Search Results (918)

Background/Objectives: Chronic wounds that fail to respond to standard wound care (SWC) remain a major clinical challenge. Platelet-rich plasma (PRP) is an advanced regenerative therapy that delivers platelet-derived growth factors involved in angiogenesis and tissue repair. However, clinical data in Asian populations and evidence regarding ulcers associated with vasculitis or microangiopathic ischemia remain limited. This study evaluated the efficacy, safety, and treatment frequency of autologous PRP gel prepared using the newly approved AutoloGel System^® in Japan. Methods: This single-center retrospective study included 20 patients with chronic ulcers unresponsive to ≥28 days of conventional therapy by a wound specialist. PRP gel was applied weekly for up to eight sessions under current insurance coverage. Primary outcomes were wound healing rate at 12 weeks after PRP initiation and healing duration. Healing time during specialist-directed conventional therapy was compared with that following PRP using the Wilcoxon signed-rank test. Results: Twenty patients (mean age 60 ± 15 years) with diverse refractory ulcers—including diabetic foot ulcers, chronic limb-threatening ischemia, vasculitic ulcers, venous leg ulcers, pressure ulcers, and surgical site infections—were analyzed. All wounds achieved complete epithelialization within 12 weeks. Healing time decreased significantly from 87.2 ± 77.1 days during conventional therapy to 47.9 ± 28.5 days after PRP initiation (median 60 vs. 44 days, p = 0.0107). No treatment-related adverse events were observed. Conclusions: Weekly autologous PRP gel therapy prepared using the AutoloGel System^® was associated with improved healing outcomes in refractory chronic wounds. Favorable outcomes were observed in traditionally difficult-to-treat conditions, including vasculitis-associated and microangiopathic ischemic ulcers. These findings suggest the potential role of PRP in promoting angiogenesis and improving microcirculatory perfusion in wounds associated with microvascular dysfunction. Full article

Umbilical cord-derived Platelet-Rich Plasma (ucPRP) promotes corneal regeneration, yet the underlying cellular mechanisms remain incompletely understood. This study evaluated the effects of ucPRP on corneal epithelial cell physiology and wound healing dynamics. In scratch assays, ucPRP treatment significantly accelerated wound closure by enhancing cell migration and proliferation. Confocal microscopy using Fluo-3 demonstrated that ucPRP induces transient increases in intracellular calcium (Ca²⁺), suggesting the activation of upstream signaling events. Furthermore, treated cells exhibited increased membrane permeability to water and hydrogen peroxide (H₂O₂), which correlated with upregulation of Aquaporin-1 (AQP1). Since AQP1 facilitates cell motility, its upregulation links fluid transport mechanisms to the observed regenerative phenotype. These findings suggest that ucPRP drives corneal re-epithelialization by modulating Ca²⁺ signaling and increasing AQP1 expression, supporting its therapeutic utility in ocular surface repair. Full article

Background and Objectives: Low back pain (LBP) is a leading cause of disability worldwide and is frequently associated with intervertebral disc degeneration (IVDD). Current therapeutic strategies are primarily symptomatic and do not restore native disc biology, largely due to the avascular nature of the intervertebral disc and the hostile inflammatory and mechanical microenvironment that characterizes degeneration. The aim of this study is to provide an updated and clinically oriented overview of the pathophysiology of IVDD and to evaluate the current evidence on mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP)-based therapies. Materials and Methods: A focused narrative literature review was performed to evaluate current evidence on MSC- and PRP-based therapies for intervertebral disc degeneration (IVDD). The search was conducted in PubMed. Only studies in English were considered eligible. Results: Mesenchymal stem cells (MSCs) demonstrated regenerative and immunomodulatory effects primarily through paracrine mechanisms, enhancing extracellular matrix synthesis and reducing inflammation and apoptosis. MSC-derived extracellular vesicles emerged as a promising cell-free alternative, potentially overcoming limitations related to cell survival and safety. Platelet-rich plasma (PRP) showed anabolic and anti-inflammatory properties, promoting disc cell proliferation and matrix production, particularly in early-stage degeneration. Clinical studies, including randomized trials, reported significant improvements in pain and function for both MSC and PRP therapies, with favourable safety profiles. However, heterogeneity in treatment protocols and limited long-term data remain significant limitations. Orthobiologic therapies represent a minimally invasive option for patients with discogenic low back pain refractory to conservative treatment. Patient selection is crucial and should consider degeneration stage, disc viability, and clinical presentation. PRP is primarily indicated in early-stage degeneration (Pfirrmann II–III), whereas MSC-based therapies may be considered in selected patients with more advanced but still viable discs. Based on current evidence, a stepwise approach is proposed, progressing from conservative management to PRP, MSCs, and ultimately surgery. Orthobiologics should be integrated within a multimodal strategy including rehabilitation. Conclusions: MSCs and PRP represent a promising and, eventually, complementary orthobiologic therapies for IVDD. PRP is primarily effective in early degenerative stages as a biologic stimulator, whereas MSCs may provide regenerative benefits in more advanced but still viable discs. Further studies are necessary to standardize protocols and confirm long-term efficacy and safety. Full article

Diabetes mellitus affects an estimated 589 million adults globally, and cutaneous manifestations occur in up to 70% of affected individuals during the course of the disease. The objective of this narrative review is to examine the intersection of diabetes mellitus, skin aging, cosmetic dermatologic procedures, and regenerative therapies, with an emphasis on evidence-based best practices and clinical considerations. While the impaired wound healing associated with diabetes has been extensively studied, the aesthetic implications of diabetic skin disease remain comparatively underexplored. Individuals with diabetes frequently exhibit features of accelerated cutaneous aging, including premature wrinkling, dyschromia, xerosis, alopecia, and other cosmetically significant dermatoses that may negatively impact quality of life. In parallel, the demand for aesthetic dermatologic procedures among patients with diabetes has increased substantially; however, evidence-based recommendations guiding the safe and effective use of cosmetic interventions in this population remain limited. Diabetic skin demonstrates accelerated biological aging driven by complex pathophysiological mechanisms, including the accumulation of advanced glycation end products, chronic low-grade inflammation, oxidative stress, microvascular dysfunction, and neuropathy. These processes partially overlap with chronological aging and photoaging but are mechanistically distinct and may influence tissue repair, inflammatory responses, and the safety profile of commonly performed aesthetic procedures such as chemical peels, laser resurfacing, dermal fillers, neuromodulators, and microneedling. Emerging regenerative approaches, including platelet-rich plasma, platelet lysate, and mesenchymal stromal cell-derived products such as exosomes and secretomes, have attracted increasing attention as biologically targeted strategies for cutaneous rejuvenation. Nevertheless, clinical evidence specifically addressing aesthetic interventions in diabetic populations remains limited. A diabetes-informed approach to aesthetic dermatology that considers metabolic status, procedure selection, and post-procedural monitoring is therefore essential to optimize safety and therapeutic outcomes. Full article

Background/Objectives: Despite being a standard biological therapy for knee osteoarthritis, inconsistent results across studies—due to varied protocols—have obscured the clinical standing of platelet-rich plasma. This meta-analysis evaluates the efficacy and safety of PRP for pain, function, and adverse events, and examines the potential benefits of combining it with hyaluronic acid. Methods: An umbrella review was conducted following the PRIOR (Preferred Reporting Items for Umbrella Reviews) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. Meta-analyses evaluating PRP in knee osteoarthritis were included. Quantitative estimates of pain, function, and safety were extracted. Random-effects models were applied when possible. Methodological quality was assessed using AMSTAR 2, and study overlaps were assessed using the CCA method. Publication bias was analyzed using a funnel plot. Results: The meta-analyses included consistently showed the superiority of PRP over hyaluronic acid and placebo in reducing pain and improving function. Pooled estimates indicated clinically relevant improvements, especially in mild-to-moderate osteoarthritis. The combination of PRP and hyaluronic acid demonstrated superior functional recovery and a potential reduction in adverse events compared to PRP monotherapy. The overall safety profile was favorable. Conclusions: PRP is an effective and safe therapy for knee osteoarthritis, with consistent evidence of superiority over conventional intra-articular treatments. Combined PRP and HA administration suggests superior clinical efficacy compared to monotherapy. Standardization of protocols and appropriate patient selection will be key in future clinical guidelines. Full article

Platelet-rich plasma (PRP) therapies are increasingly used in musculoskeletal and regenerative medicine; however, substantial variability in reported outcomes persists even when similar preparation protocols are employed. In quantitative terms, PRP preparation can be interpreted as a stochastic process in which uncertainty propagates through multiple biological and technical inputs. Herein we propose a probabilistic framework to quantify variability in the platelet dose delivered (PDD) using Monte Carlo simulations. The platelet dose was formulated as a random variable defined by a multiplicative model involving the platelet count (modeled as a normal distribution), concentration factor (log-normal), injected volume (uniform), and processing efficiency (beta). Input parameters were represented by probability distributions derived from ranges reported in the literature, and uncertainty propagation was explored through 100,000 Monte Carlo iterations. The resulting simulations revealed a wide dispersion in PDD, characterized by a right-skewed distribution with a median of 3.1 × 10⁹ platelets and an interquartile range of 1.9 × 10⁹ platelets, yielding a coefficient of variation exceeding 50%. Sensitivity analysis based on variance-based global sensitivity measures (Sobol indices) identified the injected volume and concentration factor as the dominant contributors to output variability, with substantial interaction effects between these parameters accounting for a considerable portion of total variance. The baseline platelet count and processing efficiency had comparatively smaller effects. These results demonstrate how probabilistic modeling can clarify the sources of variability in PRP preparation and provide a generalizable framework for uncertainty quantification in multiplicative biomedical systems. Full article

Purpose: To critically evaluate the role or effect of platelet-rich plasma (PRP) in anterior cruciate ligament (ACL) reconstruction in terms of clinical and radiological outcomes. Method: We conducted a systematic search of PubMed, Embase, the Cochrane Library, and Web of Science to identify relevant studies. Clinical outcomes included the Visual Analogue Scale (VAS), International Knee Documentation Committee (IKDC) subjective and objective evaluations, Lysholm score, Tegner score, anterior knee laxity, Knee Injury and Osteoarthritis Outcome Score (KOOS), Kujala score, Victorian Institute of Sport Assessment (VISA) scale, proprioception, isokinetic strength, and physical examination tests (anterior drawer, Lachman, and pivot-shift tests). Radiological outcomes encompassed measures obtained via magnetic resonance imaging (MRI), computed tomography (CT), X-ray, and ultrasound. Statistical significance was defined as a p value < 0.05, and all analyses were performed using R software (version 4.1.3). Results: A total of 23 studies, including 19 randomized controlled trials, met the inclusion criteria, encompassing 1072 patients overall. The meta-analysis showed significant differences between PRP group and non-PRP group with regard to VAS score at 6- and 12-month follow-up, Lysholm score at 6-month follow-up, and Tegner score at 6-month follow-up. Meta-regression showed that the two group differences in VAS score changed significantly with follow-up time (p < 0.01). In terms of radiological findings, about half of the assessments favored PRP to facilitate the graft maturation and integration at 6-month follow-up. Conclusions: PRP application in ACL reconstruction compared with non-PRP, may produce short-term but not long-term clinical outcomes such as VAS score, Lysholm score and Tegner score. While some short-term statistical differences exist, their magnitude and durability do not yet justify routine clinical adoption of PRP in ACL reconstruction. Larger samples and higher-quality studies are needed to support our results and further explore the advantages of PRP in other aspects. Level of evidence: Level II. Full article

Background/Objectives: Platelet-rich plasma (PRP) is an autologous blood-derived biologic enriched in platelets and bioactive mediators. In urology and sexual medicine, PRP has been promoted for erectile dysfunction (ED) and a growing range of urogenital disorders on the premise that it may support angiogenesis, neuroregeneration, immune modulation, and tissue remodeling. However, clinical uptake has outpaced high-quality evidence, while heterogeneity in PRP preparation, characterization, and delivery limits interpretability and reproducibility. This structured narrative review aims to critically integrate mechanistic, preclinical, and clinical evidence regarding PRP use in ED, Peyronie’s disease (PD), stress urinary incontinence (SUI), interstitial cystitis/bladder pain syndrome (IC/BPS), and selected emerging indications. We further aim to identify sources of heterogeneity and propose an actionable minimum reporting framework (PRP-Uro Checklist) to guide future research. Methods: A structured search of PubMed/MEDLINE was conducted for studies published between 2021 and 2025. The relevant literature on PRP use in ED, PD, SUI, IC/BPS, and related indications was included for critical narrative synthesis. Emphasis was placed on PRP classification and preparation variables, outcome measure validity, and sources of heterogeneity across studies. Results: Mechanistic and preclinical evidence supports PRP’s potential to modulate nerve repair, angiogenesis, extracellular matrix remodeling, and immune polarization through a complex secretome of growth factors, cytokines, and extracellular vesicles (EVs). Clinical evidence suggests that intracavernosal PRP may improve erectile function in selected populations, but effect size, durability, and superiority over placebo remain uncertain due to small trials, substantial placebo effects, short follow-up, and incomplete biologic characterization. Evidence for PRP in PD, SUI, and IC/BPS remains preliminary and is derived largely from small cohorts, proof-of-concept studies, or uncontrolled designs, although early findings suggest potential symptom benefit and acceptable short-term tolerability. Across indications, inconsistent PRP reporting, particularly the absence of absolute platelet dose, leukocyte quantification, activation method, and standardized treatment protocols, represents a major barrier to reproducibility and evidence synthesis. Conclusions: PRP is biologically plausible and appears broadly safe, but its role in urology and sexual medicine remains investigational and is not yet supported by guideline-level evidence. To enhance reproducibility and interpretation, we propose a Minimum PRP Reporting Checklist for Urology and Sexual Medicine Trials (PRP-Uro Checklist). Future progress requires rigorous standardized reporting, indication-specific biologic characterization, rigorously designed sham-controlled trials, clinically meaningful endpoints, and longer-term follow-up. Full article

Purpose: This study compared the therapeutic efficacy of different bladder monotherapies and multimodal therapy in patients with interstitial cystitis/bladder pain syndrome (IC/BPS). Materials and methods: In total, 190 patients with a confirmed diagnosis of IC/BPS were treated with different bladder therapies. The bladder monotherapies included intravesical platelet-rich plasma (PRP) injection (n = 60), intravesical botulinum toxin A (BoNT-A) injection (n = 33), intravesical hyaluronic acid (HA) instillation (n = 36), and low-energy shock wave (LESW) bladder therapy (n = 61). Multimodal therapy (MMT) was provided to patients who had unsuccessful initial bladder treatment targeting chronic inflammation, urothelial dysfunction, bladder pain, pelvic floor muscle pain, psychological stress, and lower urinary tract dysfunction. The treatment outcome was assessed using self-reported Global Response Assessment scores at 3 months and during the follow-up time points after bladder treatment. Results: Thirty-one patients received MMT. The 3-month success rates of bladder therapy were 55.0% for PRP injection, 57.6% for BoNT-A injection, 50.0% for HA instillation, 46.7% for LESW bladder therapy, and 58.1% for MMT. The success rates of bladder monotherapy decreased after 6 months. However, the success rate of MMT increased at 9 (67.7%) and 12 (73.1%) months. Patients treated with MMT exhibited improvement in glomerulation grade after cystoscopic hydrodistention. Only patients with successful treatment outcomes after MMT had improvement in bladder pain severity and pelvic floor muscle pain parameters. Conclusions: Bladder monotherapy such as PRP injection, BoNT-A injection, HA instillation, and LESW bladder therapy had successful treatment outcomes in patients with IC/BPS. In patients who had unsuccessful initial bladder therapy, the 3-month success rate of MMT was 58.1% and sustained improvement with time, particularly in the improvement of bladder pain and PFM pain severity. Full article

Background/Objectives: Platelet-rich plasma (PRP)–based regimens are widely used in non-scarring alopecia, yet objective response is variable and clinic-ready predictors are lacking. We evaluated short-term trichoscopic outcomes in routine practice and tested whether baseline complete blood count–derived inflammatory status, quantified by the neutrophil-to-lymphocyte ratio (NLR), can stratify response under PRP-based therapy. Methods: We performed an ambispective observational cohort study (October 2024–October 2025) in an outpatient dermatology practice. The final analytic cohort included 129 patients allocated to four treatment groups: PRP alone (n = 54), PRP combined with microneedling-assisted Purasomes Hair & Scalp Complex (HCS50+, Dermoaroma; exosome-containing) (n = 33), PRP combined with microneedling-assisted Mesoaroma Hair Cocktail (scalp formulation; nutrient complex) (n = 24), and a nutrient complex alone (n = 18). Trichoscopy (FotoFinder ATBM; FotoFinder Systems GmbH, Bad Birnbach, Germany) was obtained at baseline (T1) and first follow-up (T2). Density response was defined as a ≥10% increase in total hair density and hair-cycle response as an anagen fraction increase ≥5 percentage points. Predictive analyses were prespecified and restricted to PRP-containing regimens, using logistic regression and a multilayer perceptron with repeated cross-validation for internal validation. Results: Across the full cohort (n = 129), total hair density and hair-cycle parameters improved from T1 to T2. In the PRP-containing subgroup (n = 111), baseline NLR strongly discriminated density responders (AUC 0.85, bootstrap 95% CI 0.77–0.91). In multivariable models, NLR remained independently associated with density response (OR 0.31 per 1-unit increase, 95% CI 0.20–0.48). Conclusions: In this cohort, baseline NLR was associated with discrimination of early trichoscopic response in PRP-based treatment of non-scarring alopecia. Using the Youden-derived cut-off (NLR = 2.202), patients with NLR > 2.202 had a higher risk of density non-response (72.1% vs. 4.7%), corresponding to a 15.49-fold increased failure risk in this cohort. These findings are exploratory and hypothesis-generating, and external validation and calibration are required before any routine clinical or decision-support use. Full article

This study delivers a comprehensive evaluation of tantalum-based coatings designed as protective surface layers for cardiovascular stents, focusing on their mechanical durability, corrosion resistance, and surface properties relevant to hemocompatibility. Coatings consisting of tantalum (Ta), tantalum oxide (Ta₂O₅), and a bilayer Ta/Ta₂O₅ system were deposited onto 316L stainless steel using plasma-assisted reactive magnetron sputtering. Structural characterization confirmed a nanocrystalline β-phase for Ta, while Ta₂O₅ exhibited an amorphous, dense, grain-boundary-free morphology that provided superior crack resistance together with enhanced corrosion protection. The bilayer configuration demonstrated the highest overall performance by combining the hardness and mechanical support of Ta with the chemical inertness and stability of Ta₂O₅. This architecture achieved the greatest hardness (861.5 HV), improved toughness proxies expressed as H/E = 0.08 and H³/E² = 0.06 GPa, and a favorable modulus gradient that effectively reduced interfacial stress and increased adhesion. Electrochemical testing in Hanks’ Body Fluid showed a dramatic 1000-fold reduction in corrosion current when compared with uncoated stainless steel, surpassing the performance of both individual monolayers. Assessments of surface properties further demonstrated that hydrophilic, oxide-rich surfaces limited protein adsorption and platelet activation, with Ta₂O₅ and Ta/Ta₂O₅ coatings performing strongly. Overall, these findings indicate that Ta/Ta₂O₅ bilayers provide a multifunctional surface solution for next-generation stents. Full article

Background: The treatment of perianal fistulas remains challenging, with low healing and high recurrence rates. Autologous adipose-derived regenerative therapies and platelet-rich plasma (PRP) have emerged as adjuncts to surgical intervention for cryptoglandular and Crohn’s disease (CD)-related perianal fistulas (PAF). This systematic review evaluates the outcomes of these therapies as an add-on to surgical intervention. Methods: A systematic search was conducted in several online databases up to December 2025. Studies with ≥10 patients reporting on the use of intraoperative autologous adipose-derived therapies and/or PRP for the treatment of cryptoglandular or CD-related PAF, and clinical healing rates, were included. Other outcomes comprised radiologic healing (as defined in the study), recurrence rates and complications. The study quality was assessed with the Effective Public Health Practice Tool. Results: In total, 28 studies on individual cases were included (n = 1017 patients, range 10–219) (17 in cryptoglandular PAF, 8 in CD-related PAF and 3 in both entities). A total of 57% of the studies were rated low quality. In cryptoglandular PAF, reported healing rates with adipose-derived therapies ranged from 50% to 90% across studies of low to good methodological quality. For PRP, three of the four randomized trials demonstrated no superiority over standard care. In CD-related PAF, healing rates after treatment with adipose-derived therapies ranged from 40% to 80%. For PRP, three studies, of which two were low quality, reported highly variable healing rates (33–80%). Radiologic healing, reported in 10 studies, ranged from 38 to 76% in cryptoglandular and 33–75% in CD-related PAF. Recurrence rates remained <17% for adipose-derived therapies and <31% following treatment with PRP. Major complications occurred in <15% of the patients. Conclusions: High heterogeneity with regard to fistula complexities, outcome definitions and surgical method was observed in the available studies on autologous add-on therapies. This hinders an overall effectiveness analysis. The promising healing rates, low recurrence rates after healing and low complication rates warrant high-quality trials. Full article