Abstract

This meta-analysis aimed to evaluate the impact of autologous platelet concentrates (APCs) on wound area reduction based on randomized controlled trials (RCTs). A comprehensive search was conducted in PubMed, Embase, China National Knowledge Infrastructure (CNKI), Web of Science, and the Cochrane Library to identify relevant literature. The primary outcome measure was the percentage of wound area reduction. Secondary outcome measures included wound healing time and the incidence of infection. A total of 14 studies were included in the meta-analysis. The results showed that the percentage of wound area reduction was significantly greater in the APCs group compared to conventional treatments (standardized mean difference [SMD] 1.98, 95% confidence interval [CI]: 1.27-2.68, p < 0.001). Subgroup analysis revealed that the percentage of wound area reduction varied based on wound location, follow-up duration, and type of APCs used. The healing time and incidence of infection presented no significant difference between the two groups. The findings suggest that APCs can effectively reduce wound areas when compared to conventional treatments, without increasing the risk of infection. In addition, the effectiveness of APCs in wound area reduction may vary depending on factors such as wound location, type of APCs used, and follow-up duration.

Abstract

PURPOSE This study aims to compare the efficacy of a single dose of Platelet-Rich Plasma (PRP) with multiple doses of PRP therapy in the treatment of knee osteoarthritis (KOA). METHODS PubMed, Embase, CINAHL, SCOPUS, Cochrane Library, grey literature and bibliographic references were searched from inception to May 2022. Only randomized controlled trials (RCTs) comparing the effect of single versus multiple doses of PRP for KOA were included. Literature retrieval and data extraction were conducted by three independent reviewers. Inclusion and exclusion criteria were based on type of study, research subjects, intervention, outcome, language and availability of data. Pooled analysis of Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores and adverse events were conducted. RESULTS Seven studies (all RCTs) of high methodological quality involving 575 patients were included. Age of patients included in this study ranged from 20 to 80, with a balanced gender ratio. Single dose PRP therapy resulted in significantly better VAS scores compared to triple dose PRP therapy at 12 months (P<0. 0001), with no significant change in VAS scores between double and single dose PRP at 12 months. Regarding adverse events, double dose (P=0.28) and triple dose (P=0.24) therapy had no significant differences in safety from single dose therapy. CONCLUSION While there is a paucity of large high-quality Level I studies, current best evidence suggests that two or three doses of PRP for KOA are as effective as one dose of PRP at providing pain relief and improvement in function up to 1 year following administration.

Abstract

INTRODUCTION This study examined the relative efficacy of growth factor therapies in healing diabetes-related foot ulcers (DFU). METHODS PubMed and Cochrane databases were searched for randomized controlled trials testing growth factor therapies for treating DFU. The primary outcome was complete wound closure. Results were reported as relative risk (RR) ± 95% credible intervals (CrI). The risk of bias was assessed using Cochrane's RoB-2 tool. RESULTS A total of 31 RCTs involving 2174 participants were included. Only 13 of the trials (n = 924) reported on the aetiology of the ulcers (85.4% neuropathic and 14.6% ischaemic). Epidermal growth factor (RR 3.83; 95% CrI 1.81, 9.10), plasma-rich protein (PRP) (RR 3.36; 95% CrI 1.66, 8.03) and platelet-derived growth factor (PDGF) (RR 2.47; 95% CrI 1.23, 5.17) significantly improved the likelihood of complete ulcer healing compared to control. Sub-analyses suggested that PRP (3 trials - RR 9.69; 95% CrI 1.37, 103.37) and PDGF (6 trials - RR 2.22; 95% CrI 1.12, 5.19) significantly improved the likelihood of wound closure amongst trial mainly recruiting participants with neuropathic ulcers. Eleven trials had a low risk of bias, 9 had some concerns and 11 had a high risk of bias. Sub-analysis of trials with a low risk of bias suggested that none of the growth factors significantly improved ulcer healing compared with control. DISCUSSION This network meta-analysis found low-quality evidence that Epidermal growth factor, PRP and PDGF therapy improved DFU healing likelihood compared with control. Larger well-designed trials are needed.

Abstract

OBJECTIVE To critically assess the effect and safety of platelet-rich plasma (PRP) in chronic wounds and vitiligo. METHODS A systematic literature searching was performed. Results were expressed as weight mean difference (WMD) or risk ratio (RR) with 95% confidence intervals (CIs). Pooled estimates were performed using a fixed-effects model or random-effects model, depending on the heterogeneity among studies. RESULTS A total of 27 studies were included in this meta-analysis. In patients with chronic diabetic ulcers, PRP significantly increased proportion of complete wound healing, percentage of wound area healed, and shortened the complete wound healing. In venous ulcers, PRP improved the epithelialized area and percentage of wound area healed. In vitiligo, PRP had better results in degree of improvement and mean repigmentation than controls. Regarding the safety profile, PRP did not increase the risk of infection in patients with chronic diabetic ulcers. Meta-regression revealed that source of PRP and preparation method of PRP significantly affected the proportion of complete wound healing, whereas age, gender, country, duration of wound, and wound size had no impact on this outcome. CONCLUSION PRP is effective and safe, and can be used as a potential therapeutic adjunct or alternative treatment in chronic wounds of multiple etiologies and vitiligo.

Abstract

BACKGROUND The efficacy and safety evaluation of the transplantation of autologous fat, platelet-rich plasma (PRP) and stromal vascular fraction (SVF) in acne scars has not been completely unified. This article will analyze and process the data of the included studies through evidence-based medicine to evaluate the efficacy and safety of autologous fat grafting, PRP and SVF for acne scar treatment, so as to provide treatment basis and strategy for the clinical treatment of acne scars. METHODS We searched the PubMed, Embase, Cochrane Library databases, CNKI, Wanfang and CQVIP databases for studies published during the time between the establishment of the databases through October 2022. We included studies that report autologous fat grafting, SVF and PRP for patients with acne scars. We excluded repeated publication, researches without full text, incomplete information or inability to conduct data extraction and animal experiments, case report, reviews and systematic reviews. STATA 15.1 software was used to analyze the data. RESULTS The findings showed that fat grafting had excellent improvement, marked improvement, moderate improvement and mild improvement rates of 36%, 27%, 18% and 18%, respectively, PRP had excellent improvement, marked improvement, moderate improvement and mild improvement rates of 0%, 26%, 47% and 25%, respectively, and the SVF had excellent improvement, marked improvement, moderate improvement and mild improvement rates of 73%, 25%, 3% and 0%, respectively. Additionally, the pooled results showed that there was no significant difference between PRP treatment and pre-treatment in Goodman and Baron scale score. However, Shetty et al. reported that Goodman and Baron scale score after fat grafting was significantly lower than pre-treatment. The results also showed that after fat grafting treatment, incidence of pain after fat grafting was 70%. After PRP treatment, in addition to pain (17%), there is a higher probability of postinflammatory hyperpigmentation (17%) and hematoma (6%). After SVF treatment, the incidence of postinflammatory hyperpigmentation and hematoma was all 0%. CONCLUSION Autologous fat grafting, PRP and SVF are effective for the treatment of acne scars, and the safety of autologous fat grafting, PRP and SVF is acceptable. Autologous fat grafting and SVF may be a better treatment for acne scars than PRP. However, this hypothesis still needs to be tested in the future large randomized controlled trials. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract

BACKGROUND Platelet transfusion refractoriness (PTR) remains an intractable issue in clinical practice, and is common in hematological patients. At present, it is believed that both immune and non-immune factors play a role. We conducted a meta-analysis of various risk factors which may contribute to PTR. METHODS PubMed, Embase, Cochrane library, and Web of Science were selected as research database platforms. Citations included were further assessed for quality and bias using the Newcastle-Ottawa Scale. All analyses were performed using Review Manager Version 5.4 and STATA 16.0. RESULTS The preliminary search revealed 1069 publications, and 17 (5929 patients in total) were ultimately included in the quantitative analysis. The following variables were associated with the occurrence of PTR: fever (OR = 2.26, 95%CI 2.00-2.55, p < 0.00001), bleeding (OR = 2.10, 95%CI 1.36-3.24, p = 0.0008), female sex (OR = 2.06, 95%CI 1.13-3.75, p = 0.02), antibiotic use (OR = 2.94, 95%CI 1.54-5.59, p = 0.001), and infection (OR = 2.19, 95%CI 1.20-4.03, p = 0.01). Antibodies involved in immune activation were a higher risk factor (OR = 4.17, 95%CI 2.36-7.36, p < 0.00001), and splenomegaly was nearly significant (OR = 1.73, 95%CI 0.97-3.07, p = 0.06). CONCLUSIONS We identified some important risk factors for PTR, but further research is needed to identify the many other possible elements that may contribute to or mediate PTR.

Abstract

BACKGROUND In recent years, platelet-rich plasma (PRP) injections for osteoarthritis (OA) have been widely promoted in clinical practice, but their effectiveness is controversial. Therefore, we conducted a meta-analysis of relevant randomized controlled trials (RCTs) to determine the efficacy and safety of PRP injections for the treatment of OA. METHODS We searched databases including Embase, Web of Science, Medline, PubMed, and the Cochrane Library for relevant studies. Two researchers (YQX and CG) performed literature screening, baseline data extraction, literature quality assessment, and heterogeneity analysis of RCTs from the retrieved studies. Based on the magnitude of heterogeneity I(2), random-effects or fixed-effects models were selected for the meta-analysis. RESULTS We included 24 RCTs comprising 1344 patients with OA who met the inclusion criteria, with the main types of morbidity being knee osteoarthritis (KOA), hip osteoarthritis (HOA), ankle osteoarthritis (AOA), and temporomandibular joint osteoarthritis (TMJOA). Our results indicate that PRP injections were effective in improving Visual Analog Scale (VAS) pain scores in patients with KOA, HOA, and AOA compared to controls (AOA, MD = -1.15, CI = 95% [-1.74, -0.56], I(2) = 40%, P < 0.05; KOA, MD = -1.03, CI = 95% [-1.16, -0.9], I(2) = 87%, P < 0.05; TMJOA, MD = -1.35, CI = 95% [-1.74, -0.97], I(2) = 92%, P < 0.05) but showed no significant efficacy in patients with HOA (MD = -0.27, CI = 95% [-0.8, 0.26], I(2) = 56%, P>0.05). Compared to controls, PRP injections were effective in improving Knee Injury and Osteoarthritis Outcome Score (KOOS), including the patient's pain symptoms, activities of daily living (ADL), and adhesion symptomatology, but not for that of sports function (KOOS-pain, MD = 2.77, CI = 95% [0, 5.53], I(2) = 0%, P < 0.05; KOOS-symptoms, MD = 3.73, CI = 95% [0.76, 6.71], I(2) = 0%, P < 0.05; KOOS-ADL, MD = 3.61, CI = 95% [0.79, 6.43], I(2) = 0%, P < 0.05; KOOS-QOL, MD = 4.66, CI = 95% [0.98, 8.35], I(2) = 29%, P < 0.05, KOOS-sport, MD = 0.48, CI = 95% [-3.02, 3.98], I(2) = 0%, P > 0.05). PRP injections were effective in improving Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores, including pain, stiffness, and functional joint motion, in patients with OA compared with the control group (WOMAC-pain, MD = -1.08, CI = 95% [-1.62, -0.53], I(2) = 87%, P < 0.05; WOMAC-stiffness, MD = -1.17, CI = 88% [-1.72, -0.63], I(2) = 87%, P < 0.05; WOMAC-function, MD = -1.12, CI = 95% [-1.65, -0.58], I(2) = 87%, P < 0.05). In addition, subgroup analysis showed that leukocyte-poor (LP) PRP injections were more effective than leukocyte-rich (LR) PRP injections in improving pain symptoms in patients with OA (VAS, LR-PRP, MD = -0.81, CI = 95% [-1.65, -0.03], I(2) = 83%, P = 0.06 > 0.05; LP-PRP, MD = -1.62, CI = 95% [-2.36, -0.88], I(2) = 92%, P < 0.05). A subgroup analysis based on injection sites showed that no statistical difference in efficacy between intra-articular (IA) combined with intra-osseous (IO) simultaneous PRP injections. IA PRP injections only improved VAS pain scores in patients with OA (IA+IO PRP injections, MD = -0.74, CI =95% [-1.29, -0.18], I(2) = 61%, P < 0.05; IA PRP injections, MD = -1.43, CI = 95% [-2.18, -0.68], I(2) = 87%, P < 0.05, test for subgroup differences, P > 0.05, I(2) = 52.7%). CONCLUSION PRP injection therapy can safely and effectively improve functional activity in patients with OA and produce positive analgesic effects in patients with KOA, TMJOA, and AOA. However, PRP injection therapy did not significantly reduce pain symptoms in patients with HOA. In addition, the analgesic effect of LP-PRP was greater than that of LR-PRP. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022362066.

Abstract

BACKGROUND Platelet-rich plasma (PRP) and corticosteroids are used to treat rotator cuff diseases. However, few reviews have compared the effects of these two treatments. In this study, we compared the effects of PRP and corticosteroid injection on the prognosis of rotator cuff diseases. METHODS According to the Cochrane Manual of Systematic Review of Interventions, the PubMed, Embase, and Cochrane databases were searched comprehensively. Two independent authors screened suitable studies and performed data extraction and risk of bias assessment. Only randomized controlled trials (RCTs) comparing the effects of PRP and corticosteroid in the treatment of rotator cuff injuries were included, as measured by clinical function and pain during different follow-up periods. RESULTS Nine studies with 469 patients were included in this review. In short-term treatment, corticosteroids were superior to PRP in the improvement of constant, SST, and ASES scores (MD -5.08, 95%CI -10.26, 0.06; P = .05 and MD -0.97, 95%CI -1.68, -0.07; P = .03 and MD -6.67, 95%CI -12.85, -0.49; P = .03, respectively). No statistically difference was observed between the two groups at mid-term (P> .05), and the recovery of the SST and ASES scores in PRP treatment was significantly better than that in corticosteroid treatment in the long-term (MD 1.21, 95%CI 0.68, 1.74; P < .00001 and MD 6.96, 95%CI 3.90, 9.61; P < .00001, respectively). In pain reduction based on VAS score, corticosteroids led to better pain reduction (MD 0.84, 95%CI 0.03, 1.64; P = .04), but no significant difference was observed in pain reduction between the two groups in the any term (P> .05). However, these differences did not reach the minimum clinically important difference. CONCLUSION Current analysis showed that corticosteroids have better efficacy in short-term, whereas PRP is more beneficial for long-term recovery. However, no difference was observed in the mid-term efficacy between the two groups. RCTs with longer follow-up periods and larger sample sizes are also needed to determine the optimal treatment.

Abstract

OBJECTIVE To analyse the safety and effectiveness of platelet-rich plasma (PRP) in anal fistula patients. METHODS Online databases including PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to December 5, 2022, for eligible studies about evaluating the efficacy of platelet-rich plasma (PRP) in treating anal fistula. Literature search, screening, data extraction, and quality assessment were carried out by two independent investigators. The overall cure rate, the complete cure rate, the recurrence rate, and the adverse event rate with their 95% confidence intervals (95% CI) were the primary calculation indexes. Subgroup analyses were conducted primarily according to whether PRP was combined with other treatments. Softwares of MedCalc 18.2 and Review Manager 5.3 were used for meta-analysis. RESULTS A total of 14 studies with 514 patients were included in the meta-analysis. The overall cure rate of 14 studies was 72.11% (95% CI 0.64-0.79). The cure rate of PRP alone was 62.39% (95% CI 0.55-0.69). The combined cure rate of PRP with other treatments was 83.12% (95% CI 0.77-0.88). The cure rate of interventions involving PRP were superior to the cure rate of surgery methods without using PRP significantly in the 4 randomized controlled studies (RR = 1.30, 95% CI 1.10-1.54, p = 0.002). The complete cure rate of the 8 studies was 66.37% (95% CI 0.52-0.79). The recurrence rate of the 12 studies was 14.84% (95% CI 0.08-0.24). The adverse event rate of the 12 studies was 6.31% (95% CI 0.02-0.12). CONCLUSION PRP showed favorable safety and effectiveness in the treatment of anal fistula, especially combined with other treatment procedures.

Abstract

BACKGROUND While early evidence concluded a lack of clinical benefit of convalescent plasma therapy (CPT) in COVID-19 management, recent trials demonstrate the therapeutic potential of CPT in ambulatory care. CPT may also potentiate thromboembolic events given the presence of coagulation factors and the prothrombotic state of COVID-19. OBJECTIVE The present study aims to assess and compare the clinical efficacy and the risk of venous/arterial thromboembolism (VTE, ATE) of CPT in ambulatory vs hospitalized COVID-19 patients. METHODS MEDLINE, Embase, and Cochrane CENTRAL were searched from December 2019 to December 2022 for randomized controlled trials that investigated the use of CPT against placebo or standard of care in adult COVID-19 patients. The primary outcome was non-mortality disease progression. Secondary outcomes include VTE, ATE, 28-day mortality, clinical improvement, length of hospitalization (LOH), sepsis/fever, and major adverse cardiovascular events (MACE). RESULTS Twenty randomized controlled trials, with 21340 patients, were included. CPT significantly reduced non-mortality disease progression in ambulatory patients (OR 0.72, 0.56-0.92, P = 0.009) but not in hospitalized patients (1.03, 0.94-1.12, P = 0.58). The risk of VTE and ATE did not differ between the CPT and the control group (1.15, 0.81 to 1.64, P = 0.44; 1.01, 0.37 to 2.79, P = 0.98). No conclusive differences between CPT and control were noted in 28-day mortality, clinical improvement, LOH, risk of sepsis/fever, and MACE. CONCLUSIONS In conclusion, treatment of COVID-19 with CPT prevents the progression of COVID-19 in the ambulatory care. It is not associated with an increased risk of VTE, ATE, or other adverse events.