Effectiveness of leukocyte- and platelet-rich fibrin in the management of medication-related osteonecrosis of the jaws ­ a systematic review / Efectividad de la fibrina rica en leucocitos y plaquetas en el tratamiento de osteonecrosis mandibular relacionada con medicamentos: una revisión sistemática

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a rare, but significant adverse event primarily associated with the intake of antiresorptive and antiangiogenic medications. Although antiresorptive and antiangiogenic the-rapies improve life expectancy, particularly in cancer patients, MRONJ may hamper the patient's quality of life due to pain, discomfort, anxiety, depression, speech impairment, difficulty in swallowing and eating, frequent medical and dental evaluations and treatments, and the possibility of treatment discontinuation. Leukocyte­ and Platelet-rich Fibrin (L-PRF) is an autologous platelet aggregate that promotes wound healing by stimulating re-epithelialization, angiogenesis, and extracellular matrix production. Aim: The present systematic review aimed to compare the results in the published literature on whether L-PRF is an effective and predictable adjuvant to surgical debridement of necrotic bone for improving the healing efficacy in patients with MRONJ. Materials and Methods: The PubMed, Scopus, Cochrane, Science Direct, LILACS, and Web of Science databases were searched using the predetermined MeSH terms and eligibility criteria, and the search yielded a total of five articles. Two studies were retrospective, and three studies were case series. Results: Seventeen participants received a combination of surgical debridement, L-PRF membrane, and antibiotics. Complete wound healing was observed in 70% of the participants, and most of them healed without any complications. Conclusions: L-PRF as an adjuvant to surgical debridement of necrosed bone appears to have a positive association with the healing outcome in patients with MRONJ.

Introducción: La osteonecrosis mandibular relacionada con medicamentos (ONMRM) es un evento adverso raro pero significativo asociado principalmente con la ingesta de medicamentos antirresortivos y antiangiogénicos. Aunque las terapias antirresortivas y antiangiogénicas mejoran la esperanza de vida, particularmente en pacientes con cáncer, la ONMRM puede obstaculizar la calidad de vida del paciente debido a dolor, incomodidad, ansiedad, depresión, discapacidad del habla, dificultad para tragar y comer, evaluaciones y tratamientos médicos y dentales frecuentes, y la posibilidad de interrupción del tratamiento. La fibrina rica en plaquetas y leucocitos (L-PRF) es un agregado de plaquetas autólogo que promueve la curación de heridas al estimular la reepitelización, la angiogénesis y la producción de la matriz extracelular. Objetivo: La presente revisión sistemática tuvo como objetivo comparar los resultados en la literatura publicada sobre si L-PRF es un adyuvante efectivo y predecible al desbridamiento quirúrgico del hueso necrótico para mejorar la eficacia curativa en pacientes con ONMRM. Materiales y Métodos: Las bases de datos de PubMed, Scopus, Cochrane, ScienceDirect, LILACS y Web of Science se registraron utilizando los términos DeCS/MeSH predeterminados y los criterios de elegibilidad, y la búsqueda arrojó un total de cinco artículos. Dos estudios fueron retrospectivos, y tres estudios fueron series de casos. Resultado: Diecisiete participantes recibieron una combinación de desbridamiento quirúrgico, membrana L-PRF y antibióticos. Se observó curación completa de heridas en el 70% de los participantes, y la mayoría de ellos se curaron sin ninguna complicación. Conclusión: L-PRF como adyuvante para el desbridamiento quirúrgico del hueso necrótico parece tener una asociación positiva con el resultado de curación en pacientes con ONMRM.

Capacidad pronóstica del dímero D en la predicción de mortalidad en pacientes con el diagnóstico de COVID-19 / Pronostic capacity of D-dimer in predicting mortality in patients diagnosed with COVID-19

RESUMEN Introducción: La infección por SARS-CoV-2 puede aumentar el riesgo de trombosis. Estudios asocian niveles de dímero D con mortalidad por COVID-19. Objetivo: Determinar la capacidad pronostica del dimero D en la predicción de mortalidad por COVID-19 en pacientes hospitalizados en la Unidad de Cuidados Intensivos. Métodos: Se realizó un estudio de cohorte retrospectiva en el Centro Médico Naval durante enero-julio de 2021. Se incluyeron 324 pacientes adultos con COVID-19 confirmada por RT-PCR. Se midieron niveles de dímero D al ingreso utilizando turbidimetría de coagulación (Sysmex CS-5100). Se analizaron variables sociodemográficas, comorbilidades y datos clínicos. El análisis estadístico se realizó con SPSS versión 26, empleando pruebas Chi cuadrado, exacta de Fisher, U de Mann Whitney, COR y regresión de Cox. Resultados: Se determinó un punto de corte de 1,40 µg/mL para los valores de dimero D con una sensibilidad de 80,9%, una especificidad de 86,4% y área bajo la curva (AUC) de 0,916 (IC 95%: 0,884 - 0,947; p =0,016) para predecir mortalidad por COVID-19. Asimismo, se encontró que pacientes con valores de dimero D mayores o iguales a 1,40 µg/mL tenian un riesgo incrementado de fallecimiento en pacientes con COVID-19 (HRa = 6,545; IC 95%: 3,867 - 11,077; p<0,001), independientemente de las variables edad, diabetes mellitus, hipertensión arterial, cardiopatía isquémica, enfermedad cerebrovascular, fibrilación auricular, enfermedad pulmonar obstructiva crónica, asma, cáncer y trombocitopenia. Conclusión: El presente estudio mostró que los niveles de dimero D al ingreso representan un biomarcador fiable en la evaluación del pronostico de pacientes con COVID-19.

ABSTRACT Introduction: SARS-CoV-2 infection can increase the risk of thrombosis. Studies associate D-dimer levels with COVID-19 mortality. Objective: To determine the prognostic capacity of D-dimer in predicting COVID-19 mortality in patients hospitalized in the Intensive Care Unit. Methods: A retrospective cohort study was conducted at the Naval Medical Center from January to July 2021. A total of 324 adult patients with RT-PCR confirmed COVID-19 were included. D-dimer levels were measured upon admission using coagulation turbidimetry (Sysmex CS-5100). Sociodemographic variables, comorbidities, and clinical data were analyzed. Statistical analysis was performed using SPSS version 26, employing Chi-square tests, Fisher's exact test, Mann-Whitney U test, ROC, and Cox regression. Results: A cut-off point of 1.40 µg/mL for D-dimer values was determined, with a sensitivity of 80.9%, specificity of 86.4%, and an area under the curve (AUC) of 0.916 (95% CI: 0.884 - 0.947; p=0.016) for predicting COVID-19 mortality. Additionally, patients with D-dimer values greater than or equal to 1.40 µg/mL had an increased risk of death (adjusted HR = 6.545; 95% CI: 3.867 - 11.077; p<0.001), independent of age, diabetes mellitus, arterial hypertension, ischemic heart disease, cerebrovascular disease, atrial fibrillation, chronic obstructive pulmonary disease, asthma, cancer, and thrombocytopenia. Conclusion: This study showed that admission D-dimer levels represent a reliable biomarker in evaluating the prognosis of COVID-19 patients. Keywords: COVID-19; SARS-CoV-2; Mortality; Fibrin-Fibrinogen Degradation Products (Source: MeSH NLM).

Fibrina rica en plaquetas y leucocitos en abordajes endonasales endoscópicos

Introducción: La medicina regenerativa y terapia celular representa una alternativa segura y eficaz en la regeneración hística. La fibrina rica en plaquetas y leucocitos favorece la cicatrización de la base craneal, con una disminución significativa en las complicaciones, en especial la fístula de líquido cefalorraquídeo. Objetivo: Describir los resultados del empleo de la fibrina rica en plaquetas y leucocitos como elemento accesorio en la reparación de la base craneal. Métodos: Se realizó un estudio descriptivo, transversal en 250 pacientes en el Hospital Hermanos Ameijeiras, operados por procedimientos endonasales endoscópicos con diversos tumores de la base craneal, en los cuales se empleó la fibrina rica en plaquetas y leucocitos durante la fase de reconstrucción. Se realizó una evaluación de la barra de reparación y las complicaciones presentes. Para el análisis de los datos se utilizaron frecuencias absolutas y relativas como medidas resumen. Resultados: El 97,2 % de las barreras de reparación fue catalogada de óptima. Se reporta con el uso de la fibrina rica en plaquetas y leucocitos 2,0 % de fístula de líquido cefalorraquídeo, 0,8 % de infección del sistema nervioso central, 4,0 % de costras nasales posoperatorias. Conclusiones: El presente estudio evidencia el efecto positivo del empleo de la fibrina rica en plaquetas y leucocitos en la reparación del base craneal con gran impacto en el índice de fístula de líquido cefalorraquídeo y la calidad de vida nasosinusal.

Introduction: Regenerative medicine and cell therapy represents a safe and effective alternative in tissue regeneration. Fibrin rich in platelets and leukocytes promotes healing of the cranial base, with a significant decrease in complications, especially cerebrospinal fluid leak. Objective: Describe the results of using fibrin rich in platelets and leukocytes as an accessory element in the repair of the cranial base. Methods: A descriptive, cross-sectional study was carried out in 250 patients at the "Hermanos Ameijeiras" Hospital operated by endoscopic endonasal procedures with various tumors of the cranial base, in which fibrin rich in platelets and leukocytes was used during the reconstruction phase. An evaluation of the repair bar and the complications present was performed. For data analysis, absolute and relative frequencies were used as summary measures. Results: 97.2% of the repair barriers were classified as optimal. With the use of fibrin rich in platelets and leukocytes, 2.0% of cerebrospinal fluid leak, 0.8% of central nervous system infection, 4.0% of postoperative nasal scabs are reported. Conclusions: The present study evidences the positive effect of the use of leukocyte-platelet-rich fibrin in the repair of the skull cranial base, with great impact on the rate of cerebrospinal fluid leak and sinonasal quality of life.

Fibrina rica en plaquetas como parte de la regeneración tisular en procedimientos quirúrgicos odontológicos / Platelet-rich fibrin as part of tissue regeneration in dental surgical procedures

Uno de los mejores biomateriales usados en odontología es la fibrina rica en plaquetas (PRF), es un concentrado plaquetario de segunda generación que se obtiene a partir de la centrifugación de sangre autóloga y no necesita aditivos. El presente documento busca determinar la eficacia del uso del PRF como parte de la regeneración de tejidos en procedimientos quirúrgicos odontológicos, tomando como base la literatura publicada en PubMed, Elsevier y Semantic Scholar entre 2018 y 2023, la búsqueda de artículos científicos fue ejecutada empleando las palabras clave platalet rich fibrin, regeneration, dentistry, blood buffy coat. La evidencia científica muestra que el PRF puede ser usado en su forma de membrana, gel, tapón, solo o combinado con otro biomaterial para conseguir propiedades biológicas exclusivas que promueven la regeneración y cicatrización mientras reduce los efectos adversos de los procedimientos quirúrgicos. Un ensayo clínico refirió la curación de alvéolos post exodoncia atraumática, y comprobó que la cicatrización con PRF muestra un índice de curación más alto en comparación con el grupo control. El sustento biológico de su eficacia radica en su capacidad para proliferar células que promueven la angiogénesis, osteogénesis y diferenciación celular, es decir, el reparo de tejidos lesionados. Todo esto nos permite llegar a la conclusión de que el PRF representa una alternativa viable y eficaz en procesos de regeneración de tejidos en procedimientos quirúrgicos odontológicos.

One of the best biomaterials used in dentistry is platelet-rich fibrin (PRF). It is a second-generation platelet concentrate obtained by centrifugation of autologous blood and requires no additives. The aim of this article is to determine the effectiveness of using PRF for tissue regeneration in dental surgery. The methodology used consists of a descriptive search of scientific articles that employ or study PRF as a biomaterial for tissue healing in the dental field and are available on PubMed, Elsevier, and Semantic Scholar. The literature shows that PRF can be used as a membrane, gel, cap form, alone or combined with other biomaterials to achieve unique biological properties that promote regeneration and healing while reducing the adverse effects of surgical procedures. For example, a clinical trial demonstrated healing of post-traumatic alveolar exodontia, proving that healing with PRF had a higher healing rate than in the control group. The biological basis of PRF's efficacy lies in its ability to proliferate cells that promote angiogenesis, osteogenesis, and cellular differentiation, and thus repair damaged tissue. All this leads us to conclude that PRF represents a viable and effective alternative in tissue regeneration processes in dental surgery procedures.

The applications of the plasma matrix in the treatments of dental pulp and periapical diseases / 口腔疾病防治

@#The plasma matrix is a kind of autologous blood conduct. It has been widely used in maxillofacial tissue regeneration, skin cosmetology and some other fields. Recently, to preserve the dental pulp as well as the teeth, pulp regeneration therapy and apical surgery have become increasingly important as well as the applications of bioactive materials. As a kind of autologous bioactive material, the plasma matrix has some natural advantages as it is easy to obtain and malleable. The plasma matrix can be used in the following cases: ①pulp revascularization of young permanent teeth with open apical foramina that cannot stimulate apical bleeding; ② apical barrier surgery with bone defects and large area perforation repair with bone defects or root sidewall repair surgery; ③ apical surgeries of teeth with large area of apical lesions, with or without periodontal diseases. The plasma matrix is a product derived from our blood, and there are no obvious contraindications for its use. Several systematic reviews have shown that the plasma matrix can effectively promote the regenerative repair of dental pulp in patients with periapical diseases. However, the applications of plasma matrix are different because its characteristics are affected by different preparation methods. In addition, there is still a lack of long-term clinical researches on the plasma matrix, and the histological evidences are difficult to obtain, so a large number of in vitro and in vivo experimental studies are still needed. This article will describe the applications of different kinds of plasma matrix for dental pulp regeneration and bone tissue regeneration in apical surgeries to provide references for clinicians in indication selection and prognosis evaluation.

Observation on A-PRF promoting regeneration of osteochondral defects in rabbit knee joints / 上海交通大学学报（医学版）

Objective·To explore the role of advanced platelet-rich fibrin(A-PRF)in osteochondral regeneration.Methods·Bone-marrow mesenchymal stem cells(BMSCs)and knee joint chondrocytes were obtained from New Zealand rabbits.A-PRF was obtained by low-speed centrifugation of the heart blood of rabbits.The histological structure of A-PRF was observed by an optical microscope.The release of growth factors in A-PRF was detected by ELISA,including platelet-derived growth factor,transforming growth factor-β,insulin-like growth factor,vascular endothelial growth factor,epidermal growth factor and fibroblast growth factor.A-PRF's cytotoxicity and capability for promoting the proliferation of rabbit BMSCs were detected by live/dead double staining and MTT methods.The effect of A-PRF on the gene expression of type Ⅱ collagen,aggrecan,alkaline phosphatase(ALP)and osteocalcin(OCN)in rabbit BMSCs was detected by real-time fluorescence quantitative polymerase chain reaction(qRT-PCR).Transwell chambers were used to determine the effect of A-PRF on the migration ability of rabbit BMSCs and the chondrocytes.Rabbit knee osteochondral defect models were established,and 18 rabbits were randomly divided into 3 groups.The A-PRF group(n=6)was implanted with A-PRF in the defect,the A-PRF+BMSCs group(n=6)was implanted with rabbit BMSCs on A-PRF,and the control group(n=6)did not undergo implantation.The rabbits were sacrificed 12 weeks after surgery and the knee joint specimens were stained with hematoxylin-eosin(H-E),toluidine blue and safranin O/fast green.Based on the surface morphology and histology of the knee joints,the International Cartilage Repair Society(ICRS)scoring system was used for macroscopic and histological scoring.Results·A-PRF had a loose network structure and can slowly release growth factors.No cytotoxicity to rabbit BMSCs was observed after adding A-PRF,and the the capability for promoting the proliferation of rabbit BMSCs was significantly increased at 24,48 and 72 h after adding A-PRF(all P<0.05).Chondrogenesis-related gene Ⅱ collagen and aggrecan,as well as osteogenesis-related genes ALP and OCN were significantly up-regulated(all P<0.05).After adding A-PRF,the migration abilities of rabbit BMSCs and chondrocytes were significantly enhanced(both P<0.05),and the migration ability of rabbit BMSCs was significantly higher than that of chondrocytes(P=0.025).The joint surface morphology in the rabbit knee joint defect models was observed.It can be seen that the defects in the A-PRF group and the A-PRF+BMSCs group were basically restored,while the the defects in the control group were only covered by soft tissue.In the ICRS macroscopic score,there was no statistical difference between the A-PRF group and the A-PRF+BMSCs group,but the scores of the two groups were all significantly higher than those of the control group(all P<0.05).According to the histological results,both the A-PRF group and the A-PRF+BMSCs group formed osteochondral repair,but the cartilage in the A-PRF group was more mature,while the control group formed fibrous repair.In the ICRS histological score,there was no statistical difference between the A-PRF group and the A-PRF+BMSCs group,but the scores of both the groups were significantly higher than those of the control group(both P<0.05).Conclusion·Autologous A-PRF has good biocompatibility and the capability for promoting the proliferation of BMSCs.It can promote the repair of cartilage and subchondral bone both in vitro and in vivo.

Establishment of Reference Ranges for Plasma Soluble Fibrin Monomer Complex Level at Different Gestational Periods of Women in Yibin Area of Sichuan / 现代检验医学杂志

Objective To explore the changes in plasma soluble fibrin monomer complex(SFMC)levels at different gestation periods of healthy women in Yibin area of Sichuan and establish reference ranges for SFMC at different gestational stages.Methods A total of 377 healthy pregnant women and 120 health examinees who received antenatal examination in Yibin Maternal and Child Health Care Hospital from May 2021 to January 2022 were enrolled in this study and grouped into the early pregnant group,the second trimester group,the late pregnant group and control group.The plasma SFMC and D-dimer(D-D)of all groups were detected using the latex immunoturbidimetry and reference ranges of SFMC were established for each group.Meanwhile,the correlation between SFMC and D-D was analyzed at the same time.Results The reference ranges of SFMC in the control group,the early pregnant group,the second trimester group and the late pregnant group were＜7.3μg/ml,＜18.4μg/ml,＜20.4μg/ml and＜58.5μg/ml,respectively.The difference between groups was statistically significant(F=55.989,P＜0.001),and the plasma SFMC levels showed an upward trend as pregnancy progressed.The SFMC level in plasma was positively correlated with the D-D level(r2=0.468 8).Conclusion The plasma SFMC levels in pregnant women significantly increased with the progression of pregnancy,and the reference range of the normal population cannot meet the risk assessment of venous thrombosis in pregnant women.This study preliminary established reference ranges for plasma SFMC in women at different gestation periods,which has important clinical significance for monitoring and preventing venous thromboembolism in pregnant population.

Application of autologous dentin particles combined with PRF in tooth extraction site preservation:A case report / 实用口腔医学杂志

Undicalcified autologous dentin particles(UADP)combined platelet rich fibrin(PRF)were used in a case after extraction of the left mandibular second molar for tooth extraction site preservation.CBCT images at 3,9 and 24 months after operation showed that the bone mass maintenance effect was obvious.Histological sections showed a large number of new bone formation around dentin particles.

Leukocyte-and platelet-rich fibrin with autologous hamstring tendon for traumatic patella dislocation / 中国组织工程研究

BACKGROUND:Traumatic patellar dislocation with medial patellofemoral ligament tearing at femoral attachment or body is usually performed by medial patellofemoral ligament reconstruction surgery.To promote tendon bone healing after medial patellofemoral ligament reconstruction,the researchers used a variety of biological treatment technologies including growth factors,stem cells and platelet-rich plasma. OBJECTIVE:To investigate the clinical effect of medial patellofemoral ligament reconstruction by leukocyte-and platelet-rich fibrin with autologous hamstring tendon for traumatic patellar dislocation. METHODS:Thirty-seven patients with traumatic patellar dislocation in First Hospital of Qinhuangdao from February 2019 to February 2021 were randomly divided into a trial group(n=18)and a control group(n=19).The trial group received medial patellofemoral ligament reconstruction by leukocyte-and platelet-rich fibrin with an autologous hamstring tendon.The control group received medial patellofemoral ligament reconstruction by a simple autologous hamstring tendon.Patients in the two groups were followed up for 12 months.Knee pain and functional status were evaluated by visual analog scale score,Lysholm score,Kujala patellofemoral joint score and knee range of motion.The patellar tilt angle,patellar congruence angle and patellar lateral shift rate of the patellofemoral joint were measured by MRI and CT films to evaluate the stability and improvement of the patellofemoral joint. RESULTS AND CONCLUSION:(1)The visual analog scale scores of the two groups at 6 and 12 months after operation were lower than those before operation(P<0.05).The Lysholm score and Kujala patellofemoral joint score at 6 and 12 months after operation were higher than those before operation(P<0.05).The Lysholm score and Kujala patellofemoral joint score in the trial group were higher than those in the control group 6 months after operation(P<0.05).There was no significant difference between the two groups in the visual analog scale score,Lysholm score and Kujala patellofemoral joint score 12 months after operation(P>0.05).(2)The patellar tilt angle,patellar congruence angle,patellar lateral shift rate and range of motion of the patellofemoral joint were significantly improved in both groups 12 months after operation(P<0.05).The patellar tilt angle was smaller in the trial group than that in the control group 12 months after operation(P<0.05).Patellar congruence angle,patellar lateral shift rate,range of motion and MRI score were not statistically significant between the two groups 12 months after operation(P>0.05).(3)These results confirm that medial patellofemoral ligament reconstruction by leukocyte-and platelet-rich fibrin with autologous hamstring tendon can treat traumatic dislocation effectively,improve the function of the knee joint,and restore the movement track of the patella.

Platelet-rich fibrin regulates apoptosis to promote cartilage repair in rats with knee osteoarthritis / 中国组织工程研究

BACKGROUND:Platelet-rich fibrin(PRF)is a second generation platelet concentrate with the advantages of simple operation,no anticoagulant,and high bioactivity,which has been applied in the fields of trauma repair,bone defect repair,and tendon soft tissue repair,and has been proved to have a certain tissue repair-promoting effect. OBJECTIVE:To study the repair effect of PRF on articular cartilage tissue in rats with knee osteoarthritis. METHODS:Thirty-six Sprague-Dawley rats were randomly divided into normal group,model group,and PRF group,with 12 rats in each group.Rats in the normal group did not undergo any treatment.In the model group,animal models of knee osteoarthritis were prepared and rat models were then given physiological saline into the joint cavity once a week after surgery.Rat models of knee osteoarthritis were also prepared in the PRF group,and autologous PRF was injected into the joint cavity once a week after surgery.After 5 weeks of continuous treatment,tissue samples were taken.Hematoxylin-eosin staining was used to observe the morphology of cartilage tissue.Tunel staining was used to detect chondrocyte apoptosis,ELISA was used to detect inflammatory factor levels.Western blot and RT-PCR were used to detect Bcl-2,Bax,and Caspase-3 expression in protein and mRNA levels,respectively. RESULTS AND CONCLUSION:The model group had severe cartilage tissue damage,while the PRF group had significantly improved cartilage tissue morphology compared with the model group.The model group had more apoptotic chondrocytes.Compared with the model group,the mean absorbance of Tunel positive staining in the PRF group significantly decreased(P<0.01).The levels of interleukin-1β,interleukin-6 and tumor necrosis factor-α were significantly increased in the model group and PRF group compared with the normal group(P<0.01)and were significantly decreased in the PRF group compared with the model group(P<0.01).The relative expressions of Bax and Caspase-3 at protein and mRNA levels were significantly increased in the model group and PRF group compared with the normal group(P<0.01),while the relative expressions of Bcl-2 at protein and mRNA were significantly decreased(P<0.01).Compared with the model group,the relative expression of Bax and Caspase-3 at protein and mRNA levels were significantly decreased in the PRF group(P<0.01),while the relative expressions of Bcl-2 at protein and mRNA levels were significantly increased(P<0.01).To conclude,PRF can inhibit chondrocyte apoptosis by inhibiting the expression of pro-inflammatory factors,thereby promoting cartilage tissue repair in knee osteoarthritis rats.

A patient with brachial artery pseudoaneurysm treated with ultrasound-guided and balloon- assisted injection of human fibrin sealant / 中华肾脏病杂志

The paper reports the treatment of a maintenance hemodialysis patient with pseudoaneurysm (PSA) caused by accidental injury of brachial artery during the puncture of internal fistula. The main treatment methods of PSA include surgical incision and repair, local pressure therapy, ultrasound-guided intraluminal thrombin injection, implantation of covered stent, coil embolization and so on, but they all have some defects. The patient was admitted to hospital due to poor fistula function, and the formation of brachial artery PSA was confirmed by color ultrasound. PSA was successfully treated with ultrasound-guided and balloon-assisted injection of human fibrin sealant. The fistula had good function 3 months after the operation.

Demineralized freeze-dried bone allograft with/without i-Platelet-rich fibrin in 3 wall intrabony defects

Demineralized freeze-dried bone allograft (DFDBA) contains bone morphogenetic proteins (BMPs), hence is osteoinductive. Autologous platelet concentrates exhibit a higher quantity of growth factors. Both these biomaterials aid in bone regeneration when placed in three-wall intrabony defects. However, their efficacy when used alone and in conjugation is not clear. Aim: To assess clinical and radiographic efficacy of injectable platelet-rich fibrin (i-PRF) with microsurgical access flap in the treatment of three-wall intrabony defects in chronic periodontitis patients. Methods: Thirty sites with three-wall intrabony defects were randomly assigned to control and test group by computer generated method. The test group obtained i-PRF mixed with DFDBA while the control group received only DFDBA. Clinical parameters such as site-specific Plaque index (PI), Radiographic intrabony defect depth (IBDD), modified- Sulcular bleeding index (mSBI), Clinical attachment level (CAL), and Probing pocket depth (PPD) were measured at baseline, three and six months. Results: Intragroup comparison within the control group and test group exhibited statistically highly significant variation of mean PI, mSBI, PPD, CAL, and IBDD score from baseline to 3 months and from 3-6 months (p<0.001). However, intergroup comparison demonstrated no statistically significant variation of mean IBDD at all 3 intervals (p>0.05). Conclusion: i-PRF combined with DFDBA enhanced the radiographic and clinical parameters as opposed to DFDBA alone. The role of i-PRF is promising in its capacity for easy obtainability and increased potential to aid in regeneration

Human venous blood derivatives as fetal bovine serum substitute for fibroblast culture cells in a fibrin construct

Aim: Venous blood derivatives (VBDs) have been suggested as substitutes for Fetal Bovine Serum (FBS) to improve the clinical transition of cell-based therapies. The literature is not clear about which is the best VBDs substitute. The present study aimed to evaluate the influence of VBDs on cell viability and describe a new method to seed these cells in a 3D Platelet-Rich Fibrin (PRF). Methods: Blood was processed to obtain Platelet-Poor Plasma from PRF (P-PRF), Human Serum (HS), Platelet-Poor Plasma from PRP (P-PRP), activated-PRP (a-PRP), and Platelet lysate (PL). Cells were supplemented with each VBD at 10% and FBS at 10% was the control. Cell viability (fibroblast 3T3/NIH) test was evaluated with MTT assay in two ways: i) cell-seeded and expanded with VBD; ii) cell-seed with FBS and expanded with VBD. To seed the Fibrin construct, cells were suspended in PBS and dropped into the blood sample before performing Choukroun's protocol for PRF. Constructs were cultured for 7 days in VBD supplements and FBS. Histological and Immunohistochemical analysis with vimentin was performed. Cell viability was analyzed by one-way ANOVA. Results: VBD's production time was very heterogeneous. Cells expanded in HS and a-PRP has grown faster. VBD-supplemented culture media provided cell culture highly sensible to trypsin/EDTA 0.25%. Cells seeded and expanded with VBD presented viability comparable to FBS in HS, a-PRP, and P-PRP (p>0.05) and lower in P-PRF and PL groups (p<0.05). The viability of cell seed with FBS and expanded with VBD was similar between P-PRF, a-PRP, PL, and FBS (p>0.05) and lower in HS and P-PRP (p<0.005). PRF-seeded cells showed a positive expression of vimentin and were able to maintain all cells supplemented with VBD. Conclusion: VBD supplements were able to maintain fibroblast cells in 2D and 3D cultures. The new method of the fibrin-cell construct was efficient to insert the cells into the fibrin network

Fatal asphyxia due to large laryngeal granuloma

ABSTRACT Laryngeal granuloma, vocal process granuloma, or post-intubation granuloma are benign, inflammatory lesions of the arytenoid cartilage vocal process. The etiology of laryngeal granulomas is multifactorial, such as chronic irritation due to endotracheal intubation, vocal cord injury or trauma, and gastroesophageal reflux disease. They can arise postoperatively after mucosal injury due to orotracheal intubation. Clinical manifestations include voice change and dyspnea, which may start one to four months after extubation and may rarely lead to asphyxia. We presented a case of death due to glottic granuloma occurring after a surgical procedure to remove a laryngeal polyp attributed to previous laryngeal injuries by multiple intubations.

Exodoncia de premolar inferior supernumerario con posterior colocación de Fibrina Rica en Plaquetas y Leucocitos (L-PRF)

Los dientes supernumerarios son una anomalía odontogénica, consiste en aumento del número dentario con respecto a la cantidad normal. La Fibrina rica en Plaquetas y Leucocitos (L-PRF) es una matriz rica en plaquetas y glóbulos blancos, que promueve la curación y regeneración de los tejidos. La exodoncia de un tercer premolar inferior supernumerario con posterior colocación de membrana de L-PRF. Paciente de sexo masculino de 27 años de edad con un probable premolar supernumerario por lingual. Se programó la cirugía incluyendo L-PRF. Se realizó extracción de sangre para preparar la membrana de L-PRF, anestesia, incisión lineal, despegamiento mucoperióstico, osteotomía, exodoncia, tratamiento del lecho quirúrgico colocando la membrana de L-PRF y sutura interdental. Se prescribió medicación antibiótica, antiinflamatoria y analgésica. La técnica con L-PRF es sencilla y económica. Los resultados postoperatorios fueron favorables, observándose una buena cicatrización, ausencia de dolor, edema o infección.

Supernumerary teeth are an odontogenic anomaly, involving an increase in the number of teeth compared to the normal amount. Platelet-Rich Fibrin (L-PRF) is a matrix rich in platelets and white blood cells that promotes tissue healing and regeneration. The Extraction of a supernumerary lower third premolar followed by placement of L-PRF membrane. A 27-year-old male patient with a probable lingual supernumerary premolar. Surgery was scheduled, including L-PRF. Blood was extracted to prepare the L-PRF membrane, followed by anesthesia, linear incision, mucoperiosteal detachment, osteotomy, extraction, treatment of the surgical site with L-PRF membrane placement, and interdental suturing. Antibiotic, anti-inflammatory, and analgesic medication was prescribed. The L-PRF technique is simple and cost-effective. Postoperative results were favorable, with good healing, absence of pain, swelling, or infection was observed.

Platelet Rich Fibrin Matrix (PRFM) and Peripheral Blood Mesenchymal Stem Cells (PBMSCs) in the management of intraosseous defects - A randomized clinical trial

Abstract A combination of peripheral blood mesenchymal stem cells (PBMSCs) and platelet rich fibrin matrix (PRFM) could be a probable periodontal regenerative material with the synergy of the added benefits of each material. Objective This randomized controlled clinical trial aimed to evaluate the regenerative capacity of supercell (PRFM and PBMSCs) compared with that of PRFM alone in human periodontal mandibular intraosseous defects (IOD). Methodology This study included 17 patients of both sexes (12 men, 5 women) aged 30-55 years (mean age = 37.7±4.4 years) who fulfilled the inclusion criteria (radiographic and clinical evaluation for bilateral IOD with probing pocket depth (PPD ≥ 6 mm). A split-mouth design was used in each patient. A total of 34 sites in the mandibular arch randomly received PRFM alone + open flap debridement (OFD) [Control sites] or supercell (PRFM+PBMSCs) + OFD [Test sites]. The clinical parameters plaque index (PI), gingival index (GI), PPD, clinical attachment level (CAL), and in the radiographic parameters; defect depth (DD) and defect fill percentage (DFP) were recorded at baseline, 3 and 6 months postoperatively. Early wound healing index (EHI) was used at 1 week to assess wound healing ability. Results At 6 months, radiographic parameters revealed significant reduction in DD (P<0.001) and significant DFP values in the test group compared with the control group. The supercell showed significant improvement in PPD and CAL at the end of 6 months (P<0.001). EHI scores at 1 week showed no statistically significant difference between the test and control groups. Conclusion Supercell can be considered a regenerative material in the treatment of periodontal IODs.

Estereología en placentas procedentes de gestaciones gemelares / Stereology in placentas from twin pregnancies

Introducción: La disfunción placentaria origina complicaciones fetales; de manera más frecuente, la restricción del crecimiento intrauterino y la preclampsia. Objetivo: Identificar el patrón estereológico en placentas gemelares, y su relación con la corionicidad y el peso del recién nacido. Métodos: Se realizó un estudio descriptivo en una muestra de 16 gestantes gemelares, 25 placentas y 32 recién nacidos. Se estudiaron las variables peso del recién nacido, número de vellosidades, superficie vellositaria total, área vellositaria, área de nodos, densidad óptica de fibrina en la superficie vellositaria y densidad óptica de fibrina alrededor del vaso. Resultados: Existió relación directa entre el número de vellosidades y la superficie vellositaria total. En las placentas monocoriónicas hubo predominio de recién nacidos bajo peso. Se percibe una diferencia en los resultados de área, según el tipo placentario y la región topográfica. En las placentas monocoriales se observó mayor área, tanto de la vellosidad placentaria como en los nodos sincitiales, siendo el área de la vellosidad mayor en la periferia placentaria, y el área de nodos sincitiales en la región 4 cm del cordón umbilical. Conclusiones: La estereología microscópica a nivel pericordón, a 4 cm del cordón y en la periferia del disco placentario, arrojó diferencias significativas para el área de la vellosidad y la densidad óptica de fibrina en la superficie de la vellosidad. Los valores promedio para el área de nodos sincitiales y la densidad óptica de fibrina alrededor del vaso no mostraron diferencias estadísticamente significativas. Es la corionicidad un predictor del bajo peso al nacer(AU)

Introduction: Placental dysfunction causes fetal complications; more frequently, intrauterine growth restriction and preeclampsia. Objective: To identify the stereological pattern in twin placentas, and its relationship with chorionicity and weight of the newborn. Methods: A descriptive study was carried out in a sample of 16 women with twin pregnancy, 25 placentas and 32 newborns. The variables weight of the newborn, number of villi, total villous surface, villous area, node area, optical density of fibrin on the villous surface and optical density of fibrin around the vessel were studied. Results: There was a direct relationship between the number of villi and the total villous surface. In monochorionic placentas there was a predominance of low birth weight newborns. A difference is observed in the area results according to the placental type and the topographic region. In monochorionic placentas, a greater area was observed, both in the placental villus and in the syncytial nodes, with the villus area being greater in the placental periphery and the area of syncytial nodes in the region 4 cm from the umbilical cord. Conclusions: Microscopic stereology at the perichordal level, 4 cm from the cord and at the periphery of the placental disc showed significant differences for the villus area and fibrin optical density on the villus surface. The average values for the area of syncytial nodes and the optical density of fibrin around the vessel did not show statistically significant differences. Chorionicity is a predictor of low birth weight(AU)

Treatment of osteoradionecrosis of the jaw with injectable platelet-rich fibrin (i-PRF): case series / Tratamento de osteorradionecrose dos maxilares com fibrina rica em plaquetas injetável (i-PRF): série de casos

Objective: This study evaluated the use of autogenous blood concentrate (injectable platelet-rich fibrin) [i-PRF] for promoting soft tissue healing in osteoradionecrosis (ORN) lesions in patients who underwent head and neck radiotherapy. Material and Methods: This study included five ORN lesions in four patients who were treated with i-PRF (applied weekly for 4 weeks to the lesions). Soft tissue features were evaluated through clinical analysis at baseline and at 7, 15, 30, 60, and 90 days after the first session of i-PRF. Extension of the bone lesions was evaluated radiographically. Patient-centered related outcomes were evaluated using quality-of-life questionnaires at baseline and 90 days after the first treatment session. Quality of life data were analyzed using descriptive and frequency statistics and the Wilcoxon test. Results: Of the 5 treated lesions, 1 was completely closed and 3 remained open. The open lesions showed increased necrotic tissue exposure. No changes were observed in the radiographic appearance of the lesions. There was also no impact on the patient's quality of life. Conclusion: The results suggest that the majority of ORN lesions remained stable after the application of i-PRF, with a slight improvement in the quality of the mucosa around the lesions. Furthermore, it was observed that i-PRF did not compromise the quality of life of patients during treatment.(AU)

Objetivo: Este estudo avaliou o uso de concentrado de sangue autógeno (fibrina rica em plaquetas injetável) [i-PRF] para promover a cicatrização de tecidos moles em lesões de osteorradionecrose (ORN) em pacientes submetidos a radioterapia de cabeça e pescoço. Material e Métodos: Este estudo incluiu cinco lesões de ORN em quatro pacientes tratados com i-PRF (aplicado semanalmente por 4 semanas nas lesões). As características do tecido mole foram avaliadas por meio de análises clínicas no início e aos 7, 15, 30, 60 e 90 dias após a primeira sessão de i-PRF. A extensão das lesões ósseas foi avaliada radiograficamente. Os resultados centrados no paciente foram avaliados usando questionários de qualidade de vida no início e 90 dias após a primeira sessão de tratamento. Os dados de qualidade de vida foram analisados usando estatísticas descritivas e de frequência, além do teste de Wilcoxon. Resultados: Das 5 lesões tratadas, 1 foi completamente fechada e 3 permaneceram abertas. As lesões abertas mostraram aumento na exposição de tecido necrótico. Não foram observadas mudanças na aparência radiográfica das lesões. Também não houve impacto na qualidade de vida do paciente. Conclusão: Os resultados sugerem que a maioria das lesões de ORN permaneceu estável após a aplicação de i-PRF, com uma discreta melhora na qualidade da mucosa ao redor das lesões. Além disso, observou-se que a i-PRF não comprometeu a qualidade de vida dos pacientes durante o tratamento.(AU)

Ultrasonographic analysis of palatal donor site healing accelerated with platelet-rich fibrin following subepithelial connective tissue harvesting

Abstract Objective Platelet-rich fibrin (PRF) contains a variety of growth factors and bioactive molecules that play crucial roles in wound healing and angiogenesis. We aimed to evaluate the effects of PRF on tissue thickness and vascularization of the palatal donor site by ultrasound (USG) following subepithelial connective tissue harvesting. Methodology A subepithelial connective tissue graft was harvested from the palatal region with a single incision for root coverage in 20 systemically healthy patients. In the test group (n = 10), the PRF membrane was placed at the donor site, whereas no material was applied in the control group (n=10). Palatal tissue thickness (PTT) and pulsatility index (PI) were evaluated by USG at baseline and on the 3rd, 7th, 14th, 30th, and 90th days after surgery. The early healing index (EHI) was used to evaluate donor site healing for 30 days. Results PTT was significantly higher in the PRF group on the 3rd and 14th days after surgery when compared to the controls. In the PRF-treated group, PI levels were significantly higher than in the controls, especially on the 14th day. PTT increased significantly 90 days after surgery compared to the test group baseline, but controls showed a significant decrease. The PRF group showed statistically significant improvements in EHI scores compared to controls on days 3, 7, and 14. This study found a negative correlation between PI values and EHI scores on postoperative days three and seven in the test group. Conclusion USG is a non-invasive, objective method to radiographically evaluate the regenerative effects of PRF on palatal wound healing after soft tissue harvesting. To overcome graft inadequacy in reharvesting procedures, PRF application may enhance clinical success and reduce possible complications by increasing tissue thickness and revascularization in the donor area.

Novel approach to soft tissue regeneration: in vitro study of compound hyaluronic acid and horizontal platelet-rich fibrin combination

Abstract Objective This study aims to develop a compound biomaterial to achieve effective soft tissue regeneration. Methodology Compound hyaluronic acid (CHA) and liquid horizontal-platelet-rich fibrin (H-PRF) were mixed at a ratio of 1:1 to form a CHA-PRF gel. Human gingival fibroblasts (HGFs) were used in this study. The effect of CHA, H-PRF, and the CHA-PRF gel on cell viability was evaluated by CCK-8 assays. Then, the effect of CHA, H-PRF, and the CHA-PRF gel on collagen formation and deposition was evaluated by qRT‒PCR and immunofluorescence analysis. Finally, qRT‒PCR, immunofluorescence analysis, Transwell assays, and scratch wound-healing assays were performed to determine how CHA, H-PRF, and the CHA-PRF gel affect the migration of HGFs. Results The combination of CHA and H-PRF shortened the coagulation time of liquid H-PRF. Compared to the pure CHA and H-PRF group, the CHA-PRF group exhibited the highest cell proliferation at all time points, as shown by the CCK-8 assay. Col1a and FAK were expressed at the highest levels in the CHA-PRF group, as shown by qRT‒PCR. CHA and PRF could stimulate collagen formation and HGF migration, as observed by fluorescence microscopy analysis of COL1 and F-actin and Transwell and scratch healing assays. Conclusion The CHA-PRF group exhibited greater potential to promote soft tissue regeneration by inducing cell proliferation, collagen synthesis, and migration in HGFs than the pure CHA or H-PRF group. CHA-PRF can serve as a great candidate for use alone or in combination with autografts in periodontal or peri-implant soft tissue regeneration.