Comparison of platelet‐rich plasma gel in the care of the pressure ulcers with the dressing with serum physiology in terms of healing process and dressing costs

This research was carried out with the aim of comparing the effects of platelet‐rich plasma (PRP) gel and gas dressing with serum physiologic applied to stage II pressure ulcer in coccyx of patients for 2 months on healing process and dressing costs. This prospective randomised controlled experimental study was conducted with 60 patients hospitalised in the palliative care unit after surgery. The experimental group (n = 30) was dressed with platelet‐rich plasma gel. The control group (n = 30) was treated with serum physiologic dressing. At the end of the 20th observation of the patients in the experimental group, it was found that the mean scores of area, exudate, and tissue type in pressure sores decreased statistically (P < .001). In the control group, no significant difference was found between the mean PUSH score at the end of the 20th observation (P > .05). The study showed that PRP gel had a positive effect on healing of stage II pressure ulcers with platelet‐rich plasma gel dressings. In addition, when evaluated in the long term, it was concluded that platelet‐rich plasma gel is easily accessible and less costly than serum physiological dressing.     

The effect of non‐thermal atmospheric pressure plasma application on wound healing after gingivectomy

Recent studies have indicated the potential benefits of Non‐thermal atmospheric pressure plasma (NTAPP) as a novel therapeutic approach. The purpose of the current study was thus to assess the effect of NTAPP on gingival wound healing. Fifteen patients with bilaterally symmetrical gingival hyperplasia were included in the study. After gingivectomy and gingivoplasty, the left‐hand side of the symmetrical surgical area was irradiated with NTAPP (plasma jet kINPen 11). Digital photographs of the gingival wounds were taken at baseline and days 3, 7, and 14. Wound epithelialisation was evaluated. Landry Wound Healing Index (WHI) scores and visual analogue scale (VAS) scores were also recorded. There were significant differences between the epithelialisation of the NTAPP‐treated sites and the control sites after the surgical procedures. The NTAPP‐treated sites had significantly smaller stained surface areas compared with the control sites on the 3rd, 7^th, and 14th days (P < .05). The NTAPP‐treated sites had better WHI scores than the control sites throughout the follow‐up period (P < .05). It can be concluded that NTAPP enhances epithelialisation and stimulates wound healing after gingivectomy and gingivoplasty. However, further clinical studies with larger sample sizes are needed to determine the exact benefits of NTAPP for gingival wound healing.     

冲击波联合富血小板血浆治疗跖筋膜炎的临床研究

目的探讨发散式体外冲击波疗法(extracorporeal shock wave therapy,ESWT)与富血小板血浆(platelet rich plasma,PRP)联合治疗慢性跖筋膜炎的临床疗效。方法前瞻性单中心随机对照研究,选取2017年1月至2018年12月因足跟痛于重庆大学附属三峡医院就诊并诊断为慢性跖筋膜炎的患者60例,其中男性19例,女性41例;年龄20~68岁,平均(44.56±10.68)岁。依照随机数字表法分为ESWT治疗组(E组)、PRP治疗组(P组)和ESWT-PRP联合治疗组(联合组),每组20例。比较三组患者治疗前及治疗结束后4、12、24周视觉模拟评分(visual analogue scale,VAS)、改良足功能指数(revised footfunction index,FFI-R)。分别于治疗前及治疗结束后24周采用超声测量跖筋膜厚度。结果三组患者一般资料及治疗前VAS评分、FFI-R评分比较差异无统计学意义(P>0.05),治疗结束后VAS评分、FFI-R评分均较治疗前明显改善(P<0.05)。4周时联合组及E组优于P组(P<0.05),24周时联合组及P组优于E组(P<0.05)。治疗结束24周后三组患者跖筋膜厚度较治疗前均有明显改善(P<0.05),相关性分析发现VAS评分与跖筋膜厚度存在正相关性。所有患者均未出现严重不良反应。结论采用发散式ESWT与PRP联合方案治疗慢性跖筋膜炎安全、有效、起效快、并发症少、治疗效果维持时间长,值得临床研究与推广。     

复合皮移植技术与富血小板血浆对烧伤后大面积瘢痕整复患者血清炎症因子水平及美观度的影响

目的:探讨复合皮移植技术与富血小板血浆(Platelet-rich plasma,PRP)对烧伤后大面积瘢痕整复患者血清炎症因子水平及美观度影响。方法:选取2016年11月-2018年11月笔者医院收治的96例烧伤后大面积瘢痕整复患者,按照随机数表法,分成对照组和研究组,每组各48例。其中对照组患者给予复合皮移植术,研究组患者采用PRP治疗,术后两组患者均定期换药。观察两组患者的创面愈合时间和临床疗效,观察两组患者炎症因子γ-干扰素(IFN-γ)、白细胞介素-2(IL-2)和白细胞介素-6(IL-6)治疗前后的变化情况,观察两组患者血管内皮生长因子(VEGF)和转化生长因子-β1(TGF-β1)的水平,采用OSAS瘢痕评价量表评价两组患者术后的美观度并比较两种方式的安全性。结果:研究组平均愈合时间明显短于对照组,且研究组总有效率明显高于对照组,差异有统计学意义(P<0.05)。治疗后,两组患者的IFN-γ和IL-2较治疗前均有明显改善,且研究组均明显高于对照组,差异有统计学意义(P<0.05)。研究组患者治疗后IL-6水平明显低于治疗前,差异有统计学意义(P<0.05)。研究组患者术后5d和10d血清中VEGT和TGF-β1的水平均明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者的瘢痕平整度、瘢痕弹性程度和瘢痕颜色均有明显改善,研究组改善更明显,差异均有统计学意义(P<0.05)。研究组总不良反应发生率为4.17%明显低于对照组的18.75%,差异有统计学意义(P<0.05)。结论:PRP对烧伤后大面积瘢痕患者具有明显的临床优势,可加快创面愈合,有效降低血清炎症因子水平,减少瘢痕生长,安全性更高,值得临床推广。     

经尿道等离子前列腺切除术治疗小体积前列腺增生的疗效分析

目的评估经尿道等离子前列腺切除术治疗小体积前列腺增生的疗效。方法回顾性分析我院2016年1月至2018年12月收治的38例行经尿道等离子前列腺切除术的小体积(前列腺体积≤30 mL)前列腺增生患者的临床资料。结果所有患者均顺利完成手术,术后1月及3月,国际前列腺症状评分(IPSS)由术前(23.89±1.80)分降至(16.55±2.10)分和(12.32±2.22)分,最大尿流率(Qmax)由术前(8.82±2.38)mL/s升至(14.50±2.32)mL/s和(14.66±2.06)mL/s。均有统计学意义(P<0.05),但术后储尿期症状改善较慢。结论经尿道前列腺等离子切除术是治疗小体积前列腺增生的重要术式,可明显改善患者下尿路症状及生活质量,但术后尿频尿急等储尿期症状恢复时间长。     

A prospective,iterative, adaptive trial of carfilzomib‐based desensitization

Proteasome inhibitor–based strategies hold promise in transplant but have yielded varying results. Carfilzomib, a second‐generation proteasome inhibitor, may possess advantages over bortezomib, the first‐generation proteasome inhibitors. The purpose of this study was to evaluate the safety, toxicity, and preliminary efficacy of carfilzomib in highly HLA‐sensitized kidney transplant candidates. Renal transplant candidates received escalating doses of carfilzomib followed by plasmapheresis (group A) or an identical regimen with additional plasmapheresis once weekly before carfilzomib dosing. Thirteen participants received carfilzomib, which was well tolerated with most adverse events classified as low grade. The safety profile was similar to bortezomib desensitization; however, neurotoxicity was not observed with carfilzomib. Toxicity resulted in permanent dose reduction in 1 participant but caused no withdrawals or deaths. HLA antibodies were substantially reduced with carfilzomib alone, and median maximal immunodominant antibody reduction was 72.8% (69.8% for group A, P = .031, 80.1% for group B, P = .938). After depletion, rebound occurred rapidly and antibody levels returned to baseline between days 81 and 141. Bone marrow studies revealed that approximately 69.2% of plasma cells were depleted after carfilzomib monotherapy. Carfilzomib monotherapy–based desensitization provides an acceptable safety and toxicity profile while leading to significant bone marrow plasma cell depletion and anti‐HLA antibody reduction.     

Effect of Storage Conditions and Activation on Growth Factor Concentration in Platelet-Rich Plasma

This study aimed to evaluate growth factor concentration in platelet-rich plasma (PRP) (leukocyte-rich PRP) based on storage temperature, duration of storage, and method of activation. PRP samples were stored at 24℃ (room temperature group), 4℃ (refrigerator group), and −70℃ (deep-freezer group). In each temperature, four aliquots were prepared based on the time of analysis (immediately, 1, 3, and 7 days after preparation). After storage, concentrations of platelet-derived growth factor-AA (PDGF-AA), transforming growth factor-β (TGF-β), vascular endothelial growth factor (VEGF), insulin-like growth factor-1 (IGF-1), and fibroblast growth factor-basic (FGF-B) were assessed with/without activation using Quantikine colorimetric sandwich immunoassay kits. PRP was activated with 10% Triton-X for PDGF-AA, VEGF, FGF-B, IGF-1 measurement and sonication for TGF-β1 measurement. Without activation, PDGF-AA concentration was highest on day 7 in the room temperature group. With activation, the concentration of PDGF-AA was constant over the observation period at all temperatures. Without activation, the TGF-β1 concentration remained negligible over the observation period at all temperatures. However, with activation, TGF-β1 gradually increased to its highest concentration on day 7 at all temperatures. Over the observation period, VEGF and IGF-1 concentrations were constant with and without activation at all temperatures. Without activation, FGF-B concentration increased, with the highest concentration observed on day 7 in the deep-freezer group. With activation, FGF-B concentration decreased after day 1 in the room temperature group. Growth factor concentration in PRP differed significantly based on storage temperature, duration of storage, and method of activation. Appropriate storage conditions and activation are important to optimize its effects on desired clinical outcomes. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:777-784, 2020     

Surgical device exchange provides improved clinical outcomes compared to medical therapy in treating continuous-flow left ventricular assist device thrombosis

The purpose of this study is to compare clinical outcomes of left ventricular assist device (LVAD) patients with device thrombosis who underwent device exchange (DE) or medical therapy (MT) alone. Consecutive patients undergoing LVAD implant between July 2008 and December 2017 were included. Device thrombosis was diagnosed with comprehensive assessments including ramp test, laboratory data, device parameters, and clinical presentations. First, MT was initiated in all patients. After MT, DE was considered if device thrombosis was refractory to initial MT, and it caused end-organ impairment and/or hemodynamic instability. Among 319 consecutive LVAD patients, 43 patients (13.5%) were diagnosed with device thrombosis. DE was performed in 28 patients (DE group); device explant was performed in 1 patient. MT was continued in 14 patients (MT group). In-hospital mortality was significantly lower in the DE group than the MT group (3.6% [1/28] vs. 28.6% [4/14], P = .0184). One-year survival was significantly better in the DE group (74.0% vs. 30.1%; log-rank = .001), and freedom from cerebrovascular accident (CVA) at 1 year was greater in the DE group (87.1% vs. 47.7%; log-rank = .004). DE was associated with improved 1-year survival and fewer CVAs. Surgical intervention, if feasible, is recommended for LVAD device thrombosis.     

Incubation of frozen-thawed llama sperm with seminal plasma

Seminal plasma is intimately connected to sperm physiology and particularly in South American Camelids, has demonstrated to be involved in multiple physiological reproductive events. Different percentages of seminal plasma (0%, 10% and 50%) were added to thawed llama semen samples with the objective of evaluating the interaction with cryopreserved sperm over time (0, 1.5 and 3 hr at 37°C). A total of 20 ejaculates from five adult llama males (n = 5; r = 4) were evaluated. A significant decrease in sperm motility, membrane function and live sperm was observed in all thawed samples (0%, 10% and 50%) at 0 hr when compared to raw semen. Neither morphology nor chromatin condensation was altered in all thawed samples (p > .05), but a significant increase in the percentage of spermatozoa with fragmented DNA was observed after thawing all samples versus raw semen. When evaluating thawed samples over time, a significant decrease of motility and membrane function was observed, while the percentages of total live sperm were preserved over the 3 hr of incubation in all final concentrations evaluated. To conclude, the addition of 10% or 50% of seminal plasma was incapable of preserving motility or membrane function of frozen-thawed llama sperm during 3 hr of incubation.