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Network meta-analysis of platelet-rich fibrin in periodontal intrabony defects
Ye L, Mashrah MA, Ge L, Fang Y, Guo X, Ge Q, Wang L
Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology. 2023
Abstract
OBJECTIVES To evaluate the effect of platelet-rich fibrin alone or in combination with different biomaterials for the treatment of periodontal intra-bony defect. METHODS Up to April 2022, Cochrane library, Medline, EMBASE, and Web of Science databases were searched for randomized clinical trials. The outcomes of interest were probing pocket depth reduction, clinical attachment level gain, bone gain, and bone defect depth reduction. Bayesian network meta-analysis with 95% credible intervals was calculated. RESULTS Thirty-eight studies with 1,157 participants were included. Platelet-rich fibrin alone or platelet-rich fibrin +biomaterials showed a statistically significant difference when compared with open flap debridement (P<0.05, low to high certainty evidence). Neither biomaterials alone nor platelet-rich fibrin +biomaterials showed a statistically insignificant difference when compared to platelet-rich fibrin alone (P>0.05, very low to high certainty evidence). Platelet-rich fibrin +biomaterials showed insignificant differences as compared to biomaterials alone (P>0.05, very low to high certainty evidence). Allograft +collagen membrane ranked the best in probing pocket depth reduction while platelet-rich fibrin +hydroxyapatite ranked the best in bone gain. CONCLUSION It seems that 1) Platelet-rich fibrin with/without biomaterials were more effective than open flap debridement. 2) Platelet-rich fibrin alone provides a comparable effect to biomaterials alone and platelet-rich fibrin +biomaterials. 3)Platelet-rich fibrin +biomaterials provide a comparable effect to biomaterials alone. Although allograft +collagen membrane and platelet-rich fibrin +hydroxyapatite ranked the best in terms of probing pocket depth reduction and bone gain respectively, the difference between different regenerative therapies remains insignificant, and therefore, further studies are still needed to confirm these results.
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Prognostic of red blood cell transfusion during extracorporeal membrane oxygenation therapy on mortality: A meta-analysis
Li Y, Wang J, Li C, Wang L, Chen Y
Perfusion. 2023;:2676591231157234
Abstract
BACKGROUND This meta-analysis aimed to explore the impact of red blood cell (RBC) transfusion on mortality during extracorporeal membrane oxygenation (ECMO). Previous studies investigated the prognostic impact of RBC transfusion during ECMO on the risk of mortality, but no meta-analysis has been published before. METHODS The PubMed, Embase, and the Cochrane library were systematically searched for papers published up to 13 December 2021, using the MeSH terms "ECMO", "'Erythrocytes", and "Mortality" to identify meta-analyses. Total or daily RBC transfusion during ECMO and mortality were examined. RESULTS The random-effect model was used. Eight studies (794 patients, including 354 dead) were included. The total volume of RBC was associated with higher mortality standardized weighted difference (SWD = -0.62, 95% CI: -1.06,-0.18, p = .006; I2 = 79.7%, P(heterogeneity) = 0.001). The daily volume of RBC was associated with higher mortality (SWD = -0.77, 95% CI: -1.11,-0.42, p < .001; I2 = 65.7%, P(heterogeneity) = 0.020). The total volume of RBC was associated with mortality for venovenous (VV) (SWD = -0.72, 95% CI: -1.23, -0.20, p = .006) but not venoarterial ECMO (p = .126) or when reported together (p = .089). The daily volume of RBC was associated with mortality for VV (SWD = -0.72, 95% CI: -1.18, -0.26, p = 0.002; I2 = 0.0%, P(heterogeneity) = 0.642) and venoarterial (SWD = -0.95, 95% CI: -1.32, -0.57, p < .001) ECMO, but not when reported together (p = .067). The sensitivity analysis suggested the robustness of the results. CONCLUSION When considering the total and daily volumes of RBC transfusion during ECMO, the patients who survived received smaller total and daily volumes of RBC transfusion. This meta-analysis suggests that RBC transfusion might be associated with a higher risk of mortality during ECMO.
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Neutralizing COVID-19 Convalescent Plasma in Adults Hospitalized with COVID-19: A Blinded Randomized Placebo-Controlled Trial
Self WH, Wheeler AP, Stewart TG, Schrager H, Mallada J, Thomas CB, Cataldo VD, O'Neal HR Jr, Shapiro NI, Higgins C, et al
Chest. 2022
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Abstract
BACKGROUND Convalescent plasma has been one of the most common treatments for COVID-19, but most clinical trial data to date have not supported its efficacy. RESEARCH QUESTION Is rigorously selected COVID-19 convalescent plasma with neutralizing anti-SARS-CoV-2 antibodies an efficacious treatment for adults hospitalized with COVID-19? STUDY DESIGN AND METHODS This was a multicenter, blinded, placebo-controlled randomized clinical trial among adults hospitalized with SARS-CoV-2 infection and acute respiratory symptoms for <14 days. Enrolled patients were randomly assigned to receive one unit of COVID-19 convalescent plasma (n=487) or placebo (n=473). The primary outcome was clinical status (illness severity) 14 days after study infusion measured with a seven-category ordinal scale ranging from discharged from the hospital with resumption of normal activities (lowest score) to death (highest score). The primary outcome was analyzed with a multivariable ordinal regression model, with an adjusted odds ratio (aOR) <1.0 indicating more favorable outcomes with convalescent plasma than placebo. In secondary analyses, trial participants were stratified by the presence of endogenous anti-SARS-CoV-2 antibodies ("serostatus") at randomization. The trial included 13 secondary efficacy outcomes, including 28-day mortality. RESULTS Among 974 randomized patients, 960 were included in the primary analysis. Clinical status on the ordinal outcome scale at 14 days did not differ between the convalescent plasma and placebo groups in the overall population (aOR: 1.04; 1/7 support interval (SI): 0.82-1.33), in patients without endogenous antibodies (aOR: 1.15; 1/7 SI: 0.74-1.80), or in patients with endogenous antibodies (aOR: 0.96; 1/7 SI: 0.72-1.30). None of the 13 secondary efficacy outcomes were different between groups. At 28 days, 89/482 (18.5%) patients in the convalescent plasma group and 80/465 (17.2%) patients in the placebo group had died (aOR: 1.04, 1/7 SI: 0.69-1.58). INTERPRETATION Among adults hospitalized with COVID-19, including those seronegative for anti-SARS-CoV-2 antibodies, treatment with convalescent plasma did not improve clinical outcomes.
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Is platelet-rich plasma better than hyaluronic acid in the treatment of knee osteoarthritis? A meta-analysis of randomized controlled trials
Wang L, Wei L, Ma H, Wang M, Rastogi S
Wideochirurgia i inne techniki maloinwazyjne = Videosurgery and other miniinvasive techniques. 2022;17(4):611-623
Abstract
INTRODUCTION Due to the complicated surgical procedure of knee arthroplasty and low effectivity of hyaluronic acid (HA) in the treatment of knee osteoarthritis, various studies highly recommend the use of platelet-rich plasma (PRP). However, some studies also reported lower efficacy and limited use of PRP. AIM: To analyze systematically the different randomized controlled trials (RCTs) comparing the effectiveness of HA vs. PRP for the treatment of knee osteoarthritis. MATERIAL AND METHODS A systematic literature review was conducted using Medline and Central databases for RCTs about the comparison of HA vs. PRP for the treatment of knee osteoarthritis. Studies were included as per the PICOS criteria and relevant event data were extracted. Risk of bias was analyzed and a random-effects model was used to calculate the pooled odds ratio and risk ratio using RevMan software. RESULTS A total of 14 studies were included in the meta-analysis from year 2000 to 2021 including 613 patients. The current meta-analysis has a low risk of publication bias and we obtained the pooled odds ratio (OR) of 2.55 (95% CI: 1.35-4.84) with a τ (2) value of 1.01, χ (2) value of 52.79, I(2) value of 77%, Z value of 2.87 and p-value < 0.00001. The pooled risk ratio was 1.34 (95% CI: 1.09-1.65) with a τ (2) value of 0.09, χ (2) value of 73.48, I(2) value of 84%, Z value of 2.80 and p-value < 0.00001. CONCLUSIONS The current meta-analysis highly recommends the use of PRP for the treatment of knee osteoarthritis.
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Comparison of the short-term clinical effectiveness of 5% dextrose water, platelet rich plasma and corticosteroid injections for carpal tunnel syndrome: a systematic review and network meta-analysis of randomized controlled trials
Gao N, Yan L, Ai F, Kang J, Wang L, Weng Y
Archives of physical medicine and rehabilitation. 2022
Abstract
OBJECTIVE To compare the short-term effectiveness of corticosteroids, 5% dextrose(D5W), and platelet-rich plasma (PRP) injections for treating carpal tunnel syndrome (CTS). DATA SOURCES Four databases (MEDLINE (PubMed), Embase, the Cochrane Controlled Trials Register, and Web of Science (WOS)) were researched from inception to the 1st of April 2022. STUDY SELECTION Two authors independently screened the literature to identify the RCTs meeting the included criteria, which involved comparing corticosteroid, 5% dextrose water (D5W), and platelet-rich plasma (PRP) injection with each other or placebo-controlled for treating CTS. DATA EXTRACTION The two reviewers independently conducted information extraction, the outcomes included were the changes in Symptom Severity Scale (SSS), Function Status Scale (FSS), and Visual Analogue Scale (VAS) at short-term follow-up after drug injection treatment and any adverse events reported. DATA SYNTHESIS Twelve randomized controlled trials with 749patients (817 hands) were included. The results of this study suggested that PRP injection was the most likely to relieve symptoms, improve functions and alleviate pain, with the SUCRA being 91.5%, 92.7%, and 80.8%, respectively, followed by D5W injection (74.4%, 72.2%, 72.1%), and corticosteroid injection (33.7%, 31.9%, 46.2%). The injection of three drugs was significantly better than that of a placebo. CONCLUSION From the results of the network meta-analysis, PRP injection is the most recommended treatment among the injection of corticosteroid, D5W, and PRP. The protocol of this network meta-analysis has been registered in PROSPERO with registration number CRD42022325228.
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Flapless osteotome-mediated sinus floor elevation using platelet-rich fibrin versus lateral approach using deproteinised bovine bone mineral for residual bone height of 2-6 mm: a randomised trial
Lv H, Sun X, Wang J, Wang H, Wang L, Zhou Y
Clinical oral implants research. 2022
Abstract
OBJECTIVES To evaluate patient-reported outcomes and radiographic results of simultaneous implant placement in severely atrophic maxilla using flapless endoscope-assisted osteotome sinus floor elevation with platelet-rich fibrin (PRF), also defined as PESS, and to compare the results with those of lateral sinus floor elevation (LSFE). METHODS Patients with a residual bone height (RBH) of 2-6 mm were included in a randomised controlled trial. PESS was performed with PRF as the sole grafting material. LSFE was performed using deproteinised bovine bone matrix. Patient-reported outcomes were recorded on a visual analogue scale (VAS-pain) and visual rating scale (VRS-swelling and VRS-willingness). Peri-implant bone height (PBH), bone mineral density (BMD), and sinus grafting remodelling index were measured using CBCT immediately postoperatively and 3(rd) , 6(th) and 18(th) months post-surgery. RESULTS The study population consisted of 20 patients in each group. The RBH of two groups averaged 3.35±0.79 mm and 2.92±0.63 mm with no significant difference (p > 0.05). VAS-pain was 18.0 (IR 15.0-22.5) and 35.0 (IR 32.5-37.0) in the PESS and LSFE groups, respectively (p < 0.01). VAS-pain decreased with time in both groups. VRS-swelling was lower in the PESS group than LSFE group. VRS-willingness was higher in the PESS group than LSFE group (p < 0.01). At 18 months post-surgery, the marginal bone loss was 0.60±0.25 mm and 0.69±0.35 mm in the two groups with no significant difference (p = 0.52). CONCLUSIONS Within the limitations of this study, PESS was associated with lower postoperative morbidity and was more tolerable than LSFE. PESS could be a reliable procedure for sinus floor elevation in patients with insufficient RBH.
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Platelet-Rich Plasma-Incorporated Autologous Granular Bone Grafts Improve Outcomes of Post-Traumatic Osteonecrosis of the Femoral Head
Xian H, Luo D, Wang L, Cheng W, Zhai W, Lian K, Lin D
The Journal of arthroplasty. 2019
Abstract
BACKGROUND To investigate the effects of platelet-rich plasma (PRP)-incorporated autologous granular bone grafts for treatment in the precollapse stages (Association of Research Circulation Osseous stage II-III) of posttraumatic osteonecrosis of the femoral head. METHODS A total of 46 patients were eligible and enrolled in the study. Twenty-four patients were treated with core decompression and PRP-incorporated autologous granular bone grafting (treatment group), and 22 patients were treated with core decompression and autologous granular bone grafting (control group). During a minimum follow-up duration of 36 months, X-ray and computed tomography were used to evaluate the radiological results, and the Harris hip score (HHS) and visual analog scale were chosen to assess the clinical results. RESULTS Both the treatment and control groups had a significantly improved HHS (P < .001). The minimum clinically important difference for the HHS was reached in 91.7% of the treatment group and 68.2% of the control group (P < .05). The HHS and visual analog scale in the treatment group were significantly improved than that in the control group at the last follow-up (P < .05). Successful clinical and radiological results were achieved 87.5% and 79.2% in the treatment group compared with 59.1% and 50.0% in the control group (P < .05), respectively. The survival rates based on the requirement for further hip surgery as an endpoint were higher in the treatment group in comparison to those in the control group (P < .05). CONCLUSION PRP-incorporated autologous granular bone grafting is a safe and effective procedure for treatment in the precollapse stages (Association of Research Circulation Osseous stage II-III) of posttraumatic osteonecrosis of the femoral head.
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[Effect of platelet rich fibrin combining with Bio-oss to treat furcation involvement]
Shen MH, Huang YL, Li Z, Zhang YD, He YP, Wang L
Shanghai kou qiang yi xue = Shanghai journal of stomatology. 2018;27(5):508-512
Abstract
PURPOSE To evaluate the effect of platelet rich fibrin (PRF) combining with Bio-oss in treating Class II furcation involvement. METHODS Thirty patients who had Class furcation involvement in the mandibular first molar were included. They were all free of systemic disease. After initial periodontal therapy, they were randomly divided into 2 groups. In the experimental group, PRF combining with Bio-oss were placed in the areas with furcation defect and covered with PRF. In the control group, only flap surgery was performed. All patients were followed up for 6 months after operation. The efficacy was evaluated with clinical parameters and cone-beam computed tomography (CBCT). The data were analyzed with SPSS 2.0 software package. RESULTS Periodontal indexes including probing depth (PD), clinical attachment loss (CAL), horizontal probing depth (HPD) significantly decreased in both groups after operation (P<0.05); alveolar bone significantly increased in the experimental group (P<0.05). CONCLUSIONS The clinical effect of PRF combined with Bio-oss on Class II furcation involvement are remarkable.
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Platelet-rich plasma for treating acute wounds: a meta-analysis . Chinese
Wang L, Gu Z, Gao C
Chung-Hua i Hsueh Tsa Chih [Chinese Medical Journal]. 2014;94((28):):2169-74.
Abstract
OBJECTIVE To evaluate the efficacy of platelet-rich plasma (PRP) in the treatment of acute wounds. METHODS Randomized controlled trials (RCT) were identified from PubMed (1950.1-2014.2), Cochrane Central Register of Controlled Trials (CENTRAL, issue 4, 2014) of Cochrane Library, China National Knowledge Infrastructure (CNKI, 1979.1-2014.2), China Biology Medicine (CBM, 1978.1-2014.2) WANFANG database (1990.1-2014.2). References of retrieved articles were also identified. The quality of each RCT was evaluated by the Cochrane collaboration's tool for assessing the risk of bias. Data analysis was performed with Review Manager 5.1 to evaluate the efficacy of PRP in the treatment of acute wounds. RESULTS A total of 13 articles involving 982 patients were included. The results of systematic review and analysis showed that wound healing time of PRP treatment group was shorter than that of control group, so did length of hospital stay (mean difference (MD): -1.45, 95%CI:-2.07 to -0.83; P < 0.01), the incidence of wound healing disturbance in PRP treatment group was less than that of control group (relative risk (RR): 0.11, 95%CI: 0.01 to 0.83; P < 0.05), so did blood product transfusion. Moreover, post-traumatic pain level of PRP treatment group was lower than that of control group (MD: -1.26, 95%CI: -1.71 to -0.82; P < 0.01). CONCLUSION Use of PRP can shorten acute wound healing time and length of hospital stay, reduce the incidence of disturbed wound healing and blood products transfusion and alleviate post-traumatic pain. Moreover, it has some effect on the control of wound infections.
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Prevention of platelet transfusion refractoriness and HLA alloimmunization by leukocyte filtered platelet transfusion: a meta analysis Chinese
Yuan Q, Chen X, Cheng L, Zhou CH, Fu XM, Li YP, Wang NH, Wang L
Chung-Kuo i Hsueh Ko Hsueh Yuan Hsueh Pao [Acta Academiae Medicinae Sinicae]. 2011;33((4):):412-20.
Abstract
Objective: To compare and assess the effectiveness of leukocyte-filtered platelet and standard platelet concentrates transfusion in preventing platelet transfusion refractoriness (PTR) and human leukocyte antigen (HLA)-alloimmunization. Methods: Randomized controlled trials (RCTs) or quasi-RCTs comparing leukocyte-filtered platelet with standard platelet concentrates transfusion (up to December 31 2009) were searched and identified from Medline, EMBASE, The Cochrane Library, and CBM. A meta-analysis was conducted with Cochrane Collaboration's RevMan 5.0. Results: The search identified 558 citations in total, in which 7 articles in English were finally included in the meta-analysis. The analysis showed that compared with standard platelet concentrates transfusion, leukocyte-filtered platelet transfusion signficantly decreased PTR [RR=0.59, 95% CI (0.42, 0.82), P=0.002] and HLA-alloimmunization [RR=0.49, 95% CI (0.33, 0.74), P=0.0006]. Subgroup analysis showed that HLA-alloimmunization was significantly reduced by leukocyte-filtered platelet transfusion among thepatients with acute myelocytic leukemia [RR=0.42, 95% CI (0.32, 0.56), P<0.00001], while no significant difference was detected in patients with acute lymphoblastic leukemia because of the limited sample size [RR=0.5, 95% CI (0.10, 2.41), P=0.39]. Conclusions: The current evidence shows that leukocyte-filtered platelet transfusion can prevent PTR and HLA-alloimmunization more effectively than standard platelet transfusion. Well-designed, large-scale RCTs are still needed to further confirm this finding.