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1.
An umbrella review of the use of platelet-rich plasma in the treatment of androgenetic alopecia
Li C, Pan L, Yang L, Kong J, Zhang L
Journal of cosmetic dermatology. 2023
Abstract
OBJECTIVE To evaluate the efficacy of platelet-rich plasma (PRP) in the treatment of androgenetic alopecia, as well as establish an effective treatment protocol and optimal PRP preparation procedure. METHODS We searched the PubMed, Scopus, Embase, Cochrane, CNKI, and Wanfang databases from inception to October 29, 2021, using PROSPERO's International Prospective Register of Systematic Reviews (registration ID: CRD42022295921). RESULTS The original literature search revealed 215 reviews; after duplication removal, 89 papers were eliminated, 95 were eliminated after reading the titles and abstracts, and eventually, 28 articles were included after reading the complete text. CONCLUSIONS PRP treatment for androgenetic alopecia is effective, and we recommend the following: (1) a PRP volume of at least 0.05 ml/cm(2) , preferably 0.1 ml/cm(2) ; (2) at least three consecutive treatments at an interval of 1 month; (3) intensive therapy is beneficial and can be provided from 3 to 6 months after continuous treatment; (4) objective indicators such as hair diameter, hair count; (5) long-term follow-up.
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Clinical application of platelet-rich fibrin to enhance dental implant stability: A systematic review and meta-analysis
Guan S, Xiao T, Bai J, Ning C, Zhang X, Yang L, Li X
Heliyon. 2023;9(2):e13196
Abstract
OBJECTIVE To investigate the effect of platelet-rich fibrin application on implant stability. STUDY DESIGN Five databases, namely, PubMed, Embase, Web of Science, Wiley, and China National Knowledge Infrastructure, were searched for reports published up to November 20, 2022. Randomized controlled trials (RCT), including parallel RCTs and split-mouth RCTs, with at least 10 patients/sites were considered for inclusion. RESULTS After screening based on the inclusion criteria, ten RCTs were included. Low heterogeneity was observed in study characteristics, outcome variables, and estimation scales (I(2) = 27.2%, P = 0.19). The qualitative and meta-analysis results showed that PRF increased the effect of implant stabilizers after implant surgery. CONCLUSIONS The results of the present systematic review and meta-analysis suggest that PRF can increase implant stability after implant surgery. PRF may also have a role in accelerating bone healing and tends to promote new bone formation at the implant site.
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Hemostatic Agent May Improve Perioperative Outcomes in Partial Nephrectomy: A Systematic Review and Meta-Analysis
Guo Q, Lin Y, Zhang C, Guo Y, Long Y, Leng F, Gao J, Cheng Y, Yang L, Du L, et al
Urologia internationalis. 2021;:1-8
Abstract
BACKGROUND Hemostatic agents (HAs) are used to achieve hemostasis and prevent postoperative complications in multiple surgeries, but the role of HAs is ambiguous during partial nephrectomy (PN), so this study aimed to assess the role of HAs in PN. METHODS PubMed, Embase, CENTRAL and ClinicalTrials.gov were searched for randomized controlled trials and cohort studies regarding the comparison of HA use alone and standard suturing during PN on January 17, 2020. RevMan 5.3 was used to conduct meta-analysis. Sensitivity analyses and subgroup analyses were performed based on surgical procedures and HA types. RESULTS Six studies involving 1,066 patients were included. The quality of studies was moderate to high. There were significant reductions in warm ischemia time (mean difference [MD] = -6.30 min, 95% confidence interval [CI] -7.70 to -4.90, p < 0.00001), operative time (MD = -19.81 min, 95% CI -27.54 to -12.08, p < 0.00001), and estimated blood loss (MD = -108.62 mL, 95% CI -177.27 to -39.9, p = 0.002) in the HA group, and HA use alone did not increase postoperative complications. The results were similar in the subgroup analyses and sensitivity analyses. CONCLUSION HA may be an effective and safe surgical material in PN, which can improve postoperative outcomes. High-quality and randomly designed studies are needed to validate the applicability.
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4.
[Evaluation of pharmaceutical prevention and treatment of intensive care unit-acquired weakness: a Meta-analysis]
Yang L, Zhang Z, Zhang C, Tian J, Ma X, Meng W, Ding N, Yao L, Wei H, Shen X
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2020;32(3):357-361
Abstract
OBJECTIVE To evaluate the effect of preventing and treatment of pharmaceuticals on intensive care unit-acquired weakness (ICU-AW) by systematic review. METHODS The randomized controlled trials (RCTs) concerning pharmaceutical prevention and treatment about ICU-AW in SinoMed, CNKI, Wanfang data, PubMed, Cochrane Library, Web of Science, EMbase, and other sources were searched from their foundation to May 30th, 2019. The patients in the intervention group were treated with drugs to prevent or treat ICU-AW; and those in control group were treated with other rehabilitation methods. Data searching, extracting and quality evaluation were assessed by two reviewers independently. Stata 12.0 software was then used for Meta-analysis. Only descriptive analysis was conducted when only one study was enrolled. RESULTS A total of 11 RCTs were enrolled with 1 865 patients in the intervention group and 1 894 in the control group. The results of quality evaluation showed that 4 studies were A-level and 7 studies were B-level, indicating that the overall quality of the enrolled literature was high. Meta-analysis showed that intensive insulin therapy could prevent ICU-AW [relative risk (RR) = 0.761, 95% confidence interval (95%CI) was 0.662-0.876, P = 0.000], but reduced phenylalanine loss (nmolx100 mL(-1)xmin(-1): -3+/-3 vs. -11+/-3, P < 0.05) and glutamine intake (nmolx100 mL(-1)xmin(-1): -97+/-22 vs. -51+/-13, P < 0.05). There was no significant difference in the prevention and treatment of ICU-AW between other drugs (including growth hormone, glutamine, dexmedetomidine, neostigmine, oxandrolone, and intravenous immunoglobulin) and control group. CONCLUSIONS Intensive insulin therapy can prevent ICU-AW, but the risk of hypoglycemia will increase. Other drugs including growth hormone, glutamine, dexmedetomidine, neostigmine, oxandrolone, and intravenous immunoglobulin have no obvious advantages in the prevention and treatment of ICU-AW, so no drug has been recommended to prevent and treat ICU-AW.
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5.
Evaluation of blood product transfusion therapies in acute injury care in low- and middle-income countries: a systematic review
Yang L, Slate-Romano J, Marques CG, Uwamahoro C, Twagirumukiza FR, Naganathan S, Moretti K, Jing L, Levine AC, Stephen A, et al
Injury. 2020
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Abstract
BACKGROUND Worldwide, injuries account for approximately five million mortalities annually, with 90% occurring in low- and middle-income countries (LMICs). Although guidelines characterizing data for blood product transfusion in injury resuscitation have been established for high-income countries (HICs), no such information on use of blood products in LMICs exists. This systematic review evaluated the available literature on the use and associated outcomes of blood product transfusion therapies in LMICs for acute care of patients with injuries. METHODS A systematic search of PubMed, EMBASE, Global Health, CINAHL and Cochrane databases through November 2018 was performed by a health sciences medical librarian. Prospective and cross-sectional reports of injured patients from LMICs involving data on blood product transfusion therapies were included. Two reviewers identified eligible records (kappa=0.92); quality was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Report elements, patient characteristics, injury information, blood transfusion therapies provided and mortality outcomes were extracted and analyzed. RESULTS Of 3411 records, 150 full-text reports were reviewed and 17 met inclusion criteria. Identified reports came from the World Health Organization regions of Africa, the Eastern Mediterranean, and South-East Asia. A total of 6535 patients were studied, with the majority from exclusively inpatient hospital settings (52.9%). Data on transfusion therapies demonstrated that packed red blood cells were given to 27.0% of patients, fresh frozen plasma to 13.8%, and unspecified product types to 50.1%. Among patients with blunt and penetrating injuries, 5.8% and 15.7% were treated with blood product transfusions, respectively. Four reports provided data on comparative mortality outcomes, of which two found higher mortality in blood transfusion-treated patients than in untreated patients at 17.4% and 30.4%. The overall quality of evidence was either low (52.9%) or very low (41.2%), with one report of moderate quality by GRADE criteria. CONCLUSION There is a paucity of high-quality data to inform appropriate use of blood transfusion therapies in LMIC injury care. Studies were geographically limited and did not include sufficient data on types of therapies and specific injury patterns treated. Future research in more diverse LMIC settings with improved data collection methods is needed to inform injury care globally.
PICO Summary
Population
Patients with injuries requiring acute care in low and middle income countries (17 studies, n=6535).
Intervention
Systematic review on the use of blood product transfusion therapies.
Comparison
Outcome
Packed red blood cells were given to 27.0% of patients, fresh frozen plasma to 13.8%, and unspecified product types to 50.1%. Among patients with blunt and penetrating injuries, 5.8% and 15.7% were treated with blood product transfusions, respectively. Four reports provided data on comparative mortality outcomes, of which two found higher mortality in blood transfusion-treated patients than in untreated patients at 17.4% and 30.4%.
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Survival analysis of intraoperative blood salvage for patients with malignancy disease: A PRISMA-compliant systematic review and meta-analysis
Wu WW, Zhang WY, Zhang WH, Yang L, Deng XQ, Ou MC, Yang YX, Liu HB, Zhu T
Medicine. 2019;98(27):e16040
Abstract
BACKGROUND Intraoperative blood salvage as a blood-saving strategy has been widely used in surgery. Considering its theoretic risk of malignant tumor cells being reinfused and the corresponding blood metastases, the safety of intraoperative blood salvage in cancer surgery remains controversial. METHODS Following the Preferred Reporting Items for Systemic Review and Meta-Analysis (PRISMA), we searched the Cochrane Library, MEDLINE and EMBASE to November 2017. We included only studies comparing intraoperative blood salvage with allogeneic blood transfusion. RESULTS This meta-analysis included 9 studies with 4354 patients with 1346 patients in the intraoperative blood salvage group and 3008 patients in the allogeneic blood transfusion group. There were no significant differences in the 5-year overall survival outcome (odds ratio [OR] 1.12; 95% confidence interval [CI], 0.80-1.58), 5-year disease-free survival outcome (OR 1.08; 95% CI 0.86-1.35), or 5-year recurrence rate (OR 0.86; 95% CI 0.71-1.05) between the 2 study groups. Subgroup analysis also showed no significant differences in the 5-year overall survival outcome (OR 0.97; 95% CI 0.57-1.67) of hepatocellular carcinoma patients in liver transplantation. CONCLUSIONS For patients with malignant disease, intraoperative blood salvage did not increase the tumor recurrence rate and had comparable survival outcomes with allogeneic blood transfusion.
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Is combined topical and intravenous tranexamic acid superior to single use of tranexamic acid in total joint arthroplasty?: A meta-analysis from randomized controlled trials
Yang L, Du S, Sun Y
Medicine. 2017;96((30)):e7609.
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Abstract
BACKGROUND To compare the efficacy and safety of the combined application of both intravenous and topical tranexamic acid (TXA) versus the single use of either application in patients with total knee and hip arthroplasty (TKA and THA). METHODS Potentially relevant studies were identified from electronic databases including Medline, PubMed, Embase, ScienceDirect, and the Cochrane Library. Randomized control trials (RCTs) of patients prepared for total joint arthroplasty that compared combined TXA with placebo were retrieved. The primary endpoint was hemoglobin decline or postoperative hemoglobin level, blood loss, drainage volume, transfusion requirements. The secondary outcomes were length of stay (LOS), and operation time as well as surgery-related adverse effects, such as wound infection, deep vein thrombosis (DVT), and pulmonary embolism (PE). After testing for publication bias and heterogeneity between studies, data were aggregated for random-effects models when necessary. RESULTS Five RCTs that included 604 patients met the inclusion criteria. The present meta-analysis indicated significant differences existed in the total blood loss (mean difference [MD] = -134.65, 95% CI: -191.66 to -77.64, P < .0001), postoperative hemoglobin level (MD = 0.74, 95% CI: 0.39-1.10, P < .0001), drainage volume (MD = -47.44, 95% CI: -64.55 to -30.33, P < .00001), and transfusion rate (risk difference [RD] = -0.06, 95% CI: -0.10 to -0.02, P = .006) between groups. CONCLUSION Combined administration of TXA in TKA and THA was associated with significantly reduced total blood loss, postoperative hemoglobin decline, drainage volume, and transfusion requirements. Well-designed, high-quality RCTs with long-term follow-up are still required.
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Use of intravenous tranexamic acid in total knee arthroplasty: a meta-analysis of randomized controlled trials
Fu DJ, Chen C, Guo L, Yang L
Chinese Journal of Traumatology. 2013;16((2):):67-76.
Abstract
Objective: The effect of tranexamic acid (TA) on patients receiving total knee arthroplasty (TKA) has been reported in many small clinical trials. But single trials are not sufficient enough to clarify the effectiveness and safety of TA. So, we carried out a meta-analysis of randomized controlled trials to investigate the efficacy and safety of the intravenous use of TA in TKA. Methods: Literatures were retrieved in Cochrane Library, OVID, PubMed, EMBASE, CNKI and Wanfang Data. All the related literatures were checked by two independent investigators and only the high quality randomized controlled trials were enrolled. Relevant data were analyzed using RevMan 5.1 to compare the difference of blood loss, transfusion and complications between TA group and control group. Results: There were 353 related literatures and only 22 randomized controlled trials met the inclusion criteria. The use of TA in TKA significantly reduced total blood loss by a mean of 435.41 ml (95% CI 300.62-570.21, P less than 0.01), post-operative blood loss by a mean of 406.69 ml (95% CI 333.16-480.22, P less than 0.01). TA also significantly lowered the transfusion rate (risk difference 0.30, 95% CI 0.21-0.39, P less than 0.01) and transfusion volume (mean difference 0.95 unit, 95% CI 0.53-1.37, P less than 0.01). The risks between TA group and control group in developing deep vein thrombosis and pulmonary embolism were not statistically significant. Conclusion: TA is beneficial for patients undergoing TKA, which can significantly reduce total blood loss, postoperative blood loss, transfusion rate, and transfusion volume. Meanwhile TA is recommended to reduce deep vein thrombosis and pulmonary embolism following TKA.
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Is fresh-frozen plasma clinically effective? An update of a systematic review of randomized controlled trials (CME)
Yang L, Stanworth S, Hopewell S, Doree C, Murphy M
Transfusion. 2012;52((8):):1673-86.
Abstract
BACKGROUND The clinical use of frozen plasma (FP) continues to increase, both in prophylactic and in therapeutic settings. In 2004, a systematic review of all published randomized controlled trials (RCTs) revealed a lack of evidence that supported the efficacy of FP use. This is an update that includes all new RCTs published since the original review. STUDY DESIGN AND METHODS Trials involving transfusion of FP up to July 2011 were identified from searches of MEDLINE, EMBASE, CINAHL, The Cochrane Library, and the UKBTS/SRI Transfusion Evidence Library. Methodologic quality was assessed. The primary outcome measure was the effect of FP on survival. RESULTS Twenty-one new trials were eligible for inclusion. These covered prophylactic and therapeutic FP use in liver disease, in cardiac surgery, for warfarin anticoagulation reversal, for thrombotic thrombocytopenic purpura treatment, for plasmapheresis, and in other settings, including burns, shock, and head injury. The largest number of recent RCTs were conducted in cardiac surgery; meta-analysis showed no significant difference for FP use for the outcome of 24-hours postoperative blood loss (weighted mean difference, -35.24[em space]mL; 95% confidence interval, -84.16 to 13.68[em space]mL). Overall, there was no significant benefit for FP use across all the clinical conditions. Only two of the 21 trials fulfilled all the criteria for quality assessment. CONCLUSION Combined with the 2004 review, 80 RCTs have investigated FP with no consistent evidence of significant benefit for prophylactic and therapeutic use across a range of indications evaluated. There has been little improvement in the overall methodologic quality of RCTs conducted in the past few years. Copyright 2012 American Association of Blood Banks.
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Efficacy and safety of glucocorticoids in addition to intravenous immunoglobulin in the initial treatment of Kawasaki disease: a meta-analysis of randomized trials Chinese
Hu JW, Zhou ZS, Yang L, Zheng CN, Wang KD
Chung-Hua i Hsueh Tsa Chih [Chinese Medical Journal]. 2011;91((18):):1259-64.
Abstract
OBJECTIVE To evaluate the efficacy and safety of glucocorticoids (GC) plus intravenous immunoglobulin (IVIG) in the initial treatment of Kawasaki disease. METHODS Fourteen electronic databases and 3 Japanese magazines were searched. Randomized controlled trials (RCT) describing the use of GC plus IVIG in the initial treatment of Kawasaki disease in children were collected. The data of methodological quality and trial information were extracted by two independent researchers. Cochrane review methodology was used for assessing the trial quality and efficacy. Each dichotomous outcome was measured in terms of odds risk (OR) while continuous outcomes shown as weighted mean differences (WMD). And a meta-analysis was made with RevMan5.0.23.0 software. RESULTS A total of 416 cases in 3 trials were included. There were 209 cases in GC + IVIG group and 207 cases in IVIG group. The incidence of coronary artery lesion (CAL) was not different between GC + IVIG and IVIG groups within 1 month or 1 month post-treatment (OR: 0.74, 0.69; 95%CI: 0.23 - 2.40, 0.35 - 1.38; P = 0.62, 0.30]. The fever duration was shorter in GC + IVIG group than that in IVIG group (WMD: -0.93 d, 95%CI: -1.15 - -0.70, P = 0.00). The treatment failure rate was less in GC + IVIG group than IVIG group (9.09% vs 17.48%, OR: 0.49, 95%CI: 0.28 - 0.86, P = 0.01). No difference in adverse events was found between two groups (OR: 0.81, 95%CI: 0.22 - 3.03, P = 0.76). CONCLUSION There is no evidence to support that GC plus IVIG can further reduce the CAL risk of KD patients. But it may lower the treatment failure rate in KD patients.