Efficacy of autologous platelet-rich plasma in treating patients with burn wounds: A protocol for systematic review and meta-analysis.

BACKGROUND: Burns are still regarded among severe health problems related to high morbidity and mortality rates globally. In essence, health problems associated with burns can cause significant economic burden to society. Regardless of treatment available options, no best treatment was considered adequate for treating severe burns. In particular, only a few studies have focused on the effect of autologous platelet-rich plasma to treat burn wounds. The present study aim to systematically review existing literature to examine the effectiveness and safety of autologous platelet-rich plasma (PRP) to treat burn wounds. METHODS: For this study, we will conduct a systematic search using MEDLINE, EMBASE, the Cochrane Library, Web of Science, CINAHL, as well as Scopus to discover randomised controlled trials (RCTs) for the examination of effectiveness and safety of autologous PRP to treat burn wounds from their inception to March 2021 with no language restrictions. Additionally, we will search Google Scholar, ClinicalTrials.gov, as well as the reference lists of studies considered in the research to ascertain possibly eligible studies. We used two independent authors to evaluate studies for inclusion and conduct data extraction. We intend to assess study bias and quality utilizing the Cochrane Collaboration's Risk of Bias Tool 2.0. Also, we will pool study results using the fixed-effects model or random-effects model. Finally, any disagreements emanating from the process will be addressed through discussion or using a third author to mediate situations leading to disagreement. RESULTS: The study aims at assessing the effectiveness and safety of autologous PRP for treating burn wounds. CONCLUSION: The study will provide specific substantiation to assess autologous PRP's effectiveness and safety in treating patients with burn wounds. ETHICS AND DISSEMINATION: The study does not require ethical approval since no published studies are used in it. OSF REGISTRATION NUMBER: March 29, 2021.osf.io/74z5u. (https://osf.io/74z5u/).

Investigating the effect of age on platelet ultrastructure using transmission electron microscopy.

In the present study, the age- and sex-related differences in platelet ultrastructure were investigated using transmission electron microscopy (TEM). A total of 15 healthy volunteers were grouped according to age, with 5 people in each of the following groups: young group (25-45 years), middle-aged group (46-65 years), and old-aged group (> 65 years). In the TEM micrographs, the internal components, specifically the α-granules, dense granules, and lysosomal granules, of 20 platelets were counted for each group. Two-way analysis of variance of age and sex variance was used to compare the results. The ultrastructure of the platelets in the old-aged group was observed to be quite different from those of the young and middle-aged groups. Specifically, with ageing, the platelet membrane becomes more irregular in shape and non-smooth, and multiple platelet membrane ruptures are observed. Furthermore, the pseudopodia and protuberances become more numerous and slender, and the number of α-granules is significantly reduced. These morphological changes indicate that ageing may affect the function of platelets, which in turn affects the efficacy of platelet concentrates. Thus, the effects of age should be considered when using platelet concentrates prepared from elderly autologous blood.

Application of standardized platelet-rich plasma in elderly patients with complex wounds.

In recent years, autologous platelet-rich plasma (PRP) derivatives have been used widely in the regeneration and repair of tissue, but a standard definition and preparation method for PRP are lacking. We developed a standardized method using platelet indices as quality-control indicators for PRP preparation. Twenty-one elderly patients (9 males, 12 females) with complex wounds were treated with standardized platelet-rich plasma (S-PRP). The platelet count in PRP after the second centrifugation was 1,069-1,436 × 109 /L. We adjusted the platelet concentration in PRP after a second centrifugation to 1,000 × 109 /L according to a formula using platelet-poor plasma (PPP). The standardized preparation method that we developed gave S-PRP with a relatively uniform platelet concentration. The wounds of 21 patients showed accelerated healing after S-PRP treatment, and there were no obvious side effects during treatment. These data suggest that our preparation method of S-PRP, using platelet indices as quality-control indicators with platelet count of 1,000 × 109 /L could be used for the treatment of complex wounds in the elderly. The preparation method of S-PRP proposed in the present study may be a simple and effective method of PRP quality control.

Application of plasma-combined regeneration technology in managing facial acne scars.

BACKGROUND AND OBJECTIVES: Plasma skin regeneration (PSR) and platelet-rich plasma（PRP） have gained popularity in the treatment of acne scars due to their efficacy and improved tolerability. The objective of this investigation was to evaluate the synergistic effect of PRP plus PSR (plasma-combined regeneration technology, PCRT) in managing facial acne scars. METHODS: From March 2015 to June 2017，a total of 25 cases with facial atrophic acne scars were treated with PCRT treatment for three to five times. Treatments were repeated at an interval of 8 weeks．Treatment parameters were titrated to an immediate end point of moderate erythema. The clinical end point for cessation of treatment was the attainment of satisfactory clinical results. Results were monitored photographically up to 6 months after treatment. The efficacy and adverse effects were evaluated by using the following outcome parameters： the duration of edema,erythema and crusting; the degree of hyperpigmentation, hypopigmentation and scarformation; subjective effective rate was evaluated by patients and physicians. RESULTS: 22 of 25 participants completed the study, and were followed up for 6-12 months. After three to five treatments, evaluation by patients showed that the total effective rate was 90.91%. Evaluation by two physicians showed that the total effective rate was 86.36%. Treatment was well tolerated by all participants. The total duration of side effects was 6.7 ± 1.7 days of edema, 8.1 ± 2.3 days of erythema,6.5 ± 1.8 days of crusting, respectively. No hyperpigmentation, depigmentation, and worsening of scarring were observed by the conclusion of the follow-up period． Conclusion: These results provide initial evidence for the safety and effectiveness of PCRT as a well-tolerated modality for the treatment of acne scars. PCRT is an ideal treatment for facial acne scars with minimal side effect．.

The effects of aging, diabetes mellitus, and antiplatelet drugs on growth factors and anti-aging proteins in platelet-rich plasma.

As the aged population continues to markedly increase worldwide, the incidences of diabetes mellitus (DM) and cardiovascular disease (CVD) are increasing. In this study, we investigated the effects of aging, DM, and antiplatelet drugs on growth factors and anti-aging proteins in platelet-rich plasma (PRP). The study participants were classified into the following four groups: Group A, healthy individuals aged ≤45 years; Group B, healthy individuals aged >45 years; Group C, DM patients aged >45 years; and Group D, CVD patients aged >45 years taking antiplatelet drugs. The concentrations of epidermal growth factor (EGF), fibroblast growth factor (FGF)-2, platelet-derived growth factor (PDGF)-AA, PDGF-AB/BB, vascular endothelial growth factor (VEGF)-A, tissue inhibitor of metalloproteinase 2 (TIMP2), insulin-like growth factor 1 (IGF-1), growth differentiation factor (GDF)11, and clusterin in PRP samples were determined to analyze the effects of aging, DM, and antiplatelet drugs. Overall, the concentrations of IGF-1, TIMP2, and clusterin did not vary significantly between the four groups. The concentrations of PDGF-AB/BB (P = 0.010), VEGF-A (P = 0.000), and GDF11 (P = 0.026) were significantly different between Group A and Group B. Further, the concentrations of EGF (P = 0.000) and GDF11 (P = 0.000) were significantly different between Groups B and C. The concentrations of EGF (P = 0.001), VEGF-A (P = 0.000), and GDF11 (P = 0.002) significantly differed between Groups A and C. The concentrations of FGF-2 (P = 0.048), PDGF-AA (P = 0.03), and GDF11 (P = 0.001) were significantly different between Groups B and D. The concentrations of PDGF-AB/BB (P = 0.032), VEGF-A (P = 0.010), and GDF11 (P = 0.02) significantly differed between Groups A and D. We found that PRP contains high concentrations of the growth factors, TIMP2 and GDF11. Aging, DM, and antiplatelet drugs can decrease the concentration of some growth factors and GDF11, which weakens the regenerative capacity and anti-aging effects of PRP and reduces the quality of PRP.

Recovery of sympathetic nerve function after lumbar sympathectomy is slower in the hind limbs than in the torso.

Local sympathetic denervation by surgical sympathectomy is used in the treatment of lower limb ulcers and ischemia, but the restoration of cutaneous sympathetic nerve functions is less clear. This study aims to explore the recovery of cutaneous sympathetic functions after bilateral L2-4 sympathectomy. The skin temperature of the left feet, using a point monitoring thermometer, increased intraoperatively after sympathectomy. The cytoplasm of sympathetic neurons contained tyrosine hydroxylase and dopamine ß-hydroxylase, visualized by immunofluorescence, indicated the accuracy of sympathectomy. Iodine starch test results suggested that the sweating function of the hind feet plantar skin decreased 2 and 7 weeks after lumbar sympathectomy but had recovered by 3 months. Immunofluorescence and western blot assay results revealed that norepinephrine and dopamine ß-hydroxylase expression in the skin from the sacrococcygeal region and hind feet decreased in the sympathectomized group at 2 weeks. Transmission electron microscopy results showed that perinuclear space and axon demyelination in sympathetic cells in the L5 sympathetic trunks were found in the sympathectomized group 3 months after sympathectomy. Although sympathetic denervation occurred in the sacrococcygeal region and hind feet skin 2 weeks after lumbar sympathectomy, the skin functions recovered gradually over 7 weeks to 3 months. In conclusion, sympathetic functional recovery may account for the recurrence of hyperhidrosis after sympathectomy and the normalization of sympathetic nerve trunks after incomplete injury. The recovery of sympathetic nerve function was slower in the limbs than in the torso after bilateral L2-4 sympathectomy.

The scalping forehead flap for 1-stage reconstruction of large facial defects after tumor resection.

Skin tumors often occur in the face or other sun-exposed areas in the aged population, and cancerous ulceration in the face leads to facial damage. Regarding the aesthetic character of the facial unit and the age or concomitant pathologies of these patients, it is necessary to use quick, reliable methods to debride malignant ulcer and cover the wound or suture the incision. We report 2 cases of large facial malignant ulcer that were treated with forehead flap based on the supratrochlear artery or the frontal branch of a side superficial temporal artery in a 1-stage operation. Both of them got satisfying functional and aesthetic results.

[Changes of hair papilla and its role in the growth cycle of the hair follicles].

OBJECTIVE: To investigate the changes of hair dermal papilla and its regulatory role in the growth cycle of the hair follicles. METHODS: Single hair follicles were isolated from surgical specimens of human scalp and cultured in Williams E medium. The growth of the hair follicle was measured and the morphology and structure of the dermal papilla in the different growth cycles were observed continuously. RESULTS: The hair follicle could grow in the medium for 12 days at the average growth rate of 0.2-0.3 mm/day. The flat and round dermal papilla lay at the bottom of the hair bulb in the telogen and anagen stages. In the hair follicle with accelerated growth, the dermal papilla became elongated, loosened, and closely adhered to the hair matrix. In the catagen stage the dermal papilla shrunk, and became separated from the hair matrix. A new hair bulb was regenerated when the hair follicle was transected at a low level. The hair follicle stopped growing after transection at a higher position. CONCLUSION: The hair dermal papilla is the essential for hair follicle growth, and plays an important role in regulating the hair growth cycle.

[Role of angiotensin II receptors in proliferation of fibroblast derived from human hypertrophic scars].

OBJECTIVE: The present study was undertaken to observe the expression of angiotensin II (Ang II) type 1 (AT1) and type 2 (AT2) receptors in human hypertrophic scars, and explore their role in the proliferation of fibroblasts in human hypertrophic scars. METHODS: The expression of both ATL and AT2 receptors in fibroblasts of hypertrophic scars was detected with immunohistochemical staining. Radioligand receptor binding assay and RT-PCR were used to determined expression level of AT1 and AT2 receptors in cultured fibroblasts derived from hypertrophic scars. DNA synthesis was examined in cultured fibroblasts of hypertrophic scars by measuring [3H]-TdR incorporation into fibroblasts. RESULTS: Positive staining signals of both AT1 and AT2 receptors were found in fibroblasts of hypertrophic scars. Expression level of AT1 and AT2 receptors were (10.69 +/- 2.15) fmol/10(6) cells, (4.9 +/- 1.05) fmol/10(6) cells respectively in cultured fibroblasts derived from hypertrophic scars. RT-PCR showed the similar results. In cultured fibroblasts, Ang II stimulation significantly increased DNA synthesis (P < 0.05 vs negative control), which was inhibited by valsartan, an AT1 receptor blocker, but augmented by PD123319, an AT2 receptor antagonist. Valsartan or PD123319 alone did not influence the proliferation of fibroblasts derived from hypertrophic scars. CONCLUSIONS: Both AT1 and AT2 receptors were expressed in the fibroblasts of hypertrophic scars, and Ang II regulates DNA synthesis in hypertrophic scar fibroblasts through a negative cross-talk between AT1 and AT2 receptors, which might contribute, at least partly to formation and maturation of human hypertrophic scars. The present study provides new insight into pathogenesis of hypertrophic scars.

[Gamma knife treatment for pituitary adenomas].

OBJECTIVE: To evaluate the function and effect of Gamma knife radiosurgery (GKR) in controlling the tumor growth and improving endocrinological abnormality of pituitary adenomas. METHODS: Two hundred and twenty-eight cases of pituitary adenoma were treated with Leksell Gamma knife. 1.0 Tesla MRI and Gamma-Plan system were used to orientate the tumor. The margin dose was 12 - 35 Gy, mean 21.3 Gy; the center does was 24 - 70 Gy, mean 46.6 Gy (NFA, 31.8 Gy; FA, 50.3 Gy). RESULTS: One hundred and sixteen cases (NFA, 28; FA, 88) were followed up for 4 - 67 months, and the mean was 27.4 months. The growth of tumors in 113 cases (97.4%) was controlled. The tumor volume became smaller in 98 cases (84.5%). Three cases (2.6%) grew larger in tumor size. A significant decrease of excessive hormone production was seen in 89.8% of the patients, and the endocrinological normalization rate was 49.7% (PRL, 47.2%; GH, 57.1%; ACTH, 55.6%). Postradiosurgical complications were seen in 6%. CONCLUSION: Gamma knife radiosurgery is safe and effective in controlling the tumor growth and improving endocrinological abnormality of pituitary adenoma.