| 1 | Efficacy of telemedicine on glycaemic control in patients with type 2 diabetes:A meta-analysis显示文摘BACKGROUND Telemedicine is defined as the delivery of health services via remote communication and technology.It is a convenient and cost-effective method of intervention,which has shown to be successful in improving glyceamic control for type 2 diabetes patients.The utility of a successful diabetes intervention is vital to reduce disease complications,hospital admissions and associated economic costs.AIM To evaluate the effects of telemedicine interventions on hemoglobin A1c(HbA1c),systolic blood pressure(SBP),diastolic blood pressure(DBP),body mass index(BMI),post-prandial glucose(PPG),fasting plasma glucose(FPG),weight,cholesterol,mental and physical quality of life(QoL)in patients with type 2 diabetes.The secondary aim of this study is to determine the effect of the following subgroups on HbA1c post-telemedicine intervention;telemedicine characteristics,patient characteristics and self-care outcomes.METHODS PubMed Central,Cochrane Library,Embase and Scopus databases were searched from inception until 18th of June 2020.The quality of the 43 included studies were assessed using the PEDro scale,and the random effects model was used to estimate outcomes and I2 for heterogeneity testing.The mean difference and standard deviation data were extracted for analysis.RESULTS We found a significant reduction in HbA1c[-0.486%;95%confidence interval(CI)-0.561 to-0.410,P<0.001],DBP(-0.875 mmHg;95%CI-1.429 to-0.321,P<0.01),PPG(-1.458 mmol/L;95%CI-2.648 to-0.268,P<0.01),FPG(-0.577 mmol/L;95%CI-0.710 to-0.443,P<0.001),weight(-0.243 kg;95%CI-0.442 to-0.045,P<0.05),BMI(-0.304;95%CI-0.563 to-0.045,P<0.05),mental QoL(2.210;95%CI 0.053 to 4.367,P<0.05)and physical QoL(-1.312;95%CI 0.545 to 2.080,P<0.001)for patients following telemedicine interventions in comparison to control groups.The results of the meta-analysis did not show any significant reductions in SBP and cholesterol in the telemedicine interventions compared to the control groups.The telemedicine characteristic subgroup analysis revealed that clinical treatment models of intervention,as well as those involving telemonitoring,and those provided via modes of videoconference or interactive telephone had the greatest effect on HbA1c reduction.In addition,interventions delivered at a less than weekly frequency,as well as those given for a duration of 6 mo,and those lead by allied health resulted in better HbA1c outcomes.Furthermore,interventions with a focus on biomedical parameters,as well as those with an engagement level>70%and those with a drop-out rate of 10%-19.9%showed greatest HbA1c reduction.The patient characteristics investigation reported that Hispanic patients with T2DM had a greater HbA1c reduction post telemedicine intervention.For self-care outcomes,telemedicine interventions that resulted in higher postintervention glucose monitoring and self-efficacy were shown to have better HbA1c reduction.CONCLUSION The findings indicate that telemedicine is effective for improving HbA1c and thus,glycemic control in patients with type 2 diabetes.In addition,telemedicine interventions were also found to significantly improved other health outcomes as well as QoL scores.The results of the subgroup analysis emphasized that interventions in the form of telemonitoring,via a clinical treatment model and with a focus on biomedical parameters,delivered at a less than weekly frequency and 6 mo duration would have the largest effect on HbA1c reduction.This is in addition to being led by allied health,through modes such as video conference and interactive telephone,with an intervention engagement level>70%and a drop-out rate between 10%-19.9%.Due to the high heterogeneity of included studies and limitations,further studies with a larger sample size is needed to confirm our findings. | Julia De Groot Dongjun Wu Declan Flynn Dylan Robertson Gary Grant Jing Sun | 2021 | World Journal of Diabetes2021，12，2： | 3 |
| 3 | Distinct roles but cooperative effect of TLR3/9 agonists and PD-1 blockade in converting the immunotolerant microenvironment of irreversible electroporation-ablated tumors显示文摘Irreversible electroporation(IRE)is a new cancer ablation technology,but methods to improve IRE-induced therapeutic immunity are only beginning to be investigated.We developed a mouse model bearing large primary(300 mm^(3))and medium distant(100 mm^(3))EG7 lymphomas engineered to express ovalbumin(OVA)as a nominal tumor antigen.We established experimental protocols including IRE alone and IRE combined with Toll-like receptor(TLR)3/9 agonists(poly I:C/CpG)(IRE+pIC/CpG),PD-1 blockade(IRE+PD-1 blockade),or both(IRE+Combo)to investigate therapeutic effects on primary and distant EG7 tumors and conversion-promoting effects on the immunotolerant tumor microenvironment(TME).We demonstrated that IRE alone simulated very weak OVA-specific CD8^(+)T cell responses and did not inhibit primary tumor growth.IRE+pIC/CpG synergistically stimulated more efficient OVA-specific CD8^(+)T cell responses and primary tumor growth inhibition than IRE+PD-1 blockade.IRE+pIC/CpG played a major role in the modulation of immune cell profiles but a minor role in the downregulation of PD-L1 expression in the TME and vice versa for IRE+PD-1 blockade.IRE+Combo cooperatively induced potent OVA-specific CD8^(+)T cell immunity and rescued exhausted intratumoral CD8^(+)T cells,leading to eradication of not only primary tumors but also untreated concomitant distant tumors and lung metastases.IRE+Combo efficiently modulated immune cell profiles,as evidenced by reductions in immunotolerant type-2(M2)macrophages,myeloid-derived suppressor-cells,plasmacytoid dendritic cells,and regulatory T cells and by increases in immunogenic M1 macrophages,CD169^(+)macrophages,type-1 conventional dendritic cells,and CD8^(+)T cells,leading to conversion of immunotolerance in not only primary TMEs but also untreated distant TMEs.IRE+Combo also showed effective therapeutic effects in two breast cancer models.Therefore,our results suggest that IRE+Combo is a promising strategy to improve IRE ablation therapy in cancer. | Fatma Babikr Jiangbo Wan Aizhang Xu Zhaojia Wu Shahid Ahmed Andrew Freywald Rajni Chibbar Yue Wu Michael Moser Gary Groot Wenjun Zhang Bing Zhang Jim Xiang | 2021 | Cellular & Molecular Immunology2021，18，12： | 0 |
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