Objective To assess the efficacy and safety of lipid-modifying agents for metabolism syndrome.Methods We searched The Cochrane Library, MEDLINE, EMbase, the China Biological Medicine Database, VIP and CMAC to 2007. We also did some handsearching and additional searching. Randomized controlled trials of lipidmodifying therapy for metabolic syndrome were included. Two reviewers independently extracted data from the eligible studies and evaluated the quality of the included studies. Meta-analyses were performed for the results of homogeneous studies using The Cochrane Collaboration’s RevMan 4.2.9 software. Results A total of 11 studies involving 1 422 patients with metabolic syndrome were included. The results indicated that there was no significant difference in TG between rosuvastatin and atorvastatin. However, rosuvastatin was more effective than atorvastatin on HDL-c improvement. Atorvastatin decreased TG levels greater than simvastatin, but simvastatin was superior to atorvastatin in HDL-c improvement. Two trials comparing fenofibrate with placebo were heterogeneous for some outcomes: one found no significant difference in improvements to HOMA-index, but the other trial indicated that fenofibrate was superior to placebo in improving QUICKI. However, the two trials revealed that fenofibrate favorably affected TG [WMD= – 1.77, 95%CI (– 2.21, – 1.33)] and HDL-c [WMD= 6.62, 95%CI (2.07, 11.17)] compared with placebo. No significant differences among atorvastatin, fenofibrate, alone or in combination, were observed in the proportion of metabolic syndrome reduction [RR=0.99, 95%CI (0.84, 1.16); RR=1.03, 95%CI (0.88, 1.20); RR=1.01, 95%CI (0.87, 1.18)]. Atorvastatin plus fenofibrate was superior to atorvastatin alone in TG and HDL-c improvement. Simvastatin-fenofibrate combination produced greater effectiveness in improving of HDL-c and TG compared with simvastatin alone. The fenofibrateorlistat combination was similar to fenofibrate in reducing metabolic syndrome [RR=1.15, 95%CI (0.68, 1.95)] and TG improvement, but was more effective than fenofibrate in HOMA-index improvement. This review of the clinical trials shows that the majority of lipid-modulating drugs did not have favorable effects on FPG, BP, BMI and WC. Six studies reported side effects, showing that the side effects for lipid-regulating drugs were mild to moderate, and well tolerated.Conclusion Our results suggest that lipid-regulating drugs in general exhibit beneficial effects on TG and HDL-c, but not on blood glucose and central obesity. The therapeutic effects of lipid-regulating drugs on blood pressure and insulin sensitivity are uncertain and have no positive effects on FPG, BMI and WC. There is insufficient evidence in this review to recommend the use of lipid-modifying drugs for metabolic syndrome due to low methodological quality, small ssamplesize and limited number of the trials. More high-quality and large-scale randomized controlled trials are required.
ObjectiveTo investigate the effectiveness of autologous injectable platelet rich fibrin (i-PRF) combined with bone marrow mesenchymal stem cells (BMSCs) for sciatic nerve injury in rats.MethodsBMSCs were isolated and cultured from tibial bone marrow of Sprague Dawley (SD) neonatal rats aged 10-15 days and passaged to the 4th generation. i-PRF was prepared from posterior orbital venous blood of adult SD rats by improved low-speed centrifugation. Twenty-four adult SD rats were selected and randomly divided into 4 groups with 6 rats in each group after the sciatic nerve Ⅲ degree injury model was established by modified crush injury method. Groups A, B, C, and D were injected with BMSCs suspension+autologous i-PRF, autologous i-PRF, BMSCs suspension, and normal saline, respectively. The Basso-Beattie-Bresnahan (BBB) score was used to evaluate the recovery of neurological function of the affected limb of rats every week from 1 to 8 weeks after operation. At 2 months after operation, the rats were sacrificed and the histological changes of sciatic nerve were observed by HE staining. The microstructural changes of nerve fibers, myelin sheath, and nucleus were observed by transmission electron microscope. The expressions of N-cadherin, Nestin, and glial fibrillary acidic protein (GFAP) were detected by Western blot.ResultsNo immune rejection or death occurred in the rats after operation. There was no significant difference in BBB scores between groups at 1 week after operation (P>0.05); at 2-8 weeks after operation, BBB scores in group A were significantly higher than those in groups B, C, and D, and in groups B, C than in group D (P<0.05), there was no significant difference between groups B and C (P>0.05). HE staining showed that the nerve fibers in group A arranged in order, without defect or demyelination; the nerve fibers in group B were not clear and slightly swollen; some of the nerve fibers in group C were disordered and demyelinated; the nerve fibers in group D were not continuous, obviously demyelinated, and some of the nerve adventitia damaged. Transmission electron microscope showed that the structure of nerve fibers in group A was clear, myelin sheath was complete, and nucleus was dense; group B was slightly less than group A; group C had fuzzy structure, demyelination, and hollowing out; group D had disorder structure, demyelination, and hollowing out, and the middle part of nerve adventitia continuity. Western blot detection results showed that there was no significant difference in the relative expression of Nestin between groups (P>0.05). The relative expression of N-cadherin was significantly lower in groups B, C, and D than in group A, in groups C and D than in group B, and in group D than in group C (P<0.05). The relative expression of GFAP was significantly lower in groups B, C, and D than in group A, in group D than in groups B and C (P<0.05); there was no significant difference between groups B and C (P>0.05).ConclusionAutologous i-PRF combined with BMSCs can effectively treat sciatic nerve tissue injury in rats.