Monoclonal gammopathy of renal significance (MGRS) is a group of diseases with different renal damage. It is a new type of renal disease with various types of diseases and complex disease mechanism. In MGRS, due to the clonal proliferation of B lymphoid cells or plasma cells, a large number of monoclonal immunoglobulin (MIg) and/or a large number of free light chain (FLC) appear. Intact MIg can interact with intrinsic cells of glomerulus to change its biology in order to promote the development of renal disease, while monoclonal FLC can potentially alter the function of various cells throughout the nephron. Given the relationship of MIg and monoclonal FLC to MGRS, inhibition of MIg and monoclonal FLC would be a promising approach for the treatment of MGRS. This paper reviews the pathogenesis of MGRS from the sites of renal involvement, including glomerulus, renal tubule-interstitium and renal blood vessel.
Objective To assess the effectiveness and safety of tongxinluo capsule for coronary heart disease. Methods Both the randomized controlled trials (RCTs) and quasi-RCTs of tongxinluo capsule for coronary heart disease were collected through searching on computer from the following databases, The Cochrane Library (Issue 4, 2010), PubMed (2000 to April 2010), WanFang Data (1996 to April 2010), CNKI (1994 to April 2010) and VIP (1989 to April 2010). The trials selection based on inclusion and exclusion criteria, data extraction, cross check and quality assessment were conducted by two reviewers independently, and meta-analysis was performed with RevMan 5.0 software. Results A total of 13 studies involving 1 496 participants were included. The results of meta-analyses showed that: compared with the nitrate esters group, the tongxinluo capsule group had a better curative effect on the coronary heart disease than isosorbide dinitrate (RR=0.50, 95%CI 0.36 to 0.70) and isosorbide mononitrate (RR=0.19, 95%CI 0.12 to 0.30); there was significant difference in the total curative effect between the two groups (RR=0.34, 95%CI 0.26 to 0.44, Plt;0.000 01); the tongxinluo capsule was also better in improving the ECG than isosorbide dinitrate (RR=0.55, 95%CI 0.46 to 0.66) and isosorbide mononitrate (RR=0.58, 95%CI 0.48 to 0.70); there was significant difference in the total ECG improvement between the two groups (RR=0.56, 95%CI 0.49 to 0.64, Plt;0.000 01); the tongxinluo capsule group had a lower incidence rate of adverse reaction than the nitrate esters group with a significant difference (RR=0.33, 95%CI 0.20 to 0.53, Plt;0.000 01). Conclusion The present evidence indicates that tongxinluo capsule is not inferior to isosorbide dinitrate or isosorbide mononitrate in improving the curative effect and ECG, and it has fewer adverse reactions. More well-designed and large scale multi-centered RCTs are required with longer follow-up time to confirm this conclusion.
Objective To evaluate the efficacy and safety of Shen Song Yang Xin Capsule for cardiac arrhythmia. Methods Randomized controlled trials (RCTs) were searched from the following electronic databases: WanFang, CNKI, CBM, VIP, PubMed, and The Cochrane Library. Quality assessment and data extraction were conducted by two reviewers independently. Disagreement was resolved through discussion. All data were analyzed by using RevMan 5.0 software. Results Thirteen studies involving 1896 participants were included. The results of meta-analyses showed that compared with the control group, a) efficacy: Shen Song Yang Xin Capsule was superior to mexiletine (OR=2.96, 95%CI 1.79 to 4.87), and propafenone (OR=2.41, 95%CI 1.60 to 3.62), but was not superior to miodarone (OR=1.25, 95%CI 0.88 to 1.71); b) safety: Shen Song Yang Xin Capsule was superior to propafenone and miodarone in reducing the incidence of cardiac arrhythmia (OR=0.06, 95%CI 0.01 to 0.35; OR=0.05, 95%CI 0.02 to 0.17), but no significant difference was found between the two groups in incidence of gastrointestinal adverse reactions. Conclusion Based on the current studies, Shen Song Yang Xin Capsule is not inferior to the commonly-used anti-arrhythmic medicine at present. It has lower incidence of cardiac arrhythmia, and has no significant difference in the incidence of gastrointestinal adverse reactions compared with western drugs. For the quality restrictions of the included studies, more double blind RCTs with high quality are required to further assess the effects.
Objective To evaluate the efficacy of n-3 PUFAs (fish oil) for prevention of cardiovascular events. Methods Randomized controlled trials (RCTs) were searched from the following electronic databases: PubMed, EMbase, The Cochrane Library (Issue 1, 2009), CBM, and CNKI. Quality assessment and data extraction were conducted by two reviewers independently. Disagreement was resolved through discussion. All data were analyzed by using Review Manager 4.2 software. Results Five studies involving 37 689 participants met the inclusion criteria. Meta-analysis results showed that: 1) Compared with placebo, the incidence rates of the cardiovascular death (RR=0.91, 95% CI 0.84 to 0.98), cardiovascular events (RR=0.95, 95%CI 0.91 to 0.98), angina (RR=0.79, 95%CI 0.64 to 0.96), and myocardial infarction (RR=0.79, 95%CI 0.65 to 0.96) could be reduced by n-3 PUFAs (fish oil). 2) There were no significant differences in death from any cause, the hospitalization rates of cardiovascular disease, sudden death, and heart failure (RR=0.95, 95%CI 0.90 to 1.00; RR=0.97, 95%CI 0.93 to 1.02; RR=0.90, 95%CI 0.79 to 1.01; RR=0.98, 95%CI 0.91 to 1.06). 3) Compared with placebo, the incidence rates of the arrhythmia and stroke could be increased, but there were no significant differences (RR=1.14, 95%CI: 0.80 to 1.62; RR=1.12, 95%CI 0.97 to 1.30). Conclusion Compared with placebo, n-3 PUFAs (fish oil) has good effects on reducing the incidence rates of total cardiovascular events, cardiovascular death, myocardial infarction, and angina pectoris, and it has the same efficacy in death from all cause, sudden death, heart failure, and the hospitalization rates of cardiovascular disease. There are no significant differences in the increased rates of arrhythmia and stroke.