Objective To assess the clinical effectiveness and safety of compound glycyrrhizin combined with acitretin for psoriasis. Methods The databases such as PubMed, The Cochrane Library, SpringerLink, CNKI, VIP, WanFang Data and CBM were searched to collect the randomized controlled trials (RCTs) about compound glycyrrhizin combined with acitretin vs. acitretin alone for psoriasis. Meanwhile, The Chinese Journal of Dermatovenereology, China Journal of Leprosy and Skin Diseases and the grey literature were also searched. The retrieval time was from January 2000 to March 2012. According to the Cochrane Reviewer’s Handbook, two reviewers independently screened the literature, extracted the data and assessed the methodological quality of the included studies. Then the meta-analysis was performed using RevMan5.0 software. Results A total of 17 RCTs involving 1 365 patients were included. The results of meta-analysis showed that, the regimen of compound glycyrrhizin combined with acitretin was superior to acitretin alone; there were significant differences in the total effective rate (OR=3.39, 95%CI 2.55 to 4.52, Plt;0.000 01) and in the incidence of skin and mucous membrane dryness (OR=0.54, 95%CI 0.32 to 0.98, P=0.04), skin erythema (OR=0.43, 95% CI 0.24 to 0.76, P=0.004), elevated AST and ALT (OR=0.13, 95%CI 0.04 to 0.41, P=0.000 5) and elevated blood lipid (OR=0.48, 95%CI 0.30 to 0.77, P=0.002). But no significant difference was found in the incidence of dry and cracked lips (OR=0.50, 95%CI 0.10 to 2.50, P=0.40). There was publication bias shown by funnel plot analysis. Conclusion The compound glycyrrhizin combined with acitretin for psoriasis can obviously increase the cure rate and effective rate, and reduce the incidence of adverse reaction, such as dryness of skin and mucous membrane, skin erythema, elevated AST and ALT, and elevated blood lipid. For the limitation of quality and quantity of included studies, this conclusion still needs to be proved by conducting more high quality researches.
Objective To assess the efficacy and safety of Dan Hong injection for patients with angina pectoris compared with compound salvia injection as the control group. Methods Databases were electronically searched from MEDLINE, EMbase, CBM, CNKI, VIP, and Wanfang Data (January, 2007 to July, 2010), and reference lists of all papers identified were also checked. Randomized controlled trials (RCTs) of the effect of Dan Hong injection on angina pectoris were identified and assessed according to the Cochrane Handbook for Systematic Reviews of Interventions and then RevMan 4.3 was used to undertake Meta analysis. Results Twenty-seven trials involving 3 030 patients were included. Meta-analysis showed that: a) Compared with compound salvia injection, Dan Hong injection was capable of significantly decreasing the angina incidence (OR=3.84, 95% CI 3.03 to 4.88, Plt;0.000 01); b) Dan Hong injection was capable of significantly improving ECG review effectiveness compared with compound salvia injection (OR=1.98, 95% CI 1.44 to 2.66, Plt;0.000 01); c) Dan Hong injection was obviously superior to compound salvia injection in improving the NST (WMD= 0.78, 95%CI 0.42 to 1.14, Plt;0.000 1) and ∑ST (WMD= 0.45, 95%CI 0.32 to 0.57, Plt;0.000 01); and d) Dan Hong injection was able to obviously improve the hemorheology index after angina pectoris; Meta-analyses of eight trials in which adverse events were reported showed that no significant difference was found between Dan Hong injection and salvia injection (OR=0.64, 95%CI 0.33 to 1.25, P=0.19). Conclusion Dan Hong injection can effectively improve the ST segment ischemia and hemorheology index after angina pectoris, significantly increase the effectiveness of electrocardiogram reviews and eventually significantly reduce the recurrence rate of angina, and appears to be much safer. Further high quality RCTs are required to provide reliable evidence on the treatment of patients with angina pectoris.
Objective Surgical repair for giant lower ventral hernia is facing challenge owing to enormous tissue defect and the critical structures of pubis and il iac vessels. To investigate the method and curative effect of intraperitoneal onlay mesh (IPOM) combined with Sublay for compound repair of giant lower ventral hernia. Methods Between November 2008 and August 2010, 26 patients with giant lower ventral hernia were treated. There were 15 males and 11 females with an averageage of 61 years (range, 36-85 years), including 11 cases of lower midl ine incisional hernia due to radical rectal procedures, 6 cases of Pfannenstiel incisional hernia due to radical uterectomy, and 9 cases of lower midl ine incisional hernia due to radical cystectomy. Of them, 11 patients underwent previous repair procedures. The mean time from hernia to admission was 8.5 years (range, 1-15 years). All hernias were defined as M3-4-5W3 according to classification criteria of Europe Hernia Society. The mean longest diameter was 17.5 cm (range, 13-21 cm) preoperatively. Before 2 weeks of operation, abdominal binder was tightened gradually until the contents of hernia sac were reduced totally, and then reconstruction of abdominal wall was performed with compound repair of IPOM and Sublay technique. Results All of compound repair procedures were performed successfully. The mean hernia size was 112.5 cm2 (range, 76.2-160.6 cm2); the mean polypropylene mesh size was 120.4 cm2 (range, 75.3-170.5 cm2); and the mean compound mesh size was 220.0 cm2 (range, 130.4-305.3 cm2). The mean operative time was 155.5 minutes (range, 105.0-195.0 minutes) and the mean postoperative hospital ization time were 12 days (range, 7-16 days). Incisions healed by first intention; 4 seromas (15.4%) and 3 chronic pains (11.5%) occurred and were cured after symptomatic treatment. All patients were followed up 3-24 months (mean, 14.5 months). No recurrence and any other discomforts related to repair procedure occurred. Conclusion Compound repair of IPOM and Sublay is a safe and efficient surgical procedure for giant lower ventral hernia, owing to its characteristics of adequate patch overlap and low recurrence rate. Perioperative management and operative technology play the key role in the success of repair procedure.
Objective Dexamethasone (DXM) can regulate the balance of neutrophil and cytokine and enhance the ischemia-reperfusion tolerance of the skin flap; amlodipine besylate (AB) can selectively expand the peripheral blood vesselsand rel ieve the vascular smooth muscle spasm. To investigate the percutaneous penetration abil ity of DXM/AB compound gel and evaluate its effect on survival of ischemic skin flap. Methods Sodium carboxymethylcellulose was used to make blank gel, which was mixed in DXM, AB, azone (AZ), and progylene glycol (PG) respectively to make the compound gel containing 0.3%DXM/0.5%AB only (group D), the compound gel containing 3%AZ/2%PG, 3%AZ, and 2%PG (groups A, B, and C), the 0.3%DXM gel containing 3%AZ/2%PG (group E), the 0.5%AB gel containing 3%AZ/2%PG (group F). The accumulative penetration of DXM and AB in compound gel, 0.3%DXM gel, 0.5%AB gel through excised rat skin and its penetration within flap tissue were investigated by ultraviolet spectrophotometry. Fifty SD rats were selected to make 100 mm × 10 mm random flap at the back, and were randomly divided into 5 groups according to different gels which were used to treat flaps (n=10): compound gel group (group A1), 0.3%DXM gel group (group B1), 0.5%AB gel group (group C1), blank gel group (group D1), and peritoneal injection of DXM (5 mg/kg) and AB (2 mg/kg) (group E1). The survival area of ischemic random skin flap was measured on the 7th day by planimetry. Twenty-four SD rats were selected to make 100 mm × 10 mm random flap at the back, and were randomly divided into 2 groups (n=12). The accumulative penetration of DXM and AB within skin flap were also detected at 2 and 6 hours after appl ication of 2 g of compound gel containing 3%AZ/2%PG (group A2) and peritoneal injection AB (2 mg/kg) / DXM (5 mg/kg) (group B2). Results The accumulative penetration of DXM and AB in compound gel were increased in time-dependent manner (P lt; 0.05), and it was the highest in group A, and was significantly higher than that in group B and group C (P lt; 0.01), but there was no significant difference when compared with group E or group F (P gt; 0.05). The accumulative penetration of DXM and AB in groups A, B, and C were significant higher than that in group D (P lt; 0.05). After 7 days, the survival area of flaps in groups A1, B1, C1, D1, and E1 were (695.0 ± 4.6), (439.3 ± 7.1), (477.5 ± 14.5), (215.2 ± 3.8), and (569.4 ± 9.7) mm2, respectively; group A1 was significantly higher than other groups (P lt; 0.05). After 2 and 6 hours, the quantities of DXM and AB in skin flap of group A2 were significantly higher than that of group B2 (P lt; 0.05). Conclusion In 0.3%DXM/0.5%AB compound gel, DXM and AB might penetrate into skin tissue, which could significantly increase the survivalarea of ischemic skin flap.
Objective To explore the differences of three-dimensional porous blended silk scaffolds with different sericin ratios in terms of molecular structure, mechanical properties, and biological characteristics. Methods Fibroin/sericin blended aqueous solution [concentration 8% (W/V)] with various sericin ratios 0%, 2%, 4%, 6%, 8%, 10%, 12% and NaCl asa porogen with different particle sizes (125-200, 200-300, 300-450, 450-600, 600-900, 900-1 100 μm) were used to fabricate the three-dimensional porous blended silk scaffolds. Gross observation of the formation of three-dimensional porous blended silk scaffolds of different sericin ratios and pore sizes was performed. Scanning electron microscope (SEM) was used to detect the distribution and diameter of the pore sizes. Its porosity was calculated by l iquids replacement method. X-ray diffractometer (XRD) and fourier transform infrared (FTIR) were used to detect its internal molecular structure. Its mechanical properties, enzyme degration rate in vitro and experiment on SD rats in vivo, and histolgy observation after coculturing homogeneous scaffold (sericin ratio 0-12%, NaCl particle size 600-900 μm) with adipose tissue-derived mesenchymal stem cells (ADSCs) were detected. Results Gross observation showed that the higher of the ratio of sericin protein, the greater of the porogen sizes scope which used to form homogeneous silk scaffolds. The result of SEM showed that the pores of the three-dimensional porous blended silk scaffolds had uniform distribution and was connected with each other. Its pore sizes was in the scope of the porogen sizes, and its porosity all above 90%. The angel corresponding to the characteristic peak of the sericin/fibroin blended scaffolds were 20.6° and 24.6° (XRD), and the wavelength corresponding to the characteristic peak of the sericin/fibroin blended scaffoldswere 3 296, 2 933 and 1 629 cm-1 (FTIR) which was the same as the angel and wavelength corresponding to the characteristic peak of the natural silk. The mechanical properties of the sericin/fibroin blended scaffolds was improved with the increase of sericin ratios, and the compressional resil ience reached 100% when the ratio ≥ 6%. The different ratios of sericin and the different particle size of porogen had no significant effect on the enzyme degradation rate in vitro. The histological observation 14 days after ADSCs-scaffold co-culture indicated that the scaffolds had slow degradation rate, and sl ight inflammatory response in vivo. ADSCs were well attached to the sericin/fibroin blended scaffolds of different sericin ratios, with varied morphology, rich cytoplasm, and nuclear enrichment, the l ight staining ECM was observed surrounding the cells. Conclusion The mechanical property of the three-dimensional porous blended silk scaffolds is improved by silk sericins with ratio ≥ 6% obviously, which will lay the groudwork for further research and making of strengthen silk scaffolds.
To develop the chitosan /polyethylene glycols succinate (CH/PEG-SA) mitomycin C (MMC) film drug del ivery system and its release effect in vitro. Methods MMC loading in composite films was determined using a UV-visible spectrophotometer. Freeze-dried films (90 mg) were immersed in 1 mL PBS buffer (pH 7.4). The concentrations ofMMC releasing in vitro were calculated refer to the standard curve of relationship between the concentrations of MMC and the value of UV-visible spectrophotometer. The curve of the concentrations of MMC releasing from the films in vitro was drawn at different time. The relationship between the films, structure and the drug releasing was revealed. Results The films showed swell ing without brittleness. The equation of Linear Regression was y=0.593x3– 2.563x2 +25.944x – 0.236 (R2=1.000). The film had a good drug del ivery capabil ity. The samples weighing 20 mg were soaked into the l iquid of PBS, the releasing concentrations of MMC were 14.961 6 μg/mL at 12 days, 14.482 4 μg/mL at 18 days and 11.409 2 μg/mL at 32 days, which was higher than ID50 of MMC (10.471 3 μg/L) to fibroblast. Then MMC was released at a low concentration. The releasing concentrations of MMC was 0.179 3 μg/ mL at 60 days until being del ivered completely. Conclusion The flexibil ity is enhanced , and the mechanical function is improved, so that there is better nature of membrane. The initial burst is avoided more effectively, and the drug releasing would be maintained for a certain time.
Objective To investigate the therapeutic effect of the chitosan/polyethylene glycols-succinate/ mitomycin C (CH/PEG-SA/MMC) film on epidural scarring tissues. Methods According to a specific proportion of respective materials, the film of CH/PEG-SA/MMC was developed under some condition. Thirty SD rats were selected and randomized into 6 groups with 5 rats in each group. A rat model of lumbar laminectomy was used. The amount of 20 mg of the CH film was implanted into the animals in group I, 20 mg of CH/PEG film in group II, 20 mg of CH/PEGSA film in group III, 0.05 mg/mL of the MMC soaking for 5 minutes in group IV, 20 mg of CH/PEG-SA/MMC film in group V, and nothing was done in group VI. Specimens were harvested 4 weeks after the above procedures and were then subjected to immunohistochemical and histological examinations to compare their therapeutic effects on epidural cicatricial tissues. Results All rats were in good conditions after operation, without gait abnormal ity, restlessness, infection and death. There was no significant difference among the 6 groups in the postoperative Rydell score (P lt; 0.05). The content of hydroxyprol ine in groups I, II, III, IV, V and VI was (0.570 8 ± 0.345 0), (0.728 6 ± 0.150 6), (0.553 4 ± 0.122 3), (0.313 3 ± 0.106 4), (0.261 9 ± 0.102 1)and (1.020 1 ± 0.120 6) μg/ mg, respectively. There was a significant difference between groups IV, V and groups I, II, III (P lt; 0.05), and there was significant difference between group VI and the rest 5 groups (P lt; 0.05). According to the histological observation, group V had less collagenous fiber parallel ing the dura mater, with few inflammatory cells infiltration, with few capillary vessels and no reaction of macrophages. Conclusion CH/PEG-SA/MMC films can effectively reduce the amount of Hyp in epidural scarring tissues after lumbar laminectomy and therefore is a good treating method in preventing scarring tissue adhesion.
Objective To introduce a method to repair soft tissue defect in different regions and different areas of hand in one procedure. Methods From May 2002 to May 2005, anterolateral femoral flap or lobulated anterolateral femoralflap(forming irregular anterolateral femoral flap) was designed into different shapes to repair multiple soft tissue defect in different regions in hand, whichwas used clinically in 27 cases. Among 27 cases, there were 16 males and 11 females; the locations were left hand in 9 , right hand in 16 and left foot in 2; including 5 penetrating injury, 9 hotpressing injury, 2 soft tissue defection of instep and planta by milled injury, 6 gearing injury and 5 carding machine injury. All the cases complicated by exposure of tendons, bones or joints. Defect was repaired with H-shape flaps in 5 cases of penetrating palm injuries; with Y-shape or K-shape flaps in 11 cases of dorsals or combined with fingers of hand with skin defect; with shape flaps in 3 cases of dorsals combined with sides of palms or the first web of hands with skin defect and in 2 cases of skin defects of dorsals combinedwith palms of feet;with h-shape flaps in 6 cases of skin defects of dorsal or palms combined with disconnected skin defect of fingers. The sizes of main flaps ranged from 6.5 cm×4.8 cm to 17.0 cm×12.0 cm, the sizes of lobulate flaps ranged from 3.5 cm×2.8 cm to 7.5 cm×4.5 cm. Results Allflaps survived without vascular crisis after operation. Except the fascia flapall recipient sites healed by first intention. The follow-up period ranged from 3 months to 1 year, all cases had satisfactory appearance, the texture of flaps was soft. Except 2 cases of penetrating injury, 3 cases of hotpressing injuryand1 case of carding machine injury whose function was not satisfactory, theremaining cases achieved the function of snap and pinch. More than 1 year after operation, the sense of pain and touch recovered. There was no functional impairment at the donor sites although scar hyperplasia was formed in some cases.Conclusion The application of irregular anterolateral femoralflap is an optimal choice for complex skin defect of hand.
Objective To evaluate the effect of nano-hydroxyapatit e collagen (nHAC) bone and marrow mesenchymal stem cells (MSCs) on the treatment of rabbit osteonecrosis of the femoral head (ONFH) defect. Methods From June to October 2004, animal models of ONFH defect were established i n 45 New Zealand rabbits. They were divided into 3 groups randomly:In group A, as the control group, defect was not filled with any implants; In group B with nHAC; In group C with nHAC+MSC. Imaging and histological observation were made 4, 8, 12 weeks after operation. Results group C had a better o steogenesis ability than group B and group A. group B had a better osteogenesis ability than group A. Obvious new bones and osteogenesis were observed in group C 4 weeks after operation. The defect areas in group C were almost repaired 12 weeks after operation. Conclusion nHAC has a better effect of o steoconduction and it is a superior material for repairing bone defect of ONFH a nd of great value in treating ONFH when compounded with MSCs.
OBJECTIVE: To investigate the effect of compound pattern of ceramic bovine bone (CBB) and hydrogel(HG) on attachment, proliferation and differentiation of bone marrow stromal cell (MSC), and to find out the best way of constructing tissue engineered bone. METHODS: CBB, HG and MSC was compounded in different patterns and sequences to form CBB/HG/MSC (group A), HG/MSC/CBB (group B), CBB/MSC/HA (group C) and CBB/MSC (control group). Attachment and morphology of MSC were observed by scanning electronic microscope; the proliferation of MSC was evaluated by cell count; alkaline phosphatase(ALP) activity was examined by histochemistry and type I collagen synthesis was examined by immunohistochemistry staining 5 and 10 days later. RESULTS: In group A, MSC spread better, and ALP activity of group A was significantly higher than that of group B and control group(P lt; 0.01); but there was no significant difference between group A and group C(P gt; 0.05). There was no significant difference in type I collagen synthesis between four groups on the 5th day; but mean gray scale of type I collagen in group B was significantly higher than that in the other groups on the 10th day(P lt; 0.01). CONCLUSION: Different compound patterns of CBB, HG and MSC affect attachment, proliferation, differentiation of MSC. The compound pattern of CBB/HG/MSC is better than the others.