗效与安全性Meta分析及GRADE评价

目的:系统评价穴位埋线治疗功能性便秘(FC)的疗效和安全性及纳入证据的质量,以期为临床决策提供循证医学证据。方法:检索中国知网(CNKI)、万方知识服务平台(WANFANG)、维普中文期刊数据库(VIP)、中国生物医学文献服务系统(SinoMed)、Embase、PubMed和Cochrane Library数据库,搜集穴位埋线治疗FC的随机对照试验(RCT),检索时间均从建库至2023年10月16日。由2名研究者独立完成文献筛选、资料提取及偏倚风险评估,采用RevMan 5.4软件进行Meta分析,并采用GRADE评价方法对各项结局指标进行证据质量评价。结果:最终共纳入19项RCT,包括1673例患者。Meta分析结果显示,与对照组比较,穴位埋线治疗FC可提高总有效率[RR=1.23,95%CI=(1.17,1.29),P<0.00001],增加完全自发排便(CSBM)次数[MD=0.61,95%CI=(0.11,1.10),P=0.02],改善粪便性状[MD=0.53,95%CI=(0.31,0.76),P<0.00001]及排便困难[MD=-0.71,95%CI=(-1.03,-0.40),P<0.00001],缩短排便时间[MD=-0.50,95%CI=(-0.72,-0.29),P<0.00001],改善便秘生活质量评估量表(PAC-QOL)评分[MD=-7.72,95%CI=(-12.83,-2.61),P<0.003];两组不良反应发生率比较,差异无统计学意义[RR=0.37,95%CI=(0.10,1.38),P=0.14]。GRADE证据级别评价结果显示:总有效率为中级别证据质量,不良反应发生率、粪便性状评分、排便困难评分为低级别证据质量,CSBM次数、排便时间、PACQOL评分为极低级别证据质量。结论:穴位埋线治疗FC具有一定的疗效,可改善便秘相关症状,且未增加不良反应发生率。但纳入研究质量总体偏低,上述结论尚需开展更多高质量的研究予以验证。

Research on Relationship Between Humic Substance Grades and Their Dispersion Ability as CWM Additives

Four humic coal samples are extracted to obtain humic substances (HS), and then subdivided(or purified) to obtain sixteen grades of HS, four from each coal. The effectiveness of these sixteen HS samples as additives for producing coal water mixture (CWM) is tested (w (additive) = 1 % and the the coal used is from the Baiyi coal preparation plant). A linear regression analysis of viscosity versus the additive’s components shows: (1)humic acids(HA) and humin (HM) are much better than fulvic acids (HF) with HA being tbe best, and (2) tke effects of grades of HS on coal dispersion as measured by viscosity are quite different. CWM additive effectiveness correlates positively with the increase of E4/E6,ash content, acid groups, and carboxyl groups, and negatively with the increase of molecular weight, HS content and phenolic alcohol content.

腕踝针干预术后疼痛疗效的Meta分析和Grade评价

目的运用循证医学方法对腕踝针干预术后疼痛的疗效和安全性进行系统评价和Grade评价。方法计算机检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、Embase、Web of Science、Cochrane Library中关于腕踝针干预术后疼痛的随机对照试验,检索时限为建库至2023年10月。采用RevMan 5.4软件进行Meta分析。结果纳入23篇文献,共计1968例患者,Meta分析结果显示,与常规治疗相比,腕踝针能够提高术后疼痛患者的总有效率[OR=4.42,95%CI(2.60,7.50),P<0.001],术后镇痛泵药量使用减少[MD=-9.03,95%CI(-12.09,-5.98),P<0.001],术后疼痛评分降低[MD=-1.39,95%CI(-1.68,-1.09),P<0.001],可减少不良反应发生率[RR=0.40,95%CI(0.32,0.48),P<0.001]以及临床满意度[OR=3.94,95%CI(2.40,6.48),P<0.001]。Grade证据分级结果显示:总有效率、不良反应发生率和临床满意度3项结局指标为中等质量证据,VAS评分指标为低质量证据,镇痛泵药量使用指标为极低质量证据。结论腕踝针可提高总有效率,减少术后镇痛药用量,不良反应少,安全性高,为患者提供了一种安全有效的镇痛方式。

Reconstruction of the Rainfall in Rainy Season Based on Historical Drought/Flood Grades

On the basis of historical yearly drought and flood grades from A.D.1470 to A.D.1949, the ten-year mean precipitation in the rainy season in Wuhan district was reconstructed by means of statistical method. The reconstructing method was testified to be simple and effective.