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Napit IB, Shrestha D, Choudhury S, Gkini E, Ilozumba O, Gill P, Bishop J, Neupane K, Adhikari A, Sartori J, Watson SI, Lilford R. A randomised Trial of Autologous Blood products, leukocyte and platelet-rich fibrin (L-PRF), to promote ulcer healing in LEprosy: The TABLE trial. PLoS Negl Trop Dis 2024; 18:e0012088. [PMID: 38696527 PMCID: PMC11093377 DOI: 10.1371/journal.pntd.0012088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 05/14/2024] [Accepted: 03/20/2024] [Indexed: 05/04/2024] Open
Abstract
INTRODUCTION Autologous blood products like Platelet Rich Plasma (PRP) and Leukocyte and Platelets Rich Fibrin (L-PRF) have been used for many years across many types of skin ulcers. However, the effectiveness of autologous blood products on wound healing is not well established. METHODS We evaluated the 'second generation' autologous product- Leukocyte and Platelet- Rich Fibrin (L-PRF). Our trial was undertaken on patients suffering from neuropathic leprosy ulcers at the Anandaban hospital which serves the entire country of Nepal. We conducted a 1:1 (n = 130) individually randomised trial of L-PRF (intervention) vs. normal saline dressing (control) to compare rate of healing and time to complete healing. Rate of healing was estimated using blind assessments of ulcer areas based on three different measurement methods. Time to complete healing was measured by the local unblinded clinicians and by blind assessment of ulcer images. RESULTS The point estimates for both outcomes were favourable to L-PRF but the effect sizes were small. Unadjusted mean differences (intervention vs control) in mean daily healing rates (cm2) were respectively 0.012 (95% confidence interval 0.001 to 0.023, p = 0.027); 0.016 (0.004 to 0.027, p = 0.008) and 0.005 (-0.005 to 0.016, p = 0.313) across the three measurement methods. Time to complete healing at 42 days yielded Hazard Ratios (unadjusted) of 1.3 (0.8 to 2.1, p = 0.300) assessed by unblinded local clinicians and 1.2 (0.7 to 2.0, p = 0.462) on blind assessment. CONCLUSION Any benefit from L-PRF appears insufficient to justify routine use in care of neuropathic ulcers in leprosy. TRIAL REGISTRATION ISRCTN14933421. Date of trial registration: 16 June 2020.
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Affiliation(s)
- Indra B. Napit
- Anandaban Hospital, The Leprosy Mission Nepal, Kathmandu, Nepal
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Dilip Shrestha
- Anandaban Hospital, The Leprosy Mission Nepal, Kathmandu, Nepal
| | - Sopna Choudhury
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Eleni Gkini
- Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Onaedo Ilozumba
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Paramjit Gill
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Jon Bishop
- Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Karuna Neupane
- Anandaban Hospital, The Leprosy Mission Nepal, Kathmandu, Nepal
| | - Anju Adhikari
- Anandaban Hospital, The Leprosy Mission Nepal, Kathmandu, Nepal
| | - Jo Sartori
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Samuel I. Watson
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Richard Lilford
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
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Vaidakis D, Papapanou M, Siristatidis CS. Autologous platelet-rich plasma for assisted reproduction. Cochrane Database Syst Rev 2024; 4:CD013875. [PMID: 38682756 PMCID: PMC11057220 DOI: 10.1002/14651858.cd013875.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
BACKGROUND Autologous platelet-rich plasma (PRP) consists of plasma and a concentrate of platelets extracted from fresh whole blood of the person being treated. Research has suggested that intrauterine or intraovarian infusion/injection of PRP before embryo transfer may improve endometrial receptivity and response to ovarian stimulation in women undergoing assisted reproduction. We compared these interventions to standard treatment, placebo, or other interventions (mechanical or pharmacological). OBJECTIVES To assess the effectiveness and safety of intrauterine and intraovarian infusion/injection of platelet-rich plasma in infertile women undergoing assisted reproductive technology cycles. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility Group's Specialised Register, CENTRAL, MEDLINE, Embase, and the Epistemonikos database in January 2023. We also searched the reference lists of relevant articles and contacted the trial authors and experts in the field for any additional trials. SELECTION CRITERIA We included randomized controlled trials (RCTs) that evaluated the application of PRP in the uterine cavity, ovaries, or both versus no intervention, placebo, or any other intervention (either mechanical or pharmacological) in women undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles. DATA COLLECTION AND ANALYSIS We followed standard methodological procedures recommended by Cochrane, including use of the updated risk of bias tool (RoB 2). The primary outcomes were live birth (or ongoing pregnancy) and miscarriage. The secondary outcomes were clinical pregnancy, complications of the procedure, multiple pregnancy, ectopic pregnancy, fetal growth restriction, preterm delivery, and fetal abnormality. We estimated the average effect of the interventions by fitting a Der Simonian-Laird's random-effects meta-analysis model. We reported pooled odds ratios (ORs) with 95% confidence intervals (CIs). We restricted the primary analyses to trials at low risk of bias for the outcomes and performed sensitivity analyses that included all studies. MAIN RESULTS We included 12 parallel-group RCTs that recruited a total of 1069 women. We identified three different comparison groups. Using GRADE, we assessed the certainty of evidence as very low for almost all outcomes. Intrauterine injection/infusion of platelet-rich plasma versus no intervention or placebo Nine studies evaluated intrauterine PRP versus no intervention or placebo. Eight included women with at least two or three previous implantation failures. Only one was assessed at low risk of bias for each outcome. This study provided very low-certainty evidence about the effect of intrauterine PRP injection versus no intervention on live birth (OR 1.10, 95% CI 0.38 to 3.14; 94 women) and miscarriage (OR 0.96, 95% CI 0.13 to 7.09; 94 women). If the likelihood of live birth following no intervention is assumed to be 17%, then the likelihood following intrauterine PRP would be 7% to 40%; and if the risk of miscarriage following no intervention is 4%, then the risk following intrauterine PRP would be 1% to 24%. When we analyzed all studies (regardless of risk of bias), we found very low-certainty evidence about the effect of intrauterine PRP compared with placebo or no intervention on live birth or ongoing pregnancy (OR 2.38, 95% CI 1.16 to 4.86; I² = 54%; 6 studies, 564 women) and miscarriage (OR 1.54, 95% CI 0.59 to 4.01; I² = 0%; 5 studies, 504 women). The study at low risk of bias provided very low-certainty evidence about the effect of intrauterine PRP compared with no intervention on clinical pregnancy (OR 1.55, 95% CI 0.64 to 3.76; 94 women) and ectopic pregnancy (OR 2.94, 95% CI 0.12 to 73.95; 94 women). The synthesis of all studies provided very low-certainty evidence about the effect of intrauterine PRP compared with placebo or no intervention on clinical pregnancy (OR 2.22, 95% CI 1.50 to 3.27; I² = 24%; 9 studies, 824 women), multiple pregnancy (OR 2.68, 95% CI 0.81 to 8.88; I² = 0%; 2 studies, 240 women), and ectopic pregnancy (OR 2.94, 95% CI 0.12 to 73.95; 1 study, 94 women; very low-certainty evidence). Intrauterine infusion of PRP may increase the risk of preterm delivery compared with no intervention (OR 8.02, 95% CI 1.72 to 37.33; 1 study, 120 women; low-certainty evidence). No studies reported pain, infection, allergic reaction, fetal growth restriction, or fetal abnormality. Intrauterine infusion of platelet-rich plasma versus intrauterine infusion of granulocyte colony-stimulating factor Two RCTs evaluated intrauterine PRP versus intrauterine granulocyte colony-stimulating factor (G-CSF); both included women with thin endometrium, and neither was judged at low risk of bias for any outcome. We are uncertain about the effect of intrauterine PRP compared with intrauterine G-CSF on live birth (OR 0.88, 95% CI 0.43 to 1.81; 1 study, 132 women; very low-certainty evidence), miscarriage (OR 1.94, 95% CI 0.63 to 5.96; 1 study, 132 women; very low-certainty evidence), and clinical pregnancy (OR 1.24, 95% CI 0.66 to 2.35; 2 studies, 172 women; very low-certainty evidence). Neither study reported adverse outcomes other than miscarriage. Intraovarian injection of platelet-rich plasma versus no intervention One RCT evaluated PRP injection into both ovaries versus no intervention; it was judged at high risk of bias for the two outcomes it reported. We are uncertain about the effect of intraovarian PRP injection compared with no intervention on ongoing pregnancy (OR 1.09, 95% CI 0.33 to 3.63; 73 women; very low-certainty evidence) and clinical pregnancy (OR 0.90, 95% CI 0.31 to 2.60; 73 women; very low-certainty evidence). The study examined no safety outcomes. AUTHORS' CONCLUSIONS We are uncertain about the effect of intrauterine or intraovarian administration of PRP on outcomes of assisted reproduction technology in infertile women. The pooled results should be interpreted with caution. Only one of the 12 included studies was judged at low risk of bias. Other limitations of the included trials were failure to report live birth, poor reporting of methods, lack of prospective protocol registration, low precision due to the small number of enrolled participants, indirectness due to the specific subpopulations and settings studied, and insufficient or absent safety data.
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Affiliation(s)
- Dennis Vaidakis
- Department of Basic and Clinical Sciences, Medical School, University of Nicosia, Nicosia, Cyprus
| | - Michail Papapanou
- Second Department of Obstetrics and Gynecology, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Obstetrics, Gynecology and Reproductive Medicine Working Group, Society of Junior Doctors, Athens, Greece
| | - Charalampos S Siristatidis
- Assisted Reproduction Unit, 2nd Department of Obstetrics and Gynaecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Karas RA, Alexeree S, Elsayed H, Attia YA. Assessment of wound healing activity in diabetic mice treated with a novel therapeutic combination of selenium nanoparticles and platelets rich plasma. Sci Rep 2024; 14:5346. [PMID: 38438431 PMCID: PMC10912747 DOI: 10.1038/s41598-024-54064-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/08/2024] [Indexed: 03/06/2024] Open
Abstract
Diabetic wound healing is sluggish, often ending in amputations. This study tested a novel, two-punch therapy in mice-Selenium nanoparticles (Se NPs) and platelet-rich plasma (PRP)-to boost healing. First, a mouse model of diabetes was created. Then, Se NPs were crafted for their impressive antioxidant and antimicrobial powers. PRP, packed with growth factors, was extracted from the mice's blood. Wound healing was tracked for 28 days through photos, scoring tools, and tissue analysis. Se NPs alone spurred healing, and PRP added extra fuel. Furthermore, when used in combination with PRP, the healing process was accelerated due to the higher concentration of growth factors in PRP. Notably, the combination of Se NPs and PRP exhibited a synergistic effect, significantly enhancing wound healing in diabetic mice. These findings hold promise for the treatment of diabetic wounds and have the potential to reduce the need for lower limb amputations associated with diabetic foot ulcers. The innovative combination therapy using Se NPs and PRP shows great potential in expediting the healing process and addressing the challenges of impaired wound healing in individuals with diabetes. This exciting finding suggests this therapy could change diabetic wound management, potentially saving limbs and improving lives.
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Affiliation(s)
- Rania A Karas
- National Institute of Laser Enhanced Sciences, Cairo University, Giza, 12613, Egypt
| | - Shaimaa Alexeree
- National Institute of Laser Enhanced Sciences, Cairo University, Giza, 12613, Egypt
| | - Hassan Elsayed
- Department of Microbial Biotechnology, Biotechnology Research Institute, National Research Centre, Dokki, 12622, Giza, Egypt
- School of Biotechnology, Badr University in Cairo, Cairo, 11829, Egypt
| | - Yasser A Attia
- National Institute of Laser Enhanced Sciences, Cairo University, Giza, 12613, Egypt.
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Peng Y, Wang J, Liu X, Zhou Y, Jia S, Xu J, Zheng C. Efficacy of Platelet-Rich Plasma in the Treatment of Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis. Ann Vasc Surg 2024; 98:365-373. [PMID: 37355015 DOI: 10.1016/j.avsg.2023.05.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND The probiological healing effect of platelet-rich plasma (PRP) during tissue repair has recently gathered much attention. This study aimed to conduct a systematic review and meta-analysis of patients with diabetic foot ulcer (DFU) receiving PRP or conventional treatment to evaluate their efficacy. METHODS PubMed, Excerpta Medica Database (EMBASE), Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases were comprehensively searched by 2 independent reviewers following PRISMA guidelines for the inclusion of randomized controlled trials (RCTs) comparing PRP with conventional treatments for DFUs. The primary measurements of healing rate and healing time, the methodological quality and extracted data were assessed using Review Manager 5.3. Statistical significance was set at P < 0.05. RESULTS A total of 10 RCTs involving 550 patients were included in this study, PRP was observed to significantly improve the healing rate (risk ratio [RR] = 1.38, 95% confidence interval [CI] 1.05-1.82, P = 0.02) and shorten the healing time (mean difference [MD] = -23.23, 95% CI -45.97 to -0.49, P = 0.05) of patients with DFU when compared to the conventional treatment. CONCLUSIONS Compared to conventional treatment, PRP effectively promoted the healing of patients with DFU by evidently improving the healing rate and healing time.
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Affiliation(s)
- Yundong Peng
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - JiePing Wang
- Laboratory of Exercise Biochemistry, Institute of Sports Sciences, University of Taipei, Taipei, Taiwan
| | - Xinyao Liu
- College of Sports Medicine, Wuhan Sports University, Wuhan, China
| | - Yanqing Zhou
- College of Sports Medicine, Wuhan Sports University, Wuhan, China
| | - Shaohui Jia
- Hubei Key Laboratory of Sport Training and Monitoring, College of Sports Medicine, Wuhan Sports University, Wuhan, China
| | - Jinrong Xu
- Hospital of Central China Normal University, Wuhan, China.
| | - Cheng Zheng
- Department of Sports Medicine, Affiliated Hospital, Wuhan Sports University, Wuhan, China.
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Napit IB, Shrestha D, Neupane K, Adhikari A, Dhital R, Koirala R, Gopali L, Ilozumba O, Gill P, Watson SI, Choudhury S, Lilford RJ. Autologous blood products: Leucocyte and Platelets Rich Fibrin (L-PRF) and Platelets Rich Plasma (PRP) gel to promote cutaneous ulcer healing - a systematic review. BMJ Open 2023; 13:e073209. [PMID: 38086583 PMCID: PMC10729115 DOI: 10.1136/bmjopen-2023-073209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE To summarise evidence on the effectiveness of Platelet-Rich Plasma (PRP) gel and Leucocyte and Platelet Rich Fibrin (L-PRF) gel as agents promoting ulcer healing compared with the standard wound dressing techniques alone. DESIGN Systematic review. ELIGIBILITY CRITERIA Individual patient randomised controlled trials on skin ulcers of all types excluding traumatic lesions.Intervention group: treatment with topical application of L-PRF gel or PRP gel to the wound surface. CONTROL GROUP treatment with standard skin ulcer care using normal saline, normgel or hydrogel dressings. INFORMATION SOURCES Medline (Ovid), Excerpta Medica Database (EMBASE), Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science and manual search of studies from previous systematic reviews and meta-analyses. The papers published from 1946 to 2022 with no restriction on geography and language were included. The last date of the search was performed on 29 August 2022. DATA EXTRACTION AND SYNTHESIS Independent reviewers identified eligible studies, extracted data, assessed risk of bias using V.2 of the Cochrane risk-of-bias tool for randomised trials tool and assessed certainty of evidence by using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. MAIN OUTCOME MEASURES Time to complete healing, proportion healed at a given time and rate of healing. RESULTS Seven studies met the inclusion criteria, five using PRP gel and two using L-PRF gel. One study showed a better proportion of complete healing, three reported reduced meantime to complete healing and five showed improved rate of healing per unit of time in the intervention group. The risk of bias was high across all studies with one exception and the GRADE showed very low certainty of evidence. CONCLUSION The findings show potential for better outcomes in the intervention; however, the evidence remains inconclusive highlighting a large research gap in ulcer treatment and warrant better-designed clinical trials. PROSPERO REGISTRATION NUMBER CRD42022352418.
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Affiliation(s)
- Indra B Napit
- Anandaban Hospital, The Leprosy Mission Nepal, Lalitpur, Nepal
| | - Dilip Shrestha
- Anandaban Hospital, The Leprosy Mission Nepal, Lalitpur, Nepal
| | - Karuna Neupane
- Anandaban Hospital, The Leprosy Mission Nepal, Lalitpur, Nepal
| | - Anju Adhikari
- Anandaban Hospital, The Leprosy Mission Nepal, Lalitpur, Nepal
| | - Rolina Dhital
- Health Action and Research Pvt Ltd, Kathmandu, Nepal
| | | | - Lovin Gopali
- Health Action and Research Pvt Ltd, Kathmandu, Nepal
| | | | - Paramjit Gill
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Samuel I Watson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sopna Choudhury
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
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Bai MY, Vy VPT, Tang SL, Hung TNK, Wang CW, Liang JY, Wong CC, Chan WP. Current Progress of Platelet-Rich Derivatives in Cartilage and Joint Repairs. Int J Mol Sci 2023; 24:12608. [PMID: 37628786 PMCID: PMC10454586 DOI: 10.3390/ijms241612608] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/04/2023] [Accepted: 08/05/2023] [Indexed: 08/27/2023] Open
Abstract
In recent years, several types of platelet concentrates have been investigated and applied in many fields, particularly in the musculoskeletal system. Platelet-rich fibrin (PRF) is an autologous biomaterial, a second-generation platelet concentrate containing platelets and growth factors in the form of fibrin membranes prepared from the blood of patients without additives. During tissue regeneration, platelet concentrates contain a higher percentage of leukocytes and a flexible fibrin net as a scaffold to improve cell migration in angiogenic, osteogenic, and antibacterial capacities during tissue regeneration. PRF enables the release of molecules over a longer period, which promotes tissue healing and regeneration. The potential of PRF to simulate the physiology and immunology of wound healing is also due to the high concentrations of released growth factors and anti-inflammatory cytokines that stimulate vessel formation, cell proliferation, and differentiation. These products have been used safely in clinical applications because of their autologous origin and minimally invasive nature. We focused on a narrative review of PRF therapy and its effects on musculoskeletal, oral, and maxillofacial surgeries and dermatology. We explored the components leading to the biological activity and the published preclinical and clinical research that supports its application in musculoskeletal therapy. The research generally supports the use of PRF as an adjuvant for various chronic muscle, cartilage, and tendon injuries. Further clinical trials are needed to prove the benefits of utilizing the potential of PRF.
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Affiliation(s)
- Meng-Yi Bai
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei 10607, Taiwan
- Adjunct Appointment to the Department of Biomedical Engineering, National Defense Medical Center, Taipei 11490, Taiwan
| | - Vu Pham Thao Vy
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan;
- Department of Radiology, Thai Nguyen National Hospital, Thai Nguyen 24000, Vietnam
| | - Sung-Ling Tang
- Department of Pharmacy Practice, Tri-Service General Hospital, Taipei 11490, Taiwan
| | | | - Ching-Wei Wang
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei 10607, Taiwan
| | - Jui-Yuan Liang
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Chin-Chean Wong
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan;
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11011, Taiwan
- International Ph.D. Program for Cell Therapy and Regenerative Medicine, College of Medicine, Taipei Medical University, Taipei 11011, Taiwan
| | - Wing P. Chan
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei 116081, Taiwan
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Tobita M, Masubuchi Y, Wakana K, Yoneda H, Namaki S, Hide M, Tamagawa T, Shinohara M. Clinical Research on the Safety Evaluation of Platelet-rich Plasma Treatment in Oral Diseases: A Study Protocol. JUNTENDO IJI ZASSHI = JUNTENDO MEDICAL JOURNAL 2023; 69:240-245. [PMID: 38855433 PMCID: PMC11153079 DOI: 10.14789/jmj.jmj23-0005-sp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/03/2023] [Indexed: 06/11/2024]
Abstract
Background Platelet-rich plasma (PRP) is a biological product obtained from autologous blood that contains growth factors, promoting the healing and regeneration of human tissues. Several oral diseases require surgical intervention, producing residual wounds that undergo a healing process, accompanied by pain, swelling, superinfections, and bone remodeling. This protocol study aims to evaluate the safety of PRP use for the following dental procedures: post-extraction socket healing, periodontal tissue regeneration, maxillary sinus floor elevation, tooth transplantation, and intentional tooth replantation. Methods Ten patients will be enrolled and subjected to the required treatment with the addition of PRP, after appropriate hematological and biochemical evaluations. The participants will then be subjected to an observation period of 4 weeks to monitor adverse events through clinical observation. Secondary outcomes will regard pain, and clinical evolution of the treated site. Among these, presence of infection, swelling, wound healing, stability of the transplanted tooth. Discussion Safety of medical procedures represents the first requirement for their introduction in routine practice. A careful evaluation of clinical response during follow-up period and registration of adverse effects is fundamental for safety confirmation and subsequent use of PRP for the proposed dental procedures. Trial registration Japan Registry of Clinical Trials (https://jrct.niph.go.jp/, registry number: jRCTc030190273, jRCTc030190274, jRCTc030190275, jRCTc030190276, jRCTc030190277; Date of registration: 31 March 2020).
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Knightly N, Lee C, O’Brien L, Qayyum T, Hurley C, Kelly J. Role for platelet rich plasma as an adjuvant therapy in wound healing and burns. EUROPEAN JOURNAL OF PLASTIC SURGERY 2023. [DOI: 10.1007/s00238-023-02050-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Abstract
Background
Platelet rich plasma (PRP) contains high concentrations of growth factors. Intuitively, these were thought to be of potential benefit in healing of chronic wounds, skin grafts and graft donor sites. This was echoed in retrospective studies and an individual case basis but had not been randomized.
Methods
A systematic search was carried out by two individuals, independently, on the MEDLINE, EMBASE and COCHRANE databases, according to PRISMA guidelines. All data analysis and statistics was pooled and analysed using the Cochrane RevMan Software.
Results
Split thickness grafts have been described by numerous authors, but PRP use did not offer a significant advantage in graft take in pooled results (MD 5.83, 95% CI − 0.69 to 12.25, random-effects, p = 0.08). The analysis of included randomized controlled trials has shown favourable split-thickness skin graft donor site healing in the PRP group (MD − 5.55, 95% CI − 7.40 to − 3.69, random-effects, p = < 0.00001) compared to the control group. For carpal tunnel syndrome, the pooled results showed no difference in functional scores vs steroid injections (SMD − 0.68, 95% CI − 1.47 to 0.10, randomeffects, p = 0.09) or indeed splinting groups.
Conclusions
With the current body of evidence, we conclude that the use of PRP as an adjuvant therapy in skin grafts, burns, carpal tunnel surgery or scars cannot be rationalised. A potential use of PRP is in donor site management but the cost of this would be difficult to justify.
Level of evidence: Not ratable.
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Rao SS, Venkatesan J, Yuvarajan S, Rekha PD. Self-assembled polyelectrolyte complexes of chitosan and fucoidan for sustained growth factor release from PRP enhance proliferation and collagen deposition in diabetic mice. Drug Deliv Transl Res 2022; 12:2838-2855. [PMID: 35445942 DOI: 10.1007/s13346-022-01144-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 02/07/2023]
Abstract
Diabetic wound management is a serious health care challenge due to higher rates of relapse, expensive treatment approaches, and poor healing outcomes. Among cell-based therapies, use of platelet-rich plasma (PRP) has been shown to be effective for diabetic wounds, but its poor shelf-life limits its clinical use. Here, we demonstrate a simple but effective polymer system to increase the shelf-life of PRP by developing a polyelectrolyte complex with dropwise addition of chitosan solution containing PRP by simple mixing at room temperature. Thus, prepared chitosan-fucoidan (CF) carrier complex encapsulated more than 95% of the loaded PRP. The resulting CF/PRP colloids were spherical in shape and ensured extended PRP release up to 72 h at 37 °C. Routine characterization (FT-IR, XRD, SEM) showed the material properties. The biological assays showed that CF complexes were biocompatible while CF/PRP enhanced the proliferation of fibroblasts and keratinocytes via higher Ki67 expression and fibroblast migration. Further investigations using a diabetic mouse model demonstrated significantly higher wound contraction and histopathological observations showed increased fibroblast migration, and collagen and cytokeratin deposition in treatment groups. The results are suggestive of the efficacy of CF/PRP as a cost-effective topical formulation for the sustained delivery of growth factors in treating chronic diabetic wounds.
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Affiliation(s)
- Sneha Subramanya Rao
- Yenepoya Research Centre, Yenepoya (Deemed To Be University), Deralakatte, Mangalore, Karnataka, 575018, India
| | - Jayachandran Venkatesan
- Yenepoya Research Centre, Yenepoya (Deemed To Be University), Deralakatte, Mangalore, Karnataka, 575018, India
| | - Subramaniyan Yuvarajan
- Yenepoya Research Centre, Yenepoya (Deemed To Be University), Deralakatte, Mangalore, Karnataka, 575018, India
| | - Punchappady-Devasya Rekha
- Yenepoya Research Centre, Yenepoya (Deemed To Be University), Deralakatte, Mangalore, Karnataka, 575018, India.
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Gomri F, Vischer S, Turzi A, Berndt S. Swiss Medical Devices for Autologous Regenerative Medicine: From Innovation to Clinical Validation. Pharmaceutics 2022; 14:pharmaceutics14081617. [PMID: 36015243 PMCID: PMC9413293 DOI: 10.3390/pharmaceutics14081617] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/15/2022] [Accepted: 07/29/2022] [Indexed: 12/01/2022] Open
Abstract
Regenerative medicine, based on the use of autologous tissues and embryonic, stem or differentiated cells, is gaining growing interest. However, their preparation, in a manner compliant with good practices and health regulations, is a technical challenge. The aim of this manuscript is to present the design of reliable CE marked medical devices for the preparation of standardized platelet-rich plasma (PRP) and other autologous biologics intended for therapeutic uses. There are numerous PRP isolation processes. Depending on the methodology used, PRP composition varies greatly in terms of platelet concentration, platelet quality, and level of contamination with red and white blood cells. This variability in PRP composition might affect the clinical outcomes. The devices presented here are based on a specific technology, patented all over the world, that allows the precise separation of blood components as a function of their density using thixotropic separator gels in closed systems. This allows the preparation, in an automated manner, of leukocyte poor PRP with a standardized composition. Production of different forms of PRP is a clinical asset to suit various therapeutic needs. Therefore, we are offering solutions to prepare PRP either in liquid or gel form, and PRP combined with hyaluronic acid. These biologics have been successfully used in many different therapeutic domains, resulting in more than 150 published clinical studies. We also developed the CuteCell technology platform for cell culture expansion for further autologous cell therapies. This technology enables the safe and rapid in vitro expansion of cells intended for therapeutic use in good manufacturing practices (GMP) and autologous conditions, using blood-derived products as culture media supplementation. We summarize in this article our 20 years’ experience of research and development for the design of PRP devices and, more recently, for PRP combined with hyaluronic acid.
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Affiliation(s)
- Farid Gomri
- Regen Lab SA, 1052 Le Mont-sur-Lausanne, Switzerland; (F.G.); (S.V.); (A.T.)
| | - Solange Vischer
- Regen Lab SA, 1052 Le Mont-sur-Lausanne, Switzerland; (F.G.); (S.V.); (A.T.)
| | - Antoine Turzi
- Regen Lab SA, 1052 Le Mont-sur-Lausanne, Switzerland; (F.G.); (S.V.); (A.T.)
| | - Sarah Berndt
- Regen Lab SA, 1052 Le Mont-sur-Lausanne, Switzerland; (F.G.); (S.V.); (A.T.)
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
- Correspondence:
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11
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Simão VP, Cury CS, Tavares GMZ, Ortega GC, Ribeiro AC, Santos GS, Lana JFSD. Platelet-rich plasma application in diabetic ulcers: A review. World J Dermatol 2022; 10:1-9. [DOI: 10.5314/wjd.v10.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/29/2022] [Accepted: 04/24/2022] [Indexed: 02/06/2023] Open
Abstract
There are 422 million diabetic people in the world. 25% of these individuals are diagnosed with diabetic foot ulcer (DFU). 20% of patients with DFU will suffer amputation of the lower limbs. Following amputation procedures, the mortality rate of patients is over 70% in 5 years. Diabetes has no cure and, therefore, treatment aims to prevent and treat its complications. Autologous platelet-rich plasma (PRP) has been shown to be a therapeutic tool for many types of disorders, including the treatment of DFU. This manuscript aims to carry out a review to provide more knowledge about the efficacy and safety of autologous PRP for wound closure in patients with DFU. The majority of studies included in this review state that PRP promotes improvement of DFU lesions by accelerating tissue healing processes. However, many studies have a small sample size and thus require larger sample range in order to improve robustness of data in the literature.
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Affiliation(s)
| | - Carolina Souza Cury
- Medical School, Centro Universitário Lusíada, Santos 11045-101, São Paulo, Brazil
| | | | | | | | - Gabriel Silva Santos
- Biomedical Science, Brazilian Institute of Regenerative Medicine, Indaiatuba 13334-170, São Paulo, Brazil
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12
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Steiner N, Vozel D, Urbančič J, Božič D, Kralj-Iglič V, Battelino S. Clinical implementation of platelet- and extracellular vesicle-rich product preparation protocols. Tissue Eng Part A 2022; 28:770-780. [DOI: 10.1089/ten.tea.2022.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nejc Steiner
- University Medical Centre Ljubljana, ENT department, ENT, Ljubljana, Slovenia,
| | - Domen Vozel
- University of Ljubljana Faculty of Medicine, 37664, Otorhinolaringology, Ljubljana, Slovenia,
- University Medical Centre Ljubljana, Otorhinolaringology, Ljubljana, Slovenia,
| | - Jure Urbančič
- University of Ljubljana Faculty of Medicine, 37664, Otorhinolaringology, Ljubljana, Slovenia,
- University Medical Centre Ljubljana, Otorhinolaringology, Ljubljana, Slovenia,
| | - Darja Božič
- University of Ljubljana Faculty of Health Sciences, 68934, Ljubljana, Slovenia,
| | | | - Saba Battelino
- University of Ljubljana Faculty of Medicine, 37664, Otorhinolaringology, Ljubljana, Slovenia,
- University Medical Centre Ljubljana, Otorhinolaringology, Ljubljana, Slovenia,
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13
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Alkandari MH, Touma N, Carrier S. Platelet-Rich Plasma Injections for Erectile Dysfunction and Peyronie's Disease: A Systematic Review of Evidence. Sex Med Rev 2022; 10:341-352. [PMID: 34219010 DOI: 10.1016/j.sxmr.2020.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 10/18/2020] [Accepted: 12/03/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Erectile Dysfunction (ED) and Peyronie's Disease (PD) are debilitating medical conditions affecting patients' quality of life (QoL). Platelet-rich plasma (PRP) injections are one of the various emerging approaches proposed to treat these medical conditions. AIM To describe the evidence of the potential role of PRP injections in ED and PD. METHODS The authors conducted a systematic review according to the PRISMA statement using the following databases in November 2019: The National Library of Medicine (PubMed), Ovid Medline, Cochrane, Scopus, Embase, and Embase classic. The search was performed using keywords drawn from studies on the use of PRP in ED and PD in clinical and preclinical studies. RESULTS Eighteen articles met the inclusion criteria for review, including 12 studies on the use of PRP in humans and 6 on the use of PRP in rats. Ten studies reported on the efficacy of PRP in ED exclusively, 7 in PD exclusively and one in both conditions. In humans, 6 and 3 studies showed promising results in PD and ED, respectively. No major complications were noted. Unwanted minor side effects were noted by studies reporting on PD, including mild penile bruising, ecchymosis, hematomas as well as transient hypotension noted in 2 out of 90 patients. CONCLUSION PRP injections for the treatment of ED may be promising, but no recommendation can be made because of scarce evidence. Safety and effectiveness of this therapy in the treatment of ED and PD require further preclinical and clinical studies with standardized protocols to gain an adequate insight into its potential implications. Patients should be offered to be part of such trials to better understand PRP potential. Alkandari MH, Touma N, Carrier S, Platelet-Rich Plasma Injections for Erectile Dysfunction and Peyronie's Disease: A Systematic Review of Evidence. Sex Med Rev 2022;10:341-352.
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Affiliation(s)
- Mohammad H Alkandari
- McGill University Health Center, Department of Surgery, Division of Urology, Montreal, Quebec, Canada
| | | | - Serge Carrier
- McGill University Health Center, Department of Surgery, Division of Urology, Montreal, Quebec, Canada.
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14
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Russo S, Landi S, Courric S. Cost-Effectiveness Analysis for the Treatment of Diabetic Foot Ulcer in France: Platelet-Rich Plasma vs Standard of Care. Clinicoecon Outcomes Res 2022; 14:1-10. [PMID: 35018103 PMCID: PMC8742138 DOI: 10.2147/ceor.s327191] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/09/2021] [Indexed: 01/13/2023]
Abstract
Introduction Diabetic chronic foot ulcers (DFU) lead to pain, reduced quality of life and represent a severe economic burden for patients and health systems. The clinical results of PRP effectiveness in the treatment of DFU are promising; on the other hand, the costs associated with treating DFUs with PRP are higher than those using standard therapy. Therefore, this study aims to determine the cost-effectiveness of platelet-rich plasma (PRP) therapy compared to standard therapy from the French healthcare system perspective. Methods A cost-effectiveness analysis (CEA) was performed using a decision Markov model with a cohort of patients with chronic DFU (duration of >3 weeks) with high orthopaedic risk and with ulcers graded 3A according to University of Texas classification. The effectiveness outcomes are reported in terms of quality adjusted life year (QALY). The costs are reported in euro (€) currency evaluated in 2019. A micro-costing approach alongside a clinical study was used to assess resource use. Deterministic sensibility analyses are reported to evaluate the robustness of the results. The analyses were carried out in the French setting. Results The incremental cost-effectiveness ratio (ICER) of PRP treatment is –€613/ QALY, which, being lower than zero, indicates the dominance of the PRP therapy. Deterministic and probabilistic sensitivity analysis underlines the main parameter affecting CE results. Lowest number of standard of care weekly medications (from 5 to 3) leads to a €622/QALY while increasing PRP weekly medication (from 1 to 4) has an ICER of €732/QALY. Discussion PRP is a cost-effective or even a cost-saving alternative in the French setting. PRP has higher cost for the complete medication, but, in the absence of wound complications, has the potential to involve lower consumption of resources in the form of routine medication over a 1-year time horizon.
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Affiliation(s)
- Salvatore Russo
- Department of Management, University of Venice, Venezia, Italy
| | - Stefano Landi
- Department of Business Administration and Management, University of Verona, Verona, Italy
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15
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Healing of Chronic Wounds with Platelet-Derived Growth Factors from Single Donor Platelet-Rich Plasma following One Freeze-Thaw Cycle. A Cross-Sectional Study. J Clin Med 2021; 10:jcm10245762. [PMID: 34945062 PMCID: PMC8705371 DOI: 10.3390/jcm10245762] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/03/2021] [Accepted: 12/07/2021] [Indexed: 12/29/2022] Open
Abstract
Chronic non-healing wounds (CNHWs) may be associated with trauma or idiopathic in nature and are difficult to treat. Our objective was to assess the use of platelet-derived growth factor (PDGF) from single-donor platelets (al-PRP), using one freeze-thaw cycle, for treating CNHWs. We conducted a cross-sectional study. A total of 23 CNHWs being treated with al-PRP. The al-PRP treatment can be considered successful in well over half (n = 13, 56.5%) of the wounds. We found that all the wounds treated for up to 7 weeks showed partial or complete healing, while those treated for between 8 and 12 weeks did not show healing, healing again being successful in cases in which treatment was extended to more than 13 weeks (85.7%). Using chi-square tests, this relationship was found to be highly significant (p < 0.001, chi2 = 19.51; p value = 0.00006). Notably, Cramer's V coefficient was very high (0.921), indicating that the effect size of PRP treatment duration on healing is very large (84.8%). We could suggest that the use of al-PRP in the healing of CNHWs is a promising approach. Further studies with larger sample sizes and long follow-ups are needed to obtain multivariate models to explain which factors favour the healing of ulcers treated with PRP.
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16
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Kauhl W, Pototschnig H, Paasch U. Can Platelet-Rich Plasma Reduce the Burden of Inflammatory Skin Diseases Such as Psoriasis and Atopic Dermatitis? Cureus 2021; 13:e18472. [PMID: 34754637 PMCID: PMC8565102 DOI: 10.7759/cureus.18472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 11/05/2022] Open
Abstract
Objective In this study, our aim was to investigate the clinical effects of platelet-rich plasma (PRP) on the skin of patients suffering from plaque psoriasis or atopic dermatitis. Methods Over a period of 53 months, we treated a total of 40 patients for inflammatory skin diseases with PRP. All of these patients were included in this study; 5-6 ml of PRP were prepared with the autologous-conditioned plasma (ACP) double syringe and injected subdermally. Follow-ups were conducted at three, six, nine, and 12 weeks after treatment. Besides the lesion size, Psoriasis Area and Severity Index (PASI) and Eczema Area and Severity Index (EASI) were also calculated. Data were evaluated statistically at a significance level of p≤0.05. Results A total of 30 patients were treated for plaque psoriasis. The elbow area represented the most common area of treatment (17 cases). The average lesion size decreased from 8.2 cm² to 0.3 cm² (p<0.00001). Of note, 80% of all patients achieved complete remission (PASI100) at the last follow-up. The remaining 20% reached at least PASI70. Ten patients were treated for atopic dermatitis. In six cases, efflorescences on patients' arms were treated, and in four cases, patients' legs were treated. The average lesion size decreased from 8 cm² to 0.155 cm² (p<0.00001). Notably, 50% of all patients achieved complete remission (EASI100) at the last follow-up. The other half reached at least EASI70. In all cases, the lesion size decreased progressively. No adverse events were reported. Conclusion Our study revealed encouraging results for both psoriasis and atopic dermatitis. The autologous treatment was safe and effective in all patients. Further studies are required to validate these initial findings.
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Affiliation(s)
- Winfried Kauhl
- Plastic and Reconstructive Surgery, Gemeinschaftspraxis Dr. med. Kauhl Dr. med. Cymorek, Moenchengladbach, DEU
| | | | - Uwe Paasch
- Department of Dermatology, Venereology, and Allergology, University of Leipzig Medical Center, Leipzig, DEU
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17
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Tatsis D, Vasalou V, Kotidis E, Anestiadou E, Grivas I, Cheva A, Koliakos G, Venetis G, Pramateftakis MG, Ouzounidis N, Angelopoulos S. The Combined Use of Platelet-Rich Plasma and Adipose-Derived Mesenchymal Stem Cells Promotes Healing. A Review of Experimental Models and Future Perspectives. Biomolecules 2021; 11:biom11101403. [PMID: 34680036 PMCID: PMC8533225 DOI: 10.3390/biom11101403] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 11/16/2022] Open
Abstract
Wound healing and tissue regeneration are a field of clinical medicine presenting high research interest, since various local and systematic factors can inhibit these processes and lead to an inferior result. New methods of healing enhancement constantly arise, which, however, require experimental validation before their establishment in everyday practice. Platelet-rich plasma (PRP) is a well-known autologous factor that promotes tissue healing in various surgical defects. PRP derives from the centrifugation of peripheral blood and has a high concentration of growth factors that promote healing. Recently, the use of adipose-derived mesenchymal stem cells (ADMSCs) has been thoroughly investigated as a form of wound healing enhancement. ADMSCs are autologous stem cells deriving from fat tissue, with a capability of differentiation in specific cells, depending on the micro-environment that they are exposed to. The aim of the present comprehensive review is to record the experimental studies that have been published and investigate the synergistic use of PRP and ADMSC in animal models. The technical aspects of experimentations, as well as the major results of each study, are discussed. In addition, the limited clinical studies including humans are also reported. Future perspectives are discussed, along with the limitations of current studies on the long-term follow up needed on efficacy and safety.
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Affiliation(s)
- Dimitris Tatsis
- Fourth Surgical Department, School of Medicine, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (V.V.); (E.K.); (E.A.); (M.-G.P.); (N.O.); (S.A.)
- Oral and Maxillofacial Surgery Department, School of Dentistry, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece;
- Correspondence: or ; Tel.: +30-693-2611-752
| | - Varvara Vasalou
- Fourth Surgical Department, School of Medicine, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (V.V.); (E.K.); (E.A.); (M.-G.P.); (N.O.); (S.A.)
| | - Efstathios Kotidis
- Fourth Surgical Department, School of Medicine, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (V.V.); (E.K.); (E.A.); (M.-G.P.); (N.O.); (S.A.)
| | - Elissavet Anestiadou
- Fourth Surgical Department, School of Medicine, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (V.V.); (E.K.); (E.A.); (M.-G.P.); (N.O.); (S.A.)
| | - Ioannis Grivas
- Laboratory of Anatomy, Histology & Embryology, School of Veterinary Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Angeliki Cheva
- Department of Pathology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Georgios Koliakos
- Department of Biochemistry, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Gregory Venetis
- Oral and Maxillofacial Surgery Department, School of Dentistry, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece;
| | - Manousos-George Pramateftakis
- Fourth Surgical Department, School of Medicine, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (V.V.); (E.K.); (E.A.); (M.-G.P.); (N.O.); (S.A.)
| | - Nikolaos Ouzounidis
- Fourth Surgical Department, School of Medicine, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (V.V.); (E.K.); (E.A.); (M.-G.P.); (N.O.); (S.A.)
| | - Stamatis Angelopoulos
- Fourth Surgical Department, School of Medicine, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (V.V.); (E.K.); (E.A.); (M.-G.P.); (N.O.); (S.A.)
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18
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Barakat M, DiPietro LA, Chen L. Limited Treatment Options for Diabetic Wounds: Barriers to Clinical Translation Despite Therapeutic Success in Murine Models. Adv Wound Care (New Rochelle) 2021; 10:436-460. [PMID: 33050829 PMCID: PMC8236303 DOI: 10.1089/wound.2020.1254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/12/2020] [Indexed: 12/15/2022] Open
Abstract
Significance: Millions of people worldwide suffer from diabetes mellitus and its complications, including chronic diabetic wounds. To date, there are few widely successful clinical therapies specific to diabetic wounds beyond general wound care, despite the vast number of scientific discoveries in the pathogenesis of defective healing in diabetes. Recent Advances: In recent years, murine animal models of diabetes have enabled the investigation of many possible therapeutics for diabetic wound care. These include specific cell types, growth factors, cytokines, peptides, small molecules, plant extracts, microRNAs, extracellular vesicles, novel wound dressings, mechanical interventions, bioengineered materials, and more. Critical Issues: Despite many research discoveries, few have been translated from their success in murine models to clinical use in humans. This massive gap between bench discovery and bedside application begs the simple and critical question: what is still missing? The complexity and multiplicity of the diabetic wound makes it an immensely challenging therapeutic target, and this lopsided progress highlights the need for new methods to overcome the bench-to-bedside barrier. How can laboratory discoveries in animal models be effectively translated to novel clinical therapies for human patients? Future Directions: As research continues to decipher deficient healing in diabetes, new approaches and considerations are required to ensure that these discoveries can become translational, clinically usable therapies. Clinical progress requires the development of new, more accurate models of the human disease state, multifaceted investigations that address multiple critical components in wound repair, and more innovative research strategies that harness both the existing knowledge and the potential of new advances across disciplines.
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Affiliation(s)
- May Barakat
- Center for Wound Repair and Tissue Regeneration, College of Dentistry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Luisa A. DiPietro
- Center for Wound Repair and Tissue Regeneration, College of Dentistry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Lin Chen
- Center for Wound Repair and Tissue Regeneration, College of Dentistry, University of Illinois at Chicago, Chicago, Illinois, USA
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He M, Guo X, Li T, Jiang X, Chen Y, Yuan Y, Chen B, Yang G, Fan Y, Liang Z, Armstrong DG, Deng W. Comparison of Allogeneic Platelet-rich Plasma With Autologous Platelet-rich Plasma for the Treatment of Diabetic Lower Extremity Ulcers. Cell Transplant 2021; 29:963689720931428. [PMID: 32510240 PMCID: PMC7563928 DOI: 10.1177/0963689720931428] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Autologous platelet-rich plasma (au-PRP) has been widely used for the management of refractory chronic wounds. However, patients with diabetic lower extremity ulcers (DLEUs) usually have complicated clinical conditions, and the utility of au-PRP is limited. In this study, the feasibility, effectiveness, and safety of allogeneic platelet-rich plasma (al-PRP) and au-PRP were investigated and compared in the treatment of DLEUs. A total of 75 in-patients with type 2 diabetes were assigned to the al-PRP group (n = 20), au-PRP group (n = 25), and conventional wound therapeutic (CWT) group (n = 30) matched by the ankle brachial index and ulcer size from December 2015 to August 2018. Based on metabolic and nutritional regulation, infective control, and topical wound management, al-PRP, au-PRP, and CWT were administered to each group, respectively. Evaluation of treatment outcomes was determined by the parameters of wound healing and adverse reactions. The therapeutic times and average concentration of platelets were not significantly different between the au-PRP and al-PRP groups. The wound healing times of the al-PRP group (56.9 ± 29.22 d) and au-PRP group (55.6 ± 33.8 d) were significantly shorter than those of the CWT group (88.0 ± 43.4 d) (P < 0.01), but there was no significant difference between the groups with PRP treatment. Although there was no significant difference in the daily healing area among all groups (P > 0.05), the trend of the healing rate in the al-PRP group (16.77 ± 12.85 mm2), au-PRP group (14.31 ± 18.28 mm2), and CWT group (9.90 ± 8.51 mm2) gradually decreased. No obvious adverse reactions (fever, edema, pain, skin itching, rash, or other sensory abnormalities) were observed in either the au-PRP or the al-PRP groups. Both al-PRP and au-PRP could effectively and safely promote wound healing in patients with DLEUs. Alternatively, al-PRP could be used for DLEUs as an off-the-shelf solution when au-PRP is limited.
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Affiliation(s)
- Min He
- Department of Endocrinology and Nephrology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, China.,Department of Endocrinology, Chongqing Southwest Hospital, China.,These authors contributed equally to this article
| | - Xuewen Guo
- Department of Endocrinology and Nephrology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, China.,Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, China.,These authors contributed equally to this article
| | - Tao Li
- Department of Endocrinology and Nephrology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, China.,Department of Endocrinology, Chongqing Southwest Hospital, China.,These authors contributed equally to this article
| | - Xiaoyan Jiang
- Department of Endocrinology and Nephrology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, China
| | - Yan Chen
- Department of Endocrinology and Nephrology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, China
| | - Yi Yuan
- Department of Endocrinology and Nephrology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, China
| | - Bing Chen
- Department of Endocrinology, Chongqing Southwest Hospital, China
| | - Gangyi Yang
- Department of Endocrinology, The Second Affiliated Hospital, Chongqing Medical University, China
| | - Yahan Fan
- Department of Blood Transfusion, Southwest Hospital, Chongqing, China
| | - Ziwen Liang
- Department of Endocrinology, Chongqing Southwest Hospital, China
| | - David G Armstrong
- Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, USA
| | - Wuquan Deng
- Department of Endocrinology and Nephrology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, China
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20
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Wang S, Yang J, Zhao G, Liu R, Du Y, Cai Z, Luan J, Shen Y, Chen B. Current applications of platelet gels in wound healing-A review. Wound Repair Regen 2021; 29:370-379. [PMID: 33749992 DOI: 10.1111/wrr.12896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/27/2020] [Accepted: 01/13/2021] [Indexed: 12/21/2022]
Abstract
Human platelets play important roles in several physiologic and pathologic processes. Platelet concentrates are activated with thrombin or calcium, resulting in a viscous coagulum (platelet gel [PG]), composed of 95% platelets at least. PG is increasingly used for the treatment of a variety of soft and hard tissue defects, most notably in the management of chronic non-healing wounds. During wound healing, platelets not only play a critical role in primary hemostasis and thrombosis, but also release growth factors and cytokines to promote tissue regeneration, enhance collagen synthesis, and trigger an immune response. This review addresses a variety of aspects relevant to the functions of well-known platelet growth factors, animal and clinical studies of PG in the last decade, and different sources of platelets for PG. PG is used for non-healing chronic wounds, such as oral ulcerations related to epidermolysis bullosa and chronic graft-versus-host disease, for those, the traditional treatment effect is poor. PG maybe provide a new therapeutic direction for these diseases. Nevertheless, some uncertainty is present, the number of clinical studies is not enough. Hence, randomized controlled trials are still required to study the potential of the use of PG in the near future.
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Affiliation(s)
- Shujun Wang
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,School of Medicine, Southeast University, Nanjing, China.,Jinling Hospital Department Blood Transfusion, Nanjing University, School Medicine, Nanjing, China
| | - Jie Yang
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,School of Medicine, Southeast University, Nanjing, China
| | - Guangchao Zhao
- Jinling Hospital Department Blood Transfusion, Nanjing University, School Medicine, Nanjing, China
| | - Ran Liu
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Ying Du
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,School of Medicine, Southeast University, Nanjing, China
| | - Zhimei Cai
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.,School of Medicine, Southeast University, Nanjing, China
| | - Jianfeng Luan
- Jinling Hospital Department Blood Transfusion, Nanjing University, School Medicine, Nanjing, China
| | - Yanfei Shen
- School of Medicine, Southeast University, Nanjing, China
| | - Baoan Chen
- Department of Hematology and Oncology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
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Vaidakis D, Sertedaki E, Karageorgiou V, Siristatidis CS. Autologous platelet-rich plasma for assisted reproduction. Hippokratia 2021. [DOI: 10.1002/14651858.cd013875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Dennis Vaidakis
- Department of Basic and Clinical Sciences; University of Nicosia; Nicosia Cyprus
| | | | - Vasilios Karageorgiou
- Second Department of Psychiatry; Medical School, National and Kapodistrian University of Athens; Athens Greece
| | - Charalampos S Siristatidis
- Assisted Reproduction Unit, 2nd Department of Obstetrics and Gynaecology; Medical School, National and Kapodistrian University of Athens; Athens Greece
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Renoprotective effect of platelet-rich plasma in obstructive uropathy. Int Urol Nephrol 2021; 53:1073-1079. [PMID: 33515156 DOI: 10.1007/s11255-021-02782-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate the effect of platelet-rich plasma (PRP) in reducing renal injury in ureteral obstruction. METHODS Twenty-four Wistar Albino rats were randomized and divided into four groups as the donor (n = 6), sham (n = 6), saline (n = 6), and PRP (n = 6). Blood was obtained from the donor group by cardiac puncture and PRP was prepared. 2 cc blood was sampled from other groups to measure blood-urea nitrogen and creatinine levels. Baseline renal scintigraphy was performed. An abdominal midline incision was made and the left ureter was exposed in the sham group. Saline infusion was given to the kidneys of the saline group after left ureteral obstruction, while PRP was given to the PRP group. On postoperative Day 7, control biochemical and scintigraphic evaluations were performed and left nephrectomies were done. Left kidneys were evaluated histopathologically. RESULTS DMSA measurements in the sham group were found to be significantly higher than the saline and PRP groups (p = 0.001 and p = 0.024, respectively). There were no significant differences between the saline and PRP groups (p = 0.525 and p > 0.05, respectively). Histopathologically, no significant difference was observed between the saline and PRP groups (p = 0.320), while the scores of the sham group were significantly higher than the saline and PRP groups (p = 0.02 and p = 0.001, respectively). CONCLUSION Our study results suggest that PRP may be effective in preventing ureteral obstruction-induced renal injury.
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Abstract
Platelets play a crucial role in hemostasis, tissue regeneration and host defense. Based on these settings, platelet-rich plasma (PRP) and its derivatives are therapeutically used to promote wound healing in several scenarios. This review summarizes the biological mechanisms underlying the most traditional as well as innovative applications of PRP in wound healing. These mechanisms involve the combined action of platelet-derived growth factors and cytokines, together with the role of plasma-derived fibrillar, antioxidant and homeostatic factors. In addition, regenerative treatments with PRP consist of personalized and non-standardized methods. Thus, the quality of PRP varies depending on endogenous factors (e.g., age; gender; concomitant medication; disease-associated systemic factors; nutrition) and exogenous factors (anticoagulants and cellular composition). This review also analyses whether these factors affect the biological mechanisms of PRP in wound healing applications.
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Affiliation(s)
- Paula Oneto
- Laboratory of Experimental Thrombosis, Institute of Experimental Medicine-CONICET, National Academy of Medicine, Buenos Aires, Argentina
| | - Julia Etulain
- Laboratory of Experimental Thrombosis, Institute of Experimental Medicine-CONICET, National Academy of Medicine, Buenos Aires, Argentina
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Dai J, Jiang C, Sun Y, Chen H. Autologous platelet-rich plasma treatment for patients with diabetic foot ulcers: a meta-analysis of randomized studies. J Diabetes Complications 2020; 34:107611. [PMID: 32402839 DOI: 10.1016/j.jdiacomp.2020.107611] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/17/2020] [Accepted: 04/19/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND This study will explore the effectiveness and safety of autologous PRP in the treatment of patients with DFU. METHODS The electronic databases of PubMed, EMBASE, BIOSIS, Cochrane central, and Google Scholar internet were searched updated on Jan 30, 2020. Evaluated outcomes included rate of complete ulcer healing, time to healing and adverse events. Statistical analysis was performed with RevMan 5.0 software and STATA 10.0 software. RESULTS Ten RCTs with 456 patients were included in this study. The meta-analysis showed a higher complete ulcer healing rate (RR = 1.32, 95% CI 1.06 to 1.65, P = 0.01, I2 = 57%), a shorter healing time (MD = -23.42, 95% CI -37.33 to -9.51, P = 0.01, I2 = 78%), with no increasing the incidence of adverse events (RR = 0.48, 95% CI 0.22 to 1.05, P = 0.75, I2 = 0%) in PRP group compared with control. Mixed evidence was seen for publication bias, but analyses by using the trim-and-fill method did not appreciably alter results. CONCLUSION Our findings suggest that autologous PRP may improve the complete ulcer healing rate, shorten the healing time, with no increasing the incidence of adverse events.
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Affiliation(s)
- Jiezhi Dai
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai, China
| | - Chaoyin Jiang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai, China
| | - Yangbai Sun
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer center, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Hua Chen
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai, China.
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Improvement of Skeletal Muscle Regeneration by Platelet-Rich Plasma in Rats with Experimental Chronic Hyperglycemia. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6980607. [PMID: 32766312 PMCID: PMC7374220 DOI: 10.1155/2020/6980607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/05/2020] [Accepted: 07/02/2020] [Indexed: 02/07/2023]
Abstract
Herein, the structural effect of autologous platelet-rich plasma (PRP) on posttraumatic skeletal muscle regeneration in rats with chronic hyperglycemia (CH) was tested. 130 white laboratory male rats divided into four groups (I—control; II—rats with CH; III—rats with CH and PRP treatment; and IV—rats for CH confirmation) were used for the experiment. CH was simulated by streptozotocin and nicotinic acid administration. Triceps surae muscle injury was reproduced by transverse linear incision. Autologous PRP was used in order to correct the possible negative CH effect on skeletal muscle recovery. On the 28th day after the injury, the regenerating muscle fiber and blood vessel number in the CH+PRP group were higher than those in the CH rats. However, the connective tissue area in the CH group was larger than that in the CH+PRP animals. The amount of agranulocytes in the regenerating muscle of the CH rats was lower compared to that of the CH+PRP group. The histological analysis of skeletal muscle recovery in CH+PRP animals revealed more intensive neoangiogenesis compared to that in the CH group. Herewith, the massive connective tissue development and inflammation signs were observed within the skeletal muscle of CH rats. Obtained results suggest that streptozotocin-induced CH has a negative effect on posttraumatic skeletal muscle regeneration, contributing to massive connective tissue development. The autologous PRP injection promotes muscle recovery process in rats with CH, shifting it away from fibrosis toward the complete muscular organ repair.
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Wang H, Gu Y, Huang L, Zeng Z, Hu X, Wang X, Quan X, Ye Z. Effectiveness of fire needle combining with moist healing dressing to promote the growth of granulation tissue in chronic wounds: A case report. Int J Nurs Sci 2020; 7:386-390. [PMID: 32817864 PMCID: PMC7424147 DOI: 10.1016/j.ijnss.2020.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 04/03/2020] [Accepted: 05/27/2020] [Indexed: 12/28/2022] Open
Abstract
In this case study, we analyzed the wound-healing process of a patient with a chronic wound who underwent fire needle treatment, and we tracked the coverage of granulation tissue and decrease of slough and exudate. An 85-year-old man had repeated right shoulder and back pain, itching, and skin festering for more than 1.5 years. A fire needle was administered combined with moist dressing once every 5 days to promote wound healing. After six rounds of fire needle treatment, granulation tissue formed over the surface of the wound base, the depth of the wound had become shallow, and the wound area was reduced. No complications occurred during the intervention. Fire needle therapy combined with a moist wound-healing dressing can be an effective alternative approach in managing chronic wounds.
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Affiliation(s)
- Haijiao Wang
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yingxuan Gu
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Linfeng Huang
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zhen Zeng
- The Third People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Xiaohui Hu
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xiaojun Wang
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xiaoming Quan
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zengjie Ye
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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Histopathologic Evaluation of the Effects of Intraurethral Platelet Rich Plasma in Urethral Trauma Experimentally Induced in Rat Model. Urology 2020; 141:187.e9-187.e14. [PMID: 32302623 DOI: 10.1016/j.urology.2020.03.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/08/2020] [Accepted: 03/23/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine the efficacy of platelet rich plasma applied early initialization after urethral trauma for preventing inflammation and spongiofibrosis. MATERIALS AND METHODS Twenty-three rats were randomized and divided into 3 groups, with 10 rats in 2 groups. Only sham group had 3 rats. The urethras of all rats were traumatized with a pediatric urethrotome knife at 6- and 12-o'clock. For 15 days, group I was given platelet rich plasma (PRP) once a day without urethral injury (sham group), group II (n = 10) was not given any medical treatment only urethral injury group (UI-PRP), group III (n = 10) was given PRP once a day intraurethrally as instillation using a 22 ga catheter sheath with urethral injury (UI+PRP). On day 15, the penises of the rats were degloved to perform penectomy. RESULTS A significant difference was detected in all parameters when the sham, UI-PRP, UI+PRP groups were compared (respectively, P = .001, / <.001, / .008 / .007) and a significant difference was observed among mucosal inflammation, fibrosis, and edema parameters when UI-PRP and UI+PRP groups were compared. (Respectively; P <.001, / <.001 / .006). CONCLUSION In this study, it was shown that intraurethral PRP applied after urethral trauma significantly decreased mucosal inflammation, spongiofibrosis, and edema. Depending on the results we acquired in this study, we think that PRP may be a promising option in urethral stricture treatment.
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