1.
Endoscopic Cyanoacrylate Injection vs BRTO for Prevention of Gastric Variceal Bleeding: A Randomized Controlled Trial
Luo X, Xiang T, Wu J, Wang X, Zhu Y, Xi X, Yan Y, Yang J, García-Pagán JC, Yang L
Hepatology (Baltimore, Md.). 2021
Abstract
The optimal treatment for gastric varices (GVs) has not yet been fully determined. This study compared the efficacy and safety of endoscopic cyanoacrylate injection and balloon-occluded retrograde transvenous obliteration (BRTO) to prevent rebleeding in patients with cirrhosis and GVs after primary hemostasis. Patients with cirrhosis and history of bleeding from gastroesophageal varices type 2 or isolated gastric varices type 1 were randomized to cyanoacrylate injection (n = 32) or BRTO treatment (n = 32). The primary outcomes were gastric variceal rebleeding or all-cause rebleeding. The patient characteristics were well-balanced between two groups. The mean follow-up time was 27.1 ± 12 months in a cyanoacrylate injection group and 27.6 ± 14.3 months in a BRTO group. The probability of gastric variceal rebleeding was higher in the cyanoacrylate injection group than in the BRTO group (p = 0.024). The probability of remaining free of all-cause rebleeding at 1 and 2 years for cyanoacrylate injection vs BRTO was 77% vs 96.3% and 65.2% vs 92.6% (p = 0.004). The survival rates, frequency of complications, and worsening of EVs were similar in both groups. BRTO resulted in fewer hospitalizations, inpatient stays, and lower medical costs. CONCLUSIONS BRTO is more effective than cyanoacrylate injection in preventing rebleeding from GVs, with similar frequencies of complications and mortalities.
2.
Efficacy and Safety of Intra-Articular Platelet-Rich Plasma in Osteoarthritis Knee: A Systematic Review and Meta-Analysis
Hong M, Cheng C, Sun X, Yan Y, Zhang Q, Wang W, Guo W
BioMed research international. 2021;2021:2191926
Abstract
BACKGROUND Knee osteoarthritis (KOA) is a common disease in aged adults. Intra-articular (IA) injection of platelet-rich plasma (PRP) therapy is an effective minimally invasive treatment for KOA. We aimed to compare the efficacy and safety of platelet-rich plasma (PRP) with placebo or other conservative treatments. METHODS We conducted a meta-analysis to identify relevant articles from online register databases such as PubMed, Medline, Embase, and the Cochrane Library. The primary outcomes were the visual analogue scale (VAS) score, Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, and International Knee Documentation Committee (IKDC) subjective score. The secondary outcome was the adverse event rate. RESULTS A total of 895 articles were identified, of which 23 randomized controlled trials that met the inclusion criteria were determined as eligible. Compared with placebo, PRP had a lower VAS score and higher IKDC subjective score at the 6(th) month after treatment and significantly less WOMAC score during the follow-up period. Compared with oral NSAIDs, PRP gained a lower WOMAC score at the 6(th) month after treatment. The VAS score decreased after treatment when reaching PRP and CS. As compared to the HA, the VAS score, WOMAC score, and IKDC subjective score all revealed better PRP results. There were no significant differences in adverse event rates comparing PRP versus placebo or HA. Different PRP applications did not show significant differences in VAS score in the 1(st) month and WOMAC score in the 3(rd) month after treatment. CONCLUSION To compare with the conservative treatments mentioned above, PRP is more effective in relieving symptoms. There were no significant differences between triple PRP application and single PRP application in short-term curative effect.