Objective To evaluate the effectiveness of oral appliance (OA) vs. continuous positive airway pressure (CPAP) in treating patients with mild to moderate obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods The following databases including PubMed, EMbase, The Cochrane Library, CBM, VIP, WanFang data and CNKI were searched from inception to November 30, 2012 to collect the randomized controlled trials (RCTs) on OA vs. CPAP in treating OSAHS. The relevant conference proceedings were also retrieved without limitation of type and publication time. In accordance with the inclusion and exclusion criteria, two reviewers independently screened studies, extracted data, and evaluated quality. And then meta-analysis was performed using RevMan 5.1 software. Besides, the level of evidence was graded using GRADEpro 3.6 software. Results A total of 7 RCTs were included. The results of meta-analysis showed that: a) compared with OA, CPAP significantly reduced the degree of apnea-hypopnea index (AHI) (WMD=9.13, 95%CI 8.77 to 9.50, Plt;0.000 01); and b) there was no significant difference in the Epworth sleeping scale (ESS) between OA and CPAP (WMD=0.00, 95%CI −0.12 to 0.12, P=0.97). Conclusion Compared with OA, CPAP takes remarkable effects in improving AHI for mild to moderate OSAHS, but it shows no significant difference in improving ESS. For the quality and quantity limitation of the included studies, this conclusion still needs to be proved by conducting more high quality RCTs.
Objective To discuss the prevalence of melamine-induced urolithiasis in infants and its development and to formulate more effective diagnosis and treatment. Methods A total of 402 cases of melamine-induced infantile urolithiasis were retrospectively analyzed with basic information, blood, urine, urinary B-mode ultrasonic diagnosis, treatment options and prognosis for infant urolithiasis. Results A total of 402 cases of infants had an excessive melamine milk feeding history, in which there were 9 self-discharged cases. The largest calculus diameter was 4 mm × 5 mm × 6 mm. The smallest calculus diameter was 0.5 mm × 0.5 mm × 1 mm. The average calculus diameter was 1 mm × 2 mm × 2 mm. There were 30 cases of abnormal serum creatinine, 27 of abnormal urea, 2 of abnormal uric acid, and urine occult blood positive for 167 cases. There were 395 cases which were administrated medical treatment; 7 cases were administrated surgical treatment; 6 cases had obstructive renal failure. Conclusion Infants whose age is more than six months but less than 12 months with a history of exposure to melamine have the larger risk of urolithiasis. B-mode ultrasonic diagnosis is practically significant on early screening urolithiasis. It is effective to perform surgical treatment for obstructive renal failure caused by calculus.
Objective To assess the clinical effectiveness and safety of uvulopalatopharyngoplasty （UPPP） in the treatment of snoring and obstructive sleep aponea syndrome （OSAS ）. Methods MEDLINE （1966 -2005 ）, EMBASE （1984 - 2005 ）, The Cochrane Library （Issue 1, 2005 ）, CBM （1979 - 2005 ）, CNKI （1994 - 2005 ）, VIP （ 1989 - 2005 ）, CMCC （1994-2005） ,Wanfang Database and Internet were searched in English and Chinese versions. Randomized controlled trials（ RC,Ts）, quasi-randomized controlled trials and prospective cohort studies were included. Study quality was evaluated by two researchers independently. RevMan4.2.7 was used for meta-analysis.Results Twelve studies were included, of which 5 were RCTs, 7 were prospective cohort studies. Compared with dental appliance（DA）, PSG （polysomnography） changes of DA group were larger than UPPP group, but patients of UPPP group had better quality of life and compliance. Comparing UPPP with LAUP （laser-assisted uvulopalatpharyngoplasty ） and RFTVR （radiofrequency tissue volume reduction）, the postoperative pain of the latter two was less than UPPP. About complications, UPPP and LAUP had no difference except for nasal reflux at 1 week after operation, there was no statistical difference between UPPP and RFTVR. There was no study to compare the PSG change among the three groups. Comparing UPPP with CPAP （continuous positive airway pressure）, PSG changes were larger in CPAP. Conclusions At present, there is no evidence to assure that UPPP is better than other treatments for snoring and OSAS or to suggest which type of surgery is most effective.The literature search is restricted to the publications of English and Chinese language, which may have resulted in missing some studies; the evidence is still weak due to the poor quality and a small number of included studies. There is an urgent need for high quality RCTs to be carried out.
ObjectiveTo study the effectiveness of liver function, hepatic energy metabolism, regeneration, and apoptosis on the obstructive jaundice rat after partial hepatectomy (PH) combined with internal biliary drainage under the condition of conspicuous bilirubinemia. MethodsOne hundred and twenty male SD rats were used in research, six of whom were divided into sham operation (SO) group. Twenty rats underwent bridge operation between common bile duct and duodenum after 70% PH (70%PH group), and 6 rats out of the 94 rats who underwent common bile duct ligation (CBDL) for 5 d were randomly selected as CBDL group, and the residual rats were done the second operations after 5 d and were divided into three groups: bile duct obstruction combined with reperfusion of bile flow group （BDO-RBF group， n=20), 42% PH with BDO-RBF group (n=20), and 70%PH with BDO-RBF group (n=25). Levels of TB, ALT, ALB, and ALP in serum; HGF, bcl-2 mRNA and protein； ATP, ADP, and AMP; hepatocyte proliferation/apoptosis index in hepatic tissues were dynamically observed after operation (24 h, 72 h, and 7 d), respectively. The liver function and hepatocyte energy metabolism were only detected in the SO group. ResultsRats without obstructive jaundice would have an excellent liver regeneration after 70% PH, while the liver function and hepatocyte energy metabolism could recover rapidly. The liver function, hepatocyte energy metabolism, HGF and bcl-2 mRNA and protein of liver tissue and the hepatocyte proliferation/apoptosis index in partial (42% or 70%) hepatectomy combined with internal biliary drainage in obstructive jaundice group were significantly influenced while recovered rapidly (Plt;0.05). ConclusionsUnder the condition of conspicuous bilirubinemia, the influences of hepatectomy combined with internal biliary drainage on hepatocyte energy metabolism, liver function, hepatocyte regeneration and apoptosis are severer than that of normal rats who underwent 70% hepatectomy, while also make the rats recover rapidly in hyperbilirubinemia groups. The database suggest that it is not necessary to do preoperative external biliary drainage before performing liver resection.
ObjectiveTo investigate the diagnostic value of endoscopic retrograde cholangiopancreatography (ERCP) in obstructive jaundice of elderly patients. MethodsTotally 338 patients with obstructive jaundice underwent ERCP were divided into elderly group (age ≥60 years old) and nonelderly group (age lt;60 years old) based on age. The levels of serum amylase (AMY), ALT, and TBIL in 6, 24, and 48 h after ERCP were detected. The success rate of cholangiopancreatography, accuracy rate of diagnosis, and incidence of complications after ERCP in two groups were analyzed. ResultsThe difference of serum AMY, ALT, and TBIL levels of patients in 6, 24, and 48 h after ERCP were not significant between two groups (Pgt;0.05). The success rate of cholangiopancreatography in nonelderly group was 96.3% (130/135) and in elderly group was 96.1% (195/203), and no difference was found (Pgt;0.05). However, the accuracy rate of diagnosis of ERCP in nonelderly group (84.6%, 110/130) was significantly lower than that in elderly group (98.5%, 192/195), Plt;0.05. The difference of the incidence of complications was not significant between two groups 〔14.8% (20/135) vs. 17.2% (35/203)〕, Pgt;0.05. There was no mortality in two groups patients. ConclusionERCP is a safe, effective, and accurate method, which is of importance to the diagnosis of obstructive jaundice in elderly patients.
【Abstract】ObjectiveTo investigate the protective effect of melatonin on renal injury induced by bile duct ligation in rats. MethodsSixtyfour rats were randomly divided into four experimental groups (n=16 rats per group): the control group (CN), sham operative group (SO), bile duct ligation group (BDL) and bile duct ligation melatonin treatment group (BDL+Mel). Obstructive jaundice was induced by common bile duct ligation. Plasma level of nitric oxide (NO), total bilirubin (TB), direct bilirubin (DB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), urea nitrogen (BUN) and creatinine (Cr) were measured 4 d and 8 d after operation. NO and inducible nitric oxide synthase (iNOS) in renal tissue were detected at the same time point, too. Histopathological changes of kidneys were examined by HE staining. ResultsIn BDL group, the plasma levels of NO, TB, DB, ALT, AST, BUN and Cr were higher than those of SO group (P＜0.01）, and the level of NO and activities of iNOS in renal tissue were significantly increased (P＜0.01）. However, in BDL+Mel group, the plasma levels of NO, ALT, AST, BUN and Cr were lower than those of the BDL group (P＜0.01）, and the level of NO and activities of iNOS in renal tissue were significantly suppressed (P＜0.01）; histopathological changes of kidneys were improved.ConclusionAugmentation of iNOS activities and increasing of NO production in local tissue contributed to renal injury induced by bile duct ligation, and the mode of melatonin’s protective actions, at least in part, relates to interference with no pathways.
【Abstract】ObjectiveTo study the effects of endothelin (ET) and Xuesaitong injection on hepatic, renal and myocardial tissues after bile duct ligation (BDL) in rabbits. MethodsSeventytwo rabbits were randomly divided into three groups: BDL group (24 rabbits), BDL+Xuesaitong injection group (24 rabbits), and sham operation group (24 rabbits). Each group was subdivided into four subgroups of postoperative 3, 6, 9 and 12 d (6 rabbits in each subgroup). Automatic biochemical analysis equipment was used to detect the levels of serum TBIL, ALT, BUN and Crea. The levels of ET in plasma, hepatic, renal and myocardial tissues were measured with radioimmunological method. ResultsThe levels of ET in plasma, hepatic, renal and myocardial tissues in both BDL group and BDL+Xuesaitong injection group were higher than those of sham operation group (P＜0.01). The levels of ET in plasma and tissues of BDL+Xuesaitong group were lower than those in BDL group (P＜0.05). ConclusionObstructive jaundice can lead to an increase of ET in plasma, hepatic, renal and myocardial tissues, the level of ET increases with the time of obstruction. Xuesaitong injection may play a protective role in the injury of hepatic, renal and myocardial tissues after obstruction by decreasing the level of ET in plasma and tissues.
【Abstract】ObjectiveTo explore the effect of glutamine on immune function of rat with obstructive jaundice and its possible mechanism. MethodsFifty male Wistar rats were randomly divided into three groups: Control group (n=10)， obstructive jaundice group (n=20) and glutamine treatment group (n=20). The serum concentration of TNF-α, IL-10 was detected by using radioimmune method. Liver function was measured through automated biochemistry analyzer. The animal model of obstructive jaundice was established by ligating the rat’s common bile duct. Bacteria cultures were performed with the rat’s tissues of lung, spleen, liver and kidney respectively. ResultsCompared with control group, obstructive jaundice group showed statistically lower serum level of TNF-α, and statistically higher serum level of IL-10, TBIL, ALT and AST during the first and the second week after ligation of common bile duct. During the first and second week after administration of glutamine, the serum TNF-α of glutamine treatment group was statistically higher than that in control group and obstructive jaundice group. Meanwhile, glutamine treatment group showed statistically lower serum level of IL-10, TBIL, ALT and AST than obstructive jaundice group. There were statistically less bacteria translocations in glutamine treatment group than those in obstructive jaundice group. Conclusion Glutamine can increase the immune function by changing serum concentration of TNF-α, IL-10 and decrease the bacteria translocation.
Objective To investigate the changes and significance of intercellular adhesion molecule-1 (ICAM-1) and tumor necrosis factor-α (TNF-α) in intestinal mucosa in rats with obstructive jaundice. MethodsTwenty-four SD rats were randomly divided into sham operation (SO) group and bile duct ligation (BDL) group, and each group were randomly divided into the day 7 and day 14 subgroup. The expression of ICAM-1 was assayed by immunohistochemistry. The level of TNF-α was determined by ELISA. The activity of myeloperoxidase (MPO) and diamine oxidase (DAO) was determined as well.ResultsOn the day 7 and 14, in the bile duct ligation group, the ICAM-1 protein was mainly expressed in the intestinal epithelia and increased with the time on (P＜0.05); the level of TNFα increased from （14.25±1.01） ng/g to （23.83±1.43） ng/g （P＜0.01）； the intestinal DAO activity decreased from （1.70±0.36） U/mg to （1.22±0.41） U/mg （P＜0.01），and plasma DAO activity increased from （6.44±1.74）U/ml to （8.93±1.29） U/ml （P＜0.01）; the MPO activity increased from （2.85±1.22 ） U/mg to （4.93±1.37） U/mg （P＜0.01）. ConclusionThe ICAM-1 expression is significantly upregulated and the level of TNFα significantly increases after bile duct ligation, which may be involved in the PMNmediated injury to intestinal mucosa.
ObjectiveTo study the changes of lipopolysaccharide binding protein (LBP) in the serum of Wistar rats with obstructive jaundice and to investigate its potential mechanism.MethodsEighty male Wistar rats were randomly divided into obstructive jaundice group (OJ group, n=40） and sham operation group (SO group, n=40）. Before operation and the 5th, 10th, 15th, 20th day after common bile duct ligation, the levels of LBP, endotoxin, tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in plasma were detected in all the rats. ResultsLBP levels in serum increased significantly in OJ group on the 10th day after operation compared with those of SO group. Moreover, LBP levels gradually increased in OJ group with the prolongation of obstructive time. A positive correlation existed between serum LBP and plasma endotoxin, TNF-α and IL-6.ConclusionThe study demonstrates that LBP in serum is high and plays an important role in the pathogenesis of multiple organ injury secondary to obstructive jaundice. It may be an appropriate way to treat patients with obstructive jaundice by decreasing LBP levels in serum.