Blog

• Increased growth factors play a role in wound healing promoted by noninvasive oxygen-ozone therapy in diabetic patients with foot ulcers

  Posted in: General | Posted on: 10-Aug-2014

  Abstract

  Management of diabetic foot ulcers (DFUs) is a great challenge for clinicians. Although the oxygen-ozone treatment improves the diabetic outcome, there are few clinical trials to verify the efficacy and illuminate the underlying mechanisms of oxygen-ozone treatment on DFUs. In the present study, a total of 50 type 2 diabetic patients complicated with DFUs, Wagner stage 2~4, were randomized into control group treated by standard therapy only and ozone group treated by standard therapy plus oxygen-ozone treatment. The therapeutic effects were graded into 4 levels from grade 0 (no change) to grade 3 (wound healing). The wound sizes were measured at baseline and day 20, respectively. Tissue biopsies were performed at baseline and day 11. The expressions of vascular endothelial growth factor (VEGF), transforming growth factor-β (TGF-β), and platelet-derived growth factor (PDGF) proteins in the pathologic specimens were determined by immunohistochemical examinations. The effective rate of ozone group was significantly higher than that of control group (92% versus 64%, P < 0.05). The wound size reduction was significantly more in ozone group than in control group (P < 0.001). After treatment, the expressions of VEGF, TGF-β, and PDGF proteins at day 11 were significantly higher in ozone group than in control group. Ozone therapy promotes the wound healing of DFUs via potential induction of VEGF, TGF-β, and PDGF at early stage of the treatment. (Clinical trial registry number is ChiCTR-TRC-14004415).

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• Bacteriostatic effect of equine pure platelet-rich plasma and other blood products against methicillin-sensitive Staphylococcus aureus

  Posted in: General | Posted on: 10-Aug-2014

  Summary

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  Objectives: 1) To evaluate the bacteriostatic in vitro effect of pure platelet-rich plasma (P-PRP), pure platelet-rich gel (P-PRG), leukocyte-poor gel (LPG), platelet-poor plasma (PPP), and heat inactivated plasma (IP) against methicillin-sensitive Staphylococcus aureus (MSSA) over a period of 24 hours. 2) To determine the degradation of platelet factor-4 (PF-4), transforming growth factor beta 1 (TGF-β1), and platelet-derived growth factor isoform BB (PDGF-BB) in these equine blood components. 3) To establish correlations between platelet and leukocyte counts, PF-4 concentrations, and MSSA growth. Methods: Fourteen horses were used. Blood components were obtained by a manual protocol. Every blood component was mixed with MSSA and M×¼ller-Hinton Broth and cultured at 37 °C for 24 hours. Samples for the determination of bacterial growth (colony-forming units) and PF-4, TGF-β1 and PDGF-BB concentrations were taken at one, four, eight, 12 and 24 hours. Results: The bacterial growth was significantly (p = 0.01) inhibited for P-PRP, P-PRG, LPG and PPP in comparison with IP and, the positive control group during the first 12 hours. The P-PRG had higher and sustained TGF-β1 and PDGF-BB concentrations over time in comparison with the other blood components. Clinical significance: The plasma complement could be one of the most responsible components of the in vitro bacteriostatic effect of P-PRP, P-PRG, LPG and PPP against MSSA. Additionally, P-PRG was the better biomaterial because it had an acceptable bacteriostatic effect and the highest concentration of growth factors.

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• Comparison of Platelet-Rich Plasma Formulations for Cartilage Healing

  Posted in: General | Posted on: 05-Aug-2014

  Platelet-rich plasma (PRP) has been advocated as one treatment for cartilage tissue regeneration. To date, several different platelet-rich formulations have been available, but a deep knowledge of their composition and mechanism of action in a specific clinical use is needed. The aim of this study was to investigate the effect of various PRP formulations on human chondrocytes in vitro.

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• Three-Dimensional Culture Environment Increases the Efficacy of Platelet Rich Plasma Releasate in Prompting Skin Fibroblast Differentiation and Extracellular Matrix Formation

  Posted in: General | Posted on: 04-Aug-2014

  Abstract

  Platelet rich plasma clot- releasate (PRCR) shows significant influence on tissue regeneration in clinical trials. Although, the mechanism of PRCR effect on fibroblast differentiation has been studied on 2D culture system, a detailed investigation is needed to establish the role of PRCR in cell seeded in 3D scaffolds. Therefore, a study was conducted to evaluate the influence of PRCR in fibroblasts (DFB) differentiation and extracellular matrix formation on both 3D and 2D culture systems. Cell viability was measured using MTT assay and DFB differentiation was evaluated by determining the expression levels of nucleostamin and alpha smooth muscle actin (α-SMA), using indirect immunostaining and Western blotting. The expression levels of extracellular matrix genes (collagen-I, collagen-III, fibronectin and laminin) and focal adhesion formation gene (integrin beta-1) were measured using Real-time PCR. The PRCR at 10% showed significant effect on cells viability compared with 5% and 20% in both culture environments. The decrease in the expression levels of nucleostamin and the increase in α-SMA signify the DFB differentiation to myofibroblast-like cells that was prominently greater in 3D compared to 2D culture. In 3D culture systems, the total collage production, expression levels of the extracellular matrix gene and the focal adhesion gene were increased significantly compared to 2D culture. In conclusion, 3D culture environments enhances the proliferative and differentiation effects of PRCR on DFB, thereby potentially increases the efficacy of DFB for future tissue engineering clinical application.

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• Comparison of short-term results of intraarticular platelet-rich plasma (PRP) and hyaluronic acid treatments in early-stage gonarthrosis patients

  Posted in: General | Posted on: 04-Aug-2014

  Abstract

  The present study aimed to compare short-term clinical outcomes between intraarticular platelet-rich plasma (PRP) and hyaluronic acid (HA) treatments in early-stage gonarthrosis patients. Data of gonarthrosis patients, who were stage 1 or stage 2 according to Kellgren-Lawrence classification and underwent intraarticular PRP or HA treatment, were obtained retrospectively. The patients received treatment for three times at one-week intervals (intraarticular PRP or HA). They were evaluated using the Knee Society's Knee Scoring System (KSS) and the visual analog scale (VAS) scoring system before treatment and at the second and sixth months of treatment. The study included 132 patients (mean age, 55.06

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• Platelet-Rich Plasma Injections for the Treatment of Hamstring Injuries A Randomized Controlled Trial

  Posted in: General | Posted on: 03-Aug-2014

  Abstract

  Background: A hamstring injury is one of the most common types of injury affecting athletes. Despite this, the optimal management of hamstring muscle injuries is not yet defined. The effect of autologous platelet-rich plasma (PRP) therapy on the recovery of hamstring injuries is unclear.

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  Purpose: To investigate the effect of a single PRP injection in the treatment of grade 2 hamstring muscle injuries.

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  Study Design: Randomized controlled trial; Level of evidence, 2.

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• Whey protein could help diabetics

  Posted in: General | Posted on: 28-Jul-2014

  Consuming whey protein - a popular protein among sportsmen who want to build muscle - before a regular breakfast reduces the blood sugar "spikes" common after meals rich in carbohydrates.

  It also is believed by Israeli and other researchers in an Israeli-Swedish study to improve the body's insulin response. The research was conducted by Prof. Daniela Jakubowicz and Dr. Julio Wainstein at Wolfson Medical Center in Holon, Prof. Oren Froy of the Hebrew University of Jerusalem, Prof. Bo Ahrשn of Lund University and colleagues.

  It was recently published in Diabetologia, the journal of the European Association for the Study of Diabetes.

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• Clinical Applications of Platelet-Rich Plasma in Patellar Tendinopathy

  Posted in: General | Posted on: 27-Jul-2014

  Introduction

  Platelet-rich plasma (PRP) is prepared by centrifuging anticoagulated whole blood obtained by phlebotomy.Therefore,it contains a hyperphysiological concentration of autologous platelets, 3-8 times the concentration of platelets in whole blood [1]. However, the exact definition of PRP has not been determined in terms of the concentration of platelet, and most published reports differ on PRP concentrations [2].

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• Does Platelet-Rich Plasma Freeze-Thawing Influence Growth Factor Release and Their Effects on Chondrocytes and Synoviocytes?

  Posted in: General | Posted on: 21-Jul-2014

  Introduction

  The use of platelet concentrates is becoming very popular in the field ofmusculoskeletal tissue regeneration.Awidespread interest has been shown for platelet-rich plasma (PRP) as an injective treatment or as a surgical augmentation procedure of several tissues [7]. These molecules bind to the transmembrane receptors of their target cells regulating cell signaling pathways [1, 7, 8]. Alpha-granules also contain cytokines, chemokines, and many other bioactive proteins that stimulate chemotaxis, cell proliferation, and maturation, modulate inflammatory molecules, and attract leukocytes [8].

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• The effect of platelet-rich plasma injections in the non-surgical treatment of a partial rotator cuff tear

  Posted in: General | Posted on: 09-Jul-2014

  Introduction: Rotator cuff tears are associated with significant morbidity and have a reported incidence of greater than 50% amongst the adult population. We present a case report of a partial rotator cuff tear treated with platelet-rich plasma injections.

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  Case Report: A 60-year-old female was presented with a partial supraspinatus tear having failed to improve with physiotherapy. The patient underwent a course of three platelet-rich plasma injections to her tear. Patient outcome was measured using the numerical pain rating scale (NPRS), percentage perceived improvement (PPI) and also a handheld dynamometer assessment of rotator cuff strength. Repeat ultrasound examination was performed. The patient reported improvements in pain as measured by NPRS and PPI, though maximal improvement was not maintained through to final data collection at 52nd week. Dynamometer follow-up showed improvement in strength. Ultrasound at 52nd week showed evidence of ingrowth of tissue though this did not resemble normal tendon. The patient noted increased pain post her second platelet-rich plasma injection though this was self-limiting and managed with simple analgesia.

  Conclusion: In this case report, platelet-rich plasma injections for the treatment of a partial rotator cuff tear resulted in improvement in all recorded outcome measures. This highlights the need for more formal controlled trials to determine the use of platelet-rich plasma in the treatment of rotator cuff pathology.

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• Efficacy and Safety of Plasma Rich in Growth Factors Intra-Articular Infiltrations in the Treatment of Knee Osteoarthritis

  Posted in: General | Posted on: 07-Jul-2014

  Purpose

  The goal of this study was to systematically review the efficacy and safety of plasma rich in growth factors (PRGF) as a treatment for reducing symptoms in patients with knee osteoarthritis.

  Methods

  A comprehensive and systematic literature search was conducted for PRGF treatment of knee osteoarthritis following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. All the studies had to include a PRGF group and a control group. Pre- and post-treatment measures of joint pain, reduced function, and stiffness were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index, Knee Injury and Osteoarthritis Outcome Score, International Knee Documentation Committee score, Lequesne index, or number of Outcome Measures for Rheumatology Committee and Osteoarthritis Research Society International Standing Committee for Clinical Trials Response Criteria Initiative (OMERACT-OARSI) responders, with a follow-up period of at least 4 weeks. An assessment of both the quality and risk of bias of the studies was conducted.

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• Platelet-rich plasma injections for the treatment of refractory Achilles tendinopathy: results at 4 years

  Posted in: General | Posted on: 29-Jun-2014

  Abstract

  BACKGROUND: Chronic Achilles tendinopathy is responsible for a severe reduction in physical performance and persistent pain. There is currently a number of therapeutic options and the local administration of growth factors is an emerging treatment strategy. In particular, platelet-rich plasma (PRP) is a widely used way to provide a local regenerative stimulus for tendon healing. The aim of this study was to document the mid-term results obtained after treating recalcitrant Achilles tendinopathy with injections of high concentrate, leucocyte-rich PRP.

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• One injection of platelet-rich plasma associated to a submaximal eccentric protocol to treat chronic jumper's knee

  Posted in: General | Posted on: 29-Jun-2014

  Abstract

  INTRODUCTION: Jumper's knee is a frequent chronic overuse syndrome of the upper part of the patellar tendon. Platelets contain lots of growth factors which could enhance the healing process of tendons.

  METHODS: Twenty patients with chronic upper patellar tendinopathy were enrolled. Assessments were made before infiltration of PRP, and 6 weeks and 3 months after the infiltration, using a 10--point Visual Analogic Scale, clinical examinations with a pressure algometer, algofunctional scores (IKDC and VISA--P), functional assessments (isokinetic and optojump evaluations) and imagery (ultrasounds and MRI). The PRP was obtained with an apheresis system (COM.TEC, Fresenius). Six millilitres of PRP were injected without local anaesthetic. One week after infiltration, patients started a standardised sub--maximal eccentric reeducation.

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• Role of platelet-released growth factors in detoxification of reactive oxygen species in osteoblasts

  Posted in: General | Posted on: 29-Jun-2014

  Abstract

  INTRODUCTION: Oxidative stress can impair fracture healing. To protect against oxidative damage, a system of detoxifying and antioxidative enzymes works to reduce the cellular stress. The transcription of these enzymes is regulated by antioxidant response element (ARE). The nuclear factor (erythroid-derived 2)-like2 (Nrf2) plays a major role in transcriptional activation of ARE-driven genes. Recently it has been shown that vascular endothelial growth factor (VEGF) prevents oxidative damage via activation of the Nrf2 pathway in vitro. Platelet-released growth factor (PRGF) is a mixture of autologous proteins and growth factors, prepared from a determined volume of platelet-rich plasma (PRP). It has already used to enhance fracture healing in vitro. The aim of the present study was to elucidate if platelets can lead to upregulation of VEGF and if platelets can regulate the activity of Nrf2-ARE system in primary human osteoblast (hOB) and in osteoblast-like cell line (SAOS-2).

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• Meniscal repair in vivo using human chondrocyte-seeded PLGA mesh scaffold pretreated with platelet-rich plasma

  Posted in: General | Posted on: 24-Jun-2014

  Abstract

  The objective of this study was to test the hypothesis that platelet-rich plasma (PRP) pretreatment on a poly-lactic-co-glycolic acid (PLGA) mesh scaffold enhances the healing capacity of the meniscus with human chondrocyte-seeded scaffolds in vivo, even when the seeded number of cells was reduced from 10 million to one million. A flexible PLGA mesh scaffold was pretreated with PRP using a centrifugal technique. One million human articular chondrocytes were seeded onto the scaffold by dynamic oscillation. After 7 days, scaffolds were placed between human meniscal discs and were implanted subcutaneously in nude mice for 6 weeks (n = 16/group). Fluorescence microscopy demonstrated uniform attachment of the chondrocytes throughout the scaffolds 24 h following seeding. Cell attachment analysis revealed a significantly increased number of chondrocytes on PRP-pretreated than non-treated scaffolds (p < 0.05). Field emission scanning electron microscopy revealed chondrocytes attached to the PRP-pretreated scaffolds interconnecting their cellular processes with the fibrin network at 24 h and day 7 of culture. Of the 16 constructs containing PRP-pretreated scaffolds implanted in mice, six menisci healed completely, nine healed incompletely and one did not heal. Histological results from the 16 control constructs containing non-treated scaffolds revealed that none had healed completely, four healed incompletely and 12 did not heal. The histological outcome between the groups was significantly different (p < 0.05). These findings suggest that human articular chondrocytes on PRP-pretreated PLGA mesh scaffolds demonstrate increased cell attachment and enhance the healing capacity of meniscus with a reduced number of seeding cells in a meniscal repair mouse model. Copyright

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• PURLs: Prolotherapy: A nontraditional approach to knee osteoarthritis

  Posted in: General | Posted on: 24-Jun-2014

  Abstract

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  Dextrose injections into the knee can reduce pain and improve a patient's quality of life.

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• Plasma rich in growth factors (PRGF) as a treatment for high ankle sprain in elite athletes: a randomized control trial

  Posted in: General | Posted on: 22-Jun-2014

  Abstract

  Purpose

  Syndesmotic sprains are uncommon injuries that require prolonged recovery. The influence of ultrasound-guided injections of platelet-rich plasma (PRP) into the injured antero-inferior tibio-fibular ligaments (AITFL) in athletes on return to play (RTP) and dynamic stability was studied.\n

  Methods

  Sixteen elite athletes with AITFL tears were randomized to a treatment group receiving injections of PRP or to a control group. All patients followed an identical rehabilitation protocol and RTP criteria. Patients were prospectively evaluated for clinical ability to return to full activity and residual pain. Dynamic ultrasound examinations were performed at initial examination and at 6

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• 5 Degree Simpósio Internacional de PRP e Medicina Regenerativa – Las Vegas

  Posted in: General | Posted on: 15-Jun-2014

  Aconteceu nos últimos dias 6 e 7 de junho, o 5° Simpósio Internacional de Plasma Rico em Plaquetas (PRP) e Medicina Regenerativa, em Las Vegas – EUA

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• An introduction to application of Platelet Rich Plasma (PRP) in skin rejuvenation

  Posted in: General | Posted on: 10-Jun-2014

  Abstract

  Platelet-rich plasma (PRP) is an autologous concentration of human platelets contained in a small volume of plasma characterized by haemostatic and tissue repairing effects. Tissue repairing effects and being enriched by various kind of growth factors, has made them the focus of attention for different procedures. PRP has been effective in bony defects, wound healing and recently for aesthetic procedures in plastic surgery.

  The purpose of this review is to evaluate and summarize the applications of PRP in the dermatology literature, with particular focus on rejuvenizaton process, advances and limitations of current PRP therapies. We studied literature related to PRP therapy, these include regeneration of soft tissue, skin aging mechanisms, as well as wound healing.

  Some studies have shown promising results, with favorable outcomes about PRP clinical application for skin rejuvenization. This article summarizes our current understanding regarding photoaging process and the role of PRP in the skin rejuvenization process. PRP has been shown to be useful in skin rejuvenization. Further studies are needed to elucidate both basic and clinical aspects of PRP therapies. In particular, platelet preparation methods, different application methods, platelet mechanism of action in rejuvenation field, interactions with the skin components, long-term efficacy and safety are necessary to be determined.

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• Outcomes of prolotherapy in chondromalacia patella patients: improvements in pain level and function

  Posted in: General | Posted on: 04-Jun-2014

  Abstract

  We retrospectively evaluated the effectiveness of prolotherapy in resolving pain, stiffness, and crepitus, and improving physical activity in consecutive chondromalacia patients from February 2008 to September 2009. Sixty-nine knees that received prolotherapy in 61 patients (33 female and 36 male) who were 18-82 years old (average, 47.2 years) were enrolled. Patients received 24 prolotherapy injections (15% dextrose, 0.1% procaine, and 10% sarapin) with a total of 40 cc in the anterior knee. At least 6 weeks after their last prolotherapy session, patients provided self-evaluation of knee pain upon rest, activities of daily living (ADL) and exercise, range of motion (ROM), stiffness, and crepitus. Symptom severity, sustained improvement of symptoms, number of pain pills needed, and patient satisfaction before treatment and improvement after treatment were recorded. Following prolotherapy, patients experienced statistically significant decreases in pain at rest, during ADL, and exercise. Stiffness and crepitus decreased after prolotherapy, and ROM increased. Patients reported improved walking ability and exercise ability after prolotherapy. For daily pain level, ROM, daily stiffness, crepitus, and walking and exercise ability, sustained improvement of over 75% was reported by 85% of patients. Fewer patients required pain medication. No side effects of prolotherapy were noted. The average length of time from last prolotherapy session was 14.7 months (range, 6 months to 8 years). Only 3 of 16 knees were still recommended for surgery after prolotherapy. Prolotherapy ameliorates chondromalacia patella symptoms and improves physical ability. Patients experience long-term improvement without requiring pain medications. Prolotherapy should be considered a first-line, conservative therapy for chondromalacia patella.

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