Efficacy and safety of platelet-rich plasma combined with hyaluronic acid versus platelet-rich plasma alone for knee osteoarthritis: a systematic review and meta-analysis.

PURPOSE: To systematically evaluate the curative efficacy and safety of platelet-rich plasma (PRP) combined with hyaluronic acid (HA) in the treatment of knee osteoarthritis (KOA), comparing with platelet-rich plasma alone. METHODS: Cochrane Library, PubMed, China National Knowledge Infrastructure (CNKI) and Embase were searched for randomized controlled trials (RCTs) and cohort studies regarding the efficacy and safety of platelet-rich plasma (PRP) combined with hyaluronic acid (HA) in the treatment of knee osteoarthritis (KOA) comparing with platelet-rich plasma alone before January 15, 2022. The methodological quality of the ultimately included studies was assessed comprehensively, and meta-analysis was implemented using RevMan 5.3 software. RESULTS: Thirteen articles (9 RCTs, 4 cohort studies), including 1118 patients, were covered. There was no significant difference between the PRP + HA therapy and PRP-alone therapy in VAS scores at 3 months, 6 months and 12 months, WOMAC total scores at 3 months and KOOS at 1 month and 6 months. Compared with PRP-alone therapy, PRP + HA therapy was associated with significantly better improvement in VAS scores at 1 month, WOMAC total scores at 6 months, KOOS at 3 months, IKDC scores at 6 months and Lequesne index scores at 3 and 6 months. However, the smallest treatment effect of VAS scores, WOMAC total scores, KOOS and IKDC scores did not exceed the minimum clinically important difference (MCID). However, PRP + HA therapy got a greater reduction in the rate of adverse events, compared with PRP-alone therapy. CONCLUSION: The results of this meta-analysis indicated that PRP + HA therapy was not found to be superior to PRP-alone therapy in pain relief and function improvement for patients with KOA. However, combined PRP with HA injections was generally safer than PRP injections alone, by assessing the incidence of adverse events.

Application of coagulation-ultrafiltration-nanofiltration in a pilot study for Tai Lake water treatment.

In this study, the inline coagulation was combined with ultrafiltration and nanofiltration (UF-NF) in a pilot study for Tai Lake water treatment. The results showed that the combination process was very effective for Tai Lake water treatment in terms of organic removal and membrane fouling control. With inline coagulation, no irreversible membrane fouling was observed for either UF or NF at fluxes of 65-90 and 22-26 L/(m2  hr), respectively. The membrane foulants were analyzed, and the results indicated that the low molecular weight fractions in the feed were main membrane fouling contributors for both UF and NF, where hydrophilic substances and proteins, as well as neutral substances and humic acids with polycarboxyl groups, contributed significantly to UF and NF membrane fouling, respectively. Compared with direct UF-NF filtration without coagulation, the coagulants could aggregate organic micromolecules for cake formation. With inline coagulation, the moving flocs could generate shear stress to scrub the membrane surface for fouling control of UF. Moreover, with inline coagulation, the organics removal efficiency could be further increased by 10%-20%. With NF, the permeate had a TOC concentration of less than 0.5 mg/L, satisfying the drinking water quality. Therefore, the coagulation-UF-NF is very useful for Tai Lake water treatment. PRACTITIONER POINTS: Inline coagulation-UF-NF for Tai Lake Water treatment is implemented. Inline coagulation can aggregate hydrophilic substances to reduce membrane fouling. Moving flocs produce shear stress for fouling control of UF-NF. Superior quality of permeate is achieved with the combined coagulation-UF-NF process.