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BACKGROUND:Immunosuppressants fight against acute rejections by influencing humoral and celular immune to suppress the immune function, and then improve patient/renal graft survival. OBJECTIVE:To evaluate the effectiveness and safety of alemtuzumab, daclizumab and antithymocyte globulin in inducing immunosuppression in kidney transplantation. METHODS:The randomized controled trials of alemtuzumab or daclizumabversusATG in kidney tranplantation published from 1966 to 2011 were enroled by searching PubMed and EMBASE using Cochrane systematic review. We colected data and major outcomes. And a meta-analysis was conducted on homogeneous studies. RESULTS AND CONCLUSION: A total of 9 randomized controled trials (777 patients) about kidney transplantation were included. The meta-analysis results showed that the safety items including patient/renal graft survival and acute rejection at a folow-up of 24 months had no statistical differences among the three drugs (al P > 0.05). But there was a significant difference between the infection rates of alemtuzumab and antithymocyte globulin at 36 months of folow-up (P < 0.05). The results indicate that alemtuzumab, daclizumab and antithymocyte globulin are equaly effective in inducing immunosuppression at a folow-up of 24 months in kidney transplantation. However, compared to antithymocyte globulin, alemtuzumab has a lower rate of infection at a folow-up of 36 months.
ABSTRACT
PURPOSE: To assess the efficacy and safety of tension-free vaginal tape (TVT)-Secur for stress urinary incontinence (SUI). METHODS: A literature review was performed to identify all published trials of TVT-Secur. The search included the following databases: MEDLINE, Embase, and the Cochrane Controlled Trial Register. RESULTS: Seventeen publications involving a total of 1,879 patients were used to compare TVT-Secur with tension-free obturator tape (TVT-O) and TVT. We found that TVT-Secur had significant reductions in operative time, visual analog score for pain, and postoperative complications compared with TVT-O. Even though TVT-Secur had a significantly lower subjective cure rate (P<0.00001), lower objective cure rate (P<0.00001), and higher intraoperative complication rate, compared with TVT-O at 1 to 3 years, there was no significant difference between TVT-Secur and TVT-O in the subjective cure rate (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.22-1.08; P=0.08), objective cure rate (OR, 0.49; 95% CI, 0.22-1.09; P=0.08), or complications at 3 to 5 years. Moreover, TVT-Secur had significantly lower subjective and objective cure rates compared with TVT. CONCLUSIONS: This meta-analysis indicates that TVT-Secur did not show an inferior efficacy and safety compared with TVT-O for SUI in 3 to 5 years, even though displaying a clear tread toward a lower efficacy in 1 to 3 years. Considering that the safety is similar, there are no advantages in using TVT-Secur.
Subject(s)
Female , Humans , Intraoperative Complications , Operative Time , Postoperative Complications , Suburethral Slings , Urinary Incontinence , Urinary Incontinence, StressABSTRACT
PURPOSE: To assess the efficacy of the continuous positive airway pressure (CPAP) on nocturia in patients with obstructive sleep apnea (OSA). METHODS: A literature review was performed to identify all published clinical trials of CPAP for the treatment of nocturia. The search included the following databases: MEDLINE, Embase, and the Cochrane Controlled Trials Register. The reference lists of the retrieved studies were also investigated. RESULTS: Five publications involving a total of 307 patients were used in the analysis, which compared the number of incidents of nocturia before and after CPAP treatment. We found that patients with OSA and nocturia who were treated with CPAP had a significant decrease in the frequency of nocturia and the volume of urine associated with it. The mean number of nocturia incidents (standardized mean difference [SMD], -2.28; 95% confidence interval [CI], -2.42 to -2.15; P<0.00001) and the associated urine volume (SMD, -183.12; 95% CI, -248.27 to -117.98; P<0.00001) indicated that CPAP was effective. Besides, the Epworth Sleepiness Scale (SMD, -5.88; 95% CI, -6.56 to -5.21; P<0.00001) and the CPAP apnea-hypopnea index (SMD, -31.57; 95% CI, -33.87 to -29.28; P<0.00001) indicated that CPAP significantly improved the quality of sleep. CONCLUSIONS: This meta-analysis indicates that CPAP maybe an effective treatment for reducing nocturia associated with OSA and improving the quality of life of such patients.
Subject(s)
Humans , Continuous Positive Airway Pressure , Nocturia , Quality of Life , Sleep Apnea, ObstructiveABSTRACT
<p><b>BACKGROUND</b>Parkinson's disease (PD) is an extrapyramidal neurological disorder. Urinary symptoms are frequently present in patients affected by PD. Symptoms such as urgency, frequency, nocturia, and urge incontinence significantly impact the patient's quality of life. We attempted to investigate the urodynamic changes and treatment of male PD patients with voiding dysfunction by means of a review.</p><p><b>METHODS</b>Comprehensive urodynamic examinations were performed in 141 male patients with PD associated with voiding dysfunction. Appropriate treatments were given to subgroups that were divided based on test results, and the changes in urodynamic parameters as well as the treatment efficacy were observed.</p><p><b>RESULTS</b>Detrusor hyperreflexia without bladder outlet obstruction (BOO) was observed in 35 patients, who exhibited significant improvements in the international prostate symptom score (IPSS), maximum flow rate (Qmax), bladder volume at the first desire to void, post-void residual (PVR), and bladder compliance. Detrusor hyperreflexia associated with BOO was observed in 59 patients. The patients exhibited significant improvements in IPSS, Qmax, PVR, and bladder compliance. Detrusor dysfunction without BOO was observed in 19 patients, for whom the IPSS and the bladder volume at the first desire to void were improved after treatment. Detrusor dysfunction with BOO was found in 28 patients, with no significant improvement in the urodynamic parameters after the treatment.</p><p><b>CONCLUSIONS</b>Urodynamic examination is recommended for male Parkinson's disease patients with voiding dysfunction. Early and effective treatment can improve the bladder function and quality of life of these patients.</p>
Subject(s)
Aged , Aged, 80 and over , Humans , Male , Middle Aged , Parkinson Disease , General Surgery , Therapeutics , Urination Disorders , General Surgery , Therapeutics , UrodynamicsABSTRACT
Objective To investigate the incidence of and risk factors for benign prostatic hyperplasia (BPH) in transplant recipients.Methods 197 males aged 50 years and older who received kidney transplants were recruited if they were clinically stable.They were divided into three age groups:50 to 59 years (87 cases),60 to 69 years (64 cases) and ≥ 70 years (46 cases).Two hundred and forty people who had not undergone kidney transplant were randomly selected from the community as controls.A cross-sectional study was performed to study the BPH incidence in kidney transplant recipients according to standard diagnostic criteria.At the same time,the expression levels of keratinocyte growth factor,transforming growth factor-β and serum testosterone and the CD4/CD8 ratio in T lymphocytes were determined.Results There was no significant difference in age,PSA and the postmicturition residual volume between the study group and the control group.The total BPH incidence in kidney transplant recipients was 16.2％ (32/197).The symptomatic BPH incidence was 6.9％ (6/87) in the 50-to 59-year-old study group and 20.2％ (19/94) in the control group,representing a significant statistical difference in the symptomatic BPH incidence between the two groups (P =0.010).The symptomatic BPH incidence was 18.8％ (12/64) in the 60-to 69-year-old study group and 41.9％ (34/81) in the control group,indicating a significant statistical difference in the symptomatic BPH incidence between the two groups (P =0.004).The symptomatic BPH incidence was 30.4％ (14/46) in the ≥ 70-year-old study group and 52.3％ (34/65) in the control group,indicating a significant statistical difference in the symptomatic BPH incidence between the two groups (P =0.032).Compared to the control group,the peripheral blood serum testosterone level (9.4 ± 4.7,18.2 ± 5.6,P =0.040) and the CD4/CD8 ratio (1.1±0.3,1.8±0.3,P=0.014) of kidney transplant recipients was lower.The transforming growth factor-β expression level (5015± 1087,1829±963,P＜0.001) was higher in kidney transplant recipients than in the control group.The kasatinocyte growth factor expression levels (35.8±20.7,21.0± 18.3,P =0.064) was not statistically different than in the control group.Conclusions Kidney transplant recipients who had long-term administration of calcineurin inhibitor might have a low benign prostatic hyperplasia incidence,which might be related to transforming growth factor-β and keratinocyte growth factor expression,testosterone levels and the lymphocyte infiltration.Further high-quality prospective studies are still needed to confirm the conclusions.
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Objective To evaluate the efficacy and safety of silodosin in the treatment of benign prostatic hyperplasia (BPH).Methods Randomized controlled trials (RCT) on the efficacy and safety of silodosin for the treatment of BPH were retrieved from Medline (1966-2012),Embase (1988-2012),Cochrane liberary,CMCC (1979-2012),CNK1 (1979-2012) and the quality of the included RCTs were evaluated using Cochrane systematic evaluation to analyze the data statistically using Rev Man 5.1.0 software.Results Six RCTs involving 2543 participants were included for the meta-analysis.Results of analysis showed that silodosin was effective in the treatment of BPH in term of total international prostate symptom score (IPSS) (standard mean difference (SMD) =2.92,95 ％ CI =2.19-3.65,P ＜ 0.05),voiding symptom score (SMD =1.92,95％ CI =1.44-2.39,P ＜0.05),storage symptom score (SMD =0.92,95％ CI=0.60-1.24,P ＜0.05),and maximum flow rate (Qmax) score (SMD =1.56,95％ CI=1.38-1.75,P ＜ 0.05),compared with the placebo.Silodosin 8 mg was more effective than tamsulosin 0.2 mg in term of IPSS-related parameters and Qmax (P ＜ 0.05).Silodosin 8mg and tamsulosin 0.4 mg were similarly effective in all the efficacy analyses.Abnormal ejaculation was less common with tamsulosin 0.2 mg and 0.4mg (P＜0.05); overall adverse events were similar with tamsulosin 0.2 and 0.4 mg (P ＜0.05).Conclusions Silodosin was significantly more effective than placebo and tamsulosin 0.2 mg in improving symptoms and as effective as tamsulosin 0.4 mg.For adverse events,abnormal ejaculation was more common with silodosin.