Efficacy of pillar suture for post-tonsillectomy morbidity in children: a meta-analysis.

INTRODUCTION: Several surgical techniques have been used during tonsillectomy to reduce complications. OBJECTIVES: To assess the effects of pillar suture in conjunction with tonsillectomy as compared to tonsillectomy without suture in children. METHODS: Two authors independently searched five databases (PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database) for studies published as recent as December 2018. Of the included studies, we compared tonsillectomy and pillar suture in combination (suture groups) with tonsillectomy alone,without suture, (control group). Postoperative pain intensity and other morbidities (e.g., postoperative bleeding, palatal hematoma, discomfort, and pillar edema) were measured during the postoperative period. RESULTS: Postoperative bleeding [primary (OR = 0.47 [0.27; 0.81]) and secondary (OR = 0.14 [0.02; 0.78]) were significantly decreased in the pillar suture group compared to the control group. There were no significant differences between the two groups in postoperative pain at day 7 (SMD = -0.39 [-0.79; 0.00]), palatal hematoma (OR = 5.00 [0.22; 112.88]), palatal discomfort sensation (OR = 2.62 [0.60; 11.46]), site infection (OR = 5.27 [0.24; 113.35]), and velopharyngeal insufficiency (OR = 2.82 [0.11; 74.51]). By contrast, pillar edema (OR = 9.55 [4.29; 21.29]) was significantly increased in the pillar suture group compared to the control group. CONCLUSIONS: Pillar suture combined with tonsillectomy may reduce postoperative bleeding incidence despite increasing pillar edema in pediatric tonsillectomy. Postoperative pain-relief, palatal hematoma, palatal discomfort sensation, site infection, and velopharyngeal insufficiency were not significantly altered compared to tonsillectomy alone. However, further studies are needed to corroborate the results of this study.

ALLOGENEIC PLATELET-RICH PLASMA FOR ROTATOR CUFF REPAIR.

OBJECTIVE: To investigate the safety and efficacy of allogeneic platelet-rich plasma (PRP) in rotator cuff repair . METHODS: Seventeen patients with a full-thickness rotator cuff tear were included. Ten patients underwent arthroscopic rotator cuff repair with allogeneic, and seven patients with autologous PRP. Three PRP gels in a volume 3 ml each were applied between the torn end and the greater tuberosity. Clinical outcomes were assessed preoperatively and at a minimum of 2 years after surgery. Structural outcomes were evaluated with the presence of retear and the change of the cross-sectional area (ACT) of the supraspinatus . RESULTS: Allogeneic PRP did not cause any adverse events during the follow-up period. There was no significant difference in the clinical outcome measures between the two groups (all p > 0.05). The retear rate was 33.3% and 25.0% in the allogeneic group and autologous group, respectively (p = 0.764). The change between the one-year postoperative and immediately postoperative ACT was not also significantly different between the two groups (p = 0.373) . CONCLUSION: Allogeneic PRP in arthroscopic rotator cuff did not cause any local or general complications and that has the efficacy comparable to autologous PRP with respect to the clinical and structural outcomes. Level of Evidence III, Retrospective Comparative Study.

OBJETIVO: Investigar a segurança e eficácia do plasma rico em plaquetas alogênico (PRP) no reparo do manguito rotador. MÉTODOS: Foram incluídos dezessete pacientes com ruptura da espessura total do manguito rotador. Dez pacientes foram submetidos a reparo artroscópico do manguito rotador com PRP alogênico e sete pacientes com PRP autólogo. Três géis de PRP de 3ml cada foram aplicados entre a extremidade lesionada e a tuberosidade maior. Os resultados clínicos foram avaliados no pré-operatório e no mínimo 2 anos após a cirurgia. Os resultados estruturais foram avaliados com a presença de nova ruptura e a alteração da área em corte transversal (ACT) do supra-espinhal. RESULTADOS: O PRP alogênico não causou quaisquer eventos adversos durante o período de acompanhamento. Não houve diferença significativa nas medidas de resultados clínicos entre os dois grupos (todos os valores p> 0,05). A taxa de nova ruptura foi de 33,3% e 25,0% no grupo alogênico e grupo autólogo, respectivamente (p = 0,764). A alteração da ACT entre o pós-operatório de um ano e imediatamente no pós-operatório também não foi significativamente diferente entre os dois grupos (p = 0,373) . CONCLUSÃO: O PRP alogênico administrado por via artroscópica no manguito rotador não causou quaisquer complicações locais ou gerais e sua eficácia é comparável ao PRP autólogo no que diz respeito aos resultados clínicos e estruturais. Nível de Evidência III, Estudo Retrospectivo Comparativo.

ALLOGENEIC PLATELET-RICH PLASMA FOR ROTATOR CUFF REPAIR / PLASMA RICO EM PLAQUETAS ALOGÊNICO PARA REPARO DO MANGUITO ROTADOR

ABSTRACT Objective: To investigate the safety and efficacy of allogeneic platelet-rich plasma (PRP) in rotator cuff repair . Methods: Seventeen patients with a full-thickness rotator cuff tear were included. Ten patients underwent arthroscopic rotator cuff repair with allogeneic, and seven patients with autologous PRP. Three PRP gels in a volume 3 ml each were applied between the torn end and the greater tuberosity. Clinical outcomes were assessed preoperatively and at a minimum of 2 years after surgery. Structural outcomes were evaluated with the presence of retear and the change of the cross-sectional area (ACT) of the supraspinatus . Results: Allogeneic PRP did not cause any adverse events during the follow-up period. There was no significant difference in the clinical outcome measures between the two groups (all p > 0.05). The retear rate was 33.3% and 25.0% in the allogeneic group and autologous group, respectively (p = 0.764). The change between the one-year postoperative and immediately postoperative ACT was not also significantly different between the two groups (p = 0.373) . Conclusion: Allogeneic PRP in arthroscopic rotator cuff did not cause any local or general complications and that has the efficacy comparable to autologous PRP with respect to the clinical and structural outcomes. Level of Evidence III, Retrospective Comparative Study.

RESUMO Objetivo: Investigar a segurança e eficácia do plasma rico em plaquetas alogênico (PRP) no reparo do manguito rotador. Métodos: Foram incluídos dezessete pacientes com ruptura da espessura total do manguito rotador. Dez pacientes foram submetidos a reparo artroscópico do manguito rotador com PRP alogênico e sete pacientes com PRP autólogo. Três géis de PRP de 3ml cada foram aplicados entre a extremidade lesionada e a tuberosidade maior. Os resultados clínicos foram avaliados no pré-operatório e no mínimo 2 anos após a cirurgia. Os resultados estruturais foram avaliados com a presença de nova ruptura e a alteração da área em corte transversal (ACT) do supra-espinhal. Resultados: O PRP alogênico não causou quaisquer eventos adversos durante o período de acompanhamento. Não houve diferença significativa nas medidas de resultados clínicos entre os dois grupos (todos os valores p> 0,05). A taxa de nova ruptura foi de 33,3% e 25,0% no grupo alogênico e grupo autólogo, respectivamente (p = 0,764). A alteração da ACT entre o pós-operatório de um ano e imediatamente no pós-operatório também não foi significativamente diferente entre os dois grupos (p = 0,373) . Conclusão: O PRP alogênico administrado por via artroscópica no manguito rotador não causou quaisquer complicações locais ou gerais e sua eficácia é comparável ao PRP autólogo no que diz respeito aos resultados clínicos e estruturais. Nível de Evidência III, Estudo Retrospectivo Comparativo.

Cytotoxicity of ethanolic extracts of Artemisia annua to Molt-4 human leukemia cells.

Although dihydroartemisinin (DHA) and other artemisinin derivatives have selective toxicity towards cancer cells, Artemisia annua (A. annua) extracts containing artemisinin have not been evaluated for their anticancer potential. Our main goal was to assess the anticancer effect of ethanolic leaf extracts of A. annua from Brazilian and Chinese origins (with DHA as a comparison) on normal and cancer cells. Leukocytes and leukemia (Molt-4) cells were counted at 0, 24, 48, and 72 hr after treatment with extracts having artemisinin concentrations of 0, 3.48, 6.96, and 13.92 µg/mL. Also, we assessed the antioxidant capacity of these extracts using the oxygen radical absorbance capacity (ORAC) test. Both extracts had high antioxidant capacity and toxicity towards Molt-4 cells. DHA was significantly more potent (p < 0.05) in killing Molt-4 cells than Brazilian extract at 48 and 72 hr and Chinese extract at 72 hr. In Molt-4 cells, LD50 values for Brazilian and Chinese extracts were comparable at all time points and not significantly different from DHA at 24 hr. In leukocytes, DHA, Chinese extract, and Brazilian extract had LD50 values of 760.42, 13.79, and 28.23 µg/mL of artemisinin, respectively, indicating a better safety index for the Brazilian extract compared to that of the Chinese extract at 24 hr. However, at 48 and 72 hr, the toxicity in leukocytes for any of the treatment groups was not significantly different. These experiments suggest that these extracts may have potential application in cancer treatment.