Attitudes and acceptance of vaccination against neglected tropical diseases: A multi-country study in Asia

This study aims to explore the willingness of individuals to be vaccinated against NTDs in Asian countries and China. Between June and December 2023, an anonymous cross-sectional survey was carried out in five Asian countries alongside China. Overall, 48.4% indicated being somewhat willing and 29.2% expressing extreme willingness to receive NTDs vaccination. High attitude scores (adjusted odds ratio [aOR] = 1.54, 95% confidence interval (CI): 11.35-1.75) was associated with higher willingness to be vaccinated against NTDs. The odds of accepting the NTDs vaccine increased among individuals without occupational exposure to NTDs (aOR = 1.46, 95% CI: 1.27-1.68). Those residing in very clean environments exhibited heightened odds of willingness (aOR = 2.94, 95% CI: 2.10-4.11), whereas individuals in somewhat dirty environments demonstrated reduced odds of willingness (aOR = 0.74, 95% CI: 0.56-0.98) compared to the baseline group (very dirty local environment). Moreover, a higher score in sanitation facilities also correlated with increased odds of willingness to receive the NTDs vaccine (aOR = 1.41, 95% CI: 1.21-1.64). The study highlighted key strategies for improving NTDs vaccine uptake in Asian countries, including China, such as fostering positive attitudes toward the vaccine and enhancing perception of infection risks.

Undenatured type II collagen for knee osteoarthritis

INTRODUCTION

Knee Osteoarthritis (OA) leads to significant pain and reduced function and affects patients' overall quality of life (QoL). Conservative modalities are the first line of management, resorting to surgery only if they fail. However, these modalities have limitations, and do not address the underlying cause of knee OA. The use of nutraceuticals, including native/undenatured type II collagen (UC-2), has evolved and shown promise in the conservative management of knee OA. This article highlights the mechanism of action, and qualitatively presents the pre-clinical, clinical and on-going scientific literature exploring the safety and efficacy of UC-2 for the management of knee OA.

METHODS

A search was performed using multiple databases (PubMed, Web of Science, Embase and Scopus) employing terms for UC-2 and Knee OA for articles published in English language, while adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. All pre-clinical and clinical studies utilizing UC-2 for knee OA were included. Studies not using UC-2 alone or not focusing on the management of knee OA were excluded.

RESULTS

Twelve studies (3 pre-clinical studies, 8 clinical studies and 1 study with both pre-clinical and clinical component) met our pre-defined search and inclusion criteria, and were included in this review.

DISCUSSION

UC-2 acts via a specific immune mediated mechanism, known as oral tolerance, which can lead to reduced inflammation and enhanced cartilage repair in the knee joint. In addition, administration of UC-2 (40 mg daily) is safe and efficacious in the short- and mid-term, reducing inflammation and pain, and improving function, range of motion (ROM) and overall QoL. Nonetheless, more adequately powered, prospective, multi-center, non-randomized and randomized controlled trials with longer follow-up are warranted to establish the long-term efficacy of UC-2 in knee OA patients and justify its routine clinical use.

Human tendon stem/progenitor cell-derived extracellular vesicle production promoted by dynamic culture

Tendon injuries significantly impact quality of life, prompting the exploration of innovative solutions beyond conventional surgery. Extracellular Vesicles (EVs) have emerged as a promising strategy to enhance tendon regeneration. In this study, human Tendon Stem/Progenitor Cells (TSPCs) were isolated from surgical biopsies and cultured in a Growth-Differentiation Factor-5-supplemented medium to promote tenogenic differentiation under static and dynamic conditions using a custom-made perfusion bioreactor. Once at 80% confluence, cells were transitioned to a serum-free medium for conditioned media collection. Ultracentrifugation revealed the presence of vesicles with a 106 particles/mL concentration and sub-200nm diameter size. Dynamic culture yielded a 3-fold increase in EV protein content compared to static culture, as confirmed by Western-blot analysis. Differences in surface marker expression were also shown by flow cytometric analysis. Data suggest that we efficiently developed a protocol for extracting EVs from human TSPCs, particularly under dynamic conditions. This approach enhances EV protein content, offering potential therapeutic benefits for tendon regeneration. However, further research is needed to fully understand the role of EVs in tendon regeneration.

Minimum reporting requirements for platelet-rich plasma in biomaterial research

Platelet-rich plasma (PRP) is gaining significant attention in regenerative medicine, offering an abundance of growth factors and bioactive molecules that promote tissue repair and healing. In biomaterial research, PRP is often incorporated into scaffolds to enhance their bioactivity, facilitating cell attachment, proliferation, and differentiation for improved tissue regeneration. However, inconsistencies in outcomes and variability across studies hinder its clinical translation. These challenges are primarily attributed to the lack of standardized reporting criteria for PRP characterization, which limits reproducibility and cross-study comparisons. Accurate characterization of PRP is essential for understanding its biological activity and therapeutic potential. Key parameters include platelet, white blood cell, and red blood cell concentrations. Recent classification systems, such as those proposed by the ISTH Subcommittee on Platelet Physiology, emphasize the importance of these parameters in categorizing PRP types. Establishing minimal reporting requirements helps address variability in PRP studies, ensuring consistency and transparency in the methodology and results. By adopting these standards as mandatory reporting requirements, researchers can reduce variability, enhance the credibility of their findings, and facilitate the development of standardized protocols for PRP-based therapies.

A Di-aptamer-functionalized scaffold promotes bone regeneration by facilitating the selective retention of MSCs and EPCs and then promoting crosstalk between osteogenesis and angiogenesis

The crosstalk between osteogenesis and angiogenesis plays an important role in promoting the formation of a microenvironment that supports bone regeneration. This suggests that the retention of endogenous osteogenic and angiogenic cells in the bone defect area can promote tissue-engineered bone (TEB) osteogenesis and cell-cell interactions. In this study, a Di-Aptamer-functionalized HA/β-TCP (Di-Aptamer-H/T) scaffold was prepared by sequential modification of APTES and sulfo-SMCC and connected with aptamer HM69 and EPC1. We confirmed that aptamers HM69 and EPC1 can specifically identify mesenchymal stem cells (MSCs) and endothelial progenitor cells (EPCs), respectively. This process triggers the expression of adhesion-related genes in these cells and allows these cells to selectively stay coupled to Di-Aptamer-H/T. The osteogenic differentiation ability of MSCs treated with Di-Aptamer-H/T in vitro was significantly increased. Similarly, the ability of Di-Aptamer-H/T-treated EPCs to form blood vessels was also enhanced. Notably, the osteogenic and angiogenic abilities of cocultured MSCs and EPCs treated with the Di-Aptamer-H/T scaffold were significantly better than those of cells cultured individually. In vivo, the results of micro-CT angiography, H&E staining, Masson's staining and histochemical staining further confirmed that Di-Aptamer-H/T formed new bones and vessels more readily than those treated with a single aptamer linked to HA/β-TCP or with HA/β-TCP alone. In brief, our study demonstrated that crosstalk between osteogenesis and angiogenesis is promoted by the Di-Aptamer-H/T scaffold, which serves as a potential treatment strategy for bone defects and can improve outcomes.

Evaluation of the management of rotator cuff injuries utilising superparamagnetic iron oxide tracking stem cells

BACKGROUND

The ultrastructure of the tendon-bone interface (TBI) is inherently complex. After arthroscopic reconstruction, it is often replaced by disorganized scar tissue, which increases the risk of re-tearing.Stem cell therapies offer a promising approach to regenerate the original tissue structure and enhance the healing environment. The effectiveness of these therapies depends on understanding the localization, proliferation, and overall behavior of the implanted stem cells. This study aimed to track the distribution of stem cells in a rat model of rotator cuff injury using Magnetic Resonance Imaging (MRI) and superparamagnetic iron oxide nanoparticles (SPIO) and to evaluate the mechanisms and therapeutic effects of stem cell therapy.

METHODS

Adipose-derived mesenchymal stem cells (ADSCs) were isolated and expanded, then labeled with SPIO at an optimized concentration. The visibility of these labeled cells was assessed via MRI, along with evaluations of their viability, potential toxicity, and migration capacity in vitro.For the in vivo study, rats with rotator cuff tears were divided into two groups: a control group that received a PBS injection, and a treatment group that received SPIO-labeled ADSCs (designated as S-A). MRI scans were conducted at 1, 2, and 4 weeks post-surgery, followed by histological analysis after the rats were euthanized. At 8 weeks post-surgery, rats were sacrificed, and their shoulder joints were analyzed biomechanically and histologically to assess the overall treatment efficacy.

RESULTS

SPIO nanoparticles were successfully incorporated into ADSCs, and MRI imaging demonstrated that these SPIO-labeled cells significantly enhanced MRI contrast without affecting cell viability, proliferation, or migration ability. Both MRI and histological analyses confirmed that the implanted stem cells survived and remained localized for at least two weeks. Further histological and biomechanical evaluations indicated that the stem cells facilitated the repair of the TBI. This repair process appeared to be mediated by an increase in M2 macrophage activity within the injured tissue, promoting improved local healing conditions.

CONCLUSION

This study confirms that labeling ADSCs with SPIO nanoparticles is an effective method for tracking these cells in vivo using MRI, providing a non-invasive approach to monitor the repair of injured TBI. Moreover, the localized survival of transplanted stem cells supports their role in enhancing TBI repair by modulating the local inflammatory response.

Melissa officinalis extract nanoemulsion, Caffeic acid and Quercetin as a novel inducer for investigating neural differentiation of human Wharton's jelly mesenchymal stem cells

BACKGROUND

Cell therapy utilizing mesenchymal stem cells, which have the ability to differentiate into different lineages, has garnered significant attention in recent years. Melissa officinalis is rich in biologically active compounds and exhibits antioxidant activity, antimicrobial properties, and sedative effects. Nanoemulsions can facilitate the effective transfer of substances and also protect drugs and biological materials from environmental factors. The aim of the present study is to investigate the role of Melissa officinalis extract nanoemulsion and the active ingredients of caffeic acid and quercetin as inducers in increasing the efficiency of differentiation of mesenchymal stem cells into neural cells in a laboratory environment.

MATERIALS AND METHODS

Human WJMSCs were cultured in the basic culture medium consisting of: Hight glucose DMEM, 10 % FBS and 1 % penicillin/streptomycin. The alcoholic extract of Melissa officinalis was extracted and its nanoemulsion was prepared along with two other effective substances. Next, zeta potential and size of nanoparticles were measured by Dynamic light scattering (DLS) technique. The optimal dose of all three material was calculated by MTT (3-4,5-dimethylthiazol-2-yl-2, 5-diphenyl tetrazolium bromide) assay and Acridine orange-ethidium bromide (AO/EB) staining. In the following, neural differentiation was investigated using Real-time Reverse Transcription Polymerase Chain Reaction (RT-PCR) and immunocytochemistry (ICC) techniques on days 7 and 14.

RESULTS

The results obtained from MTT and AO/EB assays showed that the optimal dose of nanoemulsion M. officinalis, caffeic acid and quercetin is 150 μg/ml, 75 μg/ml and 25 μg/ml, respectively. The ideal particle size for nanoemulsion is below 100 nm. The zeta potential of the M. officinalis extract nanoemulsion was reported to be -9.45 and the average particle size was 17.76 nm. The results of this study indicated that the expression of neural marker genes (MAP-2, β-tubulin III and NSE) and proteins (MAP-2, β-tubulin III and Gamma-enolase) increased in differentiated cells treated with the synthesized nanoemulsion compared to the control group on days 7 and 14 (P ≤ 0.05).

CONCLUSION

In general, our results showed that M. officinalis extract nanoemulsion, caffeic acid and quercetin caused induction of neural differentiation mechanism in human WJ-MSCs.

Prospects of Innovative Therapeutics in Combating the COVID-19 Pandemic

The sudden global crisis of COVID-19, driven by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), demands swift containment measures due to its rapid spread and numerous problematic mutations, which complicate the establishment of herd immunity. With escalating fatalities across various nations no foreseeable end in sight, there is a pressing need to create swiftly deployable, rapid, cost-effective detection, and treatment methods. While various steps are taken to mitigate the transmission and severity of the disease, vaccination is proven throughout mankind history as the best method to acquire immunity and circumvent the spread of infectious diseases. Nonetheless, relying solely on vaccination might not be adequate to match the relentless viral mutations observed in emerging variants of SARS-CoV-2, including alterations to their RBD domain, acquisition of escape mutations, and potential resistance to antibody binding. Beyond the immune system activation achieved through vaccination, it is crucial to develop new medications or treatment methods to either impede the infection or enhance existing treatment modalities. This review emphasizes innovative treatment strategies that aim to directly disrupt the virus's ability to replicate and spread, which could play a role in ending the SARS-CoV-2 pandemic.

Cascade learning in multi-task encoder-decoder networks for concurrent bone segmentation and glenohumeral joint clinical assessment in shoulder CT scans

Osteoarthritis is a degenerative condition that affects bones and cartilage, often leading to structural changes, including osteophyte formation, bone density loss, and the narrowing of joint spaces. Over time, this process may disrupt the glenohumeral (GH) joint functionality, requiring a targeted treatment. Various options are available to restore joint functions, ranging from conservative management to surgical interventions, depending on the severity of the condition. This work introduces an innovative deep learning framework to process shoulder CT scans. It features the semantic segmentation of the proximal humerus and scapula, the 3D reconstruction of bone surfaces, the identification of the GH joint region, and the staging of three common osteoarthritic-related conditions: osteophyte formation (OS), GH space reduction (JS), and humeroscapular alignment (HSA). Each condition was stratified into multiple severity stages, offering a comprehensive analysis of shoulder bone structure pathology. The pipeline comprised two cascaded CNN architectures: 3D CEL-UNet for segmentation and 3D Arthro-Net for threefold classification. A retrospective dataset of 571 CT scans featuring patients with various degrees of GH osteoarthritic-related pathologies was used to train, validate, and test the pipeline. Root mean squared error and Hausdorff distance median values for 3D reconstruction were 0.22 mm and 1.48 mm for the humerus and 0.24 mm and 1.48 mm for the scapula, outperforming state-of-the-art architectures and making it potentially suitable for a PSI-based shoulder arthroplasty preoperative plan context. The classification accuracy for OS, JS, and HSA consistently reached around 90% across all three categories. The computational time for the entire inference pipeline was less than 15 s, showcasing the framework's efficiency and compatibility with orthopedic radiology practice. The achieved reconstruction and classification accuracy, combined with the rapid processing time, represent a promising advancement towards the medical translation of artificial intelligence tools. This progress aims to streamline the preoperative planning pipeline, delivering high-quality bone surfaces and supporting surgeons in selecting the most suitable surgical approach according to the unique patient joint conditions.

Optimizing bone marrow harvesting sites for enhanced mesenchymal stem cell yield and efficacy in knee osteoarthritis treatment

Knee osteoarthritis (OA) is a debilitating condition with limited long-term treatment options. The therapeutic potential of mesenchymal stem cells (MSCs), particularly those derived from bone marrow aspirate concentrate, has garnered attention for cartilage repair in OA. While the iliac crest is the traditional site for bone marrow harvesting (BMH), associated morbidity has prompted the exploration of alternative sites such as the proximal tibia, distal femur, and proximal humerus. This paper reviews the impact of different harvesting sites on mesenchymal stem cell (MSC) yield, viability, and regenerative potential, emphasizing their relevance in knee OA treatment. The iliac crest consistently offers the highest MSC yield, but alternative sites within the surgical field of knee procedures offer comparable MSC characteristics with reduced morbidity. The integration of harvesting techniques into existing knee surgeries, such as total knee arthroplasty, provides a less invasive approach while maintaining therapeutic efficacy. However, variability in MSC yield from these alternative sites underscores the need for further research to standardize techniques and optimize clinical outcomes. Future directions include large-scale comparative studies, advanced characterization of MSCs, and the development of personalized harvesting strategies. Ultimately, the findings suggest that optimizing the site of BMH can significantly influence the quality of MSC-based therapies for knee OA, enhancing their clinical utility and patient outcomes.

Next-gen novel nanocage-based multivalent vaccine candidate to tackle the rising menace of Mpox

The recent emergence and global spread of the human Monkeypox virus (MPXV), including its transmission to non-endemic regions, have raised significant global health concerns. In this proof-of-concept study, we developed a recombinant protein-based MPXV vaccine candidate, employing an innovative and versatile multivalent, self-assembled nanocage protein scaffold. Two immunogenic antigens derived from the contemporary circulating MPXV strain have been incorporated into a self-assembled non-structural protein-10 (NSP-10) scaffold, expressed, and purified using an Escherichia coli expression system without a purification tag. The vaccine candidate elicited strong antibody responses in mice and conferred protection against the lethal Vaccinia virus in an intranasal and skin pock in vivo study. Additionally, an intranasal challenge with the MPXV strain clade IIb in immunized mice demonstrated promising outcomes, including a significant reduction in viral titres and eliciting a robust neutralizing antibody response. This study demonstrates a feasible, scalable, and cost-effective approach for the development of the MPXV vaccine.

Inhibition of autophagy in the amygdala ameliorates anxiety-like behaviors induced by morphine-protracted withdrawal in male mice

OBJECTIVE

Morphine withdrawal triggers a range of negative affective states, wherein anxiety is typically common, significantly contributing to the morphine relapse. To date, the exact mechanism underlying morphine withdrawal-induced anxiety has remained unclear. Previous studies have proposed that autophagy is involved in the pathogenesis of morphine addiction and anxiety; however, the possible relationship between autophagy and morphine withdrawal-induced anxiety has not been explored before. In this study, we aimed to reveal the potential role of autophagy in anxiety-like behaviors elicited by protracted morphine withdrawal, and which brain region is involved.

METHODS

We established the model mice of anxiety by chronic intermittent escalating-dose morphine administration for 7 days and then withdrawing for 4 days. Anxious behaviors were detected using the Open field test and the Elevated plus maze test. Western blot was performed to measure the change of autophagy-associated proteins (ATG5, Beclin-1, LC3) in different brain regions.

RESULTS

Our results showed that intraperitoneal injection of an autophagy inhibitor 3-Methyladenine attenuated protracted morphine withdrawal-induced anxiety-like behaviors in male mice. Moreover, protracted morphine withdrawal predominantly promoted autophagy in the amygdala, rather than other related brain regions, suggesting the crucial involvement of amygdala in autophagy-mediated anxiety after morphine withdrawal. We further validated that 3-Methyladenine can effectively reduce autophagy-associated protein levels in the relevant brain region.

CONCLUSION

These findings indicated that protracted morphine withdrawal-elicited autophagy in the amygdala contributes to the anxiety-like behaviors and may have implications for the future treatment of this disorder.

Application of machine learning in the context of reoperation, outcome and management after ACL reconstruction - A systematic review

INTRODUCTION

Machine learning-based tools are becoming increasingly popular in clinical practice. They offer new possibilities but are also limited in their reliability and accuracy.

OBJECTIVES

The present systematic review updates and discusses the existing literature regarding machine learning algorithm-based tools to predict outcome and management in patients after ACL reconstruction.

METHOD

PubMed was searched for articles containing machine learning algorithms related to anterior cruciate ligament reconstruction and its outcome and management. No additional filters or time constraints were used. All eligible studies were accessed by hand.

RESULTS

After screening of 115 articles, 15 were included. Six studies evaluated predictors for reoperation after ACL surgery. Four studies investigated the clinical outcome prediction after ACL reconstruction including prediction of secondary meniscus tear and secondary knee osteoarthritis. Single topics addressed in patients with ACL reconstruction were costs, opioid use, the need for a femoral nerve block, short term complications, hospital admission, and reduction of the burden to complete the Knee Osteoarthritis and Outcome score questionnaire. Predictive power was very heterogeneous, depending on the specific research question and parameters included.

CONCLUSION

New machine-learning tools offer interesting insights into variables affecting the target outcome and general management of patients with ACL reconstruction. While present machine-learning based prediction models seem to outperform previous existing benchmark regression models, their predictive ability often is still too low to base individual decision making on them. With the rapid progress observed over the last few years, it is conceivable that this might change, however, in the foreseeable future.

Artificial intelligence and machine learning in knee arthroplasty

BACKGROUND

Artificial intelligence (AI) and its subset, machine learning (ML), have significantly impacted clinical medicine, particularly in knee arthroplasty (KA). These technologies utilize algorithms for tasks such as predictive analytics and image recognition, improving preoperative planning, intraoperative navigation, and postoperative complication anticipation. This systematic review presents AI-driven tools' clinical implications in total and unicompartmental KA, focusing on enhancing patient outcomes and operational efficiency.

METHODS

A systematic search was conducted across multiple databases including Cochrane Central Register of Controlled Trials, Embase, OVID Medline, PubMed, and Web of Science, following the PRISMA guidelines for studies published in the English language till March 2024. Inclusion criteria targeted adult human models without geographical restrictions, specifically related to total or unicompartmental KA.

RESULTS

A total of 153 relevant studies were identified, covering various aspects of ML application for KA. Topics of studies included imaging modalities (n = 28), postoperative primary KA complications (n = 26), inpatient status (length of stay, readmissions, and cost) (n = 24), implant configuration (n = 14), revision (n = 12), patient-reported outcome measures (PROMs) (n = 11), function (n = 11), procedural communication (n = 8), total knee arthroplasty/unicompartmental knee arthroplasty prediction (n = 6), outpatient status (n = 4), perioperative efficiency (n = 4), patient satisfaction (n = 3), opioid usage (n = 3). A total of 66 ML models were described, with 48.7% of studies using multiple approaches.

CONCLUSION

This review assesses ML applications in knee arthroplasty, highlighting their potential to improve patient outcomes. While current algorithms and AI show promise, our findings suggest areas for enhancement in predictive performance before widespread clinical adoption.

An informational video for informed consent improves patient comprehension before total hip replacement- a randomized controlled trial

PURPOSE

Effective patient comprehension is critical for informed consent, particularly in Total Hip Arthroplasty (THA), a globally prevalent procedure. This study evaluates the efficacy of an informational video to improve the patients' understanding, self-perceived knowledge, and emotional comfort in the context of THA informed consent. This randomized controlled trial investigates the impact of an additional informational video on (I) the patients' understanding, (II) self-precepted knowledge and (III) emotional comfort during the informed consent process for THA.

METHODS

Participants were randomized to receive either the standard informed consent procedure or the standard procedure supplemented with an informational video. The effect of the video was tested with post-consent questionnaires.

RESULTS

The informational video significantly (p = 0.014) improved the patients' understanding from 78.6% to 86.5%. Self-precepted knowledge and Emotional comfort was not effected by the video (p = 0.986; p = 0.333).

CONCLUSIONS

The informational video significantly improved patient comprehension during the informed consent process before THA.

The biomedical applications of artificial intelligence: an overview of decades of research

A significant area of computer science called artificial intelligence (AI) is successfully applied to the analysis of intricate biological data and the extraction of substantial associations from datasets for a variety of biomedical uses. AI has attracted significant interest in biomedical research due to its features: (i) better patient care through early diagnosis and detection; (ii) enhanced workflow; (iii) lowering medical errors; (v) lowering medical costs; (vi) reducing morbidity and mortality; (vii) enhancing performance; (viii) enhancing precision; and (ix) time efficiency. Quantitative metrics are crucial for evaluating AI implementations, providing insights, enabling informed decisions, and measuring the impact of AI-driven initiatives, thereby enhancing transparency, accountability, and overall impact. The implementation of AI in biomedical fields faces challenges such as ethical and privacy concerns, lack of awareness, technology unreliability, and professional liability. A brief discussion is given of the AI techniques, which include Virtual screening (VS), DL, ML, Hidden Markov models (HMMs), Neural networks (NNs), Generative models (GMs), Molecular dynamics (MD), and Structure-activity relationship (SAR) models. The study explores the application of AI in biomedical fields, highlighting its enhanced predictive accuracy, treatment efficacy, diagnostic efficiency, faster decision-making, personalised treatment strategies, and precise medical interventions.

The Combination of Graphene and Polycaprolactone Scaffolds Enhancing Bone Mineralization and Hydroxyapatite

This study aimed to evaluate the effects of incorporating varying concentrations of graphene (0.5, 1.5, and 2.5 wt%) into polycaprolactone (PCL) scaffolds on mineralization and hydroxyapatite formation for bone tissue engineering applications.PCL scaffolds were fabricated with three different graphene concentrations: 0.5, 1.5, and 2.5 wt%. The scaffolds underwent characterization using Fourier-transform infrared spectroscopy (FTIR) to assess chemical composition and mineralization. Radiological imaging was employed to evaluate structural integrity and mineral density over a 21-day period. Additionally, histology analysis was performed to assess cellular interactions and scaffold integration.FTIR analysis on day 7 indicated early mineralization across all scaffolds, evidenced by phosphate (∼1030 cm-1) and hydroxyl (∼3500 cm-1) peaks, suggesting initial hydroxyapatite deposition. By day 21, the 2.5 wt% graphene scaffold demonstrated the highest degree of mineralization, with significantly increased hydroxyapatite formation compared with the other groups. However, this scaffold also exhibited signs of degradation, implying that higher graphene concentrations might compromise long-term scaffold stability. The 1.5 wt% graphene scaffold showed consistent mineralization and favorable osteoconductivity but did not reach the mineral deposition levels observed in the 2.5 wt% group.Incorporating graphene into PCL scaffolds enhances mineralization and hydroxyapatite formation, with the 2.5 wt% concentration achieving the most substantial effects. The 2.5 wt% graphene scaffold presents a balanced alternative, promoting steady mineralization and maintaining structural integrity, making it a promising candidate for bone tissue engineering applications.

Role of frequency-dependent and capacitive tissue properties in spinal cord stimulation models

Objective.Spinal cord stimulation (SCS) models simulate the electric fields (E-fields) generated in targeted tissues, which in turn govern physiological and then behavioral outcomes. Notwithstanding increasing sophistication and adoption in therapy optimization, SCS models typically calculateE-fields using quasi-static approximation (QSA). QSA, as implemented in neuromodulation models, neglects the frequency-dependent tissue conductivity (dispersion), as well as propagation, capacitive, and inductive effects on theE-field. The objective of this study is to calculate the impact of frequency-dependent tissue conductivity and permittivity in SCS models, across a broad frequency range.Approach.We solved a high-resolution RADO-SCS finite element model to simulateE-field magnitudes in spinal column tissues under voltage-controlled (VC) and current-controlled (CC) SCS. Varied combinations of epidural space and dura conductivity based on prior SCS modeling studies (under the QSA-method), as well as values from the Gabriel (1996Compilation of the Dielectric Properties of Body Tissues at RF and Microwave Frequencies) dataset for 1 Hz, 1 kHz, 2.5 kHz, 16.66 kHz, and 1 MHz were considered. We assessed the relative contribution of epidural space and dura permittivity on peakE-field magnitude and neural activation, and compared results to the QSA-method models.Main results.Across published SCS models, the conductivities of epidural space (considered either fat or mixed tissues; 0.025-0.25 S m-1) and dura (0.02-0.6 S m-1) vary by over an order of magnitude, associated with differences in predicted spinal cord peakE-field magnitudes for VC-SCS (6.55-43.71 V m-1per V) and CC-SCS (10.94-25.20 V m-1per mA). These literature variations in conductivity and resulting peakE-field magnitude are greater than from epidural/dura tissue dispersion (1 kHz-1 MHz) based on Gabriel (1996Compilation of the Dielectric Properties of Body Tissues at RF and Microwave Frequencies) database (VC-SCS: 7.26-8.09 V m-1per V; CC-SCS: 21.14-21.25 V m-1per mA). Changes inE-field magnitudes were not associated with significant changes in relative spatial profiles of theE-field or activating function. The impact of epidural space/dural permittivity (at 1 kHz) onE-field magnitudes and activating function was minimal (⩽1%) for both SCS modes.Significance.The impact of dispersion/permittivity is significantly less than existing variations in tissue conductivities used across SCS modeling studies. As relativeE-field or activating function profiles were not significantly changed by tissue conductivities, any impact of neuronal activation thresholds tracks changes inE-field magnitude. We limited our analysis to a single geometry and epidural/dural properties to isolate the impact of QSA.

Copper-Silver Nanoparticle/Lipase Nanobiohybrids for Enhanced Activity Against Viral Pathogens

The development of sustainable, low-toxicity materials that are effective against a wide range of microorganisms is crucial in addressing emerging infectious diseases. The recent spread of monkeypox virus (MPXV), respiratory pathogens such as rhinoviruses or seasonal coronaviruses, and animal pathogens such as porcine reproductive and respiratory syndrome virus (PRRSV) highlights the urgent need for innovative solutions in both human and animal health. In this study, we designed a bimetallic nanobiohybrid material, NanoCuAg, composed of a lipase and in situ-synthesized copper and silver nanoparticles, with a low silver-to-copper ratio, through a simple and sustainable synthetic process. The nanobiomaterial, featuring a supramolecular flower structure containing ∼4 nm average diameter nanoparticles, contains 32% copper and 3% silver, mainly in the Cu-(II) and Ag-(I) oxidation states. Despite its low silver content, the nanobiomaterial showed a strong catalytic efficacy in different model reactions. Then, its virucidal activity was evaluated under different conditions. At 200 ppm, in combination with hydrogen peroxide, it inactivated 99% of human rhinovirus B14 and 99.99% of human coronavirus 229E. At 1000 ppm, it achieved 90% efficacy against MPXV and a 4.8 log10 (≈99.999%) reduction in PRRSV. These results demonstrate the potential of NanoCuAg as a highly effective virucidal material, capable of inactivating both enveloped and nonenveloped viruses at low concentrations, making it a promising candidate for broad-spectrum virucidal applications.

Artificial Intelligence in Rotator Cuff Tear Detection: A Systematic Review of MRI-Based Models

Objective: This descriptive systematic review aimed to assess in the available literature on the current application and overall performance of Artificial Intelligence (AI) models in the diagnosis and classification of Rotator Cuff Tears (RCTs) using MRIs. Methods: The systematic review was performed by two of the authors from 2020 to November 2024. Only diagnostic studies involving AI application to MRI images of the rotator cuff were considered, including supraspinatus and biceps tears. Studies evaluating AI applications to Ultrasound or X-ray, or including only healthy rotator cuffs, were not analyzed in this paper. Results: The coronal plane in the T2 sequence emerged as the predominant imaging protocol, with the VGG network being the most widely utilized AI model. The studies included in this research exhibited a solid performance of the AI models with accuracy, ranging from 71.0% to 100%. The statistical analysis revealed no significant differences (p > 0.05) in accuracy, sensitivity, specificity, or precision between AI and human experts across studies that included such comparisons. Conclusions: While AI can significantly improve diagnostic efficiency and workflow optimization, future studies must focus on external validation, regulatory approval, and AI-human collaboration models to ensure safe and effective integration into orthopedic imaging.

The Effectiveness of Mesenchymal Stem Cell (MSCs) Therapy Combined with Arthroscopy as Treatment for Knee Osteoarthritis (KOA): A Systematic Review

Osteoarthritis (OA) is a progressive and chronic disease that can result in the patient's increased pain and loss of function. There might be some potential approaches to improve the recovery with mesenchymal stem cells (MSCs). The efficacy of using MSCs in treatment of OA was found to have a significant impact on the treatment and was focused on improving physical function and psychometric measures of pain. Although various available data and research studies regarding MSCs have shown their potential in clinical use, there is still limited data of MSCs regarding actual long-term safety and efficacy in larger clinical trials. To address these issues and inform future studies, we performed a clinical systematic review of MSC therapy for knee osteoarthritis combined with arthroscopy procedure. Cochrane (2022), EMBASE (2022), MEDLINE (2022) and PubMed (2022) were utilized as research platforms. Using the inclusion criteria, the total viable studies that were used within the systematic review amounts to around 18 studies. Clinically, MSCs treatment on OA have also reported improvements on the target site, such as that of articular cartilage, subchondral bone, and joint-space width. The results were obtained from data results of WOMAC, VAS, KOOS and ICRS, as well as through radiological imaging using MRI. However, there are still limitations that the reviews provide such as heterogeneity complications of MSCs of the studies reviewed, as well as the potential of risk bias assessment during publication. Therefore, future studies will need to address the evaluation of MSCs effect on cartilage regeneration on knee osteoarthritis (OA), improving structural outcomes of the knee, as well as its efficacy during combined treatment methods of arthroscopy.

Clinical Efficacy of Platelet-Rich Plasma and Hyaluronic Acid Versus Hyaluronic Acid for Knee Osteoarthritis with MRI Analysis: A Randomized Controlled Trial

Background: Some evidence suggests that combining hyaluronic acid (HA) with platelet-rich-plasma (PRP) may offer synergistic benefits by enhancing the biological and mechanical properties of joints. However, data on the combination of HA+PRP vs. HA alone in the management of knee osteoarthritis (OA) remain limited. Methods: A double-blinded randomized controlled trial was conducted at an outpatient clinic and enrolled 58 patients with Kellgren-Lawrence grade 2-3 knee OA. They were randomly allocated to receive either intra-articular PRP combined with HA (n = 29 knees) or HA alone (n = 29 knees). The primary outcome was pain, assessed using a visual analog scale (VAS). Secondary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), health-related quality of life (EQ-5D-5L), and structural changes on MRI, measured by the Whole-Organ MRI Score (WORMS). The VAS, WOMAC, and EQ-5D-5L were evaluated at baseline and at months 1, 3, 6, and 12. MRI WORMS was assessed at baseline and 12 months. Results: The baseline characteristics were comparable between the HA+PRP and HA groups. Both interventions showed improvements in pain and function at 12 months. However, the between-group difference in VAS at 12 months-the primary outcome-was not statistically significant (p = 0.102) and did not exceed the minimal clinically important difference (MCID) of 20 mm. The HA group demonstrated significantly greater VAS score reductions at 1 month (-31.1 [95% CI: -38.9 to -23.2] vs. -14.3 [95% CI: -22.2 to -6.4], p = 0.003) and at 6 months (-32.1 [95% CI: -40.1 to -24.1] vs. -19.2 [95% CI: -27.1 to -11.3], p = 0.024), compared to the HA+PRP group, although these differences did not reach clinical significance. No significant between-group differences were observed in the WOMAC scores, EQ-5D-5L, or total WORMS scores at all time points (p > 0.05). At 12 months, MRI assessment revealed a significant decrease in bone marrow edema in the HA+PRP group (-0.7 [95% CI: -1.6 to 0.2]) compared to the HA group (0.7 [95% CI: -0.2 to 1.6], p = 0.030). Conclusions: Both HA+PRP and HA treatments were effective in reducing pain and improving function in patients with knee OA over 12 months. While HA demonstrated greater early pain relief, the addition of PRP was associated with a significant reduction in bone marrow edema at 12 months. These findings suggest potential structural benefits of HA+PRP, although clinical superiority over HA alone was not established.

TNFRSF11B-modified umbilical cord mesenchymal stem cells as a novel strategy for bone-related diseases by suppressing osteoclast activity

BACKGROUND AND OBJECTIVE

Mesenchymal stem cells (MSCs), possessing multilineage potential, are capable of differentiating into osteoblasts and thus serve as suitable seed cells for bone regeneration. Tumor necrosis factor receptor superfamily member 11B (TNFRSF11B) gene encodes osteoprotegerin (OPG), which has a critical role in repressing osteoclast differentiation and has been reported to influence the adipogenic differentiation of bone marrow mesenchymal stem cells (BMMSCs). Nevertheless, the impact of TNFRSF11B on the osteogenic differentiation of umbilical cord mesenchymal stem cells (UCMSCs) remains unclear. This study aimed to investigate the role of TNFRSF11B in the osteogenesis of UCMSCs and bone remodeling.

METHODS

Differentially expressed genes (DEGs) were identified from the GEO database using R software. TNFRSF11B was transduced into UCMSCs by a lentiviral vector. Cell differentiation capacity was assessed by ALP staining, TRAP staining, and qRT-PCR assay. Proteomic analysis was performed to investigate the key proteins in TNFRSF11B-OE-UCMSCs that inhibit osteoclast differentiation.

RESULTS

We found that the TNFRSF11B gene was upregulated during osteogenic differentiation and downregulated during adipogenic differentiation of UCMSCs. UCMSCs overexpressing the TNFRSF11B gene were successfully generated via lentivirus transfection. However, neither the overexpression of TNFRSF11B nor treatment with exogenous OPG protein was sufficient to enhance the osteogenic potential of UCMSCs in vitro. Conditioned medium from TNFRSF11B-overexpressing UCMSCs significantly suppressed RANKL-induced osteoclast differentiation, while no significant effect was observed on osteoblast differentiation compared to the control group. Proteome analysis revealed that in the TNFRSF11B-OE-CM group, the expression of C1R, MDH1, and ACLY was significantly downregulated, while the expression of FETUB and METRNL was upregulated in the TNFRSF11B-OE-CM group, which was associated with the inhibition of osteoclast differentiation.

CONCLUSION

This study demonstrates that although TNFRSF11B overexpression does not promote osteogenesis in UCMSCs, it may participate in regulating bone remodeling by inhibiting osteoclast differentiation.

Characterization and Specific Detection of Lactobacillus paracasei-Derived Extracellular Vesicles Using Anti-p40-Modified Au Thin Film

Background/Objectives: Extracellular vesicles (EVs) are nanoscale, membrane-enclosed structures that play key roles in intercellular communication and biological regulation. Among them, Lactobacillus paracasei-derived EVs (Lp-EVs) have attracted attention for their anti-inflammatory and anti-aging properties, making them promising candidates for therapeutic and cosmetic use. However, methods for specific detection and quantitative evaluation of Lp-EVs are still limited. This study aims to develop a surface plasmon resonance (SPR)-based sensor system for the precise and selective detection of Lp-EVs. Methods: Anti-p40 antibodies were immobilized on gold thin films to construct an SPR sensing platform. The overexpression of the p40 protein on Lp-EVs was confirmed using flow cytometry and Western blotting. For functional evaluation, Lp-EVs were applied to an artificial skin membrane mounted on a Franz diffusion cell, followed by SPR-based quantification and fluorescence imaging to assess their skin penetration behavior. Results: The developed SPR sensor demonstrated high specificity and a detection limit of 0.12 µg/mL, with a linear response range from 0.1 to 0.375 µg/mL. It successfully discriminated Lp-EVs from other bacterial EVs. In the skin diffusion assay, Lp-EVs accumulated predominantly in the epidermal layer without penetrating into the dermis, likely due to their negative surface charge and interaction with the hydrophobic epidermal lipid matrix. Fluorescence imaging confirmed this epidermal confinement, which increased over 24 h. Conclusions: This study presents a sensitive and selective SPR-based platform for detecting Lp-EVs and demonstrates their potential for targeted epidermal delivery. These findings support the use of Lp-EVs in skin-focused therapeutic and cosmetic applications. Future studies will explore strategies such as microneedle-assisted delivery to enhance transdermal penetration and efficacy.

Efficacy of decellularized extracellular matrix (dECM) for articular cartilage repair in osteoarthritis (OA): a systematic review and meta-analysis

BACKGROUND

Osteoarthritis (OA) is a common degenerative joint disease causing chronic pain, disability, and mobility limitations, severely affecting quality of life. Traditional treatments like physical therapy and surgery often have limited efficacy due to side effects, incomplete recovery, and disease progression, highlighting the need for innovative therapies.

METHODS

We searched PubMed and Embase from January 1, 2010 to November 1, 2024, preliminary included studies involving animal experiments on the therapeutic effects of decellularized extracellular matrix (dECM) and its derived materials on cartilage defect. After removing duplicates, we conducted a bibliometric analysis. Following the exclusion and evaluation of literature, the random/fixed effects model was employed to perform meta-analysis and obtain Weighted Mean Difference (WMD) of Osteoarthritis Research Society International (OARSI) score and International Cartilage Repair Society (ICRS) score between the dECM treatment group and corresponding control group. We verify the robustness of the results through subgroup analysis and sensitivity analysis, with heterogeneity assessed by Q-test and quantified via I2 values.

RESULTS

We included a total of 10 studies, of which 7 were used for ICRS-based meta-analysis and 3 were used for OARSI-based meta-analysis. The combined mean ICRS of dECM treatment group/control group resulted in an WMD of 2.45 (95% CI: 1.07 to 3.84; I2 = 97.4%); P-value < 0.001). Meanwhile, the combined mean OARSI of dECM treatment group/control group resulted in an WMD of -1.65 (95% CI: -3.63 to 0.34; I2 = 97.3%). The subsequent funnel plot confirmed the low publication bias of the above results.

CONCLUSIONS

Based on the dual-index meta-analysis, the dECM and relative derivatives have been proved to possess significant cartilage repair function in OA, which can be further explored in tissue regeneration filed.

Removing barriers to COVID-19 vaccine intention in a university population: Results of a serial mediation study through the dimensions of the Health Belief Model

BACKGROUND

While many studies have used the Health Belief Model (HBM) to understand vaccine intention, none claim to have used serial mediation to understand the relationship between HBM dimensions and COVID-19 vaccine intention. This study developed a serial mediation model to assess the direct and indirect effects of the latent HBM dimensions on COVID-19 primary vaccine intention.

METHODS

A cross-sectional study: from 01 April to 10 June 2021, a self-administered online questionnaire on vaccine intention against COVID-19 was distributed to staff and students at the University of Liège (Belgium). Direct and indirect effects of the HBM dimensions (perceived susceptibility, severity, benefits, barriers, self-efficacy and cues to action) on vaccine intention (score 0-100) were assessed with serial mediation models. Actually, each permutation of the latent HBM dimensions, i.e., each causal chain, was assessed using partial least squares path modelling (PLS-PM) according to the order of the HBM dimensions in that particular chain.

RESULTS

The sample was made up of 1256 participants. The final model revealed that the causal chain with the lowest Bayesian Information Criterion (BIC) value was barriers (Effect estimation (CI95%): -0.09 (-0.15 - -0.03)) ↘ severity (-0.13 (-0.20 - -0.07)) ↘ low self-efficacy (0.20 (0.15-0.25)) ↘ low susceptibility (-0.55 (-0.60 - -0.51)) ↘ vaccine intention (outcome). This revealed a significant indirect and direct effect (-0.20 (-0.25 - -0.15)) between barriers and vaccine intention.

CONCLUSIONS

The results demonstrated that perceived barriers are a key determinant in COVID-19 primary vaccine intention. Public health practitioners need to prioritise messaging that addresses the barriers reducing vaccine intention to enable individuals to make an informed choice. These messages could form part of a mass communication campaign aimed at hesitant individuals, with evidence-based information about vaccine safety a priority in order to establish a climate of trust.

Lyophilized MSC-EVs attenuates COVID-19 pathogenesis by regulating the JAK/STAT pathway

BACKGROUND

The JAK/STAT signaling pathway plays a crucial role in the release of interferons (IFNs) and the proinflammatory response during SARS-CoV-2 infection, contributing to the cytokine storm characteristic of severe COVID-19 cases. STAT3, a key protein in this pathway, has been implicated in promoting inflammation, making its inhibition a potential therapeutic strategy to mitigate disease severity. Mesenchymal Stem Cell-derived Extracellular Vesicles (MSC-EVs), enriched with immunomodulatory and antiviral miRNAs, offer a promising therapeutic approach by modulating gene expression and regulating inflammatory responses. This study investigates the ability of Lyophilized MSC-EVs to inhibit the JAK/STAT pathway, highlighting their potential application in COVID-19 management.

METHODS

Male Syrian hamsters were used as an experimental model, housed under controlled laboratory conditions. SARS-CoV-2 (hCoV-19/Egypt/NRC-03/2020) was propagated in Vero E6 cells, and viral titers were determined using plaque assays. Hamsters were intranasally challenged with the virus and treated intraperitoneally with 0.5 mL of lyophilized human Wharton's jelly-derived MSC-extracellular vesicles (MSC-EVs). Histopathological evaluations were performed on lung tissues using H&E, Masson's trichrome, and immunohistochemical staining. Morphometric analyses were conducted to assess lung injury and fibrosis. Western blotting was employed to evaluate protein expression. All procedures adhered to ethical and biosafety guidelines.

RESULTS

The administration of MSC-EVs significantly upregulated the expression levels of miRNA-146a, miRNA-124, miRNA-155, miRNA-29b, miRNA-7, miRNA-145 and miRNA-18a compared to their levels in the COVID-19 group, suggesting a targeted release of miRNA-cargo from the MSC-EVs into the lung tissue of the animals. MSC-EVs impaired the activation of the STAT3/STAT1 signaling pathway and reduced the cytokine storm and coagulopathy associated with COVID-19.

CONCLUSIONS

These findings suggest that MSC-EVs have the potential to effectively mitigate the pathogenesis of COVID-19 by targeting the JAK/STAT signaling pathway. Further research is needed to fully understand the mechanisms underlying the therapeutic effects of MSC-EVs and their clinical application in combating the COVID-19 pandemic.

Enhancing Cartilage Repair in Osteoarthritis Using Platelet Lysates and Arthroscopic Microfracture

Background

Osteoarthritis (OA) is the most prevalent joint degenerative disease. MF is considered as a first-line treatment for OA. In the long term, the cartilage tissue regenerated after MF is fibrocartilage. In this study, we examine whether combined treatment of MF and Platelet lysate (PL) can inhibit promotion of cartilage repair and antifibrosis.

Methods

OA rat model established by the modified Hulth method. Rat PL injected into treated knee joints after MF surgery. The expression levels of metabolic and fibrosis molecules (Col2, Mmp13, Col1, Col3, α-SMA, and Ctgf) of chondrocytes were examined by immunohistochemistry. Cell immunofluorescence was used to assess bone marrow MSCs (BMSCs) proliferation. Transwell assays evaluated BMSCs migration, and qPCR and Western blot analyzed the mechanisms of PL. Moreover, a retrospective analysis was conducted to determine the clinical efficacy and safety of the combined treatment of MF and PL on OA patients.

Results

In vivo data showed that the combined treatment of MF and PL significantly alleviated joint pain, protected chondrocytes and inhibited synovial fibrosis on OA rats, as was confirmed by upregulation of Collagen II and downregulation of Mmp13, Col1, Col3, α-SMA, and Ctgf. Such anti-OA and antifibrosis effects of the combined treatment of MF and PL were superior to MF alone. In vitro data showed that PL induced cellular chondrogenic differentiation and migration of BMSCs, suggesting that PL facilitated stem cell homing to the cartilage injury sites and promoted cartilage repair and regeneration. Furthermore, the clinical data showed significant improvements of pain reduction and cartilage repair in OA patients.

Conclusion

This study demonstrated the anti-OA and antifibrosis effects of the combination of MF and PL, providing a promising synergistic therapeutic option for the treatment of OA.

Roles for Exosomes from Various Cellular Sources in Spinal Cord Injury

Spinal cord injury (SCI) is a severe disorder characterized by regeneration challenges in the central nervous system (CNS), resulting in permanent paralysis, loss of sensation, and abnormal autonomic functions. The complex pathophysiology of SCI poses challenges to traditional treatments, highlighting the urgent need for novel treatment approaches. Exosomes have emerged as promising candidates for SCI therapy because of their ability to deliver a wide range of bioactive molecules, such as RNAs, proteins, and lipids, to target cells with minimal immunogenicity, which contribute to anti-inflammatory, anti-apoptotic, autophagic, angiogenic, neurogenic, and axon remodeling activities. In this study, we classified exosomes from different sources into four categories based on the characteristics of the donor cells (mesenchymal stem cells, neurogenic cells, immune cells, vascular-associated cells) and provided a detailed summary and discussion of the current research progress and future directions for each source. We also conducted an in-depth investigation into the applications of engineered exosomes in SCI therapy, focusing on their roles in drug delivery and combination with surface engineering technologies and tissue engineering strategies. Finally, the challenges and prospects of exosomal clinical applications in SCI repair are described.

Amniotic fluid: its role in fetal development and beyond

Amniotic fluid is a complex biological medium that surrounds the fetus and offers not only mechanical protection but also provides nutrition and plays a critical role in normal fetal growth, organogenesis, and potentially fetal programming. Despite its importance, the biology of amniotic fluid has been understudied because of ethical and technical challenges in obtaining amniotic fluid samples from healthy human pregnancies, translational limitations of animal models to humans due to species-specific differences. Recent progress in understanding its dynamic physiology, composition, and clinical applications has advanced prenatal care and facilitated improved diagnostic and therapeutic strategies. As research continues to elucidate the complexities and evolutionary function of amniotic fluid, its increasingly recognized role in maternal-fetal medicine and its potential to transform clinical practice will only become more evident. The purpose of this review is to underscore the key roles of amniotic fluid in shaping fetal development and therapeutic potential.

High-intensity interval training exercise decreases brain CB1 receptor levels in male and female adult rats

The numerous health benefits of exercise are well-documented, including its efficacy in treating substance use disorders (SUDs). Several exercise regimens have been proposed; however, the most effective regimen for patients with addiction has yet to be elucidated. High-intensity interval training (HIIT) exhibits considerable potential compared to aerobic and resistance exercise. Dopamine signaling is recognized as a key neurobiological mechanism contributing to HIIT's therapeutic potential for SUDs; however, the role of the endocannabinoid system in this context is not well understood. The present study investigated the effects of HIIT exercise on endocannabinoid signaling by measuring cannabinoid receptor 1 (CB1R) binding in the brains of male and female rats using [3H]SR141716A autoradiography. Male and female rats were separated into sedentary and HIIT exercise groups. For six weeks, exercise was completed daily on a treadmill for 30 min (10 3-min intervals) progressively increasing speed to 0.8 mph (21.5 m/min). The HIIT program significantly reduced CB1R binding in both sexes across multiple brain regions, including the striatum, thalamus, and distinct areas of the cortex. Sex differences were observed wherein males exhibited greater CB1R binding than females across brain regions, including the cerebellum, striatum, and parts of the cortex. Males experienced an increase in mean cerebellum CB1R binding due to HIIT, whereas females showed no effect in this region. The results suggest HIIT exercise can modulate endocannabinoid signalling by way of decreased CB1R binding. These findings further support the intensity dependence of endocannabinoid modulation and highlight potential pathways for exercise-induced neurobiological and behavioural change.

Mesenchymal stem cell-derived exosomes: a novel therapeutic frontier in hematological disorders

Mesenchymal stem cells (MSCs) are multipotent stromal cells valued for their immunomodulatory and regenerative properties, positioning them as a cornerstone of regenerative medicine. Their derived exosomes small extracellular vesicles laden with bioactive molecules such as proteins, lipids, and nucleic acids have emerged as critical mediators of MSC therapeutic effects. This review systematically explores the biology of MSC-derived exosomes, detailing their biogenesis, molecular composition, and pivotal roles in hematopoiesis, inflammation, and immune regulation. In hematological disorders, including leukemia, lymphoma, and myelodysplastic syndromes, these exosomes exhibit significant therapeutic potential by modulating the tumor microenvironment, enhancing hematopoietic recovery, and suppressing malignant cell proliferation. Notable findings include their ability to induce cell cycle arrest in leukemia cells via the p53 pathway and to reduce chemoresistance through targeted signaling mechanisms, such as the IRF2/INPP4B axis. However, clinical translation is hindered by several challenges, including the standardization of isolation techniques such as ultracentrifugation which are costly and susceptible to contamination as well as difficulties in optimizing large-scale production and ensuring long-term safety and efficacy. Despite these obstacles, MSC-derived exosomes offer a promising, cell-free therapeutic alternative that minimizes risks such as immune rejection and tumorigenicity associated with whole-cell therapies. Future research must prioritize the refinement of isolation and production protocols, the development of precise delivery strategies, and the execution of comprehensive safety evaluations to unlock their full clinical potential in treating hematological disorders and beyond. This review integrates recent advancements to provide a clearer understanding of their multifaceted contributions and highlights the critical gaps that remain.

Adipose Tissue-Derived Therapies for Osteoarthritis: Multifaceted Mechanisms and Clinical Prospects

Osteoarthritis (OA) is a degenerative joint disease that significantly impacts quality of life and poses a growing economic burden. Adipose tissue-derived therapies, including both cell-based and cell-free products, have shown promising potential in promoting cartilage repair, modulating inflammation, and improving joint function. Recent studies and clinical trials have demonstrated their regenerative effects, highlighting their feasibility as a novel treatment approach for OA. This review summarises the therapeutic mechanisms and latest advancements in adipose tissue-derived therapies, providing insights into their clinical applications and future prospects.

Safety and utilisation of AZD1222 (ChAdOx1 nCoV-19) COVID-19 vaccine: a UK post-authorisation active surveillance study

OBJECTIVES

To monitor the safety and utilisation of AZD1222 under real-world use in the UK.

DESIGN

A non-interventional post-authorisation active surveillance study.

SETTING

Vaccination sites in the UK.

PARTICIPANTS

A total of 17 945 participants were eligible and provided consent to participate in the study between 1 March 2021 and 6 April 2023. Participants were followed up at weeks 1, 4 and 14 and at months 6, 9, 12 and 18 after the first dose of AZD1222 vaccination and prompted to complete electronic data capture forms. A total of 11 219 participants submitted a Follow-Up 1 form and 5189 participants submitted a Follow-Up 7 form (at 18 months).

PRIMARY AND SECONDARY OUTCOME MEASURES

The safety of AZD1222, including the identification, assessment and quantification of serious adverse events (SAEs) and adverse events of special interest (AESI), was examined. The utilisation of AZD1222 was described and characterised, including populations with missing information.

RESULTS

The majority of participants were women (n=10 845; 60.4%) and the median age (IQR) was 50 (43, 62) years. Most participants were from white ethnic groups (n=13 112; 73.1%). Headache and fatigue had the highest reported incidence rate (421.28 cases per 1000 person years and 386.00 cases per 1000 person years, respectively). The most frequently reported AESI was anosmia (6.25 cases per 1000 person years). An increased Observed versus Expected (O:E) ratio was seen for anaphylaxis (O:E 7.38 (95% CI 2.80 to 11.95); based on 10 observed cases (expected cases: 1.36)) and anosmia and/or ageusia (O:E 39.23 (95% CI 29.13 to 49.32), based on 58 observed cases (expected cases: 1.48)).

CONCLUSIONS

The most frequent vaccinee-reported adverse events (AEs) were headache and fatigue. An increased O:E ratio was seen for the AEs of anaphylaxis and anosmia and/or ageusia. No safety signals were identified throughout the course of this study.

TRIAL REGISTRATION NUMBER

This study is registered with the HMA-EMA Catalogue of RWD studies (EUPAS44035).

Bone marrow aspirate concentrate (BMAC) harvested in the axial and appendicular skeleton does not differ in progenitor cell count: A systematic review and meta-analysis

Introduction

Bone marrow aspirate concentrate (BMAC) is a reliable source of progenitor cells that facilitate healing, and it is typically harvested from the iliac crest. The purpose of this systematic review and meta-analysis was to compare total nucleated cell (TNC) count and the presence of colony-forming units (CFUs) in BMAC harvested from axial versus appendicular harvest sites.

Methods

In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, PubMed, Embase, and Cochrane Library databases were searched in August 2024 for studies published after 2004. Studies were included if they evaluated cell counts within BMAC samples harvested from males and females of any age and were prospective. Studies that had no reported cell count within BMAC samples, had evaluations of biologic material other than BMAC, or were translational or cadaveric studies, as well as review articles or technical notes, were excluded. Patients were divided into two cohorts based on whether BMAC was harvested from their axial or appendicular skeleton.

Results

The initial search identified 2126 studies, of which 15 non-randomized prospective studies with a total of 583 patients were included. Each study had low risk of bias. In the axial skeleton, TNC counts ranged from 0.1-502 × 106 cells/mL, and CFU concentration ranged from 0 to 807 CFU/mL. In the appendicular skeleton, TNC counts ranged from 0.1-87 × 106 cells/mL and CFU counts ranged from 0 to 802.7 CFU/mL. No significant differences in TNC or CFU count in BMAC harvested from the axial versus appendicular skeleton were observed.

Conclusions

BMAC harvested from the axial and appendicular skeletons demonstrate significant variability in progenitor cell concentration. These findings suggest that harvesting at appendicular sites near the operative location allows the surgeon to extract sufficient quality BMAC as compared to harvest sites within the axial skeleton, such as the iliac crest.

Level of evidence

Level II, systematic review of level II studies.

Surgical Antibiotic Prophylaxis Dosing in Adult Patients with Obesity: A Comprehensive Review of Pharmacokinetic and Pharmacodynamic Data

Surgical antibiotic prophylaxis is an important measure to prevent postoperative surgical site infections. Current guideline recommendations do not treat obesity specifically, although it can affect pharmacokinetics and pharmacodynamics. The objective of this review was to synthesize current evidence on the need for obesity-related dosing adjustments in surgical antibiotic prophylaxis. MEDLINE and Cochrane Library were searched for studies investigating antibiotic prophylaxis dosing in surgical patients with obesity. Outcomes of interest were pharmacokinetic parameters such as plasma and interstitial fluid concentrations, area under the concentration time curve in plasma and in interstitial fluid, and other pharmacokinetic measures. Thirty studies investigating cefazolin, cefoxitin, cefuroxime, piperacillin/tazobactam, meropenem, ertapenem, metronidazole, vancomycin, ciprofloxacin, and gentamicin were included in this analysis. Except for metronidazole, cefoxitin, and gentamicin, there is currently no evidence suggesting the need for dosing adjustments.

Utilization of a precision medicine genetic and psychosocial approach in outcome assessment of bariatric weight loss surgery: a narrative review

The obesity epidemic has become a global public health issue, impacting more than one billion people worldwide. 9% of the US population, or 28.8 million Americans will have an eating disorder in their lifetime. In fact, global eating disorder prevalence increased from 3.5% to 7.8% between 2000 and 2018. In spite of the fact that less than 6% of people with an eating disorder are medically underweight, it is indeed an important factor when considering issues related to obesity. This public health problem is often described as being caused by various genetic and psychosocial factors. One of the most effective strategies for treating morbid obesity and achieving significant weight loss is bariatric surgery. Recent focus on precision medicine approaches has expanded into bariatric surgery in an effort to better understand and achieve improved outcomes and reduce risk for post-operative weight regain and addiction transfers during the recovery process. Addiction transfers, including substance and non-substance addictions, are well established concerns for post-bariatric patients. This review details the genetic, molecular and psychosocial factors that can be utilized to inform and guide personalized treatment. Additionally, this review details some of the molecular mechanisms including dysregulation of catecholamine signaling as well as other neurotransmitter systems relevant to help further understand recovery science.

Therapeutic potential of stem cell-derived exosomes for bone tissue regeneration around prostheses

Artificial joint replacement is a widely recognized treatment for arthritis and other severe joint conditions. However, one of the primary causes of failure in joint replacements is the loosening of the prosthesis. After implantation, wear particles between the implant and the adjacent bone tissue are the principal contributors to this loosening. Recently, exosomes have garnered significant interest due to their low immunogenicity and effective membrane binding. They have shown potential in promoting bone regeneration via the paracrine pathway. This review examines the role and mechanisms of exosomes derived from mesenchymal stem cells (MSCs) in bone regeneration, their impact on the integration of various implants into surrounding bone tissue and current challenges and future directions for the clinical application of exosomes. The Translational Potential of this Article: Emerging evidence suggests that mesenchymal stem cell-derived exosomes may offer a promising therapeutic strategy for aseptic prosthesis loosening, potentially mediated through mechanisms such as modulation of inflammatory responses, suppression of osteoclastogenesis, enhancement of osteogenic differentiation and facilitation of bone regeneration. Preclinical studies further indicate that the therapeutic potential of these extracellular vesicles could be optimized through bioengineering strategies, including surface modification and cargo-loading techniques, warranting further investigation to advance their clinical translation.

NGF regulates survival and differentiation of umbilical mesenchymal stem/stromal cells into GABAergic, dopaminergic and cholinergic lineages

Mesenchymal stem cells advantageous properties have led scientists to conduct trials on a range of medical conditions, including incurable neurodegenerative diseases. Wharton-Jelly derived mesenchymal stem cells, given their ease of collection, are frequently selected for these studies. This research aimed to investigate the effects of nerve growth factor (NGF) gene overexpression on the neural differentiation, survivability, and gene and protein expression of these cells. The level of gene expression was tested using the ddPCR method. Six umbilical cords from donors were collected, and three randomly chosen primary cultures of Wharton-Jelly derived mesenchymal stem cells were used in experiment. Cells were transduced with lentiviral vectors and underwent a 12-day differentiation process. The results revealed neuron-like cells with significantly high expression of CHAT, GAD2 and TH genes. A corresponding increase in protein expression was also observed. Immunostaining demonstrated notable differences in neuron-like phenotypes, contingent on the environmental conditions of the research groups. Throughout the experiment, samples with transduced mesenchymal stem cells overexpressing the NGF gene showed the highest expression levels from almost all of studied genes and proteins, and were also the most phenotypically similar to neuron-like cells. The study concluded that sustained overexpression of NGF: guides mesenchymal stem cells towards the neural pathway, facilitates the differentiation of modified mesenchymal stem cells into GABAergic, dopaminergic, and cholinergic neuron-like cells, suggests that GABAergic neurons' marker predominantly co-expresses with other neurons' markers, such as cholinergic or dopaminergic ones, increases survivability of modified mesenchymal stem cells in toxic conditions; The limitations of the study is that we merely know that cells have begun to express neurogenic markers, but in the absence of standards for mature neuronal markers, we do not yet know how far they have progressed as differentiating cells.

PRP or not PRP: Is the debate surrounding platelets-based blood-derived products evolving?

The increasing interest in biologic treatments for musculoskeletal disorders has led to the advancement of orthobiologics, particularly in non-operative care through injectable therapies. However, defining these treatments clearly is crucial for proper clinical application. Orthobiologics include biologic substances that enhance healing, such as cell-based therapies and blood-derived products. Among these, platelet-rich plasma (PRP) is widely used, but its classification remains complex due to variations in preparation methods, platelet concentration, leucocyte content, and activation techniques. Strictly, the term 'PRP' refers to plasma enriched in platelets relative to baseline blood levels. Yet, scientific debate persists regarding whether platelet count or enrichment is more significant in clinical outcomes. Additionally, leucocyte-rich and leucocyte-poor PRPs offer different therapeutic advantages depending on the target tissue, complicating standardization. Similarly, the presence of red blood cells is generally discouraged, given their association with joint inflammation. Beyond the classical 'PRP' formulations, alternative blood-derived products offer distinct biological effects. A standardized classification system is therefore essential for research and clinical application, emphasizing precise documentation of products' characteristics, including platelet count, activation state and bioactive molecule interactions. Understanding these variables and their impact on patient-specific conditions will refine orthopaedic regenerative strategies and optimize treatment efficacy.

A systematic review of the etiology and neurobiology of intermittent explosive disorder

Intermittent Explosive Disorder (IED) is characterized by repeated inability to control aggressive impulses. Although the etiology and neurobiology of impulsive anger and impulse control disorders have been reviewed, no systematic review on these aspects has been published for IED specifically. We conducted a systematic search in seven electronic databases for publications about IED, screened by two authors, and retained twenty-four studies for the review. Our findings highlight a multifactorial etiology and neurobiology of IED, emphasizing the role of the amygdala and orbitofrontal cortex in emotional regulation and impulse control, and supporting interventions that target serotonergic signaling. Research also shows that childhood trauma and adverse family environment may significantly contribute to the development of IED. Yet, genetic studies focusing on IED were largely lacking, despite many examining the genetics underlying aggression as a general trait or other related disorders. Future research using consistently defined IED as a phenotype is required to better understand the etiology and underlying mechanisms and assist in informing the development of more effective interventions for IED.

Closed-Loop Spinal Cord Stimulation in Chronic Pain Management: Mechanisms, Clinical Evidence, and Emerging Perspectives

Background: Chronic pain remains a major clinical challenge, which is often resistant to conventional treatments. Spinal cord stimulation has been used for decades to manage refractory pain, traditionally relying on open-loop systems with fixed-output stimulation. However, these systems fail to account for physiological variability, leading to inconsistent pain relief. Closed-loop spinal cord stimulation represents a significant advancement by utilizing evoked compound action potentials to continuously modulate stimulation intensity in real-time, ensuring more stable and effective pain management. Methods: A comprehensive literature review was conducted using PubMed and ClinicalTrials.gov to identify and synthesize relevant published and ongoing studies with a focus on open-loop spinal cord stimulation for managing lower back pain. Results: Clinical trials, including the Avalon and Evoke studies, have demonstrated that closed-loop spinal cord stimulation provides superior pain relief, functional improvement, and reduced opioid dependence compared to traditional open-loop systems. Patients receiving closed-loop stimulation reported significantly higher rates of sustained pain reduction, improved quality of life, and fewer complications related to overstimulation. Emerging studies suggest its potential for conditions beyond back pain, such as neuropathic pain, cancer-related pain, and Raynaud's phenomenon. Furthermore, cost-effectiveness analyses indicate that closed-loop spinal cord stimulation is a more economically viable treatment option compared to conventional medical management and open-loop systems. Conclusions: Closed-loop spinal cord stimulation represents a transformative development in neuromodulation, offering personalized and adaptive pain management that is distinct from open-loop spinal cord stimulation. Further research is warranted to explore its long-term durability, broader applications, and integration with emerging technologies in pain management.

Efficacy of electrical stimulation for antimicrobial capacity of titanium materials implants: a systematic review and meta-analysis

BACKGROUND

Antimicrobial resistance undermines the effectiveness of drugs for treating implant-associated infections. Consequently, there is growing interest in identifying alternative methods to prevent and eliminate infections. The aim of this systematic review was to ascertain whether the electrical stimulation of titanium implants or titanium-based implant materials has antimicrobial properties against bacterial biofilms. The search was conducted in various databases, including PubMed/Medline, Web of Science, EMBASE, SCOPUS, and Google Scholar, in February 2024. In addition, a manual search of the reference lists of the included articles was conducted. The eligibility criteria included in vivo and in vitro studies evaluating the effects of electrical stimulation on titanium implants or titanium-based implant materials in reducing biofilm formation or adhesion as well as eradicating or reducing the viability of bacterial biofilms. The variability between studies was determined using the inverse variance method with random- and fixed-effects models. Heterogeneity was assessed using the I2 and prediction interval statistics. Publication bias was qualitatively evaluated using funnel plots.

HIGHLIGHTS

Different electrical stimulation (ES) parameters (current and voltage) exhibited antibacterial activity, resulting in either bacteriostatic or bactericidal effects.

CONCLUSIONS

ES in titanium or titanium-based implant materials confers antimicrobial capacity against bacterial biofilms, and its effectiveness depends on the applied tension. The association between ES and antimicrobials was more robust than with ES administered individually.

Effectiveness and safety of multiple injections of human placenta-derived MSCs for knee osteoarthritis: a nonrandomized phase I trial

OBJECTIVE

This study investigates the safety and efficacy of three intra-articular (IA) injections of cryopreserved human placenta-derived mesenchymal stem cells (hP-MSCs) for knee osteoarthritis (KOA) over a 1-year follow-up period.

METHODS

A total of 26 patients with stage II-III KOA were enrolled in this non-randomized, open-label study. Patients received either conventional therapy with hyaluronic acid (HA) alone (Control group, n = 11) or in combination with hP-MSCs (MSC group, n = 15) via three intra-articular injections with 4-week intervals. Clinical outcomes were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analogue Scale (VAS), and magnetic resonance imaging (MRI) at 6 and 12 months following the first injection. Blood samples were analyzed for cytokine levels.

RESULTS

Three injections of hP-MSCs combined with HA were well-tolerated, with no severe adverse events observed. Significant improvements in WOMAC and VAS scores were noted in the MSC group compared to the Control group at both 6 and 12 months. MRI analysis revealed no significant differences in cartilage thickness or optical density index between the groups. Additionally, serum cytokine analysis showed a significant decrease in interleukin-2 (IL-2) levels in the MSC group, indicating an anti-inflammatory effect of hP-MSCs. However, no significant changes were observed in other cytokines.

CONCLUSION

This study demonstrates that three intra-articular injections of cryopreserved hP-MSCs in combination with HA are safe and effective for treating KOA, providing sustained clinical improvement at the 1-year follow-up.

TRIAL REGISTRATION

NCT04453111, #7/09.26.2018. Registered 02 January 2020, https://www.

CLINICALTRIALS

gov/study/NCT04453111 .

The relationship between maternal emotional self-disclosure and children's anxiety in the post-COVID-19 era

BACKGROUND

Following pandemics, anxiety often remains prevalent within families, particularly among mothers, even after the acute phase. Mothers typically engage in increased emotional self-disclosure and interactions with family members, which can promote improved mental health and strengthen family dynamics through the shared expression and management of psychological concerns. This study aimed to determine the relationship between maternal emotional self-disclosure and children's anxiety in the post-COVID-19 era.

METHODS

In this cross-sectional correlation study, 305 mothers of elementary school children in Borujerd, Lorestan, Iran, in 2022 were included using a multi-stage sampling method. Data collection tools comprised demographic questionnaires, the Emotional Self-Disclosure Scale, and the Spence Children's Anxiety Scale-Parent Report, all of which were completed by mothers as self-reports. Independent t-tests, one-way analysis of variance, Pearson's correlation test, and multivariate regression were employed to analyze the data.

RESULTS

There was a negative and significant correlation between mothers' emotional self-disclosure and children's anxiety (r = -0.890, P < 0.001) which remained significant after controlling for confounding variables (B = -0.667, P < 0.001). There was a statistically significant difference in mothers' mean emotional self-disclosure scores based on their place of residence, education, occupation, and their spouse's age, education, and occupation, as well as the child's sex, educational level, and age (P < 0.001). However, the results were insignificant concerning the mother's age (P > 0.05).

CONCLUSIONS

There was an inverse and relatively strong relationship between maternal emotional self-disclosure and child anxiety. This indicates that an increase in maternal emotional self-disclosure was associated with a reduction in child anxiety. Therefore, in similar crises, managing and promoting emotional self-disclosure among mothers may help in reducing children's anxiety, particularly in mothers who are well-educated, employed, reside in urban areas; have younger, well-educated, and employed spouses; and have female children with younger age and lower educational levels.

Emergence and evolution of monkeypox virus: Epidemiology, pathology, clinical symptoms, preventative and treatment measures

As the COVID-19 pandemic situation was on an end, a new monkeypox menace has been discovered in several places of the world. The most comforting thing is that the fatality rate of monkeypox is unlike Covid-19. But the recent global outbreaks and the rise in the number of cases has drawn attention of world towards it. The number of cases in multiple countries have already surpassed 25,000, according to the WHO report released on July 25, 2022. The zoonotic disease monkey-pox virus causes a feverish sickness in humans, with characteristic skin rashes and is similar to smallpox in structure, clinical presentation, and response to antiviral medicine. This review offers important insights on the evolution of the monkeypox virus and its different modes of transmission. It also discusses epidemiology, clinical findings, management, challenges, and current strategies for the disease, as well as the implications of the current epidemic on public health. Comprehensive research on the pathophysiology and management of monkeypox is still lacking. In order to solve this problem, we reviewed the pathology and virology of monkeypox infection and provided an overview of the most recent developments in anti-monkeypox medications.

Quercetin-primed MSC exosomes synergistically attenuate osteoarthritis progression

BACKGROUND

Osteoarthritis (OA), a degenerative joint disease characterized by cartilage degradation and inflammation, lacks effective disease-modifying therapies. Quercetin, a bioactive flavonoid derived from Traditional Chinese Medicine, exhibits anti-inflammatory and chondroprotective properties but is limited by poor bioavailability. Mesenchymal stem cell-derived exosomes (MSC-Exos) offer a promising strategy for targeted drug delivery and cartilage regeneration.

METHODS

Bone marrow-derived MSC exosomes (Que-Exo) were isolated after preconditioning with quercetin (1µM, 24 h). Their effects were evaluated in IL-1β-stimulated chondrocytes via RT-qPCR, Western blot, transcriptomics, and proteomics. An ACLT-induced OA mouse model received intra-articular injections of Que-Exo, with cartilage integrity assessed by Safranin O staining and OARSI scoring.

RESULTS

Que-Exo significantly reduced IL-1β-induced pro-inflammatory markers (MMP9 and COX-2) and restored cartilage repair genes (SOX9 and Collagen II) compared to untreated exosomes. Multi-omics analyses revealed activation of PI3K-AKT signaling and glutathione metabolism pathways. In vivo, Que-Exo mitigated cartilage degradation and preserved proteoglycan content.

CONCLUSIONS

Quercetin-preconditioned MSC exosomes synergistically enhance chondroprotection and anti-inflammatory effects, offering a novel therapeutic strategy for OA by combining herbal bioactive compounds with exosome-mediated delivery.

Recurrent Mpox: divergent virulent clades and the urgent need for strategic measures including novel vaccine development to sustain global health security

In August 2024, the Africa CDC and WHO declared Mpox a Public Health Emergency of Continental Security and a Public Health Emergency of International Concern, respectively, following a devastating global outbreak driven by newly emerged virulent clades I (Ia, IIb) and II (IIa, IIb) of the Mpox virus. These new clades are genetically and phylogenetically distinct from previously known strains, with the re-emerging variants originating from the Democratic Republic of the Congo (DRC) and rapidly spreading to neighbouring regions and across the globe. The ongoing epidemic is characterized by alarming morbidity and mortality, and the newly identified clades are linked to significant changes in the epidemiology of the disease, resulting in worse clinical outcomes. Sexual transmission has emerged as a key factor in sustaining the spread of the virus, particularly among sexually active young adults, facilitating the virus's spread beyond Africa. To combat the growing threat, there is an urgent need for the development of a polyvalent vaccine that incorporates the diverse circulating clades as part of other mitigation measures.. Widespread vaccination with such a vaccine could help achieve herd immunity and complement other infection prevention and control strategies to effectively mitigate the impact of this global health crisis.

Re-Evaluating Platelet-Rich Plasma Dosing Strategies in Sports Medicine: The Role of the "10 Billion Platelet Dose" in Optimizing Therapeutic Outcomes-A Narrative Review

Platelet-rich plasma (PRP) therapy is increasingly recognized as a promising treatment for musculoskeletal disorders, including osteoarthritis (OA), tendinopathy, and muscle injuries. This narrative review synthesizes the current literature to evaluate the efficacy of PRP, with a focus on platelet dosing strategies, leukocyte composition, and preparation protocols. Evidence suggests that optimal therapeutic outcomes are achieved when platelet doses exceed 3.5 billion per injection, with cumulative doses of 10-12 billion across multiple treatments. In intra-articular applications, leukocyte-poor PRP (LP-PRP), characterized by reduced neutrophil content, demonstrates superior efficacy compared to leukocyte-rich PRP (LR-PRP). However, its effectiveness in tendon and muscle regeneration remains a subject of debate. Preliminary data suggest that the inclusion of peripheral blood mononuclear cells (PBMNCs) may enhance PRP efficacy, though robust clinical trials are required to confirm these findings. Furthermore, red blood cell contamination and pre-activation have been identified as detrimental to PRP effectiveness, highlighting the need for standardized preparation protocols. This review emphasizes the importance of tailoring PRP formulations to patient-specific factors and musculoskeletal conditions. Future research should focus on refining PRP preparation techniques, identifying optimal leukocyte compositions, and establishing standardized guidelines to enhance clinical outcomes.