A systematic review and meta-analysis for platelet-rich plasma in treatment of knee osteoarthritis

Objective:Knee osteoarthritis(KOA)is a common chronic joint disease that usually occurs in older people,and injuries articular cartilage and cartilage proliferation. Studies have shown that platelet-rich plasma(PRP),as one of non-surgical treatments,is used to alleviate the symptoms of patients with KOA,becoming popular with doctors. In this study,the purpose was to investigate the effects of platelet-rich plasma on the level of pain and function in patients with KOA. Methods:The Pubmed,Cochrane Library,Embase,and Medline were investigated from 2005 through May 2020. All randomized double-blind controlled trials on the effect of PRP injections for KOA were included. Outcome indicators included the Western Ontario and McMaster Universities Arthritis Index(WOMAC)and the Knee Osteoarthritis Outcome Score(KOOS)for function,the visual analogue scale(VAS)for pain,and adverse events(AEs). Review Manager 5.3 was used to calculate these outcome indicators. Results:In this study,(1)Seven studies met the eligibility criteria,including 250 patients in the experiment(PRP)group and 230 patients in the control(no PRP)group.(2)Meta-analysis results showed that the WOMAC scores were differed significantly between the PRP and no PRP groups at the 6 months follow-up(MD=9.63,95%CI:3.29 to 15.96,P=0.003),and 12 months follow-up(MD=3.85,95%CI:2.66 to 5.04,P<0.000 01)(P<0.05). In a comparison of KOOS function scores at the 6 months follow-up,PRP improved knee function scores more than no PRP(MD=8.63,95%CI:0.85 to 16.42,P=0.03)(P<0.05). PRP injections reduced pain more effectively than no PRP injections in patients with KOA at 3,6 months of follow-up,and the VAS pain score showed a significant difference(SMD=0.88,95%CI:0.13 to 1.62,P=0.02)(SMD=0.85,95%CI:0.11 to 1.59,P=0.002)(P<0.05). However,adverse events(AEs)were all not significantly different(RR=0.96,95%CI:0.65 to 1.40,P=0.82)(P>0.05).(3)Results showed that PRP has significant advantages in pain relief and functional improvement. Conclusion:In improving knee function and relieving pain,PRP showed superiority to other non-surgical treatments in long-term follow-up from well-designed double-blind trials. Due to the limited quality and data,more high-quality multi-center studies are required.

Effects of kidney-tonifying and blood circulation-promoting recipes and platelet-rich plasma on the activity and expression of type I collagen

Objective:To observe the effects of kidney-tonifying and blood circulation-promoting recipes and platelet-rich plasma(PRP)on the activity and expression of type I collagen in co-culture system.Methods:The subcutaneous adipose tissue and degenerative nucleus pulposus tissue of patients with nucleus pulposus removal under lumbar intervertebral disc degeneration were isolated and cultured by multiple enzyme digestion methods to establish a co-culture system of ADSCs/NPCs.Patients with lumbar intervertebral disc degeneration were enrolled for 2 weeks.The venous blood was taken 50mL before the first dose and one hour after the last dose.Platelet-rich plasma was prepared by secondary centrifugation and cultured with different plasma.The experiment was divided into five groups:platelet-rich plasma group(PRP),platelet-poor plasma group(PPP),drug-rich platelet-rich plasma group(M-PRP)and drug-poor platelet plasma group(M-PPP),fetal bovine serum group(FBS).The morphological changes of the cells in each group were observed under an inverted microscope.The changes of type I collagen activity were detected by immunofluorescence assay.The expression of CCOL1A1 gene was detected by RT-PCR two weeks after the intervention.Results:In this study,the results of kidney-tonifying and blood circulation-promoting recipes and PRP group intervention were shown.The results of the group intervention showed that the M-PRP group and the PRP group had clearer cell contours and better refractive index than the other groups,and there was no significant difference between the two groups.The results of immunofluorescence staining showed that the number of cells in PRP group and M-PRP group was higher,but the staining intensity of single cells was significantly lower than that in FBS group.RT-PCR results showed that the expression of COL1A1 mRNA in PPP group,PRP group,M-PRP group and M-PPP group was significantly down-regulated(P<0.05),respectively:0.343±0.040,0.294±0.018,0.310±0.022,0.430±0.020.Conclusions:Kidney-tonifying and blood circulation-promoting recipes combined with platelet-rich plasma can decrease the activity and exhibit a tendency to inhibit the expression of type I collagen.

Systematic evaluation and meta-analysis of acupuncture treatment for residual pain after lumbar disc herniation

Objective:To systematically evaluate the effectiveness and safety of acupuncture in the treatment of postoperative residual pain in lumbar disc herniation,and to provide evidence for its clinical treatment.Methods:A randomized controlled trial(RCT)of all acupuncture treatments for postoperative lumbar disc herniation in PubMed,CBM,CNKI,Wanfang,VIP,E mbase,and Cochrane libraries was published by May 2019,followed by RevMan5.3 software for meta-analysis.Results:11 randomized controlled trials were included in 855 patients,including 428 in the experimental group and 427 in the control group,with a ratio of 1:1.The results of the meta-analysis showed that the overall effective rate of the experimental group[RR=1.22,95%CI(1.15,1.29),P<0.00001],visual analogue pain(VAS)score[MD=1.59,95%CI(1.22,1.95),P<0.00001],Japanese Orthopaedic Association evaluation treatment score(JOA)[MD=5.66,95%CI(2.58,8.74),P=0.0003],the incidence of adverse hair loss[RR=0.35,95%CI(0.18,0.71),P=0.003]were significantly better than the control group,the difference was statistically significant.Conclusion:Acupuncture has obvious advantages in the treatment of residual pain after lumbar disc herniation,which can significantly relieve postoperative pain and improve quality of life.However,the conclusions of this study need to be further verified by the large sample and high quality literature.

On the prevention and treatment of cervical spondylosis^1

Cervical spondylosis is a kind of frequently occurring and refractory disease with high recurrence rate and tends to be younger. It has become a multiple refractory disease at home and abroad, and its mechanism research and clinical diagnosis and treatment are still controversial. This article will discuss the etiology, pathogenesis, mechanism and treatment of cervical spondylosis from ancient Chinese medicine and modern western medicine, and focus on the research progress of modern prevention and treatment of cervical spondylosis, in order to provide reference for modern clinical treatment of cervical spondylosis.

Effects of Kidney-tonifying and Blood Circulation-promoting Recipes and PRP on the Activity and Expression of Type I Collagen

Objective:To observe the effects of kidney-tonifying and blood circulation-promoting recipes and platelet-rich plasma (PRP) on the activity and expression of type I collagen in co-culture system.Methods:The subcutaneous adipose tissue and degenerative nucleus pulposus tissue of patients with nucleus pulposus removal under lumbar intervertebral disc degeneration were isolated and cultured by multiple enzyme digestion methods to establish a co-culture system of ADSCs/NPCs. Patients with lumbar intervertebral disc degeneration were enrolled for 2 weeks.The venous blood was taken 50mL before the first dose and one hour after the last dose. Platelet-rich plasma was prepared by secondary centrifugation and cultured with different plasma. The experiment was divided into five groups: platelet-rich plasma group (PRP), platelet-poor plasma group (PPP), drug-rich platelet-rich plasma group (M-PRP) and drug-poor platelet plasma group (M-PPP), fetal bovine serum group (FBS). The morphological changes of the cells in each group were observed under an inverted microscope. The changes of type I collagen activity were detected by immunofluorescence assay. The expression of CCOL1A1 gene was detected by RT-PCR two weeks after the intervention.Results:In this study, the results of kidney-tonifying and blood circulation-promoting recipes and PRP group intervention were shown. The results of the group intervention showed that the M-PRP group and the PRP group had clearer cell contours and better refractive index than the other groups, and there was no significant difference between the two groups. The results of immunofluorescence staining showed that the number of cells in PRP group and M-PRP group was higher, but the staining intensity of single cells was significantly lower than that in FBS group. RT-PCR results showed that the expression of COL1A1 mRNA in PPP group, PRP group, M-PRP group and M-PPP group was significantly down-regulated (P<0.05), respectively: 0.343±0.040, 0.294±0.018, 0.310±0.022, 0.430±0.020.Conclusion:Kidney-tonifying and blood circulation-promoting recipes combined with platelet-rich plasma can decrease the activity and exhibit a tendency to inhibit the expression of type I collagen.

Systematic evaluation and Meta-analysis 0f the improvement of pain and function after total knee replacement by percutaneous electrical stimulation

Objective:To systematically evaluate the effectiveness and safety of acupuncture in the treatment of postoperative residual pain in lumbar disc herniation, and to provide evidence for its clinical treatment. Methods A randomized controlled trial (RCT) of all acupuncture treatments for postoperative lumbar disc herniation in PubMed, CBM, CNKI, Wanfang, VIP, Embase and Cochrane libraries was published by May 2019, followed by RevMan5.3 software for meta-analysis. Results 11 randomized controlled trials were included in 855 patients, including 428 in the experimental group and 427 in the control group, with a ratio of 1:1. The results of the meta-analysis showed that the overall effective rate of the experimental group [RR=1.22, 95%CI(1.15, 1.29), P<0.00001], visual analogue pain (VAS) score [MD=1.59, 95%CI(1.22, 1.95), P<0.00001], Japanese Orthopaedic Association evaluation treatment score(JOA)[MD=5.66, 95%CI (2.58, 8.74), P=0.0003], the incidence of adverse hair loss [RR=0.35, 95%CI(0.18, 0.71), P=0.003]were significantly better than the control group, the difference was statistically significant. Conclusions Acupuncture has obvious advantages in the treatment of residual pain after lumbar disc herniation, which can significantly relieve postoperative pain and improve quality of life. However, the conclusions of this study need to be further verified by the large sample and high quality literature.

Effect of Static Load on the Nucleus Pulposus of Rabbit Intervertebral Disc Motion Segment in Ex vivo Organ Culture

Background：The development of mechanically active culture systems helps increase the understanding of the role of mechanical stress in intervertebral disc （IVD） degeneration.Motion segment cultures allow for preservation of the native IVD structure,and adjacent vertebral bodies facilitate the application and control of mechanical loads.The purpose of this study was to establish loading and organ culture methods for rabbit IVD motion segments to study the effect of static load on the whole disc organ.Methods：IVD motion segments were harvested from rabbit lumbar spines and cultured in no-loading 6-well plates （control conditions） or custom-made apparatuses under a constant,compressive load （3 kg,0.5 MPa） for up to 14 days.Tissue integrity,matrix synthesis,and the matrix gene expression profile were assessed after 3,7,and 14 days of culturing and compared with those of fresh tissues.Results：The results showed that ex vivo culturing of motion segments preserved tissue integrity under no-loading conditions for 14 days whereas the static load gradually destroyed the morphology after 3 days.Proteoglycan contents were decreased under both conditions,with a more obvious decrease under static load,and proteoglycan gene expression was also downregulated.However,under static load,immunohistochemical staining intensity and collagen Type Ⅱ alpha 1 （COL2A 1） gene expression were significantly enhanced （61.54 ± 5.91,P =0.035） and upregulated （1.195 ± 0.040,P =0.000）,respectively,compared with those in the controls （P 〈 0.05）.In contrast,under constant compression,these trends were reversed.Our initial results indicated that short-term static load stimulated the synthesis of collagen Type Ⅱ alpha l;however,sustained constant compression led to progressive degeneration and specifically to a decreased proteoglycan content.Conclusions：A loading and organ culture system for ex vivo rabbit IVD motion segments was developed.Using this system,we were able to study the effects of mechanical stimulation on the biology of IVDs,as well as the pathomechanics of IVD degeneration.