Comparing the efficacy of different intra-articular injections for knee osteoarthritis: A network analysis.

BACKGROUND: The findings on the effectiveness of platelet-rich plasma, ozone, and hyaluronic acid in the treatment of osteoarthritis of the knee are controversial, and the existing original studies and meta-analyses are mostly comparisons of a single joint cavity injection method, lacking direct and indirect comparisons of different drugs in the joint cavity. The lack of direct and indirect comparisons of different drugs in the joint cavity makes it difficult to have a clearer and more comprehensive understanding of joint cavity injection methods. In this study, the efficacy of platelet-rich, ozone, sodium hyaluronate, and combined knee cavity injections were compared directly or indirectly using a reticulated meta-analysis in this field, and the efficacy of treatment measures was ranked to provide more comprehensive and reliable evidence-based clinical evidence for the selection of knee cavity injections in osteoarthritis of the knee. OBJECTIVE: To compare the effects of platelet-rich plasma, ozone, and sodium glassate injection interventions on the efficacy of osteoarthritis of the knee through reticulated Meta-analysis, and to comprehensively compare the clinical effectiveness of platelet-rich plasma, ozone, and sodium glassate injection joint cavity injection for the treatment of osteoarthritis of the knee. METHODS: The PubMed, CBM, CNKI, VIP, and Wan-Fang databases were searched for information on the effectiveness of platelet-rich plasma, ozone, and sodium vitrate injection for the comparative treatment of osteoarthritis of the knee, with a search time frame of each database from the date of creation to July 20, 2021. Two investigators independently screened the literature, extracted data according to inclusion and exclusion criteria, and evaluated the quality of the literature in parallel. Statistical analysis was performed using Stata 16.0 software to compare the differences in the efficacy of each treatment measure using the ratio and 95% confidence interval as effect indicators and to rank the efficacy. RESULTS: Thirty-three RCTs with 7003 patients with osteoarthritis of the knee were included, involving 5 therapeutic measures. Meta-analysis showed that the efficacy of platelet-rich plasma injection was superior to both ozone and hyaluronic acid therapies. Hyaluronic acid+ozone and platelet-rich plasma+hyaluronic acid were both superior to ozone and hyaluronic acid monotherapy. The differences in efficacy between hyaluronic acid and ozone compared with platelet-rich plasma were statistically significant, and the differences in efficacy between the 2 combination therapies (platelet-rich plasma+hyaluronic acid, hyaluronic acid+ozone) and the 3 monotherapies (platelet-rich plasma, ozone, hyaluronic acid) were statistically significant. Platelet-rich plasma+hyaluronic acid, hyaluronic acid+ozone compared with 3 monotherapies (platelet-rich plasma, ozone, hyaluronic acid) were statistically significant, except for the difference in efficacy with platelet-rich plasma, which was not statistically significant, indicating that this platelet-rich plasma+hyaluronic acid and Hyaluronic acid+ozone combination therapy was superior to monotherapy. Also, the efficacy of platelet-rich plasma was better than hyaluronic acid and ozone and the difference was statistically significant, indicating that platelet-rich plasma was more effective than ozone and sodium glass in the treatment of osteoarthritis of the knee in monotherapy. CONCLUSION: It is believed that in the course of clinical practice, hyaluronic acid+ozone or platelet-rich plasma+hyaluronic acid combination therapy or platelet-rich plasma therapy can be preferred for patients with osteoarthritis of the knee.

Amikacin can be added to blood to reduce the fall in platelet count.

Our objective was to develop an effective method to prevent the fall in platelet count for patients with anticoagulant-dependent (AD) pseudothrombocytopenia, a spurious phenomenon due to anticoagulant-induced aggregation of platelets. We report a case of insidious multianticoagulant-dependent pseudothrombocytopenia in which AD pseudothrombocytopenia may be caused by 4 anticoagulants, eg, EDTA, sodium citrate, heparin, and sodium fluoride (NaF). Multianticoagulant-dependent pseudothrombocytopenia was confirmed by finding clumped platelets on microscopic evaluation in 4 anticoagulated blood samples. With this case, we tried a variety of reagents, including aminoglycosides, eg, gentamicin and amikacin, vitamin B(6), and aminophylline to inhibit pseudothrombocytopenia. Except for amikacin, all reagents failed to prevent pseudothrombocytopenia. Microscopic examination of K(2)-EDTA-, heparin-, sodium citrate-, and NaF-anticoagulated blood samples showed massive platelet clumping, but no aggregate was seen in the anticoagulated blood with amikacin. When amikacin was added within 1 hour after blood sample withdrawal, platelet, WBC, and RBC counts and hemoglobin level, mean corpuscular volume, and mean platelet volume remained unchanged for up to 4 hours at room temperature. These findings suggest that amikacin could inhibit and dissociate pseudo platelet aggregation in multianticoagulant-dependent pseudothrombocytopenia and EDTA-induced pseudothrombocytopenia.

Expression of albumin, IGF-1, IGFBP-3 in tumor tissues and adjacent non-tumor tissues of hepatocellular carcinoma patients with cirrhosis.

AIM: To explore the expression of albumin (ALB), insulin-like growth factor (IGF)-1, and insulin-like growth factor binding protein (IGFBP)-3 in tumor tissues and adjacent non-tumor tissues of hepatocellular carcinoma (HCC) patients with cirrhosis. METHODS: Twenty-four HCC patients with cirrhosis who underwent hepatectomy were studied. ALB mRNA, IGF-1 mRNA, and IGFBP-3 mRNA in liver tissues (including tumor tissues and adjacent non-tumor tissues) were detected by reverse transcriptase-polymerase chain reaction (RT-PCR). Liver Ki67 immunohistochemistry staining was studied. At the same time, 12 patients with cholelithiasis or liver angioma who underwent operation were segregated as normal control. RESULTS: In HCC patients with cirrhosis, hepatic ALB mRNA, IGF-1 mRNA, and IGFBP-3 mRNA of tumor tissues or adjacent non-tumor tissues were lower than the normal liver tissues, while in tumor tissues, hepatic ALB mRNA and IGFBP-3 mRNA were lower, hepatic IGF-1 mRNA was higher than in adjacent non-tumor tissues. Liver Ki67 labeling index (Ki67 LI) in tumor tissues or adjacent non-tumor tissues were higher than that in the normal liver tissues, while in tumor tissues it was higher than that in adjacent non-tumor tissues. CONCLUSION: Imbalance of IGF-1 and IGFBP-3 may play a role in hepatocarcinogenesis and tumor development of liver cirrhosis patients.

[Clinical analysis of missed diagnosis of duodenal injury in 9 cases].

OBJECTIVE: To study the reasons and possibly solutions for missed diagnosis of duodenal injury. METHOD The clinical records were retrospectively analyzed in 9 cases of missed diagnosis of duodenal injury treated in our hospital in the year 1992 to 2002. RESULTS Of the 15 cases of duodenal injury, missed diagnoses occurred in 9 cases. The reasons for the missed diagnoses included complications by injuries of the other abdominal organs that concealed duodenal injuries, neglect of the light injuries, and the lack of clinical experience on the part of the young doctors. CONCLUSION Duodenal injury frequently occurs along with other abdominal organ injuries and is easy to escape detection, which can be avoided by careful preoperative examination of the characteristics of injuries and the patients' clinical manifestations after the injury.