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

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Chinese Journal of Integrative medicine 2012年第10期18卷 723-729页

作者： claudia m.witt 黄文静 Lixing Lao Berman Bm Charit University medical Center Institute for Social MedicineEpidemiology and Health Economics University of maryland School of medicine Center for Integrative Medicine Chengdu University of Traditional Chinese medicine The Institute for Integrative Health

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.

关键词： comparative effectiveness research decision making integrative medicine Chinese medicine acupuncture

我们需要什么研究来支持将结合医学运用于临床的决策?--效益比较研究可以填补其间的沟壑吗?

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中国中西医结合杂志 2013年第8期33卷 1030-1035页

作者： claudia m.witt 黄文静劳力行 Brian m.Berman 德国柏林医科大学社会医学、流行病学及卫生经济学研究所德国柏林10117 马里兰大学医学院结合医学中心美国巴尔的摩21201 成都中医药大学针灸推拿学院成都610075 结合卫生研究所美国巴尔的摩21231

在补充和结合医学临床研究中,专家和科研工作者往往片面地追求研究纲领而没有充分考虑到最终服务对象,即患者的需求。因此,以往大多数的临床研究都集中在评价治疗措施的效力,却缺乏关于其临床效果的研究数据。效益比较研究(comparative ... 详细信息

在补充和结合医学临床研究中,专家和科研工作者往往片面地追求研究纲领而没有充分考虑到最终服务对象,即患者的需求。因此,以往大多数的临床研究都集中在评价治疗措施的效力,却缺乏关于其临床效果的研究数据。效益比较研究(comparative effectivenesresearch,CER)旨在通过提供对可能的最佳治疗方案利弊的比较证据,使决策者能明智选择最佳治疗方案。这种证据,较之传统意义上的RCT研究证据更普遍,更适用于对实际医疗方案的决策。重视CER将为临床循证医学的发展及政策制定提供支持。诚然,在补充和结合医学的大多数领域中,CER的数据还很匮乏,针灸研究已为CER提供了一定的证据。笔者将重点介绍CER,并对将来的研究方向提供建议。

关键词：效益比较研究决策结合医学中医针刺

Thirteen years to get from b to a:one of the neglected isoforms of IL-37 enters the stage

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Cellular & molecular Immunology 2024年第2期21卷 201-202页

作者： Steven X.Cho Ina Rudloff Andrew m.Ellisdon claudia A.Nold-Petry marcel F.Nold Ritchie Centre Hudson Institute of Medical ResearchMelbourneVICAustralia Department of Pediatrics Monash UniversityMelbourneVICAustralia Cancer Program Biomedicine Discovery InstituteMonash UniversityMelbourneVICAustralia monash Newborn Monash Children’s HospitalMelbourneVICAustralia

Interleukin(IL)-37 is one of the few anti-inflammatory members of the predominantly pro-inflammatory IL-1 cytokine ***-37 possesses alarmin-like properties[1]and exerts its activities via intracellular[2]as well as cell surface receptor-dependent mechanisms,and the latter involves IL-1R8 and IL-18Rα[3].Because of its powerful and broad-spectrum“peacemaking”[4]functions,considerable efforts have been invested in developing IL-37-based anti-inflammatory therapeutics[5,6].

关键词： Interleukin neglected cytokine

Ammonia and greenhouse gas distribution in a dairy barn during warm periods

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Frontiers of Agricultural Science and Engineering 2024年第3期11卷 428-441页

作者： Provvidenza Rita D’URSO claudia ARCIDIACONO Giovanni CASCONE Department of Agriculture Food and EnvironmentUniversity of CataniaVia S.Sofia n.100Catania 95123Italy

This research aimed to quantify concentrations of ammonia(NH3),carbon dioxide(CO_(2))and methane(CH_(4)),estimate emissions,and analyze the factors influencing them during warm periods in an open dairy barn equipped with two cooling systems in a mediterranean climate *** distribution within the barn was observed to vary both vertically and horizontally,with the highest gas concentrations observed in the central area of the ***_(3),CH_(4)and CO_(2)ranged in 1.7–7.4,7–18,560–724μg·g^(–1),*** ventilation through openings and the operation of cooling systems induced changes in indoor microclimate conditions,influencing cow behavior and,consequently,gas *** concentrations were the highest at air velocities below 0.5 m·s^(–1).The highest concentration of NH_(3)was observed when the temperature-humidity index(THI)was>72 and≤78;and CO_(2)and CH_(4)concentrations were the highest with THI≥72 and decreased with THI≤***_(3)concentrations when barn management included three daily milkings were higher than those measured when barn management was based on two daily milkings,and lower for CH_(4)and CO_(2).NH_(3)and CH_(4)emissions were the highest during barn cleaning,while the lowest NH_(3)emissions occurred during activity of the cows(i.e.,feeding,walking).

关键词： Ammonia greenhouse gas environmental monitoring cows’behavior barn management housing system climatic parameters

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西方国家藏医临床研究综述

中国藏学 2014年第2期 163-167页

作者： K.Philip Reuter Thorolf E.R.Weiβ huhn claudia m.witt 罗辉中国藏学研究中心藏医药研究所

本文通过全面检索各医学文献数据库中收录的以英文、德文、芬兰文或西班牙文发表的临床研究文献,对西方国家近40年来开展的医临床研究进行了系统综述。结果显示:这些研究在类型和规模、试验条件、治疗措施、结局测量指标和研究质量方面... 详细信息

本文通过全面检索各医学文献数据库中收录的以英文、德文、芬兰文或西班牙文发表的临床研究文献,对西方国家近40年来开展的医临床研究进行了系统综述。结果显示:这些研究在类型和规模、试验条件、治疗措施、结局测量指标和研究质量方面具有很大的异质性。本检索分析后认为,目前西方开展的藏医临床研究数量少,研究的方法和结果各异,今后还需要开展高质量、大样本的临床试验,进一步探索藏医药的疗效。

关键词：西方藏医药研究状况

Extracellular vesicles-coupled miRNAs from oviduct and uterus modulate signaling pathways related to lipid metabolism and bovine early embryo development

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Journal of Animal Science and Biotechnology 2024年第4期15卷 1528-1549页

作者： Rosane mazzarella Karina Canon‑Beltran Yulia N.Cajas meriem Hamdi Encina m.Gonzalez Juliano C.da Silveira claudia L.V.Leal D.Rizos Department of Animal Reproduction INIA-CSICMadridSpain Department of Biochemistry and molecular Biology Veterinary FacultyComplutense University of Madrid(UCM)MadridSpain Department Agrarian Production Technical University of MadridUPMMadridSpain Departamento de Ciencias Biologicas Universidad Tecnica Particular de LojaUTPLLojaEcuador Department of Anatomy and Embryology FV-UCMMadridSpain Department of Veterinary medicine FZEA-USPPirassunungaBrazil

Background Extracellular vesicles(EVs) present in oviductal(OF) and uterine fluid(UF) have been shown to enhance bovine embryo quality during in vitro culture by reducing lipid contents and modulating lipid metabolism-related genes(LmGs), while also influencing cell proliferation, suggesting their involvement on the regulation of different biological pathways. The regulation of signaling pathways related to cell differentiation, proliferation, and metabo-lism is crucial for early embryo development and can determine the success or failure of the pregnancy. Bioactive molecules within EVs in maternal reproductive fluids, such as micro RNAs(miRNAs), may contribute to this regulatory process as they modulate gene expression through post-transcriptional *** This study evaluated miRNA cargo in OF-EVs from the early luteal phase and UF-EVs from the mid-luteal phase, coinciding with embryo transit within oviduct and uterus in vivo, and its possible influence on LmGs and sign-aling pathways crucial for early embryo development. A total of 333 miRNAs were detected, with 11 exclusive to OF, 59 to UF, and 263 were common between both groups. From the 20 differentially expressed miRNAs, 19 up-regulated in UF-EVs(bta-miR-134, bta-miR-151-3p, bta-miR-155, bta-miR-188, bta-miR-181b, bta-miR-181d, bta-miR-224, bta-miR-23b-3p, bta-miR-24-3p, bta-miR-27a-3p, bta-miR-29a, bta-miR-324, bta-miR-326, bta-miR-345-3p, bta-miR-410, bta-miR-652, bta-miR-677, bta-miR-873 and bta-miR-708) and one(bta-miR-148b) in OF-EVs. These miRNAs were predicted to modulate several pathways such as Wnt, Hippo, mAPK, and lipid metabolism and degradation. Differ-ences in miRNAs found in OF-EVs from the early luteal phase and UF-EVs from mid-luteal phase may reflect differ-ent environments to meet the changing needs of the embryo. Additionally, miRNAs may be involved, particularly in the uterus, in the regulation of embryo lipid metabolism, immune system, and *** Our study su

关键词： Embryo-maternal interaction Epigenetic Exosomes mammalian Preimplantation Reproductive fluids

Reproductive patterns in Araucaria araucana forests in the Andean range, Chile

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Ecological Processes 2024年第1期13卷 252-261页

作者： Sergio Donoso Karen Pe?a-Rojas claudia Espinoza Carolain Badaracco Rómulo Santelices-moya Antonio Cabrera-Ariza mediterranean Forests Laboratory Faculty of Forestry and Nature Conservation Centro Secano Faculty of Agricultural and Forestry Sciences Universidad Católica del Maule maule Advanced Studies Research Center Vice-Rector's Office for Research and Postgraduate Studies Catholic University of Maule

Background Araucaria araucana is a mast species that presents a high variability in annual cone production. Researchers have recorded synchronization events in cone production in different populations, which allows the seed production to be concentrated, reducing the percentage of seeds consumed by different animal *** We sampled three populations located in the Andes mountains, Araucanía Region, Chile. In 2004 we began the collection of data on cone production, for which we installed permanent plots（1200 m2each） at each location. We identified and labeled each female tree in each plot to monitor its cone production. In 2012 we selected a total of 30 trees near the plots to evaluate the number of seeds per cone. In each February from 2012 to 2014 we selected two mature cones and covered them with a porous mesh for subsequent collection and storage in march. At the beginning of June, we counted and weighed the seeds, determining the average weight, the number of seeds per cone, the germination capacity（GC）, and the germination speed（GS）.Results Cone production was synchronous across the three locations. We observed significant differences among the locations and years evaluated. The cones had fewer seeds in 2013（high production） compared to those in 2012（low production）, but their weights were similar. In 2014 the cones produced smaller seeds in fewer quantities. The difference between the years 2013 and 2014 resulted from the high-energy expenditure in 2013. Regarding GC and GS, there were significant differences among the three locations（GC: F = 45.41, p mber of cones produced in a given year. These annual fluctuations in seed production are determining factors in the population dynamics of forest species. Our results allow a better understanding of the reproductive phenology of A. araucana and could hel

关键词： Seed weight Germination potential masting species Sustainable use Dioecious species

STANDARDIZED *** ACUPUNCTURE FOR CHRONIC LOW BACK PAIN — A RANDOmIZED CONTROLLED TRIAL

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Journal of Integrative medicine 2014年第3期 224-225页

作者： Daniel Pach Xiaoli Yang-Strobel Rainer Lüdtke Lüdtke Stephanie Roll Katja Icke Benno Brinkhaus claudia m.witt Institute for Social medicine Epidemiology and Health EconomicsCharité-Universittsmedizin Berlin Karl and Veronica Carstens Foundation 3. Center for Integrative medicine University of Maryland School of Medicine

Background: Chinese medical diagnoses and treatment recommendations for specific patients with chronic low back pain vary widely across practitioners.A comparison of individualized treatment with a thoughtfully developed standardized approach is useful to determine which, if either, is ***: We aimed to compare the effectiveness of standardized and individualized acupuncture treatment in patients with chronic low back ***: We performed a single-centre randomized controlled single-blind trial in a general medical practice in Germany run by a Chinese born medical doctor trained in Western and Chinese medicine.150 outpatients with chronic low back pain were randomly allocated to two groups(78 standardized acupuncture and 72 individualized acupuncture).Patients received either standardized acupuncture or individualized *** encompassed between 10 to 15 treatments based on individual symptoms with two treatments per *** main outcome measure was the area under the curve(AUC), summarizing eight weeks of daily rated pain severity measured with a visual analogue scale(0 mm=no pain, 100 mm=worst imaginable pain).Results: No significant differences between groups were observed for the AUC(individualized acupuncture mean:1768.7 [95% CI, 1460.4; 2077.1]; standardized acupuncture 1482.9 [1177.2; 1788.7]; group difference, 285.8 [-33.9; 605.5] P=0.080).Conclusion: In this single-centre trial individualized acupuncture was not superior to standardized acupuncture for patients suffering from chronic *** a next step a multi-centre non-inferiority study should be performed to investigate whether standardized acupuncture treatment for chronic low back pain might be applicable in a broader usual care setting.

关键词： AUC STANDARDIZED VS.INDIVIDUALIZED ACUPUNCTURE FOR CHRONIC LOW BACK PAIN A RANDOmIZED CONTROLLED TRIAL

利用经济学评价证据支持针灸医疗保险报销决策:现有证据及挑战

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英国医学杂志中文版 2022年第6期25卷 315-319页

作者：李洪超金雪晶 Patricia m Herman claudia m witt 陈英耀岗卫娟景向红宋坪杨龙会 Dan Ollendorf 张渊 Gordon Guyatt 黄璐琦张誉清(文/译) 王欣恬中国药科大学国际医药商学院中国药科大学药物经济学评价研究中心北京中医药大学循证医学中心 RAND Corporation USA Institute for Complementary and Integrative medicine University Hospital Zurich and University of ZurichZurichSwitzerland 复旦大学公共卫生学院复旦大学国家卫生委员会卫生技术评估重点实验室中国中医科学院针灸研究所中国中医药循证医学研究中心中国医学科学院 Center for the Evaluation of Value and Risk in Health Institute for Clinical Research and Health Policy StudiesTufts Medical CenterUSA 加拿大麦克马斯特大学健康研究方法、证据与影响学系 Department of medicine Faculty of Health SciencesMcMaster UniversityHamiltonONCanada 中国中医科学院广安门医院中加整合医学循证医学研究合作中心宁波诺丁汉大学宁波诺丁汉GRADE中心

李洪超和同事们探索了在针灸医疗保险报销决策过程中引入经济学评价证据的全球挑战。医疗保险报销决策的过程本质上是复杂的。除了安全性和有效性,社会、经济、政治、地理、制度等非医学因素通常也会对决策制订产生重要的影响。

关键词：经济学评价医疗保险非医学因素报销决策评价证据针灸全球挑战证据支持