Comparison of bleb morphologies between phacoemulsification combined with Ex-PRESS mini shunt implantation, phacotrabeculectomy and trabeculectomy alone: a two-year retrospective in vivo confocal microscopy study.

BACKGROUND: To compare the bleb morphologies of phacoemulsification combined with Ex-PRESS implantation (Phaco-ExPRESS), phaco trabeculectomy (Phaco-Trab), and trabeculectomy (Trab) in postoperative two years. METHODS: Patients with primary open-angle glaucoma (POAG) with or without cataracts were included in this study. All patients underwent surgeries of either Phaco-ExPRESS, Phaco-Trab, or Trab. The morphologic structures of the filtering bleb, including microcysts area, hyperreflective dot density, and stromal connective tissue under in vivo confocal microscope (IVCM), were compared between the three groups. The data were collected preoperatively and postoperatively at 2 weeks, 1 month, 3 months, 6 months, 12 months, 18 months, and 24 months. RESULTS: Eighty-nine eyes from 89 patients were enrolled, including 32 in the Phaco-ExPRESS group, 25 in the Phaco-Trab group, and 32 in the Trab group. In a 24-month follow-up, bleb morphologies in Phaco-ExPRESS were similar to the Trab group. The area of epithelial microcysts was significantly increased in Phaco-ExPRESS and Trab groups while significantly decreased in Phaco-Trab. At postoperative 24 months, the complete success rate was 65.1% in Phaco-ExPRESS, 32.0% in Phaco-Trab, and 59.4% in the Trab group (P = 0.03). The phaco-Trab group had more postoperative anti-glaucoma medications than the other two groups (P < 0.05). CONCLUSIONS: Phaco-ExPRESS group and Trab group had similar blebs morphologies in IVCM, with larger microcyst area, looser connective tissue, and less inflammation than Phaco-Trab, indicating that the function of blebs in the Phaco-ExPRESS and Trab group, was more potent than that of Phaco-Trab. All these surgical methods provided adequate IOP control, but Phaco-Trab required more anti-glaucoma medications.

Ocular Characteristics of Pseudophakic Eyes with Malignant Glaucoma.

INTRODUCTION: The aim of the study was to investigate the clinical characteristics and treatment outcomes of the pseudophakic eyes with malignant glaucoma (MG). METHODS: This retrospective case-control study enrolled 53 eyes of 47 patients with primary angle-closure glaucoma having cataract surgery history, including 19 patients (25 eyes) diagnosed with MG and 28 patients (28 eyes) without MG as the match. Among patients diagnosed with MG, 14 patients (18 eyes) underwent zonulo-hyaloido-vitrectomy (ZHV) and the other 5 patients (7 eyes) received conservative treatments. The visual acuity, refraction status, intraocular pressure (IOP), extent of peripheral anterior synechia, classes of anti-glaucoma medications, and ultrasound biomicroscopy (UBM) examination were recorded before cataract surgery, at the diagnosis of MG, and 3 months after ZHV or atropine application, respectively. RESULTS: In the pseudophakic eyes with MG, the IOP cannot be well controlled compared to the matched eyes (27.24 ± 8.72 mm Hg vs. 14.30 ± 2.63 mm Hg, p < 0.001). In addition, there was a difference in the average spherical equivalent refractive error between 2 groups of patients (-2.23 ± 0.84 D in MG vs. -0.12 ± 0.64 D in the matched eyes, p < 0.001). By UBM analysis, the anterior chamber depth (ACD) was shallower in MG than that in the matched eyes (2.34 ± 0.20 mm vs. 3.47 ± 0.29 mm, p < 0.001). The difference between the anterior vault distance of the pseudophakic eyes with MG and that of the matched eyes was also significant (p < 0.001). After treated with ZHV, the IOP was greatly decreased from 27.84 ± 10.14 mm Hg to 15.85 ± 4.41 mm Hg (p < 0.001). The refractive error also changed from -2.11 ± 0.91 D to +0.42 ± 0.99 D (p < 0.001). At the same time, the central ACD was significantly deepened from 2.30 ± 0.39 mm to 3.30 ± 0.31 mm (p < 0.001). CONCLUSION: Uncontrolled IOP and shallow anterior chamber both centrally and peripherally are the primary clinical characteristics for the pseudophakic eyes with MG. An unexpected refractive error or myopic shift for the eyes with PACG after cataract surgery can be an important hint for diagnosis of MG. The typical UBM image is an anterior displacement of the lens-iris diaphragm and a bow-shaped change of the intraocular lens. It is an effective way to treat pseudophakic MG with the ZHV through a peripheral iridectomy.

Comparison between 3-dimensional and 2-dimensional endoscopic thyroidectomy for benign and malignant lesions: a meta-analysis.

BACKGROUND: The use of 3-dimensional (3D) endoscopic thyroidectomy (ET) has been increasing, but its feasibility and safety have not been well documented for thyroidectomy. Hence, to systematically investigate the comparative outcomes during 3D-ET and 2-dimensional (2D) ET for benign and malignant lesions, we conducted this meta-analysis. METHODS: Based on the PRISMA guidelines, a systematic database search of the PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), and Chinese Wanfang databases was performed. The eligible studies were published in English and Chinese up to October 2020. The major endpoints evaluated were procedure time, blood loss, postoperative drainage, postoperative hospitalization, postoperative complications, total number of lymph node dissections (LNDs), and total cost. RESULTS: A total of 15 relevant studies including 1190 patients (583 for 3D-ET and 607 for 2D-ET) compared the application of 3D and 2D laparoscopic systems in thyroid surgery, of which 8 were endoscopic benign thyroidectomy (EBT) and 7 were endoscopic malignant thyroidectomy (EMT). Our meta-analysis indicated that 3D-ET generally had advantages over 2D-ET in terms of procedure time (P = 0.000), blood loss (P = 0.000), postoperative drainage (P = 0.000), postoperative complications (P = 0.000), and LNDs (P = 0.006). However, there were no significant differences between the two systems in terms of total cost (P = 0.245) or postoperative hospitalization (P = 0.068). Subgroup analysis showed consistency of the overall outcomes in each subset, but a shorter postoperative hospitalization in 3D-EBT was revealed. CONCLUSIONS: Compared to 2D-ET, 3D endoscopic thyroidectomy is an efficient, safe, and reliable method with better depth perception and stereoscopic vision, and an equally satisfactory outcome. More clinical RCTs with long-term follow-up are required to reproduce these promising results.

Epigallocatechin-3-gallate (EGCG) inhibits myofibroblast transformation of human Tenon's fibroblasts.

Myofibroblast transformation of human Tenon's fibroblasts severely challenges the outcome of glaucoma filtration surgery. epigallocatechin-3-gallate (EGCG) is considered as a potential reagent to overcome this issue for its anti-fibrosis effect on various human diseases, but it is unclear on the fibrosis of Tenon's fibroblasts. This study was conducted to investigate the effect of EGCG on TGF-ß1-induced myofibroblast transformation of human Tenon's fibroblasts. The human Tenon's fibroblasts were incubated in the medium containing 10 ng/mL TGF-ß1, and subsequently treated with EGCG or mitomycin C (MMC). The cell proliferation and migration were analyzed. The expression of alpha-smooth muscle actin (α-SMA), type I collagen (Col-I), and p-Smad2/3 were also evaluated. It showed that EGCG and MMC strongly inhibited the elevation in cell number in tissue explants compared to the tissues treated with TGF-ß1 alone. Scratch-Wound assay showed that 48 h after TGF-ß1 induction, only 10% of the wound width remained. But cells treated with EGCG still showed over 93% wound width. Further, EGCG effectively inhibited TGF-ß1-induced expression of α-SMA and Col-I as well as phosphorylation of Smad2/3 in Tenon's fibroblasts. Altogether, we concluded that EGCG suppressed the myofibroblast transformation in Tenon's fibroblasts through inactivating TGF-ß1/Smad signaling. These findings demonstrate that EGCG can be considered as one of the possible antifibrotic reagents for preventing postoperative scarring in glaucoma filtration surgery.

The Effect of Problem-Based Learning on Improvement of the Medical Educational Environment: A Systematic Review and Meta-Analysis.

OBJECTIVES: The aim of this study was to evaluate the effect of problem-based learning on improving the medical educational environment. MATERIALS AND METHODS: All relevant studies on problem-based learning and the medical educational environment were searched for in PubMed, the Education Resources Information Center (ERIC) catalogue, Google Scholar, China National Knowledge Infrastructure (CNKI) and WanFang Data (WF) databases for material dating from 1969 to May 2015 without any language limitation. Six randomized controlled trials of problem-based learning compared to traditional lecture-based learning were included. The Cochrane risk of bias tool was used to assess the quality of the included studies. Review Manager (Revman) version 5.3 software was used for data analysis. The effect size of the improvement on the medical educational environment was calculated as the mean difference and 95% confidence interval. Heterogeneity was evaluated with Cochrane's χ2 test and I2. Publication bias was assessed by funnel plot, Begg's rank correlation test, and Egg's linear regression test. RESULTS: The six included studies were at low risk of bias in all domains except for three that were at high risk of bias in the domain of allocation concealment. The pooled effect size showed that problem-based learning was better than lecture-based learning in improving the medical educational environment, as measured by the Dundee Ready Education Environment Measure (DREEM), with statistically significant differences. No significant publication bias was observed. The sensitivity analysis showed that the result was reliable. CONCLUSIONS: This study showed that problem-based learning was able to improve the medical educational environment as measured by DREEM. However, further studies with larger sample sizes and high-quality data are needed.

Interocular asymmetry of retinal change in Parkinson's disease.

PURPOSE: To investigate interocular asymmetry (IA) of retinal structure and vessel density in patients with Parkinson's disease (PD) and normal controls (NC). METHODS: Seventy-eight subjects including 40 PD patients and 38 NC had completed optical coherence tomography angiography (OCTA) and neurological examinations for three rating scales (UPDRS-III, MMSE and MoCA). The IA was calculated by the absolute value of difference in right and left eyes. The IA of thickness in macular ganglion cell inner-plexiform layer (GCIPL), peripapillary retinal nerve fiber layer (pRNFL), and vessel density of superficial capillary plexus (SCP), deep capillary plexus (DCP), radial peripapillary capillary (RPC) were obtained from OCTA. RESULTS: The motor-symptom-onset side of eyes showed lower vessel density in parafovea of SCP (51.09 ± 3.46 vs 49.81 ± 4.16, P = 0.03) and superior hemi of perifovea DCP (49.55 ± 5.81 vs 47.33 ± 5.71, = 0.04). The PD patients showed larger IA in thickness of superior half of pRNFL (5.27 [2.67, 10.87] vs 3.08 [1.62, 5.61], P = 0.02) and parafovea GCIPL (2.40[1.25, 6.35] vs 1.40[0.50, 2.45], P = 0.02). No significant interocular asymmetry was found in vessel density between PD and NC. A higher UPDRS-III scale was associated with larger IA in GCIPL (ß = 0.093, P = 0.001) and smaller IA in DCP (ß = -0.065, P = 0.037). CONCLUSION: The motor-symptom-onset side of eyes showed more severe loss of macular vessel density than the other side of eyes. The PD patients showed asymmetrical structural change in GCIPL and pRNFL, which showed the potential as the diagnostic biomarker for PD.

Distribution and speciation of selenium in soybean proteins and its effect on protein structure and functionality.

Although the Se concentration and recovery efficiency of soybean seeds treated with selenate were âˆ¼ 1.8 times those of the selenite treatment, the Se was mainly in the organic form of selenomethionine (>90% of total Se) irrespective of the Se source. The Se concentrations of soybean protein isolate (SPI) and glycinin (11S) were 29.1%-38.6% higher than those of soybean protein concentrate (SPC) and ß-conglycinin (7S) in Se-enriched soybeans, with selenomethionine accounting for > 80% of the Se in all proteins. The content of sulfur-containing methionine in SPI and 11S markedly decreased in Se-enriched soybeans compared with the control. No significant effect of Se was observed on protein content, subunit composition, secondary structure, micromorphology, or functionality. Foliar spray of selenate provides an economical and efficient way to produce Se-enriched soybeans without affecting protein structure and functionality, where SPI and 11S display a high ability to enrich Se (mainly selenomethionine).

Microbial induced carbonate precipitation contributes to the fates of Cd and Se in Cd-contaminated seleniferous soils.

Bioremediation based on microbial induced carbonate precipitation (MICP) was conducted in Cd-contaminated seleniferous soils with objective to investigate effects of MICP on the fates of Cd and Se in soils. Results showed that soil indigenous microorganisms could induce MICP process to stabilize Cd and mobilize Se without inputting exogenous urease-producing strain. After remediation, soluble Cd (SOL-Cd) and exchangeable Cd (EXC-Cd) concentrations were decreased respectively by 59.8% and 9.4%, the labile Cd measured by the diffusive gradients in thin-films technique (DGT) was decreased by 14.2%. The MICP stabilized Cd mainly by increasing soil pH and co-precipitating Cd during the formation of calcium carbonate. Compared with chemical extraction method, DGT technique performs better in reflecting Cd bioavailability in soils remediated with MICP since this technique could eliminate the interference of Ca2+. The increase in pH resulted in Se conversion from nonlabile fraction to soluble and exchangeable fractions, thus improving Se bioavailability. And Se in soil solution could adsorb to or co-precipitate with the insoluble calcium carbonate during MICP, which would partly weaken Se bioavailability. Taken together, MICP had positive effects on the migration of Se. In conclusion, MICP could stabilize Cd and improve Se availability simultaneously in Cd-contaminated seleniferous soils.

Comparison of Ex-PRESS implantation versus trabeculectomy combined with phacoemulsification in primary open-angle glaucoma: a retrospective in vivo confocal microscopy study.

BACKGROUND: To compare the efficacy of Ex-PRESS implantation versus trabeculectomy combined with phacoemulsification. METHODS: A retrospective 12-month study on patients with coincident primary open-angle glaucoma (POAG) and cataract. The patients underwent combined phacoemulsification and Ex-PRESS implant (Phaco-ExPRESS, n = 35) or phacotrabeculectomy (Phaco-Trab, n = 35). The morphological structures of the filtering bleb were examined by slit-lamp, anterior segment optical coherence tomography (AS-OCT) and in vivo confocal microscopy (IVCM). Complete success was defined as postoperative intraocular pressure (IOP) < 18 mmHg without the use of anti-glaucoma medication. Qualified success was defined as postoperative IOP < 18 mmHg with or without anti-glaucoma medications. The data were collected preoperatively and postoperatively at 2 weeks, 1 month, 3 months, 6 months, and 12 months. RESULTS: No significant difference in the variables such as age, IOP and perimetry was found between the groups of Phaco-ExPRESS and Phaco-Trab. At the one-year postoperative visit for filtering blebs, Phaco-ExPRESS increased the mean area of epithelial microcysts significantly from 0.10 ± 0.05 to 0.20 ± 0.09 µm2 per µm2, while Phaco-Trab decreased the mean area significantly from 0.08 ± 0.04 to 0.04 ± 0.06 µm2 per µm2. Notably, the hyperreflective dots detected by IVCM decreased by 84.9% in Phaco-ExPRESS but increased by 36.3% in Phaco-Trab. The hyperreflective dots were further identified as neutrophil- and monocyte-like cells. The number of these cells were negatively correlated with the microcysts area (r = - 0.7, P < 0.01) but positively associated with the grade of connective tissue (r = 0.5, P < 0.01). By creating different microstructural changes in the filtering blebs, Phaco-ExPRESS produced a higher complete success rate (84.9% vs. 41.2%, P < 0.01) and significant decrease in the number of anti-glaucoma medications (P < 0.01) when compared with those in Phaco-Trab. However, the qualified success showed no significant difference between the two groups (100.0% vs. 91.2%, P = 0.24). CONCLUSIONS: At the one-year follow-up, Phaco-ExPRESS generated better filtering bleb with larger area of microcysts, looser connective tissues, and less inflammation than that of Phaco-Trab, providing adequate IOP control and less IOP-lowering medications. These findings indicate that Phaco-ExPRESS could be more preferred than Phaco-Trab for the treatment of patients with coincident POAG and cataract.

The effect of black coral extraction on acute lung inflammation induced by cigarette smoke in mice.

Short-term exposure to cigarette smoke (CS) introduces an abundance of free radicals into the lungs, causing oxidative stress and inflammation. CS is an important risk factor related to the pathogenesis of several pulmonary diseases, especially chronic obstructive pulmonary disease. Black coral (BC) is a marine biomaterial commonly used for cigarette holders in southeast China. The purpose of the present study was to evaluate the in vivo bioactivity of BC extract (BCE). Groups of mice (male Kunming) were subjected to ultrasonic atomizing inhalation of BCE (0.3, 1.5, and 3 mg/mL) before being exposed to CS (10 cigarettes per day for 4 days). The control group and the CS group were administered normal saline rather than BCE prior to CS exposure. Superoxide dismutase (SOD), malondialdehyde (MDA), and myeloperoxidase (MPO) levels were measured in lung homogenates. Histologic and morphologic studies of the right upper lung were performed. SOD activity increased 1.32 times in the CS+BCE (3 mg/mL) group (P < .001) compared with the CS group. The MDA content increased 4% (P < .001) in the CS+BCE (3 mg/mL) group compared with the control group. MPO was reduced 40% in the CS+BCE (3 mg/mL) group compared with the CS group (P < .001). Histologic analysis revealed decreased inflammation in the BCE group compared with the CS group. These results suggest that BCE has antioxidant and anti-inflammatory activity in vivo. BCE may protect against lung injury in smokers.

Characteristics of selenium enrichment and assessment of selenium bioavailability using the diffusive gradients in thin-films technique in seleniferous soils in Enshi, Central China.

Agricultural products from seleniferous areas commonly face problems associated with substantial variation in selenium (Se) concentration, which is mainly caused by the heterogeneity of Se bioavailability in soil. Many studies have assessed the bioavailability of Se and its influencing factors using soil samples treated with exogenous Se. Given the distinctly different characteristics of Se-spiked soils and naturally seleniferous soils, exploring Se bioavailability in naturally seleniferous soils is crucial to the stable production of Se-enriched agricultural products. In this study, we used the classical sequential extraction method to determine the Se fractionation and then applied the diffusive gradients in thin-films (DGT) technique to assess the Se bioavailability in naturally seleniferous soils. The results indicated that soluble and exchangeable Se fractions with high bioavailability accounted for only 0.7% and 5.1% of total Se, respectively. Both soluble and exchangeable Se concentrations were significantly positively correlated with soil pH (r = 0.329 and 0.262, respectively; P < 0.01). Se mainly exists in Fe-Mn oxide-bound, organic matter-bound, and residual Se fractions with low mobility (94.2% of total Se), among which organic matter-bound Se was the predominant fraction (49.5% of total Se). A significant positive correlation was found between total Se and soil organic matter (r = 0.539; P < 0.01). Multiple regression analysis revealed that the DGT-determined Se was mostly derived from soluble and exchangeable Se. The high correlation between the DGT-determined Se fraction and Se uptake by rice (r = 0.91; P < 0.01) confirmed that DGT can accurately assess Se bioavailability in naturally seleniferous soils in Enshi and other similar environmental settings.

Three-Random-Point Marking Method for Toric Intraocular Lens Alignment Using the iTrace Aberrometer.

PURPOSE: To evaluate the clinical outcome of the three-random-point (TRP) marking method for toric intraocular lens (IOL) alignment using the iTrace aberrometer (Tracey Technologies Corp., Houston, TX). Setting. Department of Ophthalmology, Guangdong Eye Institute, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China. DESIGN: Prospective, randomized comparative trial. METHOD: Thirty eyes of 30 patients undergoing cataract surgery with coexisting corneal astigmatism of over 1.0 D were included in this study. All patients were prospectively randomized into the TRP marking group or slit-lamp horizontal meridian (SHM) marking group. TRP marking involved marking three points randomly in the corneal limbus of the patients and accurately marking the horizontal meridian was not required. The follow-up duration was 3 months after cataract surgery. RESULTS: Fifteen eyes of 15 patients were in the TRP marking group and 15 eyes of 15 patients in the SHM marking group. There was no statistically significant difference in BCVA, UDVA, preexisting corneal astigmatism, or residual astigmatism between the groups before or after surgery (P > 0.05). The mean toric IOL misalignment was lesser but without significance in the TRP marking group than in the SHM marking group after 3 postoperative months (2.66° ± 1.42° versus 3.29° ± 1.67°; P=0.295). CONCLUSION: The TRP marking method using the iTrace aberrometer is simple and accurate for preoperative marking of toric IOLs. It can eliminate the potential systematic errors resulting from varying head positions during the preoperative keratometry measurement and from manual marking.

Linkage analysis and mutation screening of the rhodopsin gene in a Chinese Bai family with autosomal dominant retinitis pigmentosa.

Autosomal dominant retinitis pigmentosa (adRP) is a common form of RP worldwide. Although rhodopsin (RHO) is the most frequently reported adRP gene in many populations, it has not been detected in patients from the Bai nationality, one of the minority ethnic groups of southwest China. In this study, we used linkage analysis and mutation screening to identify the RHO gene in a Chinese Bai family with adRP. We found that in all affected members of the Bai family, the maximum two-point logarithm of odds score obtained was 3.61 and 4.52 at a recombination fraction (θ) of zero, with markers D3S3606 and D3S1292, respectively. Haplotype analysis showed cosegregation at the 1-c region harboring the RHO gene between the two markers with the disease. Direct sequencing of RHO revealed a c.1040C>T (p.Pro347leu) mutation in exon 5, which was supported by the reaction of the restriction enzyme. Two nonpathogenic single-nucleotide polymorphisms, rs7984 and rs2269736, were found in exon 1. To the best of our knowledge, this is the first genetic analysis of a Chinese Bai family with adRP, and a known missense RHO mutation (p.Pro347leu) is responsible for it.

Comparisons of Ocular Anatomic Differences of Lens-Subluxated Eye with or without Acute Angle Closure: A Retrospective Study.

PURPOSE: To compare ocular anatomy differences of lens subluxation between eyes with or without acute angle closure (AAC). METHODS: This is a retrospective and case-control study. Sixty cases with mild lens subluxation were recruited. Among them, 30 eyes with acute angle closure were assigned to the AAC group and 30 eyes without AAC were assigned to the non-AAC group. The anterior segment was quantitatively evaluated by ultrasound biomicroscopy (UBM). The axial length (AL) was measured with IOL Master. All patients underwent lens extraction surgery and were followed up for six months. RESULTS: The history of blunt trauma accounted for 22 (73.3%) cases in the AAC group and 21 (70%) cases in the non-AAC group. Fifteen (50%) patients in the AAC group had iridotomy history, and high intraocular pressure recurred. The UBM analysis showed that the average central chamber depth of the affected eyes in the AAC group was 1.82 mm, which was significantly shallower than that in the fellow eyes (2.58 mm, P < 0.05) or both eyes in the non-AAC group.Both eyes in the AAC group presented a shorter AL and shallower anterior chamber than the eyes in the non-AAC group. CONCLUSIONS: An asymmetrical anterior chamber between bilateral eyes is an important feature in lens subluxation-induced AAC. The crowded anterior chamber and shorter AL might be the anatomic basis for the eye with lens subluxation-induced AAC.

MicroRNA-34a promoting apoptosis of human lens epithelial cells through down-regulation of B-cell lymphoma-2 and silent information regulator.

AIM: To investigate the role of microRNA-34a (miR-34a) in the induction of apoptosis of human lens epithelial (HLE-B3) cells. METHODS: The apoptosis of HLE-B3 cells was detected by Annexin V-PE apoptosis detection kit after the treatment with 200 µmol/L H2O2 for 24h and lentiviral miR-34a vector transfection. The expression of miR-34a in the cells was quantified by quantitative real time polymerase chain reaction (qRT-PCR) in response to H2O2 exposure and the vector transfection. The effects of overexpression of miR-34a on the expression of B-cell lymphoma-2 (Bcl-2) and silent information regulator 1 (SIRT1) was determined by qRT-PCR and Western blot. RESULTS: The expression of miR-34a was up-regulated by the treatment of H2O2 in HLE-B3 cells. The increased expression of miR-34a is accompanied with the cell apoptosis. Consistence with the H2O2 exposure, ectopic overexpression of miR-34a in HLE-B3 cells promoted cells apoptosis. Importantly the anti-apoptosis factors Bcl-2 and SIRT1 were reduced significantly by up-regulation of miR-34a in HLE-B3 cells. CONCLUSION: MiR-34a promotes the apoptosis of HLE-B3 cells by down-regulating Bcl-2 and SIRT1, suggesting that miR-34a may involve in the pathogenesis of cataract formation and targeting miR-34a may be a potentially therapeutic approach for treatment of cataract.

The efficacy and safety of Chinese herbal medicine, Rhodiola formulation in treating ischemic heart disease: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Rhodiola formulation is widely used in treating ischemic heart disease (IHD), angina pectoris in China. A number of clinical studies have reported and claimed that Rhodiola formulation can relieve the symptoms of IHD. This study provides the first Preferred Reporting Items for Systematic Reviews (PRISMA)-compliant systematic review to evaluate the efficacy and safety of Rhodiola formulation in treating ischemic heart disease either as a sole agent or in combination with routine western medicine (RWM). METHODS: Search strategy - PubMed, Science Direct, the Cochrane Library, China National Knowledge Infrastructure (CNKI), China Master Theses Full-text Database (CMTD), China Doctor Dissertations Full-text Database (CDMD), Wanfang Data (WF) databases were searched for all relevant studies on Rhodiola formulation that have been published in English and Chinese. The last search of all databases was performed on 31 January 2013. All randomized controlled trials (RCTs) of Rhodiola formulation for patients with IHD were included, and the quality of included RCTs was assessed with Cochrane risk of bias tool. The primary outcomes, including the effective size of symptomatic and electrocardiography (ECG) improvement were calculated as an odds ratio (OR) and 95% confidence intervals (CIs). Because of obvious heterogeneity in the studies with regard to herbal species, herbal formulations, treatment group medicines, control group medicines and outcome measurement, subgroup analysis and sensitivity analysis were performed to evaluate the effects of study characteristics of RCTs, including quality, the role of Rhodiola formulations in treatment group and the different control group medicines. RESULTS: A total of thirteen studies (n=1672) were included. most of included studies were found to be high risk of bias with low quality of methodology. The Rhodiola formulations used alone or in combination with RWM demonstrated a positive effect on both improvement of symptoms and ECG. For the subgroup analysis, the ORs of symptomatic improvement in Rhodiola formulations versus other Chinese herbal medicines (CHMs), Rhodiola formulations versus RWM, and Rhodiola formulations plus RWM versus RWM were 1.51, 2.64, 5.63, respectively. The ORs of symptomatic improvement for Rhodiola formulations versus other CHMs, Rhodiola formulations versus RWM, and Rhodiola formulations plus RWM versus RWM were 1.33, 3.11, 2.27, respectively. Overall, the effectiveness of Rhodiola formulations was higher compared to medicines in control groups, with statistically significant differences observed both in symptomatic improvement (OR=2.40, 95% CI: 1.57-3.66, P<0.0001) and ECG improvement (OR=1.48, 95% CI: 1.17-1.87, P<0.01). However, the sensitivity test indicated that overall effects of Rhodiola formulation versus other CHMs in ECG improvement were not stable (after removing the study by Yin, P=0.05); the differences of CHMs in the control group are a possible source of heterogeneity. CONCLUSION: Rhodiola formulations may have a positive effect on treating IHD alone and in combination with RWM. However, poor quality of methodology and heterogeneity of the included trials means that larger sample size, multi-center, placebo-controlled, double blind studies are needed.

Two novel MOF-74 analogs exhibiting unique luminescent selectivity.

Two MOF-74 analogs with OH groups on 1D channel surfaces have been synthesized through multi-component self-assembly at room temperature. Their guest-free forms demonstrate a potential luminescent probe or sensor for small molecules, and OH-MOF-74 (2a) also showed exceptional fluorescence quenching and enhancement behavior for different types of aromatic molecules.