Short- and Long-term Therapeutic Efficacies of Intravenous Transplantation of Bone Marrow Stem Cells on Cardiac Function in Rats with Acute Myocardial Infarction:A Meta-analysis of Randomized Controlled Trials

Objective To investigate the short- and long-term therapeutic efficacies of intravenous transplantation of bone marrow stem cells(MSCs) in rats with experimental myocardial infarction by metaanalysis.Methods Randomized controlled trials were systematically searched from Pub Med,Science Citation Index(SCI),Chinese journal full-text database(CJFD) up to December 2014.While the experimental groups(MSCs groups) were injected MSCs intravenously,the control groups were injected Delubecco's minimum essential medium(DMEM) or phosphate buffered saline(PBS).Subgroup analysis for each outcome measure was performed for the observing time point after the transplantation of MSCs.Weighted mean differences(WMD) and 95% confidence intervals(CI) were calculated for outcome parameters including ejection fraction(EF) and fractional shortening(FS),which were measured by echocardiogram after intravenous injection and analyzed by Rev Man 5.2 and STATA 12.0.Results Data from 9 studies(190 rats) were included in the meta-analysis.As compared to the control groups,the cardiac function of the experimental groups were not improved at day 7(EF:WMD=0.08,95%CI-1.32 to 1.16,P>0.01; FS:WMD=-0.12,95%CI-0.90 to 0.65,P>0.01) until at day 14 after MSCs' transplantation(EF:WMD=10.79,95%CI 9.16 to 12.42,P<0.01; FS:WMD=11.34,95%CI 10.44 to 12.23,P<0.01),and it lasted 4 weeks or more after transplantation of MSCs(EF:WMD=13.94,95%CI 12.24 to 15.64,P<0.01; FS:WMD=9.64,95%CI 7.98 to 11.31,P<0.01).Conclusion The therapeutic efficacies of MSCs in rats with myocardid infarction become increasing apparent as time advances since 2 weeks after injection.

Rifaximin vs conventional oral therapy for hepatic encephalopathy:A meta-analysis

AIM: To characterize the efficacy of rifaximin in the management of hepatic encephalopathy (HE) as several randomized controlled studies have shown contradictory results on its effectiveness in comparison to other oral agents. METHODS: We performed a systematic review and random effects meta-analysis of all eligible trials identifi ed through electronic and manual searches. Twelve randomized controlled trials met the inclusion criteria with a total of 565 patients. RESULTS: The clinical effectiveness of rifaximin was equivalent to disaccharides or other oral antibiotics[odds ratio (OR) 0.96; 95% CI: 0.94-4.08] but with a better safety profi le (OR 0.27; 95% CI: 0.12-0.59). At the completion of treatment protocols, patients receiving rifaximin showed lower serum ammonia levels [weighted mean difference (WMD) = -10.65; 95% CI: -23.4-2.1; P = 0.10], better mental status (WMD = -0.24; 95% CI: -0.57-0.08; P = 0.15) and less asterixis (WMD -0.1; 95% CI -0.26-0.07; P = 0.25) without reaching statistical signifi cance. On the other hand, other psychometric outcomes such as electroencephalographic response and grades of portosystemic encephalopathy were superior in patients treated with rifaximin in comparison to the control group (WMD = 0.21, 95% CI: -0.33-0.09, P = 0.0004; and WMD = -2.33, 95% CI: -2.68-1.98, P = 0.00001, respectively). Subgroup and sensitivity analysis did not show any signifi cant difference in the above fi ndings. CONCLUSION: Rifaximin appears to be at least as effective as other conventional oral agents for the treatment of HE with a better safety profi le.

A meta-analysis of tight versus conventional glycemia control in critically ill brain-injured adults

Objective: To evaluate the benefits and risks of tight glycemia control (TGC) versus conventional glucose control (CGC) in critically ill brain-injured adults. Methods: We performed meta-analysis by systematically searching PubMed, EMBASE, OVID, ScienceDirect, Web of Science, CNKI, Wanfang Data, and CQVIP databases to retrieve RCTs in any languages. We used Review Manager to perform meta-analysis. Odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated in analyses. Results: Twenty-six RCTs with a total of 3,759 participants were included in this meta-analysis. In-hospital mortality showed significant dissimilarity between TGC and CGC groups with OR of 0.76 (95%CI 0.58, 0.99). However, in terms of overall mortality and long-term neurological severity outcome, it didn't show differences with ORs of 0.93 (95%CI 0.79, 1.10) and 1.15 (95%CI 0.96, 1.37). There were also discrepancies in infection rate and ICU length of stay with OR of 0.51 (95%CI 0.42, 0.62) and WMD of -2.37 (95%CI -2.99, -1.74). Significances were observed in hypoglycemia events with ORs of 6.24 (95%CI 4.83, 8.07) and 2.73 (95%CI 2.56, 2.91) using two methods. Conclusion: In critically ill brain injury, TGC did not show beneficial effects on reducing overall mortality and long term neurological outcome, but it increased the risk of hypoglycemia.

游离三碘甲状腺原氨酸治疗胸部火器伤后心功能不全的实验研究

目的 观察胸部火器伤后游离三碘甲状腺原氨酸 (FT3)变化及其对伤后心功能不全的治疗作用。 方法 家兔 18只 ,随机分为正常对照组 (A组 ,6只 )、火器伤组 (B组 ,6只 )、FT3 治疗组 (C组 ,6只 )。监测平均动脉压、左室舒张末压、中心静脉压、FT3 及心肌肌钙蛋白T(cTnT)的变化 ,观察心肌病理及超微结构。 结果 B组伤后平均动脉压明显低于A组 (P <0 .0 5 ) ,左室舒张末压及中心静脉压分别显著高于A组 ,cTnT漏出较A组增加明显 ,血FT3 浓度明显低于A组 ,心肌间质大量红细胞浸润。治疗组平均动脉压明显高于B组 ,中心静脉压及左室舒张末压明显低于B组 ,FT3 浓度接近正常水平 ,明显高于B组。心肌肿胀减轻 ,间质出血、肌丝断裂和溶解减轻现象明显。 结论 胸壁心前区切线位火器伤可造成心肌病理损害及心功能不全 ;FT3 明显减低 ,与心功能减退有一致性关系 ;纠正伤后低T3

Ilioinguinal approach versus Stoppa approach for open reduction and internal fixation in the treatment of displaced acetabular fractures： A systematic review and meta-analysis

Purpose： To compare the efficacy and safety of open reduction and internal fixation through ilioinguinal approach and Stoppa approach for the treatment of displaced acetabular fractures. Methods： Case-controlled trials （CCTs） published from January 2010 to August 2015 that compared the ilioinguinal approach and Stoppa approach in the management of displaced acetabular fractures were retrieved from the databases of Cochrane Library, Pubmed, CNKI, and so on. Methodological quality of the trials was critically assessed. Statistical software RevMan 5.0 was used for data analysis. Results： Eight articles were included in the meta-analysis. Through comparing the efficacy and safety of ilioinguinal approach and Stoppa approach in the treatment of displaced acetabular fracture, statistical significance was found in the average operation time [WMD = 68.29, 95% CI （10.52, 126.05）, p 〈 0.05] and the median intraoperative blood loss [WMD = 142.26, 95% CI （9.30, 275.23）, p 〈 0.05]. However, there existed no statistical significance in the fracture end reset satisfaction rate [RR = 0.63, 95% CI （0.17, 2.37）, p 〉 0.05], the early complications rate [RR = 0.89, 95% CI （0.33, 2.40）, p 〉 0.05], the late complications rate [RR = 0.91, 95% CI （0.27, 3.01）, p 〉 0.05], and Harris hip score good function rate [RR = 0.52, 95% CI （0.25, 1.10）, p 〉 0.05]. Conclusion： Though both techniques can obtain satisfactory clinical functions in the treatment of displaced acetabular fractures, Stoppa approach is superior to the ilioinguinal approach in terms of operation time and intraoperative blood loss.

Percutaneous poking reduction and fixation versus open reduction and fixation in the treatment of displaced calcaneal fractures for Chinese patients： A systematic review and meta-analysis

Purpose： To compare the efficacy of percutaneous poking reduction and fixation with open reduction and fixation in the treatment of displaced calcaneal fractures. Methods： Reports of studies using case-controlled trials （CCT） to compare the percutaneous poking reduction and fixation with the open reduction and fixation in the management of calcaneal fractures were retrieved from the Cochrane Library, PubMed Database, CNKI, Chinese Biomedical Database, Wanfang Data （fromJanuary of 2005 to August of 2015）. Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical software Revman 5.0 was used for data-analysis. Results： Fifteen articles were included in the meta-analysis. Comparison of the efficacy of percutaneous poking reduction and fixation with open reduction and fixation in the treatment of calcaneal fractures revealed statistical significance in the incidence of complications after operation [RR -- 0.32, 95,~ Cl （0.20, 0.5）, p 〈 0.05]. However, there were neither statistical significance in the degrees of recovery for calcaneal Bohler angle [WMD = -1.65, 95% CI （ 3.43, 0.14）, p 〉 0.05] and calcaneal Gissane angle [WMD - -3.21, 95%, Cl （-6.75, 0.33）, p 〉 0.05], nor statistical significance in the rate of good foot function after operation [RR = 0.95, 95Z Cl （0.90, 1.00）, p 〉 0.05]. Conclusion： For the treatment of calcaneal fractures, percutaneous poking reduction and fixation is superior to open reduction and fixation in terms of the incidence of postoperative complications. But both techniques can obtain satisfactory clinical function.

Integrated traditional and Western medicine for treatment of depression based on syndrome differentiation:a meta-analysis of randomized controlled trials based on the Hamilton depression scale

OBJECTIVE:To systematically review the benefits of integrated traditional and Western medicine therapies based on the Hamilton depression scale(HAMD) following syndrome differentiation of depression.METHODS:We searched six English and Chinese electronic databases for randomized clinical trials(RCTs) on integrated traditional and Western medicine for treatment of depression.Two authors extracted data and independently assessed the trial quality.RevMan 5 software was used for data analyses with an effect estimate presented as weighted mean difference(WMD) with a 95% confidence interval(CI).RESULTS:Seven RCTs with 576 participants were identified for this review.All trials were eligible for the meta-analysis and were evaluated as unclear or having a risk of bias.Meta-analysis showed,compared with Western medicine alone,integrated traditional and Western medicine based on syndrome differentiation could improve the effect of treatment represented by the HAMD [WMD=-2.39,CI(-2.96,-1.83),Z=8.29,P<0.00001].There were no reported serious adverse effects that were related to integrated traditional and Western medicine based therapies in these trials.CONCLUSIONS:Integrated traditional and Western medicine based therapies for the syndrome differentiation of depression significantly improved the HAMD,illustrating that combining therapies from integrated traditional and Western medicine for treatment of depression is better than Western medicine alone.However,further large,rigorously designed trials are warranted due to the insufficient methodological rigor seen in the trials included in this study.

Reamed or unreamed intramedullary nailing for tibial fractures： a meta-analysis

Objective：To compare the treating effects of different intramedullary nailing methods on tibial fractures in adults.Methods：Literature reports in both Chinese and English languages were retrieved （from the earliest available records to October 1,2013） from the PubMed,FMJS,CNKI,Wanfang Data using randomized controlled trials （RCTs） to compare reamed and unreamed intramedullary nailing for treatment of tibial fractures.Methodological quality of the trials was critically assessed,and relevant data were extracted.Statistical software Revman 5.0 was used for data-analysis.Results：A total of 12 randomized controlled trials,comprising 985 patients （475 in the unreamed group and 510 in the reamed group）,were eligible for inclusion in this meta-analysis.The results of metaanalysis showed that there were no statistically significant differences between the two methods in the reported outcomes of infection （RR=0.64; 95％CI,0.39 to 1.07;P=0.09）,compartment syndrome （RR=1.44; 95％CI,0.8to 2.41; P=0.16）,thrombosis （RR=1.29; 95％CI,0.43to 3.87; P=0.64）,time to union （WMD=5.01; 95％CI,-1.78 to 11.80; P=0.15）,delayed union （nonunion）（RR=1.56; 95％CI,0.97 to 2.49; P=0.06）,malunion （RR=1.75; 95％CI,1.00 to 3.08; P=0.05） and knee pain （RR=0.94; 95％CI,0.73 to 1.22; P=0.66）.But there was a significantly higher fixation failure rate in the unreamed group than in the reamed group （RR=4.29; 95％CI,2.58to 7.14; P＜0.00001）.Conclusion：There is no significant difference in the reamed and unreamed intramedullary nailing for the treatment of tibial fractures,but our result recommends reamed nails for the treatment of closed tibial fractures for their lower fixation failure rate.