scholarly journals No Effects of Intra-Articular Injections of Sodium Hyaluronate, Corticosteroids, Platelet-Rich Plasma on Temporomandibular Joint Osteoarthritis: a Systematic Review and Network Meta-analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Yuan Xie ◽  
Kun Zhao ◽  
Guanchen Ye ◽  
Xudong Yao ◽  
Mengfei Yu ◽  
...  
Keyword(s):  
Temporomandibular Joint ◽  
Functional Outcomes ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Mouth Opening ◽  
Lateral Movement ◽  
Randomized Controlled ◽  
Temporomandibular Joint Osteoarthritis ◽  
Maximal Mouth Opening

Abstract Background Intra-articular injections of corticosteroids (CCS), hyaluronic acid (HA), and platelet-rich plasma (PRP) have often been used for temporomandibular joint osteoarthritis (TMJ OA). However, there is no guideline for the choice of pharmacological injections. The aim of this network meta-analysis (NMA) is to compare the efficacy of different intra-articular injectable treatments on TMJ OA. Methods Studies were identified from PubMed, Embase and Cochrane Central with date up to December 2020. Randomized Controlled Trials (RCTs) included were the studies of patients with TMJ OA who had intra-articular treatment with CCS, HA, PRP, placebo and follow-up assessing TMJ function in target outcome variables. The primary outcome was temporomandibular joint pain (VAS). The secondary outcomes were maximal mouth opening (mm), and lateral movement to the affected side (mm). Results Nine RCTs involving 316 patients were included. For primary pain outcome, no significance was detected when CCS, HA and PRP were compared with placebo by both short- (3-6 months) and long-term (>12 months) follow-up. In addition, these injectables did not significantly outperform placebo by evaluating secondary functional outcomes (maximal mouth opening and lateral movement) with the same follow-up. Subgroup analyses showed that the effect of CCS on subgroups with more than 70% women was statistically less effective compared with placebo. Conclusion Evidence suggested that intra-articular pharmacological injections of CCS, HA, and PRP had no effect on improving TMJ pain and functional outcomes compared with placebo injection. Trial registration This study is registered with PROSPERO, number CRD42021270914.

scholarly journals Behavioral interventions for sleep disturbances in children with neurological and neurodevelopmental disorders: a systematic review and meta-analysis of randomized controlled trials

SLEEP ◽  
2020 ◽  
Vol 43 (9) ◽  
Author(s):  
Natalie L Phillips ◽  
Teleri Moore ◽  
Arthur Teng ◽  
Naomi Brookes ◽  
Tonya M Palermo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Neurodevelopmental Disorders ◽  
Functional Outcomes ◽  
Behavioral Interventions ◽  
Sleep Disturbances ◽  
Meta Analysis ◽  
Sleep Onset ◽  
Controlled Trials ◽  
Randomized Controlled

Abstract Study Objectives Sleep disturbances are common and associated with negative functional and health consequences in children with neurological and neurodevelopmental disorders (NNDDs) and represent an important potential target for behavioral interventions. This systematic review examined the efficacy of behavioral sleep interventions (BSIs) for children with NNDDs and comorbid sleep disturbances. Methods A systematic search of MEDLINE, EMBASE, PsychINFO, and CENTRAL was conducted in April 2019. Randomized controlled trials (RCTs) of BSI for children with NNDDS were included. Meta-analysis and GRADE quality ratings were performed on sleep and secondary functional outcomes (cognition, academics, and behavior). Results Nine RCTs were identified (n = 690; Mage = 8.39 ± 2.64years; 71.11% male). The quality of the evidence was predominantly rated as moderate. Posttreatment improvements in sleep were found on self-reported sleep disturbances (total sleep disturbance [standardized mean difference, i.e. SMD = 0.89], night wakings [SMD = 0.52], bedtime resistance [SMD = 0.53], parasomnias [SMD = 0.34], sleep anxiety [SMD = 0.50]) and self-reported sleep patterns (sleep duration [SMD = 0.30], sleep onset duration [SMD = 0.75]) and (2) objectively measured actigraphic sleep patterns (total sleep time [MD = 18.09 min; SMD = 0.32], sleep onset latency [MD = 11.96 min; SMD = 0.41]). Improvements in sleep (self-reported, not actigraphy) were maintained at follow-up, but few studies conducted follow-up assessments resulting in low-quality evidence. Reduction in total behavioral problems (SMD = 0.48) posttreatment and attention/hyperactivity (SMD = 0.28) at follow-up was found. Changes in cognition and academic skills were not examined in any studies. Conclusions BSIs improve sleep, at least in the short term, in children with NNDDs. Benefits may extend to functional improvements in behavior. More rigorous RCTs involving placebo controls, blinded outcome assessment, longer follow-up durations, and assessment of functional outcomes are required.

scholarly journals Efficacy of Intraoperative Platelet-Rich Plasma Augmentation and Postoperative Platelet-Rich Plasma Booster Injection for Rotator Cuff Healing: A Randomized Controlled Clinical Trial

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110061
Author(s):  
Bei Liu ◽  
Hyeon Jang Jeong ◽  
Ji Hyun Yeo ◽  
Joo Han Oh
Keyword(s):  
Rotator Cuff ◽  
Functional Outcomes ◽  
Platelet Rich Plasma ◽  
Rotator Cuff Tears ◽  
Control Group ◽  
Level Of Evidence ◽  
Booster Injection ◽  
Randomized Controlled ◽  
Shoulder Range Of Motion

Background: Platelet-rich plasma (PRP) has been applied as an adjuvant treatment for arthroscopic rotator cuff repair (ARCR) to enhance rotator cuff healing. However, it remains debatable whether PRP enhances tendon-to-bone healing. Purpose: To assess the efficacy of intraoperative augmentation and postoperative injection of PRP that was prepared using the double-spin method and calcium activation without thrombin in patients with ARCR. Study Design: Randomized controlled trial; Level of evidence, 1; and cohort study; Level of evidence, 3. Methods: A total of 58 patients underwent ARCR using intraoperative PRP augmentation. Half of the patients were randomly assigned to receive an additional ultrasound-guided PRP injection at the repair site at 2 weeks postoperatively (PRP-booster group); the other half did not receive the booster injection (PRP-only group). A control group that did not receive any PRP treatment was retrospectively matched using propensity score matching. Structural integrity was assessed using magnetic resonance imaging at 1 year postoperatively, and healing rates were compared between patients with tear sizes ≤2 cm versus >2 cm. Functional outcomes were assessed using the visual analog scale (VAS) for pain; VAS for satisfaction; shoulder range of motion; and Constant, American Shoulder and Elbow Surgeons, and Simple Shoulder Test scores at minimum 2-year follow-up. Results: In patients with tears >2 cm, the rate of healing failure at 1-year follow-up was significantly less in the overall PRP group than in the control group (12.9% vs 35.7%, respectively; P = .040), however, the PRP-booster group did not present a better healing rate than did the PRP-only group. The overall PRP group had lower VAS for pain scores compared with the control group (0.5 ± 1.1 vs 1.3 ± 1.8, respectively; P = .016) and higher VAS for satisfaction scores (9.2 ± 1.2 vs 8.6 ± 1.7; P = .023) at the final follow-up, whereas no statistical difference was found between the PRP-only and PRP-booster groups in functional outcomes. Conclusion: Intraoperative PRP augmentation during ARCR demonstrated superior anatomic healing results in patients with rotator cuff tears >2 cm as well as reduced pain and increased subjective satisfaction. PRP booster injection provided no additional benefit to tendon integrity or functional recovery.

The Efficacy of Platelet-Rich Plasma and Platelet-Rich Fibrin in Arthroscopic Rotator Cuff Repair: A Meta-analysis of Randomized Controlled Trials

2018 ◽  
Vol 47 (3) ◽  
pp. 753-761 ◽  
Author(s):  
Eoghan T. Hurley ◽  
Daren Lim Fat ◽  
Cathal J. Moran ◽  
Hannan Mullett
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Functional Outcomes ◽  
Platelet Rich Plasma ◽  
Constant Score ◽  
Meta Analysis ◽  
Tendon Healing ◽  
Randomized Controlled ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background: Basic science studies suggest that platelet-rich therapies have a positive effect on tendon repair. However, the clinical evidence is conflicted on whether this translates to increased tendon healing and improved functional outcomes. Purpose: To perform a systematic review of randomized controlled trials (RCTs) in the literature to ascertain whether platelet-rich plasma (PRP) or platelet-rich fibrin (PRF) improved patient outcomes in arthroscopic rotator cuff repair. Study Design: Meta-analysis. Methods: Two independent reviewers performed the literature search based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, with a third author resolving any discrepancies. RCTs comparing PRP or PRF to a control in rotator cuff repair were included. Quality of evidence was assessed using the Jadad score. Clinical outcomes were compared using the risk ratio for dichotomous variables and the mean difference for continuous variables. A P value <.05 was deemed statistically significant. Results: Eighteen RCTs with 1147 patients were included in this review. PRP resulted in significantly decreased rates of incomplete tendon healing for all tears combined (17.2% vs 30.5%, respectively; P < .05), incomplete tendon healing in small-medium tears (22.4% vs 38.3%, respectively; P < .05), and incomplete tendon healing in medium-large tears (12.3% vs 30.5%, respectively; P < .05) compared to the control. There was a significant result in favor of PRP for the Constant score (85.6 vs 83.1, respectively; P < .05) and the visual analog scale score for pain at 30 days postoperatively (2.9 vs 4.3, respectively; P < .05) and at final follow-up (1.2 vs 1.4, respectively; P < .05) compared to the control. PRF did not result in a significantly decreased rate of incomplete tendon healing for all tears combined (23.0% vs 24.6%, respectively; P = .74) or an improved Constant score (80.8 vs 79.8, respectively; P = .27) compared to the control. PRF resulted in a significantly longer operation time (99.1 vs 83.3 minutes, respectively; P< .05) compared to the control. Conclusion: The current evidence indicates that the use of PRP in rotator cuff repair results in improved healing rates, pain levels, and functional outcomes. In contrast, PRF has been shown to have no benefit in improving tendon healing rates or functional outcomes.

scholarly journals Can platelet-rich plasma injections provide better pain relief and functional outcomes in persons with common shoulder diseases: a meta-analysis of randomized controlled trials

2021 ◽  
Author(s):  
Apurba Barman ◽  
Archana Mishra ◽  
Rituparna Maiti ◽  
Jagannatha Sahoo ◽  
Kaustav Basu Thakur ◽  
...  
Keyword(s):  
Pain Relief ◽  
Randomized Controlled Trials ◽  
Functional Outcomes ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Functional Improvement ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Effective Pain Relief ◽  
Meta Analyses

Background: To evaluate the efficacy of autologous platelet-rich plasma (PRP) injections in the treatment of common shoulder diseases.Methods: The PubMed, Medline, and Central databases and trial registries were searched from their inception to July 2020 for randomized controlled trials of autologous PRP injections for shoulder diseases versus placebo or any control intervention. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed in the selection, analysis, and reporting of findings. The primary outcome was pain intensity (visual analog scale), and secondary outcomes were changes in function and quality of life (QoL). Results: A total of 17 randomized controlled trials of PRP versus control were analyzed. From 8–12 weeks to ≥1 year, PRP injections were associated with better pain relief and functional outcomes than control interventions. PRP injections were also associated with greater QoL, with an effect size of 2.61 (95% confidence interval, 2.01–14.17) at medium-term follow-up. Compared with placebo and corticosteroid injections, PRP injections provide better pain relief and functional improvement. In subgroup analyses, trials in which PRP was prepared by the double centrifugation technique, the platelet concentration in the PRP was enriched ≥5 times, leucocyte-rich PRP was used, or an activating agent was used before application reported the most effective pain relief at 6–7 months. Conclusions: PRP injections could provide better pain relief and functional outcomes than other treatments for persons presenting with common shoulder diseases. PRP injections have a greater capacity to improve shoulder-related QoL than other interventions.

scholarly journals THE TLINICAL EFFICACY OF AUTOLOGOUS CONCENTRATED PLATELETS IN TREATMENT OF TMJ DISORDERS - A PILOT STUDY

2014 ◽  
Vol 04 (03) ◽  
pp. 070-074
Author(s):  
S.M. Sharma ◽  
Dhruvit Thakar
Keyword(s):  
Growth Factors ◽  
Temporomandibular Joint ◽  
Platelet Rich Plasma ◽  
Autologous Blood ◽  
Venous Blood ◽  
Mouth Opening ◽  
Adhesive Properties ◽  
Novel Approach ◽  
Plasma Cytokines

AbstractPlatelet rich plasma is a natural concentrate of autologous blood growth factor which is obtained by sequestering and concentrating platelets by gradient density centrifugation experimented in different fields of medicine in order to test its potential to enhance tissue regeneration. These platelets when activated undergo degranulation to release growth factors with healing properties. It also contains plasma, cytokines, thrombin, and other growth factors that are implicated in wound healing and have inherent biological and adhesive properties. The aim of the study is to explore a novel approach to treat degenerative lesion of the articular cartilage of temporomandibular joint. Patients with chronic degenerative conditions of the joint, were treated with intra articular PRP injections. The procedure involved collection of 10 ml of venous blood and twice centrifuged to obtain 2 ml of PRP which was used for injection after activation by calcium chloride. The patients were clinically prospectively evaluated before and at the end of the treatment, and at 2, 4, and 6 months of follow up. Inter incisical mouth opening, clicking of temporomandibular joint and VAS for pain were used for clinical evaluation. The results showed significant improvement of all clinical scores from basal evaluation to the end of the therapy and on follow up at 2-6 months. The preliminary results indicate that the treatment with PRP injections are safe and has the potential to reduce pain and improvement joint function with low degree of articular degeneration.

scholarly journals Conservative oxygen therapy for critically ill patients: a meta-analysis of randomized controlled trials

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Xiao-Li Chen ◽  
Bei-Lei Zhang ◽  
Chang Meng ◽  
Hui-Bin Huang ◽  
Bin Du
Keyword(s):  
Sensitivity Analysis ◽  
Randomized Controlled Trials ◽  
Critically Ill Patients ◽  
Oxygen Therapy ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Icu Patients ◽  
Randomized Controlled

Abstract Objective Conservative oxygen strategy is recommended in acute illness while its benefit in ICU patients remains controversial. Therefore, we sought to conduct a systematic review and meta-analysis to examine such oxygen strategies’ effect and safety in ICU patients. Methods We searched PubMed, Embase, and the Cochrane database from inception to Feb 15, 2021. Randomized controlled trials (RCTs) that compared a conservative oxygen strategy to a conventional strategy in critically ill patients were included. Results were expressed as mean difference (MD) and risk ratio (RR) with a 95% confidence interval (CI). The primary outcome was the longest follow-up mortality. Heterogeneity, sensitivity analysis, and publication bias were also investigated to test the robustness of the primary outcome. Results We included seven trials with a total of 5265 patients. In general, the conventional group had significantly higher SpO2 or PaO2 than that in the conservative group. No statistically significant differences were found in the longest follow-up mortality (RR, 1.03; 95% CI, 0.97–1.10; I2=18%; P=0.34) between the two oxygen strategies when pooling studies enrolling subjects with various degrees of hypoxemia. Further sensitivity analysis showed that ICU patients with mild-to-moderate hypoxemia (PaO2/FiO2 >100 mmHg) had significantly lower mortality (RR, 1.24; 95% CI, 1.05–1.46; I2=0%; P=0.01) when receiving conservative oxygen therapy. These findings were also confirmed in other study periods. Additional, secondary outcomes of the duration of mechanical ventilation, the length of stay in the ICU and hospital, change in sequential organ failure assessment score, and adverse events were comparable between the two strategies. Conclusions Our findings indicate that conservative oxygen therapy strategy did not improve the prognosis of the overall ICU patients. The subgroup of ICU patients with mild to moderate hypoxemia might obtain prognosis benefit from such a strategy without affecting other critical clinical results.

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