Objective According to health technology assessment (HTA) methodology, to assess the efficacy and safety of different doses of metoprolol in the treatment of atrial fibrillation (AF). Methods Based on the principles of HTA, we searched some important medical databases including MEDLINE, EMBASE, The Cochrane Library and CMCC, as well as several national special heart disease databases and side effect centers. We selected eligible studies based on the inclusion and exclusion criteria and critically assessed their quality. Results Intravenous metoprolol 10 mg - 15 mg could control rapid ventricular rate in patients with chronic AF. On either rest or exercise, oral metoprolol 150 mg/d had a better control of rapid ventricular rate than 50 mg/d in patients with chronic AF. For preventing postoperative AF (POAF), the intravenous metoprolol 20 mg group and the 30 mg group could decrease the incidence of POAF compared to the 10 mg group. Oral metoprolol 150 mg/d was more effective than 100 mg/d in preventing POAF. In addition, intravenous metoprolol therapy was well-tolerated and more effective than oral metoprolol therapy in preventing atrial fibrillation after cardiac surgery. Results from several national side effect centers demonstrated that the incidence of adverse reactions associated with metoprolol was low. Conclusion Present evidence showed that high dose of metoprolol was superior to low dose in treating AF, however, the evidence available is insufficient. It is suggested that adequate evidence through further studies are needed. The safety profile of different doses of metoprolol is similar.
ObjectiveTo compare the radiation dose distribution in irradiated target area and organs at risk among conventional radiotherapy, conformal radiotherapy and semi-field conformal radiotherapy in Graves' ophthalmopathy patients. MethodsThirty patients with Grave's ophthalmopathy treated between January 2010 and December 2012 were included in this study.CT scan was performed to obtain images of each patients; three-dimensional planning system (3D-TPS) was done to design conventional radiotherapy, conformal radiotherapy and semi-field conformal radiotherapy for each patient.Then, we counted the standard deviation of study parameters for each radiotherapy technique, and the results were compared among the three groups. ResultsAverage irradiation dose in target area of patients accepting conventional irradiation, conformal irradiation and semi-field conformal irradiation therapy was not significantly different (P > 0.05).V95 and the conformity index values of conformal irradiation and semi-field conformal irradiation therapy were better than those of the conventional irradiation therapy (P < 0.001), while no significant difference between conformal irradiation and semi-field conformal irradiation therapy was detected (P > 0.05).Patients accepting conventional irradiation got the highest cumulative irradiation dose in eye lens, while patients accepting semi-field conformal irradiation therapy got the lowest irradiation dose in eye lens, and the differences were significant (P < 0.05).Patients accepting conventional irradiation got the highest cumulative irradiation dose in pituitary, while cumulative irradiation dose in pituitary in patients accepting conformal irradiation and semi-field conformal irradiation therapy was not significantly different (P > 0.05). ConclusionsConformal irradiation and semi-field conformal irradiation techniques are superior to conventional irradiation technique, with a better target conformal degree and higher does distribution in target area, as well as a lower radiation dose in normal tissues surrounding target area.Semi-field conformal irradiation technique has a better performance than conformal irradiation therapy in eye lens protection.
Objective To investigate the effect of the synthetic bone morphogenetic protein 2 (BMP-2)derived peptide on the osteogenic induction in the marrow mesenchymal stem cells (MSCs）and to evaluate the osteoinductivity and dosedependence of the BMP-2 derived peptide in vitro. Methods MSCs of 4-week old Wistar rats were separated and cultured. In the 3rd passage, the conditional culture medium was changed, in which the BMP-2-derived peptide in the following doses was added: 300,200, 100, 50, and 0 μg/ml, respectively (Groups A-E). The activity of alkaline phosphatase (ALP）and the amount of calciumdeposition were meassured at 5，10，15 and 20 days during the culture with the conditional culture medium. The real-time fluorescent quantitative polymerase chain reaction (FQ-PCR) was performed to measure the mRNA expressions of collagen type Ⅰ, osteopontin (OPN), and osteocalcin（OCN）and to measure the osteoinductivity of the BMP-2-derived peptide in the different concentrations.Results Under the inverted phase contrast microscope, MSCs cultured in the conditional culture medium for 3-4 days were changed in shape, from long fusiform to short fusiform or polygon. As the concentration of the BMP-2-derived peptide increased, the time for MSCs to change into the osteoblasts decreased. There was a significantly greater level of the ALP activity and amount of the calcium deposition in Groups A and B than in the other groups（Plt;0.05）. However,there was no significant difference between Group A and Group B （Pgt;0.05）. Theresult of FQPCR showed that after MSCs were cultured in the different doses of theconditional culture medium for 14 days, the mRNA expressions of collagen type Ⅰ, OPN andOCN were at higher levels. An increasing order in the level of the cycle threshold (Ct) was found in the following groups: Agt;Bgt;Cgt;D. Almost no expression was found in Group E. The Ct levels were significantly greater in Groups A and B thanin Groups C and D（Plt;0.05）. However, there was no significant difference between Group A and Group B （Pgt;0.05）.ConclusionThe BMP-2-derived peptide can greatly promote differentiation of MSCs into the osteoblasts, the promotion of osteogenesis has a dosedependent pattern, and the best inducing dosage is 200 μg/ml.
ObjectiveTo systematically review the dose-effect relationship between resistance exercise intervention and lower extremity muscle strength and function enhancement in the aging. MethodsEBSCO, PubMed, Web of Science, CNKI, VIP, and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on the effects of resistance exercise on muscle strength and function of the lower extremities in older adults from inception to July 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. A network meta-analysis was then performed by using RevMan 5.4 and Stata 15.0 software. ResultsA total of 32 RCTs with a total sample size of 1 594 individuals were included. The results of network meta-analysis showed that the elements of resistance exercise prescription: intensity 50%-70% 1RM, period 8-12 weeks, frequency 3-4 times/week, duration 30-45 min, and intervals 1.1-2 min were superior to other doses. ConclusionThe optimal dose of resistance exercise for improving lower extremity muscle strength and function in older adults is moderate exercise intensity (50%-70% 1RM) for 8-12 weeks, 3-4 times per week, 30-45 min per exercise, and 1.1-2 min interval between sets.
Objective To investigate the effects of QUE on proliferation and DNA synthesis of cultured retinal pigment epithelium(RPE) cells with or without EGF. Methods With or without EGF, cultured RPE cells were treated with QUE by various concentrations(200,100,50,1mu;mol/L) and with QUE 200mu;mol/L at different times(24-168 hr), cells proliferation and DNA synthesis were evaluated by cell count method and the uptake of thymidine. The viability of cells was determined by trypanblue exclusion. Results The best concentration of QUE which inhibits proliferation and DNA synthesis of PRE cells was 200mu;mol/L. The significant inhibition effect of QUE occurred at 48hr, and the best inhibition of QUE occurred at 96hr. QUE had more powerful effect of antiproliferation on RPE cells, and the viability of RPE cells was over85%. Conclusion The results suggested that QUE could inhibit the proliferation of RPE cells in a dose-dependent and time-dependent manner, especially inhibit the proliferation induced by EGF stimulating. QUE had no cyto-toxic effect on RPE cells cultured in vitro. (Chin J Ocul Fundus Dis,1999,15:27-29)
Does-response meta-analysis, which has being developed for more than 30 years, is a type of regression function and can be both linear and non-linear model. It plays an important role in investigating the relationship between dependent and independent variable. With its special advantages, dose-response meta-analysis has been widely used in evidence-based practice and decision. Currently there are several models can be used to perform dose-response metaanalysis with various advantages and disadvantages. It is vital to choose best model to perform dose-response metaanalysis in evidence-based practice. In this paper, we briefly introduce and summarize the methodology of dose-response meta-analysis.
Dose-response meta-analysis, as a subset of meta-analysis, plays an important role in dealing with the relationship between exposure level and risk of diseases. Traditional models limited in linear regression between the independent variables and the dependent variable. With the development of methodology and functional model, Nonlinear regression method was applied to dose-response meta-analysis, such as restricted cubic spline regression, quadratic B-spline regression. However, in these methods, the term and order of the independent variables have been assigned that may not suit for any trend distribution and it may lead to over fitting. Flexible fraction polynomial regression is a good method to solve this problem, which modelling a flexible fraction polynomial and choosing the best fitting model by using the likelihood-ratio test for a more accurate evaluation. In this article, we will discuss how to conduct a dose-response meta-analysis by flexible fraction polynomial.
Objective To assess the radiation dose and image quality with low-dose multi-detector row CT urography （CTU） for the evaluation of children patients with ureteropelvic junction stenosis （UJS）. Methods In this prospective study， 30 children patients with UJS underwent CTU were classified half-randomly through exam numbers into 3 groups （115 mA， 100 mA， and 75 mA）. Consecutive acquisitions including CT dose index weighted （CTDIw） and dose long product （DLP） were obtained in each patient and compared for each group. Three experienced chest radio-logists were unaware of the CT technique reviewed CT images for overall image quality using a 3-grade scale （excellent， good， and worst）. The data were analyzed using a parametric analysis of variance test and Wilcoxon’s signed rank test. Results The CTDIws of 115 mA group， 100 mA group， and 75 mA group were （7.63±0.83） mGy， （6.29±0.51） mGy， and （4.72±0.18） mGy， respectively， the difference was significant among three groups （F=36.445， P=0.000）. The mean CTDIw reduction was 38.2% in the 75 mA group as compared with 115 mA group （P＜0.001）. The DLPs of 115 mA group， 100 mA group， and 75 mA group were （173.89±29.88） mGy•cm， （145.96±26.21） mGy•cm， and （102.78±12.72） mGy•cm， respectively， the difference was significant among three groups （F=13.955， P=0.000）. The mean radiation dose reduction was 40.9% （75 mA group versus 115 mA group， P＜0.001）. The assessment of image quality was no significant difference with the same protocol and post-processing technique （Wilcoxon’s signed rank test， P＞0.05）. There was a good agreement for image quality scoring among the three reviewers （Kappa=0.736）. Conclusion Low-dose multi-detector row CTU should be considered as a promising technique for the evaluation of children patients with UJS because it could decrease radiation dose and obtain acceptable image quality.
Objective To evaluate the effectiveness and safety of different doses of interferon alfa (INF-α) in the treatment of chronic hepatitis C (CHC). Methods Such databases as MEDLINE, EMbase, CENTRAL, CBM, CNKI, VIP and WanFang Data were searched to collect the randomized controlled trials (RCTs) on different doses of INF-α in the treatment of CHC published before August, 2012. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data and evaluated the quality of the included studies, and then meta-analysis was performed using RevMan 5.0 software. Results A total of 13 RCTs involving 1 442 patients were included. The results of meta-analysis on different doses of INF-α showed that, a) There was no significant difference in the complete response rate between the 3 MU dose group and the 1 MU dose group (RR=0.83, 95%CI 0.52 to 1.32, P=0.43), but there was significant difference in the sustained response rate between those 2 groups (RR=1.89, 95%CI 1.00 to 3.59, P=0.05); and b) No significant differences were found in the complete response rate among the 3 MU dose group, the 6 MU dose group, and the 1 MU dose group. Conclusion INF-α in dose of 3 MU, 3 times daily, is effective in treating CHC, but it would not rule out that higher dose takes more effective action. When INF-α is used to treat CHC, an individualized medication should be applied according to patients’ tolerance and economic status.
ObjectivesTo compare different formula calculated dosages with the actual doses of warfarin from patients in Beijing Hospital so as to investigate suitable warfarin dosing models for Chinese patients.MethodsOne hundred and three Chinese patients with long-term prescription of warfarin were randomly selected from Beijing Hospital from July 2012 to May 2013. The CYP2C9 and VKROC1 genotypes and basic statistical information were collected. SPSS 18.0 software was used to compare the differences between different formula calculated dosages and the actual dosages of warfarin.ResultsFive genotypes were found in 103 patients, including: CYP2C9 AA genotype + VKORC1 AA genotype (n=72, 69.9%), CYP2C9 AA genotype + VKORC1 AG genotype (n=17, 16.5%), CYP2C9 AC genotype + VKORC1 AA genotype (n=10, 9.7%), CYP2C9 AC genotype + VKORC1 AG genotype (n=3, 2.9%) and CYP2C9 AA genotype + VKORC1 GG genotype (n=1, 1%). Compared with the actual dosages of warfarin, the degree of coincidence was highest for dosages calculated by Jeffrey’s formula.Conclusions Using Jeffrey’s formula to calculate warfarin dosages may be more suitable for Chinese patients with using long-term warfarin. Due to limited sample size, prospective and large sample size studies are required to verify the above conclusion.