Acute myocardial infarction (AMI) represents a leading cause of morbidity and mortality worldwide. Extracellular vesicles (EVs) are being recognized as a promising therapeutic approach in protecting against MI. Serum is a rich source of EVs, which transports various microRNAs (miRNAs, miRs). EVs from serum have been shown beneficial for protecting against ischemia-reperfusion injury; however, their roles in AMI are unclear. In addition, whether a miRNA might be responsible for the effects of serum EVs on protecting against AMI is undetermined. Here, we demonstrated that serum EVs significantly reduced cardiomyocytes apoptosis in both cellular and mouse models of AMI, and dramatically attenuated the infarct size in mouse hearts after AMI. Inhibition of miR-21 was shown to reduce the protective effects of serum EVs in inhibiting cardiomyocytes apoptosis. miR-21 was decreased in mouse hearts after AMI, while serum EVs increased that. In addition, the programmed cell death 4 (PDCD4) expression was identified as a target gene of miR-21. Therefore, our study showed the protective effects of serum EVs on AMI, and provided a novel strategy for AMI therapy.
The aim was to investigate the clinical efficacy and safety of extracorporeal shock wave lithotripsy (ESWL) in pediatric urolithiasis. A comprehensive systematic review and meta-analysis were performed. PubMed, Embase, and the Cochrane central register of controlled trials (CENTRAL) were searched, and the stone-free rates (SFRs) of various stone sizes and stone positions were extracted from the eligible articles. The quality of the original articles was assessed according to the McHarm Scale. The risk ratios (RRs) and 95% confidential intervals (CIs) were pooled, and the sensitive analysis was performed to evaluate the heterogeneity among all eligible studies. In total, 14 studies with 1842 patients were identified. The pooled RR for the SFR of stones less than 10 mm and greater than 10 mm was 1.14 (95% CI: 1.07, 1.21, P < 0.001); the RR for the SFR of stones in the renal pole calix (PC) and the renal pelvis was 0.95 (95% CI: 0.893, 1.009, P < 0.01); the RR for the SFR of stones in the upper/middle PC and the lower PC was 1.07 (95% CI: 0.997, 1.156, P < 0.061); and the RR for the SFR of stones in the proximal ureter and middle/distal ureter was 1.077 (95% CI: 1.005, 1.154, P = 0.036). Heterogeneity was low in all the analyses. Major complications in ESWL of pediatric urolithiasis were steinstrasse and abdominal colic, the incidences of which were 6.00 and 6.29 %, respectively. The SFR of stones <10 mm was significantly higher than stones >10 mm, and the SFR of stones located in proximal ureter was statistically greater than stones in middle or distal ureter in pediatric urolithiasis, leaving no significant between stones in renal PC and renal pelvis, or between upper/middle PC and lower PC. The use of ESWL in children is highly efficient, with negligible complications; ESWL therapy could be considered the first-line treatment for pediatric urolithiasis.
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