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Yew Toong L, Ghauth S, Yin Xuan N. Skull Base Osteomyelitis: A 5-Year Review and Prognostic Outcome in a Single Tertiary Institution. OTO Open 2024; 8:e70001. [PMID: 39206427 PMCID: PMC11351174 DOI: 10.1002/oto2.70001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 06/29/2024] [Accepted: 08/10/2024] [Indexed: 09/04/2024] Open
Abstract
Objective The primary objective of this study is to review the clinical parameters associated with skull base osteomyelitis (SBO), with a secondary aim of studying their association with patient outcomes 1 and 6 months after treatment initiation. Study Design This is a single-center restrospective observational study. Setting The study was conducted from January 2018 to December 2022 at the University Malaya Medical Center in Kuala Lumpur. Methods Patients aged over 15 years with a diagnosis of SBO were included in the study. Clinical parameters, investigations, and follow-up records were recorded. The disease outcomes were analyzed at 1 and 6 months after treatment initiation using multivariable analyses. Results The study identified 31 patients with SBO, the majority of whom were elderly males with comorbidities such as diabetes and hypertension. Otalgia and otorrhea were the most common symptoms, and computed tomography scans were used for diagnosis. Pseudomonas aeruginosa was the most commonly identified pathogen, and intravenous broad-spectrum antimicrobials were used to treat all patients. Surgical intervention was required for 25% of patients, and underlying ischemic heart disease, anemia, and single nerve palsy were significantly associated with an unfavorable prognosis. Patients with higher body mass index and elevated C-reactive protein showed poorer outcomes after 1 and 6 months of treatment, respectively. Conclusion Early recognition, prompt treatment, better control of comorbidities, nutrition, and monitoring can improve SBO outcomes and reduce complications. Therefore, as the prevalence of SBO increases, diagnostic criteria or management guidelines should be established to guide the best clinical practice.
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Affiliation(s)
- Liew Yew Toong
- Department of OtolaryngologyUniversiti MalayaKuala LumpurMalaysia
| | - Sakina Ghauth
- Department of OtolaryngologyUniversiti MalayaKuala LumpurMalaysia
| | - Ng Yin Xuan
- Department of OtolaryngologyUniversiti MalayaKuala LumpurMalaysia
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Jiang X, Li A, Hao W, Yang C, Wang H, Deng W. Limb salvage and systemic management of gouty tophi: Case series. Medicine (Baltimore) 2024; 103:e38137. [PMID: 38758848 PMCID: PMC11098208 DOI: 10.1097/md.0000000000038137] [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] [Received: 01/24/2024] [Accepted: 04/15/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION Gout is a chronic disease characterized by deposition of monosodium urate crystals. Tophi develop in some individuals with untreated or uncontrolled gout, which leads to ulcerations, cosmetic problems, mechanical obstruction of joint movement, joint damage and musculoskeletal disability. Currently, the treatment of gouty tophi is controversial and challenging. Both surgical and internal medical treatments have limitations and require further exploration in clinical practice. PATIENT CONCERNS In Case 1, we treated a patient with severe infection of diabetic foot ulcers with concomitant multiple gouty tophi in the same limb. A systematic management strategy was formulated to close the wound and save the limb. The ulcers healed successfully after half a year. In Case 2, a giant gouty tophi located in the first metatarsophalangeal joint of the left foot was removed by surgical treatment and vancomycin-loaded bone cement implantation. In Case 3, we present a case of gouty tophi that was resolved by standardized systemic medical management. DIAGNOSIS Three patients were all diagnosed with gout accompanied by gouty deposition, although there were other different comorbidities. INTERVENTIONS In case 1, we used debridement to gradually remove gouty tophi. In case 2, the giant gouty tophi was removed by surgical operation. In case 3, the gouty tophi disappeared after standardized treatment with medicine, diet and lifestyle management. OUTCOMES Three patients underwent different treatment therapies to remove gouty tophi based on their specific conditions. LESSONS We explored effective interventions for tophi in gout by surgical or other interventions in combination with pharmacotherapy.
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Affiliation(s)
- Xiaoyan Jiang
- Department of Endocrinology and Metabolism, Diabetic Foot Center, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Anxin Li
- Department of Endocrinology and Metabolism, Diabetic Foot Center, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Wei Hao
- Department of Endocrinology and Metabolism, Diabetic Foot Center, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Cheng Yang
- Department of Endocrinology and Metabolism, Diabetic Foot Center, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Hongyan Wang
- Department of Endocrinology and Metabolism, Diabetic Foot Center, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
| | - Wuquan Deng
- Department of Endocrinology and Metabolism, Diabetic Foot Center, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, China
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Advances in the Clinical Application of Platelet-Rich Plasma in the Foot and Ankle: A Review. J Clin Med 2023; 12:jcm12031002. [PMID: 36769649 PMCID: PMC9917505 DOI: 10.3390/jcm12031002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 01/31/2023] Open
Abstract
Autologous and recombinant biologic substances have been generated as a result of the research into the cellular features of the healing process. Orthobiologics are increasingly being used in sports medicine and musculoskeletal surgery. Nevertheless, clinical data are limited; consequently, further studies are required, particularly in foot and ankle pathologies. This review aims to provide evidence of the most recent literature results and ignite the interest of orthopedic specialists eager for an update about the most current discussion on platelet-rich plasma (PRP) clinical applications in the foot and ankle fields. Previous studies have shown that platelet-rich plasma can be beneficial in treating various conditions, such as chronic foot ulcers, osteoarthritis, Achilles tendinopathy, etc. Despite the positive effects of PRP on various musculoskeletal conditions, more prospective studies are needed to confirm its effectiveness at treating ankle and foot pathologies. In addition to clinical trials, other factors, such as the quality of the research and the procedures involved, must be considered before they can be used in patients. More long-term evaluations are needed to support or oppose its application in treating foot and ankle disorders. We present the most extensive review of PRP's clinical applications in the foot and ankle field.
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Deng Z, Long ZS, Gong FP, Chen G. The efficacy and safety of platelet-rich plasma in the tendon-exposed wounds: a preliminary study. J Orthop Surg Res 2022; 17:497. [PMCID: PMC9675281 DOI: 10.1186/s13018-022-03401-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 11/11/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Currently, among wounds with large skin tissue defects caused by various reasons, the treatment of refractory wounds is still a major clinical problem. This study is aimed to preliminarily assess the therapeutic potentials of platelet-rich plasma (PRP) in refractory wounds with exposed tendons, as well as corresponding efficacy and safety. Methods A total of 12 patients (5 males and 7 females) with refractory wounds and exposed tendons who were admitted to our hospital from June 2018 to December 2020 were included in this study. After the preparation of PRP, the included patients underwent the PRP injection after the debridement of wounds, and the efficacy and prognosis were assessed by the same group of senior surgeons. Results The average age of included patients was 42.7 ± 12.9 years, and the causes of injury included traffic accidents (3 cases), contusion (2 cases), burns (2 cases), diabetes complications (4 cases), and melanoma complications (1 cases). The average healing time was 23.0 ± 5.0 days, and the mean size of the wound was 3.1 × 5.1 cm2. During the whole treatment process, Vancouver Scar Scale (VSS) decreased from 7.4 ± 1.6 before PRP treatment to 3.6 ± 0.9 after treatment (P < 0.001), Manchester Scar Scale (MSS) decreased from 12.3 ± 4.5 before PRP treatment to 5.4 ± 1.2 after treatment (P < 0.001), and no redness and swelling were observed around wounds, the size and degree of wounds gradually reduced, the coverage rate of granulation tissue was acceptable, overall quality of scar was relatively good, skin sensitivity around wounds was normal, there was no local wounds secretion, and postoperative patient's satisfaction was relatively good during follow-up. Conclusions Our study has preliminarily indicated that PRP can promote the wounds healing, reduce the inflammation around wounds, and improve the granulation tissue and angiogenesis, thereby effectively polishing up the safety and efficacy.
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Affiliation(s)
- Zhuan Deng
- grid.415002.20000 0004 1757 8108Department of Orthopedics, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006 Jiangxi China ,grid.260463.50000 0001 2182 8825Medical College, Nanchang University, Nanchang, 330006 Jiangxi China
| | - Zhi-Sheng Long
- grid.415002.20000 0004 1757 8108Department of Orthopedics, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006 Jiangxi China ,grid.260463.50000 0001 2182 8825Medical College, Nanchang University, Nanchang, 330006 Jiangxi China
| | - Fei-Peng Gong
- grid.415002.20000 0004 1757 8108Department of Orthopedics, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006 Jiangxi China
| | - Gang Chen
- grid.415002.20000 0004 1757 8108Department of Orthopedics, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006 Jiangxi China
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He M, Chen T, Lv Y, Song P, Deng B, Guo X, Rui S, Boey J, Armstrong DG, Ma Y, Deng W. The role of allogeneic platelet-rich plasma in patients with diabetic foot ulcer: Current perspectives and future challenges. Front Bioeng Biotechnol 2022; 10:993436. [PMID: 36246379 PMCID: PMC9557159 DOI: 10.3389/fbioe.2022.993436] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/16/2022] [Indexed: 02/05/2023] Open
Abstract
The frequency of chronic cutaneous wounds are sharply increasing in aging populations. Patients with age-related diseases, such as diabetes, tumors, renal failure and stroke are prone to soft tissue and skin injury, compounded by slowed healing in aging. Imbalance of wound inflammation, loss of growth factor secretion, and impairment of tissue repair abilities are all possible reasons for failed healing. Therefore, it is vital to explore novel approaches to accelerate wound healing. Platelet-rich plasma (PRP) as a cell therapy has been widely applied for tissue repair and regeneration. PRP promotes wound healing by releasing antimicrobial peptides, growth factors and micro-RNAs. Medical evidence indicates that autologous platelet-rich plasma (au-PRP) can promote wound healing effectively, safely and rapidly. However, its clinical application is usually restricted to patients with chronic cutaneous wounds, generally because of other severe complications and poor clinical comorbidities. Allogeneic platelet-rich plasma (al-PRP), with abundant sources, has demonstrated its superiority in the field of chronic wound treatment. Al-PRP could overcome the limitations of au-PRP and has promising prospects in clinical applications. The aim of this review is to summarize the current status and future challenges of al-PRP in chronic cutaneous wound management. We also summarized clinical cases to further describe the application of al-PRP for chronic wounds in clinical practice.
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Affiliation(s)
- Min He
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
- General Practice Department, Chongqing Southwest Hospital, Chongqing, China
| | - Tianyi Chen
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Yuhuan Lv
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Peiyang Song
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Bo Deng
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Xuewen Guo
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Shunli Rui
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Johnson Boey
- Department of Podiatry, National University Hospital, Singapore, Singapore
| | - David G. Armstrong
- Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
| | - Yu Ma
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Wuquan Deng
- Department of Endocrinology, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
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Jiang X, Deng F, Rui S, Ma Y, Wang M, Deng B, Wang H, Du C, Chen B, Yang X, Boey J, Armstrong DG, Deng W, Duan X. The Evaluation of Gait and Balance for Patients with Early Diabetic Peripheral Neuropathy: A Cross-Sectional Study. Risk Manag Healthc Policy 2022; 15:543-552. [PMID: 35386278 PMCID: PMC8977473 DOI: 10.2147/rmhp.s361698] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/18/2022] [Indexed: 01/02/2023] Open
Abstract
Objective Falls often occur in patients with diabetic neuropathy due to biomechanical alternation. The implication of diabetic peripheral neuropathy (DPN) on gait and balance remains poorly understood. Methods A total of 11 dynamic gait, balance and electrophysiological parameters were evaluated in 176 participants. The biomechanical parameters were compared between groups. Results Stride length and stride velocity were significantly lower in all subgroups of DPN compared with healthy subjects (p<0.05). Stance phase and double support phase were significantly higher, but swing phase were significantly lower across all subgroups of DPN than healthy subjects (p<0.05). Under eyes-open standing, the ML and AP range parameters of CoM sway, ankle sway and hip sway, CoM sway index, ankle swing index in both subclinical and confirmed DPN patients were all significantly higher compared to healthy subjects (p<0.05). Under eyes-closed standing, AP range parameters of CoM sway in subclinical DPN and confirmed DPN patients were significantly higher than healthy subjects (p<0.05). The hip sway areas in diabetics were significantly higher compared to healthy subjects (p<0.05). Conclusion The abnormal biomechanical parameters existed in the early stages of patients with DPN. The static balance under eyes-open and eye-closed condition is maintained by ankle joint compensation strategy and hip joint protection strategy. An early evaluation and better risk management is essential for diabetic patients with a history of more than 5 years even without DPN clinical symptoms and signs. Clinical Trial Registration Number No. ChiCTR1800019179, www.chictr.org.cn.
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Affiliation(s)
- Xiaoyan Jiang
- Department of Endocrinology, Chongqing University Central Hospital, School of Medicine Chongqing University, Chongqing, 400014, People’s Republic of China
| | - Fang Deng
- Department of Endocrinology, Chongqing University Central Hospital, School of Medicine Chongqing University, Chongqing, 400014, People’s Republic of China
- Department of Endocrinology, Chongqing Southwest Hospital, Chongqing, 400038, People’s Republic of China
| | - Shunli Rui
- Department of Endocrinology, Chongqing University Central Hospital, School of Medicine Chongqing University, Chongqing, 400014, People’s Republic of China
| | - Yu Ma
- Department of Endocrinology, Chongqing University Central Hospital, School of Medicine Chongqing University, Chongqing, 400014, People’s Republic of China
| | - Min Wang
- Department of Endocrinology, Chongqing University Central Hospital, School of Medicine Chongqing University, Chongqing, 400014, People’s Republic of China
| | - Bo Deng
- Department of Endocrinology, Chongqing University Central Hospital, School of Medicine Chongqing University, Chongqing, 400014, People’s Republic of China
| | - Hongyan Wang
- Department of Endocrinology, Chongqing University Central Hospital, School of Medicine Chongqing University, Chongqing, 400014, People’s Republic of China
| | - Chenzhen Du
- Department of Endocrinology, Chongqing University Central Hospital, School of Medicine Chongqing University, Chongqing, 400014, People’s Republic of China
| | - Bing Chen
- Department of Endocrinology, Chongqing Southwest Hospital, Chongqing, 400038, People’s Republic of China
| | - Xiuhua Yang
- Department of Lower Extremity Surgery, NO.1 Orthopedics Hospital of Chengdu, Chengdu City, 610000, Sichuan, People’s Republic of China
| | - Johnson Boey
- Department of Podiatry, National University Hospital, 169608, Singapore
| | - David G Armstrong
- Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, 90033, USA
| | - Wuquan Deng
- Department of Endocrinology, Chongqing University Central Hospital, School of Medicine Chongqing University, Chongqing, 400014, People’s Republic of China
| | - Xiaodong Duan
- Department of Rehabilitation, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, People’s Republic of China
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7
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Zhang X, Wang H, Du C, Fan X, Cui L, Chen H, Deng F, Tong Q, He M, Yang M, Tan X, Li L, Liang Z, Chen Y, Chen D, Armstrong DG, Deng W. Custom-Molded Offloading Footwear Effectively Prevents Recurrence and Amputation, and Lowers Mortality Rates in High-Risk Diabetic Foot Patients: A Multicenter, Prospective Observational Study. Diabetes Metab Syndr Obes 2022; 15:103-109. [PMID: 35046681 PMCID: PMC8759996 DOI: 10.2147/dmso.s341364] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/21/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Recurrence of high-risk diabetic feet, after wound, healing is a common challenge among diabetic patients. Continuous use of an offloading device significantly prevents recurrence of high-risk diabetic feet, although patient adherence is imperative to ensuring this therapy's clinical efficacy. In this study, we explored clinical outcomes of patients with a high-risk diabetic foot who had been prescribed with custom-molded offloading footwear under different adherence conditions. METHODS A total of 48 patients (17 females and 31 males) with high-risk diabetic feet, who had been with prescribed offloading footwear in 13 medical centers across 4 cities, were enrolled in the current study. The patients were assigned into either continuous offloading therapy (COT, n = 31) or interrupted offloading therapy (IOT, n = 17) groups, according to their adherence to the therapy. All patients were followed up monthly, and differences in recurrence, amputation, and deaths between the groups were analyzed at 4 months after therapy. RESULTS Forty-eight patients met our inclusion criteria and were therefore included in the final analysis. Among them, 31 were stratified into the COT group and adhered to offloading therapy throughout the study period, whereas 17 were grouped as IOT and exhibited interrupted adherence to offloading therapy. We found statistically significant differences in recurrence rates (0 vs 38.46%, p < 0.01), amputation (0 vs 11.76%, p < 0.01), and deaths (0% vs 5.88%, p < 0.01) between the groups during follow-up. CONCLUSION Patients' adherence is imperative to efficacy of custom-molded offloading footwear during treatment of high-risk diabetic foot. Further studies are needed to elucidate the role of improved design of the offloading device and the need for enhanced patient education for improved adherence.
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Affiliation(s)
- Xi Zhang
- Department of Endocrinology, Chongqing University Central Hospital, Chongqing University, Chongqing, People’s Republic of China
| | - Hongyan Wang
- Department of Endocrinology, Chongqing University Central Hospital, Chongqing University, Chongqing, People’s Republic of China
| | - Chenzhen Du
- Department of Endocrinology, Chongqing University Central Hospital, Chongqing University, Chongqing, People’s Republic of China
| | - Xiaoyun Fan
- Department of Endocrinology, Hospital for Occupational Diseases of Chongqing, Chongqing, People’s Republic of China
| | - Long Cui
- Department of Endocrinology, Armed Police Hospital of Chongqing, Chongqing, People’s Republic of China
| | - Heming Chen
- Department of Endocrinology, Ankang Central Hospital, Ankang, Shaanxi, People’s Republic of China
| | - Fang Deng
- Department of Endocrinology, Chongqing Southwest Hospital, Chongqing, People’s Republic of China
| | - Qiang Tong
- Department of Endocrinology, Chongqing Xinqiao Hospital, Chongqing, People’s Republic of China
| | - Min He
- Department of Endocrinology, The People’s Hospital of Shapingba District, Chongqing, People’s Republic of China
| | - Mei Yang
- Department of Endocrinology, The First People’s Hospital of Chongqing Liangjiang New Area, Chongqing, People’s Republic of China
| | - Xingrong Tan
- Department of Endocrinology, The 9th People’s Hospital of Chongqing, Chongqing, People’s Republic of China
| | - Lin Li
- Department of Endocrinology, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, People’s Republic of China
| | - Zerong Liang
- Department of Endocrinology, Chongqing Red Cross Hospital, People’s Hospital of Jiangbei District, Chongqing, 400020, People’s Republic of China
| | - Yaqin Chen
- Department of Endocrinology, The People’s Hospital of Shizhu, Chongqing, People’s Republic of China
| | - Deqing Chen
- Department of Endocrinology, The People’s Hospital of Rongchang, Chongqing, People’s Republic of China
| | - David G Armstrong
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Wuquan Deng
- Department of Endocrinology, Chongqing University Central Hospital, Chongqing University, Chongqing, People’s Republic of China
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Rui S, Yuan Y, Du C, Song P, Chen Y, Wang H, Fan Y, Armstrong DG, Deng W, Li L. Comparison and Investigation of Exosomes Derived from Platelet-Rich Plasma Activated by Different Agonists. Cell Transplant 2021; 30:9636897211017833. [PMID: 34006140 PMCID: PMC8138303 DOI: 10.1177/09636897211017833] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PRP-Exos are nanoscale cup-shaped vesicles that carry a variety of proteins,
mRNAs, microRNAs, and other bioactive substances. PRP-Exos can be formed through
several induction pathways, which determine their molecular profiles and
facilitate their tailormade participation in intercellular communication.
Currently, little is known on how the PRP-Exos activation method influences the
quality and quantity of PRP-Exos. The present study aims to observe and analyze
the number, profile, and growth factors of PRP-Exos through TEM, Nanoflow, and
WB after PRP activation and compare the difference in function of PRP-Exos on
HUVECs, with different stimuli (calcium gluconate, thrombin, or both). We found
that PRP activated with both thrombin and calcium gluconate harvested the
highest concentration of exosomes [(7.16 ± 0.46) × 1010
particles/ml], compared to thrombin group [(4.87 ± 0.15) × 1010
particles/ml], calcium gluconate group [(5.85 ± 0.43) × 1010
particles/ml], or saline group [(7.52 ± 0.19) × 109 particles/ml],
respectively (P < 0.05) via Nanoflow analysis. The WB
analysis showed that cytokines (VEGF, PDGFBB, bFGF, TGF-β) are differentially
encapsulated in PRP-Exos, depending on the PRP stimulus, in which the
mixture-PRP-Exos yielded the highest concentration of cytokines. In the function
assay of PRP-Exos on HUVECs, the mixture-PRP-Exos promoted HUVECs proliferation,
increased HUVECs migration, promoted the formation of vessel-like by HUVECs via
the AKT ERK signal pathway more dramatically, compared with other groups. In
summary, our studies showed that PRP activated by the mixture of calcium
gluconate and thrombin harvested the best quality of exosomes which had the top
biological functions. This study provides a protocol for selecting appropriate
PRP activators to obtain high-quality exosomes for future applications.
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Affiliation(s)
- Shunli Rui
- The Key Laboratory of Laboratory Medical Diagnostics in the Ministry
of Education and Department of Clinical Biochemistry, College of Laboratory
Medicine, Chongqing Medical
University, Chongqing, China
| | - Yi Yuan
- Department of Endocrinology, Multidisciplinary Diabetic Foot Medical
Center, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing University,
Chongqing, China
| | - Chenzhen Du
- Department of Endocrinology, Multidisciplinary Diabetic Foot Medical
Center, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing University,
Chongqing, China
| | - Peiyang Song
- Department of Endocrinology, Multidisciplinary Diabetic Foot Medical
Center, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing University,
Chongqing, China
| | - Yan Chen
- Department of Endocrinology, Multidisciplinary Diabetic Foot Medical
Center, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing University,
Chongqing, China
| | - Hongyan Wang
- Department of Endocrinology, Multidisciplinary Diabetic Foot Medical
Center, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing University,
Chongqing, China
| | - Yahan Fan
- Department of Blood Transfusion, Southwest Hospital, Chongqing,
China
| | - David G. Armstrong
- Department of Surgery, Keck School of Medicine of the University of Southern
California, CA, USA
| | - Wuquan Deng
- Department of Endocrinology, Multidisciplinary Diabetic Foot Medical
Center, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing University,
Chongqing, China
- Wuquan Deng, Department of Endocrinology,
Multidisciplinary Diabetic Foot Medical Center, Chongqing Emergency Medical
Center, Chongqing University Central Hospital, Chongqing University, Chongqing
400014, China.
| | - Ling Li
- The Key Laboratory of Laboratory Medical Diagnostics in the Ministry
of Education and Department of Clinical Biochemistry, College of Laboratory
Medicine, Chongqing Medical
University, Chongqing, China
- Ling Li, The Key Laboratory of Laboratory
Medical Diagnostics in the Ministry of Education and Department of Clinical
Biochemistry, College of Laboratory Medicine, Chongqing Medical University,
Chongqing 400016, China.
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9
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Wang Y, Zhang H, Zhou M, Yi X, Duan P, Yu A, Qi B. Autologous Fat Grafting Promotes Macrophage Infiltration to Increase Secretion of Growth Factors and Revascularization, Thereby Treating Diabetic Rat Skin Defect. Diabetes Metab Syndr Obes 2020; 13:4897-4908. [PMID: 33328749 PMCID: PMC7734072 DOI: 10.2147/dmso.s286787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/13/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Diabetic skin defect is difficult to manage in surgical clinics, and there is still lack of effective treatments for diabetic skin defects. Currently, autologous fat grafting (AFG) is promising in the field of reconstructive surgery, while macrophage infiltration in autologous adipose tissue is considered vital for tissue regeneration. But AFG is rarely applied to the treatment of diabetic skin defects, and whether macrophage infiltration assists AFG to promote wound healing is still unknown. METHODS Full-thickness skin defect diabetic rats were divided into 3 groups: control group, autologous fat grafting (AFG) group and AFG with macrophage depletion (AFG+MD) group. We examined the amount of macrophages in the wounds bed and the expression level of inflammatory factors IL-10, IL-6, TNF-α, and also growth factors PDGF-β, TGF-β, IGF-1 at the same time. The content of collagen-I and α-smooth muscle actin protein in the wounds were determined by Western blot analysis. Finally, the healing of the wounds was evaluated. RESULTS The AFG group showing more rapid healing, secreting more growth factors and more obvious vascularization in the healing process, compared with the control group. But, the secretion of growth factors and the construction of extracellular matrix (ECM) in the wounds were limited when macrophages were depleted after AFG. CONCLUSION AFG promotes the infiltration of macrophages to improve the healing environment of diabetic wounds by increasing the secretion of growth factors and revascularization, which provides a potential method for the treatment of diabetic skin defects.
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Affiliation(s)
- Yu Wang
- Department of Orthopaedic Trauma and Microsurgery, Wuhan University Zhongnan Hospital, Wuhan, Hubei430071, People’s Republic of China
| | - Hao Zhang
- Department of Orthopaedic Trauma and Microsurgery, Wuhan University Zhongnan Hospital, Wuhan, Hubei430071, People’s Republic of China
| | - Min Zhou
- Department of Orthopaedic Trauma and Microsurgery, Wuhan University Zhongnan Hospital, Wuhan, Hubei430071, People’s Republic of China
| | - Xinzeyu Yi
- Department of Orthopaedic Trauma and Microsurgery, Wuhan University Zhongnan Hospital, Wuhan, Hubei430071, People’s Republic of China
| | - Ping Duan
- Department of Orthopaedic Trauma and Microsurgery, Wuhan University Zhongnan Hospital, Wuhan, Hubei430071, People’s Republic of China
| | - Aixi Yu
- Department of Orthopaedic Trauma and Microsurgery, Wuhan University Zhongnan Hospital, Wuhan, Hubei430071, People’s Republic of China
- Correspondence: Aixi Yu; Baiwen Qi Wuhan University Zhongnan Hospital, 169 East Lake Road, Wuchang District, Wuhan, Hubei430071, People’s Republic of ChinaTel/Fax +86 67813120 Email ;
| | - Baiwen Qi
- Department of Orthopaedic Trauma and Microsurgery, Wuhan University Zhongnan Hospital, Wuhan, Hubei430071, People’s Republic of China
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