Denosumab treatment for progressive Enneking stage II cervical giant-cell tumor conservatively.

Cervical giant cell tumor of the bone (GCTB) is a rare, primary benign bone tumor in pediatric patients. Surgery remains the primary choice for treating resectable cervical GCTB. Additional adjuvant therapeutic options are available for patients with unresectable cervical GCTB, including the anti-RANKL monoclonal antibody, denosumab. We represented a case incidentally found in a 7-year-old female, who complained severe craniocervical pain, grade 2-3 dysphagia, dysphonia, hypesthesia, and extremity weakness. The patient showed an impressive clinical response to denosumab, both clinically and radiologically, without adverse events or recurrence. To date, this is the youngest patient ever reported to have a progressive Enneking stage II C3 GCTB treated with denosumab alone. Denosumab can be administered as a single and conservative therapy for pediatric patients with unresectable upper cervical GCTB, avoiding the risks and morbidity of surgical and radiative treatment.

TNF-α promotes osteoclastogenesis through JNK signaling-dependent induction of Semaphorin3D expression in estrogen-deficiency induced osteoporosis.

Tumor necrosis factor α (TNF-α)-induced osteoclast formation have been demonstrated to play an important role in the pathogenesis of estrogen deficiency-mediated bone loss, but the exact mechanisms by which TNF-α enhanced osteoclast differentiation were not fully elucidated. The class III semaphorins members were critical to regulate bone homeostasis. Here, we identified a novel mechanism whereby TNF-α increasing Semaphorin3D expression contributes to estrogen deficiency-induced osteoporosis. In this study, we found that Semaphorin3D expression was upregulated by TNF-α during the process of RANKL-induced osteoclast differentiation. Inhibition of Semaphorin3D in pre-osteoclasts could attenuate the stimulatory effects of TNF-α on osteoclast proliferation and differentiation. Mechanistically, blocking of the Jun N-terminal kinase (JNK) signaling markedly rescued TNF-α-induced Semaphorin3D expression, suggesting that JNK signaling was involved in the regulation of Semaphorin3D expression by TNF-α. In addition, silencing of Semaphorin3D in vivo could alleviate estrogen deficiency-induced osteoporosis. Our results revealed a novel function for Semaphorin3D and suggested that increased Semaphorin3D may contribute to enhanced bone loss by increased TNF-α in estrogen deficiency-induced osteoporosis. Thus, Semaphorin3D may provide a potential therapeutic target for the treatment of estrogen-deficiency induced osteoporosis.

Determination of urine-derived odorous compounds in a source separation sanitation system.

Source separation sanitation systems have attracted more and more attention recently. However, separate urine collection and treatment could induce odor issues, especially in large scale application. In order to avoid such issues, it is necessary to monitor the odor related compounds that might be generated during urine storage. This study investigated the odorous compounds that emitted from source-separated human urine under different hydrolysis conditions. Batch experiments were conducted to investigate the effect of temperature, stale/fresh urine ratio and urine dilution on odor emissions. It was found that ammonia, dimethyl disulfide, allyl methyl sulfide and 4-heptanone were the main odorous compounds generated from human urine, with headspace concentrations hundreds of times higher than their respective odor thresholds. Furthermore, the high temperature accelerated urine hydrolysis and liquid-gas mass transfer, resulting a remarkable increase of odor emissions from the urine solution. The addition of stale urine enhanced urine hydrolysis and expedited odor emissions. On the contrary, diluted urine emitted less odorous compounds ascribed to reduced concentrations of odorant precursors. In addition, this study quantified the odor emissions and revealed the constraints of urine source separation in real-world applications. To address the odor issue, several control strategies are recommended for odor mitigation or elimination from an engineering perspective.

Correlations between posterior longitudinal injury and parameters of vertebral body damage.

BACKGROUND: The posterior longitudinal ligament (PLL) is an important structure of spinal stability. The loss of vertebral body height, local kyphosis (LK), and canal compromise may lead to spinal instability. This study determined the correlations between injury of the PLL and the loss of vertebrae height, kyphosis, and canal compromise. MATERIALS AND METHODS: A retrospective review of a thoracolumbar burst fracture database was conducted from January 2009 to December 2011. Patients were divided into an intact group and a disrupted group according to the status of the PLL. The loss of vertebral height, mid-sagittal canal diameter, and LK was measured. The anterior, middle, and posterior vertebral compression ratios (AVBCR, MVBCR, and PVBCR) and mid-sagittal diameter compression ratio (MSDCR) were calculated. RESULTS: Forty-seven patients were included in the study, including 25 patients in the intact group and 22 patients in the disrupted group. There were significant differences in the AVBCR (t = -3.048, P = 0.004), MVBCR (t = -2.301, P = 0.048), PVBCR (t = -2.116, P = 0.040), and MSDCR (t = -4.095, P = 0.000) but no difference in the LK (t = 0.408, P = 0.686) between the two groups. There was a positive correlation between the injury of the PLL and the MSDCR (r = 0.428, P < 0.01), AVBCR (r = 0.372, P < 0.01), and PVBCR (r = 0.271, P < 0.05). There was no correlation between the injury of the PLL and the LK and MVBCR. CONCLUSIONS: The MVBCR and LK are not predictive of a PLL injury. The MSDCR, AVBCR, and PVBCR were associated with a PLL injury.

Mining nutrients (N, K, P) from urban source-separated urine by forward osmosis dewatering.

Separating urine from domestic wastewater promotes a more sustainable municipal wastewater treatment system. This study investigated the feasibility of applying a forward osmosis (FO) dewatering process for nutrient recovery from source-separated urine under different conditions, using seawater or desalination brine as a low-cost draw solution. The filtration process with the active layer facing feed solution exhibited relatively high water fluxes up to 20 L/m(2)-h. The process also revealed relatively low rejection to neutral organic nitrogen (urea-N) in fresh urine but improved rejection of ammonium (50-80%) in hydrolyzed urine and high rejection (>90%) of phosphate, potassium in most cases. Compared to simulation based on the solution-diffusion mechanism, higher water flux and solute flux were obtained using fresh or hydrolyzed urine as the feed, which was attributed to the intensive forward nutrient permeation (i.e., of urea, ammonium, and potassium). Membrane fouling could be avoided by prior removal of the spontaneously precipitated crystals in urine. Compared to other urine treatment options, the current process was cost-effective and environmentally friendly for nutrient recovery from urban wastewater at source, yet a comprehensive life-cycle impact assessment might be needed to evaluate and optimize the overall system performance at pilot and full scale operation.

Adaptation of urine source separation in tropical cities: Process optimization and odor mitigation.

UNLABELLED: Source-separating urine from other domestic wastewaters promotes a more sustainable municipal wastewater treatment system. This study investigated the feasibility and potential issues of applying a urine source-separation system in tropical urban settings. The results showed that source-separated urine underwent rapid urea-hydrolysis (ureolysis) at temperatures between 34-40 degrees C, stale/fresh urine ratios greater than 40%, and/or with slight fecal cross-contamination. Undiluted (or low-diluted) urine favored ureolysis; this can be monitored by measuring conductivity as a reliable and efficient indicator The optimized parameters demonstrated that an effective urine source-separation system is achievable in tropical urban areas. On the other hand, the initial release of CO2 and NH3 led to an elevated pressure in the headspace of the collection reservoir, which then dropped to a negative value, primarily due to oxygen depletion by the microbial activity in the gradually alkalized urine. Another potential odor source during the ureolysis process was derived from the high production of volatile fatty acids (VFA), which were mainly acetic, propanoic, and butyric acids. Health concerns related to odor issues might limit the application of source separation systems in urban areas; it is therefore vital to systematically monitor and control the odor emissions from a source separation system. As such, an enhanced ureolysis process can attenuate the odor emissions. IMPLICATIONS: Urine source separation is promising to improve the management of domestic wastewater in a more sustainable way. The work demonstrates the achievability of an effective urine source-separation system in tropical urban areas. The installation of urine-stabilization tanks beneath high-rise buildings lowers the risk of pipe clogging. Conductivity measurement can be utilized as a reliable process indicator for an automated system. However, urine hydrolysis raises a strong potential of odor emission (both inorganic and organic), which might limit the application of source separation systems in urban areas. An enhanced ureolysis process could shorten and attenuate the odor emissions.

The relationship between adjuvant radiotherapy and survival of osteosarcoma: a case-control study.

To investigate whether adjuvant radiotherapy (RT) is associated with survival rate of osteosarcoma patients. A total of 3938 osteosarcoma patients between 1975 and 2016 from Surveillance, Epidemiology, and End Results (SEER) database were enrolled in this study. Survival rate was obtained by Kaplan-Meier method, with log-rank test identifying the difference. Multivariate Cox regression analysis was used to explore independent prognostic factors. The 5-year overall survival (OS) and cancer-specific survival (CSS) rates in surgery plus adjuvant RT group and surgery alone group were 38.2%, 66.3% (OS), and 41.6%, 68% (CSS), respectively. Multivariate analysis showed that adjuvant RT served as the independent unfavorable prognostic factor for OS and CSS. Based on the propensity score matching (PSM) method, the patients who received adjuvant RT had a poorer prognosis. Adjuvant RT showed an association with survival of osteosarcoma. Patients who received adjuvant RT had poorer survival. In the clinical use of adjuvant RT for osteosarcoma, the potential for reduced survival should be considered.

Measurement of air exchange rates in different indoor environments using continuous CO2 sensors.

A new air exchange rate (AER) monitoring method using continuous CO2 sensors was developed and validated through both laboratory experiments and field studies. Controlled laboratory simulation tests were conducted in a 1-m3 environmental chamber at different AERs (0.1-10.0 hr(-1)). AERs were determined using the decay method based on box model assumptions. Field tests were conducted in classrooms, dormitories, meeting rooms and apartments during 2-5 weekdays using CO2 sensors coupled with data loggers. Indoor temperature, relative humidity (RH), and CO2 concentrations were continuously monitored while outdoor parameters combined with on-site climate conditions were recorded. Statistical results indicated that good laboratory performance was achieved: duplicate precision was within 10%, and the measured AERs were 90%-120% of the real AERs. Average AERs were 1.22, 1.37, 1.10, 1.91 and 0.73 hr(-1) in dormitories, air-conditioned classrooms, classrooms with an air circulation cooling system, reading rooms, and meeting rooms, respectively. In an elderly particulate matter exposure study, all the homes had AER values ranging from 0.29 to 3.46 hr(-1) in fall, and 0.12 to 1.39 hr(-1) in winter with a median AER of 1.15.

Surgical strategy and outcomes for thoracolumbar disc herniation with Autologous Bone-Fusion or Cage-Fusion surgery: case series and literature review.

To analyze the clinical characteristics and surgical outcomes of TLDH with Autologous Bone-Fusion for T10-L1 TLDH or Cage-Fusion for T12-L3 TLDH. This is a retrospective multi-center clinical study, involving a total of 43 patients with TLDH who underwent surgery in our institutions from December 2013 to January 2021. In all, 15 of 43 patients (34.9%) with T10-11(2)/T11-12(5)/T12-L1 (8) TLDH underwent Autologous Bone-Fusion surgery and 28 of 43 patients (65.1%) with T12-L1(3)/L1-L2(12)/L2-L3(13) TLDH underwent Cage-Fusion surgery. Demographic data, clinical characteristics and perioperative outcomes were recorded. During the follow-up, pre- to post-operative ODI, VAS back and leg pain scores significantly decreased (P1.2 = 0.001) and the score changes had no significant difference between two groups (P3 = 0.81, 0.59, 0.68). The intraoperative blood loss and operation time showed no significant difference between two groups (P = 0.056, 0.072). The patients showed prominent improvement of hypokinesia and satisfactory rate in two groups (5/7, 71.4% VS 9/12, 75.0%, P = 0.633; 11, 73.3% VS 25, 89.3%, P = 0.281). Notably, no recurrence and severe complications were reported. The choice of surgery approach should be individualized by clinical characteristics and radiology. Selectively Autologous Bone-Fusion for T10-L1 TLDH or Cage-Fusion for T12-L3 TLDH provided adequate nerve decompression and immediate stability. The overall fusion surgical outcomes were satisfactory without major complications during follow-up.

Elevated procalcitonin levels in the absence of infection in procalcitonin-secretin hepatocellular carcinoma: A case report.

BACKGROUND: Serum procalcitonin (PCT) is widely used to diagnose bacterial infection and sepsis. However, PCT may be elevated in some neoplasms. It is important to distinguish infection from no infection in such neoplasms. The relationship between hepatocellular carcinoma (HCC) and PCT is unknown. CASE SUMMARY: A 62-year-old male was admitted due to a hepatic lesion of unknown origin. The patient had an elevated PCT level. Infectious diseases were excluded after appropriate examination. He then underwent exploratory laparotomy and a left lateral hepatectomy was performed. The patient recovered with an uneventful postoperative course and PCT level decreased gradually and was normal on day 16. HCC was diagnosed by histopathology and no evidence of infection was observed. Furthermore, immunohistochemical analyses revealed that tumor cells were positive for PCT. CONCLUSION: HCC cells can secrete PCT in the absence of infection and PCT may be used as a marker to monitor the efficacy of tumor therapy.

Successful laparoscopic treatment for sustained abdominal pain due to fish bone migrating into the neck of the pancreas: a case report and thinking about surgical approach through the literature review.

BACKGROUND: The majority of ingested foreign bodies pass through the gastrointestinal tract smoothly, with less than 1% requiring surgery. Fish bone could perforate through the wall of stomach or duodenum and then migrate to other surrounding organs, like the pancreas and liver. CASE PRESENTATION: We report herein the case of a 67-year-old male who presented with sustained mild epigastric pain. Abdominal computed tomography revealed a linear, hyperdense, foreign body along the stomach wall and pancreatic neck. We made a final diagnosis of localized inflammation caused by a fish bone penetrating the posterior wall of the gastric antrum and migrating into the neck of the pancreas. Upper gastrointestinal endoscopy was performed firstly, but no foreign body was found. Hence, a laparoscopic surgery was performed. The foreign body was removed safely in one piece and was identified as a 3.2-cm-long fish bone. The patient was discharged from the hospital on the fifth day after surgery without any postoperative complications. CONCLUSION: Laparoscopic surgery has proven to be a safe and effective way to remove an ingested fish bone embedded in the pancreas.

CT45A1 promotes the metastasis of osteosarcoma cells in vitro and in vivo through ß-catenin.

Increased expression of cancer/testis antigens (CTAs) is reported in various tumors. However, the unique role of CTAs in tumor genesis has not yet been verified. Here, we first report the functional role of CT45A1 in the carcinogenesis of osteosarcoma. RNA sequencing and immunohistochemistry confirmed that elevated expression of CT45A1 was detected in osteosarcoma, especially in metastatic tissues of osteosarcoma. Furthermore, osteosarcoma patients with poorer prognosis showed high expression of CT45A1. In cell tests, CT45A1 overexpression was shown to strengthen the proliferation, migration, and invasion abilities of osteosarcoma cells, while silencing CT45A1 markedly elicited the opposite effects in these tests by disrupting the activation of ß-catenin. In summary, we identify a novel role of CT45A1 in osteosarcoma. Furthermore, our results suggested that CT45A1 may contribute to the development of osteosarcoma and could be a possible therapeutic target for osteosarcoma patients.

Intrahepatic cholangiocarcinoma is more complex than we thought: A case report.

BACKGROUND: Brain metastasis from intrahepatic cholangiocarcinoma is rare. To the best of our knowledge, only a few cases have been reported. The biological behavior was complex, and treatment requires further investigation. CASE SUMMARY: A 62-year-old woman complained of left limb weakness. Abdominal computed tomography showed a 5.0 cm × 5.6 cm lesion in the left lobe of the liver. Tumor markers were normal. Serological analysis indicated absence of hepatitis virus. Brain magnetic resonance imaging revealed a 1.0 cm × 1.3 cm mass in the right frontal lobe. Intrahepatic cholangiocarcinoma with brain metastasis was diagnosed by our liver cancer multidisciplinary team. After sufficient preparation, the patient underwent partial frontal lobotomy and left hemihepatectomy. Histopathological results confirmed that both the lesions were cholangiocarcinoma. Six cycles of gemcitabine combined with S1 were administered. During a 39 mo postoperative follow-up, no sign of local recurrence or distant metastasis was observed. CONCLUSION: This case expands our knowledge concerning the complex and heterogeneous nature of tumor metastasis.

Blueberry anthocyanin­enriched extract ameliorates transverse aortic constriction­induced myocardial dysfunction via the DDAH1/ADMA/NO signaling pathway in mice.

Blueberry anthocyanin­enriched extract (BAE) has been demonstrated to protect against cardiovascular diseases by activating multiple target genes. The present study investigated the effects of BAE on transverse aortic constriction (TAC)­induced myocardial dysfunction in mice and explored its possible molecular mechanisms. A total of 30 male mice were divided randomly into control, TAC and TAC + BAE groups. Mice in the TAC + BAE groups were administered BAE by oral gavage for 6 consecutive weeks. Myocardial dysfunction was assessed using echocardiogram, histopathology, TUNEL assay, immunofluorescence staining, reverse transcription­quantitative PCR and western blot analysis. The results demonstrated that BAE treatment significantly ameliorated heart weight, left ventricular weight, myocardial dysfunction, left ventricular hypertrophy and fibrosis. In addition, BAE treatment alleviated TAC­induced inflammation, oxidative stress and apoptosis. Notably, BAE treatment markedly reduced asymmetric dimethylarginine (ADMA) concentration and significantly increased dimethylarginine dimethylaminohydrolase 1 (DDAH1) expression and nitric oxide (NO) production. The present data indicated that BAE treatment ameliorated TAC­induced myocardial dysfunction, oxidative stress, inflammatory response and apoptosis via the DDAH1/ADMA/NO signaling pathway.

Simvastatin With PRP Promotes Chondrogenesis of Bone Marrow Stem Cells In Vitro and Wounded Rat Achilles Tendon-Bone Interface Healing In Vivo.

BACKGROUND: Tendons and ligaments are joined to bone in a specialized interface that transmits force from muscle to bone and permits body movement. Tendon/ligament injuries always occur in the interface areas, and injured tendons/ligaments have a limited healing response because the insertion site is composed of a fibrocartilaginous zone. PURPOSE: To study the effect of simvastatin with platelet-rich plasma (PRP) on chondrogenesis of rat bone marrow stem cells (BMSCs) in vitro and wounded rat Achilles tendon-bone interface healing in vivo. STUDY DESIGN: Controlled laboratory study. METHODS: The in vitro model was performed by the culture of rat BMSCs with various concentrations of simvastatin (0, 10, 50, 100 nM) for 2 weeks. The effect of simvastatin on the chondrogenic differentiation of the BMSCs was examined by histochemical analysis and real-time quantitative reverse transcription polymerase chain reaction. The in vivo model was carried out by testing the healing effect of simvastatin with PRP on 12 wounded rat Achilles tendon-bone interfaces. RESULTS: Simvastatin induced chondrogenic differentiation of rat BMSCs in a concentration-dependent manner as evidenced by histological staining and real-time quantitative reverse transcription polymerase chain reaction. The wounds treated with simvastatin alone or with simvastatin-containing PRP gel healed much faster than the wounds treated with saline alone or PRP alone. Histological analysis showed that higher percentages of healed tissues were positively stained with safranin O and fast green in wounds treated with simvastatin-containing PRP gel than in the other 3 groups. Immunohistochemical analysis further demonstrated these findings, as evidenced by more positively stained healed tissues with collagen I and II antibodies in the wound areas treated with simvastatin-containing PRP gel than the other 3 groups. CONCLUSION: The combination of simvastatin with PRP induced chondrogenesis of BMSCs in vitro and enhanced fibrocartilage formation in vivo. The simvastatin-PRP gel treatment promotes wounded tendon-bone interface healing in clinical treatment. CLINICAL RELEVANCE: The combination of simvastatin with PRP may be a good clinical treatment for wounded tendon/ligament junction healing, especially for acute sports-related tendon/ligament injuries.

A novel curcumin-loaded nanoparticle restricts atherosclerosis development and promotes plaques stability in apolipoprotein E deficient mice.

Although curcumin possesses anti-atherogenic and anti-inflammatory properties, its application is limited because of its low aqueous solubility and poor oral bioavailability. Recently, our group synthesized a novel linear-dendrimer methoxy-poly (ethylene glycol)-b-poly(ε-caprolactone) copolymer nanoparticle loading curcumin (Cur-NPs) which could improve solubility and release property of curcumin. In the present study, we further evaluated its anti-atherosclerotic effect in apolipoprotein E-/- mice. Our results demonstrated that the Cur-NPs significantly decreased atherosclerotic lesion areas and were more effective in stabilizing vulnerable plaques compared with free curcumin. The anti-atherosclerotic mechanisms of Cur-NPs include decreasing the number of introplaque microvessels, inhibiting the matrix metalloproteinase 2 and 9 activity, reducing the inflammatory response and regulating lipoprotein cholesterol metabolism more effectively compared with free curcumin. Furthermore, Cur-NPs could increase the amount of curcumin in the thoracic aorta and no significant toxicity was observed in the blood biochemical parameters in Cur-NPs-treated groups. Overall, our findings suggested that Cur-NPs could be a stabilized aqueous formulation for application with improved curcumin activity, which could be a potential treatment strategy for arteriosclerosis in the future.

Inhalation cancer risk estimation of source-specific personal exposure for particulate matter-bound polycyclic aromatic hydrocarbons based on positive matrix factorization.

In previous studies, inhalation cancer risk was estimated using conventional risk assessment method, which was normally based on compound-specific analysis, and cannot provide substantial data for source-specific particulate matter concentrations and pollution control. In the present study, we applied an integrated risk analysis method, which was a synthetic combination of source apportionment receptor model and risk assessment method, to estimate cancer risks associated to individual PAHs coming from specific sources. Personal exposure particulate matter samples referring to an elderly panel were collected in a community of Tianjin, Northern China, in 2009, and 12 PAH compounds were measured using GC-MS. Positive matrix factorization (PMF) was used to extract the potential sources and quantify the source contributions to the PAH mixture. Then, the lung cancer risk of each modeled source was estimated by summing up the cancer risks of all measured PAH species according to the extracted source profile. The final results indicated that the overall cancer risk was 1.12 × 10-5, with the largest contribution from gasoline vehicle emission (44.1%). Unlike other risk estimation studies, this study was successful in combining risk analysis and source apportionment approaches, which allow estimating the potential risk of all source types and provided suitable information to select prior control strategies and mitigate the main air pollution sources that contributing to health risks.

Bioinformatics analysis of the gene expression profiles in human intervertebral disc degeneration associated with inflammatory cytokines.

BACKGROUND: To investigate the microarray data on the gene expression profiles of intervertebral disc degeneration related to cytokine exposure. The purpose of the study was to identify the key genes that were differentially expressed in these disc cells compared to cells without inflammatory cytokine treatment, using bioinformatics analyses, and to explore the related signaling pathways and interaction networks, providing clues to the molecular mechanisms of disc degeneration for future experimental studies. METHODS: The gene expression profiles data were obtained using the same microarray platform for two groups of patients suffering from degenerative disc diseases: GSE41883 (Human annulus disc cells exposed to TNF-a; 4 samples) and GSE27494 (Human annulus disc cells exposed to IL-1ß; 4 samples). The genes that were differentially expressed in these two datasets compared to control disc cells (without cytokine exposure; 4 samples each) were identified using the R language, and were pooled using the Excel software program to select the common differentially expressed genes in the two datasets. The initial functional clustering, signaling pathways and protein-protein interaction relationship analyses were conducted using the DAVID and STRING software programs. RESULTS: Of the 255 concomitantly and differentially expressed genes identified after respective treatment with TNF-α and IL-1ß, 141 were up-regulated and 114 were down-regulated. The gene ontology annotation analysis showed that these differentially expressed genes were primarily associated with cytokine activity, growth factor activity, the inflammatory reaction and the response to injury. The signaling pathway analysis showed that these differentially expressed genes were mainly related to the interactions of cytokines, apoptosis and NOD-like receptor signaling pathways. The interaction network analysis indicated that PTGS2, ICAM1, NOV and other genes may play a role in disc degeneration. CONCLUSIONS: We found that ICAM1 and other genes may play a role in the development of disc degeneration induced by inflammatory reactions using a bioinformatics analysis of the gene expression profiles of degenerative intervertebral disc cells stimulated with inflammatory factors, suggesting that bioinformatics methods can be used to identify potential target for intervertebral disc degeneration.

Effect of Clonidine on Hemodynamic Responses During Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis.

BACKGROUND: Clonidine might be beneficial to the patients undergoing laparoscopic cholecystectomy. This meta-analysis focused on the influence of clonidine on hemodynamic responses in patients undergoing laparoscopic cholecystectomy. METHODS: We searched several databases including PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases. This meta-analysis included randomized controlled trials regarding the influence of clonidine versus placebo on laparoscopic cholecystectomy. The primary outcomes were mean arterial pressure (MAP) and heart rate (HR) at pneumoperitoneum. The random-effect model was applied for this study. RESULTS: Compared with control intervention, clonidine intervention was found to significantly reduce the MAP at pneumoperitoneum [standard mean difference=-2.58; 95% confidence interval (CI),-4.63 to -0.53; P=0.01), HR at pneumoperitoneum (standard mean difference=-3.67; 95% CI, -6.57 to -0.76; P=0.01), MAP at intubation (standard mean difference=-2.40; 95% CI, -4.75 to -0.06; P=0.04), HR at intubation (standard mean difference=-3.39; 95% CI, -5.75 to -1.02; P=0.005), propofol requirement (standard mean difference=-2.25; 95% CI, -4.01 to -0.48; P=0.01), as well as postoperative nausea and vomiting (risk ratio, 0.35; 95% CI, 0.19-0.63; P=0.0005). CONCLUSIONS: Compared with control intervention, clonidine intervention was found to significantly reduce MAP and HR at pneumoperitoneum and intubation, propofol requirement, as well as postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy.