Gender and age differences in growth factor concentrations from platelet-rich plasma in adults.

The use of platelet-rich plasma (PRP) to facilitate healing of orthopedic-related injuries has gained popularity; however, the clinical benefits are not consistent. Differences may result from variations in growth factor (GF) levels in normal populations. The purpose of this study was to determine if GF levels present in activated PRP preparations differed by gender and age (≤ 25 versus >25 years) in a healthy population (N = 102). All GFs analyzed (epidermal growth factor [EGF], hepatocyte growth factor [HGF], insulin growth factor-1 [IGF-1], platelet-derived growth factor-AB [PDGF-AB], platelet-derived growth factor-BB [PDGF-BB], transforming growth factor beta-1 [TGFß-1], and vascular endothelial growth factor) had higher levels for females and for those ≤ 25 years old. Of the GFs tested, four of seven were significantly higher (p < 0.05) for females (EGF, HGF, IGF-1, PDGF-BB), the most significant being IGF-1 (female, 85.0; male, 69.3 ng/mL; p < 0.01). Five of seven GFs achieved significance (p < 0.05) for people ≤ 25 years old (EGF, IGF-1, PDGP-AB, PDGF-BB, and TGFß-1), with IGF and PDGF-AB achieving p < 0.001 (≤ 25 years, 85.1; >25 years, 56.8, and ≤ 25 years, 7.66; >25 years, 5.77 ng/mL, respectively). Finally, for both genders, most of the GFs were positively correlated with all GFs. This study demonstrated that both age and gender account for variations in specific GFs present in PRP, and this may partially explain some of the inconsistent results of PRP clinical trials.

Comfort and efficacy of a longer and thinner endoscope for average risk colon cancer screening.

The aim of this prospective study was to assess patient comfort during nonsedated screening sigmoidoscopy with the use of a standard 60-cm sigmoidoscope compared with a thinner 100-cm upper endoscope. Patients undergoing routine colon cancer screening with sigmoidoscopy were randomly assigned to either a 60-cm sigmoidoscope or a 100-cm upper endoscope. The procedure time, depth of insertion, anatomic landmarks, and presence of polyps were documented. Likert 7-point scales and visual analog scales (VAS) were performed to measure comfort and symptoms immediately after the procedure and again in 1 week. These scales, procedure time, insertion depth, percent reaching transverse colon, and percent with polyps were analyzed. Eighty-one patients were enrolled with 38 in the 100-cm group and 43 in the 60-cm group. Patients in the 100-cm group reported greater comfort on the VAS compared with the 60-cm group (P = .035) as well as less cramping on the initial Likert scale (P = .017). One week later, the 100-cm group reported higher comfort (P = .015) and less bloating (P = .040). Procedure time was longer for the 100-cm group (8.8 versus 5.9 minutes; P = .001). Insertion depth was 74 versus 56 cm (P = .001), and percent reaching splenic flexure was 76% versus 35% (P = .001) in the 100 and 60 cm groups, respectively. More adenomas were found with the 100-cm scope (P = .035). The use of a thinner and longer endoscope is more comfortable than a standard sigmoidoscope. Although a 100-cm endoscope procedure takes longer to perform, it allows better evaluation of the colon and misses fewer adenomas.

Clinical and immunological comparison of smallpox vaccine administered to the outer versus the inner upper arms of vaccinia-naive adults.

BACKGROUND: Current recommendations direct health care providers to administer smallpox vaccine to the upper outer arm. However, concerns about cosmetically bothersome scarring, accidental contact transmission, interference by body tattoos, and even malignant transformation suggest evaluation of alternate vaccination sites is warranted. METHODS: We randomized 20 vaccinia-naive adults to undergo smallpox vaccination on the outer (n = 10) or inner (n = 10) upper arm. Evaluations included major reaction ("take") rates and vaccination site cultures on postvaccination day 7, determination of serum vaccinia-specific neutralizing antibody titers on days 0 (prevaccination) and 21, and determination of adverse events. RESULTS: On postvaccination day 7, a total of 18 participants (9 per group) had major reactions, 17 of whom had culture evidence of viable vaccinia. The inner and outer arm groups had similar major reaction mean sizes (P = .17), but the amount of erythema (in square centimeters) was smaller in the inner arm group (P = .05). At day 21, all participants had higher titers of vaccinia-specific neutralizing antibodies, compared with at day 0, and the geometric mean titer values of the 2 vaccine groups were similar (P = .45). Adverse event rates were similar. CONCLUSION: The comparable clinical, immunological, and tolerability outcomes between smallpox vaccine applied to the conventional upper outer arm site versus the upper inner arm, coupled with modestly less vaccine-site erythema on the inner arm, indicate that the inner arm may be a suitable alternate vaccination site.

Randomized trial comparing vaccinia on the external surfaces of 3 conventional bandages applied to smallpox vaccination sites in primary vaccinees.

BACKGROUND: Concern about accidental contact transmission after smallpox vaccination has prompted various recommendations regarding vaccination site coverage. METHODS: On days 6-8 after their first-ever smallpox vaccination, 63 adult subjects were randomized to apply a self-adhesive bandage (n=20), gauze with adhesive tape (n=21), or gauze with a semipermeable dressing (n=22) over the vaccination site for a mean of 8+/-2 h. Swabs from the external bandage surfaces and the vaccination sites were then assessed by real time vaccinia-specific polymerase chain reaction (PCR) in blinded fashion. RESULTS: Among 58 subjects completing the study, PCR results were positive for the vaccination site in 55 (94.8%) and on 10 swabs (17.2%) from external bandage surfaces. There were no differences among the 3 bandages (P=.57). CONCLUSIONS: At 7 days after smallpox vaccination, a peak time for vaccinia shedding, a self-adhesive bandage was as effective as 2 bulkier, less convenient bandages in limiting PCR-detectable virus on the external surface.