Objectives To assess the effectiveness and safety of carnitine in the treatment of idiopathic asthenozoospermia. Methods The Cochrane Library, MEDLINE, EMbase, and CNKI were searched between Jan 1995 and Dec 2006. Both English and Chinese studies were included in the review if they were randomized controlled trials (RCTs) involving men with idopathic asthenozoospermia who were treated with carnitine. Trial screening, data extraction, and quality assessment of included trials were conducted by method recommended by Cochrane Collaboration. Statistical analysis was conducted using RevMan 4.2.10 software. Results Five RCTs involving 346 patients met the inclusion criteria, and 307 patients were included in the meta-analysis. The results showed that: after being treated with carnitine for 3 and 6 months, the difference of the patients’ partners’ spontaneous pregnancy rate between treatment group and control group was statistically significant with RR2.46 and 95% CI1.12 to 5.43 (Z=2.23, P=0.03). After being treated with carnitine for 3 and 6 months, the difference of forward motile sperm per ejaculate between treatment group and control group was not statistically significant with WMD 9.16 and 95%CI 0.14 to 18.18 (Z=1.99, P=0.05) and WMD 5.28 and 95%CI –4.45 to 15.01 (Z=1.06, P=0.29). After being treated with carnitine for 3 and 6 months, the difference of percentage of forward sperm motility between treatment group and control group was not statistically significant with WMD 14.56 and 95%CI –4.49 to 33.61( Z=1.50 ,P=0.13), and WMD 7.34 and 95%CI –5.93 to 20.61 (Z=1.08, P=0.28). After being treated with carnitine for 3 and 6 months, the difference of total motile sperm per ejaculate between treatment group and control group was not statistically significant with WMD 15.32 and 95%CI –1.34 to 31.98 (Z=1.80, P=0.07) and WMD 6.20, 95%CI –3.00 to 15.39 (Z=1.32, P=0.19).After being treated with carnitine for 3 and 6 months, the difference of percentage of total sperm motility between treatment group and control group was not statistically significant with WMD 2.97 and 95%CI –5.75 to 11.69 (Z=0.67, P=0.50) and WMD 4.48 and 95%CI-9.17 to18.14 (Z=0.64, P=0.52). After being treated with carnitine for 3 and 6 months, the difference of semen volume between treatment group and control group was not statistically significant with WMD –0.12 and 95%CI –0.55 to 0.30 (Z=0.57, P=0.57) and WMD 0.03 and 95%CI –0.38 to 0.45 (Z=0.16, P=0.87). After being treated with carnitine for 3 and 6 months, the difference of sperm concentration between treatment group and control group was not statistically significant with WMD 7.92 and 95%CI – 2.85 to18.68 (Z=1.44, P=0.15), and WMD 1.02 and 95%CI –5.09 to 7.14 (Z=0.33, P=0.74). Three RCTs reported that there were no serious side effects of carnitine during the treatment period. Conclusions The available evidence indicates that spontaneous pregnancy rate would increase with carnitine therapy, while it is short of improvement of semen parameters. There is no serious side effect of carnitine. Because of lack of evidence, we cannot conclude that carnitine is effective in improving the prognosis of infertile patients with idiopathic asthenozoospermia. More high quality trials with large sample are proposed.
To discuss renovascular reconstruction during l iving related donor kidney transplantation (LDKT). Methods Seventy-seven cases of LDKT from April 2006 to March 2008 were retrospectively analyzed, including 63 cases in single renal artery group and 14 cases in multi ple artery group. In multi ple artery group, there were 3 cases of three arteries and 11 cases of double arteries; 9 cases of donated left kidneys and 5 cases of donated right kidneys. Potential donors underwent fully medical evaluation before operation, including donor-reci pient human leucocyte antigen matchingand a cross match test. The donor’s operation of the incision either underneath the 12th rib approaching the dorsal lumbar was performed and the transplantation operation adopted the extraperitoneal approach in the contralateral fossa il iac. The arteries in the multiple artery group were implanted onto the external (or common) il iac artery different from the orthodox method. Results In multiple artery group, no blood transfusion during operation was performed, no compl ication occurred after operation and all donors were discharged after 7-9 days of postoperation. After a follow-up of 3 months to 1 year, all the recipients kept normal kidney function without renal tubule necrosis, renal artery embol ism, vascular stenosis, urinary fistula and ureter necrosis. The ultrasound examination showed that the transplanted kidney had good blood supply. There was no significant difference in the time of urine secretion, serum creatinine level after 1 week of operation, length of hospital ization between the multiple artery group and the single artery group (P gt; 0.05). Conclusion The accurate treatment of multiple artery anastomosis are critical for the safety of the LDKT.
Objective To determine whether antibiotic prophylaxis can reduce the risk of postoperative bacteriuria in men undergoing transurethral resection of prostate (TURP) who have sterile preoperative urine. Method MEDLINE, EMBASE and Cochrane Library were searched for RCTs comparing antibiotic prophylaxis and placebo/blank controls for men undergoing TURP with preoperative sterile urine. The search strategy was established according to the Cochrane Prostatic Diseases and Urologic Cancers Group search strategy. Data was extracted by two reviewers using the designed extraction form. RevMan were used for data management and analysis. Results Fifty three relevant trials were searched, of which 27 trials were included and 26 were excluded. Antibiotic prophylaxis significantly decreased the rate of post-TURP bacteriuria.The pooled relative risk (RR) and 95% confidence interval were 0.36 (0.28, 0.46). Conclusions Prophylactic antibiotics could significantly decrease the incidence of post-TURP bacteriuria. Further comparative RCTs and cost-effective should be performed analysis to establish the optimal antibiotic regimes for the benefit of patients undergoing TURP.
【摘要】 目的 了解行肾切除手术疾病谱、疾病的临床表现及诊治方法的演变，探讨避免肾脏切除保留肾单位的术式，以期提高对肾脏疾病的诊治水平。 方法 回顾性分析泌尿外科1955年1月－2001年12月收治入院22 603例患者的临床资料，对其中行肾切除手术的1 952例进行分析。根据肾切除手术病因，将疾病分为3类:肾肿瘤、肾结核、其他疾病。将47年分为5个时段:50、60、70、80、90年代。应用平均值、构成比、中位数、率等对各项指标进行统计学分析。 结果 5个时段年平均入院人数与年均切肾率呈上升趋势。疾病谱构成中肾肿瘤共计663例，占33.97%；肾结核共计599例，占30.69%；其他疾病共计690例，占35.35%。肾肿瘤与其他疾病的例数及构成比分别随着年代的推进不断增加。而肾结核则未显示出该特点。各年代3类疾病发病年龄（中位数）在肾肿瘤、肾结核与其他疾病亦沉陷；体检发现疾病自70年代分别为1.10%、5.10%、8.80%。 结论 90年代后，肾切除手术的术式更加标准和成熟，保留肾单位的肾脏手术正在受到临床的重视和推广。【Abstract】 Objective To study the spectrum of diseases subjected to nephrectomy, to find out the clinical manifestations of the diseases, to summarize the evolvement of operational technology of kindney removal, to discuss the method of nephron sparing surgery in the purpose of avoiding nephrectmoy and reducing the operational risk, and to promote the level of diagnosing and treating nephropathy. Methods There were 1 952 cases of nephrectomy selected in the total 22 603 cases treated in the Department of Urology from January 1955 to December 2001. According to the diseases subjected to the surgery, these 1 952 cases were assigned into 3 groups: renal tumor group, renal tuberculosis group and other diseases group. The 47 years from 1955 to 2001 were divided into 5 periods: the 1950s (1955-1960), 60s (1961-1970), 70s (1971-1980), 80s (1981-1990) and 90s (1991-2001). Indexes such as average, proportion, median, and ratio were analyzed statistically. Results From the 1950s to 1990s, the number of patients undergoing nephrectomy increased from period to period. Among the diseases causing the surgery, the number of renal tumor cases was 663 (33.97%), the number of renal tuberculosis cases was 599 (30.69%), and the number of other disease cases was 690 (35.35%). The number and proportion of renal tumor and other disease cases increased from year to year, while the nuber of renal tuberculosis cases did not show this feature. The median age of patients treated with nephrectomy increased year by year, and the patient’s age of renal tumor was older than that of renal tuberculosis and other diseases. The proportion of patients whose diseases were found out by physical examination since the 1970s was respectively 1.10%, 5.10% and 8.80%. Conclusion Since the 1990s, the technology of nephrectomy has become maturer and more standardized, and nephron sparing surgery has caught more attention and has been applied more in clinics.
Objective To evaluate the association between coronary heart disease (CHD) and plasma homocysteine level, and to provide additional information for prevention and management of CHD. Methods We searched CBM, CNKI, WanFang, and VIP databases. Case-control studies about the association between CHD and plasma homocysteine level published in China were identified. Meta-analysis was performed using RevMan 4.2 software. Results The result of meta-analysis showed the plasma homocysteine level in the CHD group was higher than that of the control group (WMD=4.88, 95%CI 4.40 to 5.35, Plt;0.000 01), and the loss of safety coefficient was 1 339. Conclusion High plasma homocysteine level is associated with increasing morbidity of CHD.
Objective To evaluate the short and long term effectiveness and safety of rapamycin-based immunosuppression regimes with CsA preserving versus CsA withdrawal. Methods We searched MEDLINE, EMBASE, The Cochrane Library and CNKI from Jan. 1995 to Dec. 2005. We identified randomized controlled trials of rapamycin-hased immunosuppression regimes with CsA preserving versus CsA withdrawal for renal transplantation patients. The quality of included trials was evaluated by two reviewers. Meta-analysis was conducted on homogeneous studies. Results Ten studies （1 121 patients） undergoing renal transplantation were included. All included studies were graded in term of randomization, allocation concealment and bhnding. Six studies were graded A and the other 4 were graded B. Meta-analysis results showed CsA withdrawal in sirolimus-based therapy in renal transplantation patients survival rate OR.（95% CI ） values were 0,77（0.17, 3.52）, 1.24（0.48, 3.16）, 1.32（0.57, 3.08）, 1.21（0.60, 2.41） at the end of 6, 12, 24, 36 months respectively; renal allografts survival rate OR. （95% CI） values were 1.79 （0.63, 5.06）, 1.15 （ 0.56, 2.36） , 1.39 （0.68, 2.85）, 1.80（0.99, 3.29）, 2. 13（1.16, 3.89）, 2.01（1.15, 3.51） at the end of 6, 12, 24, 36, 48, 54 months respectively; and acute rejection OP,（95% CI） values were 0.92（0.48, 1.78）, 1.90（1.25, 2.89）, 2. 01 （0.94,4.27）, 1.93（0.93, 4.00）, 1.52（0.77, 3.02） at the end of6, 12, 24, 36, 48 months respectively. Conclusions Available evidence shows that compared with CsA preserving, CsA withdrawal in rapamycin-based immunosuppression regimes can lead to higher incidence rates of acute rejection at the end of one year while there is no statistical difference to survival rate of patients/renal allograft in cases with stabilized renal function post-transplantation. And CsA withdrawal is of benefit to allografts for long term survival rate and is helpful to recovery of renal function. Owing to high possibility of selection bias and measurement bias in included studies, there must be a negative impact on evidence intensity of our results. We expect best evidence from with high quality double blind randomized control trials.
Objective To evaluate factors such as renal injury grade （Sargent Method）, blunt or penetrative renal injury, injury severity score（ISS）, and shock influencing the need for operation or nephrectomy, and predictive of mortality in renal injury. Methods A well~tesigned questionnaire was used to collect medical records retrospectively. Two hundred and twenty-one cases of renal injury in West China Hospital from 1998 to 2002 were included, logistic regression analysis was used for multi-factors analysis. Results The average age of the 221 cases was 31.6, with 191 males （86.4%） and 30 females （13.6% ）, 175 blunt injuries （79.2%） and 46 penetrative injuries （20.8%）, and 101 concomitant injuries （45.7%）. Six cases died of renal injury （2.7%）. The results of logistic regression showed that the need of operation was related to injury grade, Type of renal injury, and shock significantly. ORs （odd ratios） were 5. 965 with 95% CI 2. 767 to 12. 859, 4. 667 with 95% CI 1. 725 to 12. 628, and 2. 547 with 95% CI 1. 684 to 3. 936 respectively. The need of nephrectomy was significantly related to injury grade with OR 11. 550 and 95% CI 4. 253 to 31. 366. The death was significantly related to ISS with OR 1. 263 and 95% CI 1. 082 to 1. 411. Conclusions The results of our data suggest the need of operation depends on injury grade, blunt or penetrative renal injury, and shock. The need of nephrectomy depends on injury grade. The death is related to ISS.
Objective To evaluate the safety and efficacy of steroid withdrawal in modern triple immunosuppressant (Cycloproine/Tacrolimus, Mycophenolate Mofetil and Steroid) on renal transplantation recipients. Methods We searched MEDLINE (1966-Sep. 2005), OVID (1966-2004), EMBASE (1984-2004), The Cochrane Library (Issue 4, 2005), CBMdisc (1994-2005), and handsearched 7 Chinese Journals. Randomized controlled trials (RCTs) adopting modern triple immunosuppressant, and comparing steroid withdrawal (SW), group and steroid continuing group (SC) were selected. The quality of included studies was evaluated and graded according to Cochrane Reviewer’s Handbook 4.2.5, and meta-analysis was performed by using RevMan 4.2.7 software. Results Nine RCTs including 1 681 patients (845 in SW and 836 in SC) were identified. The average follow-up time was 6-12 months. No significant difference was found in using CsA or Tac in modern triple immunosuppressant. The results of our meta-analysis showed: ① the risk of acute rejection was two times higher in SW than SC (RR 2.05, 95% CI 1.54 to 2.72, P lt;0.000 01), mainly Banff grade I (mild) (RR 1.92, 95% CI 1.16 to 3.17, P =0.01); but no significant differences were found on Banff grade II and III between the two groups. ② the rate of graft and patient survival and chronic rejection were the same between two groups. ③ Steroid withdrawal decreased the incidence of opportunistic infection (mainly caused by simplex herpes virus and Candida) and urinary tract infection. While the incidence of CMV and sepsis infection has no significant difference between two groups. Conclusion Steroid withdrawal within 3 months in modern immunosuppressive regimen ① increases the risk of Banff Grade I rejection reaction, but the moderate and severe rejection are similar between the two groups; ② doesn’t affect the rate of graft, patient survival, and chronic rejection; ③ decreases the incidence of opportunistic and urinary tract infection, but doesn’t improve the CMV infection and sepsis. To prophylaxis serious infection, steroid withdrawal is worth considering under sufficient immunosuppressive regimen. The key point is to balance the benefit and harm for individual recipients.
ObjectiveTo conduct a Meta-analysis to determine the clinical effect of protocol biopsy (PB)-monitored therapy after renal transplantation.MethodsPubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang Standards Database and VIP Database for Chinese Technical Periodicals were searched for trials comparing the efficacy of timely intervention under PB surveillance with the conventional treatment. The quality of included studies was assessed and Meta-analysis was conducted by RevMan 5.3 software.ResultsSix randomized controlled trials met our inclusion criteria, including 698 cases. No significant difference was found between the PB group and the control group in 1-year [relative risk (RR)=0.99, 95% confidence interval (CI) (0.97, 1.01), P=0.39] and 2-year recipient survival rate [RR=1.00, 95%CI (0.97, 1.02), P=0.72]. Graft survival rate after 1 year [RR=1.01, 95%CI (0.99, 1.04), P=0.29] and 2 years [RR=1.02, 95%CI (0.99, 1.06), P=0.19] were also statistically similar. No statistical difference was found in glomerular filtration rate between the two groups [mean difference (MD)=0.45 mL/(min·1.73 m2), 95%CI (–3.77, 4.67) mL/(min·1.73 m2), P=0.83]. Renal function of PB group, monitored by serum creatinine, was superior to the control group [MD=–0.46 mg/dL, 95%CI (–0.63, –0.29) mg/dL, P<0.000 01]. No statistical difference was found in infection between the two groups [RR=1.23, 95%CI (0.69, 2.19), P=0.48].ConclusionsOur study did not suggest PB for every kidney transplantation recipient. However, long-term randomized controlled trials with larger sample size would be necessary to determine whether PB was effective for specific populations.