Objective To systematically review the effectiveness and safety of autologous implantation of stem cells for diabetic peripheral neuropathy (DPN). Methods Randomized controlled trials on relevant studies were retrieved in databases including CBM (1978-2011.6), CNKI (1979-2011.6), MEDLINE (1950-2011.6), PubMed (1950-2011.6), EMbase (1970-2011.6) and The Cochrane Library (Issue 3, 2011). References of the included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assess the methodological quality of the included studies. Then, meta-analysis was performed using RevMan 5.0 software.Results Four RCTs involving 68 patients (136 limbs) were included, most of which were low in methodological quality. The results of meta-analysis indicated that, autologous stem cell therapy improved or even eliminated DPN symptoms including pain, numbness, and cold sensation in the limbs, intermittent limping, and rest pain. Compared with the routine therapy, autologous stem cell therapy improved tibial sensory nerve conduction velocity (MD=5.75, 95%CI 3.86 to 7.64, Plt;0.000 01), tibial motor nerve conduction velocity (MD=4.04, 95%CI 0.90 to 7.18, P=0.001), sural sensory nerve conduction velocity (MD=7.47, 95%CI 4.00 to 10.94, Plt;0.000 1), and sural motor nerve conduction velocity (MD=3.38, 95%CI 0.07 to 7.58, P=0.05), with no adverse reaction reported. Conclusion Current evidence shows that, autologous stem cell therapy is effective in treating DPN. Due to the lack of high quality studies, more high quality RCTs are needed to verify the above conclusion.
Objective To evaluate the effectiveness and safety of autologous hemopoietic stem cell implantation for peripheral arterial disease (PAD). Methods Randomized controlled trials (RCTs) were identified from CBM (1978 to September 2010), CNKI (1979 to September 2010), MEDLINE (1950 to September 2010), Pubmed (1950 to September 2010), Embase (1970 to September 2010), and Cochrane l ibrary (issue 4, 2010). The papers of the RCTs of cl inical therapeutic studieson PAD treated by autologous hemopoietic stem cell implantation were included and analyzed according to the criteria of the Cochrane handbook. Results Eight RCTs involving 280 patients and 322 extremities were included, with majority of trials of low methodological qual ity. Meta-analysis indicated that autologous hemopoietic stem cell transplantation had an increased ulcer cure rate [RD=0.38, 95% CI= (0.25, 0.50)], a significant improvement in the ankle brachial index [MD=0.11, 95%CI= (0.04, 0.18)], transcutaneous oxygen tension [MD=7.33, 95%CI= (3.14, 11.51)], and pain-free walking distance [SMD=1.35, 95%CI= (0.90, 1.79)], a significant reduction in rest pain scores [MD= —1.70, 95%CI= (—2.15, —1.25)], and a significant benefit in terms of l imb salvage [RD= —0.19, 95%CI= (—0.31, —0.07)]. Only 2 trials reported the side effects of autologous hemopoietic stem cell transplantation, such as l imbs swell ing and concentrations of serum creatine phosphokinase increasing, and the long-term safety was not reported. Conclusion Based on the review, autologous hemopoietic stem cell transplantation may have positive effect on “no-option” patients with PAD. However, the evidence is not b enough due to the general low methodological qual ity, so we can not draw a rel iable conclusion about the effects of autologous stem cell transplantation for PAD at the moment. Further larger, randomized, double bl ind, placebo-controlled, and multicenter trials are needed.
Objective To investigate the relationship among central retinal vein occlusion (CRVO), major systemic diseases, ocular local diseases and related risk factors in Chinese population. Methods Seventeen-six patients with CRVO diagnosed by fundus fluorescein angiography (FFA) without any medical treatment were in CRVO group. Another 76 patients without CRVO or any vascular diseases of ocular fundus were in the control group who were matched with the ones in CRVO group to a one-to-one partnership according to the age and gender. The 2 groups were subdivided into le;45 years old (25 patients, 32.9%) and gt;45 years old (51 patients, 67.1%) subgroups according to the age, and 2 ischemia and non-ischema subgroups according to the results of FFA, respectively. The blood lipid, blood pressure, and fasting blood glucose were measured. The systematic diseases, ocular local diseases and the related risk factors were statistically analyzed and compared. Results The incidence of hypertension and hyperlipemia in CRVO group were significantly higher than that in the control group (Plt;0.001,P=0.001). There was no significant difference of cardiovascular diseases, cerebrovascular diseases, open-angle glaucoma, and smoking and drinking between the two groups(Pgt;0.05). In le;45 years old subgroups, there was no significant difference of each examination target between CRVO and control group(Pgt;0.05). In ischemia subgroups, except for the hypertension and hyperlipemia, the incidence of diabetes mellitus was obviously higher in CRVO group than that in the control group (hyperlipidemia:P=0.031; diabetes mellitus:P=0.024; diabetes mellitus: Plt;0.001). Conclusion Hypertension and hyperlipidemia are the systematic factors in Chinese population with occurrence of CRVO. In addition, diabetes mellitus is associated with ischemic CRVO. Timely diagnosis and treatment of the systematic diseases is important to the prevention and treatment for CRVO. (Chin J Ocul Fundus Dis, 2007, 23:159-162)
Objective To evaluate the effectiveness and safety of sarpogrelate hydrochloride for patients with peripheral arterial disease (PAD). Methods The randomized controlled trials (RCTs) on PAD treated by sarpogrelate hydrochloride were identified from CBM (1978 to September 2011), CNKI (1979 to May 2011), PubMed (1950 to May 2011), EMbase (1970 to May 2011) and The Cochrane Library (Issue 3, 2011). According to the criteria of the Cochrane Handbook, two reviewers independently screened the studies, extracted and cross-checked the data, and assessed the methodological quality. Then meta-analysis was conducted by using RevMan 5.0 software. Results Nine RCTs involving 522 patients and 532 limbs were included, with low methodological quality in most trials. The results of meta-analyses indicated that compared with the conventional treatment, sarpogrelate hydrochloride could reduce the area of ulcers (MD= –3.22, 95%CI –3.99 to –2.45), and it could increase the ankle-brachial index (SMD=0.49, 95%CI 0.07 to 0.91), blood flow of dorsalis pedis artery (MD=0.16, 95%CI 0.09 to 0.23) and pain-free walking distance (MD=200.87, 95%CI 3.39 to 398.36). Five trials reported the adverse effects of sarpogrelate hydrochloride, most of which were mild gastrointestinal symptoms. Conclusion Based on the review, sarpogrelate hydrochloride may have positive effect on patients with PAD. However, the evidence is not b enough due to the general low methodological quality, so the reliable conclusion has to be drawn with more high quality studies in future.
Objective To evaluate the efficacy and safety of inhaled amphotericin B ( AmB) in prophylaxis of invasive pulmonary aspergillosis ( IPA) in both animal studies and clinical researches. Methods MEDLINE, ISI, EMBASE and Wanfang Periodical Databases were searched until march 2011 for case-control study on the efficacy and safety of inhaled AmB in prophylaxis of IPA. The articles were evaluated according to inclusion criteria. Poor-quality studies were excluded, and RevMan 4. 22 sofeware was applied for investigating the heterogeneity among individual studies and calculating the pooled odds ratio ( OR) and 95% confidence interval ( CI) . Results Five animal studies with a total of 626 animals were included. The overall survival rate of the immunosuppressed animals with pulmonary aspergillosis treated with nebulized AmB was increased ( 38.3% vs. 9.7% , OR=13.93, 95% CI 7.46 ～26.01, Plt;0. 000 01) . Six clinical trials including 1354 patients were considered. Our meta-analysis showed that inhaled AmB could significantly reduce the incidence rate of IPA ( 2.6% vs. 9.2% , OR=0.27, 95% CI 0.16 ～0.46, P lt;0. 000 01) , but had no definite benefit on mortality. Four studies evaluated the potential side effects of nebulized AmB and showed that there were no significant adverse events. Conclusions Empirical inhaled AmB is associated with a lower rate of IPA but no significant
Objective To examine the effect of endothelial progenitor cell (EPC) on lung ischemia-reperfusion injury (LIRI). Methods Twenty-four recipients were randomized into 3 groups including a sham group, a LIRI group, and an EPC group. Rats in the sham group only received anesthesia. Rats in the LIRI and EPC groups received left lung transplantation and received saline or EPC immediately after reperfusion. The partial pressure of oxygen to fraction of inspiratory oxygen (PaO2/FiO2) ratio, wet-to-dry weight ratio and protein levels in the transplanted lung and inflammation-related factors levels in serum were examined. Histological change of transplanted lung were analyzed. The nuclear factor (NF)-κB in the transplanted lung was detected. Results Compared with the LIRI group, the PaO2/FiO2 ratio dramaticly increased, and the wet-to-dry weight ratio and protein level significantly decreased by EPC after reperfusion. The lung histological injury was attenuated by EPC. The pro-inflammatory factors in serum were down-regulated, whereas IL-10 was up-regulated in the EPC group. The expression of NF-κB was decreased by EPC. Conclusion EPC ameliorated LIRI after lung transplantation. The protection of EPC partly associated with anti-inflammation.
ObjectiveTo estimate whether alpha 1-antitrypsin (AAT) can reduce ventilator-induced lung injury (VILI) in acute respiratory distress syndrome (ARDS) rats after mechanical ventilation.MethodsThe rats were randomly divided into 3 groups: a sham (S) group, a mechanical ventilation (V) group and a mechanical ventilation/AAT (VA) group. The rats in the S group only received anesthesia, and the rats in the V and VA groups received endotoxin to simulate ARDS followed by mechanical ventilation for 4 hours. At the beginning of ventilation, the rats in the V group received saline, and the rats in the VA group received AAT. The PaO2/FiO2 ratio and the lung wet/dry (W/D) weight ratio were tested. The total protein and neutrophil elastase concentrations and the neutrophil and macrophage counts in bronchoalveolar lavage fluid (BALF) were tested. Proinflammatory factors in BALF and intercellular cell adhesion molecule-1 (ICAM-1) and microphage inflammatoryprotein-2 (MIP-2) in the serum were also detected. Furthermore, the oxidative stress response was detected, and histological injury and apoptosis were evaluated.ResultsCompared with the S group, PaO2/FiO2 was significantly decreased in the V group and the VA group, the protein concentration in the BALF and the lung W/D weight ratio were significantly increased, the concentration of inflammatory factors in BALF and peripheral blood was significantly increased, and inflammatory cells in BALF also increased. Meanwhile, malondialdehyde (MDA) concentration, myeloperoxidase (MPO) and nicotinamide adeninedinucleotide phosphate (NADPH) activity increased significantly. The V group and VA group were severely damaged, and the number of apoptotic cells increased significantly. Compared with the V group, the PaO2/FiO2 in the VA group significantly increased; the W/D weight ratio and the BALF protein concentration decreased; the number of macrophages and neutrophils in the BALF, and the concentration of elastase significantly decreased; tumor necrosis factor-α, interleukin (IL)-1β, and IL-6 in BALF decreased, IL-10 increased; ICAM-1 and MIP-2 in peripheral blood decreased. At the same time, the MDA concentration, MPO and NADPH activities in the VA group were significantly lower than those in the V group; the tissue damage was significantly reduced, and the number of apoptosis was significantly reduced. In addition, compared with the V group, the expression of Bax, gelsolin and cleaved caspase-3 decreased in the VA group, but the expression of Bcl-2 was increased (all P<0.05).ConclusionsAAT can relieve VILI in ARDS rats. The protection conferred by AAT may be associated with the anti-inflammatory, antioxidative stress response and antiapoptotic effect of AAT.
Objective To investigate the effects of antithrombin-Ⅲ ( AT-Ⅲ) on the inflammatory reaction in oleic acid-induced acute lung injury ( ALI) rats. Methods Sixtymale Sprague-Dawley rats were randomly divided into five groups, ie. a normal control group, an ALI group, an AT-Ⅲ treatment group, an AT-Ⅲ +heparin treatment group, and a heparin treatment group ( n =12) . The ALI rats were induced by injecting oleic acid ( 0. 2 mL/kg) intravenously. The lung histology was scored by modified Smithtechnique. The albumin permeability of pulmonary microvascular ( Palb) was measured by single nuclide tracer technique. The extravascular lung water ( EVLW) and wet/dry weight ratio ( W/D) of lung tissues were measured by gravity way. The activity of AT-Ⅲ in plasma was determined by the method of syntheticchromogenic substrate. Tumor necrosis factor α( TNF-α) , interleukin 6 ( IL-6) and von Willebrand factor ( vWF) levels in serum were determined using commercial enzyme-linked immunosorbent assay kits. The expressions of lung tissue extacellular signal-regulated kinases ( ERK) -1 /2, P38 mitogen-activated proteinkinase ( MAPK) and c-jun N-terminal kinases ( JNK) were determined by Western blot. Results The Smith scores, EVLW, Palb , plasma level of vWF, lung tissue levels of phospho-ERK1 /2 and phospho-P38 MAPK expressions in the ALI group were all significantly higher than those in the normal control group ( P lt; 0.05) , while not significant differentwith other three treatment groups. There were not significant differences in the activity of AT-Ⅲ in plasma and phospho-JNK expression among all five groups. The serum levels of TNF-αand IL-6 in the ALI group were significantly higher than those in the normal control group and three treatment groups. Conclusions AT-Ⅲ downregulates the levels of downstreamcytokines TNF-αand IL-6,but can not inhibite the activation of ERK1 /2 and P38 MAPK, and can not relieve endothelial permeability.The study do not demonstrate the lung protective effect of AT-Ⅲ in oleic acid-induced acute lung injury.