冷圈套息肉切除术与热圈套息肉切除术治疗结直肠小息肉疗效比较的Meta分析

目的系统性评价冷圈套息肉切除术(CSP)与热圈套息肉切除术(HSP)治疗结直肠小息肉的有效性和安全性,并进行Meta分析。方法检索PubMed、Embase、Cochrane Librabry、中国知网、万方数据和维普网等6个数据库,筛选研究CSP和HSP治疗结直肠息肉疗效的前瞻性随机对照试验(RCT)。采用RevMan 5.3统计软件进行分析,指标包括:息肉切除率、标本回收率、术后并发症和手术时间。结果20项RCT纳入该研究,包含4103例患者,6890枚息肉。其中,CSP 3452枚,HSP 3438枚。CSP与HSP息肉完整切除率比较,差异无统计学意义(R^R=1.00,95%CI:0.98~1.01,P=0.596);CSP与HSP整块切除率比较,差异无统计学意义(R^R=0.98,95%CI:0.95~1.01,P=0.222)。CSP与HSP标本回收率比较,差异无统计学意义(R^R=1.00,95%CI:0.99~1.01,P=0.824)。术后并发症(术中出血、迟发性出血及穿孔):CSP术中出血风险高于HSP(R^R=1.66,95%CI:1.24~2.24,P=0.001),CSP迟发性出血风险低于HSP(R^R=0.31,95%CI:0.16~0.63,P=0.001),CSP与HSP穿孔发生率比较,差异无统计学意义(R^R=0.33,95%CI:0.09~1.22,P=0.097)。手术时间:CSP总操作时间短于HSP(MD=-7.15,95%CI:-8.25~-6.06,P=0.000),CSP息肉切除时间短于HSP(MD=-1.86,95%CI:-2.85~-0.86,P=0.000)。结论CSP切除结直肠小息肉的疗效与HSP相当,但能降低迟发性出血发生率,缩短手术时间,值得在临床推广应用。

Programmed cell death in stem cell-based therapy: Mechanisms and clinical applications

Stem cell-based therapy raises hopes for a better approach to promoting tissue repair and functional recovery.However,transplanted stem cells show a high death percentage,creating challenges to successful transplantation and prognosis.Thus,it is necessary to investigate the mechanisms underlying stem cell death,such as apoptotic cascade activation,excessive autophagy,inflammatory response,reactive oxygen species,excitotoxicity,and ischemia/hypoxia.Targeting the molecular pathways involved may be an efficient strategy to enhance stem cell viability and maximize transplantation success.Notably,a more complex network of cell death receives more attention than one crucial pathway in determining stem cell fate,highlighting the challenges in exploring mechanisms and therapeutic targets.In this review,we focus on programmed cell death in transplanted stem cells.We also discuss some promising strategies and challenges in promoting survival for further study.