-
1.
Combination of mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP) in the treatment of knee osteoarthritis: a meta-analysis of randomised controlled trials
Zhao J, Liang G, Han Y, Yang W, Xu N, Luo M, Pan J, Liu J, Zeng LF
BMJ open. 2022;12(11):e061008
Abstract
OBJECTIVES The purpose of this meta-analysis was to investigate the efficacy and safety of mesenchymal stem cells (MSCs) combined with platelet-rich plasma (PRP) in the treatment of knee osteoarthritis (KOA). DESIGN Systematic review and meta-analysis. PARTICIPANTS Patients with KOA. INTERVENTIONS Use of MSCs+PRP. PRIMARY AND SECONDARY OUTCOMES Visual Analogue Scale (VAS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS) and adverse reactions. DATA SOURCES PubMed, Cochrane Library, Embase and China National Knowledge Infrastructure were searched from inception to 15 July 2021. MEASURES The OR or weighted mean difference (WMD) of relevant outcome indicators was calculated. Study quality was evaluated using the risk-of-bias assessment tool version 2.0. Heterogeneity among studies was evaluated by calculating I(2). If I(2)<50%, a fixed-effect model was applied; conversely, if I(2) ≥50%, a random-effect model was applied. RESULTS Six controlled clinical trials with 493 cases were included. The meta-analysis results showed that in terms of the VAS score 3 months after treatment, MSCs+PRP had no significant effect on the reduction of the VAS score in patients with KOA compared with the control (p=0.09), hyaluronic acid (HA) (p=0.15) or PRP alone (p=0.07). MSCs+PRP was more effective in reducing the VAS score at 6 and 12 months after treatment than the control (WMD=-0.55, 95% CI -0.87 to -0.22, p<0.001), HA (WMD=-1.20, 95% CI -2.28 to -0.13, p=0.03) or PRP alone (WMD=-0.54, 95% CI -0.89 to -0.18, p=0.003). Regarding the decrease in the total WOMAC score at 3 and 6 months after treatment, MSCs+PRP showed better clinical efficacy than the control or HA alone (p<0.01). Compared with the control, MSCs+PRP exhibited no significant difference in reducing the total WOMAC score 12 months after treatment (p=0.39). There was no significant difference between MSCs+PRP and the control in terms of improvement of the KOOS 12 months after treatment (p=0.16). Compared with MSCs alone, MSCs+PRP exhibited no significant difference in the incidence of adverse reactions (p=0.22) 12 months after treatment. CONCLUSIONS Treatment with MSCs+PRP showed good clinical efficacy in improving pain and joint function in patients with KOA. Compared with MSCs alone, there was no significant difference in the incidence of adverse reactions with MSCs+PRP. PROSPERO REGISTRATION NUMBER CRD 42021275830.
-
2.
The application of platelet-rich plasma in the treatment of knee osteoarthritis: A literature review
Li W, Pan J, Lu Z, Zhu H, Guo J, Xie D
Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association. 2021
Abstract
BACKGROUND Primary knee osteoarthritis remains a difficult-to-control degenerative disease. With the rise in average life expectancy and the incidence of obesity, osteoarthritis has brought an increasing economic and physical burden on people. This article summarizes the latest understanding of platelet-rich plasma in the treatment of knee osteoarthritis, and reviews the economic issues of PRP. METHODS The literatures in Pubmed, Embase, Cochrane library, Web-science and other databases were searched, and literature inclusion and exclusion criteria were formulated. According to the Cochrane systematic reviewer's manual, the included literatures were grouped, and qualitative descriptions and quantitative meta-analysis were performed. Continuous statistical methods were used to compare the effects and adverse effects of PRP before and after treatment, as well as between PRP and other conservative treatments. RESULTS A total of 12 randomized controlled trials were included in this study. A total of 959 KOA patients (1070 knees) were enrolled and followed for 3-12 months. PRP total knee scores were significantly better than baseline at 1, 2, 3, 6 and 12 months after treatment (1 month: SMD = 0.60, P < 0.01; 2 months: SMD = 0.98, P < 0.01; 3 months: SMD = 1.16, P < 0.01; 6 months: SMD = 1.49, P < 0.01; 12 months: SMD = 1.47, P < 0.01). In terms of adverse reactions, PRP did not increase the risk of adverse events compared with HA (OR = 0.96, P = 0.85). CONCLUSIONS Compared with many other treatment methods, intra-articular injection of PRP has been proven to be safe and effective to improve the quality of life of patients with KOA.
-
3.
Clinical efficacy of comprehensive nursing in patients with cerebral hemorrhagic hemiplegia
Wang Z, Pan J, Wang L, Chen P
American journal of translational research. 2021;13(5):5526-5532
Abstract
OBJECTIVE To explore the clinical efficacy of comprehensive rehabilitation nursing (CRN) intervention in patients with cerebral hemorrhagic hemiplegia (CHH). METHODS A total of 102 patients with CHH admitted to our hospital were selected for the prospective study. The patients were randomly divided into the control group (n=51) and the observation group (n=51) according to the random number table method. Routine nursing was performed in the control group, while CRN was conducted in the observation group. Fugl-Meyer motor function assessment scale, activity of daily living scale (Barthel index), self-rating anxiety scale (SAS), complications and muscle strength improvement (Brunnstrom assessment) were compared between the two groups. RESULTS Compared with those before nursing, Fugl-Meyer score, Barthel index and SAS score in the two groups after nursing were significantly improved (P<0.01). Fugl-Meyer score and Barthel index of the observation group were significantly higher than those of the control group after nursing, while SAS score showed the opposite change (P<0.001). The incidence of complications in the control group was 49.02%, and that in the observation group was 29.41% (P<0.05). The rate of muscle strength improvement in the observation group was 80.39% after nursing, which was significantly higher than that in the control group (60.78%; P<0.05). CONCLUSION CRN intervention has a positive clinical efficacy in patients with CHH. It can enhance motor ability, improve the ability of daily life, amend psychological mood and reduce the incidence of complications.
-
4.
Predictive performance of dynamic arterial elastance for arterial pressure response to fluid expansion in mechanically ventilated hypotensive adults: a systematic review and meta-analysis of observational studies
Zhou X, Pan W, Chen B, Xu Z, Pan J
Annals of intensive care. 2021;11(1):119
Abstract
BACKGROUND Dynamic arterial elastance (Ea(dyn)) has been extensively considered as a functional parameter of arterial load. However, conflicting evidence has been obtained on the ability of Ea(dyn) to predict mean arterial pressure (MAP) changes after fluid expansion. This meta-analysis sought to assess the predictive performance of Ea(dyn) for the MAP response to fluid expansion in mechanically ventilated hypotensive patients. METHODS We systematically searched electronic databases through November 28, 2020, to retrieve studies that evaluated the association between Ea(dyn) and fluid expansion-induced MAP increases in mechanically ventilated hypotensive adults. Given the diverse threshold value of Ea(dyn) among the studies, we only reported the area under the hierarchical summary receiver operating characteristic curve (AUHSROC) as the primary measure of diagnostic accuracy. RESULTS Eight observational studies that included 323 patients with 361 fluid expansions met the eligibility criteria. The results showed that Ea(dyn) was a good predictor of MAP increases in response to fluid expansion, with an AUHSROC of 0.92 [95% confidence interval (CI) 0.89 to 0.94]. Six studies reported the cut-off value of Ea(dyn), which ranged from 0.65 to 0.89. The cut-off value of Ea(dyn) was nearly conically symmetrical, most data were centred between 0.7 and 0.8, and the mean and median values were 0.77 and 0.75, respectively. The subgroup analyses indicated that the AUHSROC was slightly higher in the intensive care unit (ICU) patients (0.96; 95% CI 0.94 to 0.98) but lower in the surgical patients in the operating room (0.72; 95% CI 0.67 to 0.75). The results indicated that the fluid type and measurement technique might not affect the diagnostic accuracy of Ea(dyn). Moreover, the AUHSROC for the sensitivity analysis of prospective studies was comparable to that in the primary analysis. CONCLUSIONS Ea(dyn) exhibits good performance for predicting MAP increases in response to fluid expansion in mechanically ventilated hypotensive adults, especially in the ICU setting.
-
5.
Better Treatment Values in Local Application of Tranexamic Acid (TXA) than Intravenous Application with the Same Dose in Total Hip Arthroplasty
Zhang X, Ma D, Wen L, Pan J
Advances in therapy. 2020
Abstract
INTRODUCTION The aim of our study was to investigate the hemostatic effect of local and intravenously administered tranexamic acid (TXA) at the same dose in total hip arthroplasty. METHODS The prospective study included 72 patients who underwent total hip arthroplasty in our hospital between March 2018 and March 2019. The patients enrolled in the study were randomly divided into two groups: the observation group (36 patients were injected with 2.0 g TXA in 10 mL 0.9% NaCl using the joint cavity drainage tube after suturing the joint capsule) and the control group (36 patients were given an intravenous infusion of 2 g TXA in 200 mL 0.9% NaCl 30 min before the operation). In each patient, apparent blood loss, hidden blood loss, average blood transfusion, and the number of cases receiving blood transfusion were compared between the two groups after treatment. Hematocrit (Hct) and hemoglobin (Hb) levels were recorded at postoperative day (POD) 1, 2, 3, 7, and 10. We also recorded the levels of C-reactive protein (CRP) and interleukin-6 (IL-6) before the operation and 12 h postoperative and POD 1, 3, 7, and 10. The incidence of deep venous thrombosis and pulmonary embolism was also taken into account. RESULTS In the observation group, apparent blood loss, hidden blood loss, average blood transfusion volume, and the number of patients receiving blood transfusion were lower compared than the control group (P < 0.001). The levels of Hct and Hb were compared between the two groups at POD 1, 2, 3, 7, and 10, and the observation group reported higher levels of Hct and Hb (P < 0.001). The levels of CRP and IL-6 were compared between the two groups at POD 1, 3, 7, and 10, and the observation group reported lower levels of CRP and IL-6 than the control group (P < 0.001). On POD 7, there was no pulmonary embolism in both groups, and no significant difference was observed in the incidence of deep venous thrombosis between the two groups (P > 0.05). CONCLUSIONS Local and intravenous applications of TXA at the same dose are effective approaches in terms of reducing bleeding and inflammatory reaction with a good safety profile; however, the effect of local application had superior therapeutic values.
-
6.
Effects of Different Applications of Tranexamic Acid on Perioperative Blood Transfusion Rate and Postoperative Pain in Unilateral Total Knee Arthroplasty
Zhang X, Ma D, Pan J, Wen L
Advances in therapy. 2020
Abstract
INTRODUCTION The current study was conducted to evaluate the effect of different applications of tranexamic acid (TXA) on perioperative blood transfusion rate and postoperative pain in unilateral total knee arthroplasty. METHODS This prospective study included a total of 102 patients undergoing unilateral total knee arthroplasty in our hospital from November 2017 to October 2019. On the basis of different TXA administration methods, these patients were randomly assigned to a surface treatment group (50 cases were treated with intraoperative spraying and drug-soaked gauze to cover the wound combined with local injection into the articular cavity) and control group (52 cases were given TXA by intravenous drip combined with local injection into the articular cavity) by random number table method. Clinical data were recorded and evaluated in the two groups. A total of five surgeons participated in the study. RESULTS In the surface treatment group, the operation time, hospital stay, tourniquet time, and blood transfusion rate were significant lower compared with the control group, and there was no significant difference in the incision length between the two groups. Our results showed that intraoperative blood loss, postoperative drainage, postoperative blood loss, total blood loss, and the incidence of deep venous thrombosis in the surface treatment group were significantly lower than those in the control group. Our results demonstrated that the surface treatment group reported significantly lower degree of pain compared with the control group at 1 day and 3 days after the operation. However, 7 days after the operation, the degree of pain in the surface treatment group did not differ significantly from that in the control group. In addition, the results of blood coagulation indexes showed that the values of prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib), D-dimer (D-D), and hemoglobin (HGB) in the surface treatment group did not differ significantly from those in the control group before the operation (P > 0.05). CONCLUSION In terms of applications of TXA, the method of intraoperative spraying and drug-soaked gauze covering the wound combined with local injection into the articular cavity can reduce the amount of bleeding and the rate of blood transfusion, and alleviate the degree of pain with high safety profile.
-
7.
Meta-analysis Comparing Platelet-Rich Plasma vs Hyaluronic Acid Injection in Patients with Knee Osteoarthritis
Han Y, Huang H, Pan J, Lin J, Zeng L, Liang G, Yang W, Liu J
Pain medicine (Malden, Mass.). 2019
-
-
Free full text
-
Abstract
PURPOSE The purpose of this meta-analysis was to compare platelet-rich plasma (PRP) and hyaluronic acid (HA) in patients with knee osteoarthritis (KOA). METHODS Randomized controlled trials (RCTs) comparing the use of PRP and HA in KOA patients were retrieved from each database from the establishment date to April 2018. Outcome measurements were the Western Ontario and McMaster Universities Arthritis Index (WOMAC), visual analog scale (VAS), International Knee Documentation Committee, and Lequesne Index scores and adverse events. The pooled data were evaluated with Review Manager 5.3.5. RESULTS Fifteen RCTs (N = 1,314) were included in our meta-analysis. The present meta-analysis indicated that PRP injections reduced pain more effectively than HA injections in patients with KOA at six and 12 months of follow-up, as evaluated by the WOMAC pain score; the VAS pain score showed a significant difference at 12 months. Moreover, better functional improvement was observed in the PRP group, as demonstrated by the WOMAC function score at three, six, and 12 months. Additionally, PRP injections did not display different adverse event rates compared with HA injections. CONCLUSION In terms of long-term pain relief and functional improvement, PRP injections might be more effective than HA injections as a treatment for KOA. The optimal dosage, the timing interval and frequency of injections, and the ideal treatment for different stages of KOA remain areas of concern for future investigations.
-
8.
Effect of platelet-rich fibrin on alveolar ridge preservation: A systematic review
Pan J, Xu Q, Hou J, Wu Y, Liu Y, Li R, Pan Y, Zhang D
Journal of the American Dental Association (1939). 2019;150(9):766-778
Abstract
BACKGROUND Platelet-rich fibrin (PRF) is the second generation of platelet concentrates and is used in many areas of dentistry. However, whether PRF is effective for alveolar ridge preservation remains controversial. The authors conducted research to evaluate the potential of PRF to preserve the alveolar ridge. METHODS A comprehensive literature search was conducted in MEDLINE, Cochrane Central Register of Controlled Trials, and Embase. Only randomized controlled trials were included. A systematic review was made for postoperative pain, soft-tissue healing, bone density, horizontal and vertical ridge dimension changes, and histologic analysis. The meta-analysis was performed on the alveolar osteitis, mesial and distal bone height changes, and bone fill with Review Manager Version 5.3 software. RESULTS Among the 588 eligible articles found in the initial search, 7 published studies from 2012 through 2019 were included. The authors' qualitative analysis showed that PRF may play a positive role in reducing postoperative pain and ridge dimension changes after tooth extraction. Among the 7 articles, only 2 trials assessed the effect of PRF on the alveolar osteitis, mesial and distal bone height changes, and bone fill. Results of our meta-analysis showed that smaller mesial bone height changes (standard mean difference, -1.07; 95% confidence interval, -1.92 to 0.22) and a greater percentage of bone fill (standard mean difference, 0.82; 95% confidence interval, 0.32 to 1.33) were observed in the PRF group. CONCLUSIONS Given the potential value of PRF, consideration should be given to PRF after tooth extraction. However, more high-quality trials are necessary to evaluate the exact role of PRF. PRACTICAL IMPLICATIONS Based on the authors' results, the usage of PRF was suggested in alveolar ridge preservation.
-
9.
Synergistic Application of Platelet-Rich Fibrin and 1% Alendronate in Periodontal Bone Regeneration: A Meta-Analysis
Li F, Jiang P, Pan J, Liu C, Zheng L
BioMed research international. 2019;2019:9148183
Abstract
Periodontal bone regeneration relies on coupled and cooperative bone formation and resorption. Accordingly a novel strategy on concurrent use of platelet-rich fibrin (PRF) (anabolic agent) and 1% alendronate (ALN) (anticatabolic agent) was proposed recently in regenerative periodontal treatment. It was supposed to enhance bone formation and reduce bone resorption simultaneously. However, there is a lack of evidence-based studies to answer whether this concurrent application was superior to single application until now. Besides, concerns on ALN lead to some reservation on this synergistic way. ALN may impair new bone formation and necrotize jaws. Thus, in order to compare the clinical efficacy between PRF plus 1%ALN and PRF alone on periodontal bone regeneration, we performed present systematic review and meta-analysis. Because it is the prerequisite for measuring the combined efficacy of PRF plus 1%ALN, firstly we evaluated the effectiveness of 1%ALN. Our data indicated that adjunctive 1%ALN was effective in promoting periodontal bone repair. Further, PRF plus 1%ALN showed a greater capacity for periodontal regeneration than PRF alone with statistical significance. The findings of this study revealed the promising prospects on synergistic application of bone anabolic agents (PRF) and antiresorption medications (1%ALN) in regenerative periodontal treatment.
-
10.
A meta-analysis of the efficacy and safety of recombinant activated factor VII for patients with acute intracerebral hemorrhage without hemophilia
Yuan ZH, Jiang JK, Huang WD, Pan J, Zhu JY, Wang JZ
Journal of Clinical Neuroscience. 2010;17((6):):685-93.
Abstract
Hematoma growth is common in intracerebral hemorrhage (ICH) and is associated with a poor outcome for patients. To evaluate the efficacy and safety of recombinant activated factor VII (rFVIIa) used as a hemostatic agent in patients with ICH without hemophilia, we searched Medline, Scopus, the Cochrane Library, Clinicaltrials.gov and the Stroke Trials Directory. Five randomized controlled trials were selected for analysis. Although rFVIIa can reduce the change in ICH volume, there was no significant difference in mortality, modified Rankin Scale (mRS) score or extended Glasgow Outcome Scale (GOS-E) score in patients treated with rFVIIa or placebo. There was a significant increase in arterial thromboembolic adverse events (TAE) in patients treated with rFVIIa. There was an increase in deep vein thrombosis in patients with spontaneous ICH and traumatic ICH. In conclusion, the use of rFVIIa reduces the growth of the hematoma but does not improve patient survival or functional outcome after ICH; in addition, rFVIIa increases the incidence of arterial TAE.