Augmentation of Autologous Platelet-Rich Plasma in Hip Salvage in Stages I and II of Avascular Necrosis: Randomized Blinded Trial Comparing 3 Surgical Techniques in 82 Patients.

Introduction: Avascular necrosis of the femoral head is common in routine orthopedic clinics. The challenge arises in managing early stages (I and II) without obvious radiological evidence. Authors explore this naïve research area by comparing surgical procedures in early AVN patients. Materials and Methods: A prospective multicentric study was performed from November 2020 to February 2023 on 82 patients treated with surgical decompression and adjuvants, concerning the defined inclusion and exclusion criteria. Radiopacity and intraosseous edema resolution and THA conversion rates were assessed. Hip pain VAS, groin/thigh pain, difficulty in sitting cross-legged incidence, pain-free walking distance, Harris hip scores, 30-s chair test, and complications were noted. Results: Among 82 patients, the mean age was 28.46 years. Male:female ratio of 3.9:1. 8.5% had bilateral affection and 48.78% had a positive family history. 93.90% presented with groin pain and difficulty in sitting cross-legged, restricted hip movements in 85.3%, and thigh pain in 54.87%. Harris hip scored worst in Group 3 followed by Group 2 and Group 1. 63.41% and 36.58% of patients had Grades 1 and 2 AVN, respectively. At 1 week post-operatively, 96.3% and 93.9% of patients were relieved from groin and thigh pain, respectively (p < 0.001); the trend being Group 3 > Group 2 > Group 1. Hip pain VAS followed a similar trend. At 4 weeks, Harris hip scores improved in Group 3 > Group 2 > Group 1. At 6 months, the trend was Group 2 > Group 3 > Group 1. Group 3 had better 30-s chair test results, pain-free walking distance, and longer cross-legged sitting time. Complication rate of 3.6%. 6.09% of patients underwent THA later. Sclerotic patch and marrow edema resolution early in Group 3, i.e., 46 and 31 days respectively, followed by Group 2 and Group 1. Conclusion: In Stages I and II AVN, biplanar core decompression (double) and intraosseous PRP injection is a promising salvage option; patients have better early hip scores (4 weeks), and early groin and thigh pain recovery. Patients treated early have better clinical and radiological recovery.

Exploring the Efficacy of Biologics in Knee Osteoarthritis: Ultrasound Evaluation of Cartilage Regeneration Effects.

Introduction: Biologics like growth factors, stem cells, and platelet-rich plasma show potential in stimulating cartilage regrowth and reducing inflammation. By synthesizing preclinical and clinical studies, this study offers insights into how these biologics work and their effectiveness in treating knee osteoarthritis. Methods and Materials: Twenty-four participants with knee osteoarthritis (Kellgren - Lawrence grade II or III) were enrolled after obtaining consent. They received three doses of 2 ml intraarticular platelet-rich plasma at 1 month intervals. The clinical assessment involved the oxford knee score (OKS) and visual analogue scale (VAS) for pain on Days 0, 90, and 180. Ultrasound measured femoral and trochlear cartilage thickness pre- (Day 0) and post-PRP (Day 90-180). Results: Before treatment, the average pain score was 7.2 (p = 1.03). On Day 90 post-PRP, it decreased to 5 (p = 0.81), and by Day 180, it further reduced to 4.5 (p = 0.97). The initial total OKS was 33.5 (p = 1.76), which increased to 36 (p = 1.71) on Day 90 and 38.5 (p = 1.89) on Day 180. The femoral and trochlear cartilage thickness also showed improvement from baseline (0.92) to Day 90 (0.96) and Day 180 (1.01), indicating significant cartilage healing post-PRP administration. Conclusion: Our study highlights the probability of PRP in treating knee OA, highlighting their ability to alleviate symptoms, enhance joint function, and promote articular cartilage regeneration.

Decoding the Decade: Exploring the Efficacy of Platelet-Rich Plasma (PRP) in Complex Wound Management - A Comprehensive Study.

Introduction: Autologous platelet-rich plasma (PRP) therapy has emerged as a promising regenerative treatment modality, offering potential improvements in healing outcomes through its rich content of growth factors and cytokines. We evaluated the effectiveness of PRP therapy in the management of complex wounds, using a decade-long retrospective analysis of treatments conducted at a tertiary care center from 2010 to 2020. The study introduces and assesses the efficacy of the Sandeep's Technique for Assisted Regeneration of Skin (STARS) in enhancing wound healing and quality of life for patients with complex wounds. Materials and methods: A prospective interventional study was conducted, involving two phases: the development and initial testing of PRP therapy (2010-2015) and the application and evaluation of the STARS protocol (2015-2020). The study included patients with complex wounds, utilizing autologous PRP prepared through a double spin centrifuge technique. Outcome measures included wound-healing rates, infection management, and complication rates, compared to conventional treatment methods. Results: The study treated 500 wounds in 432 patients with autologous PRP, noting significant improvements in wound-healing rates, 97.7% had infection control without antibiotics (even in MRSA cases), and all had a good pain control. Histopathological examinations confirmed collagen-rich healing with minimal scarring. The STARS protocol demonstrated the potential of PRP therapy in accelerating wound healing, reducing the need for additional surgical interventions, and enhancing patient outcomes. Conclusion: PRP therapy, particularly when administered following the STARS protocol, represents a safe, effective, and patient-friendly approach for the management of complex wounds. This study supports the integration of PRP therapy into regenerative care strategies, suggesting a shift toward more innovative and efficacious treatments in wound management.

Autolougous platelet concentrates in esthetic medicine.

This narrative review summarizes current knowledge on the use of autologous platelet concentrates (APCs) in esthetic medicine, with the goal of providing clinicians with reliable information for clinical practice. APCs contain platelets that release various growth factors with potential applications in facial and dermatologic treatments. This review examines several facial esthetic applications of APCs, including acne scarring, skin rejuvenation, melasma, vitiligo, stretchmarks, peri-orbital rejuvenation, peri-oral rejuvenation, hair regeneration and the volumizing effects of APC gels. A systematic review of literature databases (PubMed/MEDLINE) was conducted up to October 2023 to identify randomized controlled trials (RCTs) in the English language on APCs for facial rejuvenation and dermatology. A total of 96 articles were selected including those on platelet rich plasma (PRP), plasma-rich in growth factors (PRGF), and platelet-rich fibrin (PRF). Clinical recommendations gained from the reviews are provided. In summary, the use of APCs in facial esthetics is a promising yet relatively recent treatment approach. Overall, the majority of studies have focused on the use of PRP with positive outcomes. Only few studies have compared PRP versus PRF with all demonstrating superior outcomes using PRF. The existing studies have limitations including small sample sizes and lack of standardized assessment criteria. Future research should utilize well-designed RCTs, incorporating appropriate controls, such as split-face comparisons, and standardized protocols for APC usage, including optimal number of sessions, interval between sessions, and objective improvement scores. Nevertheless, the most recent formulations of platelet concentrates offer clinicians an ability to improve various clinical parameters and esthetic concerns.

Platelet-Rich Plasma Treatment for the Lumbar Spine: A Review and Discussion of Existing Gaps.

BACKGROUND: Platelet-rich plasma (PRP) is obtained by centrifuging autologous whole blood to extract a layer concentrated with platelets, growth factors found in platelet granules, and cytokines. These components work together to promote and facilitate the healing process at sites of injury. An increasing number of clinical studies are assessing the efficacy of PRP as a treatment for lower back pain. OBJECTIVES: Lumbar back pain is a significant cause of years lived with disability. This paper conducts a thorough review of clinical studies on intradiscal, facet-joint, epidural, and mixed-target PRP interventions in the lumbar spine. Furthermore, gaps in the current literature regarding lumbar spinal PRP injections are identified to help guide future clinical trials. STUDY DESIGN: Literature review. METHODS: An initial search was conducted using Ovid MEDLINE, focusing on PRP injections in the spine. Boolean operators were used to combine MeSH terms and key words such as "spine," "lumbar spine," "thoracic spine," "cervical spine," "intervertebral disc," "platelet-rich plasma," and "inject." The search revealed an absence of papers about PRP injections into the cervical and thoracic spine, so the review was written with a specific focus on the lumbar spine. For the purposes of this paper, the selected manuscripts were separated into categories of intradiscal, facet-joint, epidural, and mixed-target PRP injections. RESULTS: A multitude of case reports, case series, prospective clinical studies, and randomized controlled trials have yielded results supporting the use of intradiscal, facet-joint, and epidural PRP injections in the lumbar spine. However, a handful of papers suggest that PRP lacks efficacy in improving lumbar back pain and function. With the relative dearth of literature assessing the effects of spinal PRP injections, additional double-blinded randomized trials are needed. Important findings from available studies include the observation of PRP's increased efficacy over time, the correlation of the number of targeted injection sites with the efficacy of PRP injections, and the correlation of platelet count with PRP injections' efficacy. LIMITATIONS: There exists wide variability in PRP preparation protocols and in the methods of assessing PRP's therapeutic benefits between each study that evaluates PRP's effects in the lumbar spine. CONCLUSIONS: All clinical studies evaluating PRP as a form of treatment for the lumbar spine should include full transparency and details about the methods used for PRP preparation and injection. Future double-blinded randomized trials can fill in existing gaps by assessing the effects of platelet concentration and dose on the extent of clinical improvement as well as by establishing an expected timeline for clinical improvement after PRP injections. Cross-study standardization of which pain scoring systems to utilize for study evaluation would increase comparability among different papers.

Prospective Outcomes After Serial Platelet-Rich Plasma (PRP) Injection in Vocal Fold Scar and Sulcus.

OBJECTIVE: Vocal fold scar and sulcus pose significant treatment challenges with no current optimal treatment. Platelet-rich plasma (PRP), an autologous concentration of growth factors, holds promise for regenerating the superficial lamina propria. This study aims to evaluate the potential benefits of serial PRP injections on mucosal wave restoration and vocal function. METHODS: In a prospective clinical trial across two institutions, patients with vocal fold scar underwent four serial PRP injections, one month apart. Blinded independent laryngologists and expert listeners used pretreatment and one-month post-fourth injection videostroboscopy and CAPE-V assessments to evaluate mucosal wave and voice quality changes, respectively. Additionally, patient reported outcome measures (PROMs) were evaluated. RESULTS: In the study, 15 patients received 55 PRP injections without adverse effects. Eight patients (53.3%) had mild, three patients (20%) had moderate, and four patients (26.7%) had severe scar. There was an average reduction of 8.7 points in post-treatment VHI-10 scores (p = 0.007). The raters observed an improvement in post-treatment voice in 73.4% of cases, and CAPE-V scores showed a reduction of 18.8 points on average (p = 0.036). The videostroboscopic VALI ratings showed an improvement in mucosal wave rating from 2.0 to 4.0. On average, the raters perceived the post-PRP exams to be better in 56.7% of cases. CONCLUSIONS: PRP has been validated as a safe autologous option for treatment of vocal fold scar. While results for mucosal wave and voice quality varied, there was a consistent improvement in PROMs. LEVEL OF EVIDENCE: Level 3: Prospective cohort study, with blinded analysis Laryngoscope, 2024.

Evaluation of orthobiological ozonized platelet-rich plasma therapy post-arthroscopic suturing and lone partial meniscectomy in the treatment of meniscal tears within degenerative knee osteoarthritis.

BACKGROUND: Knee joint osteoarthritis (OA)-related meniscal tears are still sometimes treated in centers by arthroscopic partial meniscectomy (APM), which is then followed by a solitary physical therapy regimen. OBJECTIVE: The present study was conducted to compare the efficacy of intra-articular injection of ozonized platelet-rich plasma (PRP) and hyaluronic acid following arthroscopic suturing, and APM to treat meniscal tear degenerative type. METHODS: In a randomized trial of prospective comparative research, 104 patients, all of whom had meniscal tears due to OA of the knee, were randomly divided into two groups. The participants in Group A (55 patients) were given intra-articular ozonized PRP and hyaluronate therapeutics, following arthroscopic suturing of meniscal tear treatment (ASMT) of degenerative knee joint OA. Group B (49 patients) was prepared for APM alone. Both groups were followed by physical therapy and a follow up visit throughout 12, 24, and 36 months. The WOMAC and Lequesne scores were evaluated. RESULTS: At every follow up visit for 6, 12, and 24, months, there was a significant decline in the mean of WOMAC and Lequesne scores in Groups A and B relative to baseline. Additionally, Group A significantly (P<0.0001) outperformed Group B at 12, 24, and 36 months for both Lequesne's and WOMAC scores. There were infection, stiffness, and widespread OA knee degeneration detected in Group B while no serious adverse effects were observed in Group A. CONCLUSION: The study's findings demonstrated that physical and intra-articular orthobiological ozonized PRP and hyaluronate therapies were more effective than APM in treating degenerative knee joint OA.

The Effect of Platelet-Rich Plasma on the Healing of Nasal Mucosa After Surgery of the Nose: A Randomized Clinical Trial.

Purpose: To investigate the effect of platelet-rich plasma (PRP) on the healing of nasal mucosa after surgery of the nose. Methods: This prospective, randomized, Comparative Analytic study was conducted on 40 patients. Patients were randomly allocated into two groups: Group A, subjected to PRP, and Group B, who were not subjected to PRP after nasal surgery. The outcome of both Techniques was analyzed and compared. Results: Significant differences were found in dryness, encrustations, and postoperative healing days in the PRP group. However, no significant differences between the two groups were observed in primary bleeding, secondary bleeding, nasal synechiae, pain, healing time, return to physical activity, and patient satisfaction. Conclusion: Our study detects the potential hopeful effect of PRP on postoperative wound healing of nasal mucosa, dryness, and nasal crustations. According to these results, the application of PRP post-nasal surgery can be considered an effective method for maintaining post-nasal surgery Mucosa.

Evidence of restorative therapies in the treatment of Peyronie disease: A narrative review.

OBJECTIVE: To describe the evidence of Platelet Rich Plasma (PRP), Stem cells therapy (SCT) and Extracorporeal shockwave therapy (ESWL) for the treatment of Peyronies disease (PD), including information from the main urological society guidelines. MATERIALS AND METHODS: A literature review of PubMed articles published between 2000 and 2023 was conducted, utilizing keywords such as "Peyronie's Disease", "Penile curvature", "Platelet Rich Plasma", "Stem cells", and "Extracorporeal shockwave therapy". Only full-text articles in English were included, excluding case reports and opinions. RESULTS: A considerable number of clinical trials were conducted using PRP penile injections for therapy of PD, showing reduction of curvature, plaque size and improvement in quality of life. Preclinical studies in rats have shown the potential benefit of adipose-derived stem cells, with improvements in erectile function and fibrosis. Human studies with mesenchymal stem cells demonstrated promising results, with reduction of curvature and plaque size. ESWL effects on PD were investigated in randomized clinical trials and demonstrated no significant impact in curvature or plaque size, but reasonable effect on pain control. CONCLUSION: Restorative therapies has emerged as an innovative treatment option for PD and the results from current studies appear to be promising and demonstrated good safety profile. Unfortunately, due to scarce evidence, PRP and SCT are still considered experimental by American Urological Association (AUA) and European Association of Urology (EAU) guidelines. ESWT is recommended, by the same guidelines, for pain control only. More high-quality studies with long-term follow-up outcomes are needed to evaluate efficacy and reproducibility of those therapies.

The growth factor content as an indicator of platelet counts in platelet-rich plasma.

BACKGROUND: Platelet contains growth factors that enhance tissue repair mechanisms, including epidermal growth factor (EGF), platelet-derived growth factor (PDGF-AA and -AB), and transforming growth factor (TGF)-ß. Autologous platelet-rich plasma (PRP) has been shown to significantly improve the treatment of tendon injuries compared with hyaluronic acid and placebo. The topic of agreement between platelet concentrations and growth factors has been covered in some previous studies, but growth factor levels did not correlate well with platelet concentrations. METHOD: In this study, autologous PRP was prepared by concentrating platelets through a J6-MI centrifuge. The automatic hematology analyzer Sysmex XN-20 was used to analyze the platelet concentration in PRP, and the PRP growth factors were determined by ELISA, including PDGF, transforming growth factor- ß1 (TGF-ß1), and EGF. Statistical analysis was conducted on data from 107 patients who received autologous PRP using Pearson correlation analysis. RESULTS: Pearson correlation analysis revealed PDGF, TGF, and EGF had a strong positive correlation with the platelet concentration of the final PRP product (r = 0.697, p < 0.0001; r = 0.488, p < 0.0001; r = 0.572, p < 0.0001, respectively) CONCLUSIONS: There was a strong positive correlation between the concentration of platelets in the final PRP product and the levels of PDGF-AB, TGF-ß, and EGF. These results suggested straightforward and cost-effective growth factor tests can provide valuable information about platelet content in PRP.

Comparison of functional performance outcomes between oral patented crystalline glucosamine sulfate and platelet-rich plasma among knee osteoarthritis patients: a propensity score matching analysis.

BACKGROUND: Among the medications used to treat knee osteoarthritis (OA), oral patented crystalline glucosamine sulfate (pCGS) and platelet-rich plasma (PRP) have become popular alternatives to painkillers or nonsteroidal anti-inflammatory drugs (NSAIDs). Although studies have shown that pCGS and PRP improve clinical outcomes, no study has compared outcomes between these optional treatments. We compared functional performance outcomes from baseline to the 1-year follow-up (FU) between oral pCGS and PRP in patients with knee OA. MATERIALS AND METHODS: Three hundred eighty-two patients receiving oral pCGS and 122 patients receiving PRP injections were enrolled for a review of functional performance outcomes, including a five-time sit-to-stand test (5xSST), time up-and-go test (TUGT), and 3-minute walk distance test (3MWDT). The patients were followed up for one year. The pCGS group received 1500 mg daily, whereas the PRP group received 2 cycles of intra-articular injections at week 0 and week 6. Using propensity score matching based on age, sex, height, weight, BMI, and Kellgren and Lawrence (KL) classification, all three functional performance outcomes were compared between the baseline (pretreatment), 6-week, 12-week, 24-week, and 1-year FUs. RESULTS: With a ratio of 2:1 (pCGS: PRP), 204 patients in the pCGS group were matched with 102 patients in the PRP group. Compared with the baseline levels, the PRP group showed significant improvements in 5xSST and TUGT outcomes from 6 weeks and significant improvements in 3MWDT outcomes from 12 weeks, whereas the pCGS group showed significant improvements in TUGT outcomes from 6 weeks and significant improvements in 5xSST and 3MWDT outcomes from 12 weeks. At the 24-week and 1-year FU, both groups showed significant improvements in all three functional performance tests without adverse events. CONCLUSIONS: Although the PRP group showed faster improvements in 5xSST outcomes at six weeks, from the 12-week to 1-year FU, both the pCGS and PRP groups showed significant improvements in 5xSST, TUGT, and 3MWDT outcomes. As the use of PRP is more complicated and invasive than the use of oral pCGS, the benefits and drawbacks of selecting PRP over pCGS in knee OA treatment should be examined.

Endodontic surgery and platelet concentrates: A comprehensive review.

While autologous platelet concentrates (APCs) have gained traction as promising regenerative materials in recent years, their impact on wound healing and tissue regeneration in periapical hard tissue defects remains controversial. Endodontic microsurgery (EMS) has embraced the potential of platelet concentrates, particularly L-PRF (Leucocyte-Platelet-Rich Fibrin) and PRP (Platelet-Rich Plasma), as regenerative tools. These concentrates, rich in growth factors and other bioactive molecules, are thought to enhance healing and treatment outcomes for various endodontic conditions. However, their effectiveness remains a subject of investigation. Despite encouraging 3-D cone beam computed tomography (CBCT) based evidence for PRP's effectiveness in complex lesions and apico-marginal defects, inconsistencies in its performance across preparation and application protocols raise questions about its superiority over existing options. More research is crucial to understand its full potential as a reliable regenerative tool in endodontics. L-PRF and its derivatives are particularly effective in treating apical-marginal defects. It enhances clinical attachment levels and reduces probing pocket depths, likely due to its slow and coordinated release of various growth factors. L-PRF has been shown to also improve patients' quality of life by reducing postoperative swelling and pain. However, more research is needed to standardize its preparation methods and confirm its long-term benefits. This paper aims to provide a comprehensive review of the current knowledge and recent advances in endodontic surgery and the use of platelet concentrates, focusing on their roles in managing periapical lesions and endo-perio lesions.

A case series utilizing bone marrow aspirate concentrate, cancellous bone autograft, platelet-rich plasma and autologous fibrin for the treatment of femur nonunions.

Aim: To assess the efficacy of a bioregenerative scaffold derived from bone marrow aspirate, cancellous bone autograft, platelet-rich plasma and autologous fibrin in treating supracondylar femur nonunions. Methods & materials: Three patients with nonunions following multiple surgical failures underwent bone stabilization and the application of a novel bioregenerative scaffold. x-rays and subjective scales were collected before surgery and at 6, 12 and 24 months post-surgery. Results: All nonunions exhibited healing with sufficient callus formation, as confirmed radiologically. After 6 months, all patients resumed full weight-bearing walking without pain. Statistical analysis showed improvements in all scales compared with pre-surgical values. Conclusion: This method presents itself as an option for treating supracondylar femur nonunions following multiple surgical failures.

What is this summary about? The objective of this case series study was to evaluate the effectiveness of a new biological autologous scaffold, comprised of stem and blood cells along with blood derivatives, in treating challenging cases of supracondylar femur nonunions.What were the results? Three participants underwent the application of this surgical method and were monitored for a period of 2 years. The therapy was well tolerated and deemed safe. Notably, all three patients experienced significant reductions in pain and improvements in functionality. Within a few months, they were able to walk with full weightbearing without pain, and clear indications of progressing toward bone union were evident by the 6 months.What do the results mean? This study demonstrates that the surgical application of autologous blood, cancellous bone and bone marrow, following the described concept and method, is an effective, safe and enduring treatment for femur nonunions. It markedly diminishes pain, enhances leg function and yields statistically significant improvements in quality of life.

Comparison of the Effectiveness of Injection Laryngoplasty Using Autologous Platelet-Rich Plasma or Autologous Fat With Platelet-Rich Fibrin for the Treatment of Patients With Unilateral Vocal Fold Paralysis.

OBJECTIVES: Unilateral vocal fold paralysis (UVFP) can be idiopathic or a result of surgery, cancer, or neurological disease. The most common presentation is dysphonia, which causes problems with communication, and can lead to anxiety and depression. Injection laryngoplasty (IL) is a current means of treatment, but there have been few studies to determine the optimal material to use. Therefore, we aimed to compare the use of autologous platelet-rich plasma and autologous fat with platelet-rich fibrin for IL under local anesthesia and general anesthesia, respectively. STUDY DESIGN: A prospective randomized controlled study was conducted at the Otolaryngology-Head and Neck Surgery Department, Ramathibodi Hospital, Faculty of Medicine, Mahidol University. METHODS: Thirty-four patients with UVFP were recruited. All met the inclusion criteria and were randomized to two groups, to be treated using autologous platelet-rich plasma under local anesthesia or autologous fat with platelet-rich fibrin under general anesthesia. The primary outcome was the mean difference in the Voice Handicap Index (VHI) between the groups at 1- and 6-months post. The secondary outcomes were the mean differences in voice acoustic parameters [maximum phonation time (MPT), jitter, shimmer, and harmonic-to-noise ratio (HNR)] between the groups at these time points. RESULTS: At the measured time points, there were no significant differences in the mean VHIs (P = 0.462), MPT (P = 0.79), jitter (P = 0.234), shimmer (P = 0.863), or HNR (P = 0.096) between the groups. Few people who underwent the procedure under local anesthesia developed laryngospasm, while some of those in the fat with platelet-rich fibrin developed postoperative abdominal contusion or hematoma which resolved spontaneously. CONCLUSIONS: We have found no difference in the effectiveness of IL using autologous platelet-rich plasma under local anesthesia or autologous fat with platelet-rich fibrin performed under general anesthesia in patients with UVFP. No serious or life-threatening complications were found in both groups.

Regenerative therapy in geriatric patients with low back pain.

Low back pain (LBP) is a prevalent and debilitating condition, particularly among older adults, with degenerative spinal disease being a major contributor. Regenerative therapy, which aims to repair and regenerate damaged spinal structures, has shown promise in providing long-term pain relief and functional improvement. This review focuses on the application and efficacy of regenerative therapies such as mesenchymal stem cells, platelet-rich plasma, and atelocollagen in older patients with LBP. Despite the potential benefits, there is a notable scarcity of studies specifically targeting the older population, and those available often have small sample sizes and limited age-related analyses. Our findings underscore the need for more comprehensive and well-designed clinical trials to evaluate the effectiveness of these therapies in older patients. Future research should prioritize larger age-specific studies to establish regenerative therapy as a viable and effective treatment option for LBP in the aging population.

Clinical Study on the treatment of chronic infectious ulcers using Platelet-Rich technology combined with moist dressings.

Objective: To explore the clinical efficacy of platelet-rich technology combined with moist dressings in the treatment of chronic infectious ulcers. Methods: This was a retrospective study. The subjects of the study were 48 patients with chronic infectious ulcers in Sichuan Provincial Orthopedics Hospital from January 2019 to June 2022. Enrolled patients were randomly divided into four groups(n=12), and received different treatment methods respectively. Further analysis and comparison were performed on the changes in wound volume, wound healing status, wound bacterial culture results, and the incidence of adverse reactions among the four groups. Results: Three months after debridement, the wound volume of all four groups of patients was significantly reduced compared with that before debridement, with a statistically significant difference in intra-Group-Comparison(P<0.05). The inter-Group-Comparison revealed a statistically significant difference in wound volume in Group-A, Group-B, and Group-C than that in Group-D(P<0.05). After treatment, the wound healing status of patients in groups A, B, and C was significantly better than that of patients in Group-D, with a statistically significant difference(P<0.05). During treatment, patients in all four groups had decreased count of would bacteria, and showed negative results of wound bacterial culture by the three-month follow-up. No serious adverse reactions were observed in the four groups during treatment, and all improved after management, with no statistically significant difference in the incidence of adverse reactions(P>0.05). Conclusion: Platelet-rich technology combined with moist dressings may effectively promote the repair of chronic infectious ulcer wounds, with good clinical safety.

The Effectiveness of Leukocyte-Poor Platelet-Rich Plasma Injections for Symptomatic Mild to Moderate Osteoarthritis of the Knee With Joint Effusion or Bone Marrow Lesions in a Japanese Population: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

BACKGROUND: Intra-articular platelet-rich plasma (PRP) injections have been proposed for the treatment of knee osteoarthritis (OA); however, their effectiveness in Japanese patients remains unclear. PURPOSE: To investigate whether 3 intra-articular injections of leukocyte-poor PRP (LP-PRP) improve symptoms and joint function in symptomatic Japanese patients with mild to moderate knee OA. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Of 72 patients screened, 30 were included and randomized to receive LP-PRP (n = 15) or saline (placebo; n = 15) injections between March 2019 and February 2023. Patients attended a screening visit and 3 treatment visits at 1 week apart, followed by 3 follow-up visits (at 4, 12, and 24 weeks) after the initial treatment visit. The primary efficacy outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, whereas the secondary efficacy outcome measures were the proportion of patients showing a visual analog scale (VAS) improvement of ≥50%. Magnetic resonance imaging was performed to evaluate joint effusion and bone marrow lesions using the Whole-Organ Magnetic Resonance Imaging Score. Patients were followed for 24 weeks. RESULTS: Patients in the PRP group (mean age, 65.9 years) had a mean hip-knee-ankle angle of 5.1°, with 7 and 8 patients demonstrating Kellgren-Lawrence grade 2 and 3 knee OA, respectively. Patients in the placebo group (mean age, 67.9 years) had a mean hip-knee-ankle angle of 3.8°, with 6 and 9 patients showing Kellgren-Lawrence grade 2 and 3 knee OA, respectively. No significant differences were identified in any baseline factors. The percentage change in Western Ontario and McMaster Universities Osteoarthritis Index scores from baseline to 24 weeks was significantly different (P= .032) between the PRP (median, 75.9%; quantile 1 [Q1], 49.6; quantile 3 [Q3], 94.1]) and placebo (median, 27.7%; Q1, -9.4; Q3, 80.9]) groups. Overall, 73.3% and 28.6% of the PRP group and placebo group, respectively, exhibited an improvement in visual analog scale scores of ≥50%, with a significant improvement observed in the PRP group (P = .027). Changes in bone marrow lesions from baseline to 24 weeks, as assessed on magnetic resonance imaging, significantly differed between groups (P = .017), with no significant differences in other secondary endpoints. CONCLUSION: In Japanese patients with knee OA, 3 intra-articular LP-PRP injections led to clinical improvements at 24-week follow-up and significant functional improvements and pain relief after 24 weeks.

Hyperdiluting Calcium Hydroxylapatite With Platelet-Rich Plasma and Hyaluronidase for Improving Neck Laxity and Wrinkle Severity.

The two cases discussed in this report investigate the efficacy and safety of a novel injectable therapy for treating neck wrinkles and skin laxity, utilizing a combination of hyperdiluted calcium hydroxylapatite (CaHA), platelet-rich plasma (PRP), and hyaluronidase. Two patients presenting with moderate neck wrinkles and laxity underwent treatment and were evaluated several months later. The combined therapy demonstrated improvements in skin texture and laxity following a single treatment. The rationale behind incorporating PRP and hyaluronidase was their potential to amplify the regenerative effects of CaHA. PRP contains growth factors that stimulate collagen production and tissue regeneration while hyaluronidase facilitates the breakdown of hyaluronic acid, promoting better diffusion and more even product dispersion. The findings from these cases provide emerging preliminary evidence supporting the safety and efficacy of this innovative combination therapy for addressing neck wrinkles and laxity. This is the first documented instance of skin priming CaHA with hyaluronidase and PRP. Future investigations are warranted to explore the application of this treatment for other anatomical regions and to delineate the role of each injected component.

A Successful Pregnancy Outcome Using Laser-Assisted Hatching and Platelet-Rich Plasma Perfusion in Advanced Maternal and Paternal Age: A Case Report.

Infertility affects millions globally, with advanced parental age posing a significant risk. This case report details a couple who experienced secondary infertility for 12 years. Following multiple unsuccessful attempts at assisted reproductive technology (ART), a personalized treatment regimen involving platelet-rich plasma (PRP) perfusion and laser-assisted hatching (LAH) resulted in a successful pregnancy. Diagnostic evaluations identified specific reproductive challenges, leading to tailored interventions. A positive pregnancy outcome was achieved after PRP treatment enhanced endometrial thickness and LAH facilitated embryo implantation. This case highlights the importance of individualized treatment strategies in infertility management and proves the potential efficacy of PRP and LAH in overcoming recurrent implantation failure. Further research is needed to explain the roles of PRP and LAH in improving pregnancy outcomes, especially in older parents and couples with a history of failed in vitro fertilization (IVF) treatments.

Comparing the efficacy and safety of microneedling and its combination with other treatments in patients with acne scars: a network meta-analysis of randomized controlled trials.

This study aimed to analyze the efficacy and safety of microneedling (MN), both alone and in combination with other treatments, to refine the approach for treating acne scars using MN. We systematically searched Pubmed, Cochrane Library, Embase, and Web of Science for randomized controlled trials examining MN or its combinations in patients with acne scars. All statistical analyses were performed using Stata 18 software. A total of 24 studies involving 1546 participants were included. The analysis revealed that MN combined with chemical peels (CP) exhibited the best results in terms of degree of improvement, patient satisfaction, and treatment efficacy compared to other treatments examined, including MN alone, MN with hyaluronic acid (HA), MN with botulinum toxin­A (TA), MN with platelet-rich plasma (PRP), PRP alone, CP, and laser therapy. The results for MN combined with additional treatments were obviously better than for MN alone. Side effects such as erythema, pain, and post-inflammatory hyperpigmentation showed no significant differences across all treatments assessed.