1.
Comparative efficacy of platelet-rich plasma applied in myringoplasty: A systematic review and meta-analysis
Huang J, Shi Y, Wu L, Lv C, Hu Y, Shen Y
PloS one. 2021;16(1):e0245968
Abstract
BACKGROUND Tympanic membrane (TM) perforation is quite common in the clinical setting. Chronic TM perforations require surgical treatments such as myringoplasty. Currently, platelet-rich plasma (PRP) is a novel, effective substance that is increasingly utilized for TM perforation repair. This study aims to evaluate the effectiveness of PRP in the application of TM perforation repair. METHODS A systematic search was conducted to screen the Medline, Embase, Cochrane, Scopus and Web of Science databases up to July 2020. Studies were identified in accordance with the selection criteria by two coauthors independently. Data regarding the healing and hearing outcomes were pooled and analyzed via Review Manager version 5.3 and STATA version 12.0 software. Odds ratio (OR) was utilized to compare the closure rate. Furthermore, the results of hearing improvements and incidence of complications were also compared to evaluate the effectiveness of PRP. RESULTS A total of eight studies with 455 participants were eligible according to the selection criteria. Compared to conventional surgery, the OR of closure was 2.70 (95% CI: 1.27 to 5.76, P = 0.01, I2 = 0%) in randomized controlled trial (RCT) subgroup and 6.18 (95% CI: 2.22 to 17.25, P = 0.0005, I2 = 0) in non-RCT subgroup. The overall OR of closure was 3.69 (95% CI: 2.02 to 6.74, P<0.0001, I2 = 0%), suggesting a significant effect on the healing of TM perforation. Between preoperative and postoperative hearing results, there is no statistical difference between the PRP and the control groups. Additionally, the use of PRP resulted in a lower incidence of complication than the use of conventional approaches. CONCLUSION The application of PRP during the TM surgeries can enhance the closure rate, provide similar hearing improvements and decrease the incidence of postoperative complications. Given these advantages, PRP can be considered an effective treatment for TM regeneration.
2.
Tympanic membrane regeneration using platelet-rich fibrin: a systematic review and meta-analysis
Huang J, Teh BM, Zhou C, Shi Y, Shen Y
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 2021
Abstract
PURPOSE Platelet-rich fibrin (PRF) results in satisfactory wound healing. This analysis focuses on assessing the effectiveness of PRF in the treatment of tympanic membrane (TM) perforations. MATERIALS AND METHODS The literature was searched using PubMed, Embase, Cochrane Library and Web of Science databases from inception to February 28th, 2021. The following healing and hearing outcomes were measured: closure rate, pre-and postoperative auditory results, and incidence of postoperative infections. Data were pooled and expressed as the odds ratio (OR). RESULTS Ten studies were eligible for qualitative review, and seven of them were included for the final quantitative comparison. The OR for the closure rate of acute perforations was 4.30 (95% CI 1.35-13.70, I(2) = 0%), and the OR in the chronic subgroup was 5.42 (95% CI 2.57-11.43, I(2) = 0%). The total OR value for the completed closure rate was 5.10 (95% CI 2.72-9.54, I(2) = 0%), indicating that the utilization of PRF can enhance the closure of both acute and chronic perforations. The qualitative review did not find improved hearing results with the use of PRF. In addition to promoting closure, PRF can reduce the incidence of infections (OR = 0.14). The sensitivity analysis did not change the final results, and there was no publication bias in this analysis. CONCLUSION PRF can increase the closure rate of acute perforations, enhance the survival rate of autografts in TM surgeries and reduce the incidence of infections. However, the literature indicates that PRF does not influence the hearing outcomes. This study shows that PRF is an effective agent for TM regeneration.
3.
The fragility of randomized controlled trials in intracranial hemorrhage
Shen Y, Cheng X, Zhang W
Neurosurgical Review. 2017
Abstract
Fragility of randomized controlled trials (RCTs) has been evaluated using a novel metric called fragility index (FI), which measures how many events the statistical significance of a dichotomous outcome depends on. This study aimed to evaluate the fragility of RCTs in intracranial hemorrhage. Literature search (PubMed/Embase) identified all RCTs of intracranial hemorrhage since 2006. The overall distribution of FI was evaluated. Subgroup and spearman correlation analyses were made to explore potential factors that may affect FI value. All the included RCTs were divided into two groups (positive and negative trials) according to the statistical significance of selected outcomes. Finally, 47 positive and 51 negative trials were included. Both the median FI ([2; IQR, 1-4] vs. [6; IQR, 4-9], p < 0.001) and the proportion of trials with FI ≤1 (2 vs. 18, p < 0.001) in positive trials were smaller than negative trials. In subgroup comparison within positive trials, sample size ([165; IQR, 87-200] vs. [83; IQR, 60-120], p = 0.015) and number of events ([35; IQR, 20-72] vs. [24; IQR, 11-32], p = 0.015) were higher in subgroup with FI >1 than the subgroup with FI ≤1. Weak positive correlations were found between FI and sample size and number of events. In the field of intracranial hemorrhage, trials reporting significant conclusions often depend on a small number of events. Compared to sample size, this phenomenon is more likely to be affected by statistical approach and trial methodology.
4.
Comparison of intra-articular versus intravenous application of tranexamic acid in total knee arthroplasty: a meta-analysis of randomized controlled trials
Liu Y, Meng F, Yang G, Kong L, Shen Y
Archives of Medical Science : Ams. 2017;13((3)):533-540.
Abstract
INTRODUCTION There is much controversy about the optimal application of tranexamic acid (TXA) in total knee arthroplasty (TKA). The purpose of this meta-analysis was to compare the efficacy of the intra-articular and intravenous regimens of TXA in TKA. MATERIAL AND METHODS A literature search of the PubMed, Embase and Cochrane Library databases was performed. Randomized controlled trials comparing the result of intra-articular and intravenous application of TXA during TKA were included. The focus was on the outcomes of blood loss, transfusion requirement and thromboembolic complications. RESULTS Six studies were eligible for data extraction and meta-analysis. We found no statistically significant difference between intra-articular and intravenous administration of tranexamic acid in terms of total blood loss (WMD, 6.01; 95% CI: -96.78 to 108.79; p = 0.91), drain output (WMD = -20.26; 95% CI: -51.34 to 10.82; p = 0.20), hemoglobin drop (WMD = 0.33; 95% CI: -0.31 to 0.98; p = 0.31), or the incidences of transfusion (RR = 0.98; 95% CI: 0.56-1.70; p = 0.93) as well as deep vein thrombosis (RR = 0.49; 95% CI: 0.09-2.73; p = 0.42). CONCLUSIONS In comparison with intravenous application of TXA, intra-articular application had a comparable effect on reducing blood loss and the transfusion rate without increasing the complication rate.