Efficacy of platelet-rich plasma as conservative treatment in orthopaedics. a systematic review and meta-analysis

Background. The aim of this systematic review and meta-analysis was to evaluate the benefit of platelet-rich plasma (PRP) in non-surgical orthopaedic procedures. Material and methods. We searched the Cochrane Wounds Specialized Register, CENTRAL, MEDLINE (through PUBMED), Embase, and SCOPUS. We also searched clinical trials registries for ongoing and unpublished studies and checked reference lists to identify additional studies. Results. We found 36 randomised controlled trials (2,073 patients) that met our inclusion criteria. The included studies mostly had small numbers of participants (from 20 to 225). Twenty-eight studies included patients with lateral epicondylitis or plantar fasciitis. PRP was compared to local steroids injection (19 studies), saline injection (6 studies), autologous whole blood (4 studies), local anaesthetic injection (3 studies), dry needling injection (3 studies), and to other comparators (4 studies). Primary outcomes were pain and function scores, and adverse events. On average, it is unclear whether or not use of PRP compared to controls reduces pain scores and functional score at short- (up to 3 months) and medium- (4-6 months) term follow-up. The available evidence for all the comparisons was rated as very low quality due to inconsistency, imprecision, and risk of bias in most of the selected studies. There were no serious adverse events related to PRP injection or control treatments. Conclusions. The results of this meta-analysis, which documents the very marginal effectiveness of PRP compared to controls, does not support the use of PRP as conservative treatment in orthopaedics

The use of viscoelastic haemostatic assays in non-cardiac surgical settings. a systematic review and meta-analysis

Background: Thrombelastography (TEG) and rotational thromboelastometry (ROTEM) are viscoelastic haemostatic assays (VHA) which exploit the elastic properties of clotting blood. The aim of this systematic review and meta-analysis was to evaluate the usefulness of these tests in bleeding patients outside the cardiac surgical setting. Materials and methods: We searched the Cochrane Library, MEDLINE, EMBASE and SCOPUS. We also searched clinical trial registries for ongoing and unpublished studies, and checked reference lists to identify additional studies. Results: We found 4 randomised controlled trials (RCTs) that met our inclusion criteria with a total of 229 participants. The sample size was small (from 28 to 111 patients) and the follow-up periods very heterogenous (from 4 weeks to 3 years). Pooled data from the 3 trials reporting on mortality (199 participants) do not show any effect of the use of TEG on mortality as compared to standard monitoring (based on the average treatment effect from a fixed-effects model): Risk Ratio (RR) 0.71; 95% Confidence Interval (CI): 0.43 to 1.16. Likewise, the use of VHA does not reduce the need for red blood cells (mean difference -0.64; 95% CI: -1.51 to 0.23), platelet concentrates (mean difference -1.12; 95% CI: -3.25 to 1.02), and fresh frozen plasma (mean difference -0.91; 95% CI: -2.02 to 0.19) transfusion. The evidence on mortality and other outcomes was uncertain (very low-certainty evidence, down-graded due to risk of biases, imprecision, and inconsistency). Conclusions: Overall, the certainty of the evidence provided by the trials was too low for us to be certain of the benefits and harms of viscoelastic haemostatic assay in non-cardiac surgical settings. More, larger, and better-designed RCTs should be carried out in this area

Safety and efficacy of tranexamic acid for prevention of obstetric haemorrhage. An updated systematic review and meta-analysis

Background. A number of clinical systematic review and meta-analysis have been published on the use of tranexamic in the obstetric setting. The aim of this meta-analysis was to evaluate the safety and effectiveness of tranexamic acid in reducing blood loss when given prior to caesarean delivery. Materials and methods. We searched the Cochrane Wounds Specialized Register, Cochrane Central, MEDLINE (through PUBMED), Embase, and SCOPUS electronic databases. We also searched clinical trials registries for ongoing and unpublished studies, and checked reference lists to identify additional studies. We used no restrictions with respect to language and date of publication. Two review authors independently performed study selection, "Risk of bias" assessment, and data extraction. Initial disagreements were resolved by discussion, or by including a third review author when necessary. Results. We found 18 randomised controlled trials (RCTs) that met our inclusion criteria. Overall, 1,764 women receiving intravenous tranexamic acid for prevention of bleeding following caesarean sections and 1,793 controls receiving placebo were enrolled in the 18 RCTs evaluated. The use of tranexamic acid compared to controls (placebo or no intervention) reduces post-partum haemorrhage >400 mL (risk ratio [RR] 0.40, 95% confidence interval [CI] 0.24-0.65; 5 trials with a total of 786 participants), severe post-partum haemorrhage >1,000 mL (RR 0.32, 95% CI: 0.12-0.84; 5 trials with a total of 1,850 participants), and need for red blood cell transfusion (RR 0.30, 95% CI: 0.18-0.49; 10 trials with a total of 1,873 participants). No particular safety concerns on the use of this antifibrinolytic agent emerged from the analysis of the 18 RCTs included. Discussion. Overall, the results of this meta-analysis support the evidence of a beneficial effect of tranexamic acid in reducing blood loss and need for blood transfusion in pregnant women undergoing caesarean section

Amniotic membrane application in complex cases of penetrating keratoplasty surgery

INTRODUCTION. The aim of the study is to investigate the ability of an amniotic membrane implant combined with penetrating keratoplasty to reduce early and mid-term complications in complex cases such as penetrating burns, infective ulcers, keratitis, or corneal graft failure. MATERIALS AND METHODS. Fifty patients: 12 with keratitis, 24 with infective ulcers, 10 with penetrating trauma, and four with a history of corneal graft failure, were divided into two groups. The first group of 25 patients (Group A) underwent penetrating keratoplasty alone, while the second group of 25 patients (Group B) received penetrating keratoplasty associated with an amniotic membrane implant. Amniotic membrane implantation was performed in a ‘patch modality’, and the membrane was sewn to the graft with the epithelium/basement membrane side facing inwards. All patients were evaluated, respectively, 3, 15, 30, 90, and 180 days after surgery. At each visit a slit-lamp examination was performed together with corneal thickness and endothelial cell count assessment. All the data were subjected to statistical analysis with Student’s t-test. RESULTS. At the slit-lamp examination in Group A 48% of patients showed Descemet folds at one and three months, respectively, while 80% of patients of Group B did not show any Descemet folds. In Group A we registered two cases of early graft failure and two cases of shallow anterior chamber, while none of these complications appeared in Group B. In Group A the average corneal thickness at 15, 30, 90, and 180 days post-operatively was, respectively, 695 ± 43 μm, 658 ± 31 μm, 588 ± 12 μm, and 518 ± 20 μm, while in Group B it was found to be, respectively, 667 ± 12 μm, 632 ± 17 μm, 562 ± 16 μm, and 516 ± 10 μm. Differences in corneal thickness between Group A and Group B were found to be statistically significant (p = 0.05). Endothelial cell count was in Group A 2582 c/mm2 at 15 days, 2500 c/mm2 at one month, 2335 c/mm2 at three months, and 2111 c/mm2 at six months, while the average count for Group B patients was 2607 c/mm2, 2503 c/mm2, 2299 c/mm2, and 2086 c/mm2, respectively. Differences in endothelial cell count between the two groups did not show any statistical significance (p > 0.05). CONCLUSIONS. Amniotic membrane implantation associated with penetrating keratoplasty reduces early and mid-term complications of corneal grafts in patients with high risk of failure. This positive effect may be due to the anti-inflammatory, neurotrophic, and anti-angiogenetic properties of the amniotic membrane. Longer observation and larger case series can be useful in evaluation of the functional outcome of grafts in these patients

Increased D-dimer value and occult cancer in the absence of detectable thrombosis.

Fibrin formation and removal occurs continuously during the development of malignancy. Accordingly, hemostatic disorders in cancer patients are a rather frequent observation and range from asymptomatic laboratory changes to massive thromboembolism or haemorrhage. We document the case of an asymptomatic women, who was enrolled as a healthy control in a study and showed up with a substantially increased D- dimer value. After ruling out the most probable sources of D-dimer elevation, such as thrombosis, inflammation and trauma, she underwent laboratory and radiological investigations for malignancy, which were consistent with a colorectal metastatic adenocarcinoma. This case allow us to hypothesize that screening for occult malignancy in the presence of apparently inexplicable elevated D-dimer values may be taken into consideration

Kata practice and concepts according to highly experienced judo teachers and referees

[ES] El objetivo del presente estudio fue caracterizar la práctica de la kata entre profesores, responsables de las competiciones y exámenes en la Federação Paulista de Judô. Se aplicó un cuestionario cerrado a 20 profesores (18 hombres y 2 mujeres). La edad de la muestra fue 46 ± 10 años, con experiencia en la práctica de judo de 34 ± 9 años, y graduación de 5 ± 1 dan. La práctica variaba entre 2 (50%) y 4 (30%) sesiones por mes. Se identificó lanage no kata como la más practicada (78%) y preferida (31%), seguida por la katame no kata (25%), ju no kata (21%) y kime no kata (12%). La iniciación al estudio de la kata comenzaba habitualmente en el dojo del profesor (79%) y a través de cursos ofertados por la federación estatal (21%). La práctica se orienta a la mejora de las técnicas (46%), complemento del entrenamiento de judo (29%), práctica espiritual/mental (14%) y como preparación de competiciones (11%). Se consideraron como más importantes los siguientes significados de la kata: fundamento (45%), esencia (25%), origen (15%), forma (10%) y principio (5%)

Long-term Events in Adult Patients with Clinical Stage IA-IIA Nonbulky Hodgkin's Lymphoma Treated with Four Cycles of Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine and Adjuvant Radiotherapy: A Single-Institution 15-Year Follow-up

Abstract Purpose: To report on long-term events after short doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy and adjuvant radiotherapy in favorable early-stage Hodgkin's lymphoma. Experimental Design: We monitored late events and causes of death over 15 years (median follow-up, 120 months) in 120 patients with nonbulky stage IA-IIA Hodgkin's lymphoma, treated with four cycles of ABVD and limited radiotherapy. Pulmonary and cardiac function tests were done throughout the follow-up. Outcome measures included cause-specific mortality, standardized mortality ratio, and standardized incidence ratio for secondary neoplasia. Results: Projected 15-year event-free and overall survival were 78% and 86%, and tumor mortality was 3%. Standardized mortality ratio was significantly higher than 1 for both males (2.8; P = 0.029) and females (9.4; P = 0.003). The risk of cardiovascular events at 5 and 12 years was 5.5% and 14%, with a median latent time of 67 months (range: 23-179 months) from the end of radiotherapy. Pulmonary toxicity developed in 8% of patients; all had received mediastinal irradiation and the median time from radiotherapy to pulmonary sequelae was 76 weeks (range: 50-123 weeks). The risk of secondary neoplasia at 5 and 12 years was 4% and 8%, respectively, with no cases of leukemia. Fertility was preserved. Conclusions: Long-term events were mostly related to radiotherapy; the role of short ABVD chemotherapy was very limited, as documented by fertility preservation and lack of secondary myelodysplasia/leukemia. A proportion of patients died from causes unrelated to disease progression and the excess mortality risk was mostly due to the occurrence of secondary neoplasms and cardiovascular diseases. A moderate dose reduction of radiotherapy from 40-44 Gy to 30-36 Gy did not decrease the risk of late complications; abolishing radiotherapy in nonbulky early-stage Hodgkin's lymphoma is being evaluated

Dinâmica de íons em solo ácido lixiviado com extratos de resíduos de adubos verdes e soluções

The influence of green manure residues addition in the dynamic of ions in acid soils is not well known. In this study, ion mobility in a sample of the Bw horizon of an Dark-Red Latosol (Oxisol), leached with citric and succinic acid pure solutions and with aqueous residue extracts of black oats (Avena strigosa) and oil seed radish (Raphanus sativus) were evaluated in soil columns (5, 10, 20, and 40 cm long by 4 cm diameter). After the solutions and extracts passed through the soil columns, the following parameters were determined: solubles contents of Cas, Mgs, Ks, Alst (total), Also (organic), Alsm (monomeric) and dissolved organic carbon. In soil, the parameters evaluated were the exchangeable contents of Caex, Mgex, Kex, and Alex and pH (CaCl2). Citric and succinic acids increased Alst and Cas contents, respectively, resulting in decreasing exchangeable fractions of these elements in soil. Black oats extract was more effective to extract Caex and oil seed radish to extract Alex. The decrease in Caex and Alex was followed by an increase in Kex. Organic complexes formed with low molecular organic ligands and Cas and Alex were suggested to play a role in the mobility of ions in subsoils of acid soils after the addition of both crop residues extracts and pure organic acid solutions.A influência da aplicação de resíduos vegetais na dinâmica de íons em solos ácidos é pouco conhecida. Neste estudo, a mobilidade de íons em amostra do horizonte Bw de um Latossolo Vermelho-Escuro álico lixiviado com soluções puras de ácidos cítrico e succínico e extratos aquosos de resíduos de nabo forrageiro (Raphanus sativus) e aveia-preta (Avena strigosa) foi avaliada em colunas de solo (5, 10, 20 e 40 cm de altura por 4 cm de diâmetro). Após a percolação das soluções e extratos pelas colunas de solo determinaram-se, nas soluções efluentes, os teores de Ca (Cas), Mg (Mgs), K (Ks), Al total (Alst), orgânico (Also), monomérico (Alsm) e carbono orgânico dissolvido. No solo, foram determinados os teores trocáveis de Ca (Catr), Mg (Mgtr), K (Ktr) e Al (Altr) e o pH (CaCl2). Os ácidos cítrico e succínico aumentaram os teores de Alst e Cas, respectivamente, causando reduções nas frações trocáveis desses elementos no solo. O extrato de aveia-preta foi mais efetivo na remoção do Catr e o de nabo forrageiro na do Altr. O decréscimo de Catr e Altr foi seguido do aumento do Ktr. A formação de complexos entre Cas e Altr com compostos orgânicos de baixo peso molecular foi sugerida como o provável mecanismo responsável pela mobilidade dos íons polivalentes no subsolo de solos ácidos após a aplicação dos extratos de resíduos vegetais e das soluções puras de ácidos orgânicos

Práctica y caracterización de las katas por profesores y árbitros de judo experimentados

El objetivo del presente estudio fue caracterizar la práctica de la kata entre profesores, responsables de las competiciones y exámenes en la Federação Paulista de Judô. Se aplicó un cuestionario cerrado a 20 profesores (18 hombres y 2 mujeres). La edad de la muestra fue 46 ± 10 años, con experiencia en la práctica de judo de 34 ± 9 años, y graduación de 5 ± 1 dan. La práctica variaba entre 2 (50%) y 4 (30%) sesiones por mes. Se identificó la nage no kata como la más practicada (78%) y preferida (31%), seguida por la katame no kata (25%), ju no kata (21%) y kime no kata (12%). La iniciación al estudio de la kata comenzaba habitualmente en el dojo del profesor (79%) y a través de cursos ofertados por la federación estatal (21%). La práctica se orienta a la mejora de las técnicas (46%), complemento del entrenamiento de judo (29%), práctica espiritual/mental (14%) y como preparación de competiciones (11%). Se consideraron como más importantes los siguientes significados de la kata: fundamento (45%), esencia (25%), origen (15%), forma (10%) y principio (5%)