Objectives To systemically review and investigate the efficacy of intensive glucose control in Type 2 diabetes mellitus. Methods Database searches of MEDLINE, EMBASE, Cochrane Controlled Trials Register, VIP Database, CNKI, and CBM disc (from the date of establishment of the databases to June 2009) were conducted. Additional studies were retrieved via references of articles and direct contact with the authors to retrieve relevant data. Prospective, randomized controlled trials of intensive glucose control compared with standard therapy in diabetic patients were selected. We accessed the quality of included trials and extracted the relevant data. Statistical analysis was performed using The Cochrane Collaboration’s software RevMan 5.0. Results Eight trials with a total of 37 004 participants were included. The Meta-analysis showed: intensive glucose therapy was associated with a significant 9% reduction in the odds of cardiovascular events [OR=0.91, 95%CI (0.85, 0.98), P=0.007], and a 26% reduction in the microvascular events [OR=0.74, 95%CI (0.60, 0.91), P=0.005]. For the peripheral vascular events, no statistical difference was found between intensive therapy and standard therapy [OR=0.94, 95%CI (0.83, 1.07), P=0.35]. No statistical difference could be found in total mortality [OR=1.00, 95%CI (0.92, 1.08), P=0.98] and cardiovascular mortality [OR=1.03, 95%CI (0.83, 1.28), P=0.77]. Intensive therapy could increase more than 1.1-fold odds of hypoglycemia compared with standard-therapy [OR=2.12, 95%CI (1.24, 3.60), P=0.006]. Conclusions Findings from this meta-analysis suggest that intensive glucose control significantly reduces the risk of cardiovascular events and microvascular events, and increases the risk of hypoglycemia, while no prominent difference is found in mortality.
【Abstract】 Objective To review the recent progress of cell therapy in cl inical appl ications. Methods Therecent l iterature about cell therapy in cl inical appl ications was extensively reviewed. Results Based on the advances in cell biology, especially the rapid progress in stem cell biology, an increasing number of cl inical trials about cell therapy for management of various diseases, such as cardiovascular system diseases, neural system diseases, musculo-skeletal diseases, diabetes, stress urinary incontinence, and others, had been reported with encouraging results. All these showed that cell therapy had great potentials in cl inical appl ication. Conclusion Cell therapy provides a novel approach for the treatment of many human diseases. However, the mechanism remains to be fully elucidated.
Objective To evaluate the efficacy and safety of rosiglitazone versus metformin in treating polycystic ovary syndrome (PCOS). Methods Randomized controlled trials (RCTs) about rosiglitazone versus metformin in treating PCOS were retrieved on computer in MEDLINE, The Cochrane Library, EMbase, EBSCO, CBM, CNKI, Chinese Medical Association Journal Database and VIP from the date of their establishment to December 2010. The trials were screened according to the inclusion and exclusion criteria by two reviewers independently, the data were extracted, the methodological quality was assessed, and finally meta-analysis was conducted with Stata 11.0 software. Results A total of six RCTs involving 286 PCOS patients were included. The results of meta-analyses showed that there was no significant difference between rosiglitazone and metformin in improving PCOS patients’ insulin sensitivity (SMD= –0.14, 95%CI –0.46 to 0.19, P=0.412) and lowering androgen levels (SMD=0.05, 95%CI –0.26 to 0.36, P=0.747). However, the effect of rosiglitazone was inferior to metformin in lowing patients’ weight with a significant difference (SMD=0.34, 95%CI 0.11 to 0.58, P=0.004). The rosiglitazone showed a lower incidence rate of adverse reaction compared with metformin. Conclusion Compared with metformin, the rosiglitazone is eqully effective in improving PCOS patients’ insulin sensitivity and lowering androgen levels, and has a lower incidence rate of adverse reaction although it is inferior to metformin in lowing patients’ weight. So rosiglitazone is more applicable for the patients who are of underweight or cannot tolerate the gastrointestinal side effects induced by metformin. There is no enough evidence for this conclusion due to the small sample size and limited number of RCTs. More high-quality, large-sample and multicentered RCTs are required to guide clinical treatment and benefit patients.
Objective To assess the efficacy and the treatment-induced side effects of intravesically administered Epirubicin (EPI) following TUR in patients with Ta and T1 superficial bladder cancer compared to TUR alone. Methods According to the Cochrane reviewer’s handbook, included studies were those on patients with histologically confirmed Ta and T1 bladder cancer. EPI and EPI derivatives, dose and schedule would be considerd appropriate for inclusion. The search strategy was developed according to the Collaborative Review Group search strategy. Medline, EMbase, CBMdisc and the Cochrane library, articles of conference proceedings, and academic collections were searched for randomised controlled trials (RCTs) and quasi-RCT comparing intravesical EPI following TUR with TUR alone. Data were extracted from each identified paper independently by two reviewers. Trials were assessed for quality according to the method of Jadad scale. RevMan4.2 software developed by the Cochrane Collaboration was used for satistical analysis. Results Two hundred and thirteen related articles were identified, but only 10 were included in our systematic review. 3 articles were high quality and the rest were low. The pooled RR=1.51 (95%CI 1.32 to 1.72) and the pooled RR=1.49 (95%CI 1.35 to 1.66) in patients with Ta and T1 bladdercancer at 1 and 2 years respectively; The pooled RR=1.34 (95%CI 1.22 to 1.48) when comparing relative efficacy of intravesical EPI (drug doselt;50 mg) following TUR with TUR alone; The pooled RR=1.63 (95%CI 1.48 to 1.79) when comparing relative efficacy of intravesical EPI (drug dosegt;50 mg) following TUR with TUR alone. RR=1.49 (95%CI 1.33 to 1.66) and RR=1.56 (95%CI 1.36 to 1.84) when comparing relative efficacy of single intravesical EPI following TUR with TUR alone respectively. RR=0.79 (95%CI 0.53 to 1.17) when comparing the incidence of disease progression of intravesical doxorubicin following TUR with TUR alone. RR=4.34 (95%CI 2.62 to 7.19) when comparing side effect of intravesical EPI following TUR with TUR alone. Conclusions Intravesically administered EPI following TUR in patients with Ta and T1 superficial bladder cancer may reduce the incidence of tumour recurrence, but cannot reduce the incidence of disease progreesion. Intravesically administered EPI following TUR has some side effects but can be tolerated and has no influence on the life of patients.
Bladder cancer is a common malignant tumor of the urinary system. The incidence and mortality of bladder cancer in China have been at a high level. In the past, people generally believed that the bladder was a sterile environment, but it has been found that there are symbiotic microorganisms in the bladder. In addition, microorganisms and their metabolites in urine may be involved in the occurrence and development of various urinary system diseases such as bladder cancer. At the same time, microorganisms and their component products such as Bacillus Calmette-Guerin vaccine play an important role in the treatment of bladder cancer. This article reviews the research progress of urinary tract microorganisms and the occurrence, development and treatment of bladder cancer, and aims to provide new ideas for the early diagnosis and treatment, prevention and prognosis evaluation of bladder cancer.
【Abstract】 Objective To explore an effective method to cultivate esophageal mucosa epithel ial cells (EMECs)of canine in vitro, and to observe the biological characteristics of EMECs growing on SIS in order to provide an experimental basis for esophagus tissue engineering. Methods Esophageal tissues were obtained from five healthy dogs aged 2 to 5 weeks under sterile conditions. The primary EMECs were cultivated with defined keratinocyte serum free medium (DKSFM) containing 6% FBS. The morphological characteristics and the growth curve of EMECs of the 2nd generation were observed for 1 to 5 days. The expressions of the EMECs marker (cytokeratin 19, CK-19) were examined by immunocytochemistry. The 2nd generation of EMECs was seeded on SIS and observed by HE staining, immunohistochemical staining, and SEM for 4 and 8 days. Results The primary culture of canine EMECs arranged l ike slabstone. Immunohistochemical staining of CK-19 of the2nd generation EMECs showed positive broadly. The cells growth reached the peak level at 2 days by MTT method. E MECs werepolygon in shape and arranged l ike slabstone, and formed a single layer on the surface of SIS. The cells were contact ed closely with each other for 4 days. Eight days later, 2 to 3 layers stratified structure was formed. Lots of EMECs were grown on SIS, andshowed laminate arrangement. Conclusion With mixed enzymatic digestion, the culture of EMECs in DKSFM containing 6 %FBS is a simple and feasible method. SIS shows good biocompatibil ity and can be used as a good scaffold material in th e tissue engineered esophagus.
Objective To determine whether intravesically administered Adriamycin can prevent superficial bladder tumor to recur through assessing the efficacy of with intravesical Adriamycin and without intravesical Adriamycin after TURB-t. Method The search strategy was made according to the demand of Cochrane Collaboration. Medline, Embase，CBMdisc and the Cochrane Library were searched for RCTs. Data were extracted by two reviewers using the designed extraction form. RevMan were used for data management and analysis. Results Thirty three relevant trials were searched, of which eighteen trials were included and fifteen trials were excluded. Meta-analysis showed intravesically administered Pirarnbicin (THP), Epirubicin (EPI) and Adriamycin (ADM) can reduce the recurrence rate of superficial bladder cancer after operation during one or two years. Conclusions Intravesically administered THP, EPI and ADM can reduce the recurrence rate of superficial bladder cancer after TUPB-t’s operation during one or two years. In addition, the factors affecting the prognosis should be performed, such as the dosage of irrigation of bladder, reserving time and the course.
ObjectiveTo evaluate the clinical efficacy and safety of the inguinal approach versus classical pubic approach for obturator nerve block (ONB) in transurethral resection of bladder tumors (TUR-BT).MethodsDatabases including PubMed, The Cochrane Library, EMbase, Web of Science, WanFang Data, CNKI and VIP databases were electronically searched to identify randomized controlled trials using ONB in TUR-BT from inception to May 2020. Two reviewers independently screened literature, extracted data, and assessed risk bias of included studies. Meta-analysis was performed by using Stata 14.2 software.ResultsA total of 7 studies involving 474 patients were included. The meta-analysis results showed that there was no significant difference between inguinal approach and pubic approach in terms of the ONB success rate (RR=1.06, 95%CI 0.96 to 1.17, P=0.23), while the one-time success rate of puncture of inguinal approach was higher than that of pubic approach (RR=1.47, 95%CI 1.01 to 2.15, P=0.04). Compared with the pubic approach, the overall complications of inguinal approach were lower (RR=0.24, 95%CI 0.08 to 0.71, P=0.01). However, no significant difference was found between the two groups in terms of subcutaneous hematoma (RR=0.46, 95%CI 0.08 to 2.66, P=0.38).ConclusionsThe current evidence indicates that the success rate of one puncture of inguinal approach is higher than that of pubic approach, and the overall complications of the inguinal approach are much lower than that of the pubic approach. However, the above conclusions are still required to be verified through more high-quality studies due to the limited quantity and quality of included studies.
The Second People’s Hospital of Yibin was taken over by West China Hospital of Sichuan University into its close hospital alliance, and simultaneously undertook the task of construction of regional hospital alliance in Yibin city. The article introduces the experiences of the Second People’s Hospital of Yibin in the high-quality development of novel healthcare system. Led by West China Hospital of Sichuan University and based on all-level medical institutions in Yibin, the Second People’s Hospital of Yibin preliminarily established a four-level hierarchical medical system as “province, city, county, village” model, according to the guide of governments within the whole region. It aims to propose a “Yibin model exploration” in hospital alliance construction based on the western regional situation.
Objective To provide an ideal seed cell for tissue engineered urinary bladder and urethra by serially culturing canine smooth muscle cells from urinary bladder in vitro and compare biological characteristics of different passagesof cells. Methods Bladder smooth muscle cells of 12-month-old male dogs weighing 10-12 kg were isolated from adult dogs’ urinary bladders by collagenase and trypsin digestion and serially cultured in DMEM medium supplemented with 10% serum of newborn bovines. Morphology and prol iferation of the cells were observed and the serially-cultured cells were identified with the transmission electron microscope and immunohistochemistry. Results The cells appeared spindle in parallel rows when they grew to the degree of subconfluence, and showed the “peak-valley” structure under the inverted phase contrast microscope. The cells could be prol iferated serially to the 12th passage in vitro. The growth curve showed the cells before the 7th passage had the similar prol iferation characteristics and the growth cycle was about 40 hours. The TEM showed myofilament and the dense body in cytoplasm of smooth muscle cells. Smooth muscle actin was positive by immunohistochemical staining. After the 7th passage, the cells’ growth became slow, and myofilament and the dense body in cytoplasm vanished. Conclusion The canine smooth muscle cells from urinary bladder can be serially cultured in vitro and highly purified and largely prol iferated by the appropriate method. The cells before the 7th passage can be used as optimal seed cells for tissue engineered urinary bladder and urethra.