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  • Xu Y
  • Li T
  • Wang L
  • Yao L
  • Li J
  • et al.
Am J Sports Med. 2024 Feb 15;3635465231213087 doi: 10.1177/03635465231213087.
BACKGROUND:

Corticosteroids (CS) have shown good short-term performance in terms of pain relief and functional improvement. However, the safety and long-term efficacy of this treatment remains controversial. Several studies have reported good results of platelet-rich plasma (PRP) in the treatment of tendinopathies. However, whether its use in the treatment of lateral epicondylitis (LE) is superior to that of CS remains controversial.

PURPOSE:

To perform a systematic review and meta-analysis of original studies to determine whether the prognosis of LE patients treated with PRP is better than that of CS.

STUDY DESIGN:

Meta-analysis; Level of evidence, 2.

METHODS:

Two independent reviewers searched online databases from January 2000 to July 2022 according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to evaluate prospective studies of PRP versus CS injection for LE. A third author addressed any discrepancies. Evidence quality was assessed using the Cochrane risk of bias tool. Risk ratios for dichotomous variables and mean differences (MDs) for continuous variables were used to compare clinical outcomes. P values <.05 were considered statistically significant.

RESULTS:

Eleven randomized controlled trials with 730 patients were included in this review. PRP provided a significantly worse short-term (<2 months) improvement in the visual analog scale (VAS) pain score (MD, 0.93 [95% CI, 0.42 to 1.44]; I2 = 85%; P = .0003) and Disabilities of the Arm, Shoulder and Hand (DASH) score (MD, 10.23 [95% CI, 9.08 to 11.39]; I2 = 67%; P < .0001) but better long-term (≥6 months) improvement in the VAS score (MD, -2.18 [95% CI, -3.13 to -1.22]; I2 = 89%; P < .0001), DASH score (MD, -8.13 [95% CI, -9.87 to -6.39]; I2 = 25%; P < .0001), and Mayo Elbow Performance Score (MD, 16.53 [95% CI, 1.52 to 31.53]; I2 = 98%; P = .03) than CS. The medium-term (2-6 months) reduction in the VAS score was not significantly different between the 2 groups. After sensitivity analysis, none of the results changed except for the short-term VAS scores (MD, 0.53 [95% CI, -0.13 to 1.19]; I2 = 78%; P = .12).

CONCLUSION:

Both PRP and CS injections are effective treatments for patients with LE. CS provides better short-term (<2 months) functional improvement and may be more advantageous in terms of short-term pain relief, while PRP provides better long-term (≥6 months) functional improvement and better performance regarding long-term pain relief.

  • Gao N
  • Yan L
  • Ai F
  • Kang J
  • Wang L
  • et al.
Arch Phys Med Rehabil. 2023 May;104(5):799-811 doi: 10.1016/j.apmr.2022.11.009.
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 first 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 PRP injection with each other or placebo-controlled for treating CTS.

DATA EXTRACTION:

The 2 reviewers independently conducted information extraction, the utcomes included were the changes in Symptom Severity Scale, Functional Status Scale, and Visual Analog Scale at short-term follow-up after drug injection treatment and any adverse events reported.

DATA SYNTHESIS:

Twelve randomized controlled trials with 749 patients (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 surface under the cumulative ranking curve being 91.5%, 92.7%, and 80.8%, respectively, after D5W injection (74.4%, 72.2%, 72.1%), and corticosteroid injection (33.7%, 31.9%, 46.2%). The injection of 3 drugs was significantly better than that of a placebo.

CONCLUSIONS:

From the results of the network meta-analysis, PRP injection is the most recommended treatment among the injection of corticosteroid, D5W, and PRP.

  • Khoury W
  • Servito M
  • Wang L
  • Baranchuk A
  • Callum J
  • et al.
Expert Rev Cardiovasc Ther. 2022 May;20(5):403-408 doi: 10.1080/14779072.2022.2074838.
INTRODUCTION:

Significant blood loss during cardiac surgery is associated with a dramatic increase in morbidity and mortality. Factor Eight Inhibitor Bypassing Activity (FEIBA), a hemostatic bypassing agent mainly used in hemophiliac patients, has also been used for intractable bleeding during cardiac surgical procedures in non-hemophiliac patients. However, concerns exist that its use may be linked to increased incidence of perioperative adverse effects including thrombotic complications.

AREAS COVERED:

A systematic literature search was performed on MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases for all studies that reported the administration of FEIBA for treatment of bleeding during adult cardiac surgery in non-hemophiliac patients. After selecting the title and abstracts, two authors assessed the methodological quality of the full-text articles prior to final inclusion in the manuscript.

EXPERT OPINION:

The safety profile of FEIBA was determined through an aggregate count of adverse events. Major complications included renal failure, re-operation for unresolved bleeding, postoperative mortality, and thromboembolic events. Overall, there is insufficient robust evidence to make a definitive conclusion about the safety or efficacy of using of FEIBA as a hemostatic agent in the setting of cardiac surgery.

  • Liu GC
  • Sui GY
  • Liu GY
  • Zheng Y
  • Deng Y
  • et al.
PLoS One. 2013 Nov 13;8(11):e79203 doi: 10.1371/journal.pone.0079203.
BACKGROUND:

Although transfusion-transmitted infection of hepatitis B virus (HBV) threatens the blood safety of China, the nationwide circumstance of HBV infection among blood donors is still unclear.

OBJECTIVES:

To comprehensively estimate the prevalence of HBsAg positive and HBV occult infection (OBI) among Chinese volunteer blood donors through bayesian meta-analysis.

METHODS:

We performed an electronic search in Pub-Med, Web of Knowledge, Medline, Wanfang Data and CNKI, complemented by a hand search of relevant reference lists. Two authors independently extracted data from the eligible studies. Then two bayesian random-effect meta-analyses were performed, followed by bayesian meta-regressions.

RESULTS:

5957412 and 571227 donors were identified in HBsAg group and OBI group, respectively. The pooled prevalence of HBsAg group and OBI group among donors is 1.085% (95% credible interval [CI] 0.859%~1.398%) and 0.094% (95% CI 0.0578%~0.1655%). For HBsAg group, subgroup analysis shows the more developed area has a lower prevalence than the less developed area; meta-regression indicates there is a significant decreasing trend in HBsAg positive prevalence with sampling year (beta = -0.1202, 95% -0.2081~-0.0312).

CONCLUSION:

Blood safety against HBV infection in China is suffering serious threats and the government should take effective measures to improve this situation.