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Long Y.,Guang Xi Medical University | Yao D.-S.,Guang Xi Medical University | Zhou K.-C.,Guang Xi Medical University
Chinese Journal of Evidence-Based Medicine | Year: 2010

Objective: To evaluate the clinical effect and safety of nerve sparing radical hysterectomy(NSRH) for cervical cancer compared with radical hysterectomy (RH). Methods: We searched the Cochrane Library (Issue 2, 2010), MEDLINE (1960 to March, 2010), EMbase (1960 to March, 2010), CBM (1960 to March, 2010), VIP (1960 to March, 2010) and CNKI (1960 to March, 2010), and hand searched related literatures. With a defined search strategy, both randomized controlled trials and controlled clinical trials of comparing NSRH with RH for cervical cancer were identified. Data were extracted and evaluated by two reviewers independently. The quality of the included trials was evaluated by Cochrane's evaluation criterion. Meta-analysis was conducted with the Cochrane collaboration's RevMan 4.2.2 software. Results: Nine controlled clinical trials involving 742 patients were identified. The meta-analysis showed that: a) There was statistical significance in postoperative recovery of bladder function between two groups; compared with RH, NSRH was much better in aspects of the recovery time of post void residual urine volume (PVR) (WMD= - 5.80, 95%CI - 6.22 to - 5.37), the bladder dysfunction morbidity (RR=0.43, 95%CI (0.26 to 0.75), and the urodynamic study; b) The operation time of NSRH was longer than that of RH with a significant difference (WMD=37.23, 95%CI 12.84 to 61.61); c) There was no significant difference between two groups in bleeding amount (WMD=19.66, 95%CI - 51.57 to 90.90); d) There was no significant difference between two groups in both survival rate and recurrent rate (RR=0.79, 95%CI 0.17 to 3.58); e) There was no significant difference between two groups in resection extension and pathologic outcome, such as, infiltration around uterus and vessels; f) One trail showed a significant difference between two groups that NSRH seldom led to anorectal and sexual dysfunction. Conclusions: Compared with RH, NSRH can quickly improve the postoperative recovery of bladder, anorectal and sexual functions, but haven't larger quantity of operative bleeding, larger resection extension, lower survival rates and higher recurrence rates except longer operation time. NSRH can improve the quality of postoperative life and is safe. However, the trails available for this systematic review were limited, as well as non-randomized controlled trails. Some outcomes were only included by one trail. So there is no confirmed conclusion about these. The prospective randomized controlled trials are required for further investigation. © 2010 Editorial Board of Chin J Evid-based Med. Source


Lu Y.,Guang Xi Medical University | Yao D.,Guang Xi Medical University | Ou T.,Guang Xi Medical University
Chinese Journal of Evidence-Based Medicine | Year: 2012

Objective To assess the efficacy and safety of laparoscopic nerve-sparing radical hysterectomy (LNSRH) in treatment of early cervical cancer. Methods Such databases as CBM (1960 to September 2011), CENTRAL (1966 to September 2011), MEDLINE (1966 to September 2011), The Cochrane Library, EMbase (1974 to September 2011) and CNKI (1994 to September 2011) were searched on computer, and relevant magazines were also searched manually. Data were extracted and the quality was assessed after including studies according to exclusive criteria, then meta-analysis was conducted using RevMan 5.1 software. Results Total 7 studies involving 506 cases were selected, of which 255 cases were in the LNSRH group and the other 251 cases were in the laparoscopic radical hysterectomy (LRH) group. There were no differences between the two groups in age, body mass index, clinical stage, pathological type and histological grade. The results of meta-analysis showed that: a) The operative time of LNSRH was longer than LRH, with significant difference (P=0.02). But there was no significant difference in intraoperative bleeding between the two groups (P=0.69); b) The length of dissected parametrium of LNSRH was shorter than LRH with significant difference (P=0.02). But there was no significant difference in the length of dissected vagina (P=0.69); and c) The functional recovery of the bladder in the LNSRH group was better than LRH (P<0.000 01). Conclusion LNSRH is safe and feasible in effectively alleviating the postoperative dysfunction of the bladder in early cervical cancer as well as in improving the quality of life for patients. It is regarded as a new model of operation. Because it has just been put into practice within a short time, and there is lack of multi-center, large-sample, prospective controlled studies at present, so its radical effectiveness, long-term recurrence rate, survival rate, etc. have not yet been confirmed. More high quality studies are needed to provide important data of comparison between LNSRH and LRH. Source


Long Y.,Guang Xi Medical University | Yao D.-S.,Guang Xi Medical University | Pan X.-W.,Guang Xi Medical University | Ou T.-Y.,Guang Xi Medical University
PLoS ONE | Year: 2014

Backgroud and Objective: Nerve-sparing radical hysterectomy (NSRH) may be associated with lower postoperative morbidity than radical hysterectomy (RH). We aimed to compare the clinical efficacy and safety of abdominal or laparoscopic NSRH and RH for treating cervical cancer through systematic review and meta-analysis. Methods: PubMed, EMBASE, The Cochrane Library and the Chinese National Knowledge Infrastructure databases were systematically searched for all relevant studies. Data were abstracted independently by two reviewers. A meta-analysis was performed to compare intra- and postoperative outcomes for the two techniques. Results: A total of 17 clinical trials were identified. Meta-analysis showed that although operating time was significantly longer for abdominal or laparoscopic NSRH than for RH, NSRH based on laparotomy or laparoscopy proved more effective for postoperative recovery of bladder function. NSRH was also associated with lower bladder dysfunction morbidity and fewer postoperative complications. Two abdominal trials and one laparoscopic study further suggested that NSRH was associated with shorter time to recovery of anal/rectal function. In contrast, RH and NSRH based on laparotomy or laparoscopy were similar in terms of extent of resection, recurrence rate, survival rate, blood loss and frequency of intraoperative complications. The meta-analysis showed that abdominal NSRH was not significantly different from RH in length of hospital stay, while one trial suggested that length of hospital stay was shorter after laparoscopic NSRH than after the corresponding RH. Conclusion: NSRH may be a reliable technique for treating early cervical cancer. Available evidence suggests that it is better than RH for postoperative recovery of pelvic organ function and postoperative morbidity, while the two techniques involve similar clinical safety and extent of resection. These results should be considered preliminary since they are based on a relatively small number of controlled trials, most of which were non-randomized. The findings should be verified in larger, well-designed studies. © 2014 Long et al. Source


Guo B.,Guang Xi Medical University | Liu Y.,Guang Xi Medical University | Tan X.,Guang Xi Medical University | Cen H.,Guang Xi Medical University
Leukemia and Lymphoma | Year: 2013

The prognostic significance of angiogenic markers remains controversial. Many studies have suggested that vascular endothelial growth factor (VEGF) or vascular endothelial growth factor receptor (VEGFR) overexpression correlates with poorer survival in adult patients with acute myeloid leukemia (AML), but some studies suggest a greater probability of survival. To investigate the prognostic significance of VEGF overexpression in adult AML, we performed a meta-analysis of the published studies that provided survival information according to VEGF expression status. Pooled hazard ratios (HRs) indicated that VEGF overexpression had a poor impact on the survival of adult patients with AML. The combined hazard ratio for event-free survival (EFS) was 1.40 and summary HR for overall survival was 1.54. The pooled HR was 1.92 in AML by enzyme-linked immunosorbent assay and 1.67 in AML by immunohistochemistry. These findings indicate that VEGF overexpression has an adverse impact on prognosis for patients with AML. VEGF may become a useful prognostic factor in the context of targeted therapy for patients with adult AML. © 2013 Informa UK, Ltd. Source


Zhong G.-Q.,Guang Xi Medical University | Zhong G.-Q.,Guangxi Medical University | Tu R.-H.,Guang Xi Medical University | Zeng Z.-Y.,Guang Xi Medical University | And 4 more authors.
Journal of Surgical Research | Year: 2014

Background Previous studies have shown that heat shock protein 90 (HSP90) plays a vital role in ischemic preconditioning. The present study was designed to explore whether HSP90 might be responsible for cardioprotection in ischemic postconditioning (PostC). Materials and methods Rat hearts underwent 30 min of regional ischemia and 2 h of reperfusion in situ, and PostC was effected with three cycles of 30-s reperfusion and 30-s coronary artery occlusion at the end of ischemia. Ninety rats were randomized into five groups: sham; ischemia-reperfusion (I/R); PostC; 1 mg/kg HSP90 inhibitor geldanamycin (GA) plus PostC (PostC + GA1); and 5 mg/kg GA plus PostC (PostC + GA5). The GA was administered 10 min before reperfusion. Results Compared with the I/R group, the PostC group exhibited lower infarct size (46.7 ± 3.0% versus 27.4 ± 4.0%, respectively), release of lactate dehydrogenase and creatine kinase-MB (2252.6 ± 350.8 versus 1713.7 ± 202.4 IU/L, 2804.3 ± 315.7 versus 1846.2 ± 238.0 IU/L, respectively), cardiomyocyte apoptosis (48.4 ± 5.6% versus 27.6 ± 3.8%, respectively), and mitochondrial damage. These beneficial effects were accompanied by an increase in mitochondrial Bcl-2 levels and a decrease in Bax levels. In addition, mitochondrial protein kinase Cepsilon (PKCepsilon) was relatively low in the I/R group but significantly higher in the PostC group, whereas cytosolic PKCepsilon was relatively high in the I/R group but significantly lower in the PostC group, suggesting the translocation of PKCepsilon from cytosol to mitochondria during PostC. However, blocking HSP90 function with GA inhibited the protection of PostC and PKCepsilon mitochondrial translocation. Conclusions HSP90 is critical in PostC-induced cardioprotection, and its activity might be linked to mitochondrial targeting of PKCepsilon, the activation of which results in upregulation of its target gene, Bcl-2, and the inhibition of proapoptotic Bax in mitochondria. © 2014 Published by Elsevier Inc. Source

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