1.
Oil-in-water emulsion adjuvants for pediatric influenza vaccines: a systematic review and meta-analysis.
Lin, YJ, Wen, CN, Lin, YY, Hsieh, WC, Chang, CC, Chen, YH, Hsu, CH, Shih, YJ, Chen, CH, Fang, CT
Nature communications. 2020;(1):315
Abstract
Standard inactivated influenza vaccines are poorly immunogenic in immunologically naive healthy young children, who are particularly vulnerable to complications from influenza. For them, there is an unmet need for better influenza vaccines. Oil-in-water emulsion-adjuvanted influenza vaccines are promising candidates, but clinical trials yielded inconsistent results. Here, we meta-analyze randomized controlled trials with efficacy data (3 trials, nā=ā15,310) and immunogenicity data (17 trials, nā=ā9062). Compared with non-adjuvanted counterparts, adjuvanted influenza vaccines provide a significantly better protection (weighted estimate for risk ratio of RT-PCR-confirmed influenza: 0.26) and are significantly more immunogenic (weighted estimates for seroprotection rate ratio: 4.6 to 7.9) in healthy immunologically naive young children. Nevertheless, in immunologically non-naive children, adjuvanted and non-adjuvanted vaccines provide similar protection and are similarly immunogenic. These results indicate that oil-in-water emulsion adjuvant improves the efficacy of inactivated influenza vaccines in healthy young children at the first-time seasonal influenza vaccination.
2.
Efficacy of Platelet-Rich Plasma in Pain and Self-Report Function in Knee Osteoarthritis: A Best-Evidence Synthesis.
Xu, Z, Luo, J, Huang, X, Wang, B, Zhang, J, Zhou, A
American journal of physical medicine & rehabilitation. 2017;(11):793-800
Abstract
OBJECTIVE The aim of this study was to assess the efficacy of platelet-rich plasma (PRP) in pain and self-report function of patients with knee osteoarthritis on the basis of comparisons with hyaluronic acid or placebo. DESIGN Best-evidence synthesis of randomized controlled trials (RCTs) was conducted. Literature retrieval was limited to RCTs assessing the efficacy of PRP in knee osteoarthritis. Methodology evaluation and data extraction were based on Cochrane Collaboration guidelines. Meta-analyses were performed using mean difference or standardized mean difference as effect size. RESULTS Ten RCTs were included and analyzed. Meta-analysis showed significant superiority of PRP in outcome scores when compared with hyaluronic acid (standardized mean difference = -0.85, P = 0.004, I = 93%), but no statistical difference was found in well-designed double-blind trials (standardized mean difference = -0.09, P = 0.38, I = 0%). Pooled standardized mean difference of trials comparing PRP with placebo directly was -2.13 (95% confidence interval = -3.29 to -0.98), and that of indirect comparison was -0.22 (95% confidence interval = -0.45 to -0.01). CONCLUSIONS In relieving pain and improving self-report function, PRP showed no superiority over hyaluronic acid in well-designed double-blind trials, and beneficial effects of PRP in most trials probably resulted from insufficient blinding methods. However, PRP is still considered more effective than placebo on the basis of present evidence.
3.
Postsurgical infections are reduced with specialized nutrition support.
Waitzberg, DL, Saito, H, Plank, LD, Jamieson, GG, Jagannath, P, Hwang, TL, Mijares, JM, Bihari, D
World journal of surgery. 2006;(8):1592-604
Abstract
OBJECTIVE The objective was to examine the relationship between pre-, peri-, and postoperative specialized nutritional support with immune-modulating nutrients and postoperative morbidity in patients undergoing elective surgery. METHODS Studies were identified by searching MEDLINE, review article bibliographies, and abstracts and proceedings of scientific meetings. All randomized clinical trials in which patients were supplemented by the IMPACT formula before and/or after elective surgery and the clinical outcomes reported were included in the meta-analysis. Seventeen studies (n=2,305), 14 published (n=2,102), and 3 unpublished (n=203), fulfilled the inclusion criteria. Ten studies (n=1,392) examined the efficacy of pre- or perioperative IMPACT supplementation in patients undergoing elective surgery, whereas 7 (n=913) assessed postoperative efficacy. Fourteen of the studies (n=2,083) involved gastrointestinal (GI) surgical patients. Postoperative complications, mortality, and length of stay in hospital (LOS) were major outcomes of interest. RESULTS IMPACT supplementation, in general, was associated with significant (39%-61%) reductions in postoperative infectious complications and a significant decrease in LOS in hospital by an average of 2 days. The greatest improvement in postoperative outcomes was observed in patients receiving specialized nutrition support as part of their preoperative treatment. In GI surgical patients, anastomotic leaks were 46% less prevalent when IMPACT supplementation was part of the preoperative treatment. CONCLUSION This study identifies a dosage (0.5-1 l/day) and duration (supplementation for 5-7 days before surgery) of IMPACT that contributes to improved outcomes of morbidity in elective surgery patients, particularly those undergoing GI surgical procedures. The cost effectiveness of such practice is supported by recent health economic analysis. Findings suggest preoperative IMPACT use for the prophylaxis of postoperative complications in elective surgical patients.