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Arthroscopy, Sports Medicine, and... Aug 2022To examine the efficacy of biologic agents in the treatment of cartilage defects associated with femoroacetabular impingement (FAI). (Review)
Review
PRP Is Not Associated With Improved Outcomes Following Hip Femoroacetabular Impingement Surgery: Very Low-Quality Evidence Suggests Hyaluronic Acid and Cell-Based Therapies May Be Beneficial-A Systematic Review of Biological Treatments.
PURPOSE
To examine the efficacy of biologic agents in the treatment of cartilage defects associated with femoroacetabular impingement (FAI).
METHODS
PubMed, Ovid MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews were reviewed by 2 independent reviewers for eligible studies. We included randomized and nonrandomized control trials as well as uncontrolled case series and retrospective studies. Studies were excluded if they included injections of corticosteroids, papers that described technique only, review papers, and those not in the English language. Demographics, treatment type, outcome of treatment, and complications were extracted, whereas risk of bias and study quality were assessed independently using the risk of bias tool (ROB2) and effective public health practice project tool. A narrative synthesis was performed, and standardized mean differences were reported. Certainty of evidence was assessed using the GRADE approach.
RESULTS
Eighteen studies consisting of 1,024 patients met the inclusion criteria. Three studies involved the use of platelet-rich plasma (PRP) as an adjuvant to surgery and were included in the meta-analysis. Three studies administered hyaluronic acid (HA) as a primary treatment. Twelve involved various cell-based methods of chondrocyte stimulation for cartilage defects associated with FAI, but heterogeneity did not allow for pooling. Low-quality evidence indicates PRP is not associated with improved outcomes following surgery (mean difference -1.42, 95% confidence interval -3.95 to 1.11, = .27). Very-low-quality evidence suggests HA (standardized mean difference 1.15, 95% confidence interval 0.64-1.66, < .001, Z = 4.39) and cell-based therapies may improve function and pain in patients with FAI.
CONCLUSIONS
Low-quality evidence indicates PRP is not associated with improved outcomes following hip FAI surgery, and very-low-quality evidence suggests HA and cell-based therapies may improve outcomes.
LEVEL OF EVIDENCE
systematic review of Level I-V studies.
PubMed: 36033174
DOI: 10.1016/j.asmr.2022.05.002 -
The Canadian Journal of Cardiology Nov 2016Platelet microparticles (PMP), shedding on platelet activation, have been proposed as key components in the procoagulant and proinflammatory process. The aim of this... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Platelet microparticles (PMP), shedding on platelet activation, have been proposed as key components in the procoagulant and proinflammatory process. The aim of this study was to clarify the correlation between plasma PMP concentration and the presence of acute coronary syndrome (ACS).
METHODS
We searched for potential relevant studies in PubMed, EMBASE, the Cochrane Library, and Web of Science databases before December 2015. After screening for eligibility, 11 observational studies that tested the plasma concentration of PMP in patients with ACS were retrieved for comprehensive review, quality assessment, and data extraction.
RESULTS
Seven studies (64%) provided explicit information between healthy controls and patients with ACS. Five studies (45%) addressed the plasma levels of PMP between patients with ACS and patients with stable angina. Moreover, 5 studies (45%) compared changes in PMP concentration before and after percutaneous coronary intervention (PCI) in patients with ACS. The results showed a significant difference in plasma PMP levels between the patients with ACS and healthy controls, with the pooled standardized mean difference of 1.95 (95% confidence intervals, 0.87-3.02; P < 0.0001). And the plasma concentration of PMP in patients with ACS was higher before PCI than after PCI (standardized mean difference, -0.97; 95% confidence interval, -1.91 to -0.03; P = 0.043). Four of the five studies described that patients with ACS had higher plasma PMP concentration than patients with stable angina, but there was no significant difference between these 2 patient cohorts.
CONCLUSIONS
PMP is a promising biomarker for the development of ACS. Moreover, PCI, the most common treatment for ACS, could effectively decrease the plasma concentration of PMP, indicating PMP as a prognostic factor.
Topics: Acute Coronary Syndrome; Biomarkers; Blood Platelets; Cell-Derived Microparticles; Humans; Prognosis
PubMed: 27177836
DOI: 10.1016/j.cjca.2016.02.052 -
Journal of Medical Virology Oct 2022Recommended treatment regimen for human immune deficiency virus (HIV) infection includes protease inhibitors/ritonavir (PIs/r) combined with two-nucleoside... (Meta-Analysis)
Meta-Analysis Review
Recommended treatment regimen for human immune deficiency virus (HIV) infection includes protease inhibitors/ritonavir (PIs/r) combined with two-nucleoside reverse-transcriptase inhibitors (2NRTIs), which enable to achieve and maintain viral suppression, restore, and preserve immune function. However, there were inconsistent findings on the levels of interleukin-6 (IL-6) levels. Systematic review and meta-analysis were performed to quantify the pooled effects of PIs/r-based antiretroviral therapy (ART) on serum/plasma IL-6 levels in people living with the HIV (PLHIV). PubMed, Web of Science, and Embase were searched from the earliest record to November 4, 2020. Data analysis was conducted on Stata version 16 and Review Manager 5.3. A random-effect model was used to compute a pooled effect size and weighted mean difference (WMD) was considered the summary effect size. Heterogeneity between studies was estimated by Cochrane's Q test (χ test) and I statistic and subgroup analysis were performed to explore the source of heterogeneity. Initial search identified 3098 records and 5 studies (7 trials) met inclusion criteria. The pooled mean difference in serum/plasma IL-6 levels from baseline to follow-up was 0.534 pg/ml (95% confidence interval: -0.012, 1.08, P = 0.05, I = 76.4%). In subgroup analysis, there was a significant association between increased serum/plasma IL-6 levels and age group ≥ 35 years old, baseline CD4 counts < 350 cell/mm , and mean viral load ≥ 4.5 log10 copies/ml. We found that serum/plasma IL-6 levels increased after combined ART among treatment-naïve individuals who initiated a successful combination of PIs/r with 2NRTIs. This result also highlights the need to monitor serum/plasma IL-6 levels during antiviral therapy, which may aid in the effective future treatment of systemic inflammation and related disorders following elevated IL-6 levels.
Topics: Adult; Anti-HIV Agents; Anti-Retroviral Agents; CD4 Lymphocyte Count; HIV Infections; HIV Protease Inhibitors; Humans; Interleukin-6; Protease Inhibitors; Ritonavir; Viral Load
PubMed: 35665943
DOI: 10.1002/jmv.27912 -
BMJ Open Jan 2024Multiple myeloma (MM) is a malignant plasma cell disorder. The most widely accepted staging system for MM is the revised International Staging System based on... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Multiple myeloma (MM) is a malignant plasma cell disorder. The most widely accepted staging system for MM is the revised International Staging System based on cytogenetic and clinical biomarkers. The circulating clonal plasma cells (CPCs) were reported to have potential prognostic impact on MM. Among various diagnostic approaches, multiparametric flow cytometry (FCM) offers heightened sensitivity, minimal invasiveness and reproducibility. We conducted a meta-analysis to evaluate the prognostic value of quantifying CPCs via FCM in newly diagnosed symptomatic MM (NDMM) patients.
DESIGN
Systematic review and meta-analysis.
DATA SOURCE
PubMed, Web of Science, Embase and references of included studies.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
We included observational studies that evaluated the prognostic value of CPCs detected by FCM in NDMM.
DATA EXTRACTION AND SYNTHESIS
Data were screened and extracted independently by two investigators. The pooled results originated from random effects models. The primary endpoint was overall survival (OS). The secondary endpoint was progression-free survival (PFS). To evaluate the prognostic value of CPCs in NDMM, HRs and their 95% CI for both OS and PFS were derived using COX multivariable models. These values were then used to compute the pooled estimated effect.
RESULTS
Our meta-analysis encompassed a total of 2704 NDMM patients from 11 studies up to 27 August 2022. The pooled HR for OS and PFS in CPC-positive (CPCs+) group and CPC-negative group were 1.95 (95% CI 1.24 to 3.07) and 2.07 (95% CI 1.79 to 2.39), respectively. The autologous stem cell transplantation (ASCT) failed to eliminate the adverse impact on OS and PFS. The heterogeneity may stem from the use of novel agents or traditional chemotherapy as initial treatment.
CONCLUSION
This meta-analysis indicates CPCs+ had an adverse impact on the prognosis of NDMM patients in the total population, and the adverse impact could not be eliminated by ASCT.
PROSPERO REGISTRATION NUMBER
CRD42021272381.
Topics: Humans; Multiple Myeloma; Prognosis; Plasma Cells; Flow Cytometry; Hematopoietic Stem Cell Transplantation; Reproducibility of Results; Transplantation, Autologous
PubMed: 38216195
DOI: 10.1136/bmjopen-2022-071548 -
Knee Surgery, Sports Traumatology,... Sep 2015The aim of this review was to analyze the available evidence on the clinical application of this biological approach for the injective treatment of cartilage lesions and... (Review)
Review
PURPOSE
The aim of this review was to analyze the available evidence on the clinical application of this biological approach for the injective treatment of cartilage lesions and joint degeneration, together with preclinical studies to support the rationale for the use of platelet concentrates, to shed some light and give indications on what to treat and what to expect from intra-articular injections of platelet-rich plasma (PRP).
METHODS
All in vitro, in vivo preclinical and clinical studies on PRP injective treatment in the English language concerning the effect of PRP on cartilage, synovial tissue, menisci, and mesenchymal stem cells were considered. A systematic review on the PubMed database was performed using the following words: (platelet-rich plasma or PRP or platelet concentrate or platelet lysate or platelet supernatant) and (cartilage or chondrocytes or synoviocytes or menisci or mesenchymal stem cells).
RESULTS
Fifty-nine articles met the inclusion criteria: 26 were in vitro, 9 were in vivo, 2 were both in vivo and in vitro, and 22 were clinical studies. The analysis showed an increasing number of published studies over time. Preclinical evidence supports the use of PRP injections that might promote a favourable environment for joint tissues healing. Only a few high-quality clinical trials have been published, which showed a clinical improvement limited over time and mainly documented in younger patients not affected by advanced knee degeneration.
CONCLUSIONS
Besides the limits and sometimes controversial findings, the preclinical literature shows an overall support toward this PRP application. An intra-articular injection does not just target cartilage; instead, PRP might influence the entire joint environment, leading to a short-term clinical improvement. Many biological variables might influence the clinical outcome and have to be studied to optimize PRP injective treatment of cartilage degeneration and osteoarthritis.
Topics: Cartilage Diseases; Humans; Injections, Intra-Articular; Orthopedic Procedures; Osteoarthritis; Platelet-Rich Plasma
PubMed: 24275957
DOI: 10.1007/s00167-013-2743-1 -
Clinical Journal of Sport Medicine :... Jul 2011To evaluate, through a systematic review of the current literature, the evidence-based outcomes of the use of platelet-rich plasma (PRP) for the treatment of tendon and... (Review)
Review
OBJECTIVE
To evaluate, through a systematic review of the current literature, the evidence-based outcomes of the use of platelet-rich plasma (PRP) for the treatment of tendon and ligament injuries.
DATA SOURCES
A search of English-language articles was performed in PubMed and EMBASE using keywords "PRP," "platelet plasma," and "platelet concentrate" combined with "tendon" and then "ligament" independently. The search was conducted through September 2010.
STUDY SELECTION
Search was limited to in vivo studies. Nonhuman studies were excluded. Tissue engineering strategies, which included a combination of PRP with additional cell types (bone marrow), were also excluded. Articles with all levels of evidence were included. Thirteen of 32 retrieved articles respected the inclusion criteria.
DATA EXTRACTION
The authors reviewed and tabulated data according to the year of study and journal, study type and level of evidence, patient demographics, method of PRP preparation, site of application, and outcomes.
DATA SYNTHESIS
The selected studies focused on the application of PRP in the treatment of patellar and elbow tendinosis, Achilles tendon injuries, rotator cuff repair, and anterior cruciate ligament (ACL) reconstruction. Seven studies demonstrated favorable outcomes in tendinopathies in terms of improved pain and functional scores. In 3 studies on the use of PRP in ACL reconstruction, no statistically significant differences were seen with regard to clinical outcomes, tunnel widening, and graft integration. One study examined the systemic effects after the local PRP application for patellar and elbow tendinosis.
CONCLUSIONS
Presently, PRP use in tendon and ligament injuries has several potential advantages, including faster recovery and, possibly, a reduction in recurrence, with no adverse reactions described. However, only 3 randomized clinical trials have been conducted.
Topics: Humans; Ligaments; Platelet-Rich Plasma; Randomized Controlled Trials as Topic; Tendon Injuries; Treatment Outcome
PubMed: 21562414
DOI: 10.1097/JSM.0b013e31821d0f65 -
Cancer Treatment Reviews Dec 2015Plasma fibrinogen may be involved in several stages of cancer progression. Clinical studies have demonstrated that pretreatment plasma fibrinogen is associated with poor... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Plasma fibrinogen may be involved in several stages of cancer progression. Clinical studies have demonstrated that pretreatment plasma fibrinogen is associated with poor survival in various cancers. The aim of this meta-analysis was to examine the prognostic effect of circulating fibrinogen in solid tumors.
MATERIALS AND METHODS
We searched Medline, EMBASE, Cochrane Database of Systematic Reviews, and meeting proceedings to identify studies assessing the effect of pretreatment plasma fibrinogen on survival of cancer patients. Pooled multivariable-adjusted hazard ratios (HRs) for overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) were estimated using random-effects models.
RESULTS
Data from 52 observational studies and 15,371 patients were summarized. An elevated baseline plasma fibrinogen was significantly associated with worse OS (pooled HR = 1.69; 95% CI = 1.48–1.92). The highest negative effect of elevated plasma fibrinogen on OS was demonstrated in renal cell carcinoma (pooled HR = 2.22), followed by head and neck cancer (pooled HR = 2.02), and colorectal cancer (pooled HR = 1.89). The adverse prognostic impact of high plasma fibrinogen remained in both non-metastatic and metastatic disease and patients of different ethnicity. Patients with high baseline fibrinogen had a significantly shorter DFS (pooled HR = 1.52) and CSS (pooled HR = 2.50).
CONCLUSIONS
An elevated pretreatment plasma fibrinogen significantly correlates with decreased survival in patients with solid tumors. Future clinical trials are warranted to determine whether plasma fibrinogen could be incorporated in cancer staging systems and whether fibrinogen-lowering therapies have a favorable effect on disease recurrence and mortality.
Topics: Disease Progression; Disease-Free Survival; Fibrinogen; Humans; Neoplasms; Prognosis; Proportional Hazards Models
PubMed: 26604093
DOI: 10.1016/j.ctrv.2015.10.002 -
Proteomics. Clinical Applications Dec 2014Biomarker analysis and proteomic discovery in pediatric sickle cell disease has the potential to lead to important discoveries and improve care. The aim of this review... (Review)
Review
Biomarker analysis and proteomic discovery in pediatric sickle cell disease has the potential to lead to important discoveries and improve care. The aim of this review article is to describe proteomic and biomarker articles involving neurological and developmental complications in this population. A systematic review was conducted to identify relevant research publications. Articles were selected for children under the age of 21 years with the most common subtypes of sickle cell disease. Included articles focused on growth factors (platelet-derived growth factor), intra and extracellular brain proteins (glial fibrillary acidic protein, brain-derived neurotrophic factor), and inflammatory and coagulation markers (interleukin-1β, l-selectin, thrombospondin-1, erythrocyte, and platelet-derived microparticles). Positive findings include increases in plasma brain-derived neurotrophic factor and platelet-derived growth factor with elevated transcranial Dopplers velocities, increases in platelet-derived growth factor isoform AA with overt stroke, and increases in glial fibrillary acidic protein with acute brain injury. These promising potential neuro-biomarkers provide insight into pathophysiologic processes and clinical events, but their clinical utility is yet to be established. Additional proteomics research is needed, including broad-based proteomic discovery of plasma constituents and blood cell proteins, as well as urine and cerebrospinal fluid components, before, during and after neurological and developmental complications.
Topics: Anemia, Sickle Cell; Biomarkers; Brain-Derived Neurotrophic Factor; Child; Humans; Nervous System Diseases; Platelet-Derived Growth Factor; Proteome; Proteomics
PubMed: 25290359
DOI: 10.1002/prca.201400069 -
Stem Cells International 2018The purpose of this study was to highlight the clinical performance of platelet-rich plasma (PRP) used as an adjunctive tool for regeneration in infrabony periodontal... (Review)
Review
BACKGROUND AND OBJECTIVE
The purpose of this study was to highlight the clinical performance of platelet-rich plasma (PRP) used as an adjunctive tool for regeneration in infrabony periodontal defects using different biomaterials or performing different surgical flap approaches. Comparative evaluation of main clinical outcomes as probing pocket depth reduction, clinical attachment gain, and recession reduction with and without the use of PRP has been analysed.
MATERIALS AND METHODS
According to the focused question, an electronic and hand searching has been performed up to December 2016. From a batch of 73 articles, the selection strategy and Jadad quality assessment led us to include 15 studies for the meta-analysis.
RESULTS
Despite the high heterogeneity found and the lack of complete data regarding the selected clinical outcomes, a comparative analysis has been possible by the categorization of used biomaterials and surgical flap approaches. This method led us to observe the best performance of grafts with the use of adjunctive PRP in CAL gain and PPD reduction. No difference has been outlined with a specific surgical flap.
CONCLUSIONS
Although PRP is considered a cheap and patient's derived growth factor, the not conclusive data reported would suggest that its use in addition to bone substitutes could be of some clinical benefit in the regenerative treatment of infrabony defects.
CLINICAL RELEVANCE
This systematic review was intended to sort out the huge controversial debate in the field about the possible use of PRP in regenerative surgery in infrabony defect. The clinical relevance of using blood-borne growth factors to conventional procedures is effective as these could determine a better performance and outcomes despite the surgical approach adopted and limit the use of additional biomaterials for the blood clot stabilization.
PubMed: 29755531
DOI: 10.1155/2018/9594235 -
American Journal of Translational... 2019Normal B lymphocyte function and antibody secretion during inflammation can provide critical protection for the host. We aimed to synthesize existing evidence to explore... (Review)
Review
OBJECTIVE
Normal B lymphocyte function and antibody secretion during inflammation can provide critical protection for the host. We aimed to synthesize existing evidence to explore whether circulating B cells and plasma immunoglobulin M (IgM) levels were associated with survival during sepsis.
METHODS
PubMed, Embase, ISI Web of Knowledge, Cochrane Central Register of Controlled Trials were systematically searched. Studies with data on circulating B cells and plasma IgM levels within the initial 24 hours after sepsis onset were selected.
RESULTS
A total of 11 studies were qualified for inclusion in this systematic review and meta-analysis with a total of 829 patients with sepsis and/or septic shock. Number of circulating B cells was similar between septic patients and health controls (SMD = -1.81, 95% CI: -4.15, 0.54; P = 0.13, I = 99%), while it was significantly reduced in sepsis survivors versus sepsis non-survivors (SMD = -0.60, 95% CI: -0.87, -0.32; P < 0.0001, I = 0%). Concentration of plasma IgM level was significantly decreased in septic patients as compared with healthy controls. Also, the plasma IgM level was significantly lower in sepsis survivors versus sepsis non-survivors.
CONCLUSIONS
A poor prognostic survival outcome was observed for patients with decreased circulating B cells as well as IgM levels within the initial 24 h after sepsis onset.
PubMed: 31934274
DOI: No ID Found