Advanced repair of recurrent and low-large hysterotomy defects using a myometrial glide flap.

BACKGROUND: The resolution of factors linked to the recurrence of cesarean section defects can be accomplished through a comprehensive technique that effectively addresses the dehiscent area, eliminates associated intraluminal fibrosis, and establishes a vascularized anterior wall by creating a sliding myometrial flap. OBJECTIVE: Propose a comprehensive surgical repair for recurrent and large low hysterotomy defects in women seeking pregnancy or recurrent spotting. STUDY DESIGN: A retrospective cohort analysis included 54 patients aged 25-41 with recurrent large cesarean scar defects treated at Otamendi, CEMIC, and Valle de Lili hospitals. Comprehensive surgical repair was performed by suprapubic laparotomy, involving a wide opening of the vesicouterine space, removal of the dehiscent cesarean scar and all intrauterine abnormal fibrous tissues, using a glide myometrial flap, and intramyometrial injection of autologous platelet-rich plasma. Qualitative variables were determined, and descriptive statistics were employed to analyze the data in absolute frequencies or percentages. The data obtained were processed using the InfostatTM statistic program. RESULTS: Following the repair, all women experienced normal menstrual cycles and demonstrated an adequate lower uterine segment thickness, with no evidence of healing defects. All patients experienced early ambulation and were discharged within 24 h. Uterine hemostasis was achieved at specific points, minimizing the use of electrocautery. The standard duration of the procedure was 60 min (skin-to-skin), and the average bleeding was 80-100 ml. No perioperative complications were recorded. A control T2-weighted MRI was performed six months after surgery. All patients displayed a clean, unobstructed endometrial cavity with a thick anterior wall (Median: 14.98 mm, IQR 13-17). Twelve patients became pregnant again, all delivered by cesarean between 36.1 and 38.0 weeks, with a mean of 37.17 weeks. The thickness of the uterine segment before cesarean ranged between 3 and 7 mm, with a mean of 3.91 mm. No cases of placenta previa, dehiscence, placenta accreta spectrum (PAS), or postpartum hemorrhage were reported. CONCLUSIONS: The comprehensive repair of recurrent low-large defects offers a holistic solution for addressing recurrent hysterotomy defects. Innovative repair concepts effectively address the wound defect and associated fibrosis, ensuring an appropriate myometrial thickness through a gliding myometrial flap.

Platelet microparticles load a repertory of miRNAs programmed to drive osteogenic phenotype.

Autologous platelet-rich plasma accelerates bone healing by releasing biomolecules during their degranulation process, which are transported by vesicle-like structures called platelet microparticles (PMPs). However, the underlying mechanisms regulating the osteogenic differentiation by PMP-released miRs remain poorly understood and this prompted us to better address this issue. Thus, miRNAseq expression profiles (E-GEOD-76789) were downloaded from ArrayExpress database. GEO2R was performed to evaluate the differential expression, and mirnatap R package was used to find targets for differentially expressed miRNAs. An extend protein-protein (ePPI) network for osteogenic marker proteins was generated using String, and DAVID tools were used to perform gene ontology and KEGG pathway analysis from ePPI and miRNAs targets. Our data show that ePPI network was composed by 232 nodes and 2,175 edges, with a clustering coefficient of 0.546. MCODE was able to identify seven clusters contained in the ePPI network, and the two that presented a score above 10 were used in further analysis. Conversely, 15,944 different targets were found as down-expressed while 5,715 different targets were up-expressed. Among the downregulated 75 miRNAs, 70 have predicted targets present in the ePPI network, while the 21 upregulated miRNAs have 19 predicted targets in the ePPI network. Our study provides a registry of miRNAs that play a central role in regulating osteogenic phenotype, which might have potential therapeutic applications in bone regeneration and bone tissue engineering.

Inhibition of Fenton reaction is a novel mechanism to explain the therapeutic effect of intra-articular injection of PRP in patients with chronic haemophilic synovitis.

INTRODUCTION AND AIM: Haemarthroses cause major morbidity in haemophilia resulting in chronic haemophilic synovitis (CHS) and arthropathy. Oxidation of haemoglobin-coupled iron released in synovium after haemolysis induces chondrocytes death and cartilage damage, allowing postulate using iron-chelating drugs as potential therapeutic tool for haemophilic joint damage. Considering that albumin, the most abundant plasma protein, is a physiologic iron chelator, we aim to demonstrate that impediment of haemoglobin oxidation is exerted by plasma as a mechanism involved in the therapeutic effect of intra-articular injection of platelet-rich plasma in CHS. METHODS: Oxidation of haemoglobin (Hb) to methaemoglobin (MeHb) through Fenton reaction was induced in vitro by addition of potassium ferricyanide in the presence or absence of peripheral blood-derived platelets-rich or platelets-poor plasma (PRP/PPP) or albumin. The relevance of in vitro findings was analysed in synovial fluid (SF) samples from one patient with CHS obtained before and after 6 months of PRP intra-articular injection. RESULTS: MeHb formation was completely impaired either by of PPP, PRP or albumin indicating that PRP exerts an anti-oxidative effect, probably due by plasma albumin. Analysis of SF samples revealed the presence of MeHb levels and haemosiderin-laden macrophages in SF obtained before PRP treatment. Reduction of synovial MeHb, normalization of cellular composition and improvement of health joint haemophilic score, pain and bleeding episodes were registered after 6 months of PRP intra-articular injection. CONCLUSION: Inhibition of Fenton reaction and the consequent normalization of joint cellular composition is a noncanonical mechanism underlying the therapeutic effect of PRP intra-articular injection in CHS.

Bioestimulación capilar con plasma rico en plaquetas contra la caída del cabello / Capillary biostimulation with platelets rich plasm against alopecia

Se describe el caso clínico de una paciente de 69 años de edad, quien acudió a la consulta de medicina regenerativa por presentar estrés mantenido y pérdida del cabello, para lo cual se decidió aplicar la bioestimulación con plasma rico en plaquetas lisado como terapia regenerativa, con plaquetas alogénicas en forma tópica, puesto que es un tratamiento inocuo y carente de complicaciones. Se obtuvo un incremento de los cabellos, espesamiento de la zona alopécica y la paciente recuperó su apariencia.

The case report of a 69 years patient is described who went to the regenerative medicine service for presenting maintained stress and loss of her hair, for which it was decided to evaluate biostimulation with platelets rich plasm as regenerative therapy for her, with topical allogeneic platelets, since it is an innocuous treatment with no complications. An increment and growing of the hair in the alopecic area was obtained and the patient recovered her look.

Effect of platelet-rich plasma on healing of class III furcation defects treated with autogenous bone grafting and guided tissue regeneration: a histomorphometric study in dogs / Efeito do plasma rico em plaquetas na reparação de lesões de furca classe III tratadas com enxerto ósseo autógeno e regeneração tecidual guiada: estudo histomorfométrico em cães

Objetivo: O objetivo deste estudo foi avaliar histologicamente os efeitos do plasma rico em plaquetas (PRP), quando usado em combinação com enxerto ósseo autógeno e membrana bioabsorvível (Resolut®) no tratamento de defeitos de furca Classe III em cães. Material e método: Cinco cães foram usados neste estudo. Defeitos de furca classe III (5 mm de altura e de profundidade) foram criados cirurgicamente no terceiro pré-molar inferior de ambos os lados. Nove semanas após a primeira cirurgia, os terceiros pré-molares foram tratados com raspagem e alisamento radicular e cada defeito recebeu um dos seguintes tratamentos: Enxerto ósseo autógeno + membrana (grupo C) ou PRP + enxerto ósseo autógeno + membrana (grupo T). Após um período de cicatrização de 90 dias, os animais foram sacrificados. Processamento histológico de rotina e coloração com hematoxilina e eosina e tricrômico de Masson foram realizados para determinar o efeito dos tratamentos na regeneração dos tecidos periodontais. Os dados foram analisados pelo teste T2 de Hotelling (p < 0,05). Resultado: A análise histomorfométrica da área de furca não mostrou nenhuma diferença estatisticamente significativa entre os grupos C e T. Os dois grupos de tratamento demonstraram resultados regenerativos semelhantes, com os defeitos de furca parcialmente preenchidos e a regeneração periodontal foi limitada à marca experimental apical das lesões. (p > 0,05). Conclusão: Dentro dos limites deste estudo, concluiu-se que o uso de PRP não melhorou a regeneração periodontal em defeitos de furca classe III tratados com enxerto ósseo autógeno e membrana bioabsorvível.

Objective: The purpose of this study was to evaluate the effects of the platelet-rich plasma (PRP) when used in combination with autogenous bone graft and bioabsorbable membrane (Resolut®) in the treatment of Class III furcation defects in dogs. Material and method: Class III furcation defects (5 mm in height and in depth) were surgically created in the mandibular third premolars of five mongrel dogs. After nine weeks, the lesions were treated with scaling and root planning and each defect received one of the following treatments: autogenous bone graft + membrane (group C) or PRP + autogenous bone graft + membrane (group T). After a healing period of 90 days, the animals were sacrificed. Routine histological processing and staining with hematoxilyn and eosin and Masson trichrome were performed and a histomorphometric analysis determined the effect of the treatments on periodontal tissue regereneration. Data were analyzed by Hotelling's T-squared (p < 0.05). Result: No statistically significant difference between C and T groups was observed by the histomorphometric analysis of the furcation area. Both treatment groups demonstrated similar regenerative results with the furcation defects partially filled and periodontal regeneration limited to the experimental notches of the lesions. (p > 0.05). Conclusion: According to the present results, PRP does not enhance the periodontal regeneration in class III furcation defects treated with autogenous bone graft and bioabsorbable membrane.

Efeito do Plasma Rico em Plaquetas na apoptose pós-traumática de condrócitos / Effect of Platelet-Rich Plasma on impact-induced chondrocyte apoptosis

OBJETIVO: Avaliar se a injeção intra-articular de Plasma rico em plaquetas (PRP) pode reduzir a apoptose pós-traumática de condrócitos. MÉTODOS: Foi desenvolvido um estudo experimental duplo-cego com quatro joelhos de coelhos adultos. Após a anestesia, os animais foram submetidos à contusão padronizada dos joelhos. Depois foi injetado 1ml de PRP humano nos dois joelhos esquerdos e 1ml de solução fisiológica (SF) nos dois joelhos direitos. Os dois coelhos foram mantidos no mesmo ambiente sob controle de temperatura, de atividades diárias e de alimentação. A eutanásia dos animais ocorreu dez dias após a intervenção e foram realizadas biópsias da cartilagem de cada joelho. As peças foram preparadas para análise em microscopia eletrônica (ME). RESULTADOS: Quatro preparados para ME foram obtidos, cada um correspondendo a um joelho. Os joelhos-PRP apresentaram as taxas de apoptose de 47,62 por cento (50/105) e de 48,36 por cento (59/122), respectivamente. Nos joelhos-SF as taxas de apoptose foram, respectivamente, 56,67 por cento (17/30) e 70,40 por cento (88/125). A diferença do índice de apoptose nos joelhos-PRP (48,02 por cento) e nos joelhos-SF (67,74 por cento) foi significante (p<0,001) e OR=0,439 (IC95 por cento=0.287-0.673). CONCLUSÃO: A injeção intra-articular de PRP imediatamente ao trauma, reduz as taxas de apoptose (pós-traumática) de condrócitos de coelhos.

OBJECTIVE: To evaluate if the injection of intra-articular platelet-rich plasma (PRP) can reduce impact-induced chondrocyte apoptosis. METHODS: A double-blind experimental study was developed in four knees of two adult rabbits. Each knee was injured after anesthesia. Subsequently, 1ml PRP was injected in the right knees and 1ml of normal saline (NS) in the left knees. The animals were euthanized ten days after the intervention. All cartilage was removed from the 4 knees and prepared for analysis in electron microscopy (EM). RESULTS: Four EM samples were obtained. The PRP-injected knees showed apoptosis rates of 47,62 percent (50/105) and 48,36 percent (59/122), respectively. NS-injected knees showed 56.67 percent (17/30) and 70.40 percent (88/125) of apoptosis. PRP-injected knees had statistically significant less apoptosis (48.02 percent) than NS-injected ones, (67.74 percent, p<0,001) and odds ratio of 0.439 (95 percent CI=0.287-0.673). CONCLUSION: Immediately post-traumatic intra-articular injection of PRP reduces impact-induced chondrocyte apoptosis in rabbits.