This document provides disclosures for Lars Engebretsen, who will be giving a lecture on PRP in muscle and tendon injuries. It lists that Engebretsen has received consulting fees, fellowship and research grants, and serves on editorial boards for several journals. He has extensive experience in sports traumatology and currently holds leadership roles in several research centers and organizations. The lecture will discuss why PRP is popular, its potential roles in tendon, ligament, muscle and cartilage, injection procedures, the role of white blood cells, adverse effects, anti-doping regulations, and provide a summary.
Using Platelet Rich Plasma for Orthopedic Conditionsregenmedsr
Platelet Rich Plasma is an excellent option, often with far better results than traditional methods, for musculoskeletal problems involving joint, tendons, and ligaments.
Platelet Rich Plasma (PRP) for Treatment of Knee ArthritisRaymond Severt
Platelet Rich Plasma (PRP) is an excellent treatment option for knee arthritis. PRP allows the arthritis knee to become less painful and preserve knee function. This is all done in a natural way, without the need of medications or invasive surgery.
Learn about the power of Regenerative Medicine or Orthobiologics. Engage the science on how stem cells and platelet rich plasma can improve quality of life and function in orthopedic needs. Check out more at www.JaxStemcell.com
Using Platelet Rich Plasma for Orthopedic Conditionsregenmedsr
Platelet Rich Plasma is an excellent option, often with far better results than traditional methods, for musculoskeletal problems involving joint, tendons, and ligaments.
Platelet Rich Plasma (PRP) for Treatment of Knee ArthritisRaymond Severt
Platelet Rich Plasma (PRP) is an excellent treatment option for knee arthritis. PRP allows the arthritis knee to become less painful and preserve knee function. This is all done in a natural way, without the need of medications or invasive surgery.
Learn about the power of Regenerative Medicine or Orthobiologics. Engage the science on how stem cells and platelet rich plasma can improve quality of life and function in orthopedic needs. Check out more at www.JaxStemcell.com
Regenerative Medicine is the revolution of the future. We are proud to use these technologies with great success in patients with orthopedic needs. Learn more about the science here.
Testosterone Replacement Benefits and Side EffectsNELSON VERGEL
Main information and facts about testosterone treatment and how to maximize benefits and minimize side effects of TRT. Included treatments are: hCG to reverse and prevent loss of fertility and testicular size, FSH to improve fertility, Androgel, Testim, Axiron, Fortesta, Natesto, Aveed (Nebido), testosterone creams and pellets, testosterone cypionate , testosterone enanthate. Blood test parameters to monitor while a patient is on TRT are also listed along with the management of such variables. Information about thyroid hormone balance is also included since it affects TRT efficacy. This information was extracted from www.ExcelMale.com by Nelson Vergel, author of Testosterone: A Man's Guide and Built to Survive.
Clinical Uses of FDA-Approved Anabolic-Androgenic Steroids (AAS)NELSON VERGEL
Nelson Vergel, author of Built to Survive, Testosterone: A Man's Guide and Beyond Testosterone, and founder of www.ExcelMale.com, www.DiscountedLabs.com, and Clinical Optimizers, speaks about the clinical uses of nandrolone, oxandrolone, and other FDA-approved anabolic androgenic steroids.
Characterized by low serum testosterone levels and diverse symptoms, male hypogonadism is a common condition. Current medical treatment focuses on testosterone supplementation using multiple modalities such as injections, gels and pellets. Interestingly, while testosterone is considered an anabolic androgenic steroid, it has not been saddled with the social stigma that other, similar medications have. The goal of this review is to highlight an anabolic steroid, 19-nortestosterone (i.e., nandrolone, deca-durabolin) and illustrate prospective therapeutic applications for male health.
Nandrolone, like other anabolic steroids, is not however, suitable as a substitute for testosterone for the treatment of testosterone deficiency, as it does not produce the effects on libido, quality-of- life and physical hardiness that testosterone itself does. In truth only testosterone itself is appropriate for testosterone replacement therapy.
Nandrolone's decreased androgenic potential means that there is less chance that it will promote hair loss or enlargement of the prostate than testosterone. This is partly because testosterone's 5-alpha reduced metabolite, called dihydrotestosterone, is more androgenic than nandrolone's 5-alpha reduced metabolite, called dihydronandrolone. Because of its lower androgenic potential, nandrolone may also be used at low doses by women who are experiencing severe weight loss.
Nandrolone is a nor-testosterone, which means that there is no carbon at the 19 position of the molecule. This prevents the binding of the enzyme called aromatase, which converts testosterone into estrogen. While some textbooks say that this means that nandrolone should not convert to estrogen at all, nandrolone has been shown to convert to estrogen at a rate of approximately 20 percent as much as testosterone does at therapeutic doses. Therefore, nandrolone has significantly less potential to cause estrogen-related side effects such as gynecomastia (breast growth) than testosterone in men. Reduced potential for androgenic and estrogenic effects, along with its high anabolic potential makes nandrolone a very good steroid to combine with testosterone for higher-dose anabolic therapy.
Cardiac Inflammation and Repair Following Myocardial InfarctionInsideScientific
Join Dr. Merry Lindsey as she discusses her research involving the physiology of recovery from cardiac events.
Age plays a pivotal role in the deterioration of cardiovascular functionality, resulting in an increased risk of cardiovascular disease in older adults. The prevalence of cardiovascular disease has also been shown to increase with age, in both men and women, including the prevalence of atherosclerosis, stroke and, myocardial infarction.
Following myocardial infarction (MI), the left ventricle (LV) undergoes a series of cardiac wound healing responses that involve both the stimulation of robust inflammation to clear necrotic myocytes and tissue debris and the induction of extracellular matrix (ECM) protein synthesis to generate an infarct scar. Collectively, this process in known as LV remodeling. Matrix metalloproteinase-9 (MMP-9) is a key regulator of LV remodeling post-MI, through direct effects on ECM turnover as well as indirect effects on the regulation of the major cell types that coordinate cardiac wound healing- namely the infiltrating leukocytes and the cardiac fibroblasts. We will discuss recent research that has expanded our understanding of MI LV remodeling, including recent proteomic advances focused on the ECM compartment to provide novel functional and translational insights. In summary, this webinar will provide an overview of how cardiac ECM research has evolved over the last decade and will provide insight into future directions that will drive further understanding of MMP directed cardiac ECM turnover after MI.
Objective: To investigate the effect of sildenafil on reducing the impact of hepatic ischemia/reperfusion (HIR) injury established by Pringle maneuver on the heart of rats.
Study Design: Forty Wistar albino rats were divided into 4 groups: Sham (laparotomy only), Control (laparotomy following sildenafil application), IR (ischemia/reperfusion injured by HIR), and IR+SIL (injured by HIR following sildenafil application). Ischemia was developed by clamping the hepatoduodenal ligament for 30 minutes; then reperfusion was applied for 30 minutes. Sildenafil (single dose of 50 mg/kg) was administered by oral gavage for 15 minutes before ischemia. Blood samples of rats were collected from Sham and Control groups at 60 minutes and from IR and IR+SIL groups at 30 minutes after initiation of reperfusion for biochemical analysis. Meanwhile, heart tissues were sampled for biochemical analysis. Malondialdehyde (MDA) and total antioxidant capacity (TAC) in serum samples and TAC, total oxidative capacity (TOC), and oxidative stress index in heart tissues were examined biochemically.
Results: Serum MDA levels were elevated significantly in the IR and IR+SIL groups as compared to the sham group. Sildenafil treatment inhibited MDA increase considerably in the IR+SIL group as compared to the IR group. Serum TAC levels were elevated significantly in the sildenafil and control groups (compared with sham groups) and in the IR+SIL group (compared with the IR group). TAC levels detected in heart tissue increased significantly in the IR group as compared to the sham group; however, sildenafil treatment had no effect on this increase.
Conclusion: Heart tissue was affected by HIR. It was revealed that sildenafil treatment may prevent the oxidative stress via increasing serum TAC levels in both control and IR+SIL groups.
Corticisteroids/certified fixed orthodontic courses by Indian dental academyIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Strategies to prevent depletion of Testosterone and the resulting muscle loss (Sarcopenia ) due to Aging. Stay Young.. Strong and Lively. Andraiz T of Body Satva Essentials on www.bodysatva.com
Regenerative Medicine is the revolution of the future. We are proud to use these technologies with great success in patients with orthopedic needs. Learn more about the science here.
Testosterone Replacement Benefits and Side EffectsNELSON VERGEL
Main information and facts about testosterone treatment and how to maximize benefits and minimize side effects of TRT. Included treatments are: hCG to reverse and prevent loss of fertility and testicular size, FSH to improve fertility, Androgel, Testim, Axiron, Fortesta, Natesto, Aveed (Nebido), testosterone creams and pellets, testosterone cypionate , testosterone enanthate. Blood test parameters to monitor while a patient is on TRT are also listed along with the management of such variables. Information about thyroid hormone balance is also included since it affects TRT efficacy. This information was extracted from www.ExcelMale.com by Nelson Vergel, author of Testosterone: A Man's Guide and Built to Survive.
Clinical Uses of FDA-Approved Anabolic-Androgenic Steroids (AAS)NELSON VERGEL
Nelson Vergel, author of Built to Survive, Testosterone: A Man's Guide and Beyond Testosterone, and founder of www.ExcelMale.com, www.DiscountedLabs.com, and Clinical Optimizers, speaks about the clinical uses of nandrolone, oxandrolone, and other FDA-approved anabolic androgenic steroids.
Characterized by low serum testosterone levels and diverse symptoms, male hypogonadism is a common condition. Current medical treatment focuses on testosterone supplementation using multiple modalities such as injections, gels and pellets. Interestingly, while testosterone is considered an anabolic androgenic steroid, it has not been saddled with the social stigma that other, similar medications have. The goal of this review is to highlight an anabolic steroid, 19-nortestosterone (i.e., nandrolone, deca-durabolin) and illustrate prospective therapeutic applications for male health.
Nandrolone, like other anabolic steroids, is not however, suitable as a substitute for testosterone for the treatment of testosterone deficiency, as it does not produce the effects on libido, quality-of- life and physical hardiness that testosterone itself does. In truth only testosterone itself is appropriate for testosterone replacement therapy.
Nandrolone's decreased androgenic potential means that there is less chance that it will promote hair loss or enlargement of the prostate than testosterone. This is partly because testosterone's 5-alpha reduced metabolite, called dihydrotestosterone, is more androgenic than nandrolone's 5-alpha reduced metabolite, called dihydronandrolone. Because of its lower androgenic potential, nandrolone may also be used at low doses by women who are experiencing severe weight loss.
Nandrolone is a nor-testosterone, which means that there is no carbon at the 19 position of the molecule. This prevents the binding of the enzyme called aromatase, which converts testosterone into estrogen. While some textbooks say that this means that nandrolone should not convert to estrogen at all, nandrolone has been shown to convert to estrogen at a rate of approximately 20 percent as much as testosterone does at therapeutic doses. Therefore, nandrolone has significantly less potential to cause estrogen-related side effects such as gynecomastia (breast growth) than testosterone in men. Reduced potential for androgenic and estrogenic effects, along with its high anabolic potential makes nandrolone a very good steroid to combine with testosterone for higher-dose anabolic therapy.
Cardiac Inflammation and Repair Following Myocardial InfarctionInsideScientific
Join Dr. Merry Lindsey as she discusses her research involving the physiology of recovery from cardiac events.
Age plays a pivotal role in the deterioration of cardiovascular functionality, resulting in an increased risk of cardiovascular disease in older adults. The prevalence of cardiovascular disease has also been shown to increase with age, in both men and women, including the prevalence of atherosclerosis, stroke and, myocardial infarction.
Following myocardial infarction (MI), the left ventricle (LV) undergoes a series of cardiac wound healing responses that involve both the stimulation of robust inflammation to clear necrotic myocytes and tissue debris and the induction of extracellular matrix (ECM) protein synthesis to generate an infarct scar. Collectively, this process in known as LV remodeling. Matrix metalloproteinase-9 (MMP-9) is a key regulator of LV remodeling post-MI, through direct effects on ECM turnover as well as indirect effects on the regulation of the major cell types that coordinate cardiac wound healing- namely the infiltrating leukocytes and the cardiac fibroblasts. We will discuss recent research that has expanded our understanding of MI LV remodeling, including recent proteomic advances focused on the ECM compartment to provide novel functional and translational insights. In summary, this webinar will provide an overview of how cardiac ECM research has evolved over the last decade and will provide insight into future directions that will drive further understanding of MMP directed cardiac ECM turnover after MI.
Objective: To investigate the effect of sildenafil on reducing the impact of hepatic ischemia/reperfusion (HIR) injury established by Pringle maneuver on the heart of rats.
Study Design: Forty Wistar albino rats were divided into 4 groups: Sham (laparotomy only), Control (laparotomy following sildenafil application), IR (ischemia/reperfusion injured by HIR), and IR+SIL (injured by HIR following sildenafil application). Ischemia was developed by clamping the hepatoduodenal ligament for 30 minutes; then reperfusion was applied for 30 minutes. Sildenafil (single dose of 50 mg/kg) was administered by oral gavage for 15 minutes before ischemia. Blood samples of rats were collected from Sham and Control groups at 60 minutes and from IR and IR+SIL groups at 30 minutes after initiation of reperfusion for biochemical analysis. Meanwhile, heart tissues were sampled for biochemical analysis. Malondialdehyde (MDA) and total antioxidant capacity (TAC) in serum samples and TAC, total oxidative capacity (TOC), and oxidative stress index in heart tissues were examined biochemically.
Results: Serum MDA levels were elevated significantly in the IR and IR+SIL groups as compared to the sham group. Sildenafil treatment inhibited MDA increase considerably in the IR+SIL group as compared to the IR group. Serum TAC levels were elevated significantly in the sildenafil and control groups (compared with sham groups) and in the IR+SIL group (compared with the IR group). TAC levels detected in heart tissue increased significantly in the IR group as compared to the sham group; however, sildenafil treatment had no effect on this increase.
Conclusion: Heart tissue was affected by HIR. It was revealed that sildenafil treatment may prevent the oxidative stress via increasing serum TAC levels in both control and IR+SIL groups.
Corticisteroids/certified fixed orthodontic courses by Indian dental academyIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Strategies to prevent depletion of Testosterone and the resulting muscle loss (Sarcopenia ) due to Aging. Stay Young.. Strong and Lively. Andraiz T of Body Satva Essentials on www.bodysatva.com
Treatment of Osteoporosis beyond Bisphosphonates therapy (2).pptxmehmoodriaz9
will gain valuable insights into emerging therapies, innovative strategies, and alternative approaches that hold promise in improving bone health and reducing fracture risk. The presentation will cover recent research findings, clinical trials, and real-world evidence, providing a comprehensive overview of the evolving
Conservative Management of Knee osteoarthritisEsserHealth
Osteoarthritis is a major burden on personal health and international health care expenditures. Learn the basics of osteoarthritis and conservative management options for the physician.
A current review by Milano G et al. (http://dx.doi.org/10.1136/jisakos-2019-000274) has duly indicated the safe, cost-effective, and pain-relieving benefits of Platelet Rich Plasma (PRP) in orthopedic sports injuries and several other musculoskeletal conditions.
With several other publications supporting regenerative therapies, S.T.A.R 2020 workshop on the applications of regenerative medicine products in the field of orthopedics helps you understand the medical benefits of PRP and other regenerative therapies like BMAC and SYNOJEL, with advanced hands-on training under the guidance of professional experts.
Register now
www.advancells.com/star-2020/
Dr. David Greene R3 Stem Cell Injections Platelet-Rich Plasma.pptxR3 Stem Cell
Regenerative medicine therapies use the body's natural healing agents to promote tissue regeneration and repair, such as bones and joints. Dr David Greene uses this type of regenerative medicine with his r3 stem cell injection, PRP therapy, and platelet-rich plasma therapy. If you’re looking for a doctor who can help you promote healing through advanced regenerative medicine therapies, call today!
Mark Sherry
Manager of Sports Rehabilitation at the University of Wisconsin Sports Medicine Center, Physical Therapist, Madison, Wisconsin, USA.
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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Lars Engebretsen MD, PhD Professor and Chair Department of Orthopaedic Surgery, U of Oslo
1. PRP in muscle and tendon
injuries
Lars Engebretsen MD, PhD
Professor and Chair Department of
Orthopaedic Surgery, U of Oslo
2. Disclosures 2013
n
n
n
Consultant
n Arthrex equipment development
Fellowship grants
n Smith and Nephew
n Arthrex
Editor and Editorial board
n BJSM
n JBJS (am)
n SJMSS
n KSSTA
n
n
Research grants
n Smith & Nephew
n Fin-Ceramica
n TBF-Tissue Engineering
n Biomet
Competitive grants
n Norwegian NIH
n AOSSM
n FIFA
n IOC
n NIH
n Health South East Norway
n Department of Culture
Norway
3. Been in Sports Traumatology as a
clinician researcher since 1984
n
n
n
n
Cochair of the Oslo Sports Trauma Research Center
Chief of the Orthopedic Department at the
University of Oslo
Consultant at the Norwegian Olympic Center
Head of three research groups in Cartilage, Knee
ligaments and Injury Prevention
n
Head of Scientific activities in the IOC
n
Past President of ESSKA
n
Editor of BJSM IPHP
n
Deputy Editor JBJS (Am)
4. This lecture will discuss:
n
n
Why is PRP hot?
Proof of concept?
n
n
n
n
n
n
n
n
Role in tendon, ligament, muscle and cartilage
Procedure- dose- frequency
White cells ?
Local anesthesia ?
Antiinflammatories ?
Adverse effects ?
Anti doping regulations
Summary
5. IOC Consensus statements
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Sports Nutrition (2003)
Sex Reassignment in Sports (2003)
Sudden Cardiovascular Death in Sports (2004)
Training the Elite Child Athlete (2005)
Female Athlete Triad (2005)
Sexual Harassment & Abuse in Sport (2006)
Molecular Basis of Connective Tissue and Muscle Injuries in Sport (2007)
Non-contact ACL Injury in the Female Athlete (2008)
Concussion in Sport (2008)
Asthma in Elite Athletes (2008)
Fasting in Sports (2009)
Periodic Health Evaluation of Elite Athletes (2009)
Age Determination in High-Level Young Athletes (2009)
Sports Nutrition (2010)
Functional Hyper-Androgenism and Sport (2010)
The Use of Platelet-Rich Plasma in Sports Medicine (2010)
Fitness and Health in Young People through Physical Activity and Sport (2011)
Thermoregulatory and altitude challenges in the high-level athlete (2011)
6.
7. Did PRP win it?
n
n
n
n
Hines Ward
Pittsburgh Steelers
wide receiver
Super Bowl XLIII Feb
2009
Pittsburgh Steelers
versus Ravens
15. Not all PRPs are the same
n
Leukocytes (white blood cells)
n Platelet concentration
n Platelet activation
Andia et al. Expert Opin Biol Ther.
2010 Oct;10(10):1415-26
Jia et al. Oper Tech Sports Med. 2011
16. Differences in PRP Systems
Competitor 1
Competitor 2
PRGFTM
Types of PRP
L-PRP1
P-PRP2
P-PRP
Input Blood
Volume
30-55ml3
9ml4
Variable (9ml per
tube)
Centrifuge
Protocol
3200rpm
(1100g) for
15min1
1500rpm
(400g) for
5min2
580g for 8min
PRP Yield
3-6ml3
2-3ml4
2ml of F2 per tube
Platelet
Enrichment
Factor
2.07 ± 1.11
1.3x2
2.3 ± 0.6
Leukocyte
Concentration
[103/ul]
34.4 ± 13.61
0.68 ± 0.422
0.7±0.7
Is Scaffold
Forming
Activator
Included in the
Kit?
No
No
Yes
3
1Castillo
et al. Am J Sports Med. 2011 Feb; 39(2): 266-71
2Sundman et al. Am J Sports Med. 2011 Oct;39(10):2135-40
Data available at: http://www.biomet.com/biologics/information/pdf/BBI0003.0.pdf
4 Data
Available at: https://www.arthrex.com/innovations/index.cfm?adid=28
18. AUTOLOGOUS PLATELETS CAN BE A SOURCE OF
GROWTH FACTORS FOR HEALING AND
TISSUE REGENERATION
Platelet-Rich Plasma
is the outcome of a
centrifugation of
autologous blood.
Contains a high
concentration of
platelets
(4-8 times)
21. Platelet activation
§ Activation
§ exposed collagen, damage or thrombin
§ Dramatic morphological change
§ Adhesion, spreading, aggregation,
activation of other platelets and clot
retraction
§ Alpha Granule release
§ 200-500 nm, ~50 to 80 per platelet
§ Over 30 bioactive proteins, with
roles in haemostasis and tissue
healing.
Harrison and Cramer 1993
0.5 µm
22. Platelet granule release
Alpha granules migrate
to platelet periphery (a),
where the plasma
membrane blebs (b),
and ruptures (c) Loss of
electron density with
rupture
Polasek J. Lysosomal concept of platelet secretion - revisited. Eur J Haematol 1989. Suppl 50; Vol 43.
23. SOURCES
ROLE
PRP
(multiplication factor)
Platelets
Blood
Initial control of haemorrhage, release GF
3-8
PDGF
Platelets
Stimulates cell replication, angiogenesis, mitogen for fibroblasts
5-29
VEGF
Platelets
Angiogenesis
6-52,7
TGF-β
Platelets
Increase chondrocyte expression, induce Chondrogenic differentiation
of MSCS, enhance matrix deposition, decrease the suppressive effects
of inflammatory mediators IL-1 on proteglycans synthesis in cartilage
3,5-27
FGF
Platelets
Stimulates proliferation of myoblasts, angiogenesis
Detected
EGF
Platelets
Proliferation of mesencymal and epithelial cells, Potentiation other GF
3
HGF
Plasma
Angiogenesis, mitogen for endothelial cells, anti-fibrotic
No increase from baseline
IGF-1
Plasma
Stimultes myoblasts and fibroblasts, mediator in growth and repair of
skeletal muscle
No increase from baseline
EGF: epidermal growth factors, HGF: hepatocyte growth factor, IGF-1: insuline-like growth factor, PDGF: platelet-derived growth factor, TGF-b: transforming
growth factor beta, VEGF: vascular endothelial growth factor, FGF: fibroblasts growth factor
24.
25.
26. Does ACP/PRP increase human
tendon, bone, cartilage and muscle
cell proliferation
Mazzocca et al UCon
27. Local anesthesia and cortison has a
harmfull effect on proliferation of
tenocytes
Mazzocca et al UCon
65. CASE: PATELLAR TENDON LESION
RMN BASAL
RMN AT 6 M F U
Male, 25 y, D LEAGUE SOCCER PLAYER
3y of pain and limited function, bilateral, previous surgery
RETURNED AT PREVIOUS ACTIVITY LEVEL AT 4 MONTHS
66. PRP IN TENDON PATOLOGY
TREATMENT
ü PROMISSING RESULTS IN ATHLETES
ü TREATMENT OF FAILED CASES
ü HAVE TO BE COMBINED WITH
PHYSICAL THERAPY
ü RANDOMIZED STUDIES ARE NEEDED
77. This lecture will teach you:
n
n
Why is PRP hot?
Proof of concept?
n
n
n
n
n
n
n
n
Role in tendon, ligament, muscle and cartilage
Procedure- dose- frequency
White cells ?
Local anesthesia ?
Antiinflammatories ?
Adverse effects ?
Anti doping regulations
Summary
78. Adverse effects?
n
n
So far no serious side
effects reported
A case report on DVT in
November 2010 and a
comment on being aware
of this possibility
79. This lecture will teach you:
n
n
Why is PRP hot?
Proof of concept?
n
n
n
n
n
n
n
n
Role in tendon, ligament, muscle and cartilage
Procedure- dose- frequency
White cells ?
Local anesthesia ?
Antiinflammatories ?
Adverse effects ?
Anti doping regulations
Summary
80. PRP from a regulatory viewpoint:
n
n
n
n
Autologous blood
No agreement on procurement (degree of
centrifugation, white cells?)
Principally no difference in mechanism on
muscle, tendon and ligaments
No indication that PRP has any effect in
healthy tissue
81.
82.
83.
84.
85.
86.
87.
88. Where does it belong?…
n
n
n
n
n
n
n
Exercises for rehabilitation
Strength training
Aligning tissue with stretching
Manual therapy
NSAIDs, cortisone
Hyaluronic acid, PRP
Surgery
PRP?
89.
90.
91.
92.
93.
94. Intratendinous
injections
of
autologous
conditioned
plasma,
or
platelet
rich
plasma
with
or
without
WBC
enrichment
for
patellar
tendinopathy
A
mul&-‐centre,
double-‐blind,
randomized
controlled
trial
*Alex
Sco*1,
*Kim
Harmon2,
Roald
Bahr3,
Lars
Engebretsen3,
Robert
LaPrade4
1.
Department
of
Physical
Therapy,
University
of
BriJsh
Columbia,
Canada
2.
Departments
of
Family
PracJce,
Orthopaedics
and
Sports
Medicine,
University
of
Washington,
USA
3.
Oslo
Trauma
Research
Centre,
Norway
4.
Steadman
Clinic,
Vail,
USA
95. EBM: Definition
Integrate current “best evidence”
from clinical research
with individual clinical expertise
and patient preferences
in making decisions about the care of individual patients
Rosenberg W & Donald A. BMJ 1995; 310:1122-6
96. The Oslo Sports Trauma Research Center
has been established at
the Norwegian School of Sport Sciences
through generous grants from the Royal Norwegian Ministry of
Culture, the South-Eastern Norway Regional Health Authority,
the International Olympic Committee, the Norwegian Olympic
Committee & Confederation of Sport, and Norsk Tipping AS